Resources for dental hygienists
Independent dental hygienist practices allow qualified professionals to shape their services and run their own operations. This offers greater autonomy, and enables you to decide how best to serve your community and expand options for patients. But what states can dental hygienists have their own practice? Let’s find out.
Feb 20, 2025
States Allowing Some Level of Independent Dental Hygienist Practice
The laws governing independent dental hygiene practice vary by state. Some grant full autonomy, while others require collaborative agreements.
The following states allow dental hygienists to practice with varying levels of independence, including collaborative agreements, public health settings, and alternative practice models.
Alaska – Collaborative agreement required; dentist’s presence not mandatory.
Arizona – Affiliated practice agreement allows independent work in specified settings.
Arkansas – Collaborative care permits enable treatment in public health settings.
California – A Registered Dental Hygienist in Alternative Practice (RDHAP) may work independently.
Colorado – No supervision required; hygienists may own practices.
Connecticut – Public health hygienists may work without supervision.
Florida – Limited autonomy in health access settings.
Idaho – Extended Access Endorsement allows work in specific facilities.
Illinois – Public health dental hygienists can operate in community settings.
Iowa – Public health dental hygienists can work under standing orders.
Kansas – Extended Care Permit system grants increasing levels of independence.
Kentucky – Volunteer community health settings allow limited independent practice.
Maine – Independent Practice Dental Hygienists can work without supervision.
Maryland – General supervision permitted in long-term care facilities.
Massachusetts – Public health dental hygienists can work in various public settings.
Michigan – PA 161 allows dental hygienists to practice in public or nonprofit facilities.
Minnesota – Collaborative practice allows expanded hygiene services.
Missouri – Medicaid-eligible children can receive care without supervision.
Montana – Limited Access Permit allows hygienists to work in public health settings.
Nebraska – Public health dental hygienists can practice unsupervised.
Nevada – Public health dental hygienists can work without supervision.
New Hampshire – Certified public health hygienists may work in specified locations.
New Mexico – Collaborative practice allows dental hygienists to own or manage practices.
New York – Collaborative agreements allow public health practice.
North Dakota – Limited public health dental hygiene supervision.
Ohio – Oral Health Access Supervision Permit allows work in public settings.
Oklahoma – General supervision allows services before dentist evaluation.
Oregon – Expanded Practice Dental Hygienists (EPDH) have prescriptive authority.
Pennsylvania – Public Health Dental Hygiene Practitioners operate in public health settings.
Rhode Island – Public health hygienists may work without direct supervision.
South Carolina – General supervision for public health hygienists.
South Dakota – Collaborative agreements allow public health work.
Texas – Hygienists may practice for six months without a dentist visit.
Utah – Public health dental hygienists work with a referral agreement.
Vermont – General supervision agreements allow independent work.
Virginia – Remote supervision permits public health work.
Washington – No supervision required in certain health facilities.
West Virginia – Public health dental hygienists can practice independently.
Wisconsin – No dentist supervision required in select public and private settings.
The following states do not permit independent dental hygienist practice and require direct or general supervision by a licensed dentist.
Alabama – Direct supervision required; independent practice not permitted.
Delaware – Direct supervision required; independent practice not allowed.
Georgia – General supervision allowed in schools, hospitals, and public health programs with experience; independent practice not permitted.
Hawaii – Direct supervision required; independent practice not authorized.
Indiana – Access Practice Agreement allows preventive services without prior dentist authorization; independent practice not fully permitted.
Louisiana – Direct supervision required; independent practice not allowed.
Mississippi – Direct supervision required; independent practice not permitted.
New Jersey – Direct supervision required; independent practice not authorized.
North Carolina – Direct supervision required; independent practice not allowed.
Tennessee – General supervision allowed in certain settings with three years of experience; independent practice not permitted.
Wyoming – Supervision required; independent practice not authorized.
Since laws are subject to change, always double check any information with your state dental board .
States Where Dental Hygienists Can Practice Fully Independently
Below are the states where dental hygienists can practice fully independently. This means no supervision, collaborative agreement, or dentist oversight are needed to provide services.
Colorado
Regulation: No supervision required.
Requirements: None.
Services Allowed: Full dental hygiene scope, including dental hygiene diagnosis, radiographs, oral inspection, prophylaxis, fluoride application, and charting. Local anesthesia requires general supervision.
Maine
Regulation: Independent Practice Dental Hygienists (IPDH) can work without supervision.
Requirements:
Bachelor’s degree: 2,000 hours of clinical experience in the last 2 years.
Associate degree: 6,000 hours in the last 6 years.
Must provide a referral plan for patients needing further care.
Services Allowed: Full hygiene scope, including periodontal charting, root planing, fluoride application, sealants, desensitizing agents, topical anesthetics, and radiographs.
California
Regulation: Registered Dental Hygienists in Alternative Practice (RDHAP) can work independently.
Requirements:
Must hold a California dental hygiene license.
2,000 hours of clinical experience in the last 36 months.
Bachelor’s degree or 120 semester units.
Completion of 150-hour RDHAP program and passing a state exam.
Services Allowed: Full hygiene scope, including prophylaxis, root planing, charting, sealants, and exams. Services must be provided in homes, schools, hospitals, or underserved areas.
Washington
Regulation: No supervision required in health facilities.
Requirements:
2 years of clinical experience in the last 5 years.
Written practice plan required for some settings.
Services Allowed: Full dental hygiene services, including prophylaxis, fluoride treatments, polishing restorations, root planing, and curettage. May practice in hospitals, nursing homes, correctional facilities, and tribal clinics.
Oregon
Regulation: Expanded Practice Dental Hygienists (EPDH) can work independently.
Requirements:
2,500 hours of supervised dental hygiene practice.
40 hours of board-approved coursework or a specialized program with 500 supervised hours in limited-access settings.
Must have liability insurance.
Services Allowed: Full hygiene scope, including patient assessments, radiographs, fluoride treatments, root planing, temporary restorations, and prescribing fluoride.
Nevada
Regulation: Public Health Dental Hygienists can work without supervision.
Requirements:
Must obtain a special endorsement from the dental board.
Submission of practice protocols to the state board.
Services Allowed: Full dental hygiene scope, including local anesthesia and nitrous oxide, if performed in an approved facility.
New Mexico
Regulation: Dental hygienists can own and manage an independent practice with a Collaborative Practice Agreement, but only for referral purposes.
Requirements:
2,400 hours of active practice in the last 18 months OR
3,000 hours in 2 of the past 3 years.
Dentists cannot collaborate with more than 3 hygienists.
Services Allowed: Full hygiene scope, including radiographs, fluoride treatments, sealants, root planing, antimicrobial applications, and prescription fluoride treatments.
Nebraska
Regulation: Public Health Dental Hygienists can practice independently.
Requirements:
3,000 hours of experience in at least 4 of the last 5 years.
Must carry professional liability insurance.
Services Allowed: Prophylaxis, sealants, fluoride treatments, and pulp vitality testing for healthy children.
Minnesota
Regulation: Collaborative Practice Dental Hygienist can work independently with a written agreement for referral purposes only.
Requirements:
3,000 career hours, including 200 hours in the last 3 years.
Additional continuing education requirements.
Services Allowed: Full hygiene scope, including prophylaxis, fluoride application, sealants, root planing, coronal polishing, and radiographs.
What are the Benefits of Independent Practices for Dental Hygienists?
Independent hygienists can offer services in areas lacking regular dental clinics. This model helps communities that have missed out on basic care and allows hygienists to educate patients directly about oral health, nutrition, and other healthy habits. In addition, mobile services run by collaborating hygienists can also visit high schools and keep students on track with preventive treatments.
Owning and managing a practice also gives hygienists autonomy to create business models that fit their skills. For some, the transition to an independent practice allows them to specialize in services like periodontal maintenance or pediatric preventive care that benefit public health and their own success.
Challenges and Criticisms of Independent Practice
The biggest criticism of independent practice boils down to maintaining consistent standards in patient safety and quality of care. But many states address this by requiring certain supervision levels or collaborative models.
Other challenges you should be aware of are legal, financial, collaborative, and insurance-related.
Legal and Regulatory Barriers
Navigating the complex legal limitations for dental hygienists can be challenging for those seeking independent practice. Each state has its own regulations and licensing requirements, which can be intricate and time-consuming to fulfill. The process of obtaining necessary endorsements or collaborative agreements often involves significant administrative effort.
Financial and Business Challenges
Starting an independent practice requires substantial financial investment. Hygienists must cover costs associated with setting up a clinic, purchasing equipment, securing office space, and obtaining insurance. Without the backing of a larger dental practice, these expenses can be burdensome. Additionally, managing the business aspects (such as accounting, marketing, and staffing) can be overwhelming for those primarily trained in clinical care.
Seeking out advancement opportunities and additional training can help prepare hygienists for these responsibilities.
Integration with Comprehensive Dental Care
While independent hygienists provide essential preventive services, they may face challenges in integrating their work within the broader scope of dental care. Coordinating with dentists for patient referrals and follow-up treatments is crucial but can be complicated without established networks. This disconnection may affect the continuity of care and holistic treatment of patients' oral health needs.
Insurance and Reimbursement Issues
Independent hygienists may encounter difficulties in obtaining reimbursements from insurance companies. Insurers may have policies favoring traditional dental practices, leading to denied claims or lower reimbursement rates for services provided by independent hygienists. This financial uncertainty can impact the viability of the practice and limit access for patients relying on insurance coverage.
Frequently Asked Questions About Independent Dental Hygiene Practice
Can I open an independent practice without a dental hygiene degree?
No, you must hold a valid dental hygiene license in your state to practice independently. Most states require graduation from an accredited dental hygiene program and passing national and state board exams. Some states with independent practice models require additional credentials, such as bachelor's degrees or specialized coursework beyond the associate degree level.
How much does it cost to start an independent dental hygiene practice?
Starting an independent practice typically requires an investment of $50,000 to $150,000. Major expenses include equipment purchases (portable or stationary units), liability insurance, business licensing, office space (if applicable), marketing, and initial supply inventory. Mobile practices generally cost less to start than brick-and-mortar locations. Create a detailed business plan and explore small business loans or grants to manage startup costs.
Do I need malpractice insurance for independent practice?
Yes, professional liability insurance is required in most states that allow independent practice. Coverage typically ranges from $50 to $200 per month depending on your state, services offered, and coverage limits. Some states specify minimum coverage amounts. Teero provides professional liability insurance coverage for all shifts worked through the platform, removing this financial burden for temporary work.
What services can independent dental hygienists provide?
Independent dental hygienists can typically provide preventive services including dental cleanings, fluoride treatments, sealants, oral health education, and radiographs. Some states allow additional services like applying desensitizing agents, periodontal charting, and root planing. Expanded Practice Dental Hygienists in Oregon can even prescribe certain medications. Services vary significantly by state, so review your state's dental practice act carefully.
How do I market my independent dental hygiene practice?
Successful marketing strategies include building a professional website optimized for local search, creating social media profiles on platforms like Facebook and Instagram, partnering with local schools and community centers, offering free oral health screenings, and networking with local healthcare providers for referrals. Focus on underserved communities where your services fill a genuine gap in care. Word-of-mouth referrals become your strongest marketing tool once you establish quality service.
Can I accept dental insurance as an independent hygienist?
Accepting insurance as an independent hygienist can be challenging. Many insurance companies credential dentists but not independent hygienists, making direct billing difficult. However, you can offer patients superbills (detailed receipts) they can submit for reimbursement. Some hygienists choose to operate on a cash-pay basis with transparent pricing. Research your state's regulations and contact insurance carriers directly about credentialing requirements.
What's the difference between collaborative practice and independent practice?
Collaborative practice requires a written agreement with a licensed dentist who provides referrals and consultation, though the dentist doesn't need to be on-site during treatment. Independent practice means you can operate without any dentist involvement or oversight. Colorado, Maine, and Washington are examples of true independent practice states. Many other states allow collaborative models with varying requirements for dentist relationships.
How long does it take to establish an independent practice?
Establishing an independent practice typically takes 3 to 6 months from initial planning to seeing your first patients. This timeline includes creating your business plan, securing funding, obtaining necessary licenses and permits, setting up your physical or mobile space, purchasing equipment, arranging insurance, and conducting initial marketing efforts. Some hygienists start part-time while maintaining other employment to manage financial risk during the startup phase.
Can I transition from independent practice back to traditional employment?
Yes, you can move between independent practice and traditional employment. Many hygienists maintain both, working independently part-time while holding a traditional position for income stability and benefits. Your independent practice experience demonstrates entrepreneurship, business acumen, and clinical competence, making you an attractive candidate for traditional roles. Teero offers flexible work arrangements that let you pick up shifts while running your practice, providing income without long-term commitment.
What continuing education is required for independent practitioners?
Continuing education requirements for independent practitioners mirror standard requirements for dental hygienists in your state, typically ranging from 12 to 30 hours every one to two years. Some states require additional coursework specific to independent practice, such as business management, pharmacology, or advanced clinical procedures. Check with your state dental board for specific requirements and approved course providers.
Do I need a separate business license to practice independently?
Yes, in addition to your dental hygiene license, you'll need a business license from your city or county. Depending on your business structure, you may also need an Employer Identification Number from the IRS, state tax permits, and health department permits if you maintain a physical location. A business attorney or accountant can help identify all necessary permits and licenses for your specific situation and location.
Can independent hygienists work in nursing homes and schools?
Yes, many independent practice models specifically target nursing homes, schools, and other community settings where access to dental care is limited. In fact, several states only allow independent practice in these specific settings. Mobile equipment makes it practical to serve patients who cannot easily access traditional dental offices. Building relationships with facility administrators and school nurses can create steady referral streams for your practice.
Taking the Next Step in Your Career
Starting your own dental hygiene practice is an exciting way to take control of your career, but success comes down to preparation. Make sure you have the right licensing, insurance, and business plan in place. Invest in marketing to reach new patients, and don’t hesitate to seek guidance from legal and financial professionals to set yourself up for long-term success.
If you're looking for a way to build flexibility into your career—whether you're starting your own practice or just want more control over your schedule—Teero can help. Our platform connects dental hygienists with flexible work opportunities, making it easier to find jobs that fit your lifestyle. Download the app to explore your options and take the next step in your career.