Dental Licenses: It’s Not Easy To Be a Dentist!

My recent survey about national licensure for dentists got a huge response. Of the hundreds of dentists who responded, fully 86% want universal licensure or national reciprocity. And when you look at how dental licenses are granted, it's hard not to see their point.

"Barbers, Beauticians and Dentists are the only people who have state licensure exams where they have to demonstrate clinical skills," pointed out an oral surgeon. "For all other doctors, it is assumed that by the time you graduate from school, you already know how to do a filling."

Dentists are envious of the flexibility physicians have. "I find it hard to believe that an MD can get a license to practice medicine in any state, and, for example, an appendectomy performed in New York is considered an equivalent procedure to one performed in California. Yet somehow, a two-surface restoration is different depending on in what state the procedure is performed," said an orthodontist. "Universal licensure, universal standards, universal education. What's so hard about getting that?!"

I must admit, I'm a little baffled by the dental licensing process. So I did a little research… and I only got more confused!

Getting a dental license in the US requires three things:

1. graduating from an ADA accredited dental school,
2. passing a written exam, and
3. passing a clinical exam.

The clinical exam is the controversial part. First of all, many don't think it's even an appropriate requirement. New York actually requires a one-year residency instead of an exam, and a few other states let applicants complete either an exam or a residency.

While prospective dentists across the country take the same written exams (National Board Exams I & II), clinical testing is theoretically done on a state-by-state basis. In reality, almost all states are part of regional testing agencies that administer the exams. There are five such agencies, four of which were founded in the 1970's. This map shows how these regions break down. (Source: ADA)

The lack of a standardized clinical examination is what make the dental licensing process so difficult. And the fact that candidates treat live patients as part of the exam is what makes dental licensing so unique.

An increasing number of states are accepting clinical exams from multiple testing agencies. This gives a new dentist more flexibility in choosing where to practice.

Confused yet?

• State dental boards license and discipline dentists.
• Regional testing agencies (also known as clinical testing agencies or regional boards) are independent non-profit corporations that contract with individual state dental boards to provide clinical examinations.
• Licensure by reciprocity happens when two state boards formally agree that they will both honor licenses granted by the other. This is less common than licensing via credentials.
• Licensure by credentials (also known as licensure by recognition or licensure by reciprocity endorsement) is when a state's dental board grants a license to a dentist who is currently licensed in another state and has practiced for a certain amount of time (normally 5 years). Currently, 46 states offer licensure by credentials – all but Delaware, Florida, Nevada, and Hawaii.
• Mutual recognition means that passing one testing agency's clinical exam is essentially equivalent to passing that of another dental testing agency.

In 2004, the American Association of Dental Examiners (AADE) agreed that there should be a standardized national clinical exam, and created the American Board of Dental Examiners (ADEX) to do just that. Currently, 40 states accept the results of the ADEX exam.

So, while things are moving in the right direction, it doesn't seem likely that we'll see universal licensure for dentists in the US anytime soon.