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Reforming Dental Licensure Exams

The Massachusetts Dental Society believes that a comprehensive and accurate clinical assessment of dental school graduates who are applying for licensure is essential to providing safe, quality dental care to residents throughout Massachusetts. However, the current live patient clinical licensing examination is limited in accomplishing this goal, while putting an excessive burden on graduates and patients alike. An Act Relative to Dental Licensure Examinations directs the Board of Registration in Dentistry to approve an exam format that is a better metric of an applicant’s skills by eliminating the problematic live patient component.

The Issue

Current Massachusetts law for certification of dentists includes an outdated, unrealistic requirement for dental students to complete procedures on "live patients.” The current live patient exam falls short of providing a quality assessment of an applicant’s education and training because:

1. It focuses on a limited set of procedures that do not accurately reflect the multifaceted requirements and responsibilities demanded of dentists in everyday clinical practice.

  • Several studies looking at the relationship between performances in dental school compared to results of live patient exams found little or no significant relationship between the two.

2. It can encourage improper patient care.

  • Applicants often must find patients months in advance of their test date, purposely delaying care so that they will have a patient who presents with the qualifying oral health issues.
  • Once in the exam, applicants may need to perform procedures that are unnecessary and potentially harmful while ignoring other pressing issues that require treatment, solely to complete the exam requirements. 
  • Using live patients in a way that their overall oral health is a secondary concern behind evaluating the applicant sets a poor example for would-be dentists and contradicts a licensed dentist’s duty to provide quality and timely care to the patient, as described in the American Dental Association’s Principles of Ethics and Code of Professional Conduct.
3. Obtaining a patient to sit for the exam is unduly burdensome on applicants.
  • Finding and vetting patients who will qualify to sit for an applicant’s live exam is exceptionally time-consuming, expensive, and difficult to accomplish.
  • Once an applicant identifies a potential patient who presents with the characteristics that fit the required procedures to be performed, the applicant is completely beholden to them to pass his or her exam. They must pay for the patient’s travel and lodging expenses, and still have no guarantee that they will appear on exam day. Knowing the implications for applicants if their patient does not show up (i.e., failure of the exam), extortion by patients is not unheard of.
  • Patients who show up but are found unqualified by the examiner cause an automatic failing grade for the applicant. This sets applicants back months and causes them to lose hundreds of dollars in exam fees.

Legislative Solution

An Act Relative to Dental Licensing Exams | H.4269

An Act Relative to Dental Licensing Exams would:
  • Eliminate the live patient component of dental licensure exams.
  • Direct the Board of Registration in Dentistry to approve an examination that does not require the performance of any procedure upon a live patient.