ADEX Dental common mistakes
ADEX Dental · Understand the traps and how to avoid them.
Cutting typodont or clinical preparations by eye to the wrong depth or taper - shallow axial reduction on one wall while over-reducing the occlusal, or leaving a soft, undefined finish line - and never measuring the reduction before moving on.
Candidates train on extracted teeth without a reduction gauge and rely on visual memory; under exam time pressure they cut once and never re-check with a probe or index.
What to do instead
Place measured depth cuts first, verify axial and occlusal reduction with a periodontal probe and a silicone putty index, and re-evaluate the finish line in the mirror before finishing. Build the same three-step check into every practice preparation so it becomes automatic.
Instrumenting and obturating a canal to a guessed length - filing to tactile resistance, skipping apex-locator or radiographic confirmation, then placing the master cone without a fit film and accepting a short or voided fill.
Endodontic time pressure plus the belief that tactile feel is reliable; candidates also skip the fit radiograph because they fear running out of time.
What to do instead
Use a fixed sequence every time: access, orifice identification, glide path, electronic working length confirmed by a radiograph, master cone fit film, then obturation. Practise the sequence on extracted teeth until it fits inside the time limit without shortcuts.
Submitting periapical images with cone-cut, elongation or foreshortening, or mounting and labelling them incorrectly; on computer-based case items, reporting only the first obvious finding and stopping the search there.
Receptor placement and angulation are done freehand rather than with the aiming device, and interpretation follows a satisfaction-of-search pattern in which the first lesion closes the case.
What to do instead
Standardise receptor placement and angulation, retake any nondiagnostic image immediately rather than justifying it, and use a fixed search order - all four quadrants, crestal bone, apices, sinuses, condyles - writing findings down before answering the item.
Breaking asepsis mid-appointment: touching the chart, phone, light handle or drawer with gloved hands, reusing a surface barrier, or doffing gloves and mask in the wrong order while the examiner watches.
These are engrained practice habits that no one has observed in years; candidates rehearse the clinical procedure but never script the operatory set-up and tear-down.
What to do instead
Rehearse a scripted set-up and breakdown, define a clean zone that ungloved hands alone may touch, and treat any contact with an unbarriered surface as contamination that requires a glove change before continuing.
Delivering an inferior alveolar block without deliberately locating the coronoid notch, pterygomandibular raphe and occlusal-plane height, depositing the solution rapidly without aspirating, and starting treatment without testing pulpal anesthesia.
Landmark anatomy is learned from diagrams but never mapped on a live patient, and rushing leads to depositing before the needle is properly seated.
What to do instead
Palpate and name each landmark aloud before inserting, aspirate in two planes, deposit slowly, then confirm anesthesia with a cold test or EPT before any cutting. Rehearse on a partner or manikin until landmark identification is consistent.
Seating a crown, bridge or removable prosthesis without checking proximal contacts, occlusion in centric and in excursions, and marginal adaptation - going straight from try-in to cement or from insertion to dismissal.
Attention shifts to aesthetics and finish-line appearance, and the occlusal check is deferred because articulating paper and shimstock take extra minutes.
What to do instead
Run a fixed insertion checklist: seat and check margin visually and with a probe, verify contacts with floss, check centric and working and balancing excursions with shimstock or articulating paper, then cement or adjust. Never cement before the checklist is complete.
Performing a cursory periodontal examination - probing only facial sites of index teeth, omitting bleeding on probing, mobility, furcation involvement and radiographic bone level - then assigning a stage and grade on those incomplete data.
Full six-point charting is treated as a time sink, and older training habits record pocket depths without attachment loss or risk factors.
What to do instead
Chart six sites per tooth including third molars when present, record bleeding on probing, recession and clinical attachment level, note mobility and furcation, then derive stage from worst-site bone loss and grade from bone loss relative to age plus risk factors such as smoking and glycaemic control.
Naming a lesion from a single visual feature and moving on - calling every white patch hyperkeratosis, never asking about duration, change, medication or systemic disease, and not arranging biopsy or referral for a lesion that has persisted.
Pattern matching from lecture slides replaces structured history-taking, and the follow-up question is never asked in a timed case item.
What to do instead
Use a structured assessment for every lesion: onset, duration, change, habits, medications, systemic history, then extraoral and intraoral examination and appropriate imaging. Any unexplained lesion persisting beyond two weeks gets biopsy or referral rather than reassurance.
Writing clinical notes after the fact in summary form, recording conclusions rather than contemporaneous findings, omitting the informed-consent discussion, or altering an earlier entry without a dated addendum.
Documentation is left to the end of a busy day and treated as paperwork rather than a legal record; candidates also fear that recording a complication makes them look bad.
What to do instead
Write the note at the time of care with findings, options discussed, consent obtained, materials and any complication. Correct errors only by a dated, signed addendum, never by erasure or overwriting, and never pre-chart treatment that has not been performed.
Applying heavy forceps or elevator force to a mandibular molar without confirmed anesthesia, bone removal or sectioning, and proceeding despite anticoagulants, bisphosphonate history or uncontrolled hypertension in the medical record.
The operator believes the tooth should deliver with more force and treats sectioning as a failure; the medical history is skimmed during check-in rather than reviewed before surgery.
What to do instead
Review medications and relevant medical history before consent, verify anesthesia, and plan sectioning or bone removal as the default for multirooted mandibular teeth. Cap the force applied, reassess if the tooth does not move, and have a written haemostasis and post-operative instruction plan ready before starting.