No part of the ABE certification process strikes fear in Board candidates to the extent that the oral examination does! Loss of sleep, worrying about forgetting data and facts, fear of total memory loss, concern about saying the wrong thing appearing dumb in front of “important” members of the specialty are all experiences candidates have shared over the years. On the flip side of the coin, when candidates who had just completed the last room during the oral examination were asked what effect preparing and studying for this event had had on them, the answers were uniformly positive: it often changed their philosophy of endodontic practice, improved their treatment skills, made them more confident in their practices, and promoted continued self-improvement.
Getting ready for the oral examination can be enhanced by providing the candidate with good recommendations, dispelling misconceptions, and developing error avoidance strategies. Let us look first at what recommendations you can give the candidate.
1. Be aware of what is expected of an oral examination candidate.
When a candidate knows what is expected, it is easier to prepare. The oral
Questions are designed primarily to test the candidate’s skills in solving endodontic problems. The majority of problems are clinical in nature, but may also include questions
That would require fundamental knowledge about biological principles, research, and research design. Don’t worry; these last questions don’t require Nobel Prize insight into complex research areas. The intent is to see if the candidate can apply the scientific method to common problems.
The clinical questions pertain to solving the types of situations that are seen in endodontic practice and require the candidate to have factual information to support his/her approach to diagnosing and treating a particular dental problem. The factual information must be evidence based from journal and textbook literature. It helps to cite
Specific references, including authors, but a candidate will probably not fail a question because a name is momentarily forgotten. It is also impressive to be able to cite opposing views and indicate which view makes the most sense.
Examination questions cover the scope of endodontics as described in the American Dental Association Accreditation Standards for Dental Education Programs. Questions are developed from a clinical case history that is presented to the Candidate. The questions are standardized, weighted and based on competencies that define the level of knowledge expected of Board Certified endodontists. A broad foundation of literature is essential for successful completion of the Oral Examination.
There are three sessions in the examination.
During each session, the Candidate spends thirty minutes with two Directors/Examiners.
Each Examiner independently completes a confidential evaluation immediately after every examination session.
Sessions are audiotape recorded for documentation.
The Oral Examination requires the Candidate to demonstrate his/her ability to:
Apply basic and dental sciences to diagnostic and treatment decisions.
Justify diagnostic and treatment decisions.
Formulate primary and secondary treatment plans.
Assess short and long term outcomes.
Alter patient management because of local or systemic pathologic conditions, psychological status and ethical considerations.
Examples of oral questions:
A. The candidate may be shown a radiograph of a central incisor with a root
fracture, given pertinent information, and then asked to make a diagnosis, how to treat, why such treatment is recommended, who has promoted such a treatment approach, and what the expected outcome is.
B. Another question may involve a radiograph of tooth #7 with a large carious lesion that appears to expose the pulp and a large periradicular lesion. Clinically, the patient presents with a canine fossa cellulites and moderate-to-severe pain. The medical history indicates penicillin allergy. The candidate is asked to describe the diagnostic work-up and treatment options. A question such as described above could also include additional questions about alternative antibiotic regimens, potential problems with spread of infection, and management of emergencies. The candidate needs to be familiar with antibiotics, analgesics, pathways of infection, and systemic implications of infections.
Surgical Endodontics is obviously an important oral examination topic
and may include a question such as this: “This is a radiograph of a mandibular incisor with a large periradicular lesion. The root canal therapy appears acceptable. Describe your treatment options.”
Pediatric dentistry also is included occasionally. A sample question: A 40
pound child presents with an acute irreversible pulpitis. Your treatment plan is to perform root canal therapy. The patient is an asthmatic who is hypersensitive to sulfites. How would you manage this patient in regard to the use and maximal dosage of local anesthetic?
E. The oral questions are for the most part case-based. Basic science is applied as appropriate as in the following question: Compare the healing response of a patient with a vitamin D deficiency with one who has no vitamin D deficiency. Assume each patient is undergoing nonsurgical root canal therapy on a tooth that has a large periapical rarefaction.
Case Based Format
Questions are designed to assess the Candidate’s higher level cognitive skills including problem solving, decision-making, and the abilities to analyze, create and evaluate.
The questions are based on competencies that define the knowledge base of a
Diplomate of the American Board of Endodontics.
A Candidate will be expected to quote literature references to support his/her statements on the following topics during the examination:
Subjective and Objective Examination
Application of Biological Principles
Complications of Treatment
Candidates sign the following confidentiality statement and examination policy on transcribing examination data prior to the examination:
“I understand that the content of the certification examination is proprietary and strictly confidential information. I hereby agree that I will not disclose, either directly or indirectly, any questions or any part of any questions from the examination to any person or entity. I understand that the unauthorized receipt, retention, possession, copying or disclosure of any examination materials, including but not limited to the content of any examination questions, before, during, or after the examination, may subject me to legal action. Such legal action may result in monetary damages and/or disciplinary action including denial or revocation of certification.”
The results of the Oral Examination are presented to the Directors of the Board by the Oral Examination Committee with a recommendation that those Candidates passing the Oral Examination be certified as Diplomates of the Board. The Secretary of the Board will notify the Candidates by letter whether they passed or failed the examination. A Candidate (who submitted their Preliminary Application on or after January 1, 1997) has two (2) years to successfully complete the Oral Examination. Candidates who exceed the two (2) year time limit for the Oral Examination or who fail to pass the examination within two tries, are required to re-apply by submitting a Preliminary Application and are required to repeat the entire certification process. An endodontist can be declared Board Eligible only two times during his/her career.
Caution: Advise the candidate: If you don’t know the answer to a question – say so! There is usually no problem saying, “I don’t know,” because the examiner can go on to another question. But if the candidate chooses to answer anyway and gives not only the wrong answer, but an answer that if it were to be applied clinically, could be harmful to the patient, then that question would be marked very low by the examiner.
2. Know that questions relate to clinical endodontics, not lists of facts.
The questions for the most part are case-based and related to clinical Endodontics. Factual information about the clinical practice of Endodontics is important, such as anatomical pathways for the spread of infection, drug interactions between medications that may be prescribed and drugs a patient may already be taking, and why the pulp may need to be extirpated in one trauma case but not in another. The candidate must be able to make a diagnosis based on a variety of facts including radiographs and histological slides. Advise the candidate to develop logical, sound treatment plans for a variety of situations including trauma, orofacial pain and medically compromised patients.
3. Understand how the oral examination is conducted.
The candidate will be examined in three rooms, 30 minutes in each room, by two examiners who more or less divide the ½ hour for questioning. The exam questions are constructed to be objective and are discussed by the entire group of examiners prior to being used. Often a silent observer will be present in the exam room. He/she may be another examiner who is not scheduled for another room, or may be an individual who is slated to join the examination group as an incoming director of the Board. The exam is tape recorded for documentation.
Answers are graded as 3,2,1, or 0 by each examiner. Individual Examiners do not make a pass or fail decision for any single candidate. At the end of the session, the candidates overall performance is evaluated. It is not expected that a candidate will get all 3’s during the examination, though occasionally a well prepared candidate may “ace” a room. Candidates should not get upset if they think they failed to answer a question or two correctly – nobody fails an oral exam by missing one or two questions.
4. Mentors: Go through a practice session with your candidate.
It is always a good idea to practice for an oral examination. A mentor who has gone through the process should be able to give a practice examination. The process of answering questions given verbally can be stressful, particularly if the candidate has had little or no experience in taking such an exam. Going through a practice session with a mentor will help to prepare the candidate to be mentally ready for the real thing.
5. Have the candidate practice being relaxed during the stress of the exam
During practice sessions, suggest that the candidate take deep breaths before answering questions, force himself/herself to think about the question, and formulate the answer in his/her mind before speaking. The candidate should tell himself/herself to relax, relax, relax. The mentor should paint a positive picture of the oral exam process so the candidate can visualize it in their mind.
6. ADVICE FOR PREPARATION FOR THE ORAL EXAMINATION
Don’t believe that just because you get good results in your clinical practice that you don’t need to prepare for the exam – you do! You need to have a scientific, evidence- based basis for your treatment decisions.
Don’t wait until a few weeks before the examination to begin preparations; it is better to study a little bit for months before the exam. Don’t keep putting it off. . .
Just Do It!
It is not necessary to memorize formulas and facts that were part of the written exam. It is necessary, however, to know the anatomical and physiological basis for the diagnosis and treatment of endodontic conditions.
Remember the examiners aren’t waiting to pounce on a candidate for making a mistake; they really do want everyone to pass!
Don’t try to impress an examiner by citing research or papers published by him/her. Stick to the best sources for evidence regardless of where it comes from.
The following are excerpts of recommendations made by some Diplomates who recently completed the process of certification.
I began studying in earnest four months before the exam date. The following regimen worked well for me:
Start by reviewing your notes, seminars, lectures, and other resource material from your residency to refresh you memory, depending on how long it has been since your residency program or how rusty your are!
Endodontic textbooks are a good resource:
Endodontic Therapy, Weine
Pathways of the Pulp, Cohen & Burns
Endodontics, Ingle & Bakland
Surgical Endodontic, Gutmann & Harrison
Principles and Practice of Endodontics. Walton & Torabinejad
Past issues of the JOURNAL OF ENDODONTICS are very important. Go back about two years and just read the abstract at the beginning of each article and pay close attention to the discussion and conclusions. You should also backtrack articles from the references given. Dental Clinics of North America and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics are also excellent sources. If available, go through Endodontics and Dental Traumatology and the International Journal of Endodontics.
Additional books for review or updating that may be helpful include:
Dental Management Of the Medically Compromised Patient, Little
Clinical Pharmacology in Dental Practice, Holroyd
Highly recommend attending annual review courses:
1. Academic Review of Endodontology, Albert Einstein Medical Center,
2. Review of the Biologic and Clinical Aspects of Endodontology,
University of Michigan, School of Dentistry, Ann Arbor, MI
Both courses were helpful, but do not rely on them as a solo study guide. Use
them as a source to clear up questions you may have.
Following is a list of topics that I felt most questions were based upon:
Inflammation and immunology as applied to clinical cases
Pharmacology of the drugs you use routinely
Treatment plans and options for medically compromised patients
Current literature (not too detailed)
Be able to support all clinical treatment with research based data.
Have someone ask you questions so that you can respond out loud and duplicate the format of the oral exam. Practice your oration and become comfortable with your responses. Have someone quiz you. Index/flash cards/palm pilots are excellent tools. Try to study a few hours a week with someone else who is taking the Board.
Tape-recording is helpful for some people. Tape yourself and critique your performance while you are on the way to work, driving, etc.
Talk with someone who has recently completed the Board exam and get their advice
Get in contact with a recent Diplomate and ask for help with organization, study materials, old questions, and plan for a practice oral exam.
Start 3 months prior to the orals and study a few hours every night.
Use 3x5 cards and separate the cards by subject
End every study session by answering a clinical question relating your response to the literature.
Meet once a month on weekends to study with your partner
Go to the orals 4-7 days early, this allows good concentrated study time.
Day before the exam – spend the day having fun.
Remember that you’ve really never failed anything and you won’t fail the orals if you’re prepared.
Embrace technology – utilize digital resources to gather, collect, and organize study material.
Set aside 4 months to study. Take the first month to organize material. 2-3 hrs/day.
Review your clinical practice and then organize your study material around the techniques and clinical strategies you employ. I.e. Justify your techniques and clinical practice with 2-3 authors.
Use of CO2 snow - 2-3 authors
Crown down technique - primary author
Lateral condensation – 2-3 authors
Use of EDTA – 2-3 authors
Smear layer Vs Non smear layer – authors on both sides of the debate
One shot endo Vs multiple appointments
Interim Ca (OH)2 placement for retreatment cases
Study pharmacology and the medically compromised patient.
Know Trowbridge’s Inflammation: A review of the process . . cold.
Have confidence. . you have what it takes. It’s not rocket science; it’s much bigger than that.
Go to Ditka’s for dinner the night before, you may meet him. ( Chicago in Nov)
Follow the 5 P’s and you WILL pass. (Proper preparation prevents poor performance)
Solicit study materials from recently successful candidates.
Solicit prior orals questions from previous candidates.
Read Pulpal Biology chapter in Walton & Torabinejad ( it is condensed)
Read numerous other chapters in most recent Ingle & Bakland and Cohen & Burns text. I selected chapters on topics in which I felt particularly weak.
Starting 3 months before the orals, I did the following:
Took Fridays off to study
Studied Saturday nights and Sundays
Quit practice at 4:00 pm daily to study for several hours
One week before the orals, I:
Went to Chicago to adjust to time zone and weather ( Chicago is very cold in
Sought immediate appointment with cardiologist to ensure I would live at least until the Board results were received. THEN, PLANNED BIG VACATION WITH WONDERFUL SUPPORTIVE WIFE.
Appeal Process for an Adverse Decision
A candidate who has received an adverse decision on the Oral Examination has the right to seek reconsideration of the adverse decision by filing a timely written request for reconsideration with the Secretary of the Board.
To be valid, the Secretary of the Board must receive the request for reconsideration within 30 calendar days after receipt by the Candidate of notice of the adverse decision. The request must contain a statement of why the Candidate believes that the adverse decision was improper and must include any supporting documentation that the Candidate wishes to have considered as part of the reconsideration. The request must be accompanied by a check or money order made payable to the American Board of Endodontics in the amount of $100 to cover administrative costs associated with the appeal process. This fee shall not be refunded, regardless of the outcome of the appeal.
Pet Peeves – Oral Examination – ABE Diplomate Newsletter
As before, the entire Board was surveyed. Each director was asked to list at least three of their most egregious peeves during the orals. It is one thing to list all the “do’s” when answering questions, but what about the little things that could be done better to negotiate your way through your three thirty minute sessions without raising the eyebrows of the directors. Hence, the pet peeves. These are not fatal errors, but enough of them and the interviewing Director(s) will have a tendency to view your oral examination less favorably.
The two greatest areas of peevishness deal with literature citations and the pace of the examination process, mentioned by no less than four Directors. The remaining peeves were mentioned by only one or two. So please read on and consider the comments from the Directors.
References! Use references when indicated or asked for. References are to be used to justify your comments. Unlike the written exam, during the orals there are almost no instances where we ask for a specific author. Failure to use any literature citations to support an answer or uses too many references from the 60’s and 70’s when more relevant and current literature is available. A candidate should be able to quote the classic literature from our specialty, at a minimum, to support a position. Don’t quote “sponsored” speakers as a justification on clinical issues and treatment procedures. Especially if those issues are controversial and not backed up by the literature.
The second most popular peeve; the candidate that tries to control the pace of the questions. Keep in mind that the Directors must complete all ten sections of their scripted scenario. A candidate that can’t completely answer a question should say so and move on. It is not good for a candidate to dwell on the question and then try and answer the question later on. Let it go. On the other hand, do not filibuster. Be concise with your answers. Brevity is a virtue.
Radiographs…when asked to describe what is seen on the radiograph, leave nothing out! Do not fall prey to tunnel vision and describe only the tooth involved.
Candidates which have a limited or outdated knowledge of pharmacology. Be prepared to discuss current pharmacology as it relates to patient care.
The candidate who uses outdated or wrong diagnostic terminology. Use the current diagnostic terminology when asked to make a diagnosis.
A candidate who fails to ask for the medical history.
Overall, not having a biologic basis for what they purport to do with a similar case in their office.
A few Directors felt compelled to throw in a few words of advice along with their favorite peeve. This advice includes such hints as: don’t be nervous, the Board is there to test you knowledge and help you through the examination process. Have a positive attitude. Demonstrate confidence that you are well prepared for the exam.
One of the Directors expressed the thoughts of all of us on the Board when he said, “I wish they weren’t so nervous. I have great admiration and respect for their effort.”
We look forward to congratulating each and every successful candidate and awarding them their pin at the Louis Grossman luncheon every year at the AAE Annual Session.
Members of the College of Diplomates would like to echo the above statement. While the journey to Board certification is a rigorous process, the College of Diplomates wishes a successful conclusion to each candidate’s journey. The major purpose of the College of Diplomates is to promote Board certification and assist candidates as they negotiate the process. We hope that this manual has been helpful to both the mentor and the candidate in this quest.