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Why Is Getting A New State Dental Hygienist License So Hard? Is Change Finally Coming?


The challenges of securing a dental hygiene license in different states.
Let’s talk state licensure hassle!😩 Why is getting a dental hygiene license in a new state so hard, and could the Dentist and Dental Hygienist Compact be the long-awaited solution?

Since embarking on my roaming journey, I've encountered the perplexing challenges and bureaucratic maze surrounding state licensure. The lack of dental hygienist license portability has become a cumbersome hurdle, especially for those of us with a nomadic spirit. One baffling question lingers — why is getting a new state license so hard when we, as dental professionals, stand ready to offer a solution to the glaring issue of limited dental healthcare in numerous communities across the United States? 


As a nomad and humanitarian at heart, it feels like my desire to share my oral health knowledge and skills with people everywhere clashes with the system's attempt to pin me down. Instead of facilitating the free flow of expertise, the current barriers hinder our potential impact on improving oral health outcomes and addressing the pressing dental care needs of various communities. 


Let’s take a closer look at how things stand now and how they could be improved to make getting a dental hygienist license in a new state easier and, potentially, cheaper.


Scope of Practice: Defining Dental Borders

The scope of practice defines our ability to deliver clinical care in various settings under varying levels of supervision. Scopes of practice for dental professionals have continuously evolved over the years, adapting to emerging technological advancements, scientific insights regarding disease treatment, and ever-changing societal demands. However, the challenge lies in the fact that dentistry in the U.S. isn’t overseen on a national level but on a state one. 


This means each state has its own set of laws and regulations governing what a dental hygienist can or cannot do. Despite the dynamic progression in our field, this branching of regulations among states is a substantial barrier to the seamless portability of dental hygienist licenses. While our profession strives to stay at the forefront of innovation and adaptability, the persisting incompatibility in regulatory frameworks makes it hard for dental hygienists to share their expertise across state borders, ultimately impeding the desired fluidity in our profession.


State Do’s and Don’ts: Navigating Diverse Regulations

Dental hygiene scopes of practice vary widely among states and get updated every so often. In certain states, they’ve expanded to include nitrous oxide administration, application of silver diamine fluoride, neuromodulator injections, lasers, as well as dental hygiene diagnosis and treatment planning. Sadly, something like my anesthesia certificate doesn’t transfer easily, even though it is a very necessary part of patient care as a dental hygienist. Some states allow hygienists to administer local anesthesia, work independently, and even own practices, while others have more restrictive regulations. It's essential to be aware of these variations and check each state's dental board website for specific details.


Level of Supervision: Deciphering the Oversight

Understanding each state’s supervision levels is crucial when getting a new dental hygienist license. General supervision involves following a licensed dentist's instructions without their physical presence.  Personal supervision means the dentist must authorize, be present, and check prior to patient dismissal. Direct supervision requires the dentist to be on-site during specific treatments, while indirect supervision involves the dentist approving the procedure beforehand and being on the premises during the treatment. In collaborative practice, an RDH may practice without supervision, following a collaborative agreement between the RDH and a licensed dentist. Lastly, direct access means the hygienist can provide services as they deem appropriate without specific authorization. To be very honest, until moving around the country, I did not realize there were so many levels of supervision.


Continuing Education Requirements

Meeting continuing education (CE) requirements is essential for the renewal of your dental hygienist license in any state. These may include live, hands-on, and self-study credits from clinical hours, board exams, or certifications. Some states have specific topic requirements, such as OSHA/infection control, HIPAA, medical emergencies, human trafficking, pain management/opioids, or cultural competency. Others mandate board-approved courses, including beyond-CE training like CPR/BLS, with variations in acceptance. Failing to meet these requirements poses several risks, from board reprimands, audits, and potential fines to probation or even loss of license, impacting future job prospects and licensure applications in new states. 


Review of My Dental Hygienist Licenses 

Each state has its own set of requirements, and some certainly make the process of applying for a dental hygienist license trickier than others. Reflecting on my journey, obtaining a license in Colorado was surprisingly straightforward, while Montana and Arizona are a bit more complicated. Here’s a quick overview of the dental hygienist requirements you need to meet in these 3 states:

Colorado Dental Hygiene License

Montana Dental Hygiene License

Arizona Dental Hygiene License

If you’re applying through the examination method, you must attest to one of the following:


● Graduated within the last 12 months from an accredited dental hygiene program; OR

● Have active clinical practice of dentistry in 1 out of the last 5 years, OR

● Taught dental hygiene or dentistry in an accredited program for at least 1 of the last 5 years; OR

● Served in the military as a dental hygienist for 1 of the last 5 years, OR

● Passed a Colorado Dental Board- approved clinical examination within the past year.

If you’re applying through examination, the requirements are: 


  • Graduated from a Commission on Dental Accreditation (CODA) approved dental hygiene school;

  • Passed the National Board Dental Hygiene Examination (NBDHE);

  • Passed a board-approved clinical examination within the last 5 years.

  • Passed the Montana Jurisprudence examination.

  • License verifications from all jurisdictions, for any professional license.

  • Self-Query of the National Practitioner Data Bank (NPDB).

  • Current CPR, ACLS, or PALS card.

If you’re applying through examination, the requirements are: 


  • Graduated from a CODA or ADA- approved dental hygiene program.

  • Passed the National Board Dental Hygiene Examination (NBDHE).

  • Passed a clinical examination administered by a state or regional testing agency in the U.S. within the last 5 years.

  • Passed the Arizona Board’s Jurisprudence examination. 

If you’re applying through the endorsement method, you must attest to one of the following:


● Have had at least 300 hours of active clinical practice in dental hygiene in 1 of the last 3 years; OR

● Taught dental hygiene/dentistry, for at least 300 hours annually in 1 of the last 3 years; OR

● Engaged in military service as a dental hygienist and gained similar experience to the requirements in the Colorado Board Dental Rule, OR

● Passed a Colorado Dental Board- approved clinical examination within 1 year of your application.

If you’re applying through endorsement, the requirements are: 


  • Graduated from a Commission on Dental Accreditation (CODA) approved dental hygiene school.

  • Passed the National Board Dental Hygiene Examination (NBDHE).

  • Passed a board-approved clinical examination.

  • Certification of hours, including proof that you’ve practiced dental hygiene for a minimum of 1000 hours in the 2 years prior to your application.

  • Passed the Montana Jurisprudence examination.

  • License verifications from all jurisdictions, for any professional license.

  • Self-Query of the National Practitioner Data Bank (NPDB).

  • Current CPR, ACLS, or PALS card.

If you’re applying by credential, the requirements are: 


  • Passed the clinical examination of another state or testing agency with a licensure standard substantially equivalent to Arizona, more than 5 years before your application.

  • Actively practiced dentistry as a dental hygienist for a minimum of 1,000 hours within the last 2 years.

  • Completed the CE requirements of the U.S. jurisdiction where you’re currently licensed.

  • Passed the Arizona Jurisprudence examination.

Fees: Application Fee - $150



*As of January 1, 2021, military spouses can apply for a 3-year temporary license at no cost if they are licensed to practice in another state.

Fees:


By Examination

Application Fee - $100

Jurisprudence Exam Fee - $85


By Endorsement

Application Fee - $100.00

Credential Fee - $75.00

Jurisprudence Exam Fee - $85.00

Fees:


By Examination

Application Fee - $55Jurisprudence Exam Fee - $100


By Endorsement:

Application Fee - $55Credential Fee - $1,000

Jurisprudence Exam Fee - $100

The New Interstate Compact’s Promise

As my fellow roaming oral health warriors will agree, we desperately need a solution to the hassles of obtaining a new dental hygienist license every time we relocate to a different state. In order to simplify multistate practice, the Council of State Governments, in collaboration with the Department of Defense, the American Dental Association, and the American Dental Hygienists’ Association, is developing the Dentist and Dental Hygienist Compact. This interstate compact, currently in drafting stages, aims to create reciprocity among participating states, reducing barriers to license portability and making it easier for dental professionals to practice across state lines. This would especially benefit those in military families or working in several states.


Could Dental Therapists Be the Solution in the Meantime?

Another topic that’s been getting attention lately is dental therapists. This mid-level position grants extended responsibilities, including restorative treatments, while operating under dentist oversight. Although each state establishes its own limitations and requirements, dental therapists are a great way of addressing health/community disparities, particularly in areas with chronic dentist shortages. In fact, the concept originated in Alaska and American Native communities for that exact reason. 


Dental therapy has only 4 programs in the US (at the time of this writing)— 1 in Alaska and 3 in Minnesota — verified during state license applications. Recently, Maine and Oregon passed dental therapist bills, joining Alaska, Arizona, Colorado, Connecticut, Idaho, Michigan, Minnesota, New Mexico, Nevada, Vermont, and Washington with authorized dental therapist practices. The Model Dental Therapist Rule and Best Practices Guide, published in January 2022 by the National Partnership for Dental Therapy, serves as a tool for state boards and governments to guide dental therapy approvals.


Final Thoughts

The call for dental hygienist license portability isn't just about personal convenience; it's a plea to collectively enhance dental healthcare accessibility and make a meaningful difference in the lives of those who need it most. With states making small but significant strides to facilitate multistate practice and enhance dental hygienists' scope of practice, there's hope for improved oral health outcomes. Recognizing hygienists as crucial components of healthcare will not only increase access to care but also elevate the value of the RDH credential. 


As we navigate the evolving landscape, let's continue working hard and looking toward the future of the dental hygiene profession. 


Before you leave, join me on Instagram and TikTok to follow my licensing journey across states. Oh, and don't forget to explore my Amazon store for my favorite dental products. 


Here's to breaking down barriers and shaping the future of dental hygiene!


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