How to Get Licensed as a Foreign-Trained Dentist in the United States

If you’re a dentist planning to immigrate to the U.S., you’ll need a U.S. dental license to continue your career. Although you may be legally allowed to work, getting licensed as a dentist can be a long process.

These challenges might tempt you to seek work outside the field of dentistry, where you don’t use your skills and training. But, it actually is possible for you to get your foreign credentials validated so you can start practicing in the U.S. and making great money.

To help make the process of getting your license smoother, we’ll go over the steps you need to take to begin the journey toward finding a job as a dentist in the U.S.

You may be wondering why you should get your dental license in the United States?

Well, it’s important to note that the United States really needs more dentists. In fact, a study done by the American Dental Association in 2021 showed there is a shortage of dentists all across the country.

Besides fulfilling the need for dentists, you could also earn substantial income. According to Indeed.com, the average salary for a dentist in New York is over $200,000 a year and in Florida, the average salary is over $225,000.

Clearly it’s worth the trouble to get licensed. But how do you begin the process?

In this guide, we will answer the following questions:

• Understanding Who Grants Your Dental License
• How to Contact Your State’s Dental Licensing Board
• Ensuring Your Education Meets U.S. Standards
• Exploring the American Dental Education Association’s CAAPID Program
• The Necessity of Credential Evaluations for Foreign-Trained Dentists
• The Role of Certified Translations in the Licensing Process
• Required English Proficiency for Dentists in the U.S.
• Preparing for the National Dental Licensure Exam (INBDE)
• Navigating State-Specific Dental Exams
• Exam Requirements by State for Dental Licensure in the U.S.
• Maintaining Your Dental License: Renewal and Continuing Education Requirements

Understanding Who Grants Your Dental License

Dentists handle delicate procedures in their practice. From performing root canals to installing dental implants, dentists need specific training to keep patients safe. Considering this, it’s not surprising that dentists are carefully reviewed before receiving a license.

American Dental Association (ADA) & Commission on Dental Accreditation (CODA)

For example, if you’re hoping to work as a dentist in Texas, you will obtain your licensure approval from the Texas State Board of Dental Examiners. Or, if you want to work as a dentist in Boston, you’ll need to get licensed by the Massachusetts Board of Registration in Dentistry.

How to Contact Your State’s Dental Licensing Board

A quick Google search will give you the phone number, mailing address, and email of the dental licensing board in the state where you want to work. But, pay close attention as some states have separate licensing boards for dental hygienists, while others have a combined board.

Here are the websites for the dental licensing boards in California, Florida, Illinois, Massachusetts, New Jersey, New York, and Texas and if you need contact information for other states, you can find it here.

Here are some tips for emailing your state’s dental licensing board.

If English isn’t your first language, you might want to compose an email or letter in your native language and then translate it for clarity. We can assist with professional translations if needed to ensure your message is clear.

You’ll also want to include as much information as possible in your email or letter. Be sure to provide your full name, phone number, regular address, phone number, and email address to make it as easy as possible for the licensing board to respond to you.

If you decide to make a phone call to the licensing board, be mindful of the board’s office hours. Licensing boards are usually in the office from 9 am to 5 pm, Monday through Friday.

Now let’s dive into more specific information you’ll need before you can become a dentist.

Ensuring Your Education Meets U.S. Standards

To be a licensed dentist in the U.S., you’ll need one of two degrees: a Doctor of Dental Surgery which is called a “DDS”, or a Doctor of Dental Medicine, also known as a DMD. While you might have an equivalent degree from your home country, there’s one more important requirement to keep in mind.

If you’ve been researching the education guidelines for foreign-trained dentists who want to work in the United States, you’ve probably heard of the “Commission on Dental Accreditation”, or “CODA.”

Nearly every state’s dental board in the U.S. will require that you have an education from a CODA-accredited dental school or program. CODA’s website explains that their accreditation ensures the education provided to students adequately prepares them for careers as dentists.

While this requirement is understandable, it could be slightly discouraging if you’ve already received a degree from your home country that wont be sufficient in the U.S. So, there’s basically two steps you can take if you’re in this situation.

First, you should directly contact the specific dental board serving the state you want to live and work in. Some states may offer alternative pathways to becoming a licensed dentist outside of having a CODA-accredited education. Your state dental board will have updated and precise information if there’s another way to become a dentist, so the best thing to do is ask them directly.

The second step you can take is to enroll in a program that accounts for the education you already have which allows you to take fewer classes, spend less time in school, and ultimately graduate with a DDS or DMD. Let’s take a look at how this program works.

Exploring the American Dental Education Association’s CAAPID Program

If you’ve had your educational credentials and professional experience evaluated and you realize you need more schooling, this program could be perfect for you.

The American Dental Education Association, or ADEA, created a program called the Centralized Application for Advanced Placement for International Dentists. We’ll call the program CAAPID for short.

The idea behind the program is that some state licensing may not recognize your foreign education. These states prefer that you attend a school accredited by CODA. Yet, a normal dental program in the United States can take from 4 to 6 years which is a long time and could be expensive.

If you apply to a CODA accredited school through CAAPID, the program will only be two to three years in length. For example, Boston University’s dental program is 24 months and University of California’s dental program is only 25 months. By recognizing your foreign education, CAAPID places you in advanced standing with a dental school in the U.S., allowing you to earn a Doctor of Dental Surgery degree or a Doctor of Medicine in Dentistry degree, in much less time.

Schools in almost every region of the United States participate in CAAPID from the East Coast to the West coast. To find a program that might work well for you, check out the list that ADEA created.

As you look at the list you’ll see the name of the school, how many months each program is, whether you’ll be awarded a DDS or a DMD, and when the program begins and ends.

The Necessity of Credential Evaluations for Foreign-Trained Dentists

Whether you’re planning to apply to a CAAPID program or take a more specific pathway through your state, you’ll need to demonstrate what education and experience you already have. The best way to demonstrate your career history is through a credential evaluation service.

These services take a detailed look at the academic and professional qualifications of people from other countries and convert them into information that makes sense to someone familiar with the U.S. educational system. Then, they create a report that explains how your foreign grades and degrees are equal to those in the U.S. This helps universities and state dental boards understand your qualifications.

To perform the credential evaluation, these companies will need your transcripts, mark sheets, certificates or diplomas, and any other relevant material depending on the country.

Credential evaluation services provide different tiers of evaluations. A less detailed service might be described as a “general evaluation” or “course by course evaluation,” and these services might cost between $70 and $200. On the other hand, a comprehensive evaluation will gather more information and could cost $150 to $500.

Dentists often perform life-changing procedures and surgeries and need to keep their patients safe. As a result, state licensing boards will probably want a comprehensive evaluation of your education and experiences. You can expect the evaluation company to ask you for official sets of your academic record which may include transcripts, report cards, and examination statements. You’ll also need to provide documentation of your internships, work experience, and licenses from your home country.

The processing time for credential evaluations can range from 5 days to 4 weeks. But luckily most evaluation companies offer expedited services for an added fee if you’re in a hurry.

As you search online for credential evaluation services, you’ll see an endless number of options, but there are two specific companies that are closely tied with the dental system in the United States.

The American Dental Association specifically says that internationally-trained candidates applying to take the Integrated National Board Dental Examination “must have their educational degree confirmed through Educational Credential Evaluators”, which is abbreviated as “ECE.”

The ADEA also mentions ECE and another credential evaluator called World Education Services, which is abbreviated as “WES.” So, if you’re hoping to become a dentist in the U.S. you might want to consider using WES or ECE to evaluate your professional experience.

However, because each state licensing board has different preferences, it’s best to directly contact the licensing board where you hope to work and ask if they prefer a certain credential evaluation company.

One thing is for sure though, credential evaluation companies require English translations of any foreign documents. For instance, ECE says that all foreign documents must be translated into English in a literal, word-for-word format consistent with the original document. The best way to make sure they’re accurate is to have them completed by a professional translation service.

One last thing to consider is that these agencies can send your evaluation directly to the dental board in the state you want to work in. In some cases, this can even be better because the licensing board may require that the evaluation and translation come directly from the evaluation or translation agencies to ensure the documents’ authenticity.

The Role of Certified Translations in the Licensing Process

One of the most important things to keep in mind is that, even if your English is perfect, you cannot translate your documents yourself. That said, typically evaluation agencies provide you with various options depending on whether you are going to have your documents translated in the U.S. or abroad. Be sure to check with the evaluation agency because they may have certain requirements.

Some evaluation agencies may even offer translation services for a fee; however, since we at US Language Services specialize in translation, our rates are usually far more competitive, and can be as much as 50% less than what evaluation agencies charge.

Also, if the agency or the board requires that the translation be sent directly to them, we are happy to do so. It’s important to understand that certified translations do not indicate the direct correspondence between a degree obtained abroad and its equivalent in the US.

Certified translations simply put the documentation in English so that you can send it and the evaluation agency or licensing board can review your academic and professional accreditations in English.

Certified translations do not change the value of a grade obtained, for example, if you have obtained a 10 in a subject in a country where it is numerically evaluated out of 10, the certified translation will indicate that you have obtained a 10, not an A+.

In addition to any document required for the credential evaluation process, you may want to have any letters of recommendation or certificates of work experience translated for future job applications.

To obtain a certified translation from U.S. Language Services, you can place your order through our website or request a quote. You can simply send us scanned documents or even photographs of them; it is not necessary to send the physical documents for this part of the process.

Order Your Certified Translation
Get a free quote

Required English Proficiency for Dentists in the U.S.

If you’re hoping to start a career as a dentist in the U.S., you’ll need to regularly use your English reading and speaking skills. Whether you’re talking with patients, prescribing medication, or updating records, strong English skills are essential. Proficiency in English will allow you to communicate effectively with colleagues and patients, engage in continuing education, and maintain your licensure.

English proficiency is particularly important for scheduling appointments, asking patients how they’re feeling, explaining procedures, and providing post-treatment care instructions. Additionally, being able to take feedback from colleagues and discuss patient care plans is vital.

Two of the most widely recognized exams to demonstrate English proficiency are the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS). Both exams can help you prove your English skills and assist in securing employment after you obtain your license.

Preparing for the National Dental Licensure Exam (INBDE)

This exam is known as the Integrated National Board Dental Examination, or the INBDE, which is administered by the Joint Commission on National Dental Examinations (JCNDE).

In addition to the INBDE, most states will require you to take a clinical exam where you perform hands-on dental procedures with a mannequin which is called a typodont. You may also need to take an exam that covers the specific laws and rules of the state where you hope to work. We’ll take a closer look at those smaller state exams later, but for now let’s focus on the INBDE.

The INBDE is a series of multiple choice questions administered on a computer over two different days, in two sections. Once you take the first part of the exam, you will be required to take the second part within 7 calendar days, in the same testing location. If you fail to take the second part of the exam within 7 days, you’ll have to retake both parts of the exam and pay the exam fees again.

The fee to take the exam is $845. Additionally, there is a $350 processing fee for international candidates, students, or graduates of a dental program outside of the United States or Canada.

You can reschedule your exam for a price but the closer you get to your exam date, the more expensive it will be to reschedule.

• If you reschedule 30 or more business days in advance, the fee is $40.
• If you reschedule within 5 to 29 business days, the fee is $70.
• If you reschedule within 1 to 4 business days, the fee is $150.

On the first day of the exam, you’ll begin with a 15-minute tutorial. Then, you’ll be given 3 sets of 100 multiple-choice questions. For each set of questions you’ll have 105 minutes, and a 15-minute break between them. After that, you’ll be given 60 case-study questions and you’ll have 105 minutes to complete those as well. The case studies will usually be accompanied by radiographs, clinical photographs, periodontal charts, and odontograms. The total testing time on the first day will be 8 hours and 15 minutes.

On the second day of the exam, you’ll begin with another 15-minute tutorial. Then, you’ll need to answer two more sets of 70 case-study questions with one 15-minute break between them. At the end of the exam, you’ll be given an optional 15-minute survey. The second day’s total time is shorter at 4 hours and 15 minutes and all together, the exam has 500 questions.

In a public PDF test guide the JCNDE explains that there are 3 subject areas covered in the exam. The first subject area is “Diagnosis & Treatment Planning” and makes up 36% of the exam questions. The second subject area is “Oral Health Management” and makes up 42% of the exam questions. The third subject area is “Practice and Profession,” and makes up 22% of the exam questions.

In order to pass the exam, you’ll need a score of 75 or higher. The scoring system is a bit confusing because a score of 75 doesn’t mean you have to answer 75% of the questions on the exam correctly. As you’ll remember from earlier, there’s a total of 500 questions. Each correct answer you give adds one point to your raw score. At the end of the test, this raw score is converted to a scaled score, which ranges from 49 to 99.

The raw score is converted to a scaled score because each person taking the INBDE exam gets a different set of questions. Since some questions are harder than others, the conversion makes sure that everyone’s score is fair. The important thing to remember is that you need at least a score of 75 to pass.

After you’ve taken the exam, your results should be available to view through an online portal in four weeks.

The JCNDE will report your exam results directly to three state licensing boards on your behalf as long as you request for these reports to be made when you apply for the INBDE.

So, if you’re moving to New York, it could be wise to go ahead and have your exam results sent to two other states in the northeast region of the U.S. such as New Jersey and Pennsylvania.

If you want to have the results of your INBDE exam sent to any other states that you didn’t list on your exam application, you’ll have to pay a $50 results report fee for every extra report. To make these report requests, you can sign into the same online portal where you see if you pass or fail the exam. Then click on the “Requests” tab.

If you don’t pass the INBDE, you can wait 60 days and take the exam again. You’ll be able to take the exam 4 times within a 1 year period. If you don’t pass the exam on your 5th attempt, you’ll need to wait one year before retesting.

One of the easiest ways to make sure you pass the exam your first time is to utilize all the resources available for studying online and on your phone.

A great place to begin studying is the 38-question practice exam provided directly by the Joint Commision on National Dental Examinations JCNDE. In the practice test you’ll be given radiographs, photos, and background history of real patients. You’ll then need to answer multiple choice questions to identify dental problems, suggest treatments, and prescribe proper medication.

Mentaldental.com is another excellent resource offering over 100 free video courses to help you study for the INBDE. When you go to their website, you’ll see these video courses are organized into miniseries such as operative dentistry, orthodontics, oral pathology, and pharmacology.

If you’re willing to pay for study materials, Bootcamp.com is highly regarded among aspiring dentists. The payment is structured based on how long you’ll be a member of the website. To access their resources for one month you’ll pay $219, for 3 months the price is $319, and for 6 months you’ll pay $419.

When you sign up, you get a detailed 45-day schedule that tells you exactly what to study each day. All the materials are housed in an online portal and also through iPhone or Android mobiles apps so you can study anywhere you go.

The course includes a library of video lessons, 2,500 practice questions, and a 500-question mock exam. One of the best things about Bootcamp’s review questions is that they’re aesthetically designed to look exactly like the real INBDE questions. So, as you practice the test questions you become familiar with both the content and the exam layout at the same time.

Another paid study guide comes from a program called INBDE Booster. In most ways the website offers pretty much the same content as Bootcamp. However, the INBDE booster is slightly cheaper at $299 for 3 months or $399 for 6 months. In addition to a cheaper price, some reviews found Booster’s explanation videos to be better than Bootcamp’s videos. The same review also said that Booster’s program is better at identifying your weaknesses and helping you improve.

If you’re looking for a cheaper option, Kaplan Medical offers around 2,600 image-based questions that you can study from a computer or from their mobile app. While Kaplan doesn’t offer video clips, it does provide detailed explanations of answers, and it’s only $150.

One of the best ways to stay updated regarding test prep and other useful information in the dental community is to join online forums. For starters you can ask questions and receive quick feedback on the subreddit r/INBDE. This subreddit is extremely active with people giving tips and responding to inquiries every day.

Similarly, a facebook group simply called “INBDE” has over 39 thousand members. The group is super active with dozens of people posting every day. Plus, the group is private so after being approved to join, you’ll have a good chance at avoiding unrelated information. Like the reddit group, you can ask for advice about anything related to the INBDE.

Navigating State-Specific Dental Exams

Aside from the INBDE, most states have one or two other exams for aspiring dentists. The first type of exam is clinical and tests your ability to diagnose patients in realistic scenarios and perform hands-on dental work. The second type of exam pertains to each state’s specific laws and rules.

In many states, you have an option to choose which clinical exam you want to take. But in recent years, one clinical exam has become so popular among state licensing boards that it’s worth taking a quick look at.

That exam is the American Board of Dental Examiners exam, which is also called the ADEX.

This exam is accepted as one possible clinical test in many states, but it might not be the only possible exam you can take. There are many states that accept other exams as well, meaning you can choose between more than one clinical exam. For example, in Texas you can choose to take the SRTA instead of the ADEX.

Among the most popular states for immigrants relocating to the U.S., the states that accept the ADEX in 2024 are California, Florida, Illinois, Massachusetts, and New Jersey.

It’s worth noting that as of 2024, New York does not accept the ADEX exam. Anyway, let’s talk about what’s on the test.

The ADEX includes computer simulations and clinical skills problems you’ll need to resolve on a manikin. It has five skill-specific parts which are the diagnostic skills examination, prosthodontics, endodontics, periodontal scaling, and restorative anterior and posterior. Let’s quickly break down what each of these subject areas entail.

The diagnostic skills exam is administered on a computer using radiographs, optical images of study and working models, laboratory data, and other digitized reproductions of patients. Candidates will have 4 hours for this part of the exam.

The prosthodontic part of the examination requires candidates to complete three crown preparations within four hours. These three crowns must be made using three separate materials which are ceramic, porcelain-fused-to-metal, and cast metal.

The endodontic portion of the exam requires candidates to complete a root canal procedure on both an anterior (front) tooth and a posterior (back) tooth within three hours. Endodontic procedures involve treating the inside of the tooth, particularly the dental pulp and root canals.

The periodontal part of the exam will require candidates to remove hardened plaque deposits called “calculus” from 12 teeth in the lower jaw within 60 minutes.

In the restorative exam, candidates have up to 7 hours to complete two tasks: fixing a cavity on a lower back tooth and fixing a cavity on an upper front tooth.

The price of this exam is $2,795 and that includes one free retake, but you’ll have to pay a fee of $150 to use the manikin on your retake. In order to pass the exam, you’ll need to score 75% or higher.

To answer some of your other questions, you can check out the ADEX Dental Candidate Manual, which is an online PDF form that provides folks with a ton of information.

The popularity of the ADEX exam has been growing since 2020. Since then, multiple dental organizations have merged to streamline the clinical exam process for dentists across the United States. But, because the ADEX is still a developing exam, it can be hard to find information about where and when to take it.

So, the best way to know exactly where and when to take the ADEX is by creating an account with the organization online. After creating an account you’ll be able to see the exam locations and calendar dates closest to you.

If you have a more specific question, you can use ADEX’s online contact form where you’ll receive an email response within 2 to 3 business days.

Exam Requirements by State for Dental Licensure in the U.S.

California

For starters, California accepts the ADEX exam for clinical purposes, but you also need to take the Dental Board of California Law and Ethics exam. In order to pass the exam you must answer 75% of the questions correctly. The fee to take the exam is $125.

If you’re a refugee, asylee, or special immigrant in California, you might be eligible to have your licensing process expedited. To qualify, applicants must provide evidence of their status, such as Form I-94, a special immigrant visa, or a Permanent Resident Card. To see if this could work for you, contact the Dental Board of California or email refugee@dca.ca.gov for assistance.

Florida

In Florida, the ADEX exam is the only clinical exam the state accepts, plus you’ll also need to take the Florida Laws and Rules Examination. The exam has 67 multiple choice questions and you’ll be given 90 minutes to complete it. The exam fee is $135 and you’ll need to answer 75% of the questions correctly to pass.

As you’re researching the Florida Laws and Rules Examination, you might find information for other exams by the same name. This is because the state of Florida modifies their laws and rules examination for each different licensed profession. Because of this, it’s really important to pay close attention to which Florida Laws and Rules Exam you’re researching. In Florida, ADEX testing also administers the laws and rules exam, so you can check out their website for specific information.

Illinois

As for Illinois, the state licensing board accepts 4 different clinical exams and the acronyms for those organizations are the ADEX, CRDTS, NERB, and SRTA. Each of these exams are a little different, but are designed to test your clinical skills.

Massachusetts

The Massachusetts Board of Registration in Dentistry requires prospective dentists to pass one of three clinical exams, the SRTA, ADEX, or CRDTS.

In addition to taking one of these exams, you’ll need to pass the Massachusetts Dental Ethics and Jurisprudence Exam. Past exams have contained 64 multiple choice questions; however, they may vary from year to year. That said, you’ll be relieved to hear that the jurisprudence exam is open-book and the state of Massachusetts provides a link of resources to study. Plus, you can email the Board of Registration to request a copy of the exam itself.

New Jersey

According to the New Jersey State Board of Dentistry, hopeful dentists will need to take the ADEX exam and the N.J. Law and Jurisprudence Exam before receiving your license. Luckily, the N.J. Law and Jurisprudence Exam only has 27, multiple choice questions. The exam is open-book and can be taken at any time during your licensure process. The exam is open to the public through a link provided by the New Jersey Division of Consumer Affairs. After you complete the exam, you simply enter your license number and submit the form online.

New York

According to the American Dental Association (ADA) In New York, applicants for dental licenses will not be required to take a clinical exam like the ADEX. Instead, they’ll need to complete a clinically-based dental residency program that lasts for a duration of at least one year. According to the New York State Education Department, the residency program must be approved by CODA.

Keep in mind as you’re researching that dental hygienists in New York are required to take a clinical exam, but dentists are not. A lot of the information for dental hygienists and dentists looks similar, so it can be misleading if you don’t pay close attention.

Another thing that’s unique about New York is that you’ll need to take a Child Abuse Reporting Course that’s approved by the New York State Education Department (NYSED). Luckily, New York’s office of professions provides a list of organizations that offer that course.

Texas

Anyone applying for a dental license in Texas can take the ADEX, CRDTS, or the SRTA. Apart from taking one of these clinical exams, you’ll also have to take the Texas Jurisprudence Assessment which costs $54, is open-book, and can be taken online by following a public link.

Maintaining Your Dental License: Renewal and Continuing Education Requirements

Each state has its license renewal guidelines, fees, and continuing education requirements, so it’s wise to research the specific requirements for the state where you plan to practice. Let’s take a look at the specific requirements dentists need to maintain their licenses in some of the most popular states for immigrants.

California

In California, dentists must complete 50 hours of continuing education every two years. Out of those 50 hours, at least 2 hours need to cover infection control and another 2 hours must focus on the California Dental Practice Act. Finally, 2 hours must cover the Responsibilities and Requirements of Prescribing Schedule II Opioid Drugs. Dentists in California need to renew their license every two years for $668.

Like California, dentists in Florida should renew their license every 2 years. The fee to renew an active dental license is $305 and you’ll need 30 credit hours of continuing education.

Illinois

Dentists in Illinois are required to complete 48 hours of continuing education and the licensing renewal period is every 3 years. According to the Illinois State Dental Society, the continuing education courses should cover sexual harassment training, safe opioid prescribing practices, mandated reporter training, implicit bias training, and basic life support training. The fee to renew an Illinois dental license is $300.

Massachusetts

In Massachusetts, dentists need 40 hours of continuing education every 2 years to keep their licenses up to date. 20 of those hours can be completed online and all dentists must complete a course regarding infection control and prevention. The fee to renew a dental license in Massachusetts is $360.

New Jersey

The New Jersey State Board of Dentistry mandates that dentists renew their licenses every 2 years for a fee of $390. Licensed dentists will need to complete 40 hours of continuing education in every 2 year licensure period.

New York

As for New York, licensed dentists will have to complete 60 hours of continuing education in every 3-year licensing period. 42 of those hours must be taken in-person, and 18 hours can be completed virtually. The fee to renew a dental license will be $287.

Texas

Finally, the Texas State Board of Dental Examiners says that dentists need at least 24 hours of continuing education every 2 years to maintain their license. The fee to renew a dental license will be $458.

That covers the most popular states for immigrants in the U.S., but many of the states in America have similar requirements. The important thing to remember is that it is possible to follow your dreams and become a dentist in the U.S.

And remember, when you need translations be sure to reach out to us here at U.S. Language Services. We can provide you with translations no matter what your situation is, whether you’re getting your dental license, need a letter of recommendation translated, or you’re applying for a visa, we’ll take care of it!

Author: Aaron Randolph | LinkedIn