Overseas registration exam: all dentists need to know

The overseas registration exam (ORE) is sat by dentists whose qualifications are not recognised for the purposes of UK dental registration. We take a look into how it works, the profession’s experience of it and how it can be improved.

What is the ORE in dentistry?

Dentists whose qualifications are not recognised for the purposes of registration can apply to sit the overseas registration examination (ORE). Once a dentist has passed the ORE, they may apply to join the UK dental register held by the General Dental Council (GDC).

Generally, most applicants whose primary qualification is from outside the European Economic Area (EEA) will be required to sit the ORE. The GDC states that exempt persons are entitled to individual assessment but stresses that this is not a guaranteed route to registration.

According to the GDC, around 30% of all dentists on the register qualified outside the UK. Of these, around one third qualified for registration by passing the ORE.

How does it work?

There are two parts to the ORE. Part 1 is used to test candidates’ application of knowledge to clinical practice, and consists of two computer-based exams.

Part 2 is designed for candidates to demonstrate their practical clinical skills. Crucially, for each examination period a maximum of 144 candidates are able to take Part 2 of the ORE.

Capacity increased in 2024, from 800 to 1,200 places for Part 1 (across two sittings) and from 432 to 576 for Part 2 (across four sittings).

In September, the GDC announced more dates for the exam in 2025, adding that there are plans to further increase capacity.

There will be an April 2025 sitting of the ORE Part 1, with 600 places available, and three sittings of the ORE Part 2 from January to April 2025, with 144 places on each. This is in addition to the September 2024 Part 2 sitting, which is fully booked. Booking opened on 3 September for the sitting of Part 2 in November.

What changes have been proposed for the overseas registration exam?

In February 2024, the government announced plans for overseas dentists to practise in the UK without passing the ORE under a new system of ‘provisional registration’.

The proposal was subject to a three-month consultation, which closed in May 2024.

Provisional registration would allow an overseas qualified dentist to practise in any dental setting, including high street dental practices, under the supervision of a dentist who has full registration on the GDC’s dentists register.

The legislation would give the GDC powers to:

• Set up a new status of provisional registrant for individuals holding an overseas dentistry qualification and who have not yet satisfied the GDC’s requirements for full registration, through the creation of a separate list in the dentists register
• Determine the level of supervision that a provisionally registered dentist will be required to work under
• Produce guidance on how provisionally registered dentists should identify their provisional registration status to patients under their care
• Set time limits on the length of time an individual can be provisionally registered, and prevent an individual from provisionally registering multiple times (other than in exceptional circumstances as prescribed by the GDC).

It is currently unclear if the consultation will be considered by the new Labour government.

Increase in exam availability

In September 2024, the GDC also announced an increase in ORE dates for 2025.

There will be an April 2025 sitting of the ORE Part 1, with 600 places available, and three sittings of the ORE Part 2 from January to April 2025, with 144 places on each.

This is in addition to the September 2024 Part 2 and November 2024 Part 2 sitting.

Working with the current providers, the GDC says it has tripled the number of places for the ORE Part 1 and will provide an additional sitting of the ORE Part 2, increasing capacity by a third.

Around 30% of all dentists on the register qualified outside the UK. Of these, around one third qualified for registration by passing the ORE.

There has been a sharp rise in ORE applications since 2021, with a total of 2,366 applications in 2023, marking a fourfold increase on the annual average across the previous five years.

Is the ORE important for UK dentistry?

Nilesh Parmar is a dental surgeon with expertise in implant dentistry and cosmetic procedures. He said: ‘My stance on this is that we need to make sure that if we do allow people to work in UK dentistry who graduated abroad, they should meet a certain standard for patient safety, and also for the profession as well.

‘From conversations with overseas dentists who have taken the exam, I think the ORE is a bit over the top for a lot of things. I don’t feel it focuses on skillsets that dentists working in the UK at the moment currently need. This could be, for example, the ability to explain NHS treatments or the ability to understand that patients in the UK are highly litigious.

‘From my work with the Dental Defence Society, we know that dentists who graduate from abroad do appear to have a higher incidence of complaints and, as a result, they can be more costly to indemnify.

‘This will be because of the way they’re taught and the often lack of understanding of the NHS system. There can also be cultural differences when it comes to the way you communicate and handle patients compared to the UK.

‘Do we need more dentists in this country? We have a population of 68 million and we have 44,000 dentists. If you do the maths, that works out to about 1,600 patients per dentist, which is not a crazy workload. Perhaps we do need some more dentists but we don’t need a whole lot more. In my opinion, I think if we had another 10,000 dentists, that would suffice for the population.

‘So shouldn’t we be asking, why is there a shortage of, or perceived shortage, of dentists? And I believe that is more relevant to the NHS. A lot of the dentists work part time, a lot of them are burnt out and a lot of them don’t work in the health service.

‘As I’ve always said, I think we need to look at the NHS contract. In an ideal world, every dentist would perform some form of NHS treatment and also private treatment; the mixed practice model is the most profitable, and it is also the one which I feel serves our patients the best.’

Joel Mannix, head of dental at Christie & Co, believes overseas staffing is crucial for UK dentistry.

‘Efficient overseas staffing is important for UK dentistry, and the ORE plays a key role in this,’ he said.

‘According to our recent sentiment survey, 59% of respondents believe that the ORE entrance exams will enhance service delivery across both private and NHS dentistry services. Specifically, 36% of respondents feel that both sectors will benefit, among these, NHS dentistry is expected to gain slightly more than private dentistry.

‘Moreover, efficient overseas staffing will help alleviate some of the workplace pressures simply due to supply versus demand. By increasing the number of qualified dentists available, we can better meet the growing needs of both NHS and private dentistry, ensuring that patients receive timely and high-quality care.’

Experiences from the profession

Gauri Pradhan

I came to the UK on 14 September 2007. I had qualified in India with a BDS and then went on to do my master’s in oral and maxillofacial surgery.

The post-graduation degree was an intensive seven-day week, with on calls and night shifts for three years, which included the submission of multiple paper presentations and two dissertations.

After that, I thought nothing could beat the stress. I was wrong.

I quickly realised that my master’s degree will go to waste as will my graduate degree as they aren’t recognised in the UK.

It still hadn’t dawned on me that I would have to jump through multiple hoops – including the overseas registration exam (ORE) – in order to practise in the UK.

Expensive

If I wanted to go the oral and maxillofacial route, I would have to go through a formal training in medicine which meant another 10 plus years of training after the eight years I had already had back in India.

I was very keen to work, and I decided to apply for senior house officer (SHO) positions in hospitals. This was both to gain UK experience but also to earn money to take courses to prepare for the exam and pay for the exam itself.

I went to London and started dropping copies of my CV in every hospital in the area I had Googled. I was lucky to get a job as an SHO at the Northwick Park Hospital. My SHO experience helped me a lot and I met some helpful people including my consultants, but the hours needed to do the job did limit the opportunities I had to prepare wholly for the ORE.

The ORE exam, I had not realised, was going to be the most expensive examination I was going to take, and I am not just talking about the exam fee. There were courses to take, travelling to do and investments to be made in equipment. I had set up a mini surgery in my house to practice for the exam, like a compressor, suction, mannequin and instruments needed for dentistry. I assure you all people taking this exam have this room set up. This was all while I had a young family.

Overseas registration exam hardships

I got in touch with people from different countries taking or preparing for the exam and started my own preparation using every free minute I had, studying late into the night and working next morning.

I took the first part of the ORE and passed. When I passed Part 1, I recall thinking to myself that if you prepare well enough you will pass so why do people say it’s tough to get through? But I was in for a big surprise, which lasted three to four years.

I continued working in hospital as an SHO while taking the part two of the exam. I prepared for Part 2, sat it and failed it. So I prepared again, sat it and failed it the second time. I then prepared again, sat it and failed it again.

By the third failed attempt, I was almost full term pregnant when I took the exam and recall one of the examiners said ‘please don’t give birth here’ in jest to lighten things up.

‘No light at the end of the tunnel’

It was a very difficult time. I recall very clearly when I received my ORE results in the afternoon and later that evening I got a call from the hospital asking me to come in for some tests as reports suggested that the baby might have problems in development due to my age and would need to run more tests.

This was the point I broke down. I could not see a light at the end of the tunnel.

I had one more go at the exam – as the rules say that one must pass this exam within five years of sitting part one otherwise you have to retake the first part. And this was when everything was at stake, for I was thinking of going back to India if I were to fail again.

My parents who are renowned in the field of dentistry advised that I should change my career and maybe it was not meant to be. I could not give up – I was top of the class at my university so how was I failing this exam again?

I prepared, retook the exam and thank God I finally passed (hats off to people who have been more successful than me).

All the above was done was done in a full-time job and, later, with a child.

Help for overseas dentists

Time has passed and my son is now 12. It was a tough time for me and my family. I would only prepare for exams or work. There was nothing else I would do during those years. I recall a mortgage advisor who came home to discuss options. While he was asking us our expenditure he asked: ‘How often do you go out to eat?’ My husband and I answered together – never. He was surprised.

I think back and ask myself several times, did it need to be so difficult?

You can read Gauri’s full account here.

Mohamed Ibrahim

As an overseas dentist with over six years of experience, my journey has taken me from Egypt to Dubai, where I’ve worked diligently to refine my skills and expand my knowledge. I have earned two aesthetics diplomas, completed numerous clinical courses in restorative dentistry, and received intensive clinical training at one of Dubai’s leading hospitals.

I was fortunate to work with Dr Ehab Rashed, a renowned oral surgeon and one of the world’s top 100 dentists as recognised by the American Academy of Oral Surgery. Under his mentorship, I practiced restorative dentistry using a microscope, striving for precision and excellence in every procedure. I hoped to bring that same level of care and dedication to the UK.

With high hopes, I joined a residency pathway program in the UK for qualified dentists, sponsored by Damira Dental Studios. The program seemed straightforward: I would register with the GDC as a dental hygienist or therapist while working as a dental assistant for six to nine months – the expected timeframe for obtaining my GDC registration.

After this period, I would transition to the role of a hygienist or therapist while preparing for the ORE. Passing the ORE would allow me to become a registered dentist in the UK, enabling me to serve the NHS and make a meaningful impact.

However, what I expected and what actually happened couldn’t be more different.

From the moment I joined Damira, I committed fully to following the steps necessary for GDC registration. I submitted applications for both the ORE and the Dental Care Professional (DCP) registration for a therapist/hygienist position, only to encounter numerous obstacles that have significantly delayed my progress. My DCP application was submitted to the GDC in March 2023 – 18 months ago – and I am still waiting for a response.

The roadblocks did not end there. In December 2023, I submitted my ORE application along with all the required supporting documents. Unfortunately, my application was canceled as the GDC claimed they had not received my documents, and their whereabouts remain unknown.

After months of persistent communication – calls, emails, and formal complaints – my application was finally processed in March 2024. However, by that time, I had already missed the opportunity to book the ORE Part 1 for April 2024, as the booking window had opened and closed in February 2024.

Questioning the future

Determined to move forward, I aimed to book the next available exam in August 2024, with booking scheduled to open on June 20, 2024. Yet again, things didn’t go as planned. Due to a technical error, the booking system inadvertently opened two days earlier on June 18, 2024.

This allowed some candidates to secure their seats prematurely, resulting in fewer available seats when the official booking window opened on June 20, 2024. Despite having high-speed internet and acting promptly, the exam was fully booked within seconds. The GDC later acknowledged that approximately 80 candidates were affected by this issue, promising an investigation and resolution. However, as of now, no action has been taken.

The challenges I have faced with the GDC have been deeply disheartening, casting a shadow over my aspirations to practice dentistry in the UK. My vision was to apply the skills and knowledge I have gained to deliver high-quality dental care and make a meaningful contribution to the community.

However, the GDC’s lack of support, prolonged delays, and unclear regulations have made this vision increasingly difficult to achieve. It has been two years, and I am still working as a dental nurse, stuck in limbo despite all my efforts. I now find myself questioning my future as a dentist in the UK.

My story is not just a personal struggle; it highlights a broader issue that many overseas dentists face when trying to integrate into the UK’s healthcare system. There is a pressing need for more transparent, efficient, and supportive pathways that recognise the expertise and potential of internationally trained professionals.

Until such changes are implemented, talented and highly qualified dentists, eager to contribute to the UK’s healthcare system, may continue to face unnecessary barriers, leaving their skills and passion underutilised.

How could the overseas registration exam be better?

Gauri Pradhan and colleagues from the International Dental Organisation – UK

The response proposes various changes to the UK’s dental registration process for overseas dentists, aiming to address the current challenges faced by non-EU dentists.

The suggestions emphasise the importance of practical experience, fair treatment, and efficient processing of registrations. Proposed solutions:

1. Provisional registration for non-EU dentists: introduce a system where non-EU dentists can practice under supervision for one or two years. During this period, their practical knowledge and work performance would be evaluated. Based on this evaluation, the GDC could decide whether the dentist is eligible for full registration or requires further practice.

2. Simplification and fairness in registration process: the GDC should streamline the registration process, making it quicker and more transparent. This includes responding to applications and inquiries promptly. The current English language requirements, such as IELTS, should be re-evaluated. Dentists who have completed their studies in English-speaking institutions should be exempt from additional language testing. Ensure that the Overseas Registration Exam (ORE) is more accessible, with more seats available and exams conducted more frequently.

3. Addressing inequities in the system: the registration process should be consistent for all overseas dentists, regardless of the country where they obtained their degree. Currently, EU dentists face fewer hurdles compared to their non-EU counterparts. Consider adopting a model similar to Germany’s, where dentists can obtain a restricted license to work for three years while preparing for full registration exams.

4. Leveraging the skills of overseas dentists: while overseas dentists navigate the ORE process, they should be allowed to work in supervised roles, such as dental therapists or treatment coordinators. This would help address the current shortage of dentists in the UK. Providing temporary registration post-ORE1 would allow these dentists to gain UK-specific experience while preparing for ORE2.

5. Reducing bureaucratic obstacles: the GDC should improve the online registration process, making it more user-friendly and efficient by allowing document uploads instead of relying on paper submissions. Address the high cost and complexity of the current registration pathway, which is significantly more expensive and time-consuming compared to other professions, such as medicine.

6. Visa support for overseas dentists already in the UK: the GDC should explore creating a new visa category specifically for overseas dentists aiming to take the ORE, similar to the PLAB visa for doctors. Consider introducing more exam centres globally and reduce exam fees to make the process more accessible to a broader range of candidates. Liaise with organisations like the IDO – UK to understand on-the-ground reality.

7. Have quality assured courses: there are many courses that seek on false pretexts & are frightfully expensive. Overseas graduates and DCPs don’t fully understand the implications and pay over top for them. This should be looked into it have quality assured courses. Conclusion: the suggestions highlight the need for a more efficient and equitable approach to integrating overseas dentists into the UK workforce.

Implementing these changes could help address the shortage of dental professionals in the UK while ensuring that patient care remains at a high standard.

Anushika Brogan, managing director and clinical lead for Damira Dental Studios

Anushika shares her thoughts on why the ORE is so critical – but stresses the importance of improved access.

The overseas registration exam (ORE) plays a critical role in UK dentistry because it serves as a pathway for qualified overseas dentists to practice in the UK. However, the limited availability of exam slots, especially for ORE2, has led to significant delays in getting these dentists into practice, contributing to the current crisis in NHS and private dental services.

The NHS mentorship requirement after passing ORE2 further complicates things. While it ensures new dentists adapt to NHS protocols, the strict rules on mentorship (one-to-two ratio, 75% working time alongside the mentor, and mentor eligibility criteria) creates bottlenecks. With mentors needing to meet specific qualifications and having to take time out of their own practice, it’s no surprise that finding willing mentors is difficult.

However, dentists who pass their ORE2 exam and obtain GDC membership can immediately start working in private practice. Essentially we then lose what little NHS workforce we would have had, and there remains a recruitment crisis in the private sector to make matters worse.

Our push for enhanced supervision – a one-to-five or one-to-six mentor-to-mentee ratio – seems like a logical solution, especially for underserved regions. Increasing the number of ORE exam slots as well as easing the mentorship burden will alleviate the shortage of dentists and ultimately improve patient access.

What does the GDC say?

Stefan Czerniawski is executive director of strategy at the General Dental Council (GDC). He said: ‘The overseas registration examination (ORE) is an important gateway for internationally qualified dentists who want to join the UK register.

‘It’s designed to assess candidates to the same high standards that we expect of BDS graduates, so it is necessarily rigorous and demanding, giving us strong evidence that the candidates who pass it will be safe and effective practitioners.

‘Internationally qualified dentists make a vital contribution to the UK dental workforce. Last year, 40% of all new dentists joining the register did so on the basis of European qualifications and a further 10% joined after having passed the ORE.

‘But those figures don’t fully reflect the level of demand. We have seen substantial growth in the number of people registering to take the ORE, with no sign of that slowing down. So, we need to increase capacity, and we are doing that in three different ways.

‘First, we are increasing the number of places available through working with our current providers. That has allowed us to triple the capacity for Part 1 of the ORE and to increase capacity for Part 2 by a third.

‘Secondly, we have a procurement exercise underway which we hope will further increase capacity, though we know demand for places will continue to outstrip supply for some time.

‘The third approach is to relieve the pressure on the ORE by opening other routes to registration. The introduction of provisional registration, proposed by the previous government, has the potential to make a significant difference. We are urging the new government to make a quick decision on taking that forward, though we recognise that it will then take time and collaborative effort to deliver.

‘Internationally qualified dentists make a huge contribution to dental care in the UK, and we very much welcome them. We will not compromise on our standards, but we will continue our efforts to stop the registration process being a bottleneck.’

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