Beginning in February of 2020, the OSCE (DSE) will only be offered at Prometric. The following are directions for PSI since they are not listed in the 2020 manual. PSI SCHEDULING THE OSCE (DSE) through January 2020

For the fastest and most convenient test scheduling process, PSI recommends that candidates register for their exams using the Internet. Candidates register online by accessing PSI’s registration website at www.psiexams.com. Internet registration is available 24 hours a day.

A candidate may receive an email confirmation of their PSI test appointment. This confirmation will provide the candidate with the PSI exam title, date, time, and location of their PSI test appointment. MAKE SURE THE DATE, TIME AND LOCATION ARE CORRECT.

A candidate must provide no less than 48-hours’ notice (Monday-Friday) to reschedule/cancel his/her testing appointment. Rescheduling/cancelling is done through PSI’s Central Registration Office, NOT the local testing center. Failure to provide 48-hours’ notice will result in forfeiting the initial OSCE test fee.

Candidates who fail to appear for their scheduled test appointment will be reported as a no-show and will need to reschedule as a retest candidate through CITA after paying the appropriate OSCE retest fee of $500. Requests for waivers must be submitted to CITA in writing within 72 hours of the missed testing appointment and must include a doctor’s note verifying a medical emergency.

In order to schedule your exam by the Internet, the following steps must be completed:

1. Log onto PSI’s website: www.psiexams.com.

2. Select Certification/Professional Associations.

3. Select Council of Interstate Testing Agencies (CITA).

4. Choose Diagnostic Skills Exam (DSE OSCE).

5. Complete the associated registration form and submit to PSI online.

6. You may get a red message indicating you need to register with CITA. If you have already done so, see step 7.

7. Be sure to scroll to bottom to “View All My Activities”. Click “View Records”

8. On the next screen, Click on “Find Records”.

9. PSI will ask you several questions and for the eligibility (CITA ID) number which can be found in the Apply tab of

your BrightTrac profile.

10. Upon completion of the online registration form, available exam dates and locations will be listed for scheduling

the examination. Select the desired testing date and location.

SCREEN #1 IN PSI PROFILE SCREEN #2 FIND RECORD SCREEN

http://www.psiexams.com/http://www.psiexams.com/

Administered by

2020 CANDIDATE MANUAL

PATIENT-BASED EXAMINATION

EXAM

CONTACT ADDRESS

1518 ELM STREET SUITE A SANFORD, NC 27330 PHONE & FAX

P: 919.460.7750 F: 919.460.7715 EMAIL

INFO@CITAEXAM.COM WEBSITE

WWW.CITAEXAM.COM

Please read all pertinent manuals in detail prior to attending the examination ONLY CITA PREPARED MANUALS AND FORMS MAY BE BROUGHT INTO THE EXAM

Copyright © 2020 Council of Interstate Testing Agencies, Inc. FINAL

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COUNCIL OF INTERSTATE TESTING AGENCIES

The Council of Interstate Testing Agencies, Inc. (CITA) is a not-for-profit corporation which serves the community as an independent regional testing agency. CITA administers the ADEX Dental and Dental Hygiene Examinations.

CITA MISSION STATEMENT

CITA’s mission is to provide psychometric, technical, and administrative services in the administration and delivery of clinical licensure examinations in dentistry and dental hygiene. CITA will demonstrate integrity and fairness as it assists with licensing boards of dentistry in their mission to protect the health, safety, and welfare of the public by assuring that only competent and qualified individuals are allowed to practice dentistry and dental hygiene.

TESTING AGENCIES VS. LICENSING BOARDS

Testing agencies contract with individual boards of dentistry to administer the clinical examination required for licensure in those states/jurisdictions. Testing agencies DO NOT have the authority to license individuals or implement policies that go beyond the laws of its member states/jurisdictions. The candidate must ascertain the qualifications and procedures necessary to obtain licensure in the intended jurisdiction of practice, prior to the candidate undertaking any activity or activities which may constitute the practice of dentistry. Candidates should contact the Licensing Board(s) in the jurisdiction(s) in which they intend to practice to find out what is required other than the ADEX exam to practice in their jurisdiction.

DISCLAIMER CITA manuals have been developed to provide the candidate with the information required to be successful on the ADEX Dental Examination. Every effort has been made to ensure that this manual is accurate, comprehensive, clear, and up-to-date. In the rare instances when examination related instructions need to be updated or clarified during the examination year, changes will be posted on CITA’s website (www.citaexam.com). There may also be other test-related material sent to candidates directly by the CITA office should the need arise. All candidates who participate in the ADEX Dental Examination are responsible for reading and understanding all CITA manuals, any documented changes to the published CITA manual posted via the website, and for reviewing and understanding all other material provided by CITA. If in reviewing any CITA provided material, questions arise, it is the candidate’s responsibility to resolve those questions by directing them to the CITA office via email.

Before taking the CITA administered ADEX Dental Examination, each candidate will be required to sign forms certifying that he/she has read the 2020 CITA ADEX Dental Manuals and all other materials provided by CITA. Occasionally examinations are interrupted or postponed because of hurricanes, blizzards, other severe weather, power outages, or similar occurrences. CITA reserves the right in its sole discretion, to delay, halt, postpone, or cancel an examination because of unforeseen and serious events. In the event of predicted severe weather events, candidates should monitor the testing agency website and their email for site-specific candidate information.

http://www.citaexam.com/

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TABLE OF CONTENTS I. ADEX Exam Overview 5

II. Administrative Overview

Address Questions to Appropriate Agencies 6

Curriculum Integrated Format 6

18-Month Rule 6

Examination Cancellation Policy 7

Limited Liability Insurance 7

Three-Time Failure Rule 7

Releasing Results 8

Scoring to Jurisdictions Accepting the ADEX Exam Results for Licensure 8

Re-examination and Remediation 8

Online Score Request 9

Appeal Process 9

III. OSCE (Diagnostic Skills Examination)

Scheduling the OSCE 11

OSCE Content 12

IV. Scoring For Patient Examinations

Content 14

Penalties 15

V. Standards of Conduct and Infection Control

Standards of Conduct 17

Dismissal From Examination 18

Infection Control Requirements 18

VI. Examination Overview

Timely Arrival and Exam Timeline 20

Examination Schedule Changes 21

Exam-Day Registration for Restorative and Periodontal Scaling Procedures 22

Interpreters 22

Assistants 23

VII. Patient Selection

Patient Selection General Guidelines 24

Health Qualifications and Patient Eligibility 25

Patient Medical History 26

Medical Clearance 27

VIII. Radiographs

General Radiographs Guidelines 29

Periodontal Scaling Radiograph requirements 30

Restorative Radiograph Requirements 30

Post-Operative or Additional Radiographs 31

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See the Application Process Manual for:

How to set up an online profile

Exam qualification information and form

How to apply for a manikin or patient-based only exam

How to request special accommodations

IX. Instrument Requirements

Required Instruments 32

X. Examination Flow

Exam Day Registration for Restorative and Periodontal Procedures 33

General Administrative Exam Flow 34

Procedures 36

Communications from Examiners 36

Check-out Procedures for ALL Examination Procedures 36

XI. Periodontal Scaling Examination

Treatment Selection Requirements 38

Patient Management Guidelines 39

Periodontal Scaling Criteria and Grading Sheets 42

XII. Restorative Treatment Guidelines

Requirements for the Anterior Composite Preparation and Restoration 45

Requirements for the Posterior Amalgam/Composite Preparation and Restoration 45

XIII. Restorative Examination

Important Reminders 47

Liners 47

Treating All Lesions 48

Sharing Patients 49

Isolation Dam 49

Caries Detector 49

Recontouring 50

Instructions To Candidates Form 50

Modifications from the Ideal 50

Exposure Processing and Indirect Pulp Cap 51

Evaluation Station Request 52

Modification Requests and Samples 56

Indirect Pulp Cap Procedure 61

Restorative Criteria and Grading Sheets 62

IVX. Examination Forms

Forms to be Completed Before the Examination 75

Documents Required for Registration 77

Forms Used During the Examination 78

Restorative Exam Flow Chart 80

Periodontal Scaling Exam Flow Chart 81

VX. CITA Pre-Exam Checklist 82

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I. ADEX EXAM OVERVIEW PART I: OSCE EXAMINATION

The computer-based ADEX OSCE Examination (Previously known as the Diagnostic Skills Examination or DSE) will be administered at a Prometric testing center of the candidate’s choice as of February 2020. Prior to February, PSI testing centers will administer the OSCE exam.

PARTS II AND III: PROSTHODONTICS AND ENDODONTICS CLINICAL EXAMINATIONS

The Prosthodontics and Endodontics Examinations are manikin-based exams administered at various testing sites. CITA strongly encourages candidates to thoroughly read the Manikin-Based Exam Manual prior to taking the exam.

PARTS IV AND V: RESTORATIVE AND PERIODONTAL SCALING CLINICAL EXAMINATIONS

The Restorative and Periodontal Scaling Examinations are patient-based exams administered at various testing sites. CITA strongly encourages candidates to thoroughly read the Patient-Based Exam Manual prior to taking the exam.

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II. ADMINISTRATIVE OVERVIEW This manual has been designed to assist candidates with the 2020 patient-based examination and other pertinent administrative guidelines. The examination is based on specific performance criteria as developed by ADEX which will be used to measure the candidate’s clinical competency.

Please see the Application Process Manual for step-by-step instructions on how to set up an online profile and register for the ADEX exam through CITA.

ADDRESS QUESTIONS TO THE APPROPRIATE AGENCY

CITA answers questions about the ADEX Examination Series.

PSI/Prometric answers scheduling questions about the OSCE. (See pages 11-12)

Licensing Boards of Dentistry answer questions regarding licensure or jurisdiction requirements. (visit http://www.citaexam.com/states for licensing board contact information)

CURRICULUM INTEGRATED FORMAT The Curriculum Integrated Format (CIF) is the pre-graduation format of the ADEX Dental Examination for D3 (junior) and D4 (final year) dental students of record. Both the Curriculum Integrated Format and the Traditional Format examinations are identical in content, criteria, and scoring. CITA allows D3 students to participate in the manikin parts of the ADEX Dental Exam. Some educators and students have favored the administration of the manikin examination during the junior year of study as the manikin examination is closer to the students’ pre-clinical laboratory experience in working with typodont simulation. D3 students’ 18-month clock does not start until July 1st of the D4 (final) year. Failures received during a candidate’s D3 year do not count towards the three-time failure rule.

18-MONTH RULE

If a manikin portion was taken as a D3, then as of July 1 of their D4 (final) year, a candidate has 18 months to complete all parts of the ADEX Dental Exam. It is in the candidate’s best interest to participate in the CIF format by taking the manikin sections of the exam and/or the OSCE (if authorized) before July 1 of their D4 (final) year if they are approved as competent to challenge the exam by the appropriate faculty of their dental school. A candidate who already has a dental degree or D4 (final year) candidate who has NOT yet attempted any part of the exam has 18 months from his/her first attempt of any part of the ADEX Dental Exam to complete all necessary parts of the ADEX Dental Exam. If a candidate fails to complete all parts of the ADEX Dental Exam within his/her assigned 18-month time frame and in three (3) or fewer attempts, he/she must contact the licensing board in the jurisdiction of sought licensure for remediation requirements, and will be required to re-start the entire exam cycle once remediation requirements have been met. *Note: To maintain the integrity of this rule, all unsuccessful candidate results will be shared among all testing agencies administering the ADEX Dental Exam.

http://www.citaexam.com/states

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EXAMINATION CANCELLATION POLICY

CITA reserves the right to cancel or postpone any examination where:

The number of candidates registered to take the examination does not, in the sole discretion of CITA, financially justify the administration of the ADEX Dental Examination

An emergency arises

Other unforeseen circumstances that are beyond CITA’s control Emergencies or unforeseen circumstances may include, but are not limited to: acts of nature, acts of terrorism, events resulting in the destruction of the CITA office or testing site facility, loss or delays in the delivery of necessary equipment and/or supplies by a shipping agent, failure of the testing site facility to provide expected and necessary services, equipment, supplies or personnel, or other similar events. Under no circumstance does CITA assume liability for costs incurred by candidates in preparing to take a CITA examination. This policy extends to situations where CITA may be forced to cancel an examination because of an emergency or unforeseen circumstance, such as those listed above, or for the lack of participants as explained above. However, if such an examination cancellation were to occur for those reasons stated or any reason in CITA’s sole discretion, CITA would refund candidates’ application fees, reassign candidates to the next available examination site, or reschedule the examination to the earliest possible date.

LIMITED LIABILITY INSURANCE

CITA has a blanket professional liability insurance policy that covers all dental candidates and assistants for all ADEX Dental Examinations. The cost of that coverage is included in CITA’s examination fee. Therefore, candidates and/or assistants are not required to obtain additional limited liability insurance.

THREE-TIME FAILURE RULE

Candidates failing one part of the ADEX Dental Examination on three (3) attempts must begin the entire examination process again and retake all parts of the examination. Any parts in which the candidate may have been previously successful will not be recognized or counted toward successful completion of the retest of the entire clinical examination process. When this situation occurs, the candidate will be considered an initial applicant. The Three-Time Failure Rule starts on July 1 of a candidate’s D4 (final) year. Failures during a candidate’s D3 year do not count towards this rule. NOTE: To maintain the integrity of this rule, all unsuccessful candidate results will be shared among all agencies administering the ADEX Dental Exam. The three-time failure rule is in effect no matter which agency delivers the exam, or if a combination of agencies gives that part of the exam. NOTE: Candidates should contact their licensing dental board for any required remediation prior to registering to restart their exam cycle.

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RELEASING RESULTS

Scores for all ADEX Dental Examinations are posted to candidate profiles within ten (10) business days of exam completion. An email will be sent to the candidate when the results have been released. The candidate will retrieve results from the Results tab of his/her BrightTrac profile. Students’ results are released to their dental schools who have entered into a confidentiality agreement with CITA. School coordinators at these schools will be given online access by CITA to view their students’ exam results. School coordinators can use the candidates’ results as opportunities for curriculum development and candidate remediation. Upon completion of a scheduled exam, results are released to all jurisdictions via the DESP (online ADEX score portal) the week following the release of the exam results.

CITA will inform licensing boards when a candidate’s conduct or performance raises issues of character and/or integrity that CITA feels should be made known to a licensure board. Results of unsuccessful candidates are also released to other agencies that administer the ADEX Dental Exam to maintain the integrity of the 18-Month Rule as well as the 3-Time Failure Rule.

SCORES TO JURISDICTIONS ACCEPTING THE ADEX EXAM RESULTS FOR LICENSURE

Results of ADEX Exams are uploaded weekly to the DESP (online ADEX score portal). All licensing dental boards have access to the DESP but not all licensing boards will retrieve results through this portal. These results typically are accepted by boards for five (5) years from the date of each candidate’s successful completion of all parts of the ADEX examination, or for a different time as determined by the individual licensing boards. Candidates should contact the individual licensing board of dentistry for an understanding of that board’s acceptance period for this examination and any other requirements that the candidate must fulfill to meet all standards and requirements for licensure. Completion of the ADEX Dental Examination alone MAY NOT qualify a candidate for licensure, as other requirements of each of the jurisdictions MUST be fulfilled before the candidate engages in any activity or activities which may be construed as the practice of dentistry. It is the candidate’s sole responsibility to determine that all requirements have been met in the jurisdiction in which he/she wishes to practice before performing those acts which may constitute the practice of dentistry. Determinations as to who is qualified for licensure are controlled by individual jurisdiction law; consequently, the requirements may not be uniform from board to board. Each licensing jurisdiction may use the examination results to the extent authorized by its statutes.

RE-EXAMINATION AND REMEDIATION Candidates failing any one or part of the ADEX Examination on three (3) attempts should contact the licensing board of dentistry or jurisdiction in which they plan to apply for licensure to determine requirements for remediation. It is the candidate’s responsibility to obtain and complete all requirements for remedial education by following the requirements of the licensing jurisdiction. Remediation may be provided at a candidate’s school as part of the Curriculum Integrated Format examination process.

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CITA does not require documentation of remedial education before re-examination for any part of the ADEX Dental Examination. CITA does not assume any responsibility for providing this information or for monitoring the completion of such requirements before re-examination.

ONLINE SCORE REQUEST

Candidates should contact the licensing board where they are seeking licensure before submitting an online Score Request. Some dental boards will retrieve scores through the DESP (online ADEX score portal). If the dental board requires an official paper score report and/or copy of the manual, candidates must submit a Duplicate Score Request. Requests can be requested electronically via accessing the citaexam.com website, and then clicking Score Request at the top right of the home page. A fee of $35.00 will be charged per address to send paper score reports to the requested jurisdictions. FedEx services are available at an additional fee of $25, if requested. A physical address must be provided if requesting FedEx delivery as FedEx will not deliver to a P.O. Box. CITA will only send official scores directly to licensing dental boards for licensure purposes. We do not send official scores to individuals. All exam procedure attempts will be sent as part of a candidate’s official scores. Any other requests must be made in writing and approved by the CITA Board of Directors. Candidates can access an unofficial copy of their scores directly from the Results tab of their online profile for personal use.

APPEALS PROCESS

If a candidate believes that his/her results were adversely affected by extraordinary conditions during the examination, the candidate may submit an appeal. Appeals are reviewed by a special committee whose charge is to review the facts, paperwork, and score tabulations to determine if the examiners’ findings substantiate the results. Appeals based on patient behavior, tardiness, or failure to appear will not be considered. The appeal process is the final review authority, and if the appeal is denied, there is no further review process authorized by or conducted by CITA or ADEX. Candidates who contact CITA’s administrative office regarding their examination results must indicate in written form VIA EMAIL whether expressing a concern related to the examination or initiating a formal appeal. A non-refundable $250.00 filing fee will be charged by CITA to file and process a formal appeal. Any request for an appeal must be received at CITA’s central office no later than fourteen (14) days following the official date on which the scores were released. CITA’s special committee is required to complete its review within sixty (60) days from the time of receiv-ing the formal request. During that time, the candidate may apply for re-examination. If the candidate files a formal request, retests and passes the examination before the request has been fully processed, the review will be terminated and the $250.00 filing fee will be forfeited by the candidate.

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In determining whether or not to file a petition for review, the candidate should be advised that all reviews are based on a re-assessment of documentation of the candidate’s paperwork for the examination. Candidates should understand that the review does not include re-grading of any exam performance. The review WILL NOT take into consideration other documentation that is not part of the examination process such as character references or testimonials, dental school grades, class ranking, faculty recommendations, or opinions of other "experts" solicited by the candidate. Also, the review will be limited to a consideration of the results of only one (1) examination at a specific test site. Candidates will not participate in the review process and will be notified in writing within sixty (60) days of receiving the review request as to the results of the review. Again, the review will not take into consideration other documentation that is not part of the examination process. Opinions of the candidate, auxiliaries, faculty members, patients, colleagues, examiners acting outside of their assignment area, or 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 documents, radiographs, post-exam photographs, or other materials that were submitted during the examination and remain in the possession of the testing agency. Any candidate who receives a failing score on an ADEX examination may, on his/her behalf, submit a candidate appeal of that failing score. The examination series content is developed and revised by the ADEX Dental Examination Committee. This committee is comprised of representatives from every ADEX member jurisdiction, as well as the participating regional test administration agencies. The committee has considerable content expertise and also relies on practice surveys, current curricula, standards of competency and the American Association of Dental Boards (AADB)’s Guidance for Clinical Licensure Examinations in Dentistry publication to ensure that the content and protocol of the examination are current and relevant to practice. Examination content is also determined by such considerations as patient availability, logistical restraints, and the potential to ensure that a skill can be evaluated reliably. The examination content and evaluation methodologies are reviewed annually and periodically changed to reflect current best practices.

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III. OSCE (DIAGNOSTIC SKILLS EXAMINATION)

CITA will begin using Prometric in 2020. Prometric scheduling availability will begin in February 2020. Candidates will still use PSI for the OSCE (DSE) through January 2020. All unused eligibility numbers will be transferred to Prometric. The computer-based ADEX OSCE is administered at a Prometric testing center of the candidate’s choice. The OSCE may be taken either before or after the patient-based and manikin-based examinations. It is given in one day and is approximately 4 hours long. The initial OSCE fee is included at no charge when a candidate has registered for both the patient and manikin-based exams through CITA. As with all sections of the ADEX exam series, the 18-month and 3-time failure rules apply to the OSCE. (Candidates should consult the three-time failure and 18-Month Rules on page 7 for details)

A current listing of the locations of Prometric Testing Centers at which the computerized OSCE is offered throughout the year can be accessed by going to CITA’s website www.citaexam.com and clicking on the Prometric button on the home page. (Bottom right)

The candidate should check the candidate profile Apply tab for his/her eligibility number and OSCE scheduling instructions. Appointments must be scheduled with a minimum 24-hour notice. Appointments are made based on availability.

SCHEDULING THE OSCE (DSE) Candidates register for the OSCE via their BrightTrac profile. Candidates will receive a confirmation email with scheduling directions. Candidates may schedule their testing appointment for Prometric online. Scheduling is available 24 hours a day. To schedule your exam online, the following steps must be completed for the OSCE exam:

1. Go to www.citaexam.com and click on the

Prometric button. 2. Once you are taken to the CITA landing page,

click on Schedule. 3. This will take you to the Prometric Scheduling

page. Follow the instructions to register. 4. Make sure you have your Eligibility ID ready to

enter into the Eligibility Information Section of the form. This number is found in your BrightTrac Candidate Profile/Apply.

5. Continue to follow the steps until your appointment is complete.

A candidate will receive an email confirmation of his/her Prometric test appointment. This confirmation will provide the candidate with the Prometric exam title, date, time, and location of his/her Prometric test appointment. MAKE SURE THE DATE, TIME AND LOCATION ARE CORRECT.

http://www.citaexam.com/http://www.citaexam.com/

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Lack of receipt of an email confirmation does not invalidate the candidate’s testing appointment when scheduling. Candidates are responsible for noting the date, time, and location of their Prometric testing appointment when scheduling. Prometric Testing Centers are open for testing Monday through Saturday. The hours of each testing facility vary. CITA strongly encourages candidates to contact Prometric as far in advance of their wanted test date as possible. NOTE: If you want to request special accommodations, you must contact the CITA office at least 45 days prior to your desired OSCE exam date. A candidate must provide no less than 48-hours’ notice (Monday-Friday) to reschedule/cancel his/her testing appointment. Rescheduling/cancellation is done through Prometric’s Central Registration Office, NOT the local testing center. Their number is 1-800-797-1813 and are available 24 hours a day, 7 days a week. Failure to provide 48-hours’ notice will result in forfeiting the initial OSCE test fee. Candidates who fail to appear for their scheduled test appointment will be reported as a no-show and will need to reschedule as a retest candidate through CITA after paying the appropriate OSCE retest fee of $500. Requests for waivers must be submitted to CITA in writing within 72 hours of the missed testing appointment and must include a doctor’s note verifying a medical emergency. Take two forms of personal identification to the Prometric Testing Center: one with a recent photo, and both with a signature. Acceptable forms of ID include a valid current driver’s license, passport, and military ID. A credit card is acceptable as a secondary form of ID. An expired driver’s license is not a valid form of ID. If your name has changed due to marriage, divorce, or other legal reasons, bring a copy of the marriage certificate or court document to the Prometric Testing Center.

OSCE (DSE) SCORING

There are 165 scored points on the DSE OSCE. There are 15 of the 165 scored points that come from pilot questions. The final score of the DSE OSCE is based on the percentage of items answered correctly and scaled to equate scores from year to year. Out of 100 possible points, a scaled score of 75 or higher is required to pass. Results are released in accordance with CITA administrative procedures.

OSCE (DSE) CONTENT

Simulations of actual patients are utilized through computer-enhanced photographs, radiographs, optical images of study, working models, laboratory data, and other clinical digitized reproductions. Three subsections of the OSCE are designed to assess more complex levels of diagnosis and treatment planning knowledge, skills, and abilities. The table below summarizes the information covered on the OSCE as of January 1, 2020: In each subsection, candidates may skip or mark items to be considered later. Once a subsection is complete, the candidate must lock out of the subsection and will not be able to return to that subsection again. The time indicated on the computer screen is the amount of time for that subsection. There is no specific time limit for each question.

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CITA does NOT offer any study material for the OSCE (DSE) Examination

OSCE (DSE) CONTENT FORMAT

(as of Jan 1, 2020)

Patient Evaluation (PE)

Designed to assess the candidate’s ability to recognize critical clinical conditions or situations encountered regularly in the general practice of dentistry.

Pathology

Physical Evaluation of - Anatomy - Identification of Systemic Conditions - Radiology - Lab Diagnostics - Therapeutics

Simulated patients presented on a computer. 165 scored points:

PE: 20%

CTP: 60%

PPMC: 20%

Time: 4 hours (max time allowed; time used may be less at the discretion of the candidate) A 15 minute break is given after each section. Results reported as either:

“PASS – 75 or greater” or

“Fail—less than 75”

Comprehensive Treatment Planning (CTP)

Designed to assess the candidate’s ability to recognize critical clinical conditions or situations encountered regularly in the general practice of dentistry, and also to identify the appropriate treatment options required for the clinical condition or situation depicted in simulations.

Systemic Diseases/Medical Emergencies/Special Care and Oral Medicine

Periodontal Diagnosis and Treatment Planning

Restorative Dentistry

Specialties - Endodontics - Orthodontics - Oral Surgery - Pediatric Dentistry

Cross-Cutting Clinical Judgments Designed to assess the candidate’s abilities to recognize critical clinical conditions or situations encountered regularly in the general practice of dentistry and to formulate appropriate treatment options as well as evaluation of treatment outcomes.

Medical emergencies

Infection control

Prosthodontics

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IV. SCORING FOR PATIENT EXAMINATIONS

Testing agencies throughout the U.S. have worked together through ADEX to refine the performance criteria for each procedure in this examination. For the majority of those criteria, grading is done on a pass-fail basis with the criteria being graded as either Acceptable or as being a Critical Deficiency. For a select group of criteria, gradations of competence are described across a 3-level rating scale. Those criteria appear in the manual and are the basis for the scoring system. The pass-fail and the three rating levels may be generally described as follows:

Acceptable: The treatment adheres to criteria, demonstrating competence in clinical judgment, knowledge, and skill; however, slight deviations from the mechanical and physiological principles of the satisfactory level may exist which restores the tooth to health and does not significantly shorten the expected life of the restoration.

Marginally Substandard: The treatment is marginally substandard usually involving an over-preparation/over reduction beyond what is necessary to remove disease or follow preparation parameters, demonstrating less than desirable clinical judgment, knowledge of or skill in the mechanical and physiological principles of restorative dentistry, which if left unmodified, may shorten the life of the restoration but when is the sole deviation from acceptable skills would not harm the patient.

Critically Deficient: The treatment is of unacceptable quality, demonstrating critical areas of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry. The tooth may or may not be temporized, or the treatment plan must be altered and additional care provided to sustain the function of the tooth and the patient’s oral health and well-being. When three or more confirmed marginally sub-standards exist within one procedure the grade for the procedure will be deemed to be Critically Deficient.

CONTENT

Restorative Content – 100 Points (Passing score is 75 or more)

The Restorative section is a patient-based examination which consists of one anterior composite preparation and restoration which are graded separately, as well as one posterior preparation and restoration that may be either an amalgam or composite.

Restorative Three-SUB Rule: If examiners confirm 3 marginally substandard over-preparation criteria on the same procedure, then the procedure will be determined to be critically deficient and the candidate will fail that procedure.

RESTORATIVE CONTENT FORMAT

1. Anterior restoration: Class III composite - cavity preparation and restoration are graded separately

2. Posterior restoration: candidate’s choice of either:

Class II amalgam - cavity preparation and restoration are graded separately

Class II composite - cavity preparation and restoration are graded separately

Performed on a patient See Procedure Schedules on page 21 for time allowed See page 62 for complete criteria guidelines and the Restorative Three Sub Rule

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Periodontal Scaling Examination – 100 points (Passing score is 75 or more) (Optional for ADEX Status, but may be required for licensure depending on licensing requirements.)

The Periodontal Scaling Examination is a patient-based examination consisting of four parts with the following points for each part:

1. Treatment Selection – Penalties are assessed for those areas that do not meet the described criteria for case acceptance. No points are accrued for treatment selection.

2. Calculus Detection and Removal – 90 points total with 7.5 points for each surface of subgingival calculus correctly detected and removed. (*If there are four (4) or more confirmed calculus detection errors, the candidate will not be allowed to proceed with the exam.)

3. Supragingival Deposit Removal – 6 points total with one point for each one of the first 6 teeth selected in ascending order.

4. Tissue & Treatment Management – 4 points total for pain control and tissue management that meets the written criteria.

PENALTIES

Throughout the examination, the conduct and clinical performance of the candidate will be observed and evaluated. Several considerations are weighed in determining the final scores. Penalties are assessed for violation of the examination standards for certain procedural errors as described below.

Any of the following may result in a deduction of points from the score of the entire examination section or dismissal from the examination.

PENALTIES AND ASSOCIATED POINT VALUES:

PATIENT MANAGEMENT DEDUCTION

Temporization or failure to complete an examination procedure 100 Points

Violation of examination standards, rules or guidelines or time schedule 100 points

Improper management of significant medical history or pathological condition 100 Points

Treatment of teeth other than those approved or assigned by examiners 100 Points

Gross damage to adjacent tooth structure – teeth or tissue 100 Points

PERIODONTAL SCALING CONTENT FORMAT

Assignment 1. Case acceptance 2. Subgingival calculus detection Treatment 4. Subgingival calculus removal 5. Supragingival plaque/stain removal 6. Tissue and treatment management

Performed on a patient See Procedure Schedules on page 21 for time allowed Treatment time: 1.5 hours (after case acceptance)

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2nd lesion rejection (not in schools participating in pre-screening) 100 Points

Unrecognized exposure 100 Points

Inappropriately managed pulpal exposure (mechanical or pathologic) 100 Points

Unjustified mechanical exposure 100 Points

Failure to complete treatment within the stated guidelines of the examination 100 Points

Administration of anesthetic before the official start of the exam for restorative procedure or before perio case acceptance if attempting the perio scaling exam.

100 Points

Restorative only: non-diagnostic radiographs(s): 3rd Time 100 Points

Critical lack of clinical judgement/diagnostic skills 100 Points

Request to remove caries or decalcification without clinical justification 15 Points

Pulp cap is inappropriately placed 15 Points

Inappropriate request for indirect pulp cap 15 Points

Indirect Pulp Cap denied 15 Points

Gross infection control violation: Items by report 10 Points

Poor patient management and/or disregard for the patient’s welfare or comfort 10 Points

Improper management of significant history or pathology 10 Points

Initial Preparation is not to at least acceptable dimensions 10 Points

Repeated requests to modify/extend approved treatment plan without clinical justification 10 Points

Unsatisfactory completion of modifications required by examiner 10 Points

Restorative only: non-diagnostic radiographs(s): 2nd time 10 Points

Improper Liner Placement 10 Points

Any denied modification request 1 Point

Appearance unprofessional. unkempt, unclean 1 Point

Violation of universal precautions, either candidate or assistant 1 Point

Improper/Incomplete recordkeeping 1 Point

Inadequate Isolation 1 Point

Unprofessional attitude, rude, inconsiderate/uncooperative with examiners/other personnel 1-100 Points

Improper operator/patient/manikin position 1 Point

This listing is not exhaustive, and penalties may be applied for errors not specifically listed since some procedures will be classified as unsatisfactory for other reasons, or a combination of several deficiencies.

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V. STANDARDS OF CONDUCT/INFECTION CONTROL

STANDARDS OF CONDUCT The ADEX examination strives to evaluate the candidate’s clinical judgment and skills in a fair manner. A candidate’s conduct, decorum, and professional demeanor are also evaluated. The candidate is required to adhere to the rules, regulations, and standards of professional conduct for the ADEX Dental Examinations. Several considerations will weigh in determining the candidate’s final score, and penalties may be assessed for violation of examination standards and/or certain procedural errors, as defined and further described within this manual. Unethical personal/professional conduct: Any substantiated evidence of collusion, dishonesty, use of unauthorized assistance, intentional misrepresentation during registration or the course of the examinations, or failure of the candidate to carry out a directive of the Chief examiner shall automatically result in failure of all five examination sections. The candidate and assisting auxiliary must behave ethically and properly. Patients shall be treated with proper concern for their safety and comfort. Improper behavior is cause for dismissal from the examination at the discretion of the Chief examiner and will result in failure of the examination. Additionally, the candidate shall be denied re-examination through any testing agency who administers the ADEX Dental Exam for one full year from the time of the infraction. Termination of the examination(s): CITA reserves the right to terminate or delay the examination(s) at any time if:

That action becomes necessary to safeguard the health, safety, or comfort of the patient.

The candidate or examiners are threatened in any manner.

Other interfering events occur that are not under the control of CITA. Completion of the examinations: Examination procedures performed outside the assigned time will be considered incomplete, and the candidate will fail the examination part. If all specified materials and required documentation are not turned in at the end of an examination, then that exam will be considered incomplete, and the candidate will fail all exams involved. Misappropriation and/or damage of equipment: No equipment, instruments, or materials shall be removed from the examination site without written permission of the owner. Willful or careless damage of dental equipment, typodonts, manikins, or shrouds may result in failure. All resulting repair or replacement costs will be charged to the candidate and must be paid to the host site before the candidate’s examination results will be released. Submission of examination records: All required records and radiographs must be turned in before the examination is considered complete.

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DISMISSAL FROM EXAMINATION

In addition to the standards of conduct listed in the previous section, the following list is provided as a quick reference for candidates. While the following is not an all-inclusive listing, it does provide examples of behaviors that may result in dismissal/failure of the examination:

• Using unauthorized equipment at any time during the examination

• Altering patient records or radiographs

• Performing required examination procedures outside the allotted examination time

• Failure to follow the published time limits and/or complete the examination within the allotted time

• Receiving assistance from another practitioner, including another candidate, dentist, school representative(s), etc.

• Exhibiting dishonesty

• Failure to recognize or respond to systemic conditions that potentially jeopardize the health of the patient, and/or total disregard for patient welfare, comfort and safety

• Unprofessional, rude, abusive, uncooperative or disruptive behavior to other candidates, patient and/or exam personnel

• Misappropriation or thievery during the examination

• Non-compliance with anonymity requirements

• Non-compliance with established guidelines for asepsis and/or infection control

• Charging patients for services performed

• Use of any electronic equipment in patient care areas for reasons other than using the clock function on the device (for time keeping purposes) PUT CELLULAR PHONES IN AIRPLANE MODE

• Use of electronic recording devices, cell phones, smart watches, or cameras by the candidate, auxiliary, or patient during any part of the examination

INFECTION CONTROL REQUIREMENTS Candidates must follow the current recommended infection control procedures and guidelines required by the jurisdiction where the examination is taking place as well as those procedures and guidelines published by the Centers for Disease Control and Prevention for the restorative and periodontal scaling procedures. These infection control procedures must begin with the initial set-up of the unit, continue throughout the procedures, and conclude with the final clean-up of the operatory. It is the candidate’s responsibility to ensure that both the candidate and his/her auxiliary fully comply with these procedures. Failure to comply will result in loss of points, and any violation that could lead to direct patient harm will result in failure of the examination. As much as possible, dental professionals must help prevent the spread of infectious diseases. Because many infectious patients are asymptomatic, all patients must be treated as if they are, in fact, contagious. Use of barrier techniques, disposables whenever possible, and proper disinfection and sterilization are essential. Candidates must adhere to the following infection control procedures:

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Barrier protection

• Gloves must be worn when setting up or performing any intra-oral procedures and when cleaning up after any treatment. Do not wear hand jewelry that can tear or puncture gloves. If gloves become ripped or torn, replace with new one. Do not wear gloves outside the operatory.

• Wash and dry hands between procedures and whenever gloves are changed. • Wear clean, long-sleeved uniforms, gowns or laboratory coats, and change them if they become

visibly soiled. Remove gowns or laboratory coats before leaving the clinic area. • Wear facemasks and protective eyewear with side shields during all procedures in which splashing

of any body fluids is likely to occur. Discard masks after each patient, or sooner if the masks become damp or soiled.

• Do not wear open-toed shoes. • Cover surfaces that may become contaminated with impervious-backed paper, aluminum foil or

plastic wrap; remove these coverings (while gloved), discard them, and replace between procedures (after removing contaminated gloves).

Sterilization and Disinfection

• Instruments that become contaminated must be placed in an appropriate receptacle and identified as contaminated.

• Any instrument that penetrates soft or hard tissue must be disposed of or sterilized before and after each use. Instruments that do not penetrate hard or soft tissue but do come in contact with oral tissue should be single-use disposable items and must be properly discarded.

• If not barrier wrapped, surfaces and counter tops must be pre-cleaned and disinfected with a site-approved tuberculocidal hospital-level disinfectant.

• Handpieces, prophy angles, and air/water syringes must 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 must be considered potentially infectious and shall be disposed of in accordance with federal, state, and local regulations.

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VI. Examination Overview TIMELY ARRIVAL

Candidates are responsible for determining travel and time schedules to ensure they can meet all of CITA’s time requirements. The candidate is expected to arrive at the examination site at the designated time stipulated in the published schedule for that particular examination, which all candidates receive via email from CITA’s central office. Failure to follow this guideline may result in failure of the examination. Candidates will be informed via the candidate profile (Apply tab) as to the date on which they are scheduled to take each part of the examination. Dates and Candidate ID #’s are posted after the 30-day deadline. Candidates should note that the patient-based examination procedures have specific time restraints. All procedures for each examination must be completed within the allotted time for that section. The charts on page 21 are examples of the timelines of these examinations; however, examination schedules are not finalized until after the examination application deadline. Candidates’ actual schedules will be emailed to them once the exam registration has closed (approx. 30-days before the exam). Candidates should consider that the time allowed for completion of the patient-based examination INCLUDES THE TIME DURING WHICH PATIENTS WILL BE IN THE EVALUATION STATION and should plan accordingly. As such, this time may vary according to the procedure being evaluated, the testing site, and the number of candidates. EXAM TIMELINE

All candidates will receive their exam packet during the exam day registration at 6:30 am. Candidates should consult page 77 for all documents required for registration. Required registration documents are also available via the Documents tab of the online candidate profile. All candidates will begin set up in the clinic at 7:00 am. While a candidate may start with either a restorative or periodontal procedure, all candidates attempting three procedures must be completed by 5:30 pm. If the final procedure of a 3 procedure exam day is a restorative procedure, the case acceptance/lesion approval for the second restoration should be completed by 4:00 pm, the candidate must be in line at the paperwork review station for paperwork acceptance of the preparation evaluation by 4:30 pm, and the candidate must be electronically checked in for final evaluation by 5:30 pm. If candidates are not electronically checked in for the final evaluation by 5:30 pm, the candidate must temporize any prepared teeth. Restorations already in place will not be graded.

If the final procedure of a 3 procedure exam day is the periodontal scaling procedure, the Case Acceptance should be completed by 4:15pm and Pre-Treatment Evaluation must be completed by 4:45 pm to allow 45 minutes for treatment time.

Note: Times are adjusted based on the number of procedures attempted. A candidate may not change the number of procedures IF the time remaining is past the allowed time for the new number of procedures. I.E. A candidate would have to have completed 2 procedures by 3:30 pm to switch from doing 3 procedures to 2 procedures. See schedule on page 21. Candidates are considered to have met their required periodontal scaling end time deadlines when they have completed working and the patient is seated in an upright position. The CANDIDATE is RESPONSIBLE for monitoring his/her own time. ANY time overage may result in a breach of exam protocol and a 100 point penalty.

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EXAMINATION SCHEDULE CHANGES

Requests for a change in assignment time will not be considered or made once the schedule has been distributed. Dental school personnel do not have the authority to accept a candidate for an examination at their site or to make any assignment changes within an examination series. Such arrangements between dental school personnel and a candidate may preclude the candidate from being admitted to the examination, as well as result in forfeiture of all fees. Requests can be made BEFORE the 30-day deadline by contacting the CITA Office. CITA’s Chief Examiner is the only authorized individual who may consider a request for a schedule change. If unusual circumstances warrant such a change and space is available, the decision is CITA’s Chief Examiner to approve such a request.

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EXAM-DAY REGISTRATION FOR RESTORATIVE AND PERIODONTAL SCALING PROCEDURES

Exam-day registration will be conducted in a room or area other than the clinic where the patient-based clinical examination will be conducted. Candidates should consult the finalized examination schedule which is emailed to them after the exam has closed (30-days before the exam).

Candidates taking either the restorative and/or periodontal scaling procedures are required to attend the exam-day registration. Candidates assigned to the exam MUST be present with all required materials during the specified exam-day registration period, or they may be denied entrance to that part of the examination. Details of what to bring to registration can be found on page 77.

INTERPRETERS

Candidates can employ the services of an interpreter for any patient who does not speak English or is hearing impaired with a hearing loss which cannot be corrected. Candidates will not be the interpreter for their patients. The interpreter will follow the patient into the Evaluation Station and translate any questions/answers the examiners may have for the patient. This is particularly important when the patient has a history of medical problems or is on medications. Interpreters may be related to a patient, but in all cases, must be at least eighteen (18) years old, nineteen (19) years old in Alabama, and twenty-one (21) years old in Puerto Rico). An interpreter may NOT be:

Under 18 years of age (under nineteen [19] years of age in Alabama and under twenty one [21] years of age in Puerto Rico).

Shared between candidates at the same time during the examination

A faculty member, dentist, or dental hygienist (licensed or unlicensed)

An employee at the school where the examination is being administered

An expanded duty auxiliary (if providing expanded duty services normally done by a dentist)

A third, fourth, or final-year dental student

A final-year dental hygiene student

The chairside assistant

Candidates should also be mindful of the fact that CITA is committed to providing a safe and secure examination site. All interpreters that are utilized by a candidate during the examination will be required to wear a photo identification badge. Candidates must bring the completed the Interpreter Form with them, along with (1) passport-sized photo of the requested interpreter taken within the last six (6) months at a local post office, drug store, or similar venue. During registration, the candidate will affix the approved photo to the interpreter badge (available to the candidate during registration). An interpreter will be not be permitted to assist a candidate and his/her patient if he/she does not have a CITA-issued photo identification badge. After delivering the badge to the interpreter, the candidate should send the Interpreter Form with the interpreter and his/her photo ID to the check-in desk during the set-up period. An authorized CITA staff member will verify the interpreter’s identity, and collect the Interpreter Form at that time.

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Candidates are responsible for the conduct of their interpreter during the examination. While there is no strict dress code for interpreters, please be mindful that the examination site is a professional setting and all personnel should be appropriately dressed. Therefore, CITA requires that:

All interpreter photographs should be indicative of their current appearance at the time of the examination.

Dark sunglasses will not be permitted at the examination; transitional lenses are permitted.

Coats, jackets, and other bulky clothing will not be permitted in the clinic area.

Appropriate dress is required. Short shorts, tank tops, sandals, open-toed shoes and/or halter-tops are not allowed.

Interpreters must remain outside the Evaluation Station operatory during examiner grading.

Interpreters may not use any electronic devices during the examination. Cell phones, smart watches, and other electronic devices should be left with the candidate in the clinic.

Interpreters must turn their badge in at the end of the exam.

The Interpreter Form can be downloaded from the Documents tab of the candidate online profile (https://cita.brighttrac.com).

Misinformation or missing information that would endanger the patient, candidate, auxiliary personnel or examiners is considered cause for dismissal from the examination.

ASSISTANTS Auxiliary personnel are permitted for the patient-based exam. Assistants may NOT be any of the following: 1. Unlicensed/licensed dentist/dental hygienist

2. Fourth-year (or final-year) dental student

3. Final-year dental hygiene student

4. Dental lab technician

5. Serving as an interpreter during the exam

6. Expanded duty auxiliary (if providing expanded duty services normally done by a dentist)

Candidates wishing to utilize an assistant for the patient-based exam must complete the Dental Assisting Form. This form is available through the online candidate profile (https://cita.brighttrac.com). Assistants will be required to wear the identification badge at all times while on the clinic floor. Candidates must bring the form with them, along with (1) passport-sized photo of the requested assistant taken within the last six (6) months at a local post office, drug store, or similar venue. During registration, the candidate will affix the approved photo to the assistant badge (provided in candidate packet). An assistant will be not be permitted to assist a candidate if he/she does not have a CITA-issued photo identification badge. After delivering the badge to the assistant, the candidate should send the Assistant Form with the assistant and his/her photo ID to the check-in desk during the set-up period. An authorized CITA staff member will verify the assistant’s identity, and collect the Assistant Form at that time. Assistant badges must be turned in at the end of the exam.

https://cita.brighttrac.com/https://cita.brighttrac.com/

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VII. PATIENT SELECTION PATIENT SELECTION GENERAL GUIDELINES

The following are general guidelines for patient selection. Specific procedure guidelines are listed in the sections for each procedure. Candidates must furnish their patients for the Periodontal Scaling and Restorative Examinations. Patient selection and management is an important part of the examination. Patient Management — The candidate and assisting auxiliary must behave ethically and properly towards all patients. Patients shall be treated with proper concern for their safety and comfort. The candidate shall accurately complete the appropriate Medical History Form and establish a diagnosis and treatment plan as required for each selected patient. The patient’s health status must be acceptable for clinical treatment and the lengthy examination process. For the Restorative Examination, the candidate may present a backup patient if the lesion on his/her first patient is not accepted by the examiners. However, only one patient may be submitted for the Periodontal Examination. Due to the natural stress of an examination, candidates should avoid selecting patients who are apprehensive, hypersensitive, have physical limitations that could hinder the examination process or are unable to stay for the duration of the examination. At the candidate’s discretion, an individual who has a physical disability may, in most cases, be a patient in the examination. Candidates must contact the testing agency a minimum of 60 days before to the examination for any special accommodations needed. Patient Consent Form — A Patient Consent Form must be completed and signed by each patient before any treatment being rendered. Initially, only the candidate’s ID label should be placed on the consent form; the candidate’s name must be added after the examination is completed and before all paperwork is turned in (once the CFE has released the patient). See page 75. Pre-medication Record — A record must be kept for each patient who requires pre-medication before or during the examination. For each procedure, there is a place on the Progress Form to record the type(s) and dosage(s) of medication(s) administered. Candidates who are sharing a patient requiring antibiotic prophylaxis must treat the patient the same clinical day. Treatment of the same patient on subsequent days will not be permitted. Anesthetic Record — ALL ANESTHETIC MUST BE DISPENSED DURING THE EXAM THROUGH THE DISPENSARY AT THE SITE WHERE THE EXAM IS BEING ADMINISTERED. At the time of the examination and before requesting a CFE’s approval for each restorative or periodontal scaling clinical procedure, the following anesthetic information must be indicated on the appropriate Progress Form:

Type(s) of injection (specific block or infiltration to be administered)

Anesthetic(s) (generic or brand name and percent used)

Vasoconstrictor (type and concentration)

Quantity (volume)

If more than two dental anesthetic carpules (approximately 3.6 ml) of local anesthetic are needed during any clinical procedure, the candidate must request approval from a CFE, who will document and initial the request. This protocol must be followed for each subsequent carpule. The additional anesthetic solution

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may be administered only with approval by the CFE. The total quantity of anesthetic solution used must also be documented on the Progress Form. An aspirating syringe and proper aspirating technique must be used for the administration of local anesthetic solutions. The administration of inhalation or parenteral analgesia or sedation is not permitted for any clinical procedures. If the patient has already received anesthesia earlier on the same day, the candidate must enter the previous anesthetic on the Progress Form, including type and amount, and present the form to the CFE for approval before administering additional anesthetic.

HEALTH QUALIFICATIONS AND PATIENT ELIGIBILITY Patients who fall into these categories will NOT be accepted:

Patients who are under age 16.

Patients who are under 18 years of age (under 19 in AL; under 21 in PR) and are unaccompanied by a legal parent or guardian.

Patients who are unable to give legal consent

Dentists (licensed or unlicensed) or fourth-year (final-year) dental students

Dental hygienists (licensed or unlicensed) and final-year dental hygiene students restricted from the periodontal scaling section only. (Can be used on the Anterior and Posterior procedures.)

To participate in the examination, patients must meet the following criteria: a) Patients must have a blood pressure reading of 159/94 or below to proceed without medical

clearance. Patients with a blood pressure reading between 160/95 and 179/109 will be accepted only with written medical clearance from the patient’s physician. Patients with a blood pressure reading 180/110 or greater will not be accepted for this examination, even if a physician authorizes treatment.

b) Candidates who are sharing a patient must each complete a Medical History Form for the patient.

c) Candidates who are using one patient for more than one procedure may use the same Medical History Form for both procedures. However, the blood pressure must be taken and recorded before each procedure.

d) 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.

e) Patients must not have a history of heart attack (myocardial infarction), stroke, or cardiac surgery within the last six months.

f) Patients may not have active tuberculosis. A patient who has tested positive for tuberculosis or is being treated for tuberculosis but does not have clinical symptoms is acceptable.

g) Patients may not have undergone chemotherapy for cancer within the last six months.

h) Patients participating in the Periodontal Scaling Examination may not have a history of taking IV or orally-administered bisphosphonate medications.

i) Patients participating in the Restorative Examination may not have a history of taking IV-administered bisphosphonate medications (except an annual IV dosage for osteoporosis); however, he/she may participate if he/she has taken oral bisphosphonates.

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j) Patients may not have an active incidence of bisphosphonate osteonecrosis of the jaw (BON) also known as osteochemonecrosis or osteonecrosis of the jaw (ONJ).

k) Patients may not have any condition or medication/drug history that might be adversely affected by the length or nature of the examination process.

l) Patients with latex allergies may not participate in the examination unless the school is a documented latex-free school. The Facility Information Sheet will list if the school is latex-free.

m) A woman in her first trimester of pregnancy must have medical clearance to be a patient for the examination. A woman in her second trimester may be a patient for the exam and a woman in her third trimester may be a patient if she is comfortable sitting in one place all day for the examination.

PATIENT’S MEDICAL HISTORY – FORM B

Medical History Form — A Medical History Form must be completed independently by the candidate (without assistance from faculty or colleagues) for each clinical patient. Except for the patient’s blood pressure, this form may be completed before the examination date; however, the form must reflect the patient’s current health at the time of the examination. See page 75. If the patient gives any positive responses to questions #4-#13, the candidate must explore the nature of the condition and provide an adequate explanation on the Medical History Form. These answers might affect the patient’s suitability for treatment. Blood Pressure — A screening blood pressure reading should be taken when the patient is selected and must be retaken on the day of the examination during the set-up period and recorded on the Medical History Form. The examination-day reading must be verified on the Medical History Form by a CFE. If the patient is sitting for more than one examination section on the same day, his/her blood pressure must be taken and recorded before each section. Failure to take or falsification of the blood pressure reading will result in dismissal of the candidate from the examination and failure for that procedure. Medications — 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 also document antibiotic premedication on the appropriate Progress Form, as well as on the Medical History Form. ASA Classification — ASA Classification must be noted on the bottom of the Medical History form; a guide to the ASA Classifications is listed on the bottom of the second page of the Medical History Form. CANDIDATES: DO NOT SIGN THE MEDICAL HISTORY FORM UNTIL YOU HAVE COMPLETED ALL ATTEMPTED PROCEDURES AND ARE READY FOR CHECK-OUT.

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MEDICAL CLEARANCE

If the patient indicates a medical history that could affect his/her 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 History Form and medical clearance will be reviewed by a CFE for the Restorative and Periodontal Scaling Examinations and must accompany the patient when submitted for evaluation (patient check-in/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. Qualified patients must meet the following criteria: a) Patients must obtain premedication with a written statement from their physician in the case of any

significant medical problems that the American Heart Association classifies as a moderate-to-high risk. The medical clearance must indicate the specific medical concern and must be attached to the Medical History Form on the day of the examination.

b) Candidates must follow the current American Heart Association antibiotic premedication recommendations when treating patients at potential risk of infective endocarditis following dental treatment. Medical clearance may be indicated to determine the patient’s potential risk of infective endocarditis. If the patient answers “yes” to any of the questions on the Medical History Form, the candidate must explore the item further and determine whether a medical clearance from a licensed physician would be appropriate. Medical clearance is required if the finding could affect the patient’s suitability for elective dental treatment during the examination.

c) Candidates must obtain written medical clearance for patients reporting a disease, condition, or problem not listed on the Medical History Form that would pose a significant risk to their own health or safety of others during the performance of dental procedures. If this clearance and/or verification of premedication is not available, the patient will not be accepted for treatment. Furthermore, the medical clearance MUST NOT contain the candidate’s name anywhere in the document.

d) Candidates must obtain written medical clearance and/or possible antibiotic prophylaxis, if necessary, for all patients who respond “yes” to any of the following questions on the Medical History Form: 8.O.: Joint Replacement 8.Q or 8.R.: Heart Valves—Damaged or Replaced 8.S.: Congenital Heart Disease 8.T.: Infective Endocarditis 8.U.: Heart Attack 8.V.: Heart Surgery 8.W.: Stroke 8.AA: Pacemaker Or have taken Dexfluramine, Fenfluramine, Adipex, Pondimin or Redux.

e) Candidates must obtain written medical clearance for Class 3 ASA on Medical History Form.

f) For the purposes of this examination, CITA has adopted the current American Heart Association guidelines for antibiotic coverage. Antibiotic prophylaxis is recommended for the prevention of infective endocarditis in the conditions listed below:

i. Prosthetic cardiac valve or prosthetic material used for cardiac valve repair

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ii. Previous infective endocarditis

iii. Congenital heart disease (CHD)

iv. Unrepaired cyanotic CHD, including palliative shunts and conduits

v. Completely repaired congenital heart defect with prosthetic material or device, whether placed by

surgery or by catheter intervention during the first 6 months after the procedure

vi. Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

vii. Cardiac transplantation recipients who develop cardiac valvulopathy The patient’s medical clearance, if necessary, must NOT contain the candidate’s name anywhere on the document, but must include:

A legible statement from a licensed physician written within 30 days before the examination on official letterhead

A positive statement of how the patient should be medically managed

The physician’s 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

A candidate may also use the medical clearance form which is available in the Document section of the candidate profile.

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VIII. Radiographs

GENERAL RADIOGRAPH GUIDELINES

Digital radiographs are CITA’s preferred radiographic method for this examination and should meet the following qualifications:

The films or digital images must be of diagnostic quality.

If not using film radiographs, candidates should submit digital images. In general, digital FMX prints should be printed on 8 ½” x 11” photo quality paper.

Digital periapical and bitewing images should each be a 4” x 6” image with both images printed on one sheet of 8½” x 11” photo quality paper.

The candidate must provide the following information on the back of the print:

o Patient’s name

o Date the radiographs were taken

o Candidate’s ID Label

If the school name is normally incorporated into the digital image, this should be removed or masked, if possible, before printing the image on photo quality paper. If not, the CFE will request the school identifier to be covered on the day of the examination.

Candidates are advised that high-speed radiographic film portrays the lesion to be smaller than in reality.

If the testing site plans to use Axium during the exam (see Facility Information Sheet to determine the use of Axium), candidates must send their radiographs to the school before the exam for them to be added to the Axium system. Digital images may be displayed on monitors at these schools. While radiographs are not required to be printed at these schools, it is always recommended to still have them as a backup. Digital prints will be accepted during the exam at these sites if the candidate prefers not to use the Axium option at that school.

Radiographs must not be retaken simply to produce a “perfect” image. Radiographs that have minor errors such as minor cone cutting, not showing all of a third molar, or a slightly off-center panoramic film, will not result in any loss of points and should not be retaken.

Additional radiographs may be required by the examiner during the examination. Post-operative radiographs, digital prints, or images are not routinely required. However, a post-operative radiograph may be requested at any time at the discretion of an examiner. Altering or failing to provide radiographs, digital prints, or images will result in failure of the examination. The radiographic films, digital prints and/or images used in the examination may be collected at the end of the examination and become the property of the testing agency.

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PERIODONTAL SCALING RADIOGRAPH REQUIREMENTS

For the Periodontal Scaling Examination, the radiograph(s) submitted must demonstrate sufficient contrast and resolution to reveal the extent of caries and other pathoses. If the candidate submits poor-quality radiographs (film or digital prints), examiners will take the following action:

ACC – no penalty

SUB – 15 point penalty

DEF – 100 point penalty; candidate will be dismissed from the exam

Periodontal Scaling Radiographs must meet the following criteria:

Candidates must submit a diagnostic panoramic radiograph or complete (full) mouth radiographic series exposed within the last three years. If a full mouth series is presented, films must be mounted according to ADA procedures (convexity up). All radiographs must indicate the exposure date, patient’s name, right and left side, and candidate identification number.

If the condition of the mouth changes after the original radiographs are taken due to a tooth extraction or filling, then the change must be noted on the candidate progress form before the patient is presented to the CFE.

RESTORATIVE RADIOGRAPH REQUIREMENTS

For the Restorative Examination, it is advisable to present a patient with a proposed restoration from which a radiographic perspective would demonstrate support for a restorative diagnosis. Typically, interproximal caries must be interpreted radiographically to penetrate at least to the dento-enamel junction, or have equivalent depth clinically. For digital radiographs, caries should appear to progress greater than one-half the thickness of the enamel to have clinically progressed to the DEJ. For film radiographs, caries should appear to progress greater than ¾ (three fourths) the thickness of the enamel, to have clinically progressed to the DEJ. Candidates are advised against presenting a proposed restoration which demonstrates questionable radiographic support for a diagnosis of disease, and also lacks radiographic, visual, or tactile supporting evidence for a restorative diagnosis.

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Restorative Radiographs must meet the following criteria:

a. Class II Pre-Operative Radiographs A periapical and bitewing radiograph of the tooth selected for the Class II restoration is required when the patient is presented for lesion approval.

b. Class III Pre-Operative Radiographs

A periapical radiograph of the tooth selected for a Class III restoration is required when the patient is presented for lesion approval.

Both the Class II and Class III pre-operative radiographic films must be of diagnostic quality and may not be more than one-year-old (twelve months). If dental treatment has changed the depiction of the clinical condition of the tooth to be treated or the surrounding teeth, a description of all changes must be written in the Communication from Candidate to the Grading Room section on the Progress Form. All radiographs must be displayed in labial view orientation according to ADA guidelines. These radiographs must be submitted (electronically or printed

hardcopy) at the conclusion of the examination and become the property of CITA. If the dental school stipulates that radiographs must be returned to the school as part of the patient’s examination records, candidates must submit duplicates of the required radiographs to the dental school. If the dental school uses Axium (or similar system), the school liaison may supply CITA copies of all x-rays used on a single storage device for all their candidates.

POST-OPERATIVE OR ADDITIONAL RADIOGRAPHS Post-operative radiographs are NOT required. However, additional or post-operative radiographs may be requested at any time during the conduct of the examination and at the discretion of any examiner. All such requested radiographs should be mounted, meet the same criteria as previously specified for pre-operative radiographs, and sent to the requesting examiner for evaluation.

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IX. Required Instruments INSTRUMENTS AND EQUIPMENT

All necessary materials and instruments for the clinical procedures other than the operating chair, light, and dental unit, must be provided by the candidate. It is the responsibility of the candidate to arrange for his/her handpiece, sonic/ultrasonic instruments, and all other equipment necessary to complete the clinical examination. Candidates are authorized to bring additional instruments. Arrangements for rental handpieces and/or other equipment may be made through the testing site if such equipment is available. Sonic/ultrasonic instruments are permissible, but they must be furnished by the candidate along with the appropriate connection mechanisms. Air-abrasive polishers are NOT permissible.

The following instruments and equipment are specifically REQUIRED and must be provided by the candidate for the examination: Both Restorative and Periodontal Scaling Examinations:

Unscratched, un-tinted # 4 or #5 front-surface, non-disposable

mouth mirror (double-surface mirrors are allowed)

Any probe with Williams Markings (1, 2, 3, 5, 7, 8, 9, 10, 11, 12 mm)

Patient eye protection (personal eyewear is acceptable)

Patient napkin holder (chain, self-adhesives, clips, etc.)

2 x 2 gauze (4 squares)

Sealed container, just large enough to hold the instruments for transporting instruments (IDEAL Rubbermaid Tagalong 7”W x 4”H x 10”L, oversized containers will not be accepted)

Periodontal Scaling Examination: In addition to the above items, the following is needed: #11/12 explorer

Restorative Examination: In addition to the above items, the following are needed:

Explorer (fine and sharp)

Cotton pliers

Floss

Articulating paper Candidates should be aware that mouth mirrors that are clouded, tinted, or unclean will be rejected. Dull explorers will be rejected as well. Furthermore, a candidate’s performance will not be evaluated without the proper instruments. Candidates are not limited to the items outlined above, but all instruments must be properly sterilized to be used.

Candidates can find exam-specific facility information posted in their candidate profile under the Document tab after registering for the exam or on the CITA website at www.citaexam.com before registration.

http://www.citaexam.com/

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X. EXAMINATION FLOW EXAM-DAY REGISTRATION FOR RESTORATIVE AND PERIODONTAL PROCEDURES

A candidate will begin the day by attending the exam-day registration. An exam packet with an assigned operatory number will be given to each candidate once proper ID and required paperwork have been verified. A question and answer session is held after the registration. The candidates will also meet the Chiefs, Assistant Chiefs, and the Clinical Floor Examiners who will work with the candidates in the clinic. Only candidates attend the exam-day registration. All patients, interpreters, and assistants MUST remain in the assigned waiting room area!

Candidates may not wear scrubs or lab coats that have ANY visible identifying names or practices on them during the exam. These may be covered with tape.

The following are to be completed and brought to the exam day registration (See page 77 for details):

1. Preparation and Orientation Form (All candidates.)

2. Limited Liability Disclosure Form (All candidates.)

3. Radiograph/Follow up Care Forms (All candidates. 1 per procedure.)

4. TWO forms of Identification: To receive all examination materials at registration, candidates must provide their 3-digit sequential number available through their BrightTrac profile under the Apply Tab, along with two forms of personal identification. One ID must contain the candidate’s signature, and one must have a photograph which is similar to the uploaded profile photo.

Forms can be found in the BrightTrac profile under the Documents tab. Acceptable forms of ID include:

• Current driver’s license

• Current passport

• Military ID

• Employee ID

• School ID

• Voter registration card (signed)

• A national credit card or debit card is an acceptable SECONDARY form of ID.

An expired driver’s license, expired passport or a social security card are NOT acceptable forms of ID for this exam.

The candidate’s name on both forms of ID must match the name used for registration. If the name on the identification presented differs from the name (other than middle name or initial) used for registration, official documentation or authorization of a name change must be presented for admittance to the examination. If a candidate is not admitted because he/she fails to provide this documentation, his/her examination fee will be forfeited.

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Once identification has been verified, each candidate will receive his/her packet. Each packet will include a minimum of the following items:

Candidate ID badge

Candidate Identification Labels

Cubicle Card

Survey

Candidate registration will be conducted in a room or area other than the clinic where the patient-based clinical examination will be held. Candidates should, therefore, consult the finalized examination schedule which is emailed after the exam has closed (30-days before the exam). Candidates may work only in the clinic, operatory, or laboratory spaces as authorized. Violation of this standard will result in failure of the examination(s). Candidates MUST be registered during the specified time for the scheduled exam(s) according to the finalized examination schedule or they will NOT be allowed to sit for the examination. There will be no exceptions! If a candidate is only taking one or two patient procedures, the candidate is required to attend the 6:30 am registration. The candidate will follow the exam schedule which matches the number of procedures he/she is registered to complete. See page 21 for exam schedules.

GENERAL ADMINISTRATIVE EXAM FLOW Following the exam-day registration, at 7:00 am candidates will be allowed into the clinic where they will set up, obtain instruments and supplies, seat their patient, obtain blood pressure readings, in their assigned operatory. During the set-up period, Clinic Floor Examiners (CFEs) will be available to answer candidates’ questions. When a candidate is ready to present his/her patient for approval, a CFE should be requested. At the candidate’s operatory, the CFE will begin the patient, paperwork, and medical history approval process. Should the review uncover an error or deficiency in patient presentation, the candidate, if appropriate, may be allowed to correct such deficiency and re-submit the patient for approval. Candidates will not be allowed to proceed with treatment until their patient and documents have been approved. If this is a Periodontal patient presentation, the backup patient (if any) cannot be used. The candidate, when ready, will submit his/her patient to the Evaluation Station with all the required documents:

A completed Progress Form/Evaluation Station Request Form

Radiographs (if not submitted electronically; see the section on radiographs for details)

Medical History Form and medical clearance (if any)

Patient Consent Form Patient Consent Form

Cubible Card Documents should be placed in a folder provided by CITA.

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BLUE and GREEN Stations will be in the clinic. The candidate may NOT bring the patient to either station. The candidate will present the paperwork folder to a CITA staff member at the BLUE Station (paperwork review). This is a review to confirm that the required documents are present and does not substitute for the approval process conducted by a CFE on the clinic floor. If the paperwork is in order, the candidate will be issued a procedure card which will be placed in the front pocket of the folder. The candidate will then move to the GREEN Station (electronic check-in) where a CITA staff member will enter the requested procedure into the electronic system.

• If an operatory is available in the Evaluation Station, an escort will follow the candidate to the operatory and then escort the patient to the Evaluation Station.

• If an operatory is not available, the candidate will return to his/her operatory. An escort will take the patient to the Evaluation Station when an operatory is available.

• Candidates must have patient, paperwork, and instruments ready for the escort. Failure to have the required instruments may result in a penalty. Required instruments are listed in the procedure section of this manual.

Once the patient returns from the Evaluation Station, the candidate will check the paperwork to see that

the form has been stamped with