All About the NDEB Equivalency Process

If you didn’t graduate from a dental program accredited by the Commission on Dental Accreditation of Canada (CDAC) – in other words,  if you’re an international student – and  want to practice dentistry in Canada, you have to pursue the National Dental Examining Board’s (NDEB) equivalency process. There are 4 steps to this process: 

1. Applying to the equivalency process 
2. Completing the Assessment of Fundamental Knowledge (AFK) 
3. Completing the Assessment of Clinical Judgement (ACJ) OR completing a Qualifying/Degree Completion program 
4. Completing the National Dental Examination of Clinical Competence (NDECC)

Once you’ve completed all of these steps, you’ll be able to join your Canadian peers in pursuing the NDEB certification process. This post provides a guide on how to become a dentist in Canada for international students by exploring the four stages of the equivalency process.

Let’s dive in!

Applying to the NDEB Equivalency Process

The first thing you need to do in order to start the equivalency application process is to make an NDEB account. Once you’ve done that, you can start submitting relevant documents. Specific documents necessary for application differ based on your country of origin. You can find out exactly what you need to submit here.

While the specifics vary, we can sort the documents into the following categories: 

• Documents you need to submit 
• Documents the university that issued your degree needs to submit 
• Documents the licensing body of your region of origin needs to submit

Documents You Need to Submit

You’ll need to submit a notarized, government-issued photo ID. If your name appears differently on your ID than it does on any of the other required documents, you’ll need to submit an additional document that proves your name change or the difference in name. Acceptable documents include...

• A photocopy of your marriage certificate
• A photocopy of your legal name change document
• An original sworn affidavit verifying the difference in name

You’ll also need a colour photocopy of the front and back of your dental degree. If it isn’t in English or French, the NDEB will also require a certified translation bearing the translator’s seal. You can find more about what constitutes a “certified translator” along with the information to be included in the required documents here.

If the dental program from which you graduated requires an internship or clinical rotation in order to award the degree but this requirement isn’t listed on your academic record, you’ll also need to submit a notarized photocopy of the front and back of your internship completion certificate. 

The final piece you need to submit directly to the NDEB is the Equivalency Process Required Document form, which you need to download from your NDEB account. 

Documents Your University Needs to Submit

You’ll also need to download a Confirmation of Degree form from your NDEB account. However, you only have to fill out a small portion of the form before sending it to the university that granted your dental degree so that the Dean, Registrar, or the Controller of Examination can complete and submit it. 

The university also needs to provide your academic record. If you attended multiple universities, each one must submit a record of the courses you completed at their institution. The record should include...

• All of the courses you completed, along with the grades you received in each course
• The dates during which you completed each course
• The university’s stamp, in ink
• A university official’s signature, in ink

Documents Your Licensing Body Needs to Submit

If you’re a licensed dentist and the licensing body in your jurisdiction of origin requires registration, they’ll need to submit one document: the Statement of Good Standing. This is a certificate that attests to the fact that you are eligible to practice in their jurisdiction. It further testifies that you weren’t suspended, disqualified, or otherwise banned from practising and that the licensing body is unaware of anything that calls your character, as a health provider, into question. 

If you’ve never been licensed, you need to submit a sworn affidavit attesting to the fact. If it’s been more than one year since your graduation, you also need to explain why you were never licensed. 

Next Steps

Once the NDEB receives all of your documents, they verify the authenticity of each one and update your account accordingly. If anything is missing or can’t be verified, you’ll receive an email indicating what steps you need to take to rectify the situation. 

Once they’ve gone over all of your documents, you’ll also receive an email indicating whether or not your application has been approved. If it can’t be approved, the email will elaborate on what steps you need to take in order to get it approved. 

Once the NDEB approves your application, you can register for the AFK.

The Assessment of Fundamental Knowledge (AFK)

This assessment is designed to test two areas of knowledge: biomedical science and clinical science. It consists of 200 multiple choice questions and takes 4 hours to complete. You can register to take the exam and pay the associated fees through your NDEB account. When you register, note that there are two formats in which you can take the exam: 

• Electronically at a Prometric test centre
• Paper format offered at exam sites

If you’re taking the exam at a Prometric site, you’ll have to schedule your exam through their website. Select “find my exam” and follow the registration instructions. If you’re taking the exam in a paper format, the registration takes place entirely through your NDEB account. 

You need to earn a passing grade – a re-scaled score of 75 or higher – in order to proceed with the equivalency program or to apply for a qualifying/degree completion program – we’ll elaborate on these programs in the following section. You can take this exam a maximum of 3 times. 

Not sure if you’re ready to take the AFK? Take the NDEB’s two-hour self-assessment quiz to gauge your preparedness. 

Once you pass the AFK, it’s time to move onto the next step of the equivalency process!

The Assessment of Clinical Judgement (ACJ) OR Qualifying/Degree Completion Programs

At this stage, you have two choices: You can either complete the ACJ or you can apply for and complete a qualifying or degree completion program. 

The ACJ

This assessment is a 5.5 hour exam made up of 120-150 multiple choice questions. It assesses your...

• Knowledge of oral radiology
• Ability to interpret radiologic images
• Ability to make a diagnosis (case-based diagnoses and using radiographic images)
• Clinical decision making

Although you have to register and pay for the exam through your NDEB account, all ACJs are administered at Prometric testing centres. Once you register for the exam, the NDEB will send you an email with instructions for scheduling your exam with Prometric. 

Just like the AFK, you need to earn a re-scaled score of 75 or higher in order to move onto the next step of the equivalency process. Here are some sample questions to help you prepare.

Qualifying/Degree Completion Programs

Instead of taking the ACJ, you could apply for and complete a qualifying or degree completion program at a Canadian university. These are shorter dental programs – usually about 2 years long – that familiarize international students with Canadian dental practices. Students in completion programs skip the first year of a traditional dental program, joining students in the second or third year of the program instead. 

At the end of the program, students are awarded a DDS or a DMD, depending on the university; either one will set you on the path to becoming a licensed dentist. While completing a qualifying or degree completion program takes longer than writing the ACJ, it also gives you practical and invaluable experience in Canadian dentistry. 

Specific admission requirements and curricula may differ from university to university, so be sure to visit each university website to learn about their programs and reach out to their admissions offices should you have any questions. You can find a list of Canadian qualifying or degree completion programs here.

Once you’ve completed either the ACJ or a qualifying/degree completion program, you can register for the fourth and final step of the equivalency process. 

The National Dental Examination of Clinical Competence.(NDECC)

The fourth and final assessment is a 2-day exam at the NDEB Test Centre in Ottawa. It’s designed to test your clinical competence and has two parts: 

• Part 1: 7 Clinical Skills scenarios which take place in a clinical setting that involve a mannequin. This section takes a full-day to complete. You must react as though working with an actual patient. These scenarios assess your clinical skills and techniques, requiring you to follow standard infection control and safety procedures as you work. They assess your skills in the following areas: 

• Class II amalgam preparation
• Class II amalgam restoration
• Class II composite restoration
• Class IV composite restoration

• Crown preparation
• Provisional restoration
• Endodontic access cavity preparation

• Part 2: 10 Situational Judgement stations that assess your work-place problem-solving skills and take half a day to complete. Each station will have specific instructions, but some stations require that you watch a video before responding. Your responses may involve writing or typing an answer, or role-play. This section assesses your competence in the following areas: 

• Patient-centred care
• Professionalism
• Communication & collaboration

• Practice & information management
• Health promotion

The grading methods used on this exam differ greatly from the first two exams involved in the equivalency process. The Clinical Skills section is graded using a Pass/Fail system. The NDEB defines a passing grade as fitting into one of the following categories:

• A competent dentist...
  • Commits no errors 
  • Is optimally prepared 
  • Completes optimal restoration

• A minimally competent dentist...
  • Has room for improvement but the clinical outcome is acceptable 
  • Is somewhat over-prepared or under-prepared 
  • Damages tissue or creates other tissue trauma

Any errors that demonstrate a significant lack of skill-level or judgement as well as errors that would require additional corrective treatments will result in a failing grade. You need to receive a passing grade in each of the clinical scenarios in order to pass this component of the exam.

While the Situational Judgement component of the exam is also graded using a Pass/Fail system, you only need to pass 6 of the 10 stations in order to receive a passing grade on this component of the exam. There are two stations for every relevant competency listed above and you can only fail one station per competency. This means that if you failed both stations that test your professionalism, for example, you would fail the entire exam. 

The NDEB defines a passing grade for this portion of the NDECC as fitting into one of these two categories: 

• A competent dentist...
  • Makes no errors 
  • Manages the given situation by following industry standards and best practices

• A minimally competent dentist...
  • Makes minor errors
  • Manages the given situation by using acceptable practices

Any major errors or omissions indicating a lack of judgement will result in a failing grade at a station. 

If you fail only one component of the exam (i.e. either the Clinical Skills OR the Situational Judgement components), you would only have to repeat the component that you failed. You can find more information on the grading criteria for both sections of the exam here.

Once you’ve passed both components, you’ll have officially completed the equivalency process. This means you’re ready to tackle the NDEB certification process alongside Canadian dental graduates and become licensed to practice in Canada! 

Looking for additional resources to prepare you for the equivalency process? Check out the NDEB’s exam orientation page which has practice questions and study resources for all of their exams. If you still have questions about the process, leave us a comment down below!