- The 2026 ADEX series pairs the CSCE OSCE at Prometric with the typodont-based SPTCE, run by the American Board of Dental Examiners.
- The full series costs $1,150 plus facility fees, and includes one free clinical retake (typodont/facility fees still apply).
- The CSCE OSCE has up to 120 items in 115 minutes; a scaled score of 75 is the passing mark on both components.
- Domain 2 (Intra and Extra Oral Assessment and Charting) carries the heaviest weight at 27% - prioritize it in review.
Quick-Reference Snapshot
Use this section as your at-a-glance sheet before diving into the details. Every figure below comes straight from the official 2026 ADEX Dental Hygiene Examination structure - no rounding, no guessing. Print it, laminate it, or paste it into your notes app for the weeks leading up to test day.
| Component | Format | Time Allowed | Passing Score |
|---|---|---|---|
| CSCE OSCE | Computer-based, Prometric test centers | 115 minutes + 15-minute tutorial | 75 (scaled) |
| SPTCE | Simulated Patient Treatment Clinical Exam on typodont | Up to 2 hours | 75 |
For a deeper breakdown of how these numbers translate into a study plan, the ADEX Study Guide 2026: How to Pass on Your First Attempt walks through week-by-week prep. If you just want the pass threshold explained in plain language, see ADEX Passing Score 2026: Exactly What You Need to Pass.
The Six CSCE OSCE Domains at a Glance
The CSCE OSCE content distribution for 2026-2027 is built around six domains. Memorizing the weights isn't busywork - it tells you exactly where to spend your limited review hours. A candidate who spends equal time on all six domains is under-preparing for the ones that actually decide the outcome.
Domain 1: Medical/Dental Assessment (12%)
Covers health history review, vital signs, and recognizing conditions that affect treatment planning.
- Know how systemic conditions alter hygiene care decisions
Domain 2: Intra and Extra Oral Assessment and Charting (27%)
The single largest domain on the exam. Expect heavy coverage of periodontal charting, soft-tissue findings, and oral pathology recognition.
- Master periodontal probing documentation and lesion identification - this domain alone is more than a quarter of the exam
Domain 3: Radiology/Imaging (15%)
Focuses on image interpretation, exposure technique, and radiographic anatomy.
- Review common radiographic errors and how to correct them
Domain 4: Dental Hygiene Care Planning (13%)
Tests your ability to sequence treatment logically based on assessment findings.
- Practice translating a chart into a defensible care plan
Domain 5: Patient Care (19%)
Covers infection control, ergonomics, and direct clinical service delivery - the second-largest domain.
- Don't skip infection control protocol details; this domain is nearly one-fifth of the exam
Domain 6: Dental Specialties and Pharmacology (14%)
Blends drug interactions, contraindications, and referral considerations across specialty areas.
- Build a quick-reference list of drug classes and their oral health implications
For a full topic-by-topic breakdown of each domain, including subtopics not covered here, see the ADEX Exam Domains 2026: Complete Guide to All 6 Content Areas. And if you're still deciding how much runway to give yourself, How Hard Is the ADEX Exam? Complete Difficulty Guide 2026 puts the domain weighting in context against the item count and time limit.
Key Takeaway
Domains 2 and 5 together make up 46% of the CSCE OSCE. If your review calendar is short on time, these two domains should never be the ones you cut.
Fee & Retake Cheat Sheet
Money mechanics catch candidates off guard more than content gaps do. Here's the exact fee structure so there are no surprises mid-cycle.
- Full series cost: $1,150 plus the clinical-site facility fee.
- First retake of the clinical exam: Included in the base fee - but you still owe the $150 typodont fee plus the facility fee.
- Third clinical attempt: $795 plus the facility fee.
- CSCE OSCE retake (second or third attempt): $275.
- Waiting period after a failed attempt: Minimum 10 days before retesting.
- Three consecutive failures of the same component: Requires restarting and repaying for the entire series.
For the complete cost breakdown, including how facility fees stack with retake fees across scenarios, read ADEX Certification Cost 2026: Complete Pricing Breakdown. If you're trying to line fees up against testing windows, the ADEX Exam Dates 2026: Testing Windows, Deadlines & Scheduling guide covers scheduling logistics in more depth.
Format, Timing & Item Types
The CSCE OSCE presents up to 120 items, though the exact total varies slightly by test form because a small number of unscored pilot items are mixed in. You get 115 minutes to work through the exam, plus a separate 15-minute tutorial that doesn't eat into your testing time.
Item formats you'll actually encounter on screen:
- Selected-response (standard single-answer)
- Multiple-response (select all that apply)
- Extended match
- Drop-down selection
- Fill-in-the-blank
- Hot spot (click the correct location on an image)
- Drag-and-drop
This variety matters for pacing. A candidate who has only ever practiced with plain multiple-choice questions will lose time re-reading instructions for hot spot or drag-and-drop items mid-exam. Practicing with a realistic mix of formats - like the full-length simulations on our practice test platform - removes that friction before test day.
Eligibility Checklist
Before you even think about domain weights or fee tiers, confirm you meet the baseline eligibility bar.
- Graduate (or final-semester student) of a CODA-accredited U.S. dental hygiene program, or
- Graduate of a CDAC-accredited Canadian dental hygiene program, or
- Authorization from the licensing jurisdiction where you intend to seek licensure, if you fall outside the above categories.
A full walkthrough of prerequisite documentation, program verification, and jurisdiction-specific authorization steps is available in ADEX Requirements 2026: Eligibility, Prerequisites & How to Qualify.
SPTCE Quick Facts
The Simulated Patient Treatment Clinical Examination is the hands-on counterpart to the computer-based CSCE OSCE. It's performed entirely on a typodont rather than a live patient, and candidates have up to two hours to complete it.
What's actually evaluated:
- Calculus detection
- Calculus removal
- Periodontal probing measurements
- Treatment management across both maxillary and mandibular typodonts
Like the CSCE OSCE, the SPTCE requires a score of 75 to pass. Because it's typodont-based rather than patient-based, tactile skill and instrumentation control matter as much as knowledge - there's no substitute for repeated hands-on practice in the weeks leading up to your test date.
Key Takeaway
Don't treat the SPTCE as an afterthought to the CSCE OSCE. Its two-hour window and 75-point threshold demand dedicated hands-on rehearsal separate from your written-content review.
One-Week-Per-Domain Review Plan
If you're building a study calendar from this cheat sheet, anchor each week to a domain weight rather than a generic topic list. Heavier domains get more days; lighter domains get compressed review sessions layered with cumulative practice questions.
Domain 2 - Intra and Extra Oral Assessment and Charting (27%)
- Drill periodontal charting scenarios and soft-tissue pathology recognition daily
Domain 5 - Patient Care (19%)
- Rehearse infection control protocols and ergonomic positioning questions
Domain 3 & Domain 6 - Radiology/Imaging (15%) and Specialties/Pharmacology (14%)
- Pair image-interpretation drills with a drug-class reference sheet
Domain 4 & Domain 1 - Care Planning (13%) and Medical/Dental Assessment (12%)
- Practice sequencing full care plans from raw assessment data, then run a full-length timed CSCE OSCE simulation
Run at least one full timed practice exam before finishing your review, using item formats that mirror the real hot spot and drag-and-drop styles. The mock exams on our ADEX practice platform are built around this exact six-domain weighting, so your practice score distribution mirrors what you'll actually face.
Cheat-Sheet Mistakes to Avoid
A few recurring errors show up when candidates rely on cheat sheets without cross-checking the source material:
- Confusing fee tiers: The first clinical retake is included in the base $1,150 fee, but the $150 typodont fee and facility fee still apply - that's not "free."
- Ignoring the 18-month clock: Passing one component doesn't reset your timeline; both CSCE OSCE and SPTCE must be passed within 18 months of your very first attempt.
- Underweighting Domain 2: At 27%, it's more than double the weight of the lightest domain - treating all six domains equally in review time is a common planning mistake.
- Forgetting the 10-day rule: You cannot retest immediately after a fail; there's a mandatory minimum 10-day wait built into the retake process.
To see how these mechanics affect real outcomes and pass expectations, review ADEX Pass Rate 2026: What the Data Shows for context on what the numbers actually measure.
Frequently Asked Questions
Confirm your program's accreditation status (CODA in the U.S. or CDAC in Canada) or secure written authorization from your target licensing jurisdiction. Full details are in the ADEX Requirements guide linked above.
No - you only retest the component you failed. But both components still need to be passed within the same 18-month window from your first attempt.
Three successive failures of the same component require restarting and repaying for the entire series, so the second and third attempts are your practical ceiling before a full reset.
Domain 2 (Intra and Extra Oral Assessment and Charting) at 27% and Domain 5 (Patient Care) at 19% together account for nearly half the CSCE OSCE - prioritize those first.
ADEX examination results themselves do not expire, but individual licensing boards can still impose their own application deadlines, so check with your specific board.