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Manikin exams: A postpandemic improvement for dental hygiene

July 26, 2023
The pandemic actually had a couple of silver linings for dentistry. Letitia Hill believes the manikin exams that evolved are a good thing for dental hygienists for many reasons.

The pandemic changed many things for many people, and the dental field was heavily impacted. There were changes to procedures and screening protocols. There’s a national shortage of staff. It’s hard to say if and when things will return to normal.

According to US News and World Report, the estimated reduction in hygienists since 2020 is 3,300 nationwide.1 As the field recovers, there have been some positive changes, one being the change to the dental hygiene patient-based clinical exam. These changes have been debated for some time, and the pandemic created a sense of urgency that helped fuel these changes. I believe they were long overdue.

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Factors that affect testing

I’m a 2020 dental hygiene graduate. In October of that year, I failed my dental hygiene patient-based clinical exam because my patient was deemed nonqualified by examiners. At that time, Pennsylvania was not accepting manikin exams for licensure, while surrounding states were. As well, patient-based testing opportunities were constantly canceled due to the pandemic. Having the opportunity to take a manikin-based exam would have been easier during those unknown and changing circumstances. Manikin-based exams are more standardized and ethical.

Throughout their education, dental hygiene students must complete multiple tests and evaluations in a clinical setting. Their final feat is presenting a patient and completing treatment for the clinical board exam. According to the Pennsylvania Department of State, dentistry was one of the only fields that still required live patients for licensure exam in 2020.2

It’s been argued that it’s inadequate to determine a student’s clinical skill based on a one-time exam, especially considering all the training and testing they undergo during their education. Studies have shown that high-stress situations can impact performance, especially on tasks that require decision-making and divided attention.3 Knowing this, how is it fair to evaluate students on their performance in these situations? Would it be more reasonable to determine competency and skill based on results from multiple testing scenarios during their education?

Relying on patients for exams is another factor that affects the exam process. There’s always the possibility a patient does not present for the student. In this scenario, the student is penalized for something that’s out of their control. On the day of the exam, patients may not even qualify for a variety of reasons. Luckily, according to the ADEX website, both patient and manikin clinical exams are now accepted for dental hygiene licensure.4

The advantages of manikins

Manikin exams eliminate ethical and safety issues and allow for standardization of testing. Patients can vary widely in difficulty when it comes to treating them, and no two situations are the same. One student’s patient may have heavier and more tenacious calculus than another student’s patient. When students are given manikins with a fixed amount of calculus, the exam is standard and fair because all students take the same exam.

While the dental field is still recovering from the pandemic, it’s nice to see the changes we’re making. Manikin exams for licensure have been debated for years. This method still tests for calculus detection and tissue management similar to patient-based exams. They’re an effective alternative for determining competency and should continue to be used for licensure. Dental hygiene students undergo a thorough education and rigorous clinical training, making them well rounded health-care providers. Providing them with more accessible and standardized testing for licensure is a step in the right direction.


  1. Pandemic bit into supply of dental hygienists. US News. February 24, 2022. https://www.usnews.com/news/health-news/articles/2022-02-24/pandemic-bit-into-supply-of-dental-hygienists
  2. Pennsylvania gives dentists and dental hygienists alternatives to live-patient clinical licensing exam during COVID-19 emergency. Pennsylvania Deptartment of State. April 24, 2020. https://www.dos.pa.gov/Documents/2020-04-24-Summary-Dentist-Dental-Hygienist-Waivers.pdf
  1. LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med. 2009;84(10):S25-33. doi:10.1097/ACM.0b013e3181b37b8f.
  2. ADEX dental hygiene. Adex testing. https://adextesting.org/adex-dental-hygiene/