The 10th Annual AACP Canada Conference was held in Vancouver, BC from November 4-5, 2016. Over 120 attendees registered, making it the largest Canada conference so far. It was a joint conference with the North American Academy of Facial Orthotropics, allowing members to hear from new speakers. A pre-conference course on good oral posture exercises was well-received. The conference theme was the structural connections between TMD, OSA, and orthodontics.

1. Journal of the American Academy of Craniofacial Pain
Volume 29 Number 2 | Winter 2016
AACP 32ND
ANNUAL INTERNATIONAL
August 4-5, 2017 – Grand America Hotel – Salt Lake City, UT
CLINICAL SYMPOSIUM

2. 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
11130 Sunrise Valley Drive | Suite 350 | Reston, VA 20191
800.322.8651 | 703.234.4142 | 703.435.4390 fax
www.aacfp.org | central@aacfp.org
Mayoor Patel, DDS, MS & 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 3
Steven R. Olmos, DDS
Institute News 4
Terry Bennett, DMD
The Academy has a New Address 5
Report from the Australian Chapter of the AACP 5
Andrew Lee, DDS
10th
Annual AACP Canada Conference 6
Edmund K.T. Liem, DDS
Content Marketing and Your Dental Practice 7
Sara Berg
Don’t Forget to Educate Your Dental Team 8
on Craniofacial Pain and TMFD
Mayoor Patel, DDS, MS
OSA Patient: Understanding a Chronic 9
Disease Model
Deepak Shrivastava, MD
Deleted TMD Codes & New Replacement 10
Codes Take Effect
Rose Nierman
American Academy of Craniofacial Pain
11130 Sunrise Valley Drive | Suite 350
Reston, Virginia, 20191 USA
P: 703.234.4142 | F: 703.435.4390 | www.aacfp.org

3. TM Diary | Winter 2016 3
President’s Report
It is my honor and privilege to repre-
sent our Academy in this position that
so many great people have served. I am
very excited about our future.
I am inspired by the hard work and
motivation that I see from attendance
at our terrific symposium in Austin,
Texas. Thank you Dr. Ed Lipskis for all
you do as our Program Chair. A wonderful meeting with
education, matriculation and comradery.
I have just returned from the Canadian Chapter meeting in
Vancouver and it was terrific. Thank you Dr. Edmund Liem
for organizing every part of that meeting and serving as
President. I am in awe of your energy.
I look forward to visiting Australia for their Annual Sympo-
sium in March 17-19, 2017. Dr. Andrew Lee as President and
his team have done a remarkable job in growth and quality
of education they provide. Congratulations!
I would like to welcome our new Board members elected at
our Summer Symposium in August. They are Dr. Joe Baba,
Dr. Gary Dennington and Dr. Chris Simmons. Members
you have done an outstanding job of electing a motivated
group that are already contributing to our Academy.
Our Membership Chair Dr. Richard Goodfellow is working
hard to increase members and member benefit. Please view
his video on our Academy website and share with all you
know. Our membership is growing under his direction.
Dr. Jeanne Bailey our Treasurer is working hard to find ways
to increase our income retention for redirection in ways that
will give our Academy a bigger voice and to serve our mem-
bers. We are all very lucky to have her and we do appreciate
her efforts.
Dr. Rick Light our Secretary is the person who keeps
record of all of our Academies efforts. It is a position that
does not get much light (sorry Rick), however his efforts
are much appreciated.
Dr. Dennis Marangos is our new President-Elect. What a
pleasure he is to work with. He is a tremendous contributor
and our future is in great hands. He has organized the online
education delivery system that we have been dreaming of
for years. Please visit the website: AACPCE.com to see the
array of courses that are now available through the Ameri-
can Academy of Craniofacial Pain Continuing Education.
Dennis was the Chair of the Education Committee and so
that position has been transferred to Dr. Joe Baba and Dr.
Cameron Khuene. This Committee has tremendous respon-
sibilities as it is responsible for all education for our Academy
outside of our annual general meeting. This includes the
AACP Institute. Dr. Terry Bennett has done a remarkable job
of developing numerous courses and delivered through-
out the US and Canada. He has developed a relationship
with the University of North Carolina Dental School to host
courses and is working with other schools. Thank you Terry.
The person who has organized the delivery and is the back-
bone is Dr. Stacy Cole. Stacy, thank you for the structure you
bring to this huge task.
AACP Mission Statement
The American Academy of Craniofacial Pain is committed
to the relief of craniofacial pain, temporomandibular disor-
ders and dental sleep related disorders and supporting the
advancement of education, research and dissemination of
knowledge and skills in these areas.
We do so in a therapeutic way as to restore hope. We are the
Academy of Hope.
Our future is very bright.
Happy Holidays and a very Happy New Year!
We Are the Academy of Hope
By Steven R. Olmos, DDS | AACP President

4. TM Diary | Winter 2016 4
Institute News
First of all, I want to wish all of you a
very, happy holidays and hope that all
of you got to enjoy it with your families.
The holiday season is a very special one
and we should stop and give thanks for
all the blessings that each of us have.
The Institute has been busy this fall
with several courses that were pre-
sented. Class 12 of the Craniofacial Pain mini residency has
two sessions behind us and we have an excellent class of
20 students. Many of the students are already putting into
practice some of the injection techniques that they learned
and are helping their patients tremendously. It’s gratifying
to see the students not only learn but practice what the
instructors are teaching them. Sessions 3 and 4 will con-
tinue in 2017 and the dates for Class 13 have already been
selected; so watch out for them on the AACP calendar.
In September, Wes Shankland presented a great dissec-
tion course in Denver. He tied together the relationships of
structures involved in both sleep and TMD and the physi-
ology of how they worked together. We also had Dania
Tamini presented her course on Cone Beam Radiology and
the anatomy that we should all consider when looking at
any CBCT scan. This course was held in Atlanta and as you
can see, we are trying to present courses in all parts of the
US. Both these courses got rave reviews from the students
and even though they were well attended, I was personally
disappointed at the attendance.
The year 2017 will start the year with two different and
new offerings of the Dental Sleep Mini Residency. We are
collaborating with the University of North Carolina with
our 3 session, 6-day course and these sessions will be held
in Feb., March and April and will include several speakers
from the North Carolina and Duke University arena. Enroll-
ment has already gotten off to a great start and I personally
hope that this partnership will develop into a long lasting
relationship. The North Carolina people that I am working
with have been amazing with their ideas and marketing and
this should be one of the best sleep courses that is being
offered in the US. We are also offering, for the first time, the
4-day Dental Sleep Mini Residency in Toronto, ON Canada in
March. This will copy the course that has been held in San
Diego in the past but will feature many Canadian speakers.
Henry Schein is offering much help in making this course
possible and the course will be held at their facility. Both of
these courses are on the web site and hopefully, you have
gotten brochures and email blasts by this time. Don’t miss
out on the chance to improve the knowledge in Sleep and
TMD by attending these courses and hopefully, I will see
you at one or the other of them.
The last course that is presently being offered is a second
offering of the very successful Injection and Botox course.
This will be held in Dallas at our new DoubleTree headquar-
ters and again, it is on the website and also the brochures
should have been mailed by the time this article is out. This
is a chance to brush up on the injection techniques that
many of us use daily and understand why we do each of
the injections. Botox will also be discussed as an adjunctive
treatment for those very difficult patients and this treat-
ment has been proven very successful for that clenching
and headache patient that can’t be controlled. Many of you
have attended other courses that are currently being offered
and if you haven’t given the Institute courses a chance for
education, you may be surprised at what you can learn from
the varied instructors that we have presenting.
I am always willing to listen to new course ideas, so if any-
one has a burning desire to teach and have something that
is new and different, please contact me with the idea and I
will tell you how to proceed with many the course a reality.
Again, Happy Holiday season and will see you next year.
2017 CE Agenda Highlighted by New Offerings
By Terry Bennett, DMD

5. TM Diary | Winter 2016 5
Continued ➥
The AACP, along with the ABCP and the ABCDSM, has moved its
central office. The new office is located at 11130 Sunrise Valley
Drive, Suite 350, Reston, VA 20191. The move was prompted by
rapid growth of the Academy’s management firm, Drohan
Management Group. In short, we simply ran out of space!
The new offices are more modern, roomy and efficient. Just a
week after the move, the AACP Budget Committee met in the new
offices and had a chance to see the upgrades. By all accounts, they
were pleased with the new location, which is still just minutes from
Dulles International Airport.
It’s important to note that all phone numbers and emails remain the same, so the transition caused almost
no issues. It has been business as usual!
If you’re ever in the Reston, Virginia, area and would like to visit, we’d love to show you around. Just contact Executive
Director Bill Carney at bcarney@drohanmgmt.com.
The Academy has a New Address
It’s now the run up to Christmas and your Committee of
the Australian Chapter of the AACP has been hard at work
finalizing the details for our Scientific Symposium next year
in March 17th-19th 2017.
It’s been a big year for the AACP in Australia, We had our 5th
Symposium in March of this year and we had over a hun-
dred delegates enjoying a jam packed 3 days in Sydney on
everything you needed to know about pains in the head.
We also had 3 well attended Local Chapter days in May,
August and October.
I would encourage all of you to try to attend these Local
Chapter days. They are designed to be accessible and low
cost and usually revolve around some of the practical and
clinical aspects of treatment. We usually have interesting
local Australian speakers from wide and diverse back-
grounds and they are always interesting and useful.
The Committee’s main focus for most of this year has been
on our upcoming Symposium in Sydney, on the 17th-19th
March, titled“ Sleep and Pain, from Research to Reality”.
This could be the best Symposium we have held yet. I am
really excited about the lineup of speakers that our Educa-
tion Officer, Karen McCloy, has organized for us and the
topics that she asked each of them to speak on. She has
done a fabulous job and deserves congratulations and grati-
tude for her dedication and work.
We have some of the best international scientists, research-
ers and speakers in the world on these topics. Karen has also
managed to organize some wonderful Australian speakers to
complement our international presenters.You would have all
received our brochure for the Symposium and I encourage all
of you to read the summaries and synopses of the speakers.
This should be first CE event that you register for in 2017.
We have 3 speakers who have previously presented for us
at one of our earlier Symposia. We would only invite them
back because they were so good that once is definitely not
enough. These 3 are Proffessors Gille Lavigne, Leila Gozal
and Peter Svensson. Gilles Lavigne needs no introduction to
anyone who has the slightest interest in the fields of Sleep,
Pain and Bruxism. He wrote the text book on it, in fact he’s
Report from the Australian Chapter of the AACP
By Andrew Lee, DDS | President, Australian Chapter, AACP

6. TM Diary | Winter 2016 6
Report from the Australian Chapter of the AACP continued
written several text books on these topics and as he so
entertainingly demonstrated when he spoke for us in 2013,
he is also a most engaging and dynamic speaker.
Dr. Peter Cistulli, one of Australia’s foremost clinicians and
researchers in Sleep Medicine and also one of our present-
ers next March, congratulated Karen when he had heard
that one of the Gozals was presenting next year. He was
absolutely gobsmacked when he was told that both the
husband and wife team of David and Leila Gozal were going
to be speaking. Professors David and Leila Gozal are abso-
lute giants in the world in their fields of Sleep and Paediatric
Sleep research. We are privileged that they have both
agreed to present their research and work to us next year.
They are not to be missed.
I won’t go through the whole speaker list. I encourage you
to look at our website or read the brochure that you would
have received and I am sure that you will see the value and
quality of our 2017 Symposium.
I look forward to welcoming all of you to our 6th Sympo-
sium held in Sydney from the 17th-19th March 2017.
The Canadian Chapter of the AACP celebrated this year
their 10th annual conference. The conference was held on
November 4-5, 2016 in Vancouver, BC.
The conference was very well attended; more than 120 have
registered and this makes this the largest AACP Canada
conference so far. Attendees were travelling from all over
Canada and the USA. We had several repeat USA visitors
that enjoy our conference program and hospitality. This year
is the very first time we have decided on a new formula: a
joint conference with a similar like-minded organization.
We found a group that has been striving a very similar
goal and that is the NAAFO (North American Academy
of Facial Orthotropics) and decided to run a joint confer-
ence. This decision has been a great success and similar
collaboration could happen again in the future. This joint
conference allows our members to hear speakers that we
not always get to see and the same applies to the other
group. This cooperation has also attracted attendees that
are completely new to both groups, resulting in about 1/3
of potential new members.­
We also had organized a pre-conference course about GOPex
which stands for “good oral postures exercises”. The course
was about exercises to create and enhance good oral posture
which is essential to create a stable orthodontic result. This
course was packed by 35 people and very well received.
This year conference was opened with a photo tribute to 10
year AACP Canada; The chapter was founded at the sum-
mer AACP meeting in 2006 in Denver, CO. Coincidently the
music that was chosen for the photo-tribute was“Hallelu-
jah”by Leonard Cohen, the iconic Canadian composer and
singer that passed away just 1 week later at the age of 82.
You can view this photo-tribute at this link:
https://goo.gl/hDEHHP.
The theme for the conference was: TMD, OSA
Orthodontics…..more than a structural connection!
The first speaker was Dr. Brian Weeks, an ENT from San
Diego who showed the importance of a proper nasal
function and the minimal invasive techniques of balloon
sinuplasty. He was followed by our AACP President Dr.
Steven Olmos who discussed the importance of identifying
the Obstructions in OSA and how to triage the treatment.
The third speaker was our own medical director Dr. Deepak
Shrivastava who has the ability to break down complex
medical issues in for us understandable pieces. He was
followed by Dr. John Remmers who shared with us the
concerns and dilemmas MD’s has with OSA treatment and
what kind solution he has for this. Last speaker of the day
was a Critical Care Nurse: Julia Worrall. She told a personal
story which lead to a call for more cooperation between the
healthcare professionals. She was unaware what dentist can
10th
Annual AACP Canada Conference
By Edmund K.T. Liem, DDS | President, AACP Canada
Continued ➥

7. TM Diary | Winter 2016 7
10th
Annual AACP Canada Conference continued
do for craniofacial and sleep disorders and she was amazed
about the potential.
For the Friday evening we have organized a trip to the
Museum of Anthropology followed with a dinner on site.
Surely it was a very interesting visit.
Day 2 started with the one and only Prof. John Mew; he
explains what he has describe more than 50 years ago
the“tropic premise”. Insight in this will help us understand
what the cause is of crooked teeth and obstructive sleep
apnea. His son Dr. Mike Mew followed him and showed
what he has seen around the world how fellow dentist
are creative to bring the midface forward. Dr. Simon Wong
from Melbourne, Australia shared with us the reasons why
he developed the Good Oral Posture exercises. Just before
lunch time we had a guest speaker: Mr. Omar Lalani; he
shared with us his compelling personal story what he has
endured with his personal orthodontic treatment. He wants
that the orthodontic profession pay attention to technique
that could impair airway. He has started a website that is
worth visiting: www.righttogrow.org.
After lunch Dr. Bill Hang showed us the future of orthodon-
tics where (an improved) airway is the main goal. The last
speaker, Patrick McKeown from Ireland, spoke about the
Buteyko breathing technique; this a breathing technique
that is developed by the late Konstantin Buteyko which,
among others, treat over-breathing.
All in all, this was a successful 2.5 days filled with lots
of information for everybody. All the sessions are video
recorded and will be available at a later stage.
Up to the next 10 years!
You’ve completed dental school, and maybe even some
advanced education courses, but what about content
marketing? Throughout your years in dental school you’ve
learned how to properly care for your patients and provide
the right services, but you weren’t shown the importance
of creating content. From educational materials to newslet-
ters, it is important to add content marketing to your dental
practice’s plans.
As a Writer, Editor, and Content Specialist, I work with Dr.
Mayoor Patel and a variety of other dentists on creating
content for their websites, newsletters, social media, and
other areas of marketing. To help you gain a better under-
standing of the need for content marketing, below are a few
areas you should pay close attention to:
Your Website
Let’s begin with your website. First, do you have a website
for your practice? If you do not have a website yet, now is
the time to get started. By having a website, you can reach
your patients while providing educational materials. A web-
site allows you to introduce yourself, your team, and your
services, while providing educational materials through
website content and blog posts.
Create a welcoming website that shows your patients
where you’re located, how to get in contact, and educa-
tional materials that will help them make the best informed
decisions about their oral health possible. The availability of
an active blog also allows you to answer common questions
and provide advanced information about your practice, and
services offered. If you don’t have time to write weekly blog
posts, don’t worry—I provide blogging services so you don’t
have to worry about finding time.
Your Social Network
It’s one thing to have website, but it is another to have an
active social network, too. Create business pages for your
practice on Twitter and Facebook for even further outreach to
your patients. When searching for a dental practice, patients
often go to Facebook or Twitter to see what you have to
offer, and what other people are saying. Seeing that you are
active on Facebook and patients love your services allow new
patients to feel more comfortable about your practice.
Content Marketing and Your Dental Practice
By Sara Berg
Continued ➥

8. TM Diary | Winter 2016 8
Content Marketing and Your Dental Practice continued
Beyond the setup of social media channels, it is important
to actively post for your patients. Whether it is an update
of the practice, photos of the office, or educational articles
and blogs, your patients want to remain up-to-date. With
weekly blogging on your website, you automatically have
something to share each week. If you need help setting up
a Facebook or Twitter account, or sharing information, I can
help you here, too.
Your Newsletters or Email Outreach
One last area that often goes overlooked is a monthly
newsletter or email marketing. By creating a mailing list,
you can send weekly or monthly newsletters to your
patients. A suggested topic for weekly emails might be
weekly dental tips. You can also do a monthly newsletter
that offers important educational information, tips, and
updates about your practice. As a dental practice that is
establishing their role in craniofacial pain or TMD, it can
significantly benefit your office by sending out monthly
emails to keep your patients informed about these new
services—it might be just what your patient needs to read
to realize they have an issue at hand.
The questions and tips you can include in newsletters are
limitless. Use your creativity to brainstorm important ideas
that your patients should know when it comes to craniofa-
cial pain, TMD, or other services. Through email marketing
you can further reach your patients because a majority of
patients check their emails multiple times a day.
To learn more about content marketing or to take the next
step in providing these services for your practice, please feel
free to contact me by visiting https://saraiceberg.com/.
So you’ve chosen to take the leap toward furthering your
education by offering craniofacial pain and TMD services
within your dental practice—that’s great! Since you’ve
already decided to advance your education in these new ser-
vices, don’t forget your dental team. It’s one thing to be fully
educated in these advanced areas, but it is another to have a
well-rounded dental team assisting you along the way.
Your Team: Getting your team the right education to pro-
vide craniofacial pain and TMD services alongside you is just
as important as your own continuing education. By educat-
ing your team, you can have the necessary support needed
to properly diagnose and treat your patients.
Below you will find some members of a typical dental team
and how education is vital to their role in your office:
– Dental Assistant: Your assistant is your go-to person in
the office, which means they should always know what
is going on, and how to provide the services you offer.
Bring your dental assistant to all courses you attend so
they, too, can be on the same page as you.
– Dental Hygienist:Your dental hygienist interacts with
patients the most, so they are often the first ones to notice
symptoms of craniofacial pain, TMD, and other conditions.
While joining you in various courses is important, there are
also classes tailored to hygienists and their specific needs.
Continuing education for hygienists will help them in ask-
ing the right questions and knowing what to look out for.
– Office Manager/Billing: Even the office manager and
billing coordinator need to be educated in craniofacial pain
and TMD, as well as other advanced areas of dentistry. The
more your office or billing manager knows about these ser-
vices, the better prepared they will be in not only providing
educational information for your patients, but in properly
billing for services and scheduling appointments.
Once a patient likes, trusts, and believes in your entire den-
tal team, you have created a patient for life. Start educating
your team now.
Don’t Forget to Educate Your Dental Team on Craniofacial
Pain and TMD
By Mayoor Patel, DDS, MS
Continued ➥

9. TM Diary | Winter 2016 9
Don’t Forget to Educate Your Dental Team on Craniofacial Pain and TMD continued
top of the latest advancements in dentistry for yourself, as
well as including your team in these advanced classes.
With a well-rounded team of dental experts, you can
provide your patients with the best care possible from the
moment they walk into your office. From the office manager
to the dental hygienist and assistant, your team needs to be
on the same level of educational care, so that nothing slips
through the cracks for quality patient care.
Importance of Education: The field of dental education
is large and varied, as it covers a lot of different jobs. People
can train as general dentists, specialists, dental hygienists,
dental assistants and also as dental laboratory technicians.
And, once a dental professional has qualified, they cannot
rest on their laurels. The world of dentistry is always chang-
ing, and at a fast pace with new technology being brought
in all the time. For that reason it is important to remain on
Obstructive sleep apnea (OSA) is a chronic disease without
any cure. Despite the treatment, OSA remains a relatively
costly disease when compared to other chronic diseases.1
The heath care utilization is a result of both OSA itself and
co-morbid conditions like obesity, hypertension, hypercho-
lesterolemia, diabetes, impotence, tobacco use, ischemic
heart disease. A comprehensive plan of chronic disease
management is desirable in this situation to improve patient
outcomes and cost containment. Many ongoing factors
influence the course of OSA including ageing, weight
changes, life style changes, substance use, and progression
of other systemic diseases and their treatments. In addition,
compliance remains a major issue in the usage of major
non-invasive treatment modalities, CPAP, and oral appliance
Therapy (OAT).
A population-based study discovered that a 10% weight
gain predicted a 32% increase in apnea hypopnoea index
(AHI) while a 10% weight loss predicted a 26% decrease in
AHI.2
Rising epidemic of obesity imposes a major demand
in continued weight management of OSA patients. Patients
who achieve significant weight loss after bariatric surgery, a
significant percentage regain their weight.3
Chronic obesity
management is required including dietary changes, exer-
cise and behavioral changes. Recently published American
Association of Clinical Endocrinologists Medical Guidelines
for Clinical Practice is a good resource for providing medical
care to the obese patients.4
Alcohol consumption and smoking are considered two
modifiable risk factors for OSA. Many screening tools are
available for alcohol dependency and providers are required
to screen for alcohol use, discuss, and educate the patient
on each follow up visit. Smoking is a known risk factor for
OSA.5, 6
Health care providers are required to screen for
smoking, discuss and educate OSA patients. Referral is
encouraged to the special counselors and special providers
to consider pharmacotherapy and regular follow up.7,8
Patients once diagnosed with OSA and treated with oral
appliance therapy require regular follow up with the dentist
every six months and yearly with sleep specialist. To ensure
effectiveness of the treatment as well as compliance and
troubleshoot problems, initial follow up visits are important.
In the event that Oral appliance therapy is not tolerated,
further investigation is planned to identify the underlying
issues with adjustment in OAT settings, further adjustments
and discussion of other confounders.
Patient with OSA need evaluation of their driving risk. Risk
factors include patients having previous motor vehicle acci-
dent, near-miss incident, or evidence of daytime sleepiness
and diminished driving performance.
OSA meets all six criteria for chronic disease model of
heath care delivery. They include 1.OSA care is linked to a
health care organization or facility, 2. Need for community
resources like alcohol anonymous or smoking cessation
program, 3. Self-management support and training,
OSA Patient: Understanding a Chronic Disease Model
By Deepak Shrivastava, MD
Continued ➥

10. TM Diary | Winter 2016 10
OSA Patient: Understanding a Chronic Disease Model continued
OSA patients to show their impact on outcomes parameters.
Considering OSA as a chronic disease, and the recognition of
the fact that these patients require ongoing care in dental,
medical, neurocognitive and public heath domains will help
develop multispecialty management programs that are likely
to improve compliance, early intervention, and positive life
style changes as well as measurable outcomes.
4. A delivery system with planned visits like durable medi-
cal equipment (DME) company and provider visits 5. Access
to specialists and educational sessions like AWAKE support
group and 6. A electronic medical record software system
that gives regular alerts for follow up checks.9,10
A variety of chronic disease management models is avail-
able for adaptation. However, there is insufficient data in
Bibliography:
1. AlGhanim N, Comondore VR, Fleetham J, Marra CA, Ayas
NT. The economic impact of obstructive sleep apnea.
Lung 2008;186(1):7e12.
2. Peppard PE, Young T, Palta M, Dempsey J, Skatrud
J. Longitudinal study of moderate weight change
and sleep-disordered breathing. J Am Med Assoc
2000;284(23):3015e21.
3. Odom, J., Zalesin, K.C., Washington, T.L. et al. OBES SURG
(2010) 20: 349.
4. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLO-
GISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY
COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR
MEDICAL CARE OF PATIENTS WITH OBESITY 2016; ENDO-
CRINE PRACTICE.22; (Suppl 3) July 2016
5. Berry RB, Bonnet MH, Light RW. Effect of ethanol on
the arousal response to airway occlusion during sleep
in normal subjects. Am Rev Respir Dis 1992;145(2 Pt
1):445e52.
6. Scanlan MF, Roebuck T, Little PJ, Redman JR, Naughton
MT. Effect of moderate alcohol upon obstructive sleep
apnoea. Eur Respir J 2000;16(5):909e13.
7. Wetter DW, Young TB, Bidwell TR, Badr MS, Palta M.
Smoking as a risk factor for sleep-disordered breathing.
Arch Intern Med 1994; 154(19): 2219e24.
8. Kashyap R, Hock LM, Bowman TJ. Higher prevalence of
smoking in patients diagnosed as having obstructive
sleep apnea. Sleep Breath 2001;5(4):167e72
9. Hroscikoski MC, Solberg LI, Sperl-Hillen JM, Harper PG,
McGrail MP, Crabtree BF. Challenges of change: a quali-
tative study of chronic care model implementation. Ann
Fam Med 2006;4(4):317e26.
10. Kreindler S. Lifting the burden of chronic disease: what
has worked? What hasn’t? what’s next? Healthc Q
2009;12(2):30e40.
Typically, when I find out about important medical codes
being deleted, my first instinct is to hit the panic button
– however this time it’s not the case. The major ICD-10 diag-
nosis codes that were deleted were replaced with new codes.
What has changed?
Revised ICD-10 codes for TMJ disorders went into effect
on October 1, 2016.
TMJ codes were rewritten to indicate laterality; ICD-10
codes specified laterality for other parts of the body and
are now that requirement is in place for the TMJ.
Injury codes specify Initial, Subsequent or Sequela;
Injury codes now need to show when an encounter is initial,
subsequent or a sequela. To determine which one applies,
put yourself in the patient’s shoes. For example, if the visit is
Deleted TMD Codes New Replacement Codes Take Effect
By Rose Nierman | Founder CEO Nierman Practice Management
Continued ➥

11. TM Diary | Winter 2016 11
a patient’s initial encounter for active treatment of an injury,
it would be coded as an initial encounter. If the patient
previously received active treatment for this condition, it
may be a subsequent encounter. ICD-10-CM says the term
sequela is“for use for complications or conditions that arise
as a direct result of an injury, such as scar formation after an
injury;“The scars are sequelae of the injury.”In other words,
sequela are the late effects of an injury.
Many of the deleted and revised ICD-10 codes are
listed below:
Deleted TMD ICD-10 codes:
– M26.60 TMJ disorder, unspecified
– M26.61 Adhesions and ankylosis of TMJ
– M26.62 Arthralgia of TMJ
– M26.63 Articular disc disorder of TMJ
Added TMD ICD-10 codes to indicate laterality:
– M26.611 Adhesions and ankylosis of right TMJ
– M26.612 Adhesions and ankylosis of left TMJ
– M26.613 Adhesions and ankylosis of bilateral TMJ
– M26.621 Arthralgia of right TMJ
– M26.622 Arthralgia of left TMJ
– M26.623 Arthralgia of bilateral TMJ
– M26.631 Articular disc disorder of right TMJ
– M26.632 Articular disc disorder of left TMJ
– M26.633 Articular disc disorder of bilateral TMJ
Added Sprain of Jaw ICD-10 codes:
– S03.41XA Sprain of jaw, right side,
initial encounter
– S03.41XD Sprain of jaw, right side,
subsequent encounter
– S03.41XS Sprain of jaw, right side, sequela
– S03.42XA Sprain of jaw, left side,
initial encounter
– S03.42XD Sprain of jaw, left side,
subsequent encounter
– S03.42XS Sprain of jaw, left side, sequela
– S03.43XA Sprain of jaw, bilateral, initial encounter
– S03.43XD Sprain of jaw, bilateral, subsequent encounter
Added Dislocation of jaw ICD-10 codes:
– S03.01XA Dislocation of jaw, right side, initial encounter
– S03.01XD Dislocation of jaw, right side, subsequent encounter
– S03.01XS Dislocation of jaw, right side, sequela
– S03.02XA Dislocation of jaw, left side, initial encounter
– S03.02XD Dislocation of jaw, left side, subsequent encounter
– S03.02XS Dislocation of jaw, left side, sequela
– S03.03XA Dislocation of jaw, bilateral, initial encounter
– S03.03XD Dislocation of jaw, bilateral, subsequent encounter
With over 37 states mandating TMJ coverage and most medi-
cal insurance covering sleep apnea appliances, put away that
panic button and begin updating your codes - so that your
patients can receive maximum medical reimbursement.
Rose Nierman, RDH, Founder of Nierman Practice
Management is the creator of DentalWriter™ and
CrossCode™ software and CE for TMJ and Dental Sleep
Medicine treatment. Nierman’s CrossCoding; Successful
Medical Insurance for Dentists course is the premier Dental
to Medical Billing Course in North America. Contact Rose at
www.Dentalwriter.com or at 1-800-879-6468.
Deleted TMD Codes New Replacement Codes Take Effect continued

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3/1/2015 to 2/28/2018
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• Expand Your Practice
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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
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insufficient enrollment or scheduling conflicts. Cancellation policy in effect. Plus taxes where applicable.
Chicago, IL.......................................January 20 21, 2017 Orange County, CA.....................March 10 11, 2017
Toronto, ON................................................April 7 8, 2017
2017 Course Dates Locations
Dates and hotels are subject to change
CE credits 14 hours lecture, case diagnosis at the course
Vancouver, BC.............................December 2 3, 2016 Dallas, TX......................................December 9 10, 2016
Miami, FL....................................March 31 April 1, 2017
2016 - 2017 Course Dates Locations
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CE credits 14 hours lecture
The Dentist’s Role in Snoring Sleep Apnea
Diagnosis Treatment of TMD
Why You Should Take This Course
In this course, you will gain basic step-by-step information on snoring and sleep apnea. Dr. Rondeau will provide you with
a clear understanding of this disorder by showing 14 cases start to finish, including full records, diagnosis and treatment.
Why You Should Take This Course
When patients have structural problems (anterior displaced discs) within the TM joint, then the dentist must become
involved to rectify this problem by using splint therapy to obtain a more stable jaw relationship. It has been estimated that
as many as 80% of headaches are related to anterior displaced discs and clenching and bruxing.
Course Content
• 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
Course Fee: $1,095 per Doctor or $495 per Staff (includes extensive course manual)
Course Content
Numerous clinical cases with full records will be shown
on how to find the correct maxillo-mandibular relationship.
• Phase I - Diagnostic Splint Therapy
• Phase II - Orthodontic Case Finishing
Dentists have the prime responsibility to diagnose and treat this common disorder. TM disorders are progressive and
worsen over time; therefore, just like orthodontics, it is imperative that the problem be treated as early as possible. Dentists
treating patients for snoring and sleep apnea need to have a clear understanding of this disorder to properly
treat their patients using oral appliances.
Course Fee: $1,095 per Doctor or $495 per Staff (includes extensive course manual)