administered by SRTA - Southern Regional Testing Agency
Transcription
administered by SRTA - Southern Regional Testing Agency
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. 2 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 3 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 4 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. 5 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. 6 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: 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. 7 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 Retained primary teeth Advanced periodontal disease Orthodontic brackets or bonded retainer Gross caries Faulty restorations Implants included in the treatment selection Extensive full or partial veneers Partially erupted third molars Multiple localized probing depths in excess of 6mm 8 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 9 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 10 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, 11 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). 12 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 13 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. 14 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. 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. Must be free of excessive soft debris 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 Must be free of excessive soft debris 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 Southern Regional Testing Agency, Inc. 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. 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 Clinic opens at 6:00 a.m. Friday and Saturday 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 Clinic opens at 6:00 a.m. Friday and Saturday 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 Clinic opens at 6:00 a.m. Friday and Saturday Concorde Career College 5100 Poplar Avenue Suite 132 Memphis, TN 38137 (901) 476-1358 http://www.concorde.edu/programs/dentalhygiene Clinic opens at 6:00 a.m. Friday and Saturday University of Louisville School of Dentistry 501 South Preston Louisville, KY 40292 (502) 852-5128 http://louisville.edu/dental/hygiene Clinic opens at 6:00 a.m. Friday and Saturday Western Kentucky University 1906 College Heights Boulevard, #11032 Bowling Green, KY 42101 (270) 745-2427 http://www.wku.edu/dentalhygiene/ Clinic opens at 6:00 a.m. Friday and Saturday West Virginia BridgeValley Community & Technical College 604 Davis Hall Montgomery, WV 25136 (304) 442-3345 http://www.bridgevalley.edu/dental-hygiene Clinic opens at 6:15 a.m. Friday and Saturday West Virginia University School of Dentistry One Medical Center Drive Morgantown, WV 26506-9401 (304) 293-7307 www.hsc.wvu.edu/sod/Departments Clinic opens at 6:00 a.m. Friday and Saturday 40 Remington College 441 Donelson Pike Nashville, TN 37214 (615) 493-9356 http://www.remingtoncollege.edu/dentalhygiene-schools/ Clinic opens at 6:00 a.m. Friday and Saturday 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/ Clinic opens at 6:00 a.m. Friday and Saturday Missouri Ozarks Technical Community College 1001 E. Chestnut Expressway Springfield, MO 65802 (417) 447-8829 http://www.otc.edu/allied health Clinic opens at 6:00 a.m. Friday and Saturday Examination site contact information South Carolina Greenville Technical College 50 Skyview Drive Greenville, SC 29606-5616 (864) 250-8588 http://www.gvltec.edu/dental Clinic opens at 6:00 a.m. Friday and Saturday Midlands Technical College 1260 Lexington Drive West Columbia, SC 29170 (803) 822-3451 http://www.midlandstech.edu Clinic opens at 6:00 a.m. Friday and Saturday Virginia Old Dominion University 4608 Hampton Boulevard 1101 C Health Sciences Building Norfolk, VA 23529-0499 (757) 683-5241 http://hs.odu.edu/dental/ Clinic opens at 6:30 a.m. Friday and Saturday Virginia Commonwealth University School of Dentistry 520 North 12th Street Richmond, VA 23298-0566 (804) 828-7978 http://www.dentistry.vcu.edu/prospective/dh/ Clinic opens at 6:00 a.m. Friday and Saturday 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 Patient Disclaimer, Consent, and 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.” Complete in ink prior to check-in: 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. Complete in ink prior to check-in: 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 computer-scoring program. 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 Southern Regional Testing Agency, Inc. 4698 Honeygrove Road, Suite 2 Virginia Beach, VA 23455-5934 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 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. 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 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 fail the examination. 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 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: 4698 Honeygrove Road, Suite 2 Virginia Beach, VA 23455-5934 (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; Patient Disclaimer, Consent, and 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 fail the examination. 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 computer-scoring program. 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