One Qualification, Thirty Rules: How Uneven Training Standards Shape Europe’s Mobile Dentists

When a dentist trained in Lisbon accepts a position in Rotterdam, the paperwork that allows them to work is remarkably straightforward. Under European Union legislation governing the mutual recognition of professional qualifications, a dental degree earned in one member of the European Economic Area opens the door to practice in all of them. Yet what happens after that door opens is far less predictable. The continuing professional development that a dentist must complete to stay licensed varies dramatically from one country to the next, and a new scoping review published in BMC Medical Education suggests that this patchwork of life-long learning requirements may be one of the most underappreciated challenges facing Europe’s mobile dental workforce.

The review, conducted by Eva Niermeier, Johanna Kroese, Andrés Vidal-Itriago, Wil van der Sanden and Josef Bruers, based at the Academic Centre for Dentistry Amsterdam and partner institutions in the Netherlands, set out to map what the existing literature actually says about EEA-qualified dentists and the variations in continuing professional development, or CPD, across the region. Following the JBI methodological guidance and the PRISMA-ScR reporting framework, the team systematically searched four major databases: MEDLINE, Embase, Web of Science and Scopus. They considered English and Dutch language sources published between 2000 and 2025 that explored postgraduate dental education, specifically the CPD of dentists qualified within the EEA and the United Kingdom. Independent screening and data extraction were carried out, and the resulting findings were mapped and analysed using basic qualitative content analysis.

The search ultimately yielded twenty-seven eligible sources, published between 2002 and 2024. From this body of work, the researchers identified eight overarching themes that together sketch a portrait of a profession on the move, but one whose movement is shaped by forces that are anything but uniform. The picture that emerges is one of genuine tension: free movement of dentists delivers real benefits to destination countries struggling with workforce shortages, yet it simultaneously risks deepening health inequalities in the countries that lose those professionals. And threaded through all of it is the problem that the regulatory scaffolding of the profession, from undergraduate curricula to mandatory CPD hours, differs substantially across Europe.

Why do dentists move in the first place? The review found that migration is driven by a complex interplay of push and pull factors. On the push side sit conditions in the home country: poor working environments, limited professional prospects and, in some cases, economic instability. On the pull side are the attractions of destination countries, with higher remuneration among the most prominent. These are not trivial calculations. A newly qualified dentist weighing a career at home against a career abroad is responding to concrete differences in pay, working conditions and opportunity, and the literature reviewed here suggests those differences remain large enough to sustain substantial migration flows within the EEA.

The consequences of those flows cut in two directions at once. For destination countries, incoming dentists can help fill vacancies and address shortages that would otherwise leave patients waiting for care. This is the promise of free movement in its purest form: labour flows to where it is needed. But for source countries, the departure of trained professionals can be corrosive. The review highlights that mobility risks exacerbating health inequalities in the countries losing their dentists, a dynamic familiar from broader debates about health worker migration. A country that invests in educating a dentist and then watches that dentist practise elsewhere has effectively subsidised another nation’s healthcare system, and the communities left behind may face reduced access to oral healthcare as a result.

Then there is the question of what a dental qualification actually certifies. The review found substantial variations in regulatory structures, undergraduate curricula and CPD requirements across Europe. Although mutual recognition legislation treats EEA dental degrees as equivalent for the purposes of registration, equivalence on paper does not necessarily mean equivalence in the specific competencies a dentist brings to the chair. Different countries emphasise different elements of dental education, allocate clinical experience differently and set different expectations for what a graduate should be able to do. For a migrant dentist, this means that professional integration is not simply a matter of passing a registration threshold; it can require adapting to unfamiliar clinical norms, technologies and patient expectations that their original training did not cover.

The life-long learning dimension compounds the problem. CPD exists to ensure that practising clinicians keep pace with evolving evidence, techniques and technologies, and it is a cornerstone of patient safety in modern healthcare regulation. But because CPD requirements vary so widely across the EEA, a dentist’s obligation to stay current depends heavily on where they happen to practise. The review identifies these variations as posing major challenges both to the professional integration of migrant dentists and to the maintenance of uniform patient safety standards across the region. A dentist who moves from a jurisdiction with rigorous, enforced CPD mandates to one with minimal requirements may find their professional development drifting, while one moving in the opposite direction may struggle to meet unfamiliar mandatory learning obligations on top of the ordinary stresses of relocation.

Perhaps the most striking finding of the review is what the literature does not contain. The authors note that research addressing the implications of variations in CPD requirements across Europe for migrant dentists appears to be limited. In other words, the specific question of how a mobile dentist navigates the patchwork of life-long learning rules, and what that means for their competence and for patient safety, has been largely neglected. Twenty-seven sources over two decades is a modest evidence base for a phenomenon that touches every EEA country, and the gap itself is a finding. Policy in this area has, to a significant degree, been running ahead of the evidence rather than being guided by it.

The review’s conclusions point toward possible remedies. The authors suggest that the benefits of a mobile dental workforce may be enhanced through greater harmonisation of educational standards and CPD requirements across Europe. Harmonisation would not erase national differences overnight, but aligning the core expectations placed on dentists, both at graduation and throughout their careers, would reduce the friction that migrant dentists currently face and would make it easier to guarantee consistent standards of care regardless of where a clinician trained or where they practise. Bodies such as the Association for Dental Education in Europe and the Council of European Dentists have long been involved in efforts to define shared professional standards, including the Graduating European Dentist framework, and the review’s findings give those efforts added weight.

The authors also emphasise the need for robust, data-driven workforce planning, alongside targeted support programmes, to facilitate the effective integration of migrant dentists and contribute to safeguarding public health. Workforce planning grounded in real data would allow countries to anticipate both shortages and surpluses rather than reacting to them, while support programmes could help arriving dentists bridge the gaps between their original training and the expectations of their new professional environment. Taken together, the review makes the case that free movement of dentists is neither an unqualified good nor a problem to be restricted, but a system whose benefits depend on how well the underlying educational and regulatory architecture is aligned. As dental care grows more technologically complex and European workforces remain mobile, the twenty-seven studies assembled here suggest that the quiet machinery of life-long learning may deserve far more attention than it has received.

Subject of Research: Free movement of dentists and variation in continuing professional development requirements across the European Economic Area

Article Title: Free movement of dentists and life-long learning requirements within the countries of the European Economic Area: a scoping review of existing insights and future considerations

Article References: Niermeijer, E., Kroese, J., Vidal-Itriago, A., van der Sanden, W., & Bruers, J. (2026). Free movement of dentists and life-long learning requirements within the countries of the European Economic Area: a scoping review of existing insights and future considerations. BMC Medical Education. https://doi.org/10.1186/s12909-026-10542-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10542-x

Keywords: dentists, European Economic Area, free movement, continuing professional development, migrant dentists, dental education, professional qualifications, harmonisation, patient safety, workforce planning, health inequalities, scoping review