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North Dakota Dental Hygiene — Requirements & Free Practice

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License to Practice Dental Hygiene

License issued by the North Dakota State Board of Dental Examiners to practice dental hygiene under NDCC chapter 43-20, including the volunteer license and reinstatement or reentry of a former license.

Licensing authority: North Dakota State Board of Dental Examiners · Application information

Reinstatement from inactive status

All of the following:

  • North Dakota Dental Jurisprudence Examination

  • At least one of the following alternatives:

    • All of the following:

      • ADEX Dental Hygiene Computer Simulated Clinical Examination (CSCE OSCE) (practice unavailable)
      • ADEX Dental Hygiene Simulated Patient Treatment Clinical Examination (SPTCE) (assessment without a question bank)
    • CRDTS Dental Hygiene Patient-Based Exam (assessment without a question bank)
    • CRDTS Dental Hygiene Simulated Patient Exam (practice unavailable)
Background
Grounds for denial under NDCC 43-20-05 must not exist; the Board requires a statewide and nationwide criminal history record check, proof of CPR, and verification of physical health and visual acuity (NDAC 20-04-01-06).
Clinical Discontinued Agencies
The Board lists CITA and WREB (and the application form lists CDCA-WREB) as approved clinical testing agencies. CDCA and WREB merged in 2021, CDCA-WREB combined with CITA in 2022, and CDCA-WREB-CITA merged with ADEX in 2025; the ADEX examination is now administered by the American Board of Dental Examiners. A passing result previously obtained from CITA or WREB is prior evidence.
Clinical Prior Evidence
A dental hygiene clinical competency examination passed with any regional dental testing service before September 17, 2009 is accepted (Board page and application packet); it is prior evidence, not a currently offered examination.
Clinical Waiver
The clinical competency examination must be passed within two years of application, and the Board may, within its discretion, waive this requirement (NDAC 20-04-01-07(1)).
Continuing Education
Sixteen hours of continuing education and a CPR course within two years of application (NDAC 20-04-01-07(3)-(4)).
Employment Proof
The Board's reinstatement packet and page ask for proof of employment in clinical dental practice or dental education (packet: previous three years for hygienists; page: five years prior to application), and license verification from every jurisdiction.
Inactive Status
Only a license on inactive status may be reinstated; a lapsed license requires a new application for licensure (NDAC 20-04-01-07; Board page).
Jurisprudence Timing
The laws and rules examination must be passed within two years of application (NDAC 20-04-01-07(2)).
License by credential review

All of the following:

Background
Grounds for denial under NDCC 43-20-05 must not exist; the Board requires a statewide and nationwide criminal history record check, proof of CPR, and verification of physical health and visual acuity (NDAC 20-04-01-06).
Canadian Alternative
The Board's License by Credential page also accepts the examination of the Dental Hygiene Certification Board of Canada in place of the JCNDE examination.
Clinical Discontinued Agencies
The Board lists CITA and WREB (and the application form lists CDCA-WREB) as approved clinical testing agencies. CDCA and WREB merged in 2021, CDCA-WREB combined with CITA in 2022, and CDCA-WREB-CITA merged with ADEX in 2025; the ADEX examination is now administered by the American Board of Dental Examiners. A passing result previously obtained from CITA or WREB is prior evidence.
Clinical Equivalent
The credential packet states the Board accepts most dental hygiene regional clinical board exams, and an applicant who has not taken a Board-approved clinical exam must show that the clinical examination taken is substantially equivalent to those accepted by the Board.
Clinical Prior Evidence
A dental hygiene clinical competency examination passed with any regional dental testing service before September 17, 2009 is accepted (Board page and application packet); it is prior evidence, not a currently offered examination.
Continuing Education
Sixteen hours of continuing education within two years of application, and a CPR course within two years (NDAC 20-04-01-05).
Good Standing
Certificate of good standing from the examining or licensing board of every jurisdiction in which the applicant is licensed (NDCC 43-20-01.3(4)).
Interview
Applicants may be scheduled to appear before the Board for an informal interview.
Jurisprudence
NDCC 43-20-01.3(5) requires the written laws and rules examination administered by the Board.
Military Applicants
Under NDCC 43-51-11.1(1) the Board shall adopt rules or grant case-by-case exceptions to its licensing standards for a military member or military spouse who demonstrates competency through methods or standards determined by the Board; the Board's page states military applicants use the application form for the license type sought.
National And Clinical Basis
NDCC 43-20-01.3 lists only the laws and rules examination but adds any requirement established by Board rule; NDAC 20-04-01-06(3)-(4) lets the Board require evidence of the JCNDE examination and a Board-approved clinical examination, and the Board's License by Credential page and packet require both.
Practice History
Licensed in good standing and actively practicing dental hygiene for at least three years immediately preceding application in another jurisdiction whose requirements are at least substantially equivalent (NDCC 43-20-01.3(1)).
License by examination

All of the following:

Background
Grounds for denial under NDCC 43-20-05 must not exist; the Board requires a statewide and nationwide criminal history record check, proof of CPR, and verification of physical health and visual acuity (NDAC 20-04-01-06).
Canadian Alternative
NDAC 20-04-01-04(1) also accepts the examination of the Dental Hygiene Certification Board of Canada in place of the JCNDE examination.
Clinical Discontinued Agencies
The Board lists CITA and WREB (and the application form lists CDCA-WREB) as approved clinical testing agencies. CDCA and WREB merged in 2021, CDCA-WREB combined with CITA in 2022, and CDCA-WREB-CITA merged with ADEX in 2025; the ADEX examination is now administered by the American Board of Dental Examiners. A passing result previously obtained from CITA or WREB is prior evidence.
Clinical Other Approved
NDCC 43-20-01.2(4)(c) also accepts a clinical competency examination administered by a licensing jurisdiction approved by the Board by rule; no such jurisdiction is named in the rules or on the Board's page.
Clinical Prior Evidence
A dental hygiene clinical competency examination passed with any regional dental testing service before September 17, 2009 is accepted (Board page and application packet); it is prior evidence, not a currently offered examination.
Clinical Retakes
After failing the clinical examination three times the applicant must complete Board-approved remedial training before a fourth attempt (NDAC 20-04-01-04.1).
Clinical Timing
NDAC 20-04-01-04(2) requires the clinical competency examination within five years of application; the Board's 2026 application packet asks for a clinical result taken within two years of application.
Education
Graduate of a dental hygiene school accredited by the American Dental Association's Commission on Dental Accreditation (NDCC 43-20-01.2(4)(a)).
Jurisprudence Timing
The written laws and rules examination must be passed within one year of making application (NDCC 43-20-01.2(4)(d)).
Military Applicants
Under NDCC 43-51-11.1(1) the Board shall adopt rules or grant case-by-case exceptions to its licensing standards for a military member or military spouse who demonstrates competency through methods or standards determined by the Board; the Board's page states military applicants use the application form for the license type sought.
National Exam Timing
NDAC 20-04-01-04(1) requires the JCNDE examination within five years of application; the Board's 2026 application packet asks for National Board results taken within two years of application, and NDAC 20-04-01-06(3) lets the Board require evidence within two years.
License renewal
No examination is required for this applicant pathway.
Continuing Education
Sixteen hours per two-year cycle including ethics or jurisprudence, infection control and CPR; passing the laws and rules examination counts as two hours of ethics or jurisprudence (NDAC 20-04-01-08).
Cycle
Dental hygienist licenses expire on December 31 of every odd-numbered year and are renewed with a renewal application, the renewal fee and proof of the continuing education required by rule (NDCC 43-20-01.4).
Late Renewal
Within sixty days after expiration: late fee added; between sixty-one days and one year: twice the late fee and other documentation the Board seeks confirming the individual retains the skills necessary to practice; after one year the individual must apply for licensure again (NDCC 43-20-01.4(4)-(6)).

Official no-examination sources

Effective from 2026-04-01.

Licensure reentry
North Dakota Dental Jurisprudence Examination
Clinical Assessment
If required by the Board: appearance before the Board, a clinical competency assessment conducted by a Board-approved dental education provider, and a Board-approved reeducation program or refresher course including a clinical post-assessment (NDAC 20-04-01-05.1(6)(b)-(d)).
Former Licensure
Formerly licensed as a hygienist in North Dakota or in a state or jurisdiction with substantially equivalent licensure requirements, and has practiced dental hygiene (NDAC 20-04-01-05.1).
Jurisprudence Timing
The laws and rules examination must be passed within one year of making application (NDAC 20-04-01-05.1(2)).
Other
CPR within two years, physical health and visual acuity, background check, and no grounds for denial under NDCC 43-20-05 (NDAC 20-04-01-05.1).
Permits
A reentering hygienist may not administer sealants, local anesthetic or nitrous oxide without completing Board-approved courses and receiving a permit (NDAC 20-04-01-05.1(7)).
Universal licensure out of state licensee

All of the following:

Canadian Alternative
NDAC 20-04-01-04(1) accepts the Dental Hygiene Certification Board of Canada examination in place of the JCNDE examination.
Clinical Discontinued Agencies
The Board lists CITA and WREB (and the application form lists CDCA-WREB) as approved clinical testing agencies. CDCA and WREB merged in 2021, CDCA-WREB combined with CITA in 2022, and CDCA-WREB-CITA merged with ADEX in 2025; the ADEX examination is now administered by the American Board of Dental Examiners. A passing result previously obtained from CITA or WREB is prior evidence.
Clinical Prior Evidence
A dental hygiene clinical competency examination passed with any regional dental testing service before September 17, 2009 is accepted (Board page and application packet); it is prior evidence, not a currently offered examination.
Competency Methods
Competency and education are demonstrated through methods determined by the Board (NDCC 43-51.1-02(1)(b)); NDAC 20-04-01-06, which implements NDCC 43-51.1-02, lets the Board require evidence of the JCNDE examination and a Board-approved clinical examination within two years of application.
Discipline
No discipline in any jurisdiction within the last ten years, no active investigation, no act constituting grounds for refusal unless the Board determines otherwise, and a criminal background check if required (NDCC 43-51.1-02(1)(c)-(f)).
Jurisprudence
NDCC 43-51.1-03(4) lets the Board require a jurisprudence examination on North Dakota law; the Board's application packet states all dental hygiene applicants must complete the online jurisprudence exam.
Out Of State License
Holds a dental hygiene license issued in another U.S. state or jurisdiction with comparable requirements and has actively used it for two of the three years immediately preceding the application (NDCC 43-51.1-01(8), 43-51.1-02(1)(a)).
Volunteer license by licensure criteria

All of the following:

Application
Application form with a current CPR certificate, a nonrefundable fee and any documentation the Board requests (NDAC 20-04-01-09(2)).
Board Page Statement
The Board's volunteer page states: "The Board determines that the applicant is qualified and satisfies the criteria specified under N.D.C.C. 43-20-1.2 or 43-20-01.3."
Canadian Alternative
NDAC 20-04-01-04(1) accepts the Dental Hygiene Certification Board of Canada examination in place of the JCNDE examination.
Clinical Discontinued Agencies
The Board lists CITA and WREB (and the application form lists CDCA-WREB) as approved clinical testing agencies. CDCA and WREB merged in 2021, CDCA-WREB combined with CITA in 2022, and CDCA-WREB-CITA merged with ADEX in 2025; the ADEX examination is now administered by the American Board of Dental Examiners. A passing result previously obtained from CITA or WREB is prior evidence.
Clinical Prior Evidence
A dental hygiene clinical competency examination passed with any regional dental testing service before September 17, 2009 is accepted (Board page and application packet); it is prior evidence, not a currently offered examination.
Eligibility
Formerly licensed in North Dakota or holding an active license in another state with at least substantially equivalent laws, and determined by the Board to be qualified and to satisfy the criteria of NDCC 43-20-01.2 (NDAC 20-04-01-09(1)(c)).
Scope
A volunteer license may only be used for primary health services without remuneration in a Board-approved setting, must be renewed annually, and may be limited by the Board (NDAC 20-04-01-09(3)).
Volunteer license by practice or board determination
No examination is required for this applicant pathway.
Application
Application form with a current CPR certificate, a nonrefundable fee and any documentation the Board requests (NDAC 20-04-01-09(2)).
Eligibility
Formerly licensed in North Dakota or holding an active license in another state with at least substantially equivalent laws, and either practiced for three of the five years immediately preceding the application or is determined by the Board to be sufficiently experienced and qualified and will be supervised by a responsible dentist (NDAC 20-04-01-09(1)(a)-(b)).
Scope
A volunteer license may only be used for primary health services without remuneration in a Board-approved setting, must be renewed annually, and may be limited by the Board (NDAC 20-04-01-09(3)).

Official no-examination sources

Effective from 2026-04-01.

ADEX Dental Hygiene Computer Simulated Clinical Examination (CSCE OSCE)

Provider
American Board of Dental Examiners; Prometric delivery
Format
Computer-based clinically based questions
Exam questions
Up to 120 items; pilot questions do not affect the final score
Passing score
Minimum scaled score 75; results reported as Pass/Fail
Examination outline
  • Medical/Dental Assessment (12%)
  • Intra and Extra Oral Assessment and Charting (27%)
    • Intra and Extra Oral Examination
    • Dental and Periodontal Charting and Assessment
    • Soft Tissue, Bone, and Tooth Abnormalities
  • Radiology/Imaging (15%)
  • Dental Hygiene Care Planning (13%)
  • Patient Care (19%)
    • Periodontal Procedures
    • Infection Control
    • Medical Emergency Management
  • Dental Specialties and Pharmacology (14%)
    • Dental Specialties
    • Applied Pharmacology
Examination sources

ADEX Dental Hygiene Simulated Patient Treatment Clinical Examination (SPTCE)

This assessment does not have a question bank.

Provider
American Board of Dental Examiners
Format
Simulated patient treatment on maxillary and mandibular typodonts
Passing score
75 or greater; results reported as Pass/Fail for this part
Examination sources

CRDTS Dental Hygiene Patient-Based Exam

This assessment does not have a question bank.

Examination sources

CRDTS Dental Hygiene Simulated Patient Exam

Examination outline
  • Extra/Intra Oral Assessment OSCE — 16 scorable items, 1 point each, 16 maximum points
    • Identify gross head and neck anatomy, variations of normal anatomy, palpation techniques used to examine head and neck extraoral and intraoral structures, and atypical or abnormal findings, whether pathologic or non-pathologic
    • Extraoral — Head, Face, and Neck: asymmetry, infected piercings, swellings, lesions
    • Extraoral — Lymph Nodes, TMJ: description of location, restricted opening
    • Intraoral — Oral Mucosa/Lips and Supporting Structures: lesions, chemical/physical irritations, tattoos, swellings, hematomas, nodules
    • Intraoral — Alveolar Ridge: lesions, chemical/physical irritations, exostosis, torus/tori, tattoos, swellings, hematomas, nodules
    • Intraoral — Palate and Oral Pharynx (tonsils and tonsillar pillars): torus, lesions, chemical/physical irritation, other significant findings
    • Intraoral — Tongue: hairy tongue, fissured tongue, loss of papilla, geographic tongue, glossitis, nodules, lesions
    • Intraoral — Floor of the Mouth: ankyloglossia, hematomas, lesions, tattoos, other significant findings
  • Calculus Detection — 12 scorable surfaces, 1 point each, 12 maximum points
    • Explore 12 random assigned surfaces on the maxillary arch and accurately record presence (Y/Yes) or absence (N/No) of calculus on each surface
    • The maxillary arch is for calculus detection only, not scaling; deposits detected on a line angle are marked on the closest interproximal surface
  • Scaling/Subgingival Calculus Removal — 12 scorable surfaces, 5 points each, 60 maximum points
    • Candidate selects the right or left mandibular quadrant during the initial online application; examiners evaluate 12 surfaces in the selected quadrant
    • Because evaluated surfaces are unknown, explore all subgingival surfaces in the selected quadrant and remove subgingival calculus so no deposits are detectable with an 11/12 explorer; detectable subgingival calculus is a scaling error
    • Supragingival deposit/stain removal is not part of this examination, so rubber cup polishing is not needed or required
  • Periodontal Probing — 12 scorable measurements, 1 point each, 12 maximum points
    • On two randomly assigned teeth in the selected treatment quadrant, chart simulated gingival sulcus/pocket depths within ±1 mm to the nearest mm on six aspects of each tooth: MF, F-midpoint, DF, ML, L-midpoint, and DL
    • Record periodontal measurements after scaling; direct facial and lingual readings are at tooth midpoint with probe parallel to root surface and long axis; interproximal readings place the shank against the contact point and tip slightly into the col; if no contact, place at proximal midpoint and record the same facial and lingual measurement; use light pressure to position the tip to sulcus depth
Examination sources

National Board Dental Hygiene Examination

Examination outline
  • Discipline-Based Component — Scientific Basis for Dental Hygiene Practice (61 items)
    • Anatomic Sciences
    • Anatomic Sciences — Anatomy
    • Anatomic Sciences — Anatomy — Head and neck anatomy
    • Anatomic Sciences — Anatomy — Dental anatomy
    • Anatomic Sciences — Anatomy — Dental anatomy — General anatomy
    • Anatomic Sciences — Anatomy — Dental anatomy — Root anatomy
    • Anatomic Sciences — Anatomy — Histology and Embryology
    • Anatomic Sciences — Physiology
    • Anatomic Sciences — Biochemistry and Nutrition
    • Anatomic Sciences — Microbiology and Immunology
    • Anatomic Sciences — Pathology
    • Anatomic Sciences — Pathology — General
    • Anatomic Sciences — Pathology — Oral
    • Anatomic Sciences — Pharmacology
  • Discipline-Based Component — Provision of Clinical Dental Hygiene Services (115 items)
    • Assessing Patient Characteristics
    • Assessing Patient Characteristics — Medical and dental history
    • Assessing Patient Characteristics — Head and neck examination
    • Assessing Patient Characteristics — Periodontal evaluation
    • Assessing Patient Characteristics — Oral evaluation
    • Assessing Patient Characteristics — General
    • Obtaining and Interpreting Radiographs
    • Obtaining and Interpreting Radiographs — Principles of radiophysics and radiobiology
    • Obtaining and Interpreting Radiographs — Principles of radiologic health
    • Obtaining and Interpreting Radiographs — Technique
    • Obtaining and Interpreting Radiographs — Recognition of normalities and abnormalities
    • Obtaining and Interpreting Radiographs — General
    • Planning and Managing Dental Hygiene Care
    • Planning and Managing Dental Hygiene Care — Infection control (application)
    • Planning and Managing Dental Hygiene Care — Recognition of emergency situations and provision of appropriate care
    • Planning and Managing Dental Hygiene Care — Individualized patient education
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Planning of individualized instruction
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Provision of instruction for prevention and management of oral diseases
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Provision of instruction for prevention and management of oral diseases — Dental caries
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Provision of instruction for prevention and management of oral diseases — Periodontal disease
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Provision of instruction for prevention and management of oral diseases — Oral conditions
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Anxiety and pain control
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Recognition and management of compromised patients
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Dental hygiene treatment strategies
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Dental hygiene treatment strategies — Diagnosis
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Dental hygiene treatment strategies — Treatment plan
    • Planning and Managing Dental Hygiene Care — Individualized patient education — Dental hygiene treatment strategies — Case presentation
    • Planning and Managing Dental Hygiene Care — Individualized patient education — General
    • Performing Periodontal Procedures
    • Performing Periodontal Procedures — Etiology and pathogenesis of periodontal diseases
    • Performing Periodontal Procedures — Prescribed therapy
    • Performing Periodontal Procedures — Prescribed therapy — Periodontal debridement
    • Performing Periodontal Procedures — Prescribed therapy — Surgical support services
    • Performing Periodontal Procedures — Prescribed therapy — Chemotherapeutic agents
    • Performing Periodontal Procedures — Prescribed therapy — General
    • Performing Periodontal Procedures — Reassessment and maintenance (e.g., implant care)
    • Using Preventive Agents
    • Using Preventive Agents — Fluorides - systemic and topical
    • Using Preventive Agents — Fluorides - systemic and topical — Mechanisms of action
    • Using Preventive Agents — Fluorides - systemic and topical — Toxicology
    • Using Preventive Agents — Fluorides - systemic and topical — Methods of administration
    • Using Preventive Agents — Fluorides - systemic and topical — Methods of administration — Water fluoridation
    • Using Preventive Agents — Fluorides - systemic and topical — Methods of administration — Self-administered
    • Using Preventive Agents — Pit and fissure sealants
    • Using Preventive Agents — Other preventive agents
    • Providing Supportive Treatment Services
    • Providing Supportive Treatment Services — Properties and manipulation of materials
    • Providing Supportive Treatment Services — Polishing natural and restored teeth
    • Providing Supportive Treatment Services — Making of impressions and preparation of study casts
    • Providing Supportive Treatment Services — Other supportive services (e.g., tooth desensitization)
    • Providing Supportive Treatment Services — General
    • Professional Responsibility
    • Professional Responsibility — Ethical principles, including informed consent
    • Professional Responsibility — Regulatory compliance
    • Professional Responsibility — Patient and professional communication
    • Professional Responsibility — General
  • Discipline-Based Component — Community Health/Research Principles (24 items)
    • Promoting Health and Preventing Disease Within Groups
    • Participating in Community Programs
    • Participating in Community Programs — Assessing populations and defining objectives
    • Participating in Community Programs — Designing, implementing, and evaluating programs
    • Analyzing Scientific Literature, Understanding Statistical Concepts, and Applying Research Results
  • Case-Based Component (150 items involving 12 to 15 dental hygiene patient cases)
    • Cases present information dealing with adult and child patients and may involve geriatric, adult-periodontal, pediatric, special needs, medically compromised, and other patient types; a medically compromised patient is one whose health status may require modification of standard treatment or special consideration.
    • Patient information is presented by means of patient histories, dental charts, radiographs, and clinical photographs.
    • Assessing patient characteristics
    • Obtaining and interpreting radiographs
    • Planning and managing dental hygiene care
    • Performing periodontal procedures
    • Using preventive agents
    • Providing supportive treatment service
    • Professional responsibility
Examination sources

North Dakota Dental Jurisprudence Examination

Provider
North Dakota State Board of Dental Examiners
Format
Open-book online examination
Passing score
The examination ends once a designated number of questions has been answered correctly
Examination outline
  • NDCC chapter 43-28 — Dentists
  • NDCC chapter 43-20 — Dental Hygienists and Assistants
  • NDCC sections 43-51-11, 43-51-11.1 and 43-51-11.2 — Members of the military and military spouses
  • NDCC chapter 43-51.1 — Universal Licensure and Board Operations
  • NDAC chapter 20-01-02 — Definitions
  • NDAC chapter 20-02-01 — General Requirements (Dentists)
  • NDAC chapter 20-03-01 — Duties (Dental Assistants)
  • NDAC chapter 20-04-01 — Duties (Dental Hygienists)
  • NDAC chapter 20-06-01 — Professional Health Program: Administration
  • ADA Principles of Ethics and Code of Professional Conduct (code of ethics adopted by the Board)
Examination sources