How to Apply for the NBDHE if You Are a Dentist in Another Country

I. What Is the NBDHE Exam?

The National Board Dental Hygiene Examination (NBDHE) is a comprehensive written exam administered by the Joint Commission on National Dental Examinations (JCNDE). It is designed to assess whether a candidate has the foundational knowledge and clinical judgment necessary to practice safely as a licensed dental hygienist in the United States.

The exam is typically taken by graduates of accredited dental hygiene programs, but it is also required for internationally trained dentists or dental hygienists who wish to become licensed dental hygienists in the U.S. Passing the NBDHE is a mandatory step in the licensure process for most states, as dental boards rely on it to ensure all applicants meet the national standard of competence in areas such as patient assessment, periodontal therapy, radiography, infection control, and community health.

Successful completion of the NBDHE demonstrates that you have the theoretical and applied knowledge needed to provide safe, effective dental hygiene care. It is one of the first major milestones to obtain your U.S. dental hygienist license and part of the educational requirements to be recognized as a certified dental hygienist.

II. Can Foreign-Trained Dentists Take the NBDHE?

Individuals attending dental programs in their home country and are planning to practice in the U.S. should carefully investigate the requirements of the licensing jurisdiction of where they wish to reside. Foreign-trained dentists can take the NBDHE, but eligibility depends on meeting the same educational requirements as any other candidate. The Joint Commission on National Dental Examinations does not grant automatic exam eligibility based solely on being a licensed dentist in another country.

To qualify, internationally trained dentists must either:

• Graduate from a dental hygiene program approved by the Commission of Dental Accreditation, or
• Meet a state’s equivalency or advanced standing requirements that allow them to be considered “NBDHE-eligible” through an approved pathway or
• Canadian programs accredited by the Commission on Dental Accreditation of Canada (CDAC)

Most states require completion of an accredited dental hygiene program before you can apply, even if you already hold a dental degree or practice dentistry abroad. Some programs offer advanced-placement or fast-track options specifically for foreign-trained dentists, allowing them to complete the required coursework in a shorter time.

In short, foreign-trained dentists can take the NBDHE but only after demonstrating that they meet U.S. educational standards for dental hygiene.

III. Steps to Apply for the NBDHE as an International Dentist

Below is a structured roadmap for internationally trained dentists who want to sit the NBDHE test. Use this as a checklist and adapt it to the specific instructions from the dental hygiene program or state dental board you’re working with.

Step 1: Verify Your Eligibility

• Confirm the pathway: Determine whether you will qualify by completing a Commission of Dental Accreditation (CODA) program, or via an equivalency/advanced-standing pathway in the U.S. state where you intend to apply for licensure.
• Check state requirements: Each state dental board sets licensure rules. Contact your state board or the dental hygiene program that admits international candidates to confirm which courses, clinical hours, and exams you must complete before you can be registered for the NBDHE, and other specific requirements.
• Make a timeline: Eligibility checks can take weeks. Ensure to plan your credential evaluation and application early.

Step 2: Credential Evaluation

• Order an official evaluation: Most programs and state boards require an independent evaluation of foreign transcripts and diplomas. Common, stable providers include Educational Credential Evaluators (ECE) and World Education Services (WES), but follow the evaluator recommended by the school or state board.
• Prepare supporting materials: Typical items requested:
  • Official transcripts and diploma/certificate of your degree (original language and certified English translations)
  • Syllabi or course descriptions to document clinical and didactic content
  • Proof of identity (passport)
• Get documents certified/translated: Use certified translations and, where requested, notarization or apostilles. Submit the evaluator’s report to the dental hygiene program or licensing board as instructed.

Step 3: Apply Through Your Program or the JCNDE Pathway

• If you’re enrolled in an accredited program: The program usually handles NBDHE exam registration for its graduates and gives you the instructions and eligibility confirmation you need. Follow the program’s timeline and paperwork process.
• If you’re using a state equivalency pathway: Carefully follow your state's dental hygiene board application steps. Some states require that the board or an approved program register you with the Joint Commission on National Dental Examinations (JCNDE) or provide specific authorization before you can schedule the exam.
• Documentation to submit with your application: Eligibility confirmation from the program or board, credential evaluation report, identification, any state forms, and payment of applicable fees.

Step 4: Prepare for the Exam

• Know the exam scope: Review the NBDHE content areas (patient assessment, periodontics, radiography, pharmacology, infection control, community health, etc.). Use official content outlines and practice materials when available.
• Study resources and schedule: Combine review books, question banks, and practice exams. Plan concentrated study blocks (for many candidates this is 6–12 weeks, but adapt to your needs).
• Hands-on readiness: If you’re entering by an advanced-placement route, ensure your clinical skills and terminology are fresh; many programs offer clinical refreshers or labs for international candidates.

Step 5: Schedule and Take the Test

• Receive your authorization to test: After your application is approved you’ll get instructions on how to schedule. Your authorization email will include test-center or online scheduling details.
• Choose a test date and location: Select a convenient date that gives you time to prepare and to handle any travel or visa logistics if you must test in the U.S.
• Test-day checklist: Bring required ID, your scheduling/authorization confirmation, and any other documentation the board or test center requires. Arrive early and follow test-center rules.

IV. Required Documents for Foreign Applicants

It can be overwhelming to start your application process for the NBDHE. Here is a quick application checklist for international dentists:

• Credential evaluation report (official)
• Certified English translations of transcripts/diploma of your dental degree
• Course descriptions or syllabi (if requested)
• Proof of identity (passport)
• Eligibility confirmation from an accredited dental hygiene program or state board
• Application fees and exam fees
• English proficiency scores (if required by the program/state)

V. English Language Proficiency Requirements

Most internationally trained dentists who plan to take the NBDHE will need to demonstrate English language proficiency, especially if they are applying through a U.S. dental hygiene program. While the NBDHE itself does not mandate English test scores, dental hygiene programs and state dental boards often require them as part of the application process for admissions or licensure.

Programs typically ask applicants for scores from the following commonly accepted tests:

• TOEFL iBT (Test of English as a Foreign Language)
• IELTS Academic (International English Language Testing System)
• PTE Academic (Pearson Test of English)

Always check which test your chosen school or contact the state board prefers you are interested in to request additional information. Exact score minimums vary by institution, but a general range includes:

• TOEFL iBT: 79–100
• IELTS Academic: 6.5–7.0 overall
• PTE Academic: 53–65

Competitive applicants, especially those seeking advanced placement or accelerated programs, often score above these minimums.

Tips for Non-Native Speakers Preparing for the NBDHE

Even after meeting formal language requirements, many internationally trained dentists benefit from targeted preparation to feel confident taking a long, English-heavy exam like the NBDHE. Here are practical strategies:

Strengthen Dental Terminology in English

• Review textbooks and question banks written specifically for U.S. dental hygiene programs.
• Create flashcards for periodontal terminology, radiographic interpretation, pharmacology, and community health vocabulary.
• Practice explaining clinical concepts aloud in English to build fluency.

Practice Reading Long Passages Quickly

• The NBDHE contains case-based questions with detailed patient histories.
• Use practice exams to build reading speed and comprehension.
• Summarize long passages in your own words as they often include distractors or extra details.

Listen to English Clinical Content Daily

• Watch dental hygiene lectures, board review videos, or public health presentations in English.
• Listen to them at 1.25× or 1.5× speed to improve comprehension under test conditions.

Learn How U.S. Dental Hygiene Is Structured

• Some concepts differ from other countries, such as:
• ADPIE (Assessment, Diagnosis, Planning, Implementation, Evaluation)
• U.S. infection control guidelines
• Medical emergency protocols
• Patient-centered care models
• Understanding these frameworks helps you interpret exam scenarios correctly.

Take Timed Mock Exams

• Simulate full-length NBDHE practice exams in English to build stamina.
• Review incorrect answers and note whether mistakes were due to vocabulary, concept gaps, or misreading.

Build Test-Day Confidence

• Practice mindfulness or focused breathing to reduce test anxiety.
• Familiarize yourself with Prometric or test-center rules so nothing feels unfamiliar on exam day.

VI. Understanding the NBDHE Exam Format

Before applying for the exam, it’s important to understand how the NBDHE is structured. For international dentists, knowing the format early helps you plan your study strategy more efficiently and increase your chances to successfully complete the NBDHE exam.

The NBDHE is a comprehensive, one-day, computer-based exam administered at authorized testing centres.

• Total Testing Time: Approximately 9 hours including optional breaks
• Total Questions: Around 350 questions
• Format: Multiple-choice and case-based questions

There are two broad content areas of the exam that are worth noting:

1. Scientific Basis for Dental Hygiene Practice

This section tests foundational knowledge that supports safe and effective clinical care. Topics include:

• Oral histology and embryology
• Anatomy and physiology
• Microbiology and immunology
• Pathology
• Nutrition
• Pharmacology (including local anesthetics and common systemic drugs)

International dentists often find it helpful to refresh terminology and guidelines specific to U.S. clinical standards.

         2. Clinical Practice

This domain assesses your ability to apply your knowledge to real patient care. Content includes:

• Patient assessment and data collection
• Periodontal evaluation
• Radiographic interpretation
• Treatment planning
• Preventive and therapeutic services
• Infection control and OSHA guidelines
• Pain management and local anesthesia
• Medical emergencies
• Community health and public health dentistry

This section makes up the majority of the exam and closely resembles day-to-day dental hygiene practice in the U.S.

Pro-Tip: For additional information about the format of the NDBHE written examination, visit BoosterPrep.com/NBDHE

VII. How to Prepare for the NBDHE as a Foreign Dentist

Preparing for the NBDHE as an internationally trained dentist requires both content review and adaptation to the U.S. dental hygiene framework. Here are some tips to get you started:

Create a Realistic Study Timeline

Most candidates, especially those balancing school, work, or immigration tasks, benefit from a 6–12 week study plan. A typical structure includes:

• Weeks 1-4: Scientific concepts, radiology, pathology, and pharmacology
• Weeks 5-8: Periodontology, patient assessment, preventive care, and clinical judgment
• Weeks 9-12: Case-based practice, mock exams, and targeted review of weak areas

Use High Quality Online Prep Tools

Recommended tools to help bridge the gap between your previous dentistry training and U.S. dental hygiene expectations include:

• NBDHEBooster: Comprehensive notes, videos, question banks, and full-length practice exams specifically designed for NBDHE candidates. Content is aligned with the exam blueprint.
• Official JCNDE outline: Updated exam specifications to guide your topics.
• Dental hygiene textbooks used in CODA-accredited programs for reinforcing terminology and theory.

Some candidates may even look into an NBDHE Tutor that will tailor to their needs and are flexible to their schedule. For additional information about NBDHE tutors, visit NBDHEBooster.com.

These tools are especially helpful for foreign dentists because they introduce U.S.-based terminology, risk assessment models, protocols, and scenario styles used on the exam.

Reinforce U.S.-Specific Guidelines

Several concepts may be unfamiliar or slightly different from your home country’s dental standards, such as:

• OSHA and CDC infection control protocols
• HIPAA privacy rules
• U.S. emergency management for medical complications
• Fluoride levels, sealant guidelines, preventive schedules
• Community health terminology
• Standard dental hygiene scope of practice

VIII. Common Challenges for International Applicants

Document Delays: Delays are extremely common and do not reflect on your qualifications. They are simply part of the international application process.

• Start requesting documents as early as possible, even before you apply to a dental hygiene program or state board.
• Contact your dental program directly to learn their processing timeline.
• Keep multiple certified copies and digital scans of everything.
• Use courier services to reduce mailing delays.
• Follow up with evaluators to ensure no items are missing.

Credential Evaluation Mismatches: Evaluators may describe your degree differently from how you expect, or a school may not grant advanced placement as hoped.

• Choose credential evaluators recommended by your target school.
• Provide detailed syllabi and course descriptions to help evaluators accurately assess your education.
• Apply to multiple dental hygiene programs as each has different policies for advanced standing.
• If needed, be open to completing additional coursework or clinic hours.

Adapting to U.S. Testing Style and Case-Based Questions: The NBDHE emphasizes long clinical scenarios, patient management decisions, and U.S. standards of care. This format may be very different from exam styles in your home country.

• Use NBDHE-style question banks that mimic U.S. case-based reasoning.
• Practice reading long passages quickly and identifying key details.
• Take multiple timed mock exams to build stamina.

IX. Costs and Fees Involved in the NBDHE Application

As international dentists, applying for the NBDHE involves several expenses beyond just the exam fee. Understanding these costs upfront helps you plan, avoid surprises, and budget effectively.

NBDHE Examination Fee

The primary cost is the official exam registration fee set by the Joint Commission on National Dental Examinations (JCNDE). This fee typically includes testing administration and scoring. It must be paid at the time of application through your JCNDE account or through your dental hygiene program, depending on your pathway.

Credential Evaluation Costs

Most international applicants must undergo a credential evaluation to verify that their education is equivalent to U.S. standards. Evaluations are done through approved credentialing agencies. Fees vary based on the service type (course-by-course, document review, etc.). Rush processing, if needed, also adds extra cost.

Program or Institutional Fees (If Applicable)

If you are completing a U.S. dental hygiene program, the school may charge administrative fees for:

• Application processing
• Transcript submission
• Verification of your eligibility to the JCNDE

These fees are typically modest but should still be factored into your planning.

Additional Documentation Expenses

International applicants often encounter extra documentation-related costs:

• Official transcripts from foreign institutions
• Translation services (if documents are not in English)
• Mailing or courier fees for international document delivery

Travel and Testing Expenses

Although the NBDHE is offered at numerous testing centre, foreign-trained applicants may incur:

• Travel costs if a local centre is unavailable
• Accommodation costs if you must stay near the testing site
• Transportation and meals on test day

Preparation Materials

Preparing for the NBDHE is essential, and many candidates invest in:

• Online review platforms like NBDHEBooster
• Textbooks, flashcards, and question banks
• Mock exams

These costs vary but should be included in your overall budget.

Pro-Tip: To get a full breakdown of costs and hidden fees, visit BoosterPrep.com/NBDHE

X. What Happens After Passing the NBDHE

Once you successfully complete the exam, several important steps follow before you can begin working as a licensed dental hygienist.

1. Apply for State Dental Hygienist License

Each U.S. state has its own dental hygiene license requirements. After receiving your NBDHE results, you’ll need to:

• Submit an application to your state’s dental board
• Provide proof of NBDHE completion
• Submit credential evaluations and transcripts (if required)
• Pay state licensing fees

It’s important to review your state licensing board's specific requirements early, as some states process applications faster than others.

2. Complete Additional Clinical Examinations

While the NBDHE evaluates your theoretical and applied knowledge, most states also require a clinical competency exam. These exams test hands-on skills such as calculus detection, instrumentation, and patient care. Some states also require a local anesthesia certification exam or jurisprudence (law and ethics) test.

3. Begin Your Dental Hygiene Career in the U.S.

With your licensing process completed, you can start practicing as a dental hygienist. Many foreign-trained dentists find that dental hygiene offers:

• Strong job stability
• Competitive salaries
• Flexible work schedules
• Opportunities to work in private practices, public health, education, or specialty clinics
• A pathway to later pursue advanced dental programs if desired

Passing the NBDHE opens the door to a new incredible opportunity and is often the most significant milestone in the licensure process.

XI. Tips for a Successful Transition to U.S. Dental Hygiene Practice

For foreign-trained dentists, entering the U.S. dental hygiene field is both an exciting and meaningful career shift. Here are practical strategies to help you build confidence, integrate smoothly, and thrive in your new role as a dental hygienist.

1. Join Professional Networks and Associations

Becoming part of the dental hygiene community helps you stay informed and supported such as the American Dental Hygienists’ Association (ADHA). These networks offer job opportunities, mentorship, continuing education, and insights from experienced hygienists.

2. Prioritize Continuing Education (CE)

Most states require CE hours for license renewal, but CE is also invaluable for skill development especially when transitioning from dentistry to dental hygiene. Continuing education ensures your knowledge stays current and builds confidence in new practice settings.

3. Learn U.S. Patient Care and Communication Norms

Clinical expectations in the U.S. may differ from those in your home country. Focus on: clear, patient-friendly communication, emphasis on patient autonomy and informed consent, and thorough documentation following U.S. legal standards.

Shadowing experienced U.S. dental hygienists or volunteering in community clinics can help you understand these norms firsthand.

XII. FAQ

Q: Can I apply for the NBDHE without studying in the U.S.?

A: Generally, no. The National Board Dental Hygiene examination is designed for candidates who have completed or are enrolled in a Commission of Dental Accreditation hygiene program. Foreign-trained dentists must usually enter a U.S. dental hygiene program before becoming eligible for licensure as a dental hygienist. Some states or programs may offer equivalency options, but these are rare and require extensive credential review.

Q: How long does the application process take?

A: For international applicants, the timeline varies based on documentation and credential evaluation. On average:

• Credential evaluation: 4–8 weeks
• Program admissions (if applicable): several months
• NBDHE application approval: 2–4 weeks

Overall, it’s best to expect the entire process to take 3–12 months, depending on your starting point and your preferred preparation timeline.

Q: Is the NBDHE difficult for international candidates?

A: The NBDHE can be challenging, especially for those who:

• Are not used to U.S. multiple-choice exam style
• Are non-native English speakers
• Have been out of school for several years
• Need to review subjects not emphasized in their dental training (e.g., U.S. ethics, preventive care philosophy

However, success rates improve dramatically with:

• Structured study plans and practice exams
• Resources like NBDHEBooster
• Early familiarization with English dental terminology

Thousands of internationally trained dentists pass the NBDHE each year.

Q: How much does it cost to take the NBDHE?

A: Overall, the total cost of taking the NBDHE will be around 600-900 USD in total including testing fees, study materials, and travel costs.

Q: What if my credentials are not accepted?

A: If your documents or transcripts do not meet U.S. standards:

• Request a detailed report from the credential evaluation agency explaining what’s missing from your degree
• Contact the dental hygiene program or JCNDE for guidance
• Provide additional documents, course descriptions, or notarized translations
• Consider enrolling in bridge or prerequisite courses if require

In most cases, discrepancies can be resolved through additional proof or coursework.