Letters: Licensure reform

I am in full agreement with Jonathan Nash, D.D.S., and his Sept. 13 My View “Licensure Reform: The Case for Eliminating the Clinical Exam.”

I have been a practicing dentist for almost 40 years, a Colorado State Dental Board member for eight years (five as president) and a dental board examiner with the Central Regional Dental Testing Service during my State Dental Board tenure.

These are my observations:

Taking a single-episode/performance-based (SE/PB) exam does not protect the public. A dental candidate who fails a SE/PB exam can immediately sign up to take another exam with no remedial training. The dental candidate usually has three attempts to pass the exam. In most cases nearly 100% of dental candidates pass these exams within three attempts (with no remedial training).

SE/PB exams on live patients are inherently unfair to the dental candidates. If you have money and dental connections you have a big advantage over other dental candidates. Candidates with dental connections and money can find patients with the smallest carious lesions and afford to pay the patients to show up for the exam. Other candidates may end up having their unpaid patients not show up for the exam and the dental candidates may have much larger and more difficult carious lesions to restore. Plus, these exams are very expensive to take with examination costs, travel costs, etc. These are added expenses that indebted dental students do not need to incur.

Finally, SE/PB exams with live patients amount to unethical treatment of the patients. The ADA’s Principles of Ethics and Code of Professional Conduct highlight the Principle’s of Nonmaleficence (“do no harm”) and Beneficence (“do good”). The restorative part of the live patient exam can take over three hours for one restoration. Having a patient wear a rubber dam unnecessarily for hours is traumatic to the TMJ, having a tooth exposed and repeatedly air dried is potentially damaging to the pulp tissue, overtreating minimal carious lesions is questionable treatment and overexposure to X-rays is wrong. These things happen at every dental exam with almost every patient and all are violations of our Code of Ethics.

Alternative dental candidate testing, without live patients, is available and is objective and does not favor the richer students and does not unethically treat patients. Come on fellow dentists, let’s move into the 21st century and adopt these alternative tests.

F. Robert Murphy, D.D.S.
Boulder, Colorado

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