About the ADEX Dental Hygiene Exam
Key Takeaways
- The ADEX Dental Hygiene Examination consists of two distinct parts: the computer-based CSCE OSCE and the clinical, hands-on SPTCE, both of which require a minimum scaled score of 75 to pass.
- The total initial examination fee is $1,150, which includes both components, while retakes are priced at $275 for the CSCE OSCE and $795 for the third SPTCE clinical attempt.
- Candidates must successfully complete both components of the exam within an 18-month window from their first attempt, or their prior passing scores will expire.
- In August 2025, CDCA, WREB, and CITA merged into the American Board of Dental Examiners (ABDE/ADEX), creating a singular, unified national licensing exam standard.
- Eligibility is restricted to current students or graduates of CODA- or CDAC-accredited dental hygiene programs, with all candidates requiring validation by 1 program director or state board.
About the ADEX Dental Hygiene Exam
The Evolution of Dental Hygiene Licensure
For decades, dental hygiene candidates in the United States navigated a fragmented landscape of regional testing agencies, including the Commission on Dental Competency Assessments (CDCA), the Western Regional Examining Board (WREB), and the Council of Interstate Testing Agencies (CITA). In August 2025, this division ended with the historic merger of CDCA-WREB-CITA into the American Board of Dental Examiners (ABDE/ADEX). This unification consolidated testing methodologies, administration, and grading systems under a single, cohesive national framework. Today, the ADEX Dental Hygiene Examination is the premier licensing standard, accepted by nearly all state dental boards in the United States and several international jurisdictions.
This unified examination is designed to assess the clinical competency of candidates seeking licensure as registered dental hygienists. By removing regional discrepancies, the ADEX framework ensures that all candidates are evaluated against identical, objective criteria, thereby enhancing license portability across state lines.
Examination Architecture: CSCE OSCE vs. SPTCE
The ADEX Dental Hygiene Examination is split into two independent components. Candidates must successfully complete both parts to qualify for licensure. These components test distinct dimensions of dental hygiene practice:
1. Computer Simulated Clinical Examination (CSCE OSCE)
The CSCE OSCE is a computer-based, objective structured clinical examination administered at Prometric testing centers. It is designed to evaluate a candidate's clinical judgment, diagnostic abilities, and theoretical knowledge. Candidates are given approximately 2 hours to complete the examination, which features case-based multiple-choice questions.
The CSCE OSCE simulates real clinical scenarios using high-resolution digital assets, including:
- Radiographs: Panoramic, full-mouth series (FMS), and bitewing radiographs.
- Clinical Photographs: Intraoral and extraoral views showing pathology, anatomical variations, or soft tissue conditions.
- Periodontal Charts: Interactive dental grids showing pocket depths, recession, mobility, furcation involvement, and bleeding points.
- Medical Histories: Realistic patient profiles detailing systemic diseases, current medications, and vital signs.
Questions assess clinical knowledge across several key domains: patient evaluation (medical history, vitals, extra/intraoral exams), treatment planning, dental hygiene therapy (scaling, root planing), pharmacology, dental materials, radiography, infection control, and professional ethics.
2. Simulated Patient Treatment Clinical Examination (SPTCE)
The SPTCE is the practical, hands-on clinical component of the exam. Candidates perform clinical tasks on a standardized typodont (manikin) in a clinic setting. This simulated patient model ensures absolute fairness, as every candidate is presented with identical anatomical features and calculus deposits, eliminating the variables and ethical issues associated with live patients.
During the SPTCE, candidates are evaluated on several core clinical skills:
- Calculus Detection: Tactile identification of subgingival calculus using an explorer.
- Calculus Removal: Complete removal of calculus deposits on assigned teeth without damaging surrounding structures.
- Periodontal Probing: Measurement of periodontal pocket depths using a standardized probe.
- Tissue Protection: Preservation of the soft tissues (gingiva, tongue, cheeks) from laceration or trauma during instrumentation.
Financial Architecture and Fee Schedule
Planning for the ADEX exam requires understanding the comprehensive fee structure. The fees are standardized nationally but vary depending on the components being taken and the attempt number:
| Exam Component / Fee Type | Cost | Details |
|---|---|---|
| Full Initial Examination Package | $1,150 | Covers the CSCE OSCE and the initial SPTCE clinical attempt. |
| CSCE OSCE Retake Fee | $275 | Applied when retaking only the computer-based CSCE OSCE component. |
| SPTCE Clinical Retake Fee (3rd Attempt) | $795 | Applied when the clinical component must be retaken on a third or subsequent attempt. The second attempt carries no examination fee (only typodont and facility fees). |
| Mandatory Typodont Fee | $150 | Standardized cost for the ADEX-approved typodont required for the SPTCE. |
Note: In addition to these primary fees, candidates are responsible for clinical facility fees charged by the host dental school, which vary by location. A complimentary retake is offered for the clinical portion only on the second attempt, but candidates must still pay the $150 typodont fee and any local facility fees associated with the retake.
Eligibility Requirements and Candidate Pathways
To register for the ADEX Dental Hygiene Examination, candidates must meet strict eligibility criteria. The primary pathway is through academic programs accredited by the Commission on Dental Accreditation (CODA) in the United States or the Commission on Dental Accreditation of Canada (CDAC):
- Current Students: Candidates currently enrolled in an accredited CODA or CDAC dental hygiene program may take the exam. They must obtain online verification or a letter from their program director confirming that they are in good academic standing and are on track to graduate.
- Graduates: Individuals who have already graduated from an accredited CODA or CDAC program must submit their official transcripts showing degree completion.
- International Graduates: Graduates of non-accredited or foreign dental hygiene programs are not eligible for direct registration. They must first apply to the state dental board of the jurisdiction where they wish to practice. Once the state board reviews their credentials and authorizes them, the candidate may register for the ADEX exam.
Grading Methodology and Passing Thresholds
Both components of the ADEX exam are graded independently using a scaled scoring system:
- The Passing Score: Candidates must achieve a scaled score of 75 or higher on both the CSCE OSCE and the SPTCE.
- Understanding Scaled Scores: A score of 75 does not equate to 75% correct. Scaled scoring is a statistical method used to ensure that scores are comparable across different test administrations and forms. It accounts for slight variations in difficulty between exam versions, maintaining a consistent standard of competency.
- The 18-Month Rule: A candidate has exactly 18 months from their first examination attempt (whether the CSCE OSCE or the SPTCE) to pass both parts. If a candidate fails to pass both components within this 18-month window, any passing score they did achieve expires. They must then re-register, pay the full $1,150 fee, and take both portions of the exam again.
A candidate is preparing to take the ADEX Dental Hygiene Examination. What is the passing score requirement for each individual component of the examination?
In August 2025, which testing agencies completed their merger into the American Board of Dental Examiners (ABDE/ADEX) to create a single, unified examination standard?
A candidate needs to retake only the Simulated Patient Treatment Clinical Examination (SPTCE) component. Which fee structure applies to this standalone clinical retake (excluding typodont and facility fees)?