ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
ADEX CSCE OSCE Exam
2026/2027 Edition
100 Actual Exam Questions with 100% Verified Answers
Graded A+ | Updated to the Latest Clinical Standards
Examination ADEX CSCE / OSCE Clinical Skills Competency
Issuing Body CDCA (Commission on Dental Competency Assessments)
Format Multiple Choice - 100 Questions, 4 Options Each, One Correct Answer
Cognitive Distribution 25% Recall | 50% Application | 25% Analysis
Question Style 75% Scenario-Based | 25% Direct Recall / Clinical Identification
Aligned Standards 2026-2027 ADEX / CDCA / AAP / AAE / AAPD / ADA / AAOMS / AHA / CDC / OSHA
Total Sections 8 Comprehensive Content Domains
Examination Overview: This comprehensive 100-question examination is designed to assess clinical competency for candidates
preparing for the ADEX Clinical Skills Competency Examination (CSCE) and Objective Structured Clinical Examination (OSCE)
administered by the Commission on Dental Competency Assessments (CDCA). The questions align with the latest 2026-2027 clinical
standards, including updated guidelines from the American Academy of Periodontology (AAP), American Association of Endodontists
(AAE), American Academy of Pediatric Dentistry (AAPD), American Association of Oral and Maxillofacial Surgeons (AAOMS),
American Heart Association (AHA), Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health
Administration (OSHA). Each question includes a detailed rationale with evidence-based clinical reasoning, diagnostic criteria,
treatment principles, pharmacology, and patient safety considerations to support deep learning and exam preparation.
SECTION 1: Patient Assessment and Medical History
Comprehensive Patient Evaluation | Medical History Review | Risk Assessment | Vital Signs (Q1 - Q15)
Q1: A 58-year-old male presents for extraction of tooth #14. His medical history includes stable angina treated
with nitroglycerin PRN, hypertension controlled with lisinopril, and type 2 diabetes (HbA1c 6.4%). Vital signs: BP
138/86 mmHg, HR 78 bpm, RR 16, SpO2 97% on room air. According to ASA Physical Status Classification, this
patient is best classified as:
A. ASA I - normal healthy patient
B. ASA II - mild systemic disease without substantive functional limitation
C. ASA III - severe systemic disease with substantive functional limitation [CORRECT]
D. ASA IV - severe systemic disease that is a constant threat to life
Correct Answer: C
Rationale: ASA III describes a patient with severe systemic disease that produces substantive functional limitation. Stable angina with
documented coronary artery disease, hypertension, and type 2 diabetes constitute multiple systemic diseases that limit physiologic
reserve under stress. ASA I applies to healthy patients with no systemic disease; ASA II covers mild disease (e.g., controlled
hypertension alone) without functional limitation; ASA IV is reserved for disease that represents a constant threat to life (e.g., unstable
angina, recent MI). This patient's combination of cardiovascular comorbidities warrants the ASA III designation, which mandates
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 1
,ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
intraoperative monitoring, shorter appointments, and consideration of stress reduction protocol.
Q2: A 45-year-old female is scheduled for three quadrants of scaling and root planing. Her blood pressure
recorded at the start of appointment is 162/104 mmHg, repeatable at 158/100 mmHg after 5 minutes of rest. She is
asymptomatic and currently takes no antihypertensive medications. The most appropriate management is to:
A. Proceed with the procedure using local anesthesia without epinephrine to avoid BP elevation
B. Proceed with the procedure but monitor BP every 15 minutes throughout
C. Defer elective dental treatment and refer the patient for medical evaluation of stage 2 hypertension
[CORRECT]
D. Administer a single dose of diazepam 5 mg for anxiolysis and proceed with treatment
Correct Answer: C
Rationale: Per the 2017 ACC/AHA hypertension guideline and the ADA 2024 update, persistent BP readings ≥160/100 mmHg (Stage
2 hypertension) in an asymptomatic patient warrant medical referral within one month, and elective surgical procedures involving
sedation should be deferred. Local anesthesia with epinephrine is not contraindicated in hypertensive patients when BP is controlled,
but at this pressure the risk of hypertensive crisis or stroke is elevated. Proceeding with or without epinephrine or using anxiolytics
without medical evaluation is contraindicated. Asymptomatic stage 2 hypertension does not require emergency department transfer, but
it does require physician evaluation prior to elective surgical care.
Q3: A 67-year-old female who has been taking alendronate (70 mg weekly) orally for 8 years for osteoporosis
requires extraction of two non-restorable mandibular premolars. The most appropriate management consistent
with the 2024 AAOMS position paper on medication-related osteonecrosis of the jaw (MRONJ) is:
A. Discontinue alendronate for 2 months before and 3 months after extraction to eliminate MRONJ risk
B. Proceed with atraumatic extraction without discontinuation; implement conservative surgical technique,
primary closure, chlorhexidine rinse, and antibiotic coverage [CORRECT]
C. Refer the patient for an IV bisphosphonate workup and serum CTX testing before any surgical intervention
D. Defer extraction indefinitely and provide non-surgical management only, as any extraction will result in MRONJ
Correct Answer: B
Rationale: Per the 2024 AAOMS Update, patients on oral bisphosphonates for less than 4 years or 4+ years without concomitant risk
factors carry a low MRONJ risk (0.01-0.05%) and surgical management may proceed with atraumatic technique, primary closure where
possible, chlorhexidine 0.12% rinse, and perioperative antibiotic coverage. Drug holidays are no longer routinely recommended for oral
bisphosphonate patients based on current evidence. CTX testing lacks sensitivity and specificity and is not recommended for risk
stratification. Indefinite deferral of necessary treatment leads to worsening infection and is contraindicated. IV bisphosphonate workup
is unnecessary for an oral alendronate patient without oncologic indications.
Q4: A 52-year-old male with a total hip replacement performed 18 months ago presents for routine periodontal
maintenance and restoration of caries on tooth #3. According to the 2014 ADA/AAOS shared decision-making
statement and the 2024 ADA clinical practice guideline, antibiotic prophylaxis prior to dental procedures is:
A. Required for all dental procedures that involve manipulation of gingival tissue for the patient's lifetime
B. Not routinely indicated; may be considered only for patients with prosthetic joints and high-risk host factors
within the first 2 years following placement [CORRECT]
C. Required only for the first 6 months after joint placement and then discontinued
D. Required for any patient who has had a prosthetic joint replacement if mucosal bleeding is anticipated
Correct Answer: B
Rationale: The 2014 ADA/AAOS Shared Decision-Making Statement and the 2024 ADA Clinical Practice Guideline on prosthetic
joint prophylaxis concluded that evidence does not support routine antibiotic prophylaxis for patients with prosthetic joints undergoing
dental procedures. Prophylaxis may be considered on a case-by-case basis for patients with prosthetic joints and high-risk host factors
(immunosuppression, history of PJI, malnourishment, hemophilia) within the first 2 years following arthroplasty. The previous lifetime
recommendation has been retired, and the 6-month cutoff is no longer the sole determinant. The shared decision-making approach
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 2
,ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
requires informed discussion between dentist, physician, and patient, with documentation of the rationale for any prescription.
Q5: A 71-year-old male on warfarin 5 mg daily for atrial fibrillation requires extraction of tooth #19. Preoperative
INR drawn yesterday is 2.4. Laboratory normal range is 0.8-1.2. The most appropriate management is:
A. Discontinue warfarin 3 days prior to extraction and resume 24 hours postoperatively
B. Bridge with low-molecular-weight heparin (LMWH) prior to extraction
C. Proceed with extraction using local hemostatic measures (sutures, oxidized cellulose, socket compression)
without altering anticoagulation [CORRECT]
D. Reduce warfarin dose by 50% for one week prior to extraction and proceed
Correct Answer: C
Rationale: Current 2024 evidence and the CHEST guideline indicate that patients with INR ≤ 3.5 can safely undergo simple dental
extractions without discontinuing or modifying warfarin therapy. Discontinuation increases thromboembolic risk (stroke, systemic
embolism) significantly. Bridging with LMWH is reserved for high-thrombotic-risk patients requiring invasive procedures, not routine
extractions. Local hemostatic measures - suturing with resorbable 4-0 chromic gut, placement of oxidized regenerated cellulose
(Surgicel) into the socket, and digital compression - are sufficient. INR should be verified within 24 hours of the procedure for patients
on stable warfarin therapy.
Q6: A patient reports a "severe allergic reaction" to latex gloves during a previous medical appointment
characterized by urticaria, bronchospasm, and hypotension requiring epinephrine administration. For an
upcoming dental procedure requiring rubber dam isolation, the most appropriate action is to:
A. Use nitrile rubber dam and ensure the operatory has been latex-free for at least 24 hours, with epinephrine and
emergency equipment immediately available [CORRECT]
B. Use a low-protein latex rubber dam as the protein content has been reduced sufficiently to prevent type I reactions
C. Administer diphenhydramine 50 mg orally 30 minutes before the procedure and proceed with standard latex dam
D. Avoid rubber dam entirely and proceed with cotton roll isolation only
Correct Answer: A
Rationale: A history of type I IgE-mediated latex anaphylaxis (urticaria + bronchospasm + hypotension) is an absolute contraindication
to any latex exposure. Even low-protein latex retains residual antigen and is contraindicated. Pre-procedural antihistamine does not
prevent anaphylaxis. The operatory must be latex-free for 24 hours to remove aerosolized latex allergen from prior patients, and
emergency medications including epinephrine autoinjector must be immediately accessible. Avoiding rubber dam entirely compromises
isolation and procedural quality, while nitrile rubber dams (e.g., HandiDam, Aseptico nitrile) provide equivalent isolation without latex
exposure.
Q7: A 29-year-old female at 28 weeks gestation presents with a symptomatic carious lesion on tooth #30 requiring
restoration. She has pregnancy-related gingivitis and mild preeclampsia managed by her obstetrician. Vital signs:
BP 142/92 mmHg, HR 88. The most appropriate management consistent with ACOG and ADA 2024 guidelines is:
A. Defer all dental treatment until the postpartum period to avoid fetal risk
B. Proceed with restorative treatment using lidocaine with epinephrine (1:100,000), positioning the patient
semi-supine with right hip elevation, limiting the appointment to under 30 minutes [CORRECT]
C. Use local anesthesia without epinephrine to prevent uterine contraction and proceed with treatment
D. Administer dental treatment only in a hospital operating room setting under obstetric consultation
Correct Answer: B
Rationale: The 2024 ACOG Committee Opinion and ADA 2024 guidance confirm that routine dental care, including restorative
procedures with local anesthesia (lidocaine 2% with 1:100,000 epinephrine), is safe and recommended throughout pregnancy, with the
second trimester being optimal. The semi-supine position with right hip tilt prevents supine hypotensive syndrome by displacing the
gravid uterus off the inferior vena cava. Epinephrine at standard dental doses does not cause uterine contraction and avoids the shorter
duration and higher toxicity risk of plain lidocaine. Deferral risks progression of caries and potential odontogenic infection, which
poses greater fetal risk than treatment. Hospital OR is reserved for emergencies or complex cases unmanageable in an outpatient
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 3
, ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
setting.
Q8: According to the 2021 AHA Scientific Statement on antibiotic prophylaxis for infective endocarditis
(reaffirmed 2024), which of the following cardiac conditions REQUIRES antibiotic prophylaxis prior to dental
procedures involving manipulation of gingival tissue or perforation of oral mucosa?
A. Mitral valve prolapse without regurgitation
B. Physiologic/innocent heart murmur with no structural abnormality
C. Previous coronary artery bypass graft (CABG) surgery
D. Previous infective endocarditis with native valve involvement [CORRECT]
Correct Answer: D
Rationale: The 2021 AHA Scientific Statement (reaffirmed 2024) restricts IE prophylaxis to four highest-risk conditions: (1)
prosthetic cardiac valves, (2) previous IE, (3) certain congenital heart diseases (unrepaired cyanotic CHD, repaired CHD with prosthetic
material within 6 months, repaired CHD with residual defect adjacent to prosthetic material), and (4) cardiac transplant recipients with
valvular regurgitation due to structurally abnormal valve. Previous IE on a native valve carries among the highest risks of recurrence.
MVP without regurgitation, innocent murmurs, CABG, and most other conditions do not require prophylaxis. The recommended
regimen is amoxicillin 2 g PO (50 mg/kg for children) 30-60 minutes preoperatively, with clindamycin 600 mg as the alternative for
penicillin-allergic patients.
Q9: A 60-year-old male with type 2 diabetes presents for routine extraction of tooth #5. His most recent HbA1c
(drawn 2 weeks ago) is 9.4%, and he reports fasting blood glucose typically 200-260 mg/dL. The most appropriate
management is:
A. Proceed with extraction; glycemic control does not affect surgical outcomes
B. Proceed with extraction but prescribe prophylactic amoxicillin for 7 days postoperatively
C. Defer extraction and refer to the patient's endocrinologist/primary care physician for glycemic optimization
before surgical treatment [CORRECT]
D. Proceed with extraction but limit to morning appointment and verify capillary blood glucose is > 300 mg/dL prior to
injection
Correct Answer: C
Rationale: HbA1c > 8.5-9% reflects poor glycemic control over the prior 2-3 months and is associated with significantly increased risk
of postoperative infection, delayed wound healing, and dry socket. Per the 2024 ADA Standards of Care, elective oral surgery should
be deferred until glycemic control is optimized. Routine prophylactic antibiotics are not indicated solely for diabetes but may be
considered on a case-by-case basis for poorly controlled diabetics requiring emergency treatment. Morning appointments are
recommended for diabetics, but treatment should be deferred if random glucose is < 70 mg/dL (hypoglycemia risk) or > 200-250
mg/dL if HbA1c is also elevated (poor control). Referral for medical optimization prior to surgery represents evidence-based care.
Q10: A 35-year-old female with moderate persistent asthma (controlled with fluticasone/salmeterol daily and
albuterol PRN) presents for restorative care. During the appointment she develops wheezing, dyspnea, and chest
tightness after placement of the rubber dam. Her SpO2 drops from 98% to 93%. The most appropriate immediate
management is to:
A. Place the patient in supine position, administer oxygen at 4 L/min via nasal cannula, and call 911
B. Position the patient upright, remove rubber dam and any intraoral materials, administer albuterol inhaler (2-4
puffs with spacer), and monitor SpO2; administer oxygen if SpO2 < 92% [CORRECT]
C. Administer subcutaneous epinephrine 0.3 mg immediately and call emergency medical services
D. Administer diphenhydramine 50 mg IV/IM and observe for 30 minutes
Correct Answer: B
Rationale: This clinical presentation is an acute asthma exacerbation triggered by either stress or latex from the rubber dam.
Positioning upright optimizes diaphragmatic excursion; removing the rubber dam eliminates potential latex trigger and oral obstruction.
Albuterol (short-acting beta-2 agonist) is the first-line rescue medication. Oxygen supplementation is indicated when SpO2 falls below
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 4
ADEX CSCE OSCE Exam
2026/2027 Edition
100 Actual Exam Questions with 100% Verified Answers
Graded A+ | Updated to the Latest Clinical Standards
Examination ADEX CSCE / OSCE Clinical Skills Competency
Issuing Body CDCA (Commission on Dental Competency Assessments)
Format Multiple Choice - 100 Questions, 4 Options Each, One Correct Answer
Cognitive Distribution 25% Recall | 50% Application | 25% Analysis
Question Style 75% Scenario-Based | 25% Direct Recall / Clinical Identification
Aligned Standards 2026-2027 ADEX / CDCA / AAP / AAE / AAPD / ADA / AAOMS / AHA / CDC / OSHA
Total Sections 8 Comprehensive Content Domains
Examination Overview: This comprehensive 100-question examination is designed to assess clinical competency for candidates
preparing for the ADEX Clinical Skills Competency Examination (CSCE) and Objective Structured Clinical Examination (OSCE)
administered by the Commission on Dental Competency Assessments (CDCA). The questions align with the latest 2026-2027 clinical
standards, including updated guidelines from the American Academy of Periodontology (AAP), American Association of Endodontists
(AAE), American Academy of Pediatric Dentistry (AAPD), American Association of Oral and Maxillofacial Surgeons (AAOMS),
American Heart Association (AHA), Centers for Disease Control and Prevention (CDC), and the Occupational Safety and Health
Administration (OSHA). Each question includes a detailed rationale with evidence-based clinical reasoning, diagnostic criteria,
treatment principles, pharmacology, and patient safety considerations to support deep learning and exam preparation.
SECTION 1: Patient Assessment and Medical History
Comprehensive Patient Evaluation | Medical History Review | Risk Assessment | Vital Signs (Q1 - Q15)
Q1: A 58-year-old male presents for extraction of tooth #14. His medical history includes stable angina treated
with nitroglycerin PRN, hypertension controlled with lisinopril, and type 2 diabetes (HbA1c 6.4%). Vital signs: BP
138/86 mmHg, HR 78 bpm, RR 16, SpO2 97% on room air. According to ASA Physical Status Classification, this
patient is best classified as:
A. ASA I - normal healthy patient
B. ASA II - mild systemic disease without substantive functional limitation
C. ASA III - severe systemic disease with substantive functional limitation [CORRECT]
D. ASA IV - severe systemic disease that is a constant threat to life
Correct Answer: C
Rationale: ASA III describes a patient with severe systemic disease that produces substantive functional limitation. Stable angina with
documented coronary artery disease, hypertension, and type 2 diabetes constitute multiple systemic diseases that limit physiologic
reserve under stress. ASA I applies to healthy patients with no systemic disease; ASA II covers mild disease (e.g., controlled
hypertension alone) without functional limitation; ASA IV is reserved for disease that represents a constant threat to life (e.g., unstable
angina, recent MI). This patient's combination of cardiovascular comorbidities warrants the ASA III designation, which mandates
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 1
,ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
intraoperative monitoring, shorter appointments, and consideration of stress reduction protocol.
Q2: A 45-year-old female is scheduled for three quadrants of scaling and root planing. Her blood pressure
recorded at the start of appointment is 162/104 mmHg, repeatable at 158/100 mmHg after 5 minutes of rest. She is
asymptomatic and currently takes no antihypertensive medications. The most appropriate management is to:
A. Proceed with the procedure using local anesthesia without epinephrine to avoid BP elevation
B. Proceed with the procedure but monitor BP every 15 minutes throughout
C. Defer elective dental treatment and refer the patient for medical evaluation of stage 2 hypertension
[CORRECT]
D. Administer a single dose of diazepam 5 mg for anxiolysis and proceed with treatment
Correct Answer: C
Rationale: Per the 2017 ACC/AHA hypertension guideline and the ADA 2024 update, persistent BP readings ≥160/100 mmHg (Stage
2 hypertension) in an asymptomatic patient warrant medical referral within one month, and elective surgical procedures involving
sedation should be deferred. Local anesthesia with epinephrine is not contraindicated in hypertensive patients when BP is controlled,
but at this pressure the risk of hypertensive crisis or stroke is elevated. Proceeding with or without epinephrine or using anxiolytics
without medical evaluation is contraindicated. Asymptomatic stage 2 hypertension does not require emergency department transfer, but
it does require physician evaluation prior to elective surgical care.
Q3: A 67-year-old female who has been taking alendronate (70 mg weekly) orally for 8 years for osteoporosis
requires extraction of two non-restorable mandibular premolars. The most appropriate management consistent
with the 2024 AAOMS position paper on medication-related osteonecrosis of the jaw (MRONJ) is:
A. Discontinue alendronate for 2 months before and 3 months after extraction to eliminate MRONJ risk
B. Proceed with atraumatic extraction without discontinuation; implement conservative surgical technique,
primary closure, chlorhexidine rinse, and antibiotic coverage [CORRECT]
C. Refer the patient for an IV bisphosphonate workup and serum CTX testing before any surgical intervention
D. Defer extraction indefinitely and provide non-surgical management only, as any extraction will result in MRONJ
Correct Answer: B
Rationale: Per the 2024 AAOMS Update, patients on oral bisphosphonates for less than 4 years or 4+ years without concomitant risk
factors carry a low MRONJ risk (0.01-0.05%) and surgical management may proceed with atraumatic technique, primary closure where
possible, chlorhexidine 0.12% rinse, and perioperative antibiotic coverage. Drug holidays are no longer routinely recommended for oral
bisphosphonate patients based on current evidence. CTX testing lacks sensitivity and specificity and is not recommended for risk
stratification. Indefinite deferral of necessary treatment leads to worsening infection and is contraindicated. IV bisphosphonate workup
is unnecessary for an oral alendronate patient without oncologic indications.
Q4: A 52-year-old male with a total hip replacement performed 18 months ago presents for routine periodontal
maintenance and restoration of caries on tooth #3. According to the 2014 ADA/AAOS shared decision-making
statement and the 2024 ADA clinical practice guideline, antibiotic prophylaxis prior to dental procedures is:
A. Required for all dental procedures that involve manipulation of gingival tissue for the patient's lifetime
B. Not routinely indicated; may be considered only for patients with prosthetic joints and high-risk host factors
within the first 2 years following placement [CORRECT]
C. Required only for the first 6 months after joint placement and then discontinued
D. Required for any patient who has had a prosthetic joint replacement if mucosal bleeding is anticipated
Correct Answer: B
Rationale: The 2014 ADA/AAOS Shared Decision-Making Statement and the 2024 ADA Clinical Practice Guideline on prosthetic
joint prophylaxis concluded that evidence does not support routine antibiotic prophylaxis for patients with prosthetic joints undergoing
dental procedures. Prophylaxis may be considered on a case-by-case basis for patients with prosthetic joints and high-risk host factors
(immunosuppression, history of PJI, malnourishment, hemophilia) within the first 2 years following arthroplasty. The previous lifetime
recommendation has been retired, and the 6-month cutoff is no longer the sole determinant. The shared decision-making approach
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 2
,ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
requires informed discussion between dentist, physician, and patient, with documentation of the rationale for any prescription.
Q5: A 71-year-old male on warfarin 5 mg daily for atrial fibrillation requires extraction of tooth #19. Preoperative
INR drawn yesterday is 2.4. Laboratory normal range is 0.8-1.2. The most appropriate management is:
A. Discontinue warfarin 3 days prior to extraction and resume 24 hours postoperatively
B. Bridge with low-molecular-weight heparin (LMWH) prior to extraction
C. Proceed with extraction using local hemostatic measures (sutures, oxidized cellulose, socket compression)
without altering anticoagulation [CORRECT]
D. Reduce warfarin dose by 50% for one week prior to extraction and proceed
Correct Answer: C
Rationale: Current 2024 evidence and the CHEST guideline indicate that patients with INR ≤ 3.5 can safely undergo simple dental
extractions without discontinuing or modifying warfarin therapy. Discontinuation increases thromboembolic risk (stroke, systemic
embolism) significantly. Bridging with LMWH is reserved for high-thrombotic-risk patients requiring invasive procedures, not routine
extractions. Local hemostatic measures - suturing with resorbable 4-0 chromic gut, placement of oxidized regenerated cellulose
(Surgicel) into the socket, and digital compression - are sufficient. INR should be verified within 24 hours of the procedure for patients
on stable warfarin therapy.
Q6: A patient reports a "severe allergic reaction" to latex gloves during a previous medical appointment
characterized by urticaria, bronchospasm, and hypotension requiring epinephrine administration. For an
upcoming dental procedure requiring rubber dam isolation, the most appropriate action is to:
A. Use nitrile rubber dam and ensure the operatory has been latex-free for at least 24 hours, with epinephrine and
emergency equipment immediately available [CORRECT]
B. Use a low-protein latex rubber dam as the protein content has been reduced sufficiently to prevent type I reactions
C. Administer diphenhydramine 50 mg orally 30 minutes before the procedure and proceed with standard latex dam
D. Avoid rubber dam entirely and proceed with cotton roll isolation only
Correct Answer: A
Rationale: A history of type I IgE-mediated latex anaphylaxis (urticaria + bronchospasm + hypotension) is an absolute contraindication
to any latex exposure. Even low-protein latex retains residual antigen and is contraindicated. Pre-procedural antihistamine does not
prevent anaphylaxis. The operatory must be latex-free for 24 hours to remove aerosolized latex allergen from prior patients, and
emergency medications including epinephrine autoinjector must be immediately accessible. Avoiding rubber dam entirely compromises
isolation and procedural quality, while nitrile rubber dams (e.g., HandiDam, Aseptico nitrile) provide equivalent isolation without latex
exposure.
Q7: A 29-year-old female at 28 weeks gestation presents with a symptomatic carious lesion on tooth #30 requiring
restoration. She has pregnancy-related gingivitis and mild preeclampsia managed by her obstetrician. Vital signs:
BP 142/92 mmHg, HR 88. The most appropriate management consistent with ACOG and ADA 2024 guidelines is:
A. Defer all dental treatment until the postpartum period to avoid fetal risk
B. Proceed with restorative treatment using lidocaine with epinephrine (1:100,000), positioning the patient
semi-supine with right hip elevation, limiting the appointment to under 30 minutes [CORRECT]
C. Use local anesthesia without epinephrine to prevent uterine contraction and proceed with treatment
D. Administer dental treatment only in a hospital operating room setting under obstetric consultation
Correct Answer: B
Rationale: The 2024 ACOG Committee Opinion and ADA 2024 guidance confirm that routine dental care, including restorative
procedures with local anesthesia (lidocaine 2% with 1:100,000 epinephrine), is safe and recommended throughout pregnancy, with the
second trimester being optimal. The semi-supine position with right hip tilt prevents supine hypotensive syndrome by displacing the
gravid uterus off the inferior vena cava. Epinephrine at standard dental doses does not cause uterine contraction and avoids the shorter
duration and higher toxicity risk of plain lidocaine. Deferral risks progression of caries and potential odontogenic infection, which
poses greater fetal risk than treatment. Hospital OR is reserved for emergencies or complex cases unmanageable in an outpatient
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 3
, ADEX CSCE OSCE Exam | 2026/2027 Edition - 100 Verified Questions (Graded A+) Updated to Latest Clinical Standards
setting.
Q8: According to the 2021 AHA Scientific Statement on antibiotic prophylaxis for infective endocarditis
(reaffirmed 2024), which of the following cardiac conditions REQUIRES antibiotic prophylaxis prior to dental
procedures involving manipulation of gingival tissue or perforation of oral mucosa?
A. Mitral valve prolapse without regurgitation
B. Physiologic/innocent heart murmur with no structural abnormality
C. Previous coronary artery bypass graft (CABG) surgery
D. Previous infective endocarditis with native valve involvement [CORRECT]
Correct Answer: D
Rationale: The 2021 AHA Scientific Statement (reaffirmed 2024) restricts IE prophylaxis to four highest-risk conditions: (1)
prosthetic cardiac valves, (2) previous IE, (3) certain congenital heart diseases (unrepaired cyanotic CHD, repaired CHD with prosthetic
material within 6 months, repaired CHD with residual defect adjacent to prosthetic material), and (4) cardiac transplant recipients with
valvular regurgitation due to structurally abnormal valve. Previous IE on a native valve carries among the highest risks of recurrence.
MVP without regurgitation, innocent murmurs, CABG, and most other conditions do not require prophylaxis. The recommended
regimen is amoxicillin 2 g PO (50 mg/kg for children) 30-60 minutes preoperatively, with clindamycin 600 mg as the alternative for
penicillin-allergic patients.
Q9: A 60-year-old male with type 2 diabetes presents for routine extraction of tooth #5. His most recent HbA1c
(drawn 2 weeks ago) is 9.4%, and he reports fasting blood glucose typically 200-260 mg/dL. The most appropriate
management is:
A. Proceed with extraction; glycemic control does not affect surgical outcomes
B. Proceed with extraction but prescribe prophylactic amoxicillin for 7 days postoperatively
C. Defer extraction and refer to the patient's endocrinologist/primary care physician for glycemic optimization
before surgical treatment [CORRECT]
D. Proceed with extraction but limit to morning appointment and verify capillary blood glucose is > 300 mg/dL prior to
injection
Correct Answer: C
Rationale: HbA1c > 8.5-9% reflects poor glycemic control over the prior 2-3 months and is associated with significantly increased risk
of postoperative infection, delayed wound healing, and dry socket. Per the 2024 ADA Standards of Care, elective oral surgery should
be deferred until glycemic control is optimized. Routine prophylactic antibiotics are not indicated solely for diabetes but may be
considered on a case-by-case basis for poorly controlled diabetics requiring emergency treatment. Morning appointments are
recommended for diabetics, but treatment should be deferred if random glucose is < 70 mg/dL (hypoglycemia risk) or > 200-250
mg/dL if HbA1c is also elevated (poor control). Referral for medical optimization prior to surgery represents evidence-based care.
Q10: A 35-year-old female with moderate persistent asthma (controlled with fluticasone/salmeterol daily and
albuterol PRN) presents for restorative care. During the appointment she develops wheezing, dyspnea, and chest
tightness after placement of the rubber dam. Her SpO2 drops from 98% to 93%. The most appropriate immediate
management is to:
A. Place the patient in supine position, administer oxygen at 4 L/min via nasal cannula, and call 911
B. Position the patient upright, remove rubber dam and any intraoral materials, administer albuterol inhaler (2-4
puffs with spacer), and monitor SpO2; administer oxygen if SpO2 < 92% [CORRECT]
C. Administer subcutaneous epinephrine 0.3 mg immediately and call emergency medical services
D. Administer diphenhydramine 50 mg IV/IM and observe for 30 minutes
Correct Answer: B
Rationale: This clinical presentation is an acute asthma exacerbation triggered by either stress or latex from the rubber dam.
Positioning upright optimizes diaphragmatic excursion; removing the rubber dam eliminates potential latex trigger and oral obstruction.
Albuterol (short-acting beta-2 agonist) is the first-line rescue medication. Oxygen supplementation is indicated when SpO2 falls below
CDCA / ADEX Clinical Skills Competency Examination Preparation Page 4
