National, Regional and State Dental Hygiene Certification Exams

Dental hygienists are devoted to the prevention of disease and the promotion and improvement of the health of the public, as defined by the American Dental Hygienists Association (ADHA).

Dental hygienists are licensed healthcare providers who are responsible for performing a number of preventive procedures in a dental office, including examining teeth and gums, discerning the presence of disease or oral abnormality, removing calculus, stains, and plaque from the teeth, and applying fluorides and sealants. In some states, dental hygienists may also administer anesthetics, remove sutures, and perform periodontal dressing duties, among others.


Because of their broad job duties and responsibilities, dental hygienists are regulated and licensed in the state in which they practice. As a way to ensure that practicing dental hygienists possess the competencies necessary to perform their jobs, State dental boards require not only the completion of a dental assisting program at either the associate’s or bachelor’s degree level, but also the successful completion of a national examination and a state/regional examination.

The Joint Commission on National Dental Examinations

The standard assessment tool for state dental boards is the National Board Dental Hygiene Examination (NBDHE) through the Joint Commission on National Dental Examinations (JCNDE), an independent agency of the American Dental Association (ADA). All U.S. jurisdictions and all 50 states recognize the NBDHE for licensure purposes. The purpose of the NBDHE is to determine the qualifications of dental hygienists who are seeking licensure to practice.

The NBDHE is designed to assess basic dental hygiene information, including biomedical, dental, and dental hygiene sciences. It also assesses a candidate’s ability to apply their knowledge of dental hygiene in a problem-solving context. Therefore, candidates who are able to pass the NBDHE are said to have achieved the level of skill, judgment, and knowledge necessary to practice in a safe and responsible fashion.

NBDHE Examination Components

The NBDHE consists of 350 questions that are organized into two components:

Component A

  • Scientific Basis for Dental Hygiene Practice
    • Anatomy
    • Physiology
    • Biochemistry and nutrition
    • Microbiology and immunology
    • Pathology
    • pharmacology
  • Provision of Clinical Dental Hygiene Services
    • Assessing patient characteristics
    • Obtaining and interpreting radiographs
    • Planning and managing dental hygiene care
    • Performing periodontal procedures
    • Using preventive agents
    • Providing supportive treatment services
    • Professional responsibility
  • Community Health/Research Principles
    • Promoting health and preventing disease within groups
    • Participating in community programs
    • Analyzing scientific literature, applying research results, and understanding statistical concepts

Component B

  • 150 case-based items that refer to 12 to 15 dental hygiene patient cases
  • Each examination includes at least one geriatric, pediatric, special needs, medically compromised, or adult-periodontal case.
  • These case-based items address the following:
    • Obtaining/interpreting radiographs
    • Using preventive agents
    • Professional responsibility
    • Planning and managing dental hygiene care
    • Assessing patient characteristics
    • Providing supportive treatment services

The JCNDE recommends test takers use their textbooks and lecture notes as their primary sources for study.

Taking the NCDBE

The NCDBE is administered through Pearson VUE testing centers throughout the United States. Candidates may familiarize themselves with the format of the NBDHE by taking a tutorial through Pearson VUE. Individuals may also take a brief tutorial at the testing center before taking the actual examination. The cost of taking the NBDHE is $400.

The NBDHE is scored using a scale score, which ranges from 49 to 99; a score of 75 represents the minimum, passing score. Candidates who pass the exam are given only a pass/fail notification. However, candidates who do not pass the exam are given a numerical score. Test takers can expect to receive their examination results about three weeks after the testing appointment.

Candidates who have not passed the NBDHE may apply for reexamination after 90 days. Candidates who have not passed the examination after 3 attempts must wait 12 months after the third attempt before they can reapply to take the examination. The JCNDE has a 5 years/5 attempts eligibility rule, which says that candidates must pass the examination within 5 years of their first attempt or within 5 examination attempts, whichever comes first.

The first step to taking the NBDHE involves applying through JCNDE. Candidates who meet the eligibility requirements for testing will have their application eligibility forwarded to Pearson VUE and will receive an email from JCNDE with testing appointment scheduling instructions. Once the application has been processed by JCNDE, candidates must take the NBDHE in a six-month period.

Eligibility Requirements to Sit for the NBDHE

To qualify to sit for the NBDHE, candidates must meet at least ONE of the following requirements:

  • Be a graduate of a dental hygiene program that was accredited by the Commission on Dental Accreditation (CODA); OR
  • Be a current dental hygiene student in a CODA-accredited program and receive certification from the director that they are prepared in all NBDHE disciplines; OR
  • Be a graduate of a non-accredited dental hygiene program;
    • Candidates may only qualify if they can furnish a letter of recommendation from the dean of the an accredited dental school or the director of an accredited dental hygiene program, as well as the secretary of a board of dentistry of a U.S. licensing jurisdiction. The letter from the school dean or director must certify that the non-accredited program meets all requirements, including study, subjects, and hours.

State/Regional Examination for Licensure

Upon the successful completion of the NBDHE, candidates for state licensure are typically required to take and pass a clinical (practical examination). Clinical examinations are designed to provide a reliable assessment of a candidate’s clinical skills. Although the examinations differ slightly, all consist of skill-specific patient treatment in a clinical setting. Some examinations also include a written or electronic patient-based component.

A few states have state-specific clinical examinations, while the majority of states use one of the five regional testing agencies:

Some states require candidates to complete a specific examination, while other states recognize the completion of more than one examination for licensure as a dental hygienist. An overview of state clinical hygiene testing requirements can be found here.

Back to Top

Search Dental Assistant Programs

Get information on Dental Assistant programs by entering your zip code and request enrollment information.

Sponsored Search