How dental licensing works in the US

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.

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.
• 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.

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.

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 and covered topics vary widely by state. 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 guide for a summary of published figures.

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 section.

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