Updated: August 2026

Many dental graduates around the world dream of continuing their dental careers in the United States or Canada. For internationally educated dentists, however, a dental degree earned outside these countries does not automatically provide eligibility to practice as a dentist.

The good news is that it is possible.

The pathway can be lengthy, competitive, and expensive, but thousands of internationally educated dentists have successfully navigated the process. The key is to understand the requirements of the country—and, in the United States, the particular state—in which you ultimately want to practice.

“A dream doesn't work unless you do.”

Before beginning, ask yourself an important question: Am I genuinely committed to this pathway?

The process may involve credential evaluation, examinations, English-language testing, applications, interviews, practical assessments, additional dental education, and finally professional licensure. Understanding the pathway before spending significant time and money can help you make a much better decision.

This guide focuses primarily on internationally educated dentists who hold a dental degree such as BDS, DDS, DMD, or an equivalent qualification from a program that is not accredited by the relevant North American accreditation system.

Part I: Practicing Dentistry in the United States

An important distinction: Education vs. Licensure

One of the most common misconceptions among international dentists is that passing a national examination automatically makes them eligible to practice.

It does not.

In the United States, dental licensure is governed primarily by individual state dental boards. Most states require an appropriate dental degree from a CODA-accredited program, a written examination, and a clinical assessment, although requirements differ among jurisdictions.

For many internationally educated dentists, the most common route is therefore:

Foreign dental degree → INBDE → Advanced Standing DDS/DMD program → Graduation → Clinical assessment and other state requirements → State dental license

Let's look at the process step by step.

Step 1: Obtain a DENTPIN®

A DENTPIN® (Dental Personal Identifier Number) is a unique identification number used for several dental education and examination services in the United States.

A DENTPIN is required to apply for the INBDE and is also used within the ADEA CAAPID application process.

When creating your DENTPIN, make sure your name and other identifying information match your government-issued identification documents exactly.

It is also wise to use a personal email address that you will continue to have access to throughout the application process.

Step 2: Have Your Dental Education Credentials Evaluated

International dental schools use different grading systems, so U.S. dental schools generally require some form of credential evaluation for internationally earned degrees.

Do not assume that ECE is universally required.

ADEA CAAPID allows participating programs to specify their own requirements, and credential evaluations may be accepted from organizations such as Educational Credential Evaluators (ECE) or World Education Services (WES), depending on the program. Individual schools may have additional requirements.

Typical academic documents may include:

Dental degree or graduation certificate
Official dental school transcript
Mark sheets or grade records
Internship documentation, where applicable
Other academic records requested by the program
Professional registration documents, if requested
English translations when documents are not in English

Important

Do not send documents or order an evaluation simply because another applicant did so.

First, make a list of the schools you are interested in and carefully check the current requirements for each program.

Requirements can change from one application cycle to another.

Step 3: Pass the INBDE

The Integrated National Board Dental Examination (INBDE) replaced NBDE Part I and Part II.

The final NBDE Part I administration occurred in 2020, and NBDE Part II was discontinued in 2022. The INBDE is now the national written examination used for U.S. dental licensure requirements.

The INBDE is designed to assess integrated biomedical and clinical knowledge and the ability to apply dental knowledge to patient-care problems.

The examination is administered by Prometric and is available at authorized testing centers in the United States and Canada. Therefore, the old advice that international dentists must travel specifically to the United States to take the examination is no longer accurate.

International dental graduates from non-CODA-accredited programs may need to submit an INBDE Certification of Eligibility as part of the application process.

Preparation

Your preparation should be based primarily on the current official INBDE Candidate Guide, examination specifications, and other JCNDE resources.

Commercial preparation resources and study groups can also be useful, but always verify current information against the official JCNDE requirements.

The INBDE is reported as Pass/Fail, rather than as the old numerical NBDE score.

Step 4: English-Language Proficiency

English proficiency is an important component of the application process for many advanced-standing programs.

The TOEFL iBT is still required or accepted by many dental schools, but requirements vary by institution. The ADA specifically notes that most dental schools require international dentists to demonstrate English proficiency, while individual programs establish their own requirements.

A major 2026 update

TOEFL iBT introduced a new 1–6 scoring scale on January 21, 2026.

During the transition period, score reports also provide a comparable 0–120 score. The new scale is aligned with the Common European Framework of Reference for Languages (CEFR).

For example, ETS currently indicates that a TOEFL score of 5.0 on the new scale corresponds broadly to the C1 level and is comparable to approximately 100 on the previous 0–120 scale. However, applicants should always follow the exact score requirement published by their target dental school.

Do not rely on an old universal TOEFL score recommendation.

Check each program's current CAAPID profile and admissions website.

Step 5: Apply Through ADEA CAAPID

ADEA CAAPID stands for American Dental Education Association Centralized Application for Advanced Placement for International Dentists.

It is the primary centralized application service used by participating U.S. advanced-standing dental programs.

Instead of submitting completely separate applications to every participating school, applicants can use one centralized application and designate the programs to which they wish to apply.

The current 2026–27 CAAPID cycle opened on March 5, 2026 and is scheduled to close on January 29, 2027. Individual programs establish their own deadlines, and some deadlines may be much earlier.

What can make your application stronger?

Depending on the school, the following may be valuable:

Strong academic performance
INBDE result
English-language proficiency
Clinical experience
Dental shadowing
Volunteer experience
Community service
Research experience
Publications or presentations
Continuing education
Leadership activities
Extracurricular activities
Strong letters of evaluation
A well-written personal statement
Excellent communication skills

However, there is no single formula that guarantees admission.

Every advanced-standing program has its own selection criteria.

ADEA recommends researching individual programs and checking their CAAPID profiles for current requirements, deadlines, and additional examinations.

Step 6: Shadowing, Research and Clinical Exposure

Although requirements differ among schools, exposure to the U.S. dental healthcare environment can help an applicant understand how dentistry is practiced in North America.

Shadowing

Shadowing generally means observing a dentist in a clinical setting without independently providing patient care.

It can help you understand:

Patient communication
Clinical workflow
Documentation
Infection-control practices
Dental team dynamics
Ethical and professional expectations
The organization of a dental practice

Research and Community Service

Research, publications, presentations, volunteer activities, and community service can also strengthen an application, particularly when they demonstrate genuine commitment rather than simply being added to a CV.

Remember that quality and meaningful involvement are generally more valuable than collecting activities simply to make a longer résumé.

Step 7: Interviews and Practical Assessments

If a dental school considers your application competitive, you may be invited for an interview.

The format varies considerably between schools.

Possible components include:

Traditional interviews
Multiple Mini Interviews (MMI)
Group activities
Ethical scenarios
Clinical scenarios
Communication assessments
Written assessments
Practical or preclinical examinations

Some programs also conduct a bench test, in which applicants demonstrate preclinical hand skills.

The exact exercises vary by school and may change from year to year.

Some programs may test procedures involving operative dentistry, fixed prosthodontics or other preclinical skills.

Therefore, applicants should study the specific requirements of each school rather than preparing for one universal bench test.

Step 8: Advanced-Standing DDS or DMD Program

For many internationally educated dentists, the most straightforward route to U.S. licensure is an advanced-standing DDS or DMD program.

These programs are designed specifically for dentists educated outside the United States and Canada and are generally shorter than the traditional four-year dental curriculum.

ADEA notes that advanced-standing programs typically allow internationally educated dentists to complete a U.S. DDS or DMD in approximately two to three years, depending on the program.

Programs may use different names, including:

Advanced Standing Program
International Dentist Program (IDP)
Internationally Trained Dentist Program
International Dental Program
Advanced Placement Program

The name varies by university.

For example, current programs listed by ADEA include two-year, 24-month, and approximately 29-month programs.

After successful completion, graduates receive a U.S. DDS or DMD degree from the institution.

Step 9: Financing Your Dental Education

This is one of the most important issues to consider before applying.

Dental education in the United States can be extremely expensive, and international students may have fewer financing options than U.S. citizens or permanent residents.

Tuition, fees, instruments, living expenses, health insurance, books, transportation and other costs can make the total cost substantial.

Do not rely on an old estimate such as "$150,000–$300,000."

Costs vary enormously between universities and continue to change.

Before accepting an offer, calculate the expected total cost of attendance, not just tuition.

Investigate:

University scholarships
Institutional financial aid
Private educational loans
International-student financing
Co-signer requirements
Interest rates
Loan repayment conditions
Living expenses
Health insurance
Additional fees

Never assume that a particular loan program is available to every international student.

Step 10: Complete the Requirements for Dental Licensure

Graduating from a U.S. dental school does not automatically grant a dental license.

After graduation, you must meet the requirements of the state in which you intend to practice.

The ADA states that U.S. licensing jurisdictions require the INBDE as the written examination component, while most jurisdictions also require a clinical assessment. The clinical examination accepted varies by state or territory.

Clinical assessment systems and agencies can change, so applicants should consult the current requirements of their intended state dental board.

The ADA's interactive dental licensure map provides state-specific information, but the ADA also advises applicants to confirm requirements directly with the relevant state board.

Additional requirements may include:

Background checks
Jurisprudence examinations
CPR certification
Fingerprinting
Proof of education
Proof of examination results
Application fees
Professional references
Other state-specific requirements

Most important:

There is no single "U.S. dental license."

A dental license is issued by the relevant state or territorial licensing authority.

What About PASS and Dental Residency?

Another option sometimes discussed among international dentists is ADEA PASS (Postdoctoral Application Support Service).

PASS is used for applications to advanced dental education programs such as residencies and other postgraduate programs.

However, completing a dental specialty or advanced dental education program is not automatically equivalent to completing an accredited predoctoral DDS/DMD degree for U.S. licensure.

The ADA specifically notes that, in most states, completing an accredited advanced dental education program does not satisfy the educational requirement for licensure when the individual's original dental degree came from a non-accredited program.

Therefore, do not assume that entering a U.S. specialty or residency program is a shortcut to general dental licensure.

Always check the requirements of the state where you intend to practice.

Part II: Practicing Dentistry in Canada

The Canadian pathway is different from the U.S. pathway.

The organization responsible for the national dental certification process is the National Dental Examining Board of Canada (NDEB).

If your dental degree is from a program that is not accredited or recognized through the Canadian accreditation framework, you generally have several pathways to NDEB certification.

Canadian Pathway 1: NDEB Equivalency Process

The traditional NDEB Equivalency Process for graduates of non-accredited dental programs consists of:

1. Assessment of Fundamental Knowledge (AFK)

The AFK evaluates biomedical and applied clinical science knowledge.

2. Assessment of Clinical Judgement (ACJ)

The ACJ evaluates clinical decision-making, diagnosis, treatment planning and related knowledge.

3. NDECC

The NDECC (NDEB Equivalency Process Clinical Examination) is the clinical component of the Equivalency Process.

After successfully completing the Equivalency Process, candidates can proceed to the NDEB Certification Process.

Canadian Pathway 2: Qualifying or Degree Completion Program

Instead of completing the examination-based Equivalency Process, eligible internationally educated dentists may apply to an accredited Qualifying or Degree Completion Program at a Canadian dental school.

These programs are designed to familiarize internationally educated dentists with Canadian dental practice and education.

After successfully completing an accredited program, graduates become eligible for the NDEB Certification Process.

Admission to these programs is highly competitive, and each university has its own requirements.

Canadian Pathway 3: A New Bridge Training Option

One of the most significant developments in 2026 is the Bridge Training to Dental Practice in Canada (BTDPC) pathway.

The program received preliminary accreditation from the Commission on Dental Accreditation of Canada (CDAC).

Beginning July 1, 2026, graduates of non-accredited dental programs who complete an accredited bridge training program can become eligible to apply to the NDEB Certification Process without taking the NDECC.

This represents an important new pathway for internationally trained dentists and should be considered when planning a Canadian career.

Because the pathway is new, applicants should carefully review the current NDEB and program-specific requirements before making decisions.

The NDEB Certification Process

After completing the required pathway, internationally educated dentists proceed to the NDEB Certification Process.

The current certification examination is the Virtual OSCE.

The Virtual OSCE assesses problem-solving and critical decision-making skills expected of beginning dental practitioners in Canada. It currently consists of 200 questions, including standard multiple-choice and case-based questions.

After successfully completing the Certification Process, the candidate can obtain NDEB certification.

But certification is not the same as provincial licensure.

Step: Provincial Dental Licensure in Canada

Once you receive NDEB certification, you must apply to the dental regulatory authority in the province or territory where you intend to practice.

The provincial regulator may require additional documentation, jurisprudence examinations, language proficiency evidence, registration fees, or other requirements.

The NDEB clearly states that NDEB certification does not automatically provide a license to practice dentistry in Canada.

Therefore, your final pathway is:

Foreign dental degree → NDEB pathway → NDEB Certification → Provincial dental regulator → Dental license

A New NDEB Examination Registration Change in 2026

Another important recent development is the NDEB's change to examination registration.

Beginning September 1, 2026, the NDEB will introduce a second registration period for the AFK, ACJ and Virtual OSCE.

The second registration period will open approximately 6–8 weeks before the examination and may allow candidates to register or transfer if seats become available because of withdrawals or increased examination capacity.

This is particularly useful information for candidates who previously had difficulty securing examination seats.

USA vs. Canada: Which Pathway Is Right for You?

There is no universally better option.

Your decision should depend on:

Where you ultimately want to live
Where you want to practice
Your financial resources
Your examination preparation
Your academic profile
Your immigration plans
Your preferred practice environment
Availability of advanced-standing or qualifying programs
Your willingness to complete additional education

United States

A common pathway is:

Foreign dental degree → DENTPIN → Credential evaluation → INBDE → English proficiency → CAAPID → Advanced Standing DDS/DMD → Graduation → Clinical assessment → State licensure

Canada

A common pathway is:

Foreign dental degree → NDEB Equivalency Process OR Qualifying/Degree Completion Program OR eligible Bridge Training pathway → NDEB Certification → Provincial licensure

The exact pathway depends on your education, eligibility and the current rules of the relevant institutions and regulators.

How Long Does the Process Take?

There is no single fixed timeline.

For the United States, the process may take several years because applicants may need to complete examinations, apply during specific admission cycles, complete a two- to three-year advanced-standing program, and then meet state licensure requirements.

For Canada, the timeline varies considerably depending on whether you choose the NDEB Equivalency Process, a qualifying/degree completion program, or an eligible bridge pathway.

Examination availability and university admission cycles can also affect the timeline.

Therefore, anyone promising that an international dentist can become fully licensed within a specific number of months should be treated cautiously.

Final Advice for International Dentists

The pathway to practicing dentistry in the United States or Canada is challenging—but it is not impossible.

The most important thing is planning.

Before spending money on examinations, credential evaluations, courses or applications:

Decide which country you want to practice in.
Research the exact licensing requirements.
Identify the universities or programs you are eligible for.
Create a realistic financial plan.
Check examination requirements directly from the official organizations.
Keep track of application deadlines.
Prepare your documents early.
Build meaningful clinical, academic and professional experience.
Never rely exclusively on information from social media or older blog posts.
Recheck official websites regularly because requirements can change.

Final Thoughts

For an internationally educated dentist, moving to the United States or Canada is not simply a matter of passing one examination.

It is a multi-stage professional transition that requires academic preparation, financial planning, patience, adaptability and determination.

The good news is that the pathway is becoming more structured, and new opportunities continue to emerge. The introduction of new Canadian bridge-training options in 2026 is one example of how pathways for internationally trained dentists continue to evolve.

Your foreign dental degree is the beginning of the journey—not necessarily the end of your opportunity to practice internationally.

If practicing dentistry in North America is your goal, start by understanding the pathway, choose your destination carefully, and build your plan step by step.

Your journey may be long, but with the right preparation, your goal can become achievable.

Important Disclaimer

This article is intended for general educational purposes and was updated in August 2026. Dental education, examination, immigration and licensure requirements can change frequently.

Admission requirements are determined by individual universities, while dental licensure requirements are determined by state or provincial/territorial regulatory authorities.

Before making financial, educational or immigration decisions, always verify the current requirements directly with the relevant official organization.