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Virginia Board of Dentistry
Forms, Applications, and Exam Info

Unless otherwise noted, the below documents are in Microsoft Word format. If you do not have Microsoft Word, you can get the Microsoft® Word Viewer 97/2000 to view and print documents. To view the PDF files below you'll need the free Adobe Acrobat Reader.

Dentist / Dental Hygienist Forms

Applicants for a Dental license (by Examination or Credential) or a Dental Hygienist license (by Examination or Endorsement) are now accepted online. Click here to begin the online application process for a Dental license or Dental Hygienist license.

View the Instructions for Dental license

View the Instructions for Dental Hygienist license

FORM A- Certification of Dental/Dental Hygiene School (Fillable form)

FORM A- Certification of Dental/Dental Hygiene School (PDF)



Reactivation application for Dentists – Revised January 2017

Reactivation application for Dental Hygienists – Revised January 2017

Reinstatement application For Dentist – Revised January 2017

Reinstatement application For Dental Hygienist – Revised January 2017

Application for Dental Temporary Restricted Permit (§54.1-2715) - contact the Board of Dentistry for an application

 

Deep Sedation/General Anesthesia

Application for a Permit to Administer Deep Sedation/General Anesthesia – Revised May 2017

Conscious/Moderate Sedation

NOTICE: The Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students adopted by the American Dental Association in October 2016 detail the current education standards for a moderate sedation course. The October 2016 Guidelines no longer include provisions for a course to administer only by an enteral method. Any moderate sedation course taken on or after November 1, 2016 must meet the October 2016 Guidelines in order for an applicant to qualify for a conscious/moderate sedation permit in Virginia. These Guidelines must be met to qualify to administer by any method and to qualify to administer by an enteral method only. Please download the Guidelines using this link.

Application for a Permit to Administer Conscious/Moderate Sedation – Revised May 2017

 

Oral and Maxillofacial Surgeon/Cosmetic Procedure Certification

Oral and Maxillofacial Surgeon Registration of Practice – Revised December 2015

Oral And Maxillofacial Surgeon Reinstatement Of Registration Of Practice – Revised December 2015

Application for Certification to Perform Cosmetic Procedures – Revised December 2015

Reinstatement of Certification to Perform Cosmetic Procedures - Revised December 2015

 

Temporary Resident / Faculty

Application for Temporary Resident’s License – Revised January 2017

Application for a Faculty License to Teach Dentistry – Revised January 2017

Application for a Dental Hygiene Faculty License – Revised January 2017

Application for Restricted License to teach dentistry for foreign dentists (§54.1-2714) - contact the Board of Dentistry for an application

 

Mobile Dental Facility / Portable Dental Operation

Application for Registration of a Mobile Dental Facility or Portable Dental Operation – Revised December 2, 2015

 

Volunteer Practice

Application for Restricted Volunteer Dental License – Revised January 2017

Application for Restricted Volunteer Dental Hygienist License – Revised December 2, 2015

Application for Dental Volunteer License - Revised December 2, 2015

Application for Dental Hygienist Volunteer License - Revised December 2, 2015

 

Dental Assistants II

Application for Registration as a Dental Assistant II - Revised January 2017

Application for Reinstatement of Registration as a Dental Assistant II - Revised January 2017

Application for Reactivation of Registration as a Dental Assistant II - Revised January 2017

 

Exam Information

Regional Examinations

CITA (Council of Interstate Testing Agencies) www.citaexam.com
Effective September 1, 2007 accept passing scores

CRDTS (Central Regional Dental Testing Services, Inc.) www.crdts.org
Effective January 1, 2005 accept passing scores

NERB (North East Regional Board) www.nerb.org
Effective Jan. 1, 2005 accept passing scores

SRTA (Southern Regional Testing Agency) www.srta.org
Accept passing scores from any year

WREB (Western Regional Examining Board) www.wreb.org
Effective 1, 2005 accept passing scores

National Boards

Administered by the American Dental Association www.ada.org

Inspection Form

76-24.3, Inspection report for dental offices, revised December 11, 2015 (MS Word)

Dental Lab Work Orders

Dental Laboratory Work Order Form (pdf) - Revised Dec. 2012

Dental Laboratory Subcontractor Work Order Form (pdf) - Revised Dec. 2012

 

Miscellaneous Forms

Name/Address Change Form - Revised 12/2016

Request for Verification of Virginia Dentist/Dental Hygienist License - Revised March 18, 2014