# Title 20 — State Board of Dental Examiners

## Article 20-04 — Dental Hygienists

## Chapter 20-04-01 — Duties

### § 20-04-01-01. Duties.

1. A dental hygienist may perform the following services under the direct supervision of a dentist:
a. Apply resin infiltration.
b. Hold impression trays in the mouth after placement by a dentist (e.g., reversible
hydrocolloids, rubber base, etc.).
c. Place and remove matrix bands or wedges.
d. Adjust permanent crowns outside of the mouth.
e. Acid-etch enamel surfaces before direct bonding of orthodontic brackets or composite
restorations.
f. Take face bow transfers.
g. Administer emergency medications to a patient in order to assist the dentist.
2. A dental hygienist authorized by permit and under the direct supervision of a dentist may:
a. Place, carve, and adjust amalgam, glass ionomer restorations, or composite restorations
with hand instruments or a slow-speed handpiece;
b. Adapt and cement stainless steel crowns; and
c. Place, contour, and adjust composite restorations where the margins are entirely within
the enamel with hand instruments or a slow-speed handpiece.
3. A dental hygienist may perform the following services under the indirect supervision of a
dentist:
a. Administer local anesthesia as authorized by section 20-04-01-03.

b. Dry root canal with paper points.
c. Place and remove rubber dams.
d. Place retraction cord in the gingival sulcus of a prepared tooth before the dentist taking
an impression of the tooth.
e. Monitor a patient who has been inducted by a dentist into nitrous oxide inhalation
analgesia.
f. Place orthodontic brackets using an indirect bonding technique by seating the transfer
tray loaded with brackets previously positioned in the dental laboratory by a dentist.
g. Assist a dentist authorized by permit as set forth in section 20-02-01-05 as follows:
(1) Sedation procedure preparation and presedation documentation, including date of
procedure, nothing by mouth status, availability of responsible adult escort, and
allergies.
(2) Emergency equipment and use preparedness.
(3) Monitor a patient discharged by a dentist once the patient is in recovery.
(4) Documentation of patient responsiveness, vital signs, including heart rate,
respiratory rate, blood pressure, oxygen saturation, and expired carbon dioxide.
(5) Training must be documented and may be acquired directly by an employer-dentist,
by a planned sequence of instruction in an educational institution, or by in-office
training.
h. A dental hygienist authorized by permit may administer nitrous oxide analgesia to a
patient who has not taken sedative medications before treatment in accordance with
section 20-02-01-05.
4. A dental hygienist authorized by permit and under contiguous supervision of a dentist
authorized by permit to provide moderate sedation, deep sedation, or general anesthesia
may:
a. Initiate and discontinue an intravenous line for a patient being prepared to receive
intravenous medications, sedation, or general anesthesia.
b. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or
open.
c. Prepare anesthesia equipment and perform patient monitoring.
d. Assist with emergency treatment and protocols.
5. A dental hygienist authorized by permit and under direct visual supervision of a dentist
authorized by permit to provide moderate sedation, deep sedation, or general anesthesia
may:
a. Draw up and prepare medications;
b. Follow instructions to deliver medication into an intravenous line upon verbal command
of the supervising dentist;
c. Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal
command of the supervising dentist; and

d. Adjust an electronic device to provide medications, such as an infusion pump upon the
verbal command of the supervising dentist.
6. A dental hygienist may perform the following services under the general supervision of a
dentist:
a. Complete prophylaxis to include removal of accumulated matter, deposits, accretions, or
stains from the natural and restored surfaces of exposed teeth. The dental hygienist also
may perform root planing and soft tissue curettage upon direct order of the dentist.
b. Polish and smooth existing restorations with a slow-speed handpiece.
c. Apply topical applications of drugs to the oral tissues and anticariogenic caries arresting
and desensitizing solutions to the teeth.
d. Take impressions for study casts on a patient of record.
e. Take and record preliminary medical and dental histories for the interpretation by the
dentist.
f. Take and record pulse, blood pressure, and temperature.
g. Provide oral hygiene treatment planning after an oral assessment or dentist's diagnosis.
h. Take dental radiographs.
i. Apply therapeutic agents subgingivally for the treatment of periodontal disease.
j. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with
hand instruments or a slow-speed handpiece.
k. Receive removable dental prosthesis for cleaning and repair.
l. Take occlusal bite registration for study casts.
m. Fabricate, adjust, place, recement, or remove a temporary crown, bridge, onlay, or
temporary restorative material. This applies only to dentitions actively under treatment for
which a permanent restoration is being fabricated.
n. Perform nonsurgical clinical and laboratory oral diagnostic tests for interpretation by the
dentist.
o. Apply pit and fissure sealants. Adjust sealants with slow-speed handpiece.
p. Place and remove periodontal dressings, dry socket medications, and packing.
q. Remove sutures.
r. Take impressions for fixed or removable orthodontic appliances, athletic mouth guards,
bleaching trays, bite splints, flippers, and removable prosthetic repairs.
s. Preselect and prefit orthodontic bands.
t. Place, tie, and remove ligature wires and elastic ties, and place orthodontic separators.
u. Place and remove arch wires or appliances that have been activated by a dentist.
v. Cut and remove arch wires or replace loose bands, loose brackets, or other orthodontic
appliances for palliative treatment.

w. Provide an oral assessment for interpretation by the dentist.
x. Orally transmit a prescription that has been authorized by the supervising dentist.
y. Repack dry socket medication and packing for palliative treatment.
z. Screenings as defined in section 20-01-02-01.
aa. Apply bleaching solution, activate light source, and monitor and remove bleaching
materials.
bb. Apply interim therapeutic restorations using the standards and protocols established by
an authorizing dentist and after completion of a board-approved course.
cc. Adjust a temporary denture or partial for dentitions actively under treatment for which
permanent dentures or partial dentures are being fabricated.
dd. Produce on a patient of record, a final scan by digital capture for review and inspection
by the authorizing dentist for a prescriptive fixed or removable appliance.
History: Effective September 1, 1980; amended effective February 1, 1992; October 1, 1993; May 1,
1996; August 1, 1998; April 1, 2000; July 1, 2004; April 1, 2006; January 1, 2011; April 1, 2015; July 1,
2017; April 1, 2021; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.2, 43-20-03, 43-20-11, 43-20-12
### § 20-04-01-02. Prohibited services.

A dental hygienist may not perform the following services:
1. Diagnosis and treatment planning.
2. Surgery on hard or soft tissue.
3. Administer anesthetics, except topical and local anesthetic, as permitted under sections
drugs without a board authorized permit.
4. Unless authorized by permit in accordance with section 20-04-01-03.1 monitor a patient who
has been induced to moderate sedation, deep sedation, or general anesthesia until the dentist
authorized by permit to administer sedation or anesthesia determines the patient may be
discharged for recovery.
5. Any irreversible dental procedure or procedures which require the professional judgment and
skill of a dentist.
6. Adjust a crown which has been permanently cemented.
7. Activate any type of orthodontic appliance or fabricate impressions for an individual who is not
a patient of record.
8. Cement or bond orthodontic bands or brackets that have not been previously placed by a
dentist.
9. Place bases or cavity liners.
10. Use a high-speed handpiece inside the mouth.

History: Effective February 1, 1992; amended effective October 1, 1993; July 1, 2004; January 1,
2011; April 1, 2015; April 1, 2021; July 1, 2022.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-03; 43-20-11, 43-20-12, 43-20-12.3
### § 20-04-01-03. Duties of dental hygienists - Administration of local anesthesia - Authorization.

A dental hygienist may perform the following services under the indirect supervision of a dentist:
1. A licensed dental hygienist may apply for authorization to administer local anesthesia to a
patient.
2. Requirements for local anesthesia authorization are as follows:
a. A licensed dental hygienist shall submit evidence that the hygienist successfully
completed a didactic and clinical course in local anesthesia within the last five years
sponsored by a dental or dental hygiene program accredited by the commission on
dental accreditation of the American dental association resulting in the dental hygienist
becoming clinically competent in the administration of local anesthesia; or
b. A licensed dental hygienist shall submit evidence that the hygienist has been authorized
to administer local anesthesia in another jurisdiction and provide verification of clinical
competency during the previous five years. Verification may consist of the following:
(1) A letter from the accredited school with the school seal affixed. Photocopies will not
be accepted.
(2) A notarized copy of the certification of the local anesthesia course .
(3) A notarized letter from a licensed dentist stating the licensed dental hygienist has
competently administered local anesthesia.
History: Effective July 1, 2004; amended effective April 1, 2021; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-03, 43-20-12
### § 20-04-01-03.1. Duties of the dental hygienist - Requirements of permit.

The board may issue or renew a permit to a dental hygienist for the following:
1. The board may issue or renew a class I dental anesthesia assistant permit authorizing a
dental hygienist to provide anesthesia assistance under the supervision of a dentist authorized
by permit to provide moderate sedation, deep sedation, or general anesthesia, upon
successful completion of the following:
a. The applicant submits evidence of a board-approved dental anesthesia assistant
education and training course.
b. The applicant submits proof of current certification status from the American association
of oral and maxillofacial surgeons dental anesthesia assistant national certification, or a
board-approved competency examination;
c. The applicant holds current and valid certification for health care provider basic life
support, or advanced cardiac life support or pediatric advanced life support; and
d. The applicant provides a copy of a valid North Dakota general anesthesia, deep
sedation, or moderate sedation permit of the dentist where the registered dental hygienist
will be performing anesthesia assistant services.

2. The board may issue or renew a class II dental anesthesia assistant permit authorizing a
registered dental hygienist to provide anesthesia assistance under the supervision of a dentist
authorized by permit to provide moderate sedation, deep sedation, or general anesthesia
upon successful completion of the following:
a. The applicant submits evidence of a board-approved dental anesthesia assistant
education and training course and has proof of current certification status from the
American association of oral and maxillofacial surgeons dental anesthesia assistant
national certification or a board-approved competency examination;
b. The applicant successfully has completed hands-on training in intravenous access or
phlebotomy that includes live experience starting and maintaining intravenous lines;
c. The applicant holds current and valid certification for health care provider basic life
support, or advanced cardiac life support or pediatric advanced life support; and
d. The applicant provides a copy of a valid North Dakota general anesthesia, deep
sedation, or moderate sedation permit of the dentist where the registered dental hygienist
will be performing anesthesia assistant services.
3. The board may issue or renew a permit on forms prescribed by the board authorizing a
registered dental hygienist under the direct supervision of a dentist to provide restorative
functions under the following conditions:
a. The applicant meets any of the following requirements:
(1) The applicant successfully has completed a board-approved curriculum from a
program accredited by the commission on dental accreditation of the American
dental association or other board-approved course and successfully passed a
dental testing agency restorative examination or other equivalent examinations
approved by the board within the last five years. The board may require successful
completion of the restorative function component of the dental assisting national
board's certified restorative functions dental assistant certification examination; or
(2) The applicant has successfully passed a dental testing agency restorative
examination or other board-approved examination over five years from the date of
application and successfully completed the restorative function component of the
dental assisting national board's certified restorative functions dental assistant
certification examination or other board-approved examination and provided
evidence from another state or jurisdiction where the applicant legally is or was
authorized to perform restorative functions and certification from the supervising
dentist of successful completion of at least twenty-five restorative procedures within
the immediate five years before the date of application.
b. A dental hygienist may perform the placement and finishing of direct alloy or direct
composite restorations, under the direct supervision of a licensed dentist, after the
supervising dentist has prepared the dentition for restoration.
c. The restorative functions may be performed after the patient has given informed consent
for the placement of the restoration by a restorative functions dental hygienist.
d. Before the patient is released, the final restorations must be checked and documented by
the supervising dentist.
History: Effective April 1, 2015; amended effective July 1, 2017; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-03, 43-20-12

### § 20-04-01-04. Additional requirements for licensure by examination.

The board may grant a license to practice dental hygiene to an applicant who has met the
requirements of North Dakota Century Code section 43-20-01.2 and all the following requirements:
1. The applicant has passed the examination administered by the joint commission on national
dental examinations or the dental hygiene certification board of Canada within five years of
application.
2. The applicant has passed, within five years of application, a clinical competency examination
administered by a dental testing agency approved by the board.
History: Effective January 1, 2011; amended effective April 1, 2021; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.2
### § 20-04-01-04.1. Clinical competency examination retakes.

A dental hygiene applicant may take a clinical examination three times before remedial training is
required. After failing the examination for a third time, and prior to the fourth attempt of the examination,
an applicant shall:
1. Submit to the board a detailed plan for remedial training by an accredited dental hygiene
school or a dental testing agency. The proposed remedial training must be approved by the
board.
2. Submit proof to the board of passing the remedial training within twenty-four months of its
approval by the board. The board may grant or deny a fourth attempt of the clinical
examination. A fourth attempt must occur within twelve months of the date of the board's
decision. If an applicant fails any part of the examination after remedial training, additional
retakes must be approved by the board.
History: Effective April 1, 2015; amended effective October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.2
### § 20-04-01-05. Additional requirements for licensure by credential review.

The board may grant a license to practice dental hygiene to an applicant who has met the
requirements of North Dakota Century Code section 43-20-01.3 and all the following requirements:
1. The applicant has successfully completed a cardiopulmonary resuscitation course within two
years of application.
2. The applicant has the physical health and visual acuity to enable the applicant to meet the
minimum standards of professional competence.
3. The applicant has completed sixteen hours of continuing education in accordance with section
History: Effective January 1, 2011.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.3

### § 20-04-01-05.1. Refresher course - Reentry.

An eligible dental hygienist may return to the practice of dental hygiene upon submitting an
application fee and application on a form provided by the board, providing proof of having successfully
completed a refresher course approved by the board, and meeting the following requirements:
1. Was previously licensed to practice dental hygiene in another state or jurisdiction where the
licensure requirements were substantially equivalent.
2. Grounds for denial of the application under North Dakota Century Code section 43-20-05 do
not exist.
3. The applicant has passed, within one year of making application, a written examination on the
laws and rules governing the practice of dentistry in this state.
4. Has successfully completed a cardiopulmonary resuscitation course within the previous two
years.
5. Has the physical health and visual acuity to enable the applicant to meet the minimum
standards of professional competence.
6. Has practiced dental hygiene.
7. Has successfully completed a refresher course approved by the board that meets the
following minimum criteria:
a. Taught at a dental hygiene school accredited by the American dental association's
commission on dental accreditation;
b. Consists of a minimum of forty-three clock-hours, including a minimum of thirty-two
clock-hours of clinical instruction;
c. Includes didactic coursework, which may be presented in a classroom or independent
study setting, or both, and clinical coursework covering the following:
(1) Infection control and sterilization;
(2) Patient assessment, including the taking of health histories, an oral inspection and
evaluation, and charting;
(3) Radiographic techniques;
(4) Instrumentation techniques, including periodontal procedures and instrument
sharpening;
(5) Current techniques in the polishing of teeth and the application of fluoride;
(6) Patient education; and
(7) Office emergency situations.
8. A formerly licensed dental hygienist who is returning to the practice of dental hygiene may not
administer local anesthesia or nitrous oxide until having completed courses of instruction in
local anesthesia and nitrous oxide approved by the board.
9. Anything necessary for a criminal history record check pursuant to North Dakota Century
Code section 43-28-11.2.
10. The applicant may be required to appear before the board.

History: Effective July 1, 2022.
General Authority: NDCC 43-28-06
Law Implemented: NDCC 43-20-01.3, 43-20-10
### § 20-04-01-06. Additional requirements for applications.

Applications must be completed within twelve months of filing. The board may require an interview
with the applicant. In addition to the application requirements of North Dakota Century Code sections
43-20-01.2, 43-20-01.3, and 43-20-06, the board may require an application to include:
1. Proof of identity, including any name change.
2. An official transcript sent by an accredited dental school directly to the board.
3. Evidence demonstrating the applicant passed the examination administered by the joint
commission on national dental examinations within two years of application.
4. Evidence demonstrating the applicant passed a clinical competency examination, approved by
the board, within two years of application.
5. A certification, from the licensing board of every jurisdiction in which the applicant is licensed,
that the applicant is licensed in good standing.
6. Certification that the applicant has completed a cardiopulmonary resuscitation course within
two years of application.
7. Verification of physical health and visual acuity.
8. For applications for licensure by credential review, the law and rules stating the requirements
for licensure, when the applicant was licensed, of the jurisdiction in which the applicant is
licensed.
9. For applications for licensure by credential review and reinstatement from inactive status,
proof of completion of sixteen hours of continuing education in accordance with section
10. Any information required by the application forms prescribed by the board.
History: Effective January 1, 2011; April 1, 2015.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.2, 43-20-01.3, 43-20-06
### § 20-04-01-07. Inactive status - License reinstatement.

A dental hygienist may, upon payment of the fee determined by the board, place the dental
hygienist's license on inactive status. A dental hygienist on inactive status shall be excused from
continuing education requirements. Inactive status must be renewed annually by completing the
inactive status renewal application and paying the renewal fee. A dental hygienist on inactive status
shall not practice dental hygiene in North Dakota. To reinstate a license on inactive status, the dental
hygienist shall apply on a form prescribed by the board, pay a reinstatement fee, and meet all of the
following requirements:
1. The applicant has passed a clinical competency examination administered by a regional
dental testing service, approved by the board in section 20-04-01-04, within two years of
application. The board may, within the board's discretion, waive this requirement.
2. The applicant passes a written examination on the laws and rules governing the practice of
dentistry in this state administered by the board at a meeting.

3. The applicant has completed sixteen hours of continuing education in accordance with section
4. The applicant has successfully completed a cardiopulmonary resuscitation course within two
years of application.
5. Grounds for denial of the application under North Dakota Century Code section 43-20-05 do
not exist.
History: Effective January 1, 2011; amended effective July 1, 2017; April 1, 2021.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-06
### § 20-04-01-08. Continuing dental education for dental hygienists.

Each dental hygienist shall provide evidence of attendance or participation in continuing clinical
dental education in accordance with the following conditions:
1. Continuing education activities include publications, seminars, symposiums, lectures, college
courses, and online education.
2. The continuing dental education hours accumulate on the basis of one hour of credit for each
hour spent in education. Subject matter directly related to clinical dentistry must be accepted
by the board without limit.
3. The minimum number of hours required within a two-year cycle is sixteen. Of these hours, a
dental hygienist may earn no more than eight hours from self-study. Self-study is an
educational process designed to permit a participant to learn a given subject without
involvement of a proctor or without the opportunity to interact in real-time with the proctor. A
qualified professional may act as a proctor who oversees a clinical continuing education
course which may be used for classroom style continuing education credits. Cardiopulmonary
resuscitation courses must provide hands-on training. All other continuing education
requirements may be satisfied from webinars or classroom style learning that allows for real-
time interaction between attendees and the proctor. The continuing education must include:
a. At least two hours of ethics or jurisprudence. Passing the laws and rules examination is
the equivalent of two hours of ethics or jurisprudence.
b. At least two hours of infection control.
c. A cardiopulmonary resuscitation course.
d. For registered dental anesthesia hygienist permitholders, at least two hours related to
sedation or anesthesia, not including local anesthesia.
e. For registered dental restorative hygienist permitholders, at least two hours related to
restorative dentistry.
f. For a dental hygienist practicing under general supervision, two hours related to medical
emergencies.
g. No more than one hour related to practice management or administration.
4. Mere registration at a dental convention without specific attendance at continuing education
presentations will not be creditable toward the continuing dental education requirement.
Certificates awarded for continuing education must indicate the name of the continuing
education provider, date, and number of hours of continuing education. Certificates obtained

from webinar courses must indicate the course was a webinar. For continuing education
courses utilizing a proctor, the certificate of attendance must be signed by the proctor.
5. All dental hygienists must hold a current cardiopulmonary resuscitation certificate.
6. A dental hygienist who maintains a license on inactive status is not subject to continuing
education requirements.
7. The board may audit the continuing education credits of a dental hygienist. Each licensee
shall maintain certificates or records of continuing education activities from the previous
renewal cycle. Upon receiving notice of an audit from the board, a licensee shall provide
satisfactory documentation of attendance at, or participation in the continuing education
activities listed. Failure to comply with the audit is grounds for nonrenewal of or disciplinary
action against the license.
History: Effective January 1, 2011; amended effective April 1, 2015; July 1, 2017; April 1, 2021; July 1,
2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.4
### § 20-04-01-09. Volunteer license.

Between meetings of the board, the executive director of the board may review the volunteer
license application and grant a provisional license if all the requirements are met. A volunteer license to
practice dental hygiene in North Dakota, renewable annually by application to the board, may be
granted when the following conditions are met:
1. The applicant was formerly licensed and actively practicing in the state of North Dakota or
another jurisdiction for at least three of the five years immediately preceding application,
where the requirements are at least substantially equivalent to those of this state or the board
determines that the applicant is qualified and satisfies the criteria specified under North
Dakota Century Code section 43-20-01.2.
2. The applicant agrees to provide services without remuneration directly or indirectly in a
board-approved setting.
3. The applicant holds a current cardiopulmonary resuscitation course certification.
4. The applicant has completed continuing education requirements of the board.
5. The applicant has made application for a volunteer license in a manner prescribed by the
board.
6. The board may collect from the applicant the nonrefundable application and license fee
prescribed by the board.
7. The board may apply such restrictions as it deems appropriate to limit the scope of the
practice under the authority of the volunteer license.
History: Effective October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.2, 43-20-01.3, 43-20-01.4
