Mini-Residency Exam | Dental Sleep Medicine Training for Dentists

A patient with chronic nasal and sinus congestion says he wakes most mornings with a dry mouth. Which explanation best connects these findings to sleep-disordered breathing?

Congestion mainly narrows the bronchi of the lower airway, so the problem is gas exchange rather than airway collapse
Congestion raises nasal resistance and forces mouth breathing, which bypasses nasal air conditioning and worsens snoring and apnea
Congestion has little effect on sleep breathing because the mouth warms and humidifies air as well as the nose does
Congestion lowers nasal resistance, so more air reaches the pharynx and the soft palate vibrates less during sleep

A patient’s study shows an AHI under 5, but the report notes repeated runs of breaths with rising effort that end in arousals without meeting the airflow threshold for a hypopnea. Which term best describes this pattern?

Treatment-emergent sleep apnea, because the events end in arousals
Primary snoring, because the events do not change the oxygen saturation
Upper airway resistance syndrome (UARS), which an AHI is not built to capture
Central sleep apnea, because airflow never drops far enough to be scored

A 70-year-old patient with congestive heart failure has a study showing repeated pauses in breathing with no respiratory effort during the events. Which statement is most accurate?

This pattern fits obstructive sleep apnea, so a mandibular advancement appliance is the expected first-line therapy
This pattern fits treatment-emergent sleep apnea, which only appears after a patient has stopped using CPAP
This pattern fits upper airway resistance syndrome, so the dentist can begin titrating an appliance right away
This pattern fits central sleep apnea, so an oral appliance alone is not the treatment and the physician addresses the cause

A patient with untreated OSA is repeatedly aroused out of stage N3 (slow wave) sleep. Which restorative processes are most directly disrupted?

Growth hormone release and glymphatic clearance of waste proteins from the brain
Slow rolling eye movements and the transition from wakefulness into sleep
Muscle atonia and the vivid dreaming that occur during rapid eye movement sleep
Sleep spindle formation and the consolidation of memory during light sleep

A patient with moderate OSA wants to keep using CPAP but keeps removing the mask because the pressure feels intolerable. Which role for an oral appliance does the course describe for a patient like this?

An appliance is only appropriate after surgery has failed, so the patient should be referred for surgery first
Combined with PAP, an appliance can lower the therapeutic pressure needed and make therapy easier to sustain
An appliance cannot be used with PAP, so the dentist should wait until the patient stops using the mask
An appliance should replace PAP immediately, because combination therapy has no role in moderate OSA

A home sleep test records nasal airflow, chest and abdominal effort belts and pulse oximetry, but no EEG. Which conclusion can the physician reliably draw from this study?

How many respiratory effort-related arousals ended in an EEG arousal
Exactly how much time was spent in each sleep stage, including REM
Whether events were obstructive or central, because respiratory effort was measured
True total sleep time, because airflow shows when the patient is asleep

A home test records 64 respiratory events over 8 hours of recording time. The patient reports lying awake for about half of that time. What is the REI, and what caution applies?

REI 16; wake time in the denominator makes the index read higher than the true severity
REI 16; the index is calculated over estimated sleep time, so wake time does not affect it
REI 8; because the result is mild, a home test in this situation rules out moderate disease
REI 8; wake time in the denominator may make the index read lower than the patient's true severity

Three patients each slept 8 hours and each has an AHI of 10. Which patient would a sleep physician most likely view as having the most severe physiology?

Mostly complete obstructions (apneas), with the lowest oxygen saturation falling to 60%
None of them, because an identical AHI means identical severity for all three patients
Mostly partial obstructions (hypopneas), with the lowest oxygen saturation at 85%
Only partial obstructions (hypopneas), with oxygen saturation staying at 94% or above

A patient with mild OSA who is about to start oral appliance therapy says it takes her hours to fall asleep because her mind races. She asks whether the appliance will fix that. Which response best stays within scope?

Yes, once your breathing improves with the appliance, you will fall asleep quickly and the racing thoughts will stop
The appliance treats your breathing, not falling asleep, so please tell your sleep doctor, and I will mention it in my note
Try an over-the-counter sleep aid for a few weeks, and we will see whether the appliance helps after that
Trouble falling asleep is unrelated to sleep medicine, so there is no need to mention it to your physician

During oral appliance titration, a follow-up study shows a high central apnea index, and the patient mentions a new heart rhythm diagnosis. What should the dentist do next?

Stop all therapy permanently and tell the patient that an oral appliance can no longer be used
Continue advancing the appliance, because further advancement will also resolve the central events
Communicate the findings to the sleep physician right away and request input before continuing treatment
Note the result in the chart and report it to the physician at the patient's next annual follow-up

A 54-year-old woman reports loud snoring and daytime tiredness and takes medication for high blood pressure. No one has observed her stop breathing. Her BMI is 31 and her neck circumference is 38 cm. What is her STOP-Bang score and risk category?

5, high risk
4, high risk
3, low risk
4, intermediate risk

True or false: A CBCT showing an airway of normal size in an awake, upright patient rules out airway collapse during sleep.

True
False

A patient asks for a night guard for heavy tooth wear. His partner reports loud snoring and pauses in his breathing, and he has never had a sleep study. What is the best next step?

Complete the sleep questions and a screening tool, and refer to a sleep physician before choosing a device
Defer any appliance until the wear progresses, then reassess the airway at the next recall visit
Fabricate a flat occlusal splint today, because protecting the teeth takes priority over the airway
Fabricate a soft night guard instead of a hard one, because soft guards do not affect breathing

As a patient opens slowly, the mandible shifts to the left and stays there at maximum opening. What does this finding most likely represent?

Deviation, usually associated with an S-shaped opening path that indicates no joint involvement
Deflection, usually associated with a non-reducing disc displacement or unilateral restriction on the left
Deviation, usually associated with a reducing disc displacement that returns the jaw to the midline
Deflection, usually associated with a healthy joint on the left and a restricted joint on the right

A patient with a Class III bite has an overjet of +1 mm (lower incisors in front of the uppers) and a maximum protrusion of +6 mm. What is the total range of motion?

3 mm
5 mm
6 mm
7 mm

Which sequence matches the sleep-focused exam taught in this course?

Document and refer, then history and screening, extraoral, intraoral, imaging, TMJ and range of motion
Intraoral, TMJ and range of motion, imaging, then history and screening only if findings are positive
History and screening, extraoral, intraoral, TMJ and range of motion, imaging, then document and refer
Imaging, intraoral, history and screening, extraoral, TMJ and range of motion, then document and refer

Which recommendations in the 2015 AASM/AADSM guideline are graded STANDARD (held with high certainty)? Select all that apply.

Provide dental oversight to survey for dental side effects and occlusal changes
Consider an oral appliance, rather than no treatment, for adults with OSA who are intolerant of CPAP or prefer an alternative
Use a custom, titratable appliance rather than a non-custom oral device
Conduct follow-up sleep testing to improve or confirm treatment efficacy
Prescribe an oral appliance, rather than no therapy, for adults who request treatment of primary snoring

A patient arrives with a current diagnosis of moderate OSA and a signed prescription for an oral appliance. The exam shows generalized tooth mobility and active periodontal disease. What is the best approach?

Proceed with impressions today and choose a softer material so the mobile teeth carry less load
Rule out oral appliance therapy permanently and tell the patient CPAP is now the only option
Deliver the appliance and reassess the periodontal condition at the six-month follow-up visit
Treat the periodontal disease first, document the decision, and share it with the patient and the sleep physician

A patient has a baseline AHI of 24 and sleeps 8 hours. He wears his appliance for 6 hours a night, with an AHI of 8 while it is in. What is his SARAH?

6
8
12
16

On a bi-block appliance, the maxillary connection sits anterior to the lower connection. How is the mandible advanced with this design?

It is a pull design, so the titration mechanism is shortened
It is a push design, so the titration mechanism is lengthened
It is a pull design, so the titration mechanism is lengthened
It is a monoblock, so it must be remade to change position

Compared with a connector that runs parallel to the occlusal plane, what happens when a connector is set at an oblique angle of about 45 degrees?

It carries about half as much force, because the load is split between two directions
It must carry about 1.4 times as much force to hold the same forward position
It transfers all of its force to the joints and none to the teeth that anchor it
It carries the same force, because the angle changes only the direction of the load

A patient has crowded lower teeth, several crowns and bridges, and sensitive teeth. Which material family’s properties best match these findings?

Nylon polymer, which can lose retention when clinical crowns are short or undercuts are shallow
Hard/soft laminate, which cannot be relined and absorbs moisture over time
Thermoplastic, which retains well with crowding, flexes over crowns and bridges, and suits sensitive teeth
Hard acrylic, which is the most rigid option and is described as too tight by some patients

A Class III patient can protrude only a short distance. How should the construction bite be approached?

Set the bite edge to edge, because Class III patients tolerate that position best
Set the bite at maximum protrusion to make the most of the limited range available
Skip the glide practice, because Class III patients rarely create a false midline
Choose a conservative starting position so the appliance can be backed off if needed

Before sending a construction bite to the lab, which findings mean the bite should be retaken? Select all that apply.

The patient placed the teeth edge to edge instead of gliding forward
A conservative start that leaves room to advance during titration
One side of the record is noticeably more open than the other
The mandible is rotated, so one side sits further forward
Even bilateral contact with the patient's natural midline

Which instruction is consistent with what every patient should leave knowing on delivery day?

At first, put the appliance in about 20 minutes before sleep, and clean it with a soft brush and mild soap, not toothpaste
Brush the appliance with toothpaste each morning, and skip the morning repositioner until the first follow-up visit
Advance the appliance as far as possible on the first night, then back it off only if the teeth feel sore
Expect dry mouth to mean the appliance does not fit, so stop wearing it until the office can remake it

At delivery, a patient finds the starting position painful. Under the DDS titration protocol, what is the next step?

Keep the starting position and prescribe a stronger pain reliever
Back off to a comfortable position and start titration from there
Advance the appliance further, because more advancement relieves joint pain
Stop therapy and refer the patient back to the sleep physician for CPAP

True or false: When a patient’s snoring, daytime sleepiness and morning headaches resolve during titration, the appliance can be documented as effective without further testing.

True
False

For a patient in long-term oral appliance therapy, which changes call for an updated sleep study? Select all that apply.

A 10% change in body weight, up or down
Return of snoring or other symptoms
A significant change in health history
Delivery of a new replacement appliance
A routine visit with stable symptoms and weight

A patient doing the morning routine reports jaw discomfort that lingers longer than expected. Which adjustment to the routine is consistent with the course?

Stop the morning routine entirely until the discomfort has fully resolved on its own
Replace the stretches with firm, continuous biting on the guide for at least 30 minutes
Also do the stretches at night or throughout the day, in addition to the morning routine
Skip the stretches and seat the morning occlusal guide immediately after removing the appliance

Which morning findings should prompt a patient to call the office rather than wait for the next visit? Select all that apply.

New joint sounds that come with pain
A bite that feels different and does not return
Jaw stiffness that eases after the exercises
Mild tooth tenderness that fades by mid-morning
Jaw pain that lasts through the day

At a two-week visit, a patient has a sore spot on the lateral border of the tongue where the appliance edge rests. How is this side effect categorized, and what is the first response?

An occlusal change; compare the bite with baseline records and monitor at recall
A TMJ-related side effect; reduce the advancement and add isometric jaw exercises
An appliance issue; send the appliance back to the lab for a full remake
An intraoral tissue side effect; check and smooth the appliance edge against the sore area

With a new appliance seated, a patient’s left molars touch first and the left side feels high. The models show the bite registration is thicker on the left. Which plane is off, and what is the right response?

Roll; balance a small difference chairside, or re-register if the tilt was recorded in the bite
Yaw; advance the appliance further until both sides make contact at the same time
Roll; ask the patient to bite firmly for a few nights so the high side wears in evenly
Pitch; reduce the vertical opening, because the lips cannot close over the appliance

At recall, a patient has a new open contact between two posterior teeth. It is not trapping food and the gingiva is healthy. What is the first step on the management ladder?

Restore the contact with a new restoration at this visit
Watchful waiting and continued use of the morning occlusal guide
Add a daytime distal wrap-around retainer immediately
Discontinue oral appliance therapy and refer to the physician

A Class III patient with limited range of motion is starting oral appliance therapy. Which approach to informed consent best reflects the course?

Hand the patient a standard consent form to sign on delivery day and answer questions if asked
Avoid discussing bite changes so the patient is not discouraged from starting therapy
Begin the discussion at the sleep exam, tailor the risks to this patient, and document the conversation
Review side effects only after they appear, so the discussion is specific to what happens

A practice wants one interested team member to keep the sleep workflow moving, follow up on open cases and manage the lab. Which role does this describe?

Financial coordinator
Reception
Hygienist
Sleep coordinator

Why does the course recommend provider-led questions as the place to start screening?

The conversation comes from the provider after the exam, and patients often receive it better
Provider-led screening allows the dental team to make the diagnosis during the visit
Patients cannot complete validated questionnaires accurately at check-in without help
Provider-led questions replace the need for validated screening tools in the health history

After explaining sleep apnea in plain language, how can a hygienist best confirm that the patient understood the next step?

Give the patient a detailed article on sleep apnea risks to read
Ask the patient to explain the next step back in their own words
Ask the patient whether they have any questions before they leave
Repeat the explanation using the correct clinical terminology

A patient’s chart already includes a CBCT. When showing the airway image in a screening conversation, which framing is consistent with the course?

The image shows the airway during sleep, so it reveals how often breathing stops each night
The image confirms sleep apnea because the airway is narrow, so treatment can begin once the patient agrees to it
The image was taken awake and upright, and a narrow airway is more likely to narrow further lying down; it shows anatomy, not a diagnosis
The image rules out sleep apnea if the airway looks wide, so no referral is needed for this patient

After a face-to-face presentation in the consult room, a patient with diagnosed OSA declines oral appliance therapy for now. What should the team tell the patient?

Treatment is optional, so no further follow-up will be needed
The office will not discuss sleep again unless the patient raises it
The patient must sign a waiver before leaving the office today
The results will be shared with their physician so care stays coordinated

A patient is scheduled for scans. The chart has the physician’s diagnosis, a signed order issued after the study was reviewed, a sleep study from 18 months ago and a signed consent. Benefits verification shows the plan requires pre-authorization, which has not been submitted. What should happen first?

Submit the documentation for pre-authorization before taking impressions or scans
Ask the patient to sign an ABN so the scans can proceed without authorization
Order a new diagnostic sleep study, because the current one is out of date
Take the scans today and submit pre-authorization with the claim after delivery

A dentist is writing a six-week titration note. Which entries are placed in the correct SOAP section? Select all that apply.

A: Neck circumference 17 inches
P: Refer for a follow-up sleep study to verify efficacy
S: Bed partner reports the snoring has stopped
O: Patient reports that morning headaches are gone
O: Total range of motion 11 mm; appliance currently at 7 mm

Which content belongs in the letter sent to the physician after an appliance delivery?

Only the delivery date, since the physician does not need clinical details until the efficacy study is complete
The diagnosis and order, the device, delivery date and starting position, the fit, and the plan for titration and the follow-up study
The appliance fee, the patient's payment plan and a copy of the signed financial agreement
The full sleep study report, the patient's dental insurance details and a request for the physician to schedule titration visits

A local physician refers a patient for an oral appliance. The patient brings a physician’s diagnosis, an order for oral appliance therapy and a diagnostic study from 18 months ago, which her plan accepts, and her weight and health have been stable. What is the best next step?

Make the diagnosis from the exam findings and order a new study yourself
Ask the referring physician to repeat the study, because it is over a year old
Use her current information and proceed with the dental sleep exam
Refer her to a sleep physician for a new diagnostic study before any exam

A practice is out of network with a patient’s commercial medical plan and offers courtesy billing. Which point should the team explain before treatment?

Courtesy billing means the practice accepts the plan's allowed amount as payment in full
The claim is submitted to the patient's dental plan, so medical deductibles and out-of-pocket maximums do not apply
Out-of-network payers always send payment directly to the practice, so the patient owes nothing further
The plan pays based on its allowed amount, and the patient may owe the balance up to the usual fee unless state law or the plan limits it

A Medicare patient had an in-person evaluation, then a covered sleep test showing an AHI of 12. The chart documents no symptoms or associated conditions. How does this case relate to Medicare’s coverage criteria?

It does not yet meet them, because an AHI of 5 to 14 requires documented symptoms or conditions
It meets them, because any AHI of 5 or more qualifies for a custom appliance
It does not meet them, because Medicare covers only an AHI of 30 or more
It meets them only if PAP intolerance or a contraindication is documented

Maria, 52, is in for a routine exam. Her partner reports pauses in her breathing at night. Her Epworth score is 8, her BMI is 26, and the exam shows mild retrognathia. What is the best next step?

Reassure her that a normal BMI and an Epworth under 10 make sleep apnea unlikely
Document the findings, ask permission to discuss sleep, and offer a referral to a physician for evaluation
Wait until her Epworth score rises above 10 before raising the topic of sleep
Take impressions for an oral appliance, since retrognathia predicts a good response

A patient’s home study shows an overall index of 8 events per hour, but 30 events per hour during REM sleep. Which interpretation is most accurate?

The difference shows a device error, so the study must be repeated before any decision
The REM number replaces the overall index, so the dentist should report severe OSA
The pattern is REM-predominant, so the all-night number can understate the patient's worst periods
The overall index is mild, so the REM number can be disregarded when planning treatment

A patient has an overjet of -2 mm (lower incisors behind the uppers) and a maximum protrusion of +8 mm. Under the DDS protocol, what is the minimum starting advancement at delivery, measured from the habitual bite?

2 mm
5 mm
8 mm
10 mm

A patient with moderate OSA and an order for an oral appliance arrives for records. The exam shows several active cavities and moderate periodontal disease. He wants the appliance started right away. What is the best plan?

Take records today, because restorations placed later will not affect how the appliance fits
Decline all treatment until his medical conditions are fully controlled by his physician
Start the appliance today and tell him that oral appliances carry no risk to his teeth
Plan the decay and gum treatment first, explain how new restorations can change the fit, and write the specific risks into his consent

After the follow-up sleep study confirms that a patient’s oral appliance is effective, what is the best next step in his care?

Discharge him from dental follow-up, because the therapy is working
Send the results to his physician and schedule follow-up at 6 months and then yearly to monitor the appliance, his bite and his symptoms
Stop the morning repositioner, because the final position has been set
Replace the appliance every year, whether or not it shows wear

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