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ADEX Exam in Dentistry

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How prepared are you for licensure, specifically the clinical exams? Independent from taking the NBDE Part I and II, there are other important steps to become licensed in the specific state where you decide to practice. The requirements vary per state, so it is important to check the licensure laws and regulations for the individual state you are interested in. Florida, for example, also requires the Florida Laws and Rules Examination and the ADEX Dental Licensing Exam.

The American Board of Dental Examiners (ADEX) dental examination is used to measure the candidate’s clinical competency for licensing purposes. The Commission on Dental Competency Assessments (CDCA), formerly known as NERB, is one of the five regional testing agencies that the state boards contract to administer the clinical exams. The CDCA administered examinations are accepted in 46 different US states/jurisdictions and Jamaica. Other agencies that administer the ADEX examination are CITA and SRTA.

The ADEX examination series consists of a computer simulation and clinical examinations. There are up to five clinical and simulated clinical sections included. The Diagnostic Skills Examination (DSE) section is computer-based. The two simulated clinical examinations are manikin-based and include Endodontics and Fixed Prosthodontics. The two clinical examination sections are performed on live patients, including Periodontal/Scaling and Restorative. All parts of the examination must be completed within 18 months of the first section taken.

To register for the ADEX examination, the candidate must visit the testing agency website, for example: https://cdcaexams.brighttrac.com/. Then, complete the candidate profile including school and expected graduation date. The candidate must also upload a photo following specific guidelines. It is important to know that uploading the photo is mandatory and the profile will not be verified until the photo has been uploaded. Once everything is complete and payment is submitted, the information is sent to the candidate’s school for confirmation. Profile verification usually takes 2-3 business days.

It is very important to familiarize yourself with the Examination Manual (http://www.cdcaexams.org/dental-exam-manual/) to know what to expect and to prepare accordingly for each section.  There is a mandatory orientation session preceding the clinical examination sessions, typically the evening before. An important white envelope will be disbursed with the candidate’s ID badge and paperwork. The candidate is required to bring two forms of ID on the day of the exam. They must supply their own instruments and provide their own patients in order to perform the diagnostic procedures and treatment. 

The candidate must score at least 75 percent in each section to pass the ADEX examination. Grading criteria is categorized as Acceptable and Marginally Substandard for passing, or Critically Deficient for failure. The candidate should try to achieve the parameters under Treatment Goals, which will result in Acceptable. Three calibrated independent examiners determine the scores and are different from the Clinic Floor Examiners.  

The Endodontics section consists of two procedures within a maximum of 3 hours: the access, canal preparation and obturation of a simulated anterior tooth and the access preparation and canal identification of a simulated posterior tooth. A separate isolation dam is required for each procedure. The placement of the access opening must reflect the position of the pulp chamber. Straight-line access to the root canal and complete debridement of the pulp chamber is expected to allow complete removal of all pulp horns. For the anterior tooth, the canal shape should taper to allow for debridement and instrumentation up to 0.5 mm from the anatomical apex. Obturation using gutta percha should extend up to 1 mm short of the root apex. The pulp chamber should be cleaned of all gutta percha and sealer material.  

The Prosthodontics section consists of three procedures within a maximum of 4 hours: preparation of a simulated maxillary incisor all ceramic crown, premolar for porcelain fused to metal bridge abutment crown, and molar for cast metal bridge abutment crown. Ideally, the crown margins should be 0.5 mm supragingival to the CEJ. The optimal occlusal reduction for the porcelain and PFM crowns is 2 mm and the reduction for the full cast metal crown should be 1.5 mm. Internal line angles and cusp tips should be rounded and the general occlusal anatomy should be maintained. Fabricating a reduction guide is recommended and helps to verify the second plane of reduction. Taking an impression and pouring a model of the preparation can be helpful to assess undercuts and path of insertion.

The Periodontics section is optional and only required in certain jurisdictions.  The candidate is evaluated for acceptability of the case for the examination, subgingival calculus detection, subgingival calculus removal, plaque and stain removal and treatment management. The candidate must remove subgingival and supragingival calculus and stain from 12 surfaces selected within 90 minutes.

The Restorative Dentistry section includes two separate sections: the preparation and restoration of a class III carious lesion on an anterior tooth using composite resin, and the preparation and restoration of a class II carious lesion on a posterior tooth using amalgam or composite resin. All lesions on the anterior tooth do not need to be treated by the end of the examination, but the candidate is expected, and will be evaluated, on the restoration of all existing lesions on the posterior tooth. An isolation dam is required during preparation and restoration of both teeth and can be removed later to adjust occlusion. There is a maximum time allowed of 7 hours for this section or a total of 9 hours if taking concurrently with the Periodontics section.

The DSE is the multiple-choice, computer-based portion administered at a testing center and is independent from the clinical sections. It assesses diagnostic and treatment planning knowledge. It consists of Patient Evaluation (PE), Comprehensive Treatment Planning (CTP), and Periodontics, Prosthodontics and Medical Considerations (PPMC) subsections. The test has 150 questions within 4 hours. A score of 75 percent is required to pass the DSE section.

My main recommendation is that you follow all the guidelines given and practice, practice, practice! I hope you find this information helpful and, if anything, it can at least be a starting point for you to ask questions about the subject. I encourage you to find more information regarding the ADEX examination and other requirements for licensing in your specific state.  Good luck!

Resources:

http://www.dentalboards.org/states/index.htm

http://www.cdcaexams.org/

https://cdcaexams.brighttrac.com/

http://www.cdcaexams.org/dental-exam-manual/

 

 

 

 

Policy Competence as Dental Professionals: Making a Difference

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    Longest (2010) defines policy competence as the “dual abilities to analyze the impact of public policies on one’s domain of interest or responsibility and exert influence in the public policymaking process” (p.28). DeBuono, Gonzalez and Rosenbaum (2007) take the definition even farther by stating that the United States won’t ever achieve optimal population health without public health practitioners embracing policy leadership. In other words, public health planners and practitioners need to contribute to the nation’s health policy or a significant improvement in overall health is unattainable. Policy competence involves understanding the policies that affect health services organizations, the process of policymaking, and the forces that affect those processes (Longest, 2004).  Longest (2010) describes how policy competence relates to dental professionals by stating, “Anyone professionally involved in the pursuit of health through any determinants has a vested interest in understanding how health policy is made at all levels of governments” (p.26).  I completely agree with the principle presented in this statement but I don’t know if every health professional displays policy competence. Every professional involved in healthcare should have a vested interest in understanding health policy but unfortunately that’s not always the case. The International Council of Nurses (2008) developed a 10-step advocacy framework to help health care professionals become more engaged in health policy. The 10 steps are as follows: take action, select an issue, understand the political context, build the evidence base, engage others, elaborate strategic plans, communicate messages and implement plans, seize opportunities, be accountable and catalyze health development. This advocacy guide is just one of the many tools available to help increase the policy competence of health care providers. 

       The Children’s Dental Health Project (CDHP, 2015) is an excellent example of how one policy-competent pediatric dentist can make large contributions to improved oral health. Dr. Burton Edelstein created the Children’s Dental Health Project in 1997 to be “the voice for children’s oral health” (para.3). The four main goals for the CDHP (2015) are: prevent childhood tooth decay, increase the number of children with meaningful dental coverage through Medicaid, CHIP and state insurance exchanges, build states’ capacity to improve oral health, and strengthen public awareness to encourage good health behaviors. These goals are only accomplished by working with policymakers and oral health advocates. Today, after a couple decades of hard work, the CDHP funded by several federal and state agencies, private foundations, and large corporations and organizations. If more public health and private dental practitioners were engaged in the policy making process that affects their every day jobs, then more people would be the recipients of improved access to and costs of dental care. 

References 

Children’s Dental Health Project (2015). Our story. Retrieved from https://www.cdhp.org/about/our-story 

Children’s Dental Health Project (2015). Mission and goals. Retrieved from https://www.cdhp.org/about/mission-and-goals

 Council of Nurses (2008). Advocacy guide for health professionals. Retrieved from  http://www.whpa.org/ppe_advocacy_guide.pdf 

 DeBuono, B., Gonzalez, A. R., & Rosenbaum, S. J. (2007). Moments in Leadership: Case Studies in Public Health Policy and Practice. 

 Longest, B. B. (2004). An international constant: the crucial role of policy competence in the effective strategic management of health services organizations. Health Services Management Research, 17(2), 71-78. 

 

Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press. 

Pointers in maintaining successful periodontal tx

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Maintenance of periodontal health of the patient after treatment needs a program as important as the treatment to help the periodontal disease. Patients must understand the importance of maintenance program and the dental student must emphasize that preservation of the teeth depends on maintenance therapy. Patients who are not maintained in a supervised recall program regress back to recurrent periodontitis with increased pocket depth, bone loss or even tooth loss.

 

it is important in making sure that all subgingival plaque is removed during scaling and root planning for a successful periodontal tx. It is important to insure complete removal of subgingival plaque while treating periodontal disease to avoid any recurrent periodontal disease. If subgingival plaque is left behind during scaling, the bacteria regrows within the pocket. Inadequate subgingival plaque removal can lead to continued loss of attachment.

 

Continuous visit is necessary for meaningful long term maintenance prevention of periodontal disease. The visits are made up of of examination and evaluation of the patient’s current oral health, necessary maintenance treatment and oral hygiene reinforcement and restorative dental procedures.

 

Examination and evaluation – looking for any changes since the last visit, update of any changes in the medical history and evaluation of restoration, caries, occlusion, tooth mobility, gingival status, and periodontal and periimplant probing depths are some of the procedures done for recall appointments.

 

Checking plaque – patient should perform hygiene regimens regularly to minimize plaque. The recall visit should indicate the maintenance performed at home. If necessary additional instruction is given to improve the hygiene regimens. Continuous encouragements to reinforce the importance of the maintenance phase of treatment should be considered at this point.

 

The dentist or dental student should take a time out to explain to patients that oral hygiene is important in maintaining a healthy life style. Failing to take care of oral health can lead to many dental problems like bad breath, cavities, gum disease, sensitivities and even tooth loss. Also, adopting healthy life style, proper tooth brushing technique, flossing, and visiting the dental office regularly is key in successful periodontal tx.