Dr. Jerry Hu, DDS, DABDSM, DACSDD
My journey into dental sleep medicine began with my own untreated Obstructive Sleep Apnea (OSA).
Prior to that, I had attained many accreditations, awards, and published journals in cosmetic and implant dentistry. I was thriving in my practice, changing lives and smiles one patient at a time. Something was missing, however! At that time, I was over one hundred pounds heavier than I am now, and my overall health was on a spiral down to death. My hypertension became uncontrolled with the need of adding multiple prescription meds; I snored, had acid reflux, fragmented sleep…the list goes on and on. Even worse, I created the classic bedroom horrors by being a “freight train” at night, causing my wife to also have fragmented sleep. Being tired and sleepy day to day, my health and OSA started to rob me of my joy in “changing lives” at work, and I knew at that point, something had to change. I first tried a CPAP, but my compliance was nothing but shameful. As an Alaskan, I also enjoy the outdoors, and for me, CPAP and camping just don’t mix. It didn’t take very long for me to try my own oral appliance therapy (OAT).
Thanks to being compliant with my oral appliance for several years, I attained a black belt in Karate, dropped several pant sizes, and went from being able to never do any chin ups to doing over 10 at each rep cycle during my workouts. How is that related to my oral appliance therapy? First, I cite evidence-based literature on three key factors for health in life, which most experts would agree on: Sleep, Exercise, and Nutrition. They are naturally intertwined, and success does not come without respecting all three. I was over 40 years old when I earned my black belt, and during my journey in Karate, I knew beyond 100% certainty that it all started with my sleep. Not only were my “appetite” hormones (leptin/ghrelin) affected for my diet/nutrition/weight loss, but my energy, stamina, and alertness were all notably changed as well. When my sensei tied my black belt around my waist, I literally started to cry (actually it was so emotional, I was gasping for air while crying)! At that point, I realized how important dental sleep medicine is!! I knew that my calling in life is not just “changing lives,” but saving them! I still do cosmetic and implant dentistry, but my deepest passion in dentistry is sleep medicine.
Without a doubt the most important finding I’ve attained with all of the equipment and credentials is that the airway trumps everything!
Without a doubt the most important finding I’ve attained with all of the equipment and credentials is that the airway trumps everything! It is my humble opinion that Airway Centric Dentistry should be the number one goal in ALL dental practices! When I look at my own airway on multiple CT scans and multiple Pharyngometer readings, just for curiosity, I can visually see the difference from pre-to post-oral appliance therapy and weight loss. It was a huge difference, not just in the circumference (axial slice) of my airway at the smallest point, but also on the pharyngometer, my modified Mueller’s Collapse is now the same as normal breathing. My airway no longer collapses! This shows me that healing of inflamed pharyngeal tissues, nitric oxide with nasal breathing, and oral appliance therapy do help tackle comorbidities connected to inflammation, endothelial dysfunction, and overall cardiovascular health. I also had seen morphologic changes in my condyles from being all the time in a retrognathic/retruded position to being, at least at night, to a more downward and forward position. Seeing that gave me an “Aha moment”.
All the smile makeovers, implant dentistry, fixed dentures (all on 4, 5, or 6 etc) and all restorative work must be connected to airway. I cannot agree more with the recent ADA Oct 2017 Scope of Practice Recommendation that states that ALL dentists should screen for OSA and that dentists are the only ones who are qualified to make an oral appliance for OSA. Tooth loss, severe parafunctional forces, and damages that come from sleep bruxism and airway issues will definitely affect my smile makeovers, implants, and restorative work. Thus, when I teach for Sleep Group Solutions, I preach that the airway trumps everything. All the effort, artistry, planning, wax ups, TMJ/TMD considerations, orthotics, neuromuscular rehab cases, all of them, must respect airway! I teach that if the body displays and/or results in red flags from tooth loss to acid erosion, and there is inflammation, anatomical problems (narrow arches, etc), they are not just going to magically go away with a smile makeover or implant. Moreover, placing a flat plane splint, as a recent Prosthodontic journal/publication shows, might even worsen the airway! Using the “tools” in my “tool box”, I am utterly convinced from my own personal experience in oral appliance therapy and dental sleep medicine to seeing living saving moments in all of my dental sleep medicine patients, that airway centric dentistry should be the number one priority in all dental practices.
I cannot agree more with the recent ADA Oct 2017 Scope of Practice Recommendation that states that all dentists should screen for OSA.
As I was led information and real data that I can analyze and collect, I learned that precision dentistry/ precision medicine is of most importance. I found that there really is a “sweet spot” position, that for me is a true therapeutic position for the patient. This position would be sensitive to the TMJs, muscles, and physiology of each unique individual I treat. For children, I also treat airway problems using craniofacial epigenetic and pneumopedic concepts, and because I also have the equipment to do so, as I concentrically expand their arches, I use my pharyngometer and neuromuscular equipment to see their progress. The board-certified Sleep Physicians I work with are also impressed about how everything is connected and affirm that our body has its own unique physiology and position. When that is respected, then there are far fewer side effects and potential doubts from naysayers to use when considering OAT for OSA. With the advancements in digital dentistry and digital workflow from design to final fabrication, dentists can be assured that if they capture a “sweet spot” or “therapeutic position” that respects the individual’s physiology, etc. that it is now possible to precisely transfer that position to the appliance’s start position! I worked with and even published research with controlled cured PMMA material, precise engineering, milling, and digital workflow with the makers of MicrO2 and Prosomnus. These case studies and feasibility studies showed that through smart engineering and materials used to respect precision, we can help minimize tooth movements and other potential side effects that can hurt compliance and overall long-term success of OAT. Furthermore, with the digital platform, we can measure the accuracy and back it up with the “tools’ in my “tool box”, such as the pharyngometer, on airway collapse. When I think about digital dentistry, I often am reminded on the statistics of traditional PVS impressions accuracy versus digitally scanned impressions. What a difference!
In Alaska, we have many shift workers who come in to see me. We all hear in the news from train derailment to FAA pilots landing in the wrong airport, disasters caused by possible untreated OSA connection. It is estimated that there are over 1 billion people worldwide with untreated OSA. It’s a pandemic, and I see people working with heavy machinery in the oil fields, (platforms, North Slope) to Alaska State Troopers and Wildlife workers— all shift workers, and their OSA affects not just the people and animals, but the environment and future of this great state. When I was lecturing in Austin, Texas years back, I showed the results showed several lifesaving and life changing dental sleep medicine cases I had the privilege of doing on Alaskan shift workers. The audience was amazed at the life changing metamorphosis of these patients after seeing the dramatic “before and after” photos I provided. The weight loss, smiles, and renewed energy, seen on the photos of the patients, make it all worthwhile.
Written by Dr. Jerry Hu, DDS, DABDSM, DACSDD
Dr. Jerry Hu, DDS, DABDSM, DACSDD
Dr. Hu is a Diplomate with The American Board of Dental Sleep Medicine, The American Sleep and Breathing Academy, and The Academy of Clinical Sleep Disorders Disciplines. Dr. Jerry Hu describes how his experience with dental sleep medicine has changed his approach to dentistry.
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