Dental License in California for Foreign Trained Dentists

Being a California dental school graduate myself and a former California Dental Association Student Representative, I wanted to talk today about the licensing process in California. Generally speaking, a foreign trained dentist, or for that matter anybody else, can obtain a license to practice dentistry in California by successfully completing one of the following scenarios:

1. California Board Examinations:

a. The Restorative Technique examination: is for all persons who:

i. Have been issued a dental degree by a foreign dental school not approved by the Board or accredited by a body that has a reciprocal accreditation agreement with a commission or accreditation organization (for practical purposes, this includes almost all foreign trained dentists), and

ii. Passed the National Board of Dental Examinations Part I and Part II by December 31, 2003.

iii. Individuals must have submitted evidence of passing Parts I & II of the NBDE to the Board by July 12, 2004 to be eligible to sit for the RT Examination.

This is why if you are new here, or have not applied by July 12, 2004, it’s really too late to pursue this option, which is due to sunset by the end of this year. But if you were one of the few who met the requirement and passed the Restorative Technique examination then you may take either the California clinical examination or the Western Regional Examining Board (WREB) examination.

More information about the Restorative Technique examination

b. The Clinical examination: if for all persons who :

i. Successfully completed the Restorative Technique examination (above) or

ii. Graduates of schools accredited by the American Dental Association Commission on Dental Accreditation.

Although this examination is referred to as the “Clinical” examination, it does have both written and clinical components which will test you on the following subjects: Endodontics, Removable Prosthodontics Evaluation, Periodontics, Class II Amalgam Restoration, Class III or IV Composite Resin Restoration, Simulated Fixed Prosthetics, California Laws and Ethics.

Specific information about the clinical examination can be found in the handbook .

Total fee for the examination is $601, and re-examination fee $525

2. Application to the Dental Board of California for licensure after successful completion of the WREB examination (After January 1, 2005), this is what most applicants seek these days, since passing the WREB examination meets the clinical examination requirement of license in many more States while the California Board examination is only for license in California. In addition to passing the WREB examination, the board also requires satisfactory evidence of having graduated from a dental school approved by the board, having passed parts I and II of the National Board Examinations. Other requirements and conditions also apply, more information can be found here.
3. Application for Licensure by Credential – This would only apply to dentists with a “clear and valid” dental license in another US state.
4. Application for Licensure by Residency – This is one of the new and exciting options to obtain dental license. On February 1, 2008 the Office of Administrative Law approved the Board’s Emergency regulations implementing SB 683, qualification for dental license on the basis of completion of a minimum of 12 months of a general practice residency or advanced education in general dentistry program approved by the ADA’s Commission on Dental Accreditation (CODA). This is in lieu of having to sit for the California Clinical examination or the WREB examination. You should be a graduate of an ADA or board approved dental program, completed a CODA-approved GPR or AEGD, passed parts I & II of the NBDE, not failed the WREB clinical examination within the last five years, other conditions and requirements must be met also, more information can be found here.

Read more at: www.foreigntraineddentist.net

Dental License in Virginia for Foreign Trained Dentists

Every state in the US has its own rules and regulations to govern and regulate various professions, and laws governing dentistry are no exception. I will start with the State of Virginia since I was recently licensed to practice dentistry in Virginia.

Education Requirements:

A diploma or a certificate from a dental program accredited by the Commission on Dental Accreditation of the American Dental Association. This dental program could be any of the following:
(a) Pre-doctoral dental education program
(b) At least a 12-month post-doctoral advanced general dentistry program
(c) Post-doctoral dental education program in any other specialty.

Licensure Examinations:

1. Successful completion of Part I and Part II of the national board dental examination.

2. Satisfactory completion of all sections of the board-approved clinical dental examinations. (The board-approved examinations are SRTA from any year and CRDTS, WREB or NERB redults for examinations completed after January 1, 2005. CITA scores are accepted if examination is taken after September 1, 2007).

3. If the candidate fails any section of a board-approved examination 3 times, the candidate shall complete a minimum of 14 hours of additional clinical training in each section of the examination to be retested in order to be approved by the board to sit for the examination a 4th time.

4. All applicants for licensure by examination shall be required to attest that they have read and understand and will remain current with the applicable Virginia dental laws and the regulations of the board. The board does not require the applicant to pass any dental laws exams, but such an exam is offered if the candidate wishes to test his/her knowledge of dental laws.

Other Requirements:

1. A final certified transcript of the grades from the college from which the applicant received the dental degree, or post-doctoral degree or certificate.

2. An original grade card issued by the Joint Commission on National Dental Examinations.

3. A current report from the Healthcare Integrity and Protection Data Bank (HIPDB) and a current report from the National Practitioner Data Bank (NPDB).

References:

You can find up-to-date laws and regulations and more in the VA Board of Dentistry Laws & Regulations webpage, and a complete listing of the required forms here.

1. Regulations Governing the Practice of Dentistry & Dental Hygiene. Virginia Board of Dentistry.
2. Chapter 27 of Title 54.1 of the Code of Virginia, Dentistry.
3. VA Dental License Application Form

Read more at: www.foreigntraineddentist.net

WREB - Western Regional Examining Board / Dental Exam

WREB serves as one of the clinical exam requirements needed for getting the license in most US states, after the educational requirement (2-yr program) and the written exam requirement (NBDE). I will try to summarize here the key points that you need to know, from my own experience with WREB, from the official WREB publications, and from the advice of my school professors and WREBs own floor examiners. Since specific exam requirements are subject to change, I will try not to go into details discussing those requirements, you can always read the candidate guide for specifics. As always, it's difficult to guarantee the accuracy of all of the information listed here, so I strongly encourage you to read the WREB candidate guide very carefully to make sure that you understand all aspects of the exam.

To pass the WREB exam: a minimum of 75 points for the overall score, and at least 55% in any section.

I. Operative Section: two different restorative procedures on patients that you provide. Worth 48 points.

A. Operative Exam Issues:

1. Unacceptable patient/case submission will result in a 3 points deduction; you can be penalized twice per procedure for a maximum deduction of 6 points per procedure. Be careful.

2. Bevels are not required on Class II composite restorations.

3. Automatic Failure: you don't want to do any of the following sins:

(a) Caries remaining in prep.

(b) Prep of wrong tooth.

(c) Prep of tooth without approval.

4. Modification Requests: Cut ideal prep before asking for modifications.

5. Rubber dam: required for grading and for modification requests; not required for procedure.

6. MO preps on mandibular first bicuspids are not allowed.

7. Posterior Class II teeth require pretreatment bitewing & PA film.

8. Avoid stained pits and fissures if possible because they may be graded as caries remaining which translates into automatic failure: e.g.,

(a) you are prepping a #14 MO, you are responsible for the distal occlusal pit (the entire occlusal surface). If the distal occlusal pit is carious, you must restore it, and it will be graded as part of your Class II prep score, even if it was restored as an individual prep due to tooth structure conservation indications.

(b) If there is buccal or lingual pit caries, you should not restore them until you have requested a prep modification. You will be automatically failed for prepping without a request, but you will also be failed for leaving caries if you ignore them!

9. Class III composite:

(a) Must be unrestored proximal surface with caries at least to the DEJ or beyond.

(b) If there are lesions on both M & D proximal surfaces, both lesions must be done.

(c) Should be an ML or DL prep; MF or DF preps can be done but must be justified.

(d) Gingival margin must be in enamel.

(e) Restoration must extend into the contact.

(f) Temporary fillings are not allowed in adjacent tooth.

(g) Tooth must be vital; preps in RCT teeth are not allowed.

(h) Teeth with veneers are unacceptable.

10. Indirect pulp caps: If you are within ½ mm of the pulp, you may make a note to the floor examiner requesting to do an indirect pulp cap. You must know how close you are to the pulp; you may take a radiograph to ascertain this. The trick is to know for sure you are only ½ mm of the pulp.

B. Common Problems:

1. Tooth not in occlusion.

2. Caries not to DEJ or deeper.

3. Caries not on proximal surface with adjacent contact.

4. Over- or under-treatment proposed on diagnosis.

5. Submitting backup patients without doing your own diagnosis: We heard about candidates who have requested to treat teeth that have been extracted, to treat lesions that were already treated by another candidate on the exam, etc!

II. Perio. Treatment: root planing and scaling on a patient that you provide. Worth 8 points. Periodontal exam failure is the least common problem.

A. Common Problems:

1. Insufficient calculus on quadrant; automatic 3 point deduction for a rejected quadrant.

2. Soft tissue damage.

III. Endodontics Section: Endo treatment on two extracted teeth. Worth 16 points. Endodontic exam failure is the most common reason for having to repeat the WREB exam.

A. Endodontics Exam Issues:

1. Caries cannot violate the pulp chamber.

2. Radiographs must show the entire tooth from incisal edge to root apex; use double film packs and take both B-L and M-D views.

3. Chipped teeth are acceptable as long as the damage does not compromise your access design and form.

4. Rubber dam must be used.

5. Only the canal you specify will be graded in the posterior tooth, but you may fill more than one of the canals.

6. If your tooth breaks, put all pieces in a bag and have the floor examiner make a note. Avoid this by keeping the teeth moist in water or glycerin.

7. Be careful not to break the tooth during lateral condensation. If this happens, a score of 3 is the highest possible if all else is well done.

8. Scoring is 0 – 5: 3 indicates minimum competence; a score of 4 on one of the two teeth does not offset a score of 2 on the other tooth – both must be 3 or above.

B. Common Problems:

1. Tooth mounted in wrong arch or backwards in socket.

2. Tooth not in occlusion.

3. Apex putty is not a minimum of 2mm from the base material.

4. The posterior tooth does not have at least two canals.

5. Non-diagnostic radiographs are submitted or no pretreatment duplicate films are submitted.

6. Time management; going overtime with live patient exam.

7. Submission of wet and/or unfixed radiographs.

8. Taking too many radiographs to get that one “perfect” film – film needs to be diagnostic, not perfect.

IV. Perio. Diagnosis: Computer simulation exam. Worth 8 points.

V. Prosthodontics: Computer simulation exam. Worth 8 points.

Common Problems with both CSW Exams (they are administered at the same time):

1. Waiting too long to make the exam appointment, Exam must be taken no more than 45 days before or 3 days after sitting for the clinical exam.

2. Not taking 2 pieces of ID that match the registered name.

VI. Patient Assessment & Treatment Planning PATP: case-based written exam. Worth 12 points.

A. PATP Exam Issues:

1. Patient cases are used, both adult and pedo cases (Photographs, radiographs, patient information sheet & health history (same forms that WREB requires), caries status and risk assessment are provided.

2. Candidate has 1 hour to treatment plan 1 case:

(a) Exam seeks evidence of good basic treatment planning skills, keep it simple.

(b) Treatment plan only for what you are given, don't read things into the case that do not exist.

(c) DO NOT OVERTREAT!

(d) Develop an appropriately sequenced treatment plan.

(e) Use of common abbreviations is allowed. Try though to stick to the ones in the official candidate guide.

B. PATP Common Problems

1. Searching for things that are not readily evident in the provided case materials.

2. Poor handwriting.

3. Not keeping it simple, again, do not overtreat or get fancy.

VII. Dental Assistants:

One of the best things that you could do is to hire an assistant to help during the exam, an experienced dental assistant is better, and one who has been involved in a WREB exam is even better, this can save you a lot of time before and during the exam. It's worth investing in.

VIII. Finding Patients:

You have to find your own patients for the exam, I encourage you to start looking for patients as early as you can, give yourself plenty of time ahead so you don't get caught up. Although luck has a lot to do with finding "the right patient" there are several things you can do to improve the odds:

A. Screen your own patients that you already see at the school, you will be surprised sometimes how you can find lesions that were not diagnosed before.

B. Offer free screenings to friends, family, etc. Or you can even extend the offer to your local area (schools, church, etc) provided that you can handle the masses that will respond to the offer (this might be better handled by a large group of volunteer students working together).

C. You could offer potential patients incentives to help them commit to showing up for your exam, I have seen several incentives offered, from powered toothbrushes, to cold hard cash.

D. Ask local dentists, especially alumni of your school to help in referring patients who might be good candidate for the exam.

E. If all fails, and you are desperate, you can always resort to patient finding agencies that specialize in locating candidates for the WREB exam, that can be very pricy, but I've seen some of my friends utilize this approach very successfully.

IX. General Information:
A. Be familiar with the regulations before the exam.

B. Be familiar with the needed paperwork beforehand.

C. Pay attention during the orientation, and ask questions if you need to.

D. Know the scoring criteria.

E. Patient selection is very important, the examiners want to see that you can diagnose properly, they do not want to reject patients, but they must if your patient does not meet the criteria. Also make sure the patient’s health is acceptable, they have no TMJ problems, not an anxious patient, etc.

F. Time management is important, especially for the endo exam, do not start late! Endo and PATP exams are timed, none of the others are, but pay attention to your time. Perio patient must be treated the same day they are accepted.

G. You may anesthetize the patient before being submitted for approval.

H. Do not ask the floor examiners to sit and look at your prep until you have cut the ideal prep, they will ask you if it is ideal before they sit down. Do not fish!

I. Candidates will not be penalized for equipment failures; if there is more than a 15 minute delay, the candidate will be compensated. Make sure you notify the floor examiner as soon as you notice the malfunction.

Read more at: www.foreigntraineddentist.net

University of the Pacific International Dental Studies Program (IDS)

So, you cleared your boards and scored very well and now you are getting ready to apply for dental schools, lets talk about the different choices that you have and all the international dental programs that are available to you. Since I am a Pacific graduate, it makes sense that I start with the International Dental Studies Program (IDS) for foreign trained dentists at the Arthur A. Dugoni School of Dentistry in the University of the Pacific, San Francisco, CA

This is a two years program that culminates with a DDS degree, 22 students are accepted each year and the program starts in July.

Application Process:

The program starts accepting applications usually in May and continues to accept them until the September deadline (deadlines may vary from one year to another, check the school web site for more details).
You can get a copy of the most recent application packet here.
You need to submit the following:
- Completed application form.
- $75 application fee.
- C.V. (make it professional, good looking, this is one of the most powerful ways to grab the attention of admission personnel and administrators, etc). I recommend this software for that purpose.
- Dental goals statement, describe what you intend to do in your future career in dentistry, go over your short and long term goals, talk about specialty training if that is your passion, if you are into teaching and education you have to mention that, whatever it is that you want to make out of your program, write it here, and write it well.
- 2 letters of recommendation.
- NBDE part I scores (80 is the minimum).
- TOEFL scores (A minimum score of 92 or above (internet-based version), 580 or above (paper-based version) or 237 or above (computer-based version) is required.
- Dental degree from the foreign dental school. (Provisional degrees are not accepted).
- ECE course-by-course evaluation (minimum GPA of 2.0).

After reviewing all received applications, the program will invite selected applicants for the interview and technique exam sometime in September or October, you will be asked to pay a small fee to participate in the technique exam. The technique exam details are released a day or two before the exam, but it usually consists of two preps (class II amalgam and PFM prep).

You will be assigned a faculty member who will conduct the interview, for the most part this interview should go smoothly, most, if not all, Pacific faculty are very friendly, and they are interested in finding out if you will be a good candidate and a good match for the school, talk to them, answer their questions, and ask them your own questions, and be honest.

Your overall performance on the technique exam, interview, and all the other items in your application will determine if you will get in or not, no body really knows the exact formula used in making those decisions, so do your best in every aspect, and hopefully a good all-around application will get you in.

Tuition & Fees:

As expected, this program is expensive, not that other programs are not, here is a rough breakdown of the tuition and some of the fees as of 2008:
Tuition: 1st yr: $73,000 & 2nd yr: $77,000
Student doctoral kit: $14,000
Instruments Management fee: over $5,000 for both years
When you add up all other fees, the total estimated annual expenses come up to $96,000 for the first year and $86,000 for the second year. Please visit the school website for more detailed information about tuition and fees.

Contact information:

International Dental Studies Office
University of the Pacific, Arthur A. Dugoni School of Dentistry
2155 Webster Street, Suite 409
San Francisco, CA 94115-2399
United States of America

415.929.6428 or 415.929.6688
Fax: 415.749.3334
IDS@pacific.edu

You can also check out the new Pacific Dugoni students forum, you can ask questions there and interact with current IDS students.

Now I know I am biased, but honestly, this is one of the best schools you can get into, they are famous for many things, but most important, their humanistic environment, friendly atmosphere, and clinical excellence. You can read more about the Dugoni Experience here.

National Board Dental Examinations NBDE

When it comes to license requirements or application to international or advanced standing programs for foreign trained dentists, NBDE is by far considered the common denominator and the first step in this long process. Since NBDE is such an important step and because it should be among the very first ones on your list I thought I'll talk about NBDE first.

As of now the NBDE exam consists of two parts and it's administered by the ADA Joint Commission on National Dental Examinations (JCNDE). Part I of NBDE covers most aspects of the biomedical sciences while part II deals mostly with clinical dentistry issues.

NBDE Part I

It's extremely important that you carefully read and review the NBDE Part I Candidate Guide, you can download a copy of the guide here. The fee for the NBDE exam is $260. The following eligibility requirements for taking the NBDE exam apply to international dental graduates or foreign trained dentists, these requirements were adapted from the NBDE candidate guide (2008):

1. You must submit an examination application and fee to:
   The Joint Commission on National Dental Examinations
   211 East Chicago Avenue, Suite 600
   Chicago, Illinois 60611-2678
   
   You can also use the online application, which is available here


2. You must have your official dental school course transcripts verified by:
   Educational Credential Evaluators, Inc.
   P.O. Box 514070
   Milwaukee, Wisconsin 53202-3470
   414-289-3400 http://www.ece.org/
   You must contact Educational Credential Evaluators, Inc. (ECE) and request an ECE application form. The ECE form will describe what educational credentials are required and how to submit them to ECE. Fees for ECE services will also be listed ($85 at the time this blog is published). You should indicate that a General Report should be sent directly to the Joint Commission on National Dental Examinations. It takes approximately four weeks for ECE to evaluate credentials.


3. Educational Credential Evaluators, Inc. will send the ECE General Evaluation Report directly to a) you and b) the Joint Commission on National Dental Examinations (if it was requested by you on the ECE application).


4. The Joint Commission will hold the NBDE examination application, but will not process it before the ECE Evaluation Report is received. The ECE report must be received in the Joint Commission office by the application deadline.


5. Your name on the ECE report must match the name on the application. Any name changes must be accompanied by legal documentation.

There are other important information listed in the NBDE guide, again you should familiarize yourself with this guide and read it a couple of times.
Most schools require foreign trained dentists to take NBDE part I and they do assign a certain weight in their acceptance decision on your score on that exam, some may also require part II.

The NBDE exam is administered only at Prometric test centers in the US and Canada, once you register you will receive information directing you on how to register for a certain date. At one point in time (when I took the test), the test was paper-based only, gosh, I feel so old!

According to the official candidate guide, the NBDE could take up to 7 hours, divided into 3.5 hours segments, 200 questions each, with an optional one hour break.

Part II

Again, your first step is to become familiar with everything listed in the NBDE Part II Candidate Guide which you can download here. The examination fee for part II is $340. You do not need a new ECE report if you have already taken care of this during Part I.

Part II is also computer-based, administered in Prometric, you can submit a paper application, or register online here. Many other regulations and procedures are similar to Part I. The only difference is the scope of the exam, NBDE Part II tackles the different dental specialties, patient management, and pharmacology.

The exam is administered in two days, day one consists of two 3.5 hours segments, 200 questions each, of discipline-based questions. Day two consists of 100 case-based questions. You will be given several cases with 10-15 questions each.

Preparation for the NBDE Exam:


Obviously, a strong and solid background is needed before you tackle any of these exams, being a foreign trained dentist gives you at least a theoretical advantage because chances are that you are familiar with at least some of the subject covered in the NBDE exam, that should be derived from your text books and lecture notes, that was certainly my case, but you may want to also supplement your preparation efforts with other educational aids, I've used some of the following, but not all, so I can't attest to how effective they are, but I know that the following teaching aids are being used by many foreign trained dentists and other international students in lots of different ways:

1. Released national board dental exams from previous years, can be a great resource, the more recent, the better, they can serve to familiarize you with the format of the exam, and you can use them to test yourself and your preparation, don't count too much on seeing the same questions though in your exam. You can purchase those directly from the American Student Dental Association. I encourage you to become a member of ASDA, foreign-trained dentists or international dental graduates who are not yet enrolled in a US dental school can join at the associate level, the dues are $53 and you get decent discounts on reprints of the released NBDE exams.


2. First Aid for the NBDE Part I (First Aid) and First Aid for the NBDE Part II are both useful guides published by McGraw-Hill , with lots of good reviews, written by students who aced the National Dental Board Exams and reviewed by top dental school faculty and practitioners, include hundreds of high-yield facts and mnemonics to maximize study time, and test-taking strategies and advice.


3. Another two books and useful guides published by Mosby are: Mosby's Review for the NBDE, Part I and Mosby's Review for the NBDE, Part II (Mosby's Review for the Nbde: Part 2 (National Board Dental Examination)). They also have very good reviews.


4. Kaplan also publishes a review guide that is available for Part I only: dentEssentials: High-Yield NBDE Part I Review (Kaplan Dentessentials)
   


5. Dental Decks: a flash card-based educational tool, could be very useful if you like that style of learning, you can check them out here. They can be somewhat pricey, so you may want to shop for them at other outlets or on eBay.


6. Crack the NBDE for the National Board Dental Examination Part 1 (2008 Deluxe Edition): seems like a nice way to "simulate" the national board dental exams, both parts I and II. It's a computer software that you download. They have several packages to chose from.


7. Kaplan provides several resources to prepare for the NBDE exam, they offer prep courses for both parts at their centers, those could be expensive, but may work well for you if you need a strong classroom-like refresher of your information. They also offer online programs which are basically question-banks with or without lecture notes. They vary in prices depending on how long you will use the service, more like a subscription-based system.



8. The Student Doctor Network Forums provide a wealth of information about the NBDE and other issues relevant to foreign trained dentists or international dental graduates

The NEW NBDE:

Effective January 2010 the JCNDE will start reporting performance in the NBDE exams as pass or fail only, and possibly administer a new version of this exam that basically combines both parts into one exam that is for the most part composed of clinical cases-specific questions.

There are couple of interesting issues that will arise because of this change, and those are mainly related to international dental graduates (foreign trained dentists). You see up until now we only needed to take part I and use that score to apply to schools that used to look at the score and make their acceptance vs. rejection based on that score and many other criteria. When the new exam is rolled, this will be impossible, since you need to be enrolled in a dental school before being allowed to take the exam, as you can see, the new format can't be used as an admission requirements since you can't even take the exam before being already accepted into school, and because standard scores cannot be reported anymore.

What could make this even more complicated is the fact that with the new format schools may feel obliged to add more biomedical sciences courses to the curriculum of the international programs to make sure their students are adequately prepared to pass the NBDE in its new comprehensive format, this could very well mean longer programs (more than two years), and higher tuition. So, if you are reading this now, and you're still thinking, my advice to you is to go ahead and take part I and secure that important step toward obtaining your license to practice dentistry here.

Good Luck !

Read more at: www.foreigntraineddentist.net

Introduction - Foreign Trained Dentists & US Licensure

I will try to do my best to explain several things related to obtaining license to practice dentistry in the United States for foreign trained dentists, this information should be useful one way or another to dentists who received their dental degrees from countries other than the US and want to be able to work as dentists in the US.

It's important to know that although I'm spending lots of time and effort compiling all of this, I can't guarantee the accuracy of all of the information listed here. It's always prudent to confirm this information and data with licensure authorities (state dental boards) in the state(s) you are considering to work in as they should have the most updated information. License requirements keep changing all the time making it even more important to get the most up-to-date information from the source directly.

The process of obtaining a license to practice dentistry in the US for international graduates or foreign trained dentists can be simply summarized in few steps (these steps represent an over-simplification, but should be useful as a basis):

1. Find out specific licensure requirements for the state or states you are considering to practice dentistry in, you can use this blog to find most of that information, but you have to always go back to the specific state dental board for the most up-to-date information.
2. Take at least the part I of the National Board Dental Examination (NBDE), you may elect to take part II too as some schools require that as part of their application process, more information about this exam will follow, including some of the changes that will affect this exam in the near future.
3. Apply to and get accepted in a two-year program at an accredited US dental school. You should select programs that grant a degree not a certificate as most dental state boards require a degree (DDS or DMD), I will try to go through most if not all the programs available out there and compare them.
4. Take a clinical license exam or apply to a post-grad program (depends on specific state).
5. Apply for license.

Since this is purely volunteer work done on my own free time, bare with me please if you can't find the information you are looking for right away, I will keep adding more info as time permits.
Good luck in your pursuit.

Read more at: www.foreigntraineddentist.net