Foreign-Trained Dentist in the USA: INBDE and Licensure

If you qualified as a dentist outside the United States and Canada, most US states will not license you on your foreign degree alone. The usual route is to have the degree evaluated by ECE, pass the Integrated National Board Dental Examination (INBDE), complete a two- to three-year advanced standing DDS or DMD programme, pass a clinical exam – usually ADEX – and apply to a state board. A minority of states accept other US training or a supervised limited licence instead.

What every state board looks for

Each state sets its own rules, but the American Dental Association (ADA) sums them up as three requirements: education in a programme accredited by the Commission on Dental Accreditation (CODA), a written exam and a clinical assessment. Education is the hurdle: in most states, the ADA notes, a US postgraduate or specialty programme does not make up for a non-accredited first degree.

CODA recognises programmes accredited in Canada under a reciprocal agreement and has accredited two schools abroad: King Abdulaziz University in Saudi Arabia (diplomas from 1 August 2019) and Yeditepe University in Turkey (from 1 February 2024). Their graduates count as CODA graduates.

Step 1: credential evaluation and the INBDE

First create a DENTPIN, the ADA’s identification number for its exams. The Joint Commission on National Dental Examinations (JCNDE) requires every candidate from a non-CODA programme to have the degree confirmed by Educational Credential Evaluators (ECE). ECE’s U.S. General Report (US$110) is enough for the exam, but if you also plan to apply to dental schools, order the U.S. Course by Course Report (US$199), which the JCNDE accepts too. The name on the report must match your DENTPIN exactly.

The INBDE replaced NBDE Part I (last given on 31 July 2020) and Part II (available until 31 December 2022). Every US state and territory accepts it for all or part of the written exam requirement.

INBDE in 2026	Details
Format	500 multiple-choice items, standalone and case-based, over two days within seven days
Time	Day 1: 8 h 15 min; day 2: 4 h 15 min (breaks included)
Where	Prometric centres in the US, its territories and Canada (not Quebec), all year round
Fees	US$890 plus a US$435 processing fee for non-CODA candidates
Result	Pass/fail; scale 49–99, pass mark 75; results usually within three weeks
Retakes	At least 60 days apart, at most four in 12 months; pass within five years or five attempts, after which you may test once every six months (12 months before June 2025)

Once approved, you have six months to test; a one-off 45-day extension costs US$150.

Step 2: English and the new TOEFL scale

All programmes in the ADEA CAAPID system require the TOEFL. Since 21 January 2026 the TOEFL iBT has been scored on a 1–6 scale in half-point steps, with a comparable 0–120 score shown for a two-year transition; scores are valid for two years. Minimums differ: in the current cycle UCLA asks for an overall 5.0, the University of the Pacific and the University at Buffalo for 4.5. Some boards set their own rules – Minnesota accepts the TOEFL or OET.

Step 3: an advanced standing DDS/DMD programme

Advanced standing programmes admit dentists with a foreign degree into the later part of a US DDS or DMD curriculum. You apply through CAAPID, a central service run by the American Dental Education Association (ADEA); its Program Finder currently lists 36 programmes, lasting 24 to 39 months.

Timing: the 2026–27 cycle opened on 5 March 2026 and takes applications until 29 January 2027, but schools set their own, often much earlier, deadlines. Pacific closed on 12 June 2026 for a class starting in July 2027.
Documents: a course-by-course evaluation from ECE or World Education Services (WES) – UCLA, Pacific and Buffalo accept only ECE – plus TOEFL scores, letters of evaluation and, for most programmes, National Board results (Pacific considers only a pass).
Selection: extra steps such as the Casper test at Pacific or a bench test and interview at Buffalo.
Fees: US$264 for the first programme, US$115 for each additional one, plus school fees (US$100 at Pacific).

Places are limited – UCLA plans to admit 30 students this cycle – and costs are high. For 2026–27, UCLA’s programme fee is US$120,968 a year and Pacific’s tuition US$135,700 a year; Pacific’s estimated direct and living costs for both years add up to almost US$400,000.

Step 4: the clinical licensure exam

Most states require a clinical exam from an independent testing agency, and the landscape changed in 2025–2026:

CDCA-WREB-CITA merged with ADEX on 1 September 2025. The combined American Board of Dental Examiners (ADEX) now administers the ADEX Dental Examination, which the ADA says is accepted or required in 48 states.
The exam has five clinical parts performed on manikins – periodontal (required from 1 August 2026), endodontic, prosthodontic, anterior and posterior restorative – and a computer-based part, which since mid-2026 has been the ADA’s DLOSCE. Standalone DLOSCE sittings ended after 9 October 2026.
The fee is US$2,995 plus a facility fee and US$150 per typodont procedure. All parts must be passed within 18 months of the first attempt.
CRDTS runs its own exam (US$2,800 for all five parts, plus site fees). Check that your state accepts it – Texas, for example, validates ADEX and CRDTS-SRTA results.

As a rule, you cannot sit ADEX on a foreign degree and the INBDE alone. Its July 2026 candidate guide admits internationally trained dentists only if they are enrolled in a CODA-accredited DDS/DMD programme (advanced standing included); are in the final year of, or have completed, a two-year CODA-accredited GPR or AEGD residency; or are in or have completed a CODA-accredited specialty programme, or a hospital residency, fellowship or postdoctoral programme affiliated with a CODA-accredited programme. The guide’s table asks for a state board authorisation letter only in the last two cases, but its general rules require one from all internationally trained graduates – check with ADEX and your state board before registering.

States with other routes

Some states license internationally trained dentists without a US DDS/DMD, though nearly always after US training. Examples confirmed in October 2026:

Texas: at least two full-time academic years in a CODA-accredited programme in an ADA-approved specialty, plus the INBDE, a clinical exam and the Jurisprudence Assessment.
Florida: instead of a US degree, at least two consecutive academic years in a full-time CODA-accredited supplemental general dentistry programme (not a specialty); the clinical exam must be ADEX.
New York: at least two academic years in a registered or accredited dental school programme, plus a residency of at least one year, which every applicant needs.
Minnesota: a Limited General License after a credential evaluation, the INBDE, an English test, an interview with your patient records, a clinical exam and a jurisprudence exam; after three years of supervised practice you can petition for an unrestricted licence.

Rules keep changing, and not every proposal becomes law – in 2026 Maine lawmakers rejected a bill for a supervised ‘associate dentist’ licence – so confirm the current requirements with your state board before you commit money.

Costs and a realistic timeline

Step	Timing	Cost (US$)
ECE report	Before the INBDE	110 or 199
INBDE	All year	890 + 435
CAAPID application	Cycle opens in March	264 + 115 per extra programme + school fees
Advanced standing programme	24–39 months	About 121,000–136,000 a year in tuition (UCLA, Pacific), plus living costs
ADEX exam	During or after the programme	2,995 + facility and typodont fees
State licence	After graduation	Varies by state

At Pacific, an applicant who met the June 2026 deadline starts in July 2027 and graduates with a DDS in June 2029. Add time beforehand for ECE, the INBDE and the TOEFL, and afterwards for the clinical exam and the licence application.

How MedMigrant can help

If you would like to talk through your options – for example, whether the US route makes sense for you compared with other countries – MedMigrant offers individual consultations on the recognition of qualifications abroad. MedMigrant is independent of the ADA, JCNDE, ADEA, ADEX and the state boards, which make all eligibility and licensing decisions.

Frequently asked questions

Can I take the INBDE in my home country?

No. It is offered only at Prometric centres in the US, its territories and Canada (excluding Quebec).

Is my old NBDE Part I and II pass still valid?

Generally yes: ADEA notes that NBDE results do not expire, although programmes may set their own limits. UCLA and Pacific accept a pass in both parts instead of the INBDE.

Can I go straight to the clinical exam after the INBDE?

Usually not: ADEX’s candidate guide requires current or completed US training (see Step 4). Minnesota is an exception: after a successful interview, its board gives you a letter permitting you to sit one of its approved clinical exams.

Will a TOEFL taken before 21 January 2026 still count?

Yes, while it is valid (two years from the test date), judged against the school’s minimum on the old 0–120 scale – at UCLA, 95 overall or the required section scores.

Sources

Last updated: 28 October 2026. Rules, dates and fees change – the official pages of the JCNDE, ADEA, ADEX and the state dental boards are decisive.

Foreign-trained dentist in the USA: INBDE, advanced standing, licence