The Board proposes the rule amendment to revise some of the procedures and requirements that are part of the Florida Dental Examination.

 

DEPARTMENT OF HEALTH
Board of Dentistry

RULE NO: RULE TITLE
64B5-2.013: Dental Examination Requirements and Grading.
PURPOSE AND EFFECT: The Board proposes the rule amendment to revise some of the procedures and requirements that are part of the Florida Dental Examination.
SUMMARY: The rule amendment will revise some of the procedures and requirements that are part of the Florida Dental Examination.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 456.017(1)(b), 466.004(4) FS.
LAW IMPLEMENTED: 456.017(1)(b), (2), 466.006(4), 466.009 F.S.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Sue Foster, Executive Director, Board of Dentistry/MQA, 4052 Bald Cypress Way, Bin #C08, Tallahassee, Florida 32399-3258

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64B5-2.013 Dental Examination Requirements and Grading.

(1) through (2) No change.

(3) PRACTICAL OR CLINICAL EXAMINATION:

(a) To take the Practical or Clinical Examination, it is the applicant’s responsibility to provide a patient who is at least 18 years of age and whose medical history is consistent with that prescribed by the board in order for patients to qualify as a patient for the examination. An applicant will be allowed no more than two three attempts to qualify a patient during the specified check-in period for each restorative procedure requiring a patient and one attempt to qualify a patient during the specified check-in period of the Periodontal part. Candidates for the state dental practical or clinical examination may assess patients for suitability as board patients at any dental office under the direct supervision of a Florida licensed dentist, or at any accredited dental school under direct supervision of a school faculty member.

(b) No change.

(c) The Practical or Clinical Examination for dental licensure shall consist of the following four (4) seven (7) parts and each part shall be passed with a grade of at least 75% be graded as to each part as follows:

 

1. Class II Amalgam and Class III Composite on a Patient a. Preparation                                2/3 b. Restoration                                1/3	30%
2. Demonstration of Periodontal Skills on a Patient: Definitive debridement (root planing, deep scaling/removal of subgingival calculus, and removal         of plaque, stain and supragingival calculus)	20%
3. Restoration of Class II Composite Resin with Cusp Replacement on Specified Tooth	10%
3.4. Demonstration of Endodontic Skills on Specified Teeth	10%
4.5. Demonstration of Prosthetics Skills: Preparation for a 3-unit fixed partial denture on a specified model and Preparation of an Anterior Crown on a Specified Model	20%
6. Class IV Composite Restoration on a Specified Tooth	5%
7. Class II Amalgam Restoration with a Cusp Replacement on a Specified Tooth	5%

 

(d) The Practical or Clinical Examination shall include the following parts and procedures and be graded on criteria as described below each examination part or procedure. Listed criteria are to be accorded equal importance in grading. Equal importance does not mean that each criterion has a numerical or point value but means that any one of the criteria, if missed to a severe enough degree so as to render the completed part or procedure potentially useless or harmful to the patient in the judgment of the examiner, could result in a failing grade on the part or procedure. The criteria do not have assigned numerical or point value but are utilized in making a holistic evaluation of the part or procedure.

1. No change.

(I) Outline form – all prepared surfaces smooth and acceptable extensions without weakening tooth surfaces.

(II) through (IV) No change.

(VI) Management of soft tissue is considered adequate in the absence of trauma or mutilation. Additionally, a grade of zero (0) is mandatory if a criteria is missed to a severe enough degree so as to render the completed part or procedure potentially useless or harmful to the patient in the judgment of at least two examiners. Examples of such instances are caries remaining in a completed preparation; if gross overcutting occurs; if mechanical exposure occurs; if the preparation is prepared or attempted on the wrong tooth or wrong surface; or if the candidate fails to attempt or complete the procedure.

b. No change.

(I) Functional anatomy – appropriate occlusal and interproximal anatomy.

(II) through (V) No change.

(VI) Management of soft tissue – is considered adequate in the absence of trauma or mutilation. Additionally, a grade of zero (0) is mandatory if a criteria is missed to a severe enough degree so as to render the completed part or procedure potentially useless or harmful to the patient in the judgment of at least two examiners. Examples of such instances are there is a total lack of contact; gross overhang; tissues grossly mutilated (may require suturing or surgical intervention); if the preparation for the restoration is prepared or attempted to be prepared on the wrong tooth or wrong surface; or there is a failure to attempt or complete the procedure.

2. Demonstration of Periodontal Skills on a Patient. Must be performed on a minimum of 6-8 5 teeth, none of which shall have a full crown restoration, three each of which shall have pockets at least 4 mm. in depth, twelve surfaces with obvious subgingival calculus detectable by visual or tactile means must be identified and treated by the candidate (no more than four surfaces may be on incisors); and radiographic evidence of osseous destruction; at least one tooth shall be a multi-rooted molar which shall be in proximal contact with at least one other tooth; three surfaces must be on interproximal surfaces of posterior teeth, i.e. molars or premolars; none of the 6-8 5 teeth shall be primary teeth. All calculus appearing on radiographs must be detectable by visual or tactile means. The periodontal exercise shall be a definitive debridement (root planing, deep scale of subgingival calculus, and plaque, stain and supragingival calculus removal). Six pocket depth measurements on each of one anterior and one posterior tooth selected by the examiners must be made by the candidate. The teeth selected by the examiner must not be among the 6-8 teeth chosen by the candidate for treatment. The following areas will be assessed in determining a grade.

a. through e. No change.

f. Accuracy of pocket depth measurements.

g.f. Management of soft tissue is considered adequate in the absence of trauma or mutilation. Additionally, a grade of zero (0) is mandatory if there is gross mutilation of gingival tissue or if the candidate fails to attempt or complete the part.

3. Restoration of a Class II Composite Resin with Cusp Replacement on a Specified Tooth. The following areas will be assessed in determining a grade for this part.

a. Functional anatomy – appropriate occlusal, and interproximal anatomy.

b. Proximal contour and contact – contact is considered present if there is definite, but not excessive, resistance to the passage of dental floss through the contact area.

c. Margins – suitable continuity with the cavosurface margin should be smooth with the absence of trauma or mutilation.

d. Gingival overhang – overhang is considered to be excess composite resin in either a proximal or gingival direction at the gingival cavosurface margin.

e. Proper handling of material including but not limited to condensing, curing, and finishing.

f. Re-establishment of correct tooth morphology.

g. Management of soft tissue is considered appropriate in the absence of trauma or mutilation.

h. Mutilation of adjacent tooth structure or restoration during finishing procedures.

Additionally, a grade of zero (0) is mandatory if the restoration is completed or is attempted to be completed on the wrong tooth or wrong surface; if there is a lack of contact; gross overhang; or if the candidate fails to attempt to complete the part.

3.4. Demonstration of Endodontic Skills on Specified Teeth. The following areas will be assessed in determining a grade for this part:

a. through d. No change.

Additionally, a grade of zero (0) is mandatory if a criteria is missed to a severe enough degree so as to render the completed part or procedure potentially useless or harmful to the patient in the judgment of at least 2 examiners. Examples of such instances are the occurance of: a perforation occurs, the candidate fails to retrieve, or fails to successfully instrument around a broken instrument, the preparation is prepared or attempted to be prepared on the wrong tooth, or the candidate fails to attempt or complete the part.

4.5. Demonstration of Prosthetics Skills – Preparation for a 3-unit fixed partial denture and a single-unit Anterior Ceramic Crown on a specified model. The following areas will be assessed in determining a grade for this part:

a. through e. No change.

f. Management of soft tissue is considered adequate in the absence of trauma of mutilation. Additionally, a grade of zero (0) is mandatory if a criteria is missed to a severe enough degree so as to render the completed part or procedure potentially useless or harmful to the patient in the judgment of at least 2 examiners. Examples of such instances are if the preparation is prepared or is attempted to be prepared on the wrong tooth or wrong surface; if the wrong type of preparation is performed or attempted to be performed, or if the candidate fails to attempt or complete the procedure.

6. Class IV Composite Restoration on a Specified Tooth – The following areas will be assessed in determining a grade for this part:

a. Functional anatomy – appropriate occlusal, incisal and interproximal anatomy.

b. Proximal contour and contact – contact is considered present if there is definite, but not excessive, resistance with dental floss through the contact area.

c. Margins – suitable continuity with the cavosurface margin should be smooth with the absence of trauma or mutilation.

d. Gingival overhang – overhang is considered to be excess amalgam in either a proximal or gingival direction at the gingival cavosurface margin.

e. Proper handling of material including but not limited to condensing, curing, and finishing.

f. Re-establishment of correct tooth morphology.

g. Management of soft tissue is considered adequate in the absence of trauma or mutilation.

h. Mutilation of adjacent tooth structure or restoration during finishing procedures.

Additionally, a grade of zero (0) is mandatory if the preparation for the Class IV lesion is prepared or attempted to be prepared or the restoration is completed or attempted to be completed on the wrong tooth or wrong surface; if the interproximal contact has not been re-established, or if the candidate fails to attempt or complete the part.

7. Class II Amalgam Restoration with a Cusp Replacement on a Specified Tooth. The following areas will be assessed in determining a grade for this part:

a. Functional anatomy – acceptable occlusal and interproximal anatomy.

b. Proximal contour and contact – contact is considered present if there is definite, but not excessive resistance to the passage of dental floss through the contact area.

c. Margins – suitable continuity with the cavosurface margin should be smooth with the absence of trauma or mutilation.

d. Gingival overhang – overhang is considered to be excess amalgam in either a proximal or gingival direction at the gingival cavosurface margin.

e. Proper handling of material including but not limited to condensing and finishing.

f. Management of soft tissue is considered adequate in the absence of trauma or mutilation. Additionally, a grade of zero (0) is mandatory if there is lack of contact; gross overhang; if the restoration is completed or attempted to be completed on the wrong tooth or wrong surface; or if the candidate fails to attempt or complete the part.

(e) The grading system used during the Practical or Clinical Examination is as follows:

The quality of a candidate’s work on the four parts of the Clinical or Practical Examination is graded in accordance with a detailed analytic scoring guide and specific scoring criteria for each component of each task. The examiners use four competency levels to rate clinical skills on the four parts of the Clinical or Practical Examination:

Mandatory 0 – Complete failure and critically deficient

Marginally Substandard – Below minimal acceptable dental treatment

Minimally Acceptable – Minimal acceptable dental treatment

Satisfactory – Optimal dental treatment

Three examiners independently evaluate all rated treatment criteria for each part of the Clinical or Practical Examination and the median competency level in each category (criteria) is determined. These median competency levels are translated into a numerical score. Candidates must earn at least 75% of the maximum possible raw score on each part to pass that part.

Critical errors (Mandatory 0) are given special consideration. Critical errors are errors of commission or omission that would be serious enough to endanger a patient’s oral or general health, or could lead to patient injury or may jeopardize the overall treatment of the patient. A corroborated critical error, such as perforation while preparing an access opening for an endodontic procedure will result in failure of the Endodontic part of the Clinical or Practical Examination even though other rated treatment criteria for the Endodontic part are acceptably completed.

A candidate’s score on a part of the Clinical or Practical Examination may also be affected by certain conduct or errors that warrant a penalty deduction from the total score on that part. An example of a penalty deduction on a part is the loss of all points if two treatment selections for either the Amalgam or the Composite procedure are not acceptable or a second treatment selection is not presented if the first treatment selection is rejected.

0 Complete failure

1 Unacceptable dental treatment

2 Below minimal acceptable dental treatment

3 Minimal acceptable dental treatment

4 Better than minimally acceptable dental treatment

5 Outstanding dental treatment

(f) A final grade of 75% 3 or better, as a general average is required on each of the four (4) parts of to pass the Practical or Clinical Examination to pass the Practical or Clinical Examination.

(g) If an applicant fails to achieve a final grade of 75% 3 or better on each of the four (4) parts of, as a general average, on the Practical or Clinical Examination because of a failing grade on just one part, the applicant shall be required to retake only that part(s) that the applicant has failed (i.e. scored below 75%). On any such retake, the applicant shall be required to obtain a passing grade on the part(s) that is/are retaken. A failing grade on the retaken part shall not be averaged to obtain a passing score on the Practical or Clinical Examination.

(h) If an applicant fails to achieve a final grade of 3 or better, as a general average, on the Practical or Clinical Examination because of a failing grade on more than one part, the applicant shall be required to retake the entire Practical or Clinical Examination.

(h)(i) Whenever an applicant is repeating only one part of the Practical or Clinical Examination and that part requires the use of a patient, that candidate shall be allowed the same amount of time to complete the part that is allowed candidates currently taking the part for the first time. Whenever a candidate is repeating only one part of the Practical or Clinical Examination and that part is performed on a mannequin, that candidate shall be allowed 3 hours to complete the part.

(i)(j) As provided in Section 466.006(4)(b)3., F.S., if an applicant fails to pass the Practical or Clinical Examination in three (3) attempts, the applicant shall not be eligible for reexamination unless she or he completes additional educational requirements as specified by the Board.

(j) Any of the parts of the Practical or Clinical Examination utilizing a patient may be terminated in the interest of Patient Safety.

(4) No change.

THIS RULE SHALL TAKE EFFECT AUGUST 1, 2008.

Specific Authority 456.017(1)(b), 466.004(4), 466.006(4) FS. Law Implemented 456.017(1)(b), (2), 466.006(4), 466.009 FS. History– New 10-8-79, Amended 6-22-80, 12-3-81, 12-6-82, 5-24-83, 12-12-83, 5-2-84, 5-27-84, Formerly 21G-2.13, Amended 12-8-85, 12-31-86, 5-10-87, 10-19-87, 12-10-89, 12-24-91, 2-1-93, Formerly 21G-2.013, 61F5-2.013, Amended 1-9-95, 2-7-96, 7-16-97, Formerly 59Q-2.013, Amended 8-25-98, 3-25-99, 11-15-99, 8-3-05, 7-17-07, 8-1-08.

NAME OF PERSON ORIGINATING PROPOSED RULE: Board of Dentistry
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Board of Dentistry
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: September 14, 2007
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: August 17, 2007