Foreign dentist in the USA: INBDE and license route (2026)

• A dental degree from your home country, verified through Educational Credential Evaluators (ECE), which JCNDE requires of everyone educated in a non-CODA-accredited program.
• For most states: a DDS or DMD from a CODA-accredited program, usually earned through an advanced standing program for international dentists.
• Admission to an advanced standing program on each school's own criteria; the ADA says most dental schools require the TOEFL.
• A pass on the INBDE (scale score of 75), taken at Prometric centers in the US or Canada.
• In most states, a pass on a clinical assessment accepted by that state, delivered by a third-party testing agency.
• For states with alternative routes, such as Minnesota's limited general license, a pass on the clinical licensure examination and the board's other requirements, followed by supervised practice.
• A DENTPIN, the personal ID used for the INBDE, CAAPID and other dental testing and application systems.
• State requirements such as jurisprudence exams, background checks and CPR certification, which vary by state.
• For employment, legal permission to work in the US, usually employer sponsorship if you are not a citizen or permanent resident.

Check your route with the route finder

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   1. Choose your target state and read its rules

   Check the state dental board's rules for foreign-trained dentists using the ADA's state board directory and licensure maps. Most states require a CODA-accredited DDS or DMD; a few, such as Minnesota, have limited licenses for graduates of non-accredited programs. This choice decides your whole route, so do it first.
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   2. Get a DENTPIN and an ECE evaluation

   Create a DENTPIN on the ADA website. Then order an ECE evaluation of your dental degree, which JCNDE requires before you can sit the INBDE as a graduate of a non-CODA program. Schools may ask for their own ECE report too, so read each program's requirements. Delays in getting transcripts from your school are common.
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   3. Take the TOEFL and plan admissions tests

   The ADA says most dental schools require the TOEFL for international dentists. Each program sets its own minimum score and may ask for other tests or a bench (hands-on) assessment. Check each school's page well before CAAPID opens.
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   4. Pass the INBDE

   Apply through JCNDE and pay $890 plus the $435 processing fee for international candidates. You then have six months to test at a Prometric center in the US or Canada. The two-day exam has 500 items. Check whether each advanced standing program you want requires an INBDE pass before admission.
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   5. Apply to advanced standing programs through CAAPID

   ADEA's CAAPID lets you send one application and set of credentials to every participating program you choose. Each program sets its own criteria and may use interviews or bench tests. Check every school's requirements and deadlines before you apply.
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   6. Complete your DDS or DMD

   Advanced standing programs are typically shorter than the four-year US DDS or DMD, and lead to the same degree. You will usually need a student visa; your school's international office issues the documents you need. Tuition is set by each school and is a major cost.
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   7. Pass a clinical licensure examination

   Most states require a clinical assessment by a third-party testing agency, and acceptance varies by state. ADEX now delivers the ADA's DLOSCE within its dental examination. Use the ADA's licensure map to confirm which clinical exams your state accepts before you book.
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   8. Apply to the state board

   Submit your application with your degree, INBDE and clinical exam results, and complete any state jurisprudence exam, background check and other requirements. Fees and processing times are set by each board.
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   9. Alternative: a state limited license

   If your target state has an alternative route, follow its rules exactly. In Minnesota, a graduate of a non-accredited program who passes the clinical licensure examination and meets the board's requirements receives a limited general dentist license and must practice for three consecutive years under the general supervision of a board-approved Minnesota dentist before an unrestricted license is granted.
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    10. Start practice and plan specialty training

    Once licensed, you can work in private practice, community health centers or public service. Specialty training, such as orthodontics or oral and maxillofacial surgery, is a separate step through CODA-accredited advanced dental education programs, and it does not replace a DDS or DMD for licensure in most states.

• INBDE (Integrated National Board Dental Examination)

  A two-day computer exam of 500 multiple-choice items: three sections of 100 standalone items and one 60-item case section on Day 1, and two 70-item case sections on Day 2, totaling 12 hours 30 minutes with breaks. Day 2 must fall within seven days of Day 1 at the same center. Results are pass or fail, with 75 as the minimum scale score. JCNDE says it is accepted in all US states and territories.

• INBDE retake rules

  You must wait at least 60 days after a failed attempt, with no more than four attempts in 12 months. Under the 5 years/5 attempts rule you must pass within five years of your first attempt or five attempts, whichever comes first; after that you may test once every six months.

• Clinical licensure examinations

  Most states require a clinical assessment from a third-party testing agency, and the agencies accepted vary by state. The DLOSCE, a computer-based objective structured clinical exam developed by the ADA, is now administered through ADEX as part of the ADEX Dental Examination.

• Admissions assessments for advanced standing programs

  Not licensing exams, but schools commonly use TOEFL results, the INBDE and their own interviews or hands-on bench tests to select international dentists. Each program publishes its own requirements.

• No national dental English test exists for licensure. The ADA says most dental schools require the TOEFL for admission to programs for international dentists.
• Minimum TOEFL scores are set by each school, so check every program you apply to.
• If you use an alternative route such as a limited license, check whether the state board sets any English requirement.
• All INBDE content and clinical exams are delivered in English.

Estimate your total cost

• ECE evaluation and transcripts: plan several months, as your home school must send official documents.
• INBDE: once JCNDE processes your application you have six months to test, and you should book 60 to 90 days ahead, JCNDE says.
• CAAPID: one application cycle a year; check ADEA's dates for the cycle you are applying in.
• Advanced standing DDS or DMD: shorter than the four-year US program, according to the ADA; each school publishes its program length.
• Minnesota limited general license: three consecutive years of supervised practice before an unrestricted license, under Minnesota law.

Median annual wages from the US Bureau of Labor Statistics Occupational Outlook Handbook, May 2025 OEWS data. Many dentists are self-employed or practice owners, and pay varies widely by state and setting.

• Dentists (all)

  $176,110

  BLS median, May 2025 ($84.67 an hour).

• Dentists, general

  $170,950

• Orthodontists

  $289,140

• Prosthodontists

  $311,180

• Oral and maxillofacial surgeons

  $352,220

• Dentists, all other specialists

  $224,990

• Government (by industry)

  $219,750

• Offices of dentists (by industry)

  $173,760

• Most dentists work in offices of dentists, including private practices, group practices and dental service organizations. BLS reports a median of $173,760 in offices of dentists.
• Government employers report the highest median by industry in BLS data ($219,750 in May 2025).
• Outpatient care centers and community health centers also hire dentists; BLS reports a median of $195,330 in outpatient care centers.
• If you hold a Minnesota-style limited license, you must work under the supervision of a dentist approved by the board, so your first employer must agree to that arrangement.
• Many employers sponsor work visas only case by case. Ask early, and remember that universities and their affiliated nonprofits are H-1B cap exempt.

• Advanced standing programs are full-time degree programs; most international students study on a US student visa using documents issued by the school. Follow your school's international office instructions.
• After graduation, dentists who are not citizens or permanent residents usually need an employer-sponsored work visa such as the H-1B.
• USCIS says H-1B workers can generally be admitted for up to three years, extendable to six in total, with an annual cap of 65,000 plus 20,000 for holders of US master's or higher degrees. Institutions of higher education, their affiliated nonprofits and nonprofit or government research organizations are cap exempt.
• USCIS says certain new H-1B petitions filed after 12:01 a.m. Eastern on September 21, 2025 require an additional $100,000 payment under a Presidential Proclamation. Check current USCIS guidance with your employer.
• Visa rules change often and this is not legal advice. Use an immigration attorney for your case.

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   Gulf licenses from DHA, DOH Abu Dhabi, MOHAP, SCFHS, QCHP and other GCC regulators do not lead directly to a US license. In most states you still need a CODA-accredited DDS or DMD, the INBDE and a clinical exam.

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   Gulf experience can strengthen an advanced standing application, and in states with limited license routes such as Minnesota your practice history will be reviewed by the board. Keep detailed employment letters with dates, settings and procedures.

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   Gulf specialty certificates and Saudi Board or Arab Board qualifications do not replace a US DDS or DMD, and the ADA notes that even US postdoctoral programs do not meet the education requirement in most states if your first degree is from a non-accredited school.

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   The INBDE is offered only at Prometric centers in the US and Canada, so plan travel from the Gulf for it.

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   Credential checks done for Gulf regulators (for example DataFlow) do not transfer. JCNDE requires an ECE evaluation of your degree, and schools may ask for their own report.

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   If your state board or school asks for verification of your Gulf licenses, request certificates of good standing directly from each Gulf regulator and allow time for them to arrive.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

Regulators make all registration decisions and set all fees. Our fee is separate from the regulator's fees, exam fees and translation costs.

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