Dentistry – your ticket around the globe?

dentistry around the worldThinking of moving abroad? Roshan Bains explores what requirements dentists need to practise elsewhere. In part one, he covers the USA and Canada.

Whether permanent or temporary, the thought of going out there and exploring something new is an attractive offer that many of us would consider.

A change of climate, lifestyle, increased earning potential and seeking better job satisfaction. There are many luring factors that play a part in one’s decision to practise dentistry around the globe.

In this series of articles I’ve picked a handful of destinations. I’ll give a brief overview of the processes you would need to go through should you wish to practice in that particular country.

We’ll first start with what you would have to do to make the jump across the pond.


Around 30 years ago, the Commission on Dental Accreditation (CODA) passed legislation that barred foreign-trained dentists from gaining licensure in the US.

Instead, a further two to three years training at an accredited US dental school to obtain a doctorate of dental surgery (DDS) was needed.

The process of transitioning to the US is a very long and arduous one. It requires a lot of time and financial backing.

Each state has specific educational requirements they expect. So the first thing to do is identify the state you want to practise in and research its criteria.

Before applying to US dental schools, foreign-trained dentists will take three exams. TOEFL is a two-hour test that you can sit in the UK and assesses your proficiency in English. Yes, even the English have to take it too.

The next two will unfortunately be a little more testing. US-graduating dentists take the National Board Dental Examinations (NBDE) during their training as well. Part one is an eight-hour exam with 400 multiple choice questions on microbiology/pathology, biochemistry and anatomy (dental and whole body). Part two is a 14-hour exam over two days (500 questions in total) assessing periodontology, paediatrics, orthodontics, radiology, oral surgery, oral medicine and restorative dentistry.

You must complete both NBDEs in either the US, Canada, Puerto Rico or Guam.

Next steps

Congratulations, now you’ve proved your dental knowledge is up to scratch. You can begin the application process to US dental schools.

A limited number of dental schools run what are known as ‘advanced standing programs’. Depending on the dental school, these allow foreign-trained dentists to either enter into the second or third year of the conventional DDS program. Or into a separate two-year international program specifically for people making the transition into the US.

Should you choose to go down this route, you can practise nationwide!

Other routes into the US do exist but provide a much more limited access in terms of where you can practise.

Limited dental licences

Highly-qualified foreign-trained dentists can work as faculty in a dental school. Typically these licences last for a year and you can renew them for up to five years.

Every state with a dental school including Massachusetts, Connecticut and Pennsylvania allows granting of licences whilst employed within the faculty.

I heard of the introduction of a bill pushing for the same idea in New York State. However, I am unsure of the outcome.


It’s the only US state to grant a US dental license without additional training.

You must however take the NBDE and TOEFL exams in order to apply.

Should you pass the applications, you can then sit the Minnesota bench exam and a clinical licensing exam. A license under three-year supervision of a Minnesota licensed dentist is then granted before receiving an unrestricted one.

Graduate and specialty programs

Nine CODA certified specialties exist – some accept foreign dentists. However, you can often only practise in specific states.


They are often hard to come across but do exist. One I have heard of is a foreign dentist is eligible for license in Texas if they complete a dental public health degree.

Others may exist and can save you serious time and cash if you’re willing to dig for them.


Before we start on the pathways into Canada, we need to clear up some terminology to avoid confusion.

Your applications to Canada will go through the National Dental Examining Board of Canada (NDEB). Don’t confuse this with the NBDE you take should you wish to practise in the US.

However, one thing that is similar to the US, is the amount of time and money you’ll have to give should you wish to make the move.

The first thing to know is that all general dentists from outside Canada must sit the NDEB written exam and OSCE in order to be granted a license.

If you’re from accredited dental programs (USA, Ireland, Australia or New Zealand), you can go straight to sitting those exams. For people with degrees from non-accredited institutions (the UK falls under that category), the pathway toward sitting the NDEB exams is a little more complex. I’ll attempt to simplify it.

Non-accredited institutions

Initiating the NDEB equivalency process is the first step we would take.

This starts off with a fee of C$900 and requires documents from both you and your university of completion. You can find details on the NDEB’s website.

Following this, candidates would sit an exam known as the ‘assessment of fundamental knowledge’ (AFK). It’s sat on one day and consists of 75 MCQ questions over three hours. It costs C$800.

Upon completion of this you then have two pathways to choose from. Should you score highly in your AFK, you could have the opportunity to complete a two-year ‘qualifying/degree completion program’ from one of the seven accredited Canadian universities. The second route involves two more exams.

Assessment of clinical judgment (ACJ) is the next exam you have to take. It focuses on case-based problems, diagnosis, treatment planning and radiology.

This exam is sat over five and a half hours on one day. It has 120 to 150 questions and will set you back C$1350.

Completion of this leaves you eligible for the third and final exam of your equivalency process – the ‘assessment of clinical skills’ (ACS).

This is a two-day exam completed on mannequins. You’ll be expected to perform an array of procedures such as class II and III preps, metal and PFM crown preps, molar access cavities etc.

The best part, this exam will set you back C$9,000!

Now all three exams of this equivalency process give you three attempts. However, you must pay full fees on each attempt. So in the interests of your wallet, it’s best if you pass first time round.

Next steps

Congratulations! You’ve made it past the equivalency process. But there are still two more exams and much more of your money that needs taking.

The NDEB exams we spoke about earlier consist of and initial C$450 fee. This is followed by a written exam and OSCE costing C$1,000 each.

Once all of this is done, you’ve earned your well-deserved license to practise dentistry in Canada.

Should you chose to practice in Quebec, it is noted that you must prove your proficiency in French. You will be given three years to meet these requirements.

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