There is work being done toward the advancement of license portability

DDH Compact: Working toward dentist and dental hygienist license reciprocity across state lines

Jan. 9, 2024
License portability is moving closer to reality as more states explore and accept the idea. The DDH Compact could be enacted in the required seven states soon.

The Dentist and Dental Hygienist Compact (DDH Compact) is a policy that supports license mobility across state lines for dentists and dental hygienists through license reciprocity among member states. Licensure portability is a policy prioritized by the American Dental Hygienists’ Association (ADHA), and activating the DDH Compact in 2024 is high on their list of goals.

Where progress stands now

For the DDH Compact to go into effect, seven US states must enact the compact into law through their legislative process. Iowa became the first state to sign the compact into law on April 27, 2023. Two more states, Washington and Tennessee, enacted the compact later in 2023. As of January 5, 2024, Kansas, Maine, Minnesota, Missouri, Nebraska, Ohio, Pennsylvania, and Wisconsin have pending legislation. New Jersey and Texas introduced it in 2023 but did not enact it.

What happens after state number seven

The compact becomes operational following enactment by a seventh state. At that point, a commission consisting of one representative from each state where the compact has been signed into law will be formed to create the rules and application process. Several state dental hygienist associations and state dental societies have expressed interest in their states joining the compact. As of January 2024, Virginia has prefiled the DDH Compact bill and intends to officially file the bill early in 2024.

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The importance of the DDH Compact

ADHA members believe the compact will provide much needed license portability for dental hygienists who practice in multiple states, or who frequently relocate. Currently, dental hygienists and dentists are limited to providing care within the borders of the states where they’re licensed. When the DDH Compact is operational, any hygienist who holds a license in a compact member state and meets other eligibility requirements related to examinations and education is eligible to use the compact to practice in other compact member states without having to obtain a separate license.

How will this work?

Rather than maintaining multiple licenses, hygienists in compact member states will apply for a “compact privilege,” a faster and less expensive process than applying for a state license. The compact privilege model is used by other professions, including physical therapy, psychology, and counseling.

A dentist or dental hygienist who holds an active unencumbered license in a compact state can apply for a compact privilege. The practitioner’s background check, license, and eligibility are verified. Then the practitioner pays fees and completes jurisprudence requirements. Upon verification, the practitioner receives a compact privilege and obtains legal authorization to practice in the specific state where they hold a compact privilege.

How it all started

The DDH Compact originated through funding from the US Department of Defense (DoD). The DoD sought to support the development of interstate compacts to ensure the portability of professional licenses for military spouses. The Council of State Governments (CSG), the ADHA, the American Dental Association (ADA), and a team of other oral health stakeholders developed the compact over the course of 18 months in 2021 and 2022. An overview of the development process and a list of group members who participated can be found at

The benefits are clear

Interstate compacts are just one of the many strategies states can use to alleviate licensure barriers. The DDH Compact seeks to benefit licensees, including veterans and military spouses, by facilitating mobility, expanding employment opportunities, and easing the burden of obtaining and maintaining multiple licenses. Active military members and their spouses have the additional benefit of not being required to pay a fee to the commission for a compact privilege.

The DDH Compact is not yet operational and compact privileges are not yet available, but we get closer every month. You can track the ongoing developments of the DDH Compact at

Jessica Thomas is a policy analyst at the Council of State Governments (CSG) National Center for Interstate Compacts. She supports the development of compacts, including the Interstate Massage Compact and the Dentist and Dental Hygienist Compact. The National Center for Interstate Compacts within CSG is the nation's only technical assistance provider on interstate compacts, offering compact education, development, and administrative services.