The Integrated National Board Dental Examination (INBDE) represents one of the most significant shifts in U.S. dental assessment in nearly a century. Introduced in 2020, the INBDE replaced the long-standing two-part National Board Dental Examination (NBDE I and NBDE II). Its creation was the result of years of research, educational reform, psychometric evaluation, and collaboration among dental educators, licensing bodies, and the Joint Commission on National Dental Examinations (JCNDE). To understand the background of the INBDE, it is important to examine the historical context, the limitations of previous examinations, the goals of modernization, and the scientific framework that guided its design.
Early History of Dental Board Examinations in the U.S.
For much of the 20th century, the NBDE served as the primary written assessment for U.S. dental licensure. In its earliest form, the NBDE was introduced to ensure uniform competency across states. Dentistry, like medicine, grew rapidly as a professional and scientific field during the mid-1900s, and state boards recognized the need for a standardized evaluation. The NBDE was eventually divided into Part I and Part II, reflecting the traditional separation between basic biological sciences and clinical dentistry.
NBDE Part I focused on subjects such as anatomy, physiology, biochemistry, pathology, and microbiology. NBDE Part II tested clinical disciplines, including operative dentistry, prosthodontics, endodontics, periodontics, oral surgery, and patient management. The two-part format matched the dental school curriculum of the time, which generally delivered biomedical sciences in the first two years and clinical training in the final two years.
For decades, this format was considered adequate. It ensured that graduating dentists possessed the necessary foundational knowledge and clinical understanding to enter supervised practice.
Limitations of the NBDE Model
By the early 2000s, however, dental education—and the expectations of modern healthcare—had changed dramatically. The NBDE’s separation of biomedical and clinical content became increasingly misaligned with how dentistry was being taught. Schools were shifting toward integrated curricula, where basic science and clinical reasoning were taught together through case-based learning. The NBDE continued to treat the two areas as separate entities, which meant the exam was no longer measuring the skills needed in real-world clinical practice.
Additionally, the NBDE was vulnerable to score misuse. Although the exam was intended as a pass/fail licensure test, dental schools—especially advanced standing programs—began using numerical NBDE scores for admissions decisions. This created competition, pressure, and inconsistent interpretation of what the scores represented. As a result, in 2012, numerical NBDE scores were eliminated, shifting both NBDE Part I and II to a pass/fail format. However, this made the exams less useful as differentiators for academic programs and raised new questions about fairness and purpose.
The JCNDE recognized another major issue: the NBDE did not adequately test clinical decision-making, ethical judgment, or integrated knowledge, all of which are essential in modern dental practice. Dentistry was shifting from procedure-driven care toward patient-centered interdisciplinary care. The NBDE, developed in an earlier era, was too content-based and insufficiently competency-based.
The Push for Modernization
In response to these challenges, a major initiative was launched to redesign dental licensure assessments from the ground up. This led to the formation of the INBDE Steering Committee, composed of experts in psychometrics, dental education, curriculum development, and clinical practice. Their mandate was to create a single examination that:
- Integrates basic and clinical sciences, mirroring how dentists actually reason in practice.
- Assesses competencies, not just knowledge recall.
- Reflects current dental curricula and evidence-based practice.
- Aligns with contemporary expectations for healthcare providers, including professionalism, ethics, and patient communication.
- Reduces redundancy and overall testing burden for candidates.
The committee’s work was informed by extensive stakeholder feedback, including academic institutions, state dental boards, professional organizations, and practicing clinicians. This collaborative approach ensured the new exam would be relevant, rigorous, and broadly accepted.
Development and Design of the INBDE
The INBDE was designed using a content integration model, meaning the exam’s items are rooted in realistic patient scenarios that require examinees to synthesize knowledge from multiple domains. Rather than isolating pathology from periodontics or pharmacology from operative dentistry, the exam blends them. This approach better reflects how dentists must think in daily practice: clinical decisions rely on a combination of scientific understanding, patient factors, systemic conditions, treatment risks, and ethical responsibilities.
The exam framework is built on the Domain of Dentistry, a competency document developed jointly by the American Dental Association (ADA) and dental education leaders. This document provides a blueprint of the knowledge, skills, and professional competencies expected of newly licensed dentists. The INBDE maps directly to these competencies, ensuring it assesses relevant ability rather than isolated memorization.
Psychometrically, the INBDE was developed using rigorous test construction methodology, including validity studies, pilot testing, item response theory analysis, and standard setting procedures. Because the exam carries major implications for licensure, reliability and fairness were central priorities. Years of field testing and statistical refinement preceded the INBDE’s official launch.
Launch and Transition to the INBDE
The INBDE was fully implemented in August 2020. NBDE Part I was discontinued, and NBDE Part II remained available only temporarily for students already in the testing pipeline. By 2022, the NBDE was entirely phased out, and the INBDE became the sole written licensure examination for dentists in the U.S.
The shift to the INBDE represented a cultural transformation in dental assessment. For the first time, the national licensing exam aligned with the integrated teaching approach already being used in most dental schools. It also reflected an expanded understanding of what modern dentists must know: biomedical science is essential, but so are reasoning skills, communication, ethics, and judgment.
Impact on International Dentists and Advanced Standing Programs
For international dentists, the INBDE now plays a central role in admission to advanced standing dental programs. Many schools require a passing INBDE result either before application or before matriculation. Because the exam tests clinical reasoning and integrated scientific knowledge, it provides programs with a standardized way to compare applicants from diverse educational backgrounds.
A passed INBDE score demonstrates that international dentists meet the same foundational standards as U.S. dental graduates—a crucial factor in competitive admissions.
Conclusion
The INBDE emerged from a long history of evolving educational standards, psychometric modernization, and the need for assessments that reflect real clinical practice. Its integrated structure, competency-based approach, and alignment with contemporary dental education make it a transformative examination. For candidates—especially international dentists—the INBDE represents not only a licensure requirement but also a benchmark of readiness to practice patient-centered, evidence-based dentistry in the United States.