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**Please make additional copies for each person registering

$6595 One Payment in full $6995 Two Payment Installments ($3497.50 each)

Dentist _________________________________ SPECIALTY _______________________________

Email ______________________________________ @ _______________________________________All registrants must provide a unique e-mail address ([email protected]) in order to access credit history and be entered into our database. Generic office email addresses that are shared by many individuals ([email protected]) cannot be used.

First Name __________________________ MI_____ Last Name ________________________ Jr./Sr.

Preferred Name _____________________ Female Male Self-identify ___________________

Employer _____________________________________________________________________________

Mailing Address _______________________________________________________________________

City ____________________________State _______ Zip _________ County in NC _________________

Daytime Phone (_____) _______________________ Fax (_____) _______________________________

Emergency Contact ___________________________ Phone Number ____________________________

Please make checks payable to AACP.Mailing Address

AACP12100 Sunset Hill Rd, Ste 130

Reston, VA 20190

REGISTER ON-LINE WITH A CREDIT CARD AT 2018 DENTAL SLEEP MEDICINE WEBSITE

I have special dietary needs, please explain: _____________________________________________ .

I have special needs. Please contact me.

ADA Statement:The University of North Carolina at Chapel Hill is committed to equality of educational opportunity and does not discriminate against applicants, students, or employees on the basis of race, color, religion, sex, national origin, age, disability, veteran’s status, or sexual orientation. If you require reasonable accommodations for a disability in order to participate fully in this continuing education course, please call 919-537-3400 no later than January 15, 2018.

By providing my information, I consent to receive communication via mail, email, fax, and phone from the University of North Carolina Continuing Dental Education office. The Continuing Dental Education office will not share your information with anyone.

The UNC School of Dentistry designates this course forup to 48.0 hours of continuing education credits.

CONFLICT OF INTERESTIn accordance with the ADA CERP Standard V., everyone involved in planning or presenting this educational Course will be required to disclose any relevant financial relationships with commercial interests and this information will be made available to participants at the start of the Course. As a continuing education provider, UNC School of Dentistry is responsible for ensuring the content, quality and scientific integrity of all continuing dental education activities for which credit is provided. The School is also responsible for taking steps to protect against and/or disclose any conflict of interest of the faculty/instructors presenting those courses.

REGISTRATION AND FEES DENTIST: $6595 One Payment in full; $6995 Two Payment Installments ($3497.50 each: The remaining payment of $3497.50 must be paid by Noon on January 5, 2018.)

A parallel program will be offered for dental staff. Dental Assistants and/or Dental Hygienists may attend a weekend session for $850 or all 3 sessions for $2200.

The registration fee includes course materials, CE credit, all meals on the agenda, group dinner, webinars between sessions, parking and more. All registrations must be received by January 19, 2018.

UNC CDE/AACP recommends that you do not make air travel arrangements prior to receiving a receipt of payment or confirmation. UNC CDE/AACP is not responsible for any travel-related costs.

CANCELLATIONS AND REFUNDSRefunds will be made only if your space is filled. Refund requests (less 10% of TOTAL cost of the program) must be submitted in writing or email at least 30 days prior to the program start date. Due to non-refundable commitments, we cannot offer refunds after this date. AACP 12100 Sunset Hills Rd, Ste 130 Reston, VA 20190 or email [email protected].

SPECIAL DIETARY REQUIREMENTS will be honored whenever possible. Please be sure to notify our office in writing of your special need no later than January 19, 2018. The April date is during Passover so we will provide a Kosher meal for those who request it.

Dental education institutions have an obligation to disseminate new knowledge related to dental practice. In so doing, some presentations may include controversial materials or commercial references. Sponsorship of a continuing education course by the University of North Carolina does not necessarily imply endorsement of a particular philosophy, procedure, or product by this institution. The University of North Carolina School of Dentistry cautions continuing dental education participants that there are potential risks of using limited knowledge when incorporating new techniques and procedures into the practice of dentistry, especially when the continuing education Course has not provided supervised clinical experience and/or competency tests in the techniques or procedures.

UNC School of Dentistry - Koury Oral Health Sciences BuildingChapel Hill, North Carolina

DENTAL SLEEP MEDICINEMini-Residency 2018

January 26-27, 2018 March 2-3, 2018 April 6-7, 2018

JOINTLY PROVIDED BY

The UNC School of DentistryDepartment of Prosthodontics

The American Acacemy of Craniofacial Pain

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DENTAL SLEEP MEDICINE Mini-Residency 2018 January 26-27, 2018 March 2-3, 2018 April 6-7, 2018 48

COURSE DIRECTORSDR. TERRY BENNETT graduated from the University of Louisville School of Dentistry in 1977. He is entering his 40th year of private practice with the last 27 being in a practice limited to the treatment of Temporomandibular Joint Dysfunction and Sleep Apnea. He is a member of several organizations and hold certifications in many of these. He has been extremely active in the American Academy of Craniofacial Pain (AACP) serving on the board of directors over a decade, in addition to serving as Program Chair for 4 years and President for 2 years. Currently he is the AACP Institute Director of Education. This position entails organizing and providing education

associated with the treatment of TMD and Dental Sleep Medicine. Among the many certifications he has attained are DABCP (Diplomate American Board of Craniofacial Pain), DABCDSM (Diplomate American Board of Craniofacial Dental Sleep Medicine), DABDSM (Diplomate American Board of Dental Sleep Medicine, DAAPM (Diplomate American Academy of Pain Management). Currently he divides his time between his private practice and lecturing for the AACP, Dental Schools and other organizations.

DR. GREG ESSICK is a Professor in the Department of Prosthodontics and Center for Pain Research and Innovation at the University of North Carolina at Chapel Hill. He is adjunct professor in the Department of Allied Health Sciences at the UNC School of Medicine where he serves as faculty in the Neurodiagnostics and Sleep Science Program. At the UNC School of Dentistry, he oversees the Dental Sleep Clinic, which provides the school’s venue for patient care, education and research in oral appliance and combination therapy for sleep-disordered breathing. Dr. Essick provides much of the school’s continuing education in sleep medicine to practicing dentists in North Carolina.

He authors/co-authors over 120 journal articles and book chapters, the most recent ones pertaining to sleep medicine. Dr. Essick is an active member of the American Academy of Dental Sleep Medicine and past chair of the Academy’s Research Committee.

DR. MAYOOR PATEL received his dental degree from the University of Tennessee in 1994. After graduation he completed a one-year residency in Advanced Education in General Dentistry (AEGD). In 2011 he completed a Masters in Science from Tufts University in the area of Craniofacial Pain and Dental Sleep Medicine. Dr. Patel has earned a Fellowship in the American Academy of Orofacial Pain, American Academy of Craniofacial Pain, the International College of Craniomandibular Orthopedics and the Academy of General Dentistry. He also became a Diplomate in the American Board of Dental Sleep Medicine, American Board of Orofacial Pain, American

Board of Craniofacial Pain and American Board of Craniofacial Dental Sleep Medicine. Dr. Patel is the 2nd dentist that has fulfilled the necessary requirements and is a registered polysomnographic technologist. Presently, Dr. Patel serves as a board member with American Academy of Craniofacial Pain. He also has taken the role as examination chair for the American Board of Craniofacial Dental Sleep Medicine and American Board of Craniofacial Pain and as Director of Clinical Education for Nierman Practice Management.

BENNETT BLAKEY DILLOW DUQUM FERRIN

HOGG KANSAGRA MOL NIERMAN RODRIGUEZ-CUE

SENIOR SPENCER VAUGHN WELLS

COURSE DESCRIPTIONThe University of North Carolina School of Dentistry and the American Academy of Craniofacial Pain (AACP) are pleased to announce the inaugural offering of the UNC/AACP Mini-Residency in Dental Sleep Medicine (DSM). The three, weekend sessions of lecture from nationally recognized experts and hands-on clinical exercises will prepare each participant to evaluate patients for, and deliver in their dental offices, customized oral appliance therapy for obstructive sleep apnea and snoring. Working in small groups, participants will be guided by course faculty in state-of-the-art patient examination techniques, impression and record taking, fitting and adjusting oral appliances that are marketed for sleep-disordered breathing, and in the identification and management of side effects. Patient specific oral appliance selection will be addressed and each participant will have three different oral appliances custom fit to their teeth. More advanced topics will include treatment of the pediatric patient with OSA, combination therapy for patients who fail to respond adequately to oral appliances alone, and maxillofacial surgical procedures for OSA and their indications. Participants will learn how to optimally collaborate with physicians to successfully treat this severe medical condition. The special challenges of Dental Sleep Medicine practice management will be described and strategies to successfully address the challenges will be discussed.• The University of North Carolina School of Dentistry’s Dental Sleep Medicine Mini-

Residency meets the American Academy of Dental Sleep Medicine’s (AADSM)continuing education criteria for the Qualified Dentist designation. Completion of thecourse may count toward fulfillment of the continuing education requirements for thedesignation. For more information regarding the AADSM Qualified Dentist designation,or to apply, visit aadsm.org/dentistqualified.aspx.

• CE-Eligible for the AADSM Qualified Dentist Designation

EDUCATIONAL OBJECTIVESUPON THE COMPLETION OF THIS COURSE, PARTICIPANTS SHOULD BE ABLE TO:

Session I(Jan 26-27, 2018)

• Describe basic physiologyof normal and abnormalsleep, of obstructive sleepapnea (OSA) and othercommon sleep disorders.

• Explain the role ofdentistry in sleepmedicine and how toscreen patients for sleepdisorders in your dentalpractice.

• Describe the differenttypes of oral appliancesused to treat OSA orsnoring, their modes ofaction, and selection ofappliance for differentpatients.

• Write a protocol fortreating patients withoral appliances in theparticipant’s office anddifferentiate the roles ofthe dental and medicalteams.

• Demonstrate how toevaluate patients for oralappliance therapy andhow to take the requiredbite records.

• Demonstrate examinationof the TMJ andmasticatory musclesin the evaluation andtreatment of patients withoral appliances.

Session II(Mar 2-3, 2018)

• Describe normal andabnormal upper airwayanatomy, its evaluation,and medical and surgicaltreatments of the airwayby otolaryngologists(ENT).

• Demonstrate how todeliver oral appliancesand assess their fit to theteeth.

• Demonstrate how toadjust oral appliances.

• Develop a plan to manageside effects of oralappliance therapy.

• Discuss how dentistsand physicians evaluatethe effectiveness of oralappliance therapy.

• Describe combinationtherapy and its use toaddress poor treatmentoutcomes.

• Explain considerations ofthe TMJ in the treatmentof OSA with oralappliances.

• Outline short and long-term side effects of oralappliance therapy andillustrate methods toaddress them.

Session III(Apr 6-7, 2018)

• Read PSG reports and usethe information obtainedin assessing patients beforeoral appliance therapy andin assessing the efficacyof therapy after the final adjustments are made.

• Demonstrate how to usehome sleep apnea testsin the adjustment of oralappliances to optimizetheir efficacy.

• Describe how pediatricOSA differs from adultOSA, and dental ap-proaches to the treatmentof pediatric OSA.

• Distinguish oral andmaxillofacial surgicalapproaches in thetreatment of OSA andtheir indications.

• Review long-termfollow-up care of patientstreated with oralappliances.

• Outline strategies tooptimize communicationsbetween dental andmedical colleagues.

• Implement strategies toengage all dental teammembers in the practiceof dental sleep medicine.

• Understand the uniquechallenges of DSMpractice managementsuch as those pertainingto medical insurancereimbursement, andstrategies for addressingthe challenges successfully.

FACULTYCHASE BENNETT, DDS is the Director of

the Craniofacial Pain Center of Colorado.GEORGE BLAKEY, DDS is Clinical

Associate Professor and the Residency Program Director in the Dept. of Oral & Maxillofacial Surgery at the UNC School of Dentistry.

KRISTIN DILLOW, RDH, MS currently serves as Adjunct Assistant Professor at the UNC School of Dentistry and the Clinical Sleep Director at Wainright & Wassel DDS in Raleigh, NC.

IBRAHIM DUQUM, DDS is a Clinical Associate Professor in the UNC Dept. of Prosthodontics and the director of the inaugural New Educational eXperience and Technology (NEXT) Center.

STEVE FERRIN, MHA, RPSGT has been a lead Neurodiagnostic Technologist II at UNC’s Sleep Disorders Center for 4 years.

JAMES HOGG, DDS practiced restorative dentistry in his own dental office for 25 years and entered into the field of Dental Sleep Medicine in 2007. He recently moved to Asheville, NC and works with Dr. Douglas Phillips treating patients with Sleep Disordered breathing.

SUJAY KANSAGRA, MD is the director of Duke University’s Pediatric Neurology Sleep Medicine Program and author of the book “My Child Won’t Sleep.”

ANDRE MOL, DDS, MS, PHD is a Clinical Associate Professor in the Dept. of Diagnostic Sciences at the UNC School of Dentistry.

ROSE NIERMAN is a pioneer of cross coding in dentistry and leading expert in her field. She is an entrepreneur, educator and author.

DOMINGO RODRIGUEZ-CUE, MD is the Chief Medical Officer in Sleep Medicine for CareHere on site Wellness.

BRENT A. SENIOR, MD, FACS, FARS is Nathaniel and Sheila Harris Distinguished Professor of Otolaryngology and Neurosurgery at the University of North Carolina at Chapel Hill where he also serves as Vice Chair of Clinical Affairs and Chief of Rhinology, Allergy, and Endoscopic Skull Base Surgery.

JAMISON SPENCER, DMD, MS is the Director of Dental Sleep Medicine at Lane and Associates in Garner, North Carolina.

BRADLEY VAUGHN, MD is a Tenured Professor of Neurology, and Adjunct Professor in Biomedical Engineering and Allied Health at the University of North Carolina, School of Medicine. He has been the medical director for the UNC Sleep Program for 25 years and is also currently serving as the Medical Director of Outpatient Care Services for the UNC Medical Center.

MARY ELLEN WELLS, PHD, RPSGT, R.EEG T., R.NCS T. is a Clinical AssociateProfessor in the Dept. of Allied HealthSciences at UNC-CH.

The UNC School of Dentistry is an ADA CERP Recognized Provider.

The UNC Continuing Dental Education program is an ADA CERP Recognized Provider. UNC CDE’s term of recognition is

May 1, 2015 through June 30, 2019. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.

Employer _____________________________________________________________________________

Mailing Address _______________________________________________________________________

Reston, VA 20190

JOINTLY PROVIDED BY

ill, N

Employer _____________________________________________________________________________

Mailing Address _______________________________________________________________________

Reston, VA 20190

JOINTLY PROVIDED BY

ill, N

Employer _____________________________________________________________________________

Mailing Address _______________________________________________________________________

Reston, VA 20190

JOINTLY PROVIDED BY

ill, N

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