Medical and Dental Assessment
12%of exam
ASA ClassificationVital SignsAntibiotic ProphylaxisDrug Interactions
Intra/Extra Oral Assessment and Charting
27%of exam
AAP StagingAAP GradingCAL MathFurcationMobility
Radiology and Imaging
15%of exam
Dental Hygiene Care Planning
13%of exam
Patient Care
19%of exam
Gracey CurettesGrasp and FulcrumSPTCE ScoringPatient Selection
Specialties and Applied Pharmacology
14%of exam
Quick Facts
- Exam
- ADEX Dental Hygiene
- Administrator
- ABDE (CDCA-WREB-CITA/ADEX)
- CSCE items
- 100 points, up to 120
- CSCE time
- 1h55m actual
- SPTCE format
- Typodont, not live patient
- Pass score
- 75, Pass/Fail
- Accepted
- ~85% of US jurisdictions
- SPTCE treatment time
- 2 hours
ASA Physical Status
- ASA I
- Healthy patient
- ASA II
- Mild systemic disease
- ASA III
- Severe, not incapacitating
- ASA IV
- Constant threat to life
AHA Antibiotic Prophylaxis
- Prosthetic heart valve
- Premedication required
- Prior infective endocarditis
- Premedication required
- MVP, no regurgitation
- No premedication needed
- Regimen
- Amoxicillin 2g, 1 hour before
CAL Quick Math
Overgrowth subtracts, recession adds, at CEJ equals PD
Margin coronal: PD minus overlapMargin apical: PD plus recessionMargin at CEJ: CAL equals PD
AAP Stage vs Grade
Stage
- Severity and extent
- CAL plus bone loss
- Tooth loss count
Grade
- Rate of progression
- Smoking, HbA1c modifiers
- A slow, C rapid
How bad vs how fast
2017 AAP Staging
- Stage I
- CAL 1-2mm, initial
- Stage II
- CAL 3-4mm, moderate
- Stage III
- 5mm+ CAL, up to 4 lost
- Stage IV
- 5+ teeth lost or dysfunction
AAP Grade Speed
Grade A slow, B moderate, C rapid or high-risk
A: no 5-year progressionB: under 2mm in 5 yearsC: 2mm plus or risk modifier
2017 AAP Grading
- Grade A
- Slow progression
- Grade B
- Moderate progression
- Grade C
- Rapid, high-risk
- Grade C modifier
- Smoking 10+/day or HbA1c 7%+
CAL Calculation Rules
- Margin at CEJ
- CAL equals probing depth
- Recession present
- CAL equals PD plus recession
- Coronal overgrowth
- CAL equals PD minus overlap
- CAL definition
- CEJ to base of pocket
Furcation - Glickman Class
- Class I
- Incipient probe engagement
- Class II
- Partial penetration, no through
- Class III
- Through-through, gingiva covers
- Class IV
- Through-through, visibly open
Mobility - Miller Class
- Class 0
- Physiologic movement only
- Class I
- Horizontal, less than 1mm
- Class II
- Horizontal, 1-2mm, no vertical
- Class III
- Over 2mm or vertical depression
Perio Diagnosis Thresholds
- Perio health
- 3mm or less PD, low BoP
- Gingivitis
- BoP 10%+, no CAL
- BoP meaning
- Inflammation, not diagnosis
- Mucogingival concern
- Keratinized tissue under 1-2mm
Horizontal vs Vertical Bone Loss
Horizontal
- Parallel to CEJ line
- Multiple teeth even
Vertical
- Angular, one-sided defect
- Deeper on one surface
Even loss vs angular defect
Radiographic Errors
- Foreshortening
- Excess vertical angulation
- Elongation
- Insufficient vertical angulation
- Overlap
- Wrong horizontal angulation
- Cone-cut
- PID off receptor center
- Ghost image
- Dense object, opposite side
Foreshortening vs Elongation
Foreshortening
- Excess vertical angle
- Image too short
Elongation
- Too little vertical angle
- Image too long
Too much angle vs too little
Radiographic Landmarks
- Inverted Y
- Nasal fossa meets sinus wall
- Zygomatic process
- Band over molar apices
- Mental foramen
- Radiolucency near premolar apex
- Genial tubercles
- Radiopaque ring at midline
ALARA Dose Reduction
- F-speed or digital
- About 60% dose cut
- Rectangular collimation
- Beam matches receptor size
- Thyroid collar
- Priority for children
- Vertical bitewing
- More apical bone coverage
Radiograph Appearance and Selection
- Subgingival calculus
- Radiopaque spike on root
- Interproximal caries
- Radiolucent notch below contact
- New perio patient
- FMX or panoramic plus bitewings
- High caries-risk recall
- Bitewings every 6-18 months
Prophylaxis vs SRP
Prophylaxis
- Gingivitis only
- No attachment loss
- Supragingival focus
SRP
- Periodontitis present
- CAL and bone loss
- Subgingival root planing
No CAL vs confirmed CAL
Treatment Selection
- Gingivitis, intact periodontium→Prophylaxis
- Stage I-II periodontitis→Scaling and root planing
- Post-SRP check needed→Re-evaluate in 4-6 weeks
- Stable Stage III-IV→Perio maintenance, 3-4 months
- High caries-risk adult→Bitewings every 6-18 months
- Low caries-risk adult→Bitewings every 24-36 months
- Persistent BoP after therapy→Continue maintenance, reassess
- Thin biotype with recession→Refer for soft-tissue graft
Treatment and Recall Rules
- Gingivitis, no CAL
- Prophylaxis
- Periodontitis present
- Scaling and root planing
- Post-SRP re-eval
- 4-6 weeks later
- Stable perio maintenance
- Recall every 3-4 months
Gracey Working-End Map
1-2 anterior, 7-8 facial, 11-12 mesial, 13-14 distal
1-2: anteriors7-8: facial or lingual post11-12: mesial posterior13-14: distal posterior
Universal vs Gracey Curette
Universal
- Two cutting edges
- 90 degree blade
- General use
Gracey
- One cutting edge
- 60-70 degree offset
- Area-specific
General purpose vs site-specific
Instrument Selection
- Heavy subgingival calculus→Ultrasonic scaler
- Anterior surfaces→Gracey 1-2
- Posterior mesial surfaces→Gracey 11-12
- Posterior distal surfaces→Gracey 13-14
- Posterior facial-lingual→Gracey 7-8
- Supragingival calculus only→Sickle scaler
- Unshielded pacemaker present→Avoid magnetostrictive ultrasonic
- Furcation entrance access→Mini or after-five curette
Gracey Curette Working Ends
- Gracey 1-2
- Anterior teeth
- Gracey 7-8
- Posterior facial-lingual
- Gracey 11-12
- Posterior mesial
- Gracey 13-14
- Posterior distal
SPTCE 100-Point Split
16 detection, 66 removal, 6 complete, 12 probe
Detection: 16 pts, 4 teethRemoval: 66 pts, 12 surfacesCompleteness: 6 pts remainingProbing: 12 pts, 2 teeth
CSCE vs SPTCE
CSCE
- Computer-based
- 100 points, ~120 items
- ~2 hours seat time
SPTCE
- Typodont clinical
- Calculus and probing scoring
- 2-hour treatment
Cognitive exam vs psychomotor exam
SPTCE Exam-Day Decisions
- Receiving typodont assignment→4 detection, 12 removal surfaces
- Calculus on one other surface→-3 completeness deduction
- Calculus on two other surfaces→-6 completeness deduction
- Laceration over 3mm→Major critical error
- Treatment time expiring→No extensions given
- Instrument contamination mid-exam→Report to Chief Examiner
- Probing depths needed→2 teeth, 6 readings each
Grasp, Fulcrum, Angulation
- Modified pen grasp
- Standard scaling grasp
- Intraoral fulcrum
- Nearest tooth or arch
- Curette angulation
- 60-80 degrees ideal
- Ultrasonic angulation
- 0-15 degrees, light strokes
SPTCE 100-Point Scoring
- Calculus detection
- 16 points, 4 maxillary teeth
- Calculus removal
- 66 points, 12 key surfaces
- Removal completeness
- 6 points, other surfaces
- Periodontal probing
- 12 points, 2 teeth
- Remaining calculus penalty
- -3 one, -6 two+
SPTCE Fixed Assignment
- Detection teeth
- 4 maxillary, pre-assigned
- Removal quadrant
- One assigned mandibular quadrant
- Removal surfaces
- 12 key subgingival surfaces
- Probing teeth
- 2 assigned teeth
- No case selection
- Assignment is fixed
SPTCE Exam Logistics
- Exam medium
- ABDE-provided typodonts
- Treatment time
- 2 hours, no extensions
- Instruments permitted
- Curettes, sickles, ultrasonic
- Sterilization rule
- Clean and disinfect, not sterile
- Major soft-tissue error
- Laceration over 3mm
Chairside Pharmacology
- Chlorhexidine 0.12%
- Rinse, staining side effect
- Arestin
- Locally delivered minocycline
- Fluoride varnish
- 5% NaF, high-risk children
- OTC dentifrice max
- About 1,100-1,500 ppm F
Infection Control Categories
- Critical instrument
- Heat sterilize always
- Semi-critical instrument
- Mirror, sterilize when possible
- Spore test frequency
- Weekly, per sterilizer
- Waterline standard
- 500 CFU/mL or less
Medical Emergencies
- Vasovagal syncope
- Supine, legs elevated first
- Adult CPR ratio
- 30 compressions to 2 breaths
- Acute asthma wheeze
- Albuterol inhaler first-line
- Percutaneous injury
- Wash first, then report
Common Traps
Prophylaxis is not SRP
Prophy: no attachment loss ≠ SRP: periodontitis present
PD is not always CAL
PD: margin to pocket base ≠ CAL: CEJ to pocket base
Horizontal loss is not vertical
Horizontal: parallel to CEJ line ≠ Vertical: angular one-sided defect
CSCE is not SPTCE
CSCE: computer cognitive exam ≠ SPTCE: typodont psychomotor exam
Universal curette is not Gracey
Universal: two edges, general ≠ Gracey: one edge, area-specific
BoP alone is not periodontitis
BoP: inflammation marker only ≠ Periodontitis needs CAL and bone loss
Foreshortening is not elongation
Foreshortening: too much vertical angle ≠ Elongation: too little vertical angle
Disinfected is not sterile
SPTCE: clean and disinfect only ≠ Critical items: heat sterilize always
Last Minute
- 1.IEO charting is heaviest domain (27%)
- 2.SPTCE now uses typodonts, not patients
- 3.Detection 16 pts, removal 66 pts
- 4.Missing 1 surface costs -3 points
- 5.Passing score 75, pass or fail
- 6.Gracey 11-12 mesial, 13-14 distal
- 7.Stage means severity, grade means risk
- 8.Ultrasonic angle 0-15 degrees, light strokes
- 9.Working curette angulation 60-80 degrees
- 10.SPTCE treatment window is 2 hours
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