Dentist Overview

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A brief summary of the subject matter and reasons for adopting those rules are found in the following sections as follows:

  • 20-01-01-01 Organization and functions of board of dental examiners.   Amends the structure of the Board as per HB 1151 adding one dental assistant and one dentist to the Board.
  • 20-01-02-01. Definitions. To carry out these proposed amendments the Board added twenty-one new definitions, edited ten definitions and removed three definitions. The bulk of amendments are related to anesthesia and sedation rules.
  • 20-02-01-01. Advertising.  The Board revised the section based upon recommendations from the Board’s previous Assistant Attorney General and to be aligned with the Board’s adopted Code of Ethics. Rather than name nationally recognized certifying boards, the proposed amendments list standards required of that organization. Dentists who choose to market their services by using a variation of the term “specialist” or “specialty” must disclose the services are provided by a general dentist and any relevant information needed for the patient to make an informed decision. Training and education should not be misrepresented or misleading to the public. 
  • 20-02-01-03. Nitrous oxide. [moved to 20-02-01-05.]  This section was amended and moved to the anesthesia and sedation section.   New language provides requirements for authorization to administer nitrous oxide inhalation analgesia and  provides standards for nitrous oxide equipment, dental records, and delegation of monitoring of nitrous oxide inhalation analgesia.
  • 20-02-01-04.2  Volunteer license to practice dentistry.  Minor clarification directed at practitioners who provide volunteer services and receive remuneration.
  • 20-02-01-04.3. Inactive status – License reinstatement.  This section was slightly amended to clarify requirements for practitioners who have "stepped away" from the practice of dentistry for a time.
  • 20-02-01-05. Anesthesia and sedation permit requirements.  Under the guidance and expertise of Dr. Marcus Tanabe, Grand Forks oral and maxillofacial surgeon, this section was substantially overhauled and is now divided into 15 sections. These areas outline requirements for nitrous oxide, minimal and moderate sedation, deep sedation and general anesthesia. Each level of sedation requires specific training, equipment, and personnel. Those personnel also have requirements for authorization to assist in the sedation and anesthesia procedures. Rules for facilities where anesthesia and sedation are provided, equipment and on-site controlled pharmaceuticals are also a component of the section as well as requirements for record keeping, emergency management, and dentists who utilized the services of other providers of sedation and anesthesia, such as a certified registered nurse anesthetist.

Aside from the introduction of authorizing dental hygienists and dental assistants duties for administration of nitrous oxide, most of the requirements are not new to sedation and anesthesia permit holders and at the same time reflect the most recent peer reviewed literature for sedation and anesthesia. During the site evaluation process many of the same requirements had to be met in order to become authorized by permit to administer sedation or anesthesia. The addition of new rules address concerns that were not discussed in the site evaluation or permit process. For example, record keeping, requirements for education of auxiliary and their role in assisting the sedation or anesthesia provider, mock code requirements, reporting requirements, emergency management requirements/standards must be provided for patient monitoring. The Board also added provisions for anesthesia providers who are not dentists, e.g., CRNA, or are an “other” dentist providing sedation or anesthesia for a” host” dentist’s patient.            

Under new rules, a registered dental assistant (RDA) or a registered dental hygienist (RDH) authorized by permit and under the indirect supervision of a dentist may administer nitrous oxide analgesia to a patient who has not taken sedative medications. Previously the RDA and RDH were strictly authorized to monitor a patient for whom Nitrous Oxide analgesia has been initiated by the dentist or may lower the amount of nitrous. To develop course curriculum requirements, the Board consulted with dental hygiene programs in ND and MN.

20-02-01-06. Continuing dental education for dentists.  In this section “clinical” continuing education is stressed and the board further clarifies who may proctor continuing education which qualifies for classroom style or “in person” continuing education. The Board adjusted the number of CE hours for practitioners who are anesthesia/sedation permit holders. Technology for simulated dental emergencies now exists and the Board unanimously moved to require this simulated training every five years for moderate, deep sedation and general anesthesia providers effective January 1, 2026.

  • 20-02-01-08. Discontinuance of practice – Retirement – Discontinuance of treatment.  This section was improved by clarification of the term “active patient” and a section was added to underscore the importance of continuity of patient dental care not being interrupted due to the retirement of the dentist who is employed within a large practice and either retires or transitions to other employment opportunities. Language exempts a licensee who retires from a group practice from providing public notice for three consecutive weeks that the licensee is no longer practicing. Patient continuity of care is not interrupted in a group practice setting. 
  • 20-02-01-09. Patient records. Poor patient record keeping is an issue the Board has struggled with for some time.  Electronic recordkeeping has removed the issue of “legible” records, and as often seen during the complaint process, pertinent information relative to the treatment of the patient especially during sedation procedures is lacking. Many states have similar requirements within administrative laws.  The Board added requirements which include the elements of a dental record including language on how to correct a record while reserving the existing recorded entries, informed consent, progress notes and personal data as well as patient access to records. This includes any entity utilizing telehealth. Record retention is defined.
  • 20-02-01-11. Permit for the use of dermal fillers and botulinum toxin for dental use.  The new language provides authorization to permit a foreign practitioner to administer dermal fillers and botulinum toxin if the course of instruction was substantially equivalent to those of this state.
  • 20-03-01-01. Duties.  (dental assisting section).  The Board introduced new supportive duties for a dental assistant who is not registered by the Board. Non-registered dental assistants and qualified dental assistants (QDA’s) are often earning on-the-job training hours to become eligible to take the Dental Assisting National Board (DANB) examination. Once successful passage of the DANB test has been achieved, less stringent supervision levels are in place depending on the type of duty and the level of training required for the duty.

Dental assisting duties were also on the radar of the American Teledentistry Association and Smile Direct Club as they opposed supervision levels for the duty of digital scans and intra oral cameras which are used for diagnostic and/or appliance fabrication purposes. The Board responded by deleting the duty for  dental assistants that are not qualified or registered and moved to allow qualified and registered dental assistants who have the additional level of training to provide this duty under general supervision which is the broadest level of supervision for auxiliary.

The dental assisting section was reorganized according to level of supervision required to perform duties with consideration given to level of training and education. Four new and very basic duties were added to the section related to a non-registered dental assistant. One new duty was provided for a qualified dental assistant. Duties which may be provided under general supervision for the registered dental assistant were expanded.

Assistants provided comments on use of the slow speed handpiece when providing restorative duties. The consensus of the Board was that the high-speed handpiece has the capability of providing greater damage to tooth structure and therefore opined that the adjustments to amalgam or glass ionomer restorations could be done with less risk to the patient and therefore opted to stay with the slow speed handpiece utilization restriction.  

  • 20-03-01-01.1 Expanded duties of registered dental assistants.  Added language to clarify who may be authorized to assist and supervision level required. Updated language. New addition to the section is authorization by permit for a registered dental assistant to administer nitrous oxide analgesia in accordance with subsection 2 or 20-03-01-05.
  • 20-03-01-01.2 Requirements of permit for expanded duties.  New section relocates all educational requirements under the section of duties which require authorization by permit.
  • 20-03-01-02. Prohibited services.   The section clarifies fabrication of orthodontic appliances for a patient who is not a patient of record. Further reiterates authorization by permit for a registered dental assistant monitoring patients under moderate sedation, deep sedation or general anesthesia.
  • 20-03-01-05. Registration of registered and qualified dental assistants.  Provides an avenue for a dental professional who has taken a national board to become registered as a registered dental assistant.
  • Furthermore, subsection two reorganizes the requirements for achieving registration for a qualified dental assistant. The ND Dental Assistants’ Association spoke against the Board’s initiative related to the Qualified Dental Assistant which reduces the number of on-the-job hours from 650 hours required for an entry level dental assistant to 300 hours.  In recognition of and exchange for the 350 hour-deficit, the Board unanimously agreed that applicants who have successfully completed the National Entry Level Dental Assistant (NELDA) certification process administered by Dental Assisting National Board are eligible to become a QDA. The NELDA exam consists of three parts; Anatomy, Morphology and Physiology; Infection Control; and Radiation Health and Safety. Two of the parts are currently required (Infection Control and Radiation Health and Safety) for registration of a Qualified Dental Assistant (QDA). It is important to note that a QDA is authorized to perform the most basic duties plus take dental radiographs under direct supervision. The third part of the NELDA exam relating to anatomy of the teeth is critical in the role of taking radiographs. The Board recognizes the value of on-the-job training but also understands that the training received in various offices cannot be consistent and determined that providing the option for an educational component that requires hours spent in comprehensive home study related to the dentition, is a fair exchange for the reduction of hours for dental assistants exposing radiographs.  
  • 20-03-01-05.1 Additional expanded duties of registered dental assistants.   This section was relocated.
  • 20-03-01-06. Continuing dental education for qualified and registered dental assistants.  Provides clarification regarding a “proctor” for classroom style learning and provides guidance on continuing education certificates and specific criteria for proof of education.
  • 20-04-01-01. Duties.  (dental hygiene section) The section is now reorganized similarly to the dental assisting section. Duties are organized by level of supervision rather than just randomly.
  • 20-04-01-02. Prohibited services.  Provides clarification related to monitoring a patient induced to moderate or deep sedation and general anesthesia. In the reorganization process the Board scrutinized duties that cannot materially be done under general supervision and listed them accordingly.
  • 20-04-01-03. Duties of dental hygienists – Administration of local anesthesia- Authorization.   Minor revisions for clarification. Also amended the title of the section for clarification. Administration of local anesthesia is authorized by the Board once the applicant provides proof of education. The endorsement does not require a permit. Rather, the endorsement is placed on the dental hygienist’s registration. In contrast, the next section are duties which require a permit. To receive the permit the applicants must show proof of continuing education for that duty.
  • 20-04-01-03.1.  Duties of the dental hygienist – Requirements of permit.   Related to anesthesia and sedation education and restorative procedures. Authorization to administer nitrous oxide inhalation therapy also requires a permit as per section 20-02-01-05.  (See subsection 1. Administration of nitrous oxide inhalation analgesia- Requirements.)
  • 20-04-01-04. Additional requirements for licensure by examination. Updated name change reflecting merger of the two clinical board examinations CDCA-WREB.
  • 20-04-01-05. 1. Refresher course – Reentry.  This is a NEW section providing an opportunity for a registered dental hygienist to return to practice of dental hygiene. Currently a dentist or dental hygienist must have a previous work history as part of the “demonstration of competency”. If the practitioner has been away for the profession too long, the Board determined that a refresher course would be a means to assist the professional to continue their dental vocation. This has not been an issue with dental practitioners at this time.
  • 20-04-01-08. Continuing dental education for dental hygienists.  Provides guidance for the practitioner and certificate of completion requirements. During the course of an audit, practitioners now have specific information they can request from CE providers. Continuing education providers also benefit from the clarification.

20-02-01-03.1. Additional requirements for licensure by examination.

The board may grant a license to practice dentistry to an applicant who has met the requirements of North Dakota Century Code section 43-28-10.1 and all the following requirements:

  1. The applicant has passed the examination administered by the joint commission on national dental examinations or the national dental examining board of Canada within five years of application.
  2. The applicant has passed, within five years of application, a clinical competency examination approved by the board. Required components shall include a  periodontal component,  posterior  composite   or  amalgam restoration,  a class three restorative procedure, and an endodontic component, and after April 1, 2021, a fixed prosthetic component.
  3. The applicant has successfully completed a cardiopulmonary resuscitation course within two years of application.
  4. The applicant has the physical health and visual acuity to enable the applicant to meet the minimum standards of professional competence.

Active Military or Military Spouses - Licensure

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.

Initial Licensure Fee vs. Renewal Fee

Both fees are required in order to obtain and maintain a license and registration with the NDSBDE. 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 dentistry. It is illegal to practice dentistry without a valid license.

Expiration of 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 dentist 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.   

Application Process 

New license applicants: The Initial License 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 six months and accompanied by the appropriate fee. If an applicant fails to complete the requirements for licensure within six 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. All application fees are non-refundable.

ID: In lieu of applications being notarized, the Board accepts current identification documents issued within the last five years. Acceptable ID means a valid driver's license, U.S. passport, or identification card issued by any branch of the armed forces of the United States. Attach a copy of the valid proof of identification to the application.

The Board investigates a dentist’s fitness, qualification, and previous professional record and performance. The Board may seek information from recognized data sources, including the National Practitioners Data Bank,  American Association of Dental Boards, 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.

 Name and Address Change

Name and address changes may be submitted in writing or by email. Name changes must be accompanied by a copy of the name change document (marriage license, section in the divorce decree, etc.)

Reprint Large Certificate of License

The Board charges $50 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 $50 payable to NDBDE. 

Prescription Drug Monitoring Program ND Administrative Code 20-02-01-12.

Subject to the exceptions described in rule 20-02-01-13, prior to the initial prescribing of any controlled substance, including samples, a dentist authorized by the DEA to prescribe, administer, sign for, dispense or procure pharmaceuticals shall authorize an employee to review or personally request and reivew the presription drug monitoring program report for all availale preeescription drug monitoring program data on the patient within the previous twelve months. Please review the rules carefully as well as the 20-02-01-13 - Exceptions to the review requirement.

How to Self-report - NDCC 43-28-18.1

When submitting a self-report to the Board, submit copies of all supporting documentation. Supporting documents may include a copy of criminal charges, police reports, judgement and disposition of criminal complaint; disposition of the offense; final disposition; any orders or any pending actions; court records, settlement agreements; copies of evaluations or assessments and recommendations for treatment if any were issued. 

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 regarding the surrender of a license, adverse action taken against a license by a licensing agency in another state, territory, or country; all proceedings, or 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.

A licensee must also report a mortality or other incident occurring in an outpatient facility of the dentist which results in temporary or permanent physical or mental injury requiring hospitalization of the patient during or as a direct result of a dental procedure or related use of general anesthesia, deep sedation, conscious sedation with a parenteral drug, or enteral sedation within sixty days of the event.

A dentist shall advise the board in a timely manner if the dentist reasonably believes another dentist has committed an illegal or immoral act or has otherwise failed to make a report.


The Board believes that a fundamental component of good dental practice includes the appropriate evaluation and management of pain. While all dentists do not require DEA authorization to practice within their specialty or as general dentists, responsibly prescribed opioid medications and psychological and physical symptoms of opioid abuse may help North Dakota licensees treat their patients' pain safely and effectively. 

It is the duty of any licensee prescribing opioid medications to be knowledgeable of both the therapeutic benefits, risks, and potential harm associated with opioid treatment. The Board of Dental Examiners expects any licensee prescribing opioids for the treatment of pain to review Administrative Rule 20-02-01-12 regarding the initial prescribing of any controlled substance, including samples. The Board notes that a failure to provide opioid treatment consistent  with Administrative Rules regarding prescribing, may subject a licensee to disciplinary action by the Board.

The publications provided reflect the most current medical and scientific research and recommended practices for prescribers. While these guidelines do not constitute regulations, practitioners may find that these guidelines can provide useful information to licensees related to the appropriate considerations to be made prior to and during treatment plans involving opioids. 

 CDC Guideline for Prescribing Opioids for Chronic Pain

The CDC has also provided a number of useful resources related to Nonopioid Treatments,  Assessing Benefits and Harms, Calculating Dosage, and Tapering. 


ONE Rx (Opioid and Naloxone Education) provides North Dakota with a proactive approach to assess opioid-related risks. It's an opportunity to provide upstream prevention of opioid misuse and accidental overdose.To find tools to help equip providers to screen patients prescribing an opioid medication and provide education, resources and support to ensure safe medication use, please visit the following website, you'll be glad you did:

ONE Rx  HEALTH PROFESSIONALS    and    ONE Rx  DENTAL RESOURCES   to find resources to help dental providers with office-based screening.