Hygienist Overview

Scope of Practice | NEW ADMINISTRATIVE RULESAccepted Clinical Board ExaminationsDental Hygiene Applicant | CoronavirusMilitary SpousesNewly Licensed Hygienists | Name & Address Changes | Expanded Duties - Permits | Reporting or Self-Report  | RDH Refresher Course

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Chapter 20-01-01        ORGANIZATION OF THE BOARD

Chapter 20-01-02        DEFINITIONS

Chapter 20-02-01        DENTISTS  - GENERAL REQUIREMENTS

Chapter 20-03-01         DENTAL ASSISTANTS  -  DUTIES 

Chapter 20-04-01         DENTAL HYGIENISTS  -  DUTIES

Chapter 20-05-01         FEES

Scope of Practice

The ND Board of Dental Examiners recognizes that the delivery of dental hygiene duties may be fulfilled in various settings. The Board does not limit the avenue for delivery of care, rather supervision and scope of practice. The dental hygiene license is a privilege granted by the Board to those who demonstrate professional competency and knowledge of ethics and laws governing the profession. Although the dental hygienist provides dental hygiene care under the general supervision of a dentist, the dental hygienist is accountable to be competent for all dental hygiene services provided. Nonetheless, individual competency and experience levels vary among professionals, therefore it is the supervising dentists prerogative to determine the duties the hygienist will be authorized to provide. A licensed dental hygienist may In accordance with Chapter 43-20-03 provide dental hygiene duties as defined under Admin. Rules Ch. 20-04-01-01, while under the general supervision of a dentist as defined in NDCC 43-28-01(5) and is permitted to provide dental hygiene services as delegated by the supervising dentist that the licensed dental hygienist knows he/she is competent to perform. A licensed dentist is not permitted to delegate to a licensed dental hygienist dental services or dental supportive services that the licensed dentist knows or has reason to know that the licensed dental hygienist is not qualified by training, experience or by licensure to perform. Protocols, services to be performed, and record keeping shall not supersede any law or regulation which require dental hygiene duties to be performed under the indirect or direct supervision of a dentist


Accepted Clinical Board Examinations
The applicant has passed, within five years of application, a clinical competency examination administered by one of the following:
  • Any regional dental testing service before September 17, 2009.
  • Central Regional Dental Testing Service.
  • Council of Interstate Testing Agencies.
  • Commission on Dental Competency Assessments-Western Regional Examining Board; and
  • American Board of Dental Examiners 


Can hygienists do anything more to prevent transmission in the dental office? Common sense recommendations: Include temperature readings as part of your routine assessment of the patient before starting your procedure. Ask patients about international travel, include any signs or symptoms of infection when you update their medical histories. Use high speed evacuation for procedures producing an aerosol. Are you using the autoclave for your handpieces after each patient? Ask your patient to rinse with 1% hydrogen peroxide before each appointment. Coronavirus is vulnerable to oxidation; this will reduce the salivary load of oral microbes. For more information from the CDC click here. or this webpage regarding COVID and variants.

New Admin Rules - Refresher Course Requirements - Effective July 1, 2022

20-04-01-05.1. Refresher course - Reentry.
An eligible dental hygienist may return to the practice of dental hygiene upon submitting an
application fee and application on a form provided by the board, providing proof of having successfully
completed a refresher course approved by the board, and meeting the following requirements:
1. Was previously licensed to practice dental hygiene in another state or jurisdiction where the
licensure requirements were substantially equivalent.
2. Grounds for denial of the application under North Dakota Century Code section 43-20-05 do
not exist.
3. The applicant has passed, within one year of making application, a written examination on the
laws and rules governing the practice of dentistry in this state.
4. Has successfully completed a cardiopulmonary resuscitation course within the previous two
5. Has the physical health and visual acuity to enable the applicant to meet the minimum
standards of professional competence.
6. Has practiced dental hygiene.
7. Has successfully completed a refresher course approved by the board that meets the
following minimum criteria:
      a. Taught at a dental hygiene school accredited by the American dental association's
commission on dental accreditation;
      b. Consists of a minimum of forty-three clock-hours, including a minimum of thirty-two
clock-hours of clinical instruction;
      c. Includes didactic course work, which may be presented in a classroom or independent study setting, or both, and clinical coursework covering the following:
             (1) Infection control and sterilization;
             (2) Patient assessment, including the taking of health histories, an oral inspection and evaluation, and charting;
             (3) Radiographic techniques;
             (4) Instrumentation techniques, including periodontal procedures and instrument sharpening;
             (5) Current techniques in the polishing of teeth and the application of fluoride;
             (6) Patient education; and
             (7) Office emergency situations.
8. A formerly licensed dental hygienist who is returning to the practice of dental hygiene may not administer local anesthesia or nitrous oxide until having completed courses of instruction in local anesthesia and nitrous oxide approved by the board.
9. Anything necessary for a criminal history record check pursuant to North Dakota Century Code section 43-28-11.2.
10. The applicant may be required to appear before the board.

New Applicants 

New license applicants: The application must received by the Executive Director of the Board at least thirty days before the Board meeting at which it is considered. The applicant shall enclose with the application a recent autographed picture of the applicant and an application fee as determined by the Board by rule. NDCC § 43-28-11. Application fees are nonrefundable.

Initial applications must be completed within twelve months and accompanied by the appropriate fee. If an applicant fails to complete the requirements for licensure within twelve months of the applications post mark, the application and fee are no longer valid. Applications which are not notarized, submitted without the required licensing fee, or without the applicant’s signed photo will be returned. 

Clinical competency board exams accepted by the NDBDE are CRDTS, CITA, CDCA-WREB and the ADEX exam. Manikin based clinical competency board exams are accepted. 

The Board investigates an applicant’s fitness, qualification, and previous professional record and performance. The Board may seek information from recognized data sources, including the National Practitioners Data Bank, liability insurers, health care institutions, and law enforcement agencies. The Board requires initial license applicants to submit to a statewide and nationwide criminal history check.

For information from the ND State College of Science course for ADMINISTRATION of nitrous oxide inhalation analgesia (follow link).

New Licensees

Initial Licensure Fee vs. Biennial Renewal Fee

Both fees are required in order to obtain and maintain a license and registration. The initial license application fee is paid to initiate administrative processes and verifications that must be completed by the Board's administrative office. The renewal fee, grants the license for the following two year period. Failure to pay the renewal fee will cause the license to expire.

If a licensee fails to renew the license by December 31st of odd numbered years, the practitioner may not practice dental hygiene. It is illegal to practice dental hygiene without a valid license.

Within 60 days after December 31st of the odd-numbered year, an expired license may be renewed by submitting the renewal application, the application fee, late fee and proof of continuing education, the license may not be renewed and the dental hygienist must apply for and meet the requirements for licensure to be granted a license.  

If you do not receive a renewal notice in the mail by November 15th of odd numbered years, call the Board immediately. 

Military Spouse - Member

Requirements of Temporary License for Military Spouses

1. The NDBDE (the board) shall grant on a case-by-case basis exceptions to the board's licensing standards to allow a military spouse to practice the occupation or profession in the state if upon application to the board:

  • The military spouse demonstrates competency in the occupation or profession through methods or standards determined by the board which must include experience in the  occupation or profession for at least two of the four years preceding the date of application under this section; and
  • The board determines the issuance of the license will not substantially increase the risk of harm to the public. The board has authority to require an applicant to submit to a statewide and national criminal history record check under section 12-60-24 may order such a record check under this subdivision.

2. The board shall issue a provisional license or temporary permit to a military spouse for which the licensure requirements under subsection 1 have been substantially met. A board may not charge a military spouse any fees for a provisional license or temporary permit under this subsection. A provisional license or temporary permit issued under this subsection may not exceed two years and remains valid while the military spouse is making progress toward satisfying the unmet licensure requirements. A military spouse may practice under a provisional license or temporary permit issued under this subsection until any of the following occurs:

  • The board grants or denies the military spouse a North Dakota license under subsection 1 or grants a North Dakota license under the traditional licensure method;
  • The provisional license or temporary permit expires;
  • The military spouse fails to comply with the terms of the provisional license or temporary permit; or
  • The board revokes the provisional license or temporary permit based on a determination revocation is necessary to protect the health and safety of the residents of the state.

3. The board that may elect to subject the board to this chapter under subsection 1 of section 43-51-01 may issue a license, provisional license, or temporary permit to a military spouse in the same manner as provided under subsections 1 and 2 regardless of whether the board has adopted rules to subject the board to this chapter.

4. A military spouse issued a license under this section has the same rights and duties as a licensee issued a license under the traditional licensure method.

5. If within thirty days of receipt of a completed application under subsection 1 the board does not grant or deny a license under subsection 1 or does not issue a provisional license or temporary permit under subsection 2, the board automatically shall issue a provisional license or temporary permit. A provisional license or temporary permit issued under this subsection remains valid until the board grants or denies the application for licensure under subsection 1 or issues a provisional license or temporary permit under subsection 2.


  • A dental hygienist may be authorized by permit to provide dental anesthesia assistant duties under the direct supervision of a dentist authorized by permit to provide moderate sedation; or,
  • A dental hygienist may be authorized by a permit to provide restorative functions under the direct supervision of a dentist. A  permit fee is not required. Once the permit is granted, renewal of the permit is required biennially with 2 hours of continuing education relevant to the permit.
  • Effective 7/1/22, a registered dental hygienist may be authorized to ADMINISTER nitrous oxide inhalation analgesia. A permit fee is not required. See Section 20-02-01-05 subsection 1. for requirements.
  • Download Application to Administer Nitrous                  Nitrous Oxide Course
  • Local Anesthesia Endorsement
  • A dental hygienist is authorized by the application process to provide local anesthesia. A fee is not required. Once the application is reviewed and accepted, the local anesthesia endorsement is posted on the website. The RDH is not required to renew the endorsement. 

A hygienist who wishes to administer block and infiltration anesthesia must complete the application for authorization. The expanded function may only be delegated to a hygienist under the direct supervision of a dentist and may only be utilized for a patient who is at least eighteen years old. A hygienist may terminate or reduce the amount of nitrous oxide previously administered by the dentist. The local anesthesia application must be approved by the Board. 

Download Local Anesthesia Permit Application

Restorative Functions 

The Board may issue a permit authorizing a dental hygienist under the direct supervision to provide restorative duties if the applicant successfully completes the following:

  1. Completes a board approved course;
  2. Passes the Western Regional Examining Board’s restorative examination or other equivalent examination approved by the Board;
  3. Completes the restorative function component of the Dental Assisting National Board’s certified restorative functions dental assistant examination.

Restorative procedures allowed under direct supervision of a dentist are as follows:

  1. Place, carve, and adjust Class I, II and Class V supragingival amalgam or glass ionomer restorations with hand instruments or a slow-speed handpiece;
  2. Adapt and cement stainless steel crowns;
  3. Place, contour, and adjust Class I, II and Class V supragingival composite restorations where the margins are entirely within the enamel with hand instruments or a slow-speed handpiece.

The University of Minnesota offers a ND Board approved course for Restorative Expanded Duties / 80 hour course.   Successful completion of this course qualifies a registered dental hygienist or registered dental assistant for application of the Restorative Procedures Permit.

 Restorative Functions Initial Application 

Dental Anesthesia Assistant

A dental hygienist may provide anesthesia assistance under the supervision of a dentist authorized by permit to provide sedation or anesthesia services once the applicant successfully completes the following:

  1. Board-approved dental anesthesia assistant education and training course;
  2. Board-approved competency examination;
  3. Completion of a training in intravenous access or phlebotomy;
  4. Has proof of current BLS or ACLS or PALS;
  5. Provides proof of a general anesthesia permit issued to the OMFS who will be supervising the anesthesia assistant’s services.

A dental hygienist authorized by permit may provide the following duties under contiguous supervision of a dentist authorized by permit to provide sedation or anesthesia services:

  1. Initiate and discontinue an IV line for a patient being prepared to receive IV medication, sedation or  general anesthesia; and
  2. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open.
  3. Prepare anesthesia equipment and perform patient monitoring.
  4. Assist with emergency treatment and protocols.

A dental hygienist authorized by permit may provide the following duties under direct visual supervision of a dentist authorized by permit to provide sedation or anesthesia services:

  1. Draw up and prepare medications;
  2. Follow instructions to deliver medication into an intravenous line upon verbal command;
  3. Adjust the rate of intravenous fluids infusion beyond a keep-open rate; and
  4. Adjust an electronic device to provide medications such as an infusion pump upon the verbal command of the supervising dentist.

Anesthesia Assistant Initial Application 

Anesthesia Assistant Courses Accepted by the NDBDE

  • The Dental Anesthesia Assistant National Certification Examination (DAANCE) is a two-part 36 hour continuing education program comprised of self-study material and a standardized computer based exam. The course is designed for auxiliary who assist a dentist or OMFS with a valid ND sedation or anesthesia permit. DAANCE certification is valid for five years. To recertify, assistants must retake the DAANCE examination every five years and maintain current BLS and/or ACLS certifications. Note: Online CPR certifications are not accepted. The course meets the requirements for a ND Class I Dental Anesthesia Assistant Permit.  
  • Sedation Consult, LLC:  Allan Schwartz, DDS, CRNA provides a 3 day course,  Monitoring Sedation/General Anesthesia & I.V. Certification meets the requirements for requirements of ND Class II Dental Anesthesia Assistant Permit.  
  • The American Dental Society of Anesthesiology is a two-day, 12 hour CE sedation course for auxiliaries featuring an in depth approach designed especially for those who work in general anesthesia and moderate sedation practices. The course provides a certificate for the completion of the CE but does not provide certification or testing therefore to achieve Permit I, the DAANCE exam would also be required. 


The use of lasers continues to be a popular treatment modality in dentistry. It is the position of the Board that any services provided by a licensee, regardless of the device used, must be within the scope of practice for each licensee. Whenever a new treatment modality is brought forward, it is the Board’s policy that the dentist must have equal or greater proficiency and training in the technology. Neither the particular technology utilized nor amendments to scope of practice alter the fact that all licensees are responsible for their individual actions with the dentist ultimately responsible for all care provided in each dental office.  Contact the Board office if you have questions about the regulations governing the practice of dental hygiene in North Dakota. A permit is not required.

Silver Diamine Fluoride (SDF)

Rules authorizing the administration of fluoride are silent on specifics or types of anticariogenic agents and desensitizing solutions. For this reason, dental hygienists are authorized to apply SDF. As with any authorized duty provided by a dental hygienist (or any other practitioner) it is incumbent upon the practitioner to become educated with a product, administration of a product or procedure. As noted with lasers, all licensees are responsible for their individual actions with the dentist being ultimately responsible for all care provided in each dental office. 

Reporting or Self-Reporting    

According to the NDBDE’s reporting laws, a licensee must report to the board in writing within sixty days of the event any illegal, unethical, or errant behavior or conduct of the dentist, including malpractice judgements or settlements or final judgment for or against the licensee, a final disposition by a licensing agency in another state, territory, or country; all proceedings, of formal or informal actions by a governmental agency; a law enforcement agency; or a court for an act or conduct that would constitute grounds for discipline.

If you have a conviction, or any other incident to report as required by application,  send with the application supporting documentation and/or certified copies of all court documents related to the matter discussed in the petition. Documentation includes, as applicable, a copy of any assessment or evaluation and recommendations for treatment, criminal charges, reported offenses, police reports, judgments, dispositions of criminal complaint, dispositions of offenses, final dispositions, court orders, actions pending, and deferred judgments. Not doing so may delay the licensing process.

Name and Address Changes

Name and address changes must be submitted in writing or by email, info@nddentalboard.org. Name changes must be accompanied by a copy of the name change document (marriage license, section in the divorce decree, etc.) Make sure your changes include your current name. For name changes, a new perforated card will be mailed to you at no charge. If renewal is coming up for you soon, it will be sent when your renew your license/registration. Your license/registration number is helpful, but not mandatory. NOTE: NAME AND ADDRESS CHANGES WILL NOT BE DONE OVER THE PHONE. 

Reprint of Large License Certificate

The Board charges $45 if you wish to have a new large certificate mailed to you. The Board only signs certificates at quarterly meetings. You must send a request for the certificate and a check or money order for $45 payable to NDBDE.