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Washington Dental Hygiene — Requirements & Free Practice

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Dental Hygiene Initial Temporary License

Five-year renewable temporary license under RCW 18.29.190 for dental hygienists licensed in another state or Canadian province; the Department of Health page calls it the initial limited license.

Licensing authority: Washington State Department of Health

Initial temporary license (called initial limited license on the Department of Health page)
Clinical Examination On Department Page
RCW 18.29.190(1) issues this license "without the examination required by this chapter" and makes passage of a patient evaluation/prophylaxis examination a renewal condition, so the clinical examination is not a leaf of this issuance route; the Department of Health page nevertheless states: "An applicant seeking an initial limited license in Washington must meet the requirements above", which include "Clinical Examinations".
Education
Graduated from an accredited dental hygiene school approved by the secretary (RCW 18.29.190(1)(b)(i)).
Fees
Pays required fees and provides information on the Uniform Disciplinary Act criteria (RCW 18.29.190(1)(c), (e)).
Other Jurisdiction License
Holds a valid license in another state or Canadian province allowing a substantively equivalent scope of practice (RCW 18.29.190(1)(a)).
Scope Limits
Practice is limited to the procedures in RCW 18.29.190(3); local anesthesia, restorations, soft tissue curettage and nitrous oxide require temporary endorsements under RCW 18.29.190(4).
Washington Law Knowledge
Demonstrates knowledge of Washington law on dental hygiene practice, including administration of legend drugs (RCW 18.29.190(1)(d)); the Department of Health page identifies the Washington State Drug and Law Examination among the requirements applicants must meet.
Renewal of the initial temporary license

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)
Discontinued Agency Exams
The WREB, CDCA and CITA dental hygiene examinations the rule and page name now correspond to the ADEX Dental Hygiene Examination: CDCA and WREB merged in 2021, CITA joined in 2022 and CDCA-WREB-CITA delivered only ADEX examinations, and on September 1, 2025 ADEX and CDCA-WREB-CITA merged as the American Board of Dental Examiners. A passing score on an earlier WREB, CDCA or CITA examination is prior evidence within the pass-date windows above.
Local Anesthesia Exam
Passage of a substantively equivalent local anesthesia examination (RCW 18.29.190(2)(b)); the Department of Health page asks for the WREB or CRDTS anesthesia examination. These examinations have no registered version and are not mounted; a temporary local anesthesia endorsement under RCW 18.29.190(4)(b) counts as passage for renewal.
Nitrous Oxide And Education
Didactic and clinical competency in nitrous oxide analgesia and completion of an educational program on local anesthesia and nitrous oxide analgesia (RCW 18.29.190(2)(c)-(d)).
Patient Evaluation Prophylaxis Exam
Passage of a substantively equivalent dental hygiene patient evaluation/prophylaxis examination (RCW 18.29.190(2)(a)); the Department of Health page asks for passing scores on an approved patient evaluation-prophylaxis examination, listing the clinical examinations and pass-date windows of the licensure-by-examination route.

Dental Hygienist License

Full license to practice dental hygiene in Washington under chapter 18.29 RCW and chapter 246-815 WAC.

Licensing authority: Washington State Department of Health (Secretary of Health, in consultation with the Dental Hygiene Examining Committee)

Licensure by examination

All of the following:

Clinical Exam Pass Dates
A clinical examination counts only if passed within the windows the Department of Health lists: WREB after May 8, 1992; CRDTS patient-based after November 1, 2001; CDCA between January 1, 2000 and August 21, 2009 or after March 16, 2018; CITA after July 23, 2021; manikin/simulated examinations (WREB, CRDTS, CDCA) after October 8, 2021, the CDCA simulated examination including both the OSCE/CCSE written part and the simulated patient clinical part.
Discontinued Agency Exams
The WREB, CDCA and CITA dental hygiene examinations the rule and page name now correspond to the ADEX Dental Hygiene Examination: CDCA and WREB merged in 2021, CITA joined in 2022 and CDCA-WREB-CITA delivered only ADEX examinations, and on September 1, 2025 ADEX and CDCA-WREB-CITA merged as the American Board of Dental Examiners. A passing score on an earlier WREB, CDCA or CITA examination is prior evidence within the pass-date windows above.
Education
Graduation from a dental hygiene program accredited by the ADA Commission on Dental Accreditation (CODA) and approved by the secretary, with an official transcript sent directly by the program (RCW 18.29.021(1)(a); WAC 246-815-020(4), 246-815-030(1); Department of Health page).
Expanded Function Education
Didactic and clinical competency in local anesthesia, nitrous oxide analgesia and restorative procedures, through the CODA program or a secretary-approved expanded functions program (WAC 246-815-030; Department of Health page).
Fees And Application
Application on department forms and the application fee under WAC 246-815-990 (WAC 246-815-020(1)-(2)).
Fitness
Has not engaged in unprofessional conduct and is not unable to practice with reasonable skill and safety due to impairment (RCW 18.29.021(1)(c)).
Local Anesthesia And Restorative Examinations
Required but not mounted because no version is registered: the local anesthesia and restorative examinations that WAC 246-815-050(2)(c)-(d) and the Department of Health page require (the page names WREB Anesthesia Exam, WREB Restorative Exam, CRDTS Anesthesia Exam and CRDTS Restorative Exam; WREB now forms part of the American Board of Dental Examiners, which offers the Local Anesthesia examination and the Dental Hygiene Restorative examination, and CRDTS offers its Local Anesthesia Exam and Restorative Auxiliary Examination in 2026) have no registered version; they are required but are not mounted as leaves. ADEX states that Washington requires both the Local Anesthesia Computer-Based and Clinical Examinations.
Personal Data Questions
Answer the personal data questions and document any professional liability claims (Department of Health page).
Practical Competencies
The practical examinations must cover patient evaluation (extra-oral and intra-oral examination), prophylaxis, local anesthesia (written and clinical) and restorative clinical competencies (WAC 246-815-050(2)).
Score Reporting
Proof of passing must be sent directly from the exam organization or testing agency (WAC 246-815-020(5)-(6); Department of Health page).
Substantially Equivalent Examination
In lieu of the WREB, CRDTS or CDCA examination or any of their subparts, the secretary may accept a substantially equivalent examination or subparts (WAC 246-815-050(1)(b)).
Work History And Licensure Verification
Complete listing of professional education and practice history since graduation; verification from every jurisdiction where a credential is or was held or applied for (Department of Health page).
Licensure by interstate endorsement of credentials (licensure by credential)

All of the following:

Application And Fees
Application on department forms and fees under WAC 246-815-990; licensure verification from the state of licensure at the applicant's cost (WAC 246-815-100(3), (6)-(7)).
Current Practice
Engaged in clinical practice as a dental hygienist in another state, or in official duties in the US Armed Services, Coast Guard, Public Health Service, Department of Veterans Affairs or Bureau of Indian Affairs, at any time within the previous year (WAC 246-815-100(3); Department of Health page).
Discontinued Agency Exams
The WREB, CDCA and CITA dental hygiene examinations the rule and page name now correspond to the ADEX Dental Hygiene Examination: CDCA and WREB merged in 2021, CITA joined in 2022 and CDCA-WREB-CITA delivered only ADEX examinations, and on September 1, 2025 ADEX and CDCA-WREB-CITA merged as the American Board of Dental Examiners. A passing score on an earlier WREB, CDCA or CITA examination is prior evidence within the pass-date windows above.
Education
Completion of a dental hygiene education program meeting WAC 246-815-030 (WAC 246-815-100(1)).
Local Anesthesia And Restorative Examinations
Anesthesia and restorative clinical competency are part of the required practical tests (WAC 246-815-100(4)(b)(iii)-(iv)); the local anesthesia and restorative examinations that WAC 246-815-050(2)(c)-(d) and the Department of Health page require (the page names WREB Anesthesia Exam, WREB Restorative Exam, CRDTS Anesthesia Exam and CRDTS Restorative Exam; WREB now forms part of the American Board of Dental Examiners, which offers the Local Anesthesia examination and the Dental Hygiene Restorative examination, and CRDTS offers its Local Anesthesia Exam and Restorative Auxiliary Examination in 2026) have no registered version; they are required but are not mounted as leaves.
Other State License
Holds a valid, current, nonlimited license in another state (WAC 246-815-100(2)); the Department of Health page asks for a license in a qualifying state verified by the state board.
Statutory Basis
RCW 18.29.045 permits licensure without the examination required by chapter 18.29 RCW when the other state's standards are substantively equivalent and lets the secretary require a demonstration of knowledge of Washington law; WAC 246-815-100 exercises that permission by requiring the listed examinations, so the route mounts them.
Substantive Equivalence
The other state's examination must be substantively equivalent: written tests are the NBDHE; practical tests anonymously graded by calibrated examiners with equivalent patient selection criteria, covering patient evaluation, prophylaxis, anesthesia and restorative competencies; in lieu of the WREB or CRDTS practical tests the secretary may accept substantially equivalent tests; where only portions are not equivalent, the applicant may take those portions (WAC 246-815-100(4)).
Annual renewal of the dental hygienist license
No examination is required for this applicant pathway.
Continuing Education
Fifteen clock hours of continuing education each year after the first renewal, current BLS certification and a signed declaration (WAC 246-815-140(1)); two hours of health equity training every four years (WAC 246-815-145); one-time suicide prevention training (WAC 246-815-155).
Fees
Renewal fee on the practitioner's birthday each year (WAC 246-815-990; WAC 246-12-030).

Official no-examination sources

Effective from 2026-09-22.

Return to active status from inactive military related status
No examination is required for this applicant pathway.
Eligibility
License placed in inactive military-related status as spouse or registered domestic partner of a deployed or out-of-state service member (WAC 246-12-500(2), 246-12-540).
Submission
Current renewal fee and any surcharge, documentation of the service member's service or discharge status, DD214 within six months of discharge where applicable (WAC 246-12-560).

Official no-examination sources

Effective from 2026-09-22.

Return to active status from military status
No examination is required for this applicant pathway.
Eligibility
License placed in military status while the practitioner served in the US Armed Forces, Public Health Service Commissioned Corps or Merchant Marine (WAC 246-12-500(1), 246-12-510).
Submission
Written notification of the change in service status, DD214, current renewal fee and any surcharge, within six months of qualifying discharge; continuing education applies after the first post-discharge renewal (WAC 246-12-530).

Official no-examination sources

Effective from 2026-09-22.

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

Washington State Dental Hygiene Drug and Law Exam

Provider
Dental Assisting National Board, Inc. (DANB), under an agreement with the Washington State Department of Health
Format
Non-proctored online computerized exam
Exam questions
20 items
Time limit
60 minutes
Exam fee
$30
Examination outline
  • Chapter 18.29 RCW - Dental hygienists (Washington State Dental Hygiene Practice Act)
  • Chapter 246-815 WAC - Dental hygienists
  • Chapter 246-817 WAC - Dental quality assurance commission
  • Chapter 246-12 WAC - Administrative procedures and requirements for credentialed health care providers
  • Chapter 246-814 WAC - Access to dental care for children
Examination sources