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Episode #449: Expanding Your Thinking beyond The Oral Cavity, with Dr. Steve Carstensen

the best practices show podcast Jul 22, 2022


People are more health-conscious than ever. And who are the best professionals to go to for better health? Dentists! But it’s not just about fixing teeth and cleaning gums. Today, Kirk Behrendt brings back Dr. Stephen Carstensen, co-founder of Premier Sleep Associates, to highlight the other side to dentistry, breathing and airway, so you can help people breathe better to live better. Don't just be another dentist — help solve airway issues before they happen. To learn how, listen to Episode 449 of The Best Practices Show!

Main Takeaways:

Start the sleep and airway conversation with your patients ASAP.

Only dentists can solve cranio-facial issues before they happen.

Be professionally curious and ask good questions.

Learn new ways to engage with your patients.

Have confidence in what you're doing.


“People who don't sleep well, they don't sleep well because they don't breathe well. And if we allow the body to breathe well — at any age — then the body will take care of its own sleeping problems. And the more we address this early in life, the better the physiology goes on through life.” (10:01—10:20)

“I treat 50 and 60 and 70-year-olds in my clinic. Well, all those people used to be five, six, and seven. Right? And so, what if we could treat a three-year-old and do something about breathing when they're tiny? Maybe they don't become 50 and 60 and 70-year-olds with massive problems.” (10:21—10:38)

“In dental school, we’re trained, ‘Well, these people need protection from themselves, so let's make them a nightguard.’ Nobody should have a nightguard without questions about their sleep and breathing while they sleep, because it’s so highly correlated — not cause it, but correlated. So, don't make any nightguards without asking, ‘Do you snore? Do you breathe well at nighttime? Do you wake up refreshed?’ those kinds of screening questions you can find from a STOP-BANG, for example.” (13:35—14:00)

“One of the things to consider is when patients come back to you and they say, ‘Well, I can't wear a nightguard,’ ‘Well, why not?’ ‘Well, it just doesn't feel comfortable.’ There are not very many reasons why a nightguard should feel uncomfortable. In Pankey training, early on, they said, ‘Well, it’s because you didn't have it fitted right, because you didn't have it adjusted right.’ So, we'd spend a lot of time doing that. But what we really need is more curiosity. Why didn’t it fit right? What’s going wrong? And you'll discover a lot of patients who don't breathe well. And when you start thinking about that, you can make a different appliance.” (14:10—14:39)

“Be professionally curious. Read some books. There are a lot of good books to read.” (14:46—14:49)

“Buy a copy of Breath [by James Nestor] and put it in the reception room, because people are going to have seen that. And when they see that, they might go to the dentist and say, ‘What should I think about that? I've heard of that book. Should I read it?’ or, ‘I read it. What are you going to do to help me?’ Just throw out the question. Start the conversations. And pay attention to what the answers are so that you can identify where it is that you need to learn some more stuff.” (15:30—15:54)

“Getting paid is not the biggest problem, any more than it used to be. The biggest thing is comfort and confidence in what you're doing.” (16:43—16:51)

“The key is the dentist has to get curious, and then train the team. Because in Washington State, I am legally obligated to do the exam, to ask the patient what their chief complaint is — and that's it. That's all I have to do, legally, to treat a patient with an oral appliance.” (17:28—17:51)

“People are wanting to find ways to improve their overall health. And as dentists are increasingly seen as part of the primary care network — not just the oral care network, but the primary care network, because we can see the results of bad health on the gums. We can listen to people’s stories and say, ‘Well, that could be because of allergies,’ or, ‘How are you breathing at night?’ or, ‘Are you eating right? Are you having too much of this or that?’” (19:25—19:54)

“Dentistry is going to take over little kids’ airway because it’s not about sleep. It’s about breathing patterns. It’s about jaw structure, growth, and development. And only we can do that.” (22:13—22:25)

“Nobody has any statistics about [whether children’s sleep issues are getting worse] because medicine has been focused on two things primarily. One is sleep issues. They framed that from their perspective of treating adults. They learned about sleep issues by watching people die in their sleep, not breathing well in their sleep — old guys. Old, fat guys in the original days. Then, they realized it’s not just old, fat guys. They have any adult.” (23:24—23:50)

“What medicine doesn't do very well is look for the reasons behind the symptoms that they're noticing. If you have a symptom, you get a pill. If you have a sleep problem, you get a sleep diagnosis. But the real reason is, behind many things, is the diet, the growth and development, the patterns. It’s the function of things. And so, if we don't have a good airway structure, if our bones aren't in the right place to support the soft tissues, it can't function well. And ultimately, it’s the function of things. It’s the function of respiration that allows the brain to have enough oxygen.” (23:59—24:36)

“Start with the questions, pay attention, and bring your dental assistants into the room with you. So, if you have an interview going on with a patient and you're curious about this, make sure your dental assistant is sitting there listening, or your front desk, anybody on your team . . . have them listen to the conversations. That way, they can support the conversation when you step out of the room. And learn together so the team learns together. It’s all new stuff. It’s not learning another composite. It’s learning a whole new way of engaging with your patients.” (25:52—26:31)

“When [patients] realize you're not there to try and sell them another filling, you're not trying to tell them they're being bad people because they don't brush and floss, they're sensing that you're really trying to help them get healthier, now, the patient engages with the office on a completely different level. And when that happens, now they have a different thing to talk about. ‘How was your checkup today?’ ‘Well, it was fine. My hygienist said I'm good. I should floss more.’ I mean, you don't want them saying that out in the community. You want them out there saying, ‘You know what? They asked me about my breathing. And they told me my gums were inflamed because I'm mouth-breathing. And so, I've got some strategies to be a better nose-breather so my lips won't be dry,’ and all the cool things that we can come up with, a different topic to spread the word in your community about your dental practice.” (26:35—27:22)

“If you think it’s simplistic enough that all you have to do is make a simple jaw-forward pulling device and that's it, well, then that's not enough.” (28:18—28:27)

“What we’re talking about here is what Dan Heath calls upstream problems. So, instead of dealing with things downstream, side effects and symptoms and things that medicine tries to do something about with pills, we go upstream. We get problems solved before they happen. So, it’s a whole new way of thinking. And that's only dentistry. Only dentists can do something about the growth and development of the cranio-facial-respiratory complex, nose, all the bone structures that support the airway. We’re the only part of medicine that could do anything about that.” (34:42—35:17)


0:00 Introduction.

2:48 Dr. Carstensen’s background.

4:30 Where his passion for his field comes from.

6:59 Dentists are well-suited for improving people’s health.

9:29 Treat patients as early as possible.

11:37 Dentists’ long history of being naysayers.

12:50 Be professionally curious.

15:54 How to introduce this sleep and airway into your practice.

18:36 More people are paying attention to their health.

20:17 Is the dental and medical community coming together?

22:52 Are children’s sleep issues getting worse?

25:26 Start by asking good questions.

27:54 What dentists get wrong about this area of dentistry.

31:05 What Dr. Carstensen teaches about the nasal cavity.  

35:44 More about Dr. Carstensen and how to get in touch.

Reach Out to Dr. Carstensen:

Dr. Carstensen’s website: https://stevecarstensendds.com/

Dr. Carstensen’s email: [email protected] 

Dr. Carstensen’s Facebook: https://www.facebook.com/steve.carstensen.35

Dr. Carstensen’s social media: @swcdds


The Pankey Institute: https://www.pankey.org/

The Breathing Cure by Patrick McKeown: https://www.betterworldbooks.com/product/detail/THE-BREATHING-CURE--Exercises-to-Develop-New-Breathing-Habits-for-a-Healthier--Happier--and-Longer-Life-9781630061975

STOP-BANG questionnaire: http://www.stopbang.ca/osa/screening.php

The Clinician’s Handbook for Dental Sleep Medicine by Dr. Ken Berley and Dr. Stephen Carstensen: https://www.greatlakesdentaltech.com/the-clinicians-handbook-for-dental-sleep-medicine-authors-ken-berley-and-steve-carstensen_070-050.html

Breath by James Nestor: https://www.mrjamesnestor.com/

Sleep-Wrecked Kids by Sharon Moore: https://sleepwreckedkids.com/

Brave Parent by Dr. Susan Smallegan Maples: https://beabraveparent.com/

Upstream by Dan Heath: https://heathbrothers.com/books/upstream/

Dental Sleep Practice magazine: https://dentalsleeppractice.com/

Collaboration Cures September 15-18, 2022: https://www.aapmd.org/collaboration-cures-2022

ADA Children’s summit September 23-24, 2022: https://www.ada.org/education/continuing-education/ada-ce-live

Dr. Steve Carstensen Bio:

After Dr. Stephen Carstensen graduated from Baylor College of Dentistry in 1983, he and his wife, Midge, a dental hygienist, started a private practice of general dentistry in Texas before moving to native Seattle in 1990.

In 1996, he achieved Fellowship in the Academy of General Dentists in recognition of over 3,000 hours of advanced education in dentistry, with an increasing amount of time in both practice and classwork devoted to sleep medicine. A lifelong educator himself, Dr. Carstensen is currently the Sleep Education Director for both The Pankey Institute and Spear Education, recognized as among the finest places for dentists to further their education. As a volunteer leader for the American Dental Association, he was a Program Chairman and General Chairman for the Annual Session, the biggest educational event the Association sponsors.

He’s a Consultant to the American Dental Association for sleep-related breathing disorders and co-author of a textbook for dentists treating the disease.

For the American Academy of Dental Sleep Medicine, he’s been a Board Member, Secretary-Treasurer, and President-Elect. In 2006, he achieved Certification by the American Board of Dental Sleep Medicine.


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