tions about its autonomy in an area characterized by considerable tension between elements of organized dentistry and dental schools.

The issue of independence is also an acute concern for allied dental personnel. The argument can be made that accreditation by an organization dominated by dentists protects dentists as much as it ensures the appropriate education of allied personnel. Allied dental groups and those involved with dental specialties also question their representation and influence in the process of accrediting allied and specialty programs. The committee heard oral and written testimony citing the lack of a separate, impartial, arm's-length accreditation commission. Only one hygienist sits on the Commission on Dental Accreditation, most of whose other members are dentists. The CDA committee that is responsible in the first instance for drafting accreditation standards for dental hygiene programs currently includes four hygienists, one public member, and three dentists (a dentist is always the chair). Site visit teams for dental hygiene programs generally have a majority of hygienists. Previous reviews of standards for dental hygiene did not address the changes requested by dental hygiene professionals, for example, required coursework in gerontology (ADHA, 1993).

Licensure

Licensure provides dentists and dental hygienists with legal authority to practice. Initial licensure involves an extensive set of requirements including written and clinical examinations. Continued licensure is largely a matter of filing forms and paying fees, although most states also require documentation of attendance at continuing education courses. Continued competency is not routinely assessed, but egregious errors or misconduct can bring discipline from state licensing bodies.

Dental licensure is distinctive in two respects. First, the requirement for a state or regional clinical examination distinguishes dentistry and dental hygiene from most other health professions. Physicians, for example, take national written examinations but face no clinical examination at either the national or the state level. In medicine, the last clinical examination element—suturing pig carcasses—was dropped 30 years ago (Foti, 1992). Some nonhealth professionals, for example, lawyers and engineers, may face special state or local examinations related to particular state laws or to geophysical conditions (e.g., earthquake zones).

Second, dental licensure is distinctive in requiring clinical examinations that use live patients who may be subjected to irre-



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