PracticeVideosBlogFlashcardsEspañol
All Practice Exams

100+ Free NDEB ACJ Practice Questions

Prepare for the NDEB Assessment of Clinical Judgement (ACJ) exam with instant access — no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately
100+ Questions
100% Free

Loading practice questions...

Same family resources

Explore More Canada Dental Licensing Exams

Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.

NDEB Assessment of Fundamental Knowledge (AFK)

Practice QuestionsStudy GuideCheat SheetFlashcards

CDMRE National Denturist Written MCQ Examination (Canada)

Practice Questions

National Dental Specialty Examination (NDSE)

Practice Questions

NDEB Equivalency Process Clinical Competence (NDECC)

Practice Questions

NDEB Virtual OSCE

Practice Questions

NDHCE National Dental Hygiene Certification Examination (Canada)

Practice Questions

Sample NDEB ACJ Practice Questions

Try these sample questions to test your NDEB ACJ exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old patient on warfarin presents for a single non-surgical extraction. Her INR measured this morning is 2.3 (therapeutic range 2.0-3.0). What is the most appropriate management?
A.Proceed with the extraction without interrupting warfarin, using local hemostatic measures
B.Stop warfarin for 5 days and reschedule the extraction
C.Reduce the warfarin dose by half for 3 days before treatment
D.Refer the patient to hospital for the extraction under heparin bridging
Explanation: Current evidence and the ADA/anticoagulation guidelines state that simple dental extractions can be performed safely without interrupting warfarin when the INR is within the therapeutic range (up to 3.5-4.0), using local measures such as sutures, packing, and tranexamic acid. Stopping anticoagulation needlessly exposes the patient to thromboembolic risk.
2During a restorative appointment, a patient suddenly clutches the chest, becomes diaphoretic, and reports crushing substernal pain radiating to the left arm. After stopping treatment and positioning the patient, what is the most appropriate immediate drug to administer if there is no contraindication?
A.Intramuscular epinephrine
B.Sublingual nitroglycerin
C.Oral aspirin 325 mg only
D.Intravenous diazepam
Explanation: Chest pain consistent with angina/acute coronary syndrome is managed with sublingual nitroglycerin (0.4 mg), which produces coronary vasodilation, along with supplemental oxygen and chewed aspirin while activating emergency services. Nitroglycerin is the first pharmacologic step when blood pressure permits.
3A healthy 30-year-old has a swollen face and a 3 mm vertical root fracture confirmed on CBCT of tooth #46. Which antibiotic is the appropriate first-line choice for an odontogenic infection with spreading cellulitis in a non-allergic patient?
A.Azithromycin
B.Clindamycin
C.Amoxicillin
D.Ciprofloxacin
Explanation: Amoxicillin remains the first-line empirical antibiotic for odontogenic infections in non-allergic patients because oral flora are predominantly susceptible streptococci and anaerobes. Source control (drainage/extraction) is always primary, with the antibiotic as an adjunct for spreading infection.
4A patient with a prosthetic heart valve requires a surgical extraction. According to current AHA guidelines, which antibiotic prophylaxis regimen is appropriate for this non-allergic patient?
A.No prophylaxis is indicated for valve prostheses
B.Amoxicillin 500 mg three times daily for 7 days after
C.Clindamycin 600 mg orally 1 hour before and 1 hour after
D.Amoxicillin 2 g orally 30-60 minutes before the procedure
Explanation: AHA guidelines recommend a single dose of amoxicillin 2 g orally 30-60 minutes before invasive dental procedures for patients with prosthetic cardiac valves, who are at high risk for infective endocarditis. A single pre-procedure dose is sufficient.
5A 25-year-old develops urticaria, wheezing, and hypotension minutes after receiving amoxicillin. After positioning supine and calling EMS, what is the definitive first-line drug and route?
A.Diphenhydramine 50 mg intravenously
B.Epinephrine 0.3-0.5 mg intramuscularly into the vastus lateralis
C.Hydrocortisone 100 mg intravenously
D.Albuterol via nebulizer alone
Explanation: Anaphylaxis is treated immediately with intramuscular epinephrine (1:1000, 0.3-0.5 mg adult) in the mid-outer thigh, repeated every 5-15 minutes as needed. Antihistamines and corticosteroids are adjuncts that do not reverse airway compromise or shock.
6A 70 kg adult requires local anesthesia. Using 2% lidocaine with 1:100,000 epinephrine (36 mg lidocaine per cartridge), what is the maximum number of cartridges considering the lidocaine dose limit of 4.4 mg/kg (max 300 mg)?
A.Approximately 4 cartridges
B.Approximately 13 cartridges
C.Approximately 8 cartridges
D.Approximately 20 cartridges
Explanation: The maximum lidocaine dose for a 70 kg adult is 4.4 mg/kg = 308 mg, capped at 300 mg. Each 1.8 mL cartridge of 2% lidocaine contains 36 mg. 300 mg / 36 mg = approximately 8 cartridges, which is the limit.
7A patient with poorly controlled hyperthyroidism (signs of thyrotoxicosis) requires anesthesia. Why should epinephrine-containing local anesthetic be used cautiously or avoided?
A.It increases the risk of allergic reaction to the amide anesthetic
B.It causes hypoglycemia in thyrotoxic patients
C.It reduces the duration of anesthesia in these patients
D.It can precipitate tachyarrhythmias and a thyroid storm
Explanation: In uncontrolled hyperthyroidism, excess thyroid hormone sensitizes the cardiovascular system to catecholamines, so exogenous epinephrine can trigger severe tachycardia, hypertension, arrhythmias, and potentially a thyroid storm. Elective care should be deferred until the patient is euthyroid.
8A type 2 diabetic on insulin becomes confused, shaky, and diaphoretic during a long morning appointment but is still conscious and able to swallow. What is the most appropriate immediate action?
A.Give 15-20 g of oral fast-acting carbohydrate such as juice or glucose gel
B.Administer intramuscular glucagon immediately
C.Give the patient a dose of their insulin
D.Place the patient supine and start chest compressions
Explanation: A conscious hypoglycemic patient who can swallow should receive 15-20 g of oral fast-acting carbohydrate (the rule of 15), then recheck. Glucagon is reserved for unconscious patients who cannot take oral glucose safely.
9A patient taking high-dose oral bisphosphonates for osteoporosis needs an extraction. What is the most relevant clinical concern when planning this procedure?
A.Delayed onset of local anesthesia
B.Increased risk of post-operative hemorrhage
C.Risk of medication-related osteonecrosis of the jaw (MRONJ)
D.Increased risk of malignant hyperthermia
Explanation: Antiresorptive agents such as bisphosphonates inhibit osteoclasts and impair bone remodeling, creating a risk of MRONJ following invasive dental procedures. Risk is higher with IV agents and long duration; conservative management and informed consent are essential.
10A pregnant patient in her second trimester requires a non-elective extraction. Which analgesic is generally considered the safest first choice for post-operative pain?
A.Codeine
B.Ibuprofen
C.Aspirin
D.Acetaminophen
Explanation: Acetaminophen is the analgesic of choice during pregnancy at recommended doses. NSAIDs are avoided particularly in the third trimester (risk of premature ductus arteriosus closure and oligohydramnios), and aspirin and opioids carry additional risks.

About the NDEB ACJ Exam

The NDEB Assessment of Clinical Judgement (ACJ) is the case-based written component of the NDEB Equivalency Process for internationally trained dentists, taken after passing the Assessment of Fundamental Knowledge (AFK). It tests the ability to formulate diagnoses, plan treatment, manage patients and interpret radiographs across all dental disciplines.

Assessment

Computer-based exam with case-based diagnosis, treatment planning and clinical decision-making questions plus radiographic interpretation questions, using case histories, charts, radiographs and photographs.

Time Limit

5.5 hours including one scheduled 30-minute break

Passing Score

A test-equated, re-scaled score of 75 or greater is reported as a Pass

Exam Fee

CAD $1,350 (2026) (National Dental Examining Board of Canada (NDEB))

NDEB ACJ Exam Content Outline

28%

Oral Medicine/Oral Pathology and Oral Surgery

Diagnosis of mucosal lesions, cysts and tumours, salivary disease, orofacial pain, spreading infections, surgical management and radiographic interpretation of pathology.

22%

Pharmacotherapeutics, Medically-Complex Patients and Medical Emergencies

Drug selection and interactions, medically compromised patients, anticoagulation and prophylaxis, local anesthesia and in-office medical emergencies.

15%

Periodontics

Periodontal diagnosis and classification, attachment loss and charting, furcation and intrabony defects, surgical/regenerative therapy and peri-implant disease.

15%

Cariology and Restorative Dentistry

Caries management, material selection, fixed and removable prosthodontics, implants and comprehensive treatment sequencing.

10%

Endodontics

Pulpal and periapical diagnosis, vital pulp therapy, canal anatomy, endodontic emergencies, resorption and endo-perio lesions.

10%

Orthodontics and Pediatric Dentistry

Mixed-dentition management, space maintenance, interceptive orthodontics, growth modification and pediatric trauma.

How to Pass the NDEB ACJ Exam

What You Need to Know

  • Passing score: A test-equated, re-scaled score of 75 or greater is reported as a Pass
  • Assessment: Computer-based exam with case-based diagnosis, treatment planning and clinical decision-making questions plus radiographic interpretation questions, using case histories, charts, radiographs and photographs.
  • Time limit: 5.5 hours including one scheduled 30-minute break
  • Exam fee: CAD $1,350 (2026)

Keys to Passing

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

NDEB ACJ Study Tips from Top Performers

1Practice with full case vignettes (history + chart + radiograph) rather than isolated facts, since every ACJ item is scenario-based and tests applied clinical judgement.
2Drill radiographic interpretation systematically (cysts, tumours, periapical and fibro-osseous lesions, technique errors) because radiographic diagnosis is its own question category.
3Build decision rules for medically-complex patients and emergencies (anticoagulation, prophylaxis, anaphylaxis, syncope) so you can choose the safest next step under time pressure.

Frequently Asked Questions

How many questions are on the NDEB ACJ and how long is it?

The ACJ contains approximately 120-150 single-answer and multi-answer multiple-choice questions and is a 5.5-hour computer-based exam that includes one scheduled 30-minute break.

What is the passing standard for the ACJ?

NDEB reports a test-equated, re-scaled score of 75 or greater as a Pass. Candidates are allowed a maximum of three attempts at the ACJ.

What does the ACJ test?

The ACJ uses case-based scenarios with histories, charts, radiographs and photographs to assess diagnosis, treatment planning, clinical decision-making and radiographic interpretation across all dental disciplines.

Do I need to pass another exam before the ACJ?

Yes. Candidates must first pass the Assessment of Fundamental Knowledge (AFK) before registering for the ACJ in the NDEB Equivalency Process. The ACJ is delivered at Prometric test centres.