Episode Description

Airway health is becoming an increasingly important part of comprehensive dental care, and dental hygienists are in a unique position to recognize potential warning signs during routine appointments. In this episode of the RDH Podcast, Jackie Sanders and Andrew Johnston talk with Andrew Lee about his journey from dental hygienist to airway-focused innovator and why screening for sleep-disordered breathing deserves a place in the dental workflow.

The conversation covers bruxism, abfractions, dentinal wear, scalloping of the tongue, STOP-Bang and Epworth assessments, workflow challenges, and the gap that can occur between identifying a potential airway concern and getting a patient to appropriate testing. Lee also discusses the importance of collaboration between dental and medical professionals and encourages hygienists to take an active role in airway screening while staying within their professional scope.

Additional reading: The dental hygienist's role in screening for sleep apnea

RDH Podcast: Making Airway Assessment Part of Comprehensive Dental Care

Why airway belongs in the conversation

Jackie Sanders:
Welcome back, everyone. This is Jackie Sanders with RDH Magazine with another edition of RDH Podcast.

I'm joined today with my co-host, Andrew Johnston. Hello, Andrew. How are you today?

Andrew Johnston:
I am great. Another wonderful day for podcasting. You just, I couldn't be happier.

There's actually, sorry, we're gonna go off on a quick tangent again, right from the start. There's actually a YouTube video, like when she opens up her, all of her, she's like, hello, and she's so happy. And that's how I feel in my heart right now because we get an opportunity to podcast. Podcast is always fun.

But I'm really excited about our topic today because it's something that when, well, Jack, you know this, when we're having these conversations with the hygienists at these conferences, when you get all those feedback forms, one of the major topics that everyone wants to talk about is airway.

Airway is so popular, right? And so we have Andrew Lee on today to talk to us a little bit about that. He's got some really cool stuff going on.

Andrew, welcome to the show.

Andrew Lee:
Hey, glad to be here. Very excited to share what I know.

Andrew Johnston:
How many podcasts have you done before?

I like the nervous laugh. That tells the story right there.

Andrew Lee:
I'd say one long ago. Yeah.

Jackie Sanders:
I will say you've never done a podcast with Andrew and I, so get ready. This is fun.

Andrew Johnston:
No, this should be a fun time. We're really excited.

This is how we want this to go. We are front row audience members and we just can't wait to soak up everything that you're going to teach us.

I think it's always good, though, whenever we have a new guest or someone that hasn't really been on the podcast circuit, to maybe start off with a little bit about who you are. Tell us your journey into this airway space and why airway is so important to you.

Andrew Lee:
Yeah, so I've been doing this for a little over 20 years now in private practice with UCSF and just took a short little stint doing clinical professorship at UOP here in San Francisco.

And preventative dentistry is just a passion of mine. I started off as a hygienist. Really love working with people. It's so rewarding just to see what we can do in the industry to just make such a huge difference in people's lives, especially their oral health.

Because I think we can all agree that the mouth is the gateway to the body. So what we do is so important to just improve systemically as well.

How the role of the hygienist has evolved

Andrew Johnston:
What were some of the things when you're starting to get into this space, what were the tools that were at our disposal and how has that kind of changed over those 20 years that you talked about?

Andrew Lee:
Man, when I first came out of school, everything just seemed so standard. We were just told to come in, do the cleanings, do the x-rays, do everything that a hygienist is supposed to do.

But I've always felt that in the past, we weren't really encouraged to innovate, to step outside of the box of the dental chair and do more. It's something that we had to take upon ourselves and just say, hey, what are we capable of?

And I think that's where I found myself just really teaching myself and just networking with other professionals, not just hygienists, even down to office staff assistants, even the dentist, just anybody within the field who could really just help you grow and continue to learn.

I think that to me was, you know, life's CE was just like my way of just really growing. And so that's how I developed.

But I do find that within the industry as a whole, I think we can still improve so much more when it comes to innovation, especially when it comes to preventative care.

I don't know if you guys can agree, but when it comes to innovation from our side, I noticed, a new electric toothbrush came out. This new floss came out. There's nothing that really says, whoa, this is a game changer for us. This will really change how we make a difference in hygiene. I think that's where we can still improve on.

Andrew Johnston:
Yeah, I mean it is few and far between. I do like what you said, though, about just like your, I guess, networking.

I didn't do like screening properly. I didn't even know I was supposed to be doing screening. So you're taught some stuff in school, but then you kind of like set it, you set it aside and then you never pick it back up again.

And then I was in a pediatric office one time and we had to do, you know, airway screening, and it was something that was brand new to me. I didn't even know that was like, I'm supposed to be doing this.

I think if we could also get back to those types of fundamentals and kind of ride that wave a little bit more. We don't also need these big innovations, right? We just need to be doing something more comprehensive.

Andrew Lee:
That's so true.

You know, we're taught in hygiene programs as well as dentists taught in their schools in their programs about the airway, but I don't think it's really our fault either. I think it's just, unfortunately, they're just parts of dentistry that still remain stagnant.

And so unfortunately, our main priority is to teeth and oral health. And so we can only do so much.

So I think that's one of the reasons why I took it upon myself. Like if nobody's going to do something to change this one problem that I'm finding right now, and I'm seeing a pattern of it, and it's becoming so viral that something needs to be done, I'm going to do it myself.

And I'm going to just really take advantage of every resource available to me to figure this out so that I can do my part to help the industry.

And so that's where I took my position as a dental hygienist, just to really make change so that things like airway can be approved on because it's such a huge factor when we're sitting there with the patients, whether it's us, whether it's the dentist, even down to the assistants, again, even down to the front desk, just talking to the patient.

We all make a difference and we're all facets of a, we're like part of the whole that makes the, that makes the patient truly a standard care process.

What a typical day looks like

Andrew Johnston:
So tell us what your day-to-day actually looks like then. Like what are you doing currently?

Andrew Lee:
Oh man.

So my morning starts at 6.30. I get up, I'm getting into my scrubs and I am starting my day in the private practice with my first patient at 8. My last patient ends at 5 and then I ride my bike home, wash up.

And then I also have a project on the side where I also have a kind of like a DTC dental lab. So I'm now bringing in cases, making night guards. That continues on until about 8 or 9.

Then from there, I'm also working on a new project now, again, focusing on airway and sleep apnea and how it's linked to bruxism, a comorbidity to bruxism.

And so that's my typical day, Monday through Thursday. And then Friday, Saturday, and Sunday, I'm answering a lot of emails and just really doing everything.

Yeah.

Andrew Johnston:
Is it the consumer emails, questions about, or is this more like scientific literature, research emails?

Andrew Lee:
Everything.

It's answering emails with patients who are involved, you know, professionals within the network, you know, dentists, dental practices, DSO executives, you know, I'm talking about C-level who are interested in what I'm doing.

Just everybody. It's a lot.

It takes a lot out of you when you're wearing every hat and you're doing this as a single founder. So, but I think I've become so accustomed to it and it's both thrilling, exciting, and scary.

And so, you're really riding the wave of emotions, but at the end of the day, you keep your eye focused on the clearing and just what it's going to produce. And that's what really just drives you to just move forward.

The gap between airway assessment and follow-through

Andrew Johnston:
I've been stuck on this like thought lately and I mean, maybe it's not right and maybe you can kind of shed a little bit of light on it.

But I feel like dentistry doesn't really have like a technology problem per se. Like I think we have a lot of tech. I think we have a lot of innovation. I think we have a lot of tools at our disposal.

I feel like it's more of like a workflow problem, right? We don't have the time or we don't have the, I don't want to say desire, but we just, we feel so darn overwhelmed.

So where for you, where do you see like the biggest breakdowns happening between like the identification, the assessment part of an airway concern, and then getting that patient properly diagnosed and treatment planned and carrying through with the procedures?

Andrew Lee:
Yeah, no, that's a great question.

And I think this goes back to, just this new project that I'm working on in bruxism airway workflows and billing.

Typically, I think when a patient sits down, I think one of the things that we commonly, we find in a patient's mouth is bruxism.

We're going to see all kinds of wear and tear, whether it's abfractions, dentinal wear, just those things, scalloping on the tongue.

But what we're finding is that up to 50% of these cases are a comorbidity to sleep apnea.

So that's where the assessment's important to come in and do those airway assessments like the STOP-Bang assessment or the Epworth assessment to really just gauge and see if this patient would benefit from a sleep test.

But here's the problem.

All we can do, again, since our first priority is to oral health, and this is what we're doing now, obviously, is we're putting them into a night guard without realizing that, oh, wait, is this the proper oral appliance therapy for this patient without getting them to the sleep test?

So dentists out there, they're doing their best and it's not their fault. Again, it's the industry being stagnant with this type of workflow and billing.

All we can do is put them in a night guard because our priority is to their teeth and protect their teeth.

And then we give them a referral to go see a physician to then get a sleep test done because unfortunately the dentists aren't licensed to do that.

And so we're seeing there's a 90% drop-off rate with that.

Because once patients get that referral, I think we can all agree. Patients don't like to agree to treatment to begin with. So could you imagine when we're giving them a referral, sending them out to do something else, they're like, forget this.

They're putting that referral slip to the side, like with anything else when we're referring to endo or ortho or oral surgery. It's the same thing.

But with this, it's even more so because we're not doing what we can to really get them to the finish line. And so that's what we're seeing right now.

Bringing airway screening into the dental chair

Andrew Lee:
And so that's the project that I'm working on where now when a patient comes in and they sit down and we see this initial bruxism where we then approach and address this with the patient together and say, hey, patient, we're also noticing that this is going on and this may be an airway issue.

We'd love to get you a sleep test done.

So what we're doing now on working in improving the workflow is providing the airway assessments right from the dental chair because every dental chair now has a computer.

So they can actually do the assessment, whether it's the hygienist or the dentist or even together during their exam or during our assessments with the patient. And then you submit that as a case.

And then from there, the case is submitted and we actually have a medical group that we're working with now who can then just now have the patient sit back.

It actually delivers a home sleep test to their home. They wear it around their finger for just a couple of nights.

That data is shared with both our medical group and the dentist.

And let's say it's OSA negative, they're negative for sleep apnea.

Well, guess what? Then it just notifies the dentist to then say, hey, Dr. Smith, you can proceed with the night guard because this patient is OSA negative.

But if it's positive, now it then proceeds forward to help with the billing and the workflow to continue in order to get that mandibular advancement device into the dentist's hand so that it can now be treated and delivered to the patient.

So you're seeing this huge automated workflow now just working for the dentist without any bottlenecking.

And now the patient doesn't have to do anything. They're literally just sitting back and just taking a sleep test from home rather than having to go to a clinic.

Andrew Johnston:
I love this. Feels more like medicine, quite honestly.

It feels more like, you know, you're doing the, if you ever watched House, you know, the differential diagnosis. Like, let's go through all of the different things.

And we're doing that in dentistry. And I love that. I think that's really great.

I hear it in the back of my head.

Yeah.

Building a bridge between dentistry and medicine

Jackie Sanders:
Collaboration is something we've been talking about for years is why, you know, why aren't we working with the other medical professionals and you've pulled it together, Andrew.

Andrew Lee:
Thank you.

And that you both hit it exactly right on the head. It's that we were all just talking about it, but nobody was really doing anything about it.

One thing that I also noticed, because there are actually other platforms out there that do the same, but they're still missing key pieces.

I think sometimes it's because when you have too many people in the kitchen, things get lost and then you've now got too many ideas kind of mixed in to where you don't know which one goes and which one doesn't.

I think that's the first problem.

The second problem is that it's really about just execution. You have to be in the dental industry to know what's really going on.

Again, I've got 20 years in it, sitting chair side, working with patients, working with the team. So I've experienced this firsthand myself.

I think that's another thing.

But you're right. One of the things that I can say is great about our industry is that we're now coming to the realization like we need to create this digital bridge between dentistry and medicine.

I think a lot of platforms are doing this right now.

I think Epic is a very good example. They're a large company with a great EMR system.

They're now linking dentistry to medical EMRs so that physicians from both sides, whether it's the doctor or the dentist, they're now communicating with each other and sharing notes so that they're really providing comprehensive standard of care.

Becoming the airway champion in your practice

Andrew Johnston:
I think as we are starting to wrap this up, I want to give the audience maybe some inspiration.

If they feel like a calling to be the champion in their office of Airway, where fundamentally should they start on their journey if they're not already started?

Andrew Lee:
It's not that hard to start.

I mean, we're already doing this right now every day with every patient that sits in that chair. We're doing our assessments, whether it's intraoral, extraoral, we're now just implementing this one little assessment portion into it that just takes one minute, as part of the assessment to really complete the full chain of standard of care for the patients.

Anybody can do it.

I think, again, when the industry has you in the stereotype of image where it's like, no, you're just a hygienist. This is what you do. Just stay in your lane.

No, you know, I think a lot of dentists are now encouraging hygienists, hey, do more.

You know, they're even incentivizing hygienists to say, hey, look, we'll even give you a portion of, you know, the production if you can really do this well, because this is how we should do it together to really make sure that the patient is treated well.

All of these things are coming into play.

I think it's for us as hygienists to say, I want to do this. I want to really treat the patient with the care that they deserve to really see optimized outcomes.

I think that's where we have to really make a decision whether or not we're going to do this.

Jackie Sanders:
Amen. Yeah, love it.

We'll repeat that and play that one over and over and over again.

Andrew Lee:
Yeah, be the champion. Put yourself at the forefront of oral care.

I think that's what it's all about. If you want to do that, then you can do it.

Jackie Sanders:
Yeah.

Well, you said on this interview earlier that for three days you answer e-mail. So I know a lot of people are reaching out to you.

How could our listeners get more information from you, Andrew? How could they contact you?

Andrew Lee:
Yeah, man.

I would love to hear from anybody who can provide feedback, insight, just support, again, doing this by myself.

It can be discouraging at times. I'll be laying in bed in the middle of the night and wondering, like, am I doing this right? Like, should I even be doing this? Am I, you know, am I equipped to take on this challenge?

So even supportive emails like, keep going, Andrew, or, hey, have you thought of doing this, Andrew?

Like all of those emails, if you want to send them over, please, by all means, even if you want to, because we're planning on launching this project by the end of this month, hopefully, with our last milestone still built and being built in production.

But once it's ready, if you like to give it a try in your own practice, there's no obligation, there's no risk, there's no volume minimum.

Like if you want to try it, you can just create an account and just start using it right away.

It's that easy.

So yeah, I can provide an e-mail at the end if anybody would like to reach out.

Andrew Johnston:
Yeah, what is the e-mail address for that?

Andrew Lee:
Yeah, it's super easy.

It's Andrew at orasom.health and orasom is spelled O-R-A-S-O-M dot health.

Andrew Johnston:
Perfect.

Andrew Lee:
Thank you so much for having me.