ABDSM common mistakes
ABDSM · Understand the traps and how to avoid them.
Selecting an oral appliance for a patient with severe OSA (AHI >30) as first-line therapy without documenting PAP failure, intolerance, or patient refusal.
Candidates conflate 'appliance is an accepted option' with 'appliance is first-line for everyone' and skip the guideline-required prerequisite that PAP be tried or declined.
What to do instead
Before choosing appliance therapy, explicitly state the PAP status (failed, intolerant, refused) and match device choice to OSA severity and phenotype; reserve first-line appliance use for mild-moderate disease or documented PAP failure.
Clearing a patient for appliance therapy without a documented comprehensive dental exam covering periodontal status, caries, tooth mobility, missing teeth, and TMJ findings.
Candidates focus on the sleep diagnosis and treat the dental evaluation as a formality, forgetting that appliance therapy requires adequate anchorage and stable dentition.
What to do instead
Build a checklist (perio charting, mobility, caries, restoration status, occlusion, TMJ, range of motion, dentition count) and state explicitly how each finding affects appliance feasibility and design.
Confusing central apnea, obstructive apnea, and hypopnea scoring criteria, or mislabeling a central event as obstructive when reporting a study.
Candidates memorize AHI thresholds but not the event definitions (e.g., absence of airflow with/without effort, arousal/desaturation rules), so they misclassify events.
What to do instead
Study the event definitions side by side: obstructive = effort present with airflow limitation; central = absent effort; hypopnea = flow reduction with desaturation or arousal per the scoring rule. Practice classifying sample events.
Treating AHI alone as the diagnostic endpoint and ignoring oxygen desaturation indices, arousal index, and sleep architecture when characterizing severity.
Candidates latch onto the single most memorized number and overlook that severity and risk depend on hypoxemia burden and sleep fragmentation too.
What to do instead
When interpreting a study, report AHI, ODI/desaturation nadir, arousal index, and sleep-stage distribution together, and explain how each informs treatment urgency and device selection.
Recommending a fixed (non-adjustable) monobloc appliance for a patient who will need titration, or conversely choosing an adjustable device without justifying the titration plan.
Candidates match device type to familiarity rather than to the clinical need for progressive mandibular advancement and the ability to manage side effects.
What to do instead
Tie device selection to the titration requirement: adjustable devices for patients needing incremental advancement or side-effect management; justify any fixed device by clinical circumstances.
Specifying a bite registration or protrusive position without a defined starting point and advancement protocol (e.g., arbitrary mm without reference to maximum protrusion).
Candidates recall that advancement matters but not that the initial position should be a defined fraction of maximum protrusion with a planned titration schedule.
What to do instead
State the reference (maximum protrusion/retrusion), the initial advancement as a proportion of it, and the planned increment and interval before finalizing the registration.
Declaring treatment success after the first follow-up visit without objective outcome data (repeat sleep study or home sleep test) or symptom resolution.
Candidates equate 'patient is wearing it' with 'it is working' and skip the objective efficacy assessment that defines success.
What to do instead
Define success by objective criteria (e.g., post-treatment AHI/ODI reduction to target) plus symptom and adherence data, and specify when to order a repeat study.
Failing to document and manage common side effects (salivation changes, dry mouth, tooth movement, bite change, TMJ/muscle discomfort) at follow-up.
Candidates treat side effects as minor and omit them from the follow-up plan, missing opportunities to adjust the device or prevent discontinuation.
What to do instead
Include a structured side-effect review at each follow-up (occlusion, tooth mobility, gingival health, TMJ, comfort) with a documented management action for each finding.
Ignoring occlusal changes and dental monitoring over long-term appliance use, assuming the appliance is inert once tolerated.
Candidates focus on the sleep outcome and forget that sustained mandibular advancement can produce measurable dental and skeletal changes requiring monitoring.
What to do instead
Build long-term monitoring into the plan: periodic occlusal, periodontal, and TMJ assessments with defined intervals, and note when to consider device modification or alternation.
Describing the dentist's role without a concrete referral and communication loop with the sleep physician (no defined criteria for referral, no shared outcome reporting).
Candidates treat interprofessional collaboration as a general attitude rather than a specific workflow with triggers, documentation, and feedback.
What to do instead
Specify referral triggers, what data the dentist sends back (adherence, efficacy, side effects), and the shared decision points, so the collaboration is a documented loop rather than a one-way referral.