CANDIDATE MANUAL American Board of Dental Examiners (ADEX) Dental Hygiene Examination 2016 (rev.) American Board of Dental Examiners, Inc. Approved by: American Board of Dental Examiners, Inc. Administered by: The Commission on Dental Competency Assessments (NERB is now the CDCA) 1304 Concourse Drive, Suite 100 Linthicum, MD 21090 www.cdcaexams.org Copyright © 2016 American Board of Dental Examiners Copyright © 2016 The Commission on Dental Competency Assessments ATTENTION DENTAL HYGIENE CANDIDATES The ADEX Dental Hygiene Examination is administered on behalf of a number of state dental boards and in accordance with state licensing requirements. This examination should be valid in any state accepting the ADEX Dental Hygiene Examination. However, to be certain, candidates should check with the state dental board of any state in which they wish to be licensed to determine whether this examination will qualify them for licensure in that state. Currently two testing agencies administer the ADEX Dental Hygiene Examination. This Manual is published by The Commission on Dental Competency Assessments (CDCA). Criteria, content, basic administration, and scoring systems are uniform. There are administrative elements that are unique to each agency. Therefore, candidates must obtain and thoroughly read the Manual published by the agency that will be administering the examination at the date and site the candidate selects. For information about examination sites, dates, and fees, visit the CDCA website: www.cdcaexams.org. Occasionally examinations are interrupted or postponed because of severe weather, power outages, or other extraordinary occurrences. T h e CDCA reserves the right in their sole discretion, to delay, halt, postpone, or cancel an examination because of unforeseen and serious events. Please read this Manual in detail prior to attending the clinical examination, and have it with you during the orientation and examination. Please retain this Manual for future reference. CONTENTS INTRODUCTION...................................................................................................... 1 About the American Board of Dental Examiners, Inc. (ADEX) ........................................... 1 ADEX Mission Statement ............................................................................................. 1 Purpose of the Examination ......................................................................................... 1 About the ADEX Dental Hygiene Examination – 2016 ...................................................... 1 ADEX Status .............................................................................................................. 2 The Candidate Manual ................................................................................................ 2 The ADEX Examination Development ............................................................................ 2 Three Time Examination Policy..................................................................................... 3 CLINICAL EXAMINATION........................................................................................ 4 Judgment Skills.......................................................................................................... 4 Patient selection and eligibility ................................................................................. 4 Case selection ........................................................................................................ 5 Calculus requirements............................................................................................. 6 Radiographs .......................................................................................................... 8 Clinical Skills ....................................................................................................... 10 Instruments ........................................................................................................ 10 Calculus Detection .............................................................................................. 11 Calculus Removal ................................................................................................ 13 Periodontal assessment......................................................................................... 13 Tissue management ............................................................................................. 14 Minor tissue trauma.............................................................................................................................................14 Major tissue trauma .............................................................................................................................................14 Final case presentation ......................................................................................... 15 Infection Control ...................................................................................................... 15 Table of Evaluation Criteria........................................................................................ 16 POINT SYSTEM ..................................................................................................... 17 COMPUTER SIMULATED CLINICAL EXAMINATION (CSCE) ..................................... 19 Content................................................................................................................... 19 Standards for the CSCE ............................................................................................ 19 Disciplines and Subject Matter Addressed in the CSCE ................................................. 1 SUPPLEMENTAL TESTING AGENCY INFORMATION ............................................... 21 GLOSSARY ............................................................................................................ 22 INTRODUCTION American Board of Dental Examiners, Inc. party assessment of the judgment and clinical skills of candidates applying for dental hygiene licensure. This examination will identify areas of deficiency or weakness within skill sets allowing candidates the opportunity for remediation. The American Board of Dental Examiners, Inc. (ADEX) is a private not-for-profit consortium of state and regional dental boards throughout the United States and some international jurisdictions. The ADEX provides for the ongoing development of a series of common national dental and dental hygiene licensing examinations. These exams are uniformly administered by individual state or regional testing agencies on behalf of participating and licensing jurisdictions. The Commission on Dental Competency Assessments (CDCA) is a member of the ADEX and have adopted the ADEX Dental and Dental Hygiene Examinations. ADEX Dental Hygiene Examination – 2016 The ADEX Dental Hygiene Examination is the examination approved by the ADEX and administered by The Commission on Dental Competency Assessments (CDCA). The ADEX Dental Hygiene Examination consists of two components – the Computer Simulated Clinical Examination (CSCE) and the Patient Treatment Clinical Examination (PTCE) performed on patients. The examination is used to assist licensing jurisdictions in making decisions concerning the licensure of dental hygienists. The examination for 2016 consists of judgment skills and clinical skills and evaluated as follows. ADEX Mission Statement To develop clinical licensure examinations for dental professionals. ADEX’s mission is further to develop examinations that: 1. are professionally relevant, defensible and psychometrically sound. 2. identify deficiencies early in the candidate’s training to allow for safe and thorough remediation within his/her educational setting. 3. are fair and effectively measure candidates skills in order to verify minimal competency and thus protect the public. Computer Simulated Clinical Examination (CSCE) • Clinically based questions presented on a computer • 100 graded questions • Passing score of 75 or greater Patient Treatment Clinical Examination (PTCE) Performed on a patient • Judgment skills • Clinical skills • Passing score of 75 or greater Purpose of the Examination The purpose of the ADEX Dental Hygiene Examination is to provide state dental boards with a uniform, accurate, third 1 The examination is based on specific performance criteria used to measure clinical competence. In this Manual ADEX provides the candidate with the criteria, content and scoring for the ADEX Dental Hygiene Examination. We believe this Manual answers most of the commonly asked questions regarding the examination process. Bring/have this Manual with you to the clinical examination and keep it available in the cubicle for easy reference. A thorough understanding of this Manual is crucial to success on the exam. Administrative information includes: candidate eligibility, fees, forms, schedules, examination sites, dates for the examinations, and policies. These procedures are provided by the testing agency the candidate chooses to use, such as the CDCA. Individual jurisdictions may require a state jurisprudence or other additional examinations. It is the candidate’s responsibility to contact the licensing jurisdiction of interest to determine current eligibility and additional requirements. Candidates taking this examination do so voluntarily and agree to accept the provisions and to follow the rules established by the ADEX and CDCA for the examination as detailed in this Manual. ADEX Examination Development The ADEX Dental Hygiene Examination is developed and revised by the ADEX Dental Hygiene Examination Committee (DHEC). This committee is comprised of representatives from every ADEX member district. The committee has considerable content expertise and also relies on practice surveys, current curricula, standards of competency and the American Association of Dental Board’s (AADB) “Guidance for Clinical Licensure Examinations in Dentistry” to ensure that the content and protocols of the examination are current and relevant to practice. Examination criteria, content, and evaluation methodologies are reviewed annually, and are determined by such considerations as: ADEX Status To achieve ADEX Status, candidates must successfully complete both the CSCE and the PTCE of the ADEX Dental Hygiene Examination with a score of 75 or greater in each of the examinations. The Candidate Manual The Candidate Manual supports and assists candidates in their preparation to participate and perform successfully in the two examinations. The Manual is designed to present the required administrative information, as well as setting forth the criteria and necessary requirements. The ADEX sets forth criteria and scoring standards that must be followed by all testing agencies administering the ADEX Dental Hygiene Examination. • • • 2 Patient selection and eligibility Psychometric validity Potential to ensure that a skill can be evaluated reliably Three Time Examination Policy Candidates failing either the CSCE or the PTCE on three successive attempts must begin the entire examination process again and retake both the CSCE and Patient Treatment Clinical Examinations of the ADEX Dental Hygiene Examination administered by the CDCA. Previously passed clinical examinations will not be recognized for successful completion of the entire clinical examination series in dental hygiene and attainment of ADEX Status. A new application must be filed together with appropriate documentation and applicable fees. (See Supplemental Section of the Manual). 3 CLINICAL EXAMINATION 100-point scale. Candidates must earn 75 or greater to pass. Examiners for the ADEX examination evaluate candidates on their clinical and judgment skills. Judgment skills include presenting an eligible patient, an acceptable case, a selection of teeth that meets all calculus requirements, and diagnostic-quality radiographs. Clinical skills include detection and removal of calculus, accurate periodontal pocket depth measurements, tissue management, and final Case Presentation. This section describes in detail the evaluation criteria for both of the categories. Judgment Skills Patient selection and eligibility For the PTCE, the candidate must present his/her own patient. Selecting an eligible patient is essential to successfully completing this examination. Candidates who present ineligible patients will fail the examination. Patient selection and management is an important part of the examination and should be completed independently, without help or assistance of faculty or colleagues. Candidates must carefully assess any physical or medical conditions that may be impacted by the examination process. Patients should be informed of the time commitment and the process of the examination. The ADEX uses a triple-blind scoring system, which requires three examiners to perform independent evaluations of the candidate’s performance in meeting specific criteria for Case presentation, calculus detection, calculus removal, periodontal pocket depth measurements, tissue management, and final Case presentation. Points are awarded on a An eligible patient must: • • • • An ineligible patient: Be at least 18 years of age. Have a physician’s written clearance, if needed. Be presented with required radiographs of diagnostic-quality. Have an acceptable health history including a blood pressure within the guidelines of this examination. • • • • • • • • 4 Dentist Dental Hygienist Dental student Final Year Dental Hygiene student Currently taking or history of injectable or oral bisphosphonate therapy Latex allergy 1st or 3rd trimester of pregnancy Oral herpetic lesions - This condition may be left to the discretion of the Clinic Floor Examiner (CFE) Case selection The presentation of a full quadrant and additional teeth for the ADEX Examination is known as the “Case.” Candidates indicate their selection of teeth for the clinical examination on the appropriate examination forms. QUICK TIP The Case selection must include: • A full quadrant with at least six natural, permanent teeth and two posterior teeth from a second quadrant • At least two molars o One must be located in the primary The candidates’ treatment phase is performed on a pre-determined selection of the patient’s teeth. The candidates select their Case in accordance with the criteria requirements presented below. Examiners evaluate the Case during the Pre-Treatment Evaluation to determine that it meets all requirements. During clinical treatment time, candidates remove all calculus on all surfaces within the Case selection. During p o s t - t r e a t m e n t evaluation, examiners evaluate the selection to ensure that the candidate properly removed all calculus while maintaining tissue integrity. The Case selection consists of one full quadrant plus two posterior teeth from a second quadrant. quadrant o One of the teeth in the second quadrant must be a molar • One of the molars must have both a mesial and a distal contact. Another molar must have at least one contact. o To be considered a contact, the adjacent surface must be no more than 2 mm from the molars o Must be free of excessive soft debris OPTIONAL: If candidates cannot identify 12 surfaces of qualifying calculus in a primary quadrant they may select surfaces on up to 2 posterior teeth in the secondary quadrant. The teeth on which these surfaces are found would be in addition to the 2 teeth that are already part of the Case Selection. So, there could be up to 4 teeth from the secondary quadrant in the Candidate’s Case Selection. There must be two molars in the selection. One of the six teeth in the quadrant and one of the two teeth in the second quadrant must be molars. The required two molars must have three mesial and/or distal contacts with an adjacent tooth within 2mm or less. QUICK TIP A Case Selection with the following tooth selection is strongly discouraged: • Class III furcation or mobility • Retained primary teeth (prohibited) • Advanced periodontal disease • Gross caries • Orthodontic brackets or bonded retainer • Defective restorations • Implants included in the treatment selection • Extensive full or partial esthetic (prohibited) veneers • Partially erupted third molars • Multiple localized probing depths in 5 excess of 6mm Third molars: If the p r i m a r y quadrant has a third molar, the candidate must choose whether to include the third molar in the selection. If the candidate chooses not to include the third molar in the case selection, that tooth does not needed to be treated and will not be evaluated. All other teeth in the quadrant and/or the additional teeth must be debrided and will be evaluated for remaining calculus, plaque, and stain. • Detect mesial and distal deposits by exploring from facial and/or lingual. Primary teeth and restored implants located in the selection will not count toward any calculus requirements, nor will they count as molars for purposes of meeting the molar requirements. However, t hey can constitute a contact with a molar to help meet the initial Case presentation criteria. The Case must include 12 surfaces of qualifying subgingival calculus distributed as follows: • At least 8 of the 12 must be on surfaces of premolars and molars • At least 5 of the 8 must be on mesial or distal surfaces of the posterior teeth within 2mm or less of an adjacent tooth • At least 3 of the 5 mesial or distal surfaces must be on molars within 2mm of an adjacent tooth. Only one distal surface of a second or third terminal molar may be used or one mesial or distal surface on a molar that does not have an adjacent tooth • The remaining 4 of the 12 qualifying surfaces qualifying calculus are the e of the candidate and must be subgingival. Primary teeth and restored implants may count as a proximal contact with a molar. No other criteria can be met by a primary tooth or a restored implant. Calculus requirements In the Case selection the candidates must list 12 surfaces where they detect qualifying calculus. Examiners will add two more surfaces from within the Case Selection. All surfaces in the selection must be debrided and will be evaluated. The Case Selection must meet the following calculus requirements: • All selected teeth must have subgingival calculus. • Qualifying surfaces may occur with or without associated supragingival deposits. 6 12 8/5/3 • Twelve surfaces of subgingival calculus are present in the Case selection, distributed in the following manner: • At least 8 of the 12 surfaces of subgingival calculus found on posterior teeth in the case • At least 5 of the 8 surfaces of subgingival calculus must be located on mesial or distal surfaces of posterior teeth within 2mm or less of an adjacent tooth • At least 3 of the 5 surfaces must be located on mesial or distal surfaces on molars within 2mm or less of an adjacent tooth • Only one of the 3 can be located on a surface with no adjacent tooth • Remaining 4 surfaces of subgingival calculus may be located on any surface in the case selection 4 QUICK TIP CHARACTERISTICS OF QUALIFYING SUBGINGIVAL CALCULUS • Explorer-detectable moderate to heavy subgingival calculus • Distinct and easily detected with an 11/12 explorer as it passes over the calculus • Must be apical to the gingival margin • May occur with or without supragingival deposits • A definite jump or bump detected by the explorer with one or two strokes • Ledges or ring deposits • Spiny or nodular deposits • Significantly enough in quantity to be readily discernible or detectable • Mesial and distal deposits detectable from lingual and/or facial 7 Radiographs In addition to selecting an eligible patient, candidates must present a full mouth series of diagnostic quality radiographs and bitewings or panoramic and bite wing radiographs of the patient. All radiographs (periapicals, bitewings and panoramic) must depict the current condition of the dentition with a written narrative on the Progress Form explaining any recent dental procedures and/or surgeries. 9. Teeth must appear in Universal Notation System (1-32). 10. Candidate number, date films are exposed, patient’s name and L & R indications must be on the mount or digital printout. 11. Neither the candidate’s name nor name of the school should be visible on the mount or digital printout.le. 12. If the candidate mounts the radiographs incorrectly or there is incomplete information on the mount, the candidate will be notified and must correct the error. Radiographic images may be displayed on monitors if they are available from the school’s database. All radiographs must be of diagnostic quality, i.e., they must be of sufficient quality for a dentist to accurately diagnose caries, periodontal health, or other dental diseases and abnormalities Although a full- mouth series plus bitewings or panoramic radiographs with bitewings must be presented and evaluated, only the images of the primary quadrant and additional teeth selected by the candidate will be scored. 1. Present 16-20 images, including two or four bitewings, depending on the number needed to show the mesial and distal surfaces, DEJ, and alveolar crestal bone of all posterior teeth or; 2. Panoramic radiographs with bitewings are acceptable in place of the fullmouth series. 3. Periapical and panoramic images must be current within 3 years. 4. Bitewings must be current within 1 year. They may be vertical or horizontal. 5. The radiographs may or may not be exposed by the candidate. 6. Duplicates, conventional, or digital radiographs printed on photo quality paper are acceptable. 7. Evidence of calculus on radiographs is not necessary for Case presentation. 8. Convexity of dimple on conventional radiographs must face the front of the mount. Exemptions: The following conditions are exempt from the diagnostic standards: 13. Un-erupted, partially erupted, and super erupted third molars (Examiners consider a third molar erupted if the entire occlusal plane of the third molar is in alignment with the occlusal plane of the rest of the teeth.) 14. A third molar with tissue covering any part of the occlusal surface of the tooth, even though the tooth is in the occlusal plane 8 patient will be declared ineligible, and the candidate will fail the exam. Examiners review and score the radiographs as a separate criterion based on whether they are an accurate depiction of the patient’s dentition and the images of the candidate’s selected teeth (both quadrant and all additional teeth) are of diagnostic quality. Also required is a written description of any restorative and/or surgical treatment, which the patient has undergone since the radiographs were taken. If t w o examiners independently confirm the radiographs presented are of such poor quality that t h e y cannot identify pathosis or determine if they belong to the patient, the Candidates will not be permitted to take radiographs at the exam sites unless an emergency arises.* *National Council on Radiation Protection and Measurement (NCRP) Report #145 “Administrative use of radiation to provide information not related to the health of the patient shall not be permitted. Students shall not be permitted to perform radiographic exposure of patients, other students or volunteers solely for purposes of their education or Licensure.” QUICK TIP RADIOGRAPHS • Full mouth periapical, including two or four bitewings, or a panoramic radiograph with two or four bitewings • Periapical and panoramic images must be current within 3 years • Bitewings must be current within 1 year • Duplicates, conventional, or digital radiographs are acceptable. • Candidate number, date films are exposed, and patient’s name must be on the mount or digital printout • Teeth must appear in Universal Notation System (1-32). 9 Clinical Skills Examiners are standardized using the 11/12 explorer and the recommended probe. It is in the candidate’s best interest to use these instruments during the examination. Presenting instruments other than those recommended will cause a delay in the evaluation process. The clinical skills section of the ADEX Dental Hygiene Examination evaluates the candidate’s ability to: • Detect calculus, • Remove calculus without damaging the surrounding tissue, • Measure periodontal pocket depths accurately, • Present the patient for final clinical skills evaluation free of calculus, plaque, and extrinsic stains in the case selection. There are two recommended instruments for evaluation on the ADEX Examination. 1. Explorer: an 11/12 explorer (e.g., the ODU 11/12) is recommended for use by candidates and examiners for calculus detection. 2. Probe: a probe, marked with 1mm increments (e.g., the UNC probe) is recommended for use for the probing exercise. The ADEX D e n t a l H y g i e n e E xamination allows candidates 2 hours to complete the calculus detection, periodontal pocket measurements, and calculus and stain removal exercises. Instruments Candidates may use instruments of their choice for patient treatment. For evaluation, it is extremely important that all candidates and examiners use the same evaluation instruments to ensure that the examination is standardized for all candidates at all testing sites. Additional requirements for instruments and materials may be found in the testing agency’s Supplement Section to this Manual. Figure 1: 11/12 explorer Figure 2: probe 10 Calculus Detection The presence or absence of explorer detectable qualifying sub- gingival calculus on the surfaces of three selected teeth must be accurately recorded. calculus may be counted: mesial (M), distal (D), facial (F), and lingual (L). Points are earned if the candidate’s “Yes” or “No” answer matches the answer of at least two of the three examiners’ answers for that surface. During Pre-Treatment Evaluation, examiners assign three teeth from anywhere in the mouth for the candidate to evaluate for the presence or absence of calculus. Three examiners evaluate the mesial, distal, facial, and lingual surfaces of those three teeth and document their findings. Each tooth has only four surfaces where calculus may be counted: mesial (M), distal (D), facial (F), and lingual (L). Note: Complete the calculus detection exercise prior to removing any calculus. If calculus is removed prior to completing the detection exercise, the candidate will be unable to make an accurate evaluation of the presence or absence of calculus. Examiners assess calculus detection during pre-treatment evaluation. Examiners use the 11/12 explorer and compressed air for calculus detection. At the start of clinical treatment time and prior to removal of any calculus, candidates evaluate the four surfaces of the three assigned teeth. If any readily detectable qualifying subgingival calculus is present on a surface, the candidate indicates “Yes” on the appropriate form. If the candidate finds no calculus on a surface, he/she enters “No” on the form. Each tooth has four surfaces where Errors are assessed when the candidate does not indicate any answer or if both “Yes and “No” are indicated. 11 Candidates should ensure that c a l c u l u s is detectable when: • The 11/12 explorer is inserted into the sulcus/pocket in contact with the crown, and then i s s l i d apically along the root using the side of the tip of the explorer to detect calculus. • Interference with the apical sliding motion along the tooth surface indicates dental calculus. • Detect calculus when interference occurs during the sliding motion of the explorer. • When calculus stops the explorer during the apical movement along the • • • 12 tooth surface, move the explorer laterally out and away from the tooth surface and continue the sliding movement apically, moving back under the calculus piece to regain contact with the root surface. Continue the apical sliding motion until the soft base of the sulcus/pocket is reached. Use compressed air to deflect the tissue and visually observe calculus deposits whenever possible. Calculus found on the line angle will be counted as being present on the mesial or distal surface. the quadrant will not count as part of the six teeth required and points may be deducted. Calculus Removal The treatment phase of the examination is the removal of calculus. Calculus removal must include the entire Case selection. All surfaces in the Case selection will be evaluated for remaining calculus, both supragingival and subgingival. Candidates will treat all teeth in the Case selection indicated on the appropriate form, including the entire primary quadrant and all additional teeth selected. Debride all surfaces on all teeth in the selection. All surfaces in the selection will be scored for remaining calculus. Remaining subgingival calculus and supragingival calculus are scored equally. Periodontal assessment Pocket depths must be accurately assessed and recorded on the two examiner-assigned teeth – one posterior and one anterior. During Pre-Treatment evaluation, examiners assign one anterior and one posterior tooth for measurement of periodontal pocket depths. Three examiners measure and record periodontal pocket depths on the two assigned teeth using a probe marked with 1mm increments and document their findings. Examiners will evaluate the surfaces of calculus listed by the candidate. If examiners are unable to validate 12 surfaces of qualifying calculus in the selection, the candidate will not be able to earn points for removing calculus on 12 surfaces. Candidates earn points for removal of calculus only on surfaces validated by two examiners to have qualifying calculus present. If 12 surfaces of qualifying calculus are not present, candidates will have fewer opportunities to earn points for calculus removal. At the start of clinical treatment time and prior to removal of calculus, measure the periodontal pocket depths and record measurements o n the Progress Form. Each tooth has three surfaces where measurements are evaluated: mesio-lingual (ML), distolingual (DL), and lingual (L). During P o s t - T r e a t m e n t Evaluation, the candidate’s measurements are evaluated and scored. The measurements made by the candidate must be no more than ± 1 mm from the median of the measurements made by the three examiners. Record each measurement in the appropriately labeled space on the Progress Form. For example, the periodontal pocket depths for the mesiolingual surface of the assigned tooth must be recorded in the space labeled “ML,” the lingual reading must be recorded in the space labeled “L,” etc. Errors are assessed for any space left blank. For example, if two of the three examiners are able to locate only 10 surfaces of qualifying calculus in the Case Selection, the candidate will have only 10 opportunities to earn points for calculus removal. When selecting t h e s u r f a c e s , quadrant and/or the additional teeth, the exclusions listed previously must be considered. Excessively decayed or primary teeth in 13 Minor tissue trauma Definition: Any injury that is inconsistent with the procedure and is expected to heal without professional treatment by a dentist or physician. Examples of minor tissue trauma: small lacerations, cavitron burns, abrasions on papillae, gingiva, tongue, lip. If four or more areas of minor tissue trauma are validated, a major tissue trauma error is assessed, resulting in automatic failure of the clinical examination module. Complete the periodontal assessment prior to the beginning of treatment. Record periodontal pocket depth readings before removing calculus in order to ensure measurements are within ± 1 mm of the examiners’ measurements. Do not use any copies or reference materials for this section. Candidates found using previously recorded and/or copied periodontal charts or other copies of the patient’s periodontal pocket depth measurements will be dismissed for unprofessional conduct and will automatically fail. Major tissue trauma Definition: Any injury that is inconsistent with the procedure and that will not heal on its own without professional treatment by a dentist or physician. Examples of major tissue trauma: amputated papilla, significant cavitron burns, severely lacerated soft tissue, exposure of the alveolar process, broken instrument tip evident in the sulcus or soft tissue, root surface abrasions that require additional definitive treatment. The unwarranted presence of major tissue trauma will result in automatic failure of the examination. Points are awarded to candidates whose patients exhibit no minor tissue trauma Tissue management Examiners evaluate subgingival calculus, supragingival calculus, plaque and stain removal from all surfaces, as well as tissue management in the Case selection. The candidate must effectively utilize hand instruments, prophy cups and/or brushes, ultrasonic/sonic cleaning devices, and dental floss without causing unwarranted soft tissue trauma (abrasions, lacerations, or burns) during this examination. Minor tissue trauma Any injury that is inconsistent with the procedure and is expected to heal without professional treatment by a dentist or physician Major tissue trauma Any injury that is inconsistent with the procedure and that will not heal on its own without professional treatment by a dentist or physician Examples of minor tissue trauma: small lacerations; cavitron burns; abrasions on papillae, gingiva, tongue, lip Examples of major tissue trauma: amputated papilla, significant cavitron burns, severely lacerated soft tissue, exposure of the alveolar process If four or more areas of minor tissue trauma are validated, a major tissue trauma error is assessed, resulting in automatic failure of the clinical examination module. The unwarranted presence of major tissue trauma will result in automatic failure of the examination. 14 Only remaining calculus that is not a part of the 12 surfaces evaluated for calculus removal is counted as an error under final Case presentation. At least two out of three examiners must independently assess an error for points to be withheld. around any of the teeth treated during the oral d e b r i d e m e n t or on any other soft tissue structures. At least two of three examiners must independently identify tissue trauma on the gingiva or soft tissue structure for points to be withheld. Pre-existing tissue injuries and/or conditions should be noted by the candidate in the Notes section on the Progress Form. All forms are collected when the candidates check out with the CFE when the patient is back from the Post Treatment Evaluation. Final case presentation . Candidates earn points by presenting the patient free of: • Remaining plaque. • Remaining calculus on surfaces within the Case Selection that are not a part of the 12 surfaces of qualified calculus assigned to evaluate removal skills. • Remaining extrinsic stains. • Other remaining residue or debris. Infection Control Candidates must follow the infection control procedures recommended by the Centers for Disease Control and Prevention. See the testing agency Supplemental Section of this Manual for more detailed information. 15 Table of Evaluation Criteria At least two out of three examiners must independently assess an error for points to be withheld. The two tables below explain the criteria for scoring. Judgment Skills Section Evaluation Criteria Initial Case Presentation • A full quadrant with at least six teeth and two posterior teeth from a second quadrant • • At least two natural, permanent molars o One must be located in the primary quadrant o One of the teeth in the second quadrant must be a molar One of the molars must have both a mesial and a distal contact. Another molar must have at least one contact. o Radiographs Calculus Requirements Clinical Skills Section • • • Periodontal pocket measurement • • • • Calculus removal Tissue management Final case presentation from the molars. Must be free of excessive soft debris Radiographs of the teeth selected are of sufficient quality for a dentist to accurately diagnose dental caries, periodontal health, or other dental diseases and abnormalities. Qualifying calculus is verified by at least two examiners on: o At least three surfaces on proximal surfaces of molars (M or D). o At least five surfaces on proximal surfaces of posterior teeth (M or D). These can include the three from molars. o At least eight surfaces on posterior teeth (M, D, F, or L). These can include the five from proximal surfaces. Evaluation Criteria • Calculus detection To be considered a contact, the adjacent surface must be no more than 2 mm Candidate correctly detects the presence or the absence of readily detectable qualifying subgingival calculus on a tooth surface. The computerized scoring system compares the candidate’s assessment of the presence or absence of calculus to the assessment made during pre-treatment evaluation by three examiners on the same three teeth. Candidate accurately records the sulcus/pocket depths of two assigned teeth. The computerized scoring system compares the candidate’s measurements to those made by three examiners on the same two teeth during pre-treatment evaluation. Measurements made by the candidate must be within ± 1 mm of the median of the measurements of the three examiners. • • • No remaining calculus is found on surfaces chosen by examiners for evaluation. No calculus is seen when tooth is dried with compressed air. No calculus is felt with 11/12 explorer. • Candidate did not inflict any avoidable minor or major tissue damage during calculus removal. • Patient is presented free of remaining calculus, plaque, stain, or prophy paste residue in the treated area. Anesthetic record is complete. • 16 POINT SYSTEM Criteria Points Possible Point System A full quadrant with at least six teeth and two posterior teeth from a second 1 quadrant At least two natural, permanent molars Initial case presentation 1 One must be located in the primary quadrant One of the teeth in the second quadrant must be a molar One of the molars must have both a mesial and a distal contact. Another molar 1 must have at least one contact. Must be free of excessive soft debris Calculus requirements 1 Qualifying calculus requirements met by teeth in the selection: (8-5-3) Eight surfaces located on any surfaces of posterior teeth Five surfaces located on M or D of posterior teeth Three surfaces located on M or D of molars 5 Radiographs Radiographs of the primary quadrant and any additional teeth are of diagnostic quality. Calculus detection 12 surfaces worth 1.5 points each, evaluated for the presence or absence of readily detectable qualifying subgingival calculus. Calculus removal Periodontal assessment Minor tissue trauma Final case presentation 8 18 12 surfaces of qualifying calculus worth 4.5 points each If examiners verify four or more surfaces with remaining calculus, an additional 15 points are deducted. 54 If two examiners are unable to verify 12 surfaces of qualifying calculus in the entire selection, points can be earned for removal only on the number of surfaces with qualifying calculus verified by examiners.* Six measurements worth one point each. 6 Three points awarded if no minor tissue trauma is present. One point deducted for each site of minor tissue trauma, up to three sites. The presence of four or more sites qualifies as major tissue trauma and automatic failure. Treated selection is presented free of calculus, visible plaque, extrinsic stains, prophy paste, and any other visible debris in the treated area. Anesthesia record is complete. Total Major tissue trauma or major infection control violation** 100-point deduction = automatic failure 3 2 100 -100 removal only on those ten surfaces, for a maximum total of 45 points for removal. If examiners verify only eight surfaces of qualifying calculus, points for removal are awarded only on those eight surfaces for a maximum of 36 points. Only when two *For example, if, after thorough examination of both the quadrant and any additional teeth selected by the candidate, two examiners independently identify only ten surfaces with qualifying calculus, the candidate can earn points for 17 Points are assigned in accordance with the nationwide task analysis survey conducted every five years. Results from this survey of practicing dental hygienists allows the testing agencies to determine which clinical skills are performed most frequently, and which clinical skills are considered more important to protect the public. Skills that rate highest (most points earned) are weighted more heavily than skills that rate lower. examiners verify 12 surfaces of qualifying calculus in the selection can the candidate earn the maximum of 54 points for calculus removal. **Examples of major infection control violations include, but are not limited to, use of non-sterile instruments; uncapped needles; and other violations that put the patient, candidate, examiner, or staff members at risk for injury or exposure. 2 POINTS SYSTEM EXPLANATION Initial Case Presentation: 4 points There are four criteria under Initial Case Presentation. If the case does not meet one of more criteria, four points are lost. There are not individual points assigned to each of the four criteria. Four points are lost if one, two, three or all four criteria are not met. Calculus Requirements: 5 points There are four criteria under Calculus Requirements. If the case does not meet one or more criteria, five points are lost There are not individual points assigned to each of the four criteria. Five points are lost if one, two, three or all four criteria are not met. Radiographs: 8 points Radiographs of the candidate’s selected teeth are evaluated as diagnostic or non-diagnostic This is also a one-time point deduction. Calculus Detection: 18 points Twelve surfaces are evaluated. Each surface is worth 1.5 points. Points are earned when the candidate correctly identifies the presence or absence of calculus on the M, D, L and F surfaces of three teeth. The candidate’s answer must match that of two out of three examiners. Calculus Removal: 54 points Twelve surfaces are evaluated for calculus removal. Each surface is worth 4.5 points each. Points are earned when the candidate successfully removes all calculus from the surface. If examiners verify four or more surfaces with remaining calculus, an additional 15 points are deducted. Periodontal Assessment: 6 points Three surfaces (ML, L and DL) on two teeth are measured for a total of six measurements. Each measurement is worth one point. Points are awarded when the measurement made by the candidate is within +/- 1 mm of the median measurement recorded by the three examiners. Minor Tissue Trauma: 3 points If no minor tissue trauma is verified, the candidate earns three points. If one area of minor tissue trauma is verified, one point is lost. If two or three areas of minor tissue trauma are verified the candidate loses two or three points respectively. If four or more are verified, the trauma is elevated to “major” tissue trauma and results in a 100 point deduction and failure of the examination. “Minor” and “Major’ trauma are defined in the Manual. Final Case Presentation: 2 points There are five criteria under Final Case Presentation. If the case does not meet one or more criteria, two points are lost. There are no individual points assigned to each of the five criteria. Two points are lost if one, two, three four or all five criteria are not met. 18 COMPUTER SIMULATED EXAM Content Computer Simulated Clinical Examination (CSCE) Medical/Dental Assessment Intra and Extra Oral Examination Format Clinically based questions presented on a computer Dental and Periodontal Charting and Assessment Soft Tissue, Bone and Tooth Abnormalities Radiography/Imaging Dental Hygiene Care Planning Periodontal Procedures The CSCE is the Computer Simulated Clinical Examination with clinically based questions that utilize a multiple-choice format to indicate examinees’ responses. It is an integral component of the ADEX Clinical Examination and differs from the National Board Dental Hygiene Examination, which is a comprehensive achievement examination in the theory of dental hygiene. Note: the local anesthesia computer-based examination is not required as part of the 2016 examinations. or greater is passing. There are an additional 15 questions being tested for possible future use, but they are not part of the examination grade. The CSCE is approximately two hours in length. The CSCE is given, by appointment, at a testing center. Contact the testing agency of your choice for information concerning testing centers. Standards for the CSCE The CSCE is designed to assess more complex levels of diagnosis and treatment planning knowledge, skills, and abilities. • Clinically based questions are utilized through computer-enhanced photographs, radiographs, optical images of study and working models, laboratory data and other clinical digitized reproductions. • The CSCE consists of 100 graded questions. Scoring for this examination is based on the percent of questions answered correctly. A final score of 75 19 Extraneous materials (textbooks or study materials) are n o t permitted at the testing center at any time. Only those materials distributed or authorized by the testing center may be brought to the examination. Use of unauthorized materials will result in failure of the entire examination. Time schedule: A specific total amount of time is allowed for the CSCE. Once a candidate has completed and locked out of the CSCE, the candidate may not reenter the CSCE. • • • Timely arrival: The date and appointment schedule established by the testing center must be adhered to as confirmed. Failure to do so will result in forfeiture of the examination fee. Behavior at the testing center: Unseemly behavior of the candidate or improper behavior toward personnel at the testing center will result in failure of the CSCE and forfeiture of the examination fee. Examination security: Security measures established by the testing agency and testing center must be followed. Failure to do so may result in failure of the examination. • • • • • • The candidate may skip or mark items to be considered later. Once the CSCE is completed and the candidate locks out of the examination, she/he will not be able to return to the examination. The time indicated on the computer screen is the amount of time for the examination. There is no specific time limitation for each item. The CSCE is administered at testing centers by appointment after eligibility authorization is granted to the examinee by the testing agency. Approximately two hours are allotted for this examination. No study materials may be brought to the center and recording of test items is prohibited. Violation of these rules constitutes a violation of the Standards for the CSCE and may result in failure of the examination. The rules of conduct of the examination as established by testing center must be followed. Disciplines and Subject Matter Addressed in the CSCE • • • • • Dental Hygiene Care Planning Periodontal Procedures Infection Control Medical Emergency Management Dental Specialties Applied Pharmacology Medical/Dental Assessment Intra and Extra Oral Examination Dental and Periodontal Charting and Assessment Soft Tissue, Bone and Tooth Abnormalities Radiography/Imaging 1 SUPPLEMENTAL TESTING AGENCY INFORMATION of the examination should be directed to the testing agency selected by the candidate. While all testing agencies administering the ADEX Dental Hygiene Examination must adhere to the patient eligibility, criteria and scoring system explained in this Manual, other details regarding administration are unique to each testing agency. Additional information regarding application, schedules, testing sites, fees, forms, policies, and procedures are found in the Supplemental Section of this Manual. This section is produced and included in the Manual by the individual testing agency or state that chooses to use the licensure examination provided by ADEX. Please refer to the following supplemental section of this Manual for further details. All questions regarding the administration 21 Glossary Abrasion Abnormal wearing of tooth substance or restoration by mechanical factors other than tooth contact. Apical The tip or apex of a root of a tooth and its immediate surroundings. Calculus A hard deposit attached to the teeth, usually consisting of mineralized bacterial plaque. Caries An infectious microbiological disease that results in localized dissolution and destruction of the calcified tissues of the teeth. Case Selection Entire selection of the teeth chosen by the candidate, which includes a primary quadrant plus two posterior teeth in a second quadrant. Cemento-enamel junction – CEJ Line formed by the junction of the enamel and cementum of a tooth. Complete treatment Removal of all supra and subgingival deposits including coronal plaque and stain. Contact area The area where two adjacent teeth are no more than two millimeters from each other. Debride Complete removal of all calculus, plaque, soft debris, food, and prophy paste. Defective restoration Ditching, poor marginal integrity, recurrent caries, or fractured. Deposits, subgingival Deposits thatare apical to the gingival margin. Deposits, supragingival Deposits coronal to the gingival margin. Diagnostic quality radiographs Radiographs of sufficient quality for a dentist to accurately diagnose caries, periodontal health, or other dental diseases and abnormalities. Gross (excessive) caries Decay that has deteriorated three of the four axial walls and involves the cervical third of the tooth. 22 Interproximal contact The area of contact between two adjacent teeth. Also called proximal contact. Line angle The angle formed by the junction of two surfaces. Long axis An imaginary straight line passing through the center of the whole tooth occlusoapically. Mobility The degree of looseness of a tooth. Optional additional Teeth Up to two posterior teeth, premolars or molars, within 2mm of each other in a second quadrant used to satisfy tooth and surface selection criteria not met in the quadrant of the Case. Pass/fail rule Candidate must have a score of 75 or greater to pass. Periapical Area around the root end of a tooth. Pocket depth measurements Pockets depths accurately assessed and recorded on the two examiner assigned teeth – one posterior and one anterior. Posterior teeth Premolars and molars Primary dentition The first set of teeth (deciduous). Proximal surfaces Mesial and Distal surfaces. Psychometric validity Test validity: the degree to which evidence and theory support the interpretations of test scores. Quadrant A quarter of the oral cavity with six to eight teeth, upper right, lower right, upper left, lower left. Qualifying calculus Explorer detectable subgingival calculus, which is distinct and easily detected with an #11/12 explorer. Qualifying surfaces Twelve surfaces with subgingival qualifying calculus. (eight surfaces on posterior teeth, five surfaces on posterior teeth on mesial and distal surfaces, three on mesial and distal surfaces of molars, four on any other sub gingival surfaces.) 23 Stain, extrinsic Stain that forms on and can become incorporated into the surface of a tooth after development and eruption. These stains can be caused by a number of developmental and environmental factors. Sonic scaler An instrument tip attached to a transducer through which high frequency current causes sonic vibrations (approximately 6,000 cps). These vibrations, usually accompanied by the use of a stream of water, produce a turbulence, which in turn removes adherent deposits from the teeth. Tissue trauma Unwarranted iatrogenic damage to extra/intraoral tissues resulting in significant injury to the patient, such as lacerations, burns, amputated papillae, or large tissue tags. Triple blind scoring Three examiners independently evaluate and score. Ultrasonic scaler An instrument tip attached to a transducer through which high frequency current causes ultrasonic vibrations (approximately 30,000 cps). These vibrations, usually accompanied by the use of a stream of water, produce a turbulence, which in turn removes adherent deposits from the teeth. Validate To be sound and just while supported by fact. Veneers A restoration that covers the facial, mesial, distal, and incisal surfaces of a tooth, usually porcelain. Acronyms AADB American Association of Dental Boards ADEX American Board of Dental Examiners APA American Psychological Association CDCA Commission of Dental Competency Assessments CODA Commission on Dental Accreditation CSCE Computer Simulated Clinical Examination DHEC Dental Hygiene Examination Committee OSHA Occupational Safety and Health Act PTCE Patient Treatment Clinical Examination 24 2016 Policies and Procedures Supplement for the ADEX Dental Hygiene Examination as administered by: The North East Regional Board of Dental Examiners is now the CDCA The Commission on Dental Competency Assessments, Inc. 1304 Concourse Drive, Suite 100 Linthicum, MD 21090 www.cdcaexams.org Copyright © 2014 American Board of Dental Examiners, Inc. Copyright © 2014 North East Regional Board of Dental Examiners, Inc. The CDCA Supplement Table of Contents I. GENERAL INFORMATION..1 VII. Examination results ....................... 1 Eligibility…………………………….……………2 Application ................................... 2 Applying for re-examination ........... 5 II. SITES, DATES, AND FEES..5 Dates and Sites……………………..……….5 Site Selection………………………….………5 Computer Simulated Examination.…5 Fees………………………………………….….….6 III. PREPARING FOR THE EXAMINATION…………... .. 8 Pre-examination preparation .......... 8 Exam materials ............................. 8 Registration ................................. 8 IV. PROCEDURES………….…. .. 9 Exam schedule and Overview ……. . 10 Cubicle set-up............................. 12 Pre-treatment evaluation ............. 13 Clinical treatment time................. 14 Use of local anesthesia................. 15 Shared patients .......................... 16 POLICIES……………….…..30 1. Anonymity .........................30 2. Candidate accessibility ........31 3. Change of name………………….31 4. Confidentiality………………………31 5. Dismissal from examination .31 6. Electronic equipment ..........32 7. Examination placement & limitations .........................32 8. Examination results ............32 9. Equipment .........................33 10. Ineligible candidates ...........33 11. Infection control .................34 12. Instruments .......................37 13. Interpreters .......................37 14. Jurisprudence ....................37 15. Malpractice Insurance .........38 16. Patients.............................38 17. Patient privacy statement ....38 18. Professional standards ........38 19. Questions ..........................38 20. Re-examination ..................38 21. Refunds ............................40 22. Restrictions .......................40 Post operative evaluation ............. 17 23. Retake Requirements ..........40 FORMS…………………….... 18 24. Scheduling confilicts ...........40 Dental Hygiene Progress Form ...... 18 Calculus detection ....................... 19 25. 26 Sharing equipment….…….41 Special testing provisions41 Probing Measurements ................. 20 27. State-only examinations ......42 V. Calculus removal………………………....20 Trtmt Selection Worksheet.……….…21 Progress Form……………………………...22 Medical History Form ................... 25 Post-Operative Care Agreement .... 28 Patient Consent, Disclosure and Assumption of Respnsibility Form .. 29 VI. APPEALS…………………... 29 28. Unethical conduct……….……42 VIII. FAQs.............................. 42 IX. EXAM CHECKLIST…….…..46 X. ONLINE REVIEW CERTIFICATION …….…...51 GRADUATION WITHIN 45 DAYS……………….……52 XI. GENERAL INFORMATION Welcome to the Commission on Dental Competency and Assessments (CDCA)administration of the ADEX Dental Hygiene Examination. The CDCA provides this Candidate Manual so candidates may become familiar with the procedures and policies for the ADEX Dental Hygiene Examination administered by CDCA. The ADEX section of this Manual covers the core requirements for the criteria and scoring needed to pass the examination. This section covers the administrative procedures including how to apply, testing site information, fees, schedules, and forms required by the CDCA. Please be aware that by registering for this examination, that you agree that the CDCA, and its examiners, volunteers, and employees will have no liability to you in the event you suffer an injury during the examination as a result of your actions or actions of your patient. Examination results The performance of the candidate is evaluated according to the ADEX criteria and standards published in the Candidate Manual Scores are automatically reported to each CDCA participating jurisdiction. Scores are also made available to candidates for each individual ADEX Dental Hygiene Examination. Scores are posted for each candidate in their profile following the examination. The CSCE scores are reported at the end of the first full week of the month following the month in which the CSCE was taken. The Patient Treatment Clinical Examination scores are generally reported within three days of the date of the candidate’s examination, if the examination is administered electronically. You will receive an email notifying you that your scores have been posted to your profile. A critique of performance in each clinical examination of the ADEX Dental Hygiene Examination is provided to the candidate together with the examination score. In order to maintain the security of the examinations, this critique is issued in lieu of a review of actual examination papers or clinical evaluation forms. Scores are not released to candidates or their representatives by telephone, facsimile or email. The individual scores of a candidate are not released by the CDCA to the school of graduation unless authorized by the candidate upon application for examination. Scores are not released at any time, except to the candidate and the CDCA participating licensing jurisdictions unless authorization is received from the candidate. 1 Scores will be provided to other licensing jurisdictions upon receipt of a request signed by the candidate and sent to the CDCA. Such request must include the following: 1. 2. 3. 4. 5. Candidate’s name, mailing address and telephone number, Candidate’s name at time of examination, Year in which the CDCA Clinical Examinations were completed, Address to which the results are to be sent, Money order in the sum of $30 per each address to which the scores are to be forwarded. Eligibility for the Clinical Exam The following are those categories of individuals qualified to take this examination. Others may qualify upon the specific request of a state dental board. (These are called State-only examinations). Graduates of dental hygiene programs accredited by the American Dental Association Commission on Dental Accreditation (ADA/CODA) or by the Commission on Dental Accreditation of Canada (CDAC) or other specified national dental commissions are eligible to apply to take the ADEX Dental Hygiene Examination administered by the CDCA upon presentation of proof of graduation. Senior students of record attending a dental hygiene program accredited by the ADA/CODA are eligible to apply to take the ADEX Dental Hygiene Examination when the Program Director (or designated school official) certifies, in writing, that the candidate is expected to complete all academic requirements and receive a dental hygiene degree within 45 days of the scheduled Patient Treatment Clinical Examination and that the candidate is sufficiently prepared to participate in the examinations. Application Online Registration Process Applying online is a multi-stage process: 1. Go to http://www.cdcaexams.org/apply. Click the fill out a basic profile link and complete the form. The email address you enter will become your username to login to your profile and will be used to communicate your site assignment and notify you when results are available for 2 release. Double check your email address, all other information and choose a secure password. After completing the online form, click the Apply button. 2. The next page that is displayed is the one you will see each time you login to your profile. The Dashboard tab is displayed by default. Here you will find a list of current items and their status: Check Mark = completed item Exclamation Mark = item requires attention 3. On your Dashboard page, you will be prompted to upload a photo. Click the Upload link and follow the instructions. A photo is required. All photos will be reviewed by the CDCA and may be rejected if they are not acceptable for identification purposes. Submitting an unacceptable photo will delay your registration. • Photos must be in one of the following formats: JPG/JPEG, GIF, or PNG. • Photos must be square and have a minimum resolution of 200 x 200 and a maximum resolution of 500 x 500. • Your photo must be a front facing headshot in the format that would be used for a passport and your name must not be visible on your photo. • Photos must not display written information, such as on a driver’s license or school identification number. • Do not submit scans of photo IDs such as a driver’s license. 4. Your graduation status must be validated before you can register for exams. Verification can take several weeks depending on the method used: • • Graduating senior at a school in a CDCA state: o A designated school official may login to the CDCA website to verify eligible candidates online. o Your school may provide the CDCA with a list of its graduating class. Graduating senior NOT in a CDCA state: o Upload a scan of the signed Certification of Completion of Requirements to Graduate Within 45 Days Form located in at the end of this Manual. To upload a scan, login to your profile, then click the Profile tab followed by the Proof of Graduation link at the top of the screen. 3 • Graduate: o Upload a scan of your diploma. To upload a scan, login to your profile, then click the Profile tab followed by the Proof of Graduation link at the top of the screen. 5. After your profile, photo and graduation status are validated, you will be able to click the link on your Dashboard to register for examinations. 6. Submit payment for examination fees. The CDCA accepts U.S. VISA and MasterCards only. Debit cards may be used if allowable by the issuing bank and if they bear the VISA or MasterCard logo. All payments are drawn immediately and must be paid in full. Failure to pay the registration fee at the time of registration may forfeit your ability to sit for the examination. Registrations that are not paid within 72 hours are automatically cancelled from your profile. CDCA Online Profile Tabs Dashboard. Under this tab you will find a find a list of items you must submit for your CDCA profile and the status of each item. Check Mark = completed item Exclamation Mark = item requires attention Apply Once all profile information has been uploaded and your profile has been verified you may use this tab to apply for examinations. Detailed instructions will be presented based on the available examinations. This tab is also where your clinical assignment will be listed once the site schedule is finalized. Documents Candidates must visit this tab prior to the examination to download and possibly fill out any required forms and documents. Instructions about each document will be given. Profile Under this tab you can view and edit your personal information and upload your photo, proof of graduation, etc. Results Your results will also be posted under this tab once they are finalized and released. Social Security Number A Social Security Number is not required to register and take the examination but may be required by a state for purposes of licensure. 4 Applying for re-examination For candidates who need to retake the examination, it is not necessary to create another profile. Simply log back into your profile and click on “Apply” at the top of the screen. Follow the instructions on the screen. SITES, DATES and FEES Dates and Sites You should refer to the CDCA website (www.cdcaexams.org) for a current and complete listing of the dates and sites at which the Patient Treatment Clinical Examinations will be offered. These can be found under the tab Dental Hygiene, menu choice Dental Hygiene Exam Calendar. Clicking on an individual site will give you specific site information. A current listing of the locations of Prometric Centers at which the CSCE is offered throughout the year can be accessed at Prometric’s website (www.prometric.com). Site Selection -Patient Treatment Clinical Exam When applying online, applicants must indicate the site at which they wish to be examined. Applicants from the school where the examination is administered receive priority. Other applicants will be accepted on a first-come, first-served space available basis. In some cases, if a site is full, the candidate may be assigned to an alternate site with their permission. Schools designated as closed sites accept only students or graduates of their school. Candidates who did not attend the school serving as their test site are encouraged to visit the site prior to the time of the examination. Site information is available on the Dental Hygiene Exam Calendar on the CDCA website as the host school makes it available. This should provide candidates from outside a school the information they need to take the examination at that institution. It is the responsibility of the candidate to find out the specific requirements for their scheduled test site. Some sites require that all instruments be supplied by the school. The candidate must make arrangements with the school for the provision of instruments, if required. The school may charge a rental fee for use of instruments, clinical facilities, supplies, and disposables. A rental charge or deposit imposed by the facility must be remitted directly to the school. This fee is independent of the ADEX examination fee and is not collected by the CDCA. 5 Computer Simulated Clinical Exam (CSCE) The CSCE is administered at Prometric Testing Centers by appointment. The locations of Prometric Testing Centers can be found on the website: www.prometric.com. CDCA will instruct you on how to make an appointment for your examination, either by calling Prometric’s National Registration Center or via their website. To cancel or reschedule an appointment, call the National Prometric Registration Center (1-800-797-1813). Do not call your local Prometric Testing Center. If you wish to cancel or reschedule, you must call at least 30 consecutive days prior to the test date. If you call 5 to 29 consecutive days prior to the exam date, you will be charged a $25 fee by Prometric. If you call less than 5 consecutive days prior to the test date or are more than 15 minutes late for the examination, the examination will be cancelled and your fee will be forfeited. When scheduling an appointment for the CSCE with Prometric, an email confirming the examination date and time may be requested. It is recommended that a copy be made and retained for future reference. If the CSCE was failed, a new application for re-examination is required prior to receiving authorization to schedule an appointment with Prometric for the retake. All CDCA rules for application procedures apply. Fees Current fees are listed on the CDCA website; www.cdcaexams.org under tab “About” and then select “Exam Fees.” Refund of Fee A request for a refund must be in writing and received by the CDCA on or before the published application deadline date for the current examination series for which the fee was submitted. Requests received after the published application deadline date will not be granted. The deadline date for the CSCE retake application is the date the retake application is received by the CDCA. Requests for refund are not granted after the date the CSCE retake application is received by the CDCA. 6 Failure to appear for any individual examination of the ADEX Examinations in Dental Hygiene results in forfeiture of the entire examination fee. A refund or partial refund is not granted for any reason. Fee Deferral: Under extenuating circumstances a request for the examination fee to be deferred to another series will be considered on an individual basis when received by the CDCA on or before the scheduled examination date and no later than 30 days after the scheduled examination date. Requests must be made in writing to the Director of Finance and Administration of the CDCA and must include original documentation in support of the request. Notification will be sent immediately after a determination is made by the CDCA. If a fee deferral is granted, the terms and conditions for future examination as set by the CDCA will be included. If the deferral is due to academic reasons, see the separate section on Academic Disqualification. Requests for fee deferral received more than 30 days after the date of the scheduled examination will be denied and the fee will be forfeited. Administrative Fee: A non-refundable administrative processing fee of $100 is applicable for any refund or fee deferral. 7 PREPARING FOR THE EXAMINATION Pre-examination preparation On the day of the exam, candidates must provide their own instruments or rent them from the examination site. The site information sheet will explain which sites do or do not rent instruments. The candidates must also provide an acceptable patient, a full-mouth series of diagnostic-quality radiographs (or panoramic film and bitewings) of the patient presented, and appropriate paperwork. Exam materials Each testing site will send a site information sheet explaining what materials will be available. Candidates should contact the testing site directly to determine whether the equipment available onsite is compatible with the candidates’ equipment. EXAM FORMS After the candidate’s application is completed and verified, he/she should download and print all forms from the website www.cdcaexams.org by going to the Dental Hygiene tab and selecting menu choice Dental Hygiene Exam Forms. Candidates may use copies of forms for pre-screening patients and to aid in patient preparation. If errors are made on forms in ink during the examination, the candidate should make a single line striking through the incorrect entry, make the correction, and initial the correction using the candidate number. Note that in addition to the Medical History Form required for all patients, some patients with sensitive medical conditions may require an additional physician’s statement clearing them for treatment. If the patient has a condition that requires a physician’s written clearance, candidates must present the physician’s letter during the pre-treatment evaluation; if no letter is presented, the patient will not be allowed to participate.. Candidates should develop a list of teeth and surfaces that meet the requirements for Case Selection and record this this information on the Treatment Selection Worksheet, then enter it into the scoring system online up until 48 hours before the start of the scheduled examination. Alternatively, the Case Selection may be entered into the scoring system by the DSM on the day of the examination. Bring a copy of the Case Selection entry or the Treatment Selection Worksheet when meeting with the DSM All Case Selection information, whether entered online or on site, must be reviewed with the DSM for Candidate confirmation before Pre-Treatment Evaluation. 8 Forms Required on Examination Day Forms/Materials Presented at PreTreatment Evaluation Forms Presented at Registration Two candidate IDs- one photo and two with the candidate’s signature. Acceptable forms include current driver’s license, Passport, Military ID, School ID, voter registration card. A credit card is acceptable as a secondary form of ID • Patient Medical History Form (and physician’s statement, if needed) • Dental Hygiene Progress Form • Patient Consent, Disclosure and Assumption of Liability Form • • Certification of Review of the Online Orientation Radiographs • Cubicle card • Application form that contains the Candidate sequential number • PROCEDURES Required ID When candidates apply for the examination, they electronically submit a recent photograph. This is applied to an Identification Card which the candidate receives on the day of the examination. Besides the photograph, the ID card includes the candidate’s sequential number, ID number, test site and date. The ID card is to be cut from the sheet it is printed on and worn in a badge holder provided the day of Orientation. This ID is to be worn at all times during the examination. Prior to Registration, candidates must go to their online profile, where they originally applied to take the examination, and under the Apply Tab, find their assigned Sequential Number. In order to enter and pick up their examination materials, candidates must print off and bring this number with them to the Registration along with 2 other forms of personal identification. Both of these additional IDs must contain the candidate’s signature and one must have a recent photograph. Acceptable forms of ID include: Current driver’s License, Passport, Military ID, Employee ID, School ID or voter registration card. A national credit card is an acceptable secondary form of ID. An expired Driver’s License is not acceptable as an ID for this examination. If the name on the documentation presented differs at all from the name currently used on the application, official documentation or authorization of a name change must be presented for admittance to the examination. If not admitted for lack of this documentation the fee will be forfeited. Note: An identification card is not issued for the CSCE, however 2 forms of ID 9 with the name identical to that on the candidate’s registration are required for admittance to test at the Prometric Testing Center. Clinical Examination Schedule Candidate Orientation is done online prior to the examination day. AM Session 6:45 - 7:15 7:15 - 7:45 7:45 10:00 12:00 Candidate Registration Set Up in Clinic CFE’s can begin checking medical histories when the candidates are ready Exam Start: Patients who are checked in can be sent to the Evaluation Area Deadline for sign-in to the Evaluation Area Exam ends PM Session 11:45 - 12:15 12:15 - 12:45 12:45 3:00 5:00 Candidate Registration Set Up in Clinic CFEs can begin checking M o the Evaluation Area Exam Start: Patients who are checked in can be sent to the Evaluation Area Deadline for sign in to the Evaluation Area Exam Ends Overview of the examination day On the day of the examination, Candidates must attend registration. Due to the number of sites at which the CDCA administers the examination, site specific information may not be provided until 2 weeks before the examination. It is the responsibility of each candidate to contact the site prior to the date of the examination to verify that all handpieces and sonic/ultrasonic scalers are compatible with school equipment. It is advisable to visit the site prior to the examination date to become familiar with the clinic. The candidate must arrange directly with school officials, as the CDCA does not arrange tours of sites. What • • • to bring to Registration: Radiographs Medical History, Consent and Treatment Selection Worksheet form Certification of Review of the Online Orientation form from the Candidate Manual • Candidate Manual • Your Sequential Number from the Apply Tab on your Profile 10 Registration Session: • IDs will be checked and examination forms will be distributed in envelopes • Specific site information will be provided by the Chief Examiner • Candidates will have the opportunity to ask questions about the examination and/or the site • Receive candidate badge and form for interpreter registration • Candidates will turn in a signed form (found at the back of this Manual) attesting that they have viewed and understood the on-line Examination Orientation • Receive candidate badges and badges for interpreters • Peel-off ID labels are affixed to all required forms Medical History forms, Consent forms and Treatment Selection Worksheets that have been printed from the website and completed by the Candidate and/or the patient may be used during the examination. Bring the completed forms to Registration and affix an ID label on them. New forms are provided at Registration if needed. The Progress Form provided at Registration must be used during the examination. Candidates who fail to attend registration will not receive individual instructions. Registration is for candidates only. If a candidate will be using an interpreter, the interpreter should submit the interpreter authorization form and two forms of ID to the Chief Examiner. Clinic Floor Examiner (CFE): A dentist who supervises the clinic floor during the examination. The CFE evaluates the patient’s health history to determine whether it is safe for the patient to participate in the examination and receive local anesthesia. The CFE serves as a liaison between the candidate and examiners, but does not evaluate the candidate’s performance. Data Systems Manager (DSM): The DSM assists candidates with entering examination data into the computer scoring system. DSM does not evaluate candidate performance. Candidates should review/enter the Case Selection with the DSM or CFE to insure its accuracy. Examination paperwork is reviewed by a CFE and when approved, the patient proceeds to a separate Evaluation Area where three examiners independently evaluate the patient during the Pre-Treatment Evaluation process. The patient is then returned to the candidate to begin clinical treatment. When the 2 hour clinical treatment time ends or if the candidate is ready before that time, the candidate escorts the patient to the 11 Evaluation Area and meets with the DSM to enter the Calculus Detection findings and Periodontal Probe readings and then the patient enters the Evaluation Area where three examiners evaluate the candidate’s work. When the final evaluation is complete, the patient returns to the candidate, the candidate dismisses the patient and cleans the cubicle. Only one patient may be presented for the Patient Treatment Clinical Examination. Once a patient’s medical history and other examination forms have been submitted to a CFE for approval, the exam has begun and a back up patient may not be presented. If, before the patient is presented to the CFE, the candidate determines that the patient is ineligible, a back-up patient may be presented. The work-up of back-up patients is at the expense of the total time allowed for the examination process. Candidates begin the Patient Treatment Clinical Examination at either 7:45 a.m. or 12:45 p.m. as assigned by group. Cubicle set-up During set up candidates check that the air, water, light, and chair are working properly, and notify the CFE of equipment failure. Locate the disposable supplies provided by the school. They need to set up and arrange instruments and paperwork take the patient’s blood pressure and record it on the Medical History. (No treatment may be provided if the systolic pressure is 160 and/or the disastolic is 100 mm Hg or above.) The CFE Checks the Medical History and enters appropriate information on the Progress Form. Anesthesia is provided if approved by the CFE. When ready, the candidate brings the patient to the Evaluation Area sign in desk and meets with the DSM to enter or confirm the previously submitted Case Selection into the scoring system. After you have checked in with the CFE you can set up the ultrasonic cleaner and make sure it works properly. QUICK TIP REQUIRED MATERIALS • 11/12 explorer and a probe with markings 1 mm apart • A blood pressure measuring device • Syringes / supplies for local anesthesia administration, if applicable. Testing sites provide cartridges of anesthetic. • A tray for the patient to transport the instruments to the designated area Sterile instruments (choice of the candidate) • Ultrasonic/sonic scaling instruments. At some schools, ultrasonic units may be available for rent. Contact the school directly to see if this service is available. CDCA does not assist in equipment rental issues • A hand-piece compatible with the examination site’s equipment 12 Pre-Treatment Evaluation Pre-treatment evaluation is the procedure during which three examiners in the Evaluation Area: If the patient is sitting for more than one examination on the same day, the blood pressure must be taken prior to each examination and recorded on a separate Medical History Form for each candidate. Pre-Treatment Evaluation Pre-Treatment Evaluation is the procedure during which three examiners in the Evaluation Area: • • • • • • Evaluate the Case Selection according to the examination criteria Assign teeth for calculus detection and periodontal assessment exercises Assign two additional surfaces of qualifying calculus Document where calculus is found on the teeth assigned for detection Measure and record the periodontal pocket depths on the teeth assigned for the periodontal assessment Validate 12 surfaces of qualifying calculus from the 12 surfaces selected by the candidate and the 2 surfaces added by the examiners. The 12 surfaces validated for the Calculus Removal exercise may be a combination of surfaces selected by the Candidate and those selected by the examiners. Pre-Treatment Evaluation may take 35 minutes once the evaluation process has begun in the Evaluation Area. Patients should remain in the candidate’s treatment chair until advised by a CFE that space is available in the Evaluation Area. Patients may use books, magazines or other non-electronic devices. The use of all electronic devices by both patients and candidates is prohibited during the examination. To facilitate the pre-treatment evaluation process, patients must be plaque-free, with no evidence of soft debris, food matter, etc. Candidates who present patients with excessive soft debris will not earn points for initial case presentation. 13 The following items must always accompany the patient to the Evaluation Area: Paperwork • Required radiographs • Color coded cublcle card • Consent Form • Completed, signed and dated Medical History Form, current within 30 days of examination date. Attach a physician’s statement, if needed. • Dental Hygiene Progress Form, with the following information completed: Candidate information Anesthesia record Quadrant and additional teeth selected for the partial debridement o These must be the same as entered into the website, if the exam is administered electronically Teeth and surfaces where qualifying calculus is located o These must be the same as entered into the website, if the exam is administered electronically Comments to examiners Instruments • • • 11/12 explorer for calculus detection Periodontal probe for periodontal assessment with markings of 1-2-3-4-5-6-78-9-10. The probe may be single or double ended Reflective front surface mirror, which may be one or two sided Other Materials • • • A tray for the patient, to transport the instruments and required paperwork to the designated area for pre-treatment evaluation Eyewear for the patient Barcode on a clean patient napkin Clinical treatment time The clinical skills section of the ADEX Dental Hygiene Examination evaluates the candidate’s ability to detect calculus, remove calculus without damaging the surrounding tissue, and accurately measure periodontal pocket depths. Candidates have 2 hours to complete the calculus detection, periodontal pocket measurements, and calculus removal exercises. Perform calculus detection and periodontal measurements before beginning calculus removal, in order to ensure accurate detection and measurements. Clinical treatment time begins and ends as noted on the Progress Form by the examiners. Stop-time is exactly 2 hours after the start-time. Post-treatment evaluation begins when the patient returns to the Evaluation Station. However, any candidate wishing to proceed to post-treatment evaluation prior to the end of the 2 hour deadline may do so. 14 Use of local anesthesia The use of injectable local anesthesia will be permitted at the discretion of the examination sites. Candidates should check with the school prior to the examination, to determine whether the use of injectable local anesthesia is allowed. The use of injectable local anesthetic is permitted, if allowed by the examination site, by candidates who are: • students at the host school and who have successfully completed the required anesthetic course work and have been certified on the day of the examination by the program director or other authorized school official at the exam site. • student candidates from schools external to the school hosting the examination, including unlicensed graduates of schools external to the host school, and who provide a letter from their program director or the authorized school official certifying successful completion of the required anesthetic course work. • graduates who are authorized by a state to use injectable local anesthetics, and who provide documentation, on the day of the examination, from their state dental board, authorizing them to utilize injectable local anesthesia (copies of active state certificates that permit the use of injectable local anesthetic are acceptable documentation). This documentation must be provided to the Chief examiner at registration. • • Candidates must provide all syringes and supplies for anesthetic administration. Cartridges may or may not be provided at the site for injectable local anesthesia but all local anesthetics must be used before their expiration date. After the CFE approves the Medical History and Anesthetic Request, the candidate may anesthetize the patient before going into the evaluation area or at any time during the clinical examination. The CFE will tell you when to anesthetize based on when a chair will be available in the Evaluation Area for your patient. All candidates who utilize local anesthesia for their patients are required to complete the appropriate documentation. When deciding whether to administer anesthesia, keep in mind that three examiners will examine the patient using the explorer and probe subgingivally during Pre-Treatment Evaluation. It is recommended to anesthetize the patient before Pre-Treatment Evaluation for better patient comfort and time utilization. The Progress Form in this Manual gives an example of a completed anesthesia record. Candidates wanting to utilize topical and/or injectable anesthesia must complete the anesthesia record on the Progress Form and have it approved by the CFE at Check-in. Permission for the use of any anesthetic agent must be 15 granted by the CFE, prior to administration, at the start of the examination and properly documented on the Progress Form. The candidate may choose not to use an injectable local anesthetic agent. Combination agents such as lidocaine and prilocaine periodontal gel 2.5%/2.5% are considered topical anesthetics. Examiners do not evaluate the technique and/or actual administration of local anesthetic. Candidates may be observed by the CFE regarding proper technique, in order to ensure patient safety and comfort. Inhalation anesthesia is not permitted for the examination. Violation of this standard will result in failure of the affected examination. If more than 2 cartridges of anesthetic are needed during the examination, the candidate must request approval from the CFE who will document and initial the request. This protocol must be followed for each subsequent cartridge. Anesthetic solution may only be administered following approval of the CFE. An aspirating syringe and proper aspirating technique must be used for the administration of local anesthetic. Candidates who are not qualified to administer local anesthetics may use topical anesthetics or anesthesia patches (Oraqix, etc.). The CDCA does not permit a third party, whether an examiner, dentist or licensed dental hygienist to administer local anesthetic for a candidate. Shared Patients For patient safety, no more than half the maximum anesthetic dose may be utilized for a patient who will be treated by two candidates on the same day. 16 Post Treatment Evaluation Examiners perform the Post Treatment Evaluation once all treatment is completed. Candidates escort their patients to the Sign In desk. Candidates meet with the DSM to enter the Perio Probing Measurement, Calculus Detection findings and Anesthesia record then the patients are taken into the Evaluation Area for Post Treatment Evaluation. Before the patient is signed in for post-treatment evaluation, candidates meet with the DSM to enter their detection findings, periodontal probe measurements, and information from the anesthetic record on the Progress Form into the computer-scoring system. Notes for Post-Treatment Evaluation Patient Preparation For Post-Treatment Evaluation Wearing safety glasses Clean patient napkin with ID label attached • Patient carries the tray of instruments and required Required Instruments & Paperwork • • • Mirror • 11/12 explorer • Dental Hygiene Progress Form • Medical History Form • Consent Form • Radiographs • Color coded cubicle card Information for Patient • • • Three examiners will complete the final evaluation. No electronic devices can be used by patients Patients may use books, magazines, and any other non-electronic means of passing time. Cubicle clean-up While patients are in the Evaluation Area for Post Treatment Evaluation, candidates can clean and disinfect their units. When patients return, the Medical History and Consent Form should be signed by the candidate, and the Post Operative Care Agreement should be signed by the patient and then the patient can be dismissed. Candidates must check out with the CFE and return all examination forms in the white envelope. 17 DENTAL HYGIENE PROGRESS FORM The Dental Hygiene Progress Form has three purposes: Examiners use it to track the examination process for each candidate and serve as an anesthetic record. Candidates use it to document periodontal pocket measurements, presence or absence of calculus on assigned teeth and to communicate patient care issues and pre-existing conditions to examiners. Candidates also use it as a communication method with the examiners. The following description explains each section and provides instructions for completing the form. The following pages show a blank Progress Form, a sample form with the candidate sections completed, and another sample showing how the Progress Form will appear after pre-treatment evaluation. At the top of the form, attach a peel-off ID label from the white envelope provided at Registration. Then complete the form in ink. Choose a primary quadrant that meets criteria to demonstrate calculus removal skills and two additional teeth in a second quadrant. This is called the Case Selection. If you are not able to fulfill the calculus requirements from within the primary quadrant, you may choose surfaces on up to two additional posterior teeth from the secondary quadrant, to fulfill the requirement. Examiners will assign two additional surfaces from within the Case Selection. All surfaces of every tooth within the Case Selection must be treated. You must also indicate if the third molar in the primary quadrant is included in the Case Selection. Next complete the anesthetic record. This includes • Name of anesthetic, both topical and injectable • Type of injection(s) planned • Dosage, form and strength • Quantity of anesthetic expected • Percentage of vasoconstrictor • If the patient has received other anesthetic the same day If candidates do not intend or are not eligible to use injectable local anesthesia, they may enter the name and type of a topical anesthetic intended to be used. However, no anesthetic needs to be used and if not, no anesthetic needs to be recorded on the Progress Form. A CFE must review the Medical History and approve the use of an anesthetic before it is administered. If the candidate is eligible for the use of injectable local anesthesia (ILA) and has provided the needed documentation to the Chief at Registration, the Chief will place a red ILA stamp on the Progress Form. If the patient is sitting for a second candidate the same day, only half the maximum anesthetic dose may be administered by the first candidate. 18 Also list any premedication if applicable. Candidates who are sharing a patient with a need for antibiotic prophylaxis must treat the patient the same clinical day. Do not initially write anything in the section labeled “Probing Measurements.” During pre-treatment evaluation, examiners assign two teeth for the probing measurement exercise. That assignment will be recorded by the examiners in this section. Once assigned, the candidate will measure and record pocket depths on the two assigned teeth, prior to scaling. At the bottom right in the section labeled “Calculus Detection Findings” again do not initially write anything in this area. During pre-treatment evaluation the examiners will assign three teeth for calculus detection evaluation. Once assigned, the candidate will determine if calculus is (Yes) or is not present (N0) on each of the four indicated surfaces. On the back of the form describe any dental treatment or surgeries that occurred since the radiographs were exposed and/or any pre-existing tissue injuries or conditions that might affect treatment or evaluation of the patient. For example: • Severe hyperplasia • Gingivitis • Excessive decay • Pre-existing tissue conditions that might be construed by examiners as minor tissue trauma • Unavoidable reasons why radiographs are less than diagnostic, e.g., narrow palate, lingual tori, etc. • Any restorative or surgical treatment, which the patient has undergone since the radiographs were taken. Calculus detection During the Pre-Treatment Evaluation, examiners assign three teeth for the calculus detection exercise, indicating the selected teeth on the Progress Form. There are spaces for candidates to indicate whether or not calculus is present on each surface. During clinical treatment time, candidates evaluate these teeth and surfaces and mark “Yes” if qualifying calculus is present or “No” if no qualifying calculus is found on that surface. This clinical skills section demonstrates that a candidate can recognize the presence of readily detectable calculus (moderate to QUICK TIP heavy calculus)—on a variety of tooth Complete the periodontal surfaces and can recognize when a surface measurements and calculus is free of calculus. detection exercise before beginning calculus removal. 19 Candidates earn points for each surface where the candidate’s findings match those of two out of three examiners. If examiners find calculus on a surface, and the candidate finds calculus on the same surface, the candidate earns points. If 2 examiners find no calculus on a surface, and the candidate also finds no calculus on the surface, the candidate also earns points. Candidates earn no points if they do not select an answer at all or if they select both “Yes” and “No.” Probing Measurements During Pre-Treatment Evaluation, examiners assign two teeth (one anterior and one posterior) for the periodontal assessment exercise, and write the selected tooth numbers on the Progress Form. During clinical treatment time and prior to any calculus removal, candidates measure and record the three pocket depths on each of the two assigned teeth on the Progress Form, for a total of six measurements. The candidates’ measurements must be no more than ± 1 mm of at least 2 of the three examiners’ measurements. Because pocket depths could change after calculus removal, candidates must complete periodontal measurements before removing calculus. Prior to post-treatment evaluation, the candidates assist the DSM in entering their periodontal pocket depth measurements into the computer scoring system. Calculus removal If fewer than 12 surfaces of qualifying calculus are verified in the selection, including all teeth in the quadrant and any additional teeth chosen by the candidate, points will be awarded only for calculus removal on the surfaces verified by two examiners as having qualifying calculus. For example, if examiners are able to verify only eight surfaces with qualifying calculus, the candidate will have only eight opportunities to earn points for calculus removal, rather than 12 opportunities, and will automatically lose points for removal on four surfaces. Treatment Selection Worksheet This is used in developing the selection of teeth and surfaces for the Case Selection and to provide to the DSM so the selected teeth and surfaces can be entered into the tablet at the beginning of the examination. It also includes a designation of the primary quadrant and extra tooth selections plus whether or not the 3rd molar is included. 20 - 21 Blank Dental Hygiene Progress Form 22 Progress Form as Completed by the Candidate for CFE Check-in 23 Progress Form after Pre-Treatment evaluation is completed 24 Medical History Form Patients complete the Medical History Form in ink prior to the day of the examination. Patients should complete this form no more than 30 days prior to the day of the examination. The information on this form should be reviewed with the patient on the day of the examination. 1. Place a peel-off ID label in the area labeled“ PLACE ID LABEL HERE” at the top left. 2. Enter the Candidate Number in the area labeled “Candidate Sequential” at the top right. 3. Enter the Cubicle Number during set up at the top right. 4. Do not complete the “Blood Pressure-Required- Must Be Taken Day of Examination” blank until set up. Complete this area after patient is seated and BP is taken. Complete “Date/Time Taken” after you record the patient’s BP on the day of the examination. 5. CFE will enter their examiner number in the area labeled “Examiner Confirms BP Taken Day of Exam” during set up. This indicates that the CFE has reviewed the form and the patient is approved to participate in the examination. 6. Patient answers questions 1 through 13, including questions 8.A through FF, within 30 days of the examination, signs, and dates the form in the area indicated. 7. At the bottom of page two, enter the ASA Classification of the patient. 8. Candidates initial and date the form but do not enter a signature until after the examination is completed, in order to preserve anonymity. 9. Present this form completed except for the candidate signature, with other forms at pre-treatment evaluation. On the day of the examination, the candidate must document on the Medical History Form all medications or supplements taken by the patient within the last 24 hours. Candidates should document antibiotic premedication on the appropriate Progress Form, as well as on the Medical History Form. In order to participate in the examination, patients must meet the following criteria: 1. The patient’s blood pressure taken on the day of the exam must be below 160 (systolic) and/or 100 (diastolic). The patient's health status must be acceptable for treatment. 2. Candidates who are sharing a patient requiring antibiotic prophylaxis must treat the patient the same day. Treatment of the same patient on subsequent clinical days will not be permitted. 3. Patients must have no history of heart attack (myocardial infarction), stroke or cardiac surgery within the last six months. 4. Patients may not have active tuberculosis. A patient who has tested positive for tuberculosis or who is being treated for tuberculosis but does not have the clinical signs is acceptable. 5. Patients may not have undergone chemotherapy for cancer within the last six months. 6. Patients may not have a history of taking IV or orally administered bisphosphonate medications. 7. Patients may not have active incidence of bisphosphonate osteonecrosis of the jaw (BON) also known as osteochemonecrosis or osteonecrosis of the jaw (ONJ). 8. Not in the first or third trimesters of pregnancy. 25 9. Patients with latex allergies may not participate 10. Candidates must follow the current American Heart Association antibiotic premedication recommendations when treating patients at potential risk of infective endocarditis following dental treatment. A medical clearance may be indicated to determine the patient’s potential risk of endocarditis. 11. If the patient answers “yes’” to any of the questions on the Medical History, the candidate must explore the item further and determine whether a medical clearance from a licensed physician would be appropriate. A medical clearance is required if the finding could affect the patient’s suitability for elective dental treatment during the examination. The candidate must have the form available during set up so the CFE can verify that: • • • All sections are complete When required, a proper physician’s statement is provided Administration of injectable local anesthesia is appropriate Patient Medical Clearance: If the patient indicates a medical history that could affect their suitability for treatment, the candidate must receive written medical clearance from a licensed physician indicating that the patient may participate in the examination. The medical clearance, if necessary, must include • A clearly legible statement from a licensed physician written within 30 days prior to the examination on official letterhead • A positive statement of how the patient should be medically managed • The physician’s clearly legible name, address and phone number • A telephone number where the physician may be reached on the day of the examination if a question arises regarding the patient’s health The Medical History Form and medical clearance will be reviewed by a CFE and must accompany the patient when the treatment selection is submitted for evaluation (pre-treatment evaluation /case acceptance). If the patient sits for more than one candidate, a separate Medical History Form and Patient Consent Form must be completed for each examination. If a patient presents with an active oral herpetic lesion, the CFE must evaluate the lesion and will decide if it is safe for the patient, candidate, and examiners to proceed with the examination using that patient. If the CFE determines that it will be unsafe for the patient to be treated, the CFE will dismiss the patient and the candidate from the examination and the candidate fails. The candidate may reapply for the earliest available examination. 26 Blank Medical History Form 27 Post-Operative Care Agreement Complete this form in ink. Please ensure the information is legible. Provide it to the patient at the end of the examinations. Both the patient and candidate must sign the form. 28 Patient Consent, Disclosure and Assumption of Responsibility Form The patient completes this form in ink, prior to registration/orientation. The patient must sign and date the form. This form requires a peel-off label, the candidate’s Sequential Number and Cubicle Number. On the back of the form the patient’s name, address, sex, age and contact information is entered along with the patient’s signature. The candidate’s name is only added at the end of the exam before the records are turned in. This form must accompany the patient when the treatment procedure is submitted for evaluation. APPEALS SCORE CERTIFICATION PROCEDURE Score Certification is a procedure whereby the electronic evaluation and accompanying documents from which the examination score were generated are re-checked for any irregularities or errors which may have occurred in establishing the score. Irregularities or errors in scoring include duplicate entries, missing or extraneous marks on accompanying documents that could have been misread prior to grading or a mathematical error. Score Certification is not a review of the examination process or candidate performance and a listing of specific candidate errors is not included. 29 For information on how to submit a request for a Score Certification, go to www.cdacexams.org click on “Scores” and then menu item Score Certification and Appeals. CANDIDATE APPEALS PROCEDURE A Candidate Appeal may be generated if the candidate believes that their examination results was/were adversely affected by extraordinary conditions during the examination, which affected the final outcome of the candidate’s examination. Appeals are reviewed on the basis of facts surrounding the decision during the examination. Appeals based on patient behavior, tardiness or failure to appear will not be considered. The appeals process is the final review authority and if the appeal is denied there is no further review process within the CDCA. All reviews of Candidate Appeals include the Score Certification Procedure described above, and are based on a reassessment of the documentation of the candidate’s performance on the examination. The review is limited to a determination of whether there exists substantial evidence to support the judgment of the examiners at the time of the examination. The review will not take into consideration other documentation that is not part of the examination process. Opinions of the candidate, faculty members, patients, colleagues, examiners acting outside of the area of their assignment and records of academic achievement are not considered in determining the results of the examination and do not constitute a factual basis for an appeal. Consideration can only be given to the electronic scoring, documents, radiographs or other materials that were created/submitted during the examination and remain in the possession of the CDCA. Any other information such as radiographs, photographs or models of a patient taken after the completion of the examination will not be considered in the appeals process. Any candidate receiving a failing score on an ADEX examination may, on one’s own behalf, submit a candidate appeal of that failing score. For information on how to submit an Appeal and the Appeal Process itself, go to www.cdcaexams.org click on “Scores” and select “Score Certification and Appeals.” POLICIES 1. Anonymity The CDCA conducts all examinations anonymously. All examination materials are identified by the candidate’s ID number assigned prior to the examination. The candidate’s name and school information do not appear on any material reviewed by the examiners. The examiners at all sites are experienced practitioners with diverse backgrounds. The examiners are trained and standardized prior to each examination and are evaluated to ensure grading to established criteria. The examiners are separated from the candidates and remain in a separate area of the facility. The candidates must observe all signs and follow instructions so as not to breach anonymity. Anonymity is preserved between the scoring examiners and the candidates and nearly always among the examiners themselves. However there are rare instances where fairness or patient safety requires consultation among examiners. 30 2. Candidate accessibility The CDCA makes every effort to accommodate and comply with ADA legislation for any candidate with a documented physical and/or learning disability that impairs sensory, Manual, or speaking skills and that requires a reasonable deviation from the normal administration of the examination. The candidate must present a written statement from a qualified physician or appropriate health care provider at the time of application. The statement must clearly define the limitation(s) and must detail the assistance required to ensure appropriate accommodations. Requests are evaluated on a case-bycase basis. Accommodations/deviations are not allowed for those components/skills the examination measures. Information regarding the physical/learning challenges of a candidate will remain confidential except in the case of disabilities that may require emergency treatment. In such cases, onsite safety personnel will be advised. 3. Change of name After creation of an online profile under one name, notification of a name change should be emailed to director@cdcaexams.org along with appropriate documentation such as a marriage certificate or court order. 4. Confidentiality The CDCA office staff or examiners will not discuss candidate scores, appeals, concerns, or questions with a candidate’s spouse, parent, faculty member, family member, or friend. 5. Dismissal from examination This listing is not all-inclusive of the reasons for which a candidate may receive a failing evaluation or dismissal. Some procedures may be deemed unsatisfactory for other reasons. Additionally, a combination of several unsatisfactory evaluations may result in failure. Reexamination may be denied for one year from the date of dismissal from the examination. Infractions that may lead to dismissal or failure include: • Evidence of dishonesty or misrepresentation during the application process, including false or misleading statements or false documentation presented by the candidate or on the candidate’s behalf • Evidence of dishonesty or misrepresentation during candidate registration or during the course of the examination • Rude, abusive, or uncooperative behavior exhibited by the candidate and/or those accompanying the candidate to the examination site • Failure of the candidate to carry out a directive of the Chief Examiner or continuing to work after published cut-off time • Failure to complete the examination within the allotted time (No make-up time, grace period or second effort is allowed for any part of this examination). • Alteration of preoperative radiographs • Receiving assistance from a dentist, another candidate, faculty member, etc. The CDCA understands that different programs will support candidates in different ways, but patient selection must be an independent decision made only by the candidate. • Thievery during the course of the examination 31 • • • • • • • 6. Performance of any unauthorized work outside of designated areas at the test site Noncompliance with anonymity requirements for pre-treatment evaluation and/or examiner scoring. Candidates must not enter the Evaluation Area beyond the sign in desk. Noncompliance with established guidelines for asepsis and infectious disease control Disregard for the oral structures or welfare of the patient or lack of skill to perform assigned clinical procedures Charging patients for services performed Failing to complete or refusing to provide a Post-Operative Care form Attempting to use a patient who is a dentist, dental hygienist, junior or senior dental student, or dental hygiene student Electronic equipment The CDCA prohibits the use of cellular telephones, pagers, cameras, electronic readers or other electronic equipment by candidates and/or patients within the clinic/scoring areas. Violation of this policy is a reason for dismissal from the examination. 7. Examination placement & limitations When the application is processed, the CDCA assigns a group and exam time for each candidate after the examination’s published registration deadline. The CDCA policy does not allow transfer to another testing date or location once an examination site assignment has been made. However, in cases of a medical emergency, the CDCA may consider transfers on a case-by-case basis. The candidate must fully document the nature of the emergency in writing. The CDCA office must receive notification prior to the examination, or the request will not be considered and the candidate will be deemed a “no-show.” Priority seating for the examination is given for the exam site’s current students and former students, then on a first come, first served basis for all other candidates. An exam site may become full prior to the application deadline and the CDCA cannot guarantee placement at any exam site. Applying early may increase the probability of placement in the preferred site. The CDCA reserves the right to cancel an exam and reassign candidates to other testing sites in the event there are too few candidates scheduled for any examination. 8. Examination results Candidates must pass the clinical examination with a score of at least 75. Candidates who fail may retake the examination and can login to their profile on the CDCA website to see a critique of the errors assessed. Results are available online within three business days after completion of the examination if administered electronically. Results from exams administered on paper take longer to report. An unofficial results report from each examination will be available to view/download online under the ‘Results’ tab of the candidates’ profile. 32 The CDCA automatically sends the examination record of each candidate to the CDCA participating state boards of dentistry. Some state boards of dentistry may require a notarized copy of the final report, which the CDCA will provide for a nominal fee. Please contact our office to request this additional service. In addition to the CDCA’s participating boards, other states accept the CDCA/ADEX results for licensure. Candidates should contact the individual state board of dentistry where they are applying for licensure to verify acceptance of the CDCA/ADEX scores and to learn of other state-specific requirements. The CDCA supplies the examination results to the participating state boards but does not analyze or interpret the records and makes no recommendations on the way the states use the scores. Individual state boards determine acceptance of the regional examination scores. 9. Equipment Providing the necessary equipment is the responsibility of each candidate or in some cases, some equipment may be rented from the host school. Contact the individual school for specific information. Each testing site charges an additional fee for the use of facilities and incidental materials. This fee is charged by each school separately from the ADEX examination fee. TheCDCA strongly advises candidates to visit the examination site at a suitable time prior to examination to familiarize themselves with the facilities and available equipment and to ensure that their hand-pieces and ultrasonic/sonic equipment can be adapted to the unit available at the testing site. These arrangements must be made directly with the school. The use of ultrasonic/sonic instruments is permitted; however, it is the candidate's responsibility to provide equipment that is compatible with testing site attachments. Some additional equipment may be available from certain schools/testing sites if candidates arrange in advance with the school. The school/testing site provides the operating chair and unit. The CDCA is not responsible for the malfunction of the facility’s or the candidate’s equipment and may not allot additional time due to the malfunction of any equipment. Equipment maintenance personnel are onsite during each examination to ensure the equipment and the water are in working order. At the site, should an equipment malfunction occur prior to or during the examination, the candidate must immediately notify the CFE or DSM so the appropriate personnel may be contacted. 10. Ineligible candidates A candidate may be disqualified from taking the ADEX Dental Hygiene Examination by the program director of the dental hygiene program the candidate attends even after acceptance of the application. Disqualification means that graduation is no longer expected to occur within 45 days of the scheduled Patient Treatment Clinical Examination. Disqualification does not apply to the Computer Simulated Clinical Examination (CSCE). Notification of disqualification by the program director (or designated school official) for the Patient Treatment Clinical Examination must be received by the CDCA, in writing or 33 by facsimile, FOURTEEN (14) CALENDAR DAYS OR MORE IN ADVANCE OF THE START DATE OF THE CURRENTLY SCHEDULED PATIENT TREATMENT CLINICAL EXAMINATION. Notification by any other source or in any other manner is not recognized or accepted. Facsimiles must be immediately followed by a letter to the CDCA with the required signature of the program director (or designated school official). Acceptance of disqualification by the CDCA is considered final. Once disqualified from any given series, a candidate will not be reinstated for examination during the series for which disqualification was received and accepted. Fees paid by candidates who are disqualified shall be applied, less $100 processing fee, to the next examination series for which they are eligible and/or certified. A new online application must be submitted with all required documentation, including the processing fee, for the series desired. The balance of the fee will be forfeited if the examination is not taken during the next examination series or if the candidate withdraws at any time after having been disqualified. If the Computer Simulated Clinical Examination (CSCE) is failed during the series for which disqualification was received for the Patient Treatment Clinical Examination, the candidate will be notified of the CSCE results. In the event the candidate wishes to retake the failed CSCE prior to the Patient Treatment Clinical Examination, a new application must be completed together with appropriate documentation and the payment of the application fee in addition to the $100 processing fee for the Patient Treatment Clinical Examination. If the official notification by the dental hygiene program is received by the CDCA in writing or facsimile less than 14 days prior to the date published for the Patient Treatment Clinical Examination, the notice of academic disqualification is not accepted and the candidate’s fee is forfeited. All applicants will be notified by the CDCA when official notification of academic disqualification has been received and recorded. 11. Infection control The current recommended infection control procedures as published by the Centers for Disease Control and Prevention must be followed for the Patient Treatment Clinical Examination. These procedures must begin with the initial setting up of the unit, continue throughout the Patient Treatment Clinical Examination and include the final cleanup of the operatory. Failure to comply will result in the loss of points and any violation that could lead to direct patient harm will result in termination of the examination and loss of all points. To the extent possible, dental professionals must prevent the spread of infectious diseases. Because many infectious patients are asymptomatic, all patients shall be treated as if they are, in fact infectious. Use of standard precautions including barriers, disposables whenever possible, and proper disinfection and sterilization is required. The following infection control procedures shall be strictly adhered to: 34 1. Personal Protective Equipment/barriers. a. Gloves, masks and eye protection must be worn when setting up or performing any intra-oral procedures and when cleaning up after any treatment. If rips or tears occur, new gloves must be donned. Gloves are not to be worn outside the operatory. Patients with known allergies to latex will NOT be allowed to participate for the examination. Hand washing must occur prior to patient treatment, during patient treatment if glove(s) are compromised and when gloves are removed. Alcohol hand sanitizer (60% alcohol or greater) is permitted in place of hand washing only if hands are not visibly soiled. No rings that can tear gloves or wrist jewelry except a watch is permitted. b. Clean long sleeved uniforms, gowns, or laboratory coats are to be worn and must be changed if they become visibly soiled. Gowns or laboratory coats are to be removed before leaving the clinic area. c. Face masks and protective eyewear with side shields must be worn during all procedures in which splashing of any body fluids is likely to occur. Masks are to be discarded after each patient or sooner if the masks become damp or soiled. d. Footwear may not include sandals, perforated clogs or open-toed shoes (a safety issue rather than strictly infection control). e. Impervious-backed paper, aluminum foil or plastic wrap may be used to cover surfaces that may become contaminated. The coverings must be removed (while gloved), discarded, and replaced (after removing gloves) between patients. f. A clean patient napkin must be worn by the patient when he/she goes to the Evaluation Station. g. Patients must wear protective eyewear during all clinical procedures and are required to bring protective eyewear with them to the Evaluation Station for use during the evaluation of clinical procedures. STERILIZATION AND DISINFECTION Instruments, gloves and other materials, which become contaminated, must be placed in appropriate receptacles. Instruments: Any instrument that penetrates soft or hard tissue shall be disposed of or sterilized before and after each use. Instruments that do not penetrate hard of soft tissues, but do come in contact with oral tissues, shall be a single use disposable item and properly discarded or sterilized when appropriate. a. Surfaces and counter tops if not barrier wrapped, surfaces and counter tops shall be pre-cleaned & disinfected with hospital level disinfectant. 35 b. Handpieces, prophy angles, air/water syringes shall be sterilized before and after use or properly disposed of after use. Used sharps are to be placed in a spill proof, puncture resistant container. Needles are to be recapped with a one-handed method or with special devices designed to prevent needle-stick injuries and disposed of properly. All waste and disposable items shall be considered potentially infectious and shall be disposed of as is customary at the testing site in accordance with federal, state and local regulations. Exposure to Blood Pathogens: An exposure incident is defined as contact with blood and/or other potentially infectious materials (OPIM) through: a. Needlestick, sharp or other percutaneous exposure, b. Non-intact skin exposure such as an open cut, burn or abrasion, or c. Contact with a mucous membrane (e.g. inside nose, eye or mouth). Since maximum benefit of therapy is most likely to occur with prompt treatment, the following policy has been established: a. Immediately following the exposure incident, puncture wounds or other percutaneous exposures should be cleaned with soap and water. Mucous membrane exposed to blood or OPIM should be extensively rinsed. b. All percutaneous exposures and other exposures to blood and OPIM should be reported immediately to the Chief Examiner and the person in authority at the examination site so that appropriate measures can be initiated and the exposure incident documented. c. If possible, post-exposure prophylactic treatment should be initiated at the examination site if appropriate, as determined by the U.S. Department of Health and Human Services recommendations or appropriate referral made. At the completion of all clinical examinations performed in operatories, it is the responsibility of candidates to thoroughly clean the operatory utilizing accepted infection control procedures. Emergency Medical Equipment: Automatic External Defibrillator (AED) equipment, pocket masks, resuscitation bags, or other ventilation devices will likely be provided by the school in strategic locations. Candidates should be familiar with their location and use. 36 12. Instruments Candidates must provide these instruments for the examiners during pre-treatment an post-treatment evaluation: • A probe with markings of 1-2-3-4-5-6-7-8-9-10. The probe may be single ended or double ended. Candidates may use the brand or manufacturer of their choice but the UNC probe is the recommended instrument. • An 11/12 explorer for calculus detection at pre-treatment and post-treatment evaluation of calculus removal • A reflective front surface mouth mirror, which may be one or two sided All other instruments are the choice of the candidate. Candidates must provide a blood pressure measuring device and supplies for anesthetic administration, including syringes. The school may or may not supply anesthetic cartridges. The only requirement is that the cartridge be within its “use by” date. Candidates may choose the type of anesthetic used. If the candidate does not provide the appropriate instruments, examiners cannot evaluate the patient at pre-treatment evaluation and the candidate loses the time necessary to provide the missing item(s). If the candidate cannot obtain the required instruments, he/she will be unable to take the examination and will fail the examination. Candidates are encouraged to secure and provide additional instruments for the examination. Candidates will not be allowed additional time for instruments dropped or for autoclaving instruments. The candidate should provide an additional sterile mirror,11/12 explorer, and correct periodontal probe in case an instrument is dropped. 13. Interpreters Candidates should utilize the services of an interpreter when their patient does not speak English or is hearing impaired and their hearing loss cannot be corrected. (This is particularly important when the patient has a history of medical problems or is on medications.) Faculty members, dentists and dental hygienists (licensed or unlicensed), third or fourth year dental students, and final year dental hygiene students may not act as interpreter during the Patient Treatment Clinical Examination. If an interpreter is utilized, the candidate must notify the Chief Examiner following registration and the Chief will provide the needed Interpreter Disclosure Statement and Interpreter ID Form. The candidate must bring two separate 2” x 2” photos of the interpreter, one to be attached to the top of the Interpreter Disclosure Statement and one attached to the bottom of the form which serves as the interpreter’s ID. During the clinical examination, the interpreter must wear a photo identifying badge provided by the CDCA at all times when on the clinic floor. Candidates are responsible for the registration of the interpreter and for the conduct of the interpreter during the examination. 14. Jurisprudence The CDCA does not administer the jurisprudence examination for the participating boards of dentistry, except for the State of Florida. The respective boards of dentistry develop, administer, and score their own jurisprudence examinations. The CDCA does not have access to nor can we provide jurisprudence study materials. Candidates should contact the boardof dentistry in the statein which licensure is sought to arrange to take the jurisprudence examination. 37 15. Malpractice Insurance Insurance in the amount of $1,000,000 / $3,000,000 is required. CNA, through the Professional Protector Plan, administered by Brown and Brown, Inc., Tampa, Florida, in cooperation with the Commission on Dental Competency Assessments, will provide complimentary professional liability coverage required for the examination for all candidates taking the human subject based portion of the CDCA/ADEX Clinical Examination in Dental Hygiene during the calendar year 2016. The limit amount of $1,000,000 / $3,000,000 will apply. To facilitate this consideration, the CDCA will forward to Brown and Brown, Inc., agents for CNA, the names, addresses and telephone numbers of all applicants for the CDCA/ADEX Dental Hygiene Examination during the calendar year 2016. 16. Patients Candidates must procure their own patient and is responsible for the patient’s arrival and return. The CDCA is not responsible for procuring patients used in examinations. Candidates must advise their patients of the time required to participate in this examination. Pre and Post-Treatment Evaluation may take up to more than 35 minutes each. Patients should expect to spend a minimum of five hours participating in the exam. Case presentation (that is, identifying a patient whose dental condition meets the criteria for the examination) is a scored part of the examination and must be completed independently. It is the candidate’s responsibility to critically analyze patient data. The candidate cannot request the recommendation of a licensed dental or dental hygiene professional for patient selection. Patients must be at least 18 years of age. No patient may be a dentist, dental hygienist, junior/senior dental student, or final year dental hygiene student. A dental assistant, whether a student or a practicing assistant, may be a patient. No one with a latex allergy may be a patient. A woman in her first or third trimester of pregnancy is not acceptable as a patient. Patients who have received oral, intravenous (IV), intramuscular (IM), or subcutaneous bisphosphonate medications may not participate in the examination. Patients presented with radiographs that are of such poor quality that examiners cannot determine whether they are an accurate depiction of the patient will be dismissed as ineligible All written and oral communication must be in English. Candidates may communicate with their patients in another language. (See Interpreter Policy.) Patients, their teeth and oral cavity may be photographed by designated examiners during the examination. The CDCA uses the images to revise the examiner standardization. 17. Patient privacy statement At the conclusion of the CDCA/ADEX Examination, the examiners collect all patient information. The CDCA uses patient information only for examiner reference during the examination or during the appeal process. 38 18. Professional standards The purpose of this examination is to assess professional competency. The CDCA expects the candidates to maintain professional standards in the following areas: • Suitable operating attire, inclusive of the Personal Protective Equipment. Patients must wear protective eyewear; candidates must follow OSHA and CDC Guidelines. • Consideration for patients and cooperation with examiners, test site personnel, and other candidates. • Aseptic techniques and general cleanliness of the cubicle during all procedures. Candidates must maintain proper infection control throughout the entire examination. • Protection of and concern for tooth structure and supporting tissue during patient treatment. The unwarranted occurrence of major tissue trauma will result in automatic failure of the entire examination. Violation of any of these standards is grounds for immediate dismissal from the examination. The CDCA may deny reexamination for 12 months. 19. Questions Direct all questions concerning jurisprudence, licensing, reciprocity, and licensure by credentials to the appropriate state board where licensure is sought. Questions concerning testing facilities, equipment, and facility fees can usually be answered by checking the appropriate examination site information sheet which is made available to candidates prior to each exam. If necessary, please contact the school/testing site after thoroughly reading this sheet, if you have further questions. Email general questions and questions relating to the dental hygiene examination to director@cdcaexams.org. Once an application has been processed for a particular site, all questions for both pre-examination and post-examination must be initiated by the candidate only. To preserve candidate confidentiality, the CDCA staff and examiners will not discuss candidate concerns and questions with a candidate’s spouse, parent, faculty member, family member, or friend. 20. Re-examination After three unsuccessful examination attempts, the candidate should contact the state in which licensure is sought to determine if it is possible to be licensed in that state because some states do not permit more than four exam attempts. Some states require remedial training after the second or third attempt. Passing a subsequent exam attempts does not negate the required remedial training. 21. Remediation The CDCA does not require remedial education prior to re-examination of any clinical examination in Dental Hygiene. However, the CDCA and ADEX strongly encourage remediation prior to retaking any portion of the examination. Licensing jurisdictions may require remedial education prior to retaking the ADEX Dental Hygiene Examination after failing one or more examinations a second or third time. 39 It is the responsibility of the candidate to obtain and complete all requirements for remedial education in accordance with the requirements of the licensing jurisdictions. The CDCA does not assume any responsibility in providing this information or in monitoring the completion of such requirements prior to examination. 22. Refunds CDCA will not refund examination fees for candidates who fail to appear for a scheduled examination unless the CDCA has received written notification prior to the application deadline date. The CDCA does not provide refunds if the candidate is unable to secure a patient for the examination or if a patient fails to appear or is deemed ineligible by the examiners. Please call the CDCA office for information on transfer of application fees. 23. Restrictions Candidates may not use • Nitrous oxide • Air-abrasive instruments • Assistants • Disclosing Solution No written materials may be taken into the operating area other than a copy of the Candidate Manual (with notes written in) and the ADEX examination forms. Candidates must wear suitable operating room attire. No personal identification of the candidate may appear on candidate clinical attire. Photo identification cards, received at registration/orientation must be worn at all times during the clinical examination by the candidate and interpreter (if present). 24. Retake requirements The computer-based and patient based examinations must be completed successfully within 18 months after the first of the two component exams is initiated. If both examinations are not successfully completed within the 18-month period described, regardless of the reason, both examinations in Dental Hygiene must be retaken. A new registration must be initiated including appropriate documentation and applicable fees. 25. Scheduling conflicts The examination assignment schedule is considered final when issued to the candidate. Request for change will not be considered or made by the CDCA personnel once the schedule has been distributed. School personnel do not have the authority to accept a candidate for examination at their site or to make assignment changes within an examination series. Such arrangements concluded between school personnel and candidate may preclude the candidate from being admitted to the examination as well as forfeiture of fee. The Chief Examiner is the only authorized individual who may consider a request for schedule change. If unusual circumstances warrant such change and space is available it is the decision of the Chief Examiner to approve such a request. This decision is made on site on the day of examination. Prior requests are not accepted or considered. 40 26. Sharing equipment The CDCA discourages sharing sonic and ultrasonic scalers, handpieces, and other equipment because it is possible that candidates who are sharing equipment could be placed in the same testing group and would need to use the shared equipment simultaneously. 27. Special Testing Provisions The CDCA will administer the ADEX Dental Hygiene Examination to an individual with a documented physical and/or learning disability, which impairs sensory, manual or speaking skills in a place and manner accessible to persons with a disability or will offer alternative accessible arrangements for such individuals. Efforts will be made to ensure that the examination results accurately reflect the individual’s aptitude or achievement level rather than reflecting the individual’s impaired sensory, manual or speaking skills, except where those skills are factors the examination purports to measure. The CDCA will provide appropriate auxiliary aids for such persons with impaired sensory, manual or speaking skills unless providing such auxiliary aids would fundamentally alter the measurement of the skills or knowledge the examination is intended to test. To ensure that auxiliary aids or other requested modifications exist and can be provided, candidates with a disability requesting such modification or auxiliary aid must: 1. Submit, in writing, a request for the auxiliary aid or modification stating the exact auxiliary aid or modifications needed. Requests received after the application date or retroactive requests will not be considered. 2. Provide documentation of the need for the auxiliary aid or modification, indicating any portion of the dental hygiene examination for which such auxiliary aid or modification will be needed. 3. Provide a letter from the appropriate health care professional documenting the disability. This letter must be received no later than 45days prior to the date of examination. In providing such auxiliary aids or modifications, the CDCA reserves the ultimate discretion to choose between effective auxiliary aids or modifications and reserves the right to maintain the security of the examination. All information obtained regarding any physical and/or learning disability of a candidate will be kept confidential with the following exceptions: 1. Authorized individuals administering the examination may be informed regarding any auxiliary aid or modification; and 2. First aid and safety personnel at the test site may be informed if the disability might require emergency treatment. Requests for Special Accommodations due to Religious Constraints: Candidates requesting special accommodation due to religious constraints must request a separate Application for Religious Accommodations from the CDCA Director of Examinations and submit it to the CDCA by the examination deadline date. 41 28. State-only Examinations Certain candidates may be required to take one or more of the two clinical examinations in Dental Hygiene at the request of an individual state. These individuals who take only part of the examination or do not meet all eligibility requirements of the standard ADEX Dental Hygiene Examination (such as graduates of dental schools outside the U.S. or Canada) are not eligible for CDCA or ADEX Status and their scores will be sent only to the jurisdiction requesting this special examination. It is the sole responsibility of the candidate to contact the individual state dental board to determine the requirements of that state and have the state board provide the CDCA a written request. Candidates for the State-only Examinations must indicate that information when registering by checking the category titled “State-only Examination” and the state for which the examination was requested. 29. Unethical conduct Professional behavior is a critical quality in the practice of dental hygiene. Candidates found guilty of unethical conduct, as defined by the guidelines, automatically fail the examination. Examples of unethical conduct include, but are not limited to • • • • • • • Using unauthorized equipment at any time during the exam Using unauthorized patients Altering patient records or radiographs Treating patients outside clinic hours or receiving assistance from another practitioner during clinical treatment time Engaging in dishonesty Altering candidate worksheet or treatment notes Any other behavior that compromises the standards of professional behavior FAQs 1. What is the best method to find out what I have to do to pass the exam? Read this Candidate Manual multiple times. Each time through, you will better understand the processes and procedures. Mark important sections with highlighters or Post-it Notes. Bring this Candidate Manual to the examination for quick reference. There is also a helpful examination overview presentation on the CDCA website. 2. Where do I get the forms? All forms are available on the CDCA website, www.cdcaexams.org, under Dental Hygiene Exam Forms. Make multiple copies in case you make errors. Ensure current year examination forms are completed in ink. 3. Which forms do I complete prior to the day of the exam? Complete the Medical History Form, Treatment Selection Worksheet, and Consent, Disclosure and Assumption of Responsibility Form in full prior to the day of the exam and bring them with you to registration. The Post Operative Care Agreement form is filled out on the day of the examination. 4. Can I use a different explorer than the ODU 11/12? Yes. Examiners will want to use an 11/12 or equivalent explorer to score calculus 42 detection and removal. You need to provide this type of explorer. You may use any scalers or explorers to complete the calculus detection and removal exercises, but examiners will need to use an 11/12 explorer for pre-treatment and post-treatment evaluation. 5. Can I use any probe I choose? No. The CDCA requires a probe with markings of 1-2-3-4-5-6-7-8-9-10. If you do not provide the correct probe, the examiners will not be able to check in the patient, and you will fail the examination. The UNC probe is recommended. 6. What is “qualifying calculus?” See the ADEX Section of this Manual for the definition of qualifying calculus. It must be easily detectable with an 11/12 explorer and cause a definite “bump” when explored. On all teeth, calculus must be subgingival to qualify. Examiners determine whether a surface of calculus qualifies. Only surfaces of qualifying calculus in the primary quadrant and any additional teeth selected by the candidate will be eligible for calculus removal points. 7. Why do I need to do the calculus detection exercise before I start to scale? During Pre-Treatment Evaluation, examiners determine the presence or absence of calculus on the four surfaces of three assigned teeth. If you remove calculus prior to completing the detection exercise, you will be unable to document the presence or absence of calculus on the assigned teeth. 8. Why do I need to complete the periodontal assessment (probing measurement) before starting the periodontal debridement? Examiners record their own measurements during pre-treatment evaluation. Removing calculus prior to recording pocket depths could result in periodontal errors, as your readings may vary by more than ± 1 mm from those recorded by examiners while calculus was still present on the surface. In addition, it is quite common for candidates to become so involved in the calculus removal exercise that they run out of time or forget to do the periodontal assessment. 9. What radiograph criteria do examiners evaluate? Examiners check to see that the mount has the appropriate information, that radiographs are of sufficient diagnostic quality that they can be determined to belong to the patient presented, that radiographs are mounted correctly and marking left and right. Indicate your candidate number, the date the radiographs were exposed, and the patient's name on the mount or digital printout. (The same information should be available for radiographs viewed on a monitor.) Radiographs of the selected teeth must be of sufficient quality to accurately diagnose caries, periodontal health, or other dental diseases and abnormalities. Examiners evaluate only the radiographs of the primary quadrant and any additional teeth selected by the candidate. Examiners dismiss patients as ineligible if the radiographs are not of sufficient quality for examiners to determine that they are an accurate depiction of the patient’s mouth. If this happens you will fail the examination. 43 10. What materials do the examiners need for Pre and Post-Treatment Evaluation? For both Pre and Post-Treatment Evaluation: Barcode label on a clean patient napkin, Dental Hygiene Progress Form, Medical History Form, Consent Form, radiographs, color-coded cubicle ID card, patient eyewear, 11/12 explorer, periodontal probe, mirror, and air-water syringe tip. For both pre-treatment and post-treatment evaluation, place the instruments on a tray, cover with a clean patient napkin and place the required forms on top. The patient, wearing a clean bib, carries the tray into and out of the Evaluation Area. 11. What should I tell the patient about what will happen when they go to the Evaluation Area? Inform the patient that they will be taken into a separate evaluation area and evaluated by three examiners. The Pre and Post-Treatment Evaluation could each take as long as 45 minutes. The CDCA prohibits electronic devices. Patients using electronic devices, especially any device with a camera, will be dismissed from the examination. 12. What type of disclosing agents may I use? The use of a disclosing agent is not permitted. 13. What materials do the schools supply? (for candidates from outside the school) Most schools provide disposable paper products and anesthetic cartridge. It is your responsibility to make sure you have the required instruments and supplies. You will receive a site information sheet by email regarding the testing site prior to the examination explaining what supplies they do and do not provide. If the information is not on the site information sheet, you need to call the examination site for specific questions regarding supplies that are or are not furnished. 14. Can I use an assistant? No. 15. Can I administer local anesthesia to my patient? Yes, if you are a student at the host school and your program director has notified the Chief Examiner that you are qualified, or you are a student from an outside school and your program director has provided written approval to the Chief Examiner on the day of the examination. In addition, graduates who hold certification to administer injectable local anesthesia from their state, may also provide injectable local anesthesia if such certification is approved by the Chief Examiner on the day of the examination. No third party is permitted to provide injectable local anesthesia for this exam. If you have not completed a local anesthesia course, you may use topical anesthesia, including Oraqix or other non-injectable anesthetic agents. 16. If my patient does not show up, can I present a different patient? If a patient does not show up or if, prior to checking with the CFE, the candidate realizes that the patient is ineligible, a different patient may be presented if the 44 required radiographs and paperwork are available. After a patient has been presented to a CFE, no patient substitutions are allowed. 17. Are ultrasonic scalers provided by the schools? It depends on the site. Check the site information sheet for the site where you will be taking the examination to determine if ultrasonic scalers will be provided. CDCA does not arrange for rental equipment. 18. Can I take radiographs on the day of the examination? No, you must bring any radiographs needed for the examination with you on the day of the examination. 19. Does the calculus for the Calculus Detection exercise have to meet the same criteria as the qualifying calculus for the Calculus Removal exercise? Yes, the requirements are the same for both exercises. 20. If I select surfaces of calculus on a third tooth in the second quadrant to fulfill the calculus requirement, where do I list this tooth on the Treatment Selection Worksheet? As part of the 12 surfaces requirement, the tooth from the second quadrant will be listed within the column of twelve boxes listing the teeth and surfaces selected for Calculus Removal. The teeth should be listed in ascending order. Additional questions? Contact the CDCA at: Email: director@cdcaexams.org 45 IX. QUICK EXAMINATION CHECKLIST Patient At least 18 years old No latex allergy No history of bisphosphonate therapy Not in first or third trimester of pregnancy No history of myocardial infarction, stroke or cardiac surgery within 6 months No chemotherapy for cancer within 6 months No active tuberculosis Not a dentist, hygienist, junior or senior dental student, hygiene student in the last year Is presented with diagnostic-quality radiographs Has a physician’s written clearance to participate, if any “Yes” answers on the Medical History indicate a significant problem Bring to registraton Two forms of ID, both with your signature and one with a recent photo A copy of the Candidate Application Form with the 3-digit sequential candidate number Any forms that you have completed: i.e. Medical History, Consent A signed copy of The Review of the Online Orientation Form Radiographs Cubicle set-up Check equipment, air, water, light, and chair to ensure proper functioning. Contact the CFE if any problems are found. Take patient’s blood pressure. Record readings on the Medical History Form. If anesthesia is planned, enter the type of injection(s) planned and the name of the anesthetic with percentage of vasoconstrictor on the Progress Form; administer anesthetic prior to pre-treatment evaluation, if approved by a CFE. When deciding whether the patient needs anesthesia prior to pretreatment evaluation, remember that three examiners will be using the explorer and probe on the patient. Enter quantity of anesthesia on the Progress Form prior to post-treatment evaluation. Verify the accuracy of case and surface selections, if entered prior to the examination date. Last minute changes can be made, if needed. The DSM and CFE will assist with this process. Preparing for Pre-Treatment Evaluation Place clean mirror, 11/12 explorer, and probe on the tray and cover them with an impermeable barrier. Place Progress Form, patient’s Medical History Form, Consent Form , Cubicle card and radiographs on top of the barriered instruments . Make sure the CFE enters their examiner number on the Med. History Form. Have patient wear safety glasses and clean patient napkin with a candidate label on the upper right side of the napkin. Ensure that patient is free of gross soft debris. 46 Clinical treatment time Complete detection exercise. Blanks are assessed as errors. Complete periodontal measurements and recording. Blanks are assessed as errors. Perform oral debridement on all teeth in primary quadrant and additional teeth. Preparing for Post-Treatment Evaluation Place clean patient napkin on patient. Place clean mirror, 11/12 explorer, and probe on the tray covered with an impermeable barrier. Place Progress Form, patient’s Medical History Form, Consent Form , Cubicle card and radiographs on top of the instruments. If ILA is used, verify that the quantity is recorded on the Progress Form. Verify that all periodontal probing measurements and detection findings are recorded on Progress Form. Ensure that the patient’s teeth are free of calculus, visible plaque, stain, and prophy paste. Have patient wear safety glasses and clean patient napkin with candidate ID label affixed. Before post-treatment evaluation Make sure that all calculus detection findings and periodontal probe measurements have been entered into the computer scoring program with the assistance of the DSM. 47 Exam Flow Prior to the Exam Day Review the online Candidate Orientation Materials Enter Case Selection online up to 48 hours before your exam Candidate Exam Day Flow Attend Registration (6:45 am or 11:45 am) Bring: Medical History, Consent Form and Treatment Selection Worksheet Radiographs Form that you completed the online Calibration Candidate Manual Bring your Sequential Number downloaded from the Apply Tab on your Profile Clinic Set UP (7:15 am or 12:45 am) Set up to seat patient and take blood Pressure, Review Medical History and do an oral exam Confirm surfaces of calculus if needed Sign up on the CFE Check-in form (in the clinic) when you are ready to present your patient to begin the exam. You have 4 hours to complete the exam. Present Patient to the CFE. Medical History, Progress Form (with anesthesia record fill out), Consent Form and radiographs. Provide a Medical Clearance if needed. Anesthetize the patient shortly before your turn to bring your patient to Pre-Treatment Evaluation. CFEs will tell you when there is an Operatory available for your patient. Keep patient in the candidate clinic with you until notified by the CFE. Escort your patient to the Evaluation Area Sign In Desk and meet with the DSM to enter and/or confirm our Case Selection into the grading system. Patient will be returned from Evaluation Area by a runner. The Progress Form will indicate your 2 teeth for Perio Probing, the 3 teeth for Calculus Detection assignment and your Finish ‘time. You will have 2 hours of Treatment Time. Complete the probing and calculus detection and write your findings on the Progress Form. Treat the patient and finish before the “Finish Time” Put on a clean patient napkin with an ID label and escort the patient to the Sign In Desk. Patient has to be signed in by the Finish Time. Meet with the DSM to enter your Probing readings. Calculus Detection findings and Anesthetic record into the grading system. While patient is in Post Treatment Evaluation clean the unit, pack your instruments and belongings. When patient returns, complete the Post Operative Care Agreement with the patient and then dismiss the patient Sign the Medical History and Consent Form. Gather all your forms and check out with the CFE. You are finished. 48 Check-Off List I have read the entire ADEX Manual for the Examination in Dental Hygiene. APPLICATION I have completed the online application by following the instructions above PROMETRIC TESTING CENTERS: I have selected the location of the Prometric Testing Center where I have elected to take the Computer Simulated Clinical Exercise. After my application has been processed and the CDCA has sent an authorization letter, I have called and made an appointment with Prometric at the national scheduling number or schedule an appointment. I will take 2 forms of personal identification: one with a recent photo, and both with my signature, with me to the Prometric Testing Center. Acceptable ID’s include: valid current Driver’s License, Passport, and Military ID. A credit card will be acceptable as a secondary form of ID. If my name has recently changed due to marriage, divorce, or other legal reasons, I will bring a copy of the marriage certificate or court document so stating to the Prometric Center to assure entry. I WILL TAKE TO THE CLINICAL EXAMINATION SITE AND REGISTRATION: Two forms of identification, both with my signature and 1 with a recent photograph. Acceptable ID’s included: valid current Driver’s License, Passport, Military ID, and Employee ID. A credit card with signature will be acceptable as a secondary form of ID. The name on the IDs is identical to the name under which I applied take the examination. I have printed the page from my online profile under the Apply tab that indicates my assigned site, time, and Candidate ID number. a ball point pen to be used on the Progress Forms, Medical History, Consent Form and Post Operative Agreement Form. two #2 lead pencils, to be used on all scannable evaluation sheets. all necessary materials and instruments. the ADEX Manual for the Examination in Dental Hygiene. SCHOOL/SITE: I have paid any school facility use fee or equipment rental fee if required to the school. 49 CONCERNING MY PATIENTS (IF APPLICABLE): I have paid any school facility use fee or equipment rental fee if required to the school. appropriate forms have been completed for each patient. the patient meets the ADEX requirements as published in the Dental Hygiene Candidate Manual. I have all necessary radiographs. I have reviewed all the criteria that are to be evaluated in the Clinical Exercises of the examination. I have informed my patient that this exercise is not a complete oral care treatment. ONLINE TRAINING: I have signed the form that I have viewed and understand the Online Orientation prior to coming to the examination. (See the next page.) 50 Certification of Review of the Online Orientation By signing this form I certify that I have viewed the online Orientation for this examination which is available on the CDCA website: www.cdcaexams.org. I also certify that I understand the examination content and process as explained in the online Orientation. ________________________________ Candidate Name (printed) ______________________ Date ________________________________ Candidate Name (Signed) Certification of Completion of Requirements to Graduate within 45 Days. 51 (For all candidates who have NOT graduated and are NOT from a school in a CDCA state) If you have not yet graduated and received your certificate or diploma, you need to have this form signed by the Program Director or designated school official as certification that you are expected to complete all academic requirements and graduate within 45 days of the Patient Treatment Clinical Examination. Once signed, scan it and submit it with your online application. Instructions will be provided online. Submit this form along with the application. Student’s Name: Last Name Student’s SS#: - First Name Middle Name - School: This letter certifies that the student listed above is a senior student of record and is expected to complete all academic requirements to graduate within 45 days of the scheduled Patient Treatment Clinical Examination and that the candidate is sufficiently prepared to participate in the examination. Signature of Program Director or designated school official Date 52