State of Maine
Board of Dental Examiners
143 State House Station • 161 Capitol StreetAugusta, ME 04333-0143
Phone: 207-287-3333 • Fax: 207-287-8140

Forms and Applications For your convenience, we are making many forms and applications available on this site. Simply select and print the form you need, fill it out and mail to the Board of Dental Examiners. If you do not have Adobe Acrobat, you may download it by clicking on the Adobe-Get Acrobat Reader link below.

NEW!

Those forms that say fill-in form may be completed using your keyboard prior to printing, signing, and mailing. If you do not have the latest version of Adobe Acrobat Reader, you may download it by clicking on the Adobe-Get Acrobat Reader link below.  You may tab through some of the fields, however, tabbing does not always move you in the order you anticipate; using your mouse allows you to click into most fields, however certain fields (e.g. signature fields or forms to be made out by third parties) are read only fields as these need to be handwritten after printing.  Those fields where you select between options (payment options, yes or no answers) are completed by using the mouse to click in the appropriate circle or box. If you hover over a field with your mouse you will be given a tip as to what the field requires. The print option is at the end of the application materials (see last page of jurisprudence exam). If you do not intend to finish the application from start to finish, you may wish to download it to your own computer before beginning. You cannot save this form to our website.

 

Proof of CPR certification/re-certification is required for all new dental, dental hygiene (IPDH and RDH), denturist, expanded function dental assistants (EFDA) and radiographer licensees, as well as the renewal of those same licenses. No on-line CPR courses are accepted.

You may change your contact information with the Board office via the link below:

ALMS Change of Contact Information Online Service

Complaint-Information on Filing One

 

Complaint Form (Fill-in Form)

 

Dental License Application

Dental License Renewal

Dental-Temporary Permit Application

Dental-Extern Permit

Denturist License Application

Denturist License Renewal

Expanded Function Dental Assistant Certification Application

 

Expanded Function Dental Assistant Certification Renewal

 

Independent Practice Dental Hygienist (IPDH) License Application      

 

Independent Practice Dental Hygienist (IPDH) Renewal

 

Local Anesthesia Permit Application (Fill-in Form)

All Local Anesthesia administered by a hygienist (IPDH & RDH) in the State of Maine

 must be administered under the direct supervision of a Maine licensed Dentist

 

Local Anesthesia Permit Renewal (Fill-in Form)

All Local Anesthesia administered by a hygienist (IPDH & RDH) in the State

 of Maine must be administered under the direct supervision of a Maine licensed Dentist

 

Nitrous Oxide Permit Application (Fill-in Form)

All Nitrous Oxide administered by a hygienist (IPDH & RDH) in the State of Maine

 must be administered under the direct supervision of a Maine licensed Dentist

 

Nitrous Oxide Renewal

All Nitrous Oxide administered by a hygienist (IPDH & RDH) in the State

of Maine must be administered under the direct supervision of a Maine licensed Dentist

 

Public Health Supervision Reporting Form

 

Public Health Supervision Notification & Standing Orders Forms

 

Radiography License Application

 

Radiography Renewal (Fill-in Form)

 

Registered Dental Hygienist (RDH) License Application

 

Registered Dental Hygienist (RDH) License Renewal

 

Sedation-Deep/General Anesthesia Application

 

Sedation-Moderate Sedation Application

 

 

CERTIFICATE OF ORAL CONDITION

Upon the receipt of a written statement of oral condition or oral health certificate, as determined by the board, by a licensed dentist, a denturist may complete clinical procedures related to the fabrication of a removable tooth-borne partial denture, including cast frameworks.  The Certificate of Oral Condition represents a collaborative effort between the involved licensed Dentist(s) and Denturist(s).  The collaborative effort should include providing the patient with: a recommended treatment plan; a recommended periodontal recall plan; and a recommended office location for periodontal care. View Certificate of Oral Condition Document Here

 

"For the protection of the health and safety of the citizens of the State of Maine"

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