Western Regional Examining Board (WREB) Overview
These study notes are designed to help candidates prepare for the WREB clinical and written examinations. The WREB uses the ADEX (American Board of Dental Examiners) format for dental hygiene and dentistry licensure. The notes focus on key clinical concepts, decision-making, and regulatory knowledge. Candidates should verify all specific exam details (dates, fees, pass marks) with the official WREB/ADEX sources.
For Dental Conquer practice planning, this module is tracked as 100 questions over about 180 minutes with a listed pass mark of 70%. Treat those numbers as practice baselines and verify the current official format before scheduling.
How This Guide Is Organized
The sections below turn the syllabus into studyable subject blocks. Read a subject first, explain the must-know ideas without notes, then use questions and flashcards to test whether the knowledge holds under pressure.
- Operative Dentistry and Restorative Procedures
- Periodontal Assessment and Clinical Therapy
- Endodontic Diagnosis and Treatment
- Prosthodontics and Treatment Planning
- Local Anesthesia and Pain Management
- Clinical Ethics and Jurisprudence
Exam Snapshot and Readiness Target
Format: ADEX-style: OSCE (Objective Structured Clinical Examination), CSCE (Computerized Simulated Clinical Examination), and clinical skills assessments. Written component may include 100 questions in 180 minutes (practice baseline).
Candidate level: Entry-to-practice for dental licensure (dentists and dental hygienists).
Readiness target: Competency in clinical decision-making, patient management, and ethical/legal standards.
Most candidates should budget at least 44+ focused study hours, then adjust upward for unfamiliar clinical systems, regulatory content, or specialty-level case reasoning.
Operative Dentistry and Restorative Procedures
Syllabus Focus
- Caries classification and diagnosis
- Cavity preparation principles
- Restorative materials (amalgam, composite, glass ionomer)
- Matrix and wedge placement
- Finishing and polishing
Key Notes
- Caries classification: Class I-VI (GV Black). Class I: pits and fissures; Class II: proximal surfaces of premolars and molars; Class III: proximal surfaces of incisors and canines not involving incisal angle; Class IV: proximal surfaces involving incisal angle; Class V: gingival third of facial/lingual surfaces; Class VI: incisal/occlusal edges.
- Cavity preparation steps: outline form, resistance form, retention form, convenience form, removal of remaining caries, finishing enamel walls, cleaning and drying.
- Amalgam: requires mechanical retention (undercuts, grooves); composite: requires acid etching, bonding agent, incremental placement; glass ionomer: chemical bond to tooth, releases fluoride, used for non-load-bearing areas.
- Matrix band placement: Tofflemire retainer for Class II; sectional matrices for tight contacts; wedge selection based on gingival contour.
- Finishing: amalgam - carvers, burnishers; composite - finishing burs, discs, polishing cups; avoid over-contouring.
Must Know
- Indications and contraindications for amalgam vs. composite vs. glass ionomer.
- Principles of isolation (rubber dam) and moisture control.
- Caries detection: visual, tactile, radiographs (bitewings), DIAGNOdent.
- Pulp protection: liners (calcium hydroxide) and bases (RMGI, zinc phosphate) for deep caries.
Clinical and Exam Application
- When restoring a Class II lesion, ensure proper contact and contour to prevent food impaction.
- For deep caries, use indirect pulp cap or stepwise excavation to avoid pulp exposure.
- Select composite for esthetic anterior restorations; amalgam for posterior stress-bearing areas.
High-Yield Distinctions
- Amalgam: requires 1.5-2mm occlusal reduction; composite: bevel enamel margins for bond strength.
- Glass ionomer: lower compressive strength, not for occlusal load; use as liner or base.
- Class V lesions: often due to abrasion/erosion; composite or RMGI preferred.
Common Pitfalls
- Inadequate caries removal leading to recurrent decay.
- Overhanging margins from improper matrix adaptation.
- Contamination of composite during placement (saliva, blood) causing bond failure.
Review Tasks
- Review GV Black classification and cavity preparation steps.
- Practice matrix band and wedge placement on typodont.
- Study material selection criteria for different clinical scenarios.
Periodontal Assessment and Clinical Therapy
Syllabus Focus
- Periodontal probing and charting
- Classification of periodontal diseases
- Scaling and root planing (SRP)
- Periodontal maintenance
- Non-surgical vs. surgical therapy
Key Notes
- Probing: 6 sites per tooth (mesiobuccal, buccal, distobuccal, mesiolingual, lingual, distolingual); normal sulcus depth 1-3mm; bleeding on probing indicates inflammation.
- Periodontal disease classification: 2017 World Workshop - periodontitis staging (I-IV) and grading (A-C); also necrotizing periodontal diseases, periodontitis as manifestation of systemic disease.
- SRP: removal of plaque and calculus from root surfaces; local anesthesia often required; use Gracey curettes (area-specific) or universal curettes.
- Maintenance: 3-4 month intervals for periodontitis patients; includes probing, SRP as needed, oral hygiene reinforcement.
- Non-surgical: SRP, antimicrobials (chlorhexidine, doxycycline); surgical: flap surgery, osseous surgery, grafting.
Must Know
- Clinical attachment loss (CAL) calculation: CAL = probing depth + gingival recession.
- Indications for SRP: probing depths ≥4mm with bleeding, calculus, or attachment loss.
- Contraindications for SRP: uncontrolled systemic disease (e.g., uncontrolled diabetes), anticoagulant therapy (consult physician).
- Furcation involvement: Class I (probeable), II (partial through), III (through-and-through).
Clinical and Exam Application
- For generalized periodontitis, full-mouth SRP within 24 hours or quadrant scaling over multiple visits.
- Use local delivery antimicrobials (e.g., Arestin) in deep pockets ≥5mm that bleed.
- Refer for surgical evaluation if residual pockets ≥5mm after SRP.
High-Yield Distinctions
- Chronic vs. aggressive periodontitis: aggressive has rapid attachment loss, familial pattern; chronic is more common, slow progression.
- Necrotizing ulcerative gingivitis (NUG): pain, punched-out papillae, pseudomembrane; treat with debridement, metronidazole.
- Peri-implantitis: inflammation around implant with bone loss; treatment similar to periodontitis.
Common Pitfalls
- Incomplete calculus removal due to poor access or inadequate anesthesia.
- Over-instrumentation causing root surface damage or sensitivity.
- Failure to document baseline probing depths and CAL.
Review Tasks
- Review periodontal probe markings and proper angulation.
- Practice SRP on typodont with calculus simulation.
- Study 2017 classification system.
Endodontic Diagnosis and Treatment
Syllabus Focus
- Pulp vitality testing
- Diagnosis of pulpal and periapical diseases
- Access cavity preparation
- Root canal instrumentation and obturation
- Emergency management
Key Notes
- Pulp tests: cold (Endo-Ice), heat (gutta-percha), electric pulp tester (EPT); periapical tests: percussion, palpation, bite test.
- Pulpal diagnoses: normal pulp, reversible pulpitis, irreversible pulpitis, pulp necrosis; periapical: normal, symptomatic apical periodontitis, asymptomatic apical periodontitis, acute apical abscess, chronic apical abscess.
- Access cavity: remove all caries, straight-line access to canal orifices; use endodontic explorer (DG-16) to locate canals.
- Instrumentation: crown-down technique with rotary files (e.g., ProTaper); irrigation with NaOCl (1-5.25%), EDTA for smear layer; obturation with gutta-percha and sealer (warm vertical or cold lateral condensation).
- Emergency: for acute apical abscess, incise and drain, prescribe antibiotics (penicillin VK 500mg q6h) if systemic signs.
Must Know
- Indications for root canal therapy: irreversible pulpitis, pulp necrosis, elective for prosthetic reasons.
- Working length determination: electronic apex locator, radiograph with file at apex.
- Master apical file size: typically #25-40 depending on canal anatomy.
- Signs of successful obturation: dense fill within 0.5-2mm of radiographic apex.
Clinical and Exam Application
- For reversible pulpitis, remove caries and place sedative dressing (e.g., IRM); monitor.
- For irreversible pulpitis, initiate RCT or refer; pain may require pulpectomy.
- In multi-rooted teeth, locate all canals (e.g., MB2 in maxillary molars).
High-Yield Distinctions
- Reversible vs. irreversible pulpitis: reversible responds to cold with sharp pain that subsides quickly; irreversible has lingering pain.
- Necrotic pulp: no response to cold/EPT; periapical radiolucency may be present.
- Acute apical abscess: rapid onset, swelling, pain; treat with drainage and antibiotics.
Common Pitfalls
- Missed canals (e.g., second mesial buccal in maxillary molars).
- Over-instrumentation beyond apex causing periapical irritation.
- Incomplete cleaning due to inadequate irrigation or insufficient file size.
Review Tasks
- Review pulp testing techniques and interpretation.
- Practice access cavity preparation on extracted teeth.
- Study root canal anatomy variations.
Prosthodontics and Treatment Planning
Syllabus Focus
- Fixed prosthodontics (crowns, bridges)
- Removable prosthodontics (partial and complete dentures)
- Implant prosthodontics
- Treatment planning sequencing
- Occlusion and articulation
Key Notes
- Fixed prosthodontics: full crown (metal, PFM, all-ceramic), partial coverage (inlay, onlay), bridge (conventional, cantilever, resin-bonded).
- Tooth preparation: reduction guidelines - 1.5-2mm occlusal, 1-1.5mm axial; finish line: chamfer, shoulder, or knife-edge.
- Removable partial denture (RPD): Kennedy classification; components: major connector, minor connector, rests, direct retainers (clasps), indirect retainers.
- Complete denture: impression techniques (primary, final), jaw relation records, try-in, delivery; post-insertion adjustments.
- Implant prosthodontics: single crown, fixed partial denture, overdenture; abutment selection (stock vs. custom).
Must Know
- Indications for fixed vs. removable: fixed for single tooth or short span with good abutments; removable for multiple missing teeth or when abutments are compromised.
- Abutment selection: tooth-supported vs. implant-supported; consider crown-to-root ratio (minimum 1:1).
- Occlusal principles: mutually protected occlusion, group function, or balanced occlusion for dentures.
- Treatment planning sequence: emergency care → periodontal therapy → restorative → prosthodontics.
Clinical and Exam Application
- For a single missing tooth, consider implant crown or three-unit bridge; resin-bonded bridge for low occlusal load.
- For edentulous patient, complete denture with proper border extension and posterior palatal seal.
- For RPD, design with indirect retention to prevent rotation.
High-Yield Distinctions
- PFM: metal coping with ceramic veneer; all-ceramic: lithium disilicate (e.g., e.max) for anterior and posterior.
- Implant crown: screw-retained vs. cement-retained; screw-retained retrievable, cement-retained esthetic.
- Overdenture: retained by implants or roots; provides stability and retention.
Common Pitfalls
- Inadequate tooth reduction leading to overcontoured restoration.
- Poor marginal fit causing recurrent decay or gingival inflammation.
- Incorrect occlusal vertical dimension (OVD) in dentures causing TMJ issues.
Review Tasks
- Review tooth preparation guidelines for different crown types.
- Practice RPD design on study models.
- Study implant components and abutment selection.
Local Anesthesia and Pain Management
Syllabus Focus
- Local anesthetic agents and vasoconstrictors
- Injection techniques (maxillary and mandibular)
- Anatomy relevant to nerve blocks
- Complications and management
- Medical emergencies related to anesthesia
Key Notes
- Common agents: lidocaine 2% with epinephrine 1:100,000 (duration ~60 min pulp, ~180 min soft tissue); articaine 4% with epinephrine 1:100,000 (higher diffusion, used for infiltration).
- Vasoconstrictors: epinephrine, levonordefrin; contraindications: severe cardiovascular disease, uncontrolled hyperthyroidism, MAO inhibitors.
- Maxillary injections: infiltration (buccal and palatal), posterior superior alveolar (PSA), infraorbital, greater palatine, nasopalatine.
- Mandibular injections: inferior alveolar nerve block (IANB), buccal nerve block, mental/incisive nerve block, Gow-Gates, Vazirani-Akinosi.
- Complications: hematoma, paresthesia, trismus, needle breakage, intravascular injection (toxicity).
Must Know
- Maximum doses: lidocaine 2% with epi - 7 mg/kg (max 500 mg); articaine 4% with epi - 7 mg/kg (max 500 mg).
- IANB technique: needle insertion at pterygomandibular raphe, 1cm above occlusal plane, advance to bone, aspirate, inject slowly.
- Signs of local anesthetic toxicity: perioral numbness, metallic taste, tinnitus, seizures, cardiac arrest.
- Treatment of toxicity: stop injection, administer oxygen, monitor vitals, call emergency; benzodiazepines for seizures.
Clinical and Exam Application
- For mandibular molars, IANB is primary; supplement with buccal infiltration of articaine for pulpal anesthesia.
- For maxillary anterior teeth, infiltration labially and palatally (nasopalatine block).
- Use aspirating syringe to prevent intravascular injection.
High-Yield Distinctions
- Articaine vs. lidocaine: articaine has higher success rate for mandibular infiltration due to bone penetration.
- Epinephrine concentration: 1:100,000 vs. 1:200,000; higher concentration for hemostasis.
- Paresthesia: more common with articaine (lingual nerve) but usually transient.
Common Pitfalls
- Incorrect IANB injection site (too low or too high) leading to failed anesthesia.
- Failure to aspirate causing intravascular injection.
- Overdose from multiple injections exceeding maximum dose.
Review Tasks
- Review anatomy of trigeminal nerve branches.
- Practice IANB on mannequin or typodont.
- Study maximum doses and calculations.
Clinical Ethics and Jurisprudence
Syllabus Focus
- Principles of dental ethics (autonomy, beneficence, non-maleficence, justice)
- Informed consent
- Patient confidentiality (HIPAA)
- State dental practice acts
- Professional misconduct and reporting
Key Notes
- Four principles: autonomy (patient's right to choose), beneficence (act in patient's best interest), non-maleficence (do no harm), justice (fair treatment).
- Informed consent: disclosure of diagnosis, treatment options, risks, benefits, alternatives; patient must be competent and consent voluntarily.
- HIPAA: protect patient health information (PHI); breach notification required.
- State dental practice acts: define scope of practice, licensure requirements, delegation, supervision levels (direct, indirect, general).
- Reporting: mandatory reporting of child abuse, elder abuse, impaired colleagues; duty to report unprofessional conduct.
Must Know
- Elements of valid consent: capacity, disclosure, understanding, voluntariness.
- Exceptions to confidentiality: public health threats, court order, abuse reporting.
- Supervision levels: direct (dentist present), indirect (dentist on premises), general (dentist available by phone).
- Professional misconduct: fraud, negligence, sexual misconduct, substance abuse.
Clinical and Exam Application
- Before treatment, obtain written informed consent; document discussion in chart.
- When treating minors, obtain parental consent; emancipated minors may consent for themselves.
- If a patient refuses recommended treatment, document refusal and discuss consequences.
High-Yield Distinctions
- Ethics vs. law: ethics are moral principles; law is regulatory framework; both must be followed.
- Negligence: breach of duty causing harm; four D's: duty, dereliction, direct cause, damages.
- Abandonment: terminating care without notice or referral; avoid by providing emergency coverage.
Common Pitfalls
- Assuming implied consent for all procedures; always obtain explicit consent.
- Sharing patient information without authorization (e.g., with family members).
- Practicing beyond scope (e.g., hygienist performing restorative procedures).
Review Tasks
- Review your state's dental practice act (e.g., WREB states: AZ, CA, etc.).
- Study HIPAA privacy rule basics.
- Practice ethical decision-making using the four principles.
How To Use These Notes With Practice Questions
Do not jump straight from reading to a full mock. Work by subject first: review the key notes, make a short recall sheet from memory, then answer a focused question set. After each miss, decide whether the problem was missing knowledge, poor clinical sequencing, weak source-rule recall, or a distractor you failed to eliminate.
Dental Conquer's question bank, flashcards, mind maps, and spaced review tools are most useful after this instruction layer because they reveal which parts of the notes are not yet retrievable.
Final Review Checklist
- Review all subject keyNotes and mustKnow items.
- Practice clinical decision-making with case scenarios.
- Verify exam format and requirements on official WREB/ADEX website.
- Focus on high-yield distinctions and common pitfalls.
- Complete review tasks for each subject.
Official Sources and Further Reading
Use these sources as the final authority for format, eligibility, rules, and exam updates. Study notes are a preparation layer, not a replacement for official candidate guidance.