How do you become a dental hygienist
You become a dental hygienist by graduating from a CODA-accredited program, passing the National Board Dental Hygiene Examination, passing a clinical board exam the state accepts, and receiving that state’s license. Dental hygienist licensure and certifications, including local anesthesia and nitrous oxide permits, are set by the state board.
Education paths
Lengths are the ones ADHA publishes for each degree. Tuition is set by the school.
| Degree | Length ADHA states | What it covers |
|---|---|---|
| Associate degree | 2–3 years | ADHA calls this the fastest route to becoming a registered dental hygienist. Coursework includes general education and sciences plus dental courses such as oral anatomy, radiology, pharmacology, dental materials, and public health. |
| Bachelor’s degree | 4 years, or 2+2 after an associate degree | ADHA describes this as the associate curriculum plus further coursework, including research, practice management, oral pathology, and local anesthesia. |
| Master’s degree | Two years, after a prior hygiene degree | ADHA describes this as preparation for teaching, leadership, public health, and research. It is not the usual first license. |
CODA-accredited programs
The Commission on Dental Accreditation accredits dental hygiene programs in the United States. The Joint Commission on National Dental Examinations uses CODA accreditation when it decides who may sit for the written board.
Search programs at coda.ada.org/find-a-program. CODA describes its role at coda.ada.org.
NBDHE and clinical boards
The National Board Dental Hygiene Examination is the written exam of the Joint Commission on National Dental Examinations, a commission of the American Dental Association. The JCNDE says it is intended to fulfill or partially fulfill the written examination requirement for licensure, and that each state board sets the final rule. Candidates test at Pearson VUE centers. The 2026 candidate guide, updated September 17, 2026, lists a $600 examination fee for a candidate from a CODA-accredited program. That fee includes results to the candidate, to three licensing jurisdictions chosen at application, and to the candidate’s program. A candidate whose program is not CODA-accredited pays an additional $435 processing fee. Rescheduling is $25. A 45-day eligibility extension is $150 and is available once per application.
Sources: jcnde.ada.org/nbdhe and NBDHE 2026 Candidate Guide (updated September 17, 2026).
ADHA’s path says the next exam is the regional or state clinical board. CDCA’s site now says CDCA is the American Board of Dental Examiners, which administers the ADEX Dental Hygiene Examination and separate exams for local anesthesia and for nitrous oxide. ADEX’s hygiene map, updated October 6, 2026, says Delaware does not accept the ADEX Dental Hygiene Examination for initial licensure. The candidate is responsible for confirming what the state board accepts.
Source: adextesting.org.
State licensure, local anesthesia, and nitrous oxide
A license comes from the state board after that board’s own list is complete. ADHA publishes licensure maps for what each state requires. The JCNDE eligibility rules require a student or graduate of a CODA-accredited program, certified by the program, or a graduate who can document an equivalent program. Passing the written and clinical exams is the usual core. Jurisprudence exams and background checks are state-specific.
Local anesthesia and nitrous oxide are not automatically part of every state license. ADHA’s bachelor’s description includes local anesthesia coursework, and ADEX offers separate local anesthesia and nitrous oxide exams. Whether a permit is required, and which course and exam count, is on the state board’s list and on ADHA’s licensure maps.
State-by-state maps: adha.org/resources/licensure-maps.
Timeline and costs
ADHA states an associate program takes 2–3 years and a bachelor’s program takes 4 years, or two additional years after an associate degree, and that someone can be working in as few as two years. The exams and the state application come after the program says the student is ready. Tuition is set by each school. ADHA’s degree page does not publish one national tuition figure.
The exam fees above are from the NBDHE 2026 Candidate Guide (updated September 17, 2026). Clinical-exam fees are on the ADEX candidate materials at adextesting.org.
Using Teero is free for hygienists. The hygienist page says there are no costs, and shifts are requested in the free app. Teero charges the office separately, and the rate in the app is the hygienist's pay before tax withholding. On Teero, direct deposit is every Thursday for shifts worked the previous week, Monday to Sunday, with taxes withheld. Instant Pay is optional: after a shift, 50% of earnings is sent within seconds (some banks take until the next business day), and the remainder comes on the next payroll so taxes can be withheld. Pay by city is on dental hygienist salary in the United States, and the state list is on salaries by state. The app is on Teero for hygienists.
Sources: adha.org/becomeahygienist; adha.org/becomeahygienist/degree-options; adha.org/resources/licensure-maps; coda.ada.org; coda.ada.org/find-a-program; jcnde.ada.org/nbdhe; NBDHE 2026 Candidate Guide (updated September 17, 2026); adextesting.org.
