ADEX Dental Hygiene Examination: Requirements, Scoring, and Retakes

The ADEX Dental Hygiene Examination is a two-part licensure test — a simulated-patient clinical exam and a computer-based clinical scenarios exam — accepted for initial dental hygiene licensure in every U.S. jurisdiction except Delaware and Nebraska.¹ The full exam costs $1,150 plus a facility fee that varies by testing site, you need a scaled score of 75 on each component, and both components must be passed within 18 months of your first attempt.²

The Two Components

Simulated Patient Treatment Clinical Examination

The clinical portion, the SPTCE, is done on standardized typodonts (model jaws with artificial teeth) mounted on a manikin, not on a live patient. It tests three skills: calculus detection on assigned maxillary teeth, calculus removal in one assigned mandibular quadrant, and periodontal probing measured within a ±1 mm tolerance. The three sections together are worth 100 points.³

Computer Simulated Clinical Examination (CSCE OSCE)

The computer-based component runs at a Prometric test center and uses high-resolution photographs, radiographs, optical images of study models, and laboratory data to present clinical scenarios. Questions cover treatment planning, identification of oral pathologies, dental hygiene ethics, and medical history interpretation.³ Taken on its own, the CSCE OSCE costs $450.²

Scoring and the Errors That Fail You

You need a scaled score of 75 or higher on each component. Score reports go to licensing jurisdictions as pass or fail only, without a numerical score.³

Tissue damage is where candidates most often fail. Each site of minor soft tissue damage costs one point, up to three sites. Four or more minor soft tissue damage sites, or a single major soft tissue damage site, is a critical error and an automatic fail. The same scale applies to hard tissue damage. Treating teeth outside your assigned quadrant is another serious violation and must be reported to the Chief Examiner.³

Who Can Register

You must be a graduate of, or a current student in the final semester of, a dental hygiene program accredited by the Commission on Dental Accreditation (CODA) in the U.S. or the Commission on Dental Accreditation of Canada (CDAC). Your program director or a designated school representative must authorize your candidacy directly through the registration system.⁴

ADEX itself does not require you to document past failures or complete remedial education before retesting. Most state boards do impose remediation after a set number of failed attempts, and those state rules control whether a passing ADEX score will actually get you licensed. Check the board where you plan to apply before you register.⁴

What the Exam Costs

The full examination (SPTCE plus CSCE OSCE) is $1,150. A clinical-only retake is $795. The CSCE OSCE alone is $450. Each of these carries a facility fee for the clinical site on top.² ADEX does not publish a standard range for the facility fee; it depends on the site you choose, so pull the site information sheet from the ADEX testing website before you budget. Score report requests later add $35 per U.S. mailing address ($50 internationally), covering up to four reports per address.⁵

Registering and Scheduling

Before you start the online application, gather your full legal name, contact information, Social Security number, date of birth, and DENTPIN (the unique identifier issued by the American Dental Association for dental education records). You’ll upload a recent head-and-shoulders photograph during profile creation. Current students need school authorization submitted through the system; graduates need proof of program completion.⁶

The name on your profile must exactly match your government-issued photo ID. Any mismatch can delay processing and cost you your preferred testing slot. Peak graduation months (April through June) fill fast, so register early. Once you’re scheduled for the computer-based exam, Prometric emails an appointment confirmation with time, date, location, and center policies.⁶

What to Bring on Exam Day

For both components, you’ll need a valid, non-expired, government-issued photo ID with your signature (driver’s license, passport, or military ID), and the name on it has to match your registration exactly.⁶

For the clinical exam, you furnish your own instruments and materials. ADEX does not publish a specific instrument list; you’re expected to bring what the procedures require. Dental restorative instruments, non-dental instruments, solvents, and non-standard techniques are prohibited and will get your exam terminated. Instruments must be clean and disinfected, though sterilization is not required for the simulated format. Some sites rent instruments for an extra fee; check the site information sheet for availability and handpiece compatibility. Bring your own PPE too: face mask, gloves, clinical attire such as scrubs, close-toed shoes, and protective eyewear (loupes or prescription glasses with side shields qualify).³

If You Fail: Retakes, the Three-Strike Rule, and the 18-Month Clock

You must wait at least 10 days after a failed component before you can reattempt it.³ Two rules can wipe out your progress entirely. Three consecutive failed attempts on the same component invalidates the whole exam series, including any component you’ve already passed, and you’d have to repay and retake both parts.⁴ The second rule is the 18-month window: both components must be passed within 18 months of your first attempt on any component, or you restart from scratch.²

After You Pass: Score Reports and State Licensing

Once both components are complete, request score reports through the ADEX candidate portal using the “Candidate Request” option. Allow 10 to 14 business days for processing, plus extra time for physical mail.⁵

ADEX doesn’t set a universal expiration for passing scores; each state board decides how long it will accept them, so contact the board where you plan to practice. Many states also require additional steps beyond ADEX — a jurisprudence exam, background check, and separate application fees are common — and meeting every state-specific requirement is on you, not on the testing agency.⁴

Appeals

A formal appeal goes to the Commission on Dental Competency Assessments (CDCA), in writing, via certified mail or overnight delivery, within 30 days of the date your scores were emailed. Include a cover sheet with your exam details, a separate statement of facts identified only by your candidate number (not your name), and a $400 administrative fee paid by cashier’s check or money order.⁷

The grounds are narrow. You must show extraordinary circumstances that materially changed your outcome, or a documented failure by an examiner to follow procedures in the Candidate Manual. Disagreeing with an examiner’s scoring judgment is not enough. And one detail that traps candidates: if you register for a retake while your appeal is still pending, the appeal is automatically dismissed and cannot be reinstated. Pick the path before you act on either one.⁷

1
American Board of Dental Examiners. Licensure Testing for the Dental Health Professions
2
American Board of Dental Examiners. ADEX Dental Hygiene Examination
3
American Board of Dental Examiners. ADEX Dental Hygiene Candidate Manual – Simulated Patient Treatment Clinical Examination (SPTCE) Procedures
4
American Board of Dental Examiners. ADEX Dental Hygiene Examination – Candidate Guide
5
American Board of Dental Examiners. Score Reports
6
American Board of Dental Examiners. ADEX Dental Hygiene Candidate Manual – Computer-Based Simulated Clinical Examination
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CDCA-WREB-CITA. Appeals Procedures