Considerable money, expertise, and even star power has been poured into a new venture in the east Texas city of Tyler, all in an effort to fight sleep apnea and bring oral appliances to the forefront of treatment. Thanks to NFL greats Gary Baxter and Earl Campbell, the Project Rose Sports Science Center is now open in conjunction with Texas Spine & Joint.
Officials at the American Sleep & Breathing Academy (ASBA) are working closely with Baxter and Campbell to help stock the facility with top-notch dentists who are experts in the treatment of sleep apnea. And while all appropriate treatment modalities will be on the table, these dentists are well aware of the effectiveness (and excellent compliance rates) of oral appliances in the successful treatment of obstructive sleep apnea (OSA).
“By some studies, about 70% of people who get a CPAP machine are not wearing it in six months,” says Harry Sugg, DDS, owner of Dallas-based Wheatland Dental, and a dentist at Project Rose. “That is too many people left untreated. Oral appliances can treat them.”
Not all clinicians agree with Sugg, but Rebecca Lauck, DDS, believes that is mostly due to a lack of education. “Most medical professionals are not even aware of oral appliances,” says Lauck, who owns a traditional dental practice, as well as a dental sleep practice. “They have never seen them or heard of them, and they are oblivious. They have only learned about CPAP.”
In her area of Keller, Texas, Lauck does her part to spread awareness by speaking with physicians and educating them about her patients who are benefitting by wearing oral appliances. “But there are not many people like me around spreading the message,” says Lauck, who will be treating Project Rose patients when the concept expands to her region of the Lone Star state. “They [physicians] would rather just refer their patients to a sleep doctor and be done with it.”
The mere existence of Project Rose, as a facility-based sleep center with dentists on staff, will contribute to the increasing level of respect enjoyed by dental sleep medicine. When the “Rose” banner spreads to a planned 100 facilities across the nation, oral appliance awareness will only be that much higher.
Baxter and Campbell will no doubt boost that awareness among sports fans who remember Baxter as a star cornerback/safety on the stalwart defense of the Baltimore Ravens, while Campbell is a past Heisman Trophy winner and star running back primarily with the Houston Oilers.
Both men care deeply about current and retired athletes, but Project Rose is designed to reach the entire patient demographic. David Gergen, CEO of the ASBA, estimates that the ratio will likely be 97% general population to 3% premier athletes. “The ultimate goal,” says Gergen, “is to integrate dentists into hospitals and make oral appliance therapy the true go-to line of defense for obstructive sleep apnea.”
Coaches have long set curfews as a way of ensuring proper slumber and better performance on the field, but these days coaches are recognizing the importance of clinically proper sleep. It’s not enough to be horizontal, because physical recovery depends on real sleep. Sugg points out that all of this applies to active and retired athletes.
“Some of those linemen at 300 pounds stop playing and they have a very high incidence of sleep apnea,” he says. “Project Rose is an avenue that Campbell and Baxter see as an opportunity to create something positive and useful for athletes and the public. They are doing it in a top-notch way, because they have the backing of the NFL. If it’s good enough for football players, it will be good enough for the general public as well. The scope of what they are doing here is phenomenal. Tyler is just the beginning.”
Into the Hospital Setting
Project Rose in Tyler is firmly in the hospital environment, which streamlines billing, and more importantly, streamlines the treatment process. “The sleep beds are right there and take-home sleep studies are also there for mild to moderate cases,” says Sugg. “Then the oral appliance gets made and it gets titrated over a couple of visits. The NFL will be helping with the promotion.”
Encompassing about 25,000 square feet, the facility will include physical therapy and rehabilitation. The top floor is the Texas Spine and Joint Hospital, recently bought out by Baylor University. “It’s a whole new way of doing sleep medicine in a hospital environment,” enthuses Sugg.
Project Rose is a “Center for Excellence” built with Texas Spine & Joint and partner Baylor Scott and White. Baxter told a local newspaper: “For Earl and myself, this is a dream come true. We’ve done a lot of hard work on this. We wanted to bring something special…We’re raising money to do research in the field of sports. We want to make sure for the next generation that we are helping to prevent injuries and stop injuries through education. Then even after guys get hurt or injured, we want to be there to help them return to the field and/or return to normal life.”
Phase 2 will feature a Bio-Mechanic Lab where researchers will work on everything from muscle tears to helping prevent and lessen the effects of concussions. “My hometown means the world to me, and to be able to give back is what life is all about,” said Earl Campbell. “My goal for this non-profit is to help as many people as possible, while we contribute to the study of sports science. I am so thankful for the opportunity.”
With the academic backing of ASBA and the promotional heft of NFL star power, Campbell’s goal fits in with what ASBA member dentists believe is a nationwide trend toward greater acceptance of oral appliances in the fight against sleep apnea. Rebecca Lauck points out that sleep apnea is a relatively young field when compared to cardiology and other facets of pulmonology. As such, it’s not surprising that acceptance is still not at particularly high levels—at least not yet.
“It’s a shame, but dentists are not really trained extensively on sleep,” says Lauck. “They might go to a quick course and learn how to do an appliance, and they may offhandedly make an appliance and not know how to really get it to work for a patient. We need to do more to help them. It needs to be a specialty within dentistry so that oral appliances are treated the way they should be.”
Assembling the Team
The Arizona-based ASBA has quickly made its mark as a zealous proponent of oral appliances for the treatment of sleep apnea. CEO David Gergen bristles at the “CPAP gold standard” comment, frequently pointing out that nothing can be a true gold standard if it’s not being worn.
Harnessing the considerable popularity of the National Football League, Gergen and executive director Alan Hickey have been able to advance the cause beyond academic shows to encompass football fans, many of whom come to sleep apnea awareness via their gridiron heroes.
Project Rose is heavily dependent on expert clinicians such as Sugg, Lauck, Edward H. Hobbs, DDS, MS, and others. Hobbs echoes a familiar story about his initial involvement with the Project Rose endeavor. “Dave Gergen, who owns a dental lab out in Phoenix, called and wanted to discuss something,” says Hobbs, owner of DENTACARE Dental Group, Longview, Texas. “He described their plans, and how it was set up to help a lot of people. The people involved were well known—Earl Campbell and Gary Baxter—and I said yes.”
Like so many of his colleagues, Hobbs heard little about sleep medicine in the early days of the dental profession. About 20 years ago, however, he decided to “Go take a sleep course in Dallas and learn something about these ‘sleep appliance’ things.” He learned from an experienced doc and this initial exposure led to mini residencies at prestigious universities. And yet, even in 2017, there is much work to be done.
“The level of respect for oral appliances has a long way to go among members of the medical community,” laments Hobbs. “These people are so busy that they have a hard time keeping up with ancillary fields such as oral appliances. They are just overwhelmed. They don’t totally understand the use of these appliances and the dentist’s role—and how successful they are.
“The lack of compliance in the CPAP world shows us that patients are using it less than 7 hours,” continues Hobbs. “The oral appliance has tremendous opportunity to help a lot of people in treating their sleep apnea and breathing disorders. The more we can get people to understand, the better for the patients, and that’s what it’s all about. Project Rose treatment centers will be instrumental in spreading this crucial awareness.”