2026 nbdhe
candidate guide updates
Finding Inspiration in Every Turn
AndyRDH's Dental Hygiene Academy has been the nationwide leader for over 23 years in helping students pass their NBDHE.
Read below to see what changes are coming for 2026!
Changes in 2026 Candidate Guide.
The NEW 2026 NBDHE Candidate Guide has been released by the American Dental Association. No notable changes are being made to the exam until the middle of 2026. While the candidate guide states the official changes will come after October 2026, it also states it may change “mid year.” Faculty need to be aware of this timeframe to ensure students are ready.
For Session One, the number of questions is changing for each category. This is good news for students as we will now have 9 additional questions in Clinical Dental Hygiene Services and less questions in Community and Scientific Basis.
New items after 10/26:
For clinical dental hygiene services:
New content being added in 2026:
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Occlusal evaluation
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Emerging technologies
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Documentation and risk management
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Local anesthesia under anxiety & pain control
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Reassessment and evaluation
This is the FIRST TIME “local anesthesia” is now explicitly stated within the guide, which means we may start seeing questions relating to anesthesia calculations. These may start as pilot questions.
Notable shifts in 2026:
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Local anesthesia is explicitly named as its own focus
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“Emerging technologies” added in:
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Radiography
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Supportive treatment services
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Documentation and risk management explicitly listed
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Research principles are more clearly defined and separated from community health
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Increased item count in Clinical Dental Hygiene Services (from 115 → 124 items)
potential new topics for the
"Emerging technologies section"
1. Digital Radiography Advancements (Core)
These are almost certainly included.
Likely Tested Concepts
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CMOS / CCD sensors vs PSP plates
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Advantages of digital systems:
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Reduced radiation dose
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Instant image acquisition
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Image enhancement capabilities
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Limitations:
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Sensor rigidity and patient comfort
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Plate handling and infection control
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Exposure errors specific to digital imaging
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Overexposure masking (dose creep)
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Underexposure artifacts
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Infection control differences between sensor types
Example NBDHE Question:
A dental hygienist notices that digital bitewing radiographs consistently appear diagnostically acceptable even when exposure settings are increased. Which risk is MOST associated with this situation?
A. Increased image noise due to underexposure
B. Increased radiation dose without visual cues
C. Loss of spatial resolution from pixel saturation
D. Increased need for retakes due to motion artifact
Correct Answer: B
Rationale:
Digital systems can mask overexposure, leading to dose creep, where patients receive unnecessarily high radiation doses without obvious image degradation.
Get to Know Us
2. Cone Beam Computed Tomography (CBCT) — Conceptual Only
CBCT is considered “emerging” within hygiene scope when tested at a recognition and principles level.
Likely Tested
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Purpose and indications:
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Implant planning
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Impacted teeth
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TMJ evaluation
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Airway assessment
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Radiation dose comparison:
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CBCT vs panoramic vs intraoral
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Field of view (FOV):
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Small vs large FOV principles
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Hygienist’s role:
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Patient education
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Radiation safety
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Recognizing incidental findings → referral
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Example NBDHE Question:
Which statement best describes the dental hygienist’s role when cone beam computed tomography (CBCT) imaging is used?
A. Diagnosing pathology visible on CBCT slices
B. Selecting CBCT as a routine alternative to bitewings
C. Educating the patient about radiation exposure and purpose
D. Interpreting incidental findings for treatment planning
Correct Answer: C
Rationale:
Hygienists are responsible for patient education, radiation safety, and referral awareness, not diagnosis or image interpretation.
Example NBDHE Question:
Which statement best describes the dental hygienist’s role when cone beam computed tomography (CBCT) imaging is used?
A. Diagnosing pathology visible on CBCT slices
B. Selecting CBCT as a routine alternative to bitewings
C. Educating the patient about radiation exposure and purpose
D. Interpreting incidental findings for treatment planning
Correct Answer: C
Rationale:
Hygienists are responsible for patient education, radiation safety, and referral awareness, not diagnosis or image interpretation.
3. Image Enhancement & Post-Processing Tools
Examples
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Contrast adjustment
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Density and brightness manipulation
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Magnification and measurement tools
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Pseudocolor imaging (conceptual awareness)
Tested Emphasis
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How enhancement can:
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Improve diagnostic visibility
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Also create artifacts or false positives
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Importance of viewing original vs enhanced images
Example NBDHE Question:
A clinician adjusts contrast and brightness on a digital radiograph to improve visibility of the alveolar crest. Which principle should guide this action?
A. Enhanced images are more diagnostically accurate than originals
B. Image manipulation can eliminate the need for retakes
C. Excessive enhancement may introduce diagnostic artifacts
D. Image enhancement replaces proper exposure technique
Correct Answer: C
Rationale:
Post-processing can improve visualization but may also create false positives or artifacts, requiring cautious interpretation.
4. Radiation Safety & Dose Optimization (Modern Emphasis)
This is where emerging technology + ethics intersect.
Concepts Likely Emphasized
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ALARA → ALADAIP (As Low As Diagnostically Acceptable, Indication-oriented, and Patient-specific)
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ALADAIP is a radiation safety principle in medical imaging, especially dentistry, meaning "As Low As Diagnostically Acceptable being Indication-oriented and Patient-specific," evolving from ALARA (As Low As Reasonably Achievable) to emphasize tailoring radiation doses to individual patient needs and specific clinical reasons, ensuring diagnostic quality while minimizing exposure, particularly important in pediatric cases.
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Rectangular collimation
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Thyroid shielding updates
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Digital receptor sensitivity and exposure reduction
Example NBDHE Question:
Which principle best reflects current radiation safety philosophy in dental radiography?
A. ALARA — minimize exposure whenever possible
B. Maximum image quality regardless of dose
C. ALADAIP — indication-oriented and patient-specific exposure
D. Standardized exposure settings for all patients
Correct Answer: C
Rationale:
ALADAIP reflects modern, patient-centered radiation protection emphasizing diagnostic necessity and individualization.
potential new topics for the
"Documentation & Risk Management"
On the NBDHE, documentation and risk management refer to how dental hygienists:
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Create accurate, timely, and defensible records
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Reduce legal, ethical, and patient-safety risk
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Support continuity of care and informed consent
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Practice within scope, standards of care, and regulations
⚠️The exam does not test office-specific charting systems or legal jargon.
It tests judgment, ethics, and consequences.
3. Image Enhancement & Post-Processing Tools
Examples
-
Contrast adjustment
-
Density and brightness manipulation
-
Magnification and measurement tools
-
Pseudocolor imaging (conceptual awareness)
Tested Emphasis
-
How enhancement can:
-
Improve diagnostic visibility
-
Also create artifacts or false positives
-
-
Importance of viewing original vs enhanced images
Example NBDHE Question:
A clinician adjusts contrast and brightness on a digital radiograph to improve visibility of the alveolar crest. Which principle should guide this action?
A. Enhanced images are more diagnostically accurate than originals
B. Image manipulation can eliminate the need for retakes
C. Excessive enhancement may introduce diagnostic artifacts
D. Image enhancement replaces proper exposure technique
Correct Answer: C
Rationale:
Post-processing can improve visualization but may also create false positives or artifacts, requiring cautious interpretation.
4. Radiation Safety & Dose Optimization (Modern Emphasis)
This is where emerging technology + ethics intersect.
Concepts Likely Emphasized
-
ALARA → ALADAIP (As Low As Diagnostically Acceptable, Indication-oriented, and Patient-specific)
-
ALADAIP is a radiation safety principle in medical imaging, especially dentistry, meaning "As Low As Diagnostically Acceptable being Indication-oriented and Patient-specific," evolving from ALARA (As Low As Reasonably Achievable) to emphasize tailoring radiation doses to individual patient needs and specific clinical reasons, ensuring diagnostic quality while minimizing exposure, particularly important in pediatric cases.
-
-
Rectangular collimation
-
Thyroid shielding updates
-
Digital receptor sensitivity and exposure reduction
Example NBDHE Question:
Which principle best reflects current radiation safety philosophy in dental radiography?
A. ALARA — minimize exposure whenever possible
B. Maximum image quality regardless of dose
C. ALADAIP — indication-oriented and patient-specific exposure
D. Standardized exposure settings for all patients
Correct Answer: C
Rationale:
ALADAIP reflects modern, patient-centered radiation protection emphasizing diagnostic necessity and individualization.
potential new topics for the
"Documentation, Risk Management
& SOAP Notes"
The NBDHE does not usually ask “What does SOAP stand for?”
Instead, it tests whether the candidate can:
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Place information in the correct section
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Use objective vs subjective data correctly
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Demonstrate clinical reasoning and defensibility
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Reduce legal and ethical risk through documentation
SOAP is the framework for safe documentation and risk management.
SOAP Components (Board-Relevant Emphasis)
S – Subjective
What the patient reports
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Chief complaint
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Symptoms
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Medical history changes
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Pain description
🚫 Do NOT include clinical findings here.
Risk note: Subjective data must be clearly attributed to the patient.
O – Objective
What the clinician observes or measures
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Periodontal charting
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Radiographic findings
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Vital signs
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Clinical exam findings
📌 This section carries major legal weight.
Example NBDHE Question:
Which entry is MOST appropriate for the Assessment portion of a SOAP note?
A. Generalized bleeding noted during probing
B. Radiographic bone loss present on molars
C. Findings consistent with moderate periodontal disease
D. Scaling and root planing recommended
✅ Correct Answer: C
Rationale:
The Assessment synthesizes subjective and objective data into a clinical interpretation, not raw data or treatment.
Get to Know Us
A – Assessment
The clinician’s professional judgment
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Interpretation of findings
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Risk assessment
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Problem identification (not diagnosis outside scope)
📌 This is where boards assess critical thinking.
P – Plan
What will be done or recommended
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Treatment provided
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Referrals
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Patient education
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Follow-up
📌 Risk management hinges on clear plans and documentation of patient response.
Example NBDHE Question:
Which documentation practice presents the GREATEST legal risk?
A. Late entry clearly labeled and dated
B. Objective findings recorded without interpretation
C. Copying prior notes without updating
D. Documenting patient refusal with explanation
✅ Correct Answer: C
Rationale:
Copy-forward documentation undermines accuracy and suggests lack of individualized care.
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