administered by SRTA - Southern Regional Testing Agency

Transcription

Administered by:
North East Regional Board of Dental Examiners, Inc.
1304 Concourse Drive, Suite 100
Linthicum, MD 21090
www.nerb.org
AND
Southern Regional Testing Agency, Inc.
4698 Honeygrove Road, Suite 2 Virginia Beach, VA 23455
www.srta.org
ATTENTION DENTAL HYGIENE CANDIDATES
The ADEX Dental Hygiene Examination is administered on behalf of a number of state
dental boards and in accordance with state licensing requirements. This examination should
be valid in any state accepting the ADEX Dental Hygiene Examination. However, to be
certain, candidates should check with the state dental board of any state in which
they wish to be licensed to determine whether this examination will qualify them for
licensure in that state.
Currently two testing agencies administer the ADEX Dental Hygiene Examination. This
manual is published jointly by the North East Regional Board, Inc. (NERB) and the
Southern Regional Testing Agency, Inc. (SRTA). Criteria, content, basic administration,
and scoring systems are uniform. There are administrative elements that are unique to
each agency. Therefore, candidates must obtain and thoroughly read the manual published
by the agency that will be administering the examination at the date and site the candidate
selects.
For information about examination sites, dates, and fees, visit the NERB website:
www.nerb.org or the SRTA website: www.srta.org.
Occasionally examinations are interrupted or postponed because of severe weather, power
outages, or similar occurrences. T h e NERB and SRTA reserve the right in their sole
discretion, to delay, halt, postpone, or cancel an examination because of unforeseen and
serious events.
Please read this manual in detail prior to attending the clinical examination, and
have it with you during the orientation and examination.
Please retain this Manual for future reference.
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CONTENTS
INTRODUCTION...................................................................................................... 4
About the American Board of Dental Examiners, Inc. (ADEX) ........................................... 4
ADEX Mission Statement ............................................................................................. 4
Purpose of the Examination ......................................................................................... 4
About the ADEX Dental Hygiene Examination – 2015 ...................................................... 4
ADEX Status .............................................................................................................. 5
The Candidate Manual ................................................................................................ 5
The ADEX Examination Development ............................................................................ 5
Three Time Examination Policy..................................................................................... 6
CLINICAL EXAMINATION........................................................................................ 7
Judgment Skills.......................................................................................................... 7
Patient selection and eligibility ................................................................................. 7
Case selection........................................................................................................ 8
Calculus requirements............................................................................................. 9
Radiographs ........................................................................................................ 11
Clinical Skills ........................................................................................................... 13
Instruments ........................................................................................................ 13
Detection of calculus ........................................................................................... 14
Removal of calculus .............................................................................................. 16
Periodontal assessment......................................................................................... 16
Tissue management ............................................................................................. 17
Minor tissue trauma...................................................................................................................................... 17
Major tissue trauma ...................................................................................................................................... 17
Final case presentation ......................................................................................... 18
Infection Control ...................................................................................................... 18
Table of Evaluation Criteria........................................................................................ 19
POINT SYSTEM ..................................................................................................... 20
COMPUTER SIMULATED CLINICAL EXAMINATION (CSCE) ..................................... 22
Content................................................................................................................... 22
Standards for the CSCE ............................................................................................ 22
Disciplines and Subject Matter Addressed in the CS CE ............................................... 23
SUPPLEMENTAL TESTING AGENCY INFORMATION ............................................... 24
GLOSSARY ............................................................................................................ 25
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INTRODUCTION
About the American Board of
Dental Examiners, Inc. (ADEX)
Purpose of the Examination
The American Board of Dental Examiners,
Inc. (ADEX) is a private not-for-profit
consortium of state and regional dental
boards throughout the United States and
its territories. The ADEX provides for the
ongoing development of a series of
common national dental and dental
hygiene licensing examinations. These
exams are uniformly administered by
individual state or regional testing
agencies on behalf of participating and
licensing jurisdictions. The North East
Regional Board of Dental Examiners
(NERB) and the Southern Regional Testing
Agency (SRTA) are members of the ADEX
and have adopted the ADEX Dental and
Dental Hygiene Examinations.
The purpose of the ADEX Dental Hygiene
Examination is to provide state dental
boards with a uniform, accurate, third
party assessment of the judgment and
clinical skills of candidates applying for
dental hygiene licensure. This examination
will identify areas of deficiency or
weakness within skill sets allowing
candidates the opportunity for
remediation.
About the ADEX Dental Hygiene
Examination – 2015
The ADEX Dental Hygiene Examination is
the examination approved by the
American Board of Dental Examiners, Inc.
(ADEX) and administered by the North
East Regional Board of Dental Examiners,
Inc. (NERB) and the Southern Regional
Testing Agency, Inc. (SRTA). The ADEX
Dental Hygiene Examination consists of
two components – the Computer
Simulated Clinical Examination (CSCE)
and the Patient Treatment Clinical
Examination (PTCE) performed on
patients. The examination is used to assist
licensing jurisdictions in making decisions
concerning the licensure of dental
hygienists. The examination for 2015
consists of judgment skills and clinical
skills and evaluated as follows.
ADEX Mission Statement
The ADEX mission is to provide the dental
community with test construction and
administrative standardization for national
uniform dental and dental hygiene clinical
licensure examinations. The schedule of
these examinations, when delivered in the
Curriculum Integrated Format (CIF),
allows for early identification of
deficiencies or weaknesses within clinical
skill sets and provides opportunities for
remediation in an educational
environment. These examinations will
demonstrate integrity and fairness in
order to assist state boards of dentistry
with 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.
Computer Simulated Clinical
Examination (CSCE)
 Clinically based questions presented
on a computer
 100 graded questions
 Passing score of 75 or greater
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Patient Treatment Clinical
Examination (PTCE)
 Performed on a patient
 Judgment skills
 Clinical skills
 Passing score of 75 or greater
The ADEX sets forth criteria and scoring
standards that must be followed by all
testing agencies administering the ADEX
Dental Hygiene Examination.
Administrative information includes
candidate eligibility; fees; forms;
schedules; examination sites; dates for
the examinations; and policies. These
procedures are provided by the testing
agency the candidate chooses to use, such
as the NERB or SRTA.
Individual jurisdictions may require a state
jurisprudence or other additional
examinations. It is the candidate’s
responsibility to contact the licensing
jurisdiction of interest to determine
current eligibility and additional
requirements.
The examination is based on specific
performance criteria used to measure
clinical competence. In this Manual ADEX
provides the candidate with the criteria,
content and scoring for the ADEX Dental
Hygiene Examination. We believe this
Manual answers most of the commonly
asked questions regarding the
examination process. Bring/have this
Manual with you to the clinical
examination and keep it available in the
cubicle for easy reference. A thorough
understanding of this Manual is crucial to
success on the exam.
The ADEX Examination
Development
Candidates taking this examination do so
voluntarily and agree to accept the
provisions and to follow the rules
established by the ADEX, NERB, and SRTA
for the examination as detailed in this
Manual.
The ADEX Dental Hygiene Examination is
developed and revised by the ADEX Dental
Hygiene Examination Committee (DHEC).
This committee is comprised of
representatives from every ADEX member
district. 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” to ensure that the content and
protocols of the examination are current and
relevant to practice. Examination criteria
and content are also determined by such
considerations as:
ADEX Status
To achieve ADEX Status, candidates must
successfully complete both the CSCE and
the PTCE of the ADEX Dental Hygiene
Examination with a score of 75 or greater
in each of the examinations.
The Candidate Manual
The Candidate Manual supports and
assists the candidates in their preparation
to participate and perform successfully in
the two examinations. The Manual is
designed to present the required
administrative information, as well as
setting forth the criteria and necessary
requirements.
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Patient availability
Psychometric validity
Potential to ensure that a skill can be
evaluated reliably.
Previously passed clinical examinations
will not be recognized for successful
completion of the entire clinical
examination series in dental hygiene and
attainment of "ADEX Status". A new
application must be filed together with
appropriate documentation and applicable
fees. (See Supplemental Section of the
Manual.)
The examination criteria, content and
evaluation methodologies are reviewed
annually.
Three Time Examination Policy
Candidates failing either the CSCE or the
PTCE on three successive attempts must
begin the entire examination process
again and retake both clinical
examinations of the ADEX Dental Hygiene
Examination administered by the NERB
and SRTA.
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CLINICAL EXAMINATION
Examiners for the ADEX examination
evaluate candidates on their clinical and
judgment skills. Judgment skills include
presenting an eligible patient, an
acceptable case, a selection of teeth that
meets all calculus requirements, and
diagnostic-quality radiographs. Clinical
skills include detection and removal of
calculus, accurate periodontal pocket
depth measurements, tissue
management, and final Case presentation.
This section describes in detail the
evaluation criteria for both of the
categories.
100-point scale. Candidates must earn 75
or greater to pass.
Judgment Skills
Patient selection and eligibility
For the PTCE, the candidate must
present his/her own patient. Selecting an
eligible patient is essential to successfully
completing this examination. Candidates
who present ineligible patients will fail the
examination.
Patient selection and management is an
important part of the examination and
should be completed independently,
without the help or assistance of faculty
or colleagues. Candidates must carefully
assess any physical or medical conditions
that may be impacted by the examination
process. Patients should be informed of
the time commitment and the process of
the examination.
The ADEX uses a triple-blind scoring
system, which requires three examiners to
perform independent evaluations of the
candidate’s performance in meeting
specific criteria for the Case presentation,
calculus detection, calculus removal,
periodontal pocket depth measurements,
tissue management, and final Case
presentation. Points are awarded on a
An eligible patient must:
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An ineligible patient:
Be at least 18 years of age.
Have a physician’s written
clearance, if needed.
Be presented with required
radiographs of diagnostic-quality.
Have an acceptable health history
including a blood pressure within
the guidelines of this examination.
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Dentist
Dental Hygienist
Dental student
Dental Hygiene student
Currently taking or history of
injectable or oral bisphosphonate
therapy
Latex allergy
1st or 3rd trimester of pregnancy
Oral herpetic lesions - This
condition may be left to the
discretion of the floor coordinator
QUICK TIP
Case selection
The presentation of a full quadrant and
additional teeth for the ADEX
Examination is known as the “Case.”
Candidates indicate their selection of
teeth for the clinical examination on
the appropriate examination forms.
The Case selection must include:
A full quadrant with at least six natural,
permanent teeth and two posterior teeth

from a second quadrant
At least two molars

o
One must be located in the selected
quadrant
The candidates’ treatment phase is
performed on a pre-determined selection
of the patient’s teeth. The candidates
select their Case in accordance with the
criteria requirements presented below.
Examiners evaluate the Case during
check-in to determine that it meets all
requirements. During clinical treatment
time, candidates remove all calculus on
all surfaces within the Case selection.
During final evaluation, examiners
evaluate the selection to ensure that the
candidate properly removed all calculus
while protecting the surrounding tissue.
The Case selection consists of one full
quadrant plus two posterior teeth from a
second quadrant.
o
One of the teeth in the second
quadrant must be a molar
One of the molars must have both a

mesial and a distal contact. Another
molar must have at least one contact.
o
To be considered a contact, the
adjacent surface must be no more
than 2 mm from the molars.
Must be free of excessive soft debris

OPTIONAL: If the c a s e s e l e c t i o n
does not fulfill these requirements, the
candidate may choose up to two
additional posterior teeth, which must
be located in the second quadrant
with the other required posterior
teeth.
There must be two molars in the
selection. One of the six teeth in the
quadrant and one of the two teeth in the
second quadrant must be molars. The
required two molars must have three
mesial and/or distal contacts with an
adjacent tooth within 2mm or less.
Third molars: If the selected quadrant
has a third molar, the candidate must
choose whether to include the third molar
in the selection. All other teeth in the
quadrant and/or the additional teeth
must be debrided and will be evaluated
for remaining calculus, plaque, and stain.
QUICK TIP
A Case selection including the following is strongly discouraged:

Class III furcation or mobility
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Retained primary teeth
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Advanced periodontal disease
Orthodontic brackets or bonded retainer
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Gross caries
Faulty restorations

Implants included in the treatment selection
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Extensive full or partial veneers

Partially erupted third molars

Multiple localized probing depths in
excess of 6mm
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toward any calculus requirements nor
will they count as molars for purposes of
meeting the molar requirements.
However, t hey can constitute a contact
with a molar to help meet the initial Case
presentation criteria.
The Case must include twelve (12)
surfaces of qualifying subgingival calculus
distributed as follows:
 At least eight of the 12 must be on
surfaces of premolars and molars
 At least five of the eight must be on
mesial or distal surfaces of the
posterior teeth within 2mm or less of
an adjacent tooth
 At least three of the five mesial or
distal surfaces must be on molars
within 2mm of an adjacent tooth. Only
one distal surface of a second or third
terminal molar may be used or one
mesial or distal surface on a molar
that does not have an adjacent tooth
 The remaining four of these 12
surfaces with qualifying calculus are at
the choice of the candidate and must
be subgingival.
Primary teeth and restored
implants may count as a proximal
contact with a molar. No other
criteria can be met by a primary
tooth or a restored implant.
Calculus requirements
In the Case selection the candidates must
list 12 surfaces where they believe
qualifying calculus is located. Examiners
add two more posterior surfaces from
within the selection. All surfaces in the
selection must be debrided and will be
evaluated.
The Case selection must meet the
following calculus requirements:
 All selected teeth must have subgingival calculus.
 Qualifying subgingival deposits must
be apical to the gingival margin.
 Qualifying surfaces may occur with or
without associated supragingival
deposits.
 Detect mesial and distal deposits by
exploring from facial and/or lingual
surfaces.
Primary teeth and restored implants
located in the selection will not count
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QUICK TIP
CHARACTERISTICS OF QUALIFYING CALCULUS
•
Explorer-detectable moderate to heavy subgingival calculus
•
Distinct and easily detected with an 11/12 explorer as it passes over the
calculus
•
Must be apical to the gingival margin
•
May occur with or without supragingival deposits
•
A definite jump or bump detected by the explorer with one or two strokes
•
Binds the explorer or causes a definite catch
•
Ledges or ring formation
•
Spiny or nodular formations
•
Significantly enough in quantity to be readily discernible or detectable
•
Mesial and distal deposits detectable from lingual and/or facial
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Radiographs
In addition to selecting an eligible patient,
candidates must present radiographs.
Examiners review and score the
radiographs as a separate criterion based
on whether they are an accurate
depiction of the patient’s dentition and the
images of the candidate’s selected teeth
(both quadrant and all additional teeth)
are of diagnostic quality. Also required is
a written description of any restorative
and/or surgical treatment, which the
patient has undergone since the
radiographs were taken. If t w o
examiners independently confirm the
radiographs presented are of such
poor quality that t h e y cannot
identify pathosis or determine if
they belong to the patient, the
patient will be declared ineligible, and
the candidate will fail the
examination.
and panoramic) must depict the
current condition of the dentition
with a written narrative explaining
any recent dental procedures.
 Present 16-20 images, including two
or four bitewings, depending on the
number needed to show the mesial
and distal surfaces, DEJ, and
alveolar crestal bone of all posterior
teeth or;
 Panoramic radiographs with bitewings
are acceptable in place of the fullmouth series.
 Periapical and panoramic images
must be current within three (3)
years.
 Bitewings must be current within one
(1) year. They may be vertical or
horizontal.
 The radiographs may or may not be
exposed by the candidate.
 Duplicates, conventional, or digital
radiographs are acceptable.
 Evidence of calculus on radiographs is
not necessary for Case presentation.
 Convexity of dimple on conventional
radiographs must face the front of the
mount.
 Teeth must appear in Universal
Notation System (1-32).
 Candidate number, date films are
exposed and patient’s name must be
on the mount or digital printout.
 Do not use a mount on which the
candidate’s name or the name of the
school is visible.
 If the candidate mounts the
radiographs incorrectly or there is
incomplete information on the
mount, the candidate will be notified
and must correct the error.
Candidates will not be permitted to take
radiographs at the exam sites unless an
emergency arises.*
*National Council on Radiation
Protection and Measurement
(NCRP) Report #145
“Administrative use of radiation to
provide information not related to
the health of the patient shall not
be permitted. Students shall not
be permitted to perform
radiographic exposure of patients,
other students or volunteers solely
for purposes of their education or
Licensure”.
Candidates must present a full-mouth
series of diagnostic-quality radiographs
and bite wings or panoramic and bite
wing radiographs of the patient. All
radiographs (periapicals, bitewings,
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All radiographs must be of diagnostic
quality, i.e. they must be of sufficient
quality for a dentist to accurately
diagnose caries, periodontal health, or
other dental diseases and abnormalities.
Exemptions: The following conditions
are exempt from the diagnostic
standards:

Un-erupted, partially erupted,
and super erupted third molars
(Examiners consider a third molar
erupted if the entire occlusal plane of
the third molar is in alignment with
the occlusal plane of the rest of the
teeth.)

A third molar with tissue covering
any part of the occlusal surface of
the tooth, even though the tooth is
in the occlusal plane
Although a full mouth series plus
bitewings or panoramic radiographs with
bitewings must be presented and
evaluated, only the images of the
selected quadrant and additional
teeth selected by the candidate will
be scored.
QUICK TIP
RADIOGRAPHS
•
Full mouth periapical, including two or four bitewings, or a panoramic radiograph
with two or four bitewings
•
Periapical and panoramic images must be current within three (3) years
•
Bitewings must be current within one (1) year
•
Duplicates, conventional, or digital radiographs are acceptable.
•
Candidate number, date films are exposed, and patient’s name must be on the
mount or digital printout
•
Teeth must appear in Universal Notation System (1-32).
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Clinical Skills
The clinical skills section of the ADEX
Dental Hygiene Examination evaluates the
candidate’s ability to:
 Detect calculus,
 Remove calculus without damaging
the surrounding tissue,
 Measure periodontal pocket depths
accurately,
 Present the patient for final clinical
skills evaluation free of calculus,
plaque, and extrinsic stains in the case
selection.
candidates at all testing sites. Examiners
are standardized using the 11/12 explorer
and the recommended probe. It is in the
candidate’s best interest to use these
instruments during the examination.
Presenting instruments other than those
recommended will cause a delay in the
check-in process.
There are two recommended
instruments for evaluation on the ADEX
Examination.
The ADEX D e n t a l H y g i e n e
E xamination allows candidates 1½
hours to complete the calculus
detection, periodontal pocket
measurements, and calculus removal
exercises.
1. Explorer: Only an 11/12
explorer (e.g. the ODU 11/12) can
be used by candidates and
examiners for calculus detection.
2. Probe: Only a probe, marked with
1mm increments (e.g. the UNC
probe) can be used for the probing
exercise.
Instruments
Candidates may use instruments of their
choice for patient treatment. For
evaluation, it is extremely important that
all candidates and examiners use the
same evaluation instruments so that the
examination is standardized for all
Additional requirements for instruments
and materials may be found in the testing
agency’s Supplement Section to this
Manual.
Figure 1: 11/12 explorer
Figure 2: probe
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Detection of calculus
The presence or absence of explorer
detectable supragingival and/or subgingival calculus on the surfaces of three
selected teeth must be accurately
recorded.
least two of the three examiners’ answers
for that surface.
Each tooth has only four surfaces where
calculus may be counted: mesial (M),
distal (D), facial (F), and lingual (L).
During check-in, examiners assign three
teeth for the candidate to evaluate for the
presence or absence of calculus. Three
examiners evaluate the mesial, distal,
facial, and lingual surfaces of those three
teeth and document their findings.
Note: Complete the calculus detection
exercise prior to removing any
calculus. If calculus is removed prior
to completing the detection exercise,
the candidate will be unable to make
an accurate evaluation of the
presence or absence of calculus.
Examiners assess calculus detection
during check-in.
Examiners use the 11/12 explorer and
compressed air for calculus detection. At
the start of clinical treatment time and
prior to removal of any calculus,
candidates evaluate the four surfaces of
the three assigned teeth. If any supra or
subgingival calculus—whether light,
moderate, or heavy—is present on a
surface, the candidate indicates “Yes” on
the appropriate form. If the candidate
finds no calculus on a surface, he/she
enters “No” on the form. Each tooth has
four surfaces where calculus may be
counted: mesial (M), distal (D), facial (F),
and lingual (L).
Errors are assessed when the candidate
Facial
Yes  No
Distal
Yes  No 
Mesial
Yes No
Lingual
Yes  No 
For the purposes of the detection exercise,
any calculus present on the surface
should be marked “Yes,” even if it does
not meet the definition of “qualifying
calculus” as outlined in the Case
presentation criteria.
Points are earned if the candidate’s “Yes”
or “No” answer matches the answer of at
does not indicate any answer or if both
“Yes” and “No” are indicated.
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Candidates should ensure that the tooth
demonstrates calculus when the following
detection methods are used:
 Insert the 11/12 explorer into the
sulcus/pocket in contact with the
crown, and then slide apically along
the root using the side of the tip of
the explorer to detect calculus.
 Interference with the apical sliding
motion along the tooth surface
indicates dental calculus. Note that a
“bump” is calculus, a concavity is
dental caries, and the change of
direction is the CEJ.
 Detect calculus when interference
occurs during the sliding motion of
the explorer or by deflection of the
tissue away from the tooth.
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15
When calculus stops the explorer
during the apical movement along the
tooth surface, move the explorer out
and away from the tooth surface and
continue the sliding movement
apically, moving back under the
calculus piece to regain contact with
the root surface.
Continue the apical sliding motion
until the soft base of the
sulcus/pocket is reached.
Use compressed air to deflect the
tissue and visually observe calculus
deposits whenever possible.
Calculus found on the line angle will
be counted as being present on the
mesial or distal surface.
quadrant, including the additional teeth,
the candidate will have only 10
opportunities to earn points for calculus
removal. When selecting t h e
s u r f a c e s , quadrant and/or the
additional teeth, the exclusions listed
previously must be considered.
Excessively decayed or primary teeth in
the quadrant will not count as part of
the six teeth required and points may
be deducted.
Removal of calculus
The treatment phase of the examination is
the removal of calculus. Calculus removal
must include the entire Case selection.
All surfaces in the Case selection will
be evaluated for remaining calculus,
both supragingival and subgingival.
Candidates will treat all teeth in the Case
selection indicated on the appropriate
form, including the entire selected
quadrant and all additional teeth selected.
Debride all surfaces on all teeth in the
selection. Any surface in the selection will
be scored for remaining calculus.
Remaining subgingival calculus and
supragingival calculus are scored equally.
Periodontal assessment
Pocket depths must be accurately
assessed and recorded on the two
examiner-assigned teeth – one posterior
and one anterior. During check-in,
examiners assign one anterior and one
posterior tooth for measurement of
periodontal pocket depths. Three
examiners measure and record
periodontal pocket depths on the two
assigned teeth using a probe marked
with 1mm increments and document their
findings.
The selection of teeth made by the
candidate must have at least 12 surfaces
of qualifying calculus. These are listed
on the appropriate form and into the
testing agency website prior to the
exam, if instructed by the testing
agency. The surfaces will be verified with
the candidate during cubicle set-up time
and any necessary changes may be made
at that time.
At the start of clinical treatment time
and prior to removal of calculus,
measure the periodontal pocket depths
and record measurements o n the
appropriate form. Each tooth has three
surfaces where measurements are
evaluated: mesio-lingual (ML), distolingual (DL), and lingual (L). During final
evaluation, the candidate’s
measurements are evaluated and scored.
The measurements made by the
candidate must be no more than ± 1 mm
from the median of the measurements
made by the three examiners.
Record each measurement in the
appropriately labeled space on the form.
For example, the periodontal pocket
depths for the mesio-lingual surface of
the assigned tooth must be recorded in
the space labeled “ML,” the lingual
reading must be recorded in the space
labeled “L,” etc.
Examiners may or may not validate
qualifying calculus on the surfaces listed
by the candidate. If examiners are
unable to validate 12 surfaces of
qualifying calculus in the selection,
the candidate will not be able to
earn points for removing calculus on
12 surfaces. Candidates earn points for
removal of calculus only on surfaces
validated by two examiners to have
qualifying calculus present. If 12 surfaces
of qualifying calculus are not present,
candidates will have fewer opportunities
to earn points for calculus removal.
For example, if two of the three examiners
are able to locate only 10 surfaces of
qualifying calculus in the selected
16
Errors are assessed for any space
left blank.
Complete the periodontal assessment
prior to the beginning of treatment.
Record periodontal pocket depth
readings before removing calculus in
order to ensure measurements are within
± 1 mm of the examiners’
measurements.
Do not use any copies or reference
materials for this section. Candidates
found using previously recorded and/or
copied periodontal charts or other copies
of the patient’s periodontal pocket depth
measurements will be dismissed for
unprofessional conduct and will
automatically fail.
Minor tissue trauma
Definition: Any injury that is inconsistent
with the procedure and is expected to
heal without professional treatment by a
dentist or physician.
Examples of minor tissue trauma:
small lacerations; cavitron burns;
abrasions on papillae, gingiva, tongue,
lip.
If four or more areas of minor tissue
trauma are validated, a major tissue
trauma error is assessed, resulting
in automatic failure of the clinical
examination module.
Major tissue trauma
Definition: Any injury that is inconsistent
with the procedure and that will not heal
on its own without professional treatment
by a dentist or physician.
Examples of major tissue trauma:
amputated papilla, significant cavitron
burns, severely lacerated soft tissue,
exposure of the alveolar process, broken
instrument tip evident in the sulcus or soft
tissue, root surface abrasions that require
additional definitive treatment.
The unwarranted presence of major tissue
trauma will result in automatic failure of
the examination.
Tissue management
Examiners evaluate subgingival calculus
removal, supragingival calculus, plaque
and stain removal from all surfaces, as
well as tissue management in the Case
selection.
The candidate must effectively utilize
hand instruments, prophy cups and/or
brushes, ultrasonic/sonic cleaning
devices, and dental floss without causing
unwarranted soft tissue trauma
(abrasions, lacerations, or burns) during
this examination.
17
order to receive full points for final
Case presentation. Remaining calculus
assessed in the calculus removal section
of the examination will not be assessed
as another error for final Case
presentation.
Points are awarded to candidates whose
patients exhibit no minor tissue trauma
around any of the teeth treated during
the oral prophylaxis or on any other soft
tissue structures. At least two of three
examiners must independently identify
tissue trauma on the gingiva or soft
tissue structure for points to be withheld.
Pre-existing tissue injuries and/or
conditions should be noted by the
candidate under “Candidate
Comments to Examiners” on the
appropriate form.
Only remaining calculus that is not a
part of the 12 surfaces evaluated for
calculus removal is counted as an
error under final Case presentation.
At least two out of three examiners must
independently assess an error for points
to be withheld.
All forms are collected when the
candidates are dismissed from the clinic
for final evaluation.
Final case presentation
Candidates earn points by presenting the
patient free of:
 Remaining plaque.
 Remaining calculus on surfaces within
the selected quadrant and/or
additional teeth that are not a part of
the ones assigned to evaluate removal
skills.
 Remaining extrinsic stains.
 Other remaining residue or debris.
.
Infection Control
Candidates must follow the infection
control procedures recommended by the
Centers for Disease Control and
Prevention. See the testing agency
Supplemental Section of this Manual for
more detailed information.
Additionally, candidates must
complete the anesthesia record in
18
Table of Evaluation Criteria
At least two out of three examiners must independently assess an error for points to be
withheld. The two tables below explain the criteria for scoring.
Judgment
Skills Section
Evaluation Criteria
Initial Case
Presentation

A full quadrant with at least six teeth and two posterior teeth from a second
quadrant


At least two natural, permanent molars
o
One must be located in the selected quadrant
o
One of the teeth in the second quadrant must be a molar
One of the molars must have both a mesial and a distal contact. Another molar
must have at least one contact.
o
Radiographs
Calculus
Requirements
Clinical Skills
Section



Periodontal
assessment




Calculus removal
Tissue
management
Final case
presentation
from the molars.
Radiographs of the teeth selected are of sufficient quality for a dentist to
accurately diagnose dental caries, periodontal health, or other dental diseases and
abnormalities.
Qualifying calculus is verified by at least two examiners on:
o
At least three surfaces on proximal surfaces of molars (M or D).
o
At least five surfaces on proximal surfaces of posterior teeth (M or D). These
can include the three from molars.
o
At least eight surfaces on posterior teeth (M, D, F, or L). These can include
the five from proximal surfaces.
Evaluation Criteria

Calculus detection
To be considered a contact, the adjacent surface must be no more than 2 mm
Candidate correctly detects the presence or the absence of any type of calculus on
a tooth surface.
The computerized scoring system compares the candidate’s assessment of the
presence or absence of calculus to the assessment made during check-in by three
examiners on the same three teeth.
Candidate accurately records the sulcus/pocket depths of two assigned teeth.
The computerized scoring system compares the candidate’s measurements to
those made by three examiners on the same two teeth during check-in.
Measurements made by the candidate must be within ± 1 mm of the median of the
measurements of the three examiners.



No remaining calculus is found on surfaces chosen by examiners for evaluation.
No calculus is seen when tooth is dried with compressed air.
No calculus is felt with 11/12 explorer.

Candidate did not inflict any avoidable minor or major tissue damage during
calculus removal.

Patient is presented free of remaining calculus, plaque, stain, or prophy paste
residue in the treated area.
Anesthetic record is complete.

19
POINT SYSTEM
Criteria
Points
Possible
Point System

A full quadrant with at least six teeth and two posterior teeth from a
1
second quadrant

Initial case
presentation

At least two natural, permanent molars
o
One must be located in the selected quadrant
o
One of the teeth in the second quadrant must be a molar
1
One of the molars must have both a mesial and a distal contact. Another
molar must have at least one contact.
1

1

Calculus
requirements
Qualifying calculus requirements met by teeth in the selection: (3-5-8)
 Three surfaces located on M or D of molars
 Five surfaces located on M or D of posterior teeth
 Eight surfaces located on any surfaces of posterior teeth
5
Radiographs
Radiographs of the selected quadrant and any additional teeth are of diagnostic
quality.
8
Calculus detection
12 surfaces worth 1.5 points each, evaluated for the presence or absence of
any type of calculus.


18
12 surfaces of qualifying calculus worth 4.5 points each
If examiners verify four or more surfaces with remaining calculus, an
additional 15 points are deducted.
Calculus removal
54
If two examiners are unable to verify 12 surfaces of qualifying calculus in the
entire selection, points can be earned for removal only on the number of
surfaces with qualifying calculus verified by examiners.*
Periodontal
assessment
Minor tissue
trauma
Final case
presentation
Six measurements worth one point each.
6



Three points awarded if no minor tissue trauma is present.
One point deducted for each site of minor tissue trauma, up to three sites.
The presence of four or more sites qualifies as major tissue trauma
and automatic failure.
Treated selection is presented free of calculus, visible plaque, extrinsic stains,
prophy paste, and any other visible debris in the treated area. Anesthesia
record is complete.
Total
Major tissue trauma or major infection control
violation**
100-point deduction = automatic failure
*For example, if, after thorough
examination of both the quadrant and any
additional teeth selected by the
candidate, two examiners independently
identify only ten surfaces with qualifying
3
2
100
-100
calculus, the candidate can earn points for
removal only on those ten surfaces, for a
maximum total of 45 points for removal. If
examiners verify only eight surfaces of
qualifying calculus, points for removal are
20
awarded only on those eight surfaces for a
maximum of 36 points. Only when two
examiners verify 12 surfaces of
qualifying calculus in the selection
can the candidate earn the maximum
of 54 points for calculus removal.
patient, candidate, examiner, or staff
members at risk for injury or exposure.
Points are assigned in accordance with the
nationwide task analysis survey conducted
every five years. Results from this survey
of practicing dental hygienists allows the
testing agencies to determine which
clinical skills are performed most
frequently, and which clinical skills are
considered more important to protect the
public. Skills that rate highest (most
points earned) are weighted more heavily
than skills that rate lower.
**Examples of major infection control
violations include, but are not limited to,
forms, patient bibs, gauze, and/or
barriers visibly contaminated with blood;
use of non-sterile instruments; uncapped
needles; and other violations that put the
21
COMPUTER SIMULATED CLINICAL EXAMINATION (CSCE)
Content
Format
Computer Simulated Clinical Examination (CSCE)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Clinically based questions
presented on a computer
Medical/Dental Assessment
Intra and Extra Oral Examination
Dental and Periodontal Charting and Assessment
Soft Tissue, Bone and Tooth Abnormalities
Radiography/Imaging
Dental Hygiene Care Planning
Periodontal Procedures
Infection Control
Medical Emergency Management
Dental Specialties
Applied Pharmacology
The CSCE is the Computer Simulated
Clinical Examination with clinically based
questions that utilize a multiple-choice
format to indicate examinees’ responses.
It is an integral component of the ADEX
Clinical Examination and differs from the
National Board Dental Hygiene
Examination, which is a comprehensive
achievement examination in the theory
of dental hygiene. The National Board
is a prelude to clinical performance
examinations such as the CSCE. Note:
the local anesthesia computer-based
examination is not required as part of
the 2015 examinations.
The CSCE consists of 100 graded
questions. Scoring for this examination is
based on the percent of questions
answered correctly. A final score of 75
or greater is passing. There are an
additional 15 questions being tested for
possible future use, but they are not part
of the examination grade.
The CSCE is approximately two hours in
length.
The CSCE is given, by appointment, at
a testing center. Contact the testing
agency of your choice for information
concerning testing centers.
The CSCE is designed to assess more
complex levels of diagnosis and
treatment planning knowledge, skills,
and abilities.
Standards for the CSCE

Clinically based questions are utilized
through computer-enhanced
photographs, radiographs, optical
images of study and working models,
laboratory data and other clinical
digitized reproductions.

22
Extraneous materials (textbooks or
study materials) are n o t permitted
at the testing center at any time. Only
those materials distributed or
authorized by the testing center may
be brought to the examination. Use
of unauthorized materials will result
in failure of the entire examination.
Time schedule: A specific total
amount of time is allowed for the



CSCE. Once a candidate has
completed and locked out of the
CSCE, the candidate may not reenter the CSCE.
Timely arrival: The date and
appointment schedule established
by the testing center must be
adhered to as confirmed. Failure to
do so will result in forfeiture of the
examination fee.
Behavior at the testing center:
Unseemly behavior of the
candidate or improper behavior
toward personnel at the testing
center will result in failure of the
CSCE and forfeiture of the
examination fee.
Examination security: Security
measures established by the
testing agency and testing center
must be followed. Failure to do so
may result in failure of the
examination.







The candidate may skip or mark items to
be considered later. Once the CSCE is
completed and the candidate locks out
of the examination, she/he will not be
able to return to the examination.
The time indicated on the computer
screen is the amount of time for the
examination. There is no specific time
limitation for each item.
The CSCE is administered at testing
centers by appointment after eligibility
authorization is granted to the examinee
by the testing agency. Approximately two
hours are allotted for this examination.
No study materials may be brought to
the center and recording of test items is
prohibited. Violation of these rules
constitutes a violation of the Standards for
the CSCE and may result in failure of the
examination. The rules of conduct of
the examination as established by testing
center must be followed.
Disciplines and Subject Matter
Addressed in the CSCE




Radiography/Imaging
Dental Hygiene Care Planning
Periodontal Procedures
Infection Control
Medical Emergency Management
Dental Specialties
Applied Pharmacology
Medical/Dental Assessment
Intra and Extra Oral Examination
Dental and Periodontal Charting
and Assessment
Soft Tissue, Bone and Tooth
Abnormalities
23
SUPPLEMENTAL TESTING AGENCY INFORMATION
Additional information regarding application, schedules, testing sites, fees, forms, policies,
and procedures are found in the Supplemental Section of this Manual. This section is
produced and included in the Manual by the individual testing agency or state that chooses
to use the licensure examination provided by ADEX.
All questions regarding the administration of the examination should be directed to the
testing agency selected by the candidate. While all testing agencies administering the ADEX
Dental Hygiene Examination must adhere to the patient eligibility, criteria and scoring
system explained in this Manual, other details regarding administration are unique to each
testing agency.
Please refer to the following supplemental section of this manual for further details.
24
GLOSSARY
Abrasion
Abnormal wearing of tooth substance or restoration by mechanical factors other than tooth
contact.
Apical
The tip or apex of a root of a tooth and its immediate surroundings.
Calculus
A hard deposit attached to the teeth, usually consisting of mineralized bacterial plaque.
Caries
An infectious microbiological disease that results in localized dissolution and destruction of
the calcified tissues of the teeth.
Case
Entire selection of the teeth chosen by the candidate, which includes a quadrant plus two
posterior teeth in a second quadrant.
Cemento-enamel junction – CEJ
Line formed by the junction of the enamel and cementum of a tooth .
Complete treatment
Removal of all supra and subgingival deposits including coronal plaque and stain.
Contact area
The area where two adjacent teeth are no more than two millimeters from each other.
Debride
Complete removal of all calculus, plaque, soft debris, food, and prophy paste.
Defective restoration
Any dental restoration that is judged to be causing or is likely to cause damage to the
remaining tooth structure if not modified or replaced
Deposits, subgingival
Deposits that are apical to the gingival margin.
Deposits, supragingival
Deposits coronal to the gingival margin.
Diagnostic quality radiographs
Radiographs of sufficient quality for a dentist to accurately diagnose caries, periodontal
health, or other dental diseases and abnormalities.
Faulty restorations
Dental fillings and or crowns with ragged and open margins.
Gross (excessive) caries
Decay that has deteriorated three of the four axial walls and involves the cervical third of
the tooth.
25
Interproximal contact
The area of contact between two adjacent teeth. Also called proximal contact.
Line angle
The angle formed by the junction of two surfaces.
Long axis
An imaginary straight line passing through the center of the whole tooth occluso-apically.
Mobility
The degree of looseness of a tooth.
Optional additional Teeth
Up to two posterior teeth, premolars or molars, within 2mm of each other in a second
quadrant used to satisfy tooth and surface selection criteria not met in the quadrant of the
Case.
Pass/fail rule
Candidate must have a score of 75 or greater to pass.
Periapical
Area around the root end of a tooth.
Pocket depth measurements
Pockets depths accurately assessed and recorded on the two examiner assigned teeth – one
posterior and one anterior.
Posterior teeth
Premolars and molars
Primary dentition
The first set of teeth (deciduous).
Proximal surfaces
Mesial and Distal surfaces.
Psychometric validity
Test validity: the degree to which evidence and theory support the interpretations of test
scores.
Quadrant
A quarter of the oral cavity with six to eight teeth, upper right, lower right, upper left, lower
left.
Qualifying calculus
Explorer detectable subgingival calculus, which is distinct and easily detected with an
#11/12 explorer.
Qualifying surfaces
Twelve surfaces with sub gingival qualifying calculus. (eight surfaces on posterior teeth, five
surfaces on posterior teeth on mesial and distal surfaces, three on mesial and distal
surfaces of molars, four on any other sub gingival surfaces.)
26
Stain, extrinsic
Stain that forms on and can become incorporated into the surface of a tooth after
development and eruption. These stains can be caused by a number of developmental and
environmental factors.
Sonic scaler
An instrument tip attached to a transducer through which high frequency current causes
sonic vibrations (approximately 6,000 cps). These vibrations, usually accompanied by the
use of a stream of water, produce a turbulence, which in turn removes adherent deposits
from the teeth.
Tissue trauma
Unwarranted iatrogenic damage to extra/intraoral tissues resulting in significant injury to
the patient, such as lacerations, burns, amputated papillae, or large tissue tags.
Triple blind scoring
Three examiners independently evaluate and score.
Ultrasonic scaler
An instrument tip attached to a transducer through which high frequency current causes
ultrasonic vibrations (approximately 30,000 cps). These vibrations, usually accompanied by
the use of a stream of water, produce a turbulence, which in turn removes adherent
deposits from the teeth.
Validate
To be sound and just while supporting by fact.
Veneers
A restoration that covers the facial, mesial, distal, and incisal surfaces of a tooth, usually
porcelain.
Acronyms
AADB
American Association of Dental Boards
ADEX
American Board of Dental Examiners
APA
American Psychological Association
CODA
Council on Dental Accreditation
CSCE
Computer Simulated Clinical Examination
DHEC
Dental Hygiene Examination Committee
NERB
North East Regional Board of Dental Examiners
OSHA
Occupational Safety and Health Act
PTCE
Patient Treatment Clinical Examination
SRTA
Southern Regional Testing Agency
27
28
SRTA Supplemental Section
to the
ADEX 2015 Dental Hygiene
Candidate Manual
29
The Southern Regional Testing Agency (SRTA) is a nonprofit corporation committed to being a leader at the
national level in examination development and administration by providing the following:





Uniformly administered examinations and confidential results that are consistently reliable for use
by licensing authorities to make initial licensure decisions
Protection of the public
Appropriate care to board patients in the examination process
The most technologically advanced examination for its member states and participating testing
sites
Valid examinations in the most candidate-friendly environment possible, while producing the next
generation of our colleagues in the dental and dental hygiene professions
Current Member States of Southern Regional Testing Agency
Alabama
South Carolina
Arkansas
Tennessee
Kentucky
Virginia
Mississippi
West Virginia
For the most up-to-date, accurate information on licensure acceptance, candidates should contact the state boards
of dentistry directly. At the time of printing, 31 states accepted SRTA results for initial licensure.
Examination purpose
The current year SRTA Examination was developed, administered, and reviewed in accordance with guidelines from
the American Dental Association (ADA), the American Association of Dental Examiners (AADE), the American
Psychological Association (APA), the American Educational Research Association, and the National Council on
Measurement in Education. In addition, the examination has undergone stringent psychometric review and input
from independent firms The Buros Institute for Testing and Alpine Testing Solutions. Former candidates and dental
hygiene program faculty provide input to address concerns of students and candidates. SRTA collects input from
practicing dental hygienists nationwide every five years through a Task Analysis Survey, which is the basis for all
decisions regarding content. SRTA develops the examination to provide a reliable clinical assessment for use by
state boards in making valid licensing decisions.
© Copyright 2015 Southern Regional Testing Agency, Inc.
All rights reserved. No part of this manual may be used or reproduced in any form
without express prior written permission of the Southern Regional Testing Agency, Inc.
4698 Honeygrove Road, Suite 2
Virginia Beach, VA 23455-5934
(757) 318-9082
30
Table of Contents
GENERAL INFORMATION ................ 34
Application ........................................ 34
Applying for reexamination .................. 35
Examination results ............................ 35
SITES, DATES, AND FEES ................ 38
Fees and application worksheet............ 39
Site limitations ................................... 39
Examination site contact information .... 40
Computer Simulated Clinical Exam (CSCE)
........................................................ 41
PREPARING FOR THE EXAMINATION
....................................................... 44
Pre-examination preparation................ 44
Patient eligibility ................................ 44
Radiographs ...................................... 44
Required materials ............................. 44
Forms ............................................... 46
Submission of case via website ............ 46
Patient communication........................ 47
PROCEDURES ................................. 50
Overview of examination day ............... 50
Mass check-in and evaluation: ......... 50
Scoring area check-in and evaluation:
.................................................... 50
Clinic schedule ............................... 50
Registration and orientation................. 51
Clinic Floor Manager (CFM):............. 51
Dental Hygiene Coordinator (DHC): .. 51
Cubicle set-up.................................... 52
Patient check-in ................................. 53
Clinical treatment time........................ 55
Use of local anesthesia........................ 55
Shared patients ................................. 56
Final evaluation.................................. 57
Cubicle clean-up ................................ 58
FORMS............................................ 60
Dental Hygiene Procedure Form ........... 60
Periodontal assessment................... 62
Calculus detection .......................... 62
Calculus removal ............................ 63
Local anesthesia............................. 63
Dental Charting Form ......................... 67
Health History Form ........................... 68
Post-Operative Care Agreement ........... 71
Patient Disclaimer, Consent, and Release
Form ................................................ 72
Incident Disclaimer ............................. 73
Surveys ............................................ 73
APPEALS......................................... 76
POLICIES ....................................... 80
1. Anonymity ......................................... 80
2. Candidate accessibility ....................... 80
3. Confidentiality ................................... 80
4. Dismissal from examination ............... 80
5. Eighteen-month completion............... 81
6. Electronic equipment and patient
comfort ..................................................... 81
7. Examination documents..................... 82
8. Examination placement & limitations . 82
9. Examination results............................ 82
10.
Equipment ..................................... 83
11.
Ineligible candidates....................... 83
12.
Infection control ............................ 83
13.
Instruments ................................... 86
14.
Interpreters.................................... 86
15.
Jurisprudence................................. 86
16.
Malpractice Insurance .................... 87
17.
Patients.......................................... 87
18.
Patient privacy statement .............. 87
19.
Professional standards ................... 87
20.
Questions....................................... 88
21.
Reexamination ............................... 88
22.
Refunds.......................................... 88
23.
Restrictions .................................... 89
24.
Scheduling conflicts........................ 89
25.
Sharing equipment ......................... 89
26.
Unethical conduct .......................... 89
STATE BOARDS OF DENTISTRY
INFORMATION ............................... 92
FAQS .............................................. 94
QUICK EXAMINATION CHECKLIST .. 98
31
32
GENERAL INFORMATION
33
online application will save significant
time. Applicants will need:
GENERAL INFORMATION
A photograph: A recent digital headshot
of close proximity to the candidate is
required for the online application. The
candidate should be clearly
distinguishable, as the photo will be
printed at 1½” x 1 ½” on the candidate
admission card. Photos must be in JPG,
GIF, or PNG format. Photographs must
not have written information on them,
such as driver’s license or school
identification, etc.
Welcome to the Southern Regional Testing
Agency’s (SRTA) Dental Hygiene
Examination. SRTA provides this
Candidate Guide so candidates may
become familiar with the procedures and
policies for the ADEX Dental Hygiene
Examination as administered by SRTA.
The ADEX section of this manual covers
the core requirements for the criteria and
scoring needed to pass the examination.
This supplemental section covers the
administrative procedures including how
to apply, testing site information, fees,
schedules, and forms required by SRTA.
Bring this guide to the examination,
and keep it available in the cubicle for
easy reference. A thorough
understanding of this manual is crucial to
success on the examination.
CPR certification: A digital copy of
current and valid CPR certification, which
includes the renewal date, is required.
Valid certification is defined as a hands-on
training program that provides an
assessment of cognitive skills and skills
acquired via classroom or web-based
training. A minimum of Basic CPR skills
certification is required. Classes provided
by Internet-only instruction are not
acceptable. Web-based didactic training
must also include a hands-on component.
The ADEX, SRTA, and North East Regional
Boards (NERB) are working to bring a
single dental hygiene licensure
examination that will be accepted in all
jurisdictions. During the 2015
examination cycle, SRTA is piloting the
ADEX examination at all testing sites.
Candidates successfully passing the ADEX
pilot examination administered by SRTA in
2015, including both the CSCE and PTCE,
will be given ADEX Status and be eligible
to apply for licensure any state that
recognizes the ADEX examination.
A diploma: Candidates must provide a
copy of their diploma from a CODAaccredited dental hygiene program for the
profile to be valid. Upload the diploma
into the profile, fax it to the office, or
email it to [email protected]. If the
candidate has not graduated, the program
director, dean, or school must provide a
letter stating that the candidate is
academically in good standing and may sit
for the exam. Upload this document into
the profile, fax, or email it to the SRTA
office. If the diploma is in any other
language, it must be translated into
English prior to submission.
Application
SRTA developed the online application for
the candidate’s convenience. To apply
online, go to http://www.srta.org/apply
and click the “Start New Application” link
to connect to a secure website that
requires the candidate's contact and
school information. Gathering all
required items prior to starting the
Payment: SRTA accepts VISA and
MasterCard only. No international
credit/debit cards are accepted. SRTA
also accepts debit cards if allowable by the
34
issuing bank and if they bear the VISA or
MasterCard logo. The total payment
includes the facility fee (site specific, see
Section II of this manual) and the
examination fee. All payments are drawn
immediately and must be paid in full,
including application fee and facility fee.
Split payments are prohibited. The U.S.
Department of Veterans Affairs has
approved the cost of the SRTA Dental
Hygiene Examination for reimbursement.
Contact the regional Veterans
Affairs/Veterans Education Office to obtain
the proper forms.
complete all required documents
for the examination. Instructions
for each document are on the
website. Some documents must
be completed and returned to
the SRTA office prior to the
examination.
Applying for reexamination
For candidates who need to retake the
examination, it is not necessary to create
another profile. Simply log back into your
profile at http://srta.brighttrac.org, and
click on “Apply” at the top of the screen.
Follow instructions on the screen.
Please call the SRTA office for any further
assistance.
After the candidate has completed the
application profile,
 SRTA staff verifies the profile:
After the candidate uploads or
enters all required information, and
the information is received by the
SRTA office, the staff verifies the
profile. Staff members cannot
verify any profile without a photo
or CPR card. Please allow up to
three days for verification.
Candidates cannot apply for the
examination until the SRTA staff
completes the verification process.
With the exception of password
changes, all profile changes will
automatically mark the candidate
temporarily modified and will
require verification again.
 Candidates apply for the
examination: Once all profile
information has been uploaded and
verified, a confirmation email will
be sent to the email address
provided. To ensure you receive all
necessary emails, please be sure to
add any @srta.org email addresses
to your address book or contact
list. Candidates may apply for
examinations by simply click on
“Apply” at the top of the screen to
begin the registration process.
 Candidates download
documents: Candidates must
visit the “Documents” portion of
the secure site to download and
QUICK TIP
APPLY ONLINE AT
www.srta.org/apply
Gather these items prior to starting
application:
•
•
•
•
•
Recent photograph (head shot;
jpg, gif, or png)
CPR certification (BLS or
higher)
Diploma or letter from program
director
VISA or MasterCard or
Veterans Administration forms
Only 1 file may be uploaded in
each place/category
Contact SRTA office if using
veteran’s benefits.
Examination results
Candidates receive notification via email
when their scores are available for viewing
online. Results are usually available
online within three business days of
completion of the examination. Log into
the SRTA website using the password and
username created during the online
registration process. Candidates who fail
35
can view the details of their evaluation
online. Details are not available for those
who pass.
graduation date, or the dental hygiene
school’s dean/program director is required
to submit a list of students who graduated
within that timeframe. For candidates
who have not formally graduated,
graduation requirements must be
completed within 12 (twelve) months of
their first examination date. SRTA will
notify each of the individual state boards
that scores are invalid if the required
diploma or letter from the dean/program
director is not received. The individual
state boards of dentistry determine the
acceptance of nullified/invalid results.
SRTA cannot grant extensions to the
graduation requirements as mandated in
our corporate documents.
Please do not call the SRTA office for test
scores or information concerning when
scores will be released.
Due to our confidentiality policy, SRTA
staff and examiners do not discuss
candidate concerns and questions with a
candidate’s spouse, parent, friend, faculty
member, or family member. SRTA is not
responsible for items lost or delayed by
the United States Postal Service.
The board of dentistry where candidates
wish to apply for licensure determines
acceptance of scores. SRTA supplies the
examination results to its participating
state boards but does not analyze or
interpret the records and makes no
recommendations on how the state uses
the scores.
The SRTA office automatically sends the
examination record of each candidate to
the secretaries of the state boards of
dentistry of Arkansas, Alabama, Kentucky,
South Carolina, Tennessee, Virginia,
Mississippi, and West Virginia. Each
current graduate’s university also receives
the examination record.
Some state boards of dentistry may
require a notarized copy of the final
report, which SRTA will provide for a
nominal fee. Please contact the SRTA
office to request this additional service.
Candidates should contact the individual
state board of dentistry where they wish
to obtain a license to verify acceptance of
ADEX scores and to learn of other statespecific requirements.
Candidates are required to provide proof
of graduation within 90 days after their
36
EXAMINATION SITES, DATES,
AND FEES
37
SITES, DATES, AND FEES
Site Location
Examination Date
Application
Deadline
West Virginia University: Morgantown, WV
February 28, 2015
January 16, 2015
Virginia Commonwealth University:
Richmond, VA
University of Louisville: Louisville, KY
March 27-28, 2015
February 13, 2015
April 10-11, 2015
February 27, 2015
Midlands Technical College: West Columbia,
SC
Western Kentucky University: Bowling
Green, KY
Bluegrass Community & Technical College:
Lexington, KY
BridgeValley Community & Technical
College: Montgomery, WV
Ozarks Technical College: Springfield, MO
April 17-18, 2015
March 6, 2015
April 17-18, 2015
March 6, 2015
April 24-25, 2015
March 13, 2015
April 24-25, 2015
March 13, 2015
May 1-2, 2015
March 20, 2015
Wytheville Community College: Wytheville,
VA
Concorde Career College: Memphis, TN
May 1-2, 2015
March 20, 2015
May 8-9, 2015
March 27, 2015
Greenville Technical College: Greenville, SC
May 8-9, 2015
March 27, 2015
University of Arkansas at Fort Smith: Fort
Smith, AR
Old Dominion University: Norfolk, VA
May 15-16, 2015
April 3, 2015
May 15-16, 2015
April 3, 2015
Tennessee State University: Nashville, TN
May 22-23, 2015
April 10, 2015
University of Arkansas for Medical Sciences:
Little Rock, AR
Virginia Commonwealth University:
Richmond, VA
University of Tennessee: Memphis, TN
May 22-23, 2015
April 10, 2015
May 29-30, 2015
April 17, 2015
June 5-6, 2015
April 24, 2015
Midlands Technical College: West Columbia,
SC
Chattanooga State Community College:
Chattanooga, TN
Remington College: Nashville, TN
June 12, 2015
May 1, 2015
July 10-11, 2015
May 29, 2015
July 24-25, 2015
June 12, 2015
Tennessee State University: Nashville, TN
October 9-10, 2015
August 28, 2015
University of Tennessee: Memphis, TN
December 4-5, 2015
October 23, 2015
Remington College: Nashville, TN
December 11-12, 2015
October 30, 2015
*Exam dates and locations may be subject to change. Please visit www.srta.org
to see the most current examination schedule.
38
Fees and application worksheet
Institution
Bluegrass Community &
Technical College
Facility
Fee
$150
Calculate Fees
Examination fee
(or reexamination fee)
$ 1000
*Facility fee
$
Clinical Reexamination Fee
$ 850
CSCE Reexamination Fee
$ 150
BridgeValley Community &
Technical College
$125
Chattanooga State University
$150
Concorde Career College
$135
Greenville Technical College
$125
**Late registration fee (if
applicable)
$ 100
Midlands Technical College
$125
Total-(personal checks are not
accepted)
$
Old Dominion University
$135
Site limitations
Ozarks Technical College
$125
Remington College
$150
Tennessee State University
$150
University of Arkansas - Fort
Smith
$135
University of Arkansas for
Medical Sciences
$135
University of Louisville
$200
University of Tennessee
$150
Virginia Commonwealth
University
$125
West Virginia University
$125
Western Kentucky University
$125
Due to limitations at some test sites, SRTA
cannot always accommodate the number of
candidates who wish to examine at a
particular site. Exam assignments begin with
the Friday sessions. Depending on the
number of candidates registered for a specific
exam site, Saturday examination sessions
may be held or may be cancelled.
SRTA assigns cubicles on a first come, first
served basis with the examination site’s
current students given first priority.
Therefore, a site may become full prior to the
application deadline.
SRTA cannot guarantee placement at any
examination site. Applying early may increase
the probability of placement in the preferred
site. Cubicles may become available after the
deadline date if other candidates withdraw or
become ineligible. Applicants may contact the
SRTA office after a deadline date has passed
to find out if any openings are available.
SRTA reserves the right to cancel an
examination if an insufficient number of
candidates apply for that date and
examination site.
*Facility fees are subject to change at the discretion of the exam site’s request. The facility fee
will be finalized upon submission of payment for registration online.
**Late registrations fees will apply to candidates who apply/register after the published
registration deadline.
Wytheville Community
College
$100
39
Examination site contact information
Arkansas
University of Arkansas – Fort Smith
5210 Grand Avenue
Fort Smith, AR 72913
(479) 788-7400
http://www.uafs.edu/academics/dental-hygiene
Clinic opens at 6:15 a.m. Friday and Saturday
Tennessee
Chattanooga State Community College
4501 Amnicola Highway
Chattanooga, TN 37406
(423) 679-4712
http://www.chattanoogastate.edu/allied_health
University of Arkansas for Medical Sciences
4301 W. Markham Street, #609
Little Rock, AR 72205
(501) 686-5733 or (501) 686-5734
www.uams.edu/chrp/dentalhygiene
Kentucky
Bluegrass Community & Technical College
470 Cooper Drive
250 Oswald Building
Lexington KY 40506-0235
(859) 246-6234
http://www.bluegrass.kctcs.edu/ah/dental_hygiene
Concorde Career College
5100 Poplar Avenue
Suite 132
Memphis, TN 38137
(901) 476-1358
http://www.concorde.edu/programs/dentalhygiene
University of Louisville School of Dentistry
501 South Preston
Louisville, KY 40292
(502) 852-5128
http://louisville.edu/dental/hygiene
Western Kentucky University
1906 College Heights Boulevard, #11032
Bowling Green, KY 42101
(270) 745-2427
http://www.wku.edu/dentalhygiene/
West Virginia
BridgeValley Community & Technical College
604 Davis Hall
Montgomery, WV 25136
(304) 442-3345
http://www.bridgevalley.edu/dental-hygiene
West Virginia University School of Dentistry
One Medical Center Drive
Morgantown, WV 26506-9401
(304) 293-7307
www.hsc.wvu.edu/sod/Departments
40
Remington College
441 Donelson Pike
Nashville, TN 37214
(615) 493-9356
http://www.remingtoncollege.edu/dentalhygiene-schools/
Tennessee State University
3500 John A. Merritt Boulevard
Nashville, TN 37209
(615) 963-5801
http://www.tnstate.edu/dentalhygiene/
Clinic opens at 6:00 a.m.
University of Tennessee College of Dentistry
875 Union Avenue
Memphis, TN 38163
(901) 448-6246
http://www.uthsc.edu/allied/dh/
Missouri
Ozarks Technical Community College
1001 E. Chestnut Expressway
Springfield, MO 65802
(417) 447-8829
http://www.otc.edu/allied health
Examination site contact information
South Carolina
Greenville Technical College
50 Skyview Drive
Greenville, SC 29606-5616
(864) 250-8588
http://www.gvltec.edu/dental
Midlands Technical College
1260 Lexington Drive
West Columbia, SC 29170
(803) 822-3451
http://www.midlandstech.edu
Virginia
Old Dominion University
4608 Hampton Boulevard
1101 C Health Sciences Building
Norfolk, VA 23529-0499
(757) 683-5241
http://hs.odu.edu/dental/
Virginia Commonwealth University School of
Dentistry
520 North 12th Street
Richmond, VA 23298-0566
(804) 828-7978
http://www.dentistry.vcu.edu/prospective/dh/
Wytheville Community College
1000 E. Main Street
Wytheville, VA 24382
(276) 223-4840
http://www.wcc.vccs.edu
Computer Simulated Clinical Exam (CSCE)
The computerized section of the examination is given at PSI testing centers. After
registering online for the SRTA examination and paying the examination fee, an
appointment can be made via the PSI website. Wait at least 24 hours after registering
with SRTA to contact PSI for an appointment. This allows time for the candidate’s
eligibility status to be sent to their system. The link to the PSI website is:
https://candidate.psiexams.com/index.jsp
Contact PSI by phone at 1-800-733-9267 (prompt 4)
For other questions concerning the CSCE, please contact the SRTA office.
41
42
Preparing for the
Examination
43
Radiographs
PREPARING FOR THE
EXAMINATION
For information regarding the
presentation of radiographs of the
patient, please refer to the ADEX
section of this manual.
The clinical examination evaluates
candidates’ ability to:
 Present a suitable case based on
the requirements outlined in this
manual
 Present diagnostic-quality
radiographs
 Identify the presence and the
absence of calculus
 Remove moderate to heavy
calculus while protecting the
surrounding soft tissue
 Measure periodontal pockets
 Observe standard infection
control protocols
Candidates may present digital
radiographs on a chair-side computer
screen, if available. A printed copy is
still required.
If the candidate presents digital
radiographs, they must be printed on
one sheet of photo quality paper with
images as close to the size of
conventional radiographs as possible.
Examiners collect all radiographs at the
conclusion of final examination. SRTA
stores them for one year, after which
they are destroyed.
Pre-examination preparation
On the day of the exam, each candidate
must provide his/her own instruments,
patient, a full-mouth series of
diagnostic-quality radiographs of the
patient presented, and appropriate
paperwork.
Required materials
Candidates are required to bring their
own instruments to the clinical
examination. Some materials and
equipment may be available at the
testing site. Each testing site will send
an orientation letter explaining what
materials will and will not be available.
Candidates should contact the testing
site directly to determine whether the
equipment available onsite is compatible
with the candidates’ equipment.
Patient eligibility
For information regarding patient
eligibility, please refer to the ADEX
section of this manual.
44
QUICK TIP
REQUIRED MATERIALS
•
•
•
•
•
•
•
•
•
•
An 11/12 explorer and a probe marked in 1mm increments (e.g. UNC probe)- yellow banded
2” x 2” gauze squares
Clipboard
Two sharpened #2 lead pencils (not mechanical) covered with a barrier of plastic film or
aluminum foil
A blood pressure measuring device or access to such a device
Syringes / supplies for local anesthesia administration, if applicable. Testing sites provide
cartridges of anesthetic.
A hard-surface sealed container, e.g., pencil box / cassette, to transport the instruments
to the designated area for late check-in, if needed
Sterile instruments (choice of the candidate)
Ultrasonic/sonic scaling instruments. At some schools, ultrasonic units may be available
for rent. Contact the school directly to see if this service is available. SRTA does not
assist in equipment rental issues, nor does SRTA know which schools provide rental units.
A hand-piece compatible with the examination site’s equipment
45
Forms
the candidate will fail the
examination.
After the candidate’s application is
completed and verified, he/she should
download and print all forms from the
candidate profile on the SRTA website,
www.srta.org. If computer/printer
access is not available, contact the
SRTA office and request to have forms
sent via mail. Candidates may use
copies of forms for pre-screening
patients and to aid in patient
preparation.
If the candidate brings a qualified
practitioner to administer anesthesia
during the examination, the practitioner
must be prepared to present credentials
verifying his/her qualification to
administer anesthesia. Candidates may
submit credentials for qualified
practitioners to the SRTA office prior to
the examination day.
Be prepared to submit the following
forms on the day of the examination:
A detailed description and instructions
for completing the forms is found later
in this manual.
Forms Presented at Registration
 One form of government- or schoolissued ID

Patient Disclaimer, Consent, and
Release Form

Incident Disclaimer

Post-Operative Care Agreement (2
copies)

Credentials of qualified practitioner,
if local anesthesia will be
administered by someone other than
the candidate and credentials were
not previously submitted to the
SRTA office
Forms Presented at Patient Check-In
 Dental Charting Form (completed
prior to examination day and
collected by examiners during
check-in)
 Patient Health History Form (and
physician’s statement, if needed)
 Dental Hygiene Procedure Form
Note that in addition to the Health
History Form required for all patients,
some patients with sensitive medical
conditions may require an additional
physician’s statement clearing them for
treatment. Review the guidelines in the
Forms section of this manual to
determine if the patient requires a
physician’s statement to participate in
the examination.
Submission of case via
website
At least two weeks prior to the
examination, candidates are advised
to enter their case selection into SRTA’s
computer scoring system by logging into
the candidate profile on the SRTA
website, https://srta.brighttrac.com .
Case selection will be verified the day of
the examination by the candidate.
If the patient has a condition that
requires a physician’s written clearance,
candidates must present the physician’s
letter during patient check-in. If no
letter is presented, the patient will
not be allowed to participate, and
46
As a part of the case selection,
candidates must identify and document
12 surfaces within the selected quadrant
plus additional teeth that have
“qualifying calculus” (that is, calculus
that meets the criteria outlined in the
ADEX section of this manual.)

Patient communication


Candidates should be in contact with
their patients in advance of the
evaluation to:
 Ensure that the patient
understands that participation in
the examination requires a
minimum of a four to five hour
time commitment.
 Determine whether the patient
meets eligibility requirements to
participate in the examination


47
and that his/her dental condition
meets the case presentation
requirements for the clinical
skills portion of the test
Prepare/collect all required
radiographs
Complete the patient’s Health
History Form and obtain a
physician’s clearance letter, if
necessary
Determine whether an
interpreter will be needed during
the examination
Complete the Dental Charting
Form
Identify the quadrant and
additional teeth that will be
included in the case selection
and identify 12 surfaces of
qualifying calculus within the
case selection
48
Procedures
49
PROCEDURES
Overview of examination day
perform final evaluation on patients. At
these sites, patients must be presented
to the scoring area no later than
10:00am for the morning group and no
later than 3:15pm for the afternoon
group. All forms, radiographs, and
instruments must be sent with the
patient. Each candidate has a unique
patient treatment start and stop times.
The unique start and stop times are
recorded for the candidates and the CFM
will monitor the times. Patients must be
presented to the desk for final
evaluation no more than five minutes
after the candidate’s clinic stop time.
Candidates presenting their patient to
the desk more than five minutes after
their clinic stop time will not be allowed
to have their patient evaluated and will
fail the examination.
On the day of the examination,
candidates attend registration
/orientation and then divide into groups
for the rest of the day. At the
designated time, found in the clinic
schedule below, members of each group
set up their cubicles.
SRTA administers the ADEX examination
using one of two procedures. The type
of administration used depends on the
size and lay out of the clinic.
Mass check-in and evaluation:
At examination sites using this method
of administration, the patients remain in
the candidates’ cubicles throughout the
examination. Examiners perform checkin and final evaluation in the clinic while
candidates wait in a designated area.
After check-in is completed, all
candidates return to their cubicles and
begin patient treatment at the same
time. Candidates are allowed one and
one-half hours to complete patient
treatment. The patient treatment stop
time is the same for all candidates. At
the end of the patient treatment time,
candidates are again moved to a
designated area while examiners
perform final evaluation on the patients
in the cubicles.
All other aspects of the examination are
the same, regardless of the method of
administration. The CFM and DHC will
announce which method will be used
during orientation.
Scoring area check-in and
evaluation:
At other sites, a separate scoring area is
used for examiners to check-in and
Groups
A (D) (G)
Clinic schedule
Candidates divide into groups to take
the examination as outlined in the
following table. The start of the
examination is the time set up begins
in the clinic. Whether a designated
scoring area is used for examiner
evaluations or if those evaluations take
place in the candidates’ assigned
cubicles, the examination start time is
the same.
Groups
B (E) (H)
Groups
C (F) (I)
Registration/Orientation
6:45 a.m.
6:45 a.m.
6:45 a.m.
Examination start time
7:30 a.m.
8:45 a.m.
12:45 p.m.
*SRTA reserves the right to amend the schedule. Candidates should be present on-site prior to the examination start time. All
scheduled times as listed could be moved earlier if conditions exist to do so and if all candidates, patients, and examiners
agree to an earlier start time.
50
due to unique site requirements:
 Watch slide presentation that
covers basic information.
 Ask questions about the
examination.
 Turn in paperwork.
 Receive candidate badges and
holders.
 Receive badges for interpreters
and qualified practitioners
providing local anesthesia.
Registration and orientation
Orientation begins promptly at 6:45
a.m. There is only one session per day,
and all candidates who are sitting for
the clinical examination that day must
attend. The following SRTA personnel
conduct registration and orientation.
Clinic Floor Manager (CFM):
A dentist who is a member of SRTA and
supervises the clinic floor during the
examination. The CFM evaluates the
patient’s health history to determine
whether it is safe for the patient to
participate in the examination and
receive local anesthesia. The CFM
serves as a liaison between the
candidates and the examiners and does
not evaluate any element of candidate
performance.
Due to the number of sites at which the
SRTA administers the examination, sitespecific orientations are not provided.
It is the responsibility of each candidate
to contact the site prior to the date of
the examination to verify that all handpieces and sonic/ultrasonic scalers are
compatible with school equipment. It is
advisable to visit the site prior to the
examination date to become familiar
with the clinic. The candidate must
arrange directly with school
officials, as SRTA cannot arrange
tours of sites.
Dental Hygiene Coordinator (DHC):
An SRTA staff member or dental
hygienist who conducts registration and
orientation, assists candidates with
entering examination data into the
computer scoring system, and assists
the CFM in supervision of the clinic floor.
The DHC does not evaluate any element
of candidate performance.
Candidates who fail to attend
orientation will not receive separate
instructions.
Orientation is for candidates only.
Visitors and patients cannot participate
unless the CFM or DHC grants
permission.
Orientation follows this general format.
Examiners may make minor
adjustments to the orientation format
QUICK TIP
FORMS REQUIRED FOR REGISTRATION/ORIENTATION
•
•
•
•
•
•
One form of government- or school-issued photo ID
Completed Post-Operative Care Agreement (two copies)
Patient Disclaimer, Consent, and Release Form
Incident Disclaimer
Patient Health History
Credentials of qualified practitioner, if someone other than the candidate will administer local
anesthesia and if those credentials were not provided to the SRTA office prior to the day of
the examination.
51
the CFM announces that set-up time is
over, candidates must leave the clinic
floor so examiners can enter to perform
patient check-in or send the patient to
the scoring area, if one is used. During
the 45 minutes allotted for set up,
follow these steps to prepare:
Cubicle set-up
At the published time, each group of
candidates and their patients enter the
clinic floor to begin cubicle set-up.
Candidates have a maximum of 45
minutes to set up their cubicles. When
The candidate must provide or have
access to a blood pressure measuring
device and take a preoperative blood
pressure reading on the patient the day
of the examination. Record these
readings on the Health History Form
prior to check-in. To protect the health
of the patient, no treatment is allowed if
the patient’s systolic blood pressure
reading is greater than 160 and/or the
diastolic reading is greater than 100 the
day of the examination.
If the patient is sitting for the
examination for more than one
candidate, the blood pressure must be
taken immediately prior to each
52
examination and recorded on a separate
Health History Form for each candidate.
To facilitate the check-in process,
patients must be plaque-free, and there
must not be evidence of soft debris,
food matter, etc. Candidates who
present patients with excessive soft
debris will not earn points for initial case
presentation.
Patient check-in
Check-in is the procedure during which
three examiners:
 Evaluate the selected teeth for the
required criteria
 Assign teeth for the detection and
periodontal assessment exercises
 Document where calculus is found
on the teeth assigned for detection
 Measure and record the periodontal
pocket depths on the teeth assigned
for the periodontal assessment
 Select the 12 surfaces with
qualifying calculus for evaluation of
calculus removal skills. These may
or may not include the surfaces
listed by the candidate.
This process may take up to 90
minutes. Advise patients to expect a
90-minute wait, and make them as
comfortable as possible. Patients may
use books, magazines, or other nonelectronic devices. SRTA prohibits the
use of all electronic devices by both
patients and candidates during the
examination except for electronic
readers, such as Nooks or Kindles.
Remind patients not to touch the light,
instruments, or any paperwork.
Candidates may not enter the clinic or
scoring area during check-in.
Candidates at sites where check-in is
performed at the cubicles may not
return to the clinic until advised by the
CFM. Candidates who fail to leave or
who re-enter the clinic without
permission from the CFM, or who
attempt to enter the scoring area, risk
dismissal from the examination and
automatic failure.
When check-in is completed, candidates
may re-enter the clinic. The CFM will
announce the clinic start-time. At that
point, candidates may begin the clinical
treatment portion of the examination.
During cubicle set-up, candidates should
ensure that their workstations are set
up appropriately for the examiners, who
will evaluate each patient during checkin. Follow these steps to prepare for the
examiners:
QUICK TIP
PREPARING FOR PATIENT CHECK-IN
•
•
•
•
Place bib and safety glasses on patient, recline chair, and turn on patient light.
Separate mirror, 11/12 explorer, and required probe from other instruments.
Place radiographs, paperwork, and covered pencils in an easily accessible area.
Instruct patient to leave patient light on and to leave all paperwork alone.
53
Provide these items for examiners during check-in:
Paperwork
• Completed Dental Charting Form
• Required radiographs of the patient
• Dental Hygiene Procedure Form, with the following information completed:
 Candidate information
 Medical alerts
 Anesthesia record
 Quadrant and additional teeth selected for the partial prophylaxis
o These must be the same as entered into the website
 Teeth and surfaces where qualifying calculus is located
o These must be the same as entered into the website
 Comments to examiners
Instruments
• 11/12 explorer for calculus detection
• Yellow-banded, color-coded probe for periodontal assessment with markings of
1-2-3-4-5-6-7-8-9-10 (UNC probe). The probe may be single or double ended.
When using a double-ended probe, the unused end must be covered with
autoclave tape.
• Reflective front surface mirror, which may be one or two sided
• Air-water syringe tip attached to the unit
• Saliva ejector
• Note: Air-abrasive instruments are not permitted.
Other Materials
• 2” x 2” gauze squares
• Clipboard
• Two sharpened #2 lead pencils (not mechanical) covered with a barrier of plastic
film or aluminum foil
• A blood pressure measuring device or access to such a device
• Syringes and supplies for local anesthesia administration, if applicable. Testing sites
provide cartridges of anesthetic.
• A hard-surface sealed container, e.g., pencil box or cassette, to transport the
instruments to the designated area for late check-in, if needed
• Sterile instruments (choice of the candidate)
• Ultrasonic/sonic scaling instruments. It is the candidate's responsibility to provide
the equipment of choice. At some schools, ultrasonic units may be available for
rent. Contact the school directly to see if this service is available. SRTA does not
assist in equipment rental issues, nor does SRTA know which schools provide rental
units.
• A hand-piece and prophy angle for polishing that are compatible with the
examination site’s equipment
54
Clinical treatment time
of local anesthetic. However, all
candidates who utilize local anesthesia
for their patients are required to
complete the appropriate
documentation. When deciding whether
to administer anesthesia, keep in mind
that three examiners will examine the
patient using the explorer and will probe
subgingivally during check-in.
The clinical skills section of the SRTA
Examination evaluates the candidate’s
ability to detect calculus, remove
calculus without damaging the
surrounding tissue, and accurately
measure periodontal pocket depths.
Candidates have 1½ hours to complete
the calculus detection, periodontal
pocket measurements, and calculus
removal exercises. Perform calculus
detection and periodontal
measurements before beginning
calculus removal, in order to ensure
accurate detection and measurements.
Candidates may administer a maximum
of four carpules of anesthetic. For
shared patients, see instructions later in
this section. Candidates may
administer anesthesia prior to patient
check-in and at any time during patient
treatment. Administer no more than
two cartridges prior to check-in.
Clinical treatment time begins when
announced by the CFM. Stop-time is
exactly 1 ½ hours after the start-time,
whether evaluation takes place in the
candidate’s cubicle or if a separate
scoring area is used. The CFM instructs
candidates to vacate the clinic at that
time or to send the patient to the
scoring area. Final evaluation begins
immediately after clinic stop-time.
However, any candidate wishing to
proceed to final evaluation prior to the
end of the 1½-hour deadline may notify
the CFM to arrange for early final
evaluation. This option may not be
available at all testing sites.
Candidates who have successfully
completed a course in local
anesthesia from a CODA-accredited
dental or dental hygiene school may
anesthetize their own patients.
Candidates must provide proof of
successful completion of a local
anesthesia course. This documentation
should include information on whether
the course covered infiltration
anesthesia only or both block and
infiltration anesthesia. This
documentation must be provided during
the application process.
 Candidates must provide all
syringes and supplies for
anesthetic administration. The
testing site provides anesthetic
cartridges.
 Candidates may anesthetize the
patient during cubicle set-up or
at any time during the clinical
examination.
Candidates who are not qualified to
administer local anesthetics may use
topical anesthetics or anesthesia
patches (Oraqix, etc.) or may bring a
qualified practitioner (dentist or dental
hygienist) to anesthetize their patient.
If a candidate wishes to utilize a
licensed practitioner from the exam site,
When a separate scoring area is used,
the candidate must stop all patient
treatment at their unique clinic stop
time. Patients must be presented at the
desk no more than five minutes after
the candidate’s clinic stop time.
Patients presented more than five
minutes after the candidate’s clinic stop
time will not be sent to the scoring area
and the candidate will fail.
Use of local anesthesia
Examiners do not evaluate the
technique and/or actual administration
55
he/she must contact the exam site to
make proper arrangements at least
one week prior to the examination
date. Schools are under no obligation
to provide anesthesia services to
candidates and some schools may elect
not to offer anesthesia administration
for the examination.
provided at the exam to acknowledge
acceptance of responsibility for
anesthesia-related emergencies. The
practitioner must also sign the
anesthesia record portion on the Dental
Hygiene Procedure Form after all
anesthetic is administered to verify the
amount of anesthetic administered.
QUICK TIP
The practitioner is allowed in the
examination clinic area only to
administer the anesthesia. However,
the practitioner should remain on the
premises during treatment time to
administer additional anesthetic if
needed and to intervene in case of an
anesthesia-related emergency.
ANESTHESIA PRIOR TO CHECKIN
•
•
Administer no more than two carpules
of anesthesia prior to check-in.
Additional carpules may be
administered at any time during
clinical treatment, up to the maximum
of four.
More than one candidate may use the
same qualified practitioner to administer
anesthesia to multiple patients, up to a
maximum of three patients per
group. Examiners will not delay checkin to allow extra time for qualified
practitioners to anesthetize patients.
A “qualified practitioner” is a person
who holds a current license to practice
dentistry or dental hygiene in the state
where the exam is held. If the
practitioner is a dental hygienist, a valid
local anesthesia permit from the state
where the exam is held is also required
for the hygienist to be considered a
qualified practitioner.
Shared patients
SRTA understands that it is sometimes
necessary for candidates to share a
patient. For patient safety in these
situations, follow the table of maximum
doses of anesthesia found on the next
page. The total number of
cartridges administered to a single
patient during one day cannot
exceed the maximum doses listed
below or four cartridges per
candidate, whichever is less. Each
candidate must plan to use no more
than half of the maximum dose on a
patient who will be shared with another
candidate on the same examination day
unless Lidocaine 2% with 1:100,000
epinephrine is used, in which case each
candidate can administer no more than
four cartridges each.
When a candidate uses a qualified
practitioner, the SRTA office must
receive copies of the following items
prior to the examination start date.
 Proof of current liability
insurance
 Photo ID
 Copy of dental or dental hygiene
license issued by state board of
dentistry where the examination
is held; if a dental hygienist is
utilized, he/she must provide
proof of local anesthesia training
or a permit to administer local
anesthesia from the state where
the exam is given.
The qualified practitioner is required to
sign the Incident Disclaimer Form
56
Maximum recommended doses of local anesthetics for dental infiltration/block injections
Anesthetic
Articaine 4% with
1:100,000 or 1:200,000
epinephrine
Lidocaine 2% with
1:100,000 epinephrine
Mepivacaine 3% plain
Prilocaine 4% plain
Maximum dose
Dose/cartridge
Maximum
cartridges for 154
lb. adult
500 mg (3.2
mg/lb.)
68 mg/1.7 mL
cartridge
7.4
500 mg (3.2
mg/lb.)
400 mg (3.0
mg/lb.)
36 mg/1.8 mL
cartridge
54 mg/1.8 mL
cartridge
600 mg (8.0
mg/lb.)
72 mg/1.8 mL
cartridge
13.9
7.4
8.3
Wahl, M.J., Brown, R.S., (2010). Dentistry’s wonder drugs: Local anesthetics and
vasoconstrictors. General Dentistry, 58 (2), 114-123.
Final evaluation
Examiners perform final evaluation in
the candidate's assigned cubicle or,
depending on the testing site, in a
designated scoring area. When final
evaluation takes place in the candidate’s
assigned cubicle, the candidate is
prohibited in the clinic during this time
and may not enter the clinic until
advised by the CFM. Candidates failing
to leave the clinic when instructed to do
so or entering the clinic or scoring area
during this time for any reason risk
dismissal from the examination or
automatic failure.
the candidate’s clinic stop time will not
be evaluated and the candidate will fail.
If a candidate finishes the partial oral
prophylaxis prior to the end of the 1½hour deadline, he/she may contact the
CFM to request an early final evaluation.
Early final evaluation is not offered at all
testing sites.
When the examiners start final
evaluation on the patients, the DHC
collects the Procedure Forms from the
cubicles and assist candidates in
entering their detection findings,
periodontal probe measurements, and
anesthetic record into SRTA’s computerscoring system.
At sites using a separate scoring area,
patients must be presented at the desk
for final evaluation no later than five
minutes after the candidate’s unique
clinic stop time. Patients presented to
the desk more than five minutes after
QUICK TIP
POLICY FOR ELECTRONIC DEVICES
•
•
All cellular phones and other electronic devices other than electronic books such as Nooks or
Kindles must be turned off during the entire examination process.
Neither candidates nor patients may use cell phones or cameras at any time. If a candidate or
patient is found using a cell phone or camera, the candidate will fail the examination.
57
Notes for Final Evaluation
Patient Preparation For
Final Evaluation
•
•
•
•
•
•
•
Patient seated
Wearing safety glasses
Clean bib
Reclined
Cubicle light on
Remove contaminated
gauze, needles, and any
other materials that
might cause infection
control violations.
Ensure that floor around
chair is free of hazards.
Required Instruments &
Paperwork
•
•
•
•
•
•
•
•
•
Mirror
Air-water syringe tip
11/12 explorer
Saliva ejector
Dental Hygiene
Procedure Form
Patient’s radiographs
Two sharpened No. 2
lead pencils (not a
mechanical pencil)
covered with a plastic
film or aluminum foil
barrier
A clipboard
Three 2” x 2” gauze
squares
Information for Patient
•
•
•
•
•
Three or more
examiners will be
performing the final
evaluation.
Evaluation may take as
long as 1 ½ hours.
Patients may take
restroom breaks but
should inform the CFM
prior to leaving the
clinic.
No electronic devices
can be used by patients
except for electronic
readers such as Nooks
and Kindles.
Patients may use books,
magazines, and any
other non-electronic
means of passing time.
Cubicle clean-up
After all patients are released, candidates may re-enter the clinic to clean and disinfect
their cubicles and to collect their personal belongings. SRTA allows 30 minutes for this
process. Candidates who fail to leave the clinic when advised to do so or who re-enter
the clinic without permission from the CFM risk dismissal from the examination or
automatic failure.
58
FORMS
59
FORMS
Download and print all forms from the
candidate’s profile on the SRTA website,
www.srta.org, after application is
completed and verified. If
computer/printer access is not available,
contact the SRTA office and request to
have forms sent via mail. Use copies of
forms for pre-screening patients and to
aid in patient preparation.
Forms Presented at Registration
 One form of government- or schoolissued photo ID

Release Form

Incident Disclaimer

Post-Operative Care Agreement (2
copies)

Patient Health History (and
physician’s statement, if needed)

Credentials of qualified practitioner,
if local anesthesia will be
administered by someone other than
the candidate and credentials were
not previously submitted to the
SRTA office
If errors are made on forms in ink
during the examination, the candidate
should make a single line striking
through the incorrect entry, make the
correction, and initial the correction
using the candidate number.
Forms Presented at Patient Check-In
 Dental Charting Form (completed
prior to examination day and
collected by examiners during
check-in)
 Dental Hygiene Procedure Form
Dental Hygiene Procedure Form
The Dental Hygiene Procedure Form has
two purposes:
 Candidates use it to document
their case selection, detection
findings, periodontal pocket
measurements, and to
communicate patient care issues
and preexisting conditions to
examiners.
 Examiners use it to make
detection and periodontal teeth
assignments and to
communicate comments to
candidates regarding minor
errors and patient care concerns.
The table on the following page explains
each section and provides instructions
for completing the form. The following
pages show a blank Procedure Form, a
sample form with the candidate sections
completed, and another sample showing
how the Procedure Form will appear
after check-in.
60
Section Number
& Title
SECTION 1.
Candidate
Information
SECTION 2.
Medical Alert
SECTION 3.
Calculus
Removal (This
section should list
the same
quadrant,
additional teeth,
and surfaces
previously
entered into the
website.)
Candidate
comments to
examiners
Examiner
comments to
candidate
FOR EXAMINER
USE ONLY
SECTION 4.
Anesthesia
Record
SECTION 5.
Periodontal
Assessment
SECTION 6.
Calculus
Detection
Examiner PIN
Instructions
Complete in ink prior to check-in:

Candidate number

Cubicle number

Examination site

Date of the exam

Whether the patient is being shared with another candidate
Complete in ink prior to check-in on the day of the exam:

Check “Yes” if there are any “Yes” answers anywhere on the Health History Form.

Check “No” if all answers on the Health History Form are “No.”

Choose a full quadrant and two posterior teeth from a second quadrant that meets criteria
to demonstrate calculus removal skills.

If the quadrant and required posterior teeth from the second quadrant do not meet all
calculus requirements, choose up to two more molars and/or premolars from the second
quadrant to achieve the calculus requirements.

List 12 surfaces in the selection where qualifying calculus is located. These surfaces will
be evaluated by the examiners for the presence of qualifying calculus. If at least two
examiners do not find qualifying calculus on a surface listed by the candidate, another
surface will be chosen from the case selection to give the candidate a better chance to
demonstrate his or her ability to remove qualifying calculus.

Candidates must clean all surfaces of all teeth in the quadrant and additional teeth
selected in Section 3. Examiners will evaluate all surfaces in the selection for remaining
calculus, not just the 12 listed by the candidate.
Alert examiners to conditions that might affect treatment or evaluation of the
patient. For example:

Severe hyperplasia or gingivitis

Excessive decay on tooth #x

Pre-existing tissue conditions that might be construed by examiners as minor tissue
trauma

Unavoidable reason why radiographs are less than diagnostic, e.g. patient is a gagger,
narrow palate, lingual tori, etc.
Examiners note any corrections to be made prior to starting clinical treatment of the patient.
The candidate must see the CFM to verify that corrections have been made before starting
patient treatment. Examiners attach a “See CFM” sticker below this area to further alert the
candidate.
Examiners attach a “See CFM” sticker here if there is an error to correct prior to starting
clinical treatment.

Type of injection(s) planned

Name of anesthetic

Percentage of vasoconstrictor

If no anesthesia is planned, slash through section and place candidate number on slash
mark.

Place candidate number in designated area.
Complete in ink prior to final evaluation:

Quantity of anesthetic used, or “0” if anesthesia was planned but not used
Do not write in Section 5 prior to patient check-in.

During check-in, examiners assign two teeth for the periodontal assessment and note
them in Section 5.

After check-in, candidates measure and record pocket depths of the assigned teeth.

Complete the periodontal assessment section prior to starting calculus removal.
Do not write in Section 6 prior to patient check-in.

During check-in, examiners assign three teeth for the calculus detection exercise and note
them in Section 6.

After check-in, candidates will circle “Yes” or “No” to indicate the presence or absence of
calculus on the three assigned teeth in Section 6.

Complete the detection exercise prior to starting calculus removal.
The first examiner to review the form and assign teeth for the detection and periodontal
exercises enters his/her PIN in this area. Contact the CFM if no PIN is present.
61
absence of calculus and enter the
findings in Section 6 of the Procedure
Form. For the purposes of the calculus
detection exercise, any calculus present
on the surface should be marked “Yes,”
even if it does not meet the definition of
“qualifying calculus.” This clinical skills
section demonstrates that a candidate
can recognize the presence of calculus
of all types—whether light, moderate, or
heavy—on a variety of tooth surfaces
and can recognize when a surface is
free of any calculus.
Periodontal assessment
During check-in, examiners assign two
teeth (one anterior and one posterior)
for the periodontal assessment exercise,
indicating the selected teeth on the
Procedure Form, Section 5. Examiners
measure and record pocket depths on
each of those two teeth. Record
measurements on three standard
periodontal pocket areas of DL, L, and
ML. Each of the three examiners enters
his/her measurements into the
computer-scoring program.
QUICK TIP
During clinical treatment time and prior
to any calculus removal, candidates
measure and record the three pocket
depths on each of the two assigned
teeth in Section 5 of the Procedure
Form, for a total of six measurements.
The candidate’s measurements must be
no more than ± 1 mm of the median of
the three examiners’ measurements.
The examiners record their pocket
depth measurements with all calculus
present. Because pocket depths
could change after calculus
removal, candidates must complete
periodontal measurements before
removing calculus.
Complete the periodontal
measurements (Section 5) and calculus
detection exercise (Procedure Form,
Section 6) before beginning calculus
removal.
If calculus removal is performed
prior to completing the detection
exercise, the candidate will be
unable to make an accurate
evaluation of the presence or
absence of calculus as it was
assessed by examiners during
check-in.
During final evaluation, the DHC will
assist candidates in entering their
periodontal pocket depth measurements
into the computer scoring system.
During final evaluation, the DHC and
candidates enter their findings into the
computer-scoring program. The
program determines whether the
candidate’s findings match those of the
examiners. Candidates earn points for
each surface where the candidate’s
findings match those of two out of three
examiners. If examiners find calculus
on a surface, and the candidate finds
calculus on the same surface, the
candidate earns points. If examiners
find no calculus on a surface, and the
candidate also finds no calculus on the
surface, the candidate also earns points.
Candidates indicate their findings on the
Procedure Form by circling “Yes” or “No”
for each of the four surfaces on the
Calculus detection
During check-in, examiners assign three
teeth for the calculus detection exercise,
indicating the selected teeth on the
Procedure Form. Examiners evaluate
the mesial, distal, facial, and lingual
surfaces of the three teeth for the
presence or absence of calculus.
Examiners enter these findings into the
During clinical treatment time,
candidates evaluate the four surfaces of
each assigned tooth for the presence or
62
assigned teeth. Candidates earn no
points if they do not select an answer at
all or if they select both “Yes” and “No.”
that will be evaluated for remaining
calculus. Therefore, candidates must
clean all surfaces of all teeth in the
selection, as any of these may be
evaluated for remaining calculus during
final evaluation.
Calculus removal
Prior to check-in, document the case
selection in Section 3 by circling the
quadrant selected and listing the two
required posterior teeth from the
second quadrant, one of which must be
a molar. List up to two additional
posterior teeth from the second
quadrant only if they are needed to
meet the calculus requirements.
Indicate whether the third molar is to be
included in the selection. List 12
surfaces within the selection that have
qualifying calculus.
If fewer than 12 surfaces of qualifying
calculus are verified in the selection,
including all teeth in the quadrant and
any additional teeth chosen by the
candidate, points will be awarded only
for calculus removal on the surfaces
verified by two examiners as having
qualifying calculus. For example, if
examiners are able to verify only eight
surfaces with qualifying calculus, the
candidate will have only eight
opportunities to earn points for calculus
removal, rather than 12 opportunities,
and will automatically lose points for
removal on four surfaces.
Example: If the upper right quadrant is
selected along with #13 and #14 as the
required posterior teeth from a second
quadrant, optional additional teeth could
be #12 and/or #15 but not #18, and
#19, since those teeth are not in the
second quadrant with #12 and #15.
Local anesthesia
Candidates should administer no more
than two carpules of anesthesia prior to
patient check-in. Additional carpules
may be administered at any other time
during the examination, up to a
maximum of four carpules.
Do not list molars or premolars from the
selected quadrant as the additional
teeth. For example, if the candidate
selects the upper right quadrant, do not
list #1, 2, 3, 4, or 5 as the additional
teeth. Ensure the accuracy of tooth
numbers for teeth that may have
drifted.
If anesthesia is planned,
 Prior to check-in, fill in the
type of injection(s) and the name
of the anesthetic with percentage
of vasoconstrictor planned.
 Prior to final evaluation, fill in
the quantity of anesthesia used.
Enter a “0” if anesthesia was
planned but not used.
For details about surface selection and
description of qualifying calculus, please
see the ADEX section of this manual.
During check-in, examiners evaluate the
12 surfaces of qualifying calculus listed
by the candidate. If examiners disagree
that qualifying calculus is located on a
surface listed by the candidate, they will
select substitute surfaces from within
the case selection for evaluation of
calculus removal skills. Candidates are
not informed of the final list of surfaces
Candidates must enter their candidate
number as a part of the anesthetic
record. If a qualified practitioner
administers anesthesia, he/she must
sign in the area indicated to verify the
amount and type of anesthesia given.
If anesthesia is not planned,
63


Place a slash (/) mark across this
section and write the candidate
number on the slash mark.
If this area is blank at check-in
and the candidate did not slash
through the area, the approving
examiner will slash through the
area and enter his/her PIN
number.

Blank Dental Hygiene Procedure Form
64
If the candidate or an examiner
has slashed through this area
but administration of anesthesia
becomes necessary, contact the
CFM for permission prior to
proceeding.
Procedure Form with candidate sections completed prior to check-in
QUICK TIP
Complete Sections 1 through 4
prior to patient check-in.
Information in Section 3 must be
entered into the SRTA website
at least two weeks prior to the
examination day. Adjustments
can be made on examination day
by the DHC, if needed.
65
Procedure Form after check-in is completed
QUICK TIP
After check-in is complete, review the
Procedure Form for:




Comments to the candidate from
examiners; SEE CFM sticker.
Two teeth assigned for the
periodontal assessment (Section
5)
Three teeth assigned for the
calculus detection exercise
(Section 6)
PIN of the examiner making
assignments at the lower border
66
Dental Charting Form
Candidates must complete the Dental Charting Form prior to the day of the
examination. The top of the form provides an area for indicating in ink the candidate
number, cubicle number, examination site, and the date of examination.
Charting may be done using either ink or pencil.
Dental charting
 Deciduous teeth: mark out the number and write in the tooth letter.
 Missing teeth: cross (X) through the entire area of the missing tooth.
 Partially erupted teeth: mark out the tooth number and write “P/E.”
 Unerupted or impacted teeth: circle the entire tooth area.
 Implants: cross (X) through the entire tooth area and change the tooth number
to “I.”
 Retained root tips: cross (X) through the tooth number and write “RT.”
67
patient's health status must be
acceptable for treatment. The
candidate must have the form
available during set up so the CFM
can verify that:
 All sections are complete
 When required, a physician’s
statement is provided
 The patient can have local
anesthesia administered, if
needed
Health History Form
Patients complete the Health History
Form in ink prior to the day of the
examination. Patients should complete
this form no more than 30 days prior
to the day of the examination. This form
must be available during registration
and set-up for review by the CFM.
1. The section at the top left “PLACE ID
LABEL HERE” should be left blank.
2. Enter the Candidate Number in the
area labeled “Candidate Sequential.”
3. Enter the Cubicle Number during set
up.
4. Do not complete the “Blood
Pressure-Required- Must Be Taken
Day of Examination” blank until set
up. Complete this area after
patient is seated and BP is
taken. Complete “Date/Time
Taken” after you record the patient’s
BP on the day of the examination.
5. CFM will enter his/her PIN in the
area labeled “Examiner Confirms BP
Taken Day of Exam” during set up.
This indicates that the CFM has
reviewed the form and the patient is
approved to participate in the
examination.
6. Patient answers questions 1 through
13, including questions 8.A through
FF, within 30 days of the
examination, signs, and dates the
form in the area indicated.
7. At the bottom of page two, enter the
ASA Classification of the patient.
8. Candidates enter their initials, date
initialed, and signature on the
second page.
9. Present this form completed except
for the patient’s blood pressure
during registration. Some CFM’s
may wait to review the Health
History until set up.
QUICK TIP
A patient will be classified as
ineligible and be dismissed from the
examination if he/she

Currently taking or history of
injectable or oral
bisphosphonate therapy


Latex allergy
1st or 3rd trimester of

pregnancy
Oral herpetic lesions - This
condition may be left to the
discretion of the CFM
Candidates attempting to present a
patient with one or more of these
conditions will fail the examination
for presenting an ineligible patient.
All questions on the Health History Form
must be answered “Yes” or “No” by the
patient. If the patient responds “Yes” to
any question on the Health History
Form, check “Yes” in Section 2 of the
Dental Hygiene Procedure Form
(Medical Alert area).
QUICK TIP
If the patient answers “Yes” to any of
the questions on this form, check “Yes”
in the Medical Alert box (Section 2) of
the Procedure Form.
The patient’s blood pressure on the day
of the exam must be below 160
(systolic) and/or 100 (diastolic). The
68
If the patient responds “Yes” to any of
the following questions a physician’s
written statement that it is safe for the
patient to participate is required and
must be presented during registration
and be available during cubicle set-up,
or the patient will not be allowed to
participate in the examination.



These conditions require a physician’s
written clearance:
8. U. High / low BP
8. V. Angina chest pain, shortness of
breath
8. W. Heart attack
8. X. Heart surgery
8. Y. Stroke
8. Z. Congestive heart failure
8. AA. Coronary artery or other
heart disease
8. BB. Arteriosclerosis/coronary
occlusion

prescription pad within 30 days
of the examination
A positive statement of how the
patient should be managed
The exact procedure that is to be
performed (i.e., dental
prophylaxis)
The physician's clearly legible
name, address, and phone
number
The physician’s signature on the
statement
If a patient presents with an active oral
herpetic lesion, the CFM must evaluate
the lesion and will decide if it is safe for
the patient, candidate, and examiners
to proceed with the examination using
that patient. If the CFM determines
that it will be unsafe for the patient to
be treated, the CFM will dismiss the
patient and the candidate from the
examination. The candidate may
reapply for the earliest available
examination. Examination fees will be
transferred to the new examination
assignment. Facility fees are not
transferrable. An additional charge for
the facility fee at the next examination
site will be assessed on the candidate’s
profile.
The candidate must present a
physician’s written clearance during
set up with the Health History Form
for any patient with a “Yes” to the
specific questions listed above. An
acceptable medical clearance/statement
includes the following elements.
 A statement from a physician
written on his/her letterhead or
69
Blank Health History Form
QUICK TIP
If the patient answers “Yes” to questions 8. U., V.,
W., X., Y., Z., AA., or BB. of the Health History
Form, a physician’s written clearance is required.
70
Post-Operative Care Agreement
Complete this form in ink and make
three copies prior to
registration/orientation. The provider of
postoperative care must sign the form.
Please ensure the information is legible
on all copies. Submit two copies of this
form during registration: one for SRTA
and one for the examination site
records. Provide one copy to the
patient.
be completed by the candidate in a
private or public dental practice setting,
complete Section I-B. If no provider
is available and/or the patient will
choose his/her own clinician for
completion of treatment, complete
Section I-C.
If the patient is returning to a
dental/dental hygiene school for
completion of treatment, complete
Section I-A and obtain a signature
from a school official (such as a faculty
member). If the patient’s treatment will
Do not leave any copies of the form in
the cubicle during patient check-in or
final evaluation.
The patient must sign this form under
Section II and receive a copy.
71
Patient Disclaimer, Consent, and Release Form
The patient completes this form in ink,
prior to registration/orientation. The
patient must sign and date the form.
Signatures on this form must be
witnessed. Any person other than the
candidate may serve as a witness.
This form requires the SRTA candidate
number. Submit this form during
registration/orientation.
QUICK TIP
The candidate must verify that this
area is filled out completely prior to
registration/orientation. The candidate
cannot sign as the witness.
72
Incident Disclaimer
Both the candidate and the patient must
sign and date the Incident Disclaimer.
As dental professionals, SRTA expects
all candidates to review this form
thoroughly with the patient.
Candidates are encouraged to print
three copies of this form upon
downloading, so both the patient and
the candidate have a copy of the
disclaimer. SRTA retains the third copy.
Submit this disclaimer during
registration/orientation. If this form
cannot be completed prior to
registration/orientation (e.g., patient is
not available for signature), the
completed form may be given to the
CFM or DHC after the patient has signed
the form.
Beginning a clinical exercise prior to
completing and submitting this
form will be grounds for dismissal
from the examination.
Surveys
Candidate surveys provide valuable feedback and information to SRTA administration
and examiners used to improve the examination process. The surveys are anonymous
and are completed online after the examination is over.
73
74
APPEALS
75
APPEALS
The host institution publishes an
examination site instruction letter that
outlines the provision of certain minimal
materials, support personnel to
dispense these materials, and support
personnel to repair and maintain
equipment in working condition within a
reasonable amount of time. SRTA may
consider appeals based upon failure of
the host institution only in instances in
which the Clinic Floor Manager (CFM) or
Dental Hygiene Coordinator (DHC) was
made aware of the problem with
reasonable time for resolution at the
examination site, rather than after the
fact upon completion of the
examination.
SRTA reviews appeals based on facts
surrounding the decision during the
examination. Any other information
such as experience, school
performance, character references,
testimonials, radiographs, photographs,
or models of a patient’s teeth taken by
the candidate or anyone else after
completion of the examination cannot
be considered in the appeals process.
Consideration can be given only to
documents, radiographs, etc., that were
submitted to the examiners during the
examination.
The Appeals Committee is obligated to
base its judgment of technical errors
upon its knowledge of the examination,
the validation and standardization
process used by SRTA, and evidence
presented in the candidate's appeal in a
systematic, consistent, reliable, and
rational manner. It is neither consistent
nor reasonable to suppose that
examiners can judge matters more
accurately and objectively after an
examination has ended than they did
during the examination. A score cannot
be reversed by any member of the
Appeals Committee unless the disputed
score is determined to be a technical
error rather than a perceived judgment
error.
The appellate process includes review of
all documentation of examination
results and candidate performance
during the examination. It may include
such additional investigation as deemed
warranted by the circumstance of the
appeal. The process will not include
records or external opinions obtained by
the candidate after the completion of
the examination.
The Appeals Committee makes every
effort possible to complete the appellate
review process within 90 days of the
receipt of the appeal in the SRTA
administrative office. When an
extended investigation becomes
necessary, SRTA will inform the
candidate by letter of this extended
investigation.
SRTA does not honor group, second
party, or verbal appeals. The Southern
Regional Testing Agency is not
responsible for any expense incurred by
any party making an appeal.
In many cases, SRTA cannot process,
evaluate, and make final decisions on
appeals prior to the next examination.
In cases in which a candidate
successfully completes another
examination while his/her appeal is
under evaluation, that appeal will be
dropped automatically by the chair of
the Appeals Committee upon notification
by the executive director. If the
SRTA does not consider appeals based
upon patient behavior, tardiness, or
failure to appear. SRTA does not
provide patients and is not responsible
for this aspect of the examination.
Situations requiring follow-up care are
the responsibility of the candidate, per
the Post-Operative Care Agreement.
76
candidate fails a subsequent
examination, the appeal process will
continue to completion, and a decision
will be rendered without the
committee's knowledge of the
candidate's performance on the
subsequent examination.
appeal form within 20 calendar days
following the release of scores, not the
date the scores are received by the
candidate. The Southern Regional
Testing Agency is not responsible for
items lost or delayed by the Postal
Service.
SRTA refunds application fees in full in
the event a candidate made payment
for a subsequent examination and an
appeal is granted before that
examination is taken. If SRTA makes a
favorable decision on an appeal, a full
refund of the appeal fee is mailed to the
candidate. SRTA notifies all
participating state boards of dentistry of
the results of a favorable decision.
File all appeals in writing on a form
provided by the Southern Regional
Testing Agency and sent by certified
mail, along with a certified check or
money order for $300 for the appeal
fee. SRTA must receive the formal
written appeal within 60 days of the
date of the examination.
Please send requests for an appeal form
and final appeals to the following
address:
The executive director will maintain a
log of all appeals and take appropriate
action to bring them to a timely
completion. The appeal becomes a
permanent part of the candidate's file
maintained in the SRTA administrative
office. The decision of the Appeals
Committee is final.
Executive Director
SRTA must receive the candidate’s
written notification/request for an
77
78
POLICIES
79
POLICIES
1. Anonymity
are not allowed for those
components/skills the examination
measures. Information regarding the
physical/learning challenges of a
candidate will remain confidential except
in the case of disabilities that may
require emergency treatment. In such
cases, onsite safety personnel will be
advised.
SRTA conducts all examinations
anonymously. All examination materials
are identified by the candidate’s SRTA
number assigned prior to the
examination. The candidate’s name and
school information should not appear on
any material reviewed by the
examiners. The examiners at all sites
are experienced practitioners with
diverse backgrounds. The examiners
are trained and standardized prior to
each examination and are evaluated to
ensure grading to established criteria.
The examiners are separated from the
candidates and remain in a separate
area of the facility. The candidates
must observe all signs and follow
instructions so as not to breach
anonymity. Anonymity is preserved
between the scoring examiners and the
candidates but not among the
examiners themselves. Examiners may
consult with one another whenever
necessary. There are times when
fairness requires consultation among
examiners.
3. Confidentiality
SRTA office staff or examiners will not
discuss candidate scores, appeals,
concerns, or questions with a
candidate’s spouse, parent, faculty
member, family member, or friend.
4. Dismissal from examination
This listing is not all-inclusive of the
reasons for which a candidate may
receive a failing evaluation or dismissal.
Some procedures may be deemed
unsatisfactory for other reasons.
Additionally, a combination of several
unsatisfactory evaluations may result in
failure. Reexamination will be denied
for one year (12 months) from the date
of dismissal from the examination.
Infractions that may lead to dismissal or
failure include:

Evidence of dishonesty or
misrepresentation during the
application process, including
false or misleading statements or
false documentation presented
by the candidate or on the
candidate’s behalf

Evidence of dishonesty or
misrepresentation during
candidate registration or during
the course of the examination

Rude, abusive, or uncooperative
behavior exhibited by the
candidate and/or those
accompanying the candidate to
the examination site
2. Candidate accessibility
SRTA makes every effort to
accommodate and comply with ADA
legislation for any candidate with a
documented physical and/or learning
disability that impairs sensory, manual,
or speaking skills and that requires a
reasonable deviation from the normal
administration of the examination. The
candidate must present a written
statement from a qualified physician at
the time of application. The statement
must clearly define the limitation(s) and
must detail the assistance required to
ensure appropriate accommodations.
Requests are evaluated on a case-bycase basis. Accommodations/deviations
80
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Failure to vacate the clinic for
patient check-in or continuing to
work after published cut-off time
Failure to complete the
examination within the allotted
time (No make-up time, grace
period or second effort is allowed
for any part of this examination.)
Alteration of preoperative
radiographs
Receiving assistance from a
dentist, another candidate,
faculty member, etc. SRTA
understands that different
programs will support candidates
in different ways, but patient
selection must be an
independent decision made only
by the candidate.
Thievery during the course of the
examination
Performance of any unauthorized
work outside of designated areas
at the test site
Noncompliance with anonymity
requirements for patient check-in
and/or examiner scoring.
Candidates must not enter the
area designated for check-in or
scoring. Candidates must
instruct their patients not to
handle any paperwork during the
course of the examination.
Noncompliance with established
guidelines for asepsis and
infectious disease control
Use of a patient who has been
removed from the patient pool.
It is the candidate’s
responsibility to determine
whether the patient has
previously been removed from
the patient pool.
Use of previously recorded
and/or copied periodontal
charting forms, calculus
detection lists/charts or other
references for the periodontal
assessment or calculus detection
exercises
Charging patients for services
performed
Failing to complete or refusing to
provide a Post-Operative Care


Agreement with a verifiable
contact name of the practitioner
who will provide postoperative
care to the patient, or the
patient’s statement that he/she
will seek care from a practitioner
of his/her own choice
Use of cellular telephones,
pagers, cameras, or other
electronic equipment, other
than electronic readers such
as Nooks or Kindles, by the
candidate and/or patient(s)
while in the clinic or scoring
areas
Attempting to use a patient who
is a dentist, dental hygienist,
junior or senior dental student,
or dental hygiene student
5. Eighteen-month completion
Both the CSCE and the Patient
Treatment Clinical Examination must be
completed successfully within 18
months after the first of the two
component exams is initiated. If both
examinations are not successfully
completed within 18 months, regardless
of the reason, both examinations in
dental hygiene must be retaken.
Contact the SRTA office for directions
regarding reapplication, appropriate
documentation and applicable fees.
6. Electronic equipment and patient
comfort
SRTA prohibits the use of cellular
telephones, pagers, cameras, or other
electronic equipment by candidates
and/or patients, other than electronic
readers such as Nooks or Kindles, within
the clinic/scoring areas. Violation of
this policy is a reason for dismissal from
the examination.
Patients may bring article of warm
clothing or blankets for their comfort, in
case the temperature in the clinics are
cold.
81
7. Examination documents
9. Examination results
Candidates must instruct their patients
not to handle any paperwork during the
course of the examination. Candidates
may be dismissed or fail the
examination if their patients handle
examination documents during the
course of the examination.
Candidates must pass the clinical
examination with a score of at least 75
percent. Candidates who fail may
retake the examination and can login to
their account on the SRTA website to
view the errors assessed.
8. Examination placement &
Results are available online within three
business days after completion of the
examination. An unofficial results
report from each examination will be
available to view/download online under
the ‘Results’ tab of the candidates’
profile. “Unofficial results” are reports
that do not have a stamp or embossed
seal proving the document came from a
valid authorized source and
guaranteeing the contents to be
accurate.
limitations
When the application is processed,
SRTA assigns a group and cubicle for
each candidate after the examination’s
published registration deadline. SRTA
policy does not allow transfer to another
testing date or location once an
examination site assignment has been
made. However, in cases of a medical
emergency, SRTA may consider
transfers on a case-by-case basis. The
candidate must fully document the
nature of the emergency in writing,
including contact information of a
medical professional included for
verification. The SRTA office must
receive notification prior to the
examination, or the request will not be
considered and the candidate will be
deemed a “no-show.”
SRTA automatically sends the
examination record of each candidate to
the SRTA Participating state boards of
dentistry, which are Alabama, Arkansas,
Kentucky, South Carolina, Mississippi,
Tennessee, Virginia, and West Virginia.
Some state boards of dentistry may
require a notarized copy of the final
report, which the Southern Regional
Testing Agency will provide for a
nominal fee. Please contact our office
to request this additional service. SRTA
may also send the examination record
to each current graduate’s university.
Priority seating for the examination is
given for the exam site’s current
students and then on a first come, first
serve basis for all other candidates. An
exam site may become full prior to the
application deadline and SRTA cannot
guarantee placement at any exam site.
Applying early may increase the
probability of placement in the preferred
site.
In addition to SRTA’s participating
boards, other states accept the
SRTA/ADEX results for licensure.
Candidates should contact the individual
state board of dentistry where they are
applying for licensure to verify
acceptance of SRTA/ADEX scores and to
learn of other state-specific
requirements.
SRTA requires a minimum of 12
candidates at any testing site and
reserves the right to cancel an exam
and reassign candidates to other testing
sites in the event there are fewer than
12 candidates scheduled for any
examination.
SRTA supplies the examination results
82
to the participating state boards but
does not analyze or interpret the
records and makes no recommendations
on the way the states use the scores.
Individual state boards determine
acceptance of the regional examination
scores.
Candidates must furnish all necessary
materials and required instruments.
SRTA is not responsible for the
malfunction of the facility’s or the
candidate’s equipment and will not allot
additional time due to the malfunction
of any equipment. Equipment
maintenance personnel are onsite
during each examination to ensure the
equipment and the water are in working
order. At the site, should an equipment
malfunction occur prior to or during the
examination, the candidate must notify
the CFM or DHC immediately so the
appropriate personnel may be
contacted.
The AADB (American Association of
Dental Boards) is creating a national
database or clearinghouse for the
reporting of results for all Dental and
Dental Hygiene clinical exams including
the number of attempts required to
obtain a passing score. This information
will be available to every state dental
board. The database will continue to be
populated with all board actions taken
on individuals after licensure is
obtained.
10.
11.
Ineligible candidates
Candidates must notify the SRTA office
of their ineligibility in writing two weeks
prior to the scheduled examination. A
letter from the program director of the
candidate’s institution will be required
as proof of ineligibility. SRTA retains
the complete application fee for any
candidate declared ineligible by his/her
program director. Candidates must
contact the school/testing site directly
for a refund of facility fees. Candidates
declared ineligible may take the
examination at a future site within a 12month period upon payment of
applicable facility fees, a $200
processing/administration fee, and
submission of a new application with all
the required documentation.
Equipment
Providing the necessary equipment is
the responsibility of each candidate.
Each testing site charges an additional
fee for the use of facilities and incidental
materials. This fee is combined with the
examination fee, which is listed by site
in Section II of this manual. SRTA
strongly advises candidates to visit the
examination site at a suitable time prior
to examination to familiarize themselves
with the facilities and available
equipment and to ensure that their
hand-pieces and ultrasonic/sonic
equipment can be adapted to the unit
available at the testing site. These
arrangements must be made directly
with the school. The use of
ultrasonic/sonic instruments is
permitted. However, it is the candidate's
responsibility to provide equipment that
is compatible with testing site
attachments. Some additional
equipment may be available from
certain schools/testing sites if
candidates arrange in advance with the
school. The school/testing site provides
the operating chair and unit.
12.
Infection control
SRTA requires candidate compliance
with the Centers for Disease Control and
Prevention: Recommended Infection
Control - U.S. Department of Health And
Human Services - Public Health Service,
Centers for Disease Control and
Prevention Guidelines for Infection
Control in Dental Health-Care Settings 2003 as reprinted from Morbidity and
Mortality Weekly Report,
83
Recommendations and Reports
December 19, 2003, Vol. 52, No. RR17. Refer to the aforementioned
publication for a complete listing of
recommended practices.
During the examination, candidates
must follow the current recommended
infection control procedures as
published by the CDC, beginning with
the initial set-up of the unit, continuing
throughout the clinical examination, and
including the final cleanup of the
cubicle. Dental professionals must
prevent the spread of infectious
diseases. Because many infectious
patients are asymptomatic, all patients
shall be treated as if they are, in fact,
contagious. It is the candidate's
responsibility to ensure that he/she
complies fully with these procedures.
This report consolidates
recommendations for preventing and
controlling infectious diseases and
managing personnel health and safety
concerns related to infection control in
dental settings. The report updates and
revises previous CDC recommendations
regarding infection control in dental
settings, incorporates relevant infection
control measures from other CDC
guidelines, and discusses concerns not
addressed in previous recommendations
for dentistry. Infection control requires
the commitment and accountability of
the dental healthcare practitioner.
Instruments, devices, and equipment
are categorized depending on their
potential risk for infection associated
with use:
Critical: Penetrates soft tissue;
contacts bone; enters into or contacts
the bloodstream or other normally
sterile tissue; includes surgical
instruments, periodontal scalers, scalpel
blades, surgical dental burs. Critical
items should be sterilized by heat.
These updates and additional topics
include the following:

Application of standard
precautions

Work restrictions for healthcare
personnel

Management of occupational
exposures

Selection and use of devices

Hand hygiene

Sterilization of unwrapped
instruments

Dental water quality concerns

Dental radiology

Aseptic technique

Pre-procedural mouth rinsing for
patients

Oral surgical procedures

Tuberculosis

Prion-related diseases, e.g.,
Creutzfeldt-Jakob disease

Infection control program
evaluation

Research considerations

Correct procedures for handling
or working with hazardous
chemicals
Semi-critical: Contacts mucous
membranes or non-intact skin; will not
penetrate soft tissue, contact bone, or
enter into or contact the bloodstream or
other normally sterile tissue; includes
dental mouth mirror, amalgam
condenser, reusable dental impression
trays, and dental hand-pieces. Semicritical items should be sterilized by
heat, or if heat sensitive, be processed
by high-level disinfection.
Non-critical: Contacts intact skin;
includes radiograph head/cone, blood
pressure cuff, face bow, pulse oximeter.
Non-critical items should be cleaned and
disinfected with an EPA-registered
hospital disinfectant.
Infection control procedures and
categories of patient care
Environmental surfaces are divided into
clinical contact surfaces and
84
housekeeping surfaces. When using
infection control strategies, candidates
should consider the 1) potential for
direct patient contact, 2) degree and
frequency of hand contact, and 3)
potential contamination of the surface
with body substances or environmental
sources of microorganisms.
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
Tasks must be performed in the safest
manner possible, including the
appropriate use of engineering controls
to reduce an exposure by removing the
hazard or isolating the worker from it.
Engineering controls are work practices
that reduce the risk of exposure in the
way a task is performed, including the
use of barriers that reduce the risk of
exposure and transmitting potentially
infectious material.

Use barrier paper, aluminum foil,
or plastic wrap to cover surfaces
that become contaminated.
Between patients, remove these
coverings while wearing gloves,
discard the coverings, and
replace them after removing
gloves.
Use a hard-surface, sealed
container (e.g., cassette or
pencil box) to transport
instruments.
Consider all waste and
disposable items potentially
infectious and dispose of these
items as is customary at the
testing site in accordance with
federal, state, and local
regulations.
Patients are allowed to use a preprocedural rinse. However, no scientific
evidence indicates that this prevents
clinical infections. Studies have
demonstrated that an antimicrobial
rinse can reduce the level of
microorganisms in aerosol- and
splatter-generating procedures.
Engineering controls include the use of
barrier techniques, disposables (when
possible), and proper disinfection and
sterilization:
 Wash and dry hands between
patients or whenever gloves are
changed. Do not wear hand
jewelry that can tear or puncture
gloves.
 Wear gloves when performing
any intra-oral procedures and
when cleaning up after any
treatment. If rips or tears occur,
put on new gloves. Do not wear
gloves outside the cubicle.
 Wear clean, long-sleeved
laboratory coats or gowns over
uniforms or clothing, and change
coats if one becomes visibly
soiled. Remove gowns or
laboratory coats before leaving
the clinic area.
 Wear facemasks and protective
eyewear during all procedures in
which exposure is likely to occur.
 Wear a mask over the nose and
mouth and discard it after each
patient, or sooner if the mask
becomes damp or soiled.
 Do not wear sandals or opentoed shoes.
Patients must wear protective
eyewear during all clinical
procedures and are required to
have protective eyewear during the
evaluation. Patients must wear a
clean patient napkin during evaluation.
Major violations of these standards
and guidelines—defined as
violations that put patients,
candidates, school staff, or
examiners at risk—may be grounds
for immediate dismissal, and
reexamination may be denied for
one year (12 months) from the date
of dismissal from the examination.
Post-exposure management: Should
a needle-stick injury or other exposure
to blood borne pathogens occur during
the clinical module of the examination,
the following protocol will be followed:
85
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13.
Contact the CFM immediately.
Follow all guidelines and
directions required by the
facility.
If time allows, the candidate and
patient may return to the clinic
and complete the examination.
If the candidate cannot complete
the examination, the
reexamination fees will apply.
the required instruments, he/she will be
unable to take the examination and will
Candidates are encouraged to secure
and provide additional instruments for
the examination. Candidates will not be
allowed additional time for instruments
dropped or for autoclaving instruments.
The candidate should provide an
additional sterile mirror, 11/12
explorer, and correct color-coded
periodontal probe in case an
instrument is dropped.
Instruments
Candidates must provide these
instruments for the examiners during
check-in and final evaluation:

A probe color-coded with
yellow banding, with markings
of 1-2-3-4-5-6-7-8-9-10-11-12
(UNC probe) only. The probe
may be single ended or double
ended. However, if the
candidate provides a doubleended probe, the unused end
must be covered using autoclave
tape. Candidates may use the
brand or manufacturer of their
choice. SRTA requires colorcoded probes with yellow bands
alternating with any other color,
including bare metal or plastic

An 11/12 explorer for calculus
detection at check-in and final
evaluation of calculus removal

A reflective front surface mouth
mirror, which may be one or two
sided
14.
Interpreters
Candidates may employ the services of
an interpreter when their patient does
not speak English or is hearing impaired
and the hearing loss cannot be
corrected. The use of an interpreter is
particularly important when the patient
has a history of medical problems or is
on medications. Faculty members,
dentists, dental hygienists (licensed or
unlicensed), third- or fourth-year dental
students, and final-year dental hygiene
students may not act as interpreters
during the examination. Candidates are
responsible for the conduct of the
interpreter during the examination.
Candidates who need the services of an
interpreter must contact the SRTA office
prior to the examination. The
interpreter must register with the CFM
or DHC and receive a badge that he or
she wears throughout the examination.
All other instruments are the choice of
the candidate. Candidates must provide
or have access to a blood pressure
measuring device and supplies for
anesthetic administration, including
syringes. The school will supply
anesthetic cartridges. Candidates may
choose the type of anesthetic used.
15.
Jurisprudence
SRTA does not administer the
jurisprudence examination for the
participating boards of dentistry. The
respective boards of dentistry develop,
administer, and score their own
jurisprudence examinations. SRTA does
not have access to nor can we provide
jurisprudence study materials.
Candidates should contact the board(s)
of dentistry in the state(s) in which
If the candidate does not provide the
appropriate instruments, examiners
cannot evaluate the patient at check-in
and the candidate loses the time
necessary to provide the missing
item(s). If the candidate cannot obtain
86
licensure is sought to arrange to take
the jurisprudence examination.
16.
as a patient. Patients who have
received any form of bisphosphonate
medications may not participate in the
examination. Patients presented with
radiographs that are of such poor
quality that examiners cannot
determine whether they are an accurate
depiction of the patient will be
dismissed as ineligible. Patients who
answer “Yes” to questions 8. U, V,
W, X, Y, Z, AA, or BB of the Health
History Form but do not present a
written physician’s clearance to
participate will be deemed
ineligible.
Malpractice Insurance
SRTA’s professional liability insurance
company provides malpractice insurance
for all candidates at no additional
charge. CNA Insurance Company
extends SRTA’s professional liability
coverage to candidates with the limit of
$1,000,000/$3,000,000 for the patientbased portion of the 2015 SRTA clinical
examination in dental hygiene.
17.
Patients
The candidate must procure his/her own
patient and is responsible for the
patient’s arrival and return. SRTA is not
responsible for procuring patients used
in examinations.
All written and oral communication must
be in English. Candidates may
communicate with their patients in
another language. (See Interpreter
Policy.)
Candidates must advise their patients of
the time required to participate in this
examination. Check-in, clinical
treatment, and final evaluation may
take up to 90 minutes each. Patients
should expect to spend a minimum of
five hours participating in the exam.
Patients may be photographed during
the examination. SRTA uses the images
to revise the examiner standardization.
18.
Patient privacy statement
At the conclusion of the SRTA
Examination, the examiners collect all
patient information. After a 12-month
holding period, the paperwork is
mechanically shredded. Patient data is
not stored electronically or by any other
means. SRTA uses patient information
only for examiner reference during the
examination or during the appeal
process.
Case presentation (that is, identifying a
patient whose dental condition meets
the criteria for the examination) is a
scored part of the examination and
must be completed independently. It is
the candidate’s responsibility to critically
analyze patient data. The candidate
cannot request the recommendation of
a licensed dental or dental hygiene
professional for patient selection.
19.
Professional standards
The purpose of this examination is to
assess professional competency. SRTA
expects the candidates to maintain
professional standards in the following
areas:

Suitable operating attire,
inclusive of the Personal
Protective Equipment. Patients
must wear protective eyewear;
Patients must be at least 18 years of
age. No patient may be a dentist,
dental hygienist, junior/senior dental
student, or dental hygiene student. A
dental assistant, whether a student or a
practicing assistant, may be a patient.
No one with a latex allergy may be a
patient. A woman in her first or third
trimester of pregnancy is not acceptable
87
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candidates must follow OSHA
and CDC Guidelines.
Consideration for patients and
cooperation with examiners, test
site personnel, and other
candidates.
Aseptic techniques and general
cleanliness of the cubicle during
all procedures. Candidates must
maintain proper infection control
throughout the entire
examination. Major violations of
these standards and guidelines
are grounds for immediate
dismissal and possible failure.
SRTA may deny reexamination
for one year (12 months) from
the date of dismissal from the
examination.
Protection of and concern for
tooth structure and supporting
tissue during patient treatment.
The unwarranted occurrence of
major tissue trauma will result in
automatic failure of the entire
examination.
and telephone numbers of all testing
facilities.
Direct all questions concerning
examination procedures, content,
applications, and examination dates to
the Southern Regional Testing Agency:
(757) 318-9082
Email general questions and questions
relating to the dental hygiene
examination to [email protected].
Be sure to include contact information.
Once an application has been processed
for a particular site, all questions for
both pre-examination and postexamination must be initiated by the
candidate only. To preserve candidate
confidentiality, the SRTA staff and
examiners will not discuss candidate
concerns and questions with a
candidate’s spouse, parent, faculty
member, family member, or friend.
Violation of any of these standards
is grounds for immediate dismissal
from the examination. SRTA may
deny reexamination for 12 months.
20.
21.
Reexamination
After three unsuccessful examination
attempts, the candidate must contact
the state in which licensure is sought
and obtain a letter of
approval/permission for a fourth
examination attempt. Some states may
require remedial training after three
unsuccessful attempts. Passing the
examination on four or more attempts
does not negate the required remedial
training. This letter from the state
dental board must be submitted with
the SRTA application for examination.
Follow the same procedure for all
subsequent examination attempts.
Questions
Direct all questions concerning
jurisprudence, licensing, reciprocity, and
licensure by credentials to the
appropriate state board where licensure
is sought. This manual lists the
addresses and telephone numbers of
the SRTA participating boards.
Direct questions concerning testing
facilities, equipment, and facility fees to
the appropriate test site. The
examination site instruction letter,
available on the SRTA website in the
downloadable forms section, may
address most questions. If necessary,
please contact the school/testing site
after thoroughly reading this letter.
This manual has a list of the addresses
22.
Refunds
SRTA will not refund examination fees
for candidates who fail to appear for a
scheduled examination unless SRTA has
received written notification 15 days
88
prior to the application deadline. In
such cases a 50 percent refund may be
given. SRTA does not provide refunds if
the candidate is unable to secure a
patient for the examination or if a
patient fails to appear or is deemed
ineligible by the examiners. Please call
the SRTA office for information on
transfer of application fees.
23.
Examples of unethical conduct include,
but are not limited to:

Using unauthorized equipment at
any time during the exam

Using unauthorized patients

Altering patient records or
radiographs

Treating patients outside clinic
hours or receiving assistance
from another practitioner during
clinical treatment time, except
for the use of a qualified
practitioner for administration of
local anesthesia

Engaging in dishonesty

Altering candidate worksheet or
treatment notes

Any other behavior that
compromises the standards of
professional behavior
Restrictions
Candidates may not use

Nitrous oxide

Air-abrasive instruments

Assistants
24.
Scheduling conflicts
Please contact the SRTA office for any
special requirements, including religious
exemptions.
25.
When SRTA charges a candidate with
unethical conduct, it is SRTA’s policy to
notify all participating state boards of
the situation. Many state statutes have
criteria that include “good moral
character” as a requirement for
licensure. If a state board finds a
candidate guilty of the alleged unethical
conduct, the candidate may be ineligible
for licensure in that state at any time in
the future. While SRTA allows
candidates to retake the SRTA
Examination, they may be unable to
obtain licensure in any participating
state. Candidates are encouraged to
address these matters with the state in
which they desire licensure prior to
retaking the examination.
Sharing equipment
SRTA discourages sharing sonic and
ultrasonic scalers, hand-pieces, and
other equipment because it is possible
that candidates who are sharing
equipment could be placed in the same
testing group and would need to use the
shared equipment simultaneously.
26.
Unethical conduct
Professional behavior is a critical quality
in the practice of dental hygiene.
Candidates exhibiting unethical conduct
are subject to examination termination
and failure of said examination.
89
90
State boards of dentistry
91
STATE BOARDS OF DENTISTRY INFORMATION
SRTA automatically sends each
candidate’s scores to the state boards of
dentistry listed below immediately
following each examination. Candidates
taking the SRTA Examination must also
apply directly to the boards of dentistry
in the states in which they seek
licensure.
participating boards of dentistry are not
available through SRTA. Candidates
must obtain these from the various
boards of dentistry.
Individual state laws regarding remedial
training may vary. Contact the states in
which licensure is sought for their
requirements on remedial education.
SRTA does not provide remedial courses
or instruction.
Note: Some states require a certified or
notarized copy of scores, which SRTA
will provide for a nominal fee. Please
contact our office to request this
additional service.
SRTA’s policy allows score certification
of the most recent examination attempt
for a period of five years. The
individual state boards of dentistry
determine acceptance of scores.
Licensure application forms for the
Arkansas
Tennessee
Donna Cobb, Executive Director
Arkansas Board of Dental Examiners
101 East Capitol Avenue, Suite 111
Little Rock, AR 72201
(501) 682-2085
http://www.asbde.org
Dea Smith, Executive Director
Tennessee Board of Dentistry
Bureau of Health, Licensure & Regulation
Division of Health Related Boards
227 French Landing, Suite 300
Nashville, TN 37243
(800) 778-4123 or (615) 532-3202
http://health.state.tn.us/boards/Dentistry/
Kentucky
Virginia
David Beyer, Executive Director
Kentucky Board of Dentistry
312 Whittington Parkway, Suite 101
Louisville, KY 40222
(502) 429-7280
http://dentistry.ky.gov
Sandra Reen, Executive Director
Virginia Board of Dentistry
9960 Mayland Drive, Suite 300
Richmond, VA 23233-1463
(804) 367-4538
http://www.dhp.virginia.gov/dentistry
South Carolina
West Virginia
Veronica Reynolds, Administrator
South Carolina State Board of Dentistry
Department of Labor, Licensing and Regulation
Synergy Business Park, Kingstree Building
110 Centerview Drive, Suite 306
Columbia, SC 29210
(803) 896-4599
http://www.llr.state.sc.us
Dr. Richard “Duff” Smith, Executive Director
West Virginia Board of Dental Examiners
1319 Robert C. Byrd Drive
P.O. Box 1447
Crab Orchard, WV 25827
(877) 914-8266 or (304) 252-8266
http://www.wvdentalboard.org
Mississippi
Alabama
Leah Diane Howell, Executive Director
Mississippi State Board of Dental Examiners
600 East Amite Street, Suite 100
Jackson, MS 39201-2801
(601) 944-9622
http://www.dentalboard.ms.gov/msbde/msbde.nsf
Susan Franklin Wilhelm, Executive Director
Alabama Board of Dental Examiners
5346 Stadium Trace Pkwy, Ste. 112
Hoover, AL 35244
(205) 985-7267
http://www.dentalboard.org/index.htm
92
faq’s and quick examination
checklist
93
FAQS
1. What is the best method to find
out what I have to do to pass the
SRTA exam?
Read this Candidate Guide multiple
times. Each time through, you will
better understand the processes and
procedures. Mark important
sections with highlighters or Post-it
Notes. Bring this Candidate Guide
to the examination for quick
reference. There is also a helpful
examination overview presentation
on the SRTA website available after
January 1, 2015.
4. Can I use a different explorer
than the 11/12?
No. Examiners will use only the
11/12 explorer, usually an ODU
11/12, to score calculus detection
and removal. If you provide another
type of explorer, the examiners
cannot evaluate the patient and
you will fail the examination. You
may use any scalers or explorers to
complete the calculus detection and
removal exercises, but examiners
use only the 11/12 for check-in and
final evaluation.
2. Where do I get the forms?
All forms are available on your
profile under the “Documents” tab
after your application is complete.
Make multiple copies in case you
make errors. Ensure current year
examination forms are completed in
ink. Complete the Dental Charting
Form in ink or pencil.
5. Can I use any probe I choose?
No. SRTA requires a probe with
markings of 1-2-3-4-5-6-7-8-9-1011-12, e.g. a UNC probe, and colorcoded with yellow banding. If you
do not provide the correct probe, the
examiners will not be able to check
in the patient, and you will fail the
examination.
3. Which forms do I complete prior
to the day of the exam?
Complete the Health History Form,
Post-Operative Care Agreement;
Release Form; Incident Disclaimer;
and Dental Charting Form in full
prior to the day of the exam.
6. What is “qualifying calculus?”
See the ADEX Section of this manual
for the definition of qualifying
calculus. It must be easily
detectable with an 11/12
explorer and cause a definite
“bump” when explored. On all
teeth, calculus must be subgingival
to qualify. Examiners determine
whether a surface of calculus
qualifies. Only surfaces of qualifying
calculus in the selected quadrant
and any additional teeth selected by
the candidate will be eligible for
calculus removal points.
For the Dental Hygiene Procedure
Form, complete Sections 1, 2, 3, 4
(except for anesthesia quantity),
and “Comments to Examiners” prior
to the day of the exam. Do not
complete Sections 5 and 6 of the
Procedure Form until clinical
treatment time begins. Enter
anesthesia quantity in Section 4
after all injections are given.
7. Why do I need to do the calculus
detection exercise before
starting the prophy?
During check-in, examiners
determine the presence or absence
94
of calculus on the four surfaces of
three assigned teeth. If you remove
calculus prior to completing the
detection exercise, you will be
unable to document the presence or
absence of calculus on the assigned
teeth.
on the number of surfaces verified
by at least two examiners as having
qualifying calculus. If that number
is less than 12, the maximum
possible points are lowered and
chances of passing are lower. It is
in your best interest to provide
additional posterior teeth in case the
selected quadrant and the required
additional posterior teeth do not
meet all calculus requirements.
8. Why do I need to complete the
periodontal assessment before
starting the prophy?
Examiners record their own
measurements during check-in.
Removing calculus prior to recording
pocket depths could result in
periodontal errors, as your readings
may vary by more than ± 1 mm
from those recorded by examiners
while calculus was still present on
the surface. In addition, it is quite
common for candidates to become
so involved in the calculus removal
exercise that they run out of time or
forget to do the periodontal
assessment.
10.What radiograph criteria do
examiners evaluate?
Examiners check to see that the
mount has the appropriate
information, that radiographs are of
sufficient diagnostic quality that they
can be determined to belong to the
patient presented, and that
radiographs are mounted correctly.
List your candidate number, the date
the radiographs were exposed, and
the patient's name on the mount or
digital printout.
9. Why should I select additional
teeth for the case presentation?
If you are confident that examiners
can verify at least 12 surfaces of
qualifying calculus in the selected
quadrant and the required posterior
teeth from the second quadrant and
that all of the proximal/posterior
calculus requirements can be met by
those required teeth, you may
choose not to present additional
teeth. However, if there is any
chance that fewer than 12 surfaces
of qualifying calculus can be verified
in the required quadrant and
posteriors from the second quadrant
or that the proximal/posterior
calculus requirements may not be
met by those teeth, it is wise to
select additional teeth for examiners
to evaluate. If examiners verify
fewer than 12 surfaces of qualifying
calculus in the quadrant, you will be
able to earn points for removal only
Radiographs of the selected teeth
must be of sufficient quality for a
dentist to accurately diagnose
caries, periodontal health, or other
dental diseases and abnormalities.
Examiners evaluate only the
radiographs of the selected quadrant
and any additional teeth selected by
the candidate. Examiners dismiss
patients as ineligible if the
radiographs are not of sufficient
quality for examiners to determine
that they are an accurate depiction
of the patient’s mouth, and you will
11.What materials do the examiners
need for check-in and final
evaluation?
For check-in: Dental Hygiene
Procedure Form, Dental Charting
Form, radiographs, 11/12 explorer,
yellow-banded periodontal probe,
95
mirror, air-water syringe tip, 2” x 2”
gauze, saliva ejector, clipboard, two
sharpened No. 2 lead pencils
covered with a plastic film or
aluminum foil barrier
device with a camera, will be
dismissed from the examination.
13.What type of disclosing agents
may I use?
The use of any color or type of
disclosing agent is permissible.
For final evaluation: Radiographs,
11/12 explorer, mirror, clean
barriers, air-water syringe tip, 2” x
2” gauze, saliva ejector, clipboard,
two sharpened No. 2 lead pencils
covered with a plastic film or
aluminum foil barrier
14.What materials do the schools
supply?
Most schools provide disposable
paper products, anesthetic
cartridges, and prophy angles;
however, you may provide your
own. It is your responsibility to
make sure you have the required
instruments and supplies. You will
receive a letter from the testing site
prior to the examination explaining
what supplies they do and do not
provide. Call the examination site
for specific questions regarding
supplies that are or are not
furnished.
For both check-in and final
evaluation, separate all instruments
required by examiners from
instruments used for patient
treatment. If paperwork or
instruments cannot be located,
examiners cannot check-in or
evaluate the patient.
Have the patient seated with a clean
bib. Discard all used gauze and
ensure that the instruments are free
of visible blood or other bioburden.
Cover air-water syringes, saliva
ejectors, prophy angles and other
areas in the treatment area with
clean barriers.
15.Can I use an assistant?
No. SRTA does not allow assistants
for the dental hygiene examination.
16.Can I administer local
anesthesia to my patient?
Yes, if you have completed a local
anesthesia course in a CODAaccredited dental or dental hygiene
school and have submitted the
required paperwork to the SRTA
office. Candidates may administer
up to four carpules. Do not
administer more than two carpules
prior to check-in.
12.What should I tell the patient
about what will happen during
check-in and final evaluation?
Inform the patient not to turn the
light off and not to touch the scoring
forms. Inform the patient that three
or more examiners will be
conducting check-in and evaluations
and that each process could take as
long as 90 minutes. Patients may
take restroom breaks, but the
patient should notify the CFM prior
to leaving the clinic. SRTA
prohibits electronic devices
except for electronic readers
such as Nooks or Kindles.
Patients using other types of
electronic devices, especially any
If you have not completed a local
anesthesia course, you may use
topical anesthesia, including Oraqix
or other non-injectable anesthetic
agents.
You may also arrange for a qualified
practitioner to administer anesthesia
to your patient. SRTA does not
96
make those arrangements. See
Section IV for specific requirements
for using a qualified practitioner.
18.Are ultrasonic scalers provided
by the schools?
No. You must provide your own
ultrasonic scaler. Some schools will
rent them to candidates. Contact
the school to see if this service is
available. SRTA does not arrange
for rental equipment.
17.If my patient does not show up,
can I present a different patient?
If a patient does not show up or if,
prior to the start of check-in, the
candidate realizes that the patient is
ineligible, a different patient may be
presented if the required
radiographs and paperwork are
available. After the start of checkin, no patient substitutions are
allowed.
Additional questions?
Contact the SRTA staff at:
Email: [email protected]
Phone: (757) 318-9082
97
QUICK EXAMINATION CHECKLIST
Patient
 At least 18 years old
 No latex allergy
 No history of bisphosphonate
therapy
 Not in first or third trimester of
pregnancy
 Not a dentist, hygienist, junior
or senior dental student,
hygiene student
 Is presented with diagnosticquality radiographs
 Has a physician’s written
clearance to participate, if any
“Yes” answers are noted on
questions 8. U, V, W, X, Y, Z,
AA, or BB of the Health History
Form
 Take patient’s blood pressure.
Record readings on the Health
History Form.
 Note “Yes” or “No” for Medical
Alerts on the Procedure Form, if
not already completed. Have
CFM enter his/her PIN in
Section 2 of the Procedure
Form.
 If anesthesia is planned, enter
the type of injection(s) planned
and the name of the anesthetic
with percentage of
vasoconstrictor on the
Procedure Form; administer
anesthetic prior to check-in, if
needed. When deciding
whether the patient needs
anesthesia prior to check-in,
remember that three examiners
will be using the explorer and
probe on the patient. Enter
quantity of anesthesia on the
Procedure Form prior to final
evaluation.
 If anesthesia is not planned,
slash through area on the
Procedure Form and write
candidate number on slash
mark.
 Verify the accuracy of case and
surface selections, if entered
prior to the examination date.
Last minute changes can be
made, if needed. The DHC and
CFM will assist with this
process.
Bring to registration/orientation
 Government- or school-issued
photo ID
 Signed Patient Disclaimer,
Consent, and Release Form
 Signed Post-Operative Care
Agreement (two copies)
 Signed Incident Disclaimer
 Completed Patient Health
History
 Credentials of qualified
practitioner, if local anesthesia
is being administered by
someone other than the
candidate
 Receive at
registration/orientation:
admission badge
Preparing for check-in
 Place clean mirror, 11/12
explorer, and probe where
examiners can easily find them
(away from other instruments).
 Place Procedure Form, Dental
Charting Form, and radiographs
Cubicle set-up
 Check equipment, air, water,
light, and chair to ensure proper
functioning. Contact the CFM if
any problems are found.
98
where examiners can easily find
them.
 Have a clipboard and covered
pencils easily available. No
mechanical pencils, please.
 Have patient wear safety
glasses and clean bib; recline
the patient with light on.
 Ensure that patient is free of
gross soft debris.
 Remove ultrasonic/sonic inserts
and contaminated prophy
angles.
 Attach tip to air/water syringe
and a saliva ejector.
 If anesthesia is used, verify that
the quantity is recorded on the
Procedure Form.
 Verify that all periodontal
assessment measurements and
detection findings are recorded
on Procedure Form.
 Ensure that all teeth in the case
selection are free of calculus,
visible plaque, stain, and
prophy paste.
 Have patient wear safety
glasses and clean bib; recline
the patient with light on, if
patient is evaluated in the
cubicle.
Clinical treatment time
 Complete periodontal
measurements and recording.
Blanks are assessed as errors.
 Complete detection exercise.
Blanks are assessed as errors.
 Perform oral prophylaxis on all
teeth in selected quadrant and
additional teeth.
Preparing for final evaluation
 Place clean bib on patient.
 Place clean mirror, 11/12
explorer, and probe where
examiners can easily find them
(away from other instruments).
 Clear area of contaminated
gauze, instruments,
syringes, anesthetic
carpules, floor hazards, etc.
During final evaluation
 With assistance from the DHC
and/or CFM, enter your
detection findings, periodontal
probe measurements, and
anesthetic quantity into the
QUICK TIP
Before sending patient to scoring area or clearing the clinic for final
evaluation:
1.
Are all periodontal pocket measurements entered on the Procedure
Form?
2.
Are all detection YES NO answers circled on the Procedure Form?
3.
Is the quantity of anesthesia used entered on the Procedure Form?
4.
Are clean barriers on all equipment? Does patient have a clean bib?
5.
Are the 11/12 explorer, mirror, and a few clean 2 x 2 gauze squares
on the tray?
6.
Does the patient have a clean bib and eye protection?
99

administered by SRTA - Southern Regional Testing Agency

Transcription

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