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Advocating for Change

Clinical licensure, which falls under state board of dentistry purview, is a hot topic for new dental school graduates and for licensed dentists who wish to relocate. It is of paramount importance to protect the public from inadequate practitioners, but it is also important to have a clinical licensure system that is fair to dentists and free from unnecessary barriers.

A brief history

In the 1990's, failure reports were "shocking"
Concerns about the dental licensure system really began to heat up in the 1990s, when many new graduates experienced difficulty transitioning to dental practice because of high levels of failure of the licensure exams. In 1994, the Journal of the American Dental Association reported "failures ranging from 50 percent to more than 80 percent were noted at certain exam sites in the Western, Southern, and Northeastern regional boards." The report added "a shocking 80 percent or greater failure rate (was) noted at two of the Central Regional Dental Testing Services schools." A little more than a year later, the picture was not much brighter: JADA reported "more than 1,000 of 1995's dental graduates failed their initial licensing test."

In 1996, discussion and collaboration begins
In 1996, the American Dental Association began an initiative to spur discussion among all the communities of interest with hopes to facilitate a licensure process that was fair and candidate-friendly as well as continue to protect the public. As a result, the ADA hosted a series of meetings on licensure with participants from the testing agencies, the American Dental Education Association (ADEA), the American Association of Dental Examiners (AADE), the American Student Dental Association (ASDA), and the ADA Committee on the New Dentist. It was agreed that uniform entry-level clinical licensure examinations was a goal shared by all of the participating organizations.

In 1997, the Agenda for Change was born
The March 1997 meeting was notable for the development of the 12-point Agenda for Change, which was accepted by the ADA, ADEA, AADE and ASDA, and addressed topics such as standardization of written and clinical examinations, a more candidate-friendly licensure process, and the use of human patients in the exam. (The full text of the Agenda follows.)

The Agenda for Change set the tone for further action on the clinical licensure front. The regional testing agencies and AADE have addressed examination calibration and have established guidelines for common content in the clinical examination process. At the same time, the ADA and ASDA continue to encourage state dental boards to accept more than one clinical exam, recognizing that if every state accepted every test, it would give new graduates more flexibility. The majority of states accept the results of more than one testing agency.

In 2003, the post-graduate residency emerged as an alternative
An alternative pathway to initial licensure was established by the state of New York in 2003: completion of a residency. The New York State Dental Association actively supported legislation to offer completion of a residency program at least one year in length (PGY-1) in an accredited postdoctoral program in lieu of the clinical licensure examination as a pathway to licensure in the state. The 2003 ADA House of Delegates amended its Policy on Dental Licensure and Guidelines on Dental Licensure to reflect this option. In 2007, the completion of a postgraduate residency program in New York was mandated. The state of New York no longer accepts clinical examination as a pathway to licensure. California (advanced general dentistry only), Connecticut, Minnesota and Washington offer the option of a PGY-1 as an alternative pathway to licensure. Washington has a PGY-1, but it is unique in that the residency must be completed in a low-income clinic. PGY-1 may be a suitable pathway to licensure for eligible dentists, unless he or she foresees the possibility of moving to another state. In that case, the dentist must seek licensure from the new home state to be eligible to practice there. For this reason, the PGY-1 may not work for everyone. ASDA policy supports the option of PGY-1 as a sufficient alternative to licensure; however the organization does not believe that a residency program option should be mandated.

Tip: Learn more about ASDA's Licensure Policies at

In 2004, CDEL supports the concept that dental students can take a single clinical examination that would have national acceptance.
"Mutual recognition"—the concept that all exams do a good job of evaluating a candidate's suitability for dental licensure—is now well-accepted, especially from a practical standpoint. However, many dentists and leaders in the profession continue to advocate for the development of a single clinical licensure examination that would be accepted by all dental boards across the country. In April 2004, the ADA Council on Dental Education and Licensure (CDEL) endorsed the concept that a dental student who has graduated from an accredited program should be able to take a single clinical examination that would have national acceptance. At its June 2004 meeting, the American Association of Dental Examiners (AADE) passed a resolution calling for the development of a national, uniform dental clinical examination administered by state and regional testing agencies. The ADA House of Delegates also took action that year to support the development of a single exam and to monitor the process.

ADEX is charged with developing an exam—but not all can agree
The American Board of Dental Examiners (ADEX) was formed as the independent agency responsible for the development of a clinical licensure examination. c. When ADEX began to develop the exam, the majority of state dental boards and regional testing agencies participated in the process. However, some state and regional testing agencies eventually withdrew from the process. Instead of just one examination, now there were multiple examinations in use. Not all state dental boards joined ADEX.

The intention was for all existing regional testing agencies to administer ADEX's exam, but by August 2005, only two agencies agreed to do so—CRDTS and NERB. SRTA, WREB and CITA did not participate in ADEX and continue to administer their existing examinations today. Eventually, CRDTS also withdrew and as of March 2010, NERB and Nevada are the only agencies that administer the ADEX exam. .

Keeping the lines of communication open
To date, there is still a strong desire for one common exam, making mobility easier for dentists and their families seeking new opportunities in different states. The ADA continues to monitor the ever-changing licensure environment and has hosted several informal inter-agency meetings in the past five years. In addition, the ADA has sent letters to the state boards of dentistry regarding the licensure process, including asking the Boards to consider the impact of CRDTS withdrawal from ADEX and to encourage them to accept results from multiple examinations. ADA's licensure policies continue to encourage states to accept results of any state or regional examination.

The 2009 ADA House discusses the development of a Part III NBDE
The 2009 ADA House of Delegates considered a resolution (26S-1) to study the development of a Part III National Boards Dental Examination that will evaluate clinical competency, ethics and professionalism. Because of conflicts with the Bylaws duties of CDEL and the Joint Commission on National Dental Examinations, the House referred the activity to an ADA Board of Trustees workgroup.

Disclaimer: We are providing information here that may not be accurate or complete when you view it; you should not rely on this summary but check with the state licensing authorities to get complete and up-to-date information. Please visit the American Association of Dental Boards for current state licensure requirements and information.