This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0517.PPH
DATE: 1/24/2022
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 517 Dentistry and Dental Hygiene Examinations
SPONSOR(S): Sirois
TIED BILLS: IDEN./SIM. BILLS: SB 926
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee Rahming McElroy
2) Health & Human Services Committee
SUMMARY ANALYSIS
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida, including
dentists, dental hygienists, and dental assistants under the Dental Practice Act. A dentist is licensed to
examine, diagnose, treat, and care for conditions within the human oral cavity and its adjacent tissues and
structures. A dental hygienist provides education and preventive and delegated therapeutic dental services.
Currently, all applicants for licensure as a dentist or dental hygienist must pass a practical or clinical
examination developed by the American Board of Dental Examiners, Inc. (ADEX), in addition to meeting other
qualifications. A live patient must be used during the clinical examination.
In response to the COVID-19 pandemic, on March 31, 2021, the State Surgeon General issued Emergency
Order 21-001, which suspended the prohibition against the use of manikins or simulated patients in lieu of live
patients during the administration of the ADEX examinations. The Emergency Order expired on June 30, 2021.
HB 517 requires the use of the CompeDont DTX manufactured tooth for the restorative and periodontal skills
portions on the dental clinical examination and for the dental hygiene clinical examination. This eliminates the
requirement for dental and dental hygienist applicants to perform clinical examination components on a live
patient. The bill also removes the following provisions that are unnecessary because the examination is no
longer on live patients:
The requirement for dental students to obtain, and the Board of Dentistry’s authority to require,
specified medical malpractice insurance;
The requirement for dental schools to make arrangements for patients who require follow-up dental
care as a result of procedures performed during the clinical examination; and
The requirement that dental schools ensure that a student’s academic record does not include any
evidence that the student poses an unreasonable risk to a patient during the clinical examination.
The bill has an insignificant, negative fiscal impact on the DOH, which current resources are adequate to
absorb. The bill has no fiscal impact on local governments.
The bill provides an effective date of July 1, 2022. STORAGE NAME: h0517.PPH PAGE: 2
DATE: 1/24/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Dentistry
The Board of Dentistry, within the Department of Health (DOH), regulates dental practice in Florida,
including dentists, dental hygienists, and dental assistants under the Dental Practice Act.
1
A dentist is
licensed to examine, diagnose, treat, and care for conditions within the human oral cavity and its
adjacent tissues and structures.
2
A dental hygienist provides education, preventive and delegated
therapeutic dental services.
3
Dental Licensure
Any person wishing to practice dentistry in this state must apply to the DOH and meet specified
requirements. Section 466.006, F.S., requires dentistry licensure applicants to sit for and pass the
following licensure examinations:
The National Board of Dental Examiners dental examination (NBDE);
A written examination on Florida laws and rules regulating the practice of dentistry; and
The American Dental Licensing Examination, a practical or clinical examination developed by
the American Board of Dental Examiners.
4
To qualify to take the Florida dental licensure examination, an applicant must be 18 years of age or
older, be a graduate of a dental school accredited by the American Dental Association Commission on
Dental Accreditation or be a student in the final year of a program at an accredited institution, and have
successfully completed the NBDE dental examination.
5
Dental Hygiene Licensure
Any person wishing to be licensed as a dental hygienist must apply to DOH and meet the following
qualifications:
6
Be 18 years of age or older;
Be a graduate of an accredited dental hygiene college or school;
7
and
Obtain a passing score on the:
o National Board Dental Hygiene Examination;
o Dental Hygiene Examination, a practical or clinical examination developed by the
American Board of Dental Examiners, Inc.; and
o A written examination on Florida laws and rules regulating the practice of dental
hygiene.
A dental hygienist may also apply to be certified to administer local anesthesia, under the direct
supervision of a dentist, to a non-sedated, adult patient if the dental hygienist is certified in basic or
advanced cardiac life support and successfully completes an accredited course that includes a
1
S. 466.004, F.S.
2
S. 466.003(3), F.S.
3
Ss. 466.003(4)-(5), F.S.
4
A passing score is valid for 365 days after the date the official examination results are published. The same is true for a passing score
on the American Dental Licensing Examination administered in another state on or after Oct. 1, 2011.
5
S. 466.006(2), F.S.
6
S. 466.007, F.S.
7
If the school is not accredited, the applicant must have completed a minimum of 4 years of postsecondary dental education and
received a dental school diploma, which must be reviewed and approved by the Board of Dentistry. STORAGE NAME: h0517.PPH PAGE: 3
DATE: 1/24/2022
minimum of 30 hours of didactic training, 30 hours of clinical experience, and additional training in
specified areas.
8
American Board of Dental Examiners
The American Board of Dental Examiners, Inc. (ADEX) is an organization of state and regional dental
boards that provides for the ongoing development of uniform national dental and dental hygiene
licensure examinations.
9
The ADEX examination is widely used: 48 states accept the ADEX for dental
licensure.
10
The Commission on Dental Competency Assessment (CDCA), formerly known as the Northeast
Regional Board, and the Council of Interstate Testing Agencies (CITA) administers the ADEX dental
licensure examination to graduates of accredited dental schools and students in their senior year at an
accredited dental school.
11
The ADEX dental examination consists of three portions: a computer-based examination, simulated
clinical examinations, and clinical examinations on live patients.
12
The simulated clinical examinations
assesses skills related to endodontics and fixed prosthodontics. The clinical examinations on live
patients assesses skills related to restorative and periodontal procedures. As of December 2021, only
four states require live patient-based examinations: Florida, Nevada, Oklahoma, and Wyoming.
13
8
S. 466.017(5), F.S.
9
American Board of Dental Examiners, Inc., About ADEX, https://adexexams.org/about-adex/ (last visited Dec. 22, 2021).
10
CDCA/WREB, 2021 ADEX Acceptance Map, https://www.cdcaexams.org/adex-acceptance-map/ (last visited Dec. 22, 2021).
11
Commission on Dental Competency Assessments (CDCA), Registration and DSE OSCE Manual: 2021 ADEX Dental Examination
Series, https://www.cdcaexams.org/wp-content/uploads/2021/03/Dental_DSE_OSCE2021-2.pdf (last visited Dec. 22, 2021).The cost
of the ADEX dental examinations is $2,295; however, additional fees may be assessed, such as a facility or score report fee. The fee is
reduced for partial exams and retakes. See CDCA, Dental (ADEX), https://www.cdcaexams.org/dental-exams/ (last visited Dec. 22,
2021).
12
CDCA, supra note 11, at 4. The simulated clinical examinations assesses skills related to endodontics and fixed prosthodontics. The
clinical examinations on live patients assesses skills related to restorative and periodontal procedures.
13
Email from Andrew Love, Director of Legislative Affairs, Florida Department of Health, RE: HB 517 Data Inquiry, regarding states that
require live patient ADEX examinations (Dec. 22, 2021). STORAGE NAME: h0517.PPH PAGE: 4
DATE: 1/24/2022
As with the dental examination, CDCA and CITA administer the ADEX dental hygiene examination.
14
The ADEX dental hygiene examination consists of two portions: a computer-simulated examination and
a clinical examination on live patients.
15
The computer-simulated examination assesses various levels
of diagnosis and treatment planning knowledge, skills, and abilities. The clinical examinations on live
patients evaluates the applicants ability to detect and remove calculus, measure periodontal pocket
depths, and present the case for evaluation of calculus removal and soft and/or hard tissue damage.
16
Only nine states require live patient-based examinations: Alaska, Florida, Idaho, Missouri, Nevada,
New Mexico, Oklahoma, Utah, and Wyoming.
17
The ADEX examination is widely used: 47 states accept the ADEX for dental hygiene licensure.
18
The DOH contracts with the CDCA to administer the ADEX examinations, as well as the jurisprudence
examinations.
19
In Fiscal Year 2020-2021, 1,196 dentists and 1,392 dental hygienists applied to the
take the ADEX examinations.
20
In April 2020, the ADEX approved the use of CompeDont™ DTX, a new manikin tooth technology
developed by the CDCA
21
that allows dental licensure candidates to choose a non-patient-based
restorative examination option to demonstrate readiness for practice. The CompeDont™ accurately
represents infected, affected and sclerotic dentin.
22
According to CDCA Director of Examinations, Dr.
Ellis Hall, “[b]oth examiners and students reported that the tooth mimics decay, stickiness and tug-back
and can be restored as if it were a natural tooth in this way.”
23
The CompeDont™’s new technology
14
CDCA, Candidate Registration and CSCE OSCE Manual: 2021 ADEX Dental Hygiene Examination, available at
https://www.cdcaexams.org/documents/manuals/Dental_Hygiene_Candidate_Registration2021.pdf (last visited Dec. 22, 2021). The
cost of the ADEX dental hygiene examinations is $995; however, additional fees may be assessed, such as a facility or score report
fee. See CDCA, Dental Hygiene (ADEX), https://www.cdcaexams.org/dental-hygiene-adex-exam/ (last visited Dec. 22, 2021).
15
Id.
16
DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 2 (Nov. 19, 2021).
17
Email, supra note 13.
18
CDCA, supra note 10.
19
DOH, 2021 Agency Legislative Bill Analysis for HB 497, p. 3 (Feb. 24, 2021).
20
DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 3 (Nov. 19, 2021).
21
The CDCA partnered with Acadental, Inc. for the development and production of the CompeDont™ DTX. See, CDCA, ADEX
Approves CompeDont(TM) Non-Patient Based Exam Alternative, https://www.cdcaexams.org/adex-approves-compedont/ (last visited
Jan. 11, 2022).
22
Id.
23
Id. STORAGE NAME: h0517.PPH PAGE: 5
DATE: 1/24/2022
provides an option to many state dental boards seeking to address public health concerns in the wake
of COVID-19 without reducing existing licensure standards.
24
In response to the COVID-19 pandemic, on March 31, 2021, the State Surgeon General issued
Emergency Order 21-001, which suspended the prohibition against the use of manikins or simulated
patients in lieu of live patients during the administration of the ADEX examinations. This expired on
June 30, 2021.
Malpractice Insurance
Under current law, dental students must possess medical malpractice insurance to take the licensure
examinations.
25
Additionally, the Board of Dentistry may require dental and dental hygiene applicants to
maintain medical malpractice insurance to cover any harmful incident to a patient during the clinical
examination.
26
The CDCA has a blanket malpractice insurance policy that covers all dental and dental
hygiene applicants for ADEX examinations.
27
This means that applicants are not required to obtain
additional insurance.
28
Patient Care
Under current law, dental schools must ensure that a student’s academic record does not include any
evidence that the student poses an unreasonable risk to a patient during the clinical examination.
29
The
schools must inform patients in writing of their right to follow-up dental care before the examination and
also make arrangements for patients who require follow-up care as a result of performed procedures.
30
Effect of Proposed Changes
Dentistry
HB 517 requires the use of the CompeDont DTX manufactured tooth for the restorative and periodontal
skills portions on the dental clinical examination and for the dental hygiene clinical examination. This
eliminates the requirement for dental and dental hygienist applicants to perform clinical examination
components on a live patient.
The bill also removes the following provisions that are unnecessary because the examination is no
longer on live patients:
The requirement for dental students to obtain, and the Board of Dentistry’s authority to require,
specified medical malpractice insurance;
The requirement for dental schools to make arrangements for patients who require follow-up
dental care as a result of procedures performed during the clinical examination; and
The requirement that dental schools ensure that a student’s academic record does not include
any evidence that the student poses an unreasonable risk to a patient during the clinical
examination.
The bill provides an effective date of July 1, 2022.
B. SECTION DIRECTORY:
Section 1: Amends s. 466.006, F.S., relating to examination of dentists.
Section 2: Amends s. 466.0065, F.S., relating to regional licensure examinations.
Section 3: Amends s. 466.007, F.S., relating to examination of dental hygienists.
24
Id. See statement of CDCA Chair, Dr. Harvey Weingarten.
25
S. 466.0065 (c), F.S.
26
S. 466.0075, F.S.
27
DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 3 (Nov. 19, 2021).
28
Id.
29
S. 466.0065 (j), F.S.
30
S. 466.0065 (e). F.S. STORAGE NAME: h0517.PPH PAGE: 6
DATE: 1/24/2022
Section 4: Repeals s. 466.0075. F.S., relating to applicants for examination; medical malpractice
insurance.
Section 5: Provides an effective date of July 1, 2022.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
The DOH will incur non-recurring costs for rulemaking, which current resources can absorb.
31
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
Not applicable. The bill does not appear to affect county or municipal governments.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
The Board of Dentistry has sufficient rulemaking authority to implement the bill.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
31
DOH, 2022 Agency Legislative Bill Analysis for HB 517, p. 4 (Nov. 19, 2021).