RDH License Requirements in Michigan, Indiana & Tennessee (2026 Guide)

RDH license requirements differ significantly across Michigan, Indiana, and Tennessee — covering which clinical exams are accepted, how many CE hours you need, how independently you can practice, and what happens when you move between states. This 2026 guide breaks down every key difference so you can make informed career decisions, avoid costly application delays, and stay fully compliant.

RDH License Requirements: What Michigan, Indiana & Tennessee All Require

Every RDH candidate in Michigan, Indiana, and Tennessee must complete these five steps regardless of state:

1. Graduated from a CODA-accredited dental hygiene program
2. Pass the NBDHE (National Board Dental Hygiene Examination)
3. Pass a regional clinical board exam — the exam depends on your state
4. Pass a state jurisprudence exam
5. Submit a criminal background check, current BLS/CPR certification, and application fee

The biggest differences start at step three — specifically, which clinical exam each state will and won't accept.

Michigan vs Indiana vs Tennessee: Initial RDH Licensure Requirements

Michigan accepts the narrowest range of clinical exams, while Indiana accepts the broadest—a critical distinction that many online guides incorrectly reverse, causing significant application delays for relocating hygienists.

If you tested under SRTA or CRDTS, Indiana or Tennessee is your most direct path to licensure. Michigan may require additional steps if your clinical exam does not meet its ADEX standard, so verify before you apply.

RDH License Renewal in Michigan, Indiana & Tennessee: Fees, CE Hours & Cycles

Renewal Cycles and Fees

Indiana has the lowest renewal fee at $50 biennially, Michigan averages approximately $150 per three-year cycle, and Tennessee sits at $75 biennially, though a fee increase is currently under board review in Tennessee.

Tennessee automatically revokes licenses unpaid for 60 days; set calendar reminders well in advance of the December 31st deadline.

Continuing Education Hours and Mandatory Topics

Tennessee carries the highest annual CE burden at 15 hours per year; Michigan requires 12 hours annually across its three-year cycle; and Indiana is the lightest at 9.5 hours per year—but each state mandates specific topics that reflect its unique regulatory priorities.

Michigan's reading credit provision is unique among the three states; hygienists may claim up to 10 CE hours per cycle for documented dental journal and article reading.

Tracking Your CE Hours: CE Broker

Indiana and Tennessee both integrate with CE Broker, the professional CE tracking platform used across dozens of healthcare licensing boards nationwide. If you practice in either state, setting up your CE Broker profile at the start of each renewal cycle eliminates audit risk and simplifies renewal submission. Michigan currently operates through its own MiPLUS tracking system, though the broader trend across state dental boards is toward CE Broker integration.

Dental Hygienist Scope of Practice: Supervision Models in All Three States

All three states require direct supervision—the dentist physically present—for local anesthesia and nitrous oxide. For routine preventive care, each state has developed a distinct autonomy model that directly determines where and how independently you can build your practice.

Michigan — Public Act 161 (PA 161): Michigan Public Act 161 is a Michigan state law that enables registered dental hygienists to provide preventive oral health services in public and nonprofit settings — including schools, community health centers, and programs serving underserved populations—without a dentist physically present. PA 161 was enacted as a direct legislative response to geographic disparities in oral health access and represents one of the most progressive direct access frameworks in the Midwest for dental hygienists.

Indiana — Prescriptive Supervision: Indiana Code 25-13-1-17 governs RDH licensure and practice and provides the statutory foundation for Indiana's prescriptive supervision model. Under this framework, a hygienist with at least two years of active practice experience averaging 20 hours per week may see patients in a dental office without the dentist physically present — provided the patient received a comprehensive oral exam within the prior seven months and the supervising dentist issued a written treatment order valid for 90 days. This is the most flexible office-based autonomy model of the three states.

Tennessee — Written Protocol: Hygienists with five or more years of experience and 2,000 documented practice hours may enter a written protocol for off-site practice in nursing homes, skilled care facilities, and public health programs. One supervising dentist may hold written protocols with no more than three hygienists simultaneously. Tennessee has also explicitly authorized teledentistry for dental hygiene screenings, making it the most formally advanced of the three states on this emerging care delivery model.

RDH Expanded Functions: Anesthesia Certification in Michigan, Indiana & Tennessee

Tennessee requires the most rigorous nitrous oxide training at 14 hours over two days; Michigan issues a permanent certificate with no renewal requirement. Indiana requires documented clinical competency on five patients supported by a signed dentist affidavit.

For restorative expanded functions, Indiana and Tennessee both offer formal certification pathways. Indiana's program — available through institutions including the University of Southern Indiana — covers placement, finishing, and polishing of Class II restorations on patients. Tennessee explicitly recognizes both restorative function and prosthetic function certifications, each requiring completion of a board-approved educational program before those procedures can be added to your authorized scope. Michigan RDHs have a comparatively limited scope of restorative practice compared with the state's Registered Dental Assistants (RDAs).

RDH License Endorsement: Transferring Between Michigan, Indiana, & Tennessee

Indiana's 8-week letter rule and Tennessee's zero-failure policy are the two most consequential — and most frequently discovered too late — requirements for hygienists transferring their RDH license between states.

Michigan: If you have been licensed three or more years in a state that did not require a regional clinical exam, Michigan may require you to sit for the ADEX or a Computer-Simulated Clinical Examination (CSCE) before endorsement is approved. English language proficiency documentation is also required — verifiable through educational transcripts or an approved English exam.

Indiana: Three original written statements from practicing dentists confirming active, moral, and ethical practice are required. These letters must have been written within eight weeks of your application date — letters older than eight weeks are rejected outright. Proof of 14 CE hours completed within the prior two years is also required.

Tennessee—the zero-failure rule: Tennessee's Criteria. The approval pathway allows RDH licensure without sitting for a new clinical exam. However, a single past failure on any accepted regional examination at any point in your professional history can disqualify you from this pathway entirely, requiring a brand-new clinical examination. This is the single most consequential endorsement rule across all three states.

FAQs on RDH License Requirements in Michigan, Indiana, & Tennessee

What clinical exam do I need for an RDH license in Michigan? Michigan primarily requires the ADEX exam administered through CDCA-WREB-CITA. It is the most restrictive of the three states on clinical exam acceptance — candidates who tested under SRTA, NERB, or CRDTS will find Indiana or Tennessee a more direct path.

Can an RDH practice without a dentist present? Yes, in all three states under specific conditions. Michigan's PA 161 permits it in public and nonprofit settings. Indiana's prescriptive supervision model allows it in dental offices after two years of active experience with a valid 90-day written order. Tennessee's written protocol enables off-site practice after five years and 2,000 documented hours.

What states have direct access for dental hygienists? Michigan offers the broadest direct access through PA 161. Indiana provides functional direct access through prescriptive supervision in office settings. Tennessee enables structured off-site access through written protocols. All three have expanded hygienist autonomy beyond traditional direct supervision models.

How many CE hours does a dental hygienist need per year? Michigan averages 12 CE hours annually (36 over 3 years). Indiana requires approximately 9.5 hours annually (19 over 2 years). Tennessee requires 15 hours annually (30 over 2 years) — the highest annual CE burden of the three states.

How long does it take to get an RDH license in these states? Michigan is generally the fastest through its MiPLUS system. Indiana and Tennessee processing times depend heavily on document completeness—missing transcripts, unverified exam scores, and incomplete background checks are the most common causes of delay across all three states.

What is the ADEX exam for dental hygienists? The ADEX exam is the primary regional clinical board exam required for RDH licensure in Michigan. Administered by the Commission on Dental Competency Assessments (CDCA-WREB-CITA), it includes a computer-based Diagnostic Skills Examination (DSE OSCE) and hands-on clinical sections covering periodontal and restorative tasks.

Can I transfer my RDH license from Indiana to Tennessee? Yes, through Tennessee's criteria approval endorsement pathway—but only if you have never failed any accepted regional clinical examination in your professional history. A single past failure disqualifies you from criteria approval, requiring a new clinical exam regardless of years in practice.