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.
2021 CLINICAL EXAMINATIONS ACCEPTED FOR LICENSURE: On October 23, 2020 the Board decided to accept passage of a manikin simulation restorative and periodontal exam taken in 2021 which is administered by testing agencies accepted by the Board (CITA, CDCA, SRTA, CRDTS and WREB) as addressed in Virginia’s applications for licensure. The Board will continue to accept live patient exam results from the testing agencies addressed in Virginia’s application information.
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.
2021 CLINICAL EXAMINATIONS ACCEPTED FOR LICENSURE: On October 23, 2020 the Board decided to accept passage of a typodont clinical examination which includes scaling on a manikin which is administered by testing agencies accepted by the Board (CITA, CDCA, SRTA, CRDTS and WREB) as addressed in Virginia’s applications for licensure. The Board will continue to accept live patient exam results from the testing agencies addressed in Virginia’s application information.
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 December 2020
Application for a Temporary Dental Hygiene Permit (pdf) - Revised December 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 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 March 2021
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