By Jake Kathleen Marcus, JD, PGDip

The issue of dental and dental hygienist license portability — the ability to transfer dental and dental hygienist licensure from state to state — has long been an issue in the dental community. While license portability is critical for any dental professional who wishes to practice in more than one state — either because they have practices in multiple or border states or because they have relocated to another state — the issue is of particular concern to members of the military and their spouses, whose service may require they move frequently between states. Additionally, since the COVID-19 shutdown, the shortage of dental hygienists and other dental staff has been crippling, leading dental boards to explore ways to increase the available population of dental auxiliaries.

While state dental boards have worked to address license portability, particularly for members of the military and their families, more recently two organizations have created proposals for “compacts” that facilitate license portability across states. The Council of State Governments (CSG) Dentist and Dental Hygienist Compact (DDHC)(1) and the American Association of Dental Boards (AADB) Interstate Dental & Dental Hygiene Licensure Compact (AADB Compact)(2) are both initiatives designed to streamline the process for dentists and dental hygienists to be able to practice, though these compacts differ in terms of governance, scope and implementation. But how these compacts work and the difference between the two has been confusing for the dental community.

This article will examine both the DDHC and the AADB Compact. Critical to the dental professional today is whether there is some action you need to take and whether either compact has changed the way you can practice in multiple states. To begin, there are two things you should know: first, whether the state in which you are currently licensed has adopted the DDHC (no state has adopted the AADB Compact yet), and second, if it has, that the DDHC will not be available for at least 18 months. If you are licensed in a state that has not yet adopted the DDHC or that is considering adopting the DDHC, you should be informed about both compacts and how they could affect you.

What Are the Key Differences Between the DDHC and AADB Compact?

The DDHC is managed by a broader, state-focused organization, the CSG, that works to facilitate multistate practice for many professions. The AADB is an organization comprised solely of state dental boards that focuses on dental board coordination and standardizing licensure practices across states.

Another critical distinction is that the AADB Compact creates uniform standards among states for licensure, while the DDHC creates a pathway for dentists to practice in multiple states via privilege to practice. Under the DDHC, dentists do not receive licenses in multiple states.

Another difference between the DDHC and the AADB Compact is the mode of funding. Under the DDHC, each state will pay a fee to the DDHC Commission, while the AADB Compact Commission would charge fees for using the compact process directly to the dental professionals seeking licensure.

Most significantly, and an object of criticism by some including the North Carolina State Board of Dental Examiners,(3) is the difference in skills requirements under each compact. Most notably, the DDHC does not require hand skills testing for dentists. To this criticism, the American Dental Association (ADA), which has partnered with the CSG, responds that extensive hands skills training takes place in dental schools followed by “14 states requir[ing] a single-encounter hand-skills clinical assessment in statute or state dental board rules, while 10 states accept alternative clinical assessments, either DLOSCE, PGY-1 or both.”(4) It is a matter of dispute whether the possibility exists that dentists would seek primary licensure in a state without such a requirement and then seek practice privilege under the DDHC in a state that does require this testing.

In addition to the difference in skills testing, a dental professional who receives practice privilege through the DDHC will be required to complete continuing education only in the state in which they are licensed. This distinction too has raised the possibility that practitioners will maintain a license only in a compact state with a lower number of continuing education hours required. By contrast, once a dentist or dental hygienist has received a license via the AADB Compact, they must meet all ongoing licensure requirements in all states in which they are licensed, as is currently the case for professionals holding licenses in multiple states.

What You Need to Know About the DDHC

While its name may lead some to believe the CSG is a governmental organization or agency, it is an independent organization that works with state government officials and other organizations on a variety of issues, one of which is occupational licensure. For example, through its National Center for Interstate Compacts (NCIC)(5) in partnership with the U.S. Department of Labor, the NCIC “works with state government officials to strengthen the portability of occupational licenses and remove duplicative and overly burdensome requirements.”(6) In the case of the DDHC, the CSG partnered with the U.S. Department of Defense (DOD) as part of a broader initiative to support interstate licensure compacts for military families. Other occupation interstate compacts that are part of the collaboration between the CSG and DOD include interstate compacts for teachers,(7) social workers(8) and school psychologists.(9)

In 2021 the CSG and DOD entered a partnership with the ADA, and the American Dental Hygienists’ Association to draft a model compact legislation, which was completed and made available to stakeholders for public comment in 2022. In 2023, the DDHC was then available for introduction as legislation in individual states. The precise language of the DDHC is available here: ddhcompact.org/wp-content/ uploads/sites/31/2024/06/Dentist_Dental-Hygienist-Compact-Model-Language_Final.pdf. The DDHC facilitates the process for dentists to practice in multiple states without having to obtain separate licenses in each state, provided they meet the requirements set forth in the compact. However, under the DDHC, professionals licensed in one compact state are not entitled to a license in another compact state. Under the DDHC, a professional meeting the compact requirements can receive the privilege to practice in another compact state. To be eligible for a compact privilege under the DDHC, a dentist or dental hygienist must show the following:

• A license with no disciplinary action in a state that has joined the compact.

• Graduation from a predoctoral dental education program accredited by the National Board Examination of the Joint Commission on National Dental Examinations; or a dental hygiene education program accredited by the Commission on Dental Accreditation (CODA).

• Having not been convicted or found guilty, or entered into an agreed disposition, of a felony offense under applicable state or federal criminal law within five years prior to the date of their application.

• Passage of the National Board Examination.

• Completion of a “clinical assessment” (defined as “examination or process, required for licensure as a dentist or dental hygienist as applicable, that provides evidence of clinical competence in dentistry or dental hygiene for licensure”).

• Completion of a background check prior to obtaining their qualifying license.

• Completion of any jurisprudence requirements established by the license state.

• Payment of all required fees.

• Report to the commission of any adverse action taken by any nonparticipating (noncompact) state.(10)

Under CSG rules, “activation” of the DDHC could not begin until the model legislation had been adopted in seven states, which occurred April 22, 2024, with the passage of DDHC by the state of Maine. As of this writing, the DDHC has become law in:

• Colorado

• Washington

• Kansas

• Minnesota

• Iowa

• Wisconsin

• Maine

• Ohio

• Virginia

• Tennessee

• Arkansas

The following states are considering passage of the DDHC:

• Oregon

• Nevada

• Arizona

• Nebraska

• Oklahoma

• Texas

• Missouri

• Indiana

• Pennsylvania

• New Jersey

• Vermont

• New Hampshire

• Massachusetts

The DDHC is now ready for “activation,” but there are still significant steps on the implementation timeline (see “What’s Next” section below).

What You Need to Know About the AADB Compact

The AADB is a national organization representing state dental boards. Unlike the DDHC, the AADB Compact draft legislation creates a centralized mechanism for dentists and dental hygienists to obtain and maintain licensure in multiple states. The full text of the AADB Compact can be found here: aadbcompact.org/wp-content/uploads/2024/11/IDDHL-Compact-Official-Final-version2-11-13-2024.pdf.

In order for a dentist licensed in an AADB Compact state to receive a license in another AADB Compact state, they must:

• Graduate from a CODA-approved dental school.

• Pass the ADEX dental licensure exam; or have been in practice five years or more and passed a regional board examination or equivalent state-administered psychomotor licensure examination prior to Jan. 1, 2024.

• Pass the written National Dental Board Exam administered by the Joint Commission on National Dental Examinations.

• Possess a “full and unrestricted dental license” issued by an AADB Compact State Dental Board.

• Never have been “convicted or received adjudication, deferred adjudication, community supervision, or deferred disposition for any offense (other than traffic offenses) by a court of appropriate jurisdiction.”

• Never have been “a subject of discipline by a licensing agency through any adverse action, order, or other restriction of the licensee by a licensing agency, with the exception of failure to pay fees or failure to complete continuing education.”

• Never had “a state or federal drug registration, permit, or license restricted, suspended, or revoked by the U.S. Drug Enforcement Administration or any licensing agency that oversees scheduled drug registrations.”

• Not “currently be under active investigation by a licensing agency or law enforcement authority in any state, federal or foreign jurisdiction.”

• Meet any jurisprudence requirement in the AADB Compact state in which they are seeking a license.(11)

While the AADB will issue a “compact privilege” to a successful applicant through this process, the license itself is issued directly by the dental board of the compact state in which the dental professional seeks a new license.

As of this writing, no state has passed AADB Compact legislation, though the AADB Compact website cites pending legislation in Texas, Oklahoma, Missouri, Kentucky, Mississippi, Pennsylvania, Massachusetts and Maryland. Notably, several of these states also have pending legislation that would adopt the DDHC, which means the state in which you as a dental professional are currently licensed may be considering legislative adoption of both compacts, only one of which is likely to succeed.

Can States Have Both Compacts?

While there is no necessity for a state to adopt either compact, a state could theoretically adopt both, since there is a difference between the privilege to practice and actually receiving a license. However, each compact requires the passage of a different state legislation and is governed by a different commission, with each commission requiring significant participation from the compact state dental board. The DDHC Compact Commission, already in development, requires a commissioner to be appointed from the dental board of each compact state. The AADB Compact Commission would require two representatives from each compact state dental board. The pathways to practice created by each compact are not exclusive, and individual state dental boards may be supporting one draft legislation and opposing another. This creates the opportunity for dental professionals to become involved in whatever debate is happening at their state boards.

What’s Next?

With the DDHC Commission now in place and having recently approved its bylaws, the commission has begun the process of creating the data system to support application record collection and maintenance. This process is expected to continue into 2026, at which point compact states will onboard, followed by the opening of the privilege application process to dentists and dental hygienists.

As no state has yet passed legislation allowing it to join the AADB Compact, no AADB Compact Commission is in place. However, the AADB already maintains a licensure depository containing disciplinary actions for dentists in all states. Unlike the DDHC, which could not move forward until legislation was adopted in seven states, the AADB Compact process does not require a minimum number of compact states in order to begin functioning. If pending AADB Compact legislature passes in two or more states, creation of a commission could follow, but the AADB has not published any timeline.

Whether or not states adopt one of the compacts, license portability for military members is an important issue for dental boards. Fees are waived for military dental professionals and their spouses under both compacts, and states such as North Carolina are independently streamlining the process for obtaining dental professional licenses by military endorsement and at an accelerated pace.(12) If you are a dentist or dental hygienist in a military family or practice in multiple states for another reason, rest assured that license portability will continue to be the subject of state action in the years to come.

Jake Kathleen Marcus, JD, PGDip, has been a regulatory lawyer primarily in the healthcare space for over 35 years. A graduate of Temple University School of Law, where they served as research editor of the Temple Law Review, they recently earned a postgraduate diploma in technology, media and telecommunications law from Queen Mary University of London School of Law. To comment on this article, email impact@agd.org.

AGD’s Stance on Dental Compacts

The AGD Legislative and Governmental Affairs and Dental Practice councils are monitoring the two dental compacts in the various state legislatures, and AGD has not taken a position in support or opposition of either compact. AGD Policy 92:33-H-7 supports licensure by credentials for licensed dentists who: 1) have passed national boards; 2) have passed a state or regional licensure exam; 3) have passed a jurisprudence exam if required by a state; and 4) have not violated any law or ethical duty in their home state.

References

1. National Center for Interstate Compacts. “Dentist and Dental Hygienist Compact.” The Council of State Governments, ddhcompact.org. Accessed 4 April 2025.

2. “Interstate Dental & Dental Hygiene Licensure Compact.” American Association of Dental Boards, aadbcompact.org. Accessed 4 April 2025.

3. “Position Statement on Selection of a Dentist and Dental Hygienist Compact.” The North Carolina State Board of Dental Examiners, March 2024, ncdentalboard.org/PDF/Compact%20Position%20 Statement%20%20Mar%2024.pdf.

4. American Dental Association. “Myths vs. Truth About Dental Education, Testing, and the DDH Compact.” DDH Compact, ddhcompact.org/wp-content/uploads/sites/31/2024/03/Myths-and-Truths-in-Testing-and-Examination.pdf. Accessed 4 April, 2025.

5. The Council of State Governments. National Center for Interstate Compacts, compacts.csg.org/. Accessed 4 April 2025.

6. The Council of State Governments. “Occupational Licensing Policy.” National Center for Interstate Compacts, compacts.csg.org/our-work/licensing/. Accessed 4 April 2025.

7. The Council of State Governments. Interstate Teacher Mobility Compact, National Center for Interstate Compacts, teachercompact.org/. Accessed 4 April 2025.

8. The Council of State Governments. Social Work Licensure Compact, National Center for Interstate Compacts, swcompact.org/. Accessed 4 April 2025.

9. The Council of State Governments. Interstate Compact for School Psychologists, National Center for Interstate Compacts, schoolpsychcompact.org/. Accessed 4 April 2025.

10. “Frequently Asked Questions.” Dentist and Dental Hygienist Compact, ddhcompact.org/faq/. Accessed 4 April 2025.

11. Interstate Dental and Dental Hygiene Licensure Compact, 13 Nov. 2024, aadbcompact.org/wp-content/uploads/2024/11/IDDHLCompact-Official-Final-version2-11-13-2024.pdf.

12. North Carolina General Statutes. Chapter 93B, Occupational Licensing Boards, § 93B-15.1. Licensure for individuals with military training and experience; proficiency examination; licensure by endorsement for military spouses; temporary license. ncleg.gov/Enacted-Legislation/Statutes/PDF/By-Section/Chapter_93B/ GS_93B-15.1.pdf. Accessed 4 April 2025.