Assessment of Clinical

Judgement (ACJ™ )
Protocol

© The National Dental Examining Board of Canada 2022

Contents

About the Assessment of Clinical Judgement (ACJ™ ) ......................................................................... 4

Check-in ...................................................................................................................................................... 4

Format .......................................................................................................................................................... 5

Sample Questions.................................................................................................................................... 5
Single Correct Answer ......................................................................................................................... 5
One or More Correct Answers ........................................................................................................... 6
Case History .......................................................................................................................................... 8
Periodontal Chart ................................................................................................................................ 9

Content ...................................................................................................................................................... 11

Diagnosis, Treatment Planning and Clinical Decision Making ..................................................... 11

Radiographic Interpretation ............................................................................................................ 11

Blueprint .................................................................................................................................................. 11

Preparation Materials ............................................................................................................................... 12

E-exam Orientation ............................................................................................................................... 12

ACJ™ Question and Answer Framework .......................................................................................... 12

Reference Texts ..................................................................................................................................... 12

Tooth Numbering System ..................................................................................................................... 12

Training Courses ..................................................................................................................................... 13

Examination Confidentiality, Security, and Integrity ............................................................................ 13

Misconduct ................................................................................................................................................ 13

Examination Day Regulations ................................................................................................................. 14

Test Accommodations ............................................................................................................................. 15

Exceptional Circumstances: Withdrawals, Compassionate Appeals, and Conduct of the

Examination ............................................................................................................................................... 15

Withdrawals............................................................................................................................................ 15

Compassionate Appeals ..................................................................................................................... 15

Conduct of an Examination ................................................................................................................ 15

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Results ......................................................................................................................................................... 16

Passing Standard....................................................................................................................................... 16

Appeals and Rescoring ............................................................................................................................ 16

Repeats ...................................................................................................................................................... 16

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About the Assessment of Clinical Judgement (ACJ™ )

The purpose of the ACJ™ is to assess your ability to formulate a diagnosis and make clinical
decisions, as well as evaluate your knowledge in oral radiology and ability to make a
radiographic interpretation and diagnosis.

Check-in

Prior to the examination, read Prometric’s test centre policies including arrival and check-in
procedures. These procedures may change at any time. It is your responsibility to know the test
centre policies prior to your examination. If you do not comply with Prometric’s policies, you may
be refused access to the test centre.

During check-in at the Prometric test centre, you must show current government issued photo
identification. Acceptable forms of government issued photo identification are:
• driver’s license,
• passport, or
• provincial photo identification card.

The ID must be in English or French.

Photo identification must show your name exactly as it appears in your online profile and must
not be expired. If the photo identification does not have an expiry date, it must have been
issued within the last 10 years.

If you do not provide government photo identification you will not be admitted.

During check-in, you may be scanned with a metal detector wand, fingerprinted, required to
raise your pant legs above your ankles, empty and turn all pockets inside-out, and raise shirt
sleeves above your wrists prior to entry into the test room.

Prometric staff will inspect eyeglasses, jewelry, and other accessories. These inspections will
occur each time you enter the testing room.

You are advised to refrain from wearing jewelry besides wedding rings. Any other jewelry
including ornate hair accessories will need to be removed and placed in the locker provided.

You will be provided with scratch paper and a pencil. These items will be collected at the end
of the examination.

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Format

The ACJ™ is a computer-based test consisting of 120-150 single and multi-answer multiple-
choice questions given in a 5-hour session plus one optional scheduled 30-minute break during
the examination.

Sample Questions

Sample questions below illustrate the formats generally used in the ACJ™ .

Single Correct Answer

Some questions have one correct answer, indicated by the direction (Select ONE correct
answer). Select the answer that is most likely to be correct.

Sample Question: 1 (Select ONE correct answer.)

Which of the following is the most likely diagnosis for the entity shown in the photograph?

o Pyogenic granuloma.
o Hemangioma.
o Oedema.
o Hematoma.
o Gingival cyst.
o Exostosis.
o Periodontal abscess.
o Acute apical abscess.
o Chronic apical abscess.

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One or More Correct Answers

Some examination questions will have more than one correct answer. These questions are
identified by the direction “Select ONE OR MORE correct answers”.
The grade you receive on each question depends on if you select all the correct answers, some
of the correct answers, or an incorrect answer. All questions have a maximum score of 1 and a
minimum score of 0. Every answer in a multi-answer multiple-choice question has a value. You
must select all the correct answers to receive the full mark for the question. If you select an
incorrect answer, it does not matter if all your other answers are correct, you receive a score of
zero.

The example below shows the responses of three different examinees and the score for each
question based on their answers.

Examinee 1
(Select ONE or MORE correct answers)
There is radiographic evidence of caries on

distal of tooth 2.3 -1

mesial of tooth 2.4 -1

distal of tooth 2.4 -1

mesial of tooth 2.5 .3

distal of tooth 2.5 .3

mesial of tooth 2.6 .4

distal of tooth 2.6 -1

mesial of tooth 2.7 -1

distal of tooth 2.7 -1

mesial of tooth 2.8 -1

distal of tooth 2.8 -1 Examinee 1 has selected the

three correct answers for a total
Total mark: 1
of 1 mark.

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 Examinee 2
(Select ONE or MORE correct answers)
There is radiographic evidence of caries on

distal of tooth 2.3 -1

mesial of tooth 2.4 -1
distal of tooth 2.4 -1
mesial of tooth 2.5 .3
distal of tooth 2.5 .3
mesial of tooth 2.6 .4
distal of tooth 2.6 -1
mesial of tooth 2.7 -1
distal of tooth 2.7 -1
Examinee 2 has selected two
mesial of tooth 2.8 -1
answers. They have not selected
distal of tooth 2.8 -1 all the correct answers, so part
Total mark: .6 marks are given for the question.

Examinee 3
(Select ONE or MORE correct answers)
There is radiographic evidence of caries on

distal of tooth 2.3 -1

mesial of tooth 2.4 -1
distal of tooth 2.4 -1
mesial of tooth 2.5 .3
distal of tooth 2.5 .3
mesial of tooth 2.6 .4
distal of tooth 2.6 -1
mesial of tooth 2.7 -1
distal of tooth 2.7 -1
Examinee 3 has selected four
mesial of tooth 2.8 -1
answers. Three of the answers
distal of tooth 2.8 -1 have a positive value but one
Total mark: 0 has a value of -1. The examinee
gets a total mark of zero.

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Case History

Many questions include patient case histories in the format illustrated below.

Patient Information:
Jane Doe
123 Main Street
Ottawa, Ontario

Age: 57 Blood Pressure: 130/86 mmHg

Gender: Female Heart Rate: 80 bpm

Height: 167 cm Respiration Rate: 15/min

Weight: 60 kg Temperature: 37C

Chief Complaint: “My front tooth hurts.”

History of Chief Complaint: Noticed pain for the last 3 days.

Dental History: Irregular visits.

Medical History:

Significant Findings:

Current Medication: None.

Allergies: None.

Social/Family History:

Significant Findings: None.

Clinical Examination:

Significant Findings:

Extraoral: None.

Intraoral: None.

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Periodontal Chart

The following represents an example of a periodontal chart that may be used. Each chart will
utilize the following notation:

• The upper part of the chart denotes the findings on the vestibular (buccal and/or labial)
surfaces of the teeth being discussed for the case.

• Missing teeth are denoted by a greyed out section and a dash “-.

• Probing depths, in millimetres, are listed in the next row below the tooth number.

• Recession is listed below the pocketing, in millimetres. If there is no number, there is no

significant recession.

• Bleeding on probing is denoted by “•” and is listed directly below the pocket where
bleeding was found.

• The middle part of the chart denotes the findings for the lingual surfaces, using the same
categories as above.

• Mobility and furcation involvement apply to the entire tooth and can be found on the
bottom part of the chart.

• Mobility for the tooth, if present, is listed as a “1, 2, or 3”, using the Miller classification.

• The Class (I, II, III) of furcation involvement (if present) is listed with the surface indicated
(B, L, M, D).

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This example is a chart of the maxillary second quadrant, with tooth 2.6 missing. The probing
depths, in millimetres, are listed, going from mesial on the left, to distal on the right. In this
example, there is 3 mm of recession all along the buccal of teeth 2.4 and 2.5. No other recession
is noted. There is bleeding on probing on the mesiobuccal and distobuccal of teeth 2.5 and 2.7,
and all along the lingual of tooth 2.7. No other bleeding is noted. Tooth 2.7 has a buccal
furcation Class II and a Class 2 mobility. There are no other mobility or furcation involvements on
any other teeth/surfaces.

Vestibular

Tooth 2.3 2.4 2.5 2.6 2.7

Probing depth 3 2 4 4 5 4 4 4 6 - - - 4 7 6

Recession 3 3 3 3 3 3 - - -

Bleeding on probing ● ● - - - ● ●

Lingual

Tooth 2.3 2.4 2.5 2.6 2.7

Probing depth 2 2 2 3 4 4 4 3 5 - - - 5 5 6

Recession - - -

Bleeding on probing - - - ● ● ●

Mobility - 2

Furcation - B-II

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Content

Each section of the ACJ™ will contain case-based diagnosis, treatment planning and clinical
decision making questions, and radiographic interpretation questions.

Diagnosis, Treatment Planning and Clinical Decision Making

Questions will evaluate your ability to formulate a diagnosis and to make clinical decisions. Case
histories, dental charts, radiographic images, and photographs may be provided.

Radiographic Interpretation

Questions will evaluate your knowledge in oral radiology and ability to make a radiographic
interpretation and diagnosis using radiographic images.

Blueprint

The blueprint below shows the content areas and approximate percentage of questions in each
area.

Approximate % of
ACJ™ Blueprint
Questions

Pharmacotherapeutics, Medically-Complex Patients, Medical 22

Emergencies, Geriatrics, Local Anesthesia

Oral Medicine/Oral Pathology, Oral Surgery 28

Periodontics 15

Endodontics 10

Orthodontics, Pediatric Dentistry 10

Cariology/Restorative Dentistry 15

Total 100%

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 Preparation Materials
You are encouraged to use the resources available, including the released examination
materials, on the NDEB website to prepare for the OSCE. These resources are for personal use
only.

E-exam Orientation

The ACJ™ will be administered electronically at Prometric test centres. The NDEB’s e-Exam
Orientation should be viewed prior to taking the ACJ™ .

ACJ™ Question and Answer Framework

The ACJ™ Question and Answer Framework containing examples of questions is available in the
How to Prepare section of the NDEB website. You are strongly encouraged to visit the website in
preparation for the ACJ™ .

Reference Texts

A list of reference materials recommended in Faculties of Dentistry in Canada can be found in

the How to Prepare section of the NDEB website. The NDEB also references journal articles,
clinical guidelines, and practice standards issued by specialty organizations.

Tooth Numbering System

The FDI two-digit tooth numbering system is used in all examinations.

FDI / UNIVERSAL NUMBERING SYSTEM

PERMANENT DENTITION

FDI 1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.1 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 FDI
Universal 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Universal
Universal 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 Universal
FDI 4.8 4.7 4.6 4.5 4.4 4.3 4.2 4.1 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 FDI
RIGHT LEFT

PRIMARY DENTITION

FDI 5.5 5.4 5.3 5.2 5.1 6.1 6.2 6.3 6.4 6.5 FDI
Universal A B C D E F G H I J Universal
Universal T S R Q P O N M L K Universal
FDI 8.5 8.4 8.3 8.2 8.1 7.1 7.2 7.3 7.4 7.5 FDI
RIGHT LEFT

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Training Courses

The NDEB is aware of third-party providers of test preparation courses. Be advised that the NDEB
is not affiliated with, nor does it endorse any third-party providers of test preparation courses. The
disclosure, distribution, solicitation and reconstruction of NDEB examination content is strictly
prohibited, as is the use for commercial purposes of NDEB examination content, including the
released examination material on the NDEB website.

Examination Confidentiality, Security, and Integrity

All NDEB content, including examination content, is the property of the NDEB. Unauthorized use,
disclosure, reproduction and publication of NDEB content is against the law and is strictly
prohibited.

The NDEB has implemented security policies and measures to preserve the confidentiality and
integrity of its examination content. These measures are in place to eliminate any unfair
advantage among examinees and avoid the high costs associated with replacing
compromised examination content.

See the NDEB’s Intellectual Property Statement for more information on how the NDEB protects
and enforces its rights.

Misconduct

All NDEB content, including examination content, is for personal use only. Any other use of NDEB
content is strictly prohibited. Examples of prohibited use of NDEB content include but are not
limited to receiving from or disclosing NDEB content, reproducing (through memorization or by
any other means), and publishing any NDEB content in whole or in part. Conduct that
compromises the confidentiality and integrity of the NDEB’s processes and examinations will be
investigated and is subject to the NDEB’s By-laws regarding misconduct.

Additional information on misconduct can be found on the NDEB website.

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Examination Day Regulations

Failure to comply with any regulation may result in an accusation of misconduct.

• You must be punctual for all sessions. If you arrive late for a session, you may be denied
entry to the examination.

• Cell phones are prohibited in the examination room.

• All watches are prohibited in the examination room.

• Devices with recording or transmitting and/or receiving abilities are prohibited in the
examination room.

• You must not wear a hat, hood, coat, hoodie with the hood up, scarf covering the head,
or bulky clothing (except where same constitutes religious attire).

• You will be required to empty all pockets before entering or leaving the examination
room.

• Food is not allowed in the examination room.

• Water is not allowed in the examination room.

• If you require water, food, medicine, or medical equipment in the examination room you
must submit a request pursuant to the NDEB test accommodations policy.

• You will be required to read and agree to a Confidentiality and Non-disclosure

Agreement before you can begin the examination. If you do not agree, you will not be
able to start the examination. This agreement must be signed to receive results.

• You cannot write on anything other than the scratch paper provided. The scratch paper
and pencil must be submitted to Prometric staff at the end of the examination.

• You can only use the washroom during the scheduled break.

• You will not have access to your locker during the scheduled break.

It may be necessary for the NDEB to introduce new regulations or modify existing regulations
for specific examination administrations. Any new or modified regulations will supersede
regulations published in the protocol.

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Test Accommodations

Test accommodations are granted on an individual basis and are dependent on the nature and
extent of the request, documentation provided, and requirements of the examination. Read the
NDEB’s policies and procedures for Test Accommodations on the NDEB website.

Exceptional Circumstances: Withdrawals, Compassionate Appeals,

and Conduct of the Examination

Withdrawals

If, before the examination, you experience a serious medical circumstance or unanticipated
exceptional circumstance beyond your control you must withdraw from the examination. Notice
of such a withdrawal should be provided in writing using the Withdrawal form if possible before
the examination, but no later than seven days following the examination. If applicable,
supporting documentation must accompany the submission.

More information can be found in the NDEB By-laws.

Compassionate Appeals

If you believe you have been prevented from demonstrating your ability because of a serious
medical circumstance or unanticipated medical circumstance during the examination, you can
submit a compassionate appeal to have the results of the examination voided. Compassionate
appeals must be submitted using the Compassionate Appeal Request form within seven days of
the examination.

More information can be found on the NDEB website and in the NDEB By-laws.

Conduct of an Examination

If, during the examination, you believe there may have been an irregularity or inconsistency in
the conduct of the examination that prevented you from demonstrating your ability it must be
immediately reported to staff at the examination centre.

Should you want to submit an appeal based on the reported irregularity or inconsistency, it must
be submitted in writing within seven days of the examination using the Appeal of the Conduct of
an Examination Form.

More information is available in the NDEB By-laws.

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Results

Results are normally released within 10 weeks of the examination. You will receive an email
notification when your results are available in your online profile.

Results will be reported as a Pass/Fail. Those who receive less than 75 will also receive their test
equated rescaled score.

Results will not be released by telephone, email, or fax.

Passing Standard

To assure a consistent level of difficulty, the NDEB uses test equating and re-scaling procedures
to correlate raw scores to scores on a reference examination and to a standardized passing
score of 75.

You must obtain a minimum test equated, re-scaled score of 75 to be successful on an NDEB
examination.

Information on test equating and re-scaling is available on the NDEB website.

Appeals and Rescoring

If you receive a failing grade, you have one month from the date results are released to request
a verification of your score.

Information can be found in the Appeals and Rescoring section of the NDEB website.

In no case will you have access to your answer score sheets or examination questions.

Repeats

The ACJ™ can be taken a maximum of three times.

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