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T
he future need for dentists in the United States and academic dentistry and information on visa and
is strong. Five thousand areas have been des- licensure requirements.
ignated Oral Health Professionals Shortage
Areas by the U.S. Department of Health and Human
Services.1 The aging U.S. population will increase the Advanced Standing D.D.S./
need for dentists in two ways: many older dentists
will retire, and the larger cohort of older patients will D.M.D. Education
need oral health care services.2 In addition, the U.S. Of the sixty-five dental schools in the United
population is becoming increasingly diverse,3 and States and Puerto Rico, twenty-five offer opportu-
individuals with limited English proficiency often nities for foreign-trained dentists to acquire a full
have poorer health,4 creating the need for health care U.S. dental degree through abbreviated training in
practitioners with multilingual skills. an advanced standing program.7 Information about
To meet the need for more dentists, several these programs appears in Table 1. Foreign-trained
new dental schools have opened in the last five years, dentists typically enter these programs after basic sci-
and existing schools are expanding their class sizes.5 ence training in the traditional dental curriculum and
However, there is also growing opportunity for before the clinical years. Entry requirements include
foreign-trained dentists to pursue dental careers in passing scores on the National Board Dental Exami-
this country. A previous article reviewed the types nation (NBDE) Part I and/or Part II and the Test of
of advanced placement and other degree programs English as a Foreign Language (TOEFL), graduation
in the United States and Canada for foreign-trained from a foreign dental school, and prior transcripts.
dentists, comparing those programs and reviewing Several advanced standing programs also require that
the similarities and differences between them.6 In our applicants undergo a psychomotor bench test, case
article, we go a step further: our aim is to provide an presentations, and a formal interview as part of the
overview of dental educational and career pathways application process. Most schools require that for-
in the United States for foreign-trained dentists, eign school transcripts be evaluated by Educational
including work opportunities in private practice Credential Evaluators Inc., World Education Services
Duration Number
Degree of Advanced of Minimum Entry Requirements:
University & School Offered Standing Program Positions Standardized Tests Estimated Costs
Loma Linda University D.D.S. 24 months 20-24 TOEFL and NBDE Part I/Part II Total costs are $113,732 per year.
School of Dentistry
Ostrow School of Dentistry of the D.D.S. 24 months 32 TOEFL and NBDE Part I Total costs are $120,823 for year 1
University of Southern California and $110,573 for year 2.
University of California, Los Angeles, D.D.S. 25 months 20 TOEFL and NBDE Part I Total costs are $116,947 for year 1
School of Dentistry and $94,832 for year 2.
University of California, San Francisco, D.D.S. 24 months 24 TOEFL and NBDE Part I Total costs are $123,561 per year.
School of Dentistry
University of the Pacific Arthur A. Dugoni D.D.S. 24 months 22 TOEFL and NBDE Part I Total costs are $143,395 for year 1
School of Dentistry and $135,237 for year 2.
The University of Colorado D.D.S. 24 months 40 TOEFL and NBDE Part I Total costs are $96,370 for year I
School of Dental Medicine and $93,260 for year II.
Howard University D.D.S. 24 months 10 TOEFL and NBDE Part I/Part II Interested applicants should contact
College of Dentistry the school financial aid office.
University of Florida D.M.D. 48 months 2 TOEFL and NBDE Part I Tuition fee for nonresidents is $68,042 per
College of Dentistry year. Instrument, equipment, living, and
miscellaneous costs are variable.
Indiana University D.D.S. 24 months 24 TOEFL and NBDE Part I/Part II Total costs for nonresidents are
School of Dentistry approximately $99,000 per year.
University of Illinois at Chicago D.M.D. 24 months 40 TOEFL and NBDE Part I Tuition fee is variable depending on
College of Dentistry range of hours enrolled.
University of Louisville D.M.D. 26 months Based on TOEFL and NBDE Part I Nonresident tuition fee is $59,500 per year.
School of Dentistry space Instrument, equipment, living, and
availability miscellaneous costs are variable.
Boston University Henry M. Goldman D.M.D. 24 months 75 TOEFL and NBDE Part I Tuition fee is $64,500 per year.
School of Dental Medicine Instrument, equipment, living, and
miscellaneous costs are variable.
Tufts University School of D.M.D. 25 months 10-20 TOEFL and NBDE Part I/Part II Total costs are $48,351 for year 1,
Dental Medicine $98,723 for year 2, and $91,803 for year 3.
Rutgers School of D.M.D. 27 months 26 TOEFL and NBDE Part I Total costs are $103,218 for year 1
Dental Medicine and Part II (including summer) and $76,135 for year 2.
Columbia University D.D.S. 30 months 2 TOEFL and NBDE Part I Total costs are $56,350 for first spring
College of Dental Medicine semester, $96,540 for year 2,
and $95,871 for year 3.
University at Buffalo D.D.S. 24 months 24 TOEFL and NBDE Part I Total costs for non-NY residents are $88,875
School of Dental Medicine for year 1 and $87,910 for year 2.
University of Oklahoma D.D.S. 29 months 4 TOEFL and NBDE Part I Total costs are $10,000 for preliminary
College of Dentistry 16-week session, $155,160 for year 1,
and $137,334 for year 2.
University of Pennsylvania D.M.D. 24 months 30 TOEFL and NBDE Part I Total costs are $33,056 for preparatory
School of Dental Medicine program, $105,069 for year 1,
and $101,862 for year 2.
The Maurice H. Kornberg D.M.D. 36 months 12 TOEFL and NBDE Part I Tuition fee is $60,690 per year.
School of Dentistry, Temple University Instrument, equipment, living, and
miscellaneous costs are variable.
University of Puerto Rico D.M.D. 25 months 8 TOEFL and NBDE Part I Total costs are $77,736 for year 1
School of Dental Medicine and $55,002 for year 2.
Virginia Commonwealth University D.D.S. 28 months 10 TOEFL and NBDE Part I/Part II Total costs are $91,000 per year.
School of Dentistry
University of Washington D.D.S. 26 months 5 TOEFL and NBDE Part I Total costs are $111,580 for year 1
School of Dentistry and $106,580 for year 2.
Marquette University D.D.S. 36 months Varies TOEFL and NBDE Part I Tuition is $51,880 for nonresidents.
School of Dentistry Instrument, equipment, living, and
miscellaneous costs are variable.
Note: Total cost is the amount (including tuition, other fees, equipment and instrument costs, and living expenses) provided by the school’s 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 Educa-
tional 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.
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.
1491
Inc., or Josef Silny & Associates Inc. Scholarships duration of these residency programs varies between
and tuition support for these programs are limited, one and four years, depending on concurrent mas-
with no financial support available in most schools. ter’s or doctoral degree programs. One- or two-year
Unfortunately for foreign-trained dentists General Practice Residency (GPR) and Advanced
considering such programs, the number is currently Education in General Dentistry (AEGD) programs
decreasing. The most common reason we have heard are also available in some dental schools and other
for closing advanced standing programs is that many academic institutions.
dental school curricula are evolving into intercon- Most of the graduate programs require that
nected, continuous programs that fully integrate applicants complete a D.D.S. or D.M.D. program
medicine, dentistry, and biology. These integrated at a Commission on Dental Accreditation (CODA)-
programs do not allow for advanced standing students accredited dental school, and some state-supported
to begin the clinical programs in a seamless fashion. dental schools do not take any foreign-trained dentists
Foreign-trained dentists are still invited to apply to into their programs due to state policies. However,
those dental schools on an advanced standing basis, a few programs accept foreign-trained dentists who
but they have to participate in the entire four years have obtained a D.D.S./D.M.D.-equivalent from
to graduate with a U.S. dental degree. dental schools outside North America. Other entrance
Apart from the advanced standing programs, requirements are school- and specialty-specific and
some dental schools also offer faculty D.D.S./D.M.D. include such factors as scores on the NBDE Part I
programs for full-time faculty members who are and/or Part II, Graduate Record Examination (GRE,
foreign-trained. Currently, there is no available conducted by the Educational Testing Service), and
list of schools that provide this option. A faculty TOEFL for non-native speakers of English, under-
D.D.S./D.M.D. option is usually negotiated at the time graduate grades/scores/grade point average, class
of the job interview and offer. These programs vary ranking (if available), dean’s letter, and letters of
depending on the school and are usually tailor-made to reference (usually from at least three individuals
meet the needs of the individual pursuing this option. who are knowledgeable about the applicant’s aca-
demic credentials, clinical work, research abilities,
and long-term career goals and objectives). Though
Advanced/Graduate/ not an absolute requirement, it helps if applicants
have experience in research, community activities,
Residency Education teaching, and leadership. Since foreign dental schools
Most foreign-trained students can also ap- vary widely in terms of grading criteria, several U.S.
ply to graduate residency programs in the United residency programs require that applicants have their
States. Currently, there are nine American Dental foreign dental school transcripts evaluated by inde-
Association (ADA)-recognized dental specialties in pendent evaluators knowledgeable about educational
the United States: dental public health, endodontics, credentials. Some U.S. dental schools and residency
oral and maxillofacial pathology, oral and maxil- programs also require that applicants be eligible for
lofacial radiology, oral and maxillofacial surgery obtaining a full clinical license in order to pursue
(OMS), orthodontics and dentofacial orthopedics, a clinical specialty residency program, while oth-
pediatric dentistry, periodontics, and prosthodon- ers require that applicants obtain a resident/limited
tics.8,9 Residency programs vary from two to six license/permit.
years, depending on type of degree. OMS programs Six types of residency programs (AEGD, den-
are a minimum of four years; six-year OMS programs tal anesthesiology, GPR, OMS, orthodontics, and
are completed concurrently with an M.D. (Doctor of pediatric dentistry) participate in the Postdoctoral
Medicine) program from affiliated medical schools. Dental Matching Program administered by National
All other residency programs are a minimum of two Matching Services, Inc. for selecting students. Ac-
years in duration. Residency programs are typically cording to the program website, for the matriculating
completed in conjunction with earning a master’s or year of 2014, the number of residency spots available
doctoral degree. through the matching program varied from a low
Advanced programs are also offered in such of twenty-seven for dental anesthesiology to a high
non-ADA-recognized dental specialties as dental of 619 for GPR programs (https://natmatch.com/
anesthesiology, dental implantology, geriatric/special dentres/aboutstats.html). The numbers of applicants
needs, operative dentistry, and oral medicine. The in 2010 to 2014 who gained admission to programs,
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 of activities on a day-to-day basis and the supportive
graduates, are shown in Table 2. AEGD programs work environment are often cited as major reasons
had the highest proportion of foreign-trained dentists for pursuing academic careers.11,12 Other advantages
(18.9 percent) followed by orthodontics (16.1 per- of being in academia include staying constantly up-
cent). Since not all dental schools participate in the dated, working at the cutting edge of the profession,
matching program, the number of positions available learning from peers who are experts in their areas,
probably exceeds those shown in the table. and working in an interdisciplinary environment.
Academic careers carry many other benefits from
secure salary to excellent insurance and retirement
Academic Careers plans. On the other hand, salary limitations compared
to private practice, work pressure, gender bias, length
For foreign-trained dentists pursuing advanced of academic training, and educational debt have been
standing predoctoral or specialty training in the Unit- cited as barriers to entering academia.13
ed States, academic dentistry is one of the options to Foreign-trained dentists enrolled in advanced
consider upon graduation. In 2000, a study reported standing or residency programs frequently obtain
that close to 66 percent of U.S. dental academicians educational loans to complete their training. Even
were more than fifty years of age, suggesting retire- though some tuition waiver programs and support
ments will lead to increased job opportunities in the from specialty foundations are available for dentists
next decades.10 Academic dentistry provides oppor- intending to pursue a full-time academic career,
tunities to teach dental students in didactic, clinical, foreign-trained dentists’ sizable loan burdens often
and laboratory settings. Apart from teaching, dental make it impossible for them to pursue this pathway
faculty members are involved in a wide range of ac- unless they have attended a tuition-free college. In
tivities such as designing and conducting independent 2013, Nalliah et al. reported a trend of reducing inter-
and/or collaborative research, performing community est in pursuing full-time academic careers in Mas-
service, reviewing articles submitted for publication, sachusetts as educational debt increased.14 It could
and conducting patient care. The exposure to a variety be argued that foreign-trained dentists, therefore,