That’s right, I said it. If you can’t attract enough new patients to satisfy your practice needs, if you struggle to make the patients you have happy, if you’re not making much money, if you’re unwilling to adjust your fees or increase your level of service (or both) and/or if you refuse to recognize the new reality then maybe treating sleep apnea is the gimmick for you.

Of course to do so while avoiding self-loathing you’ll have to think highly enough of yourself to believe that you are more qualified than ENTs and other medical specialists who have trained their whole lives to manage airway issues (in real school where they get real degrees).

I’ve never met a busy orthodontist who engages in extra-orthodontic treatments for long (and most are smart enough to avoid these time wasters all together). If your ortho office is known for great service, great results, a caring, competent doctor and a fun environment you’ll be overrun with new ORTHODONTIC patients and won’t have time to mess about with ancillary treatments like TMD treatment or so called airway orthodontics. If you are known in town as the office that offers affordable treatment you’ll likewise be inundated with ORTHODONTIC new patients. If you refuse to be awesome or affordable (or preferably both) then you’ll struggle like many orthodontic practices do and perhaps claiming to be an airway specialist after a couple weekend courses is the way to go.

Be sure to ignore the hypocrisy of orthodontists claiming general dentists shouldn’t do orthodontics because “they aren’t properly trained and only did a weekend course in a hotel”.

Deny the fact that there is virtually no science to back up the claims that doing an RPE cures everything from breathing issues to bed wetting to low test scores. Forget that someone with REAL breathing issues may not get professional care from a qualified MD because you convince them your weekend courses make your treatment “just as effective”. Listen to those Key Opinion Leaders who are paid hundreds of thousands of dollars (a huge percentage of their income when compared to what they make in their tiny orthodontic practices) to put a shine on the litany of “new products” and “new procedures” that allow their corporate employers to sell us gullible orthodontists more stuff we don’t need and further transfer the inherent profitability of practicing orthodontics to corporate coffers. Go ahead and claim to be the “hub of the wheel” and demand to be the quarterback when it comes to dealing with the MDs who are trying to help patients in real need with real breathing problems. Feel free to put expanders in 4 year olds so you can beat the pediatric dentists and phase I orthodontists to the punch and claim those patients as your own.

Why wouldn’t you?

Well there are lots of reasons you shouldn’t and I hope you’ll ignore the hype and think it though:

  • Orthodontists are well trained to do orthodontics and we are the most qualified to render this service. Stick to what you know.
  • Orthodontics is the most profitable thing an orthodontist can do in our practice. (If you want to be really profitable then do ortho with brackets and wires – inexpensive ones)
  • Many of us have become distracted with TMD treatment and other stupid stuff in the past and this resulted in a huge waste of both time and money. If you’ve done this in a successful practice then you know what I mean. If you haven’t discovered what this kind of distraction can cost you then please take my word for it (or ask a very busy orthodontist if you don’t believe me – don’t ask your broke buddy from residency who is still trying to get their practice off the ground while working part time as an associate for someone else to make ends meet).
  • Sleep apnea treatment is just another distraction just like TMD was. Instead of wasting your time and money while wasting patients’ time and money, learn to get great ORTHODONTIC results, run on time, finish cases on time and offer great service at a price that patients perceive as valuable (this doesn’t necessarily mean a low fee – the right fee varies depending on how good you are at what you do, where you live and the demographic you’re trying to serve).

You’re smart. You’re well trained. You care about patients. Do right by your patients and offer the services you’re well trained to provide. Leave the sleep disorders to the MDs… or go back to medical school and get a real degree if you’re truly that “passionate about sleep disorder orthodontics”.

To do otherwise is rank hypocrisy.

Related Reading:

Pediatric Airway Orthodontics: Keep Rolling the DISE

13 thoughts on “If You’re Broke, Consider Sleep Apnea Orthodontics

  1. Haha. Respect the ballsyness on a contravestial topic. 🙂
    Thnx for sharing.

  2. https://orthopreneurs.com/2019/01/27/is-treating-sleep-disordered-breathing-in-the-orthodontic-office-a-fad/

    Coincidental to have posted on the same day. It’s nice that this article basically makes one of the arguments you’re making: look, you need to grow your orthodontic practice since it’s stagnating, so do so by quarterbacking this ‘new’ opportunity and you’ll hopefully have tons of patients.

    And where is the proof that anything we’re doing is actually helping these kids, since the current literature is clear that it likely does nothing? Well, according to this article: “document your results from your own treatment outcomes so you can review the impact of your treatment choices.” So basically the lowest level of evidence: a bunch of case reports done by yourself without any controls. *face palm*

    1. Good thoughts Kevin.
      I wrote this one in response to the article you cite. Someone sent it to me and I couldn’t take this sleep apnea talk any more and had to speak up. Thanks for sharing since I obviously didn’t make it clear 😁 Have a great week!

  3. Hi Ben,
    I thought I would disagree with this article but I’m actually mixed. I was treated for sleep apnea successfully with orthognathic surgery before I knew anything about this stuff. Always been an interest of mine thereafter. I get your point. Obviously SDB and OSA are multifactorial and I am by no means putting expanders in 4 year olds or claiming I’m going to solve it, but I discuss it often enough and refer to ENT or talk to surgeons at least a few times a week based on findings, clinical exam, and conversations wit patients and parents. What if the practice is running well (obviously there’s always room to improve) and Orthodontics IS going well? Are you talking about specifically TREATING versus conversation, referral, etc? And if so, what treatment methods are we talking about? Thanks in advance!

    1. There are exceptions to every rule. I’m sure there are some dentists and/or dental specialists who actually know what they are doing when it comes to treating airway problems. If they are truly competent and work with MDs then I wish them nothing but well. Also if someone is doing well in ortho and just likes doing this kind of stuff (with the proper training and with MDs) then they should go for it despite what I said about efficiency in an ortho office. Further, if one can identify and refer serious issues then there’s nothing wrong with that of course. In this piece I was speaking to the dental/ortho device/supply company driven nonsense that passes for training/treatment and those who espouse said nonsense for money while trying to act like that’s not why they do it. It’s annoying to watch and listen to and has been for quite a while but the combination of the American Association of ORTHODONTISTS mid winter being focused on airway issues and a blog post I read Sunday put me over the top. Actually it’s more than annoying – it’s contrary to our ethical responsibilities as healthcare providers. Consider this a call for common sense and reason – it’s ublikely either will prevail but at least I gave it a shot. Thanks for the input.

  4. Well said, I attended the AAO midwinter meeting on sleep disordered breathing and sleep apnea, and the bottom line is when you start treating these patients you marry them! 😂

  5. “Do right by your patients and offer the services you’re well trained to provide.”

    I couldn’t agree more. The health care profession doesn’t need orthodontists who limit their scope to what they were trained to see in dental school interfering with the need of young, growing people to gain the ability to take every breath without effort through properly influenced growth and development of their airway.

    If your income and professional goals depend on creating excellent smiles and acceptable occlusion, then please be the best you can be at that, and “and offer great service at a price that patients perceive as valuable.”

    Through exposure to orthodontists, dentists, and physicians who recognize that orthodontists are the medical professionals best trained to influence skeletal growth and development and shape not only the foundation for the dental arch but the size of the airway, more and more doctors are realizing that there is an opportunity to achieve more for their patients than straight teeth. And that this opportunity is best taken during years of natural growth, to avoid invasive procedures later in life. If you’ve ever seen an adult in your practice who has to consider surgery to achieve a wider, longer arch or a better skeletal alignment of the maxilla or mandible, that is a person who could have benefited from early intervention with the right treatment plan.

    The right treatment plan by the right medical professional. Once attention is paid to how medicine is siloed, taking the position that ‘ENTs and other medical specialists who have trained their whole lives to manage airway issues’ must consider that these physicians have no training whatsoever in developing airway size during growth. Relegating all patients to our physician colleagues is going to limit their choices for treatment.

    Every professional is ethically bound to treat within their training and abilities. What is dawning for the orthodontic profession is the ability to influence health for lifetimes, far beyond traditional goals of straight teeth and acceptable occlusion. The research is there if one looks for it, although more is always needed – that’s true throughout medicine, so it’s not unique to this subject. Common sense and logic say a bigger airway is better than a smaller one, and influencing growth is better than intervening later in the operating room. Dentists, orthodontists, and physicians have known this for over 100 years – the literature is filled with exhortations to help kids grow bigger and wider arches to help them breathe.

    Paying attention to airway is not for every orthodontist, but it is a legitimate part of the orthodontic profession and I applaud the AAO for taking the step of concentrating an educational event on this topic. Those who want to hear, will hear, those who wish to see beyond the horizon will do so.

    1. That’s a rousing speech but it’s a little short on detail. Please post links to all the evidence you mention and please give specifics of what you do, when and how in terms of treatment so we can all learn from you.
      I do have to question your statement of “Common sense and logic say a bigger airway is better than a smaller one” since this is a silly, irresponsible thing to say for lots of reasons.
      I looked at your website and this is on the landing page:

      “Premier Sleep Associates is the only dental practice in Bellevue specializing in the treatment of Sleep Apnea and Snoring in the Adult and Child population.

      You will get access to the best treatments available in dental sleep medicine.”

      I didn’t realize that there is an accredited speciality in Sleep Apnea. Can you tell me more about that? Also what are the best treatments available in dental sleep medicine exactly and who says so? Also why only the best treatment in DENTAL sleep medicine? Do you do DISE studies on your patients before tinkering with their airways?
      Thanks in advance.

      PS here’s another article you might want to check out https://orthopundit.com/pediatric-airway-orthodontics-keep-rolling-the-dise/

      1. Those who are interested in learning can find the evidence and be able to judge for themselves what is known, what is suspected, and what is currently being investigated. There are many excellent avenues for increasing one’s practice scope through education, some short, some quite involved, but all require a professional commitment. Every educational message I’m familiar with emphasizes the multidisciplinary nature of airway therapy, which includes ‘dental sleep medicine.’ I’m sure there are courses that pitch a quick-fix, financially-focused approach, but I think our colleagues are smart enough to choose those that are grounded in good medical practice.

        You can, and no doubt will, carry on promoting your opinions – it’s your website. Your readers will choose for themselves whether they agree or disagree with you, with what I wrote, or with another writer’s position. We all filter what we’re interested in learning about. My only hope is that one or more orthodontists considers what impact they can have on health and discovers for themselves the important role they have the opportunity to choose.

        1. So, let me get this straight… you know better but you won’t answer simple direct questions, share any of your info/wisdom or knowledge or give any details of how things should be done?
          Nice! That’s about what I expected.
          Have a great week.

  6. Hello,

    I am a layperson, with a 9 year old son, recently diagnosed with severe sleep apnea and restless leg syndrome after an in-hospital sleep study.

    The pediatric pulmonologist we are using has referred us to both ENT and an airway-focused functional dentist that uses removable Anterior Growth Guidance Appliances on children with mixed dentition to increase airway and improve function.

    Both the ENT and pulmonologist (who are in separate states and don’t work together) say they have seen many of their own pediatric apnea cases improved by the use of this orthodontic technique.

    To note, I will also be taking my son to an ENT who does DISE.

    Would you suggest that we do not seek evaluation by the orthodontist until we have exhausted all other medical routes, or is your main feeling that these cases may be improved, but that the evidence doesn’t exist to support them at scale? Right now anecdotal and perhaps improved apnea index on sleep study?

    I’m desperate to find answers and a fix for my son, but don’t want to subject him to unsound treatments.

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