HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 497 Dentistry and Dental Hygiene Examinations
SPONSOR(S): Buchanan
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Professions & Public Health Subcommittee 17 Y, 1 N Rahming McElroy
2) Health & Human Services Committee 18 Y, 0 N Rahming Calamas
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 examination
developed by the American Board of Dental Examiners, Inc. (ADEX), in addition to meeting other
qualifications.
HB 497 authorizes the Board of Dentistry to accept passing scores on the examinations produced by the
Western Regional Examining Board for licensure as a dentist or dental hygienist, in addition to the ADEX
examinations it currently accepts.
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, 2021.
FULL ANALYSIS
This document does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0497c.HHS
DATE: 3/9/2021
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: h0497c.HHS PAGE: 2
DATE: 3/9/2021
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 ADEX was created in 2003, with representatives from four regional testing
agencies and 12 states. At the time ADEX was created, there were 16 different dental and dental
hygiene examinations.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 ADEX
examination is widely used: 48 states accept the ADEX for dental licensure.13
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
8 S. 466.017(5), F.S.
9 American Board of Dental Examiners, Inc., About ADEX, https://adexexams.org/about-adex/ (last visited Feb. 22, 2021).
10 Id.
11 Commission on Dental Competency Assessments (CDCA), Registration and DSE OSCE Manual: 2020 ADEX Dental Examination
Series, https://www.cdcaexams.org/documents/manuals/Dental_DSE_OSCE2020.pdf (last visited Feb. 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 Feb. 22, 2021).
12 Id. at p. 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 CDCA, 2021 ADEX Acceptance Map, https://www.cdcaexams.org/adex-acceptance-map/ (last visited Feb. 22, 2021).
14 CDCA, Candidate Registration and CSCE OSCE Manual: 2020 ADEX Dental Hygiene Examination, available at
https://www.cdcaexams.org/documents/manuals/Dental_Hygiene_Candidate_Registration2020.pdf (last visited Feb. 22, 2020). 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 Feb. 22, 2021).
STORAGE NAME: h0497c.HHS PAGE: 3
DATE: 3/9/2021
a clinical examination on live patients.15 The ADEX examination is widely used: 45 states accept the
ADEX for dental hygiene licensure.16
Currently, Florida only accepts the ADEX examinations. The DOH contracts with the CDCA to
administer the ADEX examinations, as well as the jurisprudence examinations.17 In Fiscal Year 2019-
2020, 869 dentists and 562 dental hygienists applied to the take the ADEX examinations.18
Western Regional Examining Board
The Western Regional Examining Board (WREB) was created in 1976, after Utah and Oregon made an
arrangement to have a simultaneous dental licensure examination.19 WREB offered its first dental
examination in 1977 and its dental hygiene examination in 1979.20
The WREB dental examination consists of three sections: operative, endodontics, and comprehensive
treatment planning.21 The operative section is performed on a live patient and the candidate must
complete up to two restorative procedures. The endodontics section is simulated and the
comprehensive treatment planning section is a computer-based written examination. A periodontal
examination, which is performed on a live patient, and a prosthodontics examination, which is a
simulated examination, are available for candidates in those states that require the examinations.22
15 Id.
16 CDCA, supra note 13.
17 Florida Department of Health (DOH), 2021 Agency Legislative Bill Analysis for HB 497, p. 3 (Feb. 24, 2021).
18 Id.
19 Western Regional Examining Board (WREB), About Us, available at https://wreb.org/about-us/ (last visited Mar. 7, 2021). The
members of the Western Regional Examining Board include Alaska, Arizona, Arkansas, Idaho, Illinois, Iowa, Kansas, Minnesota,
Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, Texas, Utah, Washington, West
Virginia, and Wyoming. California and Hawaii are dental member states only.
20 Id.
21 Western Regional Examining Board, 2021 WREB Exam Procedures, available at
https://wreb.org/Candidates/Dental/2021_Dental_PDFs/2021_WREB_Exam_Procedures.pdf (last visited Feb. 11, 2021). The WREB
dental examination costs $2,560 plus an additional school use fee that varies by site. See Western Regional Examining Board, 2021
Dental Exam Fees, available at https://wreb.org/dental-candidates/2019-dental-exam-fees/ (last visited Feb. 11, 2021).
22 Id. Florida requires a periodontal examination for licensure.
STORAGE NAME: h0497c.HHS PAGE: 4
DATE: 3/9/2021
The WREB dental hygiene examination assesses the candidates on patient qualification, extraoral and
intraoral evaluation, calculus detection and removal, tissue management, periodontal assessment, and
professional judgment.23
The WREB does not administer a state-specific jurisprudence examination.
The Western Regional Examining Board’s licensure examinations are widely used: 40 states accept the
WREB for licensure.24
Florida does not accept the WREB dentist or dental hygiene examinations for licensure.
Effect of Proposed Changes
HB 497 authorizes the Board of Dentistry to accept passing scores on the examinations produced by
the Western Regional Examining Board for licensure as a dentist or dental hygienist, in addition to the
ADEX examinations it currently accepts.
The bill provides an effective date of July 1, 2021.
B. SECTION DIRECTORY:
Section 1: Amends s. 466.006, F.S., relating to examination of dentists.
Section 2: Amends s. 466.007, F.S., relating to examination of dental hygienists.
Section 3: Provides an effective date of July 1, 2021.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
23 WREB, 2020 Dental Hygiene Examination Candidate Guide, available at
https://wreb.org/Candidates/Hygiene/hygienePDFs/2020_DH_Forms/2020_WREB_Candidate_Guide_HYG_v11012019.pdf (last visited
Feb. 22, 2021). The WREB dental hygiene examination costs $1,175 plus a school use fee, which varies by site. See Western Regional
Examining Board, Dental Hygiene, Local Anesthesia, and Restorative Exam Fees, https://wreb.org/hygiene-candidates/2018-hygiene-
exam-fees/ (last visited Feb. 22, 2021).
24 WREB, supra note 19.
STORAGE NAME: h0497c.HHS PAGE: 5
DATE: 3/9/2021
1. Revenues:
None.
2. Expenditures:
The DOH will experience a non-recurring increase in workload and costs associated with updating
the Licensing and Enforcement Information Database System (LEIDS) to record examination
results received from the WREB dental examination. Additionally, a new web service will be
required to support receiving examination results from the WREB on candidates applying for
licensure in Florida, which current resources can absorb.25
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
Dentists and dental hygienists who have received acceptable scores on the WREB examinations will
not incur additional expenses to take the ADEX examinations when applying for Florida licensure.
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
25 DOH, supra note 18, pp. 5-6.
STORAGE NAME: h0497c.HHS PAGE: 6
DATE: 3/9/2021