BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 1524
                                                                  Page  1

          Date of Hearing:   January 12, 2010

                   ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
                                 Mary Hayashi, Chair
                   AB 1524 (Hayashi) - As Amended:  January 4, 2010
           
          SUBJECT  :   Dentistry: examination requirements.

           SUMMARY :   Establishes an alternative to the current dental  
          clinical exam for licensure in which dental students may  
          complete the clinical portion of the licensure exam throughout  
          dental school, instead of during a single examination.   
          Specifically,  this bill  :  

          1)Specifies that each dentistry licensure applicant must  
            successfully complete both Parts I and II written examinations  
            of the National Board Dental Examination (NBDE).

          2)Deletes the English language requirement for the dentistry  
            exam.

          3)Deletes the current Dental Board of California (DBC) clinical  
            exam and replaces it with a hybrid portfolio pathway  
            examination (HPP) which shall be conducted while the applicant  
            is enrolled in a dental school program at a DBC-approved  
            school located in California.  This examination shall utilize  
            uniform standards of minimal clinical experiences and  
            competencies.  The applicant shall pass a final assessment of  
            the submitted portfolio at the end of his or her dental school  
            program. 

          4)Requires an applicant to pay a $350 fee, to be deposited into  
            the State Dentistry Fund (SDF), and submit a letter of good  
            standing signed by the dean or the dean's delegate of his or  
            her dental school stating that the applicant has graduated or  
            will graduate with no pending ethical issues.

          5)Requires DBC to monitor HPP and audit the standardization and  
            calibration of dental school competency instructors at least  
            biennially with DBC-appointed examiners, and requires the  
            DBC-appointed examiners to ensure standardization and an  
            acceptable level of calibration in the grading of the  
            examination. 

          6)Requires DBC to biennially audit each dental school's  








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            competency examinations.

          7)Prohibits DBC from interfering with the dental school's  
            authority to establish and deliver an accredited curriculum. 

          8)Requires DBC to determine an end-of-year deadline, in  
            consultation with the current DBC -approved dental schools, to  
            determine when the portfolio examinations shall be completed  
            and submitted to DBC for review by DBC's examiners.

          9)Requires DBC, in consultation with the current DBC-approved  
            dental schools, to determine the minimum number of clinical  
            experiences required for successful completion of the  
            portfolio examination in each of the following areas:

             a)   Comprehensive oral diagnosis and treatment planning,  
               with each case including a health history evaluation,  
               periodontal evaluation, hard and soft tissue evaluation,  
               smoking and tobacco product cessation, and treatment  
               planning for optimal restoration of dentition to form and  
               function;

             b)   Periodontics, including adult prophylaxis and  
               periodontal management, root planning, and periodontal  
               reevaluation;

             c)   Direct restoration;

             d)   Indirect restoration;

             e)   Endodontics;

             f)   Removable prosthetics; and,

             g)   Oral surgical procedures.

          10)Requires DBC to verify, as specified, successful completion  
            of the following competency examinations that were performed  
            on a patient of record of a DBC-approved dental school:

             a)   Comprehensive oral diagnosis and treatment planning,  
               including:

               i)     Collection of the patient's medical and dental  
                 history;








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               ii)    A comprehensive examination;

               iii)   Evaluation of data to identify problems;

               iv)    Development of alternative treatment plans; and,

               v)     Development of a final treatment plan and  
                 documentation according to risk management standards. 

             b)   Periodontics, including:

               i)     Performance of a comprehensive periodontal  
                 examination;

               ii)    Diagnosis and development of a periodontic treatment  
                 plan;

               iii)   Performance of nonsurgical periodontal therapy; and,

               iv)    Performance of periodontal reevaluation. 

             c)   Direct restorations, as specified, including:

               i)     Restoration of a tooth containing a primary carious  
                 lesion or lesions requiring a Class II restoration using  
                 amalgam or composite;

               ii)    Restoration of a tooth containing a primary carious  
                 lesion or lesions requiring a Class III or IV restoration  
                 using composite resin; and,

               iii)   Restoration of a tooth containing a primary carious  
                 lesion or lesions requiring a Class V restoration using  
                 glass ionomer, composite resin, or amalgam. 

             d)   Indirect restorations, including restoration of a tooth  
               with a crown or onlay according to approved procedures and  
               materials, with the case selected based on minimum criteria  
               for indirect restorations. 

             e)   Removable prosthodontics, including:

               i)     Development of the diagnosis and treatment options  
                 with the prognosis for removable prosthesis;








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               ii)    Restoration of edentulous spaces with removable  
                 prostheses;

               iii)   Management of tooth loss transition with immediate  
                 or transitional prostheses; and,

               iv)    Management of prosthetic problems and evaluation of  
                 laboratory services for prostheses. 

             f)   Endodontics, including:

               i)     Application of case selection criteria;

               ii)    Demonstration of pretreatment preparation;

               iii)   Performance of access opening, shaping, cleaning,  
                 and obturation techniques;

               iv)    Completion of an endodontic case; and,

               v)     Providing recommendations for postendodontic  
                 treatment. 

           EXISTING LAW  :

          1)Provides for the licensure and regulation of dentists and  
            associated professions by DBC through the Dental Practice Act.  


          2)Existing law requires an applicant for a license to practice  
            dentistry to complete various examinations, including NBDE, an  
            examination in California law and ethics developed by the  
            board, and a clinical and written examination administered  
            either by DBC or the Western Regional Examining Board (WREB). 

          3)Existing law prescribes the maximum amount of fees to be  
            charged for examination, licensure, and renewal, for deposit  
            into the SDF. 

           FISCAL EFFECT  :   Unknown

           COMMENTS  :   

           Purpose of this bill  .  According to the author's office, "DBC is  








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          seeking an alterative pathway to initial licensure because of  
          concerns about public safety and its failure to sample the full  
          range of competencies.  This new pathway will permit California  
          dental students to prove their skills throughout their dental  
          schooling and eliminate the need and expense of securing a  
          subject for an anxiety-ridden final clinical examination.    

          "The goal of the new HPP is to include not only those types of  
          cases currently evaluated in the existing clinical exams, but  
          include other, more complex cases that cannot be assessed within  
          the present three day time constraint." 

           Background  .  California dental students are currently required  
          to take both a written and practical exam to become a licensed  
          dentist.  The clinical exam may be administered by either DBC or  
          the WREB.  

          The present clinical examination is administered over three  
          days, costs each applicant over $2,000, and requires the  
          participation of a volunteer patient provided by the student.   
          According to DBC, finding a volunteer patient has been  
          especially problematic for dental students because of practical  
          and medical ethical issues.  Additionally, concerns have been  
          raised about the reliability of judgments made about candidate  
          performance in "one shot" tests.

          According to the sponsors, HPP assesses a dental student's  
          abilities throughout the dental school education.  A portfolio  
          of the student's completed cases would be maintained by the  
          student and submitted to DBC for consideration as part of the  
          candidate's application for licensure.  In addition to these  
          cases, the portfolio will include independent competency exams  
          supervised by DBC during the student's third and fourth year of  
          education.   The cases submitted in HPP will be monitored by a  
          DBC-approved on-site evaluator to validate the treatment  
          rendered by the candidate.  Successful completion of the dental  
          school curriculum does not ensure licensure by DBC, however.  

          HPP would only allow a candidate who has attended dental school  
          in California to obtain a license to practice in California.   
          The WREB exam is regional and is accepted in 29 states. 

           Suggested committee amendments :

          Business & Professions Code section code 1630 was inadvertently  








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          deleted by the sponsors.  Section 1630 shall remain, which  
          states, "The examination by the board of applicants for a  
          license to practice dentistry in this State shall be  
          sufficiently thorough to test the fitness of the applicant to  
          practice dentistry, and both questions and answers shall be  
          written in the English language."    

           REGISTERED SUPPORT / OPPOSITION  :   

           Support 
           
          Dental Board of California (sponsor)

           Opposition 
           
          None on file.
           
          Analysis Prepared by  :    Sarah Huchel / B. & P. / (916) 319-3301