Image © Valeriy Velikov Adobe Stock #99990429

Image © Valeriy Velikov Adobe Stock #99990429


Working As A Dentist in the United States

Licensure for foreign-educated dentists is a costly and lengthy process, with each state requiring different procedures for licensure. The following guide provides an overview of the process and options to gain licensure. It is highly recommended that you check the American Dental Association (ADA),, for more details and the most up-to-date information. You should also refer to the American Association of Dental Boards,, to check the requirements of each state dental board for licensure.

There are two major options towards licensure:

1.     Acquire a Doctorate of Dental Surgery (DDS) or Doctor of Medicine in Dentistry/Doctor of Dental Medicine (DMD)

Texas and most states require that foreign educated graduates acquire a DDS or a DMD, which are equivalent degrees involving studying at a university accredited by the Commission on Dental Accreditation (CODA) for two to four years. This degree allows foreign educated graduates to apply for licensure as if they are a US-based graduate and provide the greatest options in terms of the states where a foreign educated dentist can apply for licensure.

2.     Complete a Specialty Education Training Program

Some states allow foreign educated graduates to apply for licensure after completion of a specialty education training program accredited by the American Dental Association (ADA). Typically, a specialty program takes a minimum of two years. Examples of accepted specialties include endodontics, pediatrics, periodontics, oral surgery, dental public health and others. Note that while Texas currently allows foreign educated graduates to apply for licensure after completing a residency, not all states accept this requirement for eligibility. If you chose to pursue this path, you are strongly urged to contact each state’s board of dental examiners, including that of Texas, to check the requirements, since they are modified regularly.

Alternatively, some states will accept application for licensure from foreign educated graduates provided that they complete a specialty education training program, a eneral Practice Residency (GPR), or an Advanced Education in General Dentistry (AEGD). Note that taking this route may greatly decrease the options for states that you can practice in. See Box 1 below for more information.


Read through the American Dental Association’s (ADA) National Board Dental Examination (NBDE) Guide

It’s important to start by reading through the guide on the NBDE to determine your eligibility for taking the exam,

The NBDE is required for all licensure paths mentioned above.


Acquire Evaluation of Coursework

In most cases, you will need to have a report of the coursework you completed in your home country to apply to take the National Board Dental Examination (NBDE) and to apply for dental programs in the United States. A commonly used service, which is also preferred by the ADA is the Educational Credential Evaluators (ECE), Inc.,

However, it is also very important to check the specific dental university programs you are interested in applying for to determine whether there is a recommended or preferred evaluation service. For example, some programs require evaluation from the World Education Services (WES), Be sure to check the websites for fees and delivery information. You may want to request additional copies for your future applications.


Acquire a DentPin Number

You must acquire a Dental Personal Identification Number or DentPin through the ADA, This number will be associated with your application throughout the licensure process, so it is very important to enter your name exactly as it appears on your identification document (i.e. passport).


Register for and take Part I and Part II of the National Board Dental Examination (NBDE)

It is necessary to take Part I and Part II of the National Board Dental Examination (NBDE), which is administered by the ADA Joint Commission on National Dental Examinations (JCNDE). You cannot apply for the DDS, DMD, specialty training programs, or any other paths without this step.

You may register to take Part I and Part II of the NBDE through the ADA’s Department of Testing Services using your DentPin, Upon submitting your application, you will receive an eligibility letter with a number from the ADA, which is required to select a test time and date through Prometric, the testing agency. This registration remains valid for six months. Once you have received the information from the ADA, you may schedule your test through Prometric, The fee for Part I of the exam is $395 and the fee for Part II is $440, with additional fees for score reports and other materials.

Part I of the NBDE contains 400 multiple choice questions on general scientific topics, including anatomic sciences, dental anatomy, biochemistry, pathology and other areas. The exam is taken in one sitting and lasts about 8 and a half hours.

Part II of the NBDE includes topics covering dental specializations, such as endodontics, periodontics, oral diagnoses and other areas. The exam is taken over a two-day period, with the first day taking 8 hours and 15 minutes and the second day lasting 4 hours.

Study and practice materials are available through the American Student Dental Association,, which offers reprints of past exams for a fee. The Joint Commission on National Dental Examinations also offers additional resources,


Take the Test of English as a Foreign Language (TOEFL ibt)

If you haven’t already done so, make sure to take the TOEFL ibt, which is administered more than 50 times a year on specific dates by ETS, You may register online for the exam and fees differ according to the test location. Usually schools require a score of 100 or above.

Practice materials can be acquired through ETS,


Research and Apply for Dental Programs or Specialty Training Programs

You should research Doctorate of Dental Surgery (DDS) or Doctor of Medicine in Dentistry or Doctor of Dental Medicine (DMD) programs on the American Dental Education Association’s (ADEA) Centralized Application for Advanced Placement for International Dentists (CAAPID), This website allows applicants to complete one application for several programs; however, not all universities are available in this database. It is highly recommended that you check the ADEA website to determine which universities are not included. The ADEA states that most programs require a minimum of two letters of recommendation, TOEFL ibt, and fees; but it is you should check each program’s specific websites for their requirements as well.

The application deadline varies by program, check for more information. Programs typically take two to four years to complete.

For the Specialty Training Programs, you may apply through ADEA Postdoctoral Application Support Service, Again, this allows applicants to complete one application for more than 700 programs.


Take a Regional Exam for Initial Licensure

Once you have completed – or are about to finish – your DDS or DMD or the specialty program, you are required to take a regional examination for initial licensure. Typically, you must acquire a form completed by the Dean of your university certifying your status as a current student or graduate of the DDS or DMD program. After completing a specialty program, some states, including Texas, require you to submit a request for taking the regional examination.

After passing one of these examinations, you become eligible to acquire licensure through the state you chose to practice in. Note that each state has its own requirements for licensure, which may include additional steps.

There are currently five regional dental examinations, which cover different geographic locations of the US. Delaware is the only state with a specific examination that does not fall under one of these five regional exams. The five exams include:

1.     Central Regional Dental Testing Service (CRDTS),

2.     Commission on Dental Competency Assessments (CDCA, formerly NERB),

3.     Council of Interstate Testing Agencies (CITA),

4.     Southern Regional Testing Agency (SRTA),

5.     Western Regional Examining Board (WREB),

The CDCA and CITA are typically the most widely accepted exams; however, there are states that do not accept the results of either exam and instead, only accept results from the WREB or completion of a residency, for example. The ADA compiles a table summarizing each state’s licensure requirements, which is updated regularly. Though it is highly recommended that you refer directly to the state’s dental board, this provides a good overview for determining which examination to take.

Typically, exams are taken on multiple days and involve a written and clinical portion with mannequins and patients. In many cases, test takers are responsible for bringing in patients to sit for the clinical portion of the examination. For additional information and details on registration, fees and practice materials, check the websites of each individual exam. Note that changes are made frequently and it’s very important to check the websites regularly for details.

As of 2017, Texas accepts the results of all five exams. Note that you can use the exam results to apply for licensure in different states for up to five years after taking the examination. It is to your advantage to apply for licensure in more than one state before your results expire to keep your options open.


Apply for State Licensure from State Dental Board

As stated above, each state has its own licensure requirements. In Texas, application for the licensure can be acquired through the Texas State Board of Dental Examiners (TSBDE),

The application involves a number of materials, which must be sent by mail. For a full list of the required materials, visit The licensure application requires completion of a Jurisprudence Assessment pertaining to the rules specific to Texas. You can register and pay for the assessment online, The cost of the assessment is currently $54.00.

Again, if you are applying for licensure in a different state, it is highly recommended you contact the board of dental examiners in that state to learn about specific requirements. Some states, such as New York, require that students complete a residency training program before applying for full licensure. Refer to the American Association of Dental Boards for more information.

Box 1.

A General Practice Residency (GPR) or an Advanced Education in General Dentistry (AEGD) program, which involve training in a hospital and clinical setting, respectively, allow foreign educated graduates to be eligible for application for the licensure in a very limited number of states. While these programs are shorter and financially less prohibitive than the DDS/DMD (some programs offer a stipend for dentists) and specialty training programs, they generally offer significantly less options in terms of the states where foreign educated graduates can practice. Again, it is highly recommended that you contact individual state boards of dental examiners for more information.

There are a total of 184 GPR programs and 91 AEGD programs in the United States. Some universities, though not all, accept application to the GPR and AEGD through the centralized ADEA PASS application,