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)
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 a Temporary Dental Permit - May 2017
Application for a Temporary Dental Hygiene Permit - February 2018
Deep Sedation/General Anesthesia
Application for a Permit to Administer Deep Sedation/General Anesthesia – Revised May 2017
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 – Revised December 2018
Reinstatement Application for a permit to administer Moderate Sedation and Deep Sedation/General Anesthesia - Revised December 2018
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 June 2017
Application for Dental Hygienist Volunteer License - Revised June 2017
Continuing Education (CE) Credit Form for Volunteer Practice
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/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 March 9, 2018 (MS Word)
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