How to Become a Dental Hygienist


Dental hygienist

Dental hygienist is a career that has great potential, with above-average job growth in most parts of the United States. The career outlook is changing and improving over time, due to several factors:

The growing number of older Americans, who have kept their natural teeth more than prior generations, and who require more dental and overall health care

The increased emphasis on preventive dental care in society, with a focus on cleaning and regular maintenance to prevent more serious problems later

Older dentists, who are less likely to use hygienists, are retiring, and being replaced by younger dentists, who are accustomed to employing hygienists in their dental practice

Overall, the job outlook is projected to grow by 20-35% in the years from 2016 to 2026, making this a fantastic time to become a dental hygienist.

About Being a Dental Hygienist? 

According to Forbes Magazine, being a dental hygienist is one of the best jobs that doesn't require a bachelor's degree. They enjoy an average starting salary of ~$45,000, and a median salary of ~$73,000 a year. Being a dental hygienist is a great way to earn a good income, and join the expanding health care industry, without investing in a four-year degree. Dental hygienists can enter the work force with less of a student loan burden and are therefore able to enjoy more disposable income out of their salary.

In contrast, dental assistants typically earn a little more than half the wages of a hygienist. Since it takes one year of study to become an assistant, and just two years to become a hygienist, many people think it is worth the time investment to pursue the additional education and become a hygienist.

Hygienists work in dentist's offices, cleaning teeth and providing preventative dental care. The exact scope of their job duties depends on the state and dental practice in which they work, but hygienists are generally expected to:

  • Perform routine cleaning of teeth
  • Perform screening of teeth for disease
  • Take dental x-rays
  • Apply preventive agents to teeth
  • Educate patients on how to care for their teeth

Patient education is a crucial role for the hygienist. Their examination determines whether a patient is practicing proper oral care at home, and their encouragement, education, and advice plays a critical role in whether a patient takes proper care of their teeth between visits.

Requirements for Becoming a Dental Hygienist

The requirements for being a dental hygienist are determined by each state, and each state licenses hygienists slightly differently. However, the states are generally guided by the procedures detailed by the American Dental Association (ADA) and their accreditation services. Hygienists must complete an accredited dental hygiene education program, then pass written and clinical exams to become licensed.

1. Education

The best and most reliable dental hygiene education programs are the ones that are accredited through the Commission on Dental Accreditation (CODA). There are currently 335 CODA-accredited dental hygiene programs in the United States. These programs are generally offered through four-year universities, community colleges, dental schools, or technical and vocational schools. Generally speaking, it takes two years of study to complete dental hygienist training, but some schools offer accelerated programs that can be completed in a shorter amount of time.

Most CODA-accredited dental hygiene programs include a clinical rotation before graduation, where an aspiring hygienist gains practical experience in the field.

2. ​Written exam

After graduation from an accredited program, hygienists must go on to pass a written examination called the National Board Dental Hygiene Examination (NBDHE). This examination is administered nationwide, usually through Pearson VUE testing centers.

3. ​Clinical exam

:These examinations are administered by different agencies in different regions, and the requirement can vary by state. Kentucky, for example, recognizes the exam results of any nationally approved agency, while New York only recognizes approval from the North East Regional Board of Dental Examiners. California and Delaware each have their own specific clinical examinations.

Generally speaking, the practical exam covers treatment selection and radiography. Some regions also include computer skills, and some regions include the administration of local anesthesia.

4.  Additional requirements for a dental hygienist's license

In many states, there are additional requirements in order to become a licensed hygienist, which may include:

  • Passing a state jurisprudence examination, indicating understanding of the state's laws and requirements governing dental practices and dental hygiene
  • Certification in Basic Life Support (BLS)
  • Passing a criminal background check
  • Obtaining a child abuse clearance
  • Providing proof of current medical vaccination and immunization status
  • Training or certification in work-related skills, such as nitrous oxide administration, infection and barrier control, or other skills

5.  License renewal

In most states, a dental hygienist's license is good for one year, and must be renewed annually. Many states have an ongoing education requirement in order to renew the license, so hygienists must prove that they have completed a certain amount of study in the preceding year.

What Makes a Good Dental Hygienist

If you are considering a career as a hygienist, you probably already know that it takes more than education and study. It is a profession that requires a balance of technical and interpersonal skills, and not everyone has the temperament for it. It's not about just doing the work well, but also about doing work that you find satisfying and enjoyable. Some qualities that help make a hygienist both happy and successful are:



Depending on the practice a hygienist works in, patients may range from quite young to quite old, and they will be dealing with people all day long. It helps to have a friendly, positive attitude.


Many people experience a degree of anxiety about dental work. In fact, 75% of American adults have some degree of fear of the dentist, and, in 5-10% of people, it is a full-blown phobia. The ability to take extra time to calm anxiety, explain the procedures, and connect them to improved health, will help put patients at ease.

Attention to detail

The mouth is small, and deposits of plaque and tartar can be tiny. Imperfections on an x-ray may be hard to spot. A hygienist needs to be able to see and react appropriately to small details, while also being continuously attentive to barriers and health protocols. It’s detail-oriented work.


Even small motions inside the mouth can potentially be painful to a patient. A hygienist has to have a lot of manual dexterity to use implements with care and precision.

Technical ability

A hygienist doesn’t just work with people. They work with computers, precision instruments, and medical devices all day. It’s important to understand the technical aspect of the work and proficiently operate equipment.


The work of a hygienist involves long hours either standing, or bent over, with repetitive motion. It can be physically taxing to perform these tasks all day.


The best hygienists are motivated by a desire to help others, to educate, and to care for people. Passion makes the work enjoyable day after day and year after year.


Some people will possess many of these qualities, and most people are stronger in some areas than others. But it’s a good idea to do an honest self-assessment to determine if the work of a hygienist is right for you.

How to Become a ​Dental Hygienist

If the bright career prospects and good salary of a hygienist appeals to you, and you think you have an aptitude for the work, congratulations! Here are the next steps toward becoming a dental hygienist.

1. Education

Research schools in your area. At minimum, you will need an associate degree to start work in the field, but you may want to pursue a bachelor's degree, or even a master's.

Look for a school that:

  • Is accredited: Your school should be CODA-accredited for your education to move you quickly toward licensing. Because of the requirements for practical coursework in a clinical setting, it is usually not possible to attend dental hygiene schools online, although licensed hygienists can often go on to pursue higher education and continuing education on the internet. When in doubt, check the website of the American Dental Association to verify accreditation
  • Has a good reputation: When possible, find a dental hygiene program that has a good reputation in your community. Because the requirements are so state-specific, you will typically want to go to school in the same state or region where you intend to work. It's good to attend a school with a good reputation among students and dental offices alike, to increase your chances of getting a job after you graduate.

2. NBDHE exame

After you have completed your education, you must pass the National Board Dental Hygiene Examination (NBDHE) exam. The NBDHE test consists of 350 multiple-choice questions.

The first 200 questions cover:

  • Scientific aspects of dental practice, including subjects like anatomy, biochemistry, microbiology, pathology, and pharmacology
  • Providing dental hygiene services, including assessing patients, interpretation of radiographs, performing periodontal procedures, using preventive agents, and providing supportive services
  • Community health principles, including promoting health and preventing disease, participating in community programs, and analyzing scientific literature

The next 150 questions cover 12-15 specific examples of dental patient cases. Each exam includes at least one geriatric, special needs, pediatric, adult periodontal, or medically compromised case. These questions address scenarios like:

  • Assessing patient characteristics
  • Obtaining and interpreting radiographs
  • Using preventive agents
  • Planning dental hygiene care
  • Providing supportive treatment services

The test is administered at Pearson VUE centers across the country. In order to take the exam, you need to first obtain a user ID from the Joint Commission on National Dental Examinations and apply for the exam. These can be done at the ADA website, and should be done about 3 months before you plan to take the test, to increase the chances that you can choose the testing time and day that works best for you. There is a testing fee, so expect to pay around $400 to take the test. If you attempt to reschedule your test with less than 24-hours’ notice, you can expect to forfeit that fee, and pay it again for a second appointment.

Taking the test

  • Most people study for 2-3 months before taking the NBDHE exam
  • When arriving to take the test, you should arrive 30-40 minutes early. Expect to present 2 forms of ID, get fingerprinted, and empty your pockets before taking the test. Most test centers have lockers available where you can store your belongings
  • The test is given on computers and is separated into two 3.5-hour test blocks, with a half hour lunch period in between. You also have two optional unscheduled breaks available.

Tests are scored as pass/fail, and results are posted within 4-6 weeks of your testing date. If you pass the test on the first try, congratulations!

If you fail the exam:

  • If you fail the test, you will get a copy of your numerical scores, so you can identify areas for further study. You have to wait 90 days before attempting to retake the test. If you fail it again, you must wait 90 days to retake it again
  • If you fail the exam three times, you must wait a year before taking it a fourth time, and another year for the fifth
  • If you fail the exam five times, you have to personally petition the ADA for permission to attempt the exam again

3. Clinical exam

Clinical dental hygiene examinations are administered by different boards for their region or state:

  • Council of Interstate Testing Agencies (CITA)
  • Central Regional Dental Testing Services (CRDTS)
  • North East Regional Board (NERB) of Dental Examiners
  • Southern Regional Testing Agency (SRTA)
  • Western Regional Examining Board (WREB)
  • California Clinical Dental Hygienist Examination (California only)
  • Delaware Practical Board Examination in Dental Hygiene (Delaware only)

Many states require that hygienists complete both the written and clinical examinations within 18 months of graduation in order to be licensed. Some regional exams also have a written component as well as a practical one.

In order to take the test, candidates need to register and apply with their regional board. Generally speaking, candidates need to present proof of graduation from an accredited dental hygiene program before taking the clinical exam. In many regions, students who have not yet graduated may instead submit a letter from their program director verifying that they are in good standing and expected to graduate within 45 days to 1 year (depending on the region) of the exam date. Some regions also require proof of CPR certification at this time.

Fees to take the test range from $950-$1000 for the base exam. In some regions, there are also additional fees for the testing site, or additional fees for certification in local anesthesia or other skills. In most regions, these fees also cover the cost of professional liability insurance for the hygienist upon certification.

While specifics vary from region to region, the clinical exam includes:

  • A treatment component, where the candidate selects 6-8 teeth or a quadrant, of which some teeth must include subgingival calculus.
  • A radiograph component, where the radiographs must be of diagnostic quality
  • Administration of local anesthesia, if applicable

If you fail the test, many regions require candidates to re-register and pay the entire fee over again, but some regions allow reduced fees for only retaking a failed portion or component of the test.

Starting a Dental Hygiene Career

Dental hygiene is an area currently undergoing tremendous growth. In 2014, 86% of hygienists said that it was difficult to find work. In 2016, just two years later, only 63% were having trouble finding work. In some states, there is more competition than others, with the western states generally having more job opportunities and higher average wages than the southeastern states.

Many dental hygiene schools offer assistance with job placement, which is helpful when just beginning your career. In addition to most conventional online job search websites, hygienists can find job listings at industry-specific websites like and Dentist Job Cafe.

  • Continuing education

Many states require dental hygienists to complete a certain amount of ongoing education hours every year, in order to maintain their license. These can generally be online or community classes, and many states require just 10-20 hours a year. Check with your state's board to determine if this is a requirement for you, and what kinds of classes meet the criteria.

Being a dental hygienist is a career in which you can truly help people, while enjoying a good salary and a good work/life balance. Because many dental practices keep regular office hours, the work is steady and predictable, and doesn't intrude on your personal time, unlike many jobs. There is tremendous potential to enter the field, and a lot of opportunities to grow. Take advantage of the changing healthcare industry and start a career as a dental hygienist now.

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