Pathways for Foreign-Trained Dentists to

Pursue Careers in the United States

Veerasathpurush Allareddy, B.D.S., M.B.A., M.H.A., M.M.Sc., Ph.D.;
Satheesh Elangovan, B.D.S., D.Sc., D.M.Sc.; Romesh P. Nalliah, B.D.S.;
Nithya Chickmagalur, B.D.S., M.D.S., D.M.D.; Veeratrishul Allareddy, B.D.S., M.S.
Abstract: With the U.S. population growing ever more diverse and the need for dentists in many areas of the United States,
there is increasing opportunity for foreign-trained dentists to pursue dental careers in this country. This article provides a broad
overview of dental education and career pathways available for foreign-trained dentists in the United States. Educational opportunities include pursuing advanced standing dental degree programs and advanced graduate education (residency programs). Career
pathways include working in academic and private practice settings. This article also describes the licensure and visa requirements foreign-trained dentists must satisfy to work legally in the United States.
Dr. Veerasathpurush Allareddy is Associate Professor, Department of Orthodontics, The University of Iowa College of
Dentistry & Dental Clinics; Dr. Elangovan is Assistant Professor, Department of Periodontics, The University of Iowa College
of Dentistry & Dental Clinics; Dr. Nalliah is Instructor, Office of Global Health, Harvard School of Dental Medicine;
Dr. Chickmagalur is an advanced graduate education student, Department of Developmental Biology, Harvard School of
Dental Medicine; and Dr. Veeratrishul Allareddy is Associate Professor, Department of Oral Pathology, Radiology, and
Medicine, The University of Iowa College of Dentistry & Dental Clinics. Direct correspondence and requests for reprints to
Dr. Veerasathpurush Allareddy, Department of Orthodontics, The University of Iowa College of Dentistry & Dental Clinics,
801 Newton Road, Iowa City, IA 52242; 319-353-5806; Veerasathpurush-Allareddy@uiowa.edu.
Keywords: dental education, dentists, academic career, private practice, foreign-trained dentists
Submitted for publication 2/5/14; accepted 4/19/14

he future need for dentists in the United States

is strong. Five thousand areas have been designated Oral Health Professionals Shortage
Areas by the U.S. Department of Health and Human
Services.1 The aging U.S. population will increase the
need for dentists in two ways: many older dentists
will retire, and the larger cohort of older patients will
need oral health care services.2 In addition, the U.S.
population is becoming increasingly diverse,3 and
individuals with limited English proficiency often
have poorer health,4 creating the need for health care
practitioners with multilingual skills.
To meet the need for more dentists, several
new dental schools have opened in the last five years,
and existing schools are expanding their class sizes.5
However, there is also growing opportunity for
foreign-trained dentists to pursue dental careers in
this country. A previous article reviewed the types
of advanced placement and other degree programs
in the United States and Canada for foreign-trained
dentists, comparing those programs and reviewing
the similarities and differences between them.6 In our
article, we go a step further: our aim is to provide an
overview of dental educational and career pathways
in the United States for foreign-trained dentists,
including work opportunities in private practice

November 2014 Journal of Dental Education

and academic dentistry and information on visa and

licensure requirements.

Advanced Standing D.D.S./

D.M.D. Education
Of the sixty-five dental schools in the United
States and Puerto Rico, twenty-five offer opportunities for foreign-trained dentists to acquire a full
U.S. dental degree through abbreviated training in
an advanced standing program.7 Information about
these programs appears in Table 1. Foreign-trained
dentists typically enter these programs after basic science training in the traditional dental curriculum and
before the clinical years. Entry requirements include
passing scores on the National Board Dental Examination (NBDE) Part I and/or Part II and the Test of
English as a Foreign Language (TOEFL), graduation
from a foreign dental school, and prior transcripts.
Several advanced standing programs also require that
applicants undergo a psychomotor bench test, case
presentations, and a formal interview as part of the
application process. Most schools require that foreign school transcripts be evaluated by Educational
Credential Evaluators Inc., World Education Services

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1490

Journal of Dental Education Volume 78, Number 11

D.D.S.
D.M.D.
D.M.D.

D.M.D.

D.M.D.

University of Illinois at Chicago

College of Dentistry

University of Louisville
School of Dentistry

Boston University Henry M. Goldman

School of Dental Medicine

Tufts University School of

Dental Medicine

D.D.S.

The University of Colorado

School of Dental Medicine

Indiana University
School of Dentistry

D.D.S.

University of the Pacific Arthur A. Dugoni

School of Dentistry

D.M.D.

D.D.S.

University of California, San Francisco,

School of Dentistry

University of Florida
College of Dentistry

D.D.S.

University of California, Los Angeles,

School of Dentistry

D.D.S.

D.D.S.

Ostrow School of Dentistry of the

University of Southern California

Howard University
College of Dentistry

D.D.S.

Loma Linda University

School of Dentistry

University & School

Degree
Offered

25 months

24 months

26 months

24 months

24 months

48 months

24 months

24 months

24 months

24 months

25 months

24 months

24 months

Duration
of Advanced
Standing Program

10-20

75

Based on
space
availability

40

24

10

40

22

24

20

32

20-24

Number
of
Positions

TOEFL and NBDE Part I/Part II

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I/Part II

TOEFL and NBDE Part I

TOEFL and NBDE Part I/Part II

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I/Part II

Minimum Entry Requirements:

Standardized Tests

Table 1. Characteristics of advanced standing D.D.S./D.M.D. programs in the United States

Total costs are $48,351 for year 1,

$98,723 for year 2, and $91,803 for year 3.

Tuition fee is $64,500 per year.

Instrument, equipment, living, and
miscellaneous costs are variable.

Nonresident tuition fee is $59,500 per year.

Instrument, equipment, living, and
miscellaneous costs are variable.

Tuition fee is variable depending on

range of hours enrolled.

Total costs for nonresidents are

approximately $99,000 per year.

Tuition fee for nonresidents is $68,042 per

year. Instrument, equipment, living, and
miscellaneous costs are variable.

Interested applicants should contact

the school financial aid office.

Total costs are $96,370 for year I

and $93,260 for year II.

Total costs are $143,395 for year 1

and $135,237 for year 2.

Total costs are $123,561 per year.

Total costs are $116,947 for year 1

and $94,832 for year 2.

Total costs are $120,823 for year 1

and $110,573 for year 2.

Total costs are $113,732 per year.

Estimated Costs

November 2014 Journal of Dental Education

1491

D.M.D.
D.D.S.

D.D.S.
D.D.S.

D.M.D.

D.M.D.
D.M.D.

D.M.D.
D.D.S.
D.D.S.
D.D.S.

Rutgers School of
Dental Medicine

Columbia University
College of Dental Medicine

University at Buffalo
School of Dental Medicine

University of Oklahoma
College of Dentistry

University of Pennsylvania
School of Dental Medicine

University of Pittsburgh
School of Dental Medicine

The Maurice H. Kornberg

School of Dentistry, Temple University

University of Puerto Rico

School of Dental Medicine

Virginia Commonwealth University

School of Dentistry

University of Washington
School of Dentistry

Marquette University
School of Dentistry

36 months

26 months

28 months

25 months

36 months

24 months

24 months

29 months

24 months

30 months

27 months

28 months

Varies

10

12

30

24

26

10

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I/Part II

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I/Part II

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

TOEFL and NBDE Part I

and Part II

TOEFL and NBDE Part I

Tuition is $51,880 for nonresidents.

Instrument, equipment, living, and
miscellaneous costs are variable.

Total costs are $111,580 for year 1

and $106,580 for year 2.

Total costs are $91,000 per year.

Total costs are $77,736 for year 1

and $55,002 for year 2.

Tuition fee is $60,690 per year.

Instrument, equipment, living, and
miscellaneous costs are variable.

Total costs for out-of-state students are

$84,170 for year 1 and $75,067 for year 2.

Total costs are $33,056 for preparatory

program, $105,069 for year 1,
and $101,862 for year 2.

Total costs are $10,000 for preliminary

16-week session, $155,160 for year 1,
and $137,334 for year 2.

Total costs for non-NY residents are $88,875

for year 1 and $87,910 for year 2.

Total costs are $56,350 for first spring

semester, $96,540 for year 2,
and $95,871 for year 3.

Total costs are $103,218 for year 1

(including summer) and $76,135 for year 2.

Total costs are $124,258 for year 1

and $92,425 for year 2.

Source: Data were obtained from American Dental Education Association (ADEA) CAAPIDSM Directory (www.adea.org/dental_education_pathways/CAAPID/Pages/CAAPIDDirectory.aspx).
The website of each dental school was visited to obtain financial data. Both accessed: February 5, 2014.

Note: Total cost is the amount (including tuition, other fees, equipment and instrument costs, and living expenses) provided by the schools financial aid office. There is no uniformity in how
costs are reported by schools, so applicants are advised to contact the schools for the most updated information. Most schools require that foreign school transcripts be evaluated by Educational Credential Evaluators Inc., World Education Services Inc., or Josef Silny & Associates Inc. Some of the schools also require a psychomotor bench test as part of the admissions process.

D.D.S.

University of Michigan
School of Dentistry

Inc., or Josef Silny & Associates Inc. Scholarships

and tuition support for these programs are limited,
with no financial support available in most schools.
Unfortunately for foreign-trained dentists
considering such programs, the number is currently
decreasing. The most common reason we have heard
for closing advanced standing programs is that many
dental school curricula are evolving into interconnected, continuous programs that fully integrate
medicine, dentistry, and biology. These integrated
programs do not allow for advanced standing students
to begin the clinical programs in a seamless fashion.
Foreign-trained dentists are still invited to apply to
those dental schools on an advanced standing basis,
but they have to participate in the entire four years
to graduate with a U.S. dental degree.
Apart from the advanced standing programs,
some dental schools also offer faculty D.D.S./D.M.D.
programs for full-time faculty members who are
foreign-trained. Currently, there is no available
list of schools that provide this option. A faculty
D.D.S./D.M.D. option is usually negotiated at the time
of the job interview and offer. These programs vary
depending on the school and are usually tailor-made to
meet the needs of the individual pursuing this option.

Advanced/Graduate/
Residency Education
Most foreign-trained students can also apply to graduate residency programs in the United
States. Currently, there are nine American Dental
Association (ADA)-recognized dental specialties in
the United States: dental public health, endodontics,
oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery
(OMS), orthodontics and dentofacial orthopedics,
pediatric dentistry, periodontics, and prosthodontics.8,9 Residency programs vary from two to six
years, depending on type of degree. OMS programs
are a minimum of four years; six-year OMS programs
are completed concurrently with an M.D. (Doctor of
Medicine) program from affiliated medical schools.
All other residency programs are a minimum of two
years in duration. Residency programs are typically
completed in conjunction with earning a masters or
doctoral degree.
Advanced programs are also offered in such
non-ADA-recognized dental specialties as dental
anesthesiology, dental implantology, geriatric/special
needs, operative dentistry, and oral medicine. The
1492

duration of these residency programs varies between

one and four years, depending on concurrent masters or doctoral degree programs. One- or two-year
General Practice Residency (GPR) and Advanced
Education in General Dentistry (AEGD) programs
are also available in some dental schools and other
academic institutions.
Most of the graduate programs require that
applicants complete a D.D.S. or D.M.D. program
at a Commission on Dental Accreditation (CODA)accredited dental school, and some state-supported
dental schools do not take any foreign-trained dentists
into their programs due to state policies. However,
a few programs accept foreign-trained dentists who
have obtained a D.D.S./D.M.D.-equivalent from
dental schools outside North America. Other entrance
requirements are school- and specialty-specific and
include such factors as scores on the NBDE Part I
and/or Part II, Graduate Record Examination (GRE,
conducted by the Educational Testing Service), and
TOEFL for non-native speakers of English, undergraduate grades/scores/grade point average, class
ranking (if available), deans letter, and letters of
reference (usually from at least three individuals
who are knowledgeable about the applicants academic credentials, clinical work, research abilities,
and long-term career goals and objectives). Though
not an absolute requirement, it helps if applicants
have experience in research, community activities,
teaching, and leadership. Since foreign dental schools
vary widely in terms of grading criteria, several U.S.
residency programs require that applicants have their
foreign dental school transcripts evaluated by independent evaluators knowledgeable about educational
credentials. Some U.S. dental schools and residency
programs also require that applicants be eligible for
obtaining a full clinical license in order to pursue
a clinical specialty residency program, while others require that applicants obtain a resident/limited
license/permit.
Six types of residency programs (AEGD, dental anesthesiology, GPR, OMS, orthodontics, and
pediatric dentistry) participate in the Postdoctoral
Dental Matching Program administered by National
Matching Services, Inc. for selecting students. According to the program website, for the matriculating
year of 2014, the number of residency spots available
through the matching program varied from a low
of twenty-seven for dental anesthesiology to a high
of 619 for GPR programs (https://natmatch.com/
dentres/aboutstats.html). The numbers of applicants
in 2010 to 2014 who gained admission to programs,

Journal of Dental Education Volume 78, Number 11

Table 2. Number of students from U.S. and foreign dental schools matched to six types of postdoctoral dental
residency programs, 2010-14

U.S./Foreign
Dental School

General
Practice
Residency

Advanced
Education in
General Dentistry

Oral and
Maxillofacial
Surgery

Pediatric
Dentistry
Orthodontics

Dental
Anesthesiology

2014
U.S.
619
164
216
357
218
27
Non-U.S.
28
31
7
15
35
4
2013
U.S.
611
159
208
336
230
32
Non-U.S.
30
30
5
15
40
0
2012
U.S.
580
170
196
302
233
29
Non-U.S.
22
23
13
22
32
1
2011
U.S.
594
139
188
308
240
22
Non-U.S.
25
25
11
17
29
3
2010
U.S.
587
111
197
282
236

Non-U.S.
20
32
9
17
26

Note: Dental anesthesiology was not included in 2010.

Source: National Matching Services Inc. Postdoctoral dental matching program: statistics for applicants (years 2010 to 2014). At: https://
natmatch.com/dentres/aboutstats.html. Accessed: February 4, 2014.

broken down into U.S. and foreign dental school

graduates, are shown in Table 2. AEGD programs
had the highest proportion of foreign-trained dentists
(18.9 percent) followed by orthodontics (16.1 percent). Since not all dental schools participate in the
matching program, the number of positions available
probably exceeds those shown in the table.

Academic Careers
For foreign-trained dentists pursuing advanced
standing predoctoral or specialty training in the United States, academic dentistry is one of the options to
consider upon graduation. In 2000, a study reported
that close to 66 percent of U.S. dental academicians
were more than fifty years of age, suggesting retirements will lead to increased job opportunities in the
next decades.10 Academic dentistry provides opportunities to teach dental students in didactic, clinical,
and laboratory settings. Apart from teaching, dental
faculty members are involved in a wide range of activities such as designing and conducting independent
and/or collaborative research, performing community
service, reviewing articles submitted for publication,
and conducting patient care. The exposure to a variety

November 2014 Journal of Dental Education

of activities on a day-to-day basis and the supportive

work environment are often cited as major reasons
for pursuing academic careers.11,12 Other advantages
of being in academia include staying constantly updated, working at the cutting edge of the profession,
learning from peers who are experts in their areas,
and working in an interdisciplinary environment.
Academic careers carry many other benefits from
secure salary to excellent insurance and retirement
plans. On the other hand, salary limitations compared
to private practice, work pressure, gender bias, length
of academic training, and educational debt have been
cited as barriers to entering academia.13
Foreign-trained dentists enrolled in advanced
standing or residency programs frequently obtain
educational loans to complete their training. Even
though some tuition waiver programs and support
from specialty foundations are available for dentists
intending to pursue a full-time academic career,
foreign-trained dentists sizable loan burdens often
make it impossible for them to pursue this pathway
unless they have attended a tuition-free college. In
2013, Nalliah et al. reported a trend of reducing interest in pursuing full-time academic careers in Massachusetts as educational debt increased.14 It could
be argued that foreign-trained dentists, therefore,
1493

have an advantage when seeking academic careers

in U.S. states that facilitate the process by which
dentists from other countries can practice and teach
in university settings.
However, the movement of foreign-trained
dentists into academia (or other fields of dentistry)
in the United States represents a loss of highly qualified dentists in foreign countries. A large number of
dentists come to the United States from developing
nations seeking better opportunities for themselves
and their families. The loss of such individuals from
developing nations has been reported in medicine,15,16
but needs to be empirically examined in dentistry. If
this does occur, the resulting brain drain can affect
those areas that need dentists the most.
Specialty training is not essential to work in an
academic setting. Foreign-trained dentists who graduate from a CODA-accredited advanced standing
dental program can teach predoctoral dental students,
but those trained as specialists in a CODA-accredited
graduate program can teach both predoctoral and
postdoctoral students. Although we have heard individuals say in recent years that graduation from a
CODA-accredited dental school is necessary to gain
an academic position, we are aware of several schools
that have hired highly qualified foreign-trained dentists as full-time faculty members and for senior-level
academic positions. If a foreign-trained dentist is in
one of the dental specialties, being board-certified is
an added advantage that further enhances ones opportunities. Board certification is a process by which
a dentist trained in a specialty goes through a series
of rigorous examinations to demonstrate exceptional
expertise in that field.
Depending on the nature of the appointment,
academic jobs in dentistry can be broadly divided
into two tracks: non-tenure and tenure. Non-tenuretrack appointments are usually clinical positions in
which the primary responsibility will be didactic and
clinical teaching. With a few exceptions, non-tenuretrack positions usually have minimal or no research
requirements. Tenure-track appointments provide
the opportunity for a faculty member to become tenured, which ensures the individuals position for the
long term. Faculty members on the tenure track are
required to pursue independent and/or collaborative
research projects and are expected to publish their
research findings on a regular basis. Tenure-track appointments in dentistry may be further divided into
research-intensive tenure-track and clinical scholartrack positions. In the research-intensive track,
research occupies the bulk of ones activities, with

1494

little or no time devoted to clinical teaching or patient

care, whereas clinical scholar-track faculty members
usually pursue clinical practice and research activities
on a roughly equal basis.
Based on the job description, dental faculty
members will be involved in research to varying
degrees. The research focus areas in dentistry can
be generally divided into oral biology research,
public health/health outcomes research, and patientoriented research. Oral biology is a broad term that
involves biological research focusing on areas such
as oral immunology, cariology, biomaterials, tissue
engineering, and molecular biology. Public health
and health outcomes research in dentistry primarily focuses on population-based studies and policy
development specific to oral conditions. In patientoriented research, patients form the vital component
of the study. Testing a newly approved dental material
for safety and efficacy for patients with dental caries is a good example of a patient-oriented clinical
research project.
In many cases, faculty dentists have the opportunity to practice general dentistry or their specialty
within the dental school where they teach. However,
there are wide variations among states and dental
schools regarding the requirements foreign-trained
dentists must satisfy to practice. Massachusetts,
Iowa, and Illinois allow foreign-trained dentists who
have academic appointments to practice in intramural faculty practice clinics for a limited number of
days with a faculty permit. Even within one state,
we know of one dental school that allows full-time
faculty members who are foreign-trained dentists
with full licensure to practice extramurally, while
another does not allow full-time faculty members
to practice extramurally. California allows faculty
members to practice within the dental school but
regulates the process, requiring that foreign-trained
dentists be full-time faculty members who teach four
days a week and are allowed to practice only one
day a week. Other states like Nebraska do not allow
foreign-trained dentists to practice.
Foreign-trained dentists who have graduated
from an advanced standing dental program in the
United States are automatically eligible for dental
licensure upon passing the state-specific licensure
exam. However, foreign-trained dentists who completed only a specialty program in the United States
are often required to obtain a university-specific
faculty dental permit to see patients in dental school
clinics. Not all dental schools offer a faculty permit
to practice and may require full dental licensure.

Journal of Dental Education Volume 78, Number 11

In the ten-year period from 1998 to 2008,

the number of full-time dental/clinical science
faculty members in the United States remained
fairly constant, ranging from 4,215 filled positions
in academic year 2007-08 to 4,636 in 2005-06.17
On the other hand, the number of filled full-time
biomedical sciences faculty positions dropped from
933 filled positions in 1998-99 to 663 in 2007-08.17
Open positions in academic dentistry are advertised
with free access on the American Dental Education
Association (ADEA)s DentEdJobs (www.adea.org/
dentedjobs.aspx), as well as at dental conferences,
general dental journals such as the Journal of Dental
Education and Journal of Dental Research, and the
journals and websites of dental specialties. Faculty
positions in dentistry are also listed on the Academic
Keys website (http://dentistry.academickeys.com/
seeker_search.php) and on the job search site of
The Chronicle of Higher Education (https://chronic
levitae.com/job_search/new).

Working in Private Practice

in the United States
To work in private practice after completion of
a dental degree from a non-CODA-accredited dental
school, foreign-trained dentists need to pursue a pathway to licensure either by completion of an advanced
standing dental degree (two- or three-year programs)
or a degree in one of the specialty programs.18,19
The only pathway that is accepted nationwide is the
completion of an advanced standing dental degree.
Only a limited number of states accept successful
completion of a clinical specialty program in lieu of
a dental degree.19
Requirements for initial licensure are statespecific, but often include successful completion of
both parts of the NBDE, advanced standing degree
(D.D.S. or D.M.D.) from a CODA-accredited dental
school or successful completion of a CODA-accredited graduate program in one of the nine recognized
specialties, plus successful completion of all parts of
a regional dental licensure exam like those given by
the Western Regional Examining Board (WREB),
North East Regional Board of Dental Examiners
(NERB), Central Regional Dental Testing Service
(CRDTS), Southern Regional Testing Agency
(SRTA), or Council of Interstate Testing Agencies
(CITA). In addition, almost all states require passing a jurisprudence exam or laws and ethics exams
before final issuing of the dental license. Almost
November 2014 Journal of Dental Education

all states at this time also require a comprehensive

background check, fingerprint clearance, history of
any personal or medical problems that may impair the
ability to practice dentistry, and information regarding malpractice pertaining to dentistry. A few states
require background clearance through a third party,
which may take several weeks to a few months. If the
foreign-trained dentist holds a license in any state in
the United States or any other country, verification
of such a license is often required unless the foreigntrained dentist is a refugee or asylum seeker.
In addition to the licensure requirements, all
foreign-trained dentists must have valid legal visa
status in the United States or be a legal permanent
resident or citizen of the United States in order to
practice. Obtaining a legal work visa is often a long
and cumbersome process, which requires adequate
planning on the part of the potential employer and
the foreign-trained dentist. Additional qualifications
must frequently be met to justify the reason for hiring
a foreign-trained dentist instead of a U.S. dentist;
some of these include advertising the position statewide and nationwide and meeting the comparable
minimum wage requirements based on qualifications
and work intended to be performed while on duty. All
these processes may take several months to a year to
complete successfully. One of the additional recent
challenges has been a lack of an adequate number
of work visas, which are issued by the United States
Citizenship and Immigration Services (USCIS; www.
uscis.gov/). This number is usually around 70,000
visas with an additional 20,000 for candidates with
masters or higher degrees that were completed in
the United States. The beginning of acceptance dates
for these visas has traditionally been April 1 for visas
beginning October 1, at the start of the USCIS fiscal
year. Over the last several years there have been more
applicants than visas available, so a lottery system is
in place to select candidates. Foreign-trained dentists
may also work on an Optional Practical Training
Status, which ranges from twelve months (for most
degrees) to thirty months (for STEM degrees) depending on the individuals field of study.

Conclusion
This article has provided a broad overview of
dental educational and career pathways available
for foreign-trained dentists to pursue in the United
States. Educational opportunities include pursuing
advanced standing dental degree programs and

1495

advanced graduate education (residency programs).

Career pathways available include working in academic and private practice settings. Both licensure
and visa requirements must be met in order to work
in the United States.

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Journal of Dental Education Volume 78, Number 11