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Transnational licensure: view from Texas.

Texas has a diverse population with many underserved communities and a dentist-to-population ratio only 80% of the national average. Currently dentists trained in other countries can be licensed after completing four years of dental school and passing either the Western or Central Regional Testing Association's examination or by completing a graduate program in an ADA-accredited specialty. Although there have been careful and lengthy analyses of comparability of training across countries, a fundamental issue is that standards for education are developed by a national voluntary organization (Commission on Dental Accreditation) and standards for licensure are determined by individual states in the United States. Elsewhere in the world, the federal government performs these roles.