Oral Appliance Efficacy – Time for Augmented Intelligence?

Oral Appliance Efficacy – Time for Augmented Intelligence?

Pankaj Singh, DDS, MD, does not mince words when assessing the knowledge levels of his dental
colleagues. Even dentists who know the scope of oral appliance therapy often practice “with guesswork,”
he says. Even more troubling, most of those in the traditional restorative realm “don’t know anything”
about sleep apnea.

As a private practice dentist in New York City, who also happens to be a physician, Singh has felt the
frustration brought on by a lack of objective data. The thirst for a better way led Singh to create APP-NEA,
LLC, a company dedicated to using “deep machine learning and augmented intelligence” to develop
automated algorithms, new technologies, and workflow processes that allow dentists to treat patients with
obstructive sleep apnea more effectively and efficiently.

“There is no such thing as predictive analytics and algorithms in dentistry,” says the 52-year-old Singh,
who also serves as an attending in the Department of Otolaryngology and Oral & Maxillofacial Surgery,
Lenox Hill Hospital, New York. “There are a lot more analytics used in medicine as compared to dentistry.
Analytics are used on a daily basis across the entire industry of finance. In finance, they don't make
decisions based on rumors.”

Machine learning and artificial intelligence are actually making the financial trades. Singh points to a
simple reason: Machines can analyze meta data from all kinds of news sources, as soon as it is made
public and comes across digital channels. Machines are scanning their sources in real time, scouring
digital platforms for certain key words. The analysis happens on a larger scale—faster and better than

“We can only base our judgement on the knowledge we have,” Singh muses. “Imagine if you put 20 years
of knowledge across multiple doctors and clinicians and compile all that data and analyze it, and figure
out that you can actually create this data base of answers to the questions. A doctor can ask a question,
and get an answer. That's what our system does. It literally guides dentists into a particular workflow for
effective treatment.”

Too often, the consequences of what Singh calls guesswork are poor results after two to three weeks.
“And patients have to keep going back and forth to the dentist to adjust the appliance, or the appliance
doesn't fit because they didn't take the bite correctly,” Singh says. “Patients will call their physician and
say, ‘How could you refer me to someone like that? I want something else.’ They aren't realizing that
dentists are not practicing based on objective data, and instead completely doing it subjectively.”
Factor in that sleep apnea treatment is not taught well, or at all, in dental school or in residency, and it
adds up to a familiar theme: Dentists need help. On the software side, there are limited offerings that
cater to dental sleep medicine, even fewer that also include medical billing. “EMR practice management
softwares are nothing more than a data warehouse,” Singh says. “There are no analytics built in there.
The software doesn't tell the doctor, that based on the parameters that have been entered, this is the
most appropriate course of therapy with the most predictive treatment outcome.”

According to Singh, APP-NEA, LLC is aligned with practice parameters set by the American Academy of
Sleep Medicine and the American Academy of Dental Sleep Medicine. It’s done ethically without “pushing
oral appliancea” when not indicated. Singh’s analytics actually exclude certain oral appliances from the
suggestions if the patient has certain conditions.

Singh points to the example of someone with claustrophobia or panic disorders; such a person would be
excluded from an oral appliance that connects their jaws together and prevents them from opening. “Most
dentists don't know this,” Singh says, “but because we've been doing this for so long, we know when
something is appropriate and when something isn't, across multiple cases.”

Singh brought APP-NEA, LLC to market last year in April. It's cloud-based, so “dentists can administer
their dental sleep medicine practice from anywhere,” as long as they have an internet connection. If there
are any updates in coding, like the ICD, CPTs, or new regulations come out, it’s done in the cloud.

“Ultimately, what we want is for the doctors to really do what's right by the patient, in the most expeditious
way, and the most comprehensive and ethical way,” Singh adds. “By migrating to the cloud, we have the
ability to analyze data in real time. Not just from one doctor and one patient, but across one doctor,
multiple patients, multiple doctors—even more patients in real time. We can scale it globally, because
sleep apnea is not just a local problem. It's a world-wide epidemic.”

INFO BOX – Singh At-a-Glance
Pankaj Singh, DDS, MD will soon present Cracking the Code: How Big Data and Analytical Algorithms
Can Prospectively Predict Treatment Efficacy at ??CONFERENCE. Singh holds diplomate status in The
International Congress of Oral Implantologists and the American Board of Oral Implantology/Implant
Dentistry, where he served as board examiner and currently serves as faculty at Foundation for Surgical
Excellence, a teaching and research foundation and is an Attending in the Department of Otolaryngology
and Oral & Maxillofacial Surgery at Lenox Hill Hospital, NYC. He is an Expert faculty at The New York
Head and Neck Institute and faculty at The Center for Facial Reconstruction at Lenox Hill Hospital and
the Northwell Health System.

He received his Bachelor of Science degree from SUNY at Stony Brook and Doctor of dental Surgery
from New York university College of Dentistry before doing his residency in Dental and Oral Surgery and
fellowship in Dental and Oral Implantology at Brookdale Hospital Medical Center, and fellowship in
Anesthesia at Albert Einstein School of Medicine and Montefiore Medical Center. He is a fellow of the
American Academy of Implant Dentistry and currently serves as an editor of the Academy’s Research
Publicaton “Journal of Oral Implantology” and serves on the board or several other publications.
Singh is the author of “Atlas of Oral Implantology – 3rd edition” by Mosby/Elsevier.  He recently invented
the minimally invasive guided implant and harvesting system, “Guided Precision Surgery” and has spent
the last 20 years researching the effects of oral appliances on airway and dental sleep medicine.