The practice of dental hygiene involves performing preventative oral health services, conducting initial patient screenings, and providing patient education on proper oral care techniques. Dental hygienists are licensed oral health professionals whose services are highly regulated due to their direct role in public health. Licensure is mandatory across all 50 states and every U.S. jurisdiction, ensuring that only qualified individuals are permitted to provide direct patient care.
The Mandatory Nature of Dental Hygiene Licensure
Licensure safeguards public health and safety by preventing unqualified practice. The authority to grant and regulate this professional license rests with individual State Boards of Dentistry or Dental Examiners, not a federal agency. These state boards interpret and enforce regulations outlined in their respective State Dental Practice Acts. This legislation defines the precise scope of practice, the required level of supervision, and the services a licensed dental hygienist is legally permitted to perform.
Educational Prerequisites for Licensure
The pathway to licensure requires formal education from a program accredited by the Commission on Dental Accreditation (CODA) of the American Dental Association. The minimum educational requirement for entry-level practice is typically an Associate of Applied Science (AAS) degree in Dental Hygiene, usually a two-to-three-year program. Many individuals pursue a Bachelor of Science (BS) degree, a four-year program that allows for expanded career opportunities in education or public health. Graduation from a CODA-accredited institution confirms the candidate has met standardized educational requirements and demonstrated clinical competency.
National and Regional Examination Requirements
Candidates must pass two distinct types of examinations to prove their knowledge and clinical skills.
National Board Dental Hygiene Examination (NBDHE)
The NBDHE is a comprehensive, written assessment administered by the Joint Commission on National Dental Examinations (JCNDE). It evaluates cognitive knowledge of biomedical sciences, dental hygiene sciences, and the application of this information in a clinical problem-solving context. Passing this national written exam fulfills the written component required by all state licensing boards.
Clinical or Regional Board Examination
The second mandatory assessment is a clinical or regional board examination, which evaluates hands-on competency in procedures like periodontal scaling, root planing, and calculus detection. Since there is no single national clinical exam, candidates typically take an exam administered by one of the regional testing agencies:
Commission on Dental Competency Assessments (CDCA-ADEX)
Central Regional Dental Testing Service (CRDTS)
Southern Regional Testing Agency (SRTA)
These regional examinations require the candidate to perform clinical procedures on live or simulated patients to demonstrate the ability to provide safe and effective care.
State Licensure Application and Jurisprudence
The final step involves applying directly to the State Board of Dentistry where the hygienist intends to work. The application requires submitting a detailed packet, including official documentation of NBDHE and clinical examination scores, proof of graduation, and often a recent photograph. A mandatory requirement in most states is the successful completion of a jurisprudence examination, which covers the laws and regulations contained within that state’s Dental Practice Act. Applicants are also routinely required to submit to a criminal background check and provide current certification in Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR). The state board reviews this package before formally granting the license.
Maintaining Licensure and Continuing Education
The dental hygiene license requires periodic renewal, typically occurring every one to three years depending on the state. A requirement for renewal is the completion of a mandated number of Continuing Education (CE) hours to ensure the practitioner remains current with advancements in the field. Many state boards require between 15 and 30 CE hours every two-year renewal cycle, often specifying courses in infection control, ethics, or pain management. Licensees must also pay a renewal fee and submit a timely application. Failure to meet the required CE hours or allowing the license to lapse can result in inactive status, necessitating further steps like paying late fees or completing additional coursework to reinstate the active license.
Interstate Practice and License Endorsement
Licensed dental hygienists who move to a new state must obtain a new license through a process known as licensure by endorsement or credential. This pathway allows a state to grant a license to an applicant who holds a current, unrestricted license in another state, often waiving the need for a new clinical examination. States typically require the applicant to have practiced actively for a minimum number of years or hours and to pass the new state’s jurisprudence examination. Requirements still vary significantly, but the recent development of the Dental and Dental Hygiene (DDH) Compact aims to create a more efficient, multi-state license for practitioners in participating jurisdictions, improving professional mobility.