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<ns0:Action>
<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2025-02-20</ns0:ActionDate>
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<ns0:Action>
<ns0:ActionText>AMENDED_ASSEMBLY</ns0:ActionText>
<ns0:ActionDate>2025-04-07</ns0:ActionDate>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Assembly Member Carrillo</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>ASSEMBLY</ns0:House>
<ns0:Name>Carrillo</ns0:Name>
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<ns0:Title> An act to amend Sections 1628 and 1634.1 of, to repeal and add Section 1636.5 of, and to repeal, add, and repeal Section 1636.6 of, the Business and Professions Code, relating to healing arts. </ns0:Title>
<ns0:RelatingClause>healing arts</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Dental Practice Act: foreign dental schools.</ns0:Subject>
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<ns0:DigestText>
<html:p>Existing law, the Dental Practice Act, provides for the licensure and regulation of dentists by the Dental Board of California within the Department of Consumer Affairs. Existing law requires an applicant for licensure to meet specified requirements, including, among others, furnishing satisfactory evidence of having graduated from a dental college approved by the board or by the Commission on Dental Accreditation of the American Dental Association (CODA). Prior law provided for the approval of foreign dental schools by the board. Beginning January 1, 2024, existing law requires foreign dental schools seeking approval by the board to complete the international consultative and accreditation process with CODA. Notwithstanding that requirement, existing law maintained the approval of any foreign dental schools whose program was renewed by the board prior to January 1, 2020, through any
date between January 1, 2024, and June 30, 2026, through that renewal date.</html:p>
<html:p>This bill would instead maintain the approval of any foreign dental school whose program was approved by the board prior to January 1, 2024, until the school has been issued a denial of accreditation by CODA and the school does not appeal, the school has been issued a denial by CODA following the completion of the appeals process, or the school withdraws its application for accreditation by CODA, provided the school applies for accreditation on or before January 1, 2026, and updates the board on the accreditation process, as specified. The bill would specify that a graduate of a foreign dental school with this extended approval is eligible for licensure to practice dentistry pursuant to the requirements of the Dental Practice Act, including graduates who were enrolled in the school at the time the extended approval expires, provided they were enrolled on or after July 1, 2025. The bill would
require an applicant who is a graduate of a foreign dental school with this extended approval to agree to practice dentistry full time in one of 5 specified practice settings for at least 2 years within the first 3 years of licensure. The bill would require the board, as part of the board’s first sunset review report following January 1, 2032, to report specified information regarding workforce data of licensees and graduates of foreign dental schools with extended approval, as specified. The bill would state findings and declarations of the Legislature relating to the shortage or maldistribution of dentists in California.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_48009B92-F904-4850-900A-BA6EE77120DC">
<ns0:Num>SECTION 1.</ns0:Num>
<ns0:Content>
<html:p>The Legislature finds and declares all of the following relating to the shortage or maldistribution of dentists throughout California, including a lack of Latino and Black dental students and licensed dentists in proportion to their population in the state:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
The State Department of Public Health’s California Oral Health Plan 2018-2028 and a study by the Healthforce Center at the University of California at San Francisco (UCSF) identified the following major oral health issues in California:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
There are marked oral health disparities in California with respect to race and ethnicity, income, and education. The uneven distribution of the oral care workforce and inadequate infrastructure and capacity in the public health system have presented difficulties in delivering preventive and early treatment for oral care services to millions of Californians.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Approximately 2.2 million Californians live in dental health professional shortage areas, which are largely concentrated in the northern Sierra counties, the central valley, and the Inland Empire.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
According to the United States Department of Health and Human Services, rural populations have a higher prevalence of cavities and tooth loss, a lower degree of private dental insurance, and limited access to public dental services. Rural areas often have inadequate public transportation systems, making it
very difficult to access dentists outside the proximal area.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Most dentists practiced in the greater bay area (25 percent), Los Angeles (26 percent), and other southern California counties (29 percent).
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
A disproportionate number of people living in poverty and the working poor reside in geographically isolated areas with a maldistribution of dentists and a limited number of Medicaid providers. As a result, those who need dental care the most are often the least likely to receive it.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
According to the UCSF study, estimates of the total supply of dentists in California do not reflect the supply available to care for medically underserved communities and individuals covered by Medi-Cal, which covers 26 percent of the state’s population and nearly one-half (43 percent) of the state’s children.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
In 2016, only 15.7 percent of California dentists participated in Medi-Cal or the Healthy Families Program, the second lowest in the nation.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
In 2024, the Little Hoover Commission, after conducting additional reviews of the program, stated that California still ranks among the worst in the nation when it comes to care and treatment of pediatric dental disease.
</html:p>
<html:p>
(h)
<html:span class="EnSpace"/>
The racial and ethnic diversity of the workforce is not congruent with California’s population, affecting access to services and culturally appropriate delivery of dental care.
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
Despite the Latino population comprising approximately 38 percent of the people in California, only 6 percent of practicing dentists are Latino, according to data from the California Health and Human Services
Open Data Portal.
</html:p>
<html:p>
(j)
<html:span class="EnSpace"/>
Similarly, Black dentists make up 2 percent of the California dentist workforce despite the Black population making up 6 percent of California’s population.
</html:p>
<html:p>
(k)
<html:span class="EnSpace"/>
The deficient number of Latino and Black dentists contributes to and accentuates the access to dental care problem as it is well documented that cultural competency in the delivery of oral health effectively addresses societal barriers in accessing and receiving preventative and treatment services.
</html:p>
<html:p>
(l)
<html:span class="EnSpace"/>
In 1998, to alleviate the shortage or maldistribution of dentists, the Legislature created a program requiring the Dental Board of California (the board) to evaluate, and if qualified, approve foreign dental schools.
</html:p>
<html:p>
(m)
<html:span class="EnSpace"/>
Under this program, the board established an evaluation
process conducted by experts in the dental arena to assess curriculum, faculty qualifications, facilities, and other relevant factors to ensure that the schools would provide an education that is equivalent to that of similar accredited institutions in the United States and that would adequately prepare students for the practice of dentistry.
</html:p>
<html:p>
(n)
<html:span class="EnSpace"/>
The board approved two foreign dental schools: the University of De La Salle-Bajío School of Dentistry (La Salle University) in Guanajuato, Mexico, in 2004, and the State University of Medicine and Pharmacy “Nicolae Testemitanu” in Moldova in 2016.
</html:p>
<html:p>
(o)
<html:span class="EnSpace"/>
Moldova University has been a center of undergraduate and postgraduate education of doctors and pharmacists since 1945, and of dentistry since 1959.
</html:p>
<html:p>
(p)
<html:span class="EnSpace"/>
Moldova University has over 5,600 students from Moldova and 30 other
countries currently studying at the university.
</html:p>
<html:p>
(q)
<html:span class="EnSpace"/>
La Salle University, founded in 1975, is ranked as one of the best dental schools in Mexico.
</html:p>
<html:p>
(r)
<html:span class="EnSpace"/>
The University of De La Salle-Bajío is composed of five campuses, with 13,500 students.
</html:p>
<html:p>
(s)
<html:span class="EnSpace"/>
In order to become approved foreign dental schools, La Salle University and Moldova University underwent extensive approval and evaluation processes conducted by the board that took years to complete.
</html:p>
<html:p>
(t)
<html:span class="EnSpace"/>
Graduates from these approved schools were required to pass the same licensure standards as graduates from schools within the United States.
</html:p>
<html:p>
(u)
<html:span class="EnSpace"/>
Since the inception of this program, approximately 900 graduates from La Salle University and Moldova
University have passed the required California exams and are practicing in California. Many are practicing in low-income, underserved communities, like Yuba City, Madera, Bakersfield, Fresno, and Los Angeles.
</html:p>
<html:p>
(v)
<html:span class="EnSpace"/>
At the board’s sunset review hearing in 2019, the board stated that it did not have the resources to continue approving foreign dental schools and requested that foreign dental schools be accredited by the Commission on Dental Accreditation of the American Dental Association (CODA) instead, as CODA is better equipped to carry on the task.
</html:p>
<html:p>
(w)
<html:span class="EnSpace"/>
Assembly Bill 1519 (Chapter 865 of the Statutes of 2019), the board’s sunset review bill, eliminated the board’s authority to approve additional foreign dental schools, and required that, to maintain their status as board-approved schools, La Salle University and Moldova University must successfully complete the international
consultative and accreditation process with CODA by January 1, 2024.
</html:p>
<html:p>
(x)
<html:span class="EnSpace"/>
Moldova University began the CODA accreditation process on March 15, 2021. CODA responded that they would not be conducting reviews of international dental schools in the foreseeable future because of travel restrictions resulting from the COVID-19 pandemic.
</html:p>
<html:p>
(y)
<html:span class="EnSpace"/>
La Salle University began the CODA accreditation process in 2007, was denied accreditation in March 2019, and is currently in the process of appealing the decision.
</html:p>
<html:p>
(z)
<html:span class="EnSpace"/>
CODA began its process of creating an international school accreditation process in 2005, completed this process in 2006, and began accepting applications in 2007. Documentation from CODA shows that in 2007, 10 international dental programs submitted applications.
</html:p>
<html:p>
(aa)
<html:span class="EnSpace"/>
In 2019, CODA approved its first foreign dental school, King Abdulaziz University in Jeddah, Saudi Arabia. The process took approximately 12 years to complete.
</html:p>
<html:p>
(ab)
<html:span class="EnSpace"/>
In 2024, CODA approved its second foreign school, Yeditepe University in Istanbul, Turkey. The process took approximately 17 years to complete.
</html:p>
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 1628 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
is amended to read:
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<ns0:Num>1628.</ns0:Num>
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<ns0:Content>
<html:p>Any person over 18 years of age is eligible to take an examination before the board upon making application therefor and meeting all of the following requirements:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
Paying the fee for applicants for examination provided by this chapter.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Furnishing satisfactory evidence of having graduated from a dental college approved by the board or by the Commission on Dental Accreditation of the American Dental Association, including a foreign dental school previously approved by the board pursuant to Section 1636.5, and presenting satisfactory evidence of having completed at dental school or schools the full number of academic years of undergraduate
courses required for graduation. For purposes of this article, “dental college approved by the board” or “approved dental school” include a foreign dental school accredited by a body that has a reciprocal accreditation agreement with any commission or accreditation organization whose findings are accepted by the board.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Furnishing the satisfactory evidence of financial responsibility or liability insurance for injuries sustained or claimed to be sustained by a dental patient in the course of the examination as a result of the applicant’s actions.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
If the applicant has been issued a degree of doctor of dental medicine or doctor of dental surgery by a foreign dental school, the applicant shall furnish all of the following documentary evidence to the board:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
That the applicant has completed, in a dental school or schools approved by the board pursuant to Section 1636.4, a resident course of professional instruction in dentistry for the full number of academic years of undergraduate courses required for graduation.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Subsequent thereto, the applicant has been issued by the dental school a dental diploma or a dental degree, as evidence of the successful completion of the course of dental instruction required for graduation.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Any applicant who has been issued a dental diploma from a foreign dental school that has not, at the time of the applicant’s graduation from the school, been approved by the board pursuant to Section 1636.4 shall not be eligible for examination
until the applicant has successfully completed a minimum of two academic years of education at a dental college approved by the board pursuant to Article 1 (commencing with Section 1024) of Chapter 2 of Division 10 of Title 16 of the California Code of Regulations and has been issued a degree of doctor of dental medicine or doctor of dental surgery or its equivalent. This subdivision shall not apply to applicants who have successfully completed the requirements of Section 1636 as it read before it was repealed on January 1, 2004, on or before December 31, 2003, or who have successfully completed the requirements of Section 1628.2 on or before December 31, 2008. An applicant who has successfully completed the requirements of Section 1636 as it read before it was repealed on January 1, 2004, on or before December 31, 2003, or who has successfully completed the requirements of Section 1628.2 on or before
December 31, 2008, shall be eligible to take the examination required by Section 1632, subject to the limitations set forth in subdivisions (b) and (c) of Section 1633.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Subdivisions (d) and (e) do not apply to a person who has been issued a degree of doctor of dental medicine or doctor of dental surgery by a foreign dental school accredited by a body that has a reciprocal accreditation agreement with any commission or accreditation organization whose findings are accepted by the board.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
If the applicant is a graduate of a foreign dental school with extended approval pursuant to subdivision (a) of Section 1636.5, the applicant agrees to practice dentistry full time for two years in one or more of the following practice settings:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A primary care clinic licensed under Section 1204 of the Health and Safety Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A clinic owned or operated by a public hospital or health system.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
A clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the county’s role under Section 17000 of the Welfare and Institutions Code.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
A federally qualified health center, as defined in Section 1396d of Title 42 of the United States Code.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The applicant shall complete the two years of practice described in paragraph (1) within the first three years of receiving a license to practice dentistry.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The board may periodically request verification of compliance with this subdivision, and may revoke the license upon a finding that the applicant has not complied with this subdivision.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The board shall provide information about the areas of the state that are experiencing a shortage of dentists in the application packet for licensure to practice dentistry pursuant to this section.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The board shall define “full-time employment status” as described in this subdivision, and the board may establish exemptions
to this requirement on a case-by-case basis.
</html:p>
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 1634.1 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
is amended to read:
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<ns0:Num>1634.1.</ns0:Num>
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<html:p>Notwithstanding Section 1634, the board may grant a license to practice dentistry to an applicant who submits all of the following to the board:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
A completed application form and all fees required by the board.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Satisfactory evidence of having graduated from a dental school approved by a national accrediting body approved by the board or by the Commission on Dental Accreditation of the American Dental Association or from a foreign dental school previously approved by the board pursuant to Section 1636.5.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Satisfactory evidence of having completed a clinically based advanced
education program in general dentistry or an advanced education program in general practice residency that is, at minimum, one year in duration and is accredited by either the Commission on Dental Accreditation of the American Dental Association or a national accrediting body approved by the board. The advanced education program shall include a certification of clinical residency program completion approved by the board, to be completed upon the resident’s successful completion of the program in order to evaluate the resident’s competence to practice dentistry in the state. The certification shall be within two years prior to the date of the resident’s application for a license under this section. Completion of the program shall be within two years prior to the date of their application for a license under this section.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
Satisfactory
evidence of having successfully completed the written examination of the National Board Dental Examination of the Joint Commission on National Dental Examinations.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
Satisfactory evidence of having successfully completed an examination in California law and ethics.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
Proof that the applicant has not failed a state, regional, or national examination for licensure to practice dentistry under this chapter within five years prior to the date of the application for a license under this chapter. If the applicant subsequently passed the examination for licensure, the prior failure shall not make the applicant ineligible under this subdivision.
</html:p>
<html:p>
(g)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
If the applicant is a graduate of a foreign dental school with
extended approval pursuant to subdivision (a) of Section 1636.5, the applicant agrees to practice dentistry full time for two years in one or more of the following practice settings:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A primary care clinic licensed under Section 1204 of the Health and Safety Code.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
A clinic owned or operated by a public hospital or health system.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
A clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the county’s role under Section 17000 of the Welfare and Institutions Code.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
A federally qualified health center, as defined in Section 1396d of Title 42 of the United States Code.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The applicant shall complete the two years of practice described in paragraph (1) within the first three years of receiving a license to practice dentistry.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The board may periodically request verification of compliance with this subdivision, and may revoke the license upon a finding that the applicant has not complied with this subdivision.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The board shall provide information about the areas of the state that are experiencing a shortage of dentists in the application packet for licensure to practice dentistry pursuant to this section.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
The board shall define “full-time employment status” as described in this subdivision, and the board may establish
exemptions to this requirement on a case-by-case basis.
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<ns0:Num>SEC. 4.</ns0:Num>
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Section 1636.5 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
is repealed.
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<ns0:Num>SEC. 5.</ns0:Num>
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Section 1636.5 is added to the
<ns0:DocName>Business and Professions Code</ns0:DocName>
, to read:
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<ns0:Num>1636.5.</ns0:Num>
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<html:p>
(a)
<html:span class="EnSpace"/>
Notwithstanding Section 1636.4, any foreign dental school whose program was approved prior to January 1, 2024, shall maintain approval until the school has been issued a denial of accreditation by the Commission on Dental Accreditation of the American Dental Association (CODA) and the school does not appeal, the school has been issued a denial by CODA following the completion of the appeals process, or the school withdraws its application for accreditation by CODA, provided it complies with both of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The foreign dental school seeks accreditation by CODA on or before January 1, 2026.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
Commencing July 1, 2026, and every six months thereafter, the foreign dental school provides updates to the board on the CODA application process.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Upon expiration of the extended approval described in subdivision (a), the foreign dental school shall be required to comply with the provisions of Section 1636.4.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A graduate of a foreign dental school with extended approval pursuant to subdivision (a) who enrolled in the school on or after July 1, 2025, shall be eligible for licensure to practice dentistry pursuant to this chapter.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
A graduate of the foreign dental school shall be eligible for licensure to practice dentistry upon expiration of the extended approval described in
subdivision (a) if they were enrolled on or after July 1, 2025, and before the expiration of the school’s extended approval.
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<ns0:BillSection id="id_BA105ECA-2417-4C61-AE3F-EDAE02495EDF">
<ns0:Num>SEC. 6.</ns0:Num>
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Section 1636.6 of the
<ns0:DocName>Business and Professions Code</ns0:DocName>
is repealed.
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<ns0:BillSection id="id_E53702DF-54A7-421A-9B18-A69F2857836B">
<ns0:Num>SEC. 7.</ns0:Num>
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Section 1636.6 is added to the
<ns0:DocName>Business and Professions Code</ns0:DocName>
, to read:
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<ns0:Fragment>
<ns0:LawSection id="id_AEBEE2AD-E4FA-4CF8-B87D-64CBBB7B46C2">
<ns0:Num>1636.6.</ns0:Num>
<ns0:LawSectionVersion id="id_476E1223-7479-49E8-9F9E-4DBF9D40F295">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
As part of its first sunset review report following January 1, 2032, as required by subdivision (d) of Section 1601.1, the board shall provide metrics summarizing all of the following:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
The total number of active licenses to practice dentistry in California.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The number of active licenses to practice dentistry in California that were issued to graduates from a foreign dental school approved pursuant to Section 1636.5.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
Rate of passage of licensing examinations by graduates from a foreign dental school approved pursuant to Section 1636.5.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The number of complaints and disciplinary actions of dentists from a foreign dental school approved pursuant to Section 1636.5.
</html:p>
<html:p>
(5)
<html:span class="EnSpace"/>
Aggregate workforce data, to the extent available to the board pursuant to Section 502 and through additional license renewal surveys, in consultation with the Department of Health Care Access and Information, relating to the following categories:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
Area of practice or specialty.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
City, county, and ZIP Code of practice.
</html:p>
<html:p>
(C)
<html:span class="EnSpace"/>
Languages spoken.
</html:p>
<html:p>
(D)
<html:span class="EnSpace"/>
Race or ethnicity.
</html:p>
<html:p>
(E)
<html:span class="EnSpace"/>
Type of employer or classification of primary practice site.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
This section shall remain in effect only until January 1, 2034, and as of that date is repealed.
</html:p>
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