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SWAMPSCOTT — A local dentist, who has grown tired of his patients not knowing the dangers that surround undiagnosed sleep apnea, is putting his money where his mouth is.
Ronald Plotka, of North Shore Dentist, has been practicing in Swampscott for 48 years. In December of 2015, his office bought a Sirona Orthophos SL cone beam scan, or cone beam computed tomography (CBCT) as it’s called in the medical field, which is estimated at $130,000. It has already helped him screen hundreds of patients for sleep apnea, a condition in which a person repeatedly stops breathing during sleep because of an obstructed airway.
“Dentists see patients two to three times a year looking down their throat, so who better to screen them for sleep apnea,” said Plotka, who will finish up his residency with Tufts Medical Sleep Medicine Center in April.
Plotka gained an interest in sleep-related disorders after an incident that occured after attending a Super Bowl weekend getaway with a group of his friends.
“We were all sleeping in the same room and in the middle of the night I heard one of my better friends stop breathing, so I told him he had a problem and when he got back home he better go to the doctor,” said Plotka. “Well, he never did and he died a couple years later.”
Soon after, the local dentist started looking into it and found out that sleep apnea didn’t become a specialty until 1996, so medical students who graduated before then may have received little education regarding sleep. According to Plotka, there are 90 million people with genetically caused sleep-related disorders.
“Ten percent of people are diagnosed, one out of four men have it, and about one out of 10 women have it,” he said.
The CBCT allows Plotka and his sleep coordinators, Louise Love and Katerina Rogers, a three-dimensional view of a patient’s airway. In order to get a proper screening, a patient must stand facing the machine, grab the bars in front in a criss-cross form, and stand still for 11 seconds.
“So we scan someone who doesn’t think they have any kind of airway obstruction, look in their mouth and all of a sudden we do this 3D scan and immediately it goes from green to red, with the red indicating a very small airway,” said Love.
Once a patient is screened for sleep apnea and they show severe signs of an obstructed airway, they are advised to speak to their physician. The next step is to take part in one of multiple sleep tests, such as a polysomnogram (PSG), an overnight observation, or an at-home sleep test which is known to only be 85 percent effective according to Plotka.
“We, the dentists, just screen the patients,” said Plotka. “The physician is the quarterback in getting the patient’s symptoms alleviated.”
One of the most common devices used to help sleep apnea patients is a CPAP machine, which is a mask worn while sleeping that forces air into their lungs. But most patients deem it to be very uncomfortable, according to Love. Other than helping to screen patients, dentists also offer MAD (mandibular advance device) appliances which tend to be more comfortable.
“We started to become a licensed DME (dental medical equipment), dentist last April,” said Love. “When you put patients in these appliances, they’re actual medical devices which brings a whole different entity to the office, so you have to be licensed for medical insurance and things like that to get the patient’s proper reimbursement.”
There are more than 100 MAD appliances, such as a Thornton Adjustable Positioner (TAP) appliance or an Elastic Mandibular Advancement (EMA) appliance, and their purpose is to pull the jaw forward which forces the airway to open in a natural way. Plotka takes each patient’s dental impressions to ensure the appliance fits comfortably on their top and bottom teeth, like a retainer.
If sleep apnea in a patient continues to go undiagnosed, strokes, high-blood pressure, cardiac arrhythmias, ADHD in children, and morning headaches can occur. Plotka and his sleep coordinators also teach their patients sleep hygiene, such as never sleeping on your back or your stomach because gravity pushes against your throat, closing off the airway.
“This is just the tip of the iceberg for the future of sleep apnea because there are so many of our patients that have these sleep-related and breathing disorders, like snoring is not normal because it means you are not getting enough air,” said Plotka. “We want people to know that sleep apnea is dangerous and life threatening, so they should be diagnosed and if they have a problem they need to address it, especially with children, because the longer you wait, the worse it becomes.”