How did you get started in dental health?
I wanted to get into medicine since I was in 8th grade. I have a biology background from Loyola University of Chicago. About my sophomore year in college, my advisor questioned me as to why I wanted to be a physician and not a dentist. I gave them all the pros of being a physician and the cons of being a dentist, but then they opened my eyes to the other side of the coin.
In the early 80s, physicians were married to their offices. They really couldn’t have a family life and I want to have a family. I wanted to be able to coach a soccer team or be a cub scout leader, girl scout leader, or whatever. And I wanted family to be number one and the practice to be second, and dentistry allowed me to do that. I don’t think medicine would have allowed me to do that. So that’s the reason I chose dentistry. But I enjoy helping people and just changing their way of looking at the world and the world the way the world looks at them.
How did Amber Dental get started?
I graduated in 1984 with a Doctor of Dental Surgery degree from the University of Illinois in Chicago Dental school. And I’ve taken a lot of continuing education mandatory in Illinois. I’ve done a lot of other training and education in everything from economics to implant restoration, to sleep medicine. My wife is my partner in the dental office. She graduated in 1988 from the University of Illinois Dental School. We started our business in Wheaton in 1989 and got a small 23-chair office. In 2005, we expanded: we built our own office and have a lot more features that allow us to offer more services to our patients.
What was it like to attain Diplomate status with the American Academy of Dental Sleep Medicine?
Diplomate status in the American Academy of Dental Sleep Medicine has changed over the years. It used to require strictly case reporting and an exam, etc. The Academy changed the profile of how you could apply for Diplomate status about five years ago. It requires over 60 hours of in-classroom lecture, reading hundreds and hundreds of pages of journal and research articles, and various practical exercises, because you need to understand the subject matter and be able to apply it.
Once you do that you’re still not a Diplomate–you have to pass the Diplomate exam. It’s four hours long, and you have to show that you understand the concepts of how and when to treat patients for obstructive sleep apnea with oral appliance therapy. You have to understand the physiology, anatomy, medicine, dentistry, and everything else that goes into treating patients with oral appliance therapy. Additionally, Diplomate status requires 25 hours of continuing education every year, specifically in sleep medicine, to maintain your status as being in Good Standing with the American Academy of Dental Sleep Medicine.
How does your Diplomate status improve patient outcomes?
It’s not just Diplomate status that improves patient outcomes, it’s the training that goes along with it. If you don’t have the correct training, you don’t know what you’re doing or why you’re doing it. If you’ve got someone who has a sleep breathing disorder because of obstructions and you’re putting hardware in their mouth, that could actually make the situation worse, not better. So you have to have the training, you have to know what you’re doing and why you’re doing it and how to achieve the best result.
And you do that through training and having the ability and the resources to keep current with industry information, current diagnostic techniques, current impression techniques, current equipment. You cannot be making these appliances without having some sort of formal training and so you know what you need to do and how you need to do it. There are over 150 different appliances on the market. You need to know which one to pick for which patient. It’s not a one-appliance-fits-all solution. There are different appliances that will suit different circumstances for different patients.
What do prospective patients need to know when looking for a dental sleep medicine doctor?
Patients need to know that their dentist for dental sleep medicine has had training. The easiest way to ascertain that is to look for the Diplomate status of the American Academy of Dental Sleep Medicine. That can assure them that their dentist has had training and that they know how to properly fit and calibrate an oral appliance for optimal outcome and maximum medical improvement. They also know how to communicate back and forth with their physician and their general dentist.
If you’re not a patient of mine, I make sure that I communicate well with your general dentist, wherever you came from, to let them know what I’m doing and to consider me a part of your medical/dental team. There may be some side effects from treatment–we watch for those and any problems with any of the appliances. Their general dentist is welcome to contact me. Same thing with their physician. We keep the lines of communication open. So a Diplomate in the American Academy of Dental Sleep Medicine knows how to communicate efficiently and effectively and properly.
What are the challenges you find as a dental sleep medicine doctor?
The biggest obstacle I see, the biggest challenge, is helping physicians understand that they shouldn’t feel that we are in competition for their patients. We’re not any more competitors in the sleep breathing disorder market than the CPAP manufacturers or the techs that are fitting people with CPAP machines.
In 2015, the American Academy of Sleep Physicians posted a policy change that for mild and moderate sleep apnea, the treatment of choice, the gold standard for mild and moderate sleep apnea is an oral appliance. And that for severe sleep apnea it’s supposed to be a CPAP machine. If the patient cannot or will not tolerate a CPAP, then you need to offer an oral appliance.
I partner with physicians to make sure that the patient is getting maximum medical improvement, and if I’m having a problem I communicate with them and get their take on it. So I feel that that’s the biggest hurdle that we have is educating the physicians to start partnering with dental sleep medicine doctors.
What do you find rewarding about providing dental sleep medicine to your patients?
Obstructive sleep apnea is a terminal condition. It will kill you over time and either you’ll have a stroke or heart attack, your diabetes or blood pressure or hypertension will become unmanageable and you will die. And it’s the result of the sleep breathing disorder, especially obstructive sleep apnea. It causes enough changes and disruptions in the body that it is terminal. So I find it extremely satisfying that I can help save lives, not just simply make people feel better about smiling and change their societal image. I can actually help save their life. That is absolutely phenomenal. And I see why the physicians get such a high knowing that they can influence people’s lives that way. So that is the most rewarding thing that I can think of.
What advice do you have for patients suffering from obstructive sleep apnea?
Patients that are suffering from obstructive sleep apnea, or a sleep breathing disorder, restless leg syndrome, insomnia, narcolepsy, any of those conditions that are considered sleep breathing disorders, and sleep disorders, need to have a conversation with a sleep physician. There are a lot of treatment modalities that are very successful and have been perfected over time. They don’t they’re not necessarily destined to having to be tied to a CPAP machine for the rest of their lives. There are alternatives.
Some surgical options can work for some people. There are some different types of CPAP machines that will work that are less intrusive to their lives. And there’s oral appliance therapy, but we can usually find something that will help them. Sometimes it’s just a modification of behavior. It’s some counseling, or it’s medication changes. So they need to start that conversation with a sleep physician to find out what they need to do to determine what their problem is and how to fix it.
What are your thoughts about the future of dental sleep medicine?
I think dental sleep medicine is in its young “teen” years. In the next 5 to 10 years the dental schools will start teaching more and more on sleep dentistry and sleep medicine and the dental component of it. Right now, they’re teaching the didactic but they’re not doing the practical training of making oral appliances. These younger dentists need to come out with the education and training they need to know to make these appliances. So as we start graduating dentists that are from the get-go in their dental school education capable and able to make sleep appliances it can only improve greater numbers of patients and have a higher impact on the general population. Medicare and Medicaid will do a better job of reimbursing, and once they do that, we’ll be able to help some of the most vulnerable of our population. I think we’re in the young years of dental sleep medicine, and I think it can only get substantially better and more widespread as time goes along.
What do you want prospective patients to know about Amber Dental?
I want prospective patients to know that I treat people the way I want to be treated. My staff and I are open to conversation and to answer questions no matter what they are. We’re non-judgmental, we’re welcoming, and we want to make sure that everyone feels that they can come in and they can have a consultation. There are no obligations.
I, myself, have had a lot of dental work done, so I’ve spent a lot of hours on the patient side of the dental chair. Fortunately, my wife is the best and she helps me immensely! I know what things feel like, what they smell like, what they sound like, what they taste like. What’s going through their mind at the time. How vulnerable you feel because I’m working in that personal space and that can be awkward or uncomfortable for people. I try to be as well-meaning and understanding.
I try to assess the patient and see what their concerns are and what their needs are. I know how to respond, how to try to put them at ease because I understand what their concerns may be. I think I’m able to do a much better job because I’ve been on the receiving end of treatment, and that makes me understand and respond empathetically to my patients.
We’re definitely a service-oriented office. We want to make sure that people have the best possible experience they possibly can with receiving the best possible dentistry that they can. We always do what’s best for the patient, and if I can’t provide that service then I find the avenue for them to get that service done in the best way possible. I make whatever recommendations or whatever referrals I need to get that patient taken care of correctly.
Dr. Koehne and the staff at Amber Dental would love to help with all of your dental health needs. Contact our office to set up a free consultation and meet our friendly staff.