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Study of Registration Practices of the
ROYAL COLLEGE OF DENTAL SURGEONS OF ONTARIO, 2007

ISBN 978-1-4249-6500-7 [HTML English version]

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1. INTRODUCTION

The Office of the Fairness Commissioner (OFC) undertook a study of registration practices of Ontario's regulated professions during the fall and winter of 2007–2008. The purpose of the study was to understand each regulated profession's 2007 registration practices and to establish baseline data and information to enable the OFC to measure progress as it fulfills its mandate under the Fair Access to Regulated Professions Act, 2006.

This report reflects the registration practices of the Royal College of Dental Surgeons of Ontario as of December 31, 2007. Information in this report was gathered from:

• face-to-face meetings with registration staff of the regulatory body

• additional documentation provided by the regulatory body

• relevant websites

• career maps for the profession posted on the Ministry of Citizenship and Immigration's website (where applicable).

The Royal College of Dental Surgeons of Ontario also provided registration information and statistics for 2005, 2006 and 2007 through a standard spreadsheet designed by the OFC.

An analysis and summary of the findings for all of the regulated professions is contained in the OFC's Ontario’s Regulated Professions: Report on the 2007 Study of Registration Practices.

2. BACKGROUND OF THE REGULATORY BODY

a. Legislation

The Royal College of Dental Surgeons of Ontario (RCDSO) operates in accordance with the Regulated Health Professions Act, 1991 (RHPA), the Dentistry Act, 1991 and Regulation 205/94, as amended by Ontario Regulation 500/07, the Registration Regulation.

b. Protected Titles

The RCDSO regulates every dental surgeon and dentist in Ontario in the public interest. Only persons registered with the RCDSO may use the protected title “dentist.”

c. Definition of the Profession

The practice of dentistry is the assessment of the physical condition of the oral-facial complex and the diagnosis, treatment and prevention of any disease, disorder or dysfunction of the oral-facial complex.

Dentists with a valid Certificate of Registration or licence from the RCDSO are permitted to practise in Ontario. Dentists are authorized to:

• Communicate a diagnosis identifying a disease or disorder of the oral-facial complex as the cause of a person’s symptoms

• Perform a procedure on tissue of the oral-facial complex below the dermis, below the surface of a mucous membrane or in or below the surfaces of the teeth, including the scaling of teeth

• Harvest tissue for the purpose of surgery on the oral-facial complex

• Set a fracture of a bone of the oral-facial complex or set a dislocation of a joint of the oral-facial complex

• Administer a substance by injection or inhalation

• Apply or order the application of a prescribed form of energy

• Prescribe or dispense drugs

• Fit or dispense a dental prosthesis or an orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from abnormal functioning.

d. Labour Market/Economic Trends

There are regional disparities between the number of dentists in southern Ontario and the number of dentists in northern Ontario; there is no overall shortage of dentists. Generally, the labour market is over-saturated.

e. New Developments Within the Profession

A nationwide process is being developed for the certification and registration of internationally trained dental specialists who apply for registration in Canada.^[1] A national memorandum of understanding (MOU) outlines the new protocol, which has the support of participants from the Canadian Dental Regulatory Authorities Federation (CDRAF).^[2] This nationwide initiative will be university-based, and the credentialing, assessment, evaluation and training of a candidate will all be done with the support of a university that has an accredited program in that specialty with department-level specialists involved. It will be a flexible program of tailor-made gap training. Once the faculty issues a certificate of completion, the candidate will need to write the standard specialty examination of the Royal College of Dentists of Canada (RCDC).^[3]

Furthermore, in accordance with the national MOU, Ontario amended its Registration Regulation in August 2007, which means that internationally trained dental specialists will no longer be required to complete a two-year undergraduate course and an examination in general dentistry; they will no longer have to hold certificates of the National Dental Examining Board of Canada (NDEB)^[4] in addition to their specialty certificates; they will be required only to successfully complete the National Dental Specialty Examination (NDSE) in the specialty for which they are seeking a specialty Certificate of Registration; and internationally trained dental specialists will be able to access their fields of expertise sooner. The program is targeted to be operational by the fall of 2008.

f. Staffing

The RCDSO has 50 staff members. Four of them are responsible for membership applications.

3. REGISTRATION PRACTICES

a. Registration Requirements and Application Process

The RCDSO issues licences, called Certificates of Registration, in the following categories:

• General (general practitioners)

• Academic (academic appointment at professorial level)

• Specialty (see below)

• Education (hospital interns and residents)

• Graduate Student (postgraduate and graduate students)

• Academic Visitor (short-term course instructor)

• Post-Specialty Training

• Short Duration

• Instructional

Recognized dental specialties in Ontario are:

• endodontics

• oral and maxillofacial surgery

• oral pathology

• oral radiology

• oral medicine

• orthodontics

• anaesthesia

• pediatric dentistry

• periodontics

• prosthodontics

• public health dentistry

The general requirements for all Certificates of Registration include attestation by the applicant that he or she:

• Has not been found guilty of a criminal offence or an offence under the Narcotic Control Act (Canada) or the Food and Drugs Act (Canada)

• Has not been the subject of a finding of professional misconduct, incompetence or incapacity, if registered or licensed to practise dentistry in another jurisdiction

• Is not the subject of a current professional misconduct, incompetence or incapacity proceeding, if registered or licensed to practise dentistry in another jurisdiction

• Holds a degree in dentistry as evidence of successful completion of a course in dental studies of at least four years duration at a university-based dental school

• Is reasonably fluent in English or French

• Has successfully completed a course in ethics and jurisprudence and other such examinations as set or approved by the RCDSO

• Is a Canadian citizen or permanent resident of Canada or has received the appropriate authorization to engage in the practice of dentistry in Canada

• Has not made false or misleading statements on the application.

A person may apply for a Certificate of Registration by submitting a completed and notarized application form, the application fee and the documentation to support the attestations listed above in addition to whatever documentation may be required by the particular class of certificate being applied for.

b. Documentation Required from Internationally Trained Individuals

i. Standard Documentation

In addition to all the documentation required of applicants generally, internationally trained individuals who were engaged in practice in any health profession in another jurisdiction and/or have been licensed to practise dentistry in another jurisdiction must submit a Certificate of Standing form completed by the regulatory authority in the jurisdiction where they practised.

ii. Options for Applicants with Unavailable/Destroyed Documents

The RCDSO decides what alternatives might be accepted on a case-by-case basis. In some cases, particularly for refugees, there might not be any documentation, and all the RCDSO can ask for is a sworn affidavit. In other situations applicants will be able to provide a multiplicity of alternative documentation specific to their country to support their claims.

Applicants will typically reveal any perceived difficulty early on in the communication, and it is addressed by the RCDSO at that time.

c. Credential Assessment (Third Party and/or Internal)

The RCDSO does not accept credentialing assessments.

Credential and/or clinical assessments are conducted by the University of Toronto’s Faculty of Dentistry and the Schulich School of Medicine and Dentistry at the University of Western Ontario as part of their admissions processes.

d. Academic/Program Requirements

In order to become licensed with the RCDSO, individuals must hold a degree in dentistry from a four-year university-based dental school.

Regardless of education, licensure or experience, internationally trained individuals who wish to practise dentistry in Ontario must complete a full-time two-year Degree Completion Program (previously known as a Qualifying Program) at a Canadian or U.S. university before they are eligible to take the NDEB examination.^[5]

At the University of Toronto, the International Dentist Advanced Placement Program (IDAPP) is a special university program held over five months. After successful completion of this program, students are fully integrated into the third year of the university’s four-year Doctor of Dental Surgery (DDS) Program, leading to the degree of doctor of dental surgery. The program is intended for graduates of non-accredited dental programs: educational programs that have not been recognized by the Commission on Dental Accreditation of Canada (CDAC) or the American Dental Association Commission on Dental Accreditation. Upon successful completion candidates will take the NDEB examinations, the same examinations which graduates of accredited dental programs must take to obtain certification. A candidate who has passed the IDAPP and the NDEB examinations becomes eligible for licensure/registration as a dentist in all provinces in Canada.

In Ontario, applications to attend a Degree Completion Program may be made to the Faculty of Dentistry at the University of Toronto and the Schulich School of Medicine and Dentistry at the University of Western Ontario in London.

e. Work Experience Requirements

Work experience is not required in order to receive a Certificate of Registration.

f. Examinations

i. General Dentist Exams

Graduates of accredited dental programs and accredited Degree Completion Programs are required to successfully complete the National Dental Examining Board of Canada’s Written Examination andObjective Structured Clinical Examination (OSCE) for certification as general dentists in Canada.

The Written Examination consists of two papers, each with 150 multiple-choice questions. Each paper is given in a 150-minute examination session. The sessions are held in the morning and the afternoon of one day. For the subjects tested in the examination, see www.ndeb.ca.

All candidates must obtain a minimum test-equated score of 65 to be successful in the Written Examination. The results of the Written Examination will be sent by regular mail within six weeks.

The OSCE is a station-type examination comprising a morning session and an afternoon session on the same day. The majority of the stations will have two questions and will require the candidate to review the information supplied (e.g., case history, photographs, radiographs, casts, models) and answer extended match-type questions. Each extended match-type question will have up to 15 answer options and one or more correct answers. A few stations may require the candidate to review the information supplied and write an acceptable prescription for a medication commonly prescribed by general dentists in Canada.

Candidates will have five minutes at each station to answer the questions. After five minutes the candidate will move to the next station. The Question and Answer Framework for this examination is available on the NDEB’s website.

All candidates must obtain a minimum test-equated score of 65 to be successful in the OSCE.

ii. Specialist Exams

The Royal College of Dentists of Canada is the examining body for dental specialists in Canada. The examinations of the RCDC are used by many provincial dental regulatory authorities as part of the requirement for licensure as a specialist and are known as the National Dental Specialty Examination. These examinations are created specifically for each dental specialty. The RCDSO requires successful completion of the NDSE as a prerequisite for licensure as a dental specialist in Ontario.

The RCDC provides examination information for each specialty on its website that describes current exam formats and the components required for each. Before taking the NDSE, applicants must be approved by the RCDC Credentials Committee. Successful completion of the RCDC specialty examination may lead to Fellowship in the RCDC and the use of the designation Fellow of the Royal College of Dentists of Canada FRCD(C).

g. Language Requirements

The RCDSO requires reasonable fluency in either English or French. In certain cases, the Test of English as a Foreign Language (TOEFL) will be required.

h. Fees

i. RCDSO Fees

Application fee	$100
Registration fee	$100
Annual membership fee	$1,760

ii. NDEB Fees^[6]

Registration fee[7]	$250
Written Examination fee[8]	$400
OSCE fee[9]	$600
Withdrawal from the Written Examination[10]	$200
Withdrawal from the OSCE[11]	$200
Rescoring fee[12]	$150

iii. RCDC Fees^[13]

Fees for 2007. Please see specialty-specific notes below.

Please note: Examination fees have not increased since 2002, although the fee structure was amended in 2005.

Application processing fee	$500	All new (including Academic) applicants will pay a non-refundable application processing fee in addition to the examination fee. If an application is not accepted, or a candidate withdraws, only the examination fee and not the processing fee will be refunded according to RCDC refund policy. This fee is waived for re-sit candidates, Members and those who have completed Part I of a previous exam format.
NDSE Examination fee	$4,500	Standard fee for all new applicants. This includes all required components.
1st component (Written) only[14]	$1,000	Applies to standard exam only.
2nd and 3rd component (Clinical)	$3,500	Applies to standard exam only.
3rd OSCE component only[15]	$2,750	Orthodontics only. Members and those who have completed Part I of a previous examination format would pay this to complete their Fellowship.
Academic NDSE Exam[16]	$4,500	The Academic NDSE is a special examination format. Applicants would pay the application processing fee in addition to the examination fee.
Formal examination review	$500	Deposit required to initiate a formal examination review.

iv. Penalties and Refunds

Withdrawing^[17] from the session for which a candidate is registered would result in the following penalties:

Before the application deadline	No penalty
After the application deadline and more than 1 month prior to the first component to be taken	Penalty is 50% of the exam fee paid
After the application deadline and less than 1 month prior to the first component to be taken	Penalty is 100% of the exam fee paid

i. Third Parties

Name of Third Party	Relationship to Regulatory Body
National Dental Examining Board of Canada	Administers the national exam for general dentistry.
Universities	Provide upgrading and bridging to fill gaps in training, education, philosophies and standards of practice by means of the Degree Completion Programs.
Royal College of Dentists of Canada	Administers the national exam for dental specialists.
University of Toronto Faculty of Dentistry	Assesses international credentials and conducts a clinical assessment where appropriate for the two-year Degree Completion Program. (This assessment is not performed for the RCDSO — it is part of the university’s admission requirements.)
Schulich School of Medicine and Dentistry at the University of Western Ontario	Assesses international credentials and conducts a clinical assessment where appropriate for the two-year Degree Completion Program. (This assessment is not performed for the RCDSO — it is part of the university’s admission requirements.)

j. Typical Length of the Registration Process

The standard processing time for a complete application is three weeks.

k. Accredited Programs

Accredited programs in Canada are those recognized by the Canadian Dental Association (CDA).^[18] The Commission on Dental Accreditation of Canada (CDAC) was established in 1988 by the CDA as an autonomous body responsible for accrediting dental, dental hygiene and dental assisting education programs in Canada.

All universities listed offer programs in general dentistry, leading to the degree doctor of dental surgery (DDS) or doctor of dental medicine (DMD). Additional programs offered by each university are also listed below.

Ontario
University of Toronto: Degree Completion Qualifying Program, dental public health, endodontics, oral and maxillofacial radiology, oral and maxillofacial surgery, oral medicine and oral pathology, orthodontics and dentofacial orthopaedics, pediatric dentistry, periodontics, prosthodontics

University of Western Ontario, London: Degree Completion Qualifying Program, oral and maxillofacial surgery, orthodontics and dentofacial orthopaedics

Alberta
University of Alberta, Edmonton: Degree Completion Qualifying Program, orthodontics and dentofacial orthopaedics

British Columbia
University of British Columbia, Vancouver: Degree Completion Qualifying Program, oral medicine and oral pathology, periodontics

Manitoba
University of Manitoba, Winnipeg: Degree Completion Qualifying Program, oral and maxillofacial surgery, orthodontics and dentofacial orthopaedics, periodontics

Nova Scotia
Dalhousie University, Halifax: Degree Completion Qualifying Program, oral and maxillofacial surgery, prosthodontics

Quebec
McGill University, Montreal: Degree Completion Qualifying Program, oral and maxillofacial surgery

Université Laval, Quebec City: oral and maxillofacial surgery, periodontics

Université de Montréal: Degree Completion Qualifying Program, orthodontics and dentofacial orthopaedics, pediatric dentistry, prosthodontics

Saskatchewan
University of Saskatchewan, Saskatoon

A list of accredited dental programs and degree completion programs (also known as advanced standing programs) in the United States is available through the American Dental Association (ADA)’s Commission on Dental Accreditation (CODA).

l. Internal Review/Appeal Process

All applications for a Certificate of Registration are reviewed by RCDSO staff. If an application meets all of the requirements for the particular certificate being applied for, it is approved and the applicant is registered as a member of the RCDSO. The Registrar of the RCDSO could refer the application to the Registration Committee in any of the following cases:

• The Registrar has doubts on reasonable grounds about whether an applicant fulfills the registration requirements.

• The Registrar is of the opinion that terms, conditions or limitations should be imposed on the certificate and the applicant does not consent to the imposition.

• The Registrar proposes to refuse the application.

When an application is reviewed by the Registration Committee, the applicant is notified and given the opportunity to provide written submissions to the committee and to attend. The committee, after reviewing the application and related documentation, may direct the Registrar to take one of these actions:

• issue a Certificate of Registration

• issue a certificate with specified terms, conditions and/or limitations

• issue a certificate upon completion of additional requirements (e.g. educational upgrading, exam completion)

• refuse to issue a certificate.

The decision of the committee is communicated to the applicant in writing, and, if appropriate, information about the appeal mechanism to the Health Professions Appeal and Review Board (HPARB) is provided.

The Registration Committee has four members: one public appointee and three members of Council.

4. BRIDGING PROGRAMS

The RCDSO does not have any bridging programs for internationally trained individuals. However, a tailor-made gap training program for dental specialists is forthcoming and will be offered by accredited universities across Canada.

5. MUTUAL RECOGNITION AGREEMENTS

The RCDSO is a signatory to a national mutual recognition agreement (MRA) between the provincial regulatory organizations for dentistry. The Dentistry MRA establishes the conditions under which a dentist with an unrestricted practice certificate in one jurisdiction will be recognized and allowed to practise in any other jurisdiction in Canada, if he or she does not meet the regular provincial registration requirements. All provinces agreed to the MRA’s terms for general dentistry, including the qualifying programs. All provinces except Alberta and Quebec agreed to the MRA’s terms for dental specialists.

6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY

a. Nature and Frequency of Communication

The RCDSO communicates daily with applicants by phone, fax and e-mail.

b. Backlogs

There are no backlogs in the RCDSO’s registration process.

c. Complaints Regarding the Registration Process

The RCDSO investigates complaints in accordance with the process outlined in the Regulated Health Professions Act, 1991. If necessary, complainants can appeal the RCDSO’s Complaints Committee decisions to the Health Professions Appeal and Review Board (HPARB).

7. CHANGES SINCE THE 2005 SURVEY

The Ministry of Citizenship and Immigration conducted a survey in 2005 to collect information about occupational regulatory bodies in Ontario.

A national memorandum of understanding was reached respecting a protocol for assessing internationally trained dental specialists. Accordingly, an amendment was made to the RCDSO’s registration regulation removing the mandatory two-year qualifying program and NDEB examination for internationally trained dental specialists.

8. REGISTRATION INFORMATION AND STATISTICS

Definitions used in these tables:

Alternative class of licence: a class of licence that enables its holder to practise with limitations; additional registration requirements must be met in order to be fully licensed. The Royal College of Dental Surgeons of Ontario has no alternative classes of licence.

Applicant: a person who has applied to start the process for entry to the profession.

Applicant actively pursuing licensing: an applicant who had some contact with the RCDSO within the year specified.

Inactive applicant: an applicant who had no contact with the RCDSO within the year specified.

Member: a person who is currently able to use the protected title or professional designation “dentist.”

Languages in which application information materials were available

Language	2005	2006	2007
English	Yes	Yes	Yes
French	No	No	No
Other(s)

Countries where internationally educated applicants were initially trained in dentistry

Applications received	2005	2006	2007
Largest number	India	India	India
Second-largest number	Romania	Iran	Iran
Third-largest number	Iran	Romania	China
Fourth-largest number	Pakistan	Brazil	Ukraine
Fifth-largest number	China, Iraq (tied)	Pakistan, Syria (tied)	Bulgaria, Iraq, Romania, Turkey (tied)

Staff employed by the Royal College of Dental Surgeons of Ontario

Number of staff	2005	2006	2007
Involved in registration process	4	4	4
Involved in appeals process	6	6	6

Jurisdiction where members were initially trained in dentistry (before they were granted use of the protected title or professional designation in Ontario)

Members	Ontario	Other Canadian Provinces	USA	Other International	TOTAL
Total members	4,958	980	886	1,236	8,060
Non-practising members1	N/A	N/A	N/A	N/A	N/A

¹The RCDSO does not track this information.

Applicants processed by the Royal College of Dental Surgeons of Ontario in 2005

	Jurisdiction where members were initially trained in dentistry (before they were granted use of the protected title or professional designation in Ontario)
In 2005 (Jan. 1 to Dec. 31)	Ontario	Other Canadian Provinces	USA	Other International	TOTAL
New applications received1	N/A	N/A	N/A	N/A	N/A
Applicants actively pursuing licensing1	N/A	N/A	N/A	N/A	N/A
Inactive applicants1	N/A	N/A	N/A	N/A	N/A
Applicants who met all requirements and were authorized to become members but did not become members1	N/A	N/A	N/A	N/A	N/A
Applicants who became members	94	59	30	58	238
Applicants who were authorized to receive an alternative class of licence but were not issued a licence	N/A	N/A	N/A	N/A	N/A
Applicants who were issued an alternative class of licence	N/A	N/A	N/A	N/A	N/A

¹ The RCDSO does not track this information.

Applicants processed by the Royal College of Dental Surgeons of Ontario in 2006

	Jurisdiction where members were initially trained in dentistry (before they were granted use of the protected title or professional designation in Ontario)
In 2006 (Jan. 1 to Dec. 31)	Ontario	Other Canadian Provinces	USA	Other International	TOTAL
New applications received1	N/A	N/A	N/A	N/A	N/A
Applicants actively pursuing licensing1	N/A	N/A	N/A	N/A	N/A
Inactive applicants1	N/A	N/A	N/A	N/A	N/A
Applicants who met all requirements and were authorized to become members but did not become members1	N/A	N/A	N/A	N/A	N/A
Applicants who became members	102	52	47	51	252
Applicants who were authorized to receive an alternative class of licence but were not issued a licence	N/A	N/A	N/A	N/A	N/A
Applicants who were issued an alternative class of licence	N/A	N/A	N/A	N/A	N/A

¹ The RCDSO does not track this information.

Applicants processed by the Royal College of Dental Surgeons of Ontario in 2007

	Jurisdiction where members were initially trained in dentistry (before they were granted use of the protected title or professional designation in Ontario)
In 2007 (Jan. 1 to Dec. 31)	Ontario	Other Canadian Provinces	USA	Other International	TOTAL
New applications received1	N/A	N/A	N/A	N/A	N/A
Applicants actively pursuing licensing1	N/A	N/A	N/A	N/A	N/A
Inactive applicants1	N/A	N/A	N/A	N/A	N/A
Applicants who met all requirements and were authorized to become members but did not become members1	N/A	N/A	N/A	N/A	N/A
Applicants who became members	104	52	49	49	254
Applicants who were authorized to receive an alternative class of licence but were not issued a licence	N/A	N/A	N/A	N/A	N/A
Applicants who were issued an alternative class of licence	N/A	N/A	N/A	N/A	N/A

¹ The RCDSO does not track this information.

9. SOURCES

American Dental Association website: http://www.ada.org/ada/index.asp. Last accessed: March 10, 2008.

Canadian Dental Association. “Accredited Education Programs.” Canadian Dental Association website: http://www.cda-adc.ca. Last accessed: January 22, 2008.

Canadian Dental Regulatory Authorities Federation website: http://www.cdraf.org. Last accessed: January 22, 2008.

National Dental Examining Board website: http://www.ndeb.ca. Last accessed: January 22, 2008.

Royal College of Dental Surgeons of Ontario. The Dispatch (May/June 2007).

Royal College of Dental Surgeons of Ontario website: http://www.rcdso.org. Last accessed: January 22, 2008.

Royal College of Dentists of Canada website: http://www.rcdc.ca. Last accessed: January 22, 2008.

University of Toronto, Faculty of Dentistry. “Admissions.” University of Toronto website: http://www.utoronto.ca/dentistry. Last accessed: January 22, 2008.

Representatives of the Royal College of Dental Surgeons of Ontario met with staff of the Office of the Fairness Commissioner on August 3, 2007, to provide further information for this study.

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