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2014 Examination Content and Scoring (Please refer to 2013 Candidate Manual for 2013 Exam Information)
 
Examination Overview

The examination consists of five individual, skill-specific parts. Each examination part is listed below:

  • PartI: National Dental Board Examination - Part I & II*
  • Manikin-Based Examination
    • Part II: Endodontics
    • Part III: Prosthodontics
  • Patient-Based Examinations
    • Part IV: Periodontics
    • Part V: Restorative
      *CRDTS does not require documentation

Content, Criteria & Scoring System - Overview

Content: Parts II, III, IV & V

PART II:  ENDODONTICS EXAMINATION - 100 POINTS

CONTENT FORMAT
  1. Endodontic access opening only on tooth #14, a multi-rooted artificial tooth.
  2. Endodontic access, canal instrumentation and obturation on tooth #8, a single-canal artificial tooth.
  • Performed on a Manikin
  • Time: 3.0 hours

PART III: FIXED PROSTHODONTICS EXAMINATION - 100 POINTS

CONTENT FORMAT
  1. Preparation of tooth #5, a single-layered artificial tooth, for a porcelain fused to metal crown as one abutment for a 3-unit bridge. (The bridge is not fabricated for this examination.)
  2. Preparation of tooth #3, a single-layered artificial tooth, for a cast gold metal crown as the other abutment for the same 3-unit bridge. Both preparations must be parallel to each other.
  3. Preparation of tooth #9, a single-layered artificial tooth for a full ceramic crown.
  • Performed on a Manikin
  • Time: 4.0 hours

PART IV: PERIODONTAL EXAMINATION - 100 POINTS

CONTENT FORMAT
  1. Treatment Selection - Patient selection & Calculus detection
  2. Oral Assessment
  3. Probing Depth Measurements/Gingival Recession 
  4. Subginbival Calculus Removal
  5. Supragingival Deposit Removal
  6. Tissue and Treatment Management                                                                        
  • Performed on a Patient

PART V: RESTORATIVE EXAMINATION - 100 PONTS

CONTENT FORMAT
  1. Class II Amalgam - Cavity Preparation
  2. Class II Amalgam - Restoration

OR

  1. Class II Composite – Cavity Preparation
  2. Class II Composite – Restoration

AND

  1. Class III Composite – Cavity Preparation
  2. Class III Composite Resin – Restoration                                                                
  • Performed on a Patient
Scoring System
The examination scoring system was developed in consultation with three different measurement specialists; the scoring system is criterion-based and was developed on an analytical model. The examination is conjunctive in that its content is divided into separate Parts containing related skill sets and competence must be demonstrated in each one of the Parts. A compensatory scoring system is used within each Part to compute the final score for each Part, as explained below.

Only State Boards of Dentistry are legally authorized to determine standards of competence for licensure in their respective jurisdictions. However, in developing the examination, CRDTS has recommended a score of 75 to be a demonstration of sufficient competence; and participating State Boards of Dentistry have agreed to accept that standard. In order to achieve "CRDTS status" and be eligible for licensure in a participating state, candidates must achieve a score of 75 or more in each Part of the examination.
 
Each examination score is based on 100 points. If all sections of an examination are not taken, a score of "0" will be recorded for that specific examination.



Parts II-V: Scoring System for Manikin and Patient-Based Restorative Procedures

CRDTS and other testing agencies have worked together on a national level to draft and refine the performance criteria for each procedure in this examination. For the majority of those criteria, gradations of competence are described across a 4-level rating scale. Those criteria appear in this manual and are the basis of the scoring system. Those four rating levels may be generally described as follows:

SATISFACTORY
The treatment is of good to excellent quality,demonstrating competence in clinical judgment, knowledge and skill. The treatment adheres to accepted mechanical and physiological principles permitting the restoration of the tooth to normal health, form and function.

MINIMALLY ACCEPTABLE
The treatment is of acceptable quality, demonstrating competence in clinical judgment, knowledge and skill to be acceptable; however,slight deviations from the mechanical and physiological principles of the satisfactory level exist which do not damage the patient nor significantly shorten the expected life of the restoration.

MARGINALLY SUBSTANDARD
The treatment is of poor quality, demonstrating a significant degree of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry, which if left unmodified, will cause damage to the patient or substantially shorten the life of the restoration.

CRITICALLY DEFICIENT
The treatment is of unacceptable quality,demonstrating critical areas of incompetence in clinical judgment, knowledge or skill of the mechanical and physiological principles of restorative dentistry. The treatment plan must be altered and additional care provided, possibly temporization in order to sustain the function of the tooth and the patient's oral health and well-being.

In Parts II, III and V, a rating is assigned for each criterion in every procedure by three different examiners evaluating independently. Based on the level at which a criterion is rated by at least two of the three examiners, points may be awarded to the candidate. In any instance that none of the three examiners' ratings are in agreement, the median score is assigned. However, if any criterion is assigned a rating of critically deficient by two or more of the examiners, no points are awarded for that procedure or for the Examination Part, even though other criteria within that procedure may have been rated as satisfactory. A description of Parts II, III and V and the number of criteria that are evaluated for the procedures in each of those Parts appears below:

PART II: ENDODONTICS EXAMINATION - 100 POINTS

The Endodontics Examination is a manikin-based examination which consists of two procedures: an access opening on an artificial posterior tooth and an access opening, canal instrumentation and obturation on an artificial anterior tooth. The criteria for these procedures are combined and scored in total:

  • Anterior Endodontics/Posterior Access Opening          16 Criteria

PART III: FIXED PROSTHODONTICS - 100 POINTS

The Prosthodontics Examination is a manikin-based examination which consists of three procedures completed on artificial teeth: a cast gold crown preparation as a terminal abutment for a 3-unit bridge, a porcelain-fused-to-metal crown preparation as an abutment for a bridge, plus an evaluation of the line of draw for the bridge abutment preparations, and an all ceramic crown preparation on an anterior central incisor.

  • Cast Gold Crown                                                 10 Criteria
  • Porcelain-Fused-to-Metal Crown Preparation              10 Criteria
  • Ceramic Crown Preparation                                    11 Criteria

PART V: RESTORATIVE EXAMINATION - 100 POINTS

The patient-based Restorative Clinical Examination consists of four procedures as specified below; for the posterior procedure, candidates may choose to place a Class II Amalgam or a Posterior Composite:

  • Class II Amalgam Preparation          13 Criteria
  • Class II Amalgam Restoration            6 Criteria

    OR

  • Class II Composite Preparation      11 Criteria
  • Class II Composite Restoration        8 Criteria

         AND

  • Class III Composite Preparation          7 Criteria
  • Class III Composite Restoration*         8 Criteria                                                                                                 

To compute the score for each individual procedure, the number of points the candidate has earned for each criterion is totaled, divided by the maximum number of possible points for that procedure and the results are multiplied by 100. This computation converts scores for each procedure to a basis of 100 points. Any penalties that may have been assessed during the treatment process are deducted after the total score for the Examination Part has been converted to a basis of 100 points.

If no critical deficiency has been confirmed by the examiners, the total score for each of Parts II, III and V is computed by adding the number of points that the candidate has earned across all procedures in that Part, and that sum is divided by the number of possible points for all procedures in that Part. If a critical deficiency has been confirmed by the examiners, an automatic failure is recorded for both the procedure and the Examination Part. An example for computing scores that include no critical deficiency is shown below for Part III:

PROCEDURE #CRITERIA POINTS EARNED POINTS POSSIBLE COMPUTED SCORE
Cast Gold Crown Preparation  10 Criteria    30   40  75.00
Porcelain-Fused-to-Metal Crown  10 Criteria    34   40  85.00
Ceramic Crown Preparation  11 Criteria    38   44  86.36
TOTALS for PART III 31 Criteria   102 124  82.25

Although there are three Parts that are scored separately for restorative clinical skills, within each Part a compensatory system is used to compute the final score for that Part, as long as there is no critical deficiency.  For Parts III and V, the computed score for each procedure is not averaged, but instead is numerically weighted by the ratio of its number of scorable criteria to the total number of scorable criteria in the Part.  For example, the Cast Gold Crown Preparation has a total of 10 scorable criteria which represents 40 possible points out of the total of 124 possible points for Part III.  As shown in the example above, the candidate earned 102 out of 124 possible points for the three procedures in Part III for a final score of 82.25 points.  If any penalties were assessed, the points would be deducted from the final score for Part III.

PART IV: PERIODONTAL EXAMINATION - 100 POINTS

  1. Treatment Selection - Penalty points are assessed for Treatment Selections that do not meet the described criteria for patient selection and calculus detection: 
    • 7 penalty points for 1st rejection
    • 7 penalty ponts for 2nd rejection
    • No additional penalty points deducted for subsequent rejections but an acceptable Treatment Selection must be submitted within the allotted time limits 
  2. Extra/Intraoral Assessment – 7 Points
    • 7 scorable items
    • 1 point awarded for each Intra/Extra-Oral structure that is evaluated and described correctly
  3. Periodontal Measurements/Gingival Recession - 8 Points
    1. 12 probing depths evaluated on two teeth
    2. 0.5 points for each correctly measured probing depth
    3. 4 gingival recession measurements taken on facial and lingual aspects of two teeth
    4. 0.5 points for each correctly measured area of gingival recession 
  4. Scaling/Subgingival Calculus Removal - 70 Points 
    1.  14 scorable items 
    2. 5 points are awarded for each of the 14 required surfaces that are acceptably debrided of subgingival accretions
  5. Supragingival Deposit Removal – 9 Points

    • 6 scorable items on 6 teeth chosen for evaluation
    • 1.5 points awarded for each of the six teeth that are free of all supragingival accretions
  6. Tissue Management – 6 Points

    • 6 scorable items on tissue surrounding 6 teeth chosen for evaluation
    • 1 point awarded for each of the six teeth and surrounding tissues that are free of damage and well managed
    • Critical Error: A tissue trauma critical error, resulting in failure of the examination, will be assessed if any of the following exist:
      • Damage to 4 or more areas of gingival tissue, lips or oral mucosa located anywhere within or near the Treatment Selection
      • An amputated papillae
      • An exposure of the alveolar process
      • A laceration or damage that requires suturing or perio packing
      • An unreported broken instrument tip found in the sulcus
      • One or more ultrasonic burns requiring follow-up treatment
  7. Treatment Standards—Penalty points are assessed for any violation of standards as defined for:
    • Infection Control
    • Record Keeping
    • Patient Management
    • Professional Conduct and Demeanor



Penalty Deductions

Throughout the examination, not only clinical performance will be evaluated, but also the candidate's professional demeanor will be evaluated by Clinic Floor Examiners. A number of considerations will weigh in determining the candidate's final grades and penalties may be assessed for violation of examination standards, as defined within this manual, or for certain procedural errors as described below:

  1. Any of the following may result in a deduction of points from the score of the entire examination Part or dismissal from the exam in any of the clinical procedures:
    1. Violation of universal precautions or infection control; gross asepsis; operating area is grossly unclean, unsanitary or offensive in appearance; failure to dispose of potentially infectious material and clean the operatory after individual examinations.
    2. Poor Professional Demeanor--unkempt, unclean, or unprofessional appearance; inconside­rate or uncooperative with other candidates, examiners or testing site personnel;
    3. Poor Patient Management--disregard for patient welfare or comfort; inadequate anesthesia
    4. Improper management of significant history or pathosis;
    5. Inappropriate request for extension or modification;
    6. Unsatisfactory completion of required modifications;
    7. Improper Operator/Patient/Manikin position;
    8. Improper record keeping;
    9. Improper treatment selection;

      Periodontal Treatment Selection Penalty Points

      • Penalty points are assessed for Treatment Selections that do not meet the described criteria
      • 7 penalty points for 1st rejection
      • 7 penalty points for 2nd rejection
      • No additional penalty points deducted for subsequent rejections but an acceptable Treatment Selection must be submitted within the allotted time limits

      Restorative Treatment Selection Penalty Points

      • Penalty points are assessed for Treatment Selections that do not meet the described criteria
      • 5 penalty points for 1st rejection on either procedure
      • No additional penalty points deducted for subsequent rejections but an acceptable Treatment Selection must be submitted within the allotted time limits
    10. Improper liner placement;
    11. Inadequate isolation - The isolation dam is inappropriately applied, torn and/or leaking, resulting in debris, saliva and/or hemorrhagic leakage in the preparation, rendering the preparation unsuitable for evaluation or the subsequent manipulation of the restorative material.
    12. Administration of anesthesia before approval of Medical History by Clinic Floor examiners 
    13. Corroborated errors for Treatment Management criteria on all Restorative procedures
  2. The following infractions will result in a loss of all points for the entire examination Part:
    1. Temporization or failure to complete a finished restoration;
    2. Violation of Examination Standards, Rules or Guidelines;
    3. Treatment of teeth or surfaces other than those approved or assigned by examiners;
    4. Gross damage to an adjacent tooth;
    5. Failure to recognize exposure;
    6. Unavoidable mechanical exposure which is poorly managed or irreparable;
    7. Unjustified or irreparable mechanical exposure;
    8. Critical Lack of Diagnostic/Clinical Judgment Skills - This penalty would be applied when the prognosis of the treatment and/or the patient's well-being is seriously jeopardized. Examples include but are not limited to:
      • Inability to differentiate between caries and a pulpal exposure.
      • Inability to carry out instructions for modifications that any competent practitioner should be able to complete.
      • Failure to recognize the need for a critical alteration of the preparation beyond the assigned surfaces, such as a fracture or defect that must be eliminated by the extension of the preparation

The penalties or deficiencies listed above do not imply limitations, since obviously some procedures will be classified as unsatisfactory for other reasons, or for a combination of several deficiencies. Corroborated errors for the treatment management criteria for each Restorative procedure – Manikin and Patient-based will be deducted as penalty points. If any restorative procedure is unacceptable for completion during the examination, any preparations must be temporized, the patient must be adequately informed of any deficiencies, and a "Follow-up Form" must be completed.

PROFESSIONAL CONDUCT
All substantiated evidence of falsification or intentional misrepresentation of application requirements, collusion, dishonesty, or use of unwarranted assistance during the course of the examination shall automatically result in failure of the entire examination by any candidate.

In addition, there will be no refund of examination fees and that candidate cannot apply for re-examination for one full year from the time of the infraction. Any of the following will result in failure of the entire examination:

  • Falsification or intentional misrepresentation of application requirements
  • Cheating (Candidate will be dismissed immediately);
  • Any candidate demonstrating complete disregard for the oral structures, welfare of the patient and/or complete lack of skill and dexterity to perform the required clinical procedures.
  • Misappropriation of equipment (theft);
  • Receiving unwarranted assistance;
  • Alteration of examination records and/or radiographs
 

 

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