A Dentist Who Bridges Gaps In New Approaches To Sleep Apnea And Joint Disorders – By Rachel Fremont
Innovation is often viewed as the application of better solutions that meet new requirements, unexpected challenges, or existing market needs. This is the story of Dr. Richard Klein, DDS, a true Michigan innovator. An injury terminated his ability to provide the services he spent a decade in college to learn. The resourceful Dr. Klein applied what he knew toward patients’ needs within his scope and capability.
Dr. Klein exclusively treats Obstructive Sleep Apnea (OSA) and Temporomandibular Joint Disorder (TMD). He does not have a dental drill or hygienist because he has not practiced routine dentistry for more than 25 years.
While the injury permanently disrupted his career as a general dentist, Dr. Klein began teaching about pain management and OSA at lunch lectures.
He has Diplomat status in OSA from the American Sleep and Breathing Academy and the American Academy of Craniofacial Dental Sleep Medicine. He is a clinical instructor at the Michigan State University Osteopathic Medical School. He has authored chapters on TMD in textbooks and published in peer-reviewed journals. Dr. Klein has lectured in 14 countries and many states about sleep apnea or TMD. He is on the Board of Directors of the DMan Foundation, a charitable organization for paraplegics.
nnovative approaches to address Obstructive Sleep Apnea and Snoring are largely recognized as standards of care. However, OSA was slow to be recognized in the medical education field. An early description of the condition was of Fat Boy Joe in Charles Dickens’s first novel “The Posthumous Papers of the Pickwick Club,” first published in 1837. Dickens wrote: “On the box sat a fat and redfaced boy, in a state of somnolency,” and “Joe—damn that boy, he’s gone to sleep again.” The identification of OSA happened slowly, almost 100 years later. Sir William Osler noticed what Dickens wrote and coined a term for OSA—the Pickwickian Syndrome.
In 1981, the invention of a continuous positive air pressure (CPAP) machine became an effective tool to treat sleep apnea. In 1995, the American Academy of Sleep Medicine accepted the CPAP as a standard treatment device. And in 2007, oral appliances (OAs) were considered acceptable treatment for patients with mild to moderate OSA who were
unable or unwilling to utilize the CPAP, including questions of compliance.
At a meeting held at the Department of Transportation in Washington D.C. on July 11, 2013, Dr. Klein was asked to address problems of truck drivers who were diagnosed with OSA but non-compliant with CPAP. He mentioned the American Academy of Dental Sleep Medicine’s statement that OAs are required to be fabricated by dentists who are experienced and qualified in the areas of sleep and TMD. Truck drivers should be treated for OSA only after a thorough evaluation of TMD.
A year later, during a three-hour PowerPoint presentation to the Federal Motor Carrier Safety Administration, Dr. Klein discussed OSA and its causes, multiple treatments including oral appliances provided by dentists, the dangers of untreated OSA to truck drivers’ health, and the resulting safety threats to thousands of other people on the highways of America.
The National Institute of Health has stated that “drowsy driving” is more dangerous than drunk driving, a statement that was stressed by Dr. Klein. He was asked to return to D.C. yet again to speak about OSA, specifically addressing multiple road accidents and railroad fatalities. In that presentation, he provided 23 recent articles concerning the problem.
Among the points raised in those studies:
- “Results show that the rate of serious, preventable crashes was five times higher among truck drivers with sleep apnea who failed to adhere to PAP therapy.” Primary Care (March 22, 2016)
- “Drowsy driving may be responsible for 1.2 million car accidents every year.” National Highway Traffic Safety Administration.
- OSA has a multitude of medical issues not limited to the well-known high blood pressure, type-2 diabetes, stroke or cardiac arrest. Data from 12 studies show the overall prevalence of OSA in people with a serious mental illness was 25.7 percent. The highest prevalence was seen in patients with major depressive disorder)(36.3 percent), followed by patients with bipolar disorder (24.5 percent).
- Obstructive sleep apnea might also increase the risk of workplace injuries. Those with sleep apnea were twice as likely as others to suffer a workplace injury, and three times more likely to have one that was related to failed vigilance—such as tripping, falling or sustaining burns.
Dr. Klein has stated, “I am pleased to help my country and the people who live in it. Volunteerism as a passion is an exhilarating and life-enhancing activity and I am blessed to be able to assist in OSA education. Dentistry should be proud that we as dentists are helping save lives and improve the health and longevity of our dental patients.”