How to Become a Dentist in 2026: Complete Licensing Guide

Dentists diagnose and treat diseases, injuries, and malformations of the teeth, gums, and related oral structures. Across the 51 states we track, 51 require the Integrated National Board Dental Examination (INBDE), and the average initial licensing fee is $1893. Becoming a licensed dentist involves years of education, rigorous exams, and state-specific licensure requirements.

This guide covers everything you need to know about becoming a licensed dentist in 2026 -- from dental school and the INBDE to regional clinical exams, sedation permits, state licensure, and continuing education requirements in every state.

What Does a Dentist Do?

Dentists are healthcare professionals who specialize in oral health. They examine patients, diagnose oral diseases, develop treatment plans, and perform a wide range of procedures to maintain and restore dental health. Day-to-day responsibilities include:

• Diagnosis and treatment planning: Evaluating patient oral health using visual exams, X-rays, and diagnostic tools to create comprehensive treatment plans
• Restorative procedures: Filling cavities, placing crowns and bridges, performing root canals, and restoring damaged teeth
• Preventive care: Cleaning teeth, applying sealants and fluoride, and counseling patients on oral hygiene and nutrition
• Surgical procedures: Extracting teeth, placing dental implants, and performing biopsies of suspicious oral tissue
• Cosmetic dentistry: Teeth whitening, veneers, bonding, and smile makeover procedures
• Prescribing medications: Writing prescriptions for antibiotics, pain medications, and other pharmaceuticals
• Managing dental teams: Supervising dental hygienists, dental assistants, and office staff

Dentists work in private practices, group dental offices, community health centers, hospitals, academic institutions, and public health agencies. Many dentists own their own practices and serve as both clinicians and business owners.

Dental Education: DDS vs. DMD

All dentists must earn a doctoral degree from a dental school accredited by the Commission on Dental Accreditation (CODA). There are two degree designations, both considered equivalent:

Dental school is highly competitive. Applicants typically need a bachelor's degree with prerequisite coursework in biology, general chemistry, organic chemistry, biochemistry, physics, and English. Most applicants also take the Dental Admission Test (DAT) and apply through the Associated American Dental Schools Application Service (AADSAS).

What You Learn in Dental School

• Biomedical sciences (Years 1-2): Anatomy, physiology, biochemistry, microbiology, pathology, and pharmacology
• Dental sciences (Years 1-2): Dental anatomy, dental materials, occlusion, radiology, and oral histology
• Pre-clinical labs (Years 1-2): Practicing procedures on simulation models (typodonts) before treating live patients
• Clinical rotations (Years 3-4): Treating patients under faculty supervision in the dental school clinic, covering all major disciplines
• Specialty exposure: Rotations in oral surgery, orthodontics, endodontics, periodontics, pediatric dentistry, prosthodontics, and oral pathology
• Practice management: Business principles, ethics, jurisprudence, and professional development

There are approximately 70 accredited dental schools in the United States. The average dental school graduate carries $280,000-$300,000 in student loan debt. Program length is typically 4 years, though some accelerated 3-year programs exist and combined degree programs (e.g., DDS/PhD, DDS/MPH) may take longer.

The INBDE (Integrated National Board Dental Examination)

The INBDE is the national written examination for dentistry, administered by the Joint Commission on National Dental Examinations (JCNDE). It replaced the former NBDE Part I and Part II exams in 2020. 51 of 51 states require passage of the INBDE as a prerequisite for licensure.

• Format: Computer-based exam with approximately 500 questions across biomedical sciences, dental sciences, and clinically-integrated scenarios
• Duration: Two-day exam, approximately 8 hours each day
• Scoring: Pass/fail. The passing standard is set by the JCNDE.
• Fee: Approximately $760
• Eligibility: Must be enrolled in or have graduated from a CODA-accredited dental program
• Retake policy: Candidates may retake the exam up to three times, with a waiting period between attempts

The INBDE is designed to assess the foundational knowledge, critical thinking skills, and clinical reasoning abilities needed for the safe and effective independent practice of general dentistry.

Regional Clinical Examinations

In addition to the INBDE written exam, 51 of 51 states require a regional clinical examination where candidates demonstrate hands-on clinical skills on live patients. Three major regional testing agencies administer these exams:

Regional clinical exams typically cost $1,500-$2,500 and require candidates to bring their own patients. Some states also accept portfolio-based assessments or have their own state-specific clinical exams as alternatives. A few states have moved to accept the INBDE alone without a separate clinical exam.

Sedation and Anesthesia Permits

While all dentists can administer local anesthesia (e.g., novocaine injections), providing sedation or general anesthesia requires additional permits in most states. 51 of 51 states have formal sedation/anesthesia permit requirements. Permit levels typically include:

• Minimal sedation (anxiolysis): Oral sedatives like nitrous oxide. Requires a permit in most states with minimal additional training.
• Moderate sedation (conscious sedation): IV or oral sedation where the patient remains responsive. Requires completion of an accredited training program (typically 60+ hours) and a state permit.
• Deep sedation and general anesthesia: Patient is unconscious. Requires advanced training (typically a residency in dental anesthesiology or oral surgery), specific facility requirements, and regular inspections.

States that offer sedation permits:

Steps to Become a Licensed Dentist

The path to becoming a dentist is one of the longest of any licensed profession. Here is the typical timeline:

1. Complete undergraduate prerequisites (3-4 years): Earn a bachelor's degree with coursework in biology, chemistry, organic chemistry, biochemistry, physics, and English. Maintain a competitive GPA (3.5+ is typical for accepted applicants).
2. Take the Dental Admission Test (DAT): A standardized exam covering natural sciences, perceptual ability, reading comprehension, and quantitative reasoning. Most applicants take it during their junior or senior year.
3. Graduate from an accredited dental school (4 years): Complete a DDS or DMD program from a CODA-accredited dental school. The program includes 2 years of biomedical and dental science courses followed by 2 years of clinical rotations.
4. Pass the INBDE: Take and pass the Integrated National Board Dental Examination during or after dental school. Most students take it during their third or fourth year.
5. Pass a regional clinical exam: Complete a CDCA/ADEX, CRDTS, or WREB clinical examination (if required by your state). Demonstrate clinical competency on live patients.
6. Pass the state jurisprudence exam (if required): 11 states require a jurisprudence exam testing knowledge of that state's dental practice act and regulations.
7. Apply for state licensure: Submit your application to the state dental board with official transcripts, exam scores, CPR/BLS certification, background check, and applicable fees.
8. Obtain additional permits (optional): Apply for sedation/anesthesia permits, DEA registration (for prescribing controlled substances), and specialty registrations as needed.

From start to finish, the process takes approximately 8 years after high school (4 years undergraduate + 4 years dental school), plus time for exams and licensure. Dentists who pursue specialty training (e.g., orthodontics, oral surgery, endodontics) complete an additional 2-6 years of residency after dental school.

State-by-State Dentist Requirements

The table below summarizes key dentist licensing requirements across all 51 states we track. Click any state for the full breakdown of education, exam, fee, and renewal requirements.

States Requiring a Regional Clinical Exam

While the INBDE tests theoretical and scientific knowledge, regional clinical exams assess hands-on clinical competency. These 51 states require candidates to pass a regional clinical exam (CDCA/ADEX, CRDTS, or WREB) for initial licensure:

Several states have been trending away from requiring live-patient clinical exams due to ethical concerns and logistical challenges. Some have adopted manikin-based alternatives or portfolio assessments, while others now accept the INBDE alone for licensure.

States Requiring the INBDE

The INBDE is the standard national board exam for dentistry. 51 of 51 states require it for licensure:

Continuing Education and License Renewal

All states require licensed dentists to complete continuing education (CE) to maintain their license. CE requirements ensure dentists stay current with evolving techniques, materials, technologies, and standards of care. Typical requirements include:

• CE hours: Average of 39.1 hours per renewal period across all states. Requirements range from 15 to 50+ hours depending on the state and renewal cycle length.
• Mandatory topics: Many states require CE in specific areas such as infection control, opioid prescribing, CPR/BLS, ethics, and abuse/neglect recognition
• Approved providers: CE must be obtained from approved providers such as the ADA CERP, state dental associations, dental schools, and approved online platforms
• CPR/BLS certification: Must remain current throughout the license period in all states
• Sedation permit renewal: Dentists with sedation permits typically have additional CE requirements and periodic office inspections

Dental Specialties

After earning a DDS or DMD, dentists may pursue specialty training through accredited residency programs. The American Dental Association recognizes 12 dental specialties:

• Orthodontics and Dentofacial Orthopedics: Braces, aligners, and correction of jaw alignment (2-3 year residency)
• Oral and Maxillofacial Surgery: Extractions, jaw surgery, implants, and trauma (4-6 year residency)
• Endodontics: Root canal therapy and treatment of dental pulp diseases (2-3 year residency)
• Periodontics: Gum disease treatment and dental implant placement (3 year residency)
• Prosthodontics: Crowns, bridges, dentures, and full-mouth reconstruction (3 year residency)
• Pediatric Dentistry: Dental care for children and adolescents (2-3 year residency)
• Oral and Maxillofacial Pathology: Diagnosis of oral diseases through biopsy and laboratory analysis
• Oral and Maxillofacial Radiology: Advanced imaging and interpretation for diagnosis
• Dental Public Health: Population-based oral health promotion and disease prevention
• Dental Anesthesiology: Administration of deep sedation and general anesthesia for dental procedures
• Oral Medicine: Diagnosis and management of complex oral conditions and medically compromised patients
• Orofacial Pain: Diagnosis and management of TMJ disorders and chronic facial pain

Most states require specialists to register their specialty with the state dental board. Board certification through a specialty board (e.g., American Board of Orthodontics) is voluntary but demonstrates advanced competence.

Frequently Asked Questions

How long does it take to become a dentist?

Becoming a dentist typically takes 8 years after high school: 4 years of undergraduate education followed by 4 years of dental school. Specialists complete an additional 2-6 years of residency training. Including exam preparation and the licensing process, most dentists begin practicing independently around age 26-28.

How much does it cost to become a dentist?

The total cost to become a dentist is substantial. Undergraduate education costs $40,000-$160,000 depending on the institution. Dental school costs $150,000-$350,000+ for four years. Additional costs include the DAT ($510), INBDE (~$760), regional clinical exam ($1,500-$2,500), and state licensing fees (average: $1893). The average dental school graduate has $280,000-$300,000 in student loan debt.

What is the difference between DDS and DMD?

There is no practical difference between DDS (Doctor of Dental Surgery) and DMD (Doctor of Medicine in Dentistry or Doctor of Dental Medicine). Both degrees require the same coursework, clinical training, and exam requirements. The difference is purely historical -- some dental schools award DDS while others award DMD. Both qualify graduates for the same licensure and scope of practice in all states.

Can I practice dentistry in multiple states?

Yes, but you need a separate license in each state where you practice. Most states offer licensure by credentials (endorsement) for dentists already licensed in another state, which streamlines the process. You may still need to pass the state jurisprudence exam and meet state-specific requirements. Some states have reciprocity agreements with neighboring states. There is currently no national dental license, though organizations like the ADA have advocated for greater interstate portability.

What is the job outlook and salary for dentists?

The Bureau of Labor Statistics projects 4% growth for dentists through 2032, about as fast as the average for all occupations. Median annual salary for general dentists is approximately $170,000, with specialists earning significantly more (orthodontists and oral surgeons often exceed $250,000). Salary varies considerably by geographic location, practice type, and years of experience. Rural and underserved areas often offer loan repayment incentives.

Do I need a sedation permit to use nitrous oxide?

In most states, yes. Nitrous oxide (laughing gas) is classified as minimal sedation, and most states require at least a minimal sedation permit to administer it. The requirements are generally less stringent than moderate or deep sedation permits -- typically completion of a short training course and registration with the state dental board. Some states include nitrous oxide authorization as part of the general dental license. Check your specific state's requirements using the table above.

Next Steps

Click any state in the table above to see its complete dentist licensing requirements. Each state page includes detailed information on education requirements, exam procedures, sedation permit levels, fees, renewal processes, and scope of practice.

If you are a dental professional looking to expand into sedation dentistry, review the sedation permit section above and check your state's specific training and facility requirements. For those considering specialty training, contact residency programs directly and review the ADA's specialty recognition guidelines.

Sources

Education, exam, licensing, and fee data are sourced from official state dental boards and national dental organizations.

• Individual state dental board websites (cited on each state page).
• American Dental Association (ADA) -- ada.org
• Commission on Dental Accreditation (CODA) -- accredited dental school listings.
• Joint Commission on National Dental Examinations (JCNDE) -- INBDE information and registration.
• Commission on Dental Competency Assessments (CDCA) -- ADEX clinical exam information.
• Central Regional Dental Testing Service (CRDTS) -- regional clinical exam information.
• Western Regional Examining Board (WREB) -- regional clinical exam information.
• Bureau of Labor Statistics -- Occupational Outlook Handbook, Dentists.

Data was last verified in February 2026. Requirements can change as states update their regulations. Always confirm current requirements with your state's dental board before making educational or career decisions.