Episode #230: Dr. Mark Murphy – Success with Dental Sleep Medicine

Dr. Eric Block: Welcome to the Stress-Free Dentist Podcast. I’m your host, Dr. Eric Block. As always, I want to inspire, entertain, and educate you on the best tools and technologies out there. My goal is to help make your practice and career more profitable, efficient, and most importantly, more enjoyable.

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Hey everyone, welcome back to another episode. And today I am joined by Dr. Mark Murphy, and he is the Chief Learning Officer, uh, an Executive Director of the International Academy of Sleep. Uh, Mark, thanks so much for joining us.

Dr. Mark Murphy: Eric, thanks so much for having me. It’s always fun to get together and talk about these kinds of things with folks, so I—I really enjoy the opportunity. Thanks so much for that.

Dr. Eric Block: Yeah, you have quite the resume. Uh, you’re a part of the Pankey Institute.

Dr. Mark Murphy: See, this, that’s what happens when you have hair this color. You get a long resume. Yeah, always impressive.

Dr. Eric Block: Yeah, that’s great. Well, a lot of people don’t do, uh, as much as you have done. And I want to get all the way up to, uh, about the IAOS, but let’s first just jump back. Um, how did you first even—even—decide to become a dentist?

Dr. Mark Murphy: Yeah, so, um, I was probably enamored with the idea of Wednesdays off and playing a lot of golf. And so, I mean, I wish I could tell you that there’s some really deep, meaningful reason I wanted to save lives or work with kids or something like that. But I thought it’d be a great way to make a living. Thought it seemed like it would be interesting work.

I had a dentist who took me down to a careers day at Detroit Mercy School of Dentistry, where I was—I grew up in the city of Detroit. And so that got me, uh, interested in that. Prior to that, I—I think I wanted to be an electrical engineer or a lawyer, so I was really kind of bouncing around and had never been to see what an electrical engineer or a lawyer actually did. They just sounded like interesting jobs. And when I saw what a dentist did, I thought, I could do that. That’d be fun. So there you go.

Dr. Eric Block: And where’d you go to dental school?

Dr. Mark Murphy: Detroit Mercy. I went there for undergraduate and for dental school. It was, uh, quite a fun experience. Um, really liked that I was able to live at home until I got married between my first and second year of dental school to my high school sweetheart, who I’d been dating for five years. And so we’ve been married 47 years this year. So it’s kind of cool. 52 years together. It’s a lot. It’s a fun run. Really fun run.

Dr. Eric Block: Now after dental school, did you go on and do an GPR or a residency? Did you specialize? What was your journey there?

Dr. Mark Murphy: No. Did you not hear the part about I was married? So that means we gotta start making money and having babies and stuff like that.

So I had talked my wife into going into hygiene. She’d have killed me if I’d have stayed in a specialty. I had done very well in dental school. I was fortunate. I taught, um, some of the courses while I was in dental school. I taught microbiology as a freshman. I taught anatomy as a sophomore, junior, and as a senior I worked with John Mullin in the clinical lab. While I was there, I was a microbiologist in undergrad.

So I—I had a really fun time going through dental school, but I could not continue to stay in school at all. So I went right out and, uh, started in an associateship for a few months, opened my own practice, was off and running. A little frustrated in dentistry in ’85. A lot of the people that I saw that were very successful in dentistry had this thing called the Pankey Institute that they’d been to. And so I said, Well, if that’s been good for them, it would probably be good for me. And off I went, and that changed the rest of my life.

Dr. Eric Block: Now, can you explain exactly what the Pankey Institute is? Did you go initially as a student, and then did you go back and teach there?

Dr. Mark Murphy: I did. So in ’85, I went down there for the first time to learn how to become a better dentist. I would argue that they’re a non-profit educational institute. They taught me to be a better person, um, a better communicator, a better philosopher, a better husband, um, a better human being, if you will, as well as, uh, chasing dots and occlusion and getting all that kind of stuff right and becoming a temporomandibular dysfunction-focused practice.

So it was, um, it was really good to go down there in ’85. And by ’91, I’d gone through the program, and they asked if I’d come back and teach, which I couldn’t imagine—they actually asked you that question—’cause I couldn’t imagine somebody saying no. But, uh, I went back down there to teach.

Actually had the choice. Uh, I got accepted under the board of directors, so I served out as a board of director for the Pankey Institute two different times.

Dr. Mark Murphy: And I spent about a year and a half as a full-time employee of the institute back in, uh, 2004, 2005. Middle of 2004, I went down there and spent a year and a half, um, helping sort of turn the institute around. It was having some challenges from an enrollment standpoint—never from a content standpoint. Did that, and then, uh, went back out and did a lot of consulting and teaching and lecturing, and started to drift away from traditional clinical dentistry and do a lot more, um, teaching, education, consulting, and then ultimately, uh, restarting a sleep practice.

I had done sleep, uh, teaching with Keith Thornton, who was one of the original fathers or pioneers of dental sleep medicine. Uh, I taught with him down at the Pankey Institute in the TMD course, and he taught me a little bit about sleep. So I had done that before. So, um, later on in my career, I had a chance to go back to that. So since about 2012, um, that’s really been my focus.

Dr. Eric Block: And so up to about 2012, would you say, were you just doing, uh, traditional general dentistry and, uh, then you made a pivot towards, um, sleep and airway?

Dr. Mark Murphy: Yeah, so I did. I had an occlusal rehab practice, if you will. Uh, practiced one day a week, uh, from about 2000 to 2005–2007. And then, uh, the education side started to take over. So probably from about 2007, 2008, um, I was maybe working a day or a day and a half a month in that practice that I had sold.

In 2012, I got diagnosed with, um, obstructive sleep apnea and started to get back into sleep. And that’s when, uh, I was doing some lecturing and teaching for a company called MicroDental Laboratories. And they wanted to develop an oral appliance, which later became the company called ProSomnus.

And so I was with them from the time that they were a device inside MicroDental Laboratories until I left them, uh, a year ago—April 1st. So just a little over a year ago I was with them. And I practiced, uh, sleep medicine all that time, um, between a half day and a day a week. You know, we’d see three or four or five patients. Uh, we’d do three or four or five devices a week over the past, uh, several years working a half day a week.

Dr. Eric Block: Was that your, kind of, your eureka moment to start focusing more specifically on dental sleep medicine? Was the fact that you were diagnosed?

Dr. Mark Murphy: You know, um, I—I guess I want to say yes, but that would be an incomplete statement. So, that I was diagnosed, uh, certainly gave me a—a focused concentration and interest back into dental sleep medicine. But if MicroDental wasn’t choosing in 2013 to develop their own sleep device, which later became the MicrO2 and the ProSomnus company when they spun out, I’m not sure that I would’ve done that.

So I guess it’s those two things coming together that, um, nudged me in that direction. You know, maybe two vector forces coming together. And the resultant vector was me going into sleep. And so I quickly became a—a lecturer, educator in dental sleep medicine ’cause I’d had such a strong background and then did a lot of research.

And I’ve worked with people like Aaron Mosca and John Remmers, um, and others. So it’s been a really fun last, uh, what—maybe 13 years—being back into sleep and being kind of on the leading edge of some of that. Um, you know, I’m double-boarded in terms of being a diplomat of the, uh, International Academy of Sleep and also a diplomat of the American Board of Dental Sleep Medicine. So I’ve got way too many—way too many credentials and degrees and letters after my name now.

Dr. Eric Block: Yeah. Personally, my journey with sleep apnea started with myself. I was my own first patient. I took a sleep study and I knew something wasn’t right. I was snoring more, and my wife told me I was gasping for air, and I didn’t feel refreshed.

Uh, so I got—sleep study. And, um, I wear a device and, um, you know, things are much better. But that was my—my introduction into, uh, getting started in my practice.

Um, for dentists unfamiliar with dental sleep medicine, you know, why is it such a critical—and would you say—growing field to get into?

Dr. Mark Murphy: Yeah, so it’s—it’s critical for all the reasons that, um, I can tell you academically. It’s critical from a clinical standpoint because, um, airway trumps everything. You know, even though the eight essential nutrients that we talk about—fats, lipids, minerals, salts, water, all that kind of stuff—like, that seems so very important that we learn in physiology, oxygen is not on that list. And you can’t go three minutes without oxygen. It’s just so plentiful that we take it for granted.

And yet, the reduction in—in oxygenation and flow while you’re sleeping, because your tidal volume is so low, allows you to do something you could not do to yourself during the day. You couldn’t hold your breath long enough to desaturate three or four percent. But that happens routinely for people at night. And when that happens, it wakes them up. And when it wakes them up, it doesn’t wake them up by tapping them nicely on the shoulder, as you know—it wakes them up by giving them a shot of adrenaline and norepinephrine.

Dr. Mark Murphy: It—it’s a sympathetic storm. And so all night long, instead of getting restful sleep and recovery, it jacks with their sleep with this balance that becomes out of control between the sympathetic and the parasympathetic nervous system. And so that causes no disease of its own, but it makes a long list of other things—whether it’s, uh, myocardial infarction or stroke, diabetes—this long list of comorbidities—much worse because that patient is not resting well.

Forget the fact that they’re tired or they’re irritable or they make poor decisions, et cetera. It’s this comorbidity, uh, acceleration that really causes the increased death rate in the population of patients that have sleep apnea. So it’s critical that we treat the airway first.

And—and back in 2017, the ADA said we should be screening for obstructive sleep apnea, sleep-related breathing sorts. Back in 2017, the American College of Prosthodontists said we should be checking people’s airway whenever we’re gonna make them a bite splint for clenching and grinding.

Dr. Mark Murphy: Why? Why did they say that? Because the moment I put a piece of plastic between their teeth and I open their VOD, I’m rotating the mandible. And as I do that, I close off the airway. So making a bite splint for clenching and grinding, which I was doing routinely, was actually making people’s airway worse.

So those people should have a protruded position bite splint made for them—which we used to just beat the crap out of when we would talk about ’em at the Pankey Institute. So that’s the clinical side.

Why is it so popular? Well, my gosh, the average dental practice—not according to me, the ADA—um, produces about $800,000 working 1,750 hours. That’s the ADA’s math. Um, that’s about $450 an hour. And about a third of that is hygiene. And so about two-thirds of that is dentistry. So that’s a little over 300 bucks an hour production that’s going to be collected in a dental practice on average.

Dr. Mark Murphy: Yours is better. All my friends are better. But that’s the average.

If you’re doing dental sleep medicine, instead of somebody being happy with their smile, they get back in bed with their spouse. They get more rest. They feel better. They think you walk on water because you’ve helped them—you know this ’cause you’ve done this. It’s an incredible rush for you and your team.

And by the way, it pays about 5-6x more per hour what you can produce as a dentist. So wait a minute:

Um, my patients love me for doing it? Yeah.

I love myself, and my team loves me for doing it? Yeah.

And oh, by the way, I get paid a multiple per hour from what I could do as a dentist.

So that’s why it’s become so popular. But ask me why more people aren’t actually doing sleep in their practice then.

Dr. Eric Block: Yeah. Uh, why is that? Because I know it’s—I—I feel like before, you know, I’d gotten started, you know, of course I didn’t learn anything about it during dental school. Uh, I was actually intimidated by it and, uh, would just refer cases out. But then I did a deep dive into it and—and, um, learned that it’s, you know, it’s not something to be intimidated by.

Dr. Mark Murphy: Yeah.

Dr. Eric Block: In fact, once you understand it, it’s very straightforward, and it’s—it’s not backbreaking work. It’s not like doing a—a crown on number…

Dr. Mark Murphy: Still lower stress.

Dr. Eric Block: Yeah. Um, but tell me your reasons why, um, you know—or some misconceptions of why dentists don’t get involved.

Dr. Mark Murphy: Yeah.

Dr. Mark Murphy: So Eric, I could not agree with you more. And—and I think you’re talking predominantly about the clinical side of dental sleep medicine. It’s very easy. If you can make a bite splint, that is way harder than taking a bite and making an upper/lower device that somebody’s gonna wear to hold their mandible forward. It doesn’t require anywhere near the precision. It’s very easy to do.

Many of those steps are delegatable to other team members because it’s a medical procedure that a dentist delivers for a medical problem. Um, but we’ve got the data that’s very interesting—some of it from the ADA and some of it from insurance bureaus in terms of their billings.

There’s a couple hundred thousand dentists in the country—give me that. About 100,000 of them have ever taken a sleep course. That’s good. That means the knowledge is rising.

Dr. Mark Murphy: I started a sleep program at Detroit Mercy School of Dentistry a few years back. So students are starting to get a little bit of that. But 100,000 of the 200,000 dentists have ever taken a sleep course—that’s great. But we know that only about 7,500—maybe, maybe 8,000—we don’t know the exact number, but certainly not more than 8,000 have ever made a device for someone other than themselves—have ever made a device for a patient. Well, that’s not very good.

And then we say, Well, wait a minute, let me tell you one more factoid: Of that 7,500 dentists who’ve made a device for another patient, only about 1,200 or 1,400—maybe as many as 1,500, but not 2,000—have ever successfully billed medical insurance.

And this is a medical procedure covered by medical insurance routinely and compensated very well.

And so then if you look around—with my history with ProSomnus and what I do with the International Academy of Sleep—and we look around and say, Well, how many dentists are doing 15 or 20 or more devices per month—really doing sleep in their practice?

Dr. Mark Murphy: And the answer there is two or three hundred. Maybe 350, but not 400.

And so—wait a minute—there’s 100,000 dentists that have taken a course, and it’s not hard to do. Oh. But you could hear from that story—it’s hard to get paid by medical insurance.

And that’s why, you know, whether it’s the International Academy of Sleep or the American Academy of Dental Sleep Medicine, there are lots of great places to learn the clinical aspects of dental sleep medicine.

But unless you have a software—and warning, warning, big warning lights coming out, I’m about to say some sort of commercially overt things—unless you have a software like our Restful software that makes sure you check all the boxes, that you get everything lined up correctly so that you can get paid by medical insurance…

And unless you have a billing partner, like our concierge billing from Restful, that really has access to all of these portals for all the insurance companies, it becomes very, very difficult to get traction and start to do the kind of numbers that you know are available.

Dr. Mark Murphy: Because the average practice has a couple thousand patients. That means 500 of ’em have sleep apnea. 480 of those—80%—have never been diagnosed or treated. And yet, when they start screening those patients—if they are screening those patients—very few of them move forward because they haven’t untangled the medical communication and the software that you need.

And they haven’t untangled the medical reimbursement model. And so they end up doing them for cash only, and they end up doing one or two devices a month.

Now, there’s nothing wrong with that if that’s what you said—that’s your goal and objective. But usually when you talk to those practices, they say, I gave up on sleep, or I quit trying to do this ’cause I couldn’t get paid by medical insurance.

And it’s because they didn’t have the right kind of software or the right kind of billing partner to really make sure that they—they had that kind of continuity of—of, uh, perpetuation.

Dr. Eric Block: Can you actually explain more about the IAOS? Um, what’s involved? Is it a membership? Do you have, um, uh, is it live? Is it online?

Dr. Mark Murphy: Sure.

Dr. Mark Murphy: Yeah. So the IAOS and Restful—think of them as one entity, if you will. The International Academy of Sleep is sort of our educational arm, and that’s kind of what I oversee. And then the Restful Academy is actually the software and the billing concierge service that we have.

But together, what we have is a subscription service to software—just like lots of other companies do. But in this particular subscription model, you’re actually subscribing to a software and a billing solution that, within the first 12 weeks of subscription, you’re actually gonna have successfully paid claims.

Because we can get access to the portals from all of the insurance companies and get a confirmation of benefits immediately—sometimes while the patient’s sitting in the chair. And we actually get paid in an average of about 14 and a half days, instead of several months. Sometimes we see customers come to us—clients come to us—who have claims that are outstanding for 12 and 18 months because they couldn’t get paid.

Dr. Mark Murphy: And it’s the littlest thing, Eric. It’s stupid shit—excuse me. It’s stupid shit. Like they didn’t dot an “i” or cross a “t,” or the zip code didn’t have that dash and the other four numbers, and that’s not how it was in the system.

And so the careful thing that we do with our system when we’re creating this onboarding or electronic verification process for our customers is, our members not only are getting the education over on this side, but we’re making sure that all of the information they have lines up with—and we test that thoroughly with—each of the payers specific to their area and their insurances so they can get paid.

And you know, there’s this thing called the Clean Claim Act, that if an insurance claim is filled out perfectly, a medical insurance company has to pay that claim within 30 days.

Dr. Mark Murphy: That’s law in all 50 states. And yet, if you talk to dental sleep medicine providers who’ve become frustrated with their payment systems, it’s because they’re not getting paid in 30 days. And guess what? Ours are.

And it’s because we stop, drop, and roll. We put out all the fires, and we make sure everything’s lined up correctly. Does that take a little bit of time? Yeah. It can be a little frustrating to wait when you get started, but the result is—it’s like the tortoise and the hare.

You know, I love—I love this line: If you wanna go fast, go by yourself and go recklessly. But if you wanna go far, go with the right people around you. Go with the team. Go together.

Dr. Eric Block: That’s great. Um, personally, uh, I wanted to talk about, you know, collaborating with the local physicians. Uh, when I have a patient—yeah—that either is getting started or I’ve successfully treated, I send a follow-up letter to all of the physicians in the area, um, just to either let them know that this patient’s being treated, delivered the device and for them to continue with a follow-up sleep study, or I’m just introducing myself, um, through just, you know, your traditional letter.

How—how can dental professionals better collaborate with physicians, in your opinion?

Dr. Mark Murphy: Yeah, thanks. That’s an important, um, construct for—for growing a dental sleep medicine practice.

So, leaning back to the IAOS discussion again, you know, this Restful software—there’s a software and a billing concierge—and whether you just sign up for that, you get 12 weeks of coaching if you sign up for the one-year program. So if you just sign up for the software and the billing, you get 12 weeks of coaching no matter what. And if you sign up for the one-year program, you get more coaching and it lasts a year. And then there’s a three-year program.

And so there’s different levels. But that coaching component is where the rubber hits the road for these kinds of successes.

If you or I just go out there on our own and we try to make those connections and try to have those conversations, try to communicate with physicians, we may or may not have success—and we’re going through this trial-and-error system of trying things that didn’t work.

Dr. Mark Murphy: I tried to bring cookies, I tried to bring lunch… That didn’t work. And so we’ve got, you know, six coaches that work with our practices, as well as my experience and others on the team, like—Here’s what worked for us. You don’t have to make the same mistakes. You could have a coach hold your hand, guide you, and find two or three—let’s call them techniques or shtick—that might help you get you into a practice so that you can have a one-on-one conversation with either the physician, or the nurse practitioner, or the PA—whoever the decision maker is.

And also, communicating with them—absolutely correct. But we’ve done some really innovative things over the years to develop those relationships.

Sometimes it’s going in and not asking for referrals from them, but instead telling them that you’re there to send them referrals.

Dr. Mark Murphy: I have a dental practice, Dr. Jones, and I’m here at your pulmonology—you know, most of ’em are pulmonologists and neurologists—I’m here at your pulmonology office because I’m looking for a sleep physician that we can send some of our tests to, ’cause we’re gonna be needing that. I was wondering if I could get some of your cards and know what kind of information you wanted.

Now, you went in and said, I’m here to tell you what I can do for you rather than ask you what you can do for me. That changes the conversation quite a bit.

I once went with a friend of mine who had to get a polysomnogram—an in-lab test—with him for his appointment with the sleep physician. It was a sleep physician we’d worked with periodically with no consistency, and I couldn’t get past the gatekeeper.

Dr. Mark Murphy: So I asked my friend Bill if I could go with him and sat in the operatory with him. When the physician walked in—and there’s two of us, I’m 6’3” and he’s 6’6”—she’s like, What are you two big guys doing here? 

And we started a conversation. Turns out she’s looking forward to me coming in and doing a lunch-and-learn. But I couldn’t get past her gatekeeper.

So there’s all kinds of tips and tricks that you’re gonna hear and think and feel—and which ones work for you, Eric, and which ones work for Mark and which ones work for Bob and Cindy and Sally are all gonna be different—but you’ll have coaches to help guide you through that development and that process.

And that’s after you’ve screened your own patients and then you want to work with local sleep physicians to keep a steady flow of patients coming in. And then we’ve got other really innovative business models that the IAOS has for creating a real, sustainable flow of patients for years.

Dr. Eric Block: Yeah. There’s just so much opportunity to become the go-to person—you know, the go-to dentist in—in, you know, in your particular town or area. Um, that’s—that’s great. I love that.

Now what about the next five to ten years? What do you—where are you seeing the best, uh, or biggest, in—you know—opportunities regarding innovations in dental sleep medicine?

Dr. Mark Murphy: Yeah, I wish I had a, um, crystal ball that I knew I could count on—or like a Ouija board or something.

What I’ve seen coming—and I talk about this a lot, but I thought it would be here by now—what I saw coming and still think is coming, is the day where—we’ve been seeing it happen slowly—oral appliances are becoming more and more accepted with physicians.

We’re seeing it because the science of precision oral appliance therapy is improving. We’ve got a lot more, um, articles, publications. We’ve got a couple of our members that are gonna be published in medical journals this year doing studies. We’ve been doing that with ProSomnus, for example, when I was there the last few years.

So it’s not just getting into dental journals and telling the story, but getting dental oral appliances featured in studies in medical journals, using physicians.

Dr. Mark Murphy: And as we’ve built that groundwork, we’re starting to get a little bit better acceptance.

So I’ll—I’ll give you some numbers. We’re not sure of the exact numbers—we are of—of some subsets of the exact numbers, so we can get pretty close. There’s about two and a half to three million CPAPs placed every year. And there’s about 200,000, maybe 225,000 oral appliances placed every year.

A 10% shift—which I think is coming—in the oral appliance prescribing pattern for sleep physicians, as they give us more of their CPAP failures or as they begin to trust mild and moderate patients more frequently to oral appliance therapy, a 10% change in their prescribing patterns would more than double the current market for oral appliances.

I’m gonna tell you something—if that happened tomorrow, overnight, we would not have enough dentists to provide that therapy. ’Cause there’s only three or three-fifty practices that are really doing sleep.

Dr. Mark Murphy: There aren’t that many Diplomates, there aren’t that many people that are really verifiable as qualified dentists doing this. So that’s another problem—we don’t really have enough providers for when that takes over.

So I think the first trend we’re gonna see is—you’re not gonna be able to get Inspire therapy. They only did about 12 or 13 thousand of those last year, for example. You’re not gonna be able to get Inspire therapy until you fail CPAP and oral appliances.

And physicians are gonna start to trust us more.

So I think we’re gonna see that as a huge quantum step for oral appliance therapy in the next 6, 12—3 years—5 years—6–12 months—5 years? Hard to say.

But I—I’ve thought it would be here by now, and it’s still not. So—it’s still coming.

Dr. Eric Block: Yeah, I’ve—I’ve gotten some letters from the local sleep physicians and—and other specialties: “Patient with CPAP intolerant, and we recommend an alternative, um, of a dental, um, oral appliance therapy.”

Yeah. What—what are you seeing out there as far as a percentage of patients that actually are—are compliant or can wear a CPAP? Um, I’ve heard it’s like 20%.

Dr. Mark Murphy: Well, so I—I’m a big data nerd guy, so I’m gonna give you data sets rather than what I see or what you see.

My—I have a pulmonologist myself. I see a pulmonologist. And so my pulmonologist tells me that all of his patients—and I said, Mohammad, it can’t be all of them. You can’t have 100% success. And he said, Well, okay, maybe 90%.

Well, that’s his anecdotal, uh, view of, uh, adherence or compliance on CPAP. But the literature suggests that by the end of the first year, there’s about 50% compliance or adherence.

But here’s the caveat: 22 to 28%—depends on the study—drop during the trial period. Completely drop.

And then when you say compliance, tell me what you mean by that. Is that seven hours a night, seven nights a week? Oh no. It’s 4.5 hours a night, five nights out of seven. That’s less—less than half their sleep time.

Dr. Mark Murphy: The other thing that’s interesting is—even though the efficacy of CPAP is about 100%—it works, flat out works—because the compliance rate is, say, 50% (and that’s a generous 50%), it’s only about 50% effective at mean disease alleviation.

If I gave you a pill for hypertension that worked 100% of the time but you only took it half the time—50% effective.

Oral appliances, on the other hand, are about 90% efficacious for mild to moderate cases and about 82 or 83% efficacious overall—so let’s say 85% all in for mild and moderates combined.

For severe cases, it drops down a little bit, as you’d expect. But the compliance is over 90%—and that’s seven hours a night, seven nights a week. So if we do the same multiplication:

90% × 80% = north of 70% effectiveness.

Dr. Mark Murphy: So, in a recent study out of Belgium by Olivier Vanderveken and his group at Ziekenhuis Antwerpen in Antwerp, it was found—now, you gotta be careful how you say things in the literature—this will be published in CHEST, and it’s being presented at the AASM and AADSM, in fact, later next month.

In that study, oral appliance therapy for moderate and severe patients was found to be not inferior in effectiveness as a therapy.

Isn’t that interesting? They couldn’t say superior—72% to about 50%—but they could say non-inferior. That’s what the literature allows you to say.

Absolutely incredible kind of thing—to be able to look at those kinds of data points like that. That’s a huge barometer that’s gonna help shift the winds in our favor a little bit as we think about oral appliance therapy.

Dr. Eric Block: Now, what about the role of technology? How’s that gonna play in the future of sleep medicine?

Dr. Mark Murphy: Well, um, some of us at the IAOS—the International Academy of Sleep—and with Restful, we’ve been looking at what remote patient monitoring looks like and the capabilities.

And with companies like ProSomnus coming out with an oral appliance probably later this year that’ll have a chip in it—and the chip won’t be just a temperature chip to say whether the patient’s wearing the device or not. It’s a full-on pulse oximeter that’s gonna give oxygen data and a remote physiologic monitoring metric that physicians can use to really manage their patients better.

That will be another giant step in the development of the relationship—and strengthening the relationship and the trust—because they don’t have data when they send you or me a patient and we make them an oral appliance. They disappear into a black hole.

With CPAP, they get data on whether or not the patient’s wearing that device every single night and how well it’s working every single night.

And they get nothing of that from us.

Dr. Mark Murphy: So to have that kind of reporting metrics from a technological standpoint is important.

Also, even though I would say that of late, ProSomnus was the only precision oral appliance manufacturer in the U.S.—they make their devices out in California—we’re now seeing other companies start to finally mimic these precision manufacturing techniques.

So, ProSomnus does a great job. I’m a huge advocate of them—I used to work for them, so take that with a grain of salt as well—but now we’re starting to see other manufacturers start to use better materials.

If you use these old materials—these cold-cure acrylics and the metals—they’re bulkier, they take up more room, you have to have more advancement, they’re not as precise, and they can’t replicate or maintain the bite as well. So there’s a mess going on.

Dr. Mark Murphy: That’s all we had back then—and it was fantastic that somebody even had invented that.

But today? We can do better.

You wouldn’t go for heart surgery and say, “We only have small, medium, and large stents for your heart.”

Now you’d say, “Don’t—can’t you do like an MRI or a CT scan and make one exact size of the vessel you’re replacing?” Of course you can. That’s the technology today when you think about personalized precision medicine.

So the technology is helping.

And then things with artificial intelligence that are helping with diagnostic standpoint for home sleep apnea testing—those have improved so much that today there’s a lot of rings that you wear that suffice as a sleep test.

We certainly didn’t have anything like that five or ten years ago. And—and when we saw COVID come along, the explosion of WatchPAT ONE, for example, as a technology and peripheral arterial tonometry that were allowable as sleep testing—it’s expanded the universe.

We’ve got a panel discussion at our retreat for the International Academy of Sleep in a couple of weeks where we’ve got several of the home sleep test manufacturers—and they’re going to compare and contrast the pros and cons of the different devices. And our members are ready to eat all that up.

So that’ll be kind of fun.

Dr. Eric Block: Love it. Uh, Dr. Mark Murphy, I’m gonna ask you two final questions.

Dr. Mark Murphy: Ooh, okay. Make ’em true or false or multiple choice, at least, will you?

Dr. Eric Block: Yeah, these will—those will be easy and I can repeat them. But it’s really, how do we get a hold of you or find out more about what you’re up to? That one’s easy.

Uh, the final question is: What advice would you give to the young dentists out there?

Dr. Mark Murphy: Oh, well, they’re easy. Thank you for that. I thought for sure you were gonna ping me with a couple zingers there.

So you can get a hold of me most easily: mark@iaos.com.  That’s mark@iaos.com. 

We’ve got an iaos.com  website and we’ve got a Restful website. But just email me and I can connect you, answer questions, send you some slides, send you some information on anything you want—not a problem at all. Happy to do that.

And then, um, I guess if I were giving advice to a young dentist, um, I’m—I’m gonna turn this into a very short story.

But I—I would repeat the advice that my son said to me when I asked him the very same question.

We—we had watched a movie—and I can’t remember the name of the movie, but I think Nicholas Cage was in it or something, doesn’t matter—where somebody got a redo on their life. And they changed something, and jokingly, it changed the time-space continuum. They didn’t meet their spouse, and all these other things happened.

And it started a conversation with my two adult children at the time about how we wouldn’t change anything. We like our lives, and although there’s pros and cons and ups and downs, there’s a lot more ups than downs. We’ve got good lives.

I wouldn’t risk changing something in the past or having a regret—undoing something in the past—because of what it might affect in the future going forward.

Dr. Mark Murphy: So then I had to change the conversation. And I said to my kids, my wife—and was ready to answer it myself—But if you had to change one thing—if you had to—what would you change?

And my son went first. And he said, simply—and this is what I would say to any new dentist—is, um, he said he would learn to take advice earlier.

He’d spent a lot of his time, he said, hearing advice from others, not heeding it, and having to learn those lessons himself.

So, you know:

A smart person makes his own mistakes and doesn’t repeat them.

The smarter person learns from other people’s mistakes and doesn’t make them.

But the smartest person listens to the sage wisdom of the sensei and only does the best things possible.

So that was my son’s message, and I think that would ring true for any young dentist: don’t be afraid to listen to smart people around you. They’ve—they’ve cut the path with a machete through the jungle, and you just might as well follow their path. You don’t have to make your own.

Dr. Eric Block: Great stuff. Dr. Mark Murphy, thank you so much for joining us. Such a great episode.

Dr. Mark Murphy: Thank you so much, Eric. Appreciate you. We’ll talk soon.

Dr. Eric Block: Sounds good. Thanks again for listening to the Stress-Free Dentist Podcast. And don’t hesitate to get in touch with me at info@thestressfreedentist.com. 

And if you haven’t already, please subscribe on your favorite platform and leave us a review. Until the next episode, I’m Dr. Eric Block, the Stress-Free Dentist.