It’s that all-too-familiar 3 a.m. sound that resembles saws cutting through wood. Lawn mowers rumbling across the grass. Motorcycles breaking the nighttime quiet.
Wives tossing and turning, and rolling their eyes. Husbands exiled to the living room couch with their bedrolls in their arms. Funny stuff.
If only snoring were as funny as the cartoons and TV sitcoms portray it. But it’s not very funny, at all. Quite the opposite.
In fact, said Mike Rowe, general manager of Denzinger Family Dentistry in New Albany, it can be a matter of survival.
“There are few life-and-death conditions in dentistry,” he said, “but sleep apnea is one of them.”
It’s also turned into a new line of business for the practice and has allowed it to expand into the Louisville market with the opening of a sleep apnea clinic last year in the East End.
Sleep apnea is a medical condition, not a dental issue. And yet, dentists are well-positioned to see signs and symptoms that most physicians are not.
“I’m in people’s mouths all day long,” said dentist Dr. Sara Denzinger-Rowe, the practice’s founder and Mike’s wife. “I can see the signs of abnormal sleep — the crunching and the grinding, the broken teeth and crenulated tongues, the clenched jaws that result in morning headaches.”
Broken teeth and headaches are not pleasant, but they’re nothing people can’t live with. However, high blood pressure, diabetes, periodontal infections and high cholesterol are not so easily dismissed.
“If your body can’t breathe, it will panic and do whatever it can to get breath,” Denzinger-Rowe said. “That could mean your heart will start racing, you’ll sweat, you might suffocate, go into cardiac arrest, have a heart attack or stroke. But you’re asleep, so you don’t know what’s happening.
She said research suggests about 30 percent of the American population has some level of apnea.
Though Denzinger-Rowe is inside the mouth, seeing issues and evaluating all sorts of dental problems, she’s quick to point out her limitations in confronting what is, in fact, a medical condition.
As dentists — even double-board-certified to treat snoring and obstructive sleep apnea with oral appliance therapy — Denzinger-Rowe and her practice partner, Tracy Guilford, are prohibited from diagnosing the condition or initiating any treatment.
“That’s strictly the prerogative of an M.D.,” Denzinger-Rowe said. “All we can do is urge these patients to go see their primary care physicians.”
A problem, she said, is that too many primary care docs don’t address the subject, or look in people’s mouths, or do much more than a perfunctory “how are you sleeping?”
“We’ll initiate the conversation based on what we see during an oral exam,” she said. “Perhaps, we’ll tell a patient, ‘You have a really large tongue … or extremely crowded teeth … or you’ve crunched so hard you’ve flattened or broken your teeth.’ “We ask them if they’re tired during the day.”
Building the business
Denzinger-Rowe, the daughter of a New Albany orthodontist, graduated from the Indiana University School of Dentistry. In 2002, she opened a two-chair general dentistry practice in New Albany. In 1994, she married Rowe, who runs the business side of the practice.
“I’m responsible for operations and marketing; Sara is responsible for the clinic,” Rowe said. “She doesn’t have to worry about payments or billings; I don’t have to worry about anything that happens in the clinic.”
A line he uses to explain their business relationship is: “She doesn’t write any checks and I don’t pull any teeth.”
So, as she began to identify sleep apnea as a health issue that needed addressing, he began to identify a unique business opportunity.
“We sent Sara and Tracy to a weekend course in Baltimore, and they came back on fire,” Rowe said. “This was something the community really needed.”
The two dentists spent two and a half years traveling all over the country, taking course work and continuing medical education on sleep apnea — “thousands of hours of classroom time,” Rowe said.
Eventually, they received board certification from the American Board of Dental Sleep Medicine and the American Board of Craniofacial Dental Sleep Medicine.
Once sleep apnea has been diagnosed by an M.D., the two board-certified specialists are able to receive referrals, to explore treatment options and fit appliances. They offer oral appliance alternatives to patients who are diagnosed as having mild to moderate obstructive sleep apnea, or those who find the traditional CPAP machines and masks uncomfortable. (CPAP stands for Continuous Positive Airway Pressure.)
Dentist Sara Denzinger-Rowe holds a mandibular advancement device for sleep apnea treatment.
As the sleep apnea practice grew, they opened the Crossings Sleep Apnea Clinic in 2014 as a separate business owned by Rowe, Denzinger-Rowe and Guilford. It’s a 13,000-square-foot building directly across the parking lot from the Denzinger Family Dentistry facility.
“We have seen steady revenue growth from it,” said Rowe, “but we didn’t get into it with immediate financial objectives. It was, and still is, much more of a strategic play. From the standpoint of investing and allocating resources, general dentistry still makes more sense. But from a strategic perspective, the sleep apnea practice is incredibly important.”
Last summer, they opened a second office, the Louisville Dental Sleep Medicine clinic on DuPont Circle.
The dental practice has about 65 employees and six more work at the two sleep apnea clinics.
“Opening … in Louisville has given us our first ‘metro’ brand,” Rowe said. “We had always been just a Southern Indiana brand until then. It has been very helpful because many of our referring physicians have offices on both sides of the river and we are now able to accommodate all of those patients. We are also able to be in network with the medical insurances in both states, which is an important part of our strategic plan.”
Without giving specifics, he said the overall business saw “a major increase” with the opening of the Louisville location.
So is that the future of the business?
“We do plan to have more sleep apnea clinics,” said Rowe, “but we don’t see them overtaking the general dentistry part of the practice.”
A tale of two businesses
Rowe said that focusing on sleep is “a window into taking a more complete look at how the use of the mouth affects a person’s total health.”
It also helps create ongoing relationships with physicians, “so we can communicate better about common patients, exchange medical records, provide referrals and insurance benefits.”
“Few dentists are doing these things,” he said, “and we think we are seeing a convergence of dentistry and medicine, which we view as an overwhelming good.”
If the convergence happens, Rowe regards it almost as incidental.
“We don’t see a lot of people coming to us for sleep apnea then joining us as a general dentistry patient,” Rowe said. “Most people already have a dentist, and we want them to know they can come to us simply as a sleep patient. If they need dental help, obviously we can provide that.
“But the objective never really was to drive patients to the practice. It was much more about expanding our services and opening discussions that extend beyond traditional dentistry, to more issues that affect total health and quality of life.”
Whether from the standpoint of financial strategy or holistic health, Rowe said that “in the last five years, our company has more than doubled.” And the sleep apnea practice continues to grow.
“We see hundreds of people a month for sleep apnea,” Rowe said.
An increasing number of those patients are children.
“Sleep apnea knows no age boundaries,” said Denzinger-Rowe. “When children don’t sleep well, they become hyperactive and can’t focus, which becomes misinterpreted as a behavioral issue. But the poor child is merely exhausted.”
She said bed-wetting can also be related to sleep apnea.
“We work closely with pediatric ear, nose and throat doctors,” she said. “All medical specialties are happy to be able to refer back to us. We become part of their bag of tools.”
“They’re appropriately trained for the follow-up treatment,” said Rowe, of his wife and Guilford. “And we also take medical insurance — the docs like that. We’re in a network with Anthem, Humana, Tricare and Medicare. Very few dentists take Medicare, but this is a medical issue.”
“Insurance helps so much because without it people might not follow through on their treatment,” said Denzinger-Rowe. “People will say, ‘Well, it’s just snoring — I can live with that.’ The sad fact is, maybe they can’t.”