Search

Purpose Concerns regarding the ethical justification for the use of single-encounter, procedure-based examinations on live patients for the licensure of dental hygienists and dentists in the United States persists despite decades of debate and publication on the subject. The purpose of this literature review was to summarize the specific ethical concerns and quantify recommendations in favor or against this examination methodology. Methods A population, intervention, control or comparison, outcome (PICO) question was developed to review the topic as follows: "For individuals receiving dental care as part of determination of candidates for competency and readiness for licensure, do patient-based licensure examinations, as compared to other assessment methods, violate or infringe upon ethical principles or ethical standards for health care or society?" An electronic search was performed in three databases: PubMed/Medline, Scopus, and Embase. Key search terms and Medical Subject Headings (MeSH) included the following: ethics, clinical, competence, dental, dental hygiene, dentistry, education, licensure, live patient, and practice. Results Ethical concerns about the use of patient examinations have been published in the professional literature for over 35 years. Of the 29 selected or endpoint articles identified, 27 articles cited one or more ethical concerns relating to single-encounter patient-based examinations while 20 articles recommended the elimination of this type of examination with an additional 6 articles citing elimination as an option in resolving the ethical issues regarding this type of licensure examination. Conclusion The literature holds a predominant, prevailing professional opinion that single-encounter, procedure-based examinations on live patients presents significant ethical concerns and should be eliminated as a method in initial dental hygiene and dental licensure. The literature also suggests that state dental boards should initiate corrective regulatory or legislative actions to expeditiously end recognition of live patient examinations in their licensure processes. [ABSTRACT FROM AUTHOR]

COVID‐19 is enforcing all professions to make decisions to alter their routine traditional method of patientcare converted into telemedicine treatment to all patient except emergency cases. Even, dental teaching to students also updated with online teaching as well as exams are being converted into typodonts based assessment and the Dental Licensure Objective Structured Clinical Exam (DL‐OSCE). It is high time for all of us to upgrade in electronic mode education through apps. One silver lining from the current pandemic situation thought us, we can move toward a more modern and ethical approach to dental licensure. [ABSTRACT FROM AUTHOR]

An Integrated National Board Dental Examination (INBDE) combining basic, behavioral, and clinical sciences will be implemented in 2020 to replace the current two-part National Board Dental Examination required for all candidates who seek to practice dentistry in the U.S. The aims of this study were to determine how U.S. dental schools are preparing for implementation of the INBDE and to assess their top administrators' attitudes about the new exam. A total of 150 deans, academic deans, and other administrators at all 64 U.S. dental schools with graduating classes in 2016 were emailed a 19-question electronic survey. The survey questions addressed the respondents' level of support, perceived benefits and challenges, and planned preparation strategies for the INBDE. The individual response rate was 59%, representing 57 of the 64 schools. Approximately 60% of the respondents either agreed or strongly agreed that they support the integrated exam, while roughly 25% either somewhat or strongly disagreed. While most respondents (72%) reported that their institutions would be prepared for the INBDE, 74% reported that the merged exam created additional strain for their institutions. Respondents reported viewing content integration and clinical applicability as benefits of the INBDE, while required curriculum changes and student preparedness and stress were seen as challenges. Most of the respondents reported their schools were currently employing strategies to prepare for the INBDE including meetings with faculty and students and changes to curricula and course content. The beginning of the fourth year and the end of the third year were the most frequently reported times when schools planned to require students to take the INBDE, although almost half of the respondents did not yet know what it would be required at their school. Several schools were reconsidering using the boards as a passing requirement. This study found that support for the INBDE was not universal, but strategies are under way to prepare students, faculty, and curricula for this new means of assessment. [ABSTRACT FROM AUTHOR]

Purpose In addition to dental education, a system for the evaluation and management of dental licensing and certification is required to meet the growing societal demand for more competent dentists. In this study, the Delphi technique was used to gather opinions from a variety of professionals on the problems of and remedies for the dental license management system in Korea. Methods Delphi surveys were conducted from April 2016 to October 2016 in South Korea. A variety of dental professionals were included and categorized into 3 groups according to their expertise as follows: the basic dentistry group, the clinical dentistry group, and the policy group. The Delphi technique was conducted in 3 rounds of e-mail surveys, each with different questions that probed with increasing depth on the dental license management system. In each successive round, the responses were categorized, scored on a Likert scale, and statistically analyzed. Results After categorizing the results of the first survey and ranking the results of the second survey using the Delphi technique, regulation by a licensing authority was found to be the most critical issue. This was followed by the license renewal system, continuing education, a tiered licensure system, improvement of foreign license approval, and utilization of retirees, in decreasing order of importance. The third Delphi survey showed a similar ranking, with regulation by a licensing authority being the major concern. Opinions regarding the dental license management system were provided as open-ended responses. The responses of the 3 groups showed statistically significant differences in the scores for the issue of regulation by a licensing authority. After re-grouping into the dentistry group and the policy group, the issue received a significantly higher score in the dentistry group. Conclusion The quality of dental treatment should be managed to protect patients and dental professionals. For this purpose, the establishment of an independent license regulation authority along with legislative changes is required.

This article reviews the data on advanced dental education for the past decade and explores what advanced dental education might look like in the years leading up to 2040, including how its graduates will address the oral health needs of the population. The authors based these projections on published data about advanced dental education collected by the American Dental Association and other organizations. Nevertheless, a certain degree of speculation was involved. The article presents current data and trends in advanced dental education, environmental factors impacting advanced dental education, and lessons drawn from other areas of health care that support the potential scenarios that are described. This article was written as part of the project "Advancing Dental Education in the 21st Century." [ABSTRACT FROM AUTHOR]

Most jurisdictions grant dental licensure to graduating students following successful completion of a clinical exam. Testing agencies, which are independent of dental schools, nevertheless conduct their exams at school facilities. Patient participation in these exams raises ethical concerns regarding such issues as unlicensed providers' performing irreversible procedures with minimal supervision and graduates' limited accessibility to provide follow-up treatment. To address these concerns, a collaborative effort between University at Buffalo School of Dental Medicine faculty and testing agency personnel was launched. The aims of this article are to describe the development and implementation of the resulting Buffalo Model, to highlight ethical advantages in its application, and to identify areas of improvement to be addressed in future iterations. With the Buffalo Model, modifications were made to the traditional exam format in order to integrate the exam into the school curriculum, enabling candidates to take it at various points during their fourth year. In addition, after calibration of school faculty members, 98.5% of cases verified by faculty were accepted by the Commission on Dental Competency Assessments for use in the exam. In two cases, restorative treatment completed during the exam did not meet the school's competency standard. This new approach ameliorates ethical concerns associated with clinical licensure exams because treatment is provided only to patients of record within a sequenced treatment plan and timely and appropriate treatment is provided to all patients. The results of this first year of implementation also suggest that calibrated faculty members will not show bias in the selection of lesions or competency evaluations of candidates. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the attitudes and perceptions of U.S. dental students and faculty members about National Board Dental Examination (NBDE) pass/fail reporting, an Integrated NBDE, clinical examinations, licensure process and strategies, and validity of licensure. A survey instrument consisting of ten statements with response options on a five-point Likert scale and a free-text comment section was developed and distributed through SurveyMonkey. A total of 411 students and 186 faculty members from ten U.S. dental schools participated, with an estimated response rate of 17%. Faculty and student responses were compared using the Mann-Whitney U test. These students' and faculty members' attitudes and perceptions were similar. Both groups showed mixed attitudes about NBDE scores as pass/fail, rather than numerical scores. The Integrated NBDE solicited mixed opinions and concerns that it would be complicated and stressful because students would be challenged to memorize information from earlier years. However, a single national clinical examination was highly preferred by both groups, preferably with simulated rather than real patients. Other strategies, such as background checks and continuing education requirements, were supported by both groups. Most of the licensure process strategies and policies were supported by both student and faculty respondents in the dental schools surveyed. [ABSTRACT FROM AUTHOR]

Failure on the National Board Dental Examination (NBDE) Parts I and II has troubling consequences for dental students, faculty members, and school administrators. Since the NBDE is a high-stakes exam for all involved, it is important to determine effective strategies to help students prepare. The purpose of this article is to describe the development and implemen-tation of online NBDE Parts I and II Review Courses by the faculty and administration at the University of Missouri-Kansas City School of Dentistry. The courses are taught by faculty members who are content experts. By utilizing distance technology, students in any geographic location can review the material at the time, place, and pace that are most convenient. Early out-comes show that 592 students from thirty-two states have participated in the courses since they were first offered in 2010-11. In post-course evaluations, students report that participation in the courses encouraged them to spend more time preparing for the exam and that the associated PowerPoint slides/handouts provided structure for their review. The literature suggests that multiple modalities are most effective in preparing for the NBDE. These online review courses can serve as a beneficial component of a student's preparation regimen. [ABSTRACT FROM AUTHOR]

The dental licensure exam in the United States has evolved over the past ten years, and two formats--the traditional format and curriculum integrated format--are now available for students to satisfy licensure requirements. The objective of this study was to examine the differences and relative merits of the two formats. A twenty-five-question survey was distributed to the fifty-seven U.S. dental schools at the time. The survey included both quantitative and discrete variables and followed a strategic sequential order. The first set of questions sought to determine what type of board preparatory/mock exam each dental school offered, and the next set of questions asked which licensure exam each school formally offered. The final questions were qualitative in nature and aimed to determine the school representatives' opinions about the curriculum integrated format versus traditional format. Of the fifty-seven schools contacted, thirty-seven agreed to participate (response rate=64.9 percent). Fourteen schools reported that they administer the traditional format only and twelve administer the curriculum integrated format only, while eleven offer both. Thirty-two schools offered mock board exams to their graduating students, and twenty-four of those said their mock exams were identical in format to the actual qualifying clinical exams offered at their institution. The respondents reported no significant advantage to preparing for the curriculum integrated format examination as compared to the traditional format examination with regards to number of clock hours taken from regular curriculum time. In reporting on this study, this article provides an overview of the relative advantages and disadvantages of the two examination formats used for the dental licensure process in the United States. [ABSTRACT FROM AUTHOR]

As part of the overall exam validation process, the Joint Commission on National Dental Examinations periodically reviews and validates the pass/fail standard for the National Board Dental Examination (NBDE), Parts I and II. The most recent standard-setting activities for NBDE Part II used the Objective Standard Setting method. This report describes the process used to set the pass/fail standard for the 2009 exam. The failure rate on the NBDE Part II increased from 5.3 percent in 2008 to 13.7 percent in 2009 and then decreased to 10 percent in 2010. This article describes the Objective Standard Setting method and presents the estimated probabilities of classification errors based on the beta binomial mathematical model. The results show that the probability of correct classifications of candidate performance is very high (0.97) and that probabilities of false negative and false positive errors are very small (.03 and <0.001, respectively). The low probability of classification errors supports the conclusion that the pass/fail score on the NBDE Part II is a valid guide for making decisions about candidates for dental licensure. [ABSTRACT FROM AUTHOR]

In this study, the authors evaluated the accuracy and precision of non-clinical testing for dental students' crown prepara-tion proficiency on a manikin-mounted typodont as a predictor of performance on patients. Eighty-six seniors at Baylor College of Dentistry were evaluated by three calibrated senior faculty members from the general dentistry department. Four areas of interest were evaluated: occlusal reduction; axial reduction; margins, design, and finish line; and operative environment. Stan-dardized grading scales were utilized to evaluate these preparation components. The kappa agreement statistic was used to assess agreement for the areas, which were then compiled to get an overall performance score. A Bland-Altman plot was generated and analyzed for agreement on overall performance between typodont and patient. Results of the analyses showed weak agreement between the two measurements for all four areas of interest with large variation in the differences. When the pairs of overall performance scores were compared, the Bland-Altman plot indicated that the typodont composite score was often larger than the patient composite score, especially for poorer performing students. The authors conclude that students' clinical performance on typodonts is a poor predictor of their clinical performance on patients since the students performed much worse on the clinical crown examination than on the typodont examination. [ABSTRACT FROM AUTHOR]

The consistency between student clinical performance in dental school and performance on initial licensure examinations is known to be weak. A review of the literature failed to identify any reports of the consistency between performance on initial licensure examinations and quality of technical work in practice. This research examines the consistency of performance among candidates who took two initial licensure examinations given by different testing agencies but for the same jurisdiction within a few weeks of each other. Twenty- even candidates from one dental school took both the California Dental Board examination and the Western Regional Examining Board initial licensure examination in 2005 and 2006. Their performance on the patient-ba ed amalgam and composite restorations and the root planing tests were compared in these two board settings and with various dental school measures of competence. Consistent with previous findings, school-to-board performance wa barely above chance levels. Board-to-board association was also insignificant and accounted for 12 percent of the common variance in the best case. Patient-based initial licensure examinations have yet to demonstrate validity in terms of consistency of performance for candidates from one performance to the next. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the associations among several dental school admission criteria and several measures of dental school achievement. Data were collected for 2000-07 University of Iowa dentistry graduates, including five specific preadmission credentials and five specific measures of dental school achievement for each student. Pearson product moment correlations or Mann-Whitney U statistics were computed for the association of each of the ten variables with the nine others. The strongest correlation observed was between predental science grade point average (GPA) and overall predental GPA. Dental Admission Test (DAT) Academic Average was very strongly correlated with DAT Total Science, and both of these were each moderately correlated with DAT Perceptual Ability, predental science GPA, and overall predental GPA. Among the measures of dental school achievement, the strongest association was observed between National Board Dental Examination (NBDE) scores and dental school GPA. These were also moderately correlated with final clinical grade. All of the measures of dental school achievement were slightly stronger for candidates who passed the Central Regional Dental Testing Service (CRDTS) examination than for those who tailed that exam. Of the predental credentials considered, predental science GPA and overall predental GPA were the best predictors of dental school GPA. DAT Academic Average was the best predictor of NBDE scores. Although DAT Perceptual Ability was the best predictor of clinical competency at the time of graduation, these two variables were only weakly correlated. DAT Perceptual Ability scores and overall predental GPA were slightly higher for candidates who passed the CRDTS examination than for those who failed that exam. [ABSTRACT FROM AUTHOR]

The National Board Dental Examination (NBDE) assists state boards of dentistry in determining the qualifications of dentists for initial licensure. This article explains the purpose and rationale for the policies and procedures that guide the NBDE. These examinations have been used for a number of purposes well beyond the assessment of the knowledge and abilities for entry-level dental practice. The article explores the uses and misuses of the National Boards and the relationship between dental licensure examinations and dental curricula. For National Board examinations to remain current and relevant, they must be consistent with standards and best practices for high-stakes testing, and they must focus on competencies and critical thinking skills essential for future practice. The National Board examinations have the potential to stimulate and support curricular reform through collaborative efforts of educators and practitioners who support the test development and standard-setting processes of the examinations. [ABSTRACT FROM AUTHOR]

Objectives: The National Institute of Dental and Craniofacial Research commissioned an assessment of the dental public health infrastructure in the United States as a first step toward ensuring its adequacy. This study examined several elements of the U.S. dental public health infrastructure in government, education, workforce, and regulatory issues, focused primarily at the state level.Methods: Data were drawn from a wide range of sources, including original surveys, analysis of existing databases, and compilation of publicly available information.Results: In 2002, 72.5% of states had a full-time dental director and 65% of state dental programs had total budgets of 1 million dollars or less. Among U.S. dental schools, 68% had a dental public health academic unit. Twelve and a half percent of dental schools and 64.3% of dental hygiene programs had no faculty member with a public health degree. Among schools of public health, 15% offered a graduate degree in a dental public health concentration area, and 60% had no faculty member with a dental or dental hygiene degree. There were 141 active diplomates of the American Board of Dental Public Health as of February 2001; 15% worked for state, county, or local governments. In May 2003, there were 640 U.S. members of the American Association of Public Health Dentistry with few members in most states. In 2002, 544 American Dental Association members reported their specialty as Dental Public Health, which ranged from 0 in five states to 41 in California. Just two states had a public health dentist on their dental licensing boards.Conclusions: Findings suggest the U.S. dental public health workforce is small, most state programs have scant funding, the field has minimal presence in academia, and dental public health has little role in the regulation of dentistry and dental hygiene. Successful efforts to enhance the many aspects of the U.S. dental public health infrastructure will require substantial collaboration among many diverse partners. [ABSTRACT FROM AUTHOR]

Many dental schools consider the successful completion of a state or regional dental licensure examination as one of the significant benchmarks for assessing effectiveness of the curriculum. At the University of Florida College of Dentistry (UFCD), performance on the state dental licensure examination is monitored and compared with senior year mock board performance and clinical productivity to identify factors that may contribute to state board "pass" rates. A retrospective analysis was conducted of "first-time" performance on the Florida Dental Licensure Exam for graduates from classes 1996 to 2003. Using ANOVA, licensure exam performance data was analyzed and compared with performance on the senior mock board exam and clinical productivity, determined by numbers of procedures completed in each discipline. Significant relationships were noted between four of thirteen aspects of mock board performance and clinical productivity data and performance on the Florida Dental Licensure Exam. First, a significant relationship (p<0.05) was found between passing the senior mock board fixed prosthodontic preparation and successful completion of that procedure on the state licensure exam. Second, a significant relationship (p<0.05) was noted between the clinical (patient-based) Class II amalgam on the senior mock board and passing that procedure on the state licensure exam. Third, a significant relationship was noted (p<0.05) between the number of Class IV clinical composite procedures completed during dental school and passing the licensure exam Class IV manikin composite procedure. Fourth, there was a significant relationship (p<0.01) between the number of clinical Class II amalgam procedures completed during the junior and senior years and passing the state licensure exam clinical amalgam procedure. No significance was found between the remaining five mock board procedures (Class II composites, Class IV composites, pin amalgams, endodontic, and periodontal scaling/root planing) and performance on the like procedures on the licensure exam. Likewise, no significance was found between the remaining four productivity measures (numbers of Class II composites, endodontic teeth treated, crowns and abutments completed, and quadrants of periodontal scaling/root planing) and performance of these procedures on the state licensure exam. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether gender affects high-stakestest performance among dental students. Our sample consisted of 128 women and 323 men from six consecutive dental classes for which we recorded AADSAS overall and science predental GPAs; Dental Admission Test (DAT) scores; National Board Dental Examination (NBDE) I and II scores and pass/fail status; North East Regional Board of Dental Examiners (NERB) pass/fail status; and cumulative GPAs following the spring quarter of year two and summer quarter of year four of dental school. DAT scores, when controlled for previous academic performance, revealed that men significantly outperformed women in all areas except reading comprehension and biology, where the women's scores significantly exceeded the men's and were comparable, respectively. NBDE I results favored men and approached significance (p = 0.066), while for Part II men significantly outscored women. NBDE I and II and NERB pass rates showed no significant differences. These board results were also controlled for previous academic performance. Although we found that differences existed between genders, which appear to be the ramification of the classic high-stakes dilemma (women do as well as men in the classroom and on course-related tests, but less well on gatekeeper board exams), the context mitigates their operational effects. DAT differences are likely reduced by most admissions processes, but may be problematic when selected predictive algorithms are used. Practically, the NBDE I and II results are unlikely to meaningfully influence women's academic progress in dental school or postgraduate education admissions due to their magnitude and timing. [ABSTRACT FROM AUTHOR]

The purpose of this report is to compare outcomes on the North East Regional Board of Dental Examiners (NERB) clinical examination to selected measures of academic performance in one U.S. dental school. The data came from results of the spring 2001 NERB examination at that school. Five measures of academic performance--number of Class II amalgam restorations completed, number of Class III/IV composite restorations completed, fixed prosthodontic units performed, fourth-year class rank, and GPA-were compared between those who passed and those who failed NERB's restorative exercise (RESTOR) and provisional fixed partial denture exercise (SIM). Analyses could not confirm a positive relationship between the school performance measures and the NERB outcome of passing RESTOR on the first attempt. On the other hand, those who passed SIM on the first attempt had, on the average, performed more amalgams, composites, and fixed prosthodontic units as students than those who failed; they also had, on average, better class rank and higher GPA. Therefore, only performance on SIM related to performance in school. However, both RESTOR and SIM had a similar number of failures from the top as well as the bottom portions of the class. These preliminary data from one dental school class raise questions about the validity of the NERB clinical examination for licensure decisions. [ABSTRACT FROM AUTHOR]

This Point/Counterpoint article examines the need for and potential impact of implementing a national clinical examination for initial licensure in dentistry. Viewpoint 1 supports a national licensure exam that meets the clinical exam's credentialing requirement for licensure in every state. According to this viewpoint, a national exam will reduce costs, enhance portability of graduates, simplify the transition from dental school to practice or specialty training programs, and standardize requirements for licensure between states. Viewpoint 2 opposes a national licensure exam. This viewpoint supports individual states' dental board decision making process, which is based on identifiable state-specific criteria. The ability to prioritize needs at the state level allows for higher exam standards, easier modifications, more focused requirements, and better calibration in specific exam areas. Viewpoint 2 argues that the delicate balance between licensure agencies and organized dentistry in each state, as well as the involvement of dental schools in the licensure process, must be preserved. This Point/Counterpoint concludes with a joint statement about the prospects for adoption of a national licensure exam.

Purpose: In addition to dental education, a system for the evaluation and management of dental licensing and certification is required to meet the growing societal demand for more competent dentists. In this study, the Delphi technique was used to gather opinions from a variety of professionals on the problems of and remedies for the dental license management system in Korea., Methods: Delphi surveys were conducted from April 2016 to October 2016 in South Korea. A variety of dental professionals were included and categorized into 3 groups according to their expertise as follows: the basic dentistry group, the clinical dentistry group, and the policy group. The Delphi technique was conducted in 3 rounds of e-mail surveys, each with different questions that probed with increasing depth on the dental license management system. In each successive round, the responses were categorized, scored on a Likert scale, and statistically analyzed., Results: After categorizing the results of the first survey and ranking the results of the second survey using the Delphi technique, regulation by a licensing authority was found to be the most critical issue. This was followed by the license renewal system, continuing education, a tiered licensure system, improvement of foreign license approval, and utilization of retirees, in decreasing order of importance. The third Delphi survey showed a similar ranking, with regulation by a licensing authority being the major concern. Opinions regarding the dental license management system were provided as open-ended responses. The responses of the 3 groups showed statistically significant differences in the scores for the issue of regulation by a licensing authority. After re-grouping into the dentistry group and the policy group, the issue received a significantly higher score in the dentistry group., Conclusion: The quality of dental treatment should be managed to protect patients and dental professionals. For this purpose, the establishment of an independent license regulation authority along with legislative changes is required.