How dental licensing works in the US
Every state issues its own dental licenses and sets its own requirements. The path follows a common structure — accredited education, national written exams, a clinical exam, and a state board application — but the details vary at each step.
Who regulates dental licensing?
There is no federal dental license. Each of the 50 states and the District of Columbia issues its own dental and dental hygiene licenses through a state dental board — a government agency with authority over who may practice within that jurisdiction. The ADA, dental schools, and national exam bodies set standards, but licensing authority rests entirely with the states.
This means a dentist licensed in Texas is not automatically licensed in California. Practicing in a new state requires either applying fresh or going through a separate endorsement process. Rules for what is accepted — and what isn't — differ significantly from state to state.
The steps below describe the general path to licensure across most states. Specific requirements — passing scores, accepted exam providers, background check rules, application timelines — vary by state. Always verify current requirements directly with your state dental board before applying.
Step 1: Graduate from an accredited dental program
Every state requires graduation from a dental program accredited by the Commission on Dental Accreditation (CODA), the nationally recognized accrediting body for dental education programs in the US. CODA accredits predoctoral dental programs (leading to a DDS or DMD degree), dental hygiene programs, and postdoctoral specialty programs.
Dentists pursuing licensure must hold a DDS or DMD from a CODA-accredited program. Dental hygienists must graduate from a CODA-accredited dental hygiene program — typically a two-year associate degree, though bachelor's and master's programs exist. Some states require a specific degree level for hygienists; verify your target state's requirement.
International dental graduates (those who trained outside the US) face additional requirements. Most states require completion of a CODA-accredited advanced standing program before applying for licensure. A small number of states have additional pathways; contact the board directly if you trained internationally.
Step 2: Pass the national written board exam
Written examinations test the biomedical sciences, clinical dentistry, and patient management knowledge required to practice safely. All states accept these national exams; none require a separate state-specific written test.
- INBDE (Integrated National Board Dental Examination) — The current written board exam for dentists, administered by the Joint Commission on National Dental Examinations (JCNDE). The INBDE replaced the older NBDE Part I and Part II exams — dental students who entered programs after January 1, 2020 are typically required to sit the INBDE. The exam integrates basic sciences with clinical reasoning across a single two-day format.
- NBDHE (National Board Dental Hygiene Examination) — The written board exam for dental hygienists, also administered by the JCNDE. The NBDHE covers biomedical sciences, dental hygiene sciences, and community and patient case scenarios.
- NBDE (Parts I and II) — The predecessor to the INBDE for dentists. Dentists who passed the NBDE prior to its sunset are generally grandfathered — most state boards accept legacy NBDE results. New applicants sit the INBDE.
Most states require a passing score on the applicable national written exam before a clinical exam application is processed or before a license application can be submitted. Some states set a minimum score above the national passing threshold — confirm your target state's requirement.
Step 3: Pass a clinical board examination
Clinical exams assess hands-on patient care competency. Unlike the INBDE, there is no single national clinical exam — states accept results from several regional testing agencies. Which exams a state accepts, and whether scores are transferable to other states, varies.
- ADEX (American Board of Dental Examiners) — Administered by the ADEX Dental Licensing Examination — dental exams conducted at testing sites and accepted by a large group of states. ADEX exams are intended to be portable: a passing score may be used for licensure in multiple accepting states within a defined validity period.
- CDCA (Commission on Dental Competency Assessments) — Formerly known as the Northeast Regional Board. CDCA exams are accepted across a group of states, primarily in the Northeast and Mid-Atlantic. CDCA's dental hygiene exam (CDCA-WREB) is widely accepted.
- CRDTS (Central Regional Dental Testing Service) — Administers dental and dental hygiene clinical exams accepted in a group of central and mid-southern states.
- WREB (Western Regional Examining Board) — Accepted across western states. WREB dental and dental hygiene exams carry portability provisions within accepting states.
- SRTA (Southern Regional Testing Agency) — Administers dental and dental hygiene clinical exams for a group of southeastern states.
If you plan to practice in multiple states over your career, check which clinical exam is accepted most broadly in the regions you're targeting before you sit. Scores generally remain valid for five to seven years for endorsement purposes, but each state sets its own window.
Step 4: Apply to the state dental board
After passing the written and clinical exams, you apply directly to the dental board in the state where you intend to practice. Applications typically require:
- Official exam score transcripts — The board will request official score reports sent directly from the JCNDE (for written exams) and the clinical testing agency.
- Diploma and transcripts — Official transcript from your dental school, confirming graduation from a CODA-accredited program.
- Background check — All states require a criminal background check. The scope — fingerprinting, multi-state databases, lookback period — varies. Certain prior convictions may disqualify an applicant or require additional review; policies differ by state.
- Application fee — Fees vary by state and license type. They typically range from a few hundred to several hundred dollars for an initial license.
- Jurisprudence exam or course — Many states require passing a jurisprudence exam — a test on the state's dental practice act and board rules — or completing a jurisprudence course before the license is issued.
- CPR certification — Most states require current CPR or BLS certification as a condition of licensure.
Processing times vary. Simple applications in states with online portals can move in a few weeks; states with paper-based review processes or high application volume may take several months. Submit complete, accurate applications and respond promptly to any board requests to avoid delays.
Transferring a license to another state
Dentists and hygienists who are already licensed in one state can apply for licensure in a new state through licensure by credentials (also called endorsement or reciprocity, depending on the state). This process recognizes prior exam results rather than requiring the applicant to sit clinical exams again.
Requirements for endorsement vary significantly. Most states require: a current, active, unencumbered license in the home state; a clean disciplinary record; exam scores within a certain validity window (commonly five to seven years); and completion of any state-specific requirements like jurisprudence or CPR. Some states impose additional continuing education requirements or require the applicant to have practiced for a minimum number of years.
A small number of states have formal reciprocity agreements with specific other states. Most use a credentials-review approach on a case-by-case basis. The National Practitioner Data Bank (NPDB) is queried as part of most endorsement applications to verify disciplinary history across states.
The Dentist and Dental Therapist Compact (DDTC), if enacted in your states of interest, would streamline multi-state practice by allowing licensed dentists to obtain a compact privilege to practice in member states without a full separate application. Check current compact membership — states are joining on a rolling basis.
Renewal and continuing education
Dental licenses are not permanent. All states require periodic renewal — typically every one or two years — and completing continuing education (CE) is a standard renewal condition. States also require attestation that required CE has been completed and, in some states, submission to a CE audit.
Required CE hours range from 6 per year (North Carolina dental hygienists) to 63 over three years (Washington dentists). Many states require specific topic coverage — opioid prescribing, infection control, or ethics — as a mandatory part of the CE total. See the CE requirements by state table for a summary of published figures.
Specialty licensure
General dental licenses do not automatically authorize a dentist to advertise or hold themselves out as a specialist. States regulate specialty practice and advertising separately. Most states require a dentist to hold a specialty permit or certification — typically tied to completion of an accredited postdoctoral specialty residency and certification by the relevant specialty board — before using specialty titles in advertising or patient communications.
Twelve dental specialties are formally recognized in the US by the National Commission on Recognition of Dental Specialties and Certifying Boards. How states regulate specialty practice varies; some require no separate permit, others require a formal application. See the dental specialties guide for details on each recognized specialty.
Find your state's licensing requirements
The general steps above apply across most states, but every state board sets its own passing scores, accepted exam providers, application fees, and jurisprudence requirements. Select your state below to go directly to its licensing requirements section.