1. WELCOME, IMPORTANT INFORMATION AND TIPS
Congratulations on exploring how to become a licensed dentist in the United States! Following are some tips and important information for you to know. This is a lengthy process and it is not easy, so prepare yourself well. The following pages will give you specific step-by-step information on how to proceed and will also provide some time and cost comparison information to help you decide what you want to do. Please take time to read this entire summary to get a total picture of how you wish to proceed.
You need a clear and realistic plan to succeed in becoming a licensed dentist in the U.S. The process is too difficult, long, expensive and competitive to do inefficiently. Take the time to develop a strategy for issues such as:
- Money: You will need significant savings, a loan, and/or a job that helps pay for this process.
- Preparation: You will need to invest time and resources in test preparation to pass your examinations. Your ability to pass your exams at the first sitting can be a very important factor. You will have to prepare U.S.-style marketing materials and perfect your interview and presentation skills in English.
- Network: You will need to rebuild a professional network. It can help to find work in a lower-level position in dentistry if you use the opportunity to actively identify mentors among specialists in your field and International Medical Graduates who have successfully licensed. These contacts can not only help you with advice, but become sources of letters of recommendation for your residency process.
- Flexibility: You will be more likely to find a residency if you are flexible about geography, program quality, and specialty type.
- Complete Credentials: Invest the time and money early to get complete educational and professional credentials for your foreign degree evaluation process. Follow up carefully with institutions where you studied and practiced dentistry to be sure they send documents in the required format.
- Pay Attention to Detail: All documents you submit either on paper or online are official: take your time to fill them out carefully and make sure your name and other information are used in exactly the same way on each document. Mistakes in these simple details are a common source of delays and complications in the licensing process.
GET YOUR QUESTIONS ANSWERED
Be your own advocate throughout the licensing process. Seek clarification about questions and concerns directly from official sources. Organize your questions and ask for assistance; email can be your most effective means of communication with the state and testing organizations.
INVEST IN TEST PREPARATION
If you can afford it, invest some money in test preparation. There are online and in-person formats available.
- Here is a link to the guide for Part I: http://www.ada.org/~/media/JCNDE/pdfs/nbde01_examinee_guide.ashx .
- Here is a link for the guide for Part II: http://www.ada.org/~/media/JCNDE/pdfs/2015_nbde_part2_guide.ashx.
These guides give more information on examination preparation. Investing money wisely now to make your licensing process a success will get you into a job that pays well that much faster! You should feel well prepared to take your exams.
MARKET YOURSELF AMERICAN STYLE
Being able to market yourself in a way that appeals to U.S. employers can play a deciding factor in your success. You may need outside guidance to assess what parts of your education and experience you should highlight, and how to present yourself to potential employers. You must learn how to overcome any cultural divide and target your presentation to a U.S. audience. Many people, who are well qualified, do not find employment because they are unable to successfully prove their value over other candidates. Consider this an opportunity to make your international experience a selling factor in this process.
CONSIDER ALTERNATIVE CAREERS: The likelihood of successfully completing all components from being a Foreign Medical Graduate to becoming licensed in the U.S. is lower for people who are from another country, and lower still for those who have been out of school for several years. Consider alternate careers in the medical field such as Dental Hygienist or Dental Lab Technician. They do require completion of a new degree in the U.S (except for Dental Lab Technician which you may be able to qualify for on your past education and experience); but are able to be completed sooner, with the possibility of getting back to work with a reasonable salary much more quickly than going through the U.S. Dental school process. See section the Other Careers and Credentials section in this document for more information on alternative careers.
FIND OUT ABOUT FINANCIAL AID
The very high cost of the Advanced Standing Program for International Dentists is a big obstacle to licensing. However, since it is a degree program, you are eligible for financial aid. You should first ask to speak with a financial aid counselor to get a better understanding about your ability to pay. Educational debt is common in the U.S. and you need to consider the income you expect to make after finishing your education.
2. HOW THE PROFESSION IS ORGANIZED IN NEW HAMPSHIRE
As a dentist, you must be licensed to practice dentistry in the State of New Hampshire. The New Hampshire Board of Dental Board Examiners regulates the profession. They give New Hampshire licenses by both Acceptance of Examination (for first time licenses) and by endorsement of existing licenses. In New Hampshire there is no specialty licensing in dentistry. If you declare a specialty the schooling is longer and then you must work in that specialty only. Dentists who work in general dentistry are not limited, and may also practice specialties for which they have been trained.
All U.S. licensing jurisdictions require evidence that a candidate for licensure has passed Parts I and II of the written National Board Dental Examinations. Each examination is composed exclusively of multiple-choice test items. Part I is a comprehensive examination covering the basic biomedical sciences, dental anatomy and ethics. Part II is a comprehensive examination covering clinical dental subjects, including patient management.
The agency responsible for the administration of National Board Dental Examinations is:
The Joint Commission on National Dental Examinations
American Dental Association
211 East Chicago Avenue, Suite 600
Chicago, Illinois 60611-2637
The American Dental Exam (ADEX) is the qualifying examination for a New Hampshire dental license. However, this is the last step in a longer process of education and examinations that international dentists must complete to practice in the state.
This guide assumes you are an international dentist who has permanent U.S. work authorization but are only now beginning to rebuild your career in the U.S. Therefore, the guide will include steps that come before the final state licensing process, including: foreign credential evaluation, 3 exams, and completion of an ADA accredited degree in General Dentistry (DMD in Eastern U.S. schools; DDS in Western or Mid-Western U.S. schools).
The vast majority of dentists practicing in the U.S. are self-employed in individual or group practices with a small staff. Staff usually includes one or more dental assistants or dental hygienists. These roles are explained in more detail in the section Other Careers and Credentials. Some international dentists decide to become dental assistants or dental hygienists.
According to the Bureau of Labor Statistics, most dentists are generalists (about 89%) and take care of a variety of dental needs. Orthodontists, who straighten and reposition teeth, are the largest group of specialists within dentistry. They make up less than 6% of all dentists. The median salary of dentists in the US was $154,640 in 2014 (from the Bureau of Labor Statistics – http://www.bls.gov/ooh/healthcare/dentists.htm).
Employment of dentists is expected to increase by 16% from 2012-2022 according to the Bureau of Labor Statistics. This is partly because the baby-boom generation will need complicated dental work, each generation is more likely to keep their teeth than previous generations, and there will be an increase in demand as studies continue to link oral health with overall health. In addition, job opportunities in dentistry will come from dentists’ retirements
3. ELIGIBILITY FOR LICENSING
This section explains 5 important steps that you need to complete before you can be licensed to practice dentistry in New Hampshire. The steps to licensing are as follows:
I. Foreign Degree Evaluation and NBDE Part I
ECE Evaluation Report
Educational Credential Evaluators, Inc. (ECE) is the only credentialing organization accepted for foreign degrees in dentistry. ECE requires official dental school transcripts, plus translations submitted according to special instructions available on their application.
Fee: $85 (as of 2015.)
You should begin the ECE before applying for the National Board Dental Exam NBDE Part I. ECE will send an Evaluation Report. You are allowed to take the NBDE Part I only after the ECE evaluation is approved.
National Board of Dental Examination (NBDE) Part I
The application for the NBDE Part I exam is an online registration and payment process. You will not be approved to sit for the exam, however, until your ECE Evaluation Report has been approved.
We discuss the test format and content in the next section, Tests.
Once you have passed the exam you are eligible to apply for a 2-year Advanced Standing program for international dentists.
II. ADA Approved/Accredited Program
The State of New Hampshire requires foreign graduates of dental programs not approved by the American Dental Association to graduate from an ADA accredited program with a General Dentistry degree from a U.S. or Canadian dental program. Some dental colleges offer what is referred to as an Advanced Standing Program for foreign graduates of dental programs. You will need to earn degree in order to obtain licensure in the U.S. by attending a dental program, the credential for which is a DMD or a DDS degree. You will need to know which school is right for you and you may need to be willing to leave New Hampshire to get this extra education.
CONSIDERING EDUCATIONAL DEBT
The cost of the program may be higher than you can imagine paying. It is also likely that U.S. dental schools will have similar costs for Advanced Standing Programs. Graduate education in the U.S. tends to be very expensive. However, you must consider this debt in the context of your future earning potential. Before you make a final decision, you should get advice from a dental school financial aid administrator or career counselor. Discuss the cost and map out the ways you may be able to pay back the loan. If necessary, you can consider other lower-level positions in the dental field. These positions can help you progress towards licensing or even become a more permanent career change for you – see the Other Careers and Credentials section for more information.
III. Pass the NBDE Part 2
You are eligible for NBDE Part II as early as 45 days before completing your US DDS degree. We discuss the test format and content in the next topic.
IV. Pass the American Dental Exam, ADEX
The American Dental Exam is your last test before being eligible for licensure! It involves clinical practice and observation. We discuss the test format and content in the next topic.
V. Application for Licensure by Acceptance of Examination
The NHBDE has a questionnaire available online. If you qualify, the NHBDE will email you an application packet. See the Links section for the web site address.
Note: if you plan to operate your own dental business, as soon as you have a business address you must also fill out the Application for State Controlled Substances Registration. This will allow you to store controlled drugs on site for your dental practice. The application cost $35 (in 2015) for each site you register. This form is a necessary first step for federal controlled substances registration and is provided in your Application for Licensure by Acceptance of Examination.
National Board Dental Examination Part I
The NBDE Part I is a computer-based exam available year-round through the testing company Prometric.
The 8 1/2-hour-test consists of 400 multiple-choice questions broken into 4 basic content areas.
- Anatomic Sciences
- Dental Anatomy and Occlusion
If you fail any part of the NBDE Part I you can retake it separately for additional fees.
National Board Dental Examination Part II
The application process is similar to NBDE Part I and can be completed online. Prometric administers the test on a rolling basis.
NBDE Part II lasts 12 hours and 15 minutes and is taken over 2 consecutive days. It is a 500-question multiple-choice test.
Day 1 has 400 questions from 9 discipline areas:
- Operative dentistry
- Oral and maxillofacial surgery/pain control
- Oral diagnosis
- Orthodontics/pediatric dentistry
- Patient management
Day 2 has 100 questions based on case simulations. The tester will review a variety of case materials presented on the screen and answer several questions about one patient at a time.
AMERICAN DENTAL ExamINATION (ADEX)
The American Dental Examination, or ADEX, is a test that combines a computer-based exam with clinical practice on both real patients and life-size models called Manikins. The exam is given three times a year.
New Hampshire refers candidates to a regional testing authority to schedule the ADLEX: The Commission on Dental Competency Assessments (CDCA) administers the ADEX Dental Exam in several cities. You will need to apply online at the CDCA website (The Commission on Dental Competency Assessments) to schedule the exam. You will have to travel to a test site. The closest one to New Hampshire is in Massachusetts.
The ADEX Dental Exam has 5 parts worth 100 points each:
- Computer-based Diagnostic Skill Exam (DSE), 3.8 hours
- Endodontics Clinical Examination (Manikin based), 3 hours
- Prosthodontic Clinical Examination (Manikin based), 4 hours
- Periodontal Scaling Examination (on patient), 4.5 hours
- Restorative Examination (on patient), 7 hours
2015 Fee: $2,085 for the exam, including $90 for Typodont registration
You must pass each of the 5 Parts with a score of 75 or higher to complete this step. A passing grade on all parts makes you eligible to apply to the state of New Hampshire for your dental license by Acceptance of Examination. If you fail any of the 5 parts, you will need to take that part(s) again. You may take each part up to three times in 18 months before having to retake the entire exam again.
5. TIME AND COSTS
Successfully licensing as a Dentist in New Hampshire depends on many factors. Just some of these include:
- The completeness of your educational and professional records
- Your performance on several tests
- Your ability to attend and finance a full-time dental program
We provide two hypothetical scenarios to show some of the variety of results that immigrant professionals may find when they seek to become dentists in New Hampshire. Please consider these scenarios as two examples out of many possibilities. Your experience will vary.
TWO HYPOTHETICAL SCENARIOS FOR DENTIST LICENSING:
Numbers are from 2015
More Efficient Scenario
Less Efficient Scenario
Evaluate degree & Pass NBDE Part I
2-year Advanced Standing Program
Pass NBDE Part II
License by Acceptance of Exam
|More Efficient Total|
About $153,000 and 4 1/2 years
|Less Efficient Total|
About $205,500 and 6 years
6. OTHER CAREERS AND CREDENTIALS
LOWER LEVEL JOB OPPORTUNITIES
You may want to consider whether taking a lower-level job in a dental practice in the short term can help you meet longer-term goals of licensing as a DDS. Working in your field in a different capacity and with fewer responsibilities may offer you some advantages:
- More energy to focus on studying and saving money for an Advanced Standing DDS program; and/or
- A chance to adapt to the US healthcare system and workplace culture in a lower-pressure environment.
If you choose any of these positions as a step towards licensing, be sure to explain your long-term plans to your employer. You may find that some employers offer benefits such as tuition reimbursement or schedule flexibility that can support your goals.
The state of New Hampshire also regulates and licenses dental hygienists in the state. Dental hygienists must complete a 2 or 4-year training program and pass the Dental Hygiene exam (written and clinical parts) from the National Board of Dental Examination before being licensed. Preventive dental treatment is the main responsibility of a dental hygienist; in the U.S. it is unusual for a dentist to perform routine cleanings of patients’ teeth. Hygienists are even able to administer nitrous oxide to patients if they complete a short training. Hygienists who work for smaller practices may work part-time or work in more than one office. A part-time hygienist earning an hourly wage may not have full medical benefits but will often receive inexpensive or free dental care. Experienced, salaried dental hygienists can earn $70,000. Many International Dentists decide to become Dental Hygienists as a permanent career change instead of returning to dental practice; others use it as a first step towards re-establishing themselves as dentists in the U.S.
DENTAL LAB TECHNICIAN
Dental lab technicians do not need a license to work. They create and repair dental prosthetics and other accessories used by dentists. On-the-job training is the norm for this position, so if you developed this skill through dental practice, you may be able to qualify for this position immediately.
A dental assistant works in a dental office helping with non-medical parts of dental procedures like preparing patients, and keeping the mouth clean and instruments ready for use by the dentist. Dental assistants work under the supervision of a licensed dentist and are not required to be licensed by the Department, but they can take certain exams to qualify them for more responsibilities.
7. BEYOND LICENSING
Licenses expire on September 30 every three years: 2015, 2018, 2021 etc. NHBDE sends a notice to you reminding you to renew your license, so be certain to keep your contact information up-to-date with their office. If you let your license expire, you will have a much more complicated process to restore the license. You must also document 48 hours of continuing education over each 3-year renewal period.
JOINING A PROFESSIONAL ASSOCIATION
State and national associations for dentists provide opportunities for professional development and networking. They also help set acceptable working conditions for the profession and give information and opinions on policy in New Hampshire and across the U.S. Their websites may offer useful orientation to dental candidates about the licensing and examination process, including test preparation. They often provide Continuing Education to members as well.
State: New Hampshire State Dental Society: http://www.nhds.org/
National: American Dental Association
Beyond these two general associations, there are a large variety of professional associations for dentists that emphasize a dentist’s specialty discipline, race and ethnicity, gender, or religion.
LICENSING MOBILITY (RECIPROCITY)
The State of New Hampshire grants licensing to dentists through Acceptance of Examination (the process described in this topic), or by Endorsement. A dentist licensed in another state, who wants to practice in New Hampshire, must independently meet all New Hampshire requirements for licensing. If you become licensed in New Hampshire and want to practice dentistry in another state, you will need to research the legal requirements for that state.
APPLYING FOR A DENTAL ANESTHESIA/ SEDATION PERMIT
You must already be a licensed dentist in New Hampshire before you can apply to NHBDE for a Dental Sedation Permit. The permit costs $350 (in 2015) and requires proof of license and other history related to your preparation to administer anesthesia. Note: If you only will use nitrous oxide in your practice, you do not have to get a Dental Sedation Permit.
8. IMPORTANT LINKS
Licensing and Regulation:
- The New Hampshire Dental Practice Act (RSA317A) has more information on regulation and renewal of a dental license
- New Hampshire Board of Dental Examiners (NHBDE) page has links to all licensing applications for Dentists and Dental Hygienists; Phone: (603) 271-4561
- New Hampshire Board of Dental Examiners (NHBDE) forms and publications, including Dentist Application for Licensure and Dental Anesthesia/Sedation Permit application
- Educational Credential Evaluators, Inc. (ECE); Phone: (414) 289-3400
- The Joint Commission on National Dental Examinations
American Dental Association
211 East Chicago Avenue, Suite 600
Chicago, Illinois 60611-2637
- National Board Dental Examination (NBDE) Part I and Part II
- The Bureau of Labor Statistics has information on the dental profession, including salary data