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Storm clouds over Florida

April 1, 2007
Are foreign-trained dentists taking over RDH jobs in Florida?
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by Cynthia R. Biron, RDH, EMT, MA

Are foreign-trained dentists taking over RDH jobs in Florida?

Florida is the only state in the U.S. that permits foreign-trained dentists (FTDs) who have not graduated from an ADA-accredited dental hygiene program to be licensed to practice dental hygiene. The American Dental Association permits individual states to rule on this, and for more than 10 years FTDs have been obtaining licenses to practice dental hygiene in Florida. Rule 64B5-2.0144 and (5) Licensure Requirements for Dental Hygiene Applicants From Unaccredited Dental Schools or Colleges outlines the requirements for FTDs to obtain licenses to practice dental hygiene in Florida. Click here to view table ranking foreign-trained dentists

In a state where there are 18 dental hygiene programs and no shortage of dental hygienists, the big question is: Why should we permit FTDs to take jobs that could be given to registered dental hygienists who are graduates of ADA-accredited dental hygiene programs?

Florida law does not permit FTDs to take the National Dental Board Examination (NDBE) as a prerequisite to taking the Florida State Dental Board Examination for licensure. The rule still stands that a dentist must be a graduate of an ADA-accredited dental school to take the Florida State Dental Board Examination. FTDs are permitted to take the Dental Hygiene National Board Examination (DHNBE) as a prerequisite to taking the Florida State Dental Hygiene Board Examination for licensure. Another big question is: Why is an FTD considered qualified to practice dental hygiene if he or she is not considered qualified to practice dentistry? Are FTDs graduating from colleges that are accredited by the ADA Commission on Accreditation? The answer is a resounding no! So if the ADA’s criteria for taking either the DHNBE or the DNBE is being a graduate of an ADA-accredited dental program, why is there an exception made for an FTD in the state of Florida?

Survey data

While we do not have the answers to these questions, we do have some interesting data from a survey sent to dental hygiene program directors throughout the country. Sixty-two of the 250 program directors surveyed responded.

Of the 164 FTDs who applied to the 62 dental hygiene programs, only 109 enrolled. Of those enrollees, only 94 graduated. Seven FTDs withdrew from the program in the first semester. Six had already passed the DHNBE before entering the dental hygiene program. Three enrollees failed out of the program in their first semester, and five took longer than the required time to complete the program.

One program director reported that an FTD in her program confessed at the end of the first semester that he had passed the DHNBE before entering the program, but was unable to pass the Florida State Clinical Board Exam. After the first semester in the dental hygiene program, he learned the instrumentation skills necessary to pass the Florida clinical exam that December. He had actually taken the place of a student who would have completed the two-year program, and he withdrew in the first semester. He got what he wanted and couldn’t care less about denying someone a two-year education in an accredited DH program.

The survey asked dental hygiene program directors to rank the knowledge base and/or skills of their FTD students from excellent to poor in several subject areas. The category of “fair” was not included in the original survey, but since many program directors added that ranking, it was shown in the compilation of the data. See Table 1 for the results.

Comments from survey respondents

At the end of the questionnaire, program directors were asked to provide written comments. There were numerous comments, so not all could be included in this article. Here are some of the comments from program directors who have personally dealt with FTDs:

This comment is from a program director who had five FTDs enroll, four of whom graduated → “All foreign-trained dentists lacked an understanding of U.S. dental hygiene standards, practice, culture, etc., which prevented them from being anything but an average student, but they did graduate. We get dozens of phone inquiries each year from FTDs about entering the program, but they hang up when they’re told that they have to take the entire program. We used to offer a review course but the quality was so poor that we stopped.”

This comment is from a program director who had six FTDs enroll, five of whom graduated → “ In my experience as a DH educator, FTDs do not possess the clinical skills commensurate with the education we are providing. In one instance, one FTD from Russia, who had held a position as a director of a dental clinic there, was surprised by our curette scalers. The scaling instrument of choice had been a spoon excavator!”

This comment is from a program director who had five FTD applicants, one enrolled who is due to graduate in August 2007 → “Not only was the background education insufficient, but the attitude was that we (hygienists) did not know anything because she knew it all because she was a dentist. She was no further along than other DH students. She went to dental school in Mexico City straight out of high school! I can’t imagine taking the DHNBE without the proper education.”

This comment is from a program director who has only had this experience →“I am working with an FTD now for possible application into the program. It has been a headache. There is a huge sense of entitlement and attempts to circumvent the system. I think they need to follow the same protocol as everyone else.”

This comment is from a program director who has had 41 FTDs apply to the program, 16 enroll, and 15 graduate. The one who did not graduate withdrew the first semester and had passed the DHNBE prior to entering the program → “We had one who graduated, but failed both the clinical and DHNBE. I think he failed because he thought he was way above dental hygiene. I have had some excellent FTDs and some poor FTDs. The ones who are excellent are that way in everything. I also have found military-trained dental hygienists who enter the program are lacking in the knowledge, and sometimes have the ‘I already know it all’ attitude.”

This comment is from a program director who had one inquiry from an FTD →“To my knowledge, the DHNBE central office has reported the failure rate to be high for those FTDs who have taken the DHNBE.”

This comment is from a program director who had five FTDs enroll, three of whom graduated → “Communication with faculty, staff, and patients is a major problem.”

This comment is from a program director who had three FTDs apply, zero of whom enrolled → “If these foreign-trained dentists are so good that they can ‘test out’ of formal education, why is it that they can’t do the same to practice dentistry? Oh, we need to ensure that they are properly trained and educated in order to protect the public? Why doesn’t that apply to hygiene? All states should have graduation from an accredited school as part of the requirements for licensure!”

This last comment tells it like it is in Florida. FTDs who graduated from nonaccredited dental schools are good enough for dental hygiene, but not good enough for dentistry. Fifty-eight out of 62 dental hygiene program directors do not agree with Rule 64B5-2.0144 and (5). We are appalled to think that our graduates are losing jobs to FTDs who are not graduates of ADA-accredited programs. Now in Florida, they expect us to remediate the FTDs to help them take jobs away from our graduates. If you call the Florida Board of Dentistry and ask what can be done about it, the retort is simply, “Nothing; it is the law.”

Hopefully, this article will at least promote awareness. To all of the program directors who took time from their busy schedules to respond to this survey, we thank you. There are many more educators and practicing registered dental hygienists who thank you, too.