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The Need for an Interstate Licensure Compact
The United States is facing a growing shortage of dental hygiene professionals, a situation that has been exacerbated in the aftermath of the pandemic.
On March 26, 2025, the American Association of Dental Boards (AADB) announced that eight states—Oklahoma, Missouri, Maryland, Massachusetts, Mississippi, Texas, Kentucky, and now Pennsylvania —had introduced legislation to join the Interstate Dental & Dental Hygiene Licensure Compact (IDDHLC), marking a significant step toward improving workforce mobility in dentistry. HERE is a link to the IDDHLC.
At Group Dentistry Now, we occasionally conduct LinkedIn polls to gauge industry sentiment. Recently, we asked our audience about the IDDHLC, as it has been widely discussed and publicized. The response was overwhelmingly supportive. However, we then learned of a competing compact, the Dentist and Dental Hygienist Compact (DDH), which has the support of the Association of Dental Support Organizations (ADSO).
Both compacts acknowledge that state-specific licensure requirements have long hindered workforce mobility, limiting opportunities for dentists and complicating hiring for DSOs and private practices. A well-designed licensure compact can help eliminate these barriers, enabling qualified professionals to practice across participating states without unnecessary testing or administrative burdens. But which one best support the industry?
To provide clarity on the matter, we reached out to ADSO for their official position, which is provided below. AADB’s position can be found HERE.
ADSO’s Official Position
As states seek forward-thinking solutions to expand access to affordable, high-quality dental care and reduce workforce barriers, two dental licensure compacts have emerged. While both aim to streamline the process for dental professionals to practice across state lines, there is a clear distinction as to which compact offers a cost-effective, state-centered, and practitioner-friendly framework: the Dentist and Dental Hygienist (DDH) Compact.
The DDH Compact is a product of years of stakeholder collaboration, backed by a broad coalition that includes the Association of Dental Support Organizations (ADSO), the American Dental Association, and the American Dental Hygienists’ Association.
The DDH Compact’s development process reflects its commitment to transparency and collaboration. Created in partnership with the Council of State Governments, the National Center for Interstate Compacts, and the U.S. Department of Defense, the DDH Compact was shaped over several years with input from a wide range of stakeholders. This speaks to the broad support the DDH Compact enjoys and why it has already been adopted by 11 states and introduced in many others this year
By comparison, the alternative developed by the American Association of Dental Boards (AADB) was drafted in less than three months, without any meaningful public engagement or input from the broader dental community. The AADB compact falls short in key areas that matter to both practitioners and states.
A significant difference between the two compacts lies in the licensure model. The AADB-backed compact requires dental practitioners to obtain and maintain a license in every state where they wish to practice at an estimated $700 per use. This approach not only creates a steep cost barrier that undermines the compact’s core purpose, but also prevents qualified practitioners from helping fill the gaps in states with high numbers of dental health professional shortage areas (HPSAs) — locations where there are not enough dental care providers to accommodate the population’s needs.
In contrast, the DDH Compact employs a privilege-to-practice system, allowing licensed dentists and dental hygienists to practice in member states. This reduces administrative burdens and costs for providers, giving them the choice to relocate to a different state seamlessly. This feature enables practitioners to provide care to patients in states where they are needed most without having to stress over unnecessary bureaucratic hurdles.
The compact supported by the AADB mandates the exclusive use of the ADEX dental examination, limiting individual states’ ability to set their own licensing requirements. Conversely, the DDH Compact preserves state sovereignty by respecting the diversity of existing licensure processes and allowing each state to accept multiple clinical examination pathways. This flexibility ensures that states retain control over their regulatory standards and do not have to conform to a one-size-fits-all model.
Additionally, the AADB-supported compact places its interstate governing commission solely under the AADB’s control, diminishing the role of state regulators. On the other hand, the DDH Compact establishes an interstate commission made up of representatives from the member states to oversee implementation and enforcement. This creates a structure that both empowers states to lead as well as collaborate with each other as equal, cooperative partners.
Given the dental workforce shortage across the country and the growing demand for high-quality dental care that is both affordable and accessible, states deserve a dental compact that is fair, efficient, and built to last. The DDH Compact offers a pragmatic path — one that strengthens state oversight, reduces unnecessary costs, and supports providers in delivering high-quality care where they are needed most.
As more states consider dental licensure compacts in 2025, the choice is clear: the DDH Compact is the one that puts patients, providers, and state regulators first.
The Path Forward
As the dental industry moves towards a solution for workforce mobility, the choice between the AADB-backed compact and the ADSO-supported compact is critical. Both aim to address the same issue of state-specific licensure barriers, but each offers a different approach to achieving that goal.
As more states take steps toward joining licensure compacts, dental professionals, DSOs, and regulators alike must consider which compact will best serve the needs of practitioners and patients while ensuring that dental care remains accessible, efficient, and of the highest quality.
As the dental hygiene field is poised for a transformative shift, we here at Group Dentistry Now will keep you informed so you can be engaged as these discussions continue to shape the future of dental workforce mobility.
