The Coalition for Modernizing Dental Licensure, launched in 2018 by the American Dental Association, the American Dental Education Association and the American Student Dental Association, disbanded in September 2026 after reaching its two main goals: ending reliance on single-encounter patient exams and making U.S. licensure more portable. For Canadian dentists, the news is a useful benchmark: Canada's own entry-to-practice route for accredited graduates already runs through the National Dental Examining Board of Canada (NDEB) and its Virtual OSCE, while the licence itself is granted by each province's dental regulator.
A licensure reform group in the United States has declared its work done. ADA News reported on September 30, 2026 that the Coalition for Modernizing Dental Licensure (CMDL) disbanded in September after accomplishing its primary goals. As of October 2026, the coalition has closed because, by its own account, it met its goals.
The story is American, but the questions behind it are familiar to dental professionals in Toronto and across Ontario. How should a new dentist prove readiness to practise? Should a one-time procedure on a live patient decide a career? And how easily should a licensed dentist or hygienist be able to move between jurisdictions when a region is short of clinicians? Here is what happened south of the border, and how Canada's system compares.
What the Coalition Set Out to Do
According to ADA News, the ADA, ADEA and ASDA launched the coalition in 2018 in response to a report by their joint Task Force on Assessment of Readiness for Practice, which called for changes to licensure exams and portability. The American Dental Hygienists' Association joined shortly afterward, and the coalition eventually grew to more than 130 partner organizations spanning dentistry, dental hygiene, education and other public interests.
Its target was the traditional U.S. clinical licensure exam. As ADA News summarizes the coalition's final report, dental licensure often depended on one-time procedures performed on a patient, and that model was vulnerable to random error, lacked strong scientific validity and raised ethical concerns.
What Changed in U.S. Licensure
Through coordinated advocacy, the coalition helped bring alternatives to the patient-based exam. ADA News reports that the U.S. licensure landscape now includes manikin-based assessments and objective structured clinical examinations (OSCEs), which evaluate candidates under more controlled conditions and assess a broader range of competencies than a single patient encounter.
The headline number: according to the coalition's final report, 49 states and Washington, D.C., now recognize at least one initial dental or dental hygiene licensure pathway that does not require a patient exam.
The second goal was portability. ADA News reports the report framed portability as a way to help address workforce shortages and improve access to care while maintaining state authority and public protections. One practical framework is the Dentist and Dental Hygienist Compact, which was activated in spring 2024 when Maine became the seventh state to join. It now includes 13 states: Arkansas, Colorado, Iowa, Kansas, Maine, Minnesota, Nebraska, Ohio, Oklahoma, Tennessee, Virginia, Washington and Wisconsin.
"CMDL demonstrated what is possible when the profession comes together around a common purpose," said JoAnn Gurenlian, Ph.D., the coalition's executive committee chair and ADHA appointee, in the ADA News report.
The Work That Is Not Finished
Sunsetting does not mean the job is complete. ADA News lists the remaining items: pushing for updates in the 14 states that still keep statutory or regulatory language recognizing procedure-based live-patient exams, expanding the compact to more states, and continuing to evaluate and refine clinical assessments. The ADA Council on Dental Education and Licensure will keep tracking licensure trends, and the ADA, ADEA and ADHA will continue working with state associations on reform.
Pro Tip: If anyone on your team is weighing a move to the U.S., or you are recruiting a U.S.-trained clinician to your GTA practice, check the specific state's licensure rules on that state board's own website. A coalition summary is not a substitute for the statute that applies to one person.
How Canada's Entry-to-Practice Route Compares
Canada handles initial certification nationally and licensure provincially. According to the National Dental Examining Board of Canada, graduates of accredited dental programs must successfully complete the NDEB's Certification Process to become licensed dentists in Canada.
The examination in that process is the Virtual OSCE. The NDEB describes it as a summative examination that assesses the problem solving and critical decision-making skills required of beginning dental practitioners in Canada. It consists of 200 questions: 50 standard single-answer multiple-choice questions and 150 case-based questions, which can include photos, radiographs, charts and other supporting material.
Then comes the provincial step. The NDEB states plainly that its certificate is not a licence: candidates must apply to the Dental Regulatory Authority in the province where they want to practise, and that authority may require additional documentation, jurisprudence tests and evidence of language proficiency. In Ontario, that authority is the Royal College of Dental Surgeons of Ontario (RCDSO).
Graduates of non-accredited dental programs, many of them internationally trained, follow a different route: the NDEB's Equivalency Process, which includes the Assessment of Fundamental Knowledge (AFK), the Assessment of Clinical Judgement (ACJ) and the NDECC. If you plan to supervise or hire an internationally trained colleague, read the NDEB's own description of each step rather than relying on second-hand summaries.
Portability: Canada Moves Province by Province
The U.S. compact is an interstate agreement. In Ontario, the College of Dental Hygienists of Ontario (CDHO) announced that "As of Right" rules came into effect on January 1, 2026. Under those rules, dental hygienists registered in good standing in another Canadian jurisdiction may practise in Ontario for up to six months while their application for registration is processed. The CDHO lists the conditions, among others: no history of professional conduct concerns, appropriate liability insurance, and a signed declaration.
For a Markham or Mississauga practice short a hygienist, that is a practical change: a qualified out-of-province registered dental hygienist can start sooner, provided the paperwork is in order. Confirm the current requirements directly with the CDHO before an offer is signed.
Pro Tip: When you hire a hygienist from another province under these rules, keep proof of their home-province registration and of their submitted CDHO application on file before the first patient booking. A rule that allows practice while an application is being processed still depends on that application existing.
Why This Matters for Ontario Practices
Three points stand out for practice owners and recent graduates in the GTA:
- The U.S. has largely moved away from the single live-patient exam. The coalition's final report argued the single-encounter model was weak on validity and ethics, and almost every state now offers an alternative. Canada's accredited-graduate route already centres on the Virtual OSCE.
- Mobility is the next frontier on both sides of the border. The U.S. is expanding a 13-state compact; Ontario has opened faster temporary practice for out-of-province hygienists. In the U.S., the coalition's report links portability to workforce shortages.
- Certification is not licensure. In Canada, the NDEB certificate is a gateway, not a licence. New associates should budget time for the provincial step, including any jurisprudence requirement the RCDSO sets.
EBIKO Dental will continue monitoring licensure and workforce developments that affect Canadian dental practices. For practice supplies and updates from our Ontario team, visit ebiko.ca.
Sources
- ADA News: Coalition for Modernizing Dental Licensure sunsets after achieving portability goals (September 30, 2026)
- NDEB: Certification Process
- NDEB: Virtual OSCE
- NDEB: home page (Equivalency Process)
- RCDSO: home page
- CDHO: "As of Right" Rules in Effect (January 5, 2026)
Frequently Asked Questions
Q: Why did the Coalition for Modernizing Dental Licensure disband?
It disbanded in September 2026 because it reached its main goals, according to ADA News: ending reliance on single-encounter patient exams and making U.S. licensure more portable. ADA News reports the ADA, ADEA and ADHA will continue the remaining advocacy work.
Q: Do Canadian dental graduates take a live-patient licensing exam?
For graduates of accredited programs, the NDEB Certification Process centres on the Virtual OSCE, a 200-question examination of problem solving and critical decision-making. After certification, candidates apply for a licence to their provincial regulator, such as the RCDSO in Ontario.
Q: Can a dental hygienist licensed in another province work in Ontario right away?
Under Ontario's "As of Right" rules, in effect since January 1, 2026, the CDHO says a hygienist in good standing in another Canadian jurisdiction may practise in Ontario for up to six months while their registration application is processed, if they meet conditions such as liability insurance and a signed declaration. Check the CDHO's current requirements before the hygienist starts.