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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 - Please note: 2020 CLINICAL EXAMINATIONS ACCEPTED FOR LICENSURE:  In addition to live patient clinical examinations, for 2020 only, the Board will accept from Dental licensure applicants a clinical dental examination which includes a simulated manikin exercise in restorative dentistry. The Board also decided to waive the scaling exercise with live patients in a 2020 clinical dental examination given by a testing agency accepted by the Board - CITA, CDCA, SRTA, CRDTS and WREB.

View the Instructions for Dental Hygienist license - Please note: 2020 CLINICAL EXAMINATIONS ACCEPTED FOR LICENSURE:  In addition to live patient clinical examinations, for 2020 only, the Board will accept from Dental hygiene licensure applicants a clinical dental hygiene examination which includes a Computer Simulated Clinical Examination (CSCE) OR a manikin-based clinical scaling exercise given by a testing agency accepted by the Board - CITA, CDCA, SRTA, CRDTS and WREB.

Supplemental forms are included with the above instructions or the below Miscellaneous Forms


Reactivation application for Dentists (pdf) – Revised August 2020

Reactivation application for Dental Hygienists (pdf) – Revised August 2020

Reinstatement application For Dentist (pdf) – Revised August 2020

Reinstatement application For Dental Hygienist (pdf) – Revised August 2020

Application for a Temporary Dental Permit (pdf) - Revised August 2020

Application for a Temporary Dental Hygiene Permit (pdf) - Revised July 2020

 

Deep Sedation/General Anesthesia

Application for a Permit to Administer Deep Sedation/General Anesthesia (pdf) – Revised August 2020

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 Moderate Sedation (pdf) – Revised August 2020

Reinstatement Application for a permit to administer Moderate Sedation and Deep Sedation/General Anesthesia (pdf) - Revised August 2020

 

Oral and Maxillofacial Surgeon/Cosmetic Procedure Certification

Oral and Maxillofacial Surgeon Registration of Practice (pdf) – Revised August 2020

Oral And Maxillofacial Surgeon Reinstatement Of Registration Of Practice (pdf) – Revised August 2020

Application for Certification to Perform Cosmetic Procedures (pdf) – Revised August 2020

Reinstatement of Certification to Perform Cosmetic Procedures (pdf) - Revised August 2020

 

Temporary Resident / Faculty

Application for Temporary Resident’s License (pdf) – Revised August 2020

Application for a Faculty License to Teach Dentistry (pdf) – Revised August 2020

Application for a Dental Hygiene Faculty License (pdf) – Revised August 2020

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 (pdf) – Revised August 2020

 

Volunteer Practice

Application for Restricted Volunteer Dental License (pdf) – Revised August 2020

Application for Restricted Volunteer Dental Hygienist License (pdf) – Revised August 2020

Application for Registration for Volunteer Dental Practice (pdf) - Revised August 2020

Application for Registration for Volunteer Dental Hygiene Practice (pdf) - Revised August 2020

Continuing Education (CE) Credit Form for Volunteer Practice - Revised May 2019

Dental Assistants II

Application for Registration as a Dental Assistant II (pdf) - Revised August 2020

Application for Reinstatement of Registration as a Dental Assistant II (pdf) - Revised August 2020

Application for Reactivation of Registration as a Dental Assistant II (pdf) - Revised August 2020

 

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/CDCA (North East Regional Board) www.cdcaexams.org
CDCA The Commission on Dental Competency Assessments
On January 9, 2015 the NERB became The Commission on Dental Competency Assessments
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 February 2020

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

Waiver Request For Electronic Transmission Of Opioid Prescriptions

Name/Address Change Form - Revised May 2019

Request for Verification of Virginia Dentist/Dental Hygienist License - Revised May 2019

Form A Dental Assistant II - Revised May 2019

Form A Dental Hygiene - Revised May 2019

Form A Dentist - Revised April 2019

Form B Dental Assistant II - Revised May 2019

Form B Dental Hygiene - Revised May 2019

Form B Dentist - Revised April 2019

Form C Dental Assistant II - Revised May 2019

Form C Dental Hygiene - Revised May 2019

Form C Dentist - Revised April 2019

Pre-Inspection Survey Form - Revised May 2019

Petition for Rule-Making Form - Revised March 2019