ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

Like dental assisting, dental laboratory technolo-
gy has voluntary national certification programs.
The ADA CDA conducts educational program site
visits and has written standards. There are 28 CDA
accredited programs (ADA, 2001).
Most states do not regulate dental laboratories or
dental technicians. Generally, laboratories work as
directed by prescriptions from licensed dentists.

LICENSING EXAMINATIONS

Basic Biomedical Sciences

Every dental licensing jurisdiction in the United
States accepts the National Board dental examina-
tions on the basic biomedical sciences, administered
by the Joint Commission on National Dental
Examinations. Some jurisdictions also require addi-
tional written examinations for licensure, such as a
theory examination and a state jurisprudence exam-
ination. Increasingly, states are accepting the
National Board written dental examination in lieu
of other examinations.

Clinical Dental Sciences

Clinical dental sciences examinations are some-
times administered by the individual state or juris-
diction. However, many states have joined one of
the regional testing services (Western Regional
Examining Board [WREB], Southern Regional
Testing Agency, Central Regional Dental Testing
Service [CREDTS] and Northeastern Regional
Board [NERB]) to pool their resources and improve
the quality of their examinations.
Forty-one of the 53 licensing jurisdictions sub-
scribe to the services of one or more regional testing
services. The remaining 12 jurisdictions continue to
examine individually. WREB and CREDTS mutual-
ly recognize their exams to be equivalent and urge
their member states to accept these results. No gov-
ernmental or private agency accredits dental licens-
ing examinations.
Clinical examinations in dentistry have changed
dramatically in recent years. The public, the practic-
ing dental community, dental educators, examiners,
examination candidates and others have demanded
greater accountability from examining agencies.
The result has been a call for in-depth evaluation
of clinical examination reliability and validity by the
testing agencies. Many of the agencies are respond-

ing and now utilize psychometric standards and

professional test analysts. The science of clinical

examination analysis is evolving because of this self-

evaluation, and the quality of clinical examinations

continues to improve.

Expressing concern about patient welfare, liabili-

ty, and examination variability, a number of inter-

ested parties have advocated removing live patients

from the licensing examination process. Several

licensing jurisdictions have instituted the use of

mannequins and other artificial patients with varied

results. Unfortunately, no simulation techniques are

available that duplicate live-patient experience to

the satisfaction of most testing agencies.

Alternative Approaches to Licensure

In 1997 clinical testing agencies, licensing juris-

dictions, and organizations within the licensure

community developed The Agenda for Change,

which offers 12 objectives to facilitate improve-

ments in the clinical licensure process. (See Table

5.1.) The Agenda'sobjectives address the develop-

ment of uniform clinical content and standardized

calibration of examiners, the use of human subjects

in clinical licensure examinations, improving and

standardizing the appeals process, and providing

remediation programs for candidates who fail the

clinical licensure examinations.

The Agenda for Changepromotes acceptance by

all licensing jurisdictions of the National Dental

Board Examination in lieu of a separate written

examination on oral diagnosis and treatment plan-

ning, and suggests collecting statistical data on

examination results to begin to address the profes-

sion's concerns about failure rates on clinical exam-

inations.

State-specific licensure requirements limit profes-

sional mobility and make it difficult for the dental

workforce to respond to geographic shortages in

personnel. The Agenda for Change, if coordinated

with a proposed study of scoring practices and post-

examination analyses, would constitute significant

progress toward standardizing all clinical licensure

examinations.

A number of alternatives to the traditional licen-

sure examination are emerging.

PRE-GRADUATION EXAMINATION

Many examining agencies offer clinical examina-

Licensure and Regulation of Dental Professionals