The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: CS/SB 652
INTRODUCER: Health Policy Committee and Senator Yarborough
SUBJECT: Dentistry
DATE: March 21, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Vanwinkle Brown HP Fav/CS
2. FP
3. RC
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 652 removes the Board of Dentistry (BOD) and the Department of Health (DOH) from
the dental examination administration process and deletes obsolete language relating to the
process.
The bill revises the dental licensure requirements by:
 Deleting language requiring dental students who have completed the coursework necessary
to prepare to pass the American Dental License Examination (ADLEX) to wait until their
final year of dental school to apply for licensure;
 Deleting the National Board of Dental Examiners (NBDE) dental examination as obsolete,
replacing it with the examination administered by the Joint Commission on National Dental
Examinations (JCNDE), or its successor organization;
 Deleting an alternate pathway to dental licensure by having an active Florida health access
dental license and meeting specific additional practice requirements;
 Deleting language relating to ADLEX scores for applicants only being valid for 365 days
after the date the official examination results are published;
 Deleting the requirement that an out-of-state licensed dentist seeking licensure to relocate to
Florida, must submit proof that he or she has never been reported to the National Practitioner
Data Bank or the Healthcare Integrity and Protection Data Bank.
The bill deletes the requirement that licensed dentists relocating to Florida who apply for and
receive a Florida license, must engage in the full-time practice of dentistry inside the geographic
BILL: CS/SB 652 Page 2
boundaries of the state for one year after licensure, and deletes the provisions related to
compliance and enforcement of this requirement.
The bill amends s. 466.009, F.S., to allow for reexamination and repeals s 466.0282, F.S.,
relating to dental specialties and advertising, because the latter statute was found
unconstitutional.
The bill provides an effective date of July 1, 2023.
II. Present Situation:
The Practice of Dentistry
The Board of Dentistry (BOD) is the state’s regulatory board for the practice of dentistry, 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
Board of Dentistry
The BOD consists of 11 members appointed by the Governor and confirmed by the Senate who
serve four year terms. Seven members must be licensed dentists actively practicing dentistry in
Florida; two members must be licensed dental hygienists actively practicing in Florida; and the
remaining two members must be laypersons who are not, and have never been, dentists, dental
hygienists, or members of any closely related profession or occupation. At least one member of
the BOD must be 60 years of age or older.3
Each member dentist must have been actively practicing dentistry, primarily as a clinical
practitioner, for at least five years immediately preceding his or her appointment and must
remain primarily in clinical practice during all periods of appointment. Each qualified member
dentist who is connected with any dental college or community college may serve so long as that
connection does not result in the college providing the person’s principal source of income, with
the exception of the dentist who is on the full-time staff of a Florida teaching hospital.4 No
member may serve more than a total of ten years.5
Dental Examinations
As of October 1, 2011, Florida stopped administering its own practical or clinical dental
examinations, and the Florida Diagnostic Skills Examination became the American Dental
License Examination (ADLEX), developed by the American Board of Dental Examiners, Inc.
(ADEX), or its successor entity if the successor entity is determined by the BOD to comply with
1 Section 466.004, F.S.
2 Section 466.003(3), F.S.
3
Section 466.004. F.S.
4
Section 466.004(1), F.S., referencing s. 456.007, F.S., exempting Board of Medicine physician members who are also
required to be faculty of a medical school, and any health care board members on the full time staff of a teaching hospital in
Florida.
5
See note 3.
BILL: CS/SB 652 Page 3
the provision of Section 466.006, F.S. The ADLEX is inclusive of a comprehensive diagnostic
skills examination covering the full scope of the practice of dentistry.6, 7
Dental Licensure
The requirements for dental licensure in Florida are found in s. 466.006, F.S. An applicant must
apply to the DOH to take and pass the following examinations:
 The ADLEX;8 and
 An examination on Florida laws and rules relating to dentistry.
To take the ADLEX clinical examination, a dental applicant must be at least 18 years of age and
must:
 Be a graduate from a dental school accredited by the American Dental Association (ADA)
Commission on Dental Accreditation (CODA) or any other dental accrediting entity
recognized by the U.S. Department of Education (DOE); or
 Be a dental student in the final year of a program at an ADA-CODA accredited dental school
who has completed all the coursework necessary to prepare the student to perform the
clinical and diagnostic procedures required to pass the examinations. A passing score on the
examination is valid for 365 days;9 and
 Have completed Part I and II of the National Board Dental Examination (NBDE),
administered by the Joint Commission on National Dental Examinations (JCNDE);10 or have
an active health access dental license in this state; and
o The applicant has 5,000 hours within four consecutive years of clinical practice
experience providing direct patient care in a health access setting;11; or
o The applicant is a retired veteran dentist of any branch of the U.S. Armed Services who
has practiced dentistry while on active duty and has at least 3,000 hours within three
6
The American Board of Dental Examiners, Inc., Frequently Asked Questions, When And How Was ADEX Created?
available at https://adexexams.org/faqs/ (last visited Mar. 21, 2023). The American Board of Dental Examiners, Inc.,
(ADEX) develops both dental and dental hygiene clinical examinations. The first ADLEX exam was produced by the ADEX
and administered in 2005; and is now simply called the “ADEX Dental Exam” or the “ADEX Dental Hygiene Exam.” The
ADEX does not administer examinations. For clarity purposes, this analysis will continue to refer to American Dental
Licensing Examination as the “ADEX,” the American Dental Hygiene Licensing Examination as the “ADHEX,” and reserve
the abbreviation “ADEX” for the American Board of Dental Examiners, Inc.
7
Fla. Admin. Code R. 64B2-2.013(1), (2022).
8
Section 466.006, F.S.
9
Section 466.006, (2)(b)2., F.S. A dental school student who takes the licensure examinations during the student’s final year
of an approved dental school must have graduated before he or she may be certified for licensure.
10
American Dental Association, Joint Commission on National Dental Examinations, Upholding Quality Oral Care For All,
available at https://jcnde.ada.org/ (last visited Mar. 21, 2023) The Joint Commission on National Dental Examinations
(JCNDE) is the agency responsible for the development and administration of the National Board Dental Examinations
(NBDE). This 16-member Commission includes representatives from dental schools, dental practice, state dental examining
boards, dental hygiene, dental students, and the public.
11
Section 466.003(14), F.S., defines a “health care access setting” as a program or an institution of the Department of
Children and Families, the DOH, the Department of Juvenile Justice, a nonprofit community health center, a Head Start
center, a federally qualified health center or look-alike as defined by federal law, a school-based prevention program, a clinic
operated by an accredited college of dentistry, or an accredited dental hygiene program in this state if such community
service program or institution immediately reports to the BOD all violations of ss. 466.027 or 466.028, F.S., or other practice
act or standard of care violations related to the actions or inactions of a dentist, dental hygienist, or dental assistant engaged
in the delivery of dental care in such setting.
BILL: CS/SB 652 Page 4
consecutive years of clinical practice experience providing direct patient care in a health
access setting; or
o The applicant has provided a portion of his or her salaried time teaching health profession
students in any public education setting, including, but not limited to, a community
college, college, or university, and has at least 3,000 hours within three consecutive years
of clinical practice experience providing direct patient care in a health access setting;
o The applicant has not been disciplined by the BOD, except for citation offenses or minor
violations;
o The applicant has not reported, or his or her professional liability insurer has not reported,
to the Office of Insurance Regulation any claim or action for damages for personal injury
alleged to have been caused by error, omission, or negligence in the performance of the
licensee’s professional services;12; and
o The applicant has not been convicted of or pled nolo contendere to, regardless of
adjudication, any felony or misdemeanor related to the practice of a health care
profession.
A dental school graduate from a school not accredited by the ADA CODA, a U.S. DOE-
recognized dental accrediting entity, or approved by the BOD, and desiring to take the ADLEX,
is not entitled to do so until the applicant:
 Demonstrates completion of a program defined by BOD rule at an accredited American
dental school and receives either a D.D.S. or D.M.D. from the school; or
 Submits proof of successful completion of at least two consecutive years at a full-time
supplemental general dentistry program accredited by the ADA CODA; and a supplemental
general dentistry program does not include an advanced education program in a dental
specialty.
Current law requires the ADLEX clinical dental examination to include the following:
 Comprehensive diagnostic skills examination including an examination, clinical diagnosis
and treatment planning;
 Two restorations on a manikin that has typodont teeth with simulated caries as approved by
the Commission on Dental Competency Assessments. The board by rule shall determine the
class of such restorations;13
 Demonstration of periodontal skills on a manikin that has typodont teeth with simulated
calculus as approved by the Commission on Dental Competency Assessments;
 Demonstration of prosthetics and restorative skills in complete and partial dentures and
crowns and bridges and the utilization of practical methods of evaluation, specifically
including the evaluation by the candidate of completed laboratory products such as, but not
limited to, crowns and inlays filled to prepared model teeth;
 Demonstration of restorative skills on a manikin on a manikin that has typodont teeth with
simulated calculus as approved by the Commission on Dental Competency Assessments;
 Demonstration of restorative skills on a manikin which requires the candidate to complete
procedures performed in preparation for a cast restoration;
12
See ss. 456.049 and 627.912, F.S.
13
See Fla. Admin. Code R. 64B5-2.013 (2022), which specified the class of restorations required for the clinical examination.
It was repealed by the BOD in May 2012, after the clinical examination was transitioned to the ADLEX, because the ADEX
had specified the class of restorations required to be performed in the ADLEX.
BILL: CS/SB 652 Page 5
 Demonstration of endodontic skills; and
 A diagnostic skills examination demonstrating ability to diagnose conditions within the
human oral cavity and its adjacent tissues and structures from photographs, slides,
radiographs, or models, pursuant to board rules.14
The DOH, in consultation with the BOD, is to plan the times, places, physical facilities, training
of personnel, and other arrangements concerning the administration of the examination. The
BOD or a duly designated committee, must approve the final plans for the administration of the
examination. The BOD may by rule provide for additional procedures to be tested on the
licensure examination, provided such procedures are common to the practice of general dentistry.
The BOD must establish by rule the passing grade for each procedure and the acceptable
variation for examiners. The DOH must require all examiners to attend a mandatory
standardization exercise prior to each practical or clinical examination and must employ only
those dentists who have substantially adhered to the standard of grading established at the
exercise.15
The cost of taking the full dental ADLEX examination is $2,560 plus ancillary fees.16
As an alternative to taking the ADLEX in Florida, an applicant may submit scores from an
ADLEX administered in another state after October 1, 2011, and those results will be recognized
as valid in Florida for the purpose of licensure. Those examination results are valid for 365 days
after the publication of the official examination results. A passing ADLEX score administered
out of state is the same required score for passing the ADLEX taken in this state.17
If an applicant’s passing score on the ADLEX administered in another state is older than 365
days, such scores are also valid for the purpose of licensure in this state, but only if the applicant
demonstrates that all of the following additional criteria have been met, that:18
 The NBDE, administered by the JCNDE. organization was taken and passed;
 The ADLEX was passed after October 1, 2011;
 The dental school graduated from was:
o Accredited by the ADA-CODA or its successor; or
o Accredited by any other dental accrediting organization recognized by the U.S. DOE; or
o A dental school not ADA-CODA accredited, but submits additional proof of:
 Successful completion of a full-time supplemental general dentistry program
accredited by the ADA-CODA of at least two consecutive academic years that
provides didactic and clinical education at the level of a D.D.S. or D.M.D. program
accredited by the ADA-CODA; and the supplemental general dentistry program does
not include an advanced education program in a dental specialty;
 The applicant possesses a current, valid and active dental license in good standing, with no
restriction, which has never been revoked, suspended, restricted, or otherwise disciplined,
14
Section 466.006(5)(a), F.S.
15
Section 466.006(5)(d), F.S.
16
The Commission on Dental Competency Assessments (CDCA) - Western Regional Examining Board (WREB) Council of
Interstate Testing Agencies (CITA), ADEX Dental, available at https://adextesting.org/adex-dental-3-2/ (last visited Mar. 21,
2023).
17
Section 466. 006(4)(b)1, F.S.
18
Section 466. 006(4)(b)2, F.S.
BILL: CS/SB 652 Page 6
from another state or territory of the United States, the District of Columbia, or the
Commonwealth of Puerto Rico;
 The applicant submits proof that he or she has never been reported to the National
Practitioner Data Bank, the Healthcare Integrity and Protection Data Bank, or the American
Association of Dental Boards Clearinghouse; or has successfully appealed to have his or her
name removed from the data banks of these agencies;