Prerequisites for Diplomate Applicants

When evaluating your prerequisites, please determine whether you meet all of the requirements and, if you do not, please do not submit an application. Applications and prerequisites will be reviewed by the ABDSM. The ABDSM will send notification of application/prerequisite approval to applicants by April 1, 2009. If such notification has not been received by April 10, 2009, please contact the ABDSM office immediately. All of the following prerequisites must be submitted in addition to a completed application and examination fee by December 1, 2008:

Documented Time in a Sleep Center/Laboratory

Each applicant must spend no less than ten (10) hours at an accredited sleep center/laboratory, documented in writing by a board-certified sleep physician (M.D., D.O. or Ph.D.) associated with that particular accredited sleep center or laboratory. The intention of this requirement is to document that the applicant has experienced direct observation of the operations of a sleepmedicine clinic. This time may include some or all of the following: direct patient interaction, observation of polysomnographypreparation, data acquisition, scoring and interpretation- clinical interaction, therapeutic intervention, and assessment of results of therapeutic intervention.

Copy of Dental License with Expiration Date

Each applicant must provide a copy of their current dental license with expiration date. If the dental license expires before the examination 2009 date, a renewed copy of the dental license is required and must be submitted to ABDSM by February 1, 2009.

Letters of Recommendation

Each applicant must provide letters of recommendation from two (2) board-certified sleep physicians (M.D., D.O. or Ph.D.).

Case Studies

Oral Appliance Track
Each applicant must submit a list of 20 documented oral appliance cases, distributed as follows: 15 distinct cases must be listed on a spreadsheet, and contain the following information: patient age, patient gender, pretreatment overall RDI or AHI, post-treatment RDI or AHI, and oral appliance utilized.

In addition to the above, each applicant must submit five (5) detailed written obstructive sleep apnea (OSA) case studies treated by the applicant using oral appliance therapy (OAT). Each case study must adhere to the following criteria:

• Document presence of OSA, by full overnight polysomnography (PSG). PSG must be performed at an accredited sleep center or laboratory and interpreted by a board-certified sleep physician.
• Document that patient has, at minimum, a pre-treatment OVERALL Apnea Hypopnea Index (AHI) or respiratory disturbance index (RDI) greater than 10; or Apnea Index (AI) greater than 5, and LSAT less than 90%.
• Include a typed synopsis stating the patient’s chief complaint, history of present illness, pertinent past medical history, clinical and radiographic examination, diagnosis, treatment, results, and disposition. Reasoning for use of the chosen appliance must be included (please note: appliances being utilized in each case MUST be FDA- approved for treatment of OSA, or have their formal FDAapproval status pending)
• Document at least three (3) follow-up appointments, the third appointment being at least three (3) months post OAT insertion.
• Contain the following sets of pre- and post-insertion supporting documentation, the post-insertion documents obtained no earlier than three (3) months after OAT delivery:
  1. Full overnight diagnostic PSG report of OSA. PSG must be performed at an accredited sleep center or laboratory and interpreted by a board-certified sleep physician.
  2. In selected cases when full overnight PSG is not obtainable, another objective measure of sleep related breathing such as a portable monitoring device must be performed, in compliance with the following criteria:
     1. A board-certified sleep physician must order, perform, interpret and report the data in writing to the dentist
     2. The same equipment must be used pre and post insertion
     3. Equipment used must report the overall treatment AHI or RDI of greater than 10, or AI greater than 5 and LSAT less than 90% (during the initial diagnostic study), with resolution (to less than 10) shown during the follow-up PSG
     4. Selection of the device is made by the sleep physician
  3. Radiographs, either panoramic and/or full mouth series. In addition, a pretreatment awake upright lateral cephalometric radiograph (taken at end-expiration) is required.
  4. Three photographs consisting of the frontal, right lateral and left lateral views of the dentition in occlusion are required pre-insertion. One frontal photograph of the dentition in occlusion with the appliance in-place is required post-insertion.
  5. Photos of study models submitted as either black and white, OR color images. Each Photo should be no smaller than 4 x 6 inches in size.
     Photos of study models are required to be submitted in the following manner:
     
     Individual Cast Views (1 photo):
     
     With full occlusal view of casts sitting back-to-back on the benchtop (1 photo)
     
     Articulated model views (6 photo):
     
     1) Anterior, right and left views of casts articulated in centric occlusion on the benchtop. (3 photos)
     2) Anterior, right and left views of casts articulated with the protrusion bite registration in place (ie: the patient’s initial treatment position) (3 photos)

     Study models themselves will not be accepted and will not be returned if submitted. Submission of stone models will delay the application process or render the application incomplete.

     Photos wherein objects cannot be clearly identified will be rejected resulting in a delay of the application process or rendering the application incomplete.

Surgery Track
A maximum of three (3) upper airway surgical cases may be substituted for no more than three (3) of the five OAT cases. Surgical procedures utilized must be well-documented in the OSA literature (peer reviewed journals and/or textbooks). All of the above OAT case specifications are required, including pre and post-operative supporting documentation, with the following modifications:

• A typed Operative Report, which must include the date and site of the procedure, the applicant listed as the primary surgeon, the specific procedures performed, indications for the operation (i.e., OSA data and other failed therapies, as applicable), and a detailed description of the operation.
• A concise rationale for the surgical procedure(s) (i.e., how it/they address the patient’s site(s) of upper airway obstruction) included in either the case synopsis and/or the Operative Report.
• The results of at least one (1) appropriate published imaging modality such as lateral cephalometry (obtained at end-tidal volume, with cephalometric analysis to include measurements of SNA, SNB, PNS-P, PAS, MP-H and Go-Pog), nasopharyngolaryngoscopy, MRI, CT scans and acoustic reflection, to document upper airway changes pre- and post-operatively.
• Panoramic radiographs, study models, and full dentition photographs (only for skeletal advancement surgery).
• Full facial photographs (only if there is a significant change in facial appearance).

The supporting documents described above should be duplicate copies and will remain in the ABDSM archives for a limited period of time. All supporting documents become property of ABDSM. The ABDSM will dispose of these supporting documents at a later date, to be determined by the ABDSM. Applicants are instructed to keep all original documents in their patients’ records.

Prerequisites for International Certificant Applicants

Certificate status has been created to allow applicants who are not permanent residents of the United States (contiguous states and territories) and Canada an opportunity to demonstrate competence in the dental sleep medicine.

All of the above requirements for Diplomate applicants shall apply to International Certificant applicants with the following exceptions:

1. Letters of Recommendation will be accepted from physicians who are not Diplomates of the American Board of Sleep Medicine
2. Pre and post overnight polysomnography (PSG) may be performed at a sleep center or laboratory that is NOT accredited by the American Board of Sleep Medicine. These studies, however, must be read and interpreted by a designated sleep physician.
3. The credentials of each attending sleep physician must be documented.