Abstract: An anonymous applicant to advanced standing international dentist programs describes overcoming admissions barriers in 2025. Limitations due to visa status affect how prepared a candidate is for taking the Integrated National Dental Board Exam (INBDE) and maintaining their clinical skills. They provide guidance to aspiring internationally-trained dentists on navigating their lives around visa-related restrictions while their applications are under review by admissions committees.
Introduction
With an environment of tighter scrutiny of non-citizen residents in the United States, the difficult road for foreign-trained dentists to be able to sit for US licensure has only gotten more challenging. Stories about arrests and deportations have captured headlines, and even immigrants who have come legally are less inclined to go to work or attend to health appointments(1). Dr. Alawieh, a Lebanese clinical professor from Brown University, was deported despite holding an H1-B visa (2).
Many are health professionals who have credentials from their home country, but want to work in the United States. Many US dental schools have an admissions program for internationally trained dentists with their own central application service, American Dental Education Association Centralized Application for Advanced Placement for International Dentists (ADEA CAAPID). To be eligible, an applicant must provide a transcript of their foreign dental degree evaluated by a US service (Educational Credential Evaluators (ECE) or World Education Services (WES)), an official report of passage on the Integrated National Board of Dental Examiners (INBDE) exam, and letters of recommendation attesting to one’s clinical skills. Schools can individually administer additional assessments, such as a Kira Talent recorded video interview and an on-site manual dexterity skills assessment (bench test) on interview day.
This article shares one person’s story as they navigate the landscape of education, immigration, and healthcare. This anonymous account describes the uncertainty they face about realizing their dreams to become a practicing dentist in the United States and the common challenges many advanced standing international dental education applicants face.
Journey as an International Dentist in the United States
I have always dreamed of becoming a dentist in the U.S. The first step in that direction was to pass the INBDE exam, which is only offered in North America. As someone from India, I needed a visa to enter the U.S. I applied for a visitor visa in late August 2019, but unfortunately, it was denied.
After graduating from dental school in 2019 (known for its strong hands-on training due to its location in the city center and being a government-run institution), I took some time off to think about my future. At one point, I considered doing postgraduate studies in dentistry in India. However, by the time I was ready to start working as a dentist, the world was hit by the COVID-19 pandemic. Due to the uncertainty caused by the pandemic, local clinics had stopped hiring. A cross-sectional study published in Dental Tribune India highlighted how young dental professionals across India faced severe disruptions in income, operational shutdowns, and a lack of opportunities during this time—many were unable to find work and considered leaving clinical dentistry altogether(3). This broader context explains why I was unable to gain clinical experience in my home country after graduation.
I could have reapplied for a visitor visa, but the U.S. Embassy in India had stopped issuing them at that time. My other option was to try for a student visa.
During the pandemic, I became very interested in public health, particularly epidemiology, after following COVID-19 predictions and research. I decided to pursue a Master’s in Epidemiology in the U.S. I began preparing for applications, including WES transcript evaluations, the Test of English as a Foreign Language (TOEFL), and the Graduate Record Exam (GRE). The process wasn’t straightforward. I had to defer my admission by six months because the university I was initially admitted to was offering only online classes, and a hybrid format was required for visa approval. I eventually applied to a university offering hybrid classes, received my acceptance, and was granted a visa in December 2020. I moved to the U.S. in January 2021.
Fulfilling Requirements While Navigating Visa Restrictions
During my graduate studies, I got a job as a Research Assistant. This gave me invaluable experience in data management and fieldwork, which eventually helped me secure a full-time job [in a different state]. That job also helped cover my living expenses. During my studies, I considered working in a dental office, but I soon learned that international students are not legally allowed to work off-campus.
After juggling full-time studies, personal and family challenges, and a part-time research job, I graduated in December 2022. I began working full-time and used my first salary to pay for the INBDE exam and study materials. I passed the INBDE on my first attempt in October 2023 while working full-time. I also took the TOEFL twice to score a 109 – all while maintaining a full-time job.
I learned how important U.S. dental experience is. I started by volunteering at a Give Kids a Smile event in February 2024. I wanted to work as a dental assistant to gain more clinical experience, but unfortunately, my visa status does not allow it, because my field of study in the U.S. isn’t directly related. However, I am legally allowed to shadow dentists, which I’ve been doing since July 2024. I’ve shadowed at three dental offices in two different states, mostly on weekends because I work full-time on weekdays. I’ve also helped Afghan refugees with resume building and job searches and occasionally driving students to their universities.
Now, I am in the final year of my F-1 STEM OPT. Due to changes in research funding, my employer is not planning to sponsor me. My STEM OPT will expire in February 2026. I’ve done everything within my reach and within the boundaries of my F-1 visa: shadowing, volunteering, attending CE courses, and even going to conferences like ADEA GoDental 2025. I am truly proud of what I’ve accomplished despite the limitations. The visa clock is always ticking in the back of my mind, but I’ve learned to live with it.
There’s a chance I may not be in the U.S. next year—this could be my last CAAPID cycle. I sincerely hope I get accepted somewhere, but I understand nothing is guaranteed.
Advice to International Dentist Program Applicants in the United States
As someone going through this process, I’ve been observing how different schools handle admissions. In some cases, it seems that schools don’t fully grasp the extent to which the F-1 visa can limit an applicant. Most admissions committees say they don’t consider visa status in their review process. But if visa status isn’t considered at all, how can the schools fully understand the limitations some applicants face in gaining U.S. clinical experience?
Many schools accept Canadian applicants, which shows the inclusiveness of the U.S. system. But I would like to point out that Canada’s visa laws are more flexible. For example, in Canada, someone studying public health can work part-time at a dental office, as a store manager, or in many other settings. In my experience, dental schools often prefer applicants with U.S. or Canadian clinical experience, but not every applicant has the same level of access to get that experience. The playing field is not equal.
Work Eligibility for Dental Assistant Roles by Immigration Status in the U.S.
All pathways described below are legal and compliant with U.S. immigration law. Policies are subject to change.
| Immigration Status | Can Legally Work as a Dental Assistant? | Notes |
|---|---|---|
| U.S. Citizen | ✅ Yes | No restrictions. Can work freely in any healthcare setting. |
| Green Card Holder (Permanent Resident) | ✅ Yes | Fully authorized to work without limitations. |
| H-4 Dependent | ⚠️ Depends | Only If they have H-4 Employment Authorization Document (EAD). Without an EAD, they cannot work. |
| H-1B Visa | ❌ No | Dental Assistant does not qualify as a “specialty occupation”. |
| Temporary Protected Status (TPS) | ✅ Yes (with EAD) | Individuals with TPS who have a valid EAD can legally work, including as Dental Assistants. |
| F-1 Student Visa | ❌ No | Cannot work as a Dental Assistant. F-1 employment must be directly related to their academic program and authorized via Curricular or Optional Practical Training (CPT/OPT). |
International Dentist Issues
Continue the discussion in the Student Doctor Network International Dentist Forum.
How Competitive Is It?
At dental schools with international dentist programs, the availability of operatories (student cubicles where dental exams and procedures are performed in the dental school clinic) and the potential for clinic income dictate the number of available positions. Clinic operations have operatories to accommodate a limited number of extra students from these advanced standing programs and other students who have had a delay in their graduation timeline. Consequently, a large number of remediated predoctoral students (those earning their DDS or DMD’s who had to repeat a year) will make fewer spots in an advanced standing program available.
Most clinical faculty want an advanced standing student to have diagnostic and procedural skills as the most desired applicants will have passed the INBDE. International students need to have patient care skills and interpersonal skills to work with clinic administrators and students.
Little is known about the profile of a desired foreign-trained dentist for these programs. Applicants should become familiar with ADEA CAAPID and are encouraged to meet with current international dentist students at their programs of interest or recent graduates.
FAQ: International Dentist Advanced Standing Programs
Advanced standing programs allow international dental graduates to become licensed for practice in the U.S. in a shorter timeframe than traditional four-year DDS and DMD programs. These programs are designed for dentists who already hold dental degrees from other countries.
You’ll need to pass the Integrated National Board of Dental Examiners (INBDE) exam and maintain your clinical skills. The specific requirements vary by program, so check with individual schools for their exact testing requirements.
It depends on your immigration status. U.S. citizens and Green Card holders can work freely. Other visa holders have restrictions – for example, H-1B visa holders cannot work as dental assistants since it doesn’t qualify as a “specialty occupation.”
Very competitive. Dental schools have limited spots for advanced standing students, and many qualified international graduates apply. Strong academic credentials, clinical experience, and English proficiency are essential.
Consult with immigration attorneys who specialize in student visas and work authorization. Visa policies can change, and professional guidance helps ensure you maintain legal status while pursuing your education.
Sources
- ICE roundups lead to a 33% spike in cancellations for some Nashville dentists, WKRN News (Nashville, Tennessee), May 13, 2025 (Yahoo News story).
- Doctor with H-1B Visa Deported, About Dr. Alaweih’s Case, Brandy Pinkerton, nurse.org, March 18, 2025.
- Ashwin Parakkaje Subramanya, MLV Prabhuji. Dental practice in Pre-COVID-19 and Future Perspectives, medRxiv 2020.11.24.20238303; doi: https://doi.org/10.1101/2020.11.24.20238303 (not peer-reviewed).
- The “One Big Beautiful Bill”: How New Budget Legislation May Reshape Medical Training and Healthcare Access, Student Doctor Network Review, July 4, 2025.
- ADEA CAAPID information for applicants: https://www.adea.org/home/application-services/internationally-educated-dentists/adea-caapid-applicants
- ADEA CAAPID Program Directory: https://programs.adea.org/CAAPID/programs
- Integrated National Board Dental Examination (INBDE), ADA Testing Services website: https://jcnde.ada.org/inbde
