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NDEB Equivalency Process · Last updated November 2026

NDEB Assessment of Clinical Judgement (ACJ): free practice test

The second NDEB Equivalency Process assessment, open once you've passed the AFK. It tests clinical judgement: diagnosis, treatment planning and decision-making from case histories, periodontal charts, photographs and radiographs, plus radiographic interpretation in every section. It runs twice a year, in May and November, and you can take it a maximum of three times.

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About the ACJ exam

The second NDEB Equivalency Process assessment, open once you've passed the AFK. It tests clinical judgement: diagnosis, treatment planning and decision-making from case histories, periodontal charts, photographs and radiographs, plus radiographic interpretation in every section. It runs twice a year, in May and November, and you can take it a maximum of three times.

What's on the exam

ACJ
Oral Medicine, Oral Pathology and Oral Surgery
6 key facts
Pharmacotherapeutics and Medically Complex Patients
7 key facts
Cariology and Restorative Dentistry
6 key facts
Periodontics
6 key facts
Endodontics
6 key facts
Orthodontics and Pediatric Dentistry
6 key facts

Each branch is a topic in the official outline. Members see every key fact on the full mind map. Read the free study guide →

How to pass the ACJ exam

  • The ACJ is case-based. Read the medical history, medications and vital signs first: they change the answer to more than one question.
  • Multi-answer questions score 1 only if you pick every correct option and no wrong one; a single wrong pick scores 0. Choose only the options you're sure of.
  • Oral medicine, pathology and oral surgery are the biggest area (about 25%), followed by pharmacotherapeutics and medically complex patients (about 22%).
  • Radiographic interpretation is in every section. Practise describing a lesion's site, margins, internal structure and effect on nearby teeth before naming it.

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Create a free account after the test: your score by topic, a mistakes bank, the complete study notes for the first topic, flashcards and the High-Yield Dental Values Sheet.

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What's in the premium ACJ prep

Premium ACJ prep is studied one topic at a time. Each step starts with that topic's key notes and flashcard deck, then its own question sets of 25, so you master one topic before you move to the next. When every topic is strong, the 6 full mock exams show you're ready.

3,000practice questions, every answer explained
6full-length mock exams, 150 questions each, timed
800flashcards with spaced repetition, sorted by topic
60comprehensive key notes across 6 topics

Your step-by-step study path

  1. 1
    Oral Medicine, Oral Pathology and Oral Surgery10 key notes, 135 flashcards, then 500 practice questions in 20 sets of 25
    Notes free with an account
  2. 2
    Pharmacotherapeutics and Medically Complex Patients10 key notes, 135 flashcards, then 500 practice questions in 20 sets of 25
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  3. 3
    Cariology and Restorative Dentistry10 key notes, 135 flashcards, then 500 practice questions in 20 sets of 25
    Premium
  4. 4
    Periodontics10 key notes, 135 flashcards, then 500 practice questions in 20 sets of 25
    Premium
  5. 5
    Endodontics10 key notes, 130 flashcards, then 500 practice questions in 20 sets of 25
    Premium
  6. 6
    Orthodontics and Pediatric Dentistry10 key notes, 130 flashcards, then 500 practice questions in 20 sets of 25
    Premium
  7. Final step: 6 full mock exams150 questions each, timed like test day. Pass them, then book your exam.
    Premium
Free with an account

Read the complete ACJ study notes for “Oral Medicine, Oral Pathology and Oral Surgery”

Our first full set of comprehensive notes, about 15 minutes of reading: Describe before you diagnose · Biopsy decisions · Jaw lesions to recognize · Infections: who stays in the chair and who goes to hospital · Surgery in medically complex patients, a worked exam example, the traps examiners use and a one-minute recap. Create a free account to read it and see how premium notes work before you decide.

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Study tools included

3,000 practice questions

3,000 exam-style questions per exam, organized topic by topic in sets of 25. Every answer explained, with the rule it comes from.

6 full mock exams

6 full-length timed mock exams per exam, with real question counts and time limits, so test day feels like practice day.

Exam Readiness Score

One 0 to 100 number that tells you when you're ready to book. Reach 80 and you're covered by our Pass Guarantee.

800 flashcards + spaced repetition

800 flashcards per exam, in a deck for each topic, that come back right before you'd forget them. Five minutes a day keeps every number fresh.

60 comprehensive key notes

60 key notes per exam, split across its topics and each explained in full: the concepts, worked exam examples, the traps examiners use and a quick recap. Your first set is free with an account.

Mind maps

See the whole exam on one screen: every topic and the facts under it.

Sample questions with answers

These are the questions in the free test above, with answers. Try the test first. You'll learn more by getting some wrong.

1. A 50-year-old has a painless, firm, smooth, pink nodule about 8 mm across on the buccal mucosa along the occlusal plane. He says it has been there for over a year and he sometimes bites it. What is the most appropriate management?
Answer: Excisional biopsy. This is most likely an irritation fibroma (fibroepithelial polyp) caused by chronic biting. A small, well-circumscribed lesion like this is removed completely by excisional biopsy, which both treats it and confirms the diagnosis. Incisional biopsy is for large lesions or those suspicious for malignancy.
2. Two days after a painful lower molar became swollen, a patient has bilateral submandibular and sublingual swelling, a raised tongue, difficulty swallowing, a muffled voice and a temperature of 39.2°C. What is the most appropriate action?
Answer: Arrange immediate transfer to a hospital emergency department. Bilateral submandibular and sublingual involvement with an elevated tongue, dysphagia and fever is Ludwig's angina, a spreading infection that can obstruct the airway. It needs emergency hospital care: airway management, IV antibiotics and surgical drainage. Office treatment or oral antibiotics alone would delay life-saving care.
3. A panoramic radiograph of a 22-year-old shows an unerupted 3.8 with a well-defined, unilocular radiolucency surrounding its crown and attached at the cementoenamel junction. The pericoronal space measures 6 mm. What is the most likely diagnosis?
Answer: Dentigerous cyst. A unilocular radiolucency around the crown of an unerupted tooth, attached at the CEJ, is typical of a dentigerous cyst. A normal follicular space is usually 3 mm or less; more than about 5 mm suggests a cyst. A radicular cyst is at the apex of a non-vital tooth. Ameloblastoma is often multilocular, but a unicystic ameloblastoma or odontogenic keratocyst can look identical, so the tissue must be sent for histology.
4. A patient on warfarin for atrial fibrillation needs a single uncomplicated extraction. Her INR, measured this morning, is 2.5. What is the most appropriate approach?
Answer: Extract without stopping warfarin, using local hemostatic measures. For simple extractions, an INR within the therapeutic range (generally below 3.0 to 3.5, checked within 24 hours) is safe to proceed. Use atraumatic technique, a hemostatic agent in the socket, sutures and pressure, and avoid NSAIDs afterwards. Stopping warfarin raises the risk of stroke more than the extraction raises the risk of bleeding; any change to anticoagulants is the prescriber's decision.
5. A patient with type 1 diabetes becomes sweaty, shaky and confused during a long appointment. She is conscious and can swallow. A glucometer reads 3.2 mmol/L. What should you do first?
Answer: Give 15 g of fast-acting carbohydrate by mouth, then recheck in 15 minutes. Mild to moderate hypoglycemia (below 4.0 mmol/L) in a conscious patient who can swallow is treated with 15 g of fast-acting carbohydrate (glucose tablets or juice), rechecking after 15 minutes and repeating if still low (Diabetes Canada). Glucagon is for patients who are unconscious or can't swallow. Insulin would make it worse.
6. A patient with a prosthetic mitral valve needs a scaling procedure involving gingival manipulation. He had anaphylaxis to penicillin in the past. According to the 2021 American Heart Association guidance, which is the most appropriate prophylaxis?
Answer: Azithromycin 500 mg orally 30 to 60 minutes before. A prosthetic valve is a highest-risk condition, and gingival manipulation needs prophylaxis. With a history of anaphylaxis to penicillin, avoid amoxicillin and cephalosporins. The 2021 AHA scientific statement, widely used in Canada, recommends azithromycin or clarithromycin 500 mg (or doxycycline 100 mg) and no longer recommends clindamycin because of its adverse effects, including C. difficile infection.
7. An 84-year-old long-term care resident with dementia has several cavitated, active root caries lesions. She can't tolerate long appointments or rubber dam isolation. Which is the most appropriate way to arrest the lesions?
Answer: Topical application of 38% silver diamine fluoride. Silver diamine fluoride 38% arrests cavitated root and coronal caries, takes seconds to apply and needs no drilling or isolation, which suits frail older patients with limited cooperation. Warn caregivers that arrested lesions stain black. Sealants don't treat root surfaces, crowns aren't realistic here, and chlorhexidine rinse alone doesn't arrest cavitated lesions.
8. A deep occlusal carious lesion on 4.6 extends into the inner quarter of dentin on the radiograph. The tooth responds normally to cold with no lingering pain and isn't tender to percussion. What is the recommended caries removal strategy?
Answer: Selective removal to soft dentin over the pulp, hard dentin at the periphery, then a well-sealed restoration. For deep lesions in teeth with a vital pulp and no signs of irreversible pulpitis, current evidence and consensus favour selective removal to soft (or leathery) dentin near the pulp, with hard dentin at the margins so the restoration seals. It greatly reduces the risk of pulp exposure, and sealed bacteria become inactive. Removing everything to hard dentin risks an exposure for no benefit.
9. A patient has sharp pain when releasing biting pressure on a cotton roll over the distolingual cusp of 3.7, which has a large MOD amalgam. Cold causes a brief sharp pain that stops quickly. The radiograph is normal. What is the most appropriate treatment?
Answer: A cuspal-coverage restoration, such as an onlay or crown. Pain on release of biting on one cusp with a normal radiograph and reversible cold response suggests a cracked cusp (cracked tooth). Covering the cusps holds the tooth together and protects it from further splitting. Root canal treatment is only needed if irreversible pulpitis or necrosis develops, and extraction is for cracks extending into the root.
10. A 24-year-old student has painful, bleeding gingiva with punched-out, cratered interdental papillae covered by a grey pseudomembrane and a foul odour. She has no fever or lymphadenopathy and is otherwise healthy. What is the most appropriate initial treatment?
Answer: Gentle debridement, chlorhexidine rinses and oral hygiene instruction, without systemic antibiotics. This is necrotizing gingivitis. Without systemic involvement, treatment is local: gentle debridement (under topical or local anesthesia), chlorhexidine 0.12% rinses, oral hygiene advice, and attention to stress, smoking and sleep. Metronidazole is added if there is fever, malaise or lymphadenopathy. Screening for underlying conditions may be appropriate, but it shouldn't delay treatment.
11. A 45-year-old who smokes 15 cigarettes a day has periodontitis. The worst radiographic bone loss is 30% of the root length. Under the 2017 classification, what grade should be assigned?
Answer: Grade C. By bone loss alone, 30 ÷ 45 = 0.67, which would be Grade B. But grade modifiers override that: smoking 10 or more cigarettes a day (or HbA1c of 7.0% or more) moves the case to Grade C. When no earlier radiographs exist, the indirect bone loss / age ratio is used, so a grade can still be assigned.
12. 6.6 was root canal treated 4 years ago and has a well-fitting crown. It now has a sinus tract, and the radiograph shows a periapical radiolucency and a root filling about 3 mm short of the apex with voids. What is the most appropriate initial treatment?
Answer: Non-surgical root canal retreatment. Persistent apical periodontitis with a short, poorly condensed root filling is best treated first by non-surgical retreatment, which can reach the missed canal space and bacteria. Apical surgery is usually reserved for when retreatment isn't possible or has failed. Antibiotics don't treat the source, and the tooth is restorable, so extraction isn't the first choice.
13. 4.5 doesn't respond to cold or electric pulp testing and is tender to percussion and biting. The radiograph shows a periapical radiolucency. There is no swelling or sinus tract. What is the diagnosis?
Answer: Pulp necrosis with symptomatic apical periodontitis. No response to cold and EPT indicates pulp necrosis. Pain on percussion or biting makes the apical periodontitis symptomatic. A chronic apical abscess would have a sinus tract, an acute apical abscess would have swelling, and an asymptomatic apical periodontitis wouldn't be tender.
14. An 8-year-old has an anterior crossbite of 1.1. In centric relation the incisors meet edge to edge, and the mandible shifts forward to reach full intercuspation. There is enough space to move 1.1 forward. What is the most appropriate management?
Answer: Correct the crossbite now, for example with a removable appliance and a finger spring. A single-tooth anterior crossbite with a functional forward shift is a dental problem, not a skeletal Class III, and should be corrected early. Leaving it can wear the incisor, cause gingival recession on the lower incisor and encourage a mandibular shift. A removable appliance with a finger spring (or a fixed sectional appliance) works when there is enough space.
15. A 3-year-old has early childhood caries and is assessed as high caries risk. How often should a 5% sodium fluoride varnish be applied?
Answer: Every 3 to 6 months. High-risk children benefit from 5% NaF varnish (22,600 ppm F) at least twice a year, and every 3 months is common for the highest risk. Varnish is suitable for young children because only a small amount is used and it sets on contact with saliva, so very little is swallowed. Combine it with diet counselling and twice-daily brushing with fluoride toothpaste.

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Certification guide

How to become a dentist in Canada as an internationally trained dentist: If your dental degree is from a program not accredited by the Commission on Dental Accreditation of Canada (CDAC), the usual route to practice is the [NDEB Equivalency Process](https://ndeb-bned.ca/equivalency-process/entry-to-practice-graduates-of-non-accredited-dental-programs/): three assessments (the AFK, the ACJ and the NDECC), then the Virtual OSCE for NDEB certification, then a licence from a provincial regulator. Here is the path, what it costs and where candidates get stuck.

ACJ exam FAQ

How many questions are on the ACJ exam?

About 150 single-answer and multi-answer multiple-choice questions (the NDEB lists 120 to 150), many built on case histories, charts, radiographs and photographs, with a time limit of about 5 hours of testing with one scheduled break (a 5.5-hour session). Format: closed book, computer-based, case-based single- and multi-answer multiple choice.

What is the passing score for ACJ?

A test-equated, re-scaled score of 75 (the NDEB's standardized passing score); multi-answer questions score 1 only if every correct option and no wrong option is chosen.

How much does the ACJ exam cost?

C$1,350 per attempt (fees effective 1 July 2025). The NDEB reviews its fees every year (the current fees took effect on 1 July 2025), so confirm on the NDEB website before you register.

Which languages is the ACJ exam offered in?

English and French.

Where do I take the ACJ exam?

Computer-based at Prometric test centres in Canada and select international locations, including Australia and New Zealand.

Is this ACJ practice test free?

Yes. The 15-question practice test on this page is free, with an explanation for every answer and no signup. A free account also unlocks the complete study notes for the first topic. The full ACJ prep is Premium at C$207 a month for this exam.

What's in the premium ACJ prep?

3,000 practice questions organized topic by topic (Oral Medicine, Oral Pathology and Oral Surgery: 500; Pharmacotherapeutics and Medically Complex Patients: 500; Cariology and Restorative Dentistry: 500; Periodontics: 500; Endodontics: 500; Orthodontics and Pediatric Dentistry: 500), 6 full-length timed mock exams of 150 questions, 800 flashcards and 60 comprehensive key notes split across all 6 topics, plus a mistakes bank and the Readiness Score.

Compare ACJ with the other NDEB assessment

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Exam details are summarized from the official candidate information available in October 2026. the National Dental Examining Board of Canada changes formats and fees, so confirm with The National Dental Examining Board of Canada (NDEB) before you book. AFKQuizBank is not affiliated with the National Dental Examining Board of Canada or Prometric.

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