How to Get Licensed as a Foreign-Trained Registered Dental Hygienist in the United States

If you’ve relocated to the U.S. or you’re thinking about immigrating to the States, and you’re already a trained dental hygienist, you probably want to continue in your career.

However, as you begin searching job listings, you’ll soon learn that you’ll need your Registered Dental Hygienist (RDH) license to work in the U.S. Even though you are legally permitted to work in the U.S., you will have to take a few steps in order to obtain this license.

When you face these kinds of obstacles, you might be discouraged and tempted to find a job outside the field of dentistry — but that won’t allow you to use your hard earned skills and training.

Luckily, it’s possible for you to get your foreign credentials validated so you can start practicing in the U.S. The accreditation process can be a bit confusing and each state has different rules. To help make the process for getting your license more clear, in this article, we’ll go over the steps to take to begin the journey towards finding a job as a dental hygienist.

In this guide, we will answer the following questions:

• Benefits of Becoming a Licensed Dental Hygienist in the U.S.
• Authority Responsible for Granting Your Dental Hygienist License
• Contacting Your State’s Dental Hygiene Board for Licensure Information
• Evaluating Your Foreign Credentials for U.S. Practice
• Essential English Proficiency for Dental Hygienists
• Understanding the National Board Dental Hygiene Examination
• State-Specific Exams for Dental Hygienists
• Maintaining Your Dental Hygienist License Throughout Your Career

Benefits of Becoming a Licensed Dental Hygienist in the U.S.

When you first considered becoming a dental hygienist, it was probably because the dental field would allow you to help others and guarantee job security for yourself in the future. People are always going to need help maintaining healthy teeth and good dental hygiene. No matter where you are in the world, there will always be jobs in the dental field.

As it turns out, dental hygienists make quite a bit of money in the U.S. In fact, the average pay for dental hygienists is $40 an hour in Florida and $53 an hour in New York according to Indeed.com.

In addition to making great money, dental hygienists can often create flexible work schedules. Dental clinics often offer a variety of appointment times so patients have lots of options when scheduling they’re check-ups. As a result, you could find a dental hygiene position that allows you to work creative hours to fit with your schedule. And in many cases, dental hygienists work part-time, which could be perfect if you’re a parent, in school, or starting another business.

By continuing in your career, you’ll be able to make use of the degree you already have and earn good money as a dental hygienist.

Authority Responsible for Granting Your Dental Hygienist License

Dental hygienists handle some sensitive tasks in their work. From taking X-rays to administering local anesthesia, dental hygienists need very specific training to keep their patients safe. Given this, it’s understandable that dental hygienists need a license to legally practice in the United States. So, let’s take a closer look at who will grant your Registered Dental Hygienist’s license.

While the United States has national organizations like the American Dental Hygienists’ Association (ADHA) and the Commission on Dental Accreditation (CODA). You will ultimately receive your Registered Dental Hygienist license from the state you plan to live in.

If you’re hoping to find a job as a dental hygienist in Florida, you will obtain your licensure approval from the Florida Board of Dentistry. Or, if you want to work as a dental hygienist in Los Angeles, you’ll need to get licensed by the Dental Hygiene Board of California.

Dental hygiene boards in each state usually have anywhere from eight to ten members. These board members are generally made up of dentists, dental hygienists, educators from the medical field, and business professionals. In nearly every state, members of the board of dental hygienists are appointed to their positions for four years.

Board members play a part in deciding things like how many hours of continuing education dental hygienists will need and which procedures dental hygienists are allowed to perform. For example, dental hygienists in Massachusetts are permitted to cement and remove temporary crowns and bridges, which is not true in every state.

Contacting Your State’s Dental Hygiene Board for Licensure Information

Due to the fact that each state has its own licensing board, it can be difficult to know the best way to contact them. It can also be confusing because some states, such as California, have specific boards for dental hygiene while other states like Florida simply have a board of dentistry which awards licenses to both dentists and dental hygienists.

Let’s go over some tips for emailing your state’s dental hygiene licensing board.

For starters, if English isn’t your first language, you can compose your email in your native language and then translate it for clarity. We can assist with professional translations if needed to ensure your message is clear.

You’ll also want to include as much information as possible in your email when you send it. In the subject line, indicate if your email is urgent and add one or two words explaining what your email is about. For example, you might write “Licensing Question for a Dental Hygienist from Brazil.”

In the body of your email, be sure to provide your full name, your phone number, and your email address. Basically, you want to make it as easy as possible for the licensing board to respond to you.

One last tip to keep in mind is the time and day to contact your licensing board. Most state licensing boards keep office hours between 9am and 5pm, Monday through Friday. So, if you email or call the board when they’re out of the office, they probably won’t answer until later.

Also, keep in mind that the United States has multiple time zones. For example, there’s a three hour difference between Florida and California. So, if you’re hoping to receive a fast email response or planning to call the licensing board, you should look up the office hours to see when their office is open.

Pay special attention to the contact links for New York and Illinois. These state licensing boards utilize an online contact form rather than an email address. However, when you receive your response it will be through your email.

Evaluating Your Foreign Credentials for U.S. Practice

To practice dental hygiene in the United States, you will need the equivalent of an associate degree in dental hygiene. The most common associate degrees for dental hygienists are the Associate of Science in Dental Hygiene (AS) and the Associate of Applied Science in Dental Hygiene (AAS).

One of the most important steps towards obtaining your dental hygienist license in the U.S. is having your educational and professional experience looked over by a professional credential evaluation service.

Credential evaluations are so important because each country has its own degrees and requirements for dental hygienists. For example, in Mexico you might have earned your “Licenciatura en Higiene Dental,” and you’re not sure if you can use that degree to be a dental hygienist in the United States.

A credential evaluation service will help you figure out if the degree and license from your home country will transfer to the U.S. Beyond that, you’ll need to research the requirements in the specific state where you’re planning to work. For example in New York, candidates who hope to become dental hygienists are required to take a specific training to identify and report child abuse.

In this case, even if your foreign credentials are accepted by the state of New York, a professional credential evaluation service could help you identify other requirements you might be missing.

You can do your own research, but it’s wise to contact the licensing board of the state you hope to work in and request a list of credential evaluation services they recommend.

Some other great resources for finding trustworthy credential evaluation services are the National Association of Credential Licensing Services (NACES) and the Association of International Credential Evaluators (AICE).

Credential evaluation services provide different tiers of evaluations. A less detailed service might be described as a “general evaluation” or “course by course evaluation,” and these services typically cost less money.

On the other hand, a comprehensive evaluation will require more time to gather in depth information about your life experience, so it will probably cost more.

For example, a company called Educational Credential Evaluators (ECE) offers a range of services beginning with a “general” evaluation for $100 all the way up to their most comprehensive evaluation which they call “Subject Analysis,” for $275. It’s not unusual for credential evaluation services to charge up to $500 depending on your needs. It’s worth noting that ECE is specifically recommended by the Joint Commission on National Dental Examinations (JCNDE).

The processing time for credential evaluations can range from five days to four weeks. But luckily most evaluation companies offer expedited services for an additional fee if you’re in a hurry.

Dental hygienists often deal with challenging procedures and need to keep their patients safe. As a result, state licensing boards will likely want a comprehensive credential evaluation of your education and experiences. You can expect the evaluation company to ask you for official sets of your academic record, which may include transcripts, report cards, and examination statements. You’ll also need to provide documentation of your internships, work experience, and licenses from your home country.

Credential evaluation companies require English translations of any foreign documents. These translations must be complete and word-for-word, so the best way to make sure they’re accurate is to have them completed by a professional translation service.

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One last thing to consider is that these agencies can send the evaluation directly to the dental hygiene board in the state you want to work in. In some cases, this can even be better because the licensing board may require that the evaluation and translation come directly from the evaluation or translation agencies to ensure the documents’ authenticity.

Essential English Proficiency for Dental Hygienists

If you’re hoping to start a career as a dental hygienist in the U.S., it’s crucial to demonstrate your English reading and speaking abilities.

Whether you’re talking with patients in the dental chair or with other folks in your office, strong English skills are essential. Proficiency in English will allow you to communicate effectively with colleagues and patients, maintain accurate dental records, and engage in continuing education to stay current in the field and maintain your licensure.

Strong English skills are particularly important for scheduling appointments, asking patients how they’re feeling, explaining procedures, and providing post-treatment care instructions. Additionally, being able to take feedback from the dentist you’re working with and discussing patient care plans is vital.

Two of the most widely recognized exams to demonstrate English proficiency are the Test of English as a Foreign Language (TOEFL) and the International English Language Testing System (IELTS). Both of these exams can help you prove your English proficiency and may assist you in securing employment after you obtain your license.

Understanding the National Board Dental Hygiene Examination

No matter what state you’re planning to work in, you will need to pass the National Board Dental Hygiene Examination (NBDHE), which is administered by the JCNDE.

Among people who are studying for the NBDHE, the exam is simply referred to as “The Boards” or “Boards.” In addition to this national exam, the majority of states will require you to take an exam that covers their specific laws and rules. We’ll take a closer look at a few state exams later, but for now let’s focus on The Boards.

The exam is made up of 350 multiple choice questions that you’ll have seven and a half hours to complete. The exam is administered on a computer and will be split into two separate sessions.

The first session is three and half hours long with 61 questions covering the science behind dental hygiene, 115 questions covering the actual practice of dental hygiene, and 24 questions regarding community health and ongoing research about dental hygiene. So in total, the first session is 200 questions.

The second session lasts four hours and contains 150 questions regarding specific patient cases. The second part of the exam features 12 to 15 patient cases dealing with both children and adults. For each patient case, you will be provided with a medical history, dental chart, periodontal charting, clinical photos, and radiographs to reference while answering the questions. It’s important to note that wrong answers won’t count against your score, so don’t leave any questions blank, just take a guess.

For more details about The Boards, the JCNDE provides a 33 page, online PDF detailing the contents of the exam, how it will be scored and other information.

There are a few fees associated with The Boards exam. For starters, there is a $565 fee that everyone has to pay. Included with this fee, the JCNDE will report your exam results directly to three state licensing boards on your behalf as long as you request for these reports to be made when you sign up for The Boards.

So, if you’re moving to New York, it could be wise to go ahead and have your exam results sent to the New Jersey and Massachusetts licensing boards since all three states are on the East Coast.

If you want to have the results of your Boards exam sent to any other states that you didn’t list on your exam application, you’ll have to pay a $50 results report fee for each additional report.

You might also have to pay the $350 processing fee for international candidates. This fee is charged to anyone who graduated from a dental hygiene program that isn’t in the United States or Canada.

Finally, if you need to reschedule your testing appointment the fee is $25. Keep in mind that you’ll have to reschedule your appointment 24 hours in advance.

In order to pass the exam, you’ll need a score of 75 or higher. The scoring system is a bit confusing because a score of 75 doesn’t mean you have to answer 75% of the questions on the exam correctly. As you’ll remember from earlier, there’s a total of 350 questions. Each correct answer you give adds one point to your raw score. At the end of the test, this raw score is converted to a scaled score, which ranges from 49 to 99.

The raw score is converted to a scaled score because each person taking the NBDHE exam gets a different set of questions. Since some questions are harder than others, the conversion makes sure that everyone’s score is fair. The important thing to remember is that you need at least a score of 75 to pass.

After you’ve taken the exam, your results should be available to view through an online portal in three to four weeks.

If you did not pass the exam on your first attempt, you’ll be permitted to take it again after waiting 60 days. You can retake The Boards up to four times in your first year. However, if you don’t pass the exam after four attempts, you’ll need to wait 12 months to retake it.

One of the easiest ways to make sure you pass is to utilize all the resources available for studying online and on your phone.

One of the most well-liked study websites is StudentRDH.com. With this company you’ll need to pay for their resources and there are different packages. The most affordable package is $297 and provides customers with physical books, colored illustrations, and a study planner. For $397 the company offers their “On-Demand Review” which is geared towards online learning with over 150 video explanations, a full eight-hour, 350 question, mock exam meant to simulate the real thing, and access to a smartphone app so you can study on the go.

Dental Hygiene Seminars is another website and mobile app combination that prospective dental hygienists love. The company offers dental hygiene reference cards for $45, an extensive review book for $250, or a “virtual review” package for $400. The virtual review includes the review book, enhanced features in the mobile app, pre-recorded video lectures, and a mock Board exam. But, before purchasing these packages, download the mobile app because it’s filled with free practice questions and explanations.

Another great resource is the subreddit “r/DentalHygiene”.There, you’ll find an ongoing conversation between people who’ve already become Registered Dental Hygienists and prospective dental hygienists. People regularly converse in the forum so just post your inquiry and you’ll receive responses from people in the dental hygiene community.

You can also search Facebook for groups of other people who are studying for their Boards Exams. The following are just a few:

• Study Sessions For The NBDHE Facebook Group
• Crack NBDHE – Hangout for Future Hygienists & Dental Hygiene Boards Prep Facebook Group
• NBDHE 2024 Facebook Group

Once you join a group, you can chat directly with Registered Dental Hygienists and students.

State-Specific Exams for Dental Hygienists

Aside from The Boards exams, most states have one or two additional exams for aspiring dental hygienists. The first type of exam is clinical and tests your ability to do hands-on dental work in a typodont, which is a model of a human mouth. The second type of exam pertains to each state’s specific laws and rules.

In California for example, you’ll need to pass the California Dental Hygiene Law and Ethics Examination. The exam is made up of 60 questions, it’s administered on a computer, and you’ll be given 90 minutes to complete it. In order to pass the exam you must answer 75% of the questions correctly. The fee to take the exam is $26.50.

If you’re a refugee, asylee, or special immigrant in California, you might be eligible to have your licensing process expedited. To qualify, applicants must provide evidence of their status, such as Form I-94, a special immigrant visa, or a Permanent Resident Card. To see if this could work for you, contact the Dental Hygiene Board of California or email refugee@dca.ca.gov for assistance.

In Florida, you’ll be required to take two state-specific exams. First, you’ll have to pass the two-part American Board of Dental Examiners (ADEX) Dental Hygiene Exam which is often called the “ADEX Manikin” exam. In the first part of the exam, you’ll use a model-mouth to demonstrate your ability to remove tartar, measure gum pockets, and manage oral tissue. This part of the exam is 2 hours in length. The second part of the exam tests your ability to diagnose and create treatment plans using computer images and X-rays. ADEX actually created a detailed youtube video demonstrating what the clinical part of the exam is like. In this part of the exam, candidates will be given 4 hours. Together, the fee for these exams is $1,150 which includes one complimentary retake. For these exams, you’ll need a score of 75% or higher to pass.

In Florida you’ll also need to take the Florida Laws and Rules Examination. The exam has 64 multiple choice questions and you’ll be given 90 minutes to complete it. The exam fee is $105 and you’ll need to answer 75% of the questions correctly to pass.

As you’re researching the Florida Laws and Rules Examination, you might find information for other exams by the same name. This is because the state of Florida modifies their laws and rules examination for each different licensed profession. Because of this, it’s really important to pay close attention to which Florida Laws and Rules Exam you’re researching.

In Illinois, hopeful dental hygienists will need to pass a clinical exam. Luckily, the Illinois Board of Dentistry accepts clinical exams from five different organizations. The acronyms for those organizations are the SRTA, NERB, CITA, WREB, and CRDTS. Each one of those exams are slightly different but aim to test your clinical skills.

The Massachusetts Board of Registration in Dentistry requires prospective dental hygienists to pass one of three different exams. Some of these overlap with the exams mentioned for Illinois, but those acronyms are ADEX, CRDTS, and SRTA. In addition to taking one of these exams, you’ll need to pass the Massachusetts Dental Ethics and Jurisprudence Exam. Past exams have contained 64 multiple choice questions; however, they may vary from year to year. That said, you’ll be relieved to hear that the jurisprudence exam is open-book and the state of Massachusetts provides a link of resources to study.

In New Jersey, you’ll need to take the Commission on Dental Competency Assessment (CDCA). In recent years, the CDCA began administering the same ADEX Dental Hygiene Exam we mentioned earlier when talking about Florida’s state-specific exams and the same information applies as with Florida.

The state of New York also requires that dental hygienist candidates take the ADEX exam, in addition to fulfilling other state license requirements. One thing that’s unique about New York is that you’ll need to take a Child Abuse Reporting Course that’s approved by the New York State Education Department (NYSED).

In Texas, you’ll have the option of taking an exam with the three organizations we’ve already mentioned. The acronyms for those organizations are CRDTS, ADEX, and SRTA and you’ll also have to complete a course on human trafficking prevention.

Maintaining Your Dental Hygienist License Throughout Your Career

After passing the Boards and a state exam, you’ll need to take some steps every two or three years to keep your Registered Dental Hygienist license up to date.

Each state is different and has its own fees, continuing education requirements, and license renewal guidelines, so it’s wise to do your own research depending on which state you want to practice in. So, let’s take a look at the specific requirements dental hygienists need to maintain their licenses in just a few of the most popular states for immigrants.

In California dental hygienists are required to complete 25 hours of continuing education every two years. A minimum of two of those 25 hours should be in regards to infection control, and two of the hours should be reviewing the California Dental Practice Act. The fee to maintain an RDH license in California will be $300 every two years.

Dental Hygienists in Florida will need to complete 22 hours of continuing education and two hours in medical error training for each two-year licensing period. Additionally, dental hygienists in Florida must take a two-hour course in domestic violence once every six years. To renew your license, you have to complete an online form and pay a $105 fee.

In Illinois, all dental hygienists must take 36 hours of approved continuing education courses for each three-year licensing period. When you renew your license you’ll need to include an affidavit stating that you completed the required continuing education. The fee to maintain your RDH license will be $150 every three years.

Now, in Massachusetts Dental Hygienists are required to complete 20 Continuing Education Units every 2 years. The cost to maintain your license will only be $60 every two years.

Next, in New Jersey, the State Board of Dentistry dictates that dental hygienists must complete 20 continuing education credits every two years. To maintain your license in New Jersey, you’ll need to pay a $120 fee each two year period.

Transitioning to New York, practicing dental hygienists must complete 24 credit hours of continuing education every three years. Additionally, as a Registered Dental Hygienist (RDH) in New York, you are required to pay an $88 renewal fee every three years.

Lastly, in Texas dental hygienists will need to renew their license every two years. The fee to renew your license is $226 and every two-year renewal period dental hygienists will need to complete 24 hours of appropriate continuing education.

Now you understand that becoming a licensed dental hygienist in the United States is achievable. Although the journey might seem challenging, it is certainly worthwhile in the long run!

Once you complete this process, you can start your career as a dental hygienist in the U.S. You’ll probably earn a higher income as a licensed dental hygienist compared to non-licensed roles.

Author: Aaron Randolph | LinkedIn