ADEX Dental Examination 2026: DLOSCE and Clinical Exam Explained

  • Dr. T
  • September 28, 2026
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Updated September 2026 · ADEX + DLOSCE

The US Clinical Licensure Exam, Explained: DLOSCE + Hands-On, Step by Step

One exam. Two halves. A computer-based clinical-judgment test and five procedures on a manikin. Here is exactly how it works now, who can sit it, and what it costs, checked against the official 2026 documents.

6h 45mDLOSCE seat time
75pass mark on every part
5hands-on clinical exams
18 moto pass every part
The two halvesWhat changedDLOSCEClinicalRulesAm I eligible?CostPlanFAQ
Start here

Two halves, one licence exam

Tap a half to see what it tests and how it is run.

What it tests

Diagnosis and treatment planning. You work through patient charts, radiographs and rotating 3D models, then choose the best clinical decision. It is the “written” half, but built from real cases, not theory recall.

6h 45mtotal seat time
148 + 2questions + prescription tasks
Prometricsecure test center

What it tests

Whether your hands can produce clinically acceptable work under time pressure. Five exams on a simulated patient manikin with a typodont: Periodontal, Endodontic, Fixed Prosthodontic, Anterior Restorative and Posterior Restorative.

5 examsgraded against published criteria
90 min to 4 hper exam
No live patientmanikin and typodont
Not the same as the INBDEThe INBDE is the separate pass/fail national board written exam recognised in every US jurisdiction. This clinical licensure exam sits on top of it. They test different things, and you need both covered.
Why older guides are wrong

What changed in 2026

If a guide compares CDCA, WREB and ADEX, it is out of date.

1 September 2025The exam boards mergedCDCA, WREB and ADEX became one body, the American Board of Dental Examiners. There is no longer a choice between three exams.
1 August 2026DLOSCE folded into ADEX, and Periodontal became requiredThe DLOSCE became the computer-based part of the ADEX Dental Examination. The Periodontal Examination became a required clinical component the same day.
After 9 October 2026Standalone DLOSCE sittings endNew candidates can only take the DLOSCE as part of the ADEX series. ADEX’s own acceptance map shows every US state except Delaware and New York accepting it; always confirm your target state board.
Half 1

Inside the DLOSCE

Your exam day, drawn to scale. Hover or tap a block.

TutS1S2S4S5
4 question sections (37 each, 75 min)Prescription tasks (2, 10 min)Optional breaksTutorial and survey

Question types: single-response and multiple-response multiple choice (partial credit is possible on multiple-response) plus the prescription tasks. Some items are unscored experimental questions that look identical, so treat every one as real. Tooth numbering is the Universal system.

What it covers, by weight

Restorative24%
Prosthodontics19%
Oral pathology, pain, TMD13%
Periodontics10%
Oral surgery9%
Endodontics8%
Orthodontics6%
Medical emergencies6%
Prescriptions5%

Diagnosis, treatment planning and occlusion are tested across every area, not as separate blocks.

How it is scored

4999

Results are reported as pass or fail, decided by your overall scale score (49 to 99) only, never by a single area. A scale score is not a raw count: 74 does not mean you were one question short. If you fail, you receive performance feedback by content area to guide remediation.

Half 2

The five hands-on exams

Tap an exam to see exactly what you do. Bars show relative time allowed.

Periodontalup to 90 min

Calculus detection (maxillary), calculus removal on an assigned mandibular quadrant, and periodontal probing depths on assigned mandibular teeth. Probing allows 1 mm of leeway. New requirement from 1 August 2026.

Endodonticup to 3 hours

One anterior procedure and one posterior procedure. Graded as one part: fail either and you retake both.

Fixed Prosthodonticup to 4 hours

Three crown preparations: all-ceramic (central incisor), zirconia (premolar) and zirconia (molar). Graded as one part: fail one and you retake all three.

Anterior Restorativeup to 3 hours

Class III preparation and restoration of a carious lesion on a maxillary incisor. Its own part, so a fail here retakes only this exam.

Posterior Restorativeup to 3.5 hours

Class II preparation and restoration of a carious lesion on a mandibular molar or premolar. Its own part. Preparation and restoration are always done together.

75

Pass mark per partBoards receive pass or fail for each part.

3x

The 3-SUB ruleWork is graded Acceptable, Marginally Substandard or Deficient. Three confirmed substandard over-preparation criteria count against you.

Free advantageADEX publishes the criteria sheets, worksheets and scoring rubrics for every procedure. Practise to those exact standards under the real time limits.
Know before you book

The rules that connect both halves

18

18-month windowPass every part within 18 months of your first attempt at any part.

10d

10-day waitMinimum gap between a failure and the re-attempt of that part.

3

3-time fail policyThree failures of the same part fails the whole series. You restart everything, including parts already passed.

$0

No refundsOnce any component has been attempted, refunds end.

ST

State remediationADEX does not require proof, but many state boards require remedial education after failures.

2

Two appointmentsDLOSCE at Prometric, clinical exams at an ADEX clinical site.

Interactive

Am I eligible? Pick your situation

This is where internationally trained dentists get stuck. You cannot register on a foreign degree alone.

Choose the option that matches you to see your route.
Eligible route

Register as a current student

Select ENROLLED during account set-up. Your school representative provides the authorisation. Internationally trained graduates are also asked for a state board authorisation letter, so confirm with your target state.

Eligible route

Register as a resident

Select RESIDENT during account set-up. Your program provides the designated school representative authorisation.

Eligible route

Register as not enrolled

Select NOT-ENROLLED and upload your residency diploma, certificate or official transcript.

Eligible route

State board authorisation letter needed

Select NOT-ENROLLED and upload a state board authorisation letter naming the ADEX Dental Examination. The letter is valid for up to 18 months.

Not yet

You need a US pathway first

The guide requires a state board authorisation naming the exam, and the routes above all run through a US CODA-accredited program. Contact your target state board about its authorisation process. Most internationally trained dentists get there through an Advanced Standing program or a residency, which is why the INBDE and your application plan come first.

Interactive

What it costs, and what a retake adds

Pick a scenario to see which fees apply.

ADEX Dental Examination (all five clinical exams plus the DLOSCE)$2,995 + facility fee
Typodont fee (charged only on your free retake)$150 per procedure
Facility feeVaries by clinical location

Choose a scenario.

Base fees only

Exam fee$2,995
Typodont fees on a first attempt$0 (supplied at check-in)
Facility feeVaries

Second attempt at a clinical exam

Exam fee for the retake$0
Typodont fee for the retake$150 per procedure
Facility feeApplies

Wait at least 10 days after the failure before re-attempting.

Third attempt at a clinical exam

Third-attempt fee$1,495 per clinical exam
Facility feeApplies

A third consecutive failure of the same part fails the entire series.

DLOSCE retake

Second or third DLOSCE attempt$695

Retakes are separate from the clinical exams. State licence fees are extra.

Also: a late registration or transfer after the clinical deadline is $345. Fees can change, so confirm on the ADEX site before paying.

Your roadmap

How to prepare, in order

Pass the INBDE firstThe national written board recognised in every US jurisdiction, and normally the first exam an internationally trained dentist takes.
Lock in your US programYour eligibility for this exam depends on it. See the route checker above.
Learn the DLOSCE interface earlyUse the official JCNDE practice questions and the free online 3D model tutorial. They teach the format, not the full difficulty. For real depth, train on case-based questions in the exam’s own style (see the TSB DLOSCE course below).
Train your hands to the criteria sheetsDownload ADEX’s criteria sheets and worksheets and practise each procedure under the real time limits.
Build your calendar backwardsFix your 18-month window and your state authorisation letter’s expiry, then place every attempt inside them.
Quick answers

Frequently asked questions

Is the DLOSCE the “written exam”?
It is the computer-based half, but it is not a theory paper. It is a clinical-judgment exam built around patient cases, images and 3D models.
Can I still take the DLOSCE on its own?
Not as a new candidate. After 1 August 2026 it is only available together with the ADEX Dental Examination, and all standalone sittings end after 9 October 2026.
Do both halves happen in the same sitting?
No. They are separate appointments, but every part must be passed within the 18-month window.
What is the pass mark?
75 on each part. For the DLOSCE this is a scale score, not a percentage of questions correct.
Which states accept it?
ADEX’s own acceptance map shows the ADEX Dental Examination accepted in every US state except Delaware and New York. Requirements and remediation rules are set by each state board, so check yours.
Prepare the DLOSCE half with TSB

DLOSCE Prep, Built The Study Boards Way

A complete prep course for the case-based DLOSCE format, with answers written by faculty.

4,500 DLOSCE questions34 timed tests10 modules in blueprint order$399 · 45 days full access

See the DLOSCE Course Blueprint

Not sure which route is yours?

The exam order, the program you enter and the state you target all affect each other. Message our Admin Team with Dr. T and Dr. Kaur on WhatsApp and we will map your route from INBDE to licence.

Message the Admin Team on WhatsApp

Current as of 28 September 2026. Sources: ADEX 2026 Candidate Guide and Clinical and Computer-based Candidate Manuals; JCNDE 2026 DLOSCE Candidate Guide; ADA and ADEX agreement announcement. Rules, fees and dates are set by ADEX, the ADA and state boards and can change; confirm with them before you register. Educational content, not licensing advice.

More on the DLOSCE and ADEX

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