As we continue our journey to help dentists navigate new trends and exciting revenue opportunities, we want to pull away from the tech-based talk of AI or 3D printing. Instead, let’s look at adding new procedure mixes that are outside of the norm. In particular, sleep dentistry is an exciting space.

Not to be confused with sleep dentistry, sleep medicine dentistry is focused on treating sleep-related conditions that involve the mouth (e.g., sleep apnea, snoring, xerostomia,
hypersalivation, GERD, orofacial pain, etc.)

In the past, sleep disorder treatment was largely confined to the medical ecosystem. Yet, increasingly, dentists play an important role in the diagnosis and treatment of these disorders. Like doctors, dentists can administer at-home sleep tests. More importantly, dentists are often the first professionals to notice sleep disorders, especially since many create complications in the mouth.

The Sleep Dentistry Population

Truthfully, +90 percent of dental sleep medicine patients have sleep apnea. Part of this is due to the sheer prevalence of sleep apnea. According to the AASM, 26 percent of adults between the ages of 30 and 70 have sleep apnea. Around 80 percent are unaware of their diagnosis, and many (if not most) will never get a diagnosis from a physician.

The role of dentistry in the diagnosis and treatment of sleep apnea is an area of ongoing study. While CPAP machines remain the most common treatment for those with sleep apnea, many patients struggle to use these machines regularly, and a significant chunk of patients outright refuse to use CPAP or are not adequately assisted by these machines.

Dental appliances are increasingly important in the treatment of sleep apnea. These include mandibular advancement devices, mouth guards, tongue-retaining devices, and a variety of other dental appliances. Current research suggests that these devices are highly effective for mild to moderate sleep apnea, which accounts for the vast majority of apnea patients.

Importantly, dentists are playing an important role in the treatment of sleep apnea patients. Despite the vast majority of physicians recommending CPAP machines by default, millions of Americans are finding dental sleep medicine to be a gateway to relief without noisy and complicated machinery.

The true number of sleep apnea patients is over 50 million in the United States alone. Worldwide, this number breaches 1 billion. The ADA has also endorsed the value of dental sleep medicine. While calls for further collaboration between physicians and dentists have yet to materialize, workflows have already been established by both the ADA and downstream dental sleep medicine organizations.

The Economics of Dental Sleep Medicine

According to Dental Economics data, the charge for each installed dental sleep medicine device is around $3,000.

Unfortunately, that same article interviewed a doctor (Dr. Jay Neuhaus), who noticed a $4,000 net return for dental sleep medicine device fits. This particular doctor only paid himself, his wife, and his assistant. He dedicated two days a month to his dental sleep medicine practice.

So, it was a relatively low-volume and low-cost operation. This $4,000 net ROI number has since been copied across dental articles. It’s not particularly accurate.

Most dentists will not hit that ROI. That said, the revenue can still be significant, but there’s a real economic commitment as well.

In terms of revenue, a full-service dental sleep clinic that helps 100 patients per month will earn around $3.6 million per year in gross revenue. On the flip side, there are plenty of costs that go into sleep dentistry that are relatively unique compared to the operating costs of a traditional dental office.

These include things such as:

• Hiring a sleep coordinator (a must-have for high-volume dental sleep medicine clinics)
• Training for dentists, hygienists, and assistants
• Creation of a new LLC to provide services
• Marketing costs
• Costs associated with “lost opportunity”
• Additional tax complexities
• New software suites and vendors
• Costs Associated With Employees

Sleep coordinators — a valuable asset for dental sleep medicine — are a significant upfront cost. The average salary for a sleep coordinator in the United States is $31,118, with those in Canada earning about $38,000.

Can offices survive without one? Of course. Plenty of dental sleep medicine providers use a hygienist (who has been trained in sleep medicine) to provide the services of a sleep coordinator.

That said, most successful full-time practices leverage a sleep coordinator to coordinate sleep testing and scheduling.

Even without the sleep coordinator, you will need a hygienist. Unless you plan on doing this full-time, we highly recommend leveraging proactive staffing or temporary employees to handle your regular hygiene duties while you and a full-time hygienist focus on these new opportunities (or vice-versa).

Depending on how many patients you plan on seeing, you may also need additional assistants and/or receptionists — which are also costly.

Costs Associated With Training

Most dentists get accredited through the AADSM. It’s $6,000 for AADSM certifications for Master Level 1 and Master Level 2. In general, US & Canadian dentists (AADSM accredits both) can expect to spend around $3,500 – $10,000 on accreditation and training — depending on how much you do.

Of course, those figures only involve the dentist. Staff will also need to be trained. While this cost is variable, you can expect around 2 full days of missed work per employee (opportunity cost). If we assume the average hygienist makes $1,800 per day, that number comes to around $2,600 for hygienist training. Assistant training will likely fall a little lower, probably around the $1,000 – $1,500 mark.

Proactive staffing can reduce some of these costs. But there’s also a hidden barrier here. To practice dental sleep medicine regularly, you’ll need a semi-dedicated hygienist, which will likely require a new hire. Given that we’re in the middle of the worst staffing shortage in history, finding one isn’t always easy.

Costs Associated With Marketing

This is a huge bucket. The average dental office spends anywhere from 2 to 5 percent of its revenue on marketing. But the population that needs dental care and the population that wants sleep medicine are very, very different.

Let’s get this out of the way: doctors are not going to refer patients to your practice. They will likely always recommend a CPAP machine, regardless of circumstances or patient.

You will be responsible for seeking out potential patients. Easier said than done. These patients have to both have sleep apnea (80 percent don’t even know they have it), and they’ll have to be willing to try sleep dentistry. Despite robust research proving its effectiveness, most people still have no idea what sleep medicine dentistry is, or that it’s even an option for them.

Thus, marketing proves to be a challenge.

Your marketing costs will be much higher than 4 to 5 percent of revenue. We would expect closer to 10 to 15 percent. These costs may go down over time (especially if you’re in a less competitive area). But we expect these costs to always remain a little higher than baseline dental costs. Not only are you going to pay more for ad targeting and clicks, but you’ll have to hustle to deliver targeted ads and materials to a unique population.

Costs Associated With Opportunity Loss

When you’re fitting a patient with a sleep device, you could be doing dentures or aesthetics instead.

You’re not getting $3,000 per device. You’re getting $3,000 – costs – opportunity costs.

If you could do a maxillary denture for $2,100 during this time instead, you’re only actually earning $900. Obviously, this gets more complicated (highly dependent on your population and patient needs).

But it’s safe to assume you could earn at least 1/3rd of this fee during regular work hours. Let’s not spend too much time on this bucket. It’s too variable. But you can (and should) consider opportunity loss when deciding whether or not dental sleep medicine makes sense for you.

Miscellaneous Costs

In addition to the costs above, there will be some minor costs associated with:

• Setting up an LLC

• Creating logos and branding

• Doing additional taxes

Final Thoughts

So, where does this leave us?

As The Profitable Dentist puts it: “99% of dentists don’t make it in sleep medicine.”¹ You have to put forward an investment. And it’s time-consuming. Dental sleep medicine can make very, very good money. But you have to approach it with a game plan. And don’t expect to just start making $3,000 pure profit per procedure.

Dental sleep medicine is a unique opportunity. And we get the hype. But it’s also a serious commitment that isn’t for everyone.