After eligibility has been confirmed, candidates must successfully complete the following five requirements within the specified time frame to qualify as a Fellow:
- Pass multiple-choice examination (passing grade: ≥70%)
- Complete case logbook (at least 15 cases)
- Complete three detailed case reports
- Obtain at least 10 hours’ experience observing in a sleep laboratory
- Obtain two references from sleep physicians in the specified format.
All candidates, regardless of prior learning or experience in dental sleep medicine, must complete a 3-hour examination comprising of 150 multiple-choice questions based on key topics of the dental sleep medicine program listed in the next section.
This Handbook contains a list of recommended reading and resources, but access to the reading material and resources is not necessarily included in the FDSM program. ASA membership benefits include access to the journals SLEEP, Sleep Advances and Sleep Medicine via the secure Journals page on our website.
The examination will be held in person at the annual Sleep DownUnder conference, and there may be other times and online options available depending on demand. Please contact Marcia Balzer ([email protected] or 02 9920 1968) to enquire about current examination time availabilities.
Candidates must obtain a mark of 70% or higher to pass the examination. Unsuccessful candidates may sit the examination a second time (additional fees apply), however no further attempts will be allowed for a minimum of two years.
After passing the examination, successful candidates will have a maximum of 12 months to complete the remaining program requirements (logbook, case reports, sleep laboratory observations, sleep physician references). If the remaining requirements are not met within 12 months, an extension of 6 months may be granted after payment of an additional fee. Inability to complete after the 6-month extension will require the candidate to re-apply for the program and re-sit the multiple-choice examination. Exceptions may be granted due to personal hardship or other extenuating circumstances.
Examination questions are multiple choice and will cover the full range of topics in the 10 key topic areas listed below. Questions for key topic areas have been provided by academics, researchers, and clinicians in various fields of medicine and dentistry to ensure a wide range of required knowledge is tested via this multiple-choice examination.
Examination key topic areas
1: Understand normal sleep including its physiology, and the pathophysiology of various sleep disorders with emphasis on sleep-disordered breathing.
1.1 Health benefits of normal sleep
1.2 Physiology of normal sleep
1.3 Pathophysiology of SDB including anatomic and non-anatomic factors
1.4 Prevalence and Comorbidities of SDB
1.5 Risk factors of SDB including age and gender
1.6 Signs and symptoms of SDB
1.7 Impact of sleep disorders on the individual
1.8 Impact of sleep disorders on society
1.9 Prevalence, pathophysiology, and the clinical features of insomnia
1.10 Other respiratory sleep disorders
1.11 Other non-respiratory sleep disorders
1.12 The effects of pharmacotherapeutics on sleep
2: Understand diagnostic sleep testing in sleep disordered breathing
2.1 Normal sleep architecture and respiratory parameters on polysomnography
2.2 Pathological sleep architecture and respiratory parameters on polysomnography
2.3 Interpretation of polysomnogram and how its influences treatment recommendations such as behavioural therapies, CPAP, oral appliance, surgery, pharmacotherapeutics
2.4 Interpretation of treatment efficacy on polysomnogram
2.5 Comparison of attended (laboratory based) and unattended (home) PSG including their indications, advantages, and disadvantages.
2.6 Other types of sleep testing such as vigilance testing (multiple sleep latency test MSLT and maintenance of Wakefulness test MWT) including their indications, method, and interpretation
2.7 Screening for sleep disordered breathing
3: Demonstrate knowledge of oral appliance therapy for sleep disordered breathing as well as other evidence-based treatments
3.1 History of oral appliance therapy
3.2 Mechanism of action of oral appliance therapy
3.3 Indications, contraindication, advantages, and disadvantages for oral appliance therapy
3.4 Positive Airways Pressure therapies (CPAP, APAP, ASV, BiPAP) indications, contraindication, advantages, and disadvantages
3.5 Surgical options for sleep disordered breathing
3.6 Other therapies (positional therapy, sleep hygiene, weight loss, cognitive behavioural therapy)
3.7 Other emerging therapies (pharmacology, Expiratory positive airway pressure (EPAP) valve, Hypoglossal Nerve Simulation, exercises, etc.)
3.8 Combination therapies
3.9 Oral appliance therapy efficacy compared to other treatment options
3.10 Concepts of Mean Disease Alleviation (effectiveness), efficacy and compliance
3.11 Understand current practice guidelines and role of evidence-based practice and concepts of best practice
4: Dental sleep medicine history taking, examination and imaging for patient selection and treatment planning
4.1 Dental sleep medicine history taking including reason for attendance, goal setting and
4.2 Medical history taking including effects of age, obesity, drugs/medications, alcohol, smoking, other sleep disorders and comorbidities on the upper airway and overall morbidity
4.3 Relationship of sleep disordered breathing to other sleep-related problems (narcolepsy, RLS, PLMD/S, insomnia, insufficient sleep, shift workers syndrome)
4.4 Understand the relevance of medical comorbidities (hypertension, cardiovascular disease, metabolic syndrome, GORD, depression, anxiety, neurocognitive decline) associated with sleep disordered breathing.
4.5 Ethics and informed consent
4.6 Working as part of a multi-disciplinary team and how to provide optimal care and communication to referring physician and interested parties
4.7 Sleep bruxism and relationship with sleep disordered breathing
4.8 Pain and sleep
5: Oral appliance selection based on history, examination and design features and impression taking, bite registration and fitting
5.1 Clinical practice guideline for oral appliance therapy in the treatment of obstructive sleep apnoea
5.2 Mechanism of action of oral appliance on the upper airway
5.3 Indications and contraindications for oral appliance therapy
5.4 Considerations for different appliance designs including advantages and disadvantages of each, manufacturing materials and fabrication techniques
5.5 Selecting the best device designs based on history, examination, sleep study findings, and patient preferences
5.6 Rationale for initial bite registration position, including vertical, horizontal, and lateral components and discuss of various bite registration techniques
5.7 Understand impression material available and requirement for an accurate impression
5.8 Writing a laboratory request for device fabrication
5.9 To deliver a retentive device along with assessing fit, comfort, vertical dimension, and protrusion at delivery
5.10 Delivery of device home care instructions
6: Assess effectiveness and titrate oral appliance
6.1 Reverting to patient’s chief complaint, history, signs, and symptoms in the titration process.
6.2 Reviewing signs and symptoms during follow-up appointments
6.3 Consideration and assessing the need for referral for objective testing of the efficacy of the oral appliance
6.4 Treatment sleep study protocols for confirming oral appliance efficacy and need for further titration
6.5 Oral appliance efficacy, long-term effectiveness, and limitations
6.6 Treatment adherence and need for monitoring compliance
7: Long-term follow-up of patients in oral appliance therapy
7.1 Impact of age, weight change, alcohol use, medication change, sleep hygiene/quantity, etc., with long-term oral appliance therapy
7.2 Relevance and documentation of evolution in patient’s initial complaint based on self-reported and sleep-observer measures
7.3 Treatment modification related to progressive nature of sleep disordered breathing
7.4 Reiterating appliance condition, stability, and care at yearly review appointments
8: Understand the diagnosis and management of paediatric sleep disordered breathing
8.1 Prevalence of snoring and obstructive sleep apnoea in children
8.2 Etiology and pathophysiology of snoring and obstructive sleep apnoea in children
8.3 Signs and symptoms of sleep disordered breathing in children and adolescents
8.4 Other causes of poor or insufficient sleep in children and impact on their development
8.5 Other causes of poor or insufficient sleep in adolescents and impact on cognition, physical performance, impulse control and decision making
8.6 Screening of children and adolescents for sleep disordered breathing
8.7 Treatment of snoring and obstructive sleep apnoea in children and adolescents including surgical options, CPAP, orthodontic treatment, and other therapies
8.8 Differences in sleep disordered breathing in children and adults
8.9 The relationship between sleep disordered breathing associated with underlying medical conditions and syndromes
8.10 Referral pathways for children and adolescents for diagnosis and treatment
9: Understanding best practice principles in dental sleep medicine
9.1 Diagnosis of sleep disordered breathing by a physician
9.2 Knowledge of record keeping requirements including baseline sleep study data, ongoing clinical notes, treatment planning, study models, informed consent and interprofessional communication
9.3 Use of correct and appropriate item codes for billing patients privately and for Department of Veteran's Affairs
9.4 Ethics in dental sleep medicine
10: Informed consent and manage side effects of oral appliance therapy
10.1 Obtaining informed consent for treatment
10.2 Understand evidence-based expectations of oral appliance side effects
10.3 Understand mandibular protrusion effect on cranio-facial structures including the soft tissue, teeth and TMJs
10.4 Use of occlusal guide and morning exercises for prevention and management of oral appliance side effects
10.5 Management of side effects
10.6 Decision-making regarding suspending or abandoning oral appliance therapy for various clinical scenarios
Recommended reading and learning resources
A recommended reading list can be downloaded below. This is based on key topics that will be examined during the 3-hour multiple choice examination. Please note that completing the readings does not guarantee you will pass the exam, and you may need to supplement this with other learning activities to fill in any knowledge gaps. A more complete library of the articles in this list is available for enrolled candidates of the FDSM and contains excepts from textbooks and journal articles not available in the link below. This library can be found here.
The Learning Centre offers opportunities for on-demand education relevant to the key topic areas as well as webinars and other training opportunities that take place in real time. Here are some suggested on-demand learning opportunities that may support your learning journey through the program. (You must be logged in to the Learning Centre for these links to work!)
The log book must include details of at least 15 dental sleep cases that the candidate has undertaken:
- all cases must be of patients with obstructive sleep apnoea (OSA)
If a patient does not complete treatment or fails treatment (thereby post-treatment assessments are unavailable), the case is still eligible to be included in the log book given candidates meet the following conditions:
- Patients lost to follow-up, post-appliance insertion: provide documentation of attempts to contact patient and/or referring sleep physician (e.g., emails, letters etc)
- Appliance or treatment fail patients: provide statement (in comments section of post-treatment log) of how it ended and any comments of other sleep apnoea-related symptoms the patient presented that may have improved (e.g. snoring, sleepiness etc.), with suggestions for other therapies or adjustments that may be beneficial.
A template example of the level of detailed required for log book is available for download:
Log books will be assessed by an examiner to ensure the cases meet the required clinical competency standards. For any log books that fail this assessment, the examiner will prepare a short report for the candidate on the reasons why, and what is required for resubmission of the log book. For example, there may be just one case where competency standards were not demonstrated, and the resubmission requirement may be to replace this single case with a new case that meets the necessary requirements. Where there are multiple concerns with the quality of treatment detailed in the log book, there may be a requirement for 15 new cases to be prepared in a second log book. There will be no additional fee if resubmission of a log book is required.
Detailed case reports
A total of three detailed case reports of more complex dental sleep medicine treatments must be provided by candidates. These cases may involve patients who were non-responders for whom the following details should be discussed in the case report by the candidate:
- written explanation to outline possible reasons why treatment was unsuccessful
- possible solutions regarding conversion of non-responder to responder and other options regarding therapy for sleep apnoea
- demonstrate detailed understanding of the case, discuss patient symptoms or concerns (i.e., snoring, sleepiness etc.) pre- and post-treatment.
Candidates are required to provide the following documentation for each of the detailed case reports:
- copy of pre- and post-treatment sleep study reports
- documentation (copies of dated clinical reports) of at-least 3 face-to-face follow-up appointments: third appointment being at least 3 months post-oral appliance insertion
- provide pre-treatment intraoral photographs or digital colour screenshots of patient’s dentition scan consisting of the following: anterior view in occlusion, right view in occlusion, left lateral view in occlusion, anterior view with the bite registration in place, right or left view with bite registration in place, anterior photograph of patient’s dentition with the appliance in place
- all photographs / radiographs must be taken before, and not more than 3 years prior, to oral appliance insertion.
An example of a detailed case report is provided below as a guide.
Case reports will be assessed by two examiners, who will each independently grade the quality of competence demonstrated in the reports. They will discuss any concerns and agree on a pass or fail result for the candidate.
The examiners will also prepare a short report for any case reports which fail on the reasons why, and what is required for resubmission of the case reports. For example, all three may need to be re-submitted with additional information, or one may not meet the required competency standards, and a replacement patient case report will need to be submitted. There will be no additional fee if resubmission of case reports is required.
Sleep laboratory observations
Each candidate will need to undertake 10 hours of observation at a sleep laboratory and submit documentation confirming they have completed the necessary requirements. The checklist of observations required is included below.
The ASA can support candidates by identifying sleep laboratories in their area that are willing to host observation visits. Please contact FDSM program staff if you require any assistance with locating sleep laboratory placements.
Candidates will meet this requirement on submission of a completed and signed checklist to program administration within the required timeframe.
Sleep physician references
Each candidate must provide letters of recommendation from two sleep physicians who have referred cases to the candidate. The required template for the letters is included below.
The ASA can support candidates by identifying sleep physicians in their area who may be willing to provide references. Contact the FDSM program staff if you need assistance with this requirement.
Candidates will satisfy this requirement when they submit two recommendations from sleep physicians in the required format.
Go to the next handbook section: Completion