Visualizing the restricted airway

Dr. Agarwal puts an economic perspective on obstructive sleep apnea (OSA) therapy.

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Many dentists don't realize or give themselves enough credit for their role in the overall health of their patients. Most patients see their dentists way more often than they see their physicians. This gives us the opportunity (or even the obligation) to screen for conditions beyond cavities.

Of course, dentists are great at screening for oral cancer and periodontal disease. But there are many more areas that we can play a role in. Since my practice made it a standard of care to take blood pressure at every visit, we have referred hundreds of patients to see their physicians for more detailed evaluations. I believe dentists will soon be a first line of defense against diabetes by implementing simple "prick" testing.

Today I would like to talk about another serious condition for which screening can help save lives and help build practice productivity. I am speaking about obstructive sleep apnea (OSA). It is believed that there are over 20 million Americans who suffer from OSA and up to 90% of them are undiagnosed.

The great news is that one form of treatment for OSA is the fabrication of an oral appliance. This procedure is quite productive, is typically paid for by medical insurance, and helps to save your patients' lives. All around, it's a win-win.

Some of the traditional methods for screening are the use of patient questionnaires, measuring neck size, and/or evaluating oral airway size (e.g., Mallapati score). While these are effective in screening, they don't really do a great job of creating awareness and urgency with the patient.

Recently, Dentsply-Sirona released its SICAT Air software, which allows for airway segmentation. Since we implemented segmented airway analyses, we have seen a dramatic difference in the attention and urgency of our patients. Quite simply, patients respond to colorful visual representations!

Let me share my own airway segmentation with you (figure 1). At the narrowest point, my airway is only 3 mm deep and 8 mm wide. That means I am trying to breathe through an airway resembling a kinked garden hose. Seeing my airway like this really hit home and made me more serious about getting a medical diagnosis for OSA and seeking therapy.

I'd like to put an economic perspective on OSA therapy in your practice. Our practice averages about $2,500 per appliance as an allowable fee through medical insurance. Oral appliance therapy for OSA is a medically covered procedure as long as your patient has an official diagnosis through a medical doctor.

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Figure 1: Dr. Agarwal's airway segmentation

You owe it to yourself, your practice, and most importantly your patients to become versed in OSA and leverage 3-D technologies to create awareness and urgency. If I can be of assistance, please don't hesitate to reach out and contact me.

Author's note: Airway segmentation is not a method for diagnosis of OSA. Diagnosis must be completed via a polysomnogram and read by a licensed medical professional.


1. Sleep Apnea. Sleepdex website. Accessed September 17, 2016.

Tarun Agarwal, DDS, is a nationally recognized educator who is changing the way general dentists practice. He offers hands-on training focused on implementing procedures and techniques that drive practice growth. You can learn more by visiting, where you can also subscribe to his free weekly podcast.

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