A Review of the Ethics of Patient-Based Licensure Examinations.

Purpose Concerns regarding the ethical justification for the use of single-encounter, procedure-based examinations on live patients for the licensure of dental hygienists and dentists in the United States persists despite decades of debate and publication on the subject. The purpose of this literature review was to summarize the specific ethical concerns and quantify recommendations in favor or against this examination methodology.Methods A population, intervention, control or comparison, outcome (PICO) question was developed to review the topic as follows: "For individuals receiving dental care as part of determination of candidates for competency and readiness for licensure, do patient-based licensure examinations, as compared to other assessment methods, violate or infringe upon ethical principles or ethical standards for health care or society?" An electronic search was performed in three databases: PubMed/Medline, Scopus, and Embase. Key search terms and Medical Subject Headings (MeSH) included the following: ethics, clinical, competence, dental, dental hygiene, dentistry, education, licensure, live patient, and practice.Results Ethical concerns about the use of patient examinations have been published in the professional literature for over 35 years. Of the 29 selected or endpoint articles identified, 27 articles cited one or more ethical concerns relating to single-encounter patient-based examinations while 20 articles recommended the elimination of this type of examination with an additional 6 articles citing elimination as an option in resolving the ethical issues regarding this type of licensure examination.Conclusion The literature holds a predominant, prevailing professional opinion that single-encounter, procedure-based examinations on live patients presents significant ethical concerns and should be eliminated as a method in initial dental hygiene and dental licensure. The literature also suggests that state dental boards should initiate corrective regulatory or legislative actions to expeditiously end recognition of live patient examinations in their licensure processes.

Performance of Generative Artificial Intelligence in Dental Licensing Examinations.

OBJECTIVES: Generative artificial intelligence (GenAI), including large language models (LLMs), has vast potential applications in health care and education. However, it is unclear how proficient LLMs are in interpreting written input and providing accurate answers in dentistry. This study aims to investigate the accuracy of GenAI in answering questions from dental licensing examinations. METHODS: A total of 1461 multiple-choice questions from question books for the US and the UK dental licensing examinations were input into 2 versions of ChatGPT 3.5 and 4.0. The passing rates of the US and UK dental examinations were 75.0% and 50.0%, respectively. The performance of the 2 versions of GenAI in individual examinations and dental subjects was analysed and compared. RESULTS: ChatGPT 3.5 correctly answered 68.3% (n = 509) and 43.3% (n = 296) of questions from the US and UK dental licensing examinations, respectively. The scores for ChatGPT 4.0 were 80.7% (n = 601) and 62.7% (n = 429), respectively. ChatGPT 4.0 passed both written dental licensing examinations, whilst ChatGPT 3.5 failed. ChatGPT 4.0 answered 327 more questions correctly and 102 incorrectly compared to ChatGPT 3.5 when comparing the 2 versions. CONCLUSIONS: The newer version of GenAI has shown good proficiency in answering multiple-choice questions from dental licensing examinations. Whilst the more recent version of GenAI generally performed better, this observation may not hold true in all scenarios, and further improvements are necessary. The use of GenAI in dentistry will have significant implications for dentist-patient communication and the training of dental professionals.

Dental Hygiene Educators' Perspectives Towards Manikin Testing for Clinical Licensure Examination.

Purpose The use of manikin testing was recently introduced for dental hygiene licensure examinations. There is currently a lack of research about the efficacy and accuracy of manikin testing for clinical licensure. The purpose of this study is to identify perceptions of dental hygiene educators regarding the use of manikins for the dental hygiene clinical licensure exam.Methods This qualitative study used an exploratory, online, focus group design with 20 dental hygiene educator participants recruited through purposive sampling. Pseudonyms were used to protect participants confidentiality. Two groups of educators were from institutions that did not use manikin testing during COVID-19, and two groups of educators were from institutions that did use manikin testing during the same time period. Themes were analyzed using the classic analysis strategy. Validity was established using investigator triangulation, member checks, and saturation.Results Lack of knowledge including preconceived assumptions regarding manikin examinations; testing considerations with benefits and concerns regarding manikins versus live patients; and perceptions regarding the value of single point in time clinical licensure examinations were the three major themes identified by the participants.Conclusion The manikin exam appeared to address ethical concerns, however, there were limitations in relation to assessing critical thinking and decision-making skills. Some participants expressed that graduation from an accredited dental hygiene program was considered sufficient for licensure. Future studies should include comparisons of recent graduates who complete a clinical licensure examination versus those who do not complete a clinical licensure examination.

The impact of dental curriculum format on student performance on the national board dental examination.

PURPOSE/OBJECTIVE: The effectiveness of different curriculum types has long been debated by dental educators aiming to provide the best education possible to their students. This study aimed to evaluate the effect of curriculum type (hybrid problem-based learning [PBL] vs. traditional) on National Board Dental Examination (NBDE) part I and II pass rates METHODS: A retrospective cohort study was conducted with a hybrid PBL cohort and traditional cohort. NBDE part I and II pass rates for the two cohorts were acquired, along with demographic and scholastic variables. Pass rates, scholastic variables, and demographic variables were compared using two-sample t-tests and chi-square tests. Associations of the variables with pass rates were analyzed using logistic regression. Significance was set at 5% RESULTS: No significant differences in pass rates for NBDE part I and II were observed between the cohorts. Cumulative dental school grade point average (GPA) was found to be an independent predictor of success for NBDE part I (odds ratio (OR): 1.40, 1.24-1.59 for 0.1 point intervals) and II (OR: 1.34, 1.18-1.52 for 0.1 point intervals), (p < 0.01). DAT biology sub-score was found to be predictive of success for NBDE part I (OR: 1.58, 1.14-2.19), (p = 0.01) CONCLUSIONS: No significant difference in NBDE part I and II pass rates between the cohorts was found. Dental school GPA was the most predictive variable for success on NBDE part I and II. These findings may be helpful considerations as institutions assess the structure of their school curricula.

A comparison of manikin and live patient-based dental hygienist clinical licensing exam.

OBJECTIVES: The Central Regional Dental Testing Service in the United States administered its first manikin-based (M) dental hygiene licensing exam in 2020. The aim of this study was to compare the licensure exam results of dental hygiene students examined using manikins versus live patients. METHODS: After obtaining the ethical approval, the de-identified exam scores of three different cohorts (2019, 2020, and 2021) were collected from the academic record database of Carrington College, Dental Hygiene School, San Jose, California. The exam scores of the students were grouped based on the exam format conducted: either M or patient-based (P). Mann-Whitney U test and two-tailed Fisher's exact were used to compare the scores of the groups. RESULTS: The scores of 108 dental hygiene graduates between 2019 and 2021 were analyzed. The study included 65 participants examined in group P and 43 participants in group M. There was no significant difference in the mean score between groups P and M (p = 0.46) or in the passing rate between the two groups (p = 0.52). However, a higher first-attempt passing rate was noted in the M group. Moreover, calculus removal scores were comparable between the two examination groups (p = 0.18). CONCLUSION: The findings of this study supported the comparability of both manikin and live P exam outcomes. Therefore, the use of M exams may be considered for future examinations. Further studies are needed in other settings to confirm the efficacy of M exams in evaluating the students' clinical performance.

State Licensing Board Requirements for Entry into the Dental Hygiene Profession.

Purpose: The purpose of this study was to identify current requirements for initial licensure and entry into the dental hygiene profession across state dental and dental hygiene licensing boards in the United States.Methods: A non-experimental study design was used to study dental and dental hygiene board licensing requirements in the United States, Puerto Rico and the Virgin Islands. Each regulatory board website was searched for requirements for entry-level dental hygiene licensure. Requirements were recorded on an Excel spreadsheet. State dental practice acts were reviewed to gather further information and 20 regulatory bodies were contacted to verify accuracy. Descriptive statistics were used to analyze data.Results: Information from a total of 52 dental boards (n=52) was examined for this study. Nearly all boards (n=51, 98.1%), with the exception of Alabama, required completion of entry-level education from a CODA accredited dental hygiene program and successful completion of the National Board Dental Hygiene Examination. Most states (n=51, 98.1%), except Delaware, also required a live-patient, a clinical board examination. Application fees ranged from $47.70 to $600. States varied considerably in terms of requirements for background checks, age, military status, and infection control training.Conclusion: Although the majority of regulatory bodies require completion of entry-level dental hygiene education from a CODA accredited program and successful completion of national board and a live-patient, clinical examination, there is considerable variation in other additional requirements for initial dental hygiene licensure.

Similarities and differences in specialty training of conservative dentistry and endodontics (India), operative dentistry (Pakistan) and restorative dentistry-endodontics (United Kingdom).

Dental education and training in Pakistan and India are largely influenced by the British system of education. However, there are some differences in the mode of postgraduate training in these countries. In Pakistan, hospital-based residency training is the mainstay, culminating in a fellowship diploma awarded by the College of Physicians and Surgeons of Pakistan. Whereas, in Indian students of dentistry pursue university-based MDS programme as the primary pathway to specialist training. From the beginning the Indian dental academia has remained vigilant in adopting a correct nomenclature for the specialty concerned with the dental conservation. They named it Conservative Dentistry & Endodontics while in Pakistan the same specialty termed Operative Dentistry has become an obsolete term and does not represent the scope of work practiced by specialists in this discipline. A simple addition of the term "Endodontics" to the present nomenclature of "Operative Dentistry" will resolve the matter of a missing identity in a clinical specialty in Pakistan. The present paper suggests the need for advocacy to change the term used for this particular dental specialty.

U.S. Re-Licensure Opioid/Pain Management Continuing Education Requirements in Dentistry, Dental Hygiene, and Medicine.

Drug-induced deaths have been accelerating over the last two decades. The aim of this study was to determine if states with high opioid-induced deaths and overall drug-induced deaths were more likely to have continuing education (CE) requirements related to opioid use/pain management than states with fewer opioid-induced deaths. Almost 200 state dental and medical law boards' websites were examined for CE requirements, license renewal periods, and CE requirements for opioid use/pain management in December 2018 and January 2019. Drug-induced death data were obtained from the Centers for Disease Control and Prevention online database. States were categorized into quartiles of opioid-induced deaths per 100,000 population. A similar categorization was created for all drug-induced deaths. The results showed that states in the second, third, and fourth quartiles of opioid-induced deaths were more likely to have dental boards requiring opioid use/pain management CE than states in the first quartile in dentistry. This pattern was not the case with the medical boards' requirements. Dentists and physicians in states with higher all drug-induced deaths per 100,000 population were as likely to be required to attend opioid use/pain management CE as dentists and physicians in states with lower opioid-induced deaths. Although many licensing boards require opioid use/pain management CE in relation to their opioid-induced death rates, there is a need for policies to increase education in substance use disorders to reduce the number of drug-induced deaths.

Do Factors from Admissions and Dental School Predict Performance on National Board Exams? A Multilevel Modeling Study.

The aim of this study was to assess the association among admissions variables, dental school performance, and licensing exam performance for six cohorts of graduates of one dental school. Data from all dental school graduates of Schulich School of Medicine & Dentistry, Western University, Canada, from 2009 to 2014 who had matching National Dental Examining Board of Canada (NDEB) data (N=298) were analyzed. In the results, significant differences between cohorts were found on both the NDEB objective structured clinical examination (OSCE) and written scores. Approximately 18% of the variation in OSCE scores was attributable to cohort differences and 82% to student differences. Approximately 10% of the variation in written scores was attributable to cohort differences and 90% to student differences. Several multilevel models were conducted. The final predictive model for NDEB OSCE scores consisted of age, Canadian Dental Aptitude Test (DAT) reading comprehension scores, year 2 average, and year 4 average. For predicting NDEB written exam scores, the final model consisted of DAT chemistry and year 1, 2, and 4 averages. The findings of this study showed that academic performance on admissions variables and in training predicted performance on dental licensing exams, whereas variables that captured noncognitive or interpersonal skills, such as interview scores, were not predictive. This difference may be due to construct mismatch, such that the outcome variables had no theoretical association with the predictors. Additional outcome measures (including noncognitive) are needed that have greater ecological validity in predicting potential for competence in practice.

Should the U.S. Adopt a National Dental Clinical Licensure Examination? Two Viewpoints: Viewpoint 1: National Licensure Would Provide Multiple Advantages for Practitioners and the Profession and Viewpoint 2: Licensing Authority Should Remain Under State Dental Boards' Jurisdiction.

This Point/Counterpoint article examines the need for and potential impact of implementing a national clinical examination for initial licensure in dentistry. Viewpoint 1 supports a national licensure exam that meets the clinical exam's credentialing requirement for licensure in every state. According to this viewpoint, a national exam will reduce costs, enhance portability of graduates, simplify the transition from dental school to practice or specialty training programs, and standardize requirements for licensure between states. Viewpoint 2 opposes a national licensure exam. This viewpoint supports individual states' dental board decision making process, which is based on identifiable state-specific criteria. The ability to prioritize needs at the state level allows for higher exam standards, easier modifications, more focused requirements, and better calibration in specific exam areas. Viewpoint 2 argues that the delicate balance between licensure agencies and organized dentistry in each state, as well as the involvement of dental schools in the licensure process, must be preserved. This Point/Counterpoint concludes with a joint statement about the prospects for adoption of a national licensure exam.

Dentists' responses about the effectiveness of continuing education activities.

OBJECTIVE: To report the responses of dentists about the effectiveness of continuing education (CE) activities. METHODS: This cross-sectional study involved the administration of a pilot-tested questionnaire amongst dentists from different cities of the eastern province of Saudi Arabia. A calculated sample of dentists (n = 323) was approached in person to collect their responses about CE activities they attended during the last one year. Descriptive statistics and multivariate logistic regression analyses were performed. RESULTS: The response rate was 79.5% as 257 dentists returned completed questionnaires. There were 54.9% male and 45.1% female participants (mean age 31.18 ± 12.4 years). The majority of participants reported an improvement in knowledge (79.8%), a motivation for learning (79.8%), and quality of dental care (73.9%) as a result of CE activities. More than two-thirds recognised the importance of CE courses for maintaining licensure in dentistry, and 91.1% felt the need to increase CE activities. Logistic regression models showed that male participants were less likely (OR = 0.48, P = 0.05) than female counterparts to report an improvement in clinical skills. Having a private job (OR = 2.38 P = 0.005) and >10 years since graduation (OR = 1.84, P = 0.05) were associated with an improvement in clinical skills. Believing in the importance of CE activities for maintaining licensure was significantly associated with the effectiveness of CE activities in improving knowledge (OR = 2.76, P = 0.01), clinical skills (OR = 2.02, P = 0.04) and patient satisfaction (OR = 2.22, P = 0.01). CONCLUSION: The majority of dentists recognised that CE activities were effective in improving their knowledge, clinical practice, quality of patient care and motivation for learning.

Polypharmacy and Off-label Drug Use in Dentistry: knowledge, attitudes and practices of California dental hygienists.

Purpose: This study examined the knowledge, attitudes, and practices of dental hygienists, licensed in the state of California, regarding polypharmacy and off-label drug use for purposes in dentistry.Methods: A cross-sectional design was used to assess the knowledge, attitudes, and practices (KAP) related to off-label drug use and polypharmacy via an online survey tool. The study sample included licensed dental hygienists, who were members of the Long Beach and Tri-County Dental Hygienists' Associations located in Southern California (n=360). Descriptive statistics were used to assess the participant characteristics. ANOVA was used to assess differences in knowledge, attitudes and practices when compared to three key variables: highest academic/professional degree, experience and license type.Results: One hundred seven electronic surveys (n=107) were returned for a 34% response rate. Over half of respondents (53%) held an associates' degree for their license, most (72%) worked in a general dentistry setting and 46% had practiced 15 years or less. Regarding knowledge of polypharmacy and off-label drug use, the results demonstrated very low knowledge, with 25% of the respondents unable to answer any of the knowledge questions correctly. No significant differences in practices related to off-label drugs or polypharmacy were found based on type of licensure, highest degree achieved, or years of experience. However, participants holding a baccalaureate degree or higher were significantly more confident (p=.011) in discussing polypharmacy with patients and colleagues.Conclusion: Participants showed a general low-level of knowledge related to polypharmacy and off-label drug use in dentistry regardless of their level of education, years of experience, or type of dental hygiene licensure; indicating a need for increased pharmacology content in both entry-level dental hygiene programs and continuing education courses.

Educational and Clinical Experiences in Administering Local Anesthesia: a study of dental and dental hygiene students in California.

Purpose: The purpose of this study was to examine the differences in educational preparation and practical educational experiences between dental and dental hygiene students in the administration of local anesthesia (LA) and management of LA related complications in the state of California.Methods: Course instructors responsible for teaching LA or the program directors of the 6 dental schools and 29 dental hygiene programs in California (n=35) were invited to participate in this study. A computer-based descriptive survey, a comparative checklist of LA instruction requirements and semi-structured interviews were used for the data collection. Descriptive statistics were used to analyze results.Results: Eighteen LA course instructors or program directors participated in the study for a response rate of 51%. One respondent was from a dental school while 17 were from dental hygiene programs. The majority of the dental hygiene (n=16) respondents reported teaching 12 types of intraoral injections; the dental school respondent reported teaching seven injection types. Fewer student-to-student injection experiences per injection type were required by the dental school (n=7) than the dental hygiene schools (n=12) and the dental school did not indicate a minimum number of student-to-patient injection requirements for graduation. Analysis of a checklist of required elements of LA instruction and individual syllabi revealed common elements of all courses; students are expected to choose the proper local anesthetic, identify the proper injection type, and manage any LA complications. The majority of the interview participants perceived that dental hygiene students had more educational preparation in LA than their dental student cohorts and that dental hygienists were educationally prepared to administer LA safely without direct supervision.Conclusions: Dental hygiene students in California programs appear to be well prepared through their education experiences to administer and manage complications related to local anesthesia. Consideration should be given to supporting changing the supervision requirements for the administration of local anesthesia by dental hygienists licensed in the state of California.

Should Live Patient Licensing Examinations in Dentistry Be Discontinued? Two Viewpoints: Viewpoint 1: Alternative Assessment Models Are Not Yet Viable Replacements for Live Patients in Clinical Licensure Exams and Viewpoint 2: Ethical and Patient Care Concerns About Live Patient Exams Require Full Acceptance of Justifiable Alternatives.

This Point/Counterpoint article addresses a long-standing but still-unresolved debate on the advantages and disadvantages of using live patients in dental licensure exams. Two contrasting viewpoints are presented. Viewpoint 1 supports the traditional use of live patients, arguing that other assessment models have not yet been demonstrated to be viable alternatives to the actual treatment of patients in the clinical licensure process. This viewpoint also contends that the use of live patients and inherent variances in live patient treatment represent the realities of daily private practice. Viewpoint 2 argues that the use of live patients in licensure exams needs to be discontinued considering those exams' ethical dilemmas of exposing patients to potential harm, as well as their lack of reliability and validity and limited scope. According to this viewpoint, the current presence of viable alternatives means that the risk of harm inherent in live patient exams can finally be eliminated and those exams replaced with other means to confirm that candidates are qualified for licensure to practice.

U.S. Dental Schools' Preparation for the Integrated National Board Dental Examination.

An Integrated National Board Dental Examination (INBDE) combining basic, behavioral, and clinical sciences will be implemented in 2020 to replace the current two-part National Board Dental Examination required for all candidates who seek to practice dentistry in the U.S. The aims of this study were to determine how U.S. dental schools are preparing for implementation of the INBDE and to assess their top administrators' attitudes about the new exam. A total of 150 deans, academic deans, and other administrators at all 64 U.S. dental schools with graduating classes in 2016 were emailed a 19-question electronic survey. The survey questions addressed the respondents' level of support, perceived benefits and challenges, and planned preparation strategies for the INBDE. The individual response rate was 59%, representing 57 of the 64 schools. Approximately 60% of the respondents either agreed or strongly agreed that they support the integrated exam, while roughly 25% either somewhat or strongly disagreed. While most respondents (72%) reported that their institutions would be prepared for the INBDE, 74% reported that the merged exam created additional strain for their institutions. Respondents reported viewing content integration and clinical applicability as benefits of the INBDE, while required curriculum changes and student preparedness and stress were seen as challenges. Most of the respondents reported their schools were currently employing strategies to prepare for the INBDE including meetings with faculty and students and changes to curricula and course content. The beginning of the fourth year and the end of the third year were the most frequently reported times when schools planned to require students to take the INBDE, although almost half of the respondents did not yet know what it would be required at their school. Several schools were reconsidering using the boards as a passing requirement. This study found that support for the INBDE was not universal, but strategies are under way to prepare students, faculty, and curricula for this new means of assessment.