Boards, Licensure, Confusion

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011110

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Right now there is so much confusion regarding licensure and boards. All these clinical board exams are coming out with manikin exams, the DLOCSE, and states not saying what’s accepted for licensure. Then if a state doesn’t accept the manikin portion, what do you have half kids taking a manikin vs patient based test. Its just one big disaster. The states, boards, and committees need to get on one unified platform - do away with all patient exams, accept the manikin tests in full, provide one pathway toward licensure and make it mandated. Otherwise there are new rules and tests everyday that no one knows will qualify them for licensure in a specific state.

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for students who have already taken and passed live patient test for WREB/ADEX, the state still accepts them like normal (pre-pandemic crisis)

For the mannequin based test or computer test proposed by these regional testing agencies, I find it incredibly difficult for the states to change legislation to grant licensure based on these alone.

Personally, I feel it is a joke for these testing agencies to come up with these mannequin based test in such a short time. For restoration portion, their super tooth is tested but reviewed to be a disaster. It is just near impossible to replicate true clinical caries on man-made material. For SRP portion, i have no idea how they can replicate this on a mannequin.

I feel the states will just make students wait out the pandemic and take the regular ADEX/WREB live patient. Too much logistical nightmare to deal with this.
 
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for students who have already taken and passed live patient test for WREB/ADEX, the state still accepts them like normal (pre-pandemic crisis)

For the mannequin based test or computer test proposed by these regional testing agencies, I find it incredibly difficult for the states to change legislation to grant licensure based on these alone.

Personally, I feel it is a joke for these testing agencies to come up with these mannequin based test in such a short time. For restoration portion, their super tooth is tested but reviewed to be a disaster. It is just near impossible to replicate true clinical caries on man-made material. For SRP portion, i have no idea how they can replicate this on a mannequin.

I feel the states will just make students wait out the pandemic and take the regular ADEX/WREB live patient. Too much logistical nightmare to deal with this.

^ You're right in that it is definitely going to be challenging to get states to change their laws to accept a mannequin based exam, but we as D4s are using this unprecedented time to enact change in an unethical exam that has been utilized way too long. Whether or not, this movement helps the class of 2020, we are trying to better the profession by doing away with this joke of a exam so future classes don't have to go through the process of finding and paying patients for their borderline carious lesion. It will be tough and challenging, but what worthwhile result is easy? Graduating from a CODA accredited dental school should be enough to be licensed, but I realize licensing board exams is a business in itself.
 
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for students who have already taken and passed live patient test for WREB/ADEX, the state still accepts them like normal (pre-pandemic crisis)

For the mannequin based test or computer test proposed by these regional testing agencies, I find it incredibly difficult for the states to change legislation to grant licensure based on these alone.

Personally, I feel it is a joke for these testing agencies to come up with these mannequin based test in such a short time. For restoration portion, their super tooth is tested but reviewed to be a disaster. It is just near impossible to replicate true clinical caries on man-made material. For SRP portion, i have no idea how they can replicate this on a mannequin.

I feel the states will just make students wait out the pandemic and take the regular ADEX/WREB live patient. Too much logistical nightmare to deal with this.

I get it from your perspective, but all of the boards are rolling out these mannequin tests and the DLOCSE. So if people take these tests, which they will, states are just gonna say sorry you passed but now we can’t accept it? Then taking the test is a waste of time and money, don’t bother offering mannequin tests and the DLOCSE. That’s why instead of all of this nonsense the state boards need to make a unified decision on what constitutes a license. You cant have people take these tests, not give them state licensure, make them take another test, or make others wait. Logistically it is a nightmare.
 
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First of all, the patient based exam is a joke. A dental student goes through 4 years of training and somehow whether they are competent or not is based off one exam? On a live patient where they have to find, hold off on treating their disease, and save them for their exam because they just happen to have the right sized cavity? Its so immoral.

There is no logic to doing a mannequin exam. It doesnt achieve anything except allow this year to do the exam without the risk of coronavirus. It doesnt address any other pitfalls of this exam and is just a temporary solution for this year. Who knows what will happen next year - do they move towards allowing the mannequin exam every year? That just justifies how unnecessary the exam is - doing an exam on plastic teeth is no way necessary after 4 years of dental school.

I think the testing boards have a real issue on their hands. This year really shows that they really are just a business. And an unnecessary expense to dental students.

I think the DLOSCE exam is the best answer (actually I think no exam is the best answer). Canada does it, it isnt unethical. Hopefully states accept this.
 
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I'm really sorry. Just know you're not alone. I'm practicing now and have been for 5 years - I can't imagine the stress from all of the uncertainty the class of 2020 is facing. Just hang in there, it will work out one way or another. If you know which state you are going to practice in, you might just want to call that board (good luck getting a reply though)...I think many states are going to issue a provisional license which is going to be an absolute nightmare - how can you hire someone with a provisional license? Will someone with a provisional license be able to secure affordable malpractice insurance? Will that person be insurable?

The most reasonable solution, in my opinion, is for all states to move to licensure by portfolio for the class of 2020 where the dean signs off on a student's competence to practice dentistry but I think that's a really big ask with such short notice.
 
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I'm really sorry. Just know you're not alone. I'm practicing now and have been for 5 years - I can't imagine the stress from all of the uncertainty the class of 2020 is facing. Just hang in there, it will work out one way or another. If you know which state you are going to practice in, you might just want to call that board (good luck getting a reply though)...I think many states are going to issue a provisional license which is going to be an absolute nightmare - how can you hire someone with a provisional license? Will someone with a provisional license be able to secure affordable malpractice insurance? Will that person be insurable?

The most reasonable solution, in my opinion, is for all states to move to licensure by portfolio for the class of 2020 where the dean signs off on a student's competence to practice dentistry but I think that's a really big ask with such short notice.

what about practicing dentists? We have to take a board exam for licensure when were in good standing, but a dental student gets licensure based on a portfolio? They need to make these new rules fair for all.
 
what about practicing dentists? We have to take a board exam for licensure when were in good standing, but a dental student gets licensure based on a portfolio? They need to make these new rules fair for all.

Are you in favor of a manikin-based exam or the DLOSCE?
 
Are you in favor of a manikin-based exam or the DLOSCE?

Well I think a manikin part combined with a computer based test is more than enough for licensure. The problem I see is the ADEX now has a manikin portion with a computer portion vs the DLOSCE which just had a computer portion. This is what I mean when state boards need to unify what the qualify for licensure. Whats the point of taking the DLOCSE when my state wants a clinical part too, but why take the ADEX when my state still wants a live portion? Everything is so volatile, but nothing is on the same page. States need to come up with answers for licensure and very quickly.
 
Well I think a manikin part combined with a computer based test is more than enough for licensure. The problem I see is the ADEX now has a manikin portion with a computer portion vs the DLOSCE which just had a computer portion. This is what I mean when state boards need to unify what the qualify for licensure. Whats the point of taking the DLOCSE when my state wants a clinical part too, but why take the ADEX when my state still wants a live portion? Everything is so volatile, but nothing is on the same page. States need to come up with answers for licensure and very quickly.
I dont think it matters - some states will want more than others, just do what your state wants. It doesnt matter than some other states have it easier - eg Minnesota already accepts the Canadian OSCE. You're right, if your state still wants a live portion then you are out of luck with the mannequin exam so theres no point you taking it. Even if other states accept it. That's another reason it's all so stupid
 
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I dont think it matters - some states will want more than others, just do what your state wants. It doesnt matter than some other states have it easier - eg Minnesota already accepts the Canadian OSCE. You're right, if your state still wants a live portion then you are out of luck with the mannequin exam so theres no point you taking it. Even if other states accept it. That's another reason it's all so stupid

Then what needs to happen is each state board needs to make an official statement on licensure requirements before all these new tests (manikin based, DLOCSE) start coming out. Tell us what you will require or accept. Telling us what tests are changing or being developed does nothing.
 
^ You're right in that it is definitely going to be challenging to get states to change their laws to accept a mannequin based exam, but we as D4s are using this unprecedented time to enact change in an unethical exam that has been utilized way too long. Whether or not, this movement helps the class of 2020, we are trying to better the profession by doing away with this joke of a exam so future classes don't have to go through the process of finding and paying patients for their borderline carious lesion. It will be tough and challenging, but what worthwhile result is easy? Graduating from a CODA accredited dental school should be enough to be licensed, but I realize licensing board exams is a business in itself.


Spot on.

Unfortunately its all about the $$$$. Canada has been doing an OSCE for years. They do just fine. These U.S. licensure exams have nothing to do with competency. Its solely money and a way for another private party to scam poor, desperate students buried in debt. And since its all run by money, it would wreck these companies if they did away with the patient exams so they won't go away without a nasty fight
 
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for students who have already taken and passed live patient test for WREB/ADEX, the state still accepts them like normal (pre-pandemic crisis)

For the mannequin based test or computer test proposed by these regional testing agencies, I find it incredibly difficult for the states to change legislation to grant licensure based on these alone.

Personally, I feel it is a joke for these testing agencies to come up with these mannequin based test in such a short time. For restoration portion, their super tooth is tested but reviewed to be a disaster. It is just near impossible to replicate true clinical caries on man-made material. For SRP portion, i have no idea how they can replicate this on a mannequin.

I feel the states will just make students wait out the pandemic and take the regular ADEX/WREB live patient. Too much logistical nightmare to deal with this.

I don’t see how states are going to make students wait... considering the pandemic itself cannot be predicted. It may come back in the fall, and then what? The class of 2020 has to wait again? For how long? Loans pile up, they need jobs too.

yea a fast tracked exam may not be the ideal situation. But something needs to be done fast.

it looks like it’s going to be a **** show for a while though.
 
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I'm really sorry. Just know you're not alone. I'm practicing now and have been for 5 years - I can't imagine the stress from all of the uncertainty the class of 2020 is facing. Just hang in there, it will work out one way or another. If you know which state you are going to practice in, you might just want to call that board (good luck getting a reply though)...I think many states are going to issue a provisional license which is going to be an absolute nightmare - how can you hire someone with a provisional license? Will someone with a provisional license be able to secure affordable malpractice insurance? Will that person be insurable?

The most reasonable solution, in my opinion, is for all states to move to licensure by portfolio for the class of 2020 where the dean signs off on a student's competence to practice dentistry but I think that's a really big ask with such short notice.

Anecdotal, but the dentist looking to hire my wife said he was on-board with a temp license or license requiring a fully licensed dentist oversight (like a MD - PA situation). So, there are some that will roll with it.

I like the idea of licensure by portfolio.

TSBDE is not being helpful as far as licensure goes.
 
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Then what needs to happen is each state board needs to make an official statement on licensure requirements before all these new tests (manikin based, DLOCSE) start coming out. Tell us what you will require or accept. Telling us what tests are changing or being developed does nothing.
I agree 100%. Personally I dont think theres any excuse for states not to accept the DLOSCE. If they dont it's just proof that money being made by the people running live patient exams is getting in the way
 
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what about practicing dentists? We have to take a board exam for licensure when were in good standing, but a dental student gets licensure based on a portfolio? They need to make these new rules fair for all.

We're already practicing so why would we need to take a board exam? Maybe if a practicing dentist was moving states...my opinion on that is that the practicing dentist will need to wait if there is no alternative way to get a license in the new state without taking the board exam. This is just one of the downsides to a state-specific license instead of a national license. Fixing this issue would require an absolute overhaul of the entire system and is probably not going to happen in the near term (maybe ever) because state licensing bodies have too much to lose.
 
Anecdotal, but the dentist looking to hire my wife said he was on-board with a temp license or license requiring a fully licensed dentist oversight (like a MD - PA situation). So, there are some that will roll with it.

I like the idea of licensure by portfolio.

TSBDE is not being helpful as far as licensure goes.

That's good that she has found an employer willing to work with a temporary license. I don't think many dentists will be that fortunate and if oversight is required, it's probably more of a liability than it's worth - there are plenty of unemployed experienced dentists available right now.
 
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We're already practicing so why would we need to take a board exam? Maybe if a practicing dentist was moving states...my opinion on that is that the practicing dentist will need to wait if there is no alternative way to get a license in the new state without taking the board exam. This is just one of the downsides to a state-specific license instead of a national license. Fixing this issue would require an absolute overhaul of the entire system and is probably not going to happen in the near term (maybe ever) because state licensing bodies have too much to lose.

If they are changing the ADEX to have a manikin portion, and it is accepted for licensure, all those taking it whether they be dental students or practicing dentists will need to be accepted otherwise its just a mess.
 
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If they are changing the ADEX to have a manikin portion, and it is accepted for licensure, all those taking it whether they be dental students or practicing dentists will need to be accepted otherwise its just a mess.

Agreed, I don't see why they'd make practicing dentists wait to take live patient version (if they even go back to that bc it's a stupid idea if you ask me).
 
If they accept whatever new testing methods (OSCE or manakin), will that be just for this year 2020?
 
I believe state board is comprised of a group of practicing dentists right? look at how many issues dentists can agree on together. Wreb and Adex are simply proposing solutions that in case states change their mind, students can still give them $$ to take these mannequin exams and they do not lose the market share.

Option 1: dental school deans can sign off on any dental students deemed competent. Problem with this is check and balance. Why there exists national board when the school can sign you off ensuring you have enough didactic knowledge. In a sense, the state boards do not trust dental schools to do this and hence they need an independent agency to validate this fact.
Some practicing dentists I saw posted (I did not ask) mention they feel the values of the fields are cheapened if you cannot pass a live patient board exam when you will spend the rest of your life working on live patients.

Option 2: every stateboard list on their website for licensure requirements. If you do not have what it asks for, you cannot apply for the license of that state. you cannot say you already pay for the mannequin based exam, how come the states do not accept it. Some states accept Wreb, some states accept ADEX, some states accept neither (Georgia). So far, no states changes their rules. I do not foresee them changing it anytime soon in 4-5 months.

Option 3: computer based case testing proposed is a joke to me. It is like NBDE part 2 all over again. It is created just to appease the pressing need of DS4 students. I don't see any point in this. This is a clinical exam. Nothing about this exam is clinical when it is held at a prometric.

I feel the most likely possibility is waiting out the pandemic to take the license because the boards do not want to set precedence to change regulatory laws to satisfy the pressing licensure need of a particular group of people (DS4 students in this case). Plus, I am sure a lot of dentist spoke out supporting this model-based non patient licensure exam, I am sure there are more dentists who oppose it but do not speak out.

The provisional license sounds like the more likely possibility but again, the regulations of such license can be confusing. Remember, there are around 20-30% of dental students in C/O 2020 who have already taken live patient ADEX/WREB. Do you want these students to outcompete you for a job because you hold a provisional license? or a model based license?

Just to clear the air, I am a DS4 myself having taken WREB on the last weekend possible before WREB cancelled all their following examinations. I am with you guys. I am stressed out also. But here are just the truthful opinions.
 
I believe state board is comprised of a group of practicing dentists right? look at how many issues dentists can agree on together. Wreb and Adex are simply proposing solutions that in case states change their mind, students can still give them $$ to take these mannequin exams and they do not lose the market share.

Option 1: dental school deans can sign off on any dental students deemed competent. Problem with this is check and balance. Why there exists national board when the school can sign you off ensuring you have enough didactic knowledge. In a sense, the state boards do not trust dental schools to do this and hence they need an independent agency to validate this fact.
Some practicing dentists I saw posted (I did not ask) mention they feel the values of the fields are cheapened if you cannot pass a live patient board exam when you will spend the rest of your life working on live patients.

Option 2: every stateboard list on their website for licensure requirements. If you do not have what it asks for, you cannot apply for the license of that state. you cannot say you already pay for the mannequin based exam, how come the states do not accept it. Some states accept Wreb, some states accept ADEX, some states accept neither (Georgia). So far, no states changes their rules. I do not foresee them changing it anytime soon in 4-5 months.

Option 3: computer based case testing proposed is a joke to me. It is like NBDE part 2 all over again. It is created just to appease the pressing need of DS4 students. I don't see any point in this. This is a clinical exam. Nothing about this exam is clinical when it is held at a prometric.

I feel the most likely possibility is waiting out the pandemic to take the license because the boards do not want to set precedence to change regulatory laws to satisfy the pressing licensure need of a particular group of people (DS4 students in this case). Plus, I am sure a lot of dentist spoke out supporting this model-based non patient licensure exam, I am sure there are more dentists who oppose it but do not speak out.

The provisional license sounds like the more likely possibility but again, the regulations of such license can be confusing. Remember, there are around 20-30% of dental students in C/O 2020 who have already taken live patient ADEX/WREB. Do you want these students to outcompete you for a job because you hold a provisional license? or a model based license?

Just to clear the air, I am a DS4 myself having taken WREB on the last weekend possible before WREB cancelled all their following examinations. I am with you guys. I am stressed out also. But here are just the truthful opinions.
If you see no point in the DLOSCE, you need to look into it again. Not at all like NBDE.
 
If you see no point in the DLOSCE, you need to look into it again. Not at all like NBDE.

I have read all the updates of WREB/ADEX and also DLOSCE. It serves a purpose but it cannot replace a clinical exam. I even think a mannequin based exam is superior to this. Plus, this DLOSCE is dropped out of nowhere. This means no test run, no trials and error.

Overall, I feel this is a hot mess.

There are a lot of old fashioned dentists in these regulatory boards. I do not think they will change just because we need a license. Especially, these dentists see their mission as safeguarding the public health and well being.

I am with you guys on this. I think the best course of action now is to take out some loans to last another 2-3 months and wait to hear news.
 
I have read all the updates of WREB/ADEX and also DLOSCE. It serves a purpose but it cannot replace a clinical exam. I even think a mannequin based exam is superior to this. Plus, this DLOSCE is dropped out of nowhere. This means no test run, no trials and error.

Overall, I feel this is a hot mess.

There are a lot of old fashioned dentists in these regulatory boards. I do not think they will change just because we need a license. Especially, these dentists see their mission as safeguarding the public health and well being.

I am with you guys on this. I think the best course of action now is to take out some loans to last another 2-3 months and wait to hear news.
The studies disagree. Clinical exams on their face are unethical, not to mention any of their other issues. That itself should make things change. But since it hasn’t, I’m perfectly fine pushing for something that is overall better. There are so many flaws with the existing clinical exams that having it on a real person loses all purpose. Everything that Canada has set up with their OSCE has proven time and time again that an OSCE is far superior.
I agree that it will be hard to change. Doesn’t mean it can’t and doesn’t mean we shouldn’t try.
 
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The studies disagree. Clinical exams on their face are unethical, not to mention any of their other issues. That itself should make things change. But since it hasn’t, I’m perfectly fine pushing for something that is overall better. There are so many flaws with the existing clinical exams that having it on a real person loses all purpose. Everything that Canada has set up with their OSCE has proven time and time again that an OSCE is far superior.
I agree that it will be hard to change. Doesn’t mean it can’t and doesn’t mean we shouldn’t try.

Yes, but do not expect this to happen in 3-4 months. By then, the crisis will probably clear out and we somehow will have a more definitive plan.
 
Yes, but do not expect this to happen in 3-4 months. By then, the crisis will probably clear out and we somehow will have a more definitive plan.
That’s because you are viewing it as a 3-4 month issue. The only reason I have hope for this to bring about real change is because it isn’t a 3-4 month issue... this is years in the making. This is not new, this is just the climax. The ADA/JCNDE has been working on the DLOSCE since 2016 and state boards were well aware of it at that time. They have had time to consider it so I believe it has a good chance of being accepted. If it takes a pandemic to kick things into gear, then so be it, but this is the most action I’ve seen in the 7 years I’ve been personally involved in licensure reform.
 
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I have read all the updates of WREB/ADEX and also DLOSCE. It serves a purpose but it cannot replace a clinical exam. I even think a mannequin based exam is superior to this. Plus, this DLOSCE is dropped out of nowhere. This means no test run, no trials and error.

Overall, I feel this is a hot mess.

There are a lot of old fashioned dentists in these regulatory boards. I do not think they will change just because we need a license. Especially, these dentists see their mission as safeguarding the public health and well being.

I am with you guys on this. I think the best course of action now is to take out some loans to last another 2-3 months and wait to hear news.
You talk like someone who has been through the tough exam and doesnt want it made easier for everyone else.

How could you possibly justify a live patient exam? Why do you think it is a good idea?
 
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If they are changing the ADEX to have a manikin portion, and it is accepted for licensure, all those taking it whether they be dental students or practicing dentists will need to be accepted otherwise its just a mess.

I agree with you that if they are offering a mannequin exam that anyone who wants to take it who would have been eligible under normal circumstances, should be allowed.
 
I am with you guys on this. I think the best course of action now is to take out some loans to last another 2-3 months and wait to hear news.
I hope this isn't too much of a derailment, but is this even possible? Especially for students who took the max loans for Spring (COL calculated by school). You can't be a D4, with no more school queued up and take student loans beyond COL estimate and especially if you are no longer registered for summer or fall classes. Oof.
 
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Everything that Canada has set up with their OSCE has proven time and time again that an OSCE is far superior.

This right here is partly why our medical colleagues **** on the dental profession. It's our seeming inability to comprehend scientific studies, evidence, and literature. This level of disregard for evidence-based decision making (after all the BS dental schools spew in their lectures halls) in accepting an OSCE shown to be a valid tool in evaluating competence, is quite frankly, appalling.

There are a lot of old fashioned dentists in these regulatory boards.

And therein lies the problem. I see this mentality everyday at my institution, re: "Back in my day, we did it this way, so now you have to as well." This is what stifles progress and innovation. What an outstanding representation of the dental profession /s.

Edit: After giving it some thought, I can now totally see states mandating both the OSCE and a clinical (patient or manikin-based) exam for licensure. Just another cash grab as if dental education wasn't already expensive enough. They will cite the evidence in the literature in support of the OSCE and adopt it (hence more money for whatever A-hole organization that will administer the exam) in addition to the clincal component (gotta keep the benjamins rolling in for ADEX/WREB/CRDTS). As if patients in Canada and elsewhere are dying bc dentists in those countries have ass for clinical skills. If state boards have such a distrust of dental schools, what good is CODA accreditation? It also makes me wonder if the people serving on these boards have some sort of financial ties in some way to ADEX, etc.
 
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I hope this isn't too much of a derailment, but is this even possible? Especially for students who took the max loans for Spring (COL calculated by school). You can't be a D4, with no more school queued up and take student loans beyond COL estimate and especially if you are no longer registered for summer or fall classes. Oof.

for my school, the COL calculated by school is always higher by like 10-20k than what a single student need to live comfortably. what I mean is for those who have not maxed out their loans.

I am a D4. If you want more validation, PM me.
 
And therein lies the problem. I see this mentality everyday at my institution, re: "Back in my day, we did it this way, so now you have to as well." This is what stifles progress and innovation. What an outstanding representation of the dental profession /s.

I hope wherever you go to for dental school does not have dental faculty who rips you apart for no reason other than what you think is not exactly what they think. Some old schooled dentists are oversensitive and think whatever new is trash.
 
I graduated as a dentist from India before moving to the US and I find it a joke how the dental licensure system works here.

In India, in our final year of dental school, we had practical exams on live patients. Show how to extract a tooth in OMFS, Class II MO/DO cavity, Impression taking or border moulding in Pros, Scaling in Perio etc. These practicals exams were in addition to theory exams and we would only pass our final year of dental school after passing these live patient exams. It made sense, you got trained in the school, you proved that you are competent at these basic procedures before graduating. To get the license, you filled out the paper work at the state dental board office with your transcripts etc and they issue you a license which you have to maintain/renew periodically.

It's a simple system but it works. Now I come here for maxillofacial radiology residency and to work in private practice as a radiologist, I have to somehow give a patient based exam on cavity filling or crown cutting to get that license? It's a ****ing joke.

Even for general dentists or clinical dental specialists who need a license, is your training in dental school not adequate or proof enough that you can be a competent dentist? Why go through dental school then. Just train a monkey or any random person these mechanical procedures and they can sit for the practical exam.
 
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You can go back to India....everything is better there.
I graduated as a dentist from India before moving to the US and I find it a joke how the dental licensure system works here.

In India, in our final year of dental school, we had practical exams on live patients. Show how to extract a tooth in OMFS, Class II MO/DO cavity, Impression taking or border moulding in Pros, Scaling in Perio etc. These practicals exams were in addition to theory exams and we would only pass our final year of dental school after passing these live patient exams. It made sense, you got trained in the school, you proved that you are competent at these basic procedures before graduating. To get the license, you filled out the paper work at the state dental board office with your transcripts etc and they issue you a license which you have to maintain/renew periodically.

It's a simple system but it works. Now I come here for maxillofacial radiology residency and to work in private practice as a radiologist, I have to somehow give a patient based exam on cavity filling or crown cutting to get that license? It's a ****ing joke.

Even for general dentists or clinical dental specialists who need a license, is your training in dental school not adequate or proof enough that you can be a competent dentist? Why go through dental school then. Just train a monkey or any random person these mechanical procedures and they can sit for the practical exam.

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