Episode #288 – Part 4 – Treatment with Dr. Mark Murphy

Now that your patients have been tested, it’s time to figure out the best way to help them. In part four of this series, Kirk Behrendt brings back Dr. Mark Murphy to talk about treatment — the easiest part of dental sleep medicine! He reviews the steps after a positive test result, his appointment process, and how to follow up with your patients. To learn more about how to treat your patients effectively and efficiently, listen to Episode 288 of The Best Practices Show! If you missed any of the previous episodes, be sure to go back and listen to Episodes 285 – 287!

Main Takeaways:

• Don't dwell on the 20% of patients you can't help. Focus on the 80%.
• Compliance with CPAP use is still low.
• But sometimes, CPAP is the only solution for particular patients.  
• Using a digital scanner has advantages for you and your patients.
• Adding sleep even one day a week is profitable.
• Treatment is physically and mentally the easiest part of this process.

Quotes:

• “See, we’re dentists. We dwell on the patient who’s focused on the money, or we dwell on this one outlier, and we build systems for that. Don't do that. Don't do that. Build systems for the 80% that are moving forward. Just run with those 80%, and tell the other 20%, ‘I can't fix you. I can't fix that. That's not my fault.’” (06:50—07:06)
• “Most studies will tell you that the average CPAP patient is only wearing their CPAP 40% of the time. This gets worse. What do you mean “wearing it”? Define wearing it. Eight hours a night, seven nights a week? Oh, no. In the CPAP world, they define compliance or adherence as 4.5 hours per night, five nights out of seven.” (22:54—23:18)
• “They’ve been making CPAP smaller, quieter, cleaner — everything. Masks, better fitting. They’ve been doing all kinds of things. And still, compliance stays like crap.” (26:36—26:45)
• “[New doctors] say to me, ‘Well, this patient only has this many teeth, and they're really mobile. What do I do?’ Well, you probably don't make an oral appliance. You probably tell them they have to have CPAP. Sorry. We can't fix everything. I can't fix that. I don't have a solution. Oral appliance therapy has some requirements, and that patient might not meet the requirements.” (31:11—31:27)
• “Today, the hard cost of a scanner has come down so much that I think it’s going to make it a more cost-effective decision for somebody to move from analog impressions to scanning. Dentists who do dental sleep medicine have made that switch like that, because a full-arch upper and lower impression costs about $45.” (36:20—36:37)
• “I scanned her upper, her lower, and took the bite in three minutes and 49 seconds . . . I'm not looking to save eight minutes. Maybe I am. Because if I save eight minutes a day, at the end of five days, that'd be 40 minutes. At the end of a month, that'd be a couple of hours. Maybe I can make my kid’s soccer game, or maybe I could schedule another crown prep or two. Or maybe I could get out of work earlier, take another vacation. I would have choices to make with my time.” (37:33—38:05)

Snippets:

• Synopsis. (02:41—04:30)
• Next steps after a positive test result. (05:10—07:07)
• Appointment structure. (07:25—11:14)
• Evolution of oral appliances. (11:30—21:01)
• “Effectiveness” of oral appliances. (21:20—23:52)
• The New England Journal of Medicine SAVE trial. (23:52—29:26)
• Dr. Murphy’s treatment process. (30:14—34:51)
• Advantages of digital scanners. (36:47—38:08)
• Follow-ups with the patient. (38:34—39:54)
• Results: four indicators to look for after treatment. (40:03—44:53)
• How to score each of those four indicators. (45:15—50:09)
• Does airway health go hand in hand with restorative dentistry? (50:47—52:20)
• The logistics of adding DSM into your practice. (53:55—56:28)
• Advice for dentists and last thoughts about treatment. (56:43—59:39)
• Dr. Murphy’s contact information. (1:00:14—1:00:55)

Reach Out to Dr. Murphy:

Dr. Murphy’s email: [email protected]   

Further Reading:

SAVE trial by McEvoy: https://www.nejm.org/doi/full/10.1056/nejmoa1606599 

Dr. Mark Murphy Bio:

Mark is an American Board of Dental Sleep Medicine Diplomate and has practiced in the Rochester area for over 35 years. He is the Lead Faculty for Clinical Education at ProSomnus Sleep Technologies, Principal of Funktional Sleep, serves on the Guest Faculty at the University of Detroit Mercy School of Dentistry, and is a Regular Presenter at the Pankey Institute. He has served on the Boards of Directors of the Pankey Institute, National Association of Dental Laboratories, the IdentAlloy Council, the Foundation for Dental Laboratory Technology, St. Vincent DePaul’s Dental Center, and The Dental Advisor. He lectures internationally on Leadership, Dental Sleep Medicine, TMD, Treatment Planning, and Occlusion.

www.funktionalsleep.com