EP 97: Important News About Dental Sleep Medicine

It’s easy to take the simple things in life for granted, like breathing.

Breathing is so simple, that we don’t even think about it. Yet, if we don’t breathe well, we don’t sleep well, and we don’t live well because our health falls apart.

In this episode of the Double Your Production Podcast, we’re discussing new developments in dental sleep medicine that can be life-changing for you and your patients.

Listen now to discover:

  • How to open the adult airways permanently (without CPAP or RPEs)
  • Why treating sleep disorders in your practice is the next “Align-type” technology
  • What nearly 60 peer-reviewed papers reveal about new sleep disorder treatments
  • The overnight “ring” for diagnosing sleep disorders that any practitioner can offer
  • Why most dentists fail at offering to treat airways (and how to avoid it)
  • And much more …

Speaker 1: Welcome to the Double Your Production Podcast, with The Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you're going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.

John Meis: Hey, everybody. Welcome to this episode of the Double Your Production Podcast. I'm Dr. John Meis, and I'm here with Wendy Briggs. Hey, Wendy.

Wendy Briggs: Good morning.

John Meis: And also with us is Kirk Huntsman. Kirk is the co-founder and CEO of Vivos. Kirk, you wanted to let us know a little bit about what Vivos is, and then we'll dig into the meat of the matter.

Kirk Huntsman: Sure, sure. Thank you guys, and great to see you both again. I'm coming to you today from the Vivos Institute, right next to the Denver International Airport. The Vivos Institute is a large training facility, over 15,000 square feet of training capacity, state-of-the-art equipment, and the ability to create and broadcast content, and also the ability to bring the world here to Colorado, where we can talk to them about airway and the future of dentistry. We believe firmly that airway will play an essential and vital role in the future of dentistry, and we want the world to know about it. We have some incredible products that we offer to help dentists and their patients with their sleep apnea and other breathing conditions, so we're just excited to be here, excited to sort of take your questions and talk a little bit about what we do and where we're going.

John Meis: So there's been somewhat of a transition, I think, in the languaging here, right? People talked before a great deal about sleep apnea, and you're using the term airway, which I think is a more prescriptive term. Do you want to talk a little bit about that evolution of the nomenclature, so to say?

Kirk Huntsman: Yeah, I appreciate that. Well, one of the things that we learned, and we've known this for a while, but I think as we go iteratively throughout life, we sort of learn how to hone things down to their bare essence, and the essence of dental sleep medicine has essentially to do with breathing, and breathing pathology precedes sleep pathology, so breathing, and the ability to breathe, since we breathe through our nose, we're obligate nasal breathers, and the shape and size of the oral cavity has a lot to do with our ability to breathe through our nose, dentists are right there at the forefront of being able to assist patients breathe better, and by breathing better, sleep better.

So we talk about the airway as the overall conduit, the connecting organ. It's not really an organ per se, but it's a functional space in our bodies, but the connecting functional space between the nasal airway and the airway itself is just... It's right there at the back of the throat, and that's right there in the wheelhouse of dentists. So we think that airway more aptly describes the essential role of breathing in our sleep and just in our overall health and wellness.

John Meis: Yeah, fantastic. The thing that has interested me about one of the products that you have is that many of the sleep devices are really designed to treat the symptoms, right? Repositioning the mandible, trying to open the airway in that way. Yours works in a little different way. Do you want to talk a little bit about that?

Kirk Huntsman: Sure. Dentistry's contribution, which I don't think should be underestimated. The contribution of dentistry to this whole difficult condition known as obstructive sleep apnea, and a myriad of attendant sleep and breathing disorders that go along with it. You know, sleep apnea's only one of a multitude of breathing and sleep disorders, but when we think about dentistry's role and dentistry's contribution, it was discovered many years ago, probably three decades ago now, that dentists had the ability to open the airway by mechanically repositioning the lower jaw, in what would be a typical class three position.

So dentists have, over the course of time, developed a value proposition that has been effective and helpful for a lot of patients, because the gold standard for treating sleep apnea has been CPAP, especially here in the United States, and since CPAP is sort of universally disdained, nobody wants to wear that contraption, what happened is that dentistry came to the table and said to the medical colleagues, "Hey, look, we have this ability to open the airway that's not CPAP, and maybe there are people that are CPAP intolerant or averse to wearing a CPAP for lots of different reasons, who might thrive in a mandibular advancement appliance or splint," so mandibular advancement became the go-to technology for dentistry's contribution here.

The challenge, of course, is that neither mandibular advancement, splints, nor CPAP were ever designed or created to be lifelong treatment modalities. They were designed to be palliative. They were designed to be temporary. They were designed to be, "Hey, let us get you out of this situation and give you the chance to sleep better, breathe better, and live another day," but what we now know, that we didn't know 20 or 30 years ago, is that a lifelong use of CPAP or mandibular advancement is not necessarily good for the patient, and that the underlying condition of sleep apnea continues to worsen.

So everybody is scrambling around right now, looking for what is the next thing that can help, and where Vivos comes into play here, since we're not a mandibular advancement driven oral appliance technology, we actually have a role to play, because we reestablish the tissues that comprise the airway by moving the jaws forward and widening the palate, widening the mandible. We are actually repositioning the tissues that define the airway such that the airway becomes more open and patent, even without our appliance. So the big difference for us is patients go into treatment and come out, as opposed to either CPAP or mandibular advancement, the patient basically is told, "Look, here's the plan. You have to wear this every night for the rest of your life or be prepared to not wake up one morning," and that's really not very appealing, and it's not really ideal.

If we had other options, we wouldn't have people do that, but what Vivos offers, that's revolutionary and groundbreaking, is the ability to put patients into treatment and then, between... We have patients resolving now, with our new protocols, in as little as nine months. Between nine and 18 or 20 months, we're seeing patients with a big, open airway. They start out breathing through a drinking straw and they end up breathing through a garden hose, and their airway is bigger, it's bolder, it's less prone to collapse, and we see a complete, in many cases, resolution of the sleep apnea. That, to us, is how we define success, and it's why we're so excited about the potential and the future for this for the entire dental profession, and for their patients.

Wendy Briggs: You know what's interesting, Kirk, is when I first met you... We've known each other for a long time, but when you first reached out and said, "Okay, I've got something you need to look at," and you mentioned it had to do with sleep, both myself and Dr. John had recognized the struggle, right? We had a lot of dentists who were super passionate about sleep, but they could never really translate it into making sense or working economically for their practice. In fact, for many [inaudible 00:09:22] it took them backwards, right? Because they were passionate about it, but it was complicated. They had to get the medical profession involved. It took a long time. So sometimes, it would take, from the day of diagnosis and first conversation with a patient to actually getting them an appliance, it could be six to eight months down the road.

Kirk Huntsman: Oh, I know.

Wendy Briggs: And we had, we often call it bright, shiny object syndrome, right? We kind of felt like, "Oh, gosh. Sleep's just another bright, shiny object for dentists who really want something new and want to be energized and passionate about something." We certainly understand and appreciate that part of it, but translating it into a model that worked in a practice to actually generate revenue and make it easy for patients. You know, we talked about, a long time about in dentistry, we've got to do a better job of making it easier for patients to do business with us. What I love about Vivos, and all of the tools that you've put together... You know, you have more than just your appliances, which by the way, several people in my family are actually actively Vivos patients, and it's amazing the difference we're seeing. I'm seeing it personally. So the appliances are just one piece of it.

What I think is so amazing about Vivos, and what you're putting together under the Vivos umbrella, is that you've made it so much easier for dentists, that are already busy, that are already successful, to embrace and integrate sleep solutions, airway solutions into their practice in such a way that they actually can have an impact on the business side. And certainly, we love to see that, because Dr. John and I, our job is to help doctors grow their practice, grow their footprint, grow their enterprise, grow their legacy, and being able to introduce Vivos solutions, sleep solutions, airway solutions that actually can have an impact has been a game-changer for some of our clients, so I love that about Vivos. Maybe you can talk a little bit about some of those extra pieces that differentiate what Vivos is doing with traditional sleep companies.

Kirk Huntsman: Perfect. Thank you so much for that. It made me think about sort of the beginnings of this. I've been in dentistry for many years. I think I'm going on 40 years almost in dentistry, so I've been around to see the advent of... I remember when implants were just coming on. I remember when Invisalign was just coming on. I remember when there were things that were major sort of watershed-type technologies that came to market, that affected the entire industry, and I really, truly believe that what Vivos has here, with our sleep products and the whole delivery mechanism that we've created, it is the next Align Technology to come to technology. We are the next Align Technology. We are the next implant groups that are coming to... that have impacted just really the way that dentistry is practiced in a lot of respects. I mean, orthodontics has never been the same, and will never be the same, since the advent of the aligners, and when we think about this, the scope of this solution...

I think you know, Wendy, we also have a diagnostic tool, the sleep image rings that we have, that are so easy to use, state-of-the-art technology, FDA cleared and approved for children and adults. When we test patients in dental practices, we're seeing that 50%, really, it's right under 50% of patients, one out of two patients are testing positive for OSA. This condition of sleep and breathing challenges and disorders is so pervasive that every dental practice in America has several hundred at a minimum and probably several thousand patients waiting for the dentists to step up and say, "Hey, we have something here that can help you."

Now, the challenge has always been, so how does the dentist do that? How does the dentist integrate this? And having been in the dental business for as many years as I've been, and running as many dental practices as we have, I was one of the founders of the DSO space, and the DSO business overall, one of the largest DSO companies in the early days of the DSO evolution, I had that. And we tried to do sleep at that early stage, and we failed, and a lot of dentists on their own who try to do sleep fail, and it's because there are natural barriers to entry that have to be addressed. You can't just attempt or propose to do sleep without addressing these natural barriers to entry.

The first is, "How do I talk to my patients about this?" And our little ring technology that gets the patient to be aware, I mean, that's a huge thing, to just get them in dialogue. That's the first order of business, but after that, you have to have the interface with a physician, who's got to diagnose and actually make the diagnosis. That has to take place. We've got all of that now. We've leveraged technology in these cell phones, to be able to do that, telemedicine, teledentistry.

Wendy Briggs: Well Kirk, let's pause for one second, because I want our listeners to really understand what you're saying, so hygienists.

Kirk Huntsman: Oh, yeah.

Wendy Briggs: Hygienists often get excited about it. Hygienists, you have the potential to say, "Hey, I see some symptoms I'm concerned about. Let's give you a ring," right? It's a few minutes to set it up. The patient has the app on their phone. They take that home that night. They wear the ring while they sleep. Super easy, right?

Kirk Huntsman: Yep.

Wendy Briggs: The next morning, they bring the ring, and they drop it back off at the dental practice.

Kirk Huntsman: Absolutely.

Wendy Briggs: Then, that sleep test result is read by one of the Vivos physicians, right? So make sure they're very clear on that. They don't have to set any of that up, right?

Kirk Huntsman: No, we have it all set up for them. Actually, they're not Vivos sleep physicians per se, right? They're associated with us, but they're separate from us, so we don't have any conflicts of interest. These people are independent sleep physicians, many of them board certified as sleep physicians, but they can read the sleep tests, and this is a medical grade, clinically... You can diagnose off of this, and this is a single-sensor ring that delivers... What I say is it delivers a dialogue. It gets the patient to start talking about their sleep and breathing.

A lot of patients don't even know they have this problem, so once they hear from the hygienist that she's concerned, their general dentist that he or she is concerned, and then the sleep physician that says, "You know, this is a really dangerous, debilitating, potentially life-threatening condition that you have here, Mrs. Jones, and you need to get this addressed, and Dr. Smith over here, the dentist, your dentist, has a potentially good solution. You should talk to them more about that." As you said, sometimes it was months down the road before that patient would cycle through, just to that point.

And now we have the ability to say we can do that in less than a week, and get everybody up to speed, to where the patient understands their condition, the physician understands their condition, their dentist understands their condition, and now they've got the ability, with information, to make a good choice about what treatment modality do they want to do? If there's a certain condition that they might have, it might be a mandibular advancement splint is the right thing for them at that time, or if they want to really tackle the condition and get well, then Vivos may be a great solution.

So we are seeing... In fact, just last week, we were in touch with one of several major carriers in the United States. These are healthcare payers and commercial plans. Everybody would recognize the name if I gave it out, but this is a national, lots of patients, millions and millions of patients are subscribed to this particular payer, and they're sitting there going, "We need a solution, a real solution for these patients, because we recognize how much we can actually save, and the patients will benefit by actually having a real solution as opposed to something palliative."

So what we've done at Vivos is try to make all of this process so simple that it puts... In this ecosystem of treating sleep and breathing disorders, it takes the ecosystem and places the dental office right in the center of it, which is where the dentists should be. And we facilitate the critical relationships, whether it's with the local sleep doctor or some remote sleep doctor over the phone, or whether it's with a local chiropractor that has something to say about it, or the myofunctional therapists. We bring all of those tools together, so the dentist just can focus in on what they do best, which is treating their patients.

John Meis: Yeah. You've made it really simple for patients, you've made it really simple for practitioners, and you've made it very, very fast, so this is something that can move the needle in a practice, and not everybody is... Just being aware of sleep apnea, helping your patients become aware of it is such a great service, because as you said, it's a life-threatening condition for some people, so it's fantastic progress. So what's the science behind this? When you talk about palatal expansion, and I know that some of our listeners are going to be saying, "What the heck? That doesn't work. All the..." You know, blah blah blah blah blah blah blah, so tell us a little bit about what the background, the meat behind it.

Kirk Huntsman: Well, look, we experience that every day. The way that dentists have been taught for the last generation of dentists that have come out of school has been that palatal expansion in adults... You can do that just fine in children, but palatal expansion in adults is really not something that is stable, it's not something that's really effective. It's something to be wary of. It's fraught with all kinds of peril. We are not doing traditional palatal expansion with RPEs, right? Rapid palatal expanders. Rapid palatal expanders are indicated and typically used on children. Children's mouths are more malleable, they heal faster, they do all these kinds of things, and rapid palatal expansion is a technique that really provides transverse linear expansion.

The actual thing that we've seen, we call it pneumatization of the maxillary arch or the maxilla. We're actually seeing an actual three-dimensional expansion, so we're not dealing in linear expansion in a transverse plane. We're actually dealing with really three-dimensional expansion that provides growth and development along different axes, including the AP axis and including the ability to improve the airway by virtue of some of this growth and development. So when we get the mouth oriented and developed to its fullest potential, our modern mouths don't hold all 32 teeth that we're given, you know? We're born with the potential for 32 teeth in the mouth, and our modern evolutionary, whatever it is, mouths only house... And that's what Dr. Ben Miraglia has done as good a job as anybody in the country, at bringing attention to the idea that in our modern society, we just don't develop the way our ancestors did.

Our ancestors had 32 teeth that fully erupted, nice, big, broad dental arches, and really no real incidence of malocclusion, and in some sort of native, indigenous societies, you still see that. They have extended and protracted times of breastfeeding. They have hard food diets, where mastication is important. In our Western culture, modern society, we don't do a lot of those things, that promote the natural, full development of our jaws, and frankly, what our appliances and protocols do is actually help the patients redevelop their jaws.

We actually have data, based on some studies that we've just come through with, and are waiting publication, but these studies show that we've actually been able to take and develop the jaw sufficiently to erupt third molars. Who's ever done that? I mean, nobody's ever, in the history of the world, that we know of, has been able to develop the dental arches and the jaws with sufficient space to allow those third molars to just drop right in or pop right up, and be there where they were supposed to be. When you do that, you get a very stable airway.

Well, we're getting AP development, we're getting transverse development, we're getting this pneumatization of the maxillary arch, and all of a sudden, we've got these big, open airways, with nice, wide, broad smiles and room for all 32 teeth. That's what we're able to do with our technology and protocols, and that's why I think, and I say, this is the next Align Technology. This is the next big thing in dentistry, and what we've done, to Wendy's point, is we've tried to take all of the barriers to entry here that have traditionally kept dentists from really embracing this fully, and we've tried to say, "Okay, we've got this handled. We've got this resource. We've got that all handled. You don't have to go and do all of these things," and now where we're at is we are now making this technology available for doctors to take advantage of at even better pricing, a more cost-effective way.

So there's a lot of things we're doing to make this more ubiquitous, because we have a few thousand dentists. We need to have tens of thousands of dentists doing this. The demand is out there. The need is out there. We just want to help as many dentists as possible take advantage.

Wendy Briggs: And Dr. John, I know you asked about the science, and that's one of the reasons we have Dr. Miraglia coming to speak for our Champions of Dentistry Summit coming up here in just a few weeks, so most of the people that listen to this, many of them will listen to this after our Champions of Dentistry Summit, but one of the reasons that we have such a great relationship with Vivos, we speak for them at some of their airway summits and they come and speak for us, because for all of the things that we've talked about, right? But I think what's awesome is for those dentists who really, really want to learn the science side, that's why you built the institute, right Kirk?

Kirk Huntsman: Right. Right.

Wendy Briggs: Because dentists can go for two or three days, and get all the science, right? I think that's really an awesome [crosstalk 00:24:57]

Kirk Huntsman: You know, I'll tell you something that's really, I think, the most telling thing. Two or three years ago, Dr. Singh and I, Dr. Dave Singh, who created some of the core technology that we have. We made a trek out to Stanford University's sleep research center in Palo Alto. We sat down with the leading lights in this entire... in the world, Dr. Christian Guilleminault, Dr. Clete Kushida. When they saw what we had brought to them, they were so impressed by it that Dr. Clete Kushida now chairs our medical advisory board and our clinical advisory board, which has dentists on it, so we have... And we're actually doing a clinical... a randomized control trial at Stanford, that will hopefully further the science along a little bit.

We have almost 60 studies and papers that have been published in the peer-reviewed literature, so we're not without a scientific foundation here, but to see the guys at Stanford, world-renowned scientists in sleep medicine, embrace our technology and embrace this to such a degree that they said, "Hey, we want to get involved. How could we at Stanford be the guys that bring this to light? Because we want that for Stanford University," to me, that made a big splash, and we've become very close to the folks at Stanford. Dr. Singh received an appointment as an adjunct professor out there after that, and we just see the science coming about. Right now, we have 1,500 doctors in North America, others scattered around the world, that basically are doing this every day in their practices, and seeing huge results. Wendy, you've seen it in your family. I've-

Wendy Briggs: I have.

Kirk Huntsman: ... seen it in my family. I've experienced it. You've experienced it. This stuff really works. I don't need a randomized control trial to tell me that this really works. We've got lots and lots of data and lots and lots of studies that show that, but more and more things are coming to light. Just stay tuned and there'll be more and more as we go, and it's just going to just continue... The snowball's going to continue to roll downhill.

Wendy Briggs: Yeah, we love that, and one of the things, just for our listeners to know as well, we have a great relationship with Vivos, so any doctors who want to learn more, that come from the Team Training Institute, we actually can provide you with a golden ticket, right? You can attend the CE. Everything is covered for you, so it's red carpet treatment. All you have to do is get yourself to the institute in Denver, so we'll be posting the link for that offer, so you can check out dates and locations. You don't have them all in Denver. You do offer some in other areas of the country. I know that as well, so for anybody who's listening who thinks, "Hey, you know what? This might be the next thing for me and my practice. I want the information," we'll post that link so that you can get that information about how you can attend with a golden ticket as a guest of TTI and Vivos.

Kirk Huntsman: Well, we love having TTI doctors here. They tend to be some of the better Vivos practitioners, and we've got a number of really, really successful Vivos doctors out there, and a lot of them have come through the Team Training Institute, so we really appreciate our relationship with you guys. We're huge fans of yours, and as I... I've known both of you now for probably the better part of a decade or more, so we're just really excited to be able to collaborate on these sorts of things, so...

John Meis: Awesome. Well Kirk, thanks so much for being on our podcast today. We appreciate the great work you're doing. We'll see you at the summit, and-

Kirk Huntsman: All right, John.

John Meis: ... in the show notes, we'll have information on how to learn more about Vivos, how to learn more about the summit, and how to learn more about TTI, so we really appreciate you being with us today, Kirk.

Kirk Huntsman: Thank you very much.

Wendy Briggs: Thanks Kirk.

John Meis: Bye.

Kirk Huntsman: See you. Bye.

Wendy Briggs: Take care, buddy.

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