Is it time to change state and regional dental licensure board exams in response to evidence from caries research?

State and regional board exams represent the final gateway to dental licensure. One would expect that the requirements for licensure would reflect procedures that are beneficial to each patient's oral health and that are consistent with the teachings of most dental schools. We conducted an Internet survey to determine whether Class 2 tooth preparations based on caries lesions whose radiolucencies were confined to enamel were allowed for state and regional exams. Information obtained for 46 of the 50 states revealed that 33 of the states (72%) allowed teeth with either an E1 or E2 lesion to be restored. Seventeen of these states allowed teeth with an E1 lesion to be restored. Only 12 of the 46 states (26%) covered by these boards did not allow teeth with E1 or E2 lesions to be surgically treated. In contrast, a recent report indicates that only 30% of dental schools permit teeth with enamel lesions to be restored to satisfy clinical requirements and competencies.