Chapter 2 briefly reviews the historical context of accreditation and licensure, highlighting the controversies that have marked their birth and development. This chapter examines current issues and debates. The background paper by Guarino provides additional information.

The accreditation of U.S. dental educational programs is a private function with a public purpose. As expressed in the mission statement adopted by the Commission on Dental Accreditation in 1989, the purpose of accreditation is "to ensure the quality of dental and dental-related education" (CDA, 1993a). If effective, accreditation

• protects the public welfare by ensuring that dental school graduates are appropriately prepared to provide oral health services;
• ensures students that their educational program meets basic educational standards;
• guards public funds from use in support of inferior programs; and
• assists educational programs in achieving—and improving on—minimum standards.

In theory, accreditation is voluntary. In practice, it has become a virtual requirement for schools because graduation from an accredited school is a prerequisite for dental licensure in most states, although some states have special provisions for licensing those who have graduated from foreign dental schools. The debates about accreditation focus on whether it is effective, whether its benefits outweigh its costs, how its ratio of benefits to costs can be improved, whether it hinders innovation and flexibility, and whether it is unduly dominated by narrow vested interests. These debates take place in the context of larger debates about the proper role of accreditation and the dozens of organizations that accredit various educational institutions and other service organizations such as hospitals and home care agencies (CDA, 1993b; Wolff, 1993; Weiss, 1994). The typical university faces dozens of accrediting organizations. Not only do these accreditation processes impose significant costs, but they may be viewed as a form of self-interested lobbying on behalf of the disciplines in question. Beyond the educational arena, questions about the independence of credentialing organizations and their effectiveness in ensuring quality are a staple of the debate over procedures for ensuring the quality of care in hospitals and other health care organizations [IOM, 1990e).