DENTAL HYGIENE
PROMETRIC EXAM, CSCE
Computer Simulated Dental Hygiene Examination
CDCA & ADEX Dental Hygiene Examination Standards
DENTAL HYGIENE COMPUTER SIMULATED CASE TEST
QUESTIONS WITH COMPLETE SOLUTIONS
Edition
Total Questions 150
Sections 9
Format Multiple Choice (A-D)
Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Style 80% Scenario-Based / 20% Direct Knowledge
CDCA CSCE Blueprint, ADEX Standards, Prometric
Alignment
Guidelines
Section 1: Patient Assessment & Medical History (Q1–Q20)
Section 2: Dental Radiography & Interpretation (Q21–Q35)
Section 3: Periodontal Assessment & Charting (Q36–Q55)
Section 4: Treatment Planning & Case Management (Q56–Q75)
Section 5: Dental Hygiene Diagnosis & Care Planning (Q76–Q90)
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
,Dental Hygiene Prometric Exam, CSCE | 2026/2027 Edition Page 2
Section 6: Local Anesthesia & Pain Management (Q91–Q105)
Section 7: Infection Control & Safety (Q106–Q120)
Section 8: Dental Materials & Instrumentation (Q121–Q130)
Section 9: CSCE Case Studies & Simulated Scenarios (Q131–Q150)
Aligned with the Commission on Dental Competency Assessments (CDCA)
Computer Simulated Case Examination (CSCE) Blueprint
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
Comprehensive Certification Examination - 150 Questions
,Dental Hygiene Prometric Exam, CSCE | 2026/2027 Edition Page 3
Section 1: Patient Assessment &
Q1 - Q20
Medical History
Q1: A 62-year-old male patient presents for a new patient examination. His medical history reveals a
myocardial infarction 4 months ago, current hypertension managed with lisinopril, and type 2 diabetes
controlled with metformin. Blood pressure is 138/88 mmHg, pulse 78 bpm. According to the ASA Physical
Status Classification System, which ASA classification is most appropriate for this patient?
A. ASA I - Normal, healthy patient
B. ASA II - Patient with mild systemic disease
C. ASA III - Patient with severe systemic disease that limits activity but is not incapacitating *[CORRECT]*
D. ASA IV - Patient with incapacitating systemic disease that is a constant threat to life
Correct Answer: C
Rationale:
ASA III is correct because the patient has a recent MI (within 6 months), which constitutes severe systemic
disease. Per the ASA classification and ADEX dental hygiene examination standards, a myocardial infarction
within the past 6 months places the patient in ASA III due to the significant cardiovascular risk. ASA II would
apply to well-controlled hypertension or diabetes alone. ASA IV requires incapacitating disease with constant
threat to life, such as unstable angina. This patient requires medical consultation, shortened appointments, stress
reduction protocol, and continuous vital sign monitoring per CDCA CSCE patient assessment guidelines.
Q2: During a routine prophylaxis appointment, you record a patient's vital signs as: blood pressure 168/104
mmHg, pulse 92 bpm, respiratory rate 18 breaths/minute. The patient states she takes amlodipine daily.
Based on the American Heart Association classification of blood pressure and CDCA CSCE clinical
guidelines, what is the most appropriate action?
A. Proceed with treatment; these values are acceptable for dental hygiene care
B. Retake blood pressure after 5 minutes of rest; if elevated, modify treatment and refer for medical
evaluation *[CORRECT]*
C. Immediately discontinue treatment and call emergency medical services
D. Administer local anesthesia with epinephrine 1:50,000 to lower blood pressure
Correct Answer: B
Rationale:
Retaking the blood pressure after 5 minutes of rest is the correct protocol because a single elevated reading may
reflect acute anxiety (white coat hypertension). A BP of 168/104 mmHg falls into Stage 2 Hypertension per the
2017 AHA guidelines. The CDCA CSCE patient assessment blueprint requires dental hygienists to reassess
abnormal vital signs, consider stress reduction protocol, limit epinephrine use (max 0.04 mg, or 2 carpules of
1:100,000), and refer for medical evaluation when readings persist above 160/100. Option A is unsafe given Stage
2 readings. Option C is unwarranted as the patient shows no acute symptoms. Option D is incorrect because
epinephrine would further increase blood pressure.
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
Comprehensive Certification Examination - 150 Questions
, Dental Hygiene Prometric Exam, CSCE | 2026/2027 Edition Page 4
Q3: A 24-year-old patient with a history of rheumatic heart disease and mitral valve prolapse with
regurgitation presents for periodontal debridement. According to the 2021 AHA Guidelines for Prevention of
Infective Endocarditis, which scenario requires antibiotic prophylaxis prior to dental hygiene procedures that
involve manipulation of gingival tissue?
A. All patients with any heart murmur require prophylaxis
B. Only patients with prosthetic cardiac valves, previous infective endocarditis, certain congenital heart
diseases, and cardiac transplant recipients with valvular regurgitation *[CORRECT]*
C. Patients with mitral valve prolapse always require prophylaxis regardless of regurgitation
D. Patients who have had coronary artery bypass grafting within the past 6 months
Correct Answer: B
Rationale:
The 2021 AHA guidelines significantly narrowed the indications for antibiotic prophylaxis. Only patients with
prosthetic cardiac valves, previous IE, unrepaired or incompletely repaired cyanotic CHD, repaired CHD with
residual defect, and cardiac transplant recipients with valvular regurgitation require prophylaxis. Mitral valve
prolapse with regurgitation alone no longer automatically qualifies, though this patient's rheumatic heart disease
may warrant cardiology consultation. CABG and simple murmurs do not require prophylaxis. The recommended
regimen is amoxicillin 2g orally 30-60 minutes before the procedure (clindamycin 600mg for penicillin-allergic
patients), per ADEX dental hygiene examination standards and CDCA CSCE clinical protocols.
Q4: A 71-year-old female patient reports taking warfarin 5mg daily for atrial fibrillation. Her most recent
INR from 3 days ago was 3.2. She requires scaling and root planing on four quadrants with moderate
subgingival calculus. What is the most appropriate management approach according to current
evidence-based dental hygiene practice?
A. Discontinue warfarin 3 days before treatment to normalize bleeding
B. Proceed with full-mouth SRP in one appointment without modification
C. Consult physician regarding INR; consider quadrant-by-quadrant treatment with local hemostatic
measures and delayed post-operative evaluation *[CORRECT]*
D. Refer to oral surgeon exclusively; dental hygienists cannot treat anticoagulated patients
Correct Answer: C
Rationale:
Current evidence demonstrates that patients with therapeutic INR (2.0-3.0 for most indications; up to 3.5 for
mechanical valves) can safely undergo scaling and root planing without discontinuing anticoagulants.
Discontinuing warfarin increases thromboembolic risk, which is more dangerous than post-operative bleeding. The
CDCA CSCE treatment planning blueprint emphasizes medical consultation to confirm recent INR, quadrant or
half-mouth sequencing to manage bleeding, use of local hemostatics (oxidized cellulose, sutures), and
post-operative evaluation within 24-48 hours. An INR of 3.2 is slightly elevated but generally acceptable for
conservative therapy. Option D is incorrect as dental hygienists are qualified to treat medically complex patients
with appropriate protocols.
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
Comprehensive Certification Examination - 150 Questions
PROMETRIC EXAM, CSCE
Computer Simulated Dental Hygiene Examination
CDCA & ADEX Dental Hygiene Examination Standards
DENTAL HYGIENE COMPUTER SIMULATED CASE TEST
QUESTIONS WITH COMPLETE SOLUTIONS
Edition
Total Questions 150
Sections 9
Format Multiple Choice (A-D)
Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Style 80% Scenario-Based / 20% Direct Knowledge
CDCA CSCE Blueprint, ADEX Standards, Prometric
Alignment
Guidelines
Section 1: Patient Assessment & Medical History (Q1–Q20)
Section 2: Dental Radiography & Interpretation (Q21–Q35)
Section 3: Periodontal Assessment & Charting (Q36–Q55)
Section 4: Treatment Planning & Case Management (Q56–Q75)
Section 5: Dental Hygiene Diagnosis & Care Planning (Q76–Q90)
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
,Dental Hygiene Prometric Exam, CSCE | 2026/2027 Edition Page 2
Section 6: Local Anesthesia & Pain Management (Q91–Q105)
Section 7: Infection Control & Safety (Q106–Q120)
Section 8: Dental Materials & Instrumentation (Q121–Q130)
Section 9: CSCE Case Studies & Simulated Scenarios (Q131–Q150)
Aligned with the Commission on Dental Competency Assessments (CDCA)
Computer Simulated Case Examination (CSCE) Blueprint
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
Comprehensive Certification Examination - 150 Questions
,Dental Hygiene Prometric Exam, CSCE | 2026/2027 Edition Page 3
Section 1: Patient Assessment &
Q1 - Q20
Medical History
Q1: A 62-year-old male patient presents for a new patient examination. His medical history reveals a
myocardial infarction 4 months ago, current hypertension managed with lisinopril, and type 2 diabetes
controlled with metformin. Blood pressure is 138/88 mmHg, pulse 78 bpm. According to the ASA Physical
Status Classification System, which ASA classification is most appropriate for this patient?
A. ASA I - Normal, healthy patient
B. ASA II - Patient with mild systemic disease
C. ASA III - Patient with severe systemic disease that limits activity but is not incapacitating *[CORRECT]*
D. ASA IV - Patient with incapacitating systemic disease that is a constant threat to life
Correct Answer: C
Rationale:
ASA III is correct because the patient has a recent MI (within 6 months), which constitutes severe systemic
disease. Per the ASA classification and ADEX dental hygiene examination standards, a myocardial infarction
within the past 6 months places the patient in ASA III due to the significant cardiovascular risk. ASA II would
apply to well-controlled hypertension or diabetes alone. ASA IV requires incapacitating disease with constant
threat to life, such as unstable angina. This patient requires medical consultation, shortened appointments, stress
reduction protocol, and continuous vital sign monitoring per CDCA CSCE patient assessment guidelines.
Q2: During a routine prophylaxis appointment, you record a patient's vital signs as: blood pressure 168/104
mmHg, pulse 92 bpm, respiratory rate 18 breaths/minute. The patient states she takes amlodipine daily.
Based on the American Heart Association classification of blood pressure and CDCA CSCE clinical
guidelines, what is the most appropriate action?
A. Proceed with treatment; these values are acceptable for dental hygiene care
B. Retake blood pressure after 5 minutes of rest; if elevated, modify treatment and refer for medical
evaluation *[CORRECT]*
C. Immediately discontinue treatment and call emergency medical services
D. Administer local anesthesia with epinephrine 1:50,000 to lower blood pressure
Correct Answer: B
Rationale:
Retaking the blood pressure after 5 minutes of rest is the correct protocol because a single elevated reading may
reflect acute anxiety (white coat hypertension). A BP of 168/104 mmHg falls into Stage 2 Hypertension per the
2017 AHA guidelines. The CDCA CSCE patient assessment blueprint requires dental hygienists to reassess
abnormal vital signs, consider stress reduction protocol, limit epinephrine use (max 0.04 mg, or 2 carpules of
1:100,000), and refer for medical evaluation when readings persist above 160/100. Option A is unsafe given Stage
2 readings. Option C is unwarranted as the patient shows no acute symptoms. Option D is incorrect because
epinephrine would further increase blood pressure.
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
Comprehensive Certification Examination - 150 Questions
, Dental Hygiene Prometric Exam, CSCE | 2026/2027 Edition Page 4
Q3: A 24-year-old patient with a history of rheumatic heart disease and mitral valve prolapse with
regurgitation presents for periodontal debridement. According to the 2021 AHA Guidelines for Prevention of
Infective Endocarditis, which scenario requires antibiotic prophylaxis prior to dental hygiene procedures that
involve manipulation of gingival tissue?
A. All patients with any heart murmur require prophylaxis
B. Only patients with prosthetic cardiac valves, previous infective endocarditis, certain congenital heart
diseases, and cardiac transplant recipients with valvular regurgitation *[CORRECT]*
C. Patients with mitral valve prolapse always require prophylaxis regardless of regurgitation
D. Patients who have had coronary artery bypass grafting within the past 6 months
Correct Answer: B
Rationale:
The 2021 AHA guidelines significantly narrowed the indications for antibiotic prophylaxis. Only patients with
prosthetic cardiac valves, previous IE, unrepaired or incompletely repaired cyanotic CHD, repaired CHD with
residual defect, and cardiac transplant recipients with valvular regurgitation require prophylaxis. Mitral valve
prolapse with regurgitation alone no longer automatically qualifies, though this patient's rheumatic heart disease
may warrant cardiology consultation. CABG and simple murmurs do not require prophylaxis. The recommended
regimen is amoxicillin 2g orally 30-60 minutes before the procedure (clindamycin 600mg for penicillin-allergic
patients), per ADEX dental hygiene examination standards and CDCA CSCE clinical protocols.
Q4: A 71-year-old female patient reports taking warfarin 5mg daily for atrial fibrillation. Her most recent
INR from 3 days ago was 3.2. She requires scaling and root planing on four quadrants with moderate
subgingival calculus. What is the most appropriate management approach according to current
evidence-based dental hygiene practice?
A. Discontinue warfarin 3 days before treatment to normalize bleeding
B. Proceed with full-mouth SRP in one appointment without modification
C. Consult physician regarding INR; consider quadrant-by-quadrant treatment with local hemostatic
measures and delayed post-operative evaluation *[CORRECT]*
D. Refer to oral surgeon exclusively; dental hygienists cannot treat anticoagulated patients
Correct Answer: C
Rationale:
Current evidence demonstrates that patients with therapeutic INR (2.0-3.0 for most indications; up to 3.5 for
mechanical valves) can safely undergo scaling and root planing without discontinuing anticoagulants.
Discontinuing warfarin increases thromboembolic risk, which is more dangerous than post-operative bleeding. The
CDCA CSCE treatment planning blueprint emphasizes medical consultation to confirm recent INR, quadrant or
half-mouth sequencing to manage bleeding, use of local hemostatics (oxidized cellulose, sutures), and
post-operative evaluation within 24-48 hours. An INR of 3.2 is slightly elevated but generally acceptable for
conservative therapy. Option D is incorrect as dental hygienists are qualified to treat medically complex patients
with appropriate protocols.
CDCA CSCE Blueprint | ADEX Dental Hygiene Examination Standards | Prometric Testing Guidelines
Comprehensive Certification Examination - 150 Questions
