ADEX Hygiene Exam Flashcards

Q: Is the ADEX Dental Hygiene Exam written, practical, or both?

Both. It pairs a computer-based Computer Simulated Clinical Examination (CSCE OSCE, ~100 items, about 1h55m testing time within a ~2.5-hour appointment) with a live-patient Simulated Patient Treatment Clinical Examination (SPTCE) for calculus detection, periodontal probing, and quadrant scaling and root planing.

Q: What is the retake waiting period if I fail a component?

Per the ADEX Candidate Guide, a 10-day waiting period is required between the date of failure and re-attempting any clinical part. Three successive failed attempts of the same exam component trigger the ADEX 3-Time Fail Policy, which fails the entire examination series and requires the candidate to restart and re-pay for all computer-based and clinical parts of the series.

Q: What are the SPTCE patient selection requirements?

Candidates must present 6-10 teeth with at least 12 qualifying subgingival calculus surfaces: at least 8 surfaces on posterior teeth, at least 3 on molars, and no more than 4 on anterior teeth. The patient supplies one mandibular quadrant for the assigned scaling procedure.

Q: How is calculus detection and removal scored on the SPTCE?

Calculus detection is evaluated on 16 surfaces (mesial, distal, facial, lingual) of 4 assigned maxillary teeth. Calculus removal is scored on 12 assigned key surfaces in one mandibular quadrant, worth 5.5 points each; missing 1 surface costs -3 points and missing 2+ costs -6 points.

Q: Which curettes are allowed on the SPTCE?

Universal curettes, area-specific Gracey curettes, sickle scalers, and ultrasonic/sonic scalers are all permitted. Candidates must select the appropriate instrument for each surface and area, and correct selection plus proper technique factor into the technical evaluation.

Q: What all counts within the 18-month completion window?

Per the ADEX Candidate Guide, all components or parts of the respective ADEX Dental Hygiene Examination series (CSCE and SPTCE) must achieve passing scores within 18 months of the initial attempt of any component in the series, or the authorization/series must be restarted.

Question 1

Purpose of the medical history review before hygiene treatment

Accepted Answer

Identifies systemic conditions, medications, and allergies that affect treatment planning, drug/anesthetic selection, bleeding risk, and the need for medical consultation or antibiotic prophylaxis before periodontal instrumentation.

Question 2

ASA Physical Status Classification I and II

Accepted Answer

ASA I = healthy patient, no systemic disease. ASA II = mild systemic disease or significant risk factor with no functional limitation (e.g., well-controlled diabetes or hypertension, current smoker, obesity 30<BMI<40).

Question 3

ASA Physical Status Classification III and IV

Accepted Answer

ASA III = severe systemic disease that limits activity (e.g., poorly controlled diabetes/hypertension, COPD, MI/CVA more than 3 months ago). ASA IV = severe systemic disease that is a constant threat to life (e.g., MI/CVA within the last 3 months, unstable angina, severe valve dysfunction); ASA III/IV needs medical consult before elective care.

Question 4

Blood pressure thresholds that affect hygiene treatment decisions

Accepted Answer

Normal adult BP is under 120/80 mmHg. Stage 2 hypertension (≥140/90) warrants caution/monitoring; ≥160/100 means defer elective treatment; ≥180/110 is a medical emergency cutoff requiring referral before any treatment. Normal pulse: 60-100 bpm; normal respiration: 12-20 breaths/min.

Question 5

Why ask about anticoagulant/antiplatelet use before scaling and root planing?

Accepted Answer

Warfarin, DOACs, and antiplatelets (aspirin, clopidogrel) raise bleeding risk during SRP and deep probing. Check INR if on warfarin (therapeutic range is about 2-3) or consult the physician; routine discontinuation is not recommended.

Question 6

Medication-related osteonecrosis of the jaw (MRONJ) risk

Accepted Answer

Long-term, especially IV, bisphosphonate or other antiresorptive/antiangiogenic therapy raises the risk of osteonecrosis after invasive dental procedures. Document duration/route of therapy and minimize unnecessary bone trauma during periodontal treatment.

Question 7

Extraoral lymph node regions palpated during assessment

Accepted Answer

Submandibular, submental, cervical (anterior and posterior chains), preauricular, and postauricular nodes are palpated for size, tenderness, mobility, and consistency to screen for infection or malignancy.

Question 8

Elements of a soft-tissue lesion description

Accepted Answer

Location, size, shape/border, color, surface texture, consistency (soft, firm, fluctuant), whether single or multiple, presence of pain, and duration since the lesion was first noticed.

Question 9

TMJ examination findings to record

Accepted Answer

Clicking or popping, crepitus, deviation on opening, limited range of motion (opening under about 40 mm is restricted), and muscle or joint tenderness on palpation.

Question 10

Normal periodontal probing depth

Accepted Answer

1-3 mm in a healthy sulcus with no bleeding on probing. Probing depths of 4 mm or more suggest attachment loss or active periodontal inflammation.

Question 11

Clinical Attachment Level (CAL) formula

Accepted Answer

CAL equals the probing depth when the gingival margin is at the CEJ. If the margin is apical to the CEJ (recession present), CAL = probing depth + the amount of gingival recession measured from the CEJ to the free gingival margin.

Question 12

Clinical significance of bleeding on probing (BOP)

Accepted Answer

BOP indicates active gingival inflammation and is one of the most reliable clinical indicators of periodontal disease activity; it is tracked over time to assess healing and treatment response.

Question 13

Glickman furcation classification, Grade I-IV

Accepted Answer

Grade I: probe detects the furcation concavity but cannot enter it (early bone loss, no radiographic change). Grade II: probe partially enters the furcation (cul-de-sac) but does not pass through. Grade III: inter-radicular bone is completely lost and the probe passes through, but soft tissue still covers the opening. Grade IV: same bone loss as Grade III but the furcation is clinically visible due to tissue recession.

Question 14

Miller tooth mobility classification, Grade 0-III

Accepted Answer

Grade 0: no detectable mobility beyond normal physiologic movement. Grade I: up to 1 mm horizontal movement. Grade II: more than 1 mm and up to 2 mm horizontal movement. Grade III: more than 2 mm horizontal movement and/or vertical (depressible) mobility.

Question 15

Gingival recession

Accepted Answer

Apical migration of the gingival margin beyond the CEJ, exposing root surface. Measured from the CEJ to the free gingival margin, then added to probing depth to calculate clinical attachment level.

Question 16

Universal Numbering System for adult permanent teeth

Accepted Answer

Teeth are numbered 1-32 starting at the maxillary right third molar (#1), continuing across the maxillary arch to the maxillary left third molar (#16), then down to the mandibular left third molar (#17) and across to the mandibular right third molar (#32).

Question 17

FDI (ISO) two-digit tooth numbering system

Accepted Answer

First digit = quadrant (1-4 for permanent teeth: 1 upper right, 2 upper left, 3 lower left, 4 lower right; 5-8 for primary teeth); second digit = tooth position from the midline (1 = central incisor through 8 = third molar). Example: 11 = permanent maxillary right central incisor.

Question 18

Standard tooth surface abbreviations used in charting

Accepted Answer

M = mesial, D = distal, F/B = facial/buccal, L = lingual, O = occlusal (posterior teeth), I = incisal (anterior teeth).

Question 19

2017 AAP/EFP periodontitis staging (Stage I-IV)

Accepted Answer

Stage I: 1-2 mm interdental CAL, under 15% bone loss, PD ≤4 mm. Stage II: 3-4 mm CAL, 15-33% bone loss, PD ≤5 mm. Stage III: ≥5 mm CAL, bone loss beyond the coronal third, ≤4 teeth lost to periodontitis, PD ≥6 mm, vertical bone loss ≥3 mm and/or Class II-III furcations. Stage IV: Stage III findings plus need for complex rehabilitation and/or fewer than 20 remaining teeth (10 opposing pairs). Extent is further noted as localized (under 30% of teeth affected) or generalized (30% or more).

Question 20

2017 AAP/EFP periodontitis grading (Grade A-C)

Accepted Answer

Grading estimates the rate of disease progression and future risk: Grade A = slow progression, no risk factors. Grade B = moderate progression. Grade C = rapid progression or documented risk factors present (e.g., smoking ≥10 cigarettes/day, uncontrolled diabetes).

Question 21

Full Mouth Series (FMX) - typical composition

Accepted Answer

Typically 18-20 intraoral images (commonly 4 bitewings plus 14 periapicals; the FDA defines the range as 14-22 images), providing crown-to-apex and interproximal coverage of the entire dentition.

Question 22

Purpose of bitewing radiographs

Accepted Answer

Detect interproximal caries and evaluate crestal alveolar bone levels and subgingival calculus; the beam is directed perpendicular to the tooth and film/sensor to minimize horizontal overlap.

Question 23

Horizontal vs. vertical (angular) bone loss on radiographs

Accepted Answer

Horizontal bone loss runs parallel to a line connecting adjacent CEJs (uniform crestal loss). Vertical/angular bone loss creates an oblique defect relative to the CEJ line and is often associated with localized or more aggressive periodontal destruction.

Question 24

ALARA principle

Accepted Answer

"As Low As Reasonably Achievable" - minimize patient radiation exposure using the fastest image receptor, proper collimation, lead/thyroid shielding, and by prescribing radiographs only when clinically justified.

Question 25

Radiographic appearance of calculus

Accepted Answer

Radiopaque projections, spurs, or ledges extending from the proximal root surface into the interproximal space, most easily seen on bitewings; thin supragingival calculus is often not radiographically visible.

Question 26

Radiographic signs of periapical pathology

Accepted Answer

Widened periodontal ligament (PDL) space, loss of the lamina dura, and periapical radiolucency indicate pulpal necrosis or periapical inflammatory disease requiring dental referral.

Question 27

Lead apron and thyroid collar use

Accepted Answer

A lead (or lead-equivalent) apron with thyroid collar is used for every intraoral radiographic exposure to shield the reproductive organs and thyroid gland from scatter radiation.

Question 28

Infection control for digital sensors and PSP plates

Accepted Answer

Use an FDA-cleared barrier sleeve on the sensor or plate for every exposure; sensors cannot be heat-sterilized, so they must be disinfected between patients per the manufacturer's instructions.

Question 29

Prophylaxis vs. scaling and root planing (SRP)

Accepted Answer

Prophylaxis removes plaque, calculus, and stain in a periodontally healthy or gingivitis patient with no attachment loss. SRP removes subgingival calculus and diseased/contaminated cementum and planes the root surface; it is indicated for periodontitis with attachment loss.

Question 30

Periodontal maintenance recall interval

Accepted Answer

Typically every 3-4 months for patients previously treated for periodontitis, compared with about 6 months for periodontally healthy prophylaxis patients, individualized by ongoing risk assessment.

Question 31

Re-evaluation timing after scaling and root planing

Accepted Answer

Typically 4-6 weeks after SRP, allowing tissue healing and reattachment before re-probing to assess response and decide whether further active therapy or periodontal maintenance is indicated.

Question 32

Purpose of treatment-need classification in care planning

Accepted Answer

Groups and prioritizes patients by periodontal status (health, gingivitis, or a specific periodontitis stage/grade) and treatment complexity, which drives care sequencing, recall interval, and documentation for third-party payers.

Question 33

Priority order for hygiene treatment planning

Accepted Answer

Address urgent or emergency needs first, then disease control (SRP plus oral hygiene instruction), then re-evaluation, then supportive periodontal maintenance, with preventive/esthetic needs addressed last.

Question 34

Core elements of patient self-care education

Accepted Answer

Toothbrushing technique (e.g., the modified Bass method), interdental cleaning (floss or interdental brush), fluoride use, and individualized reinforcement based on the patient's plaque control record.

Question 35

Universal curette design

Accepted Answer

The blade forms a 90-degree angle to the lower shank and has two parallel cutting edges, allowing use on mesial, distal, facial, and lingual surfaces of any tooth with a single instrument.

Question 36

Area-specific (Gracey) curette design

Accepted Answer

The blade is offset 60-70 degrees from the lower shank and has only one cutting edge (the lower, longer edge). Each numbered pair is designed for specific teeth and surfaces, improving adaptation to root curvature versus a universal curette.

Question 37

Gracey 1/2 and 3/4 - area assignment

Accepted Answer

Anterior teeth: incisors and canines.

Question 38

Gracey 7/8 and 9/10 - area assignment

Accepted Answer

Posterior teeth, facial and lingual surfaces (7/8 premolars and molars; 9/10 a less commonly used posterior facial/lingual variant).

Question 39

Gracey 11/12 and 13/14 - area assignment

Accepted Answer

Gracey 11/12 = posterior mesial surfaces. Gracey 13/14 = posterior distal surfaces.

Question 40

Ultrasonic scaling - key contraindications

Accepted Answer

Unshielded cardiac pacemakers/ICDs (per manufacturer guidance), patients with communicable respiratory disease or high aerosol risk, difficulty swallowing/aspiration risk, and demineralized or exposed root/implant surfaces needing plastic or specialty tips instead of metal.

Question 41

What limits the number of local anesthetic cartridges given?

Accepted Answer

Maximum recommended dose (MRD) is calculated from patient body weight for the specific agent; for lidocaine 2% with epinephrine the classically taught adult MRD is 4.4 mg/kg (2 mg/lb). In practice, the epinephrine content (about 0.2 mg limit for a healthy adult) is often reached first and becomes the true limiting factor.

Question 42

Fluoride varnish - concentration and typical frequency

Accepted Answer

5% sodium fluoride (22,600 ppm) varnish applied to all tooth surfaces; recommended about every 3-6 months for moderate-to-high caries-risk patients.

Question 43

Dental sealant indication and material

Accepted Answer

A resin-based (or resin-modified glass ionomer) material placed in the pits and fissures of caries-susceptible posterior teeth, typically permanent first and second molars soon after eruption, to block bacterial colonization of the fissure.

Question 44

First response to a syncope episode in the dental chair

Accepted Answer

Position the patient supine with legs elevated (Trendelenburg), ensure an open airway, administer an aromatic ammonia inhalant and oxygen, and monitor vital signs; most vasovagal episodes resolve within 1-2 minutes.

Question 45

AHA antibiotic prophylaxis regimen for at-risk cardiac patients

Accepted Answer

Amoxicillin 2 g orally, 1 hour before the dental/hygiene procedure, for patients with prosthetic heart valves, a prior episode of infective endocarditis, certain congenital heart disease, or a cardiac transplant with valvulopathy, per 2021 AHA guidance.

Question 46

First-line analgesic for mild-to-moderate post-hygiene pain

Accepted Answer

NSAIDs (e.g., ibuprofen) are first-line when not contraindicated; combination NSAID/acetaminophen is used for more significant pain before escalating to an opioid, per current dental pain-management guidance.

Question 47

Primary dentition and mixed dentition timeline

Accepted Answer

20 primary teeth erupt between about 6 months and 2.5-3 years of age. Mixed dentition (primary plus permanent teeth present together) begins around age 6, typically starting with the first permanent molars and mandibular central incisors.

Question 48

Biofilm control considerations for orthodontic patients

Accepted Answer

Brackets and bands create extra plaque-retentive surfaces, raising caries and gingivitis risk; recommend interdental/orthodontic brushes, fluoride rinses, and shorter recall intervals during active treatment.

Question 49

CDC/Spaulding instrument classification for sterilization

Accepted Answer

Critical instruments (penetrate soft tissue or bone, e.g., scalers, curettes, surgical instruments) require heat sterilization. Semi-critical instruments (contact mucosa, e.g., mirrors, impression trays) require heat sterilization or high-level disinfection. Non-critical instruments (contact intact skin) require intermediate or low-level disinfection.

Question 50

Scope of practice and informed consent in dental hygiene ethics

Accepted Answer

Hygienists must practice within their state-defined scope (e.g., supervision level, local anesthesia permit status) and obtain informed consent - disclosing diagnosis, proposed treatment, risks/benefits, and alternatives - before performing procedures.

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