ADEX CSCE OSCE ACTUAL EXAM
2026/2027 | 100 Exam Q&A | Verified
Answers | Graded A+ | Updated to Latest
Standards | Pass Guaranteed - A+ Graded
Domain 1: Patient Assessment & Diagnosis (Questions 1–20)
Q1. A 68-year-old patient reports taking warfarin (Coumadin) for atrial fibrillation. Their INR from
yesterday is 3.2 (therapeutic range 2.0–3.0). They need a simple extraction of a mobile tooth #31. What
is the MOST appropriate management?
A. Extract the tooth immediately – INR 3.2 is safe for simple extractions
B. Have the patient stop warfarin for 3 days, then extract
C. Consult with the prescribing physician before extraction and obtain INR on the day of procedure
[CORRECT]
D. Prescribe oral tranexamic acid instead of consulting the physician
Correct Answer: C
Rationale: Current guidelines recommend not stopping warfarin for simple extractions if INR is
therapeutic, but the physician should be consulted when INR is at the upper limit (3.2). Distractor A is
wrong because INR 3.2 is at the high end of therapeutic range and slightly increases bleeding risk; same-
day confirmation is prudent.
Q2. A periapical radiograph of tooth #19 shows a well-defined radiolucency at the apex with a corticated
border. The tooth is non-vital and asymptomatic. What is the MOST likely diagnosis?
A. Periapical granuloma
B. Periapical cyst [CORRECT]
C. Periapical abscess
D. Osteosarcoma
Correct Answer: B
,Rationale: A well-defined, corticated radiolucency at the apex of a non-vital tooth is characteristic of a
periapical cyst. Distractor A (granuloma) typically presents as a poorly defined radiolucency without
cortication.
Q3. A 45-year-old patient with a prosthetic joint replacement (hip, 2 years ago) presents for routine
dental prophylaxis. According to the 2021 AHA guidelines, what is the appropriate management
regarding antibiotic prophylaxis?
A. Prescribe amoxicillin 2 g orally 30–60 minutes before the procedure
B. Prescribe clindamycin 600 mg if penicillin-allergic
C. Antibiotic prophylaxis is NOT indicated for dental procedures [CORRECT]
D. Prescribe azithromycin 500 mg as an alternative
Correct Answer: C
Rationale: The 2021 AHA guidelines do NOT recommend antibiotic prophylaxis for prosthetic joints
during dental procedures due to lack of evidence for efficacy. Distractor A reflects outdated 2007 AHA
guidelines that have been superseded.
Q4. A panoramic radiograph shows a multilocular radiolucency in the posterior mandible with "soap
bubble" or "honeycomb" internal structure. The patient is 28 years old and reports painless swelling.
What is the MOST likely diagnosis?
A. Odontogenic keratocyst
B. Ameloblastoma [CORRECT]
C. Central giant cell granuloma
D. Dentigerous cyst
Correct Answer: B
Rationale: Ameloblastoma classically presents as a multilocular radiolucency with "soap bubble" internal
structure in the posterior mandible. Distractor A (odontogenic keratocyst) is typically unilocular and
associated with an impacted tooth.
Q5. A 55-year-old patient presents with a blood pressure of 168/102 mmHg, is asymptomatic, and is
scheduled for a routine restoration. According to ASA classification, what is the appropriate
classification and management?
A. ASA II; proceed with caution and monitor vitals
B. ASA III; proceed with dental treatment with stress reduction [CORRECT]
,C. ASA IV; defer elective dental treatment
D. ASA I; no modifications needed
Correct Answer: B
Rationale: BP 168/102 mmHg meets criteria for ASA III (systolic ≥160 or diastolic ≥100 mmHg). Elective
dental treatment can proceed with stress reduction and monitoring. Distractor C (ASA IV) is incorrect
because the patient is asymptomatic and not in hypertensive crisis.
Q6. A bitewing radiograph shows a radiolucency extending into the dentin but not reaching the pulp.
According to the ICDAS/ADA caries classification, what is the appropriate depth classification?
A. Enamel caries only
B. Moderate dentin caries [CORRECT]
C. Deep dentin caries
D. Pulpal involvement
Correct Answer: B
Rationale: Radiolucency extending into dentin without pulpal involvement is classified as moderate
dentin caries (ICDAS code 5 or ADA moderate). Distractor C (deep dentin) would show radiolucency
approaching the pulp chamber.
Q7. A patient reports taking alendronate (Fosamax) 70 mg weekly for osteoporosis for 4 years. They
need extraction of tooth #3. What is the MOST appropriate management?
A. Proceed with extraction normally; bisphosphonates do not affect oral surgery
B. Discontinue alendronate 3 months before extraction
C. Perform atraumatic extraction with antibiotic coverage and informed consent regarding osteonecrosis
risk [CORRECT]
D. Refer to oral surgeon for hyperbaric oxygen therapy before extraction
Correct Answer: C
Rationale: For patients on oral bisphosphonates >3 years, atraumatic technique with informed consent
is recommended; drug holiday is controversial and not evidence-based. Distractor B is incorrect because
stopping oral bisphosphonates does not guarantee reduced risk due to long bone half-life.
Q8. A periodontal charting reveals probing depths of 5–7 mm on teeth #2, #3, and #4 with bleeding on
probing, but no furcation exposure or mobility. According to the 2017 AAP/EFP classification, what is the
staging?
, A. Stage I periodontitis
B. Stage II periodontitis [CORRECT]
C. Stage III periodontitis
D. Gingivitis only
Correct Answer: B
Rationale: Probing depths 5–7 mm with interdental clinical attachment loss (CAL) 3–4 mm indicates
Stage II periodontitis. Distractor C (Stage III) requires CAL ≥5 mm, furcation involvement, or mobility.
Q9. A patient with a history of infective endocarditis presents for dental cleaning. According to 2021
AHA guidelines, for which dental procedures is antibiotic prophylaxis indicated?
A. All dental procedures including cleanings
B. Only procedures involving manipulation of gingival tissue, periapical region, or perforation of oral
mucosa [CORRECT]
C. Only extractions and oral surgery
D. No procedures require prophylaxis anymore
Correct Answer: B
Rationale: AHA 2021 guidelines recommend prophylaxis only for procedures with risk of bacteremia
(gingival manipulation, periapical region, mucosal perforation). Distractor A is incorrect because routine
cleanings without tissue manipulation do not require prophylaxis.
Q10. An extraoral examination reveals a firm, non-tender, 2 cm lymph node in the left submandibular
region. The patient has a draining abscess on tooth #19. What is the MOST appropriate next step?
A. Biopsy the lymph node immediately
B. Treat the dental infection and re-evaluate the node in 2 weeks [CORRECT]
C. Prescribe antibiotics only and observe
D. Refer to oncology for metastatic workup
Correct Answer: B
Rationale: Reactive lymphadenopathy from a dental infection should resolve after source control; biopsy
is indicated only if the node persists >2–4 weeks after infection resolution. Distractor A is premature
without first eliminating the infectious source.
2026/2027 | 100 Exam Q&A | Verified
Answers | Graded A+ | Updated to Latest
Standards | Pass Guaranteed - A+ Graded
Domain 1: Patient Assessment & Diagnosis (Questions 1–20)
Q1. A 68-year-old patient reports taking warfarin (Coumadin) for atrial fibrillation. Their INR from
yesterday is 3.2 (therapeutic range 2.0–3.0). They need a simple extraction of a mobile tooth #31. What
is the MOST appropriate management?
A. Extract the tooth immediately – INR 3.2 is safe for simple extractions
B. Have the patient stop warfarin for 3 days, then extract
C. Consult with the prescribing physician before extraction and obtain INR on the day of procedure
[CORRECT]
D. Prescribe oral tranexamic acid instead of consulting the physician
Correct Answer: C
Rationale: Current guidelines recommend not stopping warfarin for simple extractions if INR is
therapeutic, but the physician should be consulted when INR is at the upper limit (3.2). Distractor A is
wrong because INR 3.2 is at the high end of therapeutic range and slightly increases bleeding risk; same-
day confirmation is prudent.
Q2. A periapical radiograph of tooth #19 shows a well-defined radiolucency at the apex with a corticated
border. The tooth is non-vital and asymptomatic. What is the MOST likely diagnosis?
A. Periapical granuloma
B. Periapical cyst [CORRECT]
C. Periapical abscess
D. Osteosarcoma
Correct Answer: B
,Rationale: A well-defined, corticated radiolucency at the apex of a non-vital tooth is characteristic of a
periapical cyst. Distractor A (granuloma) typically presents as a poorly defined radiolucency without
cortication.
Q3. A 45-year-old patient with a prosthetic joint replacement (hip, 2 years ago) presents for routine
dental prophylaxis. According to the 2021 AHA guidelines, what is the appropriate management
regarding antibiotic prophylaxis?
A. Prescribe amoxicillin 2 g orally 30–60 minutes before the procedure
B. Prescribe clindamycin 600 mg if penicillin-allergic
C. Antibiotic prophylaxis is NOT indicated for dental procedures [CORRECT]
D. Prescribe azithromycin 500 mg as an alternative
Correct Answer: C
Rationale: The 2021 AHA guidelines do NOT recommend antibiotic prophylaxis for prosthetic joints
during dental procedures due to lack of evidence for efficacy. Distractor A reflects outdated 2007 AHA
guidelines that have been superseded.
Q4. A panoramic radiograph shows a multilocular radiolucency in the posterior mandible with "soap
bubble" or "honeycomb" internal structure. The patient is 28 years old and reports painless swelling.
What is the MOST likely diagnosis?
A. Odontogenic keratocyst
B. Ameloblastoma [CORRECT]
C. Central giant cell granuloma
D. Dentigerous cyst
Correct Answer: B
Rationale: Ameloblastoma classically presents as a multilocular radiolucency with "soap bubble" internal
structure in the posterior mandible. Distractor A (odontogenic keratocyst) is typically unilocular and
associated with an impacted tooth.
Q5. A 55-year-old patient presents with a blood pressure of 168/102 mmHg, is asymptomatic, and is
scheduled for a routine restoration. According to ASA classification, what is the appropriate
classification and management?
A. ASA II; proceed with caution and monitor vitals
B. ASA III; proceed with dental treatment with stress reduction [CORRECT]
,C. ASA IV; defer elective dental treatment
D. ASA I; no modifications needed
Correct Answer: B
Rationale: BP 168/102 mmHg meets criteria for ASA III (systolic ≥160 or diastolic ≥100 mmHg). Elective
dental treatment can proceed with stress reduction and monitoring. Distractor C (ASA IV) is incorrect
because the patient is asymptomatic and not in hypertensive crisis.
Q6. A bitewing radiograph shows a radiolucency extending into the dentin but not reaching the pulp.
According to the ICDAS/ADA caries classification, what is the appropriate depth classification?
A. Enamel caries only
B. Moderate dentin caries [CORRECT]
C. Deep dentin caries
D. Pulpal involvement
Correct Answer: B
Rationale: Radiolucency extending into dentin without pulpal involvement is classified as moderate
dentin caries (ICDAS code 5 or ADA moderate). Distractor C (deep dentin) would show radiolucency
approaching the pulp chamber.
Q7. A patient reports taking alendronate (Fosamax) 70 mg weekly for osteoporosis for 4 years. They
need extraction of tooth #3. What is the MOST appropriate management?
A. Proceed with extraction normally; bisphosphonates do not affect oral surgery
B. Discontinue alendronate 3 months before extraction
C. Perform atraumatic extraction with antibiotic coverage and informed consent regarding osteonecrosis
risk [CORRECT]
D. Refer to oral surgeon for hyperbaric oxygen therapy before extraction
Correct Answer: C
Rationale: For patients on oral bisphosphonates >3 years, atraumatic technique with informed consent
is recommended; drug holiday is controversial and not evidence-based. Distractor B is incorrect because
stopping oral bisphosphonates does not guarantee reduced risk due to long bone half-life.
Q8. A periodontal charting reveals probing depths of 5–7 mm on teeth #2, #3, and #4 with bleeding on
probing, but no furcation exposure or mobility. According to the 2017 AAP/EFP classification, what is the
staging?
, A. Stage I periodontitis
B. Stage II periodontitis [CORRECT]
C. Stage III periodontitis
D. Gingivitis only
Correct Answer: B
Rationale: Probing depths 5–7 mm with interdental clinical attachment loss (CAL) 3–4 mm indicates
Stage II periodontitis. Distractor C (Stage III) requires CAL ≥5 mm, furcation involvement, or mobility.
Q9. A patient with a history of infective endocarditis presents for dental cleaning. According to 2021
AHA guidelines, for which dental procedures is antibiotic prophylaxis indicated?
A. All dental procedures including cleanings
B. Only procedures involving manipulation of gingival tissue, periapical region, or perforation of oral
mucosa [CORRECT]
C. Only extractions and oral surgery
D. No procedures require prophylaxis anymore
Correct Answer: B
Rationale: AHA 2021 guidelines recommend prophylaxis only for procedures with risk of bacteremia
(gingival manipulation, periapical region, mucosal perforation). Distractor A is incorrect because routine
cleanings without tissue manipulation do not require prophylaxis.
Q10. An extraoral examination reveals a firm, non-tender, 2 cm lymph node in the left submandibular
region. The patient has a draining abscess on tooth #19. What is the MOST appropriate next step?
A. Biopsy the lymph node immediately
B. Treat the dental infection and re-evaluate the node in 2 weeks [CORRECT]
C. Prescribe antibiotics only and observe
D. Refer to oncology for metastatic workup
Correct Answer: B
Rationale: Reactive lymphadenopathy from a dental infection should resolve after source control; biopsy
is indicated only if the node persists >2–4 weeks after infection resolution. Distractor A is premature
without first eliminating the infectious source.
