A License to Drill

Who knew becoming a dentist was controversial?


John Heckathorn
At the moment, you can't become a dentist in Hawai'i. Even if you've graduated from dental school. Even if you're a practicing dentist or a specialist, such as an orthodontist or endodontist, with an active practice elsewhere in the United States.

This is, believe or not, a consequence of Sept. 11.

As we were working on this, our Best Dentists issue, we stumbled across a controversy in, of all things, dental licensure. Dentists anywhere in the United States have to be licensed by the state in which they are practicing. For medical doctors moving from state to state, this is largely a pro forma. A cardiologist in good standing from New York, say, can become a cardiologist in Hawai'i, and vice versa.

Not so a dentist. That's because each state or region has its own requirements. Usually, the first is graduating from an accredited dental school. In Hawai'i, interestingly enough, that became a requirement only last year. Before that, graduates of unaccredited foreign schools could get licensed here.

Graduates must also pass a national written exam. In addition, each state or region also requires a clinical exam, in which a prospective dentist must work on several live patients. In Hawai'i, this three-day exam was held at the dental clinic in Pearl Harbor, the only place with enough private rooms to ensure the candidates' work was judged anonymously. In the wake of Sept. 11, with bases likely to tighten security at a moment's notice, the exam was suspended.

According to Kaua'i dentist Stan Kanna, chairman of the Hawai'i Dental Board of Examiners, having no Hawai'i exam may not be a problem much longer. His board is proposing that the Legislature change the rules. In a year or so, there will be a new national clinical exam. Candidates who pass it can practice in most U.S, jurisdictions, including, if the Legislature agrees, Hawai'i.

That doesn't help Amanda Wilson. A California orthodontist, Wilson married a local dentist she'd met in school. She lives here most weeks of the month, wants to stay and start a family. But to pay off $200,000 in student loans, she commutes to Sacramento one week each month to straighten teeth. She wants to practice here, but can't get licensed.

Before it was suspended, Wilson took Hawai'i's clinical exam, without success-no surprise, she says, because it tests the ability to fill cavities, which, as an orthodontist, she doesn't and, for that matter, shouldn't, do. "All specialists have years of additional training," she points out. "The exam has absolutely nothing to do with what I or any other specialist does."

A stop-gap measure is in place. Wilson could, at considerable expense, fly herself and four to six patients to the Mainland to retake an alternate exam. "But that's crazy," she says.

Instead, she's trying to get the law changed to licensure by credential. That means that, like doctors, a specialist in good standing could move his or her practice here. At present, 45 states have some form of licensing by credential. The American Dental Association favors it, because it gives dentists freedom of movement.

Wilson's bill focuses on specialists, because (1) Hawai'i has plenty of general dentists already and (2) that way she expects less resistance from dentists already in practice.

There doesn't seem to be as much resistance as caution. "We are going to look at her bill," says Kanna. "However, our priority is our own bill to recognize the national exam. We don't want to distract from that, because it's important." There are other considerations as well, he notes, "because specialists sometimes end up doing some general dentistry."

Still, he argues, Wilson is right in theory. "Eventually, we are going to have national standards for dentists and freedom of movement. That's the trend."

That may be the future. Right now, Wilson is stuck between a rock and a hard place. "Teeth are teeth," she says. "If you can do dentistry well elsewhere, you can do it here." She worries her bill will fall prey to an instinct to protect dentists already in place.

"As I constantly remind my colleagues, that's not what licensing is for," says Kanna. "It's not about protecting dentists, it's about protecting the public. It's just that the ways we do that are evolving."

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