Implementing Dental Sleep Medicine is NOT as easy as many lecturers would have you believe. In addition to having protocols in place for treatment, it’s important to adopt clear sustainable systems for the acquisition of new patients. Although referrals from the medical community will be your long-term main source of patients, screening your existing patient population can help jump start this part of your practice. The goal of this article is to help you develop an ethical and effective approach to uncovering the sleep disordered breathing “SDB” patients from within your existing patient population. This is best accomplished by using a questionnaire that not only collects data, but educates patients as well. The Lamberg Questionnaire will help get your patients thinking about the connections between many common medical conditions and their sleep disorder.
SDB is frequently associated with conditions such as: hypertension, heart failure, heart rhythm disturbances, atherosclerotic heart disease, pulmonary hypertension, insulin resistance, GERD, gout, enuresis, peripheral neuropathy, mood disorders, cognitive impairment, erectile dysfunction, depression, anxiety, chronic pain, nasal resistance, and excessive daytime sleepiness. The literature reveals that 90% of affected people have not yet been diagnosed and approximately 20% of your patient population may be at risk of SDB.
Because there is evidence that the prevalence of comorbid medical conditions confers an increased risk of having “SDB,” illuminating these comorbidities can help patients understand the damaging results of their existing condition as well as appreciate the necessity of treatment.
Since treatment options include oral appliances, starting the conversation in the dental office provides patients important information as they pursue resolution of SDB. Dentists have a unique and excellent opportunity to screen community populations for SDB simply by discussing a more detailed medical history with patients.
An ideal risk assessment questionnaire can identify those who should have diagnostic polysomnography sleep testing (PSG) and also educate patients about total body wellness at the same time. There are many SDB screening questionnaires such as: Epworth Sleepiness Scale “ESS”, StopBang Questionnaire, Berlin Questionnaire and the Lamberg Questionnaire.
The ESS measures sleep propensity and is not specific for SDB. The StopBang is used in pre-surgical screening while the Berlin Questionnaire was developed for use in a primary care settings. The LQ is the only questionnaire that reviews medical comorbidities through a methodical review of systems. Most of your patients will be intrigued by learning how many common medical conditions can be attributed to SDB.
To create the LQ, over 300 articles were reviewed to uncover the odds ratios of having SDB when presenting with other medical conditions. The more conditions the patient checks off, the higher the risk that they have SDB. The LQ, as well as a list of the articles reviewed, are available for your use at www.LambergSeminars.com. You are encouraged to download the free printable pdf format of the LQ and put it on your practice website or copy the version on the next page.
Who is it for? In addition to new patients, we have all of our existing patients fill out this single page form once per year at one of their hygiene maintenance visits.
The Lamberg Questionnaire has been designed to aid in identifying patients at risk for having SDB and to help form a medically appropriate basis for dialog with your patient and their other medical providers. Accurate diagnosis will lead to the most complete care for your patients. Review this questionnaire carefully and learn to discuss the ways that the medical conditions relate to SDB. As future research provides more evidence correlating SDB and comorbidities, this document will be updated. Hopefully you will enjoy providing oral appliance therapy as much as I do. Your patient’s overall health and wellness depends on you.
Dr. Steve Lamberg has been practicing all phases of dentistry in New York for over 30 years and developed a passion for dental sleep medicine over the last 11 years. He lectures nationally on topics including: occlusion, esthetic dentistry and dental sleep medicine. He is also a Diplomate in the AADSM as well as the ACSDD. Contact Information: 631-261- 6014 or SteveLambergDDS@gmail.com. www.LambergSeminars.com
