Everything you never wanted to know about dental licensure

This week, for me, was totally consumed with one thought. Boards.

For those who don't know, the field of dentistry (like many other professions) has several hoops that one must jump through in order to actually be a dentist. These hoops start with the classes that must be completed in order to even apply for dental school. I mean really, I am still trying to figure out how Ecology is going to make me better at placing fillings. These hoops continue on through dental school until you get to the end and you are about to graduate. Then there are the BIG FOUR. National Boards. Regional Boards. Graduation. State Licensure.

First, National boards. National boards is a 2-part written exam. The first part is usually taken during, or soon after the second year of dental school and it tests your knowledge of all things non-clinical. You know, things like microbiology, dental materials, dental anatomy, etc. This is the test that, if you want to specialize, you need to get an awesome score on. Please note that this is not because orthodontists or oral surgeons or any other specialty need to have an above-average understanding of microbiology (if anything, it's probably the other way around). Nope. This test is a hoop. A barrier. Something that is totally unrelated to the applicant's ability and is instead there just to narrow down the playing field. But none of this really mattered to me since I "just" wanted to be a general dentist anyway. I took National Boards Part-One during Thanksgiving break of my second year and did fine.

The second part of national boards doesn't come around until the middle of your last year of school. It is also a written exam but is much more practical. It tests your knowledge of clinical procedures as well as your ability to make judgement calls in different situations. I took this at the beginning of my last Christmas vacation, and again, I did fine. It was, I felt, a good test, and really the first hoop I had jumped through that actually made sense.

So, National Boards-Check. Now on to the second of the BIG FOUR. Regional boards. These are the ones that people lose sleep over. There are two main regional boards: The NERB (Northeast Region) and the WREB (Western region). There are others as well, and some states have their own board exam, but most students end up taking one or both of these two exams (unless they are Canadian- they do their own special thing). Since Rachel and I are planning on moving to the West it made sense for me to take WREB.

A little bit about the format of the exam. First of all there is a written portion which I took several weeks ago. It basically tests your ability to make accurate diagnoses and to then formulate an acceptable treatment plan based on those findings. The second part of the test is clinic-based. This is the stressful part. It takes place over two-three days and involves five procedures in three different categories: Endo (you do 2 root canals), perio (1 deep cleaning), and operative (you do 2 fillings). Everything except for the endo is done on live patients (endo is done on real teeth which were extracted).

The reasons people stress about the test are as follows:

1. You are responsible for providing your own patients (and your own teeth for endo)
2. If your patient doesn't show up for any reason, you fail (unless you can hurry and find a backup).
3. If the examiners don't think your patient needs the work you are planning to do, you fail (unless you can hurry and find a backup).
4. There are some things in dentistry that just go wrong sometimes, that are total freak accidents, and that are totally out of the control of the dentist. If these things happen to you, you fail.
5. The examiners seem to be extra nit-picky.
6. If you fail, it costs mega-bucks to make up the exam since it entails paying a bunch of money for re-registration, and then finding patients who have the time, and then paying for all of their costs of transportation, room, and board (not to mention your own) as well as compensation for their time to fly out to a different dental school and re-take the exam.

This clinical portion of WREB took place last week. Let me tell you, I have never felt so much tension in the air as those few days leading up to the exam. Some people were getting physically ill just thinking about it. The crazy thing is that I don't think I have the capacity to get stressed about things. I actually tried to stress about this. I told myself how important it was and how this was pretty much laying everything on the line in a giant all-or-nothing toss to see if the last four years of my life (and a whole lot of money) were completely meaningless. It didn't help. I just could not build up the worry that I was going for.

Even when test day came I felt pretty good, made even better by the fact that my patient for that morning called at 6:15 a.m. to inform me that she was at the school and ready to go (I told her to go and eat breakfast- the test didn't start until 8:00). And really, the test went pretty smoothly. Actually, it went really smoothly. My patients all showed up, they all qualified for the work I was doing, and I didn't run out of time (you know, they only give us 5 hours to do a filling)! On my second filling I was actually submitting my patient for grading before most other people had even been approved to begin the exam. And I feel like I did very well in all sections...except endo.

Yes, one of the root canals I did turned out to be a complete disaster. It was one of those unexpected freak accident type of things that I had no control over and so it was pretty frustrating. For those of you who are dental people, call me and I'll fill you in on the details. For the rest of you, imagine that you put a stick of dynamite inside of a tooth and then lite it. That is pretty much what my tooth looked like. And, for the record, that is not a good thing.

Well, I guess we'll just have to see what happens when I get the results in a couple of weeks. I did an awesome job on the other tooth and they average the two scores together for the root canals, so I may not be out of the game quite yet. And the silver lining is that if I do have to re-take the endo portion I don't have to worry about finding and paying for a patient. Instead, the hardest part may be convincing airport security, with a straight face, why I have a jar of human teeth stowed in my carry-on.

So that was pretty much my experience with WREB. Assuming that all goes well, the next step will be graduation (which will take place in 5 more weeks) and then on to state licensure (really, just a bunch of paperwork). What I am saying is that the hard part is over. I am done. It's all down hill from here. I am going to be a dentist.

And I even picked up a new skill during the process of all of this.

Hoop jumping.

Here I am, relaxing after the exam.

Evelyn went to her friend's birthday party. She wrote her name totally by herself on the card without any guidance whatsoever (I have electronically darkened the letters and inserted arrows to help you read it). We are proud of our girl.

Here she is riding on a manatee at the zoo last week while Rachel was at her interpreting workshop.