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InternationalClinicalSymposiumLive Music Capital of the World
Journal of the American Academy of C...
Dental Sleep Medicine
A comprehensive,multi-part
programconsistingof 3 three-
day modules plus gu...
TMDiary is the official journal of the America Academy of Craniofacial
Pain. TMDiary is published twice yearly:  Fall/Wint...
TM Diary  |  Summer 2016 4
President’s Report
I am excited to have my friends in the
AACP return to Texas again for our an...
TM Diary  |  Summer 2016 5
This has been a particularly eventful few
months for the AACP and for the staff
here at your Ce...
July29–30, 2016 | HiltonAustin | Austin,Texas
TM Diary  |  Summer 2...
TM Diary  |  Summer 2016 7
First of all, I would like to thank all of you
who have attended any AACP Institute
meeting in ...
TM Diary  |  Summer 2016 8
By now the majority of us have read the
article on JADA about the prevalence of
orofacial pain ...
TM Diary  |  Summer 2016 9
Simultaneously and serendipitously we see questionable
improvement of these symptoms with the u...
TM Diary  |  Summer 2016 10
J Craniomandib Disord. 1991 Fall; 5(4):258-64.
Nocturnal Bruxing Events in Subjects with Sl...
TM Diary  |  Summer 2016 11
Dr. Dave Shirazi Bio:
Dr. David Shirazi graduated from Howard University College
of Dentistry,...
TM Diary  |  Summer 2016 12
However, the physician MUST review the information and
comment on pertinent findings in the bo...
TM Diary  |  Summer 2016 13
HIV/AIDS patient pose an infection control risk but also develop
different complications like ...
TM Diary  |  Summer 2016 14
Neurological: Numb fingers and hand may indicate neuropathy
related to many underlying causes....
TM Diary  |  Summer 2016 15
Protocols for Photographic Documentation for the
TMJ, OSA and Orthodontic Practice. (Part 2)
TM Diary  |  Summer 2016 16
As you already know, the process of
gaining new patients is more than just
hanging a sign outs...
TM Diary  |  Summer 2016 17
The good news is you don’t have to do it on your own!
With over 6 years of professional experi...
TM Diary  |  Summer 2016 18
Another important takeaway from our policy review at Nier-
man Practice Management is from Uni...
TM Diary  |  Summer 2016 19
Our Committee organised a stellar line up of international speak-
ers, some of the best in the...
TM Diary  |  Summer 2016 20
The Canadian Chapter of the American Academy of Craniofa-
cial Pain (AACP) was founded at the ...
TM Diary  |  Summer 2016 21
ABCP Plans for Austin Summer Symposium
By Jeanne K. Bailey, DDS
American Board of Craniofa...
TM Diary  |  Summer 2016 22
Approved PACE Program Provider
Approval does not imply acceptance by a state ...
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TMDiary Journal of the American Academy of Craniofacial Pain - Summer 2016


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TMDiary is the Journal of the American Academy of Craniofacial Pain. In the Summer 2016 issue, my article, "3 New Ways to Market Your Dental Practice for Digital Survival" appeared on page 16. In this article I discuss marketing and its need in Dentistry, especially for Craniofacial Pain and Dental Sleep Medicine practices.

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TMDiary Journal of the American Academy of Craniofacial Pain - Summer 2016

  1. 1. !!! AACP’ s 31st Annual InternationalClinicalSymposiumLive Music Capital of the World Journal of the American Academy of Craniofacial Pain Volume 29  Number 1 | Summer 2016 July29–30, 2016 |HiltonAustin |Austin,TX
  2. 2. 2016-2017 Dental Sleep Medicine Mini-Residency A comprehensive,multi-part programconsistingof 3 three- day modules plus guided self- study and videoconferences. Module I: October 13-15, 2016 Module II: January12-14, 2017 Module III: April 6-8, 2017 All modules conducted at the Tufts University School of DentalMedicine, Boston, MA Act Now - Previous Classes Have Sold Out! For pre-registration, please visit, or contact the Tufts University Office of Continuing Education:|617.636.6629
  3. 3. TMDiary is the official journal of the America Academy of Craniofacial Pain. TMDiary is published twice yearly:  Fall/Winter and Spring/Summer and is intended solely for the use of Academy members and to act as an open forum for disseminating pertinent clinical, scientific, and personal information. Letters and articles represent the view of the writer and do not necessarily represent the view of the AACP, this journal, or the editorial staff. Comments and letters to the editor from Academy members and non-members are welcomed. Please send these items to the executive director. The editorial staff reserves the right to select articles for publication and edit same. For more information concerning the American Academy of Craniofacial Pain please contact: Bill Carney, Executive Director 12100 sunset Hills Rd, Suite 130 | Reston, VA 20190 800.322.8651 | 703.234.4142 | 703.435.4390 fax | Mayoor Patel, DDS & Edmund Liem, DDS, Editors Jack C. Cherin, DMD, Associate Editor and Photojournalist NOTE: The statements and opinions contained in editorials and articles in these publications are solely those of the authors and not of the AACP or of its officers, members or employees. Statements and facts contained in advertisements for products or services are the responsibility of the advertisers alone. The editors and AACP directors and officers, and employees disclaim all responsibility for facts and opinions referred to in any articles or advertisements in this or other publications by the AACP. Table of Contents President’s Report 4 Executive Director’s Report 5 Institute News: 7 New Courses Dominate the Institute’s 2016-2017 Schedule Terry Bennett, DMD TMD/Orofacial Pain and OSA, Correlation 8 or Causation? Dave Shirazi, DDS, MS, MA LAc RPSGT D.ABCP D.ABC-DSM The Rationale for Obtaining a Review of Systems 11 as Part of History and Physical Examination Deepak Shrivastava, MD ABCDSM Board Activity 14 Roger W. Roubal, DDS Protocols for Photographic Documentation 15 for the TMJ, OSA and Orthodontic Practice. (Part 2) Edmund K.T. Liem, DDS 3 New Ways to Market Your Dental Practice 16 for Digital Survival Sara Berg What’s New with Medical Policies for 17 Obstructive Sleep Apnea Rose Nierman, RDH Report from the Australian Chapter of the AACP 18 Andrew Lee, DDS Canadian Chapter Report: Chapter Gears Up 20 for 10th Anniversary Conference Edmund K. T. Liem, DDS ABCP Plans for Austin Summer Symposium 21 Jeanne K. Bailey, DDS American Academy of Craniofacial Pain 12100 Sunset Hills Road | Suite 130 Reston, Virginia, 20190 USA P: 703.234.4142 | F: 703.435.4390 |
  4. 4. TM Diary  |  Summer 2016 4 President’s Report I am excited to have my friends in the AACP return to Texas again for our annual event. I’m sure you are aware that we Texans are proud of our State, and I want to personally invite you to attend a wonderful conference and enjoy some hospitality. Please take time to enjoy the Texas capitol, music, and one of our five major food groups: steak, chicken fried steak, Mexican food, BBQ, or Tacos. Since we have chosen to suspend the winter conference, this will be our only time together until next sum- mer, so please make arrangements to come. This will also mark my last meeting as your president, and I would l like to take this opportunity to personally thank you for your confidence and affording me the privilege of serving the last two years. I have to brag on a few individuals that have served the AACP this year. First is our Immediate Past President and Institute Director, Dr. Terry Bennett. Dr. Bennett has really energized the Institute by making it more vital and by adding many courses. Please visit the website link and take notice of the upcoming courses listed: A Tongue-Tie course starting in June, Class 12 of the CP Mini-Residency starting in September, an anatomy and dissection course starting in September, Class 5 of the Sleep Mini-residency starting in September, a Cone Beam course starting in October, and the Tufts Sleep Course starting in Octo- ber. You also need to know that Dr. Dennis Marangos has put in many hours as our Education Committee chair this year, and with the help of Dr. Stacy Cole are in the process of creating a World Class online continuing education program for the AACP by joining hands with an educational online group mdBrief- Case. In the near future we will begin to roll out new online programs. Finally, I would like to give special recognition to Dr. Ed Lipskis our program chair for a tremendous effort to bring great clinical symposium speakers to us. Planning our Symposium is very likely the most difficult job in our Academy, and Dr. Lipskis has done a fantastic job. One of the tasks we have at each summer meeting will be to elect new board members. The board of course is now much smaller after the retirement of our founders, and it is being filled with many new energetic members. Last year we were thankful to add Dr. Larry Pribyl to the board, and we also dur- ing the year appointed Dr. Cameron Kuehne to fill the vacancy created by Dr. Rick Light as he moved up to the position of Secretary. Dr. Kuehne had been the highest vote recipient in line at the last board elections and will complete the term of Dr. Light. Dr. CynthiaWiggins resigned from her position as secre- tary, since she needed the extra time in her schedule to help her daughter land a college softball scholarship. Dr. Elliot Alpher and Dr. Jeanne Bailey will be completing their term limits on the board this summer, and we will be voting for their replacements. Please join me in thanking both of them for their dedication and service to the AACP. Also every two years one of our board mem- bers will be voted to move up to the President Elect position. This will create altogether three open board positions to fill.You will be able to read about the slate of candidates in the TMDiary: Dr. JosephTregaskes, Dr. Gary Dennington, Dr. Greg Bixby, Dr. Cris Simmons, Dr. Michael Hoefs, and Dr. Joseph Baba. Remember as you make your choices, we need workers on the board that are willing to take the rolls of committee chairs and later fill the offices of the board. We have been truly blessed with workers on our board this past year as mentioned, and I don’t want their tasks to go unnoticed, because these individuals are very busy behind the scenes making things happen. Please again join me in thanking each of them for their dedication to the AACP mem- bers: Dr. Steve Olmos as President Elect; Dr. Richard Klein as Treasurer; Dr. Rick Light as Secretary; Dr. Terry Bennett as Immediate Past President and Institute Director; Dr. Deepak Shrivastava, MD as Medical Director; Drs. Edmund Liem and Mayoor Patel as directors of publishing, website, and the online university; Dr. Rick Light as Secretary and Ethics/Bylaw Committee Chair; Dr. Richard Goodfellow as Membership Committee Chair; Dr. Ed Lipskis as Program Chair; Dr. Jack Cherin for his extensive work in production of our periodicals the FMO and TMDiary; Dr. Dennis Marangos as the Education Chair; and Dr. Stacy Cole as the Institute Committee Chair. There are also too many to list other Board Members and AACP members that are busy in committees and behind the scenes that are not mentioned. The take home point is that you know that the AACP is thriving because of the many volunteer efforts. The AACP has been very good to me, and I have enjoyed immensely being a part of it, especially the fellowship of like- minded individuals and educational opportunities. Again thank you for your support, and I will always appreciate having had the opportunity to serve. It has also been a pleasure working with Bill Carney and Homaira at Drohan Management. I am looking forward to seeing you at our Bigger in Texas Meeting. Academy Transitions to New Leadership By Jeffrey McCarty, DDS AACP President
  5. 5. TM Diary  |  Summer 2016 5 This has been a particularly eventful few months for the AACP and for the staff here at your Central Office. I have been privileged to be your executive director for five years now, and I have never seen this volume of positive activity. And best of all —it’s all designed to help you, our cherished members, further your dental educations and grow your practices. The summer symposium in Austin is only weeks away. The agreement the Academy signed with mdBrief- Case is now yielding fruit and the AACP Institute is flush with new and exciting continuing education programs. Please allow me a few minutes to expand on these efforts. The Annual Clinical Symposium As you may be aware, the AACP Board of Directors voted last summer to cease the production of the annual winter sym- posium, which allows us to focus our year-round attention on developing and presenting just one major clinical sympo- sium— the annual summer meeting. Our wonderful vendors and many of you loyal members have told us these past couple of years that it was just too difficult to support two AACP symposia each year. We listened! And now we are making the summer program—complete with ancillary meetings for your assistants—our primary concern. AACP’s 2016 International Clinical Symposium—our 31st annual summer program—will take place July 29-30 at the beautiful Hilton Austin in Austin, Texas. Austin is the“Live Music Capital of the World,”and our hotel’s central location will make it easy for you to enjoy everything this vibrant city has to offer. In the end, of course, our Symposium is all about the program. This year we have perhaps the finest cadre of presenters we’ve ever assembled, thanks to our tireless Program Chair, Dr. Ed Lipskis. Professor Mariano Rocabado is our featured pre- senter. I’m sure you’ve heard about this industry legend, but if you haven’t been privileged to hear him in person, you’re in for a treat. Dr. Steven Olmos, our incoming Academy president, is another internationally recognized lecturer and researcher ready to energize you in Austin. World renowned oral and maxillofacial surgeon Dr. Larry Wolford and pediatric specialist Dr. Kevin Boyd are among the other stars of our program. You simply can’t afford to miss out. The AACP Online U The most exciting development over the past few years has been our collaboration with Canada’s mdBriefCase to expand our Online U and to make it a much more sophisticated and dynamic dental education resource. We have spent many months now working closely with mdBriefCase to prepare to launch this state-of-the-art dental education website. I’m delighted to say we are ready to launch this fall! Once we launch, you’ll find accredited programs for doctors and assistants in your practice who want to further their educa- tions and who find it more productive to study online at their own pace and on their own schedule. AACP’s Online U fills the bill! Stay tuned for many more Online U programs now in the pipeline. The AACP Institute For personal, sophisticated, hands-on dental education nothing can ever replace live programs. Dr. Terry Bennett, our AACP Institute Director, continues to grow the Institute. There are cur- rently four live programs dealing with craniofacial pain and/or dental sleep medicine available for you to sign up for right now at discounted member rates: ❱ AACP’s Craniofacial Pain Mini-Residency, Class 12, takes place over four weekends (first session is September 8-10, 2016) in Fort Worth, Texas. This is the AACP Institute’s cornerstone program. Completion will provide you with the knowledge and clinical skills required to assess, dif- ferentially diagnose, and effectively treat the majority of craniofacial pain patients seen in today’s dental office. Executive Director’s Report Be Sure You are Taking Advantage of Everything the Academy has to Offer! By Bill Carney Executive Director Continued ➥
  6. 6. !!! AACP’ s 31st Annual InternationalClinicalSymposium July29–30, 2016 | HiltonAustin | Austin,Texas TM Diary  |  Summer 2016 6 Executive Director’s Report continued ❱ AACP’s Sleep Medicine and Dentistry Mini-Residency, Class 5, takes place over ONE four-day weekend in San Diego, California. The dates are September 28-October 1, 2016. Here you’ll learn everything you need to know to successfully manage patients with sleep disordered breathing issues—a huge potential profit center for your practice. ❱ BRAND NEW—AACP’s Hands-on Dissection Course will take place September 16-17, 2016 in Denver, Colorado. Dr. Wesley Shankland and Dr. Stacy Cole will focus on head and neck anatomy and neuroanatomy, with special emphasis on pain perception and sleep. ❱ BRAND NEW—How to Read Conebeam CT for TMJ and Sleep Dentistry will take place October 7-8, 2016 in Atlanta, Georgia. Dr. Dania Tamimi, a Harvard-trained radiology expert who runs her own oral radiology practice in Orlando, Florida, will teach clinicians how to review a CBCT volume for the purposes of TMJ and Sleep Dentistry diagnosis. You’ll quickly understand why diagnosis is 90% of the treatment! These Institute programs, coupled with the AACP/Tufts School of Dental Medicine 2016-2017 Dental Sleep Medicine Mini-Res- idency, are keeping us very busy here at the Central Office as we process registrations. For more information and to register, please go to Our Amazing Program Director Before closing, I want to pay tribute to Homaira Sheikh, your AACP Program Director here at the Central Office. Homaira is by far the most valuable team member we have ever had working here at the AACP Central Office. I can’t begin to list all of the innovations and improvements she has made. She has made the AACP Facebook page a valuable marketing tool; she has streamlined and refined the registration process for all programs; she has managed the annual membership renewal process flawlessly; she has made many, many wonderful improvements to the devel- opment and management of the annual symposia; and she has taken on the extremely complicated and critical task of renewing our ADA CERP and our AGD PACE continuing education certifications. I hope you’ll join me in thanking Homaira for her tireless efforts on behalf of the Academy. I am so grateful to have her on our AACP team. I look forward to seeing you in Austin this July. Check out the candidates for election to the AACP Board elsewhere in the issue. Come to Texas prepared to vote for your favorite candidate.
  7. 7. TM Diary  |  Summer 2016 7 First of all, I would like to thank all of you who have attended any AACP Institute meeting in the past few years. By choosing these meetings, you are supporting the very organization that you belong to, the AACP. I know that there are many choices for your continuing education dollars and the AACP appreciates your continued support of our nonprofit organization. Ok, enough editorializing and on to the better news. The 11th edition of the CFP mini residency was just completed in April. We had 19 students for this class and I feel that the AACP can be proud of all the people who completed the course work. Testing is almost totally completed and this group tested extremely well on all the work and I am proud to have many of them complete all the requirements for their Fellowship designation. In addition, we also just completed the 4th class of the Dental Sleep Mini Residency that was held in Atlanta. This was another great class and as expected, has led several of these students to want to continue their education in the CFP resi- dency that will start in the fall. Several courses have been planned for the fall and you should start getting brochures in the near future. First of all, in August, we are adding a new course,“Beyond the TMJ”by Dr. Mayoor Patel. This course will be held in Atlanta on August 26 and 27 and will focus on the advanced diagnosis and management of orofacial pain, current theory and diagnostic aids used in the differential diagnosis of craniofacial pain. This is an excellent course to supplement what many of you have learned already in the different TMD courses as it delves deeply into cranial nerve pathology, vascular pain, neuropathic pain and much more. Sep- tember, will see the start of the 12th CFP mini residency. This will be the last year at the AATCC in Ft. Worth as American Airlines will be keeping the whole facility for their own staff training. This has been a great training facility for us and the search is on for a new place to hold the course in the future. We are also having a new course“Dissection of the Head and Neck Anatomy and Neu- roanatomy with Special Emphasis on Pain Perception and Sleep” in September. The course will be held on September 16 and 17 at the beautiful Mountain West Dental Institute in Denver. This is a gorgeous facility in downtown Denver and features 2 large audi- toriums, 4 dental operatory setups, wet lab, and other lecture facilities. This course will be taught by Drs.Wes Shankland and Stacy Cole and will include two days of dissection of the head and neck and will have clinical applications to dentistry from post op restorative pain to TMD pain and also sleep and breath- ing disorders. In other words, it’s going to tie all the stuff together for you to actually observe the workings of all the pieces. To end the busy month of September, we will start the 2nd session of the four day Dental Sleep Mini Residency. The course dates are starting on September 27th and end on October 1st and will be held again at the beautiful ResMed facility in LaJolla California just outside San Diego. This course will be basically the same format as last year but will include bonus hours from our medical director Deepak Shrivastava. Last year everyone liked the oppor- tunity to complete this course in a four day period which helped save on expenses of flying, hotels and out of office time. In October, we are bringing Dr. DaniaTamimi to Atlanta to host the course“How to Read Conebeam CT for TMJ and Sleep Dentistry: Diagnosis is 90% of the Treatment.”Dr. Tamimi is a Board Certified Oral and Maxillofacial Radiologist and has had a major part in the writing of 3 different textbooks on this subject. She is one of the leading Oral Radiologists in the country and we are fortunate and happy to have her for this course. This course should be a must for any of us who have a CBCT machine as she will cover TMJ anatomy in both the CBCT and MRI, review the growth and development of the TMJ and many other aspects of what to look for when we take these images. Please look for the brochure or eblast for further information on this and all the other courses. Fall is always a busy time for educational courses and I truly hope that you look at what we are trying to offer in the way of new courses and take advantage of these opportunities. Other courses are being planned at this time and we will keep you updated as they come about. I just want to thank the AACP for the opportunity to serve as the Institute Director as I have been able to meet and get to know many of our new members as they start their long journey and also get to be around many of our members who I have known for a long time as they come to take advantage of some of the new materials that is being offered. New Courses Dominate the Institute’s 2016-2017 Schedule By Terry R. Bennett, DMD Institute Director Institute News
  8. 8. TM Diary  |  Summer 2016 8 By now the majority of us have read the article on JADA about the prevalence of orofacial pain among our patients between the ages of 18-931 , specifically how one in 15 have musculoligamentous pain, but one in 6 have dentoalveolar pain (which includes referred pain to dentoal- veoloar areas not associated with an infectious process). In the 6-17 year old subgroup the numbers are even more bleak at one in 32 or one in 43 children and adolescents respec- tively are suffering, largely in silence. If the prevalence is that high in children, why aren’t they being treated or referred for treatment? How did this happen seemingly‘all of sudden’? The answer to that, in truth, comes as the answer to all such questions in medicine: we never looked. We’ve heard that expression called the new meaning of the acronym WNL, and I have to say I would agree with it given my anecdotal observa- tions of dentists and how they view their existing patient population at new and recall appointments. The challenge is in education as well treatment. Many of us received minimal to no education on orofacial pain in our pre-doctoral training, but much of what we were given or what we believed to be efficacious is now outdated, outmoded or more directly entirely inaccurate, such as the use of occlusal equilibration as a methodology to treat chronic facial pain or TMD (TemporoMandibular Disorders) or Sleep Bruxism (SB)4, 5, 6 . In fact, new research has demonstrated that raising the occlusion iatrogenically with gold foil to mimic the supposed ‘high bite’did little to nothing increase masseter EMG activity nor pain in patients already suffering from myofascial pain7 . To have comprehensive knowledge which leads to diagnosis and treatment (or referral) takes a worldly view on the subject, whereby orofacial pain, TMD and musculoskeletal disorders associated with the stomatognathic system are demonstrating correlation and/or causation with a myriad of other disorders such as tension headache, migraine and CN neuralgias8 . Further studies have seen the correlation with ear pain9, 10 and somatic tinnitus11, 12 and fibromyalgia13, 14 . Thankfully, were seeing a new trend in predoctoral training in Orofacial Pain from University of Minnesota, University of Tennessee, Memphis as well as Tufts and others, and I’m hopeful that with great leaders such as Drs. Mehta, Olmos and Lavigne leading the pre-doctoral and post doctoral training, who take on this more worldly view of the immense complexity of these patients, the mind of the cur- rent and future dentist will go far beyond the enamel. And the segue at the heart of the controversy lies in Sleep Bruxism and its role in both TMD and OSA (Obstructive Sleep Apnea). Many speculations have been made about SB as it relates to all aspects of dentistry, and definitions and boundar- ies need to be understood. Ultimately SB is a centrally mediated movement disorder characterized by Rhythmic Masticatory Muscle Activity (RMMA) associated with tooth grinding and occasional tooth clenching15, 16 and has a world wide preva- lence of 5.5%17 . Its classification is more along the lines of RLS (Restless Leg Syndrome) and PLMD (Periodic Limb Movement Disorder), unlike awake bruxism which has been associated with nervous tics and reactions to stress18 . It has been observed with causality to UARS (Upper Airway Resistance Syndrome), which is not to be confused with OSA. UARS is a pre-OSA condi- tion characterized by negative esophageal pressure changes that happen concomitantly with decreased oronasal flow in the absence of apneas or oxygen desaturation and also with brain wave arousals that disturb brain wave activity from a deeper stage of sleep to a lighter one, or REM to non-REM sleep19 . It’s interesting to note that SB is also exasperated by sleeping in the supine position20 , and though casually observed with OSA21 with resolution of SB when using CPAP therapy to treat OSA, it’s when we narrow our focus to patients with UARS and SB, 86% show resolution in SB with the use of CPAP22 . Which is signifi- cant when we observe that SB does not typically resolve on its own over time, regardless of the number of years between observances23 . Given this data, observance of the effects of SB on teeth and associated structures should prompt the dental clinician to at least educate and refer the patient for a sleep evaluation in an overnight sleep study to evaluate for UARS with a physician. The dental clinician may even inquire about the presence of nasal obstruction with the patient. What is not recommended is to mask the symptom of SB with an occlusal/night guard as a stand alone treatment, not least of which is due to the possible worsening of their Sleep Breathing Disorder that can be caused by one24 , regardless of how small the worsening may be25, 26 , this can be attributed due to the relatively mild nature of UARS when compared to OSA. Patients with SB have also been shown to overlap with TMD and Orofacial pain, with at least one of the following symptoms present: arthralgia, osteoarthritis and osteoarthrosis of the condyle(s)27 , jaw pain (capsular) and myofascial pain28 , chronic migraine, episodic migraine and tension type headache29, 30 . TMD/Orofacial Pain and OSA, Correlation or Causation? By Dave Shirazi, DDS, MS, MA LAc RPSGT D.ABCP D.ABC-DSM Continued ➥
  9. 9. TM Diary  |  Summer 2016 9 Simultaneously and serendipitously we see questionable improvement of these symptoms with the use of the said occlu- sal/night guard or flat plane splints31, 32, 33, 34 . However we do see improvements in these pain symptoms when the mandible is advanced with anteriorly advancing orthotic therapy35, 36, 37 , and improvements again with mandibular advancements in patients with UARS38 and OSA39, 40, 41 , along with the well observed signifi- cant reduction in SB with mandibular advancement42, 43, 44 . REFERENCES 1 J Am Dent Assoc. 2015 Oct;146(10):721-8.e3. doi: 10.1016/j.adaj.2015.04.001. Prevalence of Pain in the Orofacial Regions in Patients Visiting General Dentists in the Northwest Practice-Based Research Collaborative in Evidence-Based Dentistry Research Network. Horst OV1 , Cunha-Cruz J, Zhou L, Manning W, Mancl L, DeRouen TA 2 J Orofac Pain. 2012 Winter; 26(1):17-25. Clinical Signs of Temporomandibular Disorders and Various Pain Conditions among Children 6 to 8 Years of Age: The PANIC Study. Vierola A1 , Suominen AL, Ikavalko T, Lintu N, Lindi V, Lakka HM, Kellokoski J, Narhi M, Lakka TA 3 Clin J Pain. 2014 Apr; 30(4):340-5. doi: 10.1097/AJP.0b013e31829ca62f. Headache Associated with Temporomandibular Disorders among Young Brazilian Adolescents. Franco AL1 , Fernandes G, Gonçalves DA, Bonafé FS, Camparis CM 4 Cochrane Database Syst Rev. 2003;(1):CD003812. Occlusal Adjustment for Treating and Preventing Temporomandibular Joint Disorders. Koh H1 , Robinson PG 5 J Prosthet Dent. 2001 Jul; 86(1):57-66. An Evidence-Based Assessment of Occlusal Adjustment as a Treatment for Temporomandibular Disorders. Tsukiyama Y1 , Baba K, Clark GT 6 J Oral Rehabil. 2010 May; 37(6):430-51. doi: 10.1111/j.1365-2842.2010.02089.x. Epub 2010 Apr 20. Management of TMD: Evidence from Systematic Reviews and Meta-Analyses. List T1 , Axelsson S 7 J Oral Facial Pain Headache. 2015 Fall; 29(4):331-9. doi: 10.11607/ofph.1478. Short-Term Sensorimotor Effects of Experimental Occlusal Interferences on the Wake-Time Masseter Muscle Activity of Females with Masticatory Muscle Pain. Cioffi I, Farella M, Festa P, Martina R, Palla S, Michelotti A 8 J Pain Res. 2014; 7: 99–115. Published online 2014 Feb 21. doi: 10.2147/JPR.S37593 Orofacial Pain Management: Current Perspectives Marcela Romero-Reyes and James M Uyanik 9 Laryngorhinootologie. 2006 May; 85(5):327-32. [Otalgia as a Result of Certain Temporomandibular Joint Disorders]. 10 J Prosthet Dent. 1996 Jan; 75(1):72-6. Otalgia in Patients with Temporomandibular Joint Disorders. Keersmaekers K1 , De Boever JA, Van Den Berghe L The overlap of TMD/orofacial pain and sleep disordered breath- ing has been repeatedly observed and correlated45, 46 and is no longer a question of‘if’or‘maybe’but a question of evaluation and diagnosis by the dental and medical teams, and its up to dental clinician who will often be the first in line to evaluate, refer and possibly manage these issues that impact such a large percentage of the population. When this happens, and I believe in my heart that it will be much sooner rather than later, we can change again the meaning of the acronym WNL to We’re Never- Endingly Looking. 11 10.1371/journal.pone.0126254 2015 May 21. doi Subtyping Somatic Tinnitus: A Cross-Sectional UK Cohort Study of Demographic, Clinical and Audiological Characteristics Jamie Ward, Claire Vella, Derek J. Hoare, and Deborah A. Hall 12 Otolaryngol Head Neck Surg. 2011 Nov; 145(5):748-52. doi: 10.1177/0194599811413376. Epub 2011 Jun 25. Tinnitus with Temporomandibular Joint Disorders: A Specific Entity of Tinnitus Patients? Vielsmeier V1 , Kleinjung T, Strutz J, Bürgers R, Kreuzer PM, Langguth B 13 J Rheumatol. 1996 Nov; 23(11):1948-52. The Relationship between Fibromyalgia and Temporomandibular Disorders: Prevalence and Symptom Severity. Plesh O1 , Wolfe F, Lane N 14 Revista Brasileira de Reumatologia (English Edition) Volume 55, Issue 2, March–April 2015, Pages 189–194 Temporomandibular Disorders in Fibromyalgia Syndrome: A Short-Communication Maísa Soares Guia, Marcele Jardim Pimentel, Célia Marisa Rizzatti-Barbosa 15 American Academy of Sleep Medicine. International Classification of Sleep Disorders, 2nd ed. Diagnostic and Coding Manual. Westchester, IL: American Academy of Sleep Medicine, 2005. 16 J Oral Rehabil. 2013 Jan; 40(1):2-4. doi: 10.1111/joor.12011. Epub 2012 Nov 4. Bruxism Defined and Graded: An International Consensus. Lobbezoo F1 , Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, de Leeuw R, Manfredini D, Svensson P, Winocur E 17 J Dent Res. 2013 Jul; 92(7 Suppl):97S-103S. doi: 10.1177/0022034513484328. Epub 2013 May 20. Polysomnographic Study of the Prevalence of Sleep Bruxism in a Population Sample. Maluly M1 , Andersen ML, Dal-Fabbro C, Garbuio S, Bittencourt L, de Siqueira JT, Tufik S 18 J Oral Rehabil. 2008 Jul; 35(7):476-94. doi: 10.1111/j.1365-2842.2008.01881.x. Bruxism Physiology and Pathology: An Overview for Clinicians. Lavigne GJ1 , Khoury S, Abe S, Yamaguchi T, Raphael K 19 Sleep Science, Review Article Upper Airway Resistance Syndrome: Still not Recognized and not Treated Síndrome da Resistência da Via Aérea Superior: Ainda Não-Reconhecida e Não-Tratada Luciana Palombini1 , Maria-Cecilia Lopes1 , Sérgio Tufik1 , Guilleminault Christian2 , Lia Rita A. Bittencourt1 20 Sleep. 2003 Jun 15; 26(4):461-5. Association between Sleep Bruxism, Swallowing-Related Laryngeal Movement, and Sleep Positions. Miyawaki S1 , Lavigne GJ, Pierre M, Guitard F, Montplaisir JY, Kato T TMD/Orofacial Pain and OSA, Correlation or Causation? continued Continued ➥
  10. 10. TM Diary  |  Summer 2016 10 21 J Craniomandib Disord. 1991 Fall; 5(4):258-64. Nocturnal Bruxing Events in Subjects with Sleep-Disordered Breathing qnd Control Subjects. Okeson JP1 , Phillips BA, Berry DT, Cook YR, Cabelka JF 22 JDSM The Link between Sleep Bruxism, Sleep Disordered Breathing and Temporomandibular Disorders: An Evidence-Based Review Ramesh Balasubramaniam, BDSc, MS1 ; Gary D. Klasser, DMD2 ; Peter A. Cistulli, MD, PhD3 ; Gilles J. Lavigne, DDS, PhD4 23 J Sleep Res. 2001 Sep; 10(3):237-44. Variability in Sleep Bruxism Activity Over Time. Lavigne GJ1 , Guitard F, Rompré PH, Montplaisir JY. 24 Int J Prosthodont. 2004 Jul-Aug; 17(4):447-53. Aggravation of Respiratory Disturbances by the Use of an Occlusal Splint in Apneic Patients: A Pilot Study. Gagnon Y1 , Mayer P, Morisson F, Rompré PH, Lavigne GJ 25 J Orofac Pain. 2013 Summer; 27(3):199-205. doi: 10.11607/jop.967. Effects of Occlusal Stabilization Splints on Obstructive Sleep Apnea: A Randomized Controlled Trial. Nikolopoulou M1 , Ahlberg J, Visscher CM, Hamburger HL, Naeije M, Lobbezoo F 26 J Oral Rehabil. 2011 Sep; 38(9):643-7. doi: 10.1111/j.1365-2842.2011.02221.x. Epub 2011 Apr 5. The Effect of Raising the Bite Without Mandibular Protrusion on Obstructive Sleep Apnoea. Nikolopoulou M1 , Naeije M, Aarab G, Hamburger HL, Visscher CM, Lobbezoo F 27 J Craniofac Surg. 2015 Nov; 26(8):2347-50. doi: 10.1097/ SCS.0000000000002084. A Study of the Association Between Sleep Bruxism, Low Quality of Sleep, and Degenerative Changes of the Temporomandibular Joint. Dias GM1 , Bonato LL, Guimarães JP, Silva JN, Ferreira LA, Grossmann E, Carvalho AC 28 J Oral Rehabil. 2012 Jul; 39(7):538-44. doi: 10.1111/j.1365-2842.2012.02308.x. Epub 2012 Apr 17. Sleep Bruxism Increases the Risk for Painful Temporomandibular Disorder, Depression and Non-Specific Physical Symptoms. Fernandes G1 , Franco AL, Siqueira JT, Gonçalves DA, Camparis CM 29 J Orofac Pain. 2013 Winter; 27(1):14-20. doi: 10.11607/jop.921. Temporomandibular Disorders, Sleep Bruxism, and Primary Headaches are Mutually Associated. Fernandes G1 , Franco AL, Gonçalves DA, Speciali JG, Bigal ME, Camparis CM 30 J Orofac Pain. 2010 Summer; 24(3):287-92. Migraine is the Most Prevalent Primary Headache in Individuals with Temporomandibular Disorders. Franco AL1 , Gonçalves DA, Castanharo SM, Speciali JG, Bigal ME, Camparis CM 31 Cochrane Database Syst Rev. 2004; (1):CD002778. Stabilisation Splint Therapy for Temporomandibular Pain Dysfunction Syndrome. Al-Ani MZ1 , Davies SJ, Gray RJ, Sloan P, Glenny AM 32 Cochrane Database Syst Rev. 2007 Oct 17; (4):CD005514. Occlusal Splints for Treating Sleep Bruxism (Tooth Grinding). Macedo CR1 , Silva AB, Machado MA, Saconato H, Prado GF. 33 J Dent Educ. 2005 Nov; 69(11):1242-50. Stabilization Splint Therapy for the Treatment of Temporomandibular Myofascial Pain: A Systematic Review. Al-Ani Z1 , Gray RJ, Davies SJ, Sloan P, Glenny AM 34 J Oral Rehabil. 2015 Dec; 42(12):890-9. doi: 10.1111/joor.12332. Epub 2015 Jul 14. Efficacy of Stabilisation Splint Therapy Combined with Non-Splint Multimodal Therapy for Treating RDC/TMD Axis I Patients: A Randomised Controlled Trial. Nagata K1 , Maruyama H1 , Mizuhashi R1 , Morita S1 , Hori S1 , Yokoe T1 , Sugawara Y1 35 Cranio. 2005 Apr; 23(2):89-99. Anterior Repositioning Appliance Therapy for TMJ Disorders: Specific Symptoms Relieved and Relationship to Disk Status on MRI. Simmons HC 3rd1 , Gibbs SJ 36 J Tenn Dent Assoc. 2009 Fall;89(4):22-30; quiz 30-1. Anterior Repositioning Appliance Therapy for TMJ Disorders: Specific Symptoms Relieved and Relationship to Disk Status on MRI. Simmons HC 3rd1 , Gibbs SJ 37 Cranio. 2006 Apr; 24(2):119-29. Intra-Articular and Muscle Symptoms and Subjective Relief During TMJ Internal Derangement Treatment with Maxillary Anterior Repositioning Splint or SVED and Mora Splints: A Comparison with Untreated Control Subjects. Tecco S1 , Caputi S, Teté S, Orsini G, Festa F 38 J Prosthet Dent. 2002 Apr; 87(4):427-30. Oral Device Therapy for The Upper Airway Resistance Syndrome Patient. Yoshida K1 39 Cranio. 2000 Apr; 18(2):98-105. Effects of a Mandibular Advancement Device for the Treatment of Sleep Apnea Syndrome and Snoring on Respiratory Function and Sleep Quality. Yoshida K1 40 Swed Dent J Suppl. 2003; (163):1-49. A Mandibular Protruding Device in Obstructive Sleep Apnea and Snoring. Fransson A1 41 Sleep Breath. 2003 Sep; 7(3):131-41. Effects of a Mandibular Protruding Device on the Sleep of Patients with Obstructive Sleep Apnea and Snoring Problems: A 2-Year Follow-Up. Fransson AM1 , Tegelberg A, Leissner L, Wenneberg B, Isacsson G 42 Int J Prosthodont. 2014 Mar-Apr; 27(2):119-26. doi: 10.11607/ijp.3675. Analysis of the Effects of a Mandibular Advancement Device on Sleep Bruxism Using Polysomnography, the Bitestrip, Tthe Sleep Assessment Questionnaire, and Occlusal Force. Mainieri VC, Saueressig AC, Fagondes SC, Teixeira ER, Rehm DD, Grossi ML 43 Int J Prosthodont. 2006 Nov-Dec; 19(6):549-56. Reduction of Sleep Bruxism Using a Mandibular Advancement Device: An Experimental Controlled Study. Landry ML1 , Rompré PH, Manzini C, Guitard F, de Grandmont P, Lavigne GJ 44 Int J Prosthodont. 2009 May-Jun; 22(3):251-9. Effect of an Adjustable Mandibular Advancement Appliance on Sleep Bruxism: A Crossover Sleep Laboratory Study. Landry-Schönbeck A1 , de Grandmont P, Rompré PH, Lavigne GJ 45 Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder Michael T. Smith, PhD,1 Emerson M. Wickwire, PhD,1 Edward G. Grace, DDS,2 Robert R. Edwards, PhD,3 Luis F. Buenaver, PhD,1 Stephen Peterson, BA,1 Brendan Klick, MS,1 and Jennifer A. Haythornthwaite, PhD1 46 Article in Journal of Pain 9(4):14-14; May 2008. Relations Between Objective Sleep Data, Sleep Disorders, and Signs and Symptoms of Temporomandibular Joint Disorder (TMD) TMD/Orofacial Pain and OSA, Correlation or Causation? continued Continued ➥
  11. 11. TM Diary  |  Summer 2016 11 Dr. Dave Shirazi Bio: Dr. David Shirazi graduated from Howard University College of Dentistry, in Washington D.C. in 2000, and earned a Masters degree in Oriental Medicine from Samara University in 2006 and is a board licensed Acupuncturist. He has completed over 2000 hours of continuing education in TMD and facial pain, craniomandibular orthopedics, and sleep disordered breath- ing. He has also completed a hospital mini-residency in oriental medicine at the China Beijing International Acupuncture Training Centre which is the only organization the World Health Organization (WHO) has authorized to teach internationally on acupuncture and herbology, and another at Kyung Hee University and Medical Center, the #1 medical hospital and medical school in Korea. In 2011, he became a board licensed RPSGT, the first dual degreed dentist and Sleep Technologist. He is the founder of the Bite, Breathe and Balance study group, dedicated to the multidisciplinary approach to treating cra- niofacial pain and sleep disorders. Dr. Shirazi is the director of a state of the art private practice, The TMJ and Sleep Therapy Centre international family, one of 40 Centres throughout the world, and is located in the beautiful hills of Thousand Oaks, CA. Personally, Dr. Shirazi enjoys hiking and camping in the state parks, traveling, and speaking. He is married to the love of his life Kimberly Shirazi, and have welcomed their first born, Maximus. They live in Malibu Lake, a subset of Agoura Hills where they are very close to nature. Dr. David Shirazi’s Disclosures: Affiliated and primary investigator of multiple research studies. Dr. Shirazi’s Sleep Lab conducts research for multiple industries including the pharmacutical industry. Adjunct Board volunteer, and lecturer for AACP, lectures privately. Dr. Shirazi is not paid to endorse any product or technique. The Rationale for Obtaining a Review of Systems as Part of History and Physical Examination By Deepak Shrivastava, MD The Review of Systems (ROS) is an inven- tory of specific body systems performed by the health care provider in the process of taking a history from the patient. The ROS is designed to bring out clinical symptoms, which the patient may have overlooked or forgotten. In theory, the ROS may illumi- nate the diagnosis by eliciting information, which the patient may not perceive as being important enough to mention to the provider. The rules for documenting the ROS are identical for both the 1995 and 1997 E/M guidelines (Evaluation and management). There are FOURTEEN Individual Systems Recognized by the E/M Guidelines: 1. Constitutional (e.g., fever, weight loss) 2. Eyes 3. Ears, Nose, Mouth, Throat 4. Cardiovascular 5. Respiratory 6. Gastrointestinal 7. Genitourinary 8. Musculoskeletal 9. Integumentary (skin and/or breast) 10. Neurological 11. Psychiatric 12. Endocrine 13. Hematologic/Lymphatic 14. Allergic/Immunologic Coding Tip: There are no specific rules about how much to ask the patient about each system. This is left up to the discretion of the individual examiner. There are THREE Levels of ROS Recognized by the E/M Guidelines: 1. Problem Pertinent ROS: Requires review of ONE system related to current problem(s) 2. Extended ROS: Requires review of TWO to NINE systems 3. Complete ROS: Requires review of at least 10 systems CodingTip: When documenting the ROS, it is not necessary to list each system individually. It is acceptable to document a few pertinent positive or negative findings and then say: “All other systems were reviewed and are negative.” Coding Tip: It is not necessary that the physician personally perform the ROS. It is acceptable to have your staff record the ROS or to let the patient fill out an ROS questionnaire. TMD/Orofacial Pain and OSA, Correlation or Causation? continued Continued ➥
  12. 12. TM Diary  |  Summer 2016 12 However, the physician MUST review the information and comment on pertinent findings in the body of the note. In addition the physician should initial the ROS questionnaire and maintain the form in the chart as a permanent part of the medical record. Coding Tip: Many physicians overlook the fact that many follow-up encounters DO require a ROS. There is a percep- tion that a ROS only needs to be done during your initial encounter with the patient, but this is not correct. For example, an extended ROS is required for a level 3 hospi- tal progress note or a level 4 office follow-up visit with an established patient. eCoding Tip: You DO NOT need to re-record a ROS if there is an earlier version available on the chart. It is acceptable to review the old ROS and note any changes. In order to use this shortcut, you must note the date and location of the previous ROS and comment on any changes in the body of the current note. For example, if you are seeing an established patient in the office you can say:“Complete ROS which was performed during a previous encounter was re-examined and reviewed with the patient. There is noth- ing new to add today. For details, please refer to my previous note in this chart, dated 11/23/2015.” A sleep specific review of systems ensures that the provider has a through understanding of individual’s sleep and its complica- tions. Proper discovery, evaluation, and management improve patients’quality of care and outcomes. Explanation on Specific Items in Sleep Review of Systems: Underweight patients are likely to have poor sleep, insomnia and other similar problems. The cause of low body weight may relate back to a medical or psychiatric condition that can have both a direct and an indirect effect on the sleep. Overweight is a self-explained confounder that worsens obstructive sleep apnea, may lead to obesity hypoventilation syndrome, and may be a contributor to pulmonary hyperten- sion. Obesity perpetuates cardiac problems and asthma. It causes insulin resistance and worsens diabetes. It worsens GERD related acid reflux and can worsen OSA. Obesity also contributes to high blood pressure. Unintentional weight loss is always a bad sign. It may lead to sleep related complications due to underlying conditions as well as poor physical and mental health. Dry mouth is an indication of mouth breathing. However, it may be a manifestation of underlying connective tissue dis- order like scleroderma or Sjogern syndrome. In patient using CPAP dry mouth can indicate air-leak. Tinnitus can worsen by the use of CPAP by oral appliance. Postnasal drainage indicates increased congestion and high air- flow resistance. It increases incidence and intensity of snoring. It also can predict future problems with CPAP use. Headaches are a strong indicator of possible obstructive sleep apnea. On the other hand, OSA and sleep disruption can cause migraine headaches. The treatment for headache itself can have significant effect on sleep and insomnia. Poor vision can be due to refractory error in vision and has been shown to be a result of macular degeneration worsened by sleep apnea. Diabetes and hypertension both can cause retinopathy and other problems. Dry eyes again can be due to connective tissue disorder that has significant effect on sleep and sleeping pattern. Allergic/Immunologic: Allergies increase the incidence of snoring and sleep apnea. In patients, using CPAP congestion leads to non-use of CPAP. Seasonal allergies can cause symp- toms during certain months. Management, adequate therapy, and control of sleep apnea depend on control of perennial and seasonal allergies. Allergy can therefore impede the success of the oral appliance therapy. Allergies can also alter the course of other diseases like asthma further complication the manage- ment of sleep apnea. Asthma is a well-known confounder in OSA. It can worsen OSA and OSA can worsen asthma control. Obesity is an increasingly known risk factor for asthma suggesting a complex relationship amongst these disorders. Medications used in asthma treat- ment can further cause side effects like insomnia in susceptible individuals and indirectly affect OSA management. Sinus problems influence breathing and nasal patency as well as use of oral appliance or CPAP usage. The airflow from CPAP can alter the humidification of mucous membranes and worsen sinus tenderness, secretions, dryness, and other symptoms. Lupus and other rheumatologic disorders can affect respira- tory system and can manifest in symptoms like shortness of breath, cough, and bleeding and lung fibrosis. Presence of such disorder should prompt concomitant medical management by specialist medical physicians. Many of these disorders cause muscle weakness and can change work of breathing and cause variable response to OSA treatment. Just like OSA, these disor- ders have involvement of organ systems in the body. The Rationale for Obtaining a Review of Systems... continued Continued ➥
  13. 13. TM Diary  |  Summer 2016 13 HIV/AIDS patient pose an infection control risk but also develop different complications like weakness, muscle wasting syn- dromes, malnutrition, neuropathies and myopathies. Many prophylactic and anti-retroviral medications have significant side effects on sleep. Respiratory: Lung disease in any form and stage affects sleep and wakefulness. Combination of COPD and OSA is more det- rimental condition recognized as overlap syndrome. Current data suggests that these patients have more frequent, steep, and sustained oxygen desaturations, causing intense oxidative stress on the cardiovascular system. Neuromuscular diseases and lung fibrosis have complex physiologic derangements that lead to oxygen and hypoventilation problems. Managing OSA with these concurrent conditions requires special medical attention and treatment modalities. Shortness of breath is a nonspecific symptom but is not a part of sleep apnea syndrome. This is important to realize as evalu- ation and co-management of shortness of breath is equally important. Coughing may represent uncontrolled acid reflux disease, worsened by OSA; cough variant asthma or aspiration. Cough is another non-specific yet very important symptom of clinical significance. Both cough and shortness of breath may represent congestive heart failure as a complication of OSA. Snoring is precursor to spectrum of OSA syndrome. Snoring may be occasional, positional, affected by behaviors and medications, and may be nightly. Absence of snoring could represent complete cessation of airflow and apnea. Cardiovascular: Sleep disorder breathing affects the cardiovas- cular system in more than one way. Individual may present with cardiovascular (CVS) condition and could have central or obstruc- tive apnea or both. CVS manifestations may present themselves at the initial evaluation. Sleep disordered breathing worsens the CVS complications and impedes the treatment efficacy. Adverse effects of sleep disorder breathing like hypertension, poor glycemic control, atherosclerosis, and cardiac arrhythmias are well recognized. Presence of pacemaker indicates history of cardiac rhythm disturbance. Palpitations represent similar distur- bance. Chest pain may indicate many conditions that affect OSA directly. Clearly, angina related chest pain is more of a concern than chest pain related to acid-reflux or indigestion. In any case, chest pain demands immediate attention before undertaking OSA treatment. Swelling on feet or hands may be a result of fluid overload or congestive heart failure. Gastrointestinal: Gastric reflux is important confounder as it gets worse with undiagnosed and untreated sleep apnea and improves with treatment. Irregular bowel habits could represent poor quality sleep, poor eating habits, and effects of medications and or medical conditions. Stomach ulcers can be result of stress related gastric acid secretion and pain interrupt- ing the sleep. Gallbladder may cause pain especially after fatty meals and can be a source of poor sleep. Genitourinary: Kidney disease in any form can be a risk factor for sleep-disordered breathing. However, medical literature supports higher incidence of sleep apnea in end-stage renal disease and in dialysis patients. Enlarged prostate is a cause of nocturia and can be confused with sleep apnea related nocturia. Nocturia can cause insomnia and fragmented sleep. Other conditions associated with sleep apnea like diabetes can also cause hyperglycemia-induced nocturia. Medication like furacemide taken in the evening can be a source of nocturia. Painful frequent urination could be due to urinary tract infec- tion or structural problems. Impotence is a major problem associated with obstructive sleep apnea due to reduced levels of testosterone. Menstrual cramping can cause sleep depriva- tion due to not only pain and discomfort but also related to hormonal changes and their influence on sleep. Pregnancy is a special situation as sleep apnea related hypox- emia affects both maternal and fetal health and outcomes. Due to increase in body fluid volume and hormonal changes dur- ing pregnancy sleep pattern changes in every trimester. A full spectrum of sleep-disordered breathing ranging from snoring to severe sleep apnea can occur. It can predispose to eclem- psia, seizures, gestational high blood pressure, and diabetes. Congenital and developmental problems, ADD and ADHD are fetal complications related to sleep apnea. . Fetal loss and maternal death is possible. Immediate evaluation and treat- ment is required especially in obese pregnant women. Birth control pills do not have direct side effect on the sleep however; they do affect hormonal balance and can disrupt sleep. Menopause is a special time of women’s reproductive cycle. It comes with hot flashes, disrupted sleep, and insomnia. There is increased incidence of sleep apnea as well. Integumentary (Skin): Skin conditions can be uncomfortable, may represent systemic illness and their treatment may have effect on the sleep. Brittle nails may be a result of electrolyte and mineral changes in the blood and may be caused by anemia. Hair loss in many situations suggests stress and under- lying medical conditions. Poor wound healing is generally a derangement of blood glucose and/or immune suppression for example with steroid use. Malnutrition can cause many integu- mentary symptoms. Musculoskeletal: Pain and sleep have very profound recip- rocal relationship. Chronic pain syndromes, chronic fatigue syndrome, and fibromyalgia have very specific patterns on elec- troencephalogram and sleep stages. A well-recognized pattern is popular as alpha-delta sleep. Many neuro-muscular disorders affect sleep, cause obstructive and central sleep apnea, and require special montage setups during a sleep study. There may be significant treatment implications as well as a variability of response to treatment. The Rationale for Obtaining a Review of Systems... continued Continued ➥
  14. 14. TM Diary  |  Summer 2016 14 Neurological: Numb fingers and hand may indicate neuropathy related to many underlying causes. Stroke and paralysis sug- gests a bilateral relationship with sleep apnea. Sleep disordered breathing can develop after the stroke and stroke may be the result of sleep disordered breathing. Stroke also increases the aspiration risk due to poor swallowing function. Stroke is a known cause of a special breathing pattern called Cheyne-Stokes breathing. Many times this pattern is reported on the full sleep study. The other cause of Cheyne-Stokes breathing is congestive heart failure. Many neurologic symptoms may be non-specific but do represent underlying disease. Seizures pose a special risk as most of the seizures occur during sleep and can complicate evaluation and management. Movement disorders are a cause of both disrupted sleep and increased sleepiness. Special problems include Parkinson’s disease and REM-behavior disorder. Psychiatric: Sleep is linked to mental health just like neuro- logical conditions. Anxiety, depression, and other psychiatric disorders have both non-specific and many specific effects on sleep. Poor quality sleep adversely affects disorders like ADHD and learning disabilities. Sleep fragmentation and other sleep related conditions can worsen dementia. Medications and sub- stances of abuse all have significant impact on sleep. Alcohol, a socially accepted drug causes many adverse effects on sleep. It decreases sleep latency and is used by many as sleeping-aid. However, it causes muscle relaxation, worsens apnea, increases arousal threshold further worsening the oxidative stress on car- diovascular system and causes diuresis presenting as nocturia. Alcohol once metabolized in the system wakes up individual in the early morning causing reduced total sleep time. Hematologic/Lymphatic: Blood disorders like polycythemia or high red blood cell count is a result of hypoxemia. Anemia can be caused by nutritional deficiencies and may be responsible for high heart rates, compensatory high cardiac output failure, poor exercise capacity, and sense of weakness. Cancers have independent affect of sleep and cause insomnia by direct and indirect mechanisms. Chemotherapeutic agents have multiple side effects on sleep. Nosebleed clearly has implications for CPAP users but it can also affect the oral appliance therapy and any hematologic disorder can complicate any potential surgical interventions in the management of sleep apnea. Endocrine: Sleep controls most of the hormones in the body. It is important to review endocrine system. Different types of arthritis can disturb sleep due to pain and discomfort in finding a comfortable position. Chronic pain syndromes have direct effect on sleep stages. Cold hand and feet may indicate presence of Raynaud’s phenomenon commonly noted in indi- viduals with certain rheumatologic disorder. Hypothyroidism is implicated in the sleep-disordered breathing and its manage- ment. Sleep apnea worsens blood sugar control. Episodes of hypoglycemia may indicate erratic glycemic control. Individuals with the sleep disorder develop poor autonomic function and therefore develop significantly more hypoglycemia than those with normal function. The sleep specific review of system is important to build a solid foundational database. This brings out any pre-existing condi- tions. Concomitant management of complications related to sleep disordered breathing is equally important in the general well-being and clinical outcomes of the patient. The Rationale for Obtaining a Review of Systems... continued Upon the resignation of Dr. Jamison Spencer from the Presidency of the ABCDSM, I assumed the position of President. Following the Board by-laws, Dr. Gary Demerjian assumed the position of President-Elect. This left a void of two at large board members positions. Again following the by-laws, the board nominating committee brought forward four qualified diplo- mates for the Board to consider to be elected to the board. I am proud to announce our two new board members. Dr. Karen Wuertz of North Carolina and Dr. Kim Ledermann of Minnesota were elected to the two open board seats. ABCDSM Board Activity By Roger W. Roubal, DDS American Board of Craniofacial Dental Sleep Medicine President I also want to congratulate our newest ABCDSM Diplomates. They will be presented their certificates during the AACP summer meeting in Austin. The following will be honored: Drs. Behzad Fareid, Nicole Ferrara, Mark Barnes, Aron Larsen, Tara Perry, Marc Marlette, Keith Stucki, Karina Patel, and Gary Dempsey. I will be attending the meeting and hope to meet those of you who are not yet acquaintances of mine, and please do not hesitate to bring forth any questions or suggestions pertaining to Board activity.
  15. 15. TM Diary  |  Summer 2016 15 Protocols for Photographic Documentation for the TMJ, OSA and Orthodontic Practice. (Part 2) By Edmund K.T. Liem, DDS In the last edition of TMDiary I have dis- cussed the photographic equipment and setup that are very helpful in producing consistent, reliable and excellence photo- graphic documentation of TMD, OSA and Orthodontic patients. In this edition of TMDiary I will discuss the implementation of a protocol that will help every practice in achieving this. Remember the key words: Consistency and Repeatability. Credibility of your practice relies heavily on consistent excellent records and photographic documentation is one of the most vis- ible one. When photographic documentation is of a poor quality; some might have (for the wrong reasons) questions about the quality of diagnosis and treatment. In order to have consistent records it is important that every team member sticks to Stan- dard Operating Procedure or in short: Protocols. The first images that should be taken for every patient are the ones for the head and neck. What to do when the patient wears glasses? I recommend to take only one picture with glasses on.
  16. 16. TM Diary  |  Summer 2016 16 As you already know, the process of gaining new patients is more than just hanging a sign outside your door saying, “Now Accepting New Patients,”or“New Patients Welcome”. Your dental office isn’t a motel with a vacancy sign, so take strides in bringing attention to your office in better ways. Over the years, the percep- tion of how a dentist should grow his or her practice continues to change. And, in such a digital world, that means you need to remain up-to-date with the latest advancements, including marketing. Fierce competition means you need to set your practice apart from the rest. But how do you do that? With a solid marketing plan that covers all spectrums. Yes, quality and reputation can get many patients in the door, they still can’t find the informa- tion they need without access to a website, Google listing, Social Media accounts, and other areas. By implementing the following marketing strategies, you can accomplish your goals of improved reputation and new patients: Website and Content Marketing The cornerstone for a solid marketing strategy is the availability of a website for your practice, but not just any website. When creating a website for your practice, it must be responsive, which means it will load, display and function properly across all devices—that means desktop, laptop, smartphone or tablet. Google prefers sites that are mobile-friendly, but they also like websites that provide up-to-date, quality content. Not only should your website be functional, but it should also be educational. It is one thing to create a website, but you need content to make it work and that is where Content Marketing comes into play. Provide information about your practice and your staff, your updated bio with office location, and then educational information about each of the services you offer. With a page of content dedicated to each of your services, not only will you help to educate your patients, but you will allow your website to be searchable online and indexed by Google—good job! Social Media and Blogging Most of us have our own personal social media accounts, but what about your dental practice? Facebook, Twitter,YouTube and Instagram have all revolutionized dental marketing. Through social media and blogging, staying in touch with your patients 3 New Ways to Market Your Dental Practice for Digital Survival By Sara Berg on an ongoing basis has never been easier! Social media allows dental teams to put a face to the practice, while offering educa- tional materials and updates on the practice so that the patient is always updated and feels part of your dental family. In addition to social media, it is important to utilize a blog on your website. Through an active blog you will not only enhance your content marketing and leverage your Google search results, but you can further educate your patients on important topics. This is also a helpful way to generate Newsletter topics, while also providing email marketing areas that you can also share via your practice’s social channels. Each area of marketing is connected to the next, which is why it is important to gener- ate an effective marketing strategy that includes both social media and blogging. Emails and Newsletters Don’t forget about emails. A major source for marketing and advertising your practice is through monthly or weekly emails. However, before you begin to send emails to your patients or potential patients, it is important to accumulate existing patients’email addresses. Through email marketing you can not only stay in touch with your existing patients, but it can also help to send reminders of upcoming appointments, promo- tional offers and updates within the practice. Everyone checks their emails on a daily basis—sometimes more than once a day if you’re anything like me. I tend to check my emails non-stop throughout the day and even on the week- ends. While your job or office might be open for a set time, it doesn’t mean the rest of the world stops, so I try to always remain up-to-date with my emails. When you begin your email marketing campaign, start off slowly—you don’t want to bom- bard your patients or cause your emails to go into the“Spam” folder. Start off with an introductory email and then keep up with once a month Newsletters. From there, when you have more to share, you can up the frequency of emails to twice a month or even once a week. But remember to make your emails interesting. A bland subject line will cause recipients to simply move past the email or delete it without even bothering to open it. Try catchy phrases like,“Say No to Jaw Clicking,”or“It’s time to enjoy your favorite food without pain,”or even,“Treat Your TMD and Enjoy That Tasty Burger”. Have fun with it and keep your patients up-to- date with important information. Continued ➥
  17. 17. TM Diary  |  Summer 2016 17 The good news is you don’t have to do it on your own! With over 6 years of professional experience in Content Marketing, specifically in the dental field and specialty areas, such as Craniofacial Pain, TMD and Dental Sleep Medicine, I have a wealth of knowledge that helps practices across the country improve their online presence to set them apart as thought leaders in the industry, such as Dr. Mayoor Patel in Atlanta, Georgia, Dr. Bonnie Foster in Warrenton, Virginia, Dr. Kambiz Kashfian in Beverly Hills, California and many others. An effective marketing strategy can help your practice stand out from the rest. Three Ways to Market Your Dental Practice... continued It is important to remember that your competitors are constantly advancing, too, so why not update your practice’s marketing plan? To learn more about Website and Content Marketing for your practice, please contact me by emailing or visiting my website at In the ever evolving arena of Dental Sleep Medicine (DSM), it’s important to keep up with individual insurer’s medical policies. The criteria for coverage found in these policies can greatly affect the success of your pre-authorization request or claim payment. There are significant changes for 2016 including the fact that more insurers than ever reimburse for oral appliances for Obstructive Sleep Apnea (OSA). More insurers also allow patients to utilize their In-Net- work deductibles and copayments in order to reduce the out of pocket costs (a GAP exception or Network Insufficiency request during the preauthorization phase). What’s New with Medical Policies for Obstructive Sleep Apnea By Rose Nierman, RDH Nierman Practice Management Premera Blue Cross Documented Attempt of a Prefabricated Device and Occlusion Considerations Premera Blue Cross Policy, Effective July, 1, 2016, for custom molded and fabricated oral appliances (Code E0486) the following criteria must be met: Custom-made intraoral appliances may be considered dentally/medically necessary as an alternative to a prefabricated intraoral appliance, when the following criteria are met: Documented attempt and failure of a prefabricated device (E0485). Documentation must include: 3 or more months of clinical history indicating failure to successfully wear a prefabricated appliance; OR Type II or type III malocclusion so severe that a prefabricated appliance would not be successfully fitted or worn. Aetna Updates to Sleep Apnea Policy A single panoramic x-ray of the jaws and a lateral cephalometric x-ray are considered medically necessary for the evaluation for an oral appliance for OSA. A second lateral cephalometric x-ray with the bite registration or oral appliance in place is considered medically necessary to visualize the mandibular repositioning and the changes in the airway space.Replacement of oral appliances is considered medically necessary at the end of 5-years. In many plans, replacement of the appliance is considered medically necessary prior to the end of the 5-year Reasonable Useful Lifetime (RUL) due to a change in the member’s condition. Replacements needed due to misuse or abuse are not covered.Cephalographic X-rays for diagnosis of OSA are considered experimental and investigational. The OSA oral appliance summaries listed below demonstrate that oral appliances are indeed developing into a predictable reimbursement option and that different insurers do vary in their guidelines. For example, one insurer now requires documenta- tion of any attempt and failure of a prefabricated device (E0485) or the presence of a Type II or III occlusion class as criteria for reimbursement of a custom device. Another considers payment of a panorex and up to two cephalometric x-rays as medically necessary while others will reimburse for a panorex or a single radiologic scan only. Some of the Blue Shield policies state that oral appliance therapy is medically necessary when there is an absence of TMJ disorder or periodontal disease. I’ve included two examples below (text emphasis such as bold, or italic are mine): Continued ➥
  18. 18. TM Diary  |  Summer 2016 18 Another important takeaway from our policy review at Nier- man Practice Management is from United Health Care’s (UHC) “Medically Necessary Plans”DME policies which state: Durable Medical Equipment (DME) and Related Supplies, Prosthetics and Orthotics are medically necessary when: — Ordered by a physician; and — The item(s) meets the plans medically necessary definition (refer to the plan specific document(s); — CMS DME MAC criteria are met — Item is not otherwise excluded from coverage. Because the UHC policy states that“Medically Necessary Plans” follow Center for Medicare and Medicaid Services (CMS) and Durable Medical Equipment (DME) guidelines, it behooves the office to inquire if the patient has a Medically Necessary Plan. Medicare uses the Pricing, Data Analysis Coding (PDAC) contractor to determine which custom made appliances are approved to be billed under HCPCS code E0486 so if the insurer utilizes Medicare’s coding guidelines, valid reimbursement may require the use of a Medicare Cleared appliance. The list of cleared appliances can be accessed at Due to of these variations in policies, in order to not only obtain, but to also retain reimbursements, it’s essential to ensure that your narrative reports demonstrate a through his- tory taking and exam with all of the information needed for documentation. Also, with all the fluctuations in DSM and TMJ treatment policies, it is essential for offices billing medical insur- ance to take a refresher course in CrossCoding and Medical Billing in Dentistry. If you have any questions for us here at Nierman Practice Management or would like access to the web links to the poli- cies discussed, please email Rose Nierman is the Founder and CEO of Nierman Practice Management, the industry leader in helping dentists implement sleep apnea treatment, TMJ therapy and medical billing. NiermanPM has a 27-year track record of providing the highest quality Sleep Apnea and TMJ Continuing education along with DentalWriter™ Software for narrative reports and documentation. What’s New with Medical Policies... continued The Australian Chapter has had another busy year fulfilling our charter to educate and increase the knowledge of our mem- bers in the complex world of Sleep and Craniofacial Pain. Our membership numbers have remained quite stable and it is always a challenge to increase the interest and membership numbers in the AACP. A strategy that has increased our numbers is to include Associ- ate Members from the Allied Health Professions who form such an important part of the multidisciplinary team required to treat our patients successfully. We now have a significant mem- bership of Chiropractors, Physiotherapists , OralMyofunctional Therapists and other Allied Health Professionals. These Asso- ciate Members are active supporters of our events and have contributed significantly to our Chapter. In the previous year, we have held 3 Local Chapter Meetings and our annual International Symposium held in Sydney in March this year. Report from the Australian Chapter of the AACP By Andrew Lee, DDS Australian Chapter President The Topics for our Local Chapter Meetings last year were: — About Sleep: Thinking on the Bed and Outside the Box — TMD: What to do when you haven’t got a Clue — ENT Essentials: the ABC of Allergy in Dentistry These Local Chapter days are held every quarter and usually feature local Australian experts in their fields giving talks on their areas of expertise. We try to make these clinically relevant, and the topics are derived from ideas gleaned from our general membership. We have had some fantastic speakers at these local Chapter days and I would extend the invitation to all of our inter- national membership to also attend one of these as I am sure that you would find it enjoyable, useful and educational. Our annual International Symposium was held in March this year in Sydney and the feedback we received from the attend- ees was fantastic. We were also delighted to host Ed and Lynne Lipskis who were representing the AACP Board at our meeting. We hope that both Ed and Lynne enjoyed the scientific presen- tations and also the more social aspects of the Symposium and their visit to Australia. Continued ➥
  19. 19. TM Diary  |  Summer 2016 19 Our Committee organised a stellar line up of international speak- ers, some of the best in the world in their fields to present their current research and information in their areas of expertise. The Symposium was Titled: Neuralgias, Myalgias and Other Pains in the Head. Some of our world class speakers included Dr. James Fricton, Dr. Lorimer Moseley, Dr. Gary Heir, Dr. Rafael Benoliel, Dr. Manuel Graeber, Dr. Steven Scrivani, Dr. Daniel Clauw and Dr. Tara Renton. James Fricton gave us two talks on improving the outcomes for patients with chronic pain and also a wide ranging review on all of the treatment modalities for TMD and craniofacial pain based on all of the recent published research. My conclusion from his talks is that a lot more research needs to be done in this challenging field. Lorimer Moseley also gave us two very entertaining as well as informative sessions on the brain and pain and the psychologi- cal aspects of chronic pain, the perception of pain and how the mind can be influenced in the treatment of chronic pain. Lorimer is a gifted presenter and well worth seeing if you ever have an opportunity to do so. Dr. Manuel Graeber is one of the foremost NeuroPathologists in the world and he gave us a fascinating presentation on the role of astrocytes and glial cells in neuroplasticity and pain. The highlight was his imaging with ultra high resolution MRI of the cellular processes of astrocytes as they interacted with the neu- ronal junctions. The technology of the imaging now available is incredible and seeing live cells functioning in vivo was amazing. Dr. Tara Renton gave us a rather disconcerting presentation on post traumatic trigeminal neuropathy and left many of us ner- vous about ever picking up a handpiece or forceps again as she went through all the things that can go wrong in clinical prac- tice and can have an adverse effect on the trigeminal nerve. She also showed us a really neat keyhole surgical technique for impacted third molar removal that I had never seen before. Unfortunately, none of my local Oral Surgeons had ever seen it either so they will have to cope with a higher risk of post- oper- ative trigeminal neuropathies. Local Aussie presenters, Radiologist Andy Whyte and Oral Surgeon Ian Rosenberg showed fascinating imaging of arthroscopy of the TMJ and the correlation of the arthroscopic imaging and MRI of the TMJ. Many of us have never seen images of an in vivo TMJ and it was most useful to actually have a look at this joint that we treat in clinical practice. Gary Heir gave us 3 presentations on 3 different topics and showed the breadth and depth of his knowledge and was also a most engaging presenter, making some dry topics interesting and accessible for his audience. Steven Scrivani showed functional neural imaging with high resolution MRI during orofacial pain and headaches and gave a second presentation on the pathophysiology of neuropathic pain. The recent research he and his team have done in this field has really expanded our understanding and it was most instructive hearing from the coalface of research. Rafi Benoliel gave us 3 erudite presentations on trigeminal neuralgia, neurovascular pain and other uncommon facial pain conditions and engaged and educated the audience in the complex topics he was asked to present on. Daniel Clauw gave us 2 presentations on the treatment of chronic pain. He and his team are one of the foremost research- ers in this field and again it was fascinating to learn what the most current knowledge is about treatment of chronic pain. We also had great presentations from some local Australian specialists in orofacial pain in Drs. Rob Delcanho, Ramesh Balasubramaniam and Dr. Mark Dexter. The three days of the Symposium went by in a flash with hardly a spare minute to relax as the programme was so jam packed with great speakers and information. The feedback we have had from the audience was uniformly excellent and it seems that everyone thoroughly enjoyed the programme that we had organised. Planning for our next Symposium in 2017 is now almost com- pleted and we look forward to hosting this again in Sydney on the 17th-19th March 2017. This Symposium is titled—Sleep and Pain: From Research to Reality and we have organised another amazing line up of speakers including Professors David and Leila Gozal, Giles Lavigne and Peter Svensson. We also have 2 more local Chapter Meetings in 2016. The next one in August 27th, titled: Medical Modalities for TMD I would encourage any of the international and USA based members of the AACP to join us at any of our meetings. Come and experience some Aussie hospitality as you learn and I’m sure that you won’t regret it. To close this report, I’d like to thank the Committee of the Australian Chapter. They have worked very hard all year in organising our events. I’d also like to thank the AACP Board for their support and a very special thanks to the President of the AACP, Dr. Steven Olmos, without whom, there would not be an Australian Chapter of the AACP. Report from Australian Chapter... continued
  20. 20. TM Diary  |  Summer 2016 20 The Canadian Chapter of the American Academy of Craniofa- cial Pain (AACP) was founded at the 2007 Annual Meeting of the AACP held in Denver. At that time, the goal of the founding Canadian members was to create a network of support and col- laboration for Canadian dentists and to facilitate the sharing of an increasing amount of knowledge of craniofacial pain across all regions of Canada. Very soon afterwards, sleep breathing disorders were included because of their inseparable connection to pain. Our 1st Conference was held in 2007 and continued every year and here we are this year at our 10th Conference! This growth and success would not have been possible without the loyalty and generous support of our members. Over the past 9 years we had a line-up of excellent speakers; to name a few: Dr. Mariano Rocabado, Dr. Gilles Lavigne, Dr. Steve Olmos, Dr. Barry Sessle, Dr. Indira Narang, Dr. Anika Isberg, Dr. Mark Abramson, Dr. Jamison Spencer, Dr. Larry Wolford and many more. This year’s conference theme is: TMD, OSA Ortho... more than a structural connection! For this year we have teamed up with another organization: the North American Association of Facial Orthotropics (NAAFO); this is a group that follows the growth guidance principles that are defined by Prof. John Mew. You can find information about this on their website: Canadian Chapter Report Chapter Gears Up for 10th Anniversary Conference By Edmund K. T. Liem, DDS Canadian Chapter President For our 10th anniversary meeting we have another impressive lineup of speakers; among the speakers will be Prof. John Mew and his son Dr. Mike Mew; we will have Dr. Deepak Shrivastava, Dr. Steven Olmos, Dr. Bill Hang and many others. This year’s conference will be in beautiful Vancouver, BC on Canada’s west coast. The dates are: November 4-5, 2016. Full information is available on our new website: If you have never attended our conferences, this might one of the best time to do so. The city of Vancouver is spectacular in its beauty and has many things to offer. For those who have the US dollar as currency, you will have a substantial benefit in the very favorable exchange rate (at this time a at least a 25% savings). Please visit our website: for informa- tion and registration. If you register early (before September 1, 2016) you will benefit from a discounted registration fee and you will also receive all the video recordings of the pre- sentations for free. We will do everything we can to make this conference a memorable one! Looking forward to greet you in beautiful Vancouver, BC! Call for Oral Examiners Training Review Session for Oral Examiners Thursday, July 28, 2016 3:30 pm Hilton Austin | Austin, Texas Oral Examinations Thursday, July 28, 2016 4:00 pm–6:00 pm Hilton Austin | Austin, Texas Your expertise would be greatly appreciated. To volunteer to serve as ABCP oral examiner in Austin, send email to: Mayoor Patel, DDS, MS ABCP Examination Committee Chair (678) 984-9558
  21. 21. TM Diary  |  Summer 2016 21 !!! ABCP Plans for Austin Summer Symposium By Jeanne K. Bailey, DDS American Board of Craniofacial Pain President The ABCP has been working all year in preparation for the AACP Summer Symposium. The Board of Directors has not only been planning for the administration of the annual ABCP written and oral examination process, but convocation and the summer ABCP Diplomate luncheon meeting. The written examination will be administered onThursday, July 28. Registration will be outside Room 619 at our host hotel, the Hilton Austin in Austin, Texas, at 8:30 AM. The written examination will be promptly administered from 9:00 AM until 1:00 PM that same day. The oral examinations will be scheduled by appointment only. Dr. Mayoor Patel and the Credentialing Committee will schedule the oral examina- tions. Oral examinations will be held on Thursday evening, July 28, from 4:00 PM to 6:00 PM and Friday, July 29, from 8:00 AM until 12:00 NOON. Oral examiners will meet for examiner training at 3:30 PM on Thursday, July 28, in room 619 at the Hilton Austin. The ABCP would like to thank all of the ABCP Dilpomates who volunteer their expertise to administer the ABCP oral examina- tions. Three examiners are assigned to each examinee to review three oral case presentations. Examinees must present and defend an internal derangement case, a myofascial pain case and a third case that can be either an internal derangement or myofascial pain case. The coordination of examiner training and scheduling three examiners per examinee is a challenging task, but the Credentialing Committee handles the challenge extremely well. The ABCP Diplomate members meeting and luncheon will be held from 12:00 PM to 1:30 PM on Friday, July 29, in Salon J of the Hilton Austin. Salon J is directly adjacent to the General Session ballroom. At the meeting, the Board of Directors will review the accomplishments for the previous year. I would like to personally thank all the Diplomates who supported the ABCP and me the past year. Thank you so much for your assistance. The AACP convocation will be held on Friday evening, July 29, from 5:00 PM to 6:00 PM in Salon H (the General Session ballroom) at the Hilton Austin. Many doctors and assistants will be honored during the graduation/awards ceremony. Award recipients should report at 4:30 PM that day to room 602 to dress and line up for convocation. Please plan to attend this time honored ceremony to recognize and support the individuals who have worked very hard to continue their education. The ABCP will honor and award four doctors who earned their ABCP Diplomate status. The ACBP would like to congratulate: Joseph G. Baba, DDS | Wichita, KS E. Kyle Dalton, DDS | Little Rock, AR John Halmaghi, DDS | Southfield, MI Wennifred Sinyu Hsu, DDS | Hollister, CA AACP’ s 31st Annual InternationalClinicalSymposium | July29–30, 2016 | HiltonAustin | Austin,TX LiveMusicCapitaloftheWorld
  22. 22. TM Diary  |  Summer 2016 22 Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 3/1/2015 to 2/28/2018 Rondeau Seminars The Leader in Dental Continuing Education Are your patients suffering from snoring and sleep apnea? Learn how to identify the patients who are already in your practice who need your help. BROCK RONDEAU, D.D.S., I.B.O., D.A.B.C.P., D-A.C.S.D.D., D.A.B.D.S.M., D.A.B.C.D.S.M. DIPLOMATE INTERNATIONAL BOARD OF ORTHODONTICS DIPLOMATE AMERICAN BOARD OF CRANIOFACIAL PAIN DIPLOMATE-ACADEMY OF CLINICAL SLEEP DISORDERS DISCIPLINES DIPLOMATE AMERICAN BOARD OF DENTAL SLEEP MEDICINE DIPLOMATE AMERICAN BOARD OF CRANIOFACIAL DENTAL SLEEP MEDICINE 1-877-372-7625 r o n d e a u s e m i n a r s . c o m Rondeau Seminars reserves the right to cancel or reschedule any portion of the seminars due to insufficient enrollment or scheduling conflicts. Cancellation policy in effect. Plus taxes where applicable. Space is Limited, Register Early! 2016 - 2017 Course Dates Locations Course Content In the January 2006 issue of the medical journal Sleep, the American Academy of Sleep Medicine recommended that oral appliances be the first treatment option for patients with mild to moderate sleep apnea. This has created an excellent opportunity for dentists who want to offer oral appliance therapy to their patients to significantly improve the health of these patients. It has been estimated that 90 million people in North America have sleep disorders and as many as 24 million suffer from obstructive sleep apnea. This is a serious health problem which increases the risk of high blood pressure, heart attack, stroke, type II diabetes, and gerd. Why You Should Take This Course Course Fee Dates and hotels are subject to change CE credits 14 hours lecture The Dentist’s Role in Snoring Sleep Apnea Expand Your Practice • Increase Your Income • Revitalize Your Interest In Dentistry Per Session Fee: $1,095 per Doctor (includes extensive course manual) Separate Staff Sleep Course also available for $495 Chicago, IL.....................................................................................September 23 24, 2016 Toronto, ON.................................................................................. November 11 12, 2016 Orange County, CA................................................................. November 18 19, 2016 Vancouver, BC ..................................................................................December 2 3, 2016 Dallas, TX ........................................................................................... December 9 10, 2016 Miami, FL..........................................................................................March 31 April 1, 2017 • Sleep Apnea Symptoms and Causes • Sleep Examinations and Forms • Hospital Sleep Studies (Polysomnogram) • ARES Sleep Study • Different Sleep Cycles • Summary of Sleep Disorders • CPAP - Continuous Positive Air Pressure • Surgical Solutions for Sleep Apnea • Comparison of Different Oral Appliances • References and Articles • Marketing Your Sleep Practice • Sample Reports to Sleep Specialists, MD’s, Dentists, and E.N.T.’s • How to Bill Insurance Companies for Oral Appliances Internet course available. For more information, visit our website.