How The Profession Is Organized In California
Regulation
As a dentist, you must be licensed to practice dentistry in the State of California. The Dental Board of California regulates the profession. It give California licenses by both Acceptance of Examination (for first-time licenses) and by endorsement of existing licenses from other states. The Dental Board of California also manages Dental Sedation permits that allow licensed dentists to administer local and general anesthesia and sedation.
The California Dental Licensure Examination is the qualifying examination for a California 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 US work authorization but is only now beginning to rebuild your career in the US. Therefore, the guide will include steps that come before the final state licensing process, including foreign credential evaluation, 3 exams, and completion of a 2-year Advanced Standing Program for International Dentists.
Employment
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 average salary of dentists in the US was $146,920 in 2010.
At this time there is only moderate growth expected in dentistry. This is partly because of new dental treatment technologies and the increased role of dental hygienists and assistants in oral health. Most new job opportunities in dentistry will come from dentists’ retirements or from increased demand as a result of an aging population who have a greater need of dental care. Cosmetic procedures such as teeth whitening and braces for all ages are other sources of expanding dental practice.
Eligibility For Licensing
Overview
In California, a foreign-educated dentist may apply directly for licensure if their foreign dental program has been approved by the Dental Board of California. Currently, only the University de La Salle in Leon, Guanajuato, Mexico has been approved. If your dental school has not been approved by the state board, there are a number of steps you must follow in order to receive licensure in California.
This section explains the important steps that you need to complete before you can be licensed to practice dentistry in California. The steps to licensing are as follows:
I. Foreign Degree Evaluation and NBDE Part 1
Foreign Degree Evaluation
The Dental Board of California requires a general report from Educational Credential Evaluators, Inc. (ECE), which 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
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 Part 1
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 topic, Tests.
Once you have passed the exam you are eligible to apply for a 2-year Advanced Standing program for international dentists.
II. 2-Year Advanced Standing Program
The state of California requires foreign graduates of dental programs not approved by the American Dental Association to take an additional 2-year course in a U.S. or Canadian accredited dental program. This is commonly referred to as an Advanced Standing Program. You will earn a Doctor of Dental Surgery, or DDS degree. As of July 2009, only four dental schools in California offer an Advanced Standing Program.
- Loma Linda University School of Dentistry
- University of California at Los Angeles (UCLA) School of Dentistry
- University of Southern California (USC) School of Dentistry
- University of the Pacific Arthur A. Dugoni School of Dentistry
These programs vary in terms of admission requirements, program components and costs. At a minimum, you will need to provide NBDE Part I scores, TOEFL scores, your foreign dental school transcripts evaluated by ECE, your CV/resume, your personal statement and an application. Please keep in mind that requirements are different at each program, and you will need to pay special attention to the admission requirements of each program you apply to. You will need to research other schools if you are willing to leave California 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 other US dental schools will have similar costs for Advanced Standing Programs. Graduate education in the US 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 Other Careers and Credentials for more information.
III. 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 Clinical Examination
The Clinical Examination 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 Dental Board of California has a detailed application package available online. Some of the documentation it requires includes:
- 4-page application
- Certification of Education Form
- Certification of 2 years’ training at an approved U.S. or Canadian dental program
- Receipt of NBDE Grade Card and ADEX exam results from the testing agencies directly
You mail the completed application package to the Dental Board of California for processing.
Fee: $149
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 costs just $5 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.
Tests
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
- Biochemistry and Physiology
- Microbiology Pathology
- Dental Anatomy and Occlusion
2012 Fee: $345
If you fail any part of the NBDE Part 1 you can retake it separately for additional fees.
National Board Dental Examination Part II
The application process is similar to NBDE Part I. You may apply for the test online and pay the testing fee using a credit card. Prometric administers the test on a rolling basis. The test must be taken in a designated testing center.
NBDE Part II lasts over 12 hours and is taken over 2 consecutive days. It is a 500-question multiple choice test.
Day 1 has 400 questions from 9 discipline areas:
- Endodontics
- Operative dentistry
- Oral and maxillofacial surgery/pain control
- Oral diagnosis
- Orthodontics/pediatric dentistry
- Patient management
- Periodontics
- Pharmacology
- Prosthodontics
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.
2012 Fee: $390
Clinical Examination
The California Dental Licensure Examination, or Clinical Examination, is a test that combines a written exam with clinical practice on both real patients and life-size models called Manikins. The exam is given 2-5 times a year in the spring, summer or fall as needed.
California candidates apply directly to the board during the application filing period. The application filing period for the upcoming year is released in November or December of the preceding year. You will need to request an application directly from the Dental Board of California to arrange scheduling for the exam. You will have to travel to a test site. There are 5 exam sites in California: two in San Francisco, two in Los Angeles and one in Loma Linda. You will specify your preferred examination date and location on your application, but applicants are assigned on a first-come, first-served basis. If your application is incomplete, you will not be scheduled for an examination.
The Clinical Examination has 6 sections, divided into 3 areas:
Written
- Endodontics: 50 multiple-choice questions (50 min)
- Removable prosthodontics: 50 multiple-choice questions performed at laboratory stations (42.5 min)
- Periodontics diagnosis and treatment: 54 multiple-choice questions from clinical slides (54 min)
Practical
- Simulated fixed prosthetics: several procedures conducted on a Manikin (4 hours)
Clinical
- Periodontics: examination and diagnosis, as well as scaling, conducted on a patient (1 hour 45 minutes)
- Class II amalgam: cavity preparation and restoration conducted on a patient (3 hours)
- Class III or IV composite: cavity preparation and restoration conducted on a patient (3 hours)
Fee: $599 Total ($450 for the exam + $100 application fee + $49 for fingerprinting)
Candidates are scored on each procedure on a 0-5 number scale, which is then converted to a percentage. You must score an overall average of at least 75% or more on at least 4 of the 6 sections. You also must score at least 75% on 2 of the 3 clinical sections.
Time and Costs
Successfully licensing as a Dentist in California 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 2-year 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 California. Please consider these scenarios as two examples out of many possibilities. Your experience will vary.
Two Hypothetical Scenarios for Dentist Licensing:
| Step | More Efficient Scenario Approximate Time and Cost | Less Efficient Scenario Approximate Time and Cost |
| 1 Evaluate degree & Pass NBDE Part I | Your degree evaluation and NBDE Part I exam go smoothly: you complete them both in four months while you are also researching Advanced Standing Programs. 4 months + $430 | Problems with your documents and translations take months to resolve and are expensive. You must pay others in your country to visit institutions for you. You pass the NBDE Part I once you are eligible ten months later. 10 months + $800 |
| 2 2-year Advanced Standing Program | You apply for a few programs, and are accepted in an California program a year later. Your financial aid package includes both loans and grants. 3 1/2 years + $140,000 | It takes you a year and a half to be accepted into an Advanced Standing Program. You do not apply for grants, so must pay for your entire education yourself. 4 years + $200,000 |
| 3 Pass NBDE Part II | As you finish your DDS program you take NBDE Pt. II and pass. $390 | You graduate and take NBDE Pt. II, which you pass. $390 |
| 4 Pass Clinical Exam | You then take the Clinical Examination on the earliest available testing date 5 months later. 5 months + $599 | You take the Clinical Examination five months later but fail two parts. You return again in three months and pass. 8 months + $1,198 |
| 5 License by Acceptance of Exam | Your license is processed in four months by Dental Board of California 4 months | Your license is processed in four months by Dental Board of California 4 months |
| More Efficient Total About $141,400 and 4 1/2 years | Less Efficient Total About $202,400 and 6 years |
Other Careers and Credentials
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:
- Having more energy to focus on studying and saving money for an Advanced Standing DDS program.
- 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.
Entry-Level
Dental Hygienist
The State of California also regulates and licenses dental hygienists in the state. Dental hygienists must complete a 2 or 4-year training program and pass the Western Regional Examination Board (WREB) Dental Hygiene exam (written and clinical parts) before being licensed. Preventive dental treatment is the main responsibility of a dental hygienist: in the US 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 $50,000 annually. 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 US.
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 find it easy to qualify for this position immediately.
Dental Assistant
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. Becoming a dental assistant in California does not require special training or licensure. However, Registered Dental Assistants (RDA) make higher wages. Becoming an RDA takes about a year and a half of education and training.
Beyond Licensing
Maintaining Licensure
Licenses expire on the last day of the birth month of the licensee. The Dental Board of California 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 and will have to pay an extra fee. You must also document 50 hours of continuing education over each renewal period. You can renew your license online or through the mail, but it will take about 3 additional months to renew your license through the mail.
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 California and across the US. 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:
- California Dental Association
National:
- American Dental Association
Licensing Mobility (Reciprocity)
The state of California grants licensing to dentists through Acceptance of Examination (the process described above), or by Credential. A dentist licensed in another state who wants to practice in California must independently meet all California requirements for licensing. If you become licensed in California and want to practice dentistry in another state, you will need to research the legal requirements for that state.
Applying for a Dental Sedation Permit
You must already be a licensed dentist in California before you can apply to Dental Board of California for a Conscious Sedation and/or General Anesthesia Permit. Permit A is for conscious sedation and Permit B is for deep sedation and general anesthesia. If you qualify for Permit B, though, you will not need to apply for Permit A. Each permit costs $200 and requires proof of license and other history related to your preparation to administer anesthesia. Each permit must be renewed when your dental licensure expires.
Important Links
Licensing and Regulation:
- The California Dental Practice Act has more information on regulation and renewal of a dental license.
- The Dental Board of California website has all licensing applications for Dentists and Dental Hygienists; Phone: (877) 729-7789
Credentialing Organizations:
- Educational Credential Evaluators, Inc. (ECE); Phone: (414) 289-3400
Advanced Standing Program for International Dentists:
- The Welcome Back Initiative publishes a list of California Advanced Standing – International Dentist Programs
Testing:
Professional Associations:
- The American Dental Association (ADA) is a professional association, accrediting body for dental programs, and an examination authority. It is headquartered in Chicago, Illinois. The ADA has a useful page of information specifically for internationally educated dentists.
- The California Dental Association is a professional association that supports its members through innovation in education and advocacy.
Tips
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.
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.
