THE STRANGE CASE OF AYANA SMITH:

by norman j clement rph., dds

 Masters Case presentation University of Florida, College of Dentistry CDP-29, May 2018, candidate American Academy of General Dentistry (FAGD)

“A Re-Examination of Dental Competency, the mistreatment of an African-American young woman by The Chief Examiner William Bell DDS, and the failure of The Commission on Dental Competency Assessment  (CDCA) to address her complaint and the dentist candidate’s appeal”

District 6 Museum, Cape Town South Africa

THE STATEMENT OF FACTS

1. The Patient Ayana Smith of Tampa Fl., was presented as a candidate for Periodontal Scaling for The Commission on Dental Competency Assessment (CDCA).
2. Pre-exam photographs, radiographs and oral exam demonstrated, Ms. Smith Generalized Gingivitisto localized Periodontitis.
3. Ms. Smith, states upon examination for Periodontal Scaling, two of the Examiners greeted her professionally utilizing Universal Precautions, Face mask, grown, caps, and magnification headlights.
4. The two Examiners agreed she was a candidate the Periodontal Scaling.
5. Ms. Smith, then sates suddenly a man identified as “The Chief Examiner” came into the dental cubicle began arguing with the two examiners, he put on pair of gloves, told her to open up and replied “NO.”
6. Ms. Smith states, “The Chief Examiner” stated, “Your mouth wasn’t dirty enough,” the Dental candidate failed this section of the examination for “Lack of Clinical Judgment”

RE: CANDIDATE APPEAL

My name is Norman J Clement, I am both Dentist/Pharmacist currently enrolled in my second year Comprehensive Dentistry Program, Class 29(CDP 29), The Academy of General Dentistry (AGD) (Master track program) at the University of Florida College of Dentistry (see exhibit 1).

I am generating this appeal because I strongly believe my results on The Commission on Dental Competency Assessments (CDCA) were adversely affected by extraordinary conditions during the examination which affected the final outcome of my examination.

This appeal arises from the demonstrated outright failure by a CDCA examiner WILLIAM  “BILL” BELL, (THE CHIEF EXAMINER)  “to comply with CDCA material examination requirements, as contained in the Candidates Manual, that directly caused this candidate to fail the examination.”

STATEMENT OF CONTENT OF APPEAL

1. The examination date May 5-6, 2017
2. University of Florida School of Dentistry, Gainesville, Florida.
3. Norman J Clement (candidate)
4. THE CHIEF EXAMINER, WILLIAM “BILL” BELL, MORE THAN DEMONSTRATED A CRITICAL LACK OF CLINICAL JUDGEMENT, DIAGNOSTIC SKILLS, BY FURTHER DEMONSTRATING COMPLETE DISREGARD FOR THE ORAL STRUCTURES AND WELFARE BY VIOLATION OF UNIVERSAL PRECATIONS[i] OF THE (MY) PATIENT AYANA SMITH (see patients exhibit 2).

ARGUMENT

I failed the Restorative/Periodontal CDCA examination because of the Critical Lack of Clinical Judgment/Diagnostic Skills and bias directed toward me by of Chief Examiner William “Bill” Bell during the entire exam. On Saturday, while setting up for the exam, Dr. Bell came over to me an asked what was my candidates number. I told him 161, but I also thought that to be somewhat unusual.  I further strongly know I passed the entire Manikin Portion of the CDCA Board Examination of May 5, 2017.

METHODOLOGY

PERIODONTAL POST RE-XAMINE

Patient Ayana Smith was re-examined (post CDCA board exam) using criteria procedures similarly to those established for Periodontal Scaling Examination on the CDCA Dental Examination Board.[ii]  Three (3) examiners, William “Bill” Bell DDS The Chief Examiner CDCA, Nora Delgado-Velasquez DDS, Practice Limited to Periodontics and Implants, Diplomate, America Board of Periodontology, Tampa, FL 33609 (see Delgado-Velasquez, exhibit- 3), and Darnell Kaigler DDS.MS, PhD, Diplomate, American Board of Periodontology, Associate Professor Department of Periodontics and Oral Medicine, University of Michigan Professor  (see Kaigler’s exhibit-4) determined if patient Ayana Smith met specifications of a CDCA Dental Board candidate.  Both Drs. Delgado-Velasquez and Kaigler’s findings are published and found in exhibits 3 and 4, of this Appeal. Dr. William “Bill” Bell’s findings are found from CDCA examination results and his observed behavior in patient Ayana Smith’s exhibit -2.

RESTORATIVE:

Patient Ayana Smith was a candidate for the Restorative Class-II, composite. Patient Smith had two clinical lesions, tooth 29, MESIAL-OCCUSAL (MO) and tooth 12, DISTAL-OCCUSSAL (DO) that met CDCA Board Criteria. Tooth #29 was selected, as this was the most ideal and simplest lesion.

Ms. Smith states upon presentation at least 2 clinical examiners agreed tooth #29 met CDCA Board criteria however Dr. Bell somehow intervened and tooth #29 was rejected (see exhibit-2 overall statement of patient).

Patient Ayana Smith returned for examination of tooth 12, DO (which was much more difficult) and stated Dr. Bell appeared outraged at her presence again. After a long discussion with other examiners the procedure was allowed. Patient Ayana Smith states, Dr. Bell wore gloves only during his examination of her throughout the restorative exams (see patient exhibit-2, pg2, 3).

STATEMENT OF FACTS

Patient Ayana Smith of Tampa, Fl. (see exhibit-6) was presented as a candidate for Periodontal Scaling for the CDCA examine held May 5-6, 2017, University of Florida College of Dentistry. Both pre-exam photographs (see exhibit-5, radiographs) and oral exam showed Patient Ayana Smith to have Generalized Gingivitis to localized Periodontitis. Patient Ayana Smith was selected as a candidate for the board using guidelines of CDCA Candidates Manual, [iii] lower anterior and posteriors 22 thru 31 were then selected.

Patient Ayana Smith, states upon examination for Periodontal Scaling, two of the Examiners greeted her professionally utilizing Universal Precautions, facemask, gowns, caps and magnification, headlights (see patient exhibit-2, pg2, 3).  Patient Ayana Smith further states these two examiners agreed she was a candidate. Patient Ayana Smith said Dr. Bell then came into the dental cubicle argued with the two examiners, put on a pair of gloves only, said “open up” and replied “NO.” I failed this part of the exam.

“YOUR MOUTH WASN’T DIRTY ENOUGH”

“YOU MUST BE HUNGRY”

In Patient Ayana Smith’s own hand writing she describes the deplorable way William “Bill” Bell degraded her, then made the statements directly to her that “YOUR MOUTH WASN’T DIRTY ENOUGH” AND OTHER DERAGATORY, DENIGRATING REMARKS (see patient exhibit-2 pg. 3).

Dr. Darnell Kaigler Jr., was asked to chart the teeth he would have chosen for scaling on the CDCA exam (see Kaigler’s exhibit-4) using their criteria. Dr. Kaigler’s charting of  Patient Ayana Smith’s lower dentition was nearly identical to the charting I presented on the day of the exam (see Kaigler’s exhibit-4).

“OVERWHELMING CLINICAL EVIDENCE”

The Clinical evidence against Dr. William “Bill” Bell’s complete failure to identify moderate generalize gingivitis (see Delgado-Velasquez, Kaigler exhibits 4&5) in  Patient Ayana Smith is simply overwhelming, and has to be based on a biased conclusion which doesn’t belong in the field of Dentistry.

Notwithstanding, Dr. William “Bill” Bell failed to use Universal Precaution Infection Control Procedures as published by the Center for Disease Control and Prevention,[iv]  by failing to wear a masks and gowns during examinations of patient Ayana Smith (see patient’s exhibits 7,8,9).

“OPEN YOUR MOUTH”

Ms. Ayana Smith stated in her own words and handwriting (see exhibit-2, pg-2) during both Periodontal and Restorative examination procedures “Mr. Bell, examine my mouth…by simply  throwing on a pair of gloves  and quickly uttering open up.” Ms. Smith was so outraged with Dr. William “Bill” Bell, she felt  compelled to further document his “sub par treatment” and took pictures (see exhibit-2, pg-3).

In patient Ayana Smith’s photos of William “Bill” Bell DDS, he is seen writing and doesn’t appear to have worn universal protective gown or mask (see patient exhibit-7, 8,9). Dr. Bell’s badge is clearly identifiable (see exhibit-7).

In preparation of tooth #12 access ideal opening and proximal box were completed. Dental caries was extensive involving areas under Dentin Enamel Junction (DEJ), which required I approximately 11 modifications, in which all caries were removed. The Examiners approved “Every Modification”. My final request was placement of dycal, glass ionomer base, and then final composite restoration.

According to Patient Ayana Smith all examiners agreed except Dr. William “Bill” Bell. I was terminated from CDCA Examination and prevented from moving forward on remaining of CDCA Exam.

FINDINGS

PERIODONTICS

The finding from Nora Delgado-Velasquez, DDS and Darnell Kaigler Jr DDS, both of whom are Diplomate America Board of Periodontology are more than clear Patient Ayana Smith was a candidate for Periodontal Scaling the day before the CDCA Board Examination, the day of the CDCA Board Examination on May 6. 2017, (at the time she was presented for treatment) and the days after the CDCA Board Examination (see Delgado-Velasquez, Kaigler exhibits 3&4).

On the day of the exam William “Bill” Bell DDS, adversely influenced and rejected Patient Ms. Smith as a candidate on the Periodontal section of the CDCA Exam, and said to her directly “Your mouth wasn’t dirty enough.” (See patient’s exhibit-2 pg. 3)

Dr. Nora Delgado-Velasquez, DDS, evaluated Patient Ayana Smith post exam, May 8, 2017, in her office in Tampa, Fl., and found “Heavy generalized plaque, Moderate supragingival calculus on lower anterior teeth and #3.  Generalized light subgingival calculus detected on probing mostly on enamel surfaces”(see Delgado-Velasquez, exhibits 3)

Patient Ayana Smith was flown to Detroit and was further evaluated by Darnell Kaigler Jr. DDS, MS, PhD in his Detroit Dental Specialty Center, May 22, 2017, and recorded during the exam:

Plague Score (O’Leary 1972) estimate 90%, Bleeding Index 63%, Calculus Moderate supragingival (generalized) Detectable subgingival (all upper and lower molars; 23-26) Probing Depths, 2-4mm in the upper and lower anterior; 2-5mm in the upper and lower posterior. In the Field of Law these Clinical Finding are Prima Fascia Evidence (see Kaigler’s exhibits 4).

PERIODONTAL THERAPY

On May 22, 2017, Patient Ayana Smith received periodontal therapy while at the Detroit Dental Specialty Center (prophy plus) with generalized scaling throughout the dentition to remove supra and sub-gingival deposits. It was recommended that Patient Ayana Smith seek regular dental care at her previous dental office or another local dental office for follow-up and long-term maintenance. Ms. Ayana Smith flew back and returned safely to Tampa, Florida that very night.

RESTORATIVE

I did not lack Clinical judgment and I strongly believe had it not been for Dr. Bell’s interferences I would have passed the Restorative section of this test. I was told by another examiner, Dr.Bell  stated the cavity prep was going all over the place.

I agree, this was not going to be an ideal prep. Good clinical judgment is “one must go where the caries goes.”  I did not have a pulp exposure. The internal prep was less than ideal but I removed all the caries and Patient Ayana Smith experienced no post-op pain.

I should have been approved to complete the exam. I was stopped by Dr. William Bell’s lack of clinical judgment. The failure to remove dental caries is Poor Clinical judgment. I know I had passed this exam.

DISCUSION

No disease state can ever be treated if there is a failure to properly diagnose and more specifically when bias is allowed to interfere with overwhelming clinical evidence[v].

Yet, “I Know Where I Have Been” and while it is not easy and painful challenging any individual Dental Board Examiner, without a full understanding of the potential adverse consequence. 

I could have just as easily sat back and done nothing or like many of my dental colleagues said to me, “ Norm, just pray about it” and “get ready for the next dental board exam.”

Yet, in the song “I Know Where I Have Been” as sung by Dana Owens also known as Queen Latifah, “from the movie Hair Spray it is stated:

I’ve come to be compelled always to be an advocate for my patient and for better dental healthcare inspight of myself.

YET ON THIS DAY

On this day William “Bill” Bell was so busy trying to be a bigot, so busy trying to be a racist, so busy trying to be the toughest Dental Examiner on the CDCA Dental Board Examination, he forgot how to be fair. 

However, I don’t believe William “Bill” Bell DDS is a racist, or bigot at all. The eight hundred pound monster in this room is the Critical Lack of Clinical Judgment, diagnostic skills, demonstrating complete disregard for the oral structures and welfare of Patient Ayana Smith by violation of universal precautions[vi]

Groots Constantia Winery, Southern Suburbs, Cape Town South Africa

So on that day of May 6, 2017, William “Bill” Bell DDS was so busy trying to be someone he isn’t, he forgot who he was, and what he was, …. A Dentist…A Clinical Examiner. Instead he just looked at Patient Ayana Smith and looked right through her…. as a modern day Sarjie Bartman[vii] (Hottenot Venus)[viii] as he looked at me and looked right through me.

CONCLUSION

WILLIAM “BILL” BELL DDS must be removed as Chief Examiner of the CDCA Dental Board Examination as having demonstrated poor clinical judgment and failure to meet minimum appropriate clinical standard of care for the patient.

More Importantly William “Bill” Bell failed to use Universal Precaution Infection Control Procedures as published by the Center for Disease Control and Prevention,[ix] by failing to wear masks and gowns when examining Patient Ayana Smith. 

Patient Ayana Smith (see exhibit-2, pg-2) felt mistreated Dr. William “Bill” Bell and became so outraged. 

Therefore, I file this timely Appeal and request review and redress of the entire exam I took at the University of Florida College of Dentistry May 5 thru 6, 2017.

In these times of fake news and alternative facts (both which have absolutely no merits in the Profession of Dentistry)…. There is one thing I’ve learned in life from a man neither I liked nor voted for, but have come to greatly respect: PRESIDENT RONALD REAGAN;

“WE MUST TRUST AND VERIFY”

norman j clement rph dds

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[i] CANDIDATE MANUAL, America Board of Dental Examiners (ADEX) 2015, The Commission on Dental Competency Assessments, www.nerb.org, (PENALTIES) pg.9.

[ii] CANDIDATE MANUAL, America Board of Dental Examiners (ADEX) 2015, The Commission on Dental Competency Assessments, www.nerb.org, pg.33-35.

[iii] Et al., pg.34.

[iv] Et al., …pg.102.

[v] Martin Luther King Cultural conditioning, “in America we are culturally condition t to under estimate, under value, and marginalize”

[vi] CANDIDATE MANUAL, America Board of Dental Examiners (ADEX) 2015, The Commission on Dental Competency Assessments, www.nerb.org, (PENALTIES) pg.9.

[vii] https://en.wikipedia.org/wiki/Sarah_Baartman

[viii] https://www.youtube.com/watch?v=gj4x-6UMg9M

[ix] Et al., pg.102. pg.102..

Living in the Spirit of Sankofa

FOR NOW YOU’RE WITHIN THE NORMS

Norman J Clement RPh, DDS