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

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."

Approaches for managing carious tissues during cavity preparations vary considerably among clinicians, which may reflect inconsistencies in the teaching of this subject by dental schools. The aims of this study were to investigate practices related to the preclinical and clinical teaching of caries removal at U.S. dental schools and the relationship between that teaching and requirements for U.S. dental licensure examinations. The electronic survey included questions about terminology, methods, instruments and materials, treatment planning, criteria for clinical exams, faculty calibration sessions, and licensure exams. The faculty members at U.S. dental schools responsible for teaching cariology were invited to participate; 54 of the 65 schools had identified a contact person at the time of the survey in October 2015. Of those 54 invited to participate, 43 completed the survey (response rate of 79.6%). Most of the respondents indicated that depth of carious lesions was a clinical determinant of the amount of carious dentin being removed in cavity preparations. Caries removal was used as a criterion in restorative clinical examinations by 95% of responding schools. Marked differences were observed regarding the criteria used for assessment and removal of carious tissues, management of deep carious lesions, and definition of "caries remaining at cavity preparations," which is considered a critical error on licensure exams. Faculty calibration sessions on caries removal were reported to occur in 65% of these schools and at different time frames. Overall, the study found a wide range of teaching practices related to caries removal. Best evidence in caries management needs to be aligned with teaching and the criteria used to calibrate faculty members and examiners.

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.

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.

Aim The aim of the present study was to assess knowledge of, and management attitude of dentists regarding Dentin hypersensitivity. Materials and methods The study involved all the dentists from private and public sectors, exerting in Senegal. The following data were requested from the surveyed dentists using an anonymous questionnaire; sociodemographics (i.e. age, gender, area of activity, etc.) and knowledge on triggering factor, type of pain, diagnosis, preventive and curative procedures. Results Out of the 238 dentists who received the questionnaire, 68.9% returned properly filled forms. They were 116 males and 48 females with a mean age of 41.99 ± 8.50 years. Eighty three percent of the participants had a good understanding of the characteristics of pain related to DH and 92% recogni-zed chemical and thermal stimuli as triggering factor while mechanical stimulus was not evoked. Many responders (90.9%) did not have any idea of the mechanism for pain transmission across the dentin. Regarding diagnosis technique, 68% use mechanical stimuli to elicit DH pain. Regarding management procedure, the use of desensitizing tooth paste is the mostly chosen option followed by professional topical application of fluoride. More than 1/3rd of the surveyed dentists confess resorting to root canal to manage DH. Conclusion We recommend incorporation of basic science knowledge on orofacial pain and competencies to manage painful conditions like dentin hypersensitivity. Also, Health regulatory institutions should make continuing dental education a requirement to preserve the dental licensure. How to cite this article Benoist FL, Ndiaye FG, Faye B, Bane K, Ngom PI, Ndong PMK. Knowledge of and Management Attitude regarding Dentin Hypersensitivity among Dentists from a West African Country. J Contemp Dent Pract 2014;15(1):86-91.

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 implementation 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 outcomes 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.

Beginning in 2012, candidate performance on the National Board Dental Examination (NBDE) has been reported as pass/fail, and only the failing candidates receive numerical scores for remediation purposes. The Joint Commission on National Dental Examinations recognizes that the numerical scores have been important information to dental schools for curriculum evaluation and that the pass/fail reports do not provide meaningful information to the schools. This article describes the process of evaluating and validating a new model for reporting standardized school-level performance data on the NBDE. Under this new model, schools are able to monitor the overall performance of their students compared to a national cohort.

The Standards for Educational and Psychological Testing emphasize the importance of documenting and describing the procedures followed in developing valid test content. As a result, the Joint Commission on National Dental Examinations, the testing agency responsible for administering the National Board Dental Examination Part I and Part II, routinely communicates information about the validity of Part II to dental schools and other communities of interest. Since 2000, the content of Part II has been validated through the use of three practice analyses. This article provides an overview of these practice analyses, including procedures and findings. In general, the findings confirm that the content of Part II is valid in determining the qualifications of individuals seeking dental licensure.

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.

With an increased number of dental schools graduating more dentists, along with the opening of new dental schools throughout the United States, more graduating dental students are considering utilizing Advanced Education in General Dentistry (AEGD) programs as a means to increase their understanding of the complexity of modern dentistry and to gain additional training and experience before heading into practice. This position paper describes how these programs can aid in transforming the face of dental education to address the needs of graduates and best educate the next generation of dental professionals. Its purpose is to examine reasons why dental students are choosing to participate in AEGD programs and to support a call for additional programs. An online survey of current AEGD residents was conducted to investigate reasons why they chose to enter this specific postgraduate opportunity. This position paper will also discuss how AEGD programs can be an effective training mechanism to address problematic issues such as access to care and dental licensure. Interest in AEGD programs will continue to rise, and this paper provides support for the expansion of such programs.

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-seven candidates from one dental school took both the California Dental Board examination and the Western Regional Examining Board initial licensure examinations in 2005 and 2006. Their performance on the patient-based 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 was 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.

In this reflection article, Dr. Huw F. Thomas, a U.S. dental school dean, identifies important messages and insights he gained from a series of twenty-one articles about the future of dental education published in the Journal of Dental Education from October 2005 to February 2009. This article addresses three questions: 1) What influence have these articles had on a dental school dean’s perspectives about his role and priorities? 2) What important messages are contained within these articles for fellow deans? and 3) What messages do these articles send to dental education in general? The American Dental Education Association’s Commission on Change and Innovation in Dental Education (ADEA CCI) was established to facilitate change and innovation in dental education. Through the ADEA CCI, ADEA brought together stakeholders in academic dentistry: dental schools, the American Dental Association (ADA) Board of Trustees, the Commission on Dental Accreditation (CODA), the ADA Council on Dental Education and Licensure (CDEL), the Joint Commission on National Dental Examinations (JCNDE), the dental licensure community, the ADA Foundation, and advanced dental education programs. The goal of the ADEA CCI is to provide a forum to build consensus within the dental community for innovative changes in the education of general dentists. As part of the consensus-building process, the ADEA CCI commissioned a series of articles, published in the Journal of Dental Education, to raise awareness and stimulate dialogue about issues and forces shaping the future of dental education and propose strategies to achieve desired enhancements. Collectively, this series of articles is known as the Perspectives and Reflections in Dental Education (PRIDE) series to acknowledge the commitment of the academic dental community to reflect on current practices and future directions and also to represent the pride of dental school faculty members in their educational responsibilities and accomplishments.

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 failed 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.

There was only one dental school in Malaysia until 1997 but five new schools have been established since 1998. This review provides information about dental education in Malaysia including; the history of dental education, the current dental school system and curriculum, and dental licensure. There are four public and two private dental schools in Malaysia. High school graduates are required to take the nationwide matriculation entrance examination or the Higher School Certificate (HSC) to apply for a dental degree programme. A five-year dental programme leads to the BDS or the DDS degree. National or state examinations are not required to practise dentistry. Currently, there are approximately 2,500 dentists, with a ratio of 1 dentist for every 10,000 people.

Background The authors explored the origins of foreign-trained dentists seeking licensure in the United States. Methods The authors analyzed data received from the American Dental Association Department of Testing Services for candidates who took the National Board Dental Examinations (NBDE) Part II from 2002 through 2005. They also established proxies for the information they sought in lieu of existing direct data. Results A total of 4,136 candidates took NBDE Part II from 2002 through 2005. The greatest number of foreign-trained dentists originated from India, the Philippines and Colombia. Conclusion The greatest number of potential U.S. dental licensees are primarily from Asia, the Middle East and South America. However, precise studies need to be conducted to generate more exact data about foreign-trained dentists who practice in the United States. Clinical Implications The source of international dental graduates seeking licensure in the United States has implications for the licensure process and for the potential accreditation of foreign dental schools.

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.

The evolution and implementation of a uniform national clinical examination has become a reality under the guidance of the American Board of Dental Examiners (ADEX). The defined purpose of this examination is to provide a defensible construct that assesses the critical clinical competencies of dental and dental hygiene candidates that will differentiate between competent and incompetent entry-level practitioners. The author includes a discussion of validity evidence that will be gathered by ADEX in order to support the decisions and interpretations made concerning competency and the agency's claim for validity. Included is a brief discussion of some controversial opinions regarding general validity concerns involving clinical dental licensure exam constructs. The author intends for this manuscript to provide a better appreciation for the science of psychometrics as it is applied to evidence-based testing for entry-level dental and dental hygiene candidates.

This study assessed relationships between academic performance in dental school and "first attempt" performance on a state dental licensure examination for 1996-2003 graduates from the University of Florida College of Dentistry (UFCD). The 524 graduates were ranked into quartiles based on graduating GPA. Using analysis of variance (ANOVA), the students' mean exam score (or exam section score) for each respective quartile (n=131) was compared with mean score for graduates in the combined four quartiles (n=524). ANOVA assessments, by quartile, were performed for the following six measures: 1) overall composite score on the dental licensure exam, 2) clinical periodontics section, 3) clinical amalgam section, 4) combination of clinical periodontics and clinical amalgam, 5) laboratory (manikin exam) with a written prosthodontic exam, and 6) manikin exam without the prosthodontic exam. For the overall exam and all exam sections, a significant (p

The goal of this article is to describe differences between the written examinations required for dental licensure in Japan and in the United States. Candidate guides, old exams, and other published data pertaining to the Japan National Examination for Dentists (NED) and the U.S. National Board Dental Examination (NBDE) were used. Dental education in Japan consists of a six-year program following high school graduation. The U.S. counterpart is usually a four-year program following a bachelor’s degree. The NED, which is made up of 330 questions, is a single, all-important gatekeeper test that immediately grants licensure to practice dentistry throughout Japan. The NED contains no evaluation of technical skills; it is purely a written exam. By contrast, in the United States, the NBDE Parts I and II, which consist of 900 questions, are only components of a three-step licensure process. An additional state or regional board examination on technical skills is required to obtain licensure to practice. There are 400 basic science questions on the NBDE Part I, while the NED has thirty. In terms of cognitive level, questions on the NED place more emphasis on recall, while those on the NBDE Part II are more focused on problem solving. The outcomes of this comparison provide dental educators with comparisons of the licensure examination process for Japanese and U.S. dentists.

An understanding of international dental education systems is critical for the education of foreign-trained dentists in U.S. dental programs. However, there is little information on this topic. This article provides information regarding 1) dental history, 2) dental school system, 3) curriculum/examination at dental school, and 4) dental licensure in India and Japan. There are 185 dental schools in India and twenty-nine in Japan. The number of first-year dental students is 12,872 and 2,647 in India and Japan, respectively. A five-year dental education, which includes 4,035 curriculum hours, leads to the B.D.S. degree in India, whereas a six-year dental education program, which includes 5,060 curriculum hours, leads to the D.D.S. degree in Japan. No undergraduate predental study is needed prior to entry into dental school in both countries. In India, the entrance examination is extremely competitive; however, there is no nationwide licensure examination. In Japan, dental schools use more sophisticated dental materials and equipment in the clinical phases of the curriculum than in India, but there is no clinical examination at the time of graduation. Several implications for U.S. dental programs for foreign-trained dentists with respect to screening applicants and curriculum development are discussed.

In an attempt to improve performance of University of Florida College of Dentistry (UFCD) graduates on the endodontic section of the Florida Dental Licensure Examination, a retrospective analysis was conducted for classes graduating between 1996 and 2003 to assess potential relationships between passing and failing performance and three factors with potential impact on "first attempt" pass rates. The three factors were clinical endodontic experience, performance on the senior mock board examination, and dialogue with representatives of the licensure examination, which resulted in modification of the endodontic section of the licensure exam. Using ANOVA, we found no differences in performance on the endodontic section of the senior mock board exam between graduates who passed the endodontic section of the dental licensure exam and those who failed this section. Furthermore, no differences were found in the mean number of clinical endodontic experiences (number of teeth treated) between graduates who passed the endodontic section of the licensure exam and those who failed. However, in 2003 following dialogue between representatives of the Florida Board of Dentistry and endodontic faculty from the two dental schools in Florida, a significant difference in senior mock board endodontic scores (p>0.05) and a significant difference in performance on the endodontic section of the licensure exam scores (p>0.005) was observed for the 2003 graduates when compared to the 2002 graduates. The mean mock board scores and the mean state board endodontic section scores were higher for the 2003 graduates. In addition, the UFCD failure rate on the endodontic section of the state board exam dropped from 34 percent in 2002 to 6 percent in 2003. The primary factors believed responsible for these improvements were a direct result of dialogue between dental school faculty and state board representatives. They include a greater appreciation by the UFCD faculty for the performance criteria used by the Board of Dentistry to evaluate procedures and a change by the board in the tooth selection criteria for the endodontic experience. The options in tooth-type used in the board exams increased from a two-rooted maxillary premolar to any anterior or premolar tooth. In conclusion, this report supports the positive benefits from ongoing discussions between dental school faculty and representatives of the state licensure board.

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

A written survey on issues in clinical testing for licensure was sent to the deans of all dental schools in the United States. Response rate was 89 percent. Results indicate that administrative leaders of the country9s dental schools think that third-party evaluation of graduates is appropriate, but they do not have confidence in current clinical tests for licensure. More than nine out of ten respondents indicated that change was needed in current testing procedures, and 82 percent thought the tests as currently conducted were not valid for decision purposes. Regional differences existed among the responses, with the least dissatisfaction occurring in the West. The highest-rated and most frequently mentioned reasons for dissatisfaction with clinical tests were the involvement of patients (human subjects) as currently done. Most respondents favored a national level for licensure tests, although the majority also approved of the recently enacted New York law that permits completion of a postgraduate year in an accredited program to substitute for clinical testing. Respondents indicated a belief that a national database on academic measures as compared to outcomes on clinical licensure tests would be useful, with overall grade point average or class rank as the favored academic measure. Informed by the recommendations of its representatives to the AADE-ADEA Innovative Testing and Educational Methodologies Committee and results of the survey of deans, ADEA is pursuing steps to foster change in the clinical licensure process.

Following calls to reform the dental licensure process, New York state has adopted an innovative approach that is responsive to the perceived shortcomings of the existing Part III examination. This solution eliminates the legally, psychometrically, and ethically compromised system, replacing it with a requirement that both ensures the public9s protection and gives the new dentist additional experience in contemporary procedures in a supervised setting. The best preparation for the practice of dentistry is the practice of dentistry--something so profound and simple; yet it constitutes the core of New York9s revolutionary reform. And the best way to measure that preparation for initial licensure is with the continual evaluation that occurs during the postdoctoral experience. New York is the first state to allow applicants for licensure to substitute the successful completion of a postdoctoral clinical program--a test in itself--for the traditional clinical licensure examination. The primary objective of this reform is to improve the quality of dentistry by elevating the standards for licensure. New York9s expanded training protocol parallels that of medicine and reflects developments in the science and practice of the dental profession. The introduction of this new professional training model renders the clinical examination requirement obsolete. The fundamental principle of New York9s new system is that a clinical examination is unnecessary to verify that a dentist is competent to enter practice following postdoctoral clinical training consisting of ongoing patient care, continuous oversight, mentoring, and evaluation.

State and regional board exams represent the final gateway to dental licensure. One would expect that the requirements for licensure would reflect procedures that are beneficial to each patient's oral health and that are consistent with the teachings of most dental schools. We conducted an Internet survey to determine whether Class 2 tooth preparations based on caries lesions whose radiolucencies were confined to enamel were allowed for state and regional exams. Information obtained for 46 of the 50 states revealed that 33 of the states (72%) allowed teeth with either an E1 or E2 lesion to be restored. Seventeen of these states allowed teeth with an E1 lesion to be restored. Only 12 of the 46 states (26%) covered by these boards did not allow teeth with E1 or E2 lesions to be surgically treated. In contrast, a recent report indicates that only 30% of dental schools permit teeth with enamel lesions to be restored to satisfy clinical requirements and competencies.

Appropriate licensure is a significant barrier to entry to the practice of dentistry. The history of dental licensure in the United States is briefly examined, and current dental licensure requirements in the United States and Mexico are noted. The impact that establishment of the European Community had on dental licensure in Europe is examined, noting that changes were the result of political, rather than professional, input. Requirements of NAFTA are examined to see how they will impact current American dental licensure requirements. Some migration of dental professionals between the United States and Mexico is expected as a result of NAFTA.

In 1994, following a request from the ten Provincial Licensing Authorities, the National Dental Examining Board of Canada (NDEB) implemented significant changes to the certification process for dentists seeking a license to practice in Canada. Prior to 1994, graduates of accredited Canadian dental programs were certified without further examination while graduates of United States and other international programs (non-Canadian, non-U.S.) were required to complete successfully a written and three-phase clinical certification examination. Changes implemented in 1994 required graduates of accredited Canadian programs to take both a Written and Objective Structured Clinical Examination (OSCE) Examination. The analysis of the results of the Written Examination for all candidates over the 1994-1996 period supports the following conclusions. There was no meaningful difference in performance of graduates across the ten Canadian dental programs; there was a small difference between the performance of graduates of Canadian and U.S. programs; and Canadian and U.S. graduates performed significantly better than graduates of other international programs. This level of candidate performance and changes to the respective accreditation processes supported the formal agreement providing reciprocal recognition of dental accreditation in Canada and the United States. As of January 1, 1997, graduates of dental programs in Canada and the United States are required to take the same certification examination while international graduates are required to complete a different certification process. These changes to the certification process were ratified by all ten Provincial Licensing Authorities, therefore maintaining a system of national portability for dental licensure in Canada that does not require preclinical or clinical board examinations for graduates of accredited North American dental programs.