An Overview of the Models in Reporting School Data on Dental Credentialing Examinations.

The development and dissemination of meaningful and useful performance reports associated with examinations involved in the licensure process are important to the communities of interest, including state boards, candidates, and professional schools. Discussions of performance reporting have been largely neglected however. The authors recognize and reinforce the need for such discussions by providing prototypes of performance reporting in dentistry with examples and recommendations to guide practice. For illustrative purposes, this article reviews and discusses the different reporting models used over the past ten years with Part I and Part II of the National Board Dental Examination (NBDE). These reporting models are distinguished by such features as the following: 1) scores in each discipline covered on the exam (four for Part I and nine for Part II) and an overall average are reported in a standard-score metric; 2) a single overall score in a standard-score metric is reported; and 3) performance on the exam is reported as pass/fail. Standard scores on the NBDE range from 49 to 99, with 75 being a passing score. Sample data, without identifying information, are used to illustrate the reporting models.

Background, training experiences, and career plans of U.S. periodontal residents: report of a web-based survey.

The purpose of this cross-sectional study was to survey the backgrounds and perspectives of U.S. periodontal residents in 2012. A 64-item web-based survey was distributed to all periodontal residents in the United States (544 residents enrolled in 54 graduate programs) via email in March 2012. Data on the residents' demographics, experiences during graduate periodontal training, and goals were collected and analyzed, and percentages were calculated. The survey had a 19.1% response rate. Most of the respondents (74%) had graduated from international dental schools, and 81.7% were in combined programs (clinical training combined with a Master's degree, PhD, or other doctoral degree). Almost one-fourth of the responding residents (24%) reported a total debt of more than $300,000 after graduation. More than 60% of the respondents planned to practice in a private setting as an associate, partner, or solo practice owner. The responding residents reported having chosen their graduate programs based mainly on the programs' clinical education and reputation (72% and 48%, respectively). Future studies will determine educational trends and outcomes for periodontal residents in the longer term.

Trends in the supply of dentists in California.

More than 35,000 dentists were licensed to practice in California in 2012, a number higher than in any other state and representing about 15.6 percent of the total number of dentists nationwide. Despite these numbers, concerns over a sufficient supply of dentists in the state have not diminished. These concerns are due in part to the uneven distribution of dentists in areas with the highest level of need, as well as to demographic and practice characteristics that may limit availability of the dental workforce. This policy brief provides an overview of changes in selected demographic and practice characteristics of California dentists from 2008 to 2012, as well as in the distribution of dentists in California regions. The findings indicate an outward migration of dentists from California, a slowly aging workforce, and low dentist-to-population ratios in some regions of California. These findings highlight the need for the continuation and fine-tuning of policies aimed at both attracting young dentists to areas with low supply and retaining existing dentists in the state.

Increased number of dental professionals in New York State counties.

Despite decreases in the population for 49 of the 62 counties in New York State between 2006 and 2013, the number of dentists increased in 52 counties. In addition, in 2013, there were more dental hygienists than dental establishments in 54 of the state counties. This change in landscape from 2000 to 2006, when the number of dentists decreased in 27 counties and a sizeable proportion of the state had little or no coverage, is reviewed using federal and state government reports.

Impact of residency requirement for dental licensure: an update.

As of 2007, New York State Education Law requires successful completion of dental school training and completion of an approved dental residency program for dental licensure. In a transitional period, from 2003-2006, a dental licensure applicant could select the path of an approved residency program or the New York State-recognized regional standardized clinical examination. By contrast, in 2007, the state of Connecticut adopted and continues to abide by regulations that permit licensure by either completion of an approved residency program or passage of the recognized regional standardized clinical examination. A review of the changing number of dentists licensed in these two adjoining Northeastern states under new licensure guidelines is considered in terms of the possible relationship to the new licensing process.

The role of women in dental education: monitoring the pipeline to leadership.

The purpose of this study was to analyze data collected by the American Dental Association and the American Dental Education Association over the past two decades relating to changes in the number of women active in dental education and dental practice. The concept of a pipeline of women in dentistry was explored by analyzing predoctoral, postdoctoral, dental practice, and dental education domains for the inclusion of women. Statistical analyses show that there has been a consistent and progressive increase in the number of women in all stages of the pipeline. Over the past two decades, the number of female students attending and graduating from dental school has steadily increased. In 1984-85, 23.7 percent of all predoctoral students were women; in 2009-10, 45.1 percent were women. Similarly, in 1999, the graduating class was 35.3 percent women; in 2009, it was 46.1 percent women. In the postdoctoral domain, in 1996, 29.9 percent of all residents were women; in 2010, this had increased to 39.0 percent. In dental practice, the number of actively licensed women dentists in 1999 was 15.3 percent of the workforce; in 2010, this percentage had grown to 24.0 percent. In dental education, the number of women clinical faculty members has gradually increased from 669 in 1997-98 to 902 in 2007-08. Until 2000, there had been only two women deans and very few associate/assistant deans, with only sixteen in 1990. In 2000, major changes began with three women deans and seventy-two women associate/assistant deans. In 2009-10, there were 111 associate/assistant women deans and twelve women deans. These data show a progressive increase in the presence of women in all domains of dentistry, especially in leadership positions in dental education.

Exploring the potential for foreign-trained dentists to address workforce shortages and improve access to dental care for vulnerable populations in the United States: a case study from Washington State.

BACKGROUND: To address dental workforce shortages in underserved areas in the United States, some States have enacted legislation to make it easier for foreign dental school graduates to become licensed dentists. However, the extent to which foreign dental school graduates will solve the problem of dental workforce shortages is poorly understood. Furthermore, the potential impact that foreign-trained dentists have on improving access to dental care for vulnerable patients living in dental Health Professional Shortage Areas (HPSAs) and those enrolled in public insurance programs, such as Medicaid, is unknown. The objective of this paper is to provide a preliminary understanding of the practice behaviors of foreign-trained dentists. The authors used Washington State as a case study to identify the potential impact foreign dental school graduates have on improving access to dental care for vulnerable populations. The following hypotheses were tested: a) among all newly licensed dentists, foreign-trained dentists are more likely to participate in the Medicaid program than U.S.-trained dentists; and b) among newly licensed dentists who participated in the Medicaid program, foreign-trained dentists are more likely to practice in dental HPSAs than U.S.-trained dentists. METHODS: The authors used dental license and Medicaid license data to compare the proportions of newly licensed, foreign- and U.S.-trained dentists who participated in the Medicaid program and the proportions that practiced in a dental HPSA. RESULTS: Using bivariate analyses, the authors found that a significantly lower proportion of foreign-trained dentists participated in the Medicaid program than U.S.-trained dentists (12.9% and 22.8%, respectively; P = 0.011). Among newly licensed dentists who participated in the Medicaid program, there was no significant difference in the proportions of foreign- and U.S.-trained dentists who practiced in a dental HPSA (P = 0.683). CONCLUSIONS: Legislation that makes it easier for foreign-trained dentists to obtain licensure is unlikely to address dental workforce shortages or improve access to dental care for vulnerable populations in the United States. Licensing foreign dental school graduates in the United States also has ethical implications for the dental workforces in other countries.

Changes in dentist and dental hygienist numbers in the European Union and economic area.

AIM: To investigate the extent to which changes in the numbers of dental hygienists and dentists have occurred in the Member States of the European Union and Economic Area (EU/EEA) during the last ten years and discuss the changes in relation to the possibilities of sharing tasks between the two groups. METHODS: Numbers for active dentists, registered hygienists and EU/EEA member state populations in 2007 were taken from the website of the Council of European Chief Dental Officers (CECDO) (www.cecdo.org) and from CECDO records for the EU/EEA member states in 1998 and for the new EU member states (who joined in 2004 and 2007) in 2000. From these data, population: active dentists, population: registered dental hygienist and active dentists: registered dental hygienist ratios were calculated together with percentage changes in the number of dentists and dental hygienists by member state, between 1998 and 2007 for the old and between 2000 and 2007 for the new EU member states. RESULTS: In 2007, there were a total of 343,922 active dentists and 30,963 registered dental hygienists in the 30 EU/EEA member states plus Switzerland. The mean population to dentist ratio was about 1500:1 and the mean population to dental hygienist ratio (in the 25 states where dental hygienists were registered) was 13,454:1. During the study period, the population of the EU/EEA plus Switzerland increased by less that 3%, the number of dentists increased by 13% and the number dental hygienists by 42%. The overall ratio of active dentists: dental hygienists changed from 18:1 to 11:1. In six of the 30 member states plus Switzerland the population to dental hygienist ratio was between 2000:1 and 6000:1 and the dentist: dental hygienist ratio less than 1:3. CONCLUSIONS: Although, most member states educate dental hygienists and their numbers in the EU/EEA during the last 10 years have risen more than the dentist numbers, there are still only a handful countries where the hygienist numbers are great enough to make a significant difference to the delivery of oral health care.

Dental students' preparation and study habits for the National Board Dental Examination Part I.

The purpose of this study was to assess dental students' study habits and level of preparation necessary to successfully prepare for the National Board Dental Examination (NBDE) Part I. Four hundred thirty-seven dental students from across the United States participated in a web-based survey about their goals, results, and study habits in preparation for taking the NBDE Part I. A majority of the respondents (76 percent; n=331) reported taking the web-based version of the exam. More than one-third (n=168) of the respondents indicated they wanted to achieve a scaled score of 90 or above, while only about one-quarter (n=120) actually achieved this target score. Students preferred to use the Dental Decks and released Part I exams to study for the exam, regardless of their score. No significant correlations between type of study source used and the score achieved on the exam were found.

A review of exam accommodations for dental students with disabilities.

The purpose of this investigation was to determine the extent to which testing accommodations are granted for students with disabilities in the dental predoctoral and doctoral settings. The investigator aimed to examine both the types of accommodations granted and estimate the number of students seeking accommodations due to a physical or learning disability. To address the research purpose, surveys were sent to the ADA and to each of the ten independent state and four regional dental licensing boards. During the five-year study period (1998-2003), there were 508 requests for accommodations on the Dental Admission Test (DAT) from 49,211 applicants (1.03 percent), 235 accommodation requests for the National Board Dental Examination, Part I from 54,750 applicants (0.43 percent), and 150 accommodation requests for the National Board Dental Examination, Part II from among 40,412 applicants (0.37 percent). Three of the fourteen U.S. licensing agencies (21.4 percent) kept no records, and eleven (78.6 percent) maintained some records. Unfortunately, a rigorous analysis of the impact that the Americans with Disabilities Act has had on standardized testing in dental education cannot be completed because of a lack of data available from the testing agencies.

Impact of gender on dental state licensure examination performance.

The purpose of this study was to identify performance differences in subgroups of dental students during dental school and on state dental licensure examinations. One of the specific aims was to determine if gender is predictive of performance in dental school and on state licensure examinations. The study consisted of a retrospective analysis of 416 graduates (136 females and 280 males) from the University of Florida College of Dentistry (UFCD) between 1996 and 2003. Four categories of variables were assessed: academic measures, clinical productivity measures, performance on a senior mock board examination, and performance on the state licensure examination. The academic measures consisted of the Dental Admission Test (DAT) academic average, DAT Perceptual Ability Test (PAT), and dental school entering and graduating grade point average (GPA). Based on univariate analyses, males had significantly higher DAT academic averages and PAT scores than females. More importantly, males had significantly higher state board clinical scores. Using stepwise regression and the maximum R2 procedure, factors most predictive for the performance on the state licensure clinical exam were the PAT, numbers of amalgams completed, and the UFCD senior mock board clinical score. Each factor was highly significant (p<0.001). After controlling for these three factors, the difference in genders was no longer statistically significant. With increasing enrollment of females in dental schools, it is important to periodically assess student performance to determine whether instructional modifications are needed to accommodate gender differences. Due to consistency of our findings with similar recent reports, it might be reasonable to think the gender gap is narrowing. Additional studies from other regions would provide support for this concept.

Practice patterns of oral and maxillofacial surgeons in Australia: 1990 and 2000.

This study was undertaken to describe practice patterns of oral and maxillofacial surgeons in Australia and compare trends over time. All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires. Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). In both 1990 and 2000 the majority of surgeons worked 80+% of the time in the private sector (64.1 and 71.4%), had 80+% referrals from dental versus medical sources (74.0 and 74.7%), and had 80+% of patients from dentoalveolar rather than major maxillofacial surgery (70.7 and 69.7%). The percentage of dual qualified (dental plus medical degree) surgeons increased from 2.5% in 1990 to 17.1% in 2000 (P < 0.05; chi2). In 2000, surgeons who worked less than 80% in the private sector were more likely to report being overworked (57.9%) and that more surgeons were required in the public sector (65.0%) than those who worked 80% or more private (17.0 and 24.0%, respectively). Multivariate linear regressions of annual non-dentoalveolar surgical procedures per surgeon showed (P < 0.05) higher provision of implant (beta = 0.362), TMJ (beta = 0.267) and bone graft surgery (beta = 0.208) in 2000 compared to 1990, and higher provision of orthognathic (beta = 0.199), implant (beta = 0.194) and bone graft surgery (beta = 0.289) by dual qualified surgeons compared to those with only dental qualifications. Despite the mix of cases remaining predominantly dentoalveolar there was some change over time for selected non-dentoalveolar surgical procedures, with growth in the percentage of medically qualified surgeons and differences in surgery rates by qualification.

Does performance on school-administered mock boards predict performance on a dental licensure exam?

Many dental schools consider the successful completion of a state or regional dental licensure examination as one of the significant benchmarks for assessing effectiveness of the curriculum. At the University of Florida College of Dentistry (UFCD), performance on the state dental licensure examination is monitored and compared with senior year mock board performance and clinical productivity to identify factors that may contribute to state board "pass" rates. A retrospective analysis was conducted of "first-time" performance on the Florida Dental Licensure Exam for graduates from classes 1996 to 2003. Using ANOVA, licensure exam performance data was analyzed and compared with performance on the senior mock board exam and clinical productivity, determined by numbers of procedures completed in each discipline. Significant relationships were noted between four of thirteen aspects of mock board performance and clinical productivity data and performance on the Florida Dental Licensure Exam. First, a significant relationship (p<0.05) was found between passing the senior mock board fixed prosthodontic preparation and successful completion of that procedure on the state licensure exam. Second, a significant relationship (p<0.05) was noted between the clinical (patient-based) Class II amalgam on the senior mock board and passing that procedure on the state licensure exam. Third, a significant relationship was noted (p<0.05) between the number of Class IV clinical composite procedures completed during dental school and passing the licensure exam Class IV manikin composite procedure. Fourth, there was a significant relationship (p<0.01) between the number of clinical Class II amalgam procedures completed during the junior and senior years and passing the state licensure exam clinical amalgam procedure. No significance was found between the remaining five mock board procedures (Class II composites, Class IV composites, pin amalgams, endodontic, and periodontal scaling/root planing) and performance on the like procedures on the licensure exam. Likewise, no significance was found between the remaining four productivity measures (numbers of Class II composites, endodontic teeth treated, crowns and abutments completed, and quadrants of periodontal scaling/root planing) and performance of these procedures on the state licensure exam.

Licensing exams in dentistry Israel 1996-2001.

AIMS AND OBJECTIVES: To describe the experiences with licensing exams in the years 1996-2001 for the Dentist Ordinance in Israel, an exam which it is required for each candidate to pass before being allowed to practice. SUBJECTS: The candidates in large numbers and with a wide variety of professional education applying to take the exam in dentistry in Israel. RESULTS: The exams are conducted in several languages and consist of two parts. 3,612 candidates were examined for Part I, out of which 1,598 passed (44%), while 3,298 candidates were examined for Part II, and 1,558 passed (47%). CONCLUSION: It is feasible and practical to conduct uniform exams for a multinational group of candidates from various dental educational backgrounds in several languages and in large numbers.

Using Medicaid claims to construct dental service market areas.

OBJECTIVE: To use Medicaid claims data to construct patient origin-based market areas for dental services and compare constructed market areas with those based on the practice county. DATA SOURCES: North Carolina Medicaid claims, eligibility, and provider files, the Cooperative Health Information Systems' dentist licensure files, and the Log Into North Carolina data. STUDY DESIGN: A visit-level file was created from the Medicaid claims data and aggregated by provider practice county and patient county of residence. Using the aggregated file and an algorithm based on the Elzinga-Hogarty approach, patient travel patterns were used to construct mutually exclusive patient origin market areas. DATA ANALYSIS: Market area characteristics were compared across definitions using Pearson correlation coefficients. In addition, estimations of provider participation were performed using market area characteristics as control variables. The beta coefficients associated with market area characteristics were compared across market area definitions. PRINCIPAL FINDINGS: Medicaid claims data, when combined with provider licensure files, can be used to construct market areas based on patient origin data. However, measures of market area characteristics are correlated highly between the two types of market areas studied. Furthermore, beta coefficients on market area variables in models of provider participation are similar in sign, significance, and magnitude across market definitions. CONCLUSIONS: Compared with market areas constructed using patient origin data, county-based market areas adequately proxy for dental markets. Using the county as the market area also avoids the time and computational costs associated with using a patient origin-based approach and facilitates the use of widely available data.

Use of discriminant and regression analyses to modify a clinical certification board examination.

The National Dental Examining Board of Canada (NDEB) conducts mandatory, high stakes, pass/fail, certification examinations for dental licensure. One of these examinations was a seven-part, simulated clinical examination in which candidates were required to perform procedures on typodonts. These requirements were two intracoronal and two extracoronal preparations, an amalgam restoration, a provisional crown, and a diagnostic wax-up. Feedback from candidates and examiners indicated that one or more of the requirements may not have been contributing effectively to the overall evaluation of candidates. The NDEB's Clinical Examination Committee therefore requested that an in-depth statistical analysis be performed to identify potential areas of concern and to provide a basis for modifying the examinations. The results of two examination sessions with a total of 168 candidates were subjected to both a discriminant and a logistic regression analysis. Every candidate had results for each of the seven requirements, and no candidate participated in both sessions of the examination. The discriminant analysis revealed that six of the seven requirements could be used to reliably assign examinees according to their true pass/fail classifications. Stepwise discriminant analysis resulted in a 98.81 percent classification success rate with a corresponding 2.50 percent false-positive classification error rate. The logistic regression analysis showed that five components correctly predicted 99.40 percent with a 1.25 percent false-positive rate. The Clinical Examination Committee concluded that one requirement (diagnostic wax-up) should be eliminated and that a second requirement (PFM preparation) be significantly modified and reevaluated. This study demonstrates the usefulness of statistical methods in the analysis and modification of a clinical certification board examination.