Licensure and Practice

In order to be licensed as a dental hygienist in the state of North Carolina, an applicant must have successfully completed the Dental Hygiene National Board Examination and the CITA (Counsel on Interstate Testing Agency) examination.  North Carolina also has a Licensure by Credential status for Hygienists moving to the state.  Specifics can be found at the following websites.

Frequently Asked Questions

In which US states are dental hygienists allowed to practice under general supervision (patient of record, but dentist not required to be onsite while dental hygienist is performing prescribed treatment.) in a private dental office?

A large number of state legislatures have voted to allow general supervision in the dental office as part of the solution to access to dental hygiene care. It is easier to list the states that do NOT allow general supervision in private practice: MS, AL, GA, NC (as of Aug, 08) Visit the ADHA website ( and click on the governmental affairs section for maps and minimum requirements for general supervision in each state.

What is SPICE? Do I need this program?

North Carolina Administrative Code 10A NCAC 41A.0206 requires that each health care organization that performs invasive procedures (including dental offices) shall implement a written infection control policy, designate a staff member to direct infection control activities, and the designated staff member shall have successfully completed a course in infection control approved by the State Health Department. Development of the course and certification of course providers is handled by the NC Statewide Program for Infection Control and Epidemiology (SPICE) staff.

The office infection control officer must attend a SPICE training course if they: do not have the state required course completion certificate, graduated from dental and dental auxiliary programs outside of NC, graduated from an NC dental or dental auxiliary program prior to 2000, were on-the-job trained, or are a dentist who is unfamiliar with this law and course. SPICE staff are in the process of documenting that all post 2000 dental and dental auxiliary programs in NC have taught from the North Carolina Basic Infection Control Curriculum for Health Care Facilities and are registered with SPICE. If you are unsure of whether you are required to become SPICE certified, ask the faculty at the dental/dental hygiene/dental assisting school that you attended, or contact the SPICE office at

The course takes about 8 hours to complete, and covers sterilization, disinfection, microbiologic monitoring, parenteral injection infection control, accessibility of infection control devices and supplies, and medical waste disposal.

Last month my employing dentist asked my opinion about having “scaling assistants” in the office. What is a “scaling assistant”?

Each state licensing board is allowed to designate the expanded functions of hygienists and assistants according to their individual state’s dental practice act. Currently, NC law does not provide for a dental assistant who can legally scale. The ADA is proposing two new dental health care personnel categories whose proposed preventive scope includes scaling of type I perio/gingivitis cases. In NC, legislative changes to the dental practice act would have to be enacted before scaling by dental assistants would be legal. For further information on these two new dental personnel categories, please visit the ADA website ( , and click on “Careers in Dentistry: Community Dental Health Coordinator” and “Careers in Dentistry: Oral Preventive Assistant.

What is an Advanced Dental Hygiene Practitioner?

Many different organizations are proposing that a mid-level dental hygiene practitioner who can perform both preventive and limited restorative services to underserved populations could be an answer to some of the unmet dental need in America. The Advanced Dental Hygiene Practitioner is the mid-level provider model that ADHA is developing a proposed curriculum for. Before services by an ADHP would be legal in NC, legislative changes to the NC Dental Practice Act would have to be enacted. For further information, please

I have a new baby and am content working two days per week as a clinical dental hygienist in a general practice. I have neither the time nor the interest to return to school for a graduate degree anytime soon. Can I continue to practice “just as I am”?

Don’t worry…there is enough dental need to go around! If and when ADHP legislation is passed, you will not be REQUIRED to increase your scope of practice, but you will have the OPPORTUNITY to increase your scope of practice if you wish to pursue an ADHP degree.

My dentist wants to know when I can start practicing without him/her in the office.

Unfortunately, many dentists and hygienists are misinformed about the nature of the new NC limited supervision law. This legislation addresses dental hygiene practice in certain alternative sites only; such as nursing homes, assisted living centers, rural health clinics operated by Board approved non-profits, etc. Patients must have had a medical history review and a dental examination within the previous 120 days. The dentist must provide a diagnosis and written treatment plan, and retain treatment records for 10 years.

How do I become certified for limited supervision status?

The Board rules for limited supervision require that the hygienist show proof of at least 3 years or 2,000 hours of clinical hygiene practice within the previous five years, maintain CPR certification, and complete 6 hours of medical emergency CE each year. There is no formal certification process. Instead, the employing dentist must designate the hygienist as being capable of performing clinical hygiene procedures without the direct supervision of the dentist.

Are there any dental hygiene duties that I cannot perform in the alternative practice site?

The law states that the hygienist may perform “one or more dental hygiene functions as described in G.S 90-221(a)”. Basically, you are allowed to perform any hygiene duty that would be legal in a dental office.

I work as a public health hygienist for the State of North Carolina. I am willing to volunteer to clean teeth at a nursing home one day per month if a dentist could do the exams and treatment plans. Who can designate me for limited supervision?

If you meet all of the qualifications for a limited supervision hygienist and can find a dentist who will vouch for your limited supervision status, medically screen your patients, examine your patients within the prescribed time, and retain your treatment statistics, the Dental Board has ruled that you may perform a dental prophylaxis under limited supervision rules. Please contact the North Carolina State Board of Dentistry if you have further questions.

I have heard that all but a few states allow dental hygienists to administer local anesthesia injections. Why can’t we do this in NC?

As of Nov, 2009, dental hygienists are permitted to administer infiltration and/or block anesthesia in 41of the 50 states. (exceptions are TX, MS, AL, GA, FL, NC, DE, with IN and MD having rules pending.) Anesthesia administration by injection is not listed as a clinical dental hygiene procedure in G.S 90-221(a), so it is not an approved dental hygiene function in NC. Until the legislature is convinced that anesthesia administration by a dental hygienist would be safe and beneficial for patients in NC, they will not change the current law. Until NC dentists, dental hygienists, and the public demand this privilege for registered dental hygienists, it will not happen.

Need More Information?

For the specific wording of SB 1337 and associated NC Dental Board rules, see the governmental affairs section of this web page. For more information on state dental practice acts, visit the governmental affairs section of the ADHA website at . For information on the CITA exam, please visit .

Want to help?

Join your professional organization and get active in local and state issues.

Ask your employing dentist to tell the North Carolina Dental Society representatives that he/she is in favor of in-office limited supervision and local anesthesia administration by dental hygienists.

Donate toward a dental hygiene student’s CITA fees-call your local dental hygiene school for suggestions. The fee for CITA application is $750.00 plus facility fees.