2020 State Fact Booklet by Dental Assisting National Board

DENTAL ASSISTING NATIONAL BOARD, INC.

2020

State Fact Booklet A complete listing by state of required DANB exams and excerpts from state dental practice acts and administrative rules for dental assistants

DANB’s State Fact Booklet: Note on the 2020 Edition This year – 2020 – has been remarkable in many ways, and DANB commends the oral healthcare community for its diligent commitment to patient safety during these challenging times. In gratitude for the extraordinary efforts made by our colleagues in oral health, we are making our 2020 state publications – DANB’s State Fact Booklet and its companion resource, DANB’s State Career Ladder Templates for Dental Assistants – available online to all stakeholders, at no cost, using the Issuu online publishing platform. The online versions of DANB’s state publications provide these advantages: • •

Search the whole document for specific text Access information from your desktop computer or mobile device

DANB will not produce and distribute print versions of its state publications for 2020. The online editions are not downloadable, but if you would to receive a copy of either publication or both in PDF format, you may send a request to Katherine Landsberg, DANB’s Director, Government Relations, at klandsberg@danb.org. We will be evaluating stakeholder feedback, environmental considerations, and practical factors to determine whether to produce print and online versions of its state publications in 2021 or to transition permanently to an online-only format. If you are a regular user of these publications and would like to provide feedback, please don’t hesitate to share your thoughts with us by sending them to Katherine at klandsberg@danb.org. We express our gratitude once again to all members of the dental community who have continued to provide quality and compassionate care during this difficult year. We are pleased and proud to work with you to protect the public.

Introduction DANB has compiled a record of valuable dental assisting information by state as a resource for dental assisting professionals and other communities of interest. Each state's listing provides specific data for that state, including: • State board of dentistry contact information • Excerpts from the state dental practice act or state administrative rules pertaining to dental assistants • Accepted/required DANB exams • General information on expanded functions and radiography requirements • List of the dental assisting programs accredited by the Commission on Dental Accreditation (CODA) • Counts of DANB certificants • Counts of DANB certificates of knowledge-based competence • 2018 DANB salary survey statistics for CDA certificants by state, compared to national averages The excerpts from each state’s dental statutes and administrative rules and regulations included were selected by DANB because they address dental assistants’ scope of practice or otherwise affect dental assistants. The selected excerpts are reproduced exactly as published by the state. The full text of each state’s dental practice act and regulations governing the practice of dentistry is not reproduced in this volume.

Each state’s listing also contains summaries of requirements for dental assistants to perform radiography procedures and expanded functions, under the headings “State Radiography Requirements” and “State Requirements for Expanded Functions.” Prior to publication, DANB asks staff for each state’s dental board to review and approve the summary information and the selected excerpts of statutes and rules. The date of each state’s review is shown on the first page of each state’s section, unless otherwise noted. DANB has compiled this information as a service to the dental community, but has no authority in connection with additions, deletions, changes or modifications to individual state dental practice acts or administrative rules. Contents of the state dental practice acts and administrative rules included in this volume are subject to change by the relevant state entities. Accordingly, DANB does not warrant the accuracy or timeliness of the information published, and encourages readers to access the full text of the most current versions of statutes and regulations for a particular state at the website of the state’s board of dentistry. DANB expresses its sincerest gratitude to the state dental board staff members who have reviewed the information in this volume and provided feedback to DANB in preparation for publication. Their assistance with this project has been invaluable.

Table of Contents About DANB DANB Certifications and Exams State and Federal Recognition Additional DANB Services and Resources Contact DANB The DALE Foundation

2 2 3 4 5 5

State Listings Alabama 6 Alaska 13 Arizona 20 Arkansas 26 California 39 Colorado 84 Connecticut 92 Delaware 97 District of Columbia 103 Florida 112 Georgia 123 Hawaii 129

Idaho 133 Illinois 137 Indiana 147 Iowa 156 Kansas 181 Kentucky 187 Louisiana 196 Maine 203 Maryland 215 Massachusetts 228 Michigan 246 Minnesota 259 Mississippi 276 Missouri 282 Montana 292 Nebraska 297 Nevada 303 New Hampshire 308 New Jersey 320 New Mexico 337 New York 360 North Carolina 369 North Dakota 379

Ohio 387 Oklahoma 414 Oregon 430 Pennsylvania 443 Rhode Island 454 South Carolina 466 South Dakota 474 Tennessee 483 Texas 495 Utah 517 Vermont 521 Virginia 529 Washington 545 West Virginia 560 Wisconsin 571 Wyoming 574 United States Military Puerto Rico U.S. Virgin Islands

579 580 583

Canada International

586 587 1

About DANB Since its inception in 1948, the Dental Assisting National Board, Inc. (DANB) has worked within — and with the support of — the dental community. The American Dental Association recognizes DANB as the national certification board for dental assistants. DANB's mission is to promote the public good by providing credentialing services to the dental community. DANB accomplishes and measures the success of this mission through: • Valid dental assisting exams • Dental assisting recertification process integrity • Visible, valuable and accessible DANB® exams, certificates and certifications • Testing services for groups within the oral healthcare community • Information services for the oral healthcare community related to dental assisting credentialing and recertification • A properly governed, financially secure, administratively sound organization

The following organizations assist DANB in developing its dental assisting exams by recommending subject matter experts to DANB’s exam committees: • American Board of Oral and Maxillofacial Radiology • American Dental Association • Academy of General Dentistry • American Association of Orthodontists • Organization for Safety, Asepsis and Prevention • American Academy of Oral and Maxillofacial Radiology DANB’s nine-member Board of Directors is elected by DANB from slates of candidates nominated by: • American Association of Dental Boards • American Dental Education Association • American Dental Assistants Association • American Dental Association • DANB certificants DANB's Board of Directors also includes a public member.

DANB National Certifications and Exams DANB exams are recognized or required in 37 states, the District of Columbia, the U.S. Air Force and the Department of Veterans Affairs. DANB currently offers five national certifications.

National Entry Level Dental Assistant (NELDA®) Includes component exams in: • Anatomy, Morphology and Physiology (AMP)* • Radiation Health and Safety (RHS®)* • Infection Control (ICE®)*

Certified Restorative Functions Dental Assistant (CRFDA®) Includes component exams in: • Impressions (IM)* • Temporaries (TMP)* • Sealants (SE)* • Restorative Functions (RF) Candidates who pass a component exam marked with an asterisk (*) will earn a certificate of knowledge-based competence. DANB is a member of the Institute for Credentialing Excellence and maintains accreditation to the rigorous National Commission for Certifying Agencies (NCCA) Standards for the Accreditation of Certification Programs for its CDA and COA certification programs.

Certified Dental Assistant™ (CDA®) Includes component exams in: • Radiation Health and Safety (RHS)* • Infection Control (ICE)* • General Chairside Assisting (GC)

Certified Orthodontic Assistant (COA ) ®

Includes component exams in: • Orthodontic Assisting (OA) • Infection Control (ICE)*

DANB’s CDA and COA certification programs are accredited by the International Accreditation Service (IAS) to the International Organization for Standardization (ISO) 17024 Standard for organizations that certify personnel.

Certified Preventive Functions Dental Assistant (CPFDA®) Includes component exams in: • Coronal Polishing (CP)* • Sealants (SE)* • Topical Fluoride (TF)*

DANB exams are available at more than 250 proctored, secure computerized testing sites nationwide through Pearson VUE. In 2020, DANB will also begin delivering exams via online remote proctoring. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

State and Federal Recognition DANB's RHS exam is recognized or required** to perform radiography procedures in: Arizona Colorado Connecticut D.C. Delaware Indiana Iowa Kentucky

Maine Maryland Massachusetts Montana New Hampshire New Jersey New Mexico North Dakota

Oregon Pennsylvania South Carolina South Dakota Tennessee Utah Virginia Wyoming

DANB’s ICE exam meets state requirements** for infection control in: Connecticut Iowa

New Hampshire New York

DANB exams are recognized or required in 37 states and D.C.

DANB’s CP exam is recognized** in:

CDA certification is recognized or required** to perform specified functions in:

DANB’s SE exam is recognized** in:

Arkansas Connecticut D.C. Georgia Illinois Iowa Maine Maryland Massachusetts

Minnesota Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York North Carolina

North Dakota Ohio Oregon Rhode Island South Dakota Vermont Virginia Washington

Massachusetts Minnesota Mississippi Nebraska New Jersey North Carolina North Dakota

Ohio South Carolina South Dakota Tennessee Texas Vermont

COA certification is recognized or required** to perform specified functions in: Connecticut Maryland

Massachusetts New Jersey

Oregon Rhode Island

CPFDA certification is required or recognized** to perform specified functions or to earn advanced status for dental assistants in: Connecticut Massachusetts

New Mexico

New Mexico Ohio

Oregon Texas

Wyoming

DANB's TF exam is recognized** in: New Jersey

New Mexico

DANB's RF exam is recognized** in: Arizona

North Dakota

DANB's AMP exam is recognized** in: Arizona

CDA certification meets state requirements** to perform radiography procedures in: Arkansas Colorado D.C. Delaware Indiana Maine Maryland

Arizona New Jersey

North Dakota Oregon

DANB's TMP exam is recognized** in: Arizona

U.S. Military and Other Federal Agencies DANB's CDA exam and RHS certificate of knowledge-based competence meet the Department of Veterans Affairs requirement for expanded duties dental assistant designation. The Indian Health Services and all branches of the U.S. Military encourage DANB certification. DANB's CDA exam is approved for the GI-to-Jobs program under the Montgomery GI Bill. DANB collaborates with the Air Force Dental Service (AFDS) to administer the RHS and ICE exams.

Oregon Rhode Island

CRFDA certification is required or recognized** to perform specified functions or to earn advanced status for dental assistants in: Connecticut

Massachusetts

Rhode Island

**Additional requirements may apply. Please check each state's listing in this publication and contact the relevant state dental board for more complete information.

Additional DANB Services and Resources Support for the Entire Dental Community

State Career Ladder Templates

DANB provides services and resources that support every member of the dental community.

DANB's State Career Ladder Templates for Dental Assistants is a reader-friendly companion guide to the State Fact Booklet, outlining dental assistant requirements and scope of practice for dental assistants in all 50 states. Updated annually, the easy-to-read, state-specific career ladders reflect each state’s job titles, education and exam requirements, and job function listings for dental assistants based on state dental practice acts and administrative rules.

Support for States DANB’s compilation of state dental assisting requirements is the most comprehensive resource available. DANB can also prepare customized comparative charts for state dental boards and policy makers, upon request. DANB monitors for and enforces against the unauthorized use of DANB credentials and notifies state regulatory boards of violations, when appropriate. DANB develops and administers state-specific exams or programs that satisfy regulatory requirements in Arizona, Maryland, Missouri, New Jersey, New Mexico, New York, Oregon and Washington. Report Exam Results: DANB can provide state dental boards, free of charge, with periodic reports of candidate performance on DANB exams; custom reports can be provided on request, free of charge. Collect Fees: DANB can collect fees on the state’s behalf. Issue Certificates: DANB can issue a state-specific certificate on the state’s behalf to those who have passed the DANB-administered exams required by the state.

Each state's entry contains: • Recognized job titles • Education, exam and training requirements • Allowable and prohibited functions • Required supervision levels To learn more, visit www.danb.org and click Meet State Requirements > State Publications.

DANB's Salary Survey Since 2001, DANB has conducted salary surveys of CDA® certificants every two years. The 2020 State Fact Booklet uses information from the 2018 DANB Salary and Satisfaction Survey to provide salary statistics for each state as compared to the national averages for DANB certified assistants and estimates of wages/salaries for all dental assistants.

Develop Exams: DANB can develop state-specific exams, including jurisprudence exams, often at little or no cost to the state.

To see more information from DANB's Salary Survey, including median salaries for CDA certificants by full- or part-time status, practice setting, type of practice, state, and level of experience, visit www.danb.org.

Credential Verification and Protection

DANB's Website

As a service to the dental community, DANB offers online credential verification services for all DANB-administered credentials at www.danb.org. State regulatory agencies can also contact DANB to request a list of those who passed a particular DANB exam in a specific state.

DANB's website at www.danb.org provides resources that support every member of the dental community.

It is often the employer dentist’s responsibility to ensure that dental assistants have met the state’s requirements, including passing any required exams. DANB simplifies the employer’s job by providing online and written credential verification at no cost.

Professional Policies and Procedures DANB promotes high standards for the dental assisting profession through DANB’s: • • • •

Code of Professional Conduct Disciplinary Policy and Procedures Complaint and Investigation Procedures Background Information Review Process

DANB's Search by State section provides state-specific dental assisting information in an interactive state map, with shortcuts to essential information such as dental assisting job titles, requirements to qualify for each dental assisting level, charts of allowed dental assisting functions and requirements, and a link to each state dental board's website. The website also features information about DANB certifications and exams, including online and downloadable applications, as well as an online credential verification tool where dentist employers, state dental boards, regulators, educators, dental office managers and other members of the oral healthcare community can verify a dental assistant’s DANB credentials.

Contact DANB If you have any questions, please contact DANB's Government Relations team at: Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 www.danb.org gr@danb.org 1-800-367-3262, ext. 431

The DALE Foundation The Dental Advancement through Learning and Education Foundation (the DALE Foundation), the official DANB affiliate, offers interactive online e-learning courses and study aids to help dental assistants prepare for DANB exams. The DALE Foundation® website, www.dalefoundation.org, also includes a Resources & State Requirements section that provides information on state dental assistant requirements, CDE requirements by state, commonly used terms, and links to other dental organizations, including state dental associations, American Dental Assistants Association state chapters and state dental boards. The DALE Foundation was established in March 2010 as a separately incorporated nonprofit foundation. The DALE Foundation’s mission is to benefit the public by providing quality education and conducting sound research to promote oral health.

States recognize the DALE Foundation’s online courses In some states, the DALE Foundation’s courses meet: • State CE requirements • Advanced training pre-requisites • Infection control requirements • Radiography didactic education requirements THE OFFICIAL DANB AFFILIATE www.dalefoundation.org Featured Advertisement

Alabama DANB Certificant Counts: Alabama Certified Dental Assistant (CDA) certificants

196.

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Bradley W. Edmonds, J.D., M.S., MBA, Executive Director Board of Dental Examiners of Alabama 2229 Rocky Ridge Rd. Birmingham, AL 35216 Phone: 205-985-7267 Fax: 205-823-9006 Email: brad@dentalboard.org Website: www.dentalboard.org

Radiation Health and Safety (RHS)

826

Infection Control (ICE)

895

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Calhoun Community College Coastal Alabama Community College Lawson State Community College–Bessemer Trenholm State Community College Wallace State Community College

DANB CDA Certificant State of Alabama+

$17.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of January 13, 2020.

* RHS and ICE: cumulative totals since 1997, excluding inactive records archived for data migration purposes in 2018; CP, SE, TA and TF: cumulative totals since 2010; AMP, IM, TMP and IS: cumulative totals since 2012 +

Source: 2018 DANB Salary Survey (state data based on 4 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Alabama State Radiography Requirements There are no radiography requirements for dental assistants in the state of Alabama. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions There is no designation for expanded function dental assistants in Alabama.

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act â&#x20AC;&#x201C; Board of Dental Examiners of Alabama Code of Alabama Article 1. General Provisions Section 34-9-1. Definitions. For the purposes of this chapter, the following terms shall have the respective meanings ascribed by this section: (2) BOARD. The Board of Dental Examiners of Alabama. (4) GENERAL ANESTHESIA. A controlled state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic method. (14) SEDATION. A depressed level of consciousness that retains the patientâ&#x20AC;&#x2122;s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, produced by a pharmacologic method. Section 34-9-6. Any person shall be deemed to be practicing dentistry who does any of the following: (1) Performs, or attempts or professes to perform, any dental operation or dental service of any kind, gratuitously or for a salary, fee, money or other remuneration paid, or to be paid, directly or indirectly, to himself or herself, or to any person in his or her behalf, or to any agency which is a proprietor of a place where dental operations or dental services are performed. (2) Directly or indirectly, by any means or method, makes impression of the human tooth, teeth, jaws or adjacent tissue, or performs any phase of any operation incident to the replacement of a tooth or any part thereof. (3) Supplies artificial substitutes for the natural teeth, and who furnishes, supplies, constructs, reproduces, or repairs any prosthesis (fixed or removable), appliance, or any other structure to be worn in the human mouth. (4) Places such appliance or structure in the human mouth, or adjusts, attempts, or professes to adjust the same, or delivers the same to any person other than the dentist upon whose prescription the work was performed. (5) Professes to the public by any method to furnish, supply, construct, reproduce, or repair any prosthesis (fixed or removable), appliance, or other structure to be worn in the human mouth, or who diagnoses, or professes to diagnose, prescribe for, professes to prescribe for, treats or professes to treat disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure, or who extracts or attempts to extract human teeth, or remove tumors, abnormal growths, or other lesions from the human gums, jaws, and adjacent structures, or who operates for cleft lip or palate, or both; or who treats surgically or mechanically fractures of the human jaw; or who administers local or general anesthetics in the treatment of any dental lesion. (6) Repairs or fills cavities in the human teeth. (7) Uses a roentgen, radiograph, or digital imaging machine for the purpose of making dental roentgenograms, radiographs, or digital images, or who gives, or professes to give, interpretations or readings of dental roentgenograms, radiographs, or digital images, or radiographic or roentgen therapy. (8) Administers an anesthetic of any nature in connection with a dental procedure. (9) Uses the words "dentist," "dental surgeon," "oral surgeon," or the letters "D.D.S.," "D.M.D." or any other words, letters, title, or descriptive matter which in any way represents him or her as being able to diagnose, treat, prescribe, or operate for any disease, pain, deformity, deficiency, injury, or physical condition of the teeth or jaws, or adjacent structures. (10) States, or professes, or permits to be stated or professed by any means or method whatsoever that he or she can perform or will attempt to perform dental procedures, or render a diagnosis connected therewith. (11) Performs any clinical operation included in the curricula of recognized dental colleges; provided, that members of the faculty, teachers, instructors, fellows, interns, residents, dental students, and student dental hygienists who are employed by or who are taking courses or instructions at the University of Alabama School of Dentistry or such other dental colleges, hospitals, or institutions in Alabama, as may be approved by the board; and provided, that the ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants work of fellows, interns, residents, dental students, and student dental hygienists is performed within the facilities of such dental colleges, hospitals, and institutions under the supervision of an instructor and as an adjunct to his or her course of study or training, shall not be required to take examination or obtain a license certificate and renewal license certificate when all of such work, dental procedures, and activities are confined to his or her work in the college, hospital, or other institution and the work is done without remuneration other than the regular salary or compensation paid by such colleges, hospitals, or other institutions. (12) Professes to the public by any method to bleach human teeth, performs bleaching of the human teeth alone or within his or her business, or instructs the public within his or her business, or through any agent or employee of his or her business, in the use of any tooth bleaching product. ARTICLE 3. Use Of Anesthesia By Dentists. Section 34-9-60. Use of local anesthesia; permit to use general anesthesia. Any person licensed or permitted to practice dentistry in the State of Alabama shall be authorized to use anesthesia in accordance with the provisions of this section. (1) All dentists are authorized to use local anesthesia. (2) Twelve months after May 29, 1985, no dentist shall use general anesthesia on an outpatient basis for dental patients, unless such dentist possesses a permit of authorization issued by the Board of Dental Examiners. a. In order to receive such permit, the dentist must apply on a prescribed application form to the Board of Dental Examiners, submit an application fee, and produce evidence showing that he or she: 4. Has a properly equipped facility for the administration of general anesthesia staffed with a supervised team of auxiliary personnel capable of reasonably assisting the dentist with procedures, problems, and emergencies incident thereto. Adequacy of the facility and competence of the anesthesia team shall be determined by the Board of Dental Examiners as outlined below. b. Prior to the issuance of such permit, the Board of Dental Examiners, at its discretion, may require an onsite inspection of the facility, equipment, and personnel to determine if, in fact, the aforementioned requirements have been met. This evaluation shall be carried out in a manner prescribed by the board. The evaluation shall be conducted by a team of three examiners appointed by the Board of Dental Examiners. These examiners shall be dentists who are authorized to administer general anesthesia. If the results of the initial evaluation are deemed unsatisfactory, the applicant may reapply for a permit subject to the correction of the deficiencies outlined in the original evaluation. Section 34-9-62. Certification in cardiopulmonary resuscitation. Any dentist using general anesthesia, and his or her auxiliary personnel shall be currently certified in cardiopulmonary resuscitation. Section 34-9-80. Definitions. As used in this article, the following terms shall have the following meanings: (1) ANALGESIA. The diminution or elimination of pain in the conscious patient. (2) ANXIOLYSIS. A pharmacological induced state, oral or inhalation, where a patient experiences a diminution of anxiety. (3) BOARD. The Alabama Board of Dental Examiners (4) ENTERAL. Any technique of administration in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa (i.e., oral, rectal, sub lingual). (5) INHALATION. A technique of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and the primary effect is due to absorption through the pulmonary bed. (6) LOCALIZED ANESTHESIA. The elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of a drug. (7) ORAL CONSCIOUS SEDATION. A depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and to respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or nonpharmacological method or a combination thereof. An oral conscious sedation permit is not required for the use of inhalation nitrous oxide following the administration of a medication given only for the purpose of diminution of anxiety. Section 34-9-82. Requirements for treatment. (a) A dentist using oral conscious sedation must comply with all of the following requirements: (10) Direct clinical observation and monitoring of the patient by a staff member must be continuous during the recovery period. The dentist shall assess the patient’s responsiveness and must determine that the patient has met discharge criteria prior to leaving the office and the patient must be discharged into the care of a responsible person. (c) Any dentist utilizing oral conscious sedation procedures must have a properly equipped facility staffed with a su8

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants pervised team of allied dental personnel who will be appropriately trained and capable of reasonably assisting the dentist with procedures, problems, and emergencies incident thereto. When inhalation equipment is used, in combination with orally administered sedatives, it must have a failsafe system that is appropriately checked and calibrated. The inhalation equipment must have the capacity for delivering 100 percent oxygen, and never less than 25 percent oxygen. A system for delivering oxygen must be available and must have adequate full-face mask and appropriate connectors, and be capable of delivering oxygen under positive pressure to the patient. Inhalation equipment must have a scavenging system. Suction equipment must be available that allows aspiration of the oral and pharyngeal cavities. A stethoscope and a sphygmomanometer with cuffs of appropriate size shall be immediately available. Section 34-9-83. Requirements for assistants. Allied dental personnel who assist dentists during oral conscious sedation procedures must be currently certified in cardiopulmonary resuscitation. During a sedation procedure, at least one additional person must be present in addition to the dentist. This may be a chair side dental assistant. Rules of the Board of Dental Examiners of Alabama Section 270-X-2.15 Standards For Infection Control In Dental Offices. All dental offices must conform to and comply with the current recommendations and guidelines of the Centers for Disease Control and Prevention (C.D.C.) relating to infection control practices for dentistry and/or dental offices. The recommendations and guidelines of the C.D.C. may be obtained from the United States Department of Health and Human Services, Public Health Service or through the Board of Dental Examiners of Alabama. It is the responsibility of all currently licensed dentists, dental hygienists, dental assistants and all other personnel who are utilized by a licensed dentist and who assist in a dental practice and may be exposed to body fluids such as blood or saliva to maintain familiarity with these recommendations and guidelines. Section 270-X-2.17 Criteria For On-Site Inspection For The Use Of General Anesthesia And Parenteral Sedation. (1) This rule contains the procedures, criteria, and information which are mandatory for the clinical administration of general anesthesia and parenteral/moderate sedation. These shall be used by the inspecting team in determining whether a dentist's facilities, equipment, and personnel have satisfied the requirements imposed by law and this rule for the issuance of a general anesthesia or a parenteral/moderate sedation permit. (a) Clinical Use of General Anesthesia and/or Parenteral Sedation. Two (2) procedures utilizing general anesthesia and/or parenteral/moderate sedation should be observed. This portion of the evaluation should not exceed two (2) hours. No evaluation can be considered complete unless this part is included. (b) Simulated Emergencies. (1) The examiners will simulate the emergency situations listed below. The permittee and office staff should be competent in managing all of these emergencies: (i) Laryngospasm (ii) Bronchospasm (iii) Emesis and aspiration of vomitus (iv) Management of foreign bodies in the airway (v) Angina pectoris (vi) Myocardial infarction (vii) Cardiopulmonary resuscitation (viii) Hypotension (ix) Hypertensive crisis (x) Acute allergic reaction (xi) Hyperventilation syndrome (xii) Convulsion of unknown etiology (xiii) Syncope (e) Office Facilities and Equipment. (1) The fundamental physical requirements for the anesthesia/sedation facility are: (i) The Operating Room/Operatory- The operatory should be large enough to adequately accommodate the patient on a table or in a dental chair and permit the anesthesia and/or sedation team, consisting of the dentist and two or three trained assistants, to move freely about the patient. (vi) Patient Recovery. (I) Patients shall be retained in the surgery area until all protective reflexes have fully returned unless the dental staff is in immediate attendance at all times in the recovery area to continue vital-sign and airway observations. (II) A patient recovering from a general anesthetic or sedation procedure shall be monitored in the recovery area. This recovery area shall include sufficient room to treat any emergency situation. The recovery area shall be equipped to provide oxygen under positive pressure, have adequate lighting, access to suction, and have electrical outlets for connecting cardiac monitoring and defibrillating equipment. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants (k) Personnel. (1) For the administration of parenteral/moderate sedation, the at least two (2) individuals, each appropriately trained, are required to be present throughout the procedure, consisting of the doctor and an assistant trained to monitor appropriate physiologic variables. (2) For the administration of general anesthesia, at least three (3) individuals, each appropriately trained, are required to be present throughout the procedure, consisting of the doctor who directs the general anesthesia, a person whose responsibilities are observation and monitoring of the patient and a third person who assists the operating dentist. Section 270-X-2.21 Oral Conscious Sedation. (5) All allied personnel who may be involved in the monitoring of a patient who is administered oral conscious sedation shall be trained to assist the dentist in the recognition and management of the following clinical emergencies: (a) Laryngospasm (b) Bronchospasm (c) Emesis and aspiration of vomitus (d) Management of foreign bodies in the airway (e) Angina pectoris (f) Myocardial infarction (g) Cardiopulmonary resuscitation (h) Hypotension (i) Hypertensive crisis (j) Acute allergic reaction (k) Hyperventilation syndrome (l) Convulsions and (m) Syncope. Section 270-X-3.06 Direct Supervision Defined. Direct supervision is defined as supervision by a dentist who authorizes the intraoral procedure to be performed, is physically present in the dental facility and available during performance of the procedure, examines the patient during the procedure and takes full professional responsibility for the completed procedure. Section 270-X-3.10 Duties Of Allied Dental Personnel. Allied dental personnel are dental hygienists, dental assistants and dental laboratory technicians. Subject to the prohibition that no intra-oral procedure can be performed unless under the direct supervision of a duly licensed dentist as defined by Board rule, the following allied dental personnel may perform the following: (1) Dental Laboratory Technicians: (a) No intra-oral duties are allowable other than assisting the dentist in determining tooth color. (2) Dental Assistants and Dental Hygienists: (a) Preliminary charting and inspection of the oral cavity. (Final examination and diagnosis must be made by a dentist before treatment can be instituted.) (b) Apply topical agents under direct supervision of the dentist (1) Apply topical anesthetics. (2) Oxygenating Agents. (Excluding endodontic therapy.) (3) Apply anti-inflammatory agents. (4) Apply astringents. (5) Desensitizing agents. (6) Topical fluoride. (7) Apply light-cured medicinal bonding agents. (8) Apply etchant materials. (c) Place and remove rubber dam. (d) Place and remove periodontal dressings. (e) Place and remove alveolar socket dressings. (f) Construct and remove with hand instruments only interim restorations. (Interim restorations being any restoration placed while a more permanent restoration is being completed.) (g) Construct and place temporary crowns (excluding stainless steel crowns placed with intentions of reasonable permanency). (h) Contour stainless steel or chrome crowns but cannot cement them. 10

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants (i) Pre-fit and pre-contour orthodontic appliances either extra-orally or intra-orally for final adaptation by the dentist. (j) Remove excess cement with hand instruments from around permanent dental restorations and orthodontic appliances. (k) Make impressions for diagnostic casts or opposing casts. (l) Place, wedge, and remove matrices for operative dentistry. (m) Take and record case history, blood pressure, pulse, and oral temperature. (n) Remove intra-oral sutures. (Excluding wire sutures.) (o) Make dental radiographs or digital images. (p) Give oral hygiene instructions including plaque staining, flossing, brushing, and caries susceptibility tests. (q) Place cavity liners and bases. (Excluding capping of exposed pulpal tissues.) (r) Assist in the administering of N2O and O2. (s) Insert into the mouth of the patient wax models of dentures, partial dentures; or any other structures and make adjustments outside the mouth of the patient to such wax models pursuant to written or verbal instructions or directions from the dentist provided, however, (1) That the dental hygienist or dental assistant shall not use these wax models of dentures, partial dentures or any other structure to register the jaw relationships or occlusal relationships of the patient, and (2) That before such wax models may be used for the manufacture of dentures, partial dentures or other structures the dentist shall personally consult with the patient, examine such wax models, and make such additional adjustments as may be required. (t) Insert into the mouth of the patient dentures, partial dentures, removable orthodontic appliances, prostheses, devices to treat sleep apnea or anti-snoring devices, or any other structures and make adjustments outside the mouth of the patient to the dentures, prostheses (fixed or removable), removable orthodontic appliances, prosthetic appliances, bridges, or other structures pursuant to written or verbal instructions or directions from the dentist provided, however, (1) That before such prostheses (fixed or removable), removable orthodontic appliances, or other structures are delivered to the patient leaving the dental office with such removable orthodontic appliances, prostheses (fixed or removable), or other structures the dentist shall personally consult with the patient, examine such prostheses (fixed or removable), removable orthodontic appliances, or other structures, and make such additional adjustments as may be required; and (2) That final placement and cementation of all fixed appliances, fixed prostheses and other fixed structures shall be performed by the dentist. (u) Apply reversible liners and bases to prostheses, orthodontic appliances, or any other structures. However, the dentist shall personally consult with the patient and examine such liners and bases, and make such additional adjustments as may be required. (v) Place and remove gingival retraction materials. (w) Make final impressions for removable and fixed prostheses, orthodontic appliances, retainers, devices to treat sleep apnea or anti-snoring devices, and medicament/whitening delivery trays. However, before said impressions may be used for the manufacture of prostheses and appliances, the dentist shall examine and approve such impressions for accuracy. (x) Use laser and/or narrow band (light) imaging technology for preliminary diagnostic purposes only with the dentist’s final examination and diagnosis. (3) Dental Hygienists Only. (a) Remove extrinsic stains, accretions, and calcareous deposits from teeth. (b) Gingival curettage. (c) Root planing. (d) Polish completed restorations. (e) Place Pit and Fissure Sealant and polish and adjust sealant as needed. (f) Place resorbable chlorhexidine chips. (g) Place topical or sub-gingival antimicrobial or antibacterial agents. (h) Periodontal probing. (i) Bleaching of teeth. Section 270-X-4.03 Approval For Training, Educational, Technical, Vocational, Or Any Other Institution Providing Instruction For Dental Assistants. Pursuant to the provisions of Code of Alabama (1975), 34-9-43(5), any training, educational, technical, vocational, or any other institution which provides instruction for dental assistants shall be required to obtain APPROVED STATUS from the Board of Dental Examiners of Alabama (hereinafter “Board”), if they wish to be listed as an approved program for the ADHP prerequisites, under the following procedure: (1) For Board approval, any training, educational, technical, vocational or any other institution (hereinafter collectively referred to as “institution”) shall meet the applicable requirements and standards for such instruction as approved or © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants

(2)

(3) (4)

(5) (6) (7)

adopted by the American Dental Association, a copy of these requirements and standards being available to the said institutions upon request to the secretary-treasurer of the Board. In determining whether the instruction at the institution meets and satisfies the requirements and standards for the same then in effect, the Board or any authorized representative(s) may conduct onsite inspections and examinations of the institution and may require the institution to submit any written information or material which the Board or its authorized representative(s) may deem necessary and appropriate. If the institution fails or refuses to allow the Board or its authorized representative(s) to conduct onsite inspections and examinations or refuses or fails to submit, after notice, and within a reasonable period of time to be determined by the Board or its authorized representative(s), any required written information or material, the Board shall deny the institution APPROVED STATUS and give the institution notice thereof in writing. If the Board determines that the instruction provided by the institution meets the requirements and standards of the Board then in effect for the same, the institution shall be so notified by the Board in writing as soon as practicable. If the Board determines that the instruction provided by the institution does not meet the requirements and standards of the Board then in effect for the same, the Board shall so notify the institution in writing as soon as practicable, said notice to include at least the following: (a) The reasons why the instruction at the institution did not meet or satisfy the requirements or standards of the Board then in effect. (b) The specific requirements or standards that the institution failed to meet or satisfy. (c) A reasonable period of time to be determined by the Board or its authorized representative(s) in which the institution can correct the deficiencies so noted or otherwise satisfy or meet the Board’s requirements or standards then in effect. If the institution fails to meet or satisfy the requirements or standards of the Board then in effect after notice and opportunity as provided in subsection (4) above, the Board shall deny the institution APPROVED STATUS. The Board may withdraw APPROVED STATUS of an institution providing instruction if it deems such action shall be necessary or in the best interest of the people of this state or to protect the health, safety, or welfare of the people in this state. Each institution with APPROVED STATUS must request in writing renewal approval on an annual basis. In deciding whether to grant any renewal, the Board may utilize any of the procedures contained in subsections (1) through (5) above.

Section 270-X-4.05 Infected Health Care Workers. (1) The Board of Dental Examiners of Alabama adopts as its rule for the reporting, assessment and practice management of HBV and HIV infected health care workers the following: Chapter 420-4-3 (and all parts of that Chapter) entitled “Infected Health Care Workers” of the rules of the State Board of Health, Bureau of Disease Control adopted on November 16, 1994. (2) All infected health care workers, as defined by law or the Rule referenced above, working in a dental office shall be required to conform to and comply with the provisions of Chapter 420-4-3 referenced above and this Rule. It is the responsibility of all currently licensed dentists/dental hygienists, dental assistants and all other personnel who provide or assist in the provision of dental/dental hygiene services to maintain familiarity with the provisions of Chapter 420-4-3 referenced above, this Rule and the Alabama Infected Health Care Worker Management Act. (3) A copy of Chapter 420-4-3 entitled “Infected Health Care Workers” of the Rules of the State Board of Health, Bureau of Disease Control, the Policy and Procedures for compliance with the current recommendations and guidelines of the Centers for Disease Control and Prevention (C.D.C.) relating to infection control practices for dentistry and/ or dental offices and Alabama’s Infected Health Care Worker Management Act are available upon request from the Board.

p 12

Alaska DANB Certificant Counts: Alaska Certified Dental Assistant (CDA) certificants

157

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Christianne Carrillo, Licensing Examiner Alaska Board of Dental Examiners Division of Corporations, Business and Professional Licensing P.O. Box 110806 Juneau, AK 99811-0806 Phone: 907 465-2542 Fax: 907-465-2974 Email: boardofdentalexaminers@alaska.gov Website: www.commerce.alaska.gov/web/cbpl/ ProfessionalLicensing/BoardofDentalExaminers.aspx

Radiation Health and Safety (RHS)

445

Infection Control (ICE)

450

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs University of Alaska Anchorage - College of Health

DANB CDA Certificant State of Alaska+

$25.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been updated by DANB as of December 30, 2019.

Source: 2018 DANB Salary Survey (state data based on 11 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the Alaska Board of Dental Examiners. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

Alaska State Radiography Requirements There are no radiography requirements for dental assistants in Alaska. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures delegated by and under the indirect supervision of an Alaska state-licensed dentist.

State Requirements For Expanded Functions To perform coronal polishing procedures in Alaska under the direct supervision of a licensed dentist, a dental assistant must: (1) Submit to the Alaska Board of Dental Examiners (ABDE) a complete, notarized application form AND (2) Pay applicable fee AND; (3a) Successfully complete a program of instruction approved by the ABDE or (3b) Be currently licensed or certified in an other jurisdiction to perform coronal polishing and provide documentation to the Board. The coronal polishing certificate must be renewed biennially on or before February 28th of odd-numbered years. A qualified dental assistant may perform specified restorative functions in Alaska under the direct supervision of a licensed dentist. To qualify for a certificate in specified restorative functions, the dental assistant must: (1) Successfully complete a course offered by or under the auspices of a program accredited by the Commission on Dental Accreditation or other equivalent course or program approved by the ABDE, AND; (2) pass the Western Regional Examining Board’s restorative examination or other equivalent examination approved by the board within the five years preceding the dental assistant’s certificate application, or have legal authorization from another state or jurisdiction to perform restorative functions. The restorative functions certificate must be renewed biennially on or before February 28th of odd-numbered years. Note: The Alaska Board of Dental Examiners maintains a registry of dental assistants who hold certificates in coronal polishing and/or restorative functions.

Alaska State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Alaska Board of Dental Examiners Alaska Statutes Chapter 32. Dental Hygienists. ARTICLE 2. REGULATION OF DENTAL HYGIENISTS. Sec. 08.32.110. Scope of practice of dental hygienists. (a) The role of the dental hygienist is to assist members of the dental profession in providing oral health care to the public. A person licensed to practice the profession of dental hygiene in the state may, (1) under the general supervision of a licensed dentist, (A) perform preliminary charting and triage to formulate a dental hygiene assessment and dental hygiene treatment plan; (B) remove calcareous deposits, accretions, and stains from the exposed surfaces of the teeth beginning at the epithelial attachment by scaling and polishing techniques; (C) remove marginal overhangs; (D) use local periodontal therapeutic agents; (E) perform nonsurgical periodontal therapy; (F) perform other dental operations and services delegated by a licensed dentist if the dental operations and services are not prohibited by (c) of this section; (G) if certified by the board, administer local anesthetic agents; and (2) if certified by the board and under the direct or indirect supervision of a licensed dentist, administer and monitor nitrous oxide-oxygen conscious sedation. (c) This section does not authorize delegation of (1) dental diagnosis, comprehensive treatment planning, and writing prescriptions for drugs; writing authorizations for restorative, prosthetic, or orthodontic appliances; (2) operative or surgical procedures on hard or soft tissues; or (3) other procedures that require the professional competence and skill of a dentist. (e) This section does not prohibit a licensed dental hygienist (1) with an endorsement issued under AS 08.32.085 from performing the activities authorized under AS 08.32.085; (2) who has entered into a collaborative agreement approved by the board under AS 08.32.115 from performing the activities authorized under the collaborative agreement; or (3) from performing a dental operation, procedure, or service a dentist may delegate to a dental assistant under AS 08.36.346.

Alaska State Dental Practice Act and Administrative Rules for Dental Assistants Chapter 36. Dentistry ARTICLE 1. BOARD OF DENTAL EXAMINERS. Sec. 08.36.070. General powers. (a) The board shall (1) provide for the examination of applicants and the credentialing, registration, and licensure of those applicants it finds qualified; (2) maintain a registry of licensed dentists, licensed dental hygienists, and registered dental assistants who are in good standing; (3) affiliate with the American Association of Dental Boards and pay annual dues to the association; (4) hold hearings and order the disciplinary sanction of a person who violates this chapter, AS 08.3, or a regulation of the board; (5) supply forms for applications, licenses, permits, certificates, registration documents, and other papers and records; (6) enforce the provisions of this chapter and AS 08.32 and adopt or amend the regulations necessary to make the provisions of this chapter and AS 08.32 effective; (7) adopt regulations ensuring that renewal of a license, registration, or certificate under this chapter or a license, certificate, or endorsement under AS 08.32 is contingent upon proof of continued professional competence; (8) at least annually, cause to be published on the Internet and in a newspaper of general circulation in each major city in the state a summary of disciplinary actions the board has taken during the preceding calendar year; (9) issue permits or certificates to licensed dentists, licensed dental hygienists, and dental assistants who meet standards determined by the board for specific procedures that require specific education and training. (10) require that a licensed dentist who has a federal Drug Enforcement Administration registration number register with the controlled substance prescription database under AS 17.30.200(o). Sec. 08.36.091. Records and reports. The board shall maintain (1) a record of its proceedings; (2) a registry containing the name, office and home addresses, and other information considered necessary by the board of each person licensed as a dentist or dental hygienist or registered as a dental assistant, a registry of the licenses, certificates, registrations, and endorsements revoked by the board, and information on the status of each licensee and each registered dental assistant. ARTICLE 3A. DENTAL ASSISTANTS. Sec. 08.36.342. Coronal polishing certificate. (a) The board shall issue a coronal polishing certificate to a dental assistant if the dental assistant furnishes evidence satisfactory to the board that the dental assistant has completed a program of instruction approved by the board. (b) A certificate issued under (a) of this section authorizes a dental assistant under the direct supervision of a dentist licensed in the state to perform coronal polishing on teeth without calculus. (c) The board may by regulation establish fees, renewal, and continuing education requirements for a certificate issued under this section. Sec. 08.36.344. Restorative function certificate. (a) The board shall issue a restorative function certificate to a dental assistant if the dental assistant furnishes evidence satisfactory to the board that the dental assistant has (1) successfully completed a course offered by or under the auspices of a program accredited by the Commission on Dental Accreditation of the American Dental Association or other equivalent course or program approved by the board; and (2) passed the Western Regional Examining Boardâ&#x20AC;&#x2122;s restorative examination or other equivalent examination approved by the board within the five years preceding the dental assistantâ&#x20AC;&#x2122;s certificate application, or the dental assistant has legal authorization from another state or jurisdiction to perform restorative functions. (b) A certificate issued under this section authorizes a dental assistant under the direct supervision of a licensed dentist to place restorations into a cavity prepared by the licensed dentist and thereafter carve, contour, and adjust contacts and occlusion of the restoration. (c) The board may by regulation establish fees, renewal, and continuing education requirements for a certificate under this section. Sec. 08.36.346. Delegation to dental assistants. (a) Except as otherwise provided in this chapter, a dentist licensed in this state may delegate to a dental assistant under indirect supervision (1) the exposure and development of radiographs; (2) application of topical preventive agents or pit and fissure sealants; and

Alaska State Dental Practice Act and Administrative Rules for Dental Assistants (3) other dental operations and services except (A) those that may be performed by a dental hygienist under AS 08.32.110(a); and (B) those that may not be delegated to a dental hygienist under AS 08.32.110(c). (b) A dentist licensed in this state may delegate to a dental assistant under direct supervision (1) coronal polishing on teeth without calculus, if the dental assistant is certified under AS 08.36.342; (2) the placement of a restoration into a cavity prepared by a dentist licensed under this chapter and the subsequent carving, contouring, and adjustment of the contacts and occlusion of the restoration, if the dental assistant is certified under AS 08.36.344; and (3) other dental operations and services as defined and regulated by the board; however, a dentist may not delegate to a dental assistant a dental operation or service that requires the professional skill of a licensed dentist or licensed dental hygienist, including those dental operations and services specified in AS 08.32.110(c). Sec. 08.36.347. Exemption from registration requirement. (a) A person enrolled in a program or course of study may perform dental assisting procedures as part of that program or course of study without a registration document if the procedures are performed (1) under the direct supervision of a member of the faculty who is licensed under this chapter or AS 08.32; and (2) as part of a clinical program that has received written approval from the board. (b) A person performing dental assisting procedures under (a) of this section is subject to all other provisions of this chapter and statutes and regulations that apply to the practice of dental assisting by a registered dental assistant. Sec. 08.36.349. Definitions. In AS 08.36.342 - 08.36.349, (1) “direct supervision” means a dentist licensed in this state is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and, before dismissal of the patient, evaluates the performance of the dental assistant; (2) “indirect supervision” means a dentist licensed in this state is in the dental office, authorizes the procedures, and remains in the dental office while the procedures are being performed by the dental assistant. ARTICLE 4. GENERAL PROVISIONS. Sec. 08.36.370. Definitions for chapter. In this chapter, unless the context requires otherwise, (1) "board" means the Board of Dental Examiners; (2) "calculus" means a hardened deposit of mineralized plaque; (3) "coronal polishing" means the removal of supragingival plaque and stains; (4) "dental assistant" means a person employed to provide clinical assistance to a dentist licensed in the state; (7) "licensed dental hygienist" means a dental hygienist licensed under AS 08.32; (8) "licensed dentist" means a dentist licensed under this chapter; (9) "registered dental assistant" means a dental assistant registered under this chapter. Alaska Administrative Code Chapter 28. Board of Dental Examiners. 12 AAC 28.060. REQUIREMENTS FOR ADMINISTERING DEEP SEDATION, GENERAL ANESTHESIA, MODERATE SEDATION, OR MINIMAL SEDATION FOR A PATIENT YOUNGER THAN 13 YEARS OF AGE. (e) When deep sedation, general anesthesia, moderate sedation, or minimal sedation to a patient younger than 13 years of age is administered, the dentist's facility shall (7) have written basic emergency procedures established and maintain a staff of supervised personnel capable of handling procedures, complications, and emergency incidents; all personnel involved in patient care must hold a certification in healthcare professional cardiopulmonary resuscitation (CPR); 12 AAC 28.061. ADDITIONAL REQUIREMENTS FOR ADMINISTERING DEEP SEDATION OR GENERAL ANESTHESIA. In addition to meeting the requirements of 12 AAC 28.060, when deep sedation or general anesthesia is administered, (10) the provider administering deep sedation or general anesthesia shall remain in the operatory room to monitor the patient continuously until the patient is responsive and recovery care can be transferred to a staff member capable of handling procedures, complications, and emergency incidents related to the type of sedation or anesthesia used; (12) if the deep sedation or general anesthesia provider is the treating dentist, the treatment team shall include a second trained person to monitor and observe the patient at all times during the procedure, and a third person to assist the dentist. 16

Alaska State Dental Practice Act and Administrative Rules for Dental Assistants 12 AAC 28.062. ADDITIONAL REQUIREMENTS FOR ADMINISTERING MODERATE SEDATION, OR MINIMAL SEDATION FOR A PATIENT YOUNGER THAN 13 YEARS OF AGE. In addition to meeting the requirements of 12 AAC 28.060, when moderate sedation is administered to a patient of any age, or minimal sedation is administered to a patient younger than 13 years of age, (3) the treatment team shall consist of the treating dentist and a second person to assist, monitor, and observe the patient; both the treating dentist and the second person shall be in the operating area with the patient throughout the dental procedure. ARTICLE 7. PROFESSIONAL PRACTICES. 12 AAC 28.730. CONTROL OVER PROFESSIONAL DENTAL MATTERS AND OPERATION OF DENTAL EQUIPMENT. In evaluating whether a person has engaged in the practice of dentistry under AS 08.36.360, the board will consider that a person “exercises control over professional dental matters or the operation of dental equipment” if the person determines, interprets, specifies, limits, prescribes, regulates, or otherwise controls by policy, lease, or other arrangement (1) the use of dental equipment or material while the equipment or material is being used for the provision of dental treatment, whether the treatment is provided by the dentist, a dental hygienist, or a dental assistant; (2) the selection of a course of treatment for the patient, the procedures, or materials to be used as part of the course of treatment and the manner in which the course of treatment is carried out by the dentist; (3) the patient records of a dentist; (4) policies and decisions relating to fees, rebates, billing, and advertising if the practice would result in the violation of AS 08.36 or this chapter, including the Principles of Ethics and Code of Professional Conduct adopted by reference under 12 AAC 28.905; (5) decisions relating to the use of auxiliary personnel for the delivery of patient care in the dentist’s practice and the hours of practice if the hours would impair the dentist’s ability to safely and professionally deliver care for patients. ARTICLE 9. CORONAL POLISHING AND RESTORATIVE FUNCTIONS BY DENTAL ASSISTANTS. 12 AAC 28.810. CORONAL POLISHING BY DENTAL ASSISTANTS. (a) The board will issue a certificate to perform coronal polishing to a dental assistant who meets the requirements of AS 08.36.342 and this section. (b) An applicant for certification under this section must submit to the department (1) a complete, notarized application on a form provided by the department; (2) the following fees: (A) $60 nonrefundable application fee; (B) $60 certification fee; (3) either (A) verification of successful completion of a course of instruction approved by the board under 12 AAC 28.820; or (B) if the applicant is currently licensed or certified in another licensing jurisdiction to perform coronal polishing, evidence showing that the applicant’s license or certificate to perform coronal polishing is current and in good standing in that licensing jurisdiction and a list of course of instruction for coronal polishing; the board will only approve the course of instruction under this subparagraph if it substantially complies with the requirements set out in 12 AAC 28.830. 12 AAC 28.820. APPROVAL OF CORONAL POLISHING COURSES. The board may, upon its own motion or upon request of any interested person, approve a course of instruction upon receipt of an application that includes (1) the name of the course sponsor; (2) the name of the instructor presenting the course; (3) a course outline showing that the course content meets the requirements of 12 AAC 28.830; (4) an explanation of the evaluation procedures used to determine successful completion of the course. 12 AAC 28.830. REQUIREMENTS FOR CORONAL POLISHING COURSES. A course of instruction in coronal polishing must include didactic and clinical instruction in (1) characteristics of abrasives used for polishing; (2) aerosol production during polishing; (3) effects of heat production during polishing; (4) removal of tooth structure by polishing; (5) indications and contraindications of polishing; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Alaska State Dental Practice Act and Administrative Rules for Dental Assistants (6) selective polishing techniques; (7) coronal polishing by removing soft plaque and stain from exposed enamel utilizing appropriate rotary instrument and suitable polishing agent; and (8) proper infection control techniques while performing rotary coronal polishing. 12 AAC 28.840. RENEWAL OF CORONAL POLISHING CERTIFICATE. (a) A dental assistant certificate to perform coronal polishing must be renewed biennially on or before February 28 of odd-numbered years. In order to renew a certificate to perform coronal polishing, a dental assistant must submit to the department a (1) completed application for renewal on a form provided by the department; and (2) $60 certificate renewal fee. (b) The board will maintain a registry of dental assistants certified to perform coronal polishing under AS 08.36.342.  12 AAC 28.850. RESTORATIVE FUNCTIONS BY DENTAL ASSISTANTS. (a) The board will issue a certificate to perform restorative functions to a dental assistant in this state who meets the requirements of AS 08.36.344 and this section. (b) An applicant for certification under this section must submit to the department (1) a complete, notarized application on a form provided by the department; (2) the following fees: (A) $60 nonrefundable application fee; (B) $60 certification fee; (3) verification that the applicant has successfully completed either (A) a restorative function program accredited by the Commission on Dental Accreditation of the American Dental Association; or (B) another course of instruction approved by the board under 12 AAC 28.860; and (4) verification that the applicant either (A) has legal authorization from another state or jurisdiction to perform restorative functions; or (B) within the five years immediately before the date of application for a certificate under this section, the applicant has passed either the restorative function examination of the Western Regional Examining Board or a restorative function examination approved by the board as equivalent to the restorative function examination of the Western Regional Examining Board. 12 AAC 28.860. APPROVAL OF RESTORATIVE FUNCTION COURSES FOR DENTAL ASSISTANTS. The board may, upon its own motion or upon request of any interested person, approve a course of instruction upon receipt of an application that includes (1) the name of the course sponsor; (2) the name and credentials of the course presenter; and (3) a course outline showing that the course content meets the requirements of 12 AAC 28.870. 12 AAC 28.870. REQUIREMENTS FOR RESTORATIVE FUNCTION COURSES FOR DENTAL ASSISTANTS. (a) A course of instruction for restorative functions for dental assistants must include (1) the physical, chemical, and biological properties of dental materials, including amalgam and composite materials; (2) the limitations and acceptability of a dental material based on the physical, chemical, and biological properties of the material; (3) proper safety when using dental materials, including appropriate infection control and mercury hygiene; (4) dental anatomy and occlusion; (5) isolation procedures; (6) proper placement and finishing of restorative materials; (7) assessment outcomes that measure the stated goals and objectives; (8) classroom hours sufficient to meet the restorative course requirements of this section; (9) laboratory experience to be able to place and finish all classes of restorations; and (10) a required clinical proficiency to establish a demonstrated ability to place and finish all classes of restorations. 12 AAC 28.880. RENEWAL OF DENTAL ASSISTANT’S RESTORATIVE FUNCTION CERTIFICATE. (a) A dental assistant’s restorative function certificate must be renewed biennially on or before February 28 of oddnumbered years. In order to renew a certificate to perform restorative function, a dental assistant must submit to the department (1) a completed application for renewal on a form provided by the department; and (2) the $60 certificate renewal fee; and (3) documentation of completion of two hours of continuing education required under (b) of this section. 18

Alaska State Dental Practice Act and Administrative Rules for Dental Assistants (b) An applicant for renewal of a dental assistant restorative function certificate shall complete two hours of continuing education approved under 12 AAC 28.410(a) relating to materials or techniques used for restoration of teeth. (c) The board will maintain a registry of dental assistants certified under AS 08.36.344 and 12 AAC 28.850 to perform restorative functions. (d) A dental assistant restorative function certificate may not be renewed if the certificate has lapsed two years or more. ARTICLE 10. GENERAL PROVISIONS.

12 AAC 28.990. DEFINITIONS. (a) In this chapter (1) “administer local anesthetic agents” means to administer an agent that induces local anesthesia and to administer that agent by injection, both infiltration and block, limited to the oral cavity, for the purposes of pain control;; (2) "American Association of Dental Examiners Clearinghouse for Board Actions" means the American Association of Dental Examiners information source described in AS 08.36.110(a)(1)(F); (3) “board” means the Board of Dental Examiners; (4) "coronal polishing," within the meaning given in AS 08.36.370, means removal of supragingival plaque and stains from teeth without calculus, including the removal of soft deposits, such as materia alba, plaque, and stains from the anatomical crowns of the teeth; (5) "deep sedation" means a drug-induced depression of consciousness during which (A) patients cannot be easily aroused but respond purposefully following repeated or painful stimulation; (B) the ability to independently maintain ventilatory function may be impaired; (C) patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate; and (D) cardiovascular function is usually maintained; (6) "department" means the Department of Commerce, Community, and Economic Development; (7) "facility" means a dental practice, office, or clinic that is subject to the requirements of AS 08.36.367; (8) "general anesthesia" means a drug-induced loss of consciousness during which (A) patients are not arousable, even by painful stimulation; (B) the ability to independently maintain ventilatory function is often impaired; (C) patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function; and (D) cardiovascular function may be impaired; (9) "local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug; (10) "minimal sedation" means a minimally depressed level of consciousness, produced by a pharmacological method, in which (A) the patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command; and (B) although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected; (11) "moderate sedation" means a drug-induced depression of consciousness, during which (A) a patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation; (B) no interventions are required to maintain a patent airway, and spontaneous ventilation is adequate; and (C) cardiovascular function is usually maintained; (12) "nitrous oxide sedation" means an induced, controlled state of minimal sedation, produced solely by the inhalation of a combination of nitrous oxide and oxygen in which the patient retains the ability to independently and continuously maintain an airway and to respond purposefully to physical stimulation and to verbal command; (13) "radiological equipment" means a control panel and associated radiological tubeheads capable of exposing a dental patient to x-rays; (14) "restorative function" means under the direct supervision of a licensed dentist, to place restorations into a cavity prepared by the licensed dentist and thereafter carve, contour, and adjust contacts and occlusion of the restoration. (b) In AS 08.32, AS 08.36, and this chapter, unless the context requires otherwise, “jurisdiction” means a state or territory of the United States.

p 19

Arizona DANB Certificant Counts: Arizona National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

324

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact

15,127

Infection Control (ICE)

1,474

Coronal Polishing (CP)

2,486

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Ryan Edmonson, Executive Director Arizona State Board of Dental Examiners 1740 W. Adams St., Suite 2470 Phoenix, AZ 85007 Phone: 602-242-1492 Fax: 602-242-1445 Website: https://dentalboard.az.gov

110

Impressions (IM)

Temporaries (TMP)

124

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Phoenix College Pima Community College

DANB CDA Certificant State of Arizona+

$19.25 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been reviewed by DANB as of October 19, 2020.

Source: 2018 DANB Salary Survey (state data based on 6 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Arizona State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in Arizona, a dental assistant must hold a current Arizona Board-approved certificate in radiology. To qualify, one must: (1) Pass the national DANB Radiation Health and Safety (RHS) exam OR (2a) Be currently certified in another U.S. jurisdiction that requires successful completion of a written dental radiography exam and (2b) Apply to the Arizona State Board of Dental Examiners (ASBDE) for Arizona Dental Assistant Radiography Certification by credential and receive the Arizona Radiologic Proficiency Certificate issued by the Arizona State Board of Dental Examiners.

State Requirements for Expanded Functions To perform coronal polishing procedures in Arizona under the general supervision of a licensed dentist, a dental assistant must hold an Arizona Coronal Polishing Certificate. To qualify, one must: (1) Pass the DANB national Coronal Polishing (CP) exam found in the Coronal Polish Exam for Arizona Residents Application Packet administered by DANB AND (2) Submit an Arizona Coronal Polishing Clinical Skills Affidavit (completed by a licensed dentist or a coronal polishing educator/course instructor) to DANB AND (3) Receive the Arizona Coronal Polishing Certificate, sent upon successful completion of the DANB CP exam and submission of the Arizona Coronal Polishing Clinical Skills Affidavit to DANB. To perform specified restorative functions in Arizona under the supervision of a licensed dentist, a dental assistant* must hold an Arizona Expanded Function-Restorative Certificate. To qualify, one must: (1a) Hold the Arizona Coronal Polishing certificate (see requirements above) and the Arizona Radiologic Proficiency certificate (see requirements above) AND (1b) Successfully complete an EFDA training course approved by the Arizona State Board of Dental Examiners (ASBDE) at a Commission on Dental Accreditation (CODA)-accredited program AND (1c) Pass DANB’s Anatomy, Morphology and Physiology (AMP), Temporaries (TMP) and Restorative Functions (RF) exams** AND (1d) Under the supervision of a licensed dentist, perform restorative procedures required by the ASBDE (place, contour and finish 20 direct restorations and place and cement five prefabricated crowns, following the preparation of the tooth by a licensed dentist) and document these procedures on a Licensed Dentist Endorsement form AND (1e) Apply to DANB for the Arizona Expanded Functions- Restorative Certificate, OR (2a) Provide evidence of currently holding or having held within the previous 10 years a license, registration, permit or certificate in expanded functions in restorative procedures issued by another U.S. state or jurisdiction, and (2b) Document clinical experience in the specified expanded functions on a Licensed Dentist Endorsement form AND (2c) Apply to DANB for the Arizona Expanded Functions- Restorative Certificate. * A registered dental hygienist may qualify to perform EFDA functions by meeting the same requirements, with the exception that a registered dental hygienist is not required to take the RHS, CP and AMP exams. ** Candidates may take DANB's AMP, TMP and RF exams together in one combined exam administration, or they may take each exam separately. An application packet is available on DANB's website, www.danb.org, in the Meet State Requirements area.

Arizona State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Arizona State Board of Dental Examiners ARIZONA REVISED STATUTES Title 32 - Professions and Occupations Chapter 11 Dentistry

Article 1. Dental Board 32-1201 Definitions 2. “Auxiliary personnel” means all dental assistants, dental technicians, dental x-ray technicians and other persons employed by dentists or firms and businesses providing dental services to dentists. 5. “Dental assistant” means any person who acts as an assistant to a dentist, dental therapist or dental hygienist by rendering personal services to a patient that involve close proximity to the patient while the patient is under treatment or observation or undergoing diagnostic procedures. 10. “Dental x-ray laboratory technician” means any person, other than a licensed dentist, who, pursuant to a written work order of a dentist, performs dental and maxillofacial radiography, including cephalometrics, panoramic and maxillofacial tomography and other dental related non-fluoroscopic diagnostic imaging modalities. 23. “Supervised personnel” means all dental hygienists, dental assistants, dental laboratory technicians, dental therapists, denturists, dental x-ray laboratory technicians and other persons supervised by licensed dentists. Article 4. Licensing and Regulation of Dental Hygienists 32-1281. Practicing as dental hygienist; supervision requirements; definitions I. For the purposes of this article: 2. "Direct supervision" means that the dentist is present in the office while the dental hygienist is treating a patient and is available for consultation regarding procedures that the dentist authorizes and for which the dentist is responsible. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Arizona State Dental Practice Act and Administrative Rules for Dental Assistants 3. "General supervision" means that the dentist is available for consultation, whether or not the dentist is in the dentist's office, over procedures that the dentist has authorized and for which the dentist remains responsible. 32-1289.01. Dental hygienists; affiliated practice relationships; rules; definition C. An affiliated practice agreement between a dental hygienist and a dentist shall be in writing and: 2. May include protocols for supervising dental assistants. J. Subject to the terms of the written affiliated practice agreement entered into between a dentist and a dental hygienist, a dental hygienist may: 2. Supervise dental assistants, including dental assistants who are certified to perform functions pursuant to section 32-1291. 32-1291. Dental assistants: regulation; duties A. A dental assistant may expose radiographs for dental diagnostic purposes under either the general supervision of a dentist or the direct supervision of an affiliated practice dental hygienist licensed pursuant to this chapter if the assistant has passed an examination approved by the Board. B. A dental assistant may polish the natural and restored surfaces of the teeth under either the general supervision of a dentist or the direct supervision of an affiliated practice dental hygienist licensed pursuant to this chapter if the assistant has passed an examination approved by the Board. 32-1291.01. Expanded function dental assistants; training and examination requirements; duties A. A dental assistant may perform expanded functions after meeting one of the following: 1. Successfully completing a board-approved expanded function dental assistant training program at an institution accredited by the American dental association Commission on Dental Accreditation and on successfully completing examinations in dental assistant expanded functions approved by the board. 2. Providing both: (a) Evidence of currently holding or having held within the preceding ten years a license, registration, permit or certificate in expanded functions in restorative procedures issued by another state or jurisdiction in the United States (b) Proof acceptable to the board of clinical experience in the expanded functions listed in subsection B of this section. B. Expanded functions include the placement, contouring and finishing of direct restorations or the placement and cementation of prefabricated crowns following the preparation of the tooth by a licensed dentist. The restorative materials used shall be determined by the dentist. C. An expanded function dental assistant may place interim therapeutic restorations under the general supervision and direction of a licensed dentist following a consultation conducted through teledentistry. D. An expanded function dental assistant may apply sealants and fluoride varnish under the general supervision and direction of a licensed dentist. E. A licensed dental hygienist may engage in expanded functions pursuant to section 32-1281, subsection B, paragraph 12 following a course of study and examination equivalent to that required for an expanded function dental assistant as specified by the board. Title 36 - Public Health and Safety Chapter 36.1 Teledentistry

Article 1. General Provisions 36-3611. Definitions In this article, unless the context otherwise requires: 1. "Board" means the state board of dental examiners. 2. "Dental provider" means a dental hygienist, affiliated practice dental hygienist or dental assistant who is licensed pursuant to title 32, chapter 11. 3. "Dentist" means a person who is licensed in the general practice of dentistry pursuant to title 32, chapter 11. 4. "Health care decision maker" has the same meaning prescribed in section 12-2801. 5. "Teledentistry" means the use of data transmitted through interactive audio, video or data communications for the purposes of examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by dentists and dental providers in settings permissible under title 32, chapter 11 or specified in rules adopted by the board.

Arizona State Dental Practice Act and Administrative Rules for Dental Assistants ARIZONA ADMINISTRATIVE CODE Title 4. PROFESSIONS AND OCCUPATIONS CHAPTER 11. STATE BOARD OF DENTAL EXAMINERS Article 1. Definitions R4-11-101. Definitions The following definitions, and definitions in A.R.S. § 32-1201, apply to this Chapter: “Analgesia” means a state of decreased sensibility to pain produced by using nitrous oxide (N2O) and oxygen (O2) with or without local anesthesia. “Deep sedation” is a drug-induced depression of consciousness during which a patient cannot be easily aroused but responds purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. The patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is maintained. “Designee” means a person to whom the Board delegates authority to act on the Board’s behalf regarding a particular task specified by this Chapter. “Direct supervision” means, for purposes of Article 7 only, that a licensed dentist is present in the office and available to provide immediate treatment or care to a patient and observe a dental assistant’s work. “General anesthesia” is a drug-induced loss of consciousness during which the patient is not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. The patient often requires assistance in maintaining a patent airway, and positive-pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. “General supervision” means, for purposes of Article 7 only, a licensed dentist is available for consultation, whether or not the dentist is in the office, regarding procedures or treatment that the dentist authorizes and for which the dentist remains responsible. “Irreversible procedure” means a single treatment, or a step in a series of treatments, that causes change in the affected hard or soft tissues and is permanent or may require reconstructive or corrective procedures to correct the changes. “Local anesthesia” is the elimination of sensations, such as pain, in one part of the body by the injection of an anesthetic drug. “Minimal sedation” is a minimally depressed level of consciousness that retains a patient’s ability to independently and continuously maintain an airway and respond appropriately to light tactile stimulation, not limited to reflex withdrawal from a painful stimulus, or verbal command and that is produced by a pharmacological or non-pharmacological method or a combination thereof. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. In accord with this particular definition, the drugs or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. “Moderate sedation” is a drug-induced depression of consciousness during which a patient responds purposefully to verbal commands either alone or accompanied by light tactile stimulation, not limited to reflex withdrawal from a painful stimulus. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is maintained. The drugs or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of a drug before the effects of previous dosing can be fully recognized may result in a greater alteration of the state of consciousness than intended by the permit holder. “Nitrous oxide analgesia” means nitrous oxide (N2O/O2) used as an inhalation analgesic. “Oral sedation” is the enteral administration of a drug or non-drug substance or combination inhalation and enterally administered drug or non-drug substance in a dental office or dental clinic to achieve minimum or moderate sedation. “Parenteral sedation” is a minimally depressed level of consciousness that allows the patient to retain the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and is induced by a pharmacological or non-pharmacological method or a combination of both methods of administration in which the drug bypasses the gastrointestinal tract. “Polish” means, for the purposes of A.R.S. § 32-1291(B) only, a procedure limited to the removal of plaque and extrinsic stain from exposed natural and restored tooth surfaces that utilizes an appropriate rotary instrument with rubber cup or brush and polishing agent. A licensee or dental assistant shall not represent that this procedure alone constitutes an oral prophylaxis. “Preventative and therapeutic agents” means substances used in relation to dental hygiene procedures that affect the hard or soft oral tissues to aid in preventing or treating oral disease. “Prophylaxis” means a scaling and polishing procedure performed on patients with healthy tissues to remove coronal plaque, calculus, and stains. “Root planing” means a definitive treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.

Arizona State Dental Practice Act and Administrative Rules for Dental Assistants Article 2. Licensure By Credential R4-11-204. Dental Assistant Radiography Certification by Credential Eligibility. To be eligible for dental assistant radiography certification by credential, an applicant shall have a current certificate or other form of approval for taking dental radiographs, issued by a professional licensing agency in another state, United States territory or the District of Columbia that required successful completion of a written dental radiography examination. R4-11-205. Application for Dental Assistant Radiography Certification by Credential A. An applicant for dental assistant radiography certification by credential shall provide to the Board a completed application, on a form furnished by the Board that contains the following information: 1. A sworn statement of the applicant’s eligibility, and 2. A letter of endorsement that verifies compliance with R4-11-204. B. Based upon review of information provided under subsection (A), the Board or its designee shall request that an applicant for dental assistant radiography certification by credential provide a copy of a certified document that indicates the reason for a name change if the applicant’s documentation contains different names. Article 3. Examinations, Licensing Qualifications, Application and Renewal, Time-Frames R4-11-304 Application Processing Procedures: Issuance and Denial of Dental Assistant Radiography Certification by Credential A. Within 14 calendar days of receiving an application from an applicant for a dental assistant radiography certification by credential, the Board or its designee shall notify the applicant, in writing, that the application package is complete or incomplete. If the package is incomplete, the notice shall specify what information is missing. B. An applicant with an incomplete application package shall supply the missing information within 60 calendar days from the date of the notice. If the applicant fails to do so, an applicant shall begin the application process anew. C. Upon receipt of all missing information, within 10 calendar days, the Board or its designee shall notify the applicant, in writing, that the application is complete. D. The Board or its designee shall not process an application until the applicant has fully complied with the requirements of this Article. E. The Board or its designee shall notify an applicant, in writing, whether the certificate is granted or denied, no later than 90 calendar days after the date of the notice advising the applicant that the package is complete. F. The notice of denial shall inform the applicant of the following: 1. The reason for the denial, with a citation to the statute or rule which requires the applicant to pass the examination; 2. The applicant’s right to request a hearing on the denial, including the number of days the applicant has to file the request; 3. The applicant’s right to request an informal settlement conference under A.R.S. §41-1092.06; and 4. The name and telephone number of an agency contact person or a designee who can answer questions regarding the application process. G. The following time-frames apply for certificate applications governed by this Section: 1. Administrative completeness review time-frame: 24 calendar days. 2. Substantive review time-frame: 90 calendar days. 3. Overall time-frame: 114 calendar days.  H. An applicant whose certificate is denied has a right to a hearing, an opportunity for rehearing, and, if the denial is upheld, may seek judicial review pursuant to A.R.S. Title 41, Chapter 6, Article 10, and A.R.S. Title 12, Chapter 7, Article 6. Article 7. Dental Assistants R4-11-701 Procedures and Functions Performed by a Dental Assistant under Supervision A. A dental assistant may perform the following procedures and functions under the direct supervision of a licensed dentist: 1. Place dental material into a patient’s mouth in response to a licensed dentist’s instruction; 2. Cleanse the supragingival surface of the tooth in preparation for: a. The placement of bands, crowns, and restorations; b. Dental dam application; c. Acid etch procedures; and d. Removal of dressings and packs; 3. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments; 4. Remove temporary cement, interim restorations, and periodontal dressings with hand instruments; 5. Remove sutures; 6. Place and remove dental dams and matrix bands; 7. Fabricate and place interim restorations with temporary cement; 8. Apply sealants; 24

Arizona State Dental Practice Act and Administrative Rules for Dental Assistants 9. Apply topical fluorides; 10. Prepare a patient for nitrous oxide and oxygen analgesia administration upon the direct instruction and presence of a dentist; or 11. Observe a patient during nitrous oxide and oxygen analgesia as instructed by the dentist. B. A dental assistant may perform the following procedures and functions under the general supervision of a licensed dentist: 1. Train or instruct patients in oral hygiene techniques, preventive procedures, dietary counseling for caries and plaque control, and provide pre- and post-operative instructions relative to specific office treatment; 2. Collect and record information pertaining to extraoral conditions; and 3. Collect and record information pertaining to existing intraoral conditions. R4-11-702. Limitations on Procedures or Functions Performed by a Dental Assistant under Supervision A dental assistant shall not perform the following procedures or functions: 1. A procedure which by law only licensed dentists, licensed dental hygienists, or certified denturists can perform; 2. Intraoral carvings of dental restorations or prostheses; 3. Final jaw registrations; 4. Taking final impressions for any activating orthodontic appliance, fixed or removable prosthesis; 5. Activating orthodontic appliances; or 6. An irreversible procedure. Article 13. General Anesthesia and Sedation R4-11-1301. General Anesthesia and Deep Sedation B.2.b. Maintains a staff of supervised personnel capable of handling procedures, complications, and emergency incidents. All personnel involved in administering and monitoring general anesthesia or deep sedation shall hold a current course completion confirmation in cardiopulmonary resuscitation (CPR) Healthcare Provider level; R4-11-1302. Parenteral Sedation B.2.b. Maintains a staff of supervised personnel capable of handling procedures, complications, and emergency incidents, including at least one staff member who: i. Holds a current course completion confirmation in cardiopulmonary resuscitation (CPR) Healthcare Provider level; ii. Is present during the parenteral sedation procedure; and iii. After the procedure, monitors the patient until discharge; R4-11-1303. Oral Sedation B.2.b. Maintains a staff of supervised personnel capable of handling procedures, complications, and emergency incidents, including at least one staff member who: i. Holds a current certificate in cardiopulmonary resuscitation (CPR) Healthcare Provider level; ii. Is present during the oral sedation procedure; and iii. After the procedure, monitors the patient until discharge;

p 25

Arkansas DANB Certificant Counts: Arkansas Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Meredith Rogers, Executive Director Arkansas State Board of Dental Examiners 101 E. Capitol Ave, Suite 111 Little Rock, AR 72201 Phone: 501-682-2085 Fax: 501-682-3543 Email: asbde@arkansas.gov Website: www.asbde.org

Radiation Health and Safety (RHS)

354

Infection Control (ICE)

408

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Arkansas Northeastern College University of Arkansas Pulaski Technical College

DANB CDA Certificant State of Arkansas+

$18.25 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 11, 2020.

Source: 2018 DANB Salary Survey (state data based on 8 responses from this state) Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Arkansas State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Arkansas, a dental assistant must be a Registered Dental Assistant (RDA) who holds a permit in radiography from the Arkansas State Board of Dental Examiners (ASBDE). To obtain this permit, one must: (1a) Hold a current national DANB Certified Dental Assistant (CDA) certification, OR (1b) Graduate from a CODA-accredited dental assisting program OR (1c) Successfully complete and submit a certificate of completion of a radiography course approved by the Board, AND (2) Hold current Basic Life Support-level CPR certification, AND (3) Apply for registration to the Arkansas State Board of Dental Examiners, AND (4) Successfully complete the Arkansas jurisprudence exam. Note: A dental assistant holding a current radiography permit dated prior to November 1, 2011 will not be required to complete an approved radiography course unless he or she is operating an imaging machine other than conventional flat film radiography, such as cone-beam computed axial tomography (CT) scan. Dental assistants operating imaging machines other than conventional flat film radiography, including dental assistants who were issued a radiography permit by the ASBDE prior to November 1, 2011, must complete a Board-approved course in radiography and submit proof of completion to the ASBDE prior to operating such machines and/or before renewal of the radiography permit.

State Requirements For Expanded Functions A Registered Dental Assistant in the state of Arkansas is an individual who holds a permit from the Arkansas State Board of Dental Examiners (ASBDE) to perform one or more of the allowed expanded functions, which include coronal polishing, operating dental radiographic equipment (see above), inducing and monitoring nitrous oxide/oxygen analgesia, and monitor patients under deep sedation or general anesthesia in offices where the dentist is permitted to provide those services. To be issued a permit for any of the expanded functions (except Sedation Monitoring, which has additional requirements), one must: (1a) Hold a current national DANB Certified Dental Assistant (CDA) certification OR (1b) Graduate from a CODA-accredited dental assisting program OR (1c) Complete an ASBDE-approved course in the desired expanded function(s), OR (1d) Receive on-the-job training from an Arkansas licensed dentist, AND (2) Hold current Basic Life Support-level CPR certification, AND (3) Provide proof of competency in the desired expanded function(s) and apply for registration to the ASBDE, AND (4) Successfully complete the Arkansas jurisprudence exam. Sedation monitoring: Hold a current permit for nitrous oxide administration, hold current CPR certification, hold current DANB CDA certification (or be a Registered Dental Assistant, RN or LPN), successfully complete the American Association of Oral and Maxillofacial Surgeons Anesthesia Assistant’s training program or a Board-approved equivalent course within the two years immediately preceding application, apply to the ASBDE for registration, and successfully complete the Arkansas jurisprudence exam. Note: To renew a permit to perform expanded functions, RDAs must provide the ASBDE proof of completing two hours of continuing education in infection control every two years.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Arkansas State Board of Dental Examiners Arkansas Code Title 17, Chapter 82 Subchapter 3 Licensing Generally 17-82-310. ANNUAL RENEWAL – PROCEDURE (a) All licenses to practice dentistry or dental hygiene issued in the State of Arkansas shall continue in full force and effect until forfeited, suspended or revoked, subject to the following provisions: (1) On January 1 of even- numbered years, every dentist and dental hygienist must renew his or her license with the Arkansas State Board of Dental Examiners on forms prepared and furnished by the board, supplying all the information and data requested on the forms; and (2) A renewal fee in an amount to be determined by the board as being necessary to provide funds for the operation of the board and for other expenses in administering this chapter must be paid to the board upon the filing of the form, duly executed, with the board. (b) Upon the filing of the renewal form and payment of the fee, the board shall issue to the licensee its certificate of renewal that authorizes the licensee to practice his or her profession in the State of Arkansas until the next date of renewal. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants (c) (1) During the month of December of odd-numbered years, the Secretary of the Arkansas State Board of Dental Examiners shall mail the approved renewal form to every dentist and dental hygienist registered in the State of Arkansas to his or her last known address. (2) The failure of the dentist or dental hygienist to receive the form does not excuse his or her failure to renew. (3) The providing of false or fraudulent information to renew the license is grounds for imposition of the penalties set forth at § 17-82-316. 17-82-311. RENEWAL - PENALTIES FOR NONCOMPLIANCE. Failure to renew a license within a period of thirty (30) days after January 1 of even-numbered years shall result in forfeiture of the license. 17-82-312. RENEWAL – RELICENSING. (a) A dentist or dental hygienist whose license has been automatically forfeited pursuant to §17-82-311 shall be relicensed, at any time until January 1 of the year following the forfeiture, by: (1) Applying in writing to the Arkansas State Board of Dental Examiners; (2) Paying all accrued renewal fees as established under § 17-82-310 and provided for in the regulations of the board, plus an additional penalty of two hundred dollars ($200); and (3) Furnishing such proof as the board may require that, in the period since January 1 of the year when his or her license ought first to have been effected, he or she has continuously conducted himself or herself in an ethical and proper fashion and complied with the regulations of the board and the provisions of the Dental Practice Act, § 17-82-101 et seq. (b) A dentist or dental hygienist who applies for relicensing, following forfeiture, after two (2) years from January 1 of the year when his or her license ought first to have been effected may be relicensed by : (1) Complying with the requirements of subsection (a) of this section; and (2) (A) Undergoing reexamination and passing the examination required by the regulations of the board. (B) The re-examination shall consist of clinical skills only. 17-82-313. RENEWAL – NONRESIDENTS. (a) (1) A dentist or dental hygienist who has been licensed and who becomes a nonresident of the State of Arkansas may continue in effect his or her license to practice in the State of Arkansas by paying the renewal fee required of resident dentists and dental hygienists; 17-82-314. FAILURE TO PRACTICE. (a) All licenses issued to dentists and dental hygienists are automatically forfeited if the licensee ceases to practice his or her profession either in the State of Arkansas or elsewhere for a period of two (2) years. (b) The licensee is not entitled to resume the practice of his or her profession in the State of Arkansas until he or she is reexamined and licensed by the Arkansas State Board of Dental Examiners. However, the examination shall consist only of clinical work. (c) A dentist or dental hygienist who resumes the practice of his or her profession in the State of Arkansas after having ceased to practice for a period of two (2) years without reexamination and relicensing is subject to the penalties and liabilities prescribed in §17-82-301(b) and (c). 17-82-316. REVOCATION OR SUSPENSION – GROUNDS – EFFECT. (c) The board may impose one (1) or more of the penalties set out in subsection (b) of this section if the board finds that the licensed dentist, dental hygienist, or permit holder has violated this chapter, or the rules of the board, or has committed one (1) or more of the following acts: (3) The commission of any criminal operation; habitual drunkenness for a period of three (3) months; insanity; adjudication of insanity or mental incompetency if deemed detrimental to patients; conviction of a felony listed under § 17-2-102; addiction to narcotics; immoral, dishonorable, or scandalous conduct; professional incompetency; failure to maintain proper standards of sanitation or failure otherwise to maintain adequate safeguards for the health and safety of patients; or employment in the practice of the profession of any drug, nostrum, unknown formula, or dangerous or unknown anesthetic not generally used by the dental profession; 17-82-802. LICENSE ELIGIBILITY. A person shall not be eligible to receive or hold a license to practice dentistry or another healthcare profession issued by the Arkansas State Board of Dental Examiners if the person has pleaded guilty or nolo contendere or has been found guilty of a felony listed under § 17-2-102.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants Subchapter 4 LICENSING OF CERTAIN DENTAL ASSISTANTS Effective Dates. Acts 1985, No. 473, §7; Mar. 21, 1985. Emergency clause provided: “It is hereby found and determined by the General Assembly of the State of Arkansas that existing laws regulating the practice of dentistry do not provide for the regulating of dental assistants who perform expanded duties, such as the monitoring of anesthetics to patients and radiology; that provisions by the Arkansas State Board of Dental Examiners to issue a permit to dental assistants who perform expanded duties are necessary to insure proper enforcement of educational and safety standards for the benefit of the public; that there is an emergency need for such provision; and that the enactment of this measure will relieve this dangerous situation. Therefore, an emergency is declared to exist and this act being necessary for the preservation of the public peace, health and safety should take effect and be in force from the date of its approval.” 17-82-401. LEGISLATIVE INTENT. The provisions of this subchapter are intended to be supplemental and in addition to subchapters 1-3 of this chapter and are intended to authorize the Arkansas State Board of Dental Examiners to issue permits to dental assistants who perform expanded duties as provided in this subchapter. 17-82-402. PENALTIES. Any person who violates the provisions of § 17-82-403 or any dentist who permits a person to violate the provisions of §17-82-403 shall be subject to the penalties and sanctions as set forth in §§17-82-301(b) and (c) and 17-82-316. 17-82-403. PERMIT REQUIRED. No person shall perform the expanded duties of a dental assistant as defined by the Arkansas State Board of Dental Examiners in the rules and regulations of the board without a permit. 17-82-404. APPLICATIONS - ISSUANCE. (a) A dental assistant who desires to perform expanded duties as defined by the rules and regulations of the Arkansas State Board of Dental Examiners in the State of Arkansas shall apply in writing for examination to the Secretary of the Arkansas State Board of Dental Examiners, and he or she shall transmit with the written application his or her examination and licensing fee. (b) The examination and licensing fee shall be determined by the board and shall be an amount reasonably calculated to cover the costs of administering the examination, issuing the license to practice and otherwise administering this subchapter. (c) An applicant must be of good moral reputation and character and a graduate of a school or course of study approved by the board for the training of dental assistants. (d) An applicant must submit, upon request, such proof as the board may require touching upon character and fitness. (e) (1) If after considering an application and its accompanying records, the board finds that the applicant is not qualified to take the examination, the board shall refund the entire amount of the examination and licensing fee paid by the applicant. (2) If a qualified applicant fails to appear for examination, the fee shall be retained by the board. (3) If an applicant fails to make the grade or percentage required by the board, the fee paid by him shall be retained by the board. (f) If an applicant makes the grade or percentage required by the board, it shall issue to him without further initial cost a permit to perform the expanded duties of a dental assistant in the State of Arkansas. (g) All permits shall be numbered and issued consecutively. (h) If a permit is lost or destroyed, the secretary shall furnish a certified copy of the permit to the permittee upon the payment of a fee to be prescribed by the board, and the fee shall be in an amount reasonably calculated to cover the cost of furnishing the certified copy. 17-82-405. ANNUAL REGISTRATION. (a) For dental assistants who perform expanded duties, all permits issued by the board shall continue in full force and effect until forfeited, suspended or revoked. Provided, on January 1 of odd numbered years, every dental assistant must register his permit with the Arkansas State board of Dental Examiners on forms prepared and furnished by the Board. (b) A registration fee of not more than sixty dollars ($60.00), to be fixed by the board, must be paid to the board upon the filing of such form duly executed with the board. (c) The procedures for registration and penalties for failure to register permits of dentists as stated in §§17-82-310 17-82-314 will apply to the registration of permits by dental assistants. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants 17-82-406. RULES AND REGULATIONS. All laws pertaining to dentists and dental hygienists as stated in subchapters 1-3 of this chapter, and the rules and regulations of the board, will apply to dental assistants who perform expanded duties. Rules & Regulations Article XI Dental Hygienist Functions A. Exclusive Functions to be Performed by a Dental Hygienist When Delegated by a Dentist 1. Effective and safe delivery of certain services to the public is dependent upon making judgments and utilizing skills that require synthesis and application of knowledge acquired in accredited dental hygiene education programs and cannot be delegated to any dental staff member other than a licensed, registered dental hygienist. 2. The following functions may only be delegated to a licensed dental hygienist: a. Oral examination. Elements of these examinations include charting of carious lesions and other abnormalities, periodontal charting and assessment of periodontal conditions, treatment planning for dental hygiene services and oral cancer screening. The dental hygienist may dictate the examination findings to a dental assistant who may then record the data on the patientâ&#x20AC;&#x2122;s dental record. b. Oral prophylaxis, scaling, root planing and curettage. If a laser instrument is used, the dental hygienist and their supervising dentist must submit to the Board proof of successful completion of an approved educational course on the use of that type of laser prior to its usage for any patient treatment. c. Using air driven, electric, sonic, ultrasonic, or otherwise powered scalers or polishers (except dental assistants possessing an expanded duties permit for polishing). d. Placing medicaments as prescribed by the supervising dentist into the sulcus or periodontal pockets, for periodontal diseases e. Place Silver Diamine Fluoride (SDF) under general supervision. If SDF is used, the dental hygienist and their supervising dentist must submit to the Board proof of successful completion of an approved educational course on SDF prior to its usage for and patient treatment. ARTICLE XIII Analgesia, Conscious Sedation, Deep Sedation and General Anesthesia Rules for a Dentist in an Ambulatory Facility A. Definitions 1. Analgesia - The diminution of pain or production of increased tolerance to pain in the conscious patient. 4. Levels of Supervision For Qualified Staff a. Direct Supervision - The dentist is in the dental office, authorizes the procedure, and remains in the dental office while the procedures are being performed by the auxiliary. b. Personal Supervision - The dentist is in the dental office, personally authorizes the procedure, and before the dismissal of the patient, evaluates the patient. c. Operative Supervision - The dentist is personally operating on the patient and authorizes the auxiliary to aid the treatment by concurrently performing a supportive procedure. 5. Nitrous Oxide/Oxygen Inhalation Analgesia - The administration, by inhalation, of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and/or verbal command. Nitrous oxide/ oxygen inhalation analgesia, when used alone, is not considered a form of sedation but is considered to be an analgesic only. 6. Qualified Staff - An individual trained to monitor appropriate physiological parameters and to help in any supportive or resuscitating measures. a. For dentists using Minimal or Moderate Sedation, qualified staff must have a current Nitrous Oxide Permit from the Board and be currently certified in health care provider CPR. b. For dentists using Deep or General Sedation, qualified staff must have a current Nitrous Oxide Permit from the Board and be currently certified in Healthcare Provider CPR AND have completed a Board approved course as outlined in Section G of this rule and be registered with the Board as a Sedation Assistant. 7. Minimal Sedation - a minimally depressed level of consciousness produced by a pharmacological method, that retains the patientâ&#x20AC;&#x2122;s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. The patient should be oriented to person, place and time. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. In accordance with this particular definition, the drug and/or techniques used should carry a margin of safety wide enough never to render unintended loss of consciousness. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation. When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the maximum recommended dose of a drug that can be prescribed for unmonitored home use. When the intent is Minimal Sedation, only one drug can be given in addition to nitrous oxide. 30

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants

Pediatric Considerations: In addition to the physiologic parameters for Minimal Sedation in children under 12 years of age, when the intent is Minimal Sedation, only one drug can be given in addition to nitrous oxide. A drug CANNOT be from the scheduled category of drugs II, III or IV with the exception of diazepam. If a child under 12 years of age is given any drug for sedation from Schedule II, III or IV, with the exception of diazepam, that child is considered more than minimally sedated. 8. Moderate Sedation - a drugâ&#x20AC;&#x201C;induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. In accordance with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the dentist. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation. 9. Deep Sedation - a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. 10. General Anesthesia - a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. C. Standard of Care These guidelines are designed to encourage a high level of quality care in the dental office setting. It should be recognized that emergency situations may require that these standards be modified based on the judgment of the clinician(s) responsible for the delivery of anesthesia care services. Changing technology and Arkansas rules, regulations or laws may also modify the standards listed herein. 2. During the anesthesia period the oxygenation, ventilation, and circulation of the patient must be continuously evaluated and documented by qualified staff assigned by the dentist. 3. Each licensed dentist administering Deep Sedation or General Anesthesia must provide for training in emergency procedures to his or her qualified staff personnel. Emergency preparedness updates or drills for all staff must be held at least annually. 6. The patient must be continuously observed during the anesthesia period either by the dentist or qualified staff. 7. Personal supervision is required for monitoring patients under nitrous oxide/oxygen analgesia for registered dental assistants holding a current Nitrous Oxide Permit from the Board. 8. Direct supervision is required for monitoring patients under nitrous oxide/oxygen analgesia for dental hygienists holding a current Nitrous Oxide Permit from the Board. 9. Supervision of dental auxiliaries monitoring sedated patients a. Personal supervision is required for Minimal and Moderate Sedation b. Operative supervision is required for Deep Sedation and General Anesthesia. c. Personal supervision is required for Qualified Staff who continuously monitor post-surgical patients before final evaluation and discharge by the dentist. D. Permits, Qualified Staff, Equipment, Documentation, Emergency Care & Patient Monitoring 1. Nitrous Oxide Inhalation Analgesia b. Qualified Staff: All patients shall be monitored continuously by personnel who hold a current permit with the Board to induce and monitor nitrous oxide /oxygen inhalation analgesia and a current certification in health-care provider level CPR. f. Patient Monitoring: The dentist or qualified staff must remain in the operatory while a patient is receiving nitrous oxide inhalation analgesia. 2. Minimal Sedation b. Qualified Staff: All patients shall be monitored continuously by qualified staff who hold a current permit with the Board to induce and monitor nitrous oxide/oxygen inhalation analgesia and a current certification in health-care provider level CPR. f. Patient Monitoring: The dentist or qualified staff must remain in the operatory during active dental treatment to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The dentist or qualified staff must monitor the patient during recovery until the patient is ready for discharge by the dentist. The dentists must determine and document that levels of consciousness, oxygenation, ventilation and circulation are satisfactory prior to discharge. 3. Moderate Sedation b. Qualified Staff: All patients shall be monitored continuously by qualified staff who hold a current permit with the Board to induce and monitor nitrous oxide/oxygen inhalation analgesia and a current certification in health-care provider level CPR. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants f.

Patient Monitoring: The dentist or qualified staff must remain in the operatory to monitor the patient continuously until the patient meets the criteria for recovery. When active treatment concludes and the patient recovers to a minimally sedated level, qualified staff may remain with the patient and continue to monitor them until they are discharged from the facility. The dentists must not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. The dentist must determine and document that levels of consciousness, oxygenation, ventilation and circulation are satisfactory prior to discharge. 4. Deep Sedation b. Qualified Staff: The technique for Deep Sedation requires the following three individuals: 1) A dentist holding a current permit for Deep Sedation from the Board 2) An individual to assist with observation and monitoring of the patient and who may administer drugs if appropriately licensed; and 3) Qualified staff to assist the operator as necessary. All individuals assisting at this level must: (a) hold a current permit from the Board to monitor and administer nitrous oxide (b) hold a current permit from the Board as a Sedation Assistant, (c) hold a current certification in health-care provider level of CPR f. Patient Monitoring: The dentist must remain in the operatory to monitor the patient continuously until the patient meets the criteria for recovery. When active treatment concludes and the patient recovers to a minimally sedated level, qualified staff may remain with the patient and continue to monitor them until they are discharged from the facility. The dentists must not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. The dentists must determine and document that levels of consciousness, oxygenation, ventilation, circulation and temperature are satisfactory prior to discharge. 5. General Anesthesia All requirements for permits, qualified staff, equipment, records, emergency care, and patient monitoring are exactly the same as for Deep Sedation. E. Obtaining Permits for Nitrous Oxide Analgesia, Minimal, Moderate and Deep Sedation, General Anesthesia and Facilities 2. Obtaining a Permit: a. Moderate Sedation, Deep Sedation and General Anesthesia Permits: 3) After the Deep Sedation â&#x20AC;&#x201C; General Anesthesia permit has been issued, the Board requires an onsite inspection of the facility, equipment and credentials of the personnel to determine if, in fact, the personnel, equipment and facility requirements have been met. The evaluation shall be conducted as outlined in this document. 4) At the discretion of the Board, a re-evaluation of an office, dentist, and staff may be scheduled at any time. The Board shall consider such factors as it deems pertinent including, but not limited to, patient complaints and reports of adverse occurrences. F. On-Site Facility Inspection and Evaluation/Re-evaluation for Moderate Sedation, Deep Sedation, General Anesthesia Facilities An evaluation or re-evaluation shall consist of a review of the following: 1. Office facilities, equipment, dental records and staff to include documentation of review of emergency preparedness with staff at least annually, written protocol for office emergencies and current appropriate licenses & permits for dentist(s) and staff. G. Qualified Staff: Sedation Monitoring Requirements There are certain situations when a dentist must entrust the monitoring of a sedated patient to a staff member. The Board recognizes this need and has developed an expanded function permit for certain dental assistants, hygienists or other staff members who meet the following minimal criteria and have applied for and received a permit from the board. Staff monitoring patients undergoing any level of sedation must hold a current Nitrous Oxide Permit from the Board and a current certification in health care provider level of CPR. Staff monitoring patients undergoing Deep Sedation or General Anesthesia must hold a current permit from the Board as a Sedation Assistant. To qualify as a Sedation Assistant, a person must: 1. Be a Certified Dental Assistant, Registered Dental Assistant, Registered Nurse or Licensed Practical Nurse 2. Hold a current certification in health care provider level CPR 3. Hold a current permit from the Board to monitor and induce nitrous oxide analgesia 4. Successfully complete the American Association of Oral and Maxillofacial Surgeons Anesthesia Assistantâ&#x20AC;&#x2122;s Training Program or a Board approved equivalent course. Renewal of permit: To renew the Sedation Assistant permit biennially, the permit holder must show proof of a minimum of two hours of continuing education related to office emergency management or direct care of sedated patients. Proof of annual review of office emergency preparedness updates or drills, as required in Section C.3 of this article, can be submitted to fulfill this requirement. 32

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants Exemptions: Licensed physicians with a specialty in anesthesiology and Certified Registered Nurse Anesthetists are exempt from the educational and permit requirements listed in this section. Other licensed health care providers, who can show proof of successful completion of a course which meets or exceeds those listed in this regulation, may obtain an exemption from the Board on a case by case basis. ARTICLE XIV Minimum Continuing Education For Dentists and Dental Hygienists I. Cardiopulmonary Resuscitation: Each licensed dentist, dental hygienist, and registered dental assistant must take a Basic Life Support level of cardiopulmonary resuscitation course and submit a photocopy of the cardiopulmonary resuscitation card or certificate with the renewal form that confirms that he or she holds at least a current certificate in cardiopulmonary resuscitation of Basic Life Support level, effective January 1, 2003. The hours dedicated to obtaining a Basic Life Support certification can be used toward CEUs. ARTICLE XV Infection Control Arkansas Code §17-82-316(a)-(c) and Arkansas Code §17-82-406 provide that the Arkansas State Board of Dental Examiners is vested with the power to revoke or suspend for any period of time, the privilege of practicing under any license issued in the State of Arkansas to any dentist, dental hygienist or dental assistant if the licensee fails to maintain proper standards of sanitation or fails to otherwise maintain adequate safeguards for the health and safety of patients. Public Law 102-141 passed in the First Session of the 102nd Congress of the United States of America approved October 28, 1991 provides that the states will establish guidelines to apply to health professionals and will determine appropriate disciplinary and other actions to ensure compliance with those guidelines in order to prevent the transmission of human immunodeficiency virus and hepatitis B virus during exposure-prone invasive procedures except for an emergency situation where the patient’s life or limb is in danger. A. Definitions as used in this Rule: 1. Dental Health Care Personnel (DHCP) Dental health-care personnel (DHCP) refers to all paid and unpaid personnel in the dental health-care setting who might be occupationally exposed to infectious materials, including body substances and contaminated supplies, equipment, environmental surfaces, water, or air. DHCP includes dentists, dental hygienists, dental assistants, dental laboratory technicians (in-office and commercial), students and trainees, contractual personnel, and other persons not directly involved in patient care but potentially exposed to infectious agents (e.g., administrative, clerical, housekeeping, maintenance, or volunteer personnel). 2. HIV- The human immunodeficiency virus, whether HIV-1 or HIV-2. 3. HBV- The Hepatitis B virus. 4. HCV- The Hepatitis C virus. 5. OPIM- Other potentially infectious materials. OPIM is a term that refers to 1) bodily fluids including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, fluids including semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures; any body fluid visibly contaminated with blood; and all body fluids in situations where differentiating between body fluids is difficult or impossible; and 2) any unfixed tissue or organ (other than intact skin) from a human (living or dead). 6. Exposure-prone invasive procedure- Any surgical, diagnostic or therapeutic procedure involving manual or instrumental contact with or entry into any blood, body fluids, cavity, internal organ, subcutaneous tissue, mucous membrane or percutaneous would of the human body in which there is a risk of contact between the blood or OPIM of the DHCP and the blood or OPIM of the patient. 7. Standard precautions- The concept that all blood and OPIM should be treated as infectious because patients with bloodborne infections can be asymptomatic or unaware they are infected. Preventive practices used to reduce blood exposures, particularly percutaneous exposures, include 1) careful handling of sharp instruments; 2) use of rubber dams to minimize blood spattering; 3) handwashing; and 4) use of personal protective barriers (e.g., gloves, masks, protective eyewear, and gowns). Standard precautions integrate and expand the elements of universal precautions (the term used by the CDC prior to 1996) into a standard of care designed to protect DHCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion. Standard precautions apply to contact with 1) blood; 2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain blood; 3) nonintact skin; and 4) mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between universal precautions and standard precautions. 8. Occupational exposure- Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or OPIM that result from the performance of an employee’s duties. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants

9. Disinfection- Destruction of pathogenic and other kinds of microorganisms by physical or chemical means. Disinfection is less lethal than sterilization, because it destroys the majority of recognized pathogenic microorganisms, but not necessarily all microbial forms (e.g., bacterial spores). Disinfection does not ensure the degree of safety associated with sterilization processes. 10. Sterilization- Use of a physical or chemical procedure to destroy all microorganisms including substantial numbers of resistant bacterial spores. 11. Critical instruments- Penetrates soft tissue, contacts bone, enters into or contacts the bloodstream or other normally sterile tissue; includes surgical instruments, periodontal scalers, scalpel blades, surgical dental burs. 12. Semicritical instruments- Contacts mucous membranes or nonintact skin; will not penetrate soft tissue, contact bone, enter into or contact the bloodstream or other normally sterile tissue; includes dental mouth mirror, amalgam condenser, reusable dental impression trays. 13. Noncritical instruments- Contacts intact skin; includes radiograph head/cone, blood pressure cuff, facebow, pulse oximeter. Education and Training 1. Training in standard precautions and other infection control standards required by OSHA and as recommended by the CDC and set forth in this rule shall be provided to all DHCP by the employer upon initial employment prior to direct patient care, whenever new tasks are assigned which effects the level of occupational exposure, and at least annually. 2. At least two (2) continuing education hours on infection control must be reported with biennial license renewals for all dentists, dental hygienists and registered dental assistants. Preventing Transmission of Bloodborne Pathogens 1. All DHCPs who are at risk for occupational exposure to blood or OPIM shall at all times use and practice standard precautions for all patient encounters. 2. Engineering and work-practice controls a. Consider sharp items (needles, scalers, burs, lab knives, and wires) that are contaminated as infective. b. Place used disposable syringes and needles, scalpel blades, and other sharp items in appropriate puncture-resistant containers. c. Do not recap used needles by using both hands or any other technique that involves directing the point of the needle toward any part of the body. Use either a one-handed scoop technique or a mechanical device designed for holding the needle cap when recapping needles. d. Do not bend or break needles prior to disposal. 3. Follow CDC guidelines after percutaneous, mucous membrane, or nonintact skin exposure to blood or OPIM. Guidelines are found in the CDC publication MMWR, Dec. 19, 2003, Volume 52, No. RR-17, pg. 13-14, Post Exposure Management and Prophylaxis. Personal Protective Equipment (PPE) 1. Masks, protective eyewear, and face shields a. A surgical mask and eye protection with solid side shields or a surgical mask and a face shield must be worn during procedures likely to generate splashing or spattering of blood or OPIM. b. Change masks between patients. Also change masks during patient treatment if mask becomes wet. c. Clean with soap and water, or if visibly soiled, clean and disinfect reusable facial protective equipment. 2. Protective clothing a. Wear reusable or disposable gowns, lab coats, or uniforms that cover personal clothing and skin (forearms) likely to be soiled with blood or OPIM. b. Change protective clothing if visibly soiled. c. Remove gloves, mask, non-prescription protective eyewear or shields before departing clinic area. 3. Gloves a. Wear medical gloves when a potential exists for contacting blood, saliva, OPIM, or mucous membranes. b. Wash hands before donning gloves. Wear a new pair of gloves for each patient, remove them promptly after use, and wash hands immediately. c. Remove gloves that are torn, cut, or punctured and wash hands before regloving. d. Do not wash or disinfect gloves before use. e. Ensure that appropriate gloves in the correct size are readily accessible. f. Use puncture and chemical resistant utility gloves when cleaning instruments and performing housekeeping tasks involving contact with chemicals and/or contaminated surfaces. g. Ensure that non-latex gloves are available for those patients and DHCPâ&#x20AC;&#x2122;s with latex allergies. Sterilization and disinfection of patient-care items 1. Instrument cleaning and sterilization a. Clean and heat-sterilize critical and semicritical instruments and items before each use using only FDAcleared medical devices for sterilization and follow the manufacturerâ&#x20AC;&#x2122;s instructions for correct use. b. Clean all visible debris from instruments and items before sterilization or disinfection using an automated cleaning process such as an ultrasonic cleaner or washer-disinfector. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants c. Wear puncture- and chemical-resistant/heavy duty utility gloves for instrument cleaning and decontamination procedures. d. Wear appropriate PPE when splashing or spraying is anticipated during cleaning (i.e., mask, eye protection or face shield). e. Single-use disposable instruments are acceptable alternatives if they are used only once and disposed of correctly. f. Ensure that noncritical patient-care items are barrier protected or cleaned and disinfected after each use with an EPA-registered hospital disinfectant. 2. Packaging of Instruments a. Instruments should be sterilized inside packages with color change markings or chemical indicator tape attached which verify that the package has been exposed to the sterilization process and required parameters of time, temperature, and the presence of steam has been achieved. b. Critical and Semicritical instruments intended for immediate reuse can be heat-sterilized unwrapped if a chemical indicator such as autoclave tape is used for each cycle and the instruments are transported immediately and aseptically to the point of use. c. Do not sterilize implantable devices unwrapped. 3. Sterilization monitoring a. Monitor each load with mechanical (e.g., time, temperature, and pressure) and chemical indicators. Color change markings on bags or autoclave tape are acceptable indicators. b. Do not use instrument packs if mechanical or chemical indicators indicate inadequate processing. c. Monitor sterilizers at least monthly by using a biological indicator (spore test) with a matching control. d. In case of a positive spore test, remove the sterilizer from service and retest. If the repeat spore test is negative put the sterilizer back in service. e. If the repeated spore test is positive, remove the sterilizer from use until it has been inspected or repaired, recall and reprocess all items processed since the last negative test. f. Maintain sterilization records or biological spore testing for three years. 4. Storing sterile items a. Place the date or sterilization and if multiple sterilizers are used in the facility, the sterilizer used on the outside of the packaging material. This will be critical in case of a failed spore test. b. Reclean, repack, and resterilize any instrument package that has been compromised (torn, punctured, etc.) c. Do not store sterile instruments where the packages might be contaminated by contact with non-sterile instruments or packages. d. Do not store critical or semicritical instruments unwrapped. F. Environmental Infection Control 1. Clinical contact surfaces a. Examples of clinical contact surfaces are light handles, switches, radiograph equipment, chairside computers, drawer handles, faucet handles, countertops, pens, doorknobs, etc. b. Use barriers such as clear plastic wrap, bags, sheets, tubing, and plastic-backed paper or other materials impervious to moisture, to protect clinical contact surfaces. Barriers must be changed between patients. c. Clean and disinfect clinical contact surfaces that are not barrier-protected, by using an EPA-registered hospital disinfectant after each patient following manufacturerâ&#x20AC;&#x2122;s directions. d. Use PPE when cleaning and disinfecting environmental surfaces. 2. Regulated medical waste a. Dispose of regulated medical waste in accordance with federal, state, and local regulations. b. Use color-coded or labeled containers that prevent leakage for nonsharp regulated medical waste. c. Place sharp items (needles, glass anesthetic carpules, scalpel blades, ortho bands/wires, broken metal instruments, and burs) in an appropriate sharps container. Do not overfill. G. Dental Unit Water Lines and Water Quality 1. Use water that meets EPA regulatory standards for drinking water. 2. Discharge water and air for a minimum of 20-30 seconds after each patient from any device connected to the dental water system that enters that patientâ&#x20AC;&#x2122;s mouth. 3. During a boil-water advisory, do not deliver water from the public water system to the patient through the dental operative unit, ultrasonic scaler, or other dental equipment that uses the public water system until the boil order is lifted by the local water utility. H. Special Considerations 1. Clean and heat-sterilize handpieces and other intraoral instruments that can be removed from the air and waterlines of dental units between patients. 2. Use heat-tolerant or disposable intraoral devices for dental radiography which are sterilized before each use. 3. For digital radiography sensors, use barriers (covers). If the items cannot tolerate heat sterilization.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants 4. Handling of extracted teeth a. Dispose of extracted teeth as regulated medical waste unless returned to the patient. b. Clean and place extracted teeth in a leak proof container, labeled with a biohazard symbol, and maintain hydration for transport to education institutions or a dental laboratory. 5. Dental laboratory a. Use PPE when handling items received in the lab until they have been decontaminated. b. Before they are handled in the lab, clean disinfect, and rinse all dental prostheses and prosthodontic materials (impressions, bite registrations, occlusal rims, and extracted teeth) by using an EPA registered hospital disinfectant. c. Clean and heat-sterilize heat tolerant items used in the mouth such as metal impression trays. I. Medical conditions, work-related illness, and work restrictions 1. A DHCP who is positive for HIV, Hepatitis B or Hepatitis C shall disclose this fact to the board. If the DHCP is not a licensee or permit holder, the supervising licensed dentist will report the DHCP’s health status to the board. The DHCP shall thereafter refrain from participating in any procedure which has a potential for occupational exposure. Said refraining will continue until such time as the board enters an Order delineating the scope of practice permitted for the DHCP. 2. The Board will then establish and appoint members to serve on a Review Panel to review, counsel, monitor and recommend restrictions, when appropriate, for the practices of HIV, Hepatitis B or Hepatitis C positive DHCPs. 3. The Review Panel shall be appointed by the Board with its members being chosen on a case-by-case basis. 4. The Review Panel will conduct its review considering that exposure-prone invasive procedures are best determined on a case-by-case basis by taking into consideration the degree of infectivity, the specific procedure(s) as well as the skill, technique, and possible mental and/or physical impairment of the infected DHCP. Following its review, the Panel Chairperson will submit a report of recommendations or restrictions of practice to the Board. 5. The Board will consider the Review Panel’s recommendations, will make the final determination of practice and/ or procedure restrictions, will develop procedures in order to monitor the compliance of the DHCP with restrictions, and will communicate said information of any restrictions and the monitoring of the restrictions to the DHCP or the supervising licensed dentist by written Order. 6. Information as to the Panel’s recommendations, the Board’s monitoring of restrictions and its disciplining of the DHCP or the supervising license dentist, if necessary, will be reported in a timely manner to the Director of the Arkansas Department of Health who will continue to ensure the confidentiality of the infected DHCP. 7. Reports and information furnished to and by the Board relative to the HIV, HBV or HCV infectivity of a DHCP shall not be deemed to constituted public record but shall be deemed and maintained by the Board as confidential and privileged as medical records. 8. At such time as there is an alleged violation of this Rule and Regulation, the Board will proceed with its procedures set forth in the Dental Practice Act and Rules and Regulations by bringing a licensee before it for alleged violations of the Practice Act. At that time, the knowledge and information pertaining to the medical condition of the DHCP may become public knowledge. 9. The failure of a dentist, dental hygienist, or registered dental assistant to comply with the terms of this Rule and Regulation or the Order of the Board concerning the scope of practice as referred to in Section I, Paragraph 1 will be considered a failure to maintain adequate safeguards for the health and safety of the patient and the public, as referred to in the Dental Practice Act. ARTICLE XVII Dental Assistant Functions A. All Functions Delegated to a Dental Assistant Must be Performed Under Personal Supervision. Personal Supervision Means: 1. The Dentist is in the office or treatment facility. 2. The Dentist has personally diagnosed the condition to be treated. 3. The Dentist has personally authorized the procedures. 4. The Dentist remains in the office or treatment facility while the procedures are being performed. 5. The Dentist evaluates the performance of the Dental Assistant before the dismissal of the patient. The supervising licensed Dentist is responsible for determining the appropriateness of delegation of any specific function based upon knowledge of the skills of the assistant, the needs of the patient, the requirements of the task and whether proof of competence is required. The Dentist is ultimately responsible for patient care. Nothing contained in the authority given the Dentist by this rule to delegate the performance of certain procedures shall in any way relieve the supervising Dentist from the liability to the patient for negligent performance by a Dental Assistant. 36

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants B. Definitions 1. Dental Assistant: A staff member of a duly licensed Dentist who is involved in direct patient care to include a Certified Dental Assistant or a Registered Dental Assistant. 2. Registered Dental Assistant: A Dental Assistant who has obtained a permit(s) from the Board to perform any or all of the following expanded duties: a. Administration of nitrous oxide/oxygen analgesia b. Operation of dental radiographic equipment c. Coronal polishing d. Monitoring of patients undergoing deep sedation or general anesthesia 3. Certified Dental Assistant: A Dental Assistant who is currently certified by the Dental Assistant National Board. C. Tasks Authorized to be Performed by Dental Assistants With the exceptions listed below, a Dental Assistant may perform any dental task or procedure assigned by the supervising dentist to the assistant that does not require the professional skills of a licensed Dentist or licensed dental hygienist, but only under the personal supervision of a licensed Dentist on the premises. A dental assistant who has obtained a coronal polishing permit may be delegated by the dentist to place dental sealants, but only under the personal supervision of the licensed Dentist. These duties may only be delegated when the effect of the procedure assigned is reversible. D. Prohibited Activities The responsibility for diagnosis, treatment planning, or the prescription of medications in the practice of Dentistry shall remain with a licensed Dentist and may not be assigned or delegated to a Dental Assistant. No dental procedure that will contribute to or result in an irreversible alteration of the oral anatomy may be performed by anyone other than a licensed Dentist. The following activities are prohibited for Dental Assistants: 1. Diagnosis and treatment planning 2. Scaling, root planing and curettage 3. Surgical or cutting procedures on hard or soft tissue. 4. Prescription, injection, inhalation, and parenteral administration of drugs (except where permitted by the Board) 5. Placement, seating, or removal of any final or permanent restorations. 6. Final placement of orthodontic brackets 7. Any procedure that contributes to or results in irreversible alteration of the oral anatomy 8. Performance of any of the following expanded duties without a permit: a. Administration of nitrous oxide/oxygen analgesia b. Operation of dental radiographic equipment c. Coronal polishing 9. Those functions relegated to a dental hygienist and stated in Regulation XI A. E. Registered Dental Assistant Expanded Function Permits It is the responsibility of the Dental Assistant to provide the Arkansas State Board of Dental Examiners with proof of competence in the desired expanded function prior to receiving a permit from the Board. 1. A Dental Assistant may induce and monitor nitrous oxide/oxygen analgesia after successful completion of a course approved by the Board and the payment of a designated fee. At this time a permit will be issued. 2. A Dental Assistant may operate dental radiographic equipment after successful completion of an education course as approved by the Board and submits proof of competency by passing an examination and the payment of a designated fee. At this time, a permit will be issued. 3. A Dental Assistant may perform coronal polishing after successful completion of education requirements as approved by the Board and submits proof of competency by passing such examination as the Board requires, and the payment of a designated fee. At this time, a permit will be issued. 4. A Dental Assistant may monitor patients who are under deep sedation or general anesthesia only in offices where the dentist(s) is permitted to perform those services, after successful completion of education requirements as approved by the Board and submits proof of competency by passing such examination as the Board requires and the payment of a designated fee. At that time, a permit will be issued. 5. A Certified Dental Assistant, or an assistant who is a graduate of a school which is accredited or provisionally accredited by the Council on Dental Accreditation of the American Dental Association, need only submit proof of graduation or certification to the board along with the designated fee and a permit will be issued for any expanded duty requested except Sedation Monitoring. After receipt of one or more of the expanded function permits, the Dental Assistant will then be considered a Registered Dental Assistant with the Board. Those permits must be on display within the dental office or treatment facility.

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants F. Process For Obtaining a Permit For Administration of Nitrous Oxide A Dental Assistant desiring to obtain an expanded duty permit for nitrous oxide/oxygen analgesia from the Board must do the following: 1. Successfully complete a nitrous oxide administration and monitoring course as approved by the Board. 2. Submit a copy of the certificate of completion to the Board along with any designated fee. 3. Successfully complete a jurisprudence examination covering the Dental Practice Act and rules of the Board. 4. Show proof of current certification in Healthcare Provider level of CPR. G. Process For Obtaining a Permit For Radiography and/or Coronal Polishing A Dental Assistant desiring to obtain an expanded duty permit for radiography and/or coronal polishing from the Board must do the following: 1. If applying for a Radiography Permit, successfully complete and submit a Certificate of completion of a radiography course approved by the Board. 2. If applying for a coronal polishing permit, successfully complete and submit a certificate of completion of coronal polishing course approved by the Board. 3. Submit completed forms and designated fees as required by the Board. 4. If applying for either permit, successfully complete a jurisprudence examination, covering the Dental Practice Act and the rules and regulations of the Board. 5. If applying for either permit, show a proof of current certification in Healthcare Provider level of CPR. 6. Dental assistants holding a current radiography permit granted by the Arkansas State Board of Dental Examiners dated prior to November 2011 will not be required to complete an approved radiography course unless that dental assistant is operating any type of imaging machine other than conventional flat film radiography, such as cone beam computed axial tomography (CT) scan. 7. Any dental assistant operating imaging machines other than conventional flat film radiography must complete a Board approved course in radiography, even if having been issued a radiography permit by the Board prior to 1 November 2011. Said completion of the course must be accomplished and submitted to the Board prior to operating said machines and/or renewal of the radiography permit. H. Process For Obtaining Permit for Sedation Monitoring A Dental Assistant desiring to obtain an expanded duty permit for sedation monitoring from the Board must do the following: 1. Hold a current permit for nitrous oxide administration 2. Hold and show proof of a current certification in Healthcare Provider level of cardiopulmonary resuscitation 3. Be a Certified Dental Assistant, Registered Dental Assistant, Registered Nurse or Licensed Practical Nurse 4. Submit proof of successful completion of the American Association of Oral and Maxillofacial Surgeons Anesthesia Assistantâ&#x20AC;&#x2122;s training program or a Board approved equivalent course within the two year period immediately previous to submitting an application to be a Sedation Assistant. 5. Successfully complete a jurisprudence examination covering the Dental Practice Act and rules of the Board. 6. Exemptions: Licensed physicians with at least six months of experience in anesthesia and anesthesia monitoring and Certified Registered Nurse Anesthetists are exempt from the educational and permit requirements listing in this section. Other licensed health care providers, who can show proof of successful completion of a course which meets or exceeds those listed in this regulation, may obtain an exemption from the Board on a case by case basis. I. Said permits must be renewed on forms as provided by the Board pursuant to Ark. Code Ann 17-82-405. As stated in that section of the code, the procedures for registration and penalties for failure to register permits of dentists as stated in 17-82-310 through 17-82-314 will apply to the registration of permits by dental assistants. J. A registered dental assistant must provide the Board proof of completing 2 hours of continuing education each 2-year reporting period on the subject of infection control in order to renew a permit to perform expanded duties. The registered dental assistant must report the continuing education hours in the manner set forth in Article XIV of the board.

p 38

California DANB Certificant Counts: California National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Karen Fischer, Executive Officer Dental Board of California 2005 Evergreen St., Suite 1550 Sacramento, CA 95815 Phone: 916-263-2300 or 877-729-7789 (toll-free) Fax: 916-263-2140 Email: dentalboard@dca.ca.gov Website: www.dbc.ca.gov

Radiation Health and Safety (RHS)

2,985

Infection Control (ICE)

2,785

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Cerritos College Chaffey College Citrus College City College of San Francisco College of Alameda College of Marin College of the Redwoods College of San Mateo Cypress College Diablo Valley College

627

Foothill College Hacienda LaPuente Adult Ed. Moreno Valley College Orange Coast College Palomar College Pasadena City College Sacramento City College San Diego Mesa College San Jose City College

DANB CDA Certificant State of California+

$22.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of May 19, 2020.

Source: 2018 DANB Salary Survey (state data based on 12 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

California State Radiography Requirements A dental assistant in the state of California must be state certified in radiography to legally operate dental x-ray equipment and perform dental radiologic procedures. To apply for state certification, a dental assistant must: (1a) Successfully complete a California Board-approved radiation safety course which includes theory and clinical application in radiographic technique or (1b) Have passed a radiation safety examination conducted by the California Board prior to January 1, 1985 AND (2) Submit a copy of the certificate of completion to the Dental Board of California.

State Requirements For Expanded Functions To perform expanded functions under the direct supervision of a licensed dentist in California, a dental assistant must be licensed as a Registered Dental Assistant in Extended Functions (RDAEF). To register as an RDAEF, one must: (1) Hold a valid license as a Registered Dental Assistant (see below) or complete the requirements for RDA licensure AND (2) Successfully complete a California Board-approved course for the application of pit and fissure sealants AND (3) Successfully complete a California Board-approved extended functions educational program AND (4) Apply to the Dental Board of California for licensure as a RDAEF AND (5) Pass a California Board-approved written exam and a state clinical and practical exam. To perform additional functions, including determining which radiographs to perform on a patient who has not received an initial examination by the dentist and placing protective restorations (interim therapeutic restorations), an RDAEF must provide evidence, satisfactory to the Dental Board of California, of having completed a Board-approved course in those functions. To be licensed as a Registered Dental Assistant (RDA) in California, one must: (1a) Graduate from a California Board-approved RDA educational program or (1b) Complete 15 months of work experience as a dental assistant or (1c) complete a combination of a non-approved educational program AND work experience AND (2)Â Successfully complete California Board-approved courses in radiation safety and coronal polishing AND (3) Successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour Board-approved infection control course within five years prior to application AND (4) Successfully complete an AHA or ARC-approved course in Basic Life Support AND (5) Apply for licensure as an RDA to the Dental Board of California, AND (6) Pass the state RDA Combined Written and Law and Ethics exam. To hold a Dental Sedation Assistant permit, one must: (1a) Be an RDAEF or (1b) Be an RDA or (1c) Complete 12 months of work experience as a dental assistant and successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour Board-approved infection control course and successfully complete an American Heart Association (AHA) or American Red Cross (ARC)-approved course in Basic Life Support (BLS) AND (2) Successfully complete a California Board-approved dental sedation assistant course AND (3) Apply for a Dental Sedation Assistant permit to the Dental Board of California AND (4) Pass a state written exam in dental sedation duties. To hold an Orthodontic Assistant permit, one must: (1a) Be an RDAEF or (1b) Be an RDA or (1c) Complete 12 months of work experience as a dental assistant and successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour Board-approved infection control course and successfully complete an AHA or ARC-approved course in BLS AND (2) Successfully complete a California Board-approved orthodontic assistant course and demonstrate completion of a Board-approved ultrasonic scaling course AND (3) Apply for an Orthodontic Assistant permit to the Dental Board of California AND (4) Pass a state written exam in orthodontic assistant duties. An Unlicensed Dental Assistant may perform basic supportive dental procedures under the supervision of a licensed dentist. The employer is responsible for ensuring that dental assistants in continuous employment for 120 days or more have proof of completing all of the following within a year from date of employment: (1) A California Board-approved course in the California Dental Practice Act AND (2) An 8-hour California Board-approved course in infection control AND (3) An AHA or ARC-approved course in BLS. The employer is also responsible for ensuring that the dental assistant maintains certification in BLS.

California State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – The Dental Board of California California Business & Professions Code Chapter 4 Dentistry Article 3. Registration 1656. Radiation safety requirements. On and after January 1, 1985, every dentist licensed to practice dentistry in the state and any person working in a dentist’s office who operates dental radiographic equipment shall meet at least one of the following requirements: (a) Pass a course, approved by the board, in radiation safety which includes theory and clinical application in radiographic technique. The board shall require the courses to be taught by persons qualified in radiographic technique and shall adopt regulations specifying the qualifications for course instructors. (b) Have passed a radiation safety examination conducted by the board prior to January 1, 1985. Article 4. Suspension and Revocation of Licenses 1682. (First of two; Repealed January 1, 2022) Acts constituting unprofessional conduct involving conscious sedation or general anesthesia In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for: (a) Any dentist performing dental procedures to have more than one patient undergoing conscious sedation or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-toone ratio while sedated by either the dentist or another licensed health professional authorized by law to administer conscious sedation or general anesthesia. (b) Any dentist with patients recovering from conscious sedation or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from conscious sedation or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one. (c) Any dentist with patients who are undergoing conscious sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment required by the board. (d) Any dentist with patients who are undergoing conscious sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially. (e) (1) Any dentist to fail to obtain the written informed consent of a patient prior to administering general anesthesia or conscious sedation. In the case of a minor, the consent shall be obtained from the child’s parent or guardian. (2) The written informed consent, in the case of a minor, shall include, but not be limited to, the following information: “The administration and monitoring of general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.” (3) Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral conscious sedation, conscious sedation, or general anesthesia. (f) This section shall remain in effect only until January 1, 2022, and as of that date is repealed. 1682. (Second of two; Operative January 1, 2022) Acts constituting unprofessional conduct involving conscious sedation or general anesthesia In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for: (a) Any dentist performing dental procedures to have more than one patient undergoing moderate sedation, deep sedation, or general anesthesia on an outpatient basis at any given time unless each patient is being continuously monitored on a one-to-one ratio while sedated by either the dentist or another licensed health professional authorized by law to administer moderate sedation, deep sedation, or general anesthesia. (b) Any dentist with patients recovering from moderate sedation, deep sedation, or general anesthesia to fail to have the patients closely monitored by licensed health professionals experienced in the care and resuscitation of patients recovering from moderate sedation, deep sedation, or general anesthesia. If one licensed professional is responsible for the recovery care of more than one patient at a time, all of the patients shall be physically in the same room to allow continuous visual contact with all patients and the patient to recovery staff ratio should not exceed three to one. (c) Any dentist with patients who are undergoing deep sedation, general anesthesia, or moderate sedation to fail to have these patients continuously monitored during the dental procedure with a pulse oximeter or similar or superior monitoring equipment and ventilation continuously monitored using at least two of the three following methods: (1) Auscultation of breath sounds using a precordial stethoscope. (2) Monitoring for the presence of exhaled carbon dioxide with capnography. (3) Verbal communication with a patient under moderate sedation. This method shall not be used for a patient under deep sedation or general anesthesia. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (d) Any dentist with patients who are undergoing moderate sedation to have dental office personnel directly involved with the care of those patients who are not certified in basic cardiac life support (CPR) and recertified biennially. (e) (1) Any dentist to fail to obtain the written informed consent of a patient prior to administering moderate sedation, deep sedation, or general anesthesia. In the case of a minor, the consent shall be obtained from the child’s parent or guardian. (2) The written informed consent for general anesthesia, in the case of a minor, shall include, but not be limited to, the following information: “The administration and monitoring of deep sedation or general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for his or her dental treatment, and consult with your dentist or pediatrician as needed.” (3) Nothing in this subdivision shall be construed to establish the reasonable standard of care for administering or monitoring oral moderate sedation, moderate sedation, deep sedation, or general anesthesia. (f) This section shall become operative on January 1, 2022. 1684.5. T reatment of a patient who is not patient of record as unprofessional conduct; Treatment provided by dental auxiliaries (a) In addition to other acts constituting unprofessional conduct under this chapter, it is unprofessional conduct for any dentist to perform or allow to be performed any treatment on a patient who is not a patient of record of that dentist. A dentist may, however, after conducting a preliminary oral examination, require or permit any dental auxiliary to perform procedures necessary for diagnostic purposes, provided that the procedures are permitted under the auxiliary’s authorized scope of practice. Additionally, a dentist may require or permit a dental auxiliary to perform all of the following duties prior to any examination of the patient by the dentist, provided that the duties are authorized for the particular classification of dental auxiliary pursuant to Article 7 (commencing with Section 1740): (1) Expose emergency radiographs upon direction of the dentist. (2) If the dental auxiliary is a registered dental assistant in extended functions, a registered dental hygienist, or a registered dental hygienist in alternative practice, determine and perform radiographs for the specific purpose of aiding a dentist in completing a comprehensive diagnosis and treatment plan for a patient using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist pursuant to Sections 1753.55, 1910.5, and 1926.05. A dentist is not required to review patient records or make a diagnosis using telehealth. (3) Perform extra-oral duties or functions specified by the dentist. (4) Perform mouth-mirror inspections of the oral cavity, to include charting of obvious lesions, malocclusions, existing restorations, and missing teeth. (b) For purposes of this section, “patient of record” refers to a patient who has been examined, has had a medical and dental history completed and evaluated, and has had oral conditions diagnosed and a written plan developed by the licensed dentist. (c) For purposes of this section, if dental treatment is provided to a patient by a registered dental assistant in extended functions, a registered dental hygienist, or a registered dental hygienist in alternative practice pursuant to the diagnosis and treatment plan authorized by a supervising dentist, at a location other than the dentist’s practice location, it is the responsibility of the authorizing dentist that the patient or the patient’s representative receive written notification that the care was provided at the direction of the authorizing dentist and that the notification include the authorizing dentist’s name, practice location address, and telephone number. This provision shall not require patient notification for dental hygiene preventive services provided in public health programs as specified and authorized in Section 1911, or for dental hygiene care when provided as specified and authorized in Section 1926. (d) A dentist shall not concurrently supervise more than a total of five registered dental assistants in extended functions, registered dental hygienists, or registered dental hygienists in alternative practice providing services pursuant to Sections 1753.55, 1910.5, and 1926.05. (e) This section shall not apply to dentists providing examinations on a temporary basis outside of a dental office in settings including, but not limited to, health fairs and school screenings. (f) This section shall not apply to fluoride mouth rinse or supplement programs administered in a school or preschool setting. Article 7. Dental Auxiliaries 1740. Legislative Intent. It is the intention of the Legislature by enactment of this article to permit the full utilization of dental auxiliaries in order to meet the dental care needs of all the state's citizens. The Legislature further intends that the classifications of dental assistants established pursuant to this article permit the continual advancement of persons to successively higher levels of licensure with additional education and training. The Legislature further intends that the Dental Board of California, in implementing this article, give specific consideration to the recommendations of the Dental Assisting Council, established pursuant to Section 1742. 42

California State Dental Practice Act and Administrative Rules for Dental Assistants 1741. Definitions. As used in this article: (a) “Board” means the Dental Board of California. (b) “Direct supervision” means supervision of dental procedures based on instructions given by a licensed dentist, who must be physically present in the treatment facility during the performance of those procedures. (c) “General supervision” means supervision of dental procedures based on instructions given by a licensed dentist but not requiring the physical presence of the supervising dentist during the performance of those procedures. 1750. Dental assistant defined; Determination of competency by supervising licensed dentist (a) A dental assistant is an individual who, without a license, may perform basic supportive dental procedures, as authorized by Section 1750.1 and by regulations adopted by the board, under the supervision of a licensed dentist. “Basic supportive dental procedures” are those procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated. (b) The supervising licensed dentist shall be responsible for determining the competency of the dental assistant to perform the basic supportive dental procedures, as authorized by Section 1750.1. (c) The employer of a dental assistant shall be responsible for ensuring that the dental assistant who has been in continuous employment for 120 days or more, has already successfully completed, or successfully completes, all of the following within a year of the date of employment: (1) A Board-approved two-hour course in the Dental Practice Act. (2) A Board-approved eight-hour course in infection control. (3) A course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent and that provides the student the opportunity to engage in hands-on simulated clinical scenarios. (d) The employer of a dental assistant shall be responsible for ensuring that the dental assistant maintains certification in basic life support. (e) This section shall become operative on January 1, 2010. 1750.1. Procedures included in practice of dental assisting (a) A dental assistant may perform the following duties under the general supervision of a supervising licensed dentist: (1) Extra-oral duties or procedures specified by the supervising licensed dentist, provided that these duties or procedures meet the definition of a basic supportive procedure specified in Section 1750. (2) Operate dental radiography equipment for the purpose of oral radiography if the dental assistant has complied with the requirements of Section 1656. (3) Perform intraoral and extraoral photography. (b) A dental assistant may perform the following duties under the direct supervision of a supervising licensed dentist: (1) Apply nonaerosol and noncaustic topical agents. (2) Apply topical fluoride. (3) Take intraoral impressions for all nonprosthodontic appliances. (4) Take facebow transfers and bite registrations. (5) Place and remove rubber dams or other isolation devices. (6) Place, wedge, and remove matrices for restorative procedures. (7) Remove postextraction dressings after inspection of the surgical site by the supervising licensed dentist. (8) Perform measurements for the purposes of orthodontic treatment. (9) Cure restorative or orthodontic materials in operative site with a light-curing device. (10) Examine orthodontic appliances. (11) Place and remove orthodontic separators. (12) Remove ligature ties and archwires. (13) After adjustment by the dentist, examine and seat removable orthodontic appliances and deliver care instructions to the patient. (14) Remove periodontal dressings. (15) Remove sutures after inspection of the site by the dentist. (16) Place patient monitoring sensors. (17) Monitor patient sedation, limited to reading and transmitting information from the monitor display during the intraoperative phase of surgery for electrocardiogram waveform, carbon dioxide and end tidal carbon dioxide concentrations, respiratory cycle data, continuous noninvasive blood pressure data, or pulse arterial oxygen saturation measurements, for the purpose of interpretation and evaluation by a supervising licensed dentist who shall be at the patient’s chairside during this procedure. (18) Assist in the administration of nitrous oxide when used for analgesia or sedation. A dental assistant shall not start the administration of the gases and shall not adjust the flow of the gases unless instructed to do so by the supervising licensed dentist who shall be present at the patient’s chairside during the implementation of these instructions. This paragraph shall not be construed to prevent any person from taking appropriate action in the event of a medical emergency. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (c) Notwithstanding subdivision (b), when operating in a school-based setting or a public health program created or administered by a federal, state, county, or local governmental entity pursuant to Sections 104762 and 104830 of the Health and Safety Code, a dental assistant may apply topical fluoride under the general direction of a licensed dentist or physician. (d) Under the supervision of a registered dental hygienist in alternative practice, a dental assistant may perform intraoral retraction and suctioning. (e) The board may specify additional allowable duties by regulation. (f) The duties of a dental assistant or a dental assistant holding a permit in orthodontic assisting or in dental sedation do not include any of the following procedures unless specifically allowed by law: (1) Diagnosis and comprehensive treatment planning. (2) Placing, finishing, or removing permanent restorations. (3) Surgery or cutting on hard and soft tissue including, but not limited to, the removal of teeth and the cutting and suturing of soft tissue. (4) Prescribing medication. (5) Starting or adjusting local or general anesthesia or oral or parenteral conscious sedation, except for the administration of nitrous oxide and oxygen, whether administered alone or in combination with each other and except as otherwise provided by law. (g) The duties of a dental assistant are defined in subdivision (a) of Section 1750 and do not include any duty or procedure that only an orthodontic assistant permitholder, dental sedation assistant permitholder, registered dental assistant, registered dental assistant in extended functions, registered dental hygienist, or registered dental hygienist in alternative practice is allowed to perform. (h) This section shall become operative on January 1, 2010. 1750.2. Orthodontic assistant Permits; Eligibility requirements; Continuing education requirements (a) The board may issue an orthodontic assistant permit to a person who files a completed application including a fee and provides evidence, satisfactory to the board, of all of the following eligibility requirements: (1) Current, active, and valid licensure as a registered dental assistant or completion of at least 12 months of verifiable work experience as a dental assistant, (2) Successful completion of a two-hour board-approved course in the Dental Practice Act and an eight-hour boardapproved course in infection control. (3) Successful completion of a course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent. (4) Successful completion of a board-approved orthodontic assistant course, which may commence after the completion of six months of work experience as a dental assistant. (5) Passage of a written examination administered by the board after completion of all of the other requirements of this subdivision. The written examination shall encompass the knowledge, skills, and abilities necessary to competently perform the duties specified in Section 1750.3. (b) A person who holds an orthodontic assistant permit pursuant to this section shall be subject to the same continuing education requirements for registered dental assistants as established by the board pursuant to Section 1645 and the renewal requirements of Article 6 (commencing with Section 1715). 1750.3. Authorized procedures for orthodontic assistants A person holding an orthodontic assistant permit pursuant to Section 1750.2 may perform the following duties under the direct supervision of a licensed dentist: (a) All duties that a dental assistant is allowed to perform. (b) Prepare teeth for bonding, and select, preposition, and cure orthodontic brackets after their position has been approved by the supervising licensed dentist. (c) Remove only orthodontic brackets and attachments with removal of the bonding material by the supervising licensed dentist. (d) Size, fit, and cement orthodontic bands. (e) Remove orthodontic bands and remove excess cement from supragingival surfaces of teeth with a hand instrument. (f) Place and ligate archwires. (g) Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment. (h) Any additional duties that the board may prescribe by regulation. 1750.4. Dental sedation assistant permits; Eligibility; Continuing education requirements (a) The board may issue a dental sedation assistant permit to a person who files a completed application including a fee and provides evidence, satisfactory to the board, of all of the following eligibility requirements: (1) Current, active, and valid licensure as a registered dental assistant or completion of at least 12 months of verifiable work experience as a dental assistant. (2) Successful completion of a two-hour board-approved course in the Dental Practice Act and an eight-hour boardapproved course in infection control. 44

California State Dental Practice Act and Administrative Rules for Dental Assistants (3) Successful completion of a course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent. (4) Successful completion of a board-approved dental sedation assistant course, which may commence after the completion of six months of work experience as a dental assistant. (5) Passage of a written examination administered by the board after completion of all of the other requirements of this subdivision. The written examination shall encompass the knowledge, skills, and abilities necessary to competently perform the duties specified in Section 1750.5. (b) A person who holds a permit pursuant to this section shall be subject to the continuing education requirements established by the board pursuant to Section 1645 and the renewal requirements of Article 6 (commencing with Section 1715). 1750.5. (First of two; Repealed January 1, 2022) Dental sedation assistant duties requiring supervision A person holding a dental sedation assistant permit pursuant to Section 1750.4 may perform the following duties under the direct supervision of a licensed dentist or other licensed healthcare professional authorized to administer conscious sedation or general anesthesia in the dental office: (a) All duties that a dental assistant is allowed to perform. (b) Monitor patients undergoing conscious sedation or general anesthesia utilizing data from noninvasive instrumentation such as pulse oximeters, electrocardiograms, capnography, blood pressure, pulse, and respiration rate monitoring devices. Evaluation of the condition of a sedated patient shall remain the responsibility of the dentist or other licensed health care professional authorized to administer conscious sedation or general anesthesia, who shall be at the patient’s chairside while conscious sedation or general anesthesia is being administered. (c) Drug identification and draw, limited to identification of appropriate medications, ampule and vial preparation, and withdrawing drugs of correct amount as verified by the supervising licensed dentist. (d) Add drugs, medications, and fluids to intravenous lines using a syringe, provided that a supervising licensed dentist is present at the patient’s chairside, limited to determining patency of intravenous line, selection of injection port, syringe insertion into injection port, occlusion of intravenous line and blood aspiration, line release and injection of drugs for appropriate time interval. The exception to this duty is that the initial dose of a drug or medication shall be administered by the supervising licensed dentist. (e) Removal of intravenous lines. (f) Any additional duties that the board may prescribe by regulation. (g) The duties listed in subdivisions (b) to (e), inclusive, may not be performed in any setting other than a dental office or dental clinic. (h) This section shall remain in effect only until January 1, 2022, and as of that date is repealed. 1750.5. (Second of two; Operative January 1, 2022) Dental sedation assistant duties requiring supervision (a) A person holding a dental sedation assistant permit pursuant to Section 1750.4 may perform the following duties under the direct supervision of a licensed dentist or other licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia in the dental office: (1) All duties that a dental assistant is allowed to perform. (2) Monitor patients undergoing moderate sedation, deep sedation, or general anesthesia utilizing data from noninvasive instrumentation such as pulse oximeters, electrocardiograms, capnography, blood pressure, pulse, and respiration rate monitoring devices. Evaluation of the condition of a sedated patient shall remain the responsibility of the dentist or other licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia, who shall be at the patient’s chairside while moderate sedation, deep sedation, or general anesthesia is being administered. (3) Drug identification and draw, limited to identification of appropriate medications, ampule and vial preparation, and withdrawing drugs of correct amount as verified by the supervising licensed dentist. (4) Add drugs, medications, and fluids to intravenous lines using a syringe, provided that a supervising licensed dentist is present at the patient’s chairside, limited to determining patency of intravenous line, selection of injection port, syringe insertion into injection port, occlusion of intravenous line and blood aspiration, line release, and injection of drugs for appropriate time interval. The exception to this duty is that the initial dose of a drug or medication shall be administered by the supervising licensed dentist. (5) Removal of intravenous lines. (6) Any additional duties that the board may prescribe by regulation. (7) The duties listed in paragraphs (2) to (5), inclusive, may not be performed in any setting other than a dental office or dental clinic. (b) This section shall become operative on January 1, 2022. 1751. Adoption of regulations governing functions of dental assistants; Review At least once every seven years, the board shall review the allowable duties for dental assistants, registered dental assistants, registered dental assistants in extended functions, dental sedation assistant permitholders, and orthodontic assistant permitholders, the supervision level for these categories, and the settings under which these duties may be performed, and shall update the regulations as necessary to keep them current with the state of the dental practice. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants 1752.1. Licensing as registered dental assistant; Educational and examination requirements; Obtaining permit as orthodontic assistant or dental sedation assistant; Review and examination of registered dental assistants (a) The board may license as a registered dental assistant a person who files an application and submits written evidence, satisfactory to the board, of one of the following eligibility requirements: (1) Graduation from an educational program in registered dental assisting approved by the board, and satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board.. (2) For individuals applying prior to January 1, 2010, evidence of completion of satisfactory work experience of at least 12 months as a dental assistant in California or another state and satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board. (3) For individuals applying on or after January 1, 2010, evidence of completion of satisfactory work experience of at least 15 months as a dental assistant in California or another state and satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board. (b) For purposes of this section, “satisfactory work experience” means performance of the duties specified in Section 1750.1 in a competent manner as determined by the employing dentist, who shall certify to such satisfactory work experience in the application. (c) The board shall give credit toward the work experience referred to in this section to persons who have graduated from a dental assisting program in a postsecondary institution approved by the Department of Education or in a secondary institution, regional occupational center, or regional occupational program, that are not, however, approved by the board pursuant to subdivision (a). The credit shall equal the total weeks spent in classroom training and internship on a week-for-week basis. The board, in cooperation with the Superintendent of Public Instruction, shall establish the minimum criteria for the curriculum of nonboard-approved programs. Additionally, the board shall notify those programs only if the program’s curriculum does not meet established minimum criteria, as established for boardapproved registered dental assistant programs, except any requirement that the program be given in a postsecondary institution. Graduates of programs not meeting established minimum criteria shall not qualify for satisfactory work experience as defined by this section. (d) In addition to the requirements specified in subdivision (a), each applicant for registered dental assistant licensure shall provide evidence of having successfully completed board-approved courses in radiation safety and coronal polishing as a condition of licensure. The length and content of the courses shall be governed by applicable board regulations. (e) In addition to the requirements specified in subdivisions (a) and (d), individuals applying for registered dental assistant licensure on or after January 1, 2010, shall demonstrate satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board and shall provide written evidence of successful completion within five years prior to application of all of the following: (1) A board-approved course in the Dental Practice Act. (2) A board-approved course in infection control. (3) A course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent. (f) A registered dental assistant may apply for an orthodontic assistant permit or a dental sedation assistant permit, or both, by submitting written evidence of the following: (1) Successful completion of a board-approved orthodontic assistant or dental sedation assistant course, as applicable. (2) Passage of the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board that shall encompass the knowledge skills, and abilities necessary to competently perform the duties of the particular permit. (g) A registered dental assistant with permits in either orthodontic assisting or dental sedation assisting shall be referred to as an “RDA with orthodontic assistant permit,” or “RDA with dental sedation assistant permit,” as applicable. These terms shall be used for reference purposes only and do not create additional categories of licensure. (h) Completion of the continuing education requirements established by the board pursuant to Section 1645 by a registered dental assistant who also holds a permit as an orthodontic assistant or dental sedation assistant shall fulfill the continuing education requirements for the permit or permits. (i) The board shall, in consultation with the Office of Professional Examination Services, conduct a review to determine whether a practical examination is necessary to demonstrate competency of registered dental assistants, and if so, how this examination should be developed and administered. The board shall submit its review and determination to the appropriate policy committees of the Legislature on or before July 1, 2017. (j) Notwithstanding any other law, if the review conducted by the Office of Professional Examination Services pursuant to subdivision (i) concludes that the practical examination is unnecessary or does not accurately measure the competency of registered dental assistants, the board may vote to suspend the practical examination. The suspension of the practical examination shall commence on the date the board votes to suspend the practical examination. (k) The Registered Dental Assistant Combined Written and Law and Ethics Examination required by this section shall comply with Section 139. 46

California State Dental Practice Act and Administrative Rules for Dental Assistants 1752.3. Examination for registered dental assistant. Repealed. 1752.4. Duties of registered dental assistant; Supervision (a) A registered dental assistant may perform all of the following duties: (1) All duties that a dental assistant is allowed to perform. (2) Mouth-mirror inspections of the oral cavity, to include charting of obvious lesions, existing restorations, and missing teeth. (3) Apply and activate bleaching agents using a nonlaser light-curing device. (4) Use of automated caries detection devices and materials to gather information for diagnosis by the dentist. (5) Obtain intraoral images for computer-aided design (CAD), milled restorations. (6) Pulp vitality testing and recording of findings. (7) Place bases, liners, and bonding agents. (8) Chemically prepare teeth for bonding. (9) Place, adjust, and finish direct provisional restorations. (10) Fabricate, adjust, cement, and remove indirect provisional restorations, including stainless steel crowns when used as a provisional restoration. (11) Place post-extraction dressings after inspection of the surgical site by the supervising licensed dentist. (12) Place periodontal dressings. (13) Dry endodontically treated canals using absorbent paper points. (14) Adjust dentures extra-orally. (15) Remove excess cement from surfaces of teeth with a hand instrument. (16) Polish coronal surfaces of the teeth. (17) Place ligature ties and archwires. (18) Remove orthodontic bands. (19) All duties that the board may prescribe by regulation. (b) A registered dental assistant may only perform the following additional duties if he or she has completed a boardapproved registered dental assistant educational program in those duties, or if he or she has provided evidence, satisfactory to the board, of having completed a board-approved course in those duties. (1) Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment. (2) The allowable duties of an orthodontic assistant permitholder as specified in Section 1750.3. A registered dental assistant shall not be required to complete further instruction in the duties of placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument. (3) The allowable duties of a dental sedation assistant permitholder as specified in Section 1750.5. (4) The application of pit and fissure sealants. (c) Except as provided in Section 1777, the supervising licensed dentist shall be responsible for determining whether each authorized procedure performed by a registered dental assistant should be performed under general or direct supervision. (d) This section shall become operative on January 1, 2010. 1752.6 Completion of course in the application of pit and fissure sealants required A registered dental assistant licensed on and after January 1, 2010, shall provide evidence of successful completion of a Board-approved course in the application of pit and fissure sealants prior to the first expiration of his or her license that requires the completion of continuing education as a condition of renewal. The license of a registered dental assistant who does not provide evidence of successful completion of that course shall not be renewed until evidence of course completion is provided. 1753. Licensing for registered dental assistant in extended functions (a) On and after January 1, 2010, the board may license as a registered dental assistant in extended functions a person who submits written evidence, satisfactory to the board, of all of the following eligibility requirements: (1) Current licensure as a registered dental assistant or completion of the requirements for licensure as a registered dental assistant. (2) Successful completion of a board-approved course in the application of pit and fissure sealants. (3) Successful completion of either of the following: (A) An extended functions postsecondary program approved by the board in all of the procedures specified in Section 1753.5. (B) An extended functions postsecondary program approved by the board to teach the duties that registered dental assistants in extended functions were allowed to perform pursuant to board regulations prior to January 1, 2010, and a course approved by the board in the procedures specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision (b) of Section 1753.5. (4) Passage of a written examination and a clinical or practical examination administered by the board. The board shall designate whether the written examination shall be administered by the board or by the board-approved extended functions program.

California State Dental Practice Act and Administrative Rules for Dental Assistants (b) A registered dental assistant in extended functions may apply for an orthodontic assistant permit or a dental sedation assistant permit, or both, by providing written evidence of the following: (1) Successful completion of a board-approved orthodontic assistant or dental sedation assistant course, as applicable. (2) Passage of a written examination administered by the board that shall encompass the knowledge, skills, and abilities necessary to competently perform the duties of the particular permit. (c) A registered dental assistant in extended functions with permits in either orthodontic assisting or dental sedation assisting shall be referred to as an “RDAEF with orthodontic assistant permit,” or “RDAEF with dental sedation assistant permit,” as applicable. These terms shall be used for reference purposes only and do not create additional categories of licensure. (d) Completion of the continuing education requirements established by the board pursuant to Section 1645 by a registered dental assistant in extended functions who also holds a permit as an orthodontic assistant or dental sedation assistant shall fulfill the continuing education requirement for such permit or permits. 1753.4. Successful completion of specified procedures required on and after January 1, 2010 On and after January 1, 2010, each applicant for licensure as a registered dental assistant in extended functions shall successfully complete an examination consisting of the procedures described in subdivisions (a) and (b). On and after January 1, 2010, each person who holds a current and active registered dental assistant in extended functions license issued prior to January 1, 2010, who wishes to perform the duties specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision (b) of Section 1753.5, shall successfully complete an examination consisting of the procedures described in subdivision (b). The specific procedures shall be assigned by a registered dental assistant in extended functions examination committee appointed by the board and shall be graded by examiners appointed by the board. Each applicant shall furnish the required materials necessary to complete the examination. (a) Successful completion of the following two procedures on a patient provided by the applicant. The prepared tooth, prior to preparation, shall have had mesial and distal contact. The preparation performed shall have margins at or below the free gingival crest and shall be one of the following: 7/8 crown, 3/4 crown, or full crown, including porcelain fused to metal. Alginate impression materials alone shall not be acceptable: (1) Cord retraction of gingiva for impression procedures. (2) Take a final impression for a permanent indirect restoration. (b) Successful completion of two of the following procedures on a simulated patient head mounted in appropriate position and accommodating an articulated typodont in an enclosed intraoral environment, or mounted on a dental chair in a dental operatory: (1) Place, condense, and carve an amalgam restoration. (2) Place and contour a nonmetallic direct restoration. (3) Polish and contour an existing amalgam restoration. 1753.5 Authorized duties and procedures of registered dental assistants in extended functions licensed on or after January 1, 2010; Supervision required (a) A registered dental assistant in extended functions licensed on or after January 1, 2010, is authorized to Perform all duties and procedures that a registered dental assistant is authorized to perform as specified in and limited by Section 1752.4, and those duties that the board may prescribe by regulation. (b) A registered dental assistant in extended functions licensed on or after January 1, 2010, is authorized to perform the following additional procedures under direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist: (1) Conduct preliminary evaluation of the patient’s oral health, including, but not limited to, charting, intraoral and extra-oral evaluation of soft tissue, classifying occlusion, and myofunctional evaluation. (2) Perform oral health assessments in school-based, community health project settings under the direction of a dentist, registered dental hygienist, or registered dental hygienist in alternative practice. (3) Cord retraction of gingiva for impression procedures. (4) Size and fit endodontic master points and accessory points. (5) Cement endodontic master points and accessory points. (6) Take final impressions for permanent indirect restorations. (7) Take final impressions for tooth-borne removable prosthesis. (8) Polish and contour existing amalgam restorations. (9) Place, contour, finish, and adjust all direct restorations. (10) Adjust and cement permanent indirect restorations. (11) Other procedures authorized by regulations adopted by the board. (c) All procedures required to be performed under direct supervision shall be checked and approved by the supervising licensed dentist prior to the patient’s dismissal from the office. 1753.55. (Operative January 1, 2018) Additional authorized duties of registered dental assistant in extended functions. (a) A registered dental assistant in extended functions is authorized to perform the additional duties as set forth in subdivision (b) pursuant to the order, control, and full professional responsibility of a supervising dentist, if the licensee meets one of the following requirements:

California State Dental Practice Act and Administrative Rules for Dental Assistants

(b)

(e) (f)

(1) Is licensed on or after January 1, 2010. (2) Is licensed prior to January 1, 2010, has successfully completed a board-approved course in the additional procedures specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision (b) of Section 1753.5, and passed the examination as specified in Section 1753.4. (1) Determine which radiographs to perform on a patient who has not received an initial examination by the supervising dentist for the specific purpose of the dentist making a diagnosis and treatment plan for the patient. In these circumstances, the dental assistant in extended functions shall follow protocols established by the supervising dentist. This paragraph only applies in the following settings: (A) In a dental office setting. (B) In public health settings, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, head start and preschool programs, and community clinics, under the general supervision of a dentist. (2) Place protective restorations, which for this purpose are identified as interim therapeutic restorations, and defined as a direct provisional restoration placed to stabilize the tooth until a licensed dentist diagnoses the need for further definitive treatment. An interim therapeutic restoration consists of the removal of soft material from the tooth using only hand instrumentation, without the use of rotary instrumentation, and subsequent placement of an adhesive restorative material. Local anesthesia shall not be necessary for interim therapeutic restoration placement. Interim therapeutic restorations shall be placed only in accordance with both of the following: (A) In either of the following settings: (i) In a dental office setting, under the direct or general supervision of a dentist as determined by the dentist. (ii) In public health settings, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, head start and preschool programs, and community clinics, under the general supervision of a dentist. (B) After the diagnosis, treatment plan, and instruction to perform the procedure provided by a dentist. The functions described in subdivision (b) may be performed by a registered dental assistant in extended functions only after completion of a program that includes training in performing those functions, or after providing evidence, satisfactory to the board, of having completed a board-approved course in those functions. No later than January 1, 2018, the board shall adopt regulations to establish requirements for courses of instruction for the procedures authorized to be performed by a registered dental assistant in extended functions pursuant to this section using the competency-based training protocols established by the Health Workforce Pilot Project (HWPP) No. 172 through the Office of Health Planning and Development. The board shall submit to the committee proposed regulatory language for the curriculum for the Interim Therapeutic Restoration to the committee for the purpose of promulgating regulations for registered dental hygienists and registered dental hygienists in alternative practice as described in Section 1910.5. The language submitted by the board shall mirror the instructional curriculum for the registered dental assistant in extended functions. Any subsequent amendments to the regulations that are promulgated by the board for the Interim Therapeutic Restoration curriculum shall be submitted to the committee. The board may issue a permit to a registered dental assistant in extended functions who files a completed application, including the fee, to provide the duties specified in this section after the board has determined the registered dental assistant in extended functions has completed the coursework required in subdivision (c). This section shall become operative on January 1, 2018.

1753.6. Scope of extended functions status (a) Each person who holds a license as a registered dental assistant in extended functions on the operative date of this section may only perform those procedures that a registered dental assistant is allowed to perform as specified in and limited by Section 1752.4, and the procedures specified in paragraphs (1) to (6), inclusive, until he or she provides evidence of having completed a board-approved course in the additional procedures specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision (b) of Section 1753.5, and an examination as specified in Section 1753.4: (1) Cord retraction of gingiva for impression procedures. (2) Take final impressions for permanent indirect restorations. (3) Formulate indirect patterns for endodontic post and core castings. (4) Fit trial endodontic filling points. (5) Apply pit and fissure sealants. (6) Remove excess cement from subgingival tooth surfaces with a hand instrument. (b) This section shall become operative on January 1, 2010. 1753.7. Restrictions on use of registered dental assistants in extended functions A licensed dentist may simultaneously utilize in his or her practice no more than three registered dental assistants in extended functions or registered dental hygienists in extended functions licensed pursuant to Sections 1753 and 1918.

California State Dental Practice Act and Administrative Rules for Dental Assistants 1765. Persons authorized to engage in practice of dental hygiene No person other than a licensed dental hygienist or a licensed dentist may engage in the practice of dental hygiene or perform dental hygiene procedures on patients, including, but not limited to, supragingival and subgingival scaling, dental hygiene assessment, and treatment planning, except for the following persons: (a) A student enrolled in a dental or a dental hygiene school who is performing procedures as part of the regular curriculum of that program under the supervision of the faculty of that program. (b) A dental assistant, registered dental assistant, or registered dental assistant in extended functions acting in accordance with the provisions of this chapter. (c) A registered dental hygienist, registered dental hygienist in alternative practice, or registered dental hygienist in extended functions licensed in another jurisdiction performing a clinical demonstration for educational purposes. 1767. Implementation of article The board shall adopt regulations necessary to implement the provisions of this article. 1771. Misrepresentation of licensed or permitted status Any person, other than a person who has been issued a license or permit by the board, who holds himself or herself out as a registered dental assistant, orthodontic assistant permitholder, dental sedation assistant permitholder, or registered dental assistant in extended functions, or uses any other term indicating or implying he or she is licensed or permitted by the board as such, is guilty of a misdemeanor. 1773. Renewal, restoration, reinstatement, and reissuance of licenses The provisions of Sections 1715, 1718, 1718.1, 1718.2, and 1718.3 shall govern the renewal, restoration, reinstatement, and reissuance of licenses issued under this article. The license shall continue in effect through the date provided in Section 1715 that next occurs after its issuance, when it shall expire if not renewed. 1777. Authorized procedures in specified primary care or specialty clinics While employed by or practicing in a primary care clinic or specialty clinic licensed pursuant to Section 1204 of the Health and Safety Code, in a primary care clinic exempt from licensure pursuant to subdivision (c) of Section 1206 of the Health and Safety Code, or a clinic owned and operated by a hospital that maintains the primary contract with a county government to fill the county’s role under Section 17000 of the Welfare and Institutions Code, the following shall apply: (a) A dental assistant, registered dental assistant, or registered dental assistant in extended functions may perform any extraoral duty under the direct supervision of a registered dental hygienist or registered dental hygienist in alternative practice. (b) A registered dental assistant or a registered dental assistant in extended functions may perform the following procedures under the direct supervision of a registered dental hygienist or a registered dental hygienist in alternative practice, pursuant to subdivision (b) of Section 1763: (1) Coronal polishing. (2) Application of topical fluoride. (3) Application of sealants, after providing evidence to the board of having completed a board-approved course in that procedure. California Code of Regulations Title 16. Professional and Vocational Regulations Division 10. Dental Board of California Chapter 1. General Provisions Applicable to All Licensees Article 1. General Provisions 1005. Minimum Standards for Infection Control. (a) Definitions of terms used in this section: (1) “Standard precautions” are a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. These include: hand hygiene, use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposure, and safe handling of sharps. Standard precautions shall be used for care of all patients regardless of their diagnoses or personal infectious status. (2) “Critical items” confer a high risk for infection if they are contaminated with any microorganism. These include all instruments, devices, and other items used to penetrate soft tissue or bone. (3) “Semi-critical items” are instruments, devices and other items that are not used to penetrate soft tissue or bone, but contact oral mucous membranes, non-intact skin or other potentially infectious materials (OPIM). 50

California State Dental Practice Act and Administrative Rules for Dental Assistants (4) “Non-critical items” are instruments, devices, equipment, and surfaces that come in contact with soil, debris, saliva, blood, OPIM and intact skin, but not oral mucous membranes. (5) “Low-level disinfection” is the least effective disinfection process. It kills some bacteria, some viruses and fungi, but does not kill bacterial spores or mycobacterium tuberculosis var bovis, a laboratory test organism used to classify the strength of disinfectant chemicals. (6) “Intermediate-level disinfection” kills mycobacterium tuberculosis var bovis indicating that many human pathogens are also killed. This process does not necessarily kill spores. (7) “High-level disinfection” kills some, but not necessarily all bacterial spores. This process kills mycobacterium tuberculosis var bovis, bacteria, fungi, and viruses. (8) “Germicide” is a chemical agent that can be used to disinfect items and surfaces based on the level of contamination. (9) “Sterilization” is a validated process used to render a product free of all forms of viable microorganisms. (10) “Cleaning” is the removal of visible soil (e.g., organic and inorganic material) debris and OPIM from objects and surfaces and shall be accomplished manually or mechanically using water with detergents or enzymatic products. (11) “Personal Protective Equipment” (PPE) is specialized clothing or equipment worn or used for protection against a hazard. PPE items may include, but are not limited to, gloves, masks, respiratory devices, protective eyewear and protective attire which are intended to prevent exposure to blood, body fluids, OPIM, and chemicals used for infection control. General work attire such as uniforms, scrubs, pants and shirts, are not considered to be PPE. (12) “Other Potentially Infectious Materials” (OPIM) means any one of the following: (A) Human body fluids such as saliva in dental procedures and any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. (B) Any unfixed tissue or organ (other than intact skin) from a human (living or dead). (C) Any of the following, if known or reasonably likely to contain or be infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV): 1. Cell, tissue, or organ cultures from humans or experimental animals; 2. Blood, organs, or other tissues from experimental animals; or 3. Culture medium or other solutions. (13) “Dental Healthcare Personnel” (DHCP), are all paid and non-paid personnel in the dental healthcare setting who might be occupationally exposed to infectious materials, including body substances and contaminated supplies, equipment, environmental surfaces, water, or air. DHCP includes dentists, dental hygienists, dental assistants, dental laboratory technicians (in-office and commercial), students and trainees, contractual personnel, and other persons not directly involved in patient care but potentially exposed to infectious agents (e.g., administrative, clerical, housekeeping, maintenance, or volunteer personnel). (b) All DHCP shall comply with infection control precautions and enforce the following minimum precautions to protect patients and DHCP and to minimize the transmission of pathogens in health care settings as mandated by the California Division of Occupational Safety and Health (Cal/OSHA). (1) Standard precautions shall be practiced in the care of all patients. (2) A written protocol shall be developed, maintained, and periodically updated for proper instrument processing, operatory cleanliness, and management of injuries. The protocol shall be made available to all DHCP at the dental office. (3) A copy of this regulation shall be conspicuously posted in each dental office.

Personal Protective Equipment: (4) All DHCP shall wear surgical facemasks in combination with either chin length plastic face shields or protective eyewear whenever there is potential for aerosol spray, splashing or spattering of the following: droplet nuclei, blood, chemical or germicidal agents or OPIM. Chemical-resistant utility gloves and appropriate, task specific PPE shall be worn when handling hazardous chemicals. After each patient treatment, masks shall be changed and disposed. After each patient treatment, face shields and protective eyewear shall be cleaned, disinfected, or disposed. (5) Protective attire shall be worn for disinfection, sterilization, and housekeeping procedures involving the use of germicides or handling contaminated items. All DHCP shall wear reusable or disposable protective attire whenever there is a potential for aerosol spray, splashing or spattering of blood, OPIM, or chemicals and germicidal agents. Protective attire must be changed daily or between patients if they should become moist or visibly soiled. All PPE used during patient care shall be removed when leaving laboratories or areas of patient care activities. Reusable gowns shall be laundered in accordance with Cal/OSHA Bloodborne Pathogens Standards (Title 8, Cal. Code Regs., section 5193).

Hand Hygiene: (6) All DHCP shall thoroughly wash their hands with soap and water at the start and end of each workday. DHCP shall wash contaminated or visibly soiled hands with soap and water and put on new gloves before treating

California State Dental Practice Act and Administrative Rules for Dental Assistants each patient. If hands are not visibly soiled or contaminated an alcohol based hand rub may be used as an alternative to soap and water. Hands shall be thoroughly dried before donning gloves in order to prevent promotion of bacterial growth and washed again immediately after glove removal. A DHCP shall refrain from providing direct patient care if hand conditions are present that may render DHCP or patients more susceptible to opportunistic infection or exposure. (7) All DHCP who have exudative lesions or weeping dermatitis of the hand shall refrain from all direct patient care and from handling patient care equipment until the condition resolves.

Gloves: (8) Medical exam gloves shall be worn whenever there is contact with mucous membranes, blood, OPIM, and during all pre-clinical, clinical, post-clinical, and laboratory procedures. When processing contaminated sharp instruments, needles, and devices, DHCP shall wear heavy-duty utility gloves to prevent puncture wounds. Gloves must be discarded when torn or punctured, upon completion of treatment, and before leaving laboratories or areas of patient care activities. All DHCP shall perform hand hygiene procedures before donning gloves and after removing and discarding gloves. Gloves shall not be washed before or after use.

Needle and Sharps Safety: (9) Needles shall be recapped only by using the scoop technique or a protective device. Needles shall not be bent or broken for the purpose of disposal. Disposable needles, syringes, scalpel blades, or other sharp items and instruments shall be placed into sharps containers for disposal as close as possible to the point of use according to all applicable local, state, and federal regulations.

Sterilization and Disinfection: (10) All germicides must be used in accordance with intended use and label instructions. (11) Cleaning must precede any disinfection or sterilization process. Products used to clean items or surfaces prior to disinfection procedures shall be used according to all label instructions. (12) Critical instruments, items and devices shall be discarded or pre-cleaned, packaged or wrapped and sterilized after each use. Methods of sterilization shall include steam under pressure (autoclaving), chemical vapor, and dry heat. If a critical item is heat-sensitive, it shall, at minimum, be processed with high-level disinfection and packaged or wrapped upon completion of the disinfection process. These instruments, items, and devices, shall remain sealed and stored in a manner so as to prevent contamination, and shall be labeled with the date of sterilization and the specific sterilizer used if more than one sterilizer is utilized in the facility. (13) Semi-critical instruments, items, and devices shall be pre-cleaned, packaged or wrapped and sterilized after each use. Methods of sterilization include steam under pressure (autoclaving), chemical vapor and dry heat. If a semi-critical item is heat sensitive, it shall, at minimum, be processed with high level disinfection and packaged or wrapped upon completion of the disinfection process. These packages or containers shall remain sealed and shall be stored in a manner so as to prevent contamination, and shall be labeled with the date of sterilization and the specific sterilizer used if more than one sterilizer is utilized in the facility. (14) Non-critical surfaces and patient care items shall be cleaned and disinfected with a California Environmental Protection Agency (Cal/EPA)-registered hospital disinfectant (low-level disinfectant) labeled effective against HBV and HIV. When the item is visibly contaminated with blood or OPIM, a Cal/EPA-registered hospital intermediate-level disinfectant with a tuberculocidal claim shall be used. (15) All high-speed dental hand pieces, low-speed hand pieces, rotary components and dental unit attachments such as reusable air/water syringe tips and ultrasonic scaler tips, shall be packaged, labeled and heat-sterilized in a manner consistent with the same sterilization practices as a semi-critical item. (16) Single use disposable items such as prophylaxis angles, prophylaxis cups and brushes, tips for high-speed evacuators, saliva ejectors, air/water syringe tips, and gloves shall be used for one patient only and discarded. (17) Proper functioning of the sterilization cycle of all sterilization devices shall be verified at least weekly through the use of a biological indicator (such as a spore test). Test results shall be documented and maintained for 12 months.

Irrigation: (18) Sterile coolants/irrigants shall be used for surgical procedures involving soft tissue or bone. Sterile coolants/irrigants must be delivered using a sterile delivery system.

Facilities: (19) If non-critical items or surfaces likely to be contaminated are manufactured in a manner preventing cleaning and disinfection, they shall be protected with disposable impervious barriers. Disposable barriers shall be changed when visibly soiled or damaged and between patients. (20) Clean and disinfect all clinical contact surfaces that are not protected by impervious barriers using a California Environmental Protection Agency (Cal/EPA) registered, hospital grade low- to intermediate-level germicide after each patient. The low-level disinfectants used shall be labeled effective against HBV and HIV. Use disinfectants

California State Dental Practice Act and Administrative Rules for Dental Assistants in accordance with the manufacturer’s instructions. Clean all housekeeping surfaces (e.g. floors, walls, sinks) with a detergent and water or a Cal/EPA registered, hospital grade disinfectant. Products used to clean items or surfaces prior to disinfection procedures shall be clearly labeled and DHCP shall follow all material safety data sheet (MSDS) handling and storage instructions. (21) Dental unit water lines shall be anti-retractive. At the beginning of each workday, dental unit lines and devices shall be purged with air or flushed with water for at least two (2) minutes prior to attaching handpieces, scalers, air water syringe tips, or other devices. The dental unit lines and devices shall be flushed between each patient for a minimum of twenty (20) seconds. (22) Contaminated solid waste shall be disposed of according to applicable local, state, and federal environmental standards.

Lab Areas:

(23) Splash shields and equipment guards shall be used on dental laboratory lathes. Fresh pumice and a sterilized or new rag-wheel shall be used for each patient. Devices used to polish, trim, or adjust contaminated intraoral devices shall be disinfected or sterilized, properly packaged or wrapped and labeled with the date and the specific sterilizer used if more than one sterilizer is utilized in the facility. If packaging is compromised, the instruments shall be recleaned, packaged in new wrap, and sterilized again. Sterilized items will be stored in a manner so as to prevent contamination. (24) All intraoral items such as impressions, bite registrations, prosthetic and orthodontic appliances shall be cleaned and disinfected with an intermediate-level disinfectant before manipulation in the laboratory and before placement in the patient’s mouth. Such items shall be thoroughly rinsed prior to placement in the patient’s mouth. (c) The Dental Board of California and Dental Hygiene Committee of California shall review this regulation annually and establish a consensus. Article 3.1. Radiation Safety Courses Section 1014. Approval of Radiation Safety Courses. (a) A radiation safety course is one which has as its primary purpose providing theory and clinical application in radiographic techniques. A single standard of care shall be maintained and the board shall approve only those courses which continuously maintain a high quality standard of instruction. (b) A radiation safety course applying for approval shall submit to the board an application and other required documents and information on forms prescribed by the board. The board may approve or deny approval of any such course. Approval may be granted after evaluation of all components of the course has been performed and the report of such evaluation indicates that the course meets the board's requirements. The board may, in lieu of conducting its own investigation, accept the findings of any commission or accreditation agency approved by the board and adopt those findings as its own. (c) The board may withdraw its approval of a course at any time, after giving the course provider written notice setting forth its reason for withdrawal and after affording a reasonable opportunity to respond. Approval may be withdrawn for failure to comply with the board's standards or for fraud, misrepresentation or violation of any applicable federal or state laws relating to the operation of radiographic equipment. (d) The processing times for radiation safety course approval are set forth in Section 1061. Section 1014.1. Requirements for Radiation Safety Courses. A radiation safety course shall comply with the requirements set forth below in order to secure and maintain approval by the board. The course of instruction in radiation safety and radiography techniques offered by a school or program approved by the board for instruction in dentistry, dental hygiene or dental assisting shall be deemed to be an approved radiation safety course if the school or program has submitted evidence satisfactory to the board that it meets all the requirements set forth below. (a) Educational Level. The course shall be established at the postsecondary educational level or a level deemed equivalent thereto by the board. (b) Program Director. The program director, who may also be an instructor, shall actively participate in and be responsible for at least all of the following: (1) Providing daily guidance of didactic, laboratory and clinical assignments; (2) Maintaining all necessary records, including but not limited to the following: (A) Copies of current curriculum, course outline and objectives; (B) Faculty credentials; (C) Individual student records, which shall include pre-clinical and clinical evaluations, examinations and copies of all successfully completed radiographic series used toward course completion. Records shall be maintained for at least five years from the date of course completion. (3) Issuing certificates to each student who has successfully completed the course and maintaining a record of each certificate for at least five years from the date of its issuance; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (4) Transmitting to the board on a form prescribed by the board the name, last four digits of the social security number and, where applicable, license number of each student who has successfully completed the course; (5) Informing the board of any significant revisions to the curriculum or course outlines. (c) Faculty. The faculty shall be adequate in number, qualifications and composition and shall be suitably qualified through academic preparation, professional expertise, and/or appropriate training, as provided herein. Each faculty member shall possess the following qualifications: (1) Hold a valid special permit or valid license as a dentist, registered dental hygienist, registered dental assistant, registered dental assistant in extended functions, registered dental hygienist in extended functions, or registered dental hygienists in alternative practice issued by the board; (2) All faculty shall have been licensed for a minimum of two years. All faculty shall have the education, background, and occupational experience and/or teaching expertise necessary to perform, teach, and evaluate dental radiographs. All faculty responsible for clinical evaluation shall have completed a two hour methodology course which shall include clinical evaluation criteria, course outline development, process evaluation, and product evaluation; (3) Shall have either passed the radiation safety examination administered by the board or equivalent licensing examination as a dentist, registered dental hygienist, registered dental assistant, registered dental assistant in extended functions, registered dental hygienist in extended functions, or registered dental hygienists in alternative practice or, on or after January 1, 1985, shall have successfully completed a board approved radiation safety course. (d) Facilities. There shall be a sufficient number of safe, adequate, and educationally conducive lecture classrooms, radiography operatories, developing or processing facilities, and viewing spaces for mounting, viewing and evaluating radiographs. Adequate sterilizing facilities shall be provided and all disinfection and sterilization procedures specified by board regulations shall be followed. (1) A radiographic operatory shall be deemed adequate if it fully complies with the California Radiation Control Regulations (Title 17, Cal. Code Regs., commencing with section 30100), is properly equipped with supplies and equipment for practical work and includes for every seven students at least one functioning radiography machine which is adequately filtered and collimated in compliance with Department of Health Services regulations and which is equipped with the appropriate position-indicating devices for each technique being taught. (2) The developing or processing facility shall be deemed adequate if it is of sufficient size, based upon the number of students, to accommodate students' needs in learning processing procedures and is properly equipped with supplies and equipment for practical work using either manual or automatic equipment. (3) X-ray areas shall provide protection to patients, students, faculty and observers in full compliance with applicable statutes and regulations. (e) Program Content. Sufficient time shall be available for all students to obtain laboratory and clinical experience to achieve minimum competence in the various protocols used in the application of dental radiographic techniques. (1) A detailed course outline shall be provided to the board which clearly states curriculum subject matter and specific instructional hours in the individual areas of didactic, laboratory, and clinical instruction. (2) General program objectives and specific instructional unit objectives shall be stated in writing, and shall include theoretical aspects of each subject as well as practical application. The theoretical aspects of the program shall provide the content necessary for students to make judgments regarding dental radiation exposure. The course shall assure that students who successfully complete the course can expose, process and evaluate dental radiographs with minimum competence. (3) Objective evaluation criteria shall be used for measuring student progress toward attainment of specific course objectives. Students shall be provided with specific unit objectives and the evaluation criteria that will be used for all aspects of the curriculum including written, practical and clinical examinations. (4) Areas of instruction shall include at least the following as they relate to exposure, processing and evaluations of dental radiographs: (A) Radiation physics and biology (B) Radiation protection and safety (C) Recognition of normal anatomical landmarks and abnormal conditions of the oral cavity as they relate to dental radiographs (D) Radiograph exposure and processing techniques using either manual or automatic methods (E) Radiograph mounting or sequencing, and viewing, including anatomical landmarks of the oral cavity (F) Intraoral techniques and dental radiograph armamentaria, including holding devices (G) Interproximal examination including principles of exposure, methods of retention and evaluation (H) Intraoral examination including, principles of exposure, methods of retention and evaluation (I) Identification and correction of faulty radiographs (J) Supplemental techniques including the optional use of computerized digital radiography (K) Infection control in dental radiographic procedures (L) Radiographic record management. Students may be given the opportunity to obtain credit by the use of challenge examinations and other methods of evaluation. 54

California State Dental Practice Act and Administrative Rules for Dental Assistants (f) Laboratory Instruction. Sufficient hours of laboratory instruction shall be provided to ensure that a student successfully completes on an x-ray manikin at least the procedures set forth below. A procedure has been successfully completed only if each radiograph is of diagnostic quality. There shall be no more than 6 students per instructor during laboratory instruction. (1) Two full mouth periapical series, consisting of at least 18 radiographs each, 4 of which must be bitewings; no more than one series may be completed using computer digital radiographic equipment; (2) Two bitewing series, consisting of at least 4 radiographs each; (3) Developing or processing, and mounting or sequencing of exposed radiographs; (4) Student and instructor written evaluation of radiographs. (g) Clinical Experience. The course of instruction shall include sufficient clinical experience, as part of an organized program of instruction, to obtain clinical competency in radiographic techniques. There shall be no more than 6 students per instructor during clinical instruction. Clinical instruction shall include clinical experience on four patients with one of the four patients used for the clinical examination. Clinical experience shall include: (1) Successful completion of a minimum of four full mouth periapical series, consisting of at least 18 radiographs each, 4 of which must be bitewings. Traditional film packets must be double film. No more than three series may be completed using computer digital radiographic equipment. Such radiographs shall be of diagnostic quality. All exposures made on human subjects shall only be made for diagnostic purposes, and shall in no event exceed three (3) exposures per subject. All clinical procedures on human subjects shall be performed under the supervision of a licensed dentist in accordance with section 106975 of the Health and Safety Code. (2) Developing or processing, and mounting or sequencing of exposed human subject radiographs; (3) Student and instructor written evaluation of radiographs. (h) Clinical Facilities. There shall be a written contract of affiliation with each clinical facility utilized by a course. Such contract shall describe the settings in which the clinical training will be received and shall provide that the clinical facility has the necessary equipment and accessories appropriate for the procedures to be performed and that such equipment and accessories are in safe operating condition. Such clinical facilities shall be subject to the same requirements as those specified in subdivision (g). (i) Length of Course. The program shall be of sufficient duration for the student to develop minimum competence in the radiation safety techniques, but shall in no event be less than 32 clock hours, including at least 8 hours of didactic instruction, at least 12 hours of laboratory instruction, and at least 12 hours of clinical instruction. (j) Certificates. A certificate shall be issued to each student who successfully completes the course. The certificate shall specify the number of course hours completed. A student shall be deemed to have successfully completed the course if the student has met all the course requirements and has obtained passing scores on both written and clinical examinations. Article 4. Continuing Education Section 1016. Continuing Education Courses and Providers. (a) Definition of Terms: (1) Course of Study Defined. "Course of study" means an orderly learning experience in an area of study pertaining to dental and medical health, preventive dental services, diagnosis and treatment planning, clinical procedures, basic health sciences, dental practice management and administration, communication, ethics, patient management or the Dental Practice Act and other laws specifically related to dental practice. (2) Coursework Defined. The term "Coursework" used herein refers to materials presented or used for continuing education and shall be designed and delivered in a manner that serves to directly enhance the licensee's knowledge, skill and competence in the provision of service to patients or the community. (b) Courses of study for continuing education credit shall include: (1) Mandatory courses required by the Board for license renewal to include a Board-approved course in Infection Control, a Board-approved course in the California Dental Practice Act and completion of certification in Basic Life Support. (A) At a minimum, course content for a Board-approved course in Infection Control shall include all content of Section 1005 and the application of the regulations in the dental environment. (B) At a minimum, course content for the Dental Practice Act [Division 2, Chapter 4 of the Code (beginning with Â§1600)] shall instruct on acts in violation of the Dental Practice Act and attending regulations, and other statutory mandates relating to the dental practice. This includes utilization and scope of practice for auxiliaries and dentists; laws governing the prescribing of drugs; citations, fines, revocation and suspension of a license, and license renewal; and the mandatory reporter obligations set forth in the Child Abuse and Neglect Reporting Act (Penal Code Section 11164 et seq.) and the Elder Abuse and Dependent Adult Civil Protection Act (Welfare and Institutions Code Section 15600 et seq.) and the clinical signs to look for in identifying abuse. (C) The mandatory requirement for certification in Basic Life Support shall be met by completion of either: (i) An American Heart Association (AHA) or American Red Cross (ARC) course in Basic Life Support (BLS) or, ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (ii) A BLS course taught by a provider approved by the American Dental Association's Continuing Education Recognition Program (CERP) or the Academy of General Dentistry's Program Approval for Continuing Education (PACE). For the purposes of this section, a Basic Life Support course shall include all of the following: 1. Instruction in both adult and pediatric CPR, including 2-rescuer scenarios; 2. Instruction in foreign-body airway obstruction; 3. Instruction in relief of choking for adults, child and infant; 4. Instruction in the use of automated external defibrillation with CPR; and; 5. A live, in-person skills practice session, a skills test and a written examination; The course provider shall ensure that the course meets the required criteria. (2) Courses in the actual delivery of dental services to the patient or the community, such as: (A) Courses in preventive services, diagnostic protocols and procedures (including physical evaluation, radiography, dental photography) comprehensive treatment planning, charting of the oral conditions, informed consent protocols and recordkeeping. (B) Courses dealing primarily with nutrition and nutrition counseling of the patient. (C) Courses in esthetic, corrective and restorative oral health diagnosis and treatment. (D) Courses in dentistry's role in individual and community health emergencies, disasters, and disaster recovery. (E) Courses that pertain to the legal requirement governing the licensee in the areas of auxiliary employment and delegation of responsibilities; the Health Insurance Portability and Accountability Act (HIPAA); actual delivery of care. (F) Courses pertaining to federal, state and local regulations, guidelines or statutes regarding workplace safety, fire and emergency, environmental safety, waste disposal and management, general office safety, and all training requirements set forth by the California Division of Occupational Safety and Health (CalDOSH) including the Bloodborne Pathogens Standard. (G) Courses pertaining to the administration of general anesthesia, conscious sedation, oral conscious sedation or medical emergencies. (H) Courses pertaining to the evaluation, selection, use and care of dental instruments, sterilization equipment, operatory equipment, and personal protective attire. (I) Courses in dependency issues and substance abuse such as alcohol and drug use as it relates to patient safety, professional misconduct, ethical considerations or malpractice. (J) Courses in behavioral sciences, behavior guidance, and patient management in the delivery of care to all populations including special needs, pediatric and sedation patients when oriented specifically to the clinical care of the patient. (K) Courses in the selection, incorporation, and use of current and emerging technologies. (L) Courses in cultural competencies such as bilingual dental terminology, cross-cultural communication, provision of public health dentistry, and the dental professional's role in provision of care in non-traditional settings when oriented specifically to the needs of the dental patient and will serve to enhance the patient experience. (M) Courses in dentistry's role in individual and community health programs. (N) Courses pertaining to the legal and ethical aspects of the insurance industry, to include management of third party payer issues, dental billing practices, patient and provider appeals of payment disputes and patient management of billing matters. (3) Courses in the following areas are considered to be primarily of benefit to the licensee and shall be limited to a maximum of 20% of a licensee's total required course unit credits for each license or permit renewal period: (A) Courses to improve recall and scheduling systems, production flow, communication systems and data management. (B) Courses in organization and management of the dental practice including office computerization and design, ergonomics, and the improvement of practice administration and office operations. (C) Courses in leadership development and team development. (D) Coursework in teaching methodology and curricula development. (E) Coursework in peer evaluation and case studies that include reviewing clinical evaluation procedures, reviewing diagnostic methods, studying radiographic data, study models and treatment planning procedures. (F) Courses in human resource management and employee benefits. (4) Courses considered to be of direct benefit to the licensee or outside the scope of dental practice in California include the following, and shall not be recognized for continuing education credit: (A) Courses in money management, the licensee's personal finances or personal business matters such as financial planning, estate planning, and personal investments. (B) Courses in general physical fitness, weight management or the licensee's personal health. (C) Presentations by political or public figures or other persons that do not deal primarily with dental practice or issues impacting the dental profession 56

California State Dental Practice Act and Administrative Rules for Dental Assistants (D) Courses designed to make the licensee a better business person or designed to improve licensee personal profitability, including motivation and marketing. (E) Courses pertaining to the purchase or sale of a dental practice, business or office; courses in transfer of practice ownership, acquisition of partners and associates, practice valuation, practice transitions, or retirement. (F) Courses pertaining to the provision of elective facial cosmetic surgery as defined by the Dental Practice Act in Section 1638.1, unless the licensee has a special permit obtained from the Board to perform such procedures pursuant to Section 1638.1 of the Code. (5) Completion of a course does not constitute authorization for the attendee to perform any services that he or she is not legally authorized to perform based on his or her license or permit type [Editor's note: paragraphs (c) through (h), addressing registration of continuing education providers, have been omitted here.]

(i) Out of State Courses and Courses Offered by Other Authorized and Non-Authorized Providers (1) Notwithstanding subdivision (b) of Section 1016, licensees who attend continuing education courses given by providers approved by the American Dental Association's Continuing Education Recognition Program (CERP) or the Academy of General Dentistry's Program Approval for Continuing Education (PACE) and who obtain a certification of attendance from the provider or sponsor shall be given credit towards his or her total continuing education requirement for renewal of his or her license with the exception of mandatory continuing education courses, if the course meets the requirements of continuing education set forth in this section. (b) A licensee who attends a course or program that meets all content requirements for continuing education pursuant to these regulations, but was presented outside California by a provider not approved by the Board, may petition the Board for consideration of the course by submitting information on course content, course duration and evidence from the provider of course completion. When the necessary requirements have been fulfilled, the board may issue a written certificate of course completion for the approved number of units, which the licensee may then use for documentation of continuing education credits. 1017. Continuing Education Units Required for Renewal of License or Permit. (a) As a condition of renewal, all licensees are required to complete continuing education as follows: (1) Two units of continuing education in Infection Control specific to California regulations as defined in section 1016(b)(1)(A). (2) Two units of continuing education in the California Dental Practice Act and its related regulations as defined in section 1016(b)(1)(B). (3) A maximum of four units of a course in Basic Life Support as specified in section 1016(b)(1)(C). (b) Mandatory continuing education units count toward the total units required to renew a license or permit; however, failure to complete the mandatory courses will result in non-renewal of a license or permit. Any continuing education units accumulated before April 8, 2010 that meet the requirements in effect on the date the units were accumulated will be accepted by the Board for license or permit renewals taking place on or after April 8, 2010. (c) All licensees shall accumulate the continuing education units equal to the number of units indicated below during the biennial license or permit renewal period assigned by the Board on each license or permit. All licensees shall verify to the Board that he or she who has been issued a license or permit to practice for a period less than two years shall begin accumulating continuing education credits within the next biennial renewal period occurring after the issuance of a new license or permit to practice. (1) Dentists: 50 units. (2) Registered dental hygienists: 25 units. (3) Registered dental assistants: 25 units. (4) Dental Sedation Assistant Permit Holders: 25 units. (5) Orthodontic Assistant Permit Holders: 25 units. (6) Registered dental hygienists in extended functions: 25 units. (7) Registered dental assistants in extended functions: 25 units. (8) Registered dental hygienists in alternative practice: 35 units. (d) Each dentist licensee who holds a general anesthesia permit shall complete, as a condition of permit renewal, continuing education requirements pursuant to Section 1646.5 of the Business and Professions Code at least once every two years, and either (1) an advanced cardiac life support course which is approved by the American Heart Association and which includes an examination on the materials presented in the course or (2) any other advanced cardiac life support course which is identical in all respects, except for the omission of materials that relate solely to hospital emergencies or neonatology, to the course entitled â&#x20AC;&#x153;2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Careâ&#x20AC;? published by the American Heart Association December 13, 2005 which is incorporated herein by reference. (e) Each dentist licensee who holds a conscious sedation permit shall complete at least once every two years a minimum of 15 total units of coursework related to the administration of conscious sedation and to medical emergencies, as a condition of permit renewal, in continuing education requirements pursuant to Section 1647.5 of the of the Business and Professions Code. Refusal to execute the required assurance shall result in non-renewal of the permit. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (f) Each dentist licensee who holds an oral conscious sedation permit for minors, as a condition of permit renewal, shall complete at least once every two years a minimum of 7 total units of coursework related to the subject area in continuing education requirements pursuant to Section 1647.13 of the Business and Professions Code. (g) Each dentist licensee who holds an oral conscious sedation permit for adults, as a condition of permit renewal, shall complete at least once every two years a minimum of 7 total units of coursework related to the subject area in continuing education requirements pursuant to Section 1647.21 of the of the Business and Professions Code. (h) Notwithstanding any other provisions of this code, tape recorded courses, home study materials, video courses, and computer courses are considered correspondence courses, and will be accepted for credit up to, but not exceeding, 50% of the licensee's total required units. (i) In the event that a portion of a licensee's units have been obtained through non-live instruction, as described in Section (h) above, all remaining units shall be obtained through live interactive course study with the option to obtain 100% of the total required units by way of interactive instruction courses. Such courses are defined as live lecture, live telephone conferencing, live video conferencing, live workshop demonstration, or live classroom study. (j) Licensees who participate in the following activities shall be issued continuing education credit for up to 20% of their total continuing education unit requirements for license renewal: (1) Participation in any Dental Board of California or Western Regional Examination Board (WREB) administered examination including attendance at calibration training, examiner orientation sessions, and examinations. (2) Participation in any site visit or evaluation relating to issuance and maintenance of a general anesthesia, conscious sedation or oral conscious sedation permit. (3) Participation in any calibration training and site evaluation training session relating to general anesthesia, conscious sedation or oral conscious sedation permits. (4) Participation in any site visit or evaluation of an approved dental auxiliary program or dental auxiliary course. (k) The Board shall issue to participants in the activities listed in subdivision (j) a certificate that contains the date, time, location, authorizing signature, 11-digit course registration number, and number of units conferred for each activity consistent with all certificate requirements herein required for the purposes of records retention and auditing. (l) The license or permit of any person who fails to accumulate the continuing education units set forth in this section or to assure the board that he or she will accumulate such units, shall not be renewed until such time as the licensee complies with those requirements. (m) A licensee who has not practiced in California for more than one year because the licensee is disabled need not comply with the continuing education requirements of this article during the renewal period within which such disability falls. Such licensee shall certify in writing that he or she is eligible for waiver of the continuing education requirements. A licensee who ceases to be eligible for such waiver shall notify the Board of such and shall comply with the continuing education requirements for subsequent renewal periods. (n) A licensee shall retain, for a period of three renewal periods, the certificates of course completion issued to him or her at the time he or she attended a continuing education course and shall forward such certifications to the Board only upon request by the Board for audit purposes. A licensee who fails to retain a certification shall contact the provider and obtain a duplicate certification. (o) Any licensee who furnishes false or misleading information to the Board regarding his or her continuing education units may be subject to disciplinary action. The Board may audit a licensee continuing education records as it deems necessary to ensure that the continuing education requirements are met. (p) A licensee who also holds a special permit for general anesthesia, conscious sedation, oral conscious sedation of a minor or of an adult, may apply the continuing education units required in the specific subject areas to their dental license renewal requirements. (q) A registered dental assistant or registered dental assistant in extended functions who holds a permit as an orthodontic assistant or a dental sedation assistant shall not be required to complete additional continuing education requirements beyond that which is required for licensure renewal in order to renew either permit. (r) Pertaining to licensees holding more than one license or permit, the license or permit that requires the largest number of continuing education units for renewal shall equal the licensee's full renewal requirement. Dual licensure, or licensure with permit, shall not require duplication of continuing education requirements. (s) Current and active licensees enrolled in a full-time educational program in the field of dentistry, including dental school program, residency program, postdoctoral specialty program, dental hygiene school program, dental hygiene in alternative practice program, or registered dental assisting in extended functions program approved by the Board or the ADA Commission on Dental Accreditation shall be granted continuing education credits for completed curriculum during that renewal period. In the event of audit, licensees shall be required to present school transcripts to the Board as evidence of enrollment and course completion. (t) Current and active dental sedation assistant and orthodontic assistant permit holders enrolled in a full-time dental hygiene school program, dental assisting program, or registered dental assisting in extended functions program approved by the Board or the ADA Commission on Dental Accreditation shall be granted continuing education credits for completed curriculum during that renewal period. In the event of audit, assisting permit holders shall be required to present school transcripts to the committee or Board as evidence of enrollment and course completion.

California State Dental Practice Act and Administrative Rules for Dental Assistants Chapter 3. Dental Auxiliaries Article 1. General Provisions 1067. Definitions. As used in this subchapter: (a) “Dental auxiliary” means a person who may perform dental supportive procedures authorized by the provisions of these regulations under the specified supervision of a licensed dentist. (b) “Dental assistant” means an unlicensed person who may perform basic supportive dental procedures specified by these regulations under the supervision of a licensed dentist. (c) “Registered dental assistant” or “RDA” means a licensed person who may perform all procedures authorized by the provisions of these regulations and in addition may perform all functions which may be performed by a dental assistant under the designated supervision of a licensed dentist. (d) “Registered dental hygienist” or “RDH” means a licensed person who may perform all procedures authorized by the provisions of these regulations and in addition may perform all functions which may be performed by a dental assistant and registered dental assistant, under the designated supervision of a licensed dentist. (e) “Registered dental assistant in extended functions” or “RDAEF” means a person licensed as a registered dental assistant who has completed post-licensure clinical and didactic training approved by the board and satisfactorily performed on an examination designated by the board for registered dental assistant in extended function applicants. (f) “Registered dental hygienist in extended functions” or “RDHEF” means a person licensed as a registered dental hygienist who has completed post-licensure clinical and didactic training approved by the board and satisfactorily performed on an examination designated by the board for registered dental hygienist in extended functions applicants. (g) “Oral prophylaxis” means the preventive dental procedures including complete removal of explorer-detectable calculus, soft deposits, plaque, stains, and the smoothing of unattached tooth surfaces. The objective of this treatment shall be creation of an environment in which hard and soft tissues can be maintained in good health by the patient. (h) “Coronal polishing” means a procedure limited to the removal of plaque and stain from exposed tooth surfaces, utilizing an appropriate rotary instrument with rubber cup or brush and a polishing agent. (i) “Direct supervision” means supervision of dental procedures based on instructions given by a licensed dentist who must be physically present in the treatment facility during the performance of those procedures. (j) “General supervision” means supervision of dental procedures based on instructions given by a licensed dentist, but not requiring the physical presence of the supervising dentist during the performance of those procedures. (k) “Satisfactory educational qualification” means theory, laboratory and/or clinical experience approved by the board. (l) “Basic supportive dental procedures” means fundamental duties or functions which may be performed by an unlicensed dental assistant under the supervision of a licensed dentist because of their technically elementary characteristics, complete reversibility and inability to precipitate potentially hazardous conditions for the patient being treated. (m) “Root planing” means the process of instrumentation by which the unattached surfaces of the root are made smooth by the removal of calculus and/or cementum. (n) “Periodontal soft tissue curettage” means the closed removal of tissue lining the periodontal pocket, not involving the reflection of a flap. (o) “Gingival” means pertaining to the gingivae, the mucous membrane with the supporting fibrous tissue. 1068. Posting of Dental Auxiliary Duties All dentists utilizing the services of dental auxiliaries shall post a notice in a common area of the office which delineates duties and functions deemed by the board as delegable within stipulated settings and/or circumstances. Such notice shall by readily accessible to all individuals under supervision of the dentist. Article 2. Educational Programs 1070. General Provisions Governing All Dental Assistant Educational Programs and Courses. (a) (1) The criteria in subdivisions (b) to (j), inclusive, shall be met by a dental assisting program or course and all orthodontic assisting and dental sedation assisting permit programs or courses to secure and maintain approval by the Board as provided in this Article. (2) The Board may approve, provisionally approve, or deny approval of any program or course for which an application to the Board for approval is required. All Registered Dental Assistant (RDA) and Registered Dental Assistant in Extended Functions (RDAEF) programs and dental assisting educational courses shall be re-evaluated approximately every seven years, but may be subject to re-evaluation and inspection by the Board at any time to review and investigate compliance with this Article and the Dental Practice Act (Act). Re-evaluation may include a site visit or written documentation that ensures compliance with all regulations. Results of re-evaluation shall be reported to the Board or its designee for final consideration and continuance of program or course approval, provisional approval or denial of approval. (3) Program and course records shall be subject to inspection by the Board at any time. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(b)

(e) (f)

(g)

(h)

(i) 60

(4) The Board may withdraw approval at any time that it determines that a program or course does not meet the requirements of this Article or any other requirement in the Act. (5) All programs and courses shall be established at the postsecondary educational level or deemed equivalent thereto by the Board. (6) The Board or its designee may approve, provisionally approve, or deny approval to any such program. Provisional approval shall not be granted for a period which exceeds the length of the program. When the Board provisionally approves a program, it shall state the reasons therefore. Provisional approval shall be limited to those programs which substantially comply with all existing standards for full approval. A program given provisional approval shall immediately notify each student of such status. If the Board denies approval of a program, the specific reasons therefore shall be provided to the program by the Board in writing within 90 days after such action. The program or course director shall possess a valid, active, and current license issued by the Board or the dental hygiene committee. The program or course director shall actively participate in and be responsible for the administration of the program or course. Specifically, the program or course director shall be responsible for the following requirements: (1) Maintaining for a period of not less than five years copies of curricula, program outlines, objectives, and grading criteria, and copies of faculty credentials, licenses, and certifications, and individual student records, including those necessary to establish satisfactory completion of the program or course. (2) Informing the Board of any major change to the program or course content, physical facilities, or faculty, within 10 days of the change. (3) Ensuring that all staff and faculty involved in clinical instruction meet the requirements set forth in this Article. Course faculty and instructional staff shall be authorized to provide instruction by the program or course director at the educational facility in which instruction is provided. No faculty or instructional staff member shall instruct in any procedure that he or she does not hold a license or permit in California to perform. Each faculty or instructional staff member shall possess a valid, active, and current license issued by the Board or the Dental Hygiene Committee of California, shall have been licensed or permitted for a minimum of two years, and possess experience in the subject matter he or she is teaching. An instructor who has held a license as a registered dental assistant or registered dental assistant in extended functions for at least two years, who then becomes a permit holder as an Orthodontic Assistant on or after January 1, 2010, shall not be required to have held such a permit for two years in order to instruct in the subject area. A certificate, diploma, or other evidence of completion shall be issued to each student who successfully completes the program or course and shall include the following: the student's name, the name of the program or course, the date of completion, and the signature of the program or course director or his or her designee. Facilities and class scheduling shall provide each student with sufficient opportunity, with instructor supervision, to develop minimum competency in all duties for which the program or course is approved to instruct. (1) The location and number of general use equipment and armamentaria shall ensure that each student has the access necessary to develop minimum competency in all of the duties for which the program or course is approved to instruct. The program or course provider may either provide the specified equipment and supplies or require that the student provide them. Nothing in this Section shall preclude a dental office that contains the equipment required by this Section from serving as a location for laboratory instruction. (2) Clinical instruction shall be of sufficient duration to allow the procedures to be performed to clinical proficiency. Operatories shall be sufficient in number to allow a ratio of at least one operatory for every five students who are simultaneously engaged in clinical instruction. (A) Each operatory shall contain functional equipment, including a power-operated chair for patient or simulation-based instruction in a supine position, operator and assistant stools, air-water syringe, adjustable light, oral evacuation equipment, work surface, handpiece connection, and adjacent hand-washing sink. (B) Each operatory shall be of sufficient size to simultaneously accommodate one student, one instructor, and one patient or student partner. (C) Prior to clinical assignments, students must demonstrate minimum competence in laboratory or preclinical performance of the procedures they will be expected to perform in their clinical experiences. The program or course shall establish written clinical and laboratory protocols that comply with the Board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005) and other federal, state, and local requirements governing infection control. The program or course shall provide these protocols to all students, faculty, and instructional staff to ensure compliance. Adequate space shall be provided for handling, processing, and sterilizing all armamentarium. A written policy on managing emergency situations shall be made available to all students, faculty, and instructional staff. All faculty and staff involved in the direct oversight of patient care activities shall be certified in basic life support procedures, including cardiopulmonary resuscitation. Recertification intervals may not exceed two years. The program or course director shall ensure and document compliance by faculty and instructional staff. A program or course shall sequence curriculum in such a manner so as to ensure that students complete instruction in basic life support prior to performing procedures on patients used for clinical instruction and evaluation. A detailed program or course outline shall clearly state, in writing, the curriculum subject matter, hours of didactic, laboratory, and clinical instruction, general program or course objectives, instructional objectives, theoretical content ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(j)

of each subject, and, where applicable, the use of practical application. Objective evaluation criteria shall be used for measuring student progress toward attainment of specific program or course objectives. Students shall be provided with all of the following: (1) Specific performance objectives and the evaluation criteria used for measuring levels of competence for each component of a given procedure including those used for examinations. (2) Standards of performance that state the minimum number of satisfactory performances that are required for each performance-evaluated procedure. (3) Standards of performance for laboratory, preclinical, and clinical functions, those steps that would cause the student to fail the task being evaluated, and a description of each of the grades that may be assigned during evaluation procedures. (1) If an extramural dental facility is utilized, students shall, as part of an extramural organized program of instruction, be provided with planned, supervised clinical instruction. Laboratory and preclinical instruction shall be performed under the direct supervision of program or course faculty or instructional staff and shall not be provided in an extramural dental facility. (2) The program or course director, or a designated faculty member, shall be responsible for selecting extramural dental facility and evaluating student competence before and after the clinical assignment. (3) Prior to student assignment in an extramural dental facility, the program or course director, or a designated faculty or instructional staff member, shall orient dentists and all licensed dental healthcare workers who may provide instruction, evaluation, and oversight of the student in the clinical setting. Orientation shall include, at a minimum, the objectives of the program or course, the student's preparation for the clinical assignment, and a review of procedures and criteria to be used by the dentist or the licensed personnel in the extramural dental facility in evaluating the student during the assignment, which shall be the same as the evaluation criteria used within the program or course. (4) There shall be a written contract of affiliation between the program and each extramural dental facility that includes written affirmation of compliance with the regulations of this Article.

1070.1. Educational Program and Course Definitions and Instructor Ratios. As used in this Article, the following definitions shall apply: (a) “Clinical instruction” means instruction in which students receive supervised experience in performing procedures in a clinical setting on patients. Clinical procedures shall only be allowed upon successful demonstration and evaluation of laboratory and preclinical skills. There shall be at least one instructor for every six students who are simultaneously engaged in clinical instruction. (b) “Didactic instruction” means lectures, demonstrations, and other instruction involving theory that may or may not involve active participation by students. The faculty or instructional staff of an educational institution or approved provider may provide didactic instruction via electronic media, home study materials, or live lecture modality. (c) “Extramural dental facility” means any clinical facility utilized by a Board-approved dental assisting educational program for instruction in dental assisting that exists outside or beyond the walls, boundaries or precincts of the primary location of the Board-approved program and in which dental treatment is rendered. (d) “Laboratory instruction” means instruction in which students receive supervised experience performing procedures using study models, mannequins, or other simulation methods. There shall be at least one instructor for every 14 students who are simultaneously engaged in instruction. (e) “Preclinical instruction” means instruction in which students receive supervised experience within the educational facilities performing procedures on simulation devices or patients which are limited to students, faculty, or instructional staff members. There shall be at least one instructor for every six students who are simultaneously engaged in instruction. (f) “Simulated clinical instruction” means instruction in which students receive supervised experience performing procedures using simulated patient heads mounted in appropriate position and accommodating an articulated typodont in an enclosed intraoral environment, or mounted on a dental chair in a dental operatory. Clinical simulation spaces shall be sufficient to permit one simulation space for each 2 students at any one time. 1070.2. Approval of Registered Dental Assistant Educational Programs. (a) All Registered Dental Assistant (RDA) programs in California shall apply for and receive Board approval prior to operation. (b) The Board may, in lieu of conducting its own investigation, accept the findings of any commission or accreditation agency approved by the Board and adopt those findings as its own. All programs accredited by the American Dental Association Commission on Dental Accreditation (Commission) shall submit to the Board after each site visit a copy of the final report of the Commission's findings within 30 days of the final report issuance. New programs approved by the Commission shall apply to the Board and shall submit proof of Provisional Approval status by the Commission, a copy of the institutional self study, and applications for Radiation Safety, Coronal Polish, Pit and Fissure Sealants and any other courses required of an RDA educational program. Acceptance of the Commission's or any accrediting agencies' findings is at the discretion of the Board and does not prohibit the Board from exercising its right to siteevaluate a program. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (c) If the program is granted the status of “Approved with Reporting Requirements” from the Commission, the program shall submit to the Board copies of any and all correspondence received from or submitted to the Commission until such time as the status of “Approval without Reporting Requirements” is granted. Additionally, if the program withdraws from accredited status by the Commission, the program shall notify the Board, in writing, of such status within 30 days. (d) In order for a registered dental assistant program to secure and maintain approval by the Board, it shall meet the requirements of Sections 1070 and 1070.1 and the requirements contained in this Section. (1) A program shall notify the Board in writing if it wishes to increase the maximum student enrollment for which it is approved and shall provide documentation to the Board to demonstrate compliance with Section 1070 and Section 1070.1 to reapprove the program for the increased enrollment prior to accepting additional students. (2) Programs shall establish and maintain an advisory committee whose membership provides for equal representation of dentists and dental assistants, all currently licensed by the Board. In addition, consideration shall be given to a student, a recent graduate or a public representative to serve on the advisory committee. The advisory committee shall meet at least once each academic year with the program director, faculty, and appropriate institutional personnel to monitor the ongoing quality and performance of the program and to receive advice and assistance from the committee. (3) Adequate provision for the supervision and operation of the program shall be made. In addition to the requirements of Sections 1070 and 1070.1, the following requirements shall be met: (A) By January 1, 2012, each faculty member shall have completed a course or certification program in educational methodology of at least 30 hours, unless he or she holds any one of the following: a postgraduate degree in education, a Ryan Designated Subjects Vocational Education Teaching Credential, a Standard Designated Subjects Teaching Credential, or a Community College Teaching Credential. Each faculty member employed after January 1, 2012, shall complete a course or certification program in educational methodology within six months of employment. The program director or designated administrator shall be responsible to obtain and maintain records of each faculty member showing evidence of having met this requirement. (B) The program director shall have teaching responsibilities that are less than those of a full-time faculty member. He or she shall actively participate in and be responsible for the administration of the program including the following: (i) Participating in budget preparation and fiscal administration, curriculum development and coordination, determination of teaching assignments, supervision and evaluation of faculty, establishment of criteria and procedures, design and operation of program facilities, and selection of extramural facilities and coordination of instruction in those facilities. (ii) Holding periodic staff meetings to provide for subject matter review, instructional calibration, curriculum evaluation, and coordinating activities of full-time, part-time, and volunteer faculty or instructional staff. (iii) Maintaining copies of minutes of all advisory committee and staff meetings for not less than five years. (C) The owner or school administrator shall be responsible for the compliance of the program director with the provisions of this Section and Sections 1070 and 1070.1. (4) The program shall have sufficient financial resources available to support the program and to comply with this Section. If the program or school requires approval by any other governmental agency, that approval shall be obtained prior to application to the Board for approval and shall be maintained at all times. The failure to maintain that approval shall result in the automatic withdrawal of Board approval of the program. (5) The program shall be of sufficient duration for the student to develop minimum competence in performing dental assistant and registered dental assistant duties, but in no event less than 800 hours, including at least 275 hours of didactic instruction, at least 260 hours of combined laboratory or preclinical instruction conducted in the program's facilities under the direct supervision of program faculty or instructional staff, and the remaining hours utilized in clinical instruction in extramural dental facilities. No more than 20 hours of instruction shall be devoted to clerical, administrative, practice management, or similar duties. Programs whose demonstrated total hours exceed 800 and who meet all the instructional requirements in this Section, may utilize the additional instructional hours as deemed appropriate for program success. To maintain approval, programs approved prior to the effective date of these regulations shall submit to the Board a completed “Notice of Compliance with New Requirements for Registered Dental Assistant Educational Programs (New 9/10)”, hereby incorporated by reference, within ninety (90) days of the effective date of these regulations. (6) In addition to the requirements of Section 1070 with regard to extramural instruction: (A) No more than 25 percent of extramural clinical instruction shall take place in a specialty dental practice. (B) Program faculty shall visit each extramural dental facility at least once every ten clinical days. (7) Facilities and class scheduling shall provide each student with sufficient opportunity, with instructor supervision, to develop minimum competency in all duties that registered dental assistants are authorized to perform. The following requirements are in addition to those contained in Sections 1070 and 1070.1: (A) The following are minimum requirements for equipment and armamentaria during laboratory, preclinical, and clinical sessions as appropriate to each type of session: amalgamator, model trimmers in the ratio of one for every seven students, dental rotary equipment in the ratio of one for every three students, vibra62

California State Dental Practice Act and Administrative Rules for Dental Assistants tors in the ratio of one for every three students, light curing devices in the ratio of one for every operatory, functional typodonts and bench mounts in the ratio of one for every two students, functional orthodontically banded typodonts in the ratio of one for every four students, facebows in the ratio of one for every ten students, automated blood pressure device, EKG machine, pulse oximeters in the ratio of one for every ten students, capnograph or simulated device, one set of hand instruments in the ratio of one set for every two students for each procedure, respiration device, camera for intraoral use, camera for extraoral use, CAD machine or simulated device, caries detection device in the ratio of one for every ten students, and all other equipment and armamentaria required to teach dental assistant and registered dental assistant duties. With the exception of a CAD machine and patient monitoring equipment specific to EKG machine, pulse oximeter, and capnograph, the program shall own the necessary equipment and have it readily available upon inspection. Patient monitoring equipment owned by the institution and utilized by more than one program within the institution premises is acceptable and may be used by the RDA program as needed for instruction. Instruction by a licensed healthcare provider is acceptable. In the event instruction in patient monitoring procedures and use of the CAD machine is provided by an outside provider, the RDA program shall not be required to have available or own patient monitoring equipment or CAD machine. (B) Instruments must be provided to accommodate students needs in learning to identify, exchange, and prepare procedural trays and assist in procedures as they relate to general and specialty dentistry. (C) Provision shall be made for reasonable access to current and diverse dental and medical reference texts, current journals, audiovisual materials, and other necessary resources. Library holdings, which may include, in total or in part, access through the Internet, shall include materials relating to all subject areas of the program curriculum. (D) Emergency materials shall include, at a minimum, an oxygen tank that is readily available and functional. Medical materials for treating patients with life-threatening conditions shall be available for instruction and accessible to the operatories. Facilities that do not treat patients shall maintain a working model of a kit of such emergency materials for instructional purposes. (8) Curriculum documentation shall be reviewed annually and revised, as needed, to reflect new concepts and techniques. This content must be integrated and of sufficient depth, scope, sequence of instruction, quality and emphasis to ensure achievement of the curriculum's defined competencies. (A) Programs that admit students in phases, including modular or open-entry programs, shall provide, at minimum, basic instruction in tooth anatomy, tooth numbering, general program guidelines, basic chairside skills, emergency and safety precautions, infection control, and sterilization protocols associated with and required for patient treatment. Such instruction shall occur prior to any other program content and prior to performances or activities involving patients. (B) All programs shall provide students with additional instruction in the California Division of Occupational Safety and Health (Cal/OSHA) Regulations (Cal. Code Regs., Title 8, Sections 330-344.85) and the Board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005) prior to the student's performance of procedures on patients. (9) In addition to the requirements of Sections 1070 and 1070.1 and subdivisions (b)(11) and (b)(12) of this Section, programs shall include the following content: (A) Instruction in radiation safety that meets all of the requirements of Cal. Code Regs., Title 16, Sections 1014 and 1014.1. (B) Instruction in coronal polishing that meets all of the requirements of Cal. Code Regs., Title 16, Section 1070.4. (C) Instruction in the application of Pit and Fissure Sealants that meets all of the requirements of Cal. Code Regs., Title 16, Section 1070.3. (D) A course in basic life support provided by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the Board as equivalent. The program may require that the student complete this course as a prerequisite to program enrollment, or that the student provide evidence of having completed the course from another provider. (E) Instruction in infection control that meets all of the requirements of Cal. Code Regs., Title 16, Section 1070.6. (F) Instruction in the Dental Practice Act that includes the content specified in Cal. Code Regs., Title 16, Section 1016 governing Dental Practice Act continuing education courses. (10) A program that desires to provide instruction in the following areas shall apply separately for approval to provide the following courses: (A) A course in the removal of excess cement with an ultrasonic scaler, that shall meet the requirements of Cal. Code Regs., Title 16, Section 1070.5. (B) An orthodontic assistant permit course that shall meet the requirements of Cal. Code Regs., Title 16, Section 1070.7, except that a program shall not be required to obtain separate approval to teach the duties of placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from surfaces of teeth with a hand instrument, and shall be no less than 51 hours, including at least 9 hours of didactic instruction, at least 22 hours of laboratory instruction, and at least 20 hours of clinical instruction. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (C) A dental sedation assistant permit course that shall meet the requirements of Cal. Code Regs., Title 16, Section 1070.8. (D) A Registered Dental Assisting educational program that includes instructional content for either the orthodontic assistant permit or dental sedation assistant permit, or both, shall provide a certificate or certificates of completion to the graduate. The certificate holder shall be deemed an eligible candidate for the permit examination process as having met all educational requirements for the permit examination. (11) General didactic instruction shall include, at a minimum, the following: (A) Principles of general anatomy, physiology, oral embryology, tooth histology, and head-neck anatomy. (B) Principles of conditions related to and including oral pathology, orthodontics, periodontics, endodontics, pediatric dentistry, oral surgery, prosthodontics, and esthetic dentistry. (C) Instruction in the Dental Practice Act that includes the content specified in Cal. Code Regs., Title 16, Section 1016, as well as principles of the Health Insurance Portability and Accountability Act (HIPAA) privacy and security standards, risk management, and professional codes of ethical behavior. (D) Principles of infection control, waste management, and hazardous communication requirements in compliance with the Board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005) and other federal, state, and local requirements governing infection control. Instruction in infection control shall meet the education requirements set forth in Section 1070.6(e). (E) Principles related to pharmacology and biomedical sciences including nutrition and microbiology. (F) Principles of medical-dental emergencies and first aid management. (G) Principles of the treatment planning process including medical health history data collection, patient and staff confidentiality, and charting. (H) Principles of record classifications including management, storage, and retention protocol for all dental records including legal and ethical issues involving patient records. (I) Principles and protocols of special needs patient management, the psychology and management of dental patients, and overall interpersonal relationships. (J) Principles, protocols, and armamentaria associated with all dental assisting chairside procedures. (K) Principles, protocols, manipulation, use, and armamentaria for contemporary dental materials used in general and specialty dentistry. (L) Principles and protocols for oral hygiene preventative methods including, plaque identification, toothbrushing and flossing techniques, and nutrition. (M) Principles, protocols, armamentaria, and procedures associated with operative and specialty dentistry. (N) Principles, protocols, armamentaria, and procedures for each duty that dental assistants and registered dental assistants are allowed to perform. (O) All content for instruction in radiation safety as set forth in Cal. Code Regs., Title 16, Section 1014.1. (P) All content for instruction in coronal polishing as set forth in Cal. Code Regs., Title 16, Section 1070.4. (Q) All content for instruction in the application of Pit and Fissure Sealants as set forth in Cal. Code Regs., Title 16, Section 1070.3. (12) Laboratory and clinical instruction shall be of sufficient duration and content for each student to achieve minimum competence in the performance of each procedure that dental assistant and registered dental assistant is authorized to perform. (13) Each student shall pass a written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director. 1070.3. Approval of Pit and Fissure Sealant Courses. The following minimum criteria shall be met for a course in the application of pit and fissure sealants to secure and maintain approval by the Board. (a) Educational Setting. The course shall be established at the post-secondary educational level. (b) Prerequisites. Each student must possess the necessary requirements for application for RDA licensure or currently possess an RDA license. Each student must have already completed a Board-approved course in coronal polishing. (c) Administration/Facility. Adequate provision for the supervision and operation of the course shall be made. (1) The course director and each faculty member shall possess a valid, active, and current RDAEF, RDH, RDHEF, RDHAP, or dentist license issued by the Board, or an RDA license issued by the Board if the person has completed Board-approved courses in coronal polishing and the application of pit and fissure sealants. All faculty shall have been licensed for a minimum of two years. All faculty shall have the education, background, and occupational experience and/or teaching expertise necessary to teach, place, and evaluate the application of pit and fissure sealants. All faculty responsible for clinical evaluation shall have completed a two hour methodology course in clinical evaluation. (2) The course director must have the education, background, and occupational experience necessary to understand and fulfill the course goals. He/she shall actively participate in and be responsible for the day-to-day administration of the course including the following: (A) Providing daily guidance of didactic, laboratory and clinical assignments. (B) Maintaining for a period of not less than 5 years: 64

California State Dental Practice Act and Administrative Rules for Dental Assistants 1. Copies of curricula, course outlines, objectives, and grading criteria. 2. Copies of faculty credentials, licenses, and certifications. 3. Individual student records, including those necessary to establish satisfactory completion of the course. (C) Informing the Board of any changes to the course content, physical facilities, and/or faculty, within 10 days of such changes. (d) Length of Course. The program shall be of sufficient duration for the student to develop minimum competence in the application of pit and fissure sealants, but shall in no event be less than 16 clock hours, including at least 4 hours of didactic training, at least 4 hours of laboratory training, and at least 8 hours of clinical training. (e) Evidence of Completion. A certificate or other evidence of completion shall be issued to each student who successfully completes the course. (f) Facilities and Resources. Facilities and class scheduling shall provide each student with sufficient opportunity, with instructor supervision, to develop minimum competency in applying pit and fissure sealants. Such facilities shall include safe, adequate and educationally conducive: (1) Lecture classrooms. Classroom size and equipment shall accommodate the number of students enrolled. (2) Operatories. Operatories shall be sufficient in number to allow a ratio of at least one operatory for every five students at any one time. (A) Each operatory shall replicate a modern dental office containing functional equipment including: a poweroperated chair for treating patients in a supine position; operator and assistant stools; air-water syringe; adjustable light; oral evacuation equipment; work surface; hand-washing sink; curing light, and all other armamentarium required to instruct in the application of pit and fissure sealants. (B) Each operatory must be of sufficient size to accommodate a practitioner, a student, an instructor, and a patient at one time. (3) Laboratories. The location and number of general use equipment shall assure that each student has the access necessary to develop minimum competency in the application of pit and fissure sealants. Protective eyewear is required for each student. (4) Infection Control. The program shall establish written clinical and laboratory protocols to ensure adequate asepsis, infection and hazard control, and disposal of hazardous wastes, which shall comply with the board's regulations and other Federal, State, and local requirements. The program shall provide such protocols to all students, faculty, and appropriate staff to assure compliance with such protocols. Adequate space shall be provided for preparing and sterilizing all armamentarium. (5) Emergency Materials/Basic Life Support. (A) A written policy on managing emergency situations must be made available to all students, faculty, and staff. (B) All students, faculty, and staff involved in the direct provision of patient care must be certified in basic life support procedures, including cardiopulmonary resuscitation. Re-certification intervals may not exceed two years. The program must document, monitor, and ensure compliance by such students, faculty, and staff. (g) Program Content. (1) Sufficient time shall be available for all students to obtain laboratory and clinical experience to achieve minimum competence in the various protocols used in the application of pit and fissure sealants. (2) A detailed course outline shall be provided to the board which clearly states curriculum subject matter and specific instruction hours in the individual areas of didactic, laboratory, and clinical instruction. (3) General program objectives and specific instructional unit objectives shall be stated in writing, and shall include theoretical aspects of each subject as well as practical application. The theoretical aspects of the program shall provide the content necessary for students to make judgments regarding the application of pit and fissure sealants. The course shall assure that students who successfully complete the course can apply pit and fissure sealants with minimum competence. (4) Objective evaluation criteria shall be used for measuring student progress toward attainment of specific course objectives. Students shall be provided with specific unit objectives and evaluation criteria that will be used for all aspects of the curriculum including written and practical examinations. The program shall establish a standard of performance that states the minimum number of satisfactory performances that are required for each procedure. (5) Areas of instruction shall include at least the following as they relate to pit and fissure sealants: (A) Dental Science - Oral Anatomy, Histology, Physiology, Oral Pathology, Normal/Abnormal Anatomical and Physiological Tooth Descriptions (B) Morphology and Microbiology (C) Dental Materials and Pharmacology (D) Sealant Basics 1. Legal requirements 2. Description and goals of sealants 3. Indications and contraindications 4. Role in preventive programs

California State Dental Practice Act and Administrative Rules for Dental Assistants (E) Sealant Materials 1. Etchant and/or etchant/bond combination material composition, process, storage and handling 2. Sealant material composition, polymerization type, process, storage and handling 3. Armamentaria for etching and sealant application 4. Problem solving for etchant and sealant material placement/manipulation (F) Sealant Criteria 1. Areas of application 2. Patient selection factors 3. Other indication factors (G) Preparation Factors 1. Moisture control protocol 2. Tooth/teeth preparation procedures prior to etching or etchant/bond (H) Acid Etching or Etchant/Bond Combination 1. Material preparation 2. Application areas 3. Application time factors 4. Armamentaria 5. Procedure 6. Etchant or etchant/bond evaluation criteria (I) Sealant Application 1. Application areas 2. Application time factors 3. Armamentaria 4. Procedure for chemical cure and light cure techniques 5. Sealant evaluation criteria 6. Sealant adjustment techniques (J) Infection control protocol (K) Clinical re-call re-evaluation protocols (6) There shall be no more than 14 students per instructor during laboratory instruction. Laboratory instruction may be conducted on a typodont, a simulated model, and/or mounted extracted teeth. Sufficient time shall be available for all students to obtain laboratory experience to achieve minimum competence in pit and fissure sealant application prior to the performance of procedures on patients. (7) Clinical instruction shall be of sufficient duration to allow the procedures to be performed to clinical proficiency. There shall be no more than 6 students per instructor during clinical instruction. Clinical instruction shall include clinical experience on four patients with two of the four patients used for the clinical examination. Each clinical patient must have a minimum of four (4) virgin, non-restored, natural teeth, sufficiently erupted so that a dry field can be maintained, for application of the etching, or etchant/bond combination, and sealant materials. Such clinical instruction shall include teeth in all four quadrants for each patient. (h) Externship Instruction. (1) If an extramural clinical facility is utilized, students shall, as part of an organized program of instruction, be provided with planned, supervised clinical instruction in the application of pit and fissure sealants. (2) The program director/coordinator or a dental faculty member shall be responsible for selecting extern clinical sites and evaluating student competence in performing procedures both before and after the clinical assignment. (3) Objective evaluation criteria shall be used by the program faculty and clinic personnel. (4) Dentists who intend to provide extramural clinical practices shall be oriented by the program director/coordinator or a dental faculty member prior to the student assignment. Orientation shall include the objectives of the course, the preparation the student has had for the clinical assignment, and a review of procedures and criteria to be used by the dentist in evaluating the student during the assignment. (5) There shall be a written contract of affiliation with each extramural clinical facility utilized by the program. Such contract shall describe the settings in which the clinical training will be received, affirm that the clinical facility has the necessary equipment and armamentarium appropriate for the procedures to be performed, and affirm that such equipment and armamentarium are in safe operating condition. (i) Evaluation and Examination. (1) Upon completion of the course, each student must be able to: (A) Identify the major characteristics of oral anatomy, histology, physiology, oral pathology, normal/abnormal anatomical and physiological tooth descriptions, morphology and microbiology as they relate to pit and fissure application. (B) Explain the procedure to patients. (C) Recognize decalcification, caries and fracture lines. (D) Identify the indications and contraindications for sealants. (E) Identify the characteristics of self curing and light cured sealant material. (F) Define the appropriate patient selection factors and indication factors for sealant application. 66

California State Dental Practice Act and Administrative Rules for Dental Assistants (G) Utilize proper armamentaria in an organized sequence. (H) Maintain appropriate moisture control protocol before and during application of etchant and sealant material. (I) Demonstrate the proper technique for teeth preparation prior to etching. (J) Select and dispense the proper amount of etchant and sealant material. (K) Demonstrate the proper techniques for application of the etchant and sealant material. (L) Implement problem solving techniques associated with pit and fissure sealants. (M) Evaluate the etchant and sealant placement techniques according to appropriate criteria. (N) Check the occlusion and proximal contact for appropriate placement techniques. (O) Adjust occlusion and evaluate or correct proximal areas(s) when indicated. (P) Maintain aseptic techniques including disposal of contaminated material. (2) Each student shall pass a written examination which reflects the entire curriculum content. (3) Each student shall pass a clinical examination in which the student successfully completes the application of pit and fissure sealants on two of the four clinical patients required for clinical instruction. The examination shall include teeth in all four quadrants. 1070.4. Approval of Coronal Polishing Courses. The following minimum criteria shall be met for a course in coronal polishing to secure and maintain approval by the Board. (a) Educational Setting. The course shall be established at the post-secondary educational level. (b) Prerequisites. Each student must possess the necessary requirements for application for RDA licensure or currently possess an RDA license. Each student must satisfactorily demonstrate to the instructor clinical competency in infection control requirements prior to clinical instruction in coronal polishing. (c) Administration/Faculty. Adequate provision for the supervision and operation of the course shall be made. (1) The course director and each faculty member shall possess a valid, active, and current RDAEF, RDH, RDHEF, RDHAP, or dentist license issued by the Board, or an RDA license issued by the Board if the person has completed a board-approved course in coronal polishing. All faculty shall have been licensed for a minimum of two years. All faculty shall have the education, background, and occupational experience and/or teaching expertise necessary to teach, place, and evaluate coronal polishing. All faculty responsible for clinical evaluation shall have completed a two hour methodology course in clinical evaluation. (2) The course director must have the education, background, and occupational experience necessary to understand and fulfill the course goals. He/she shall actively participate in and be responsible for the day-to-day administration of the course including the following: (A) Providing guidance of didactic, laboratory and clinical assignments. (B) Maintaining for a period of not less than 5 years: i. Copies of curricula, course outlines, objectives, and grading criteria. ii. Copies of faculty credentials, licenses, and certifications. iii. Individual student records, including those necessary to establish satisfactory completion of the course. (C) Informing the board of any changes to the course content, physical facilities, and/or faculty, within 10 days of such changes. (d) Length of Course. The program shall be of sufficient duration for the student to develop minimum competence in coronal polishing, but shall in no event be less than 12 clock hours, including at least 4 hours of didactic training, at least 4 hours of laboratory training, and at least 4 hours of clinical training. (e) Evidence of Completion. A certificate or other evidence of completion shall be issued to each student who successfully completes the course. (f) Facilities and Resources. Facilities and class scheduling shall provide each student with sufficient opportunity, with instructor supervision, to develop minimum competency in coronal polishing. Such facilities shall include safe, adequate and educationally conducive: (1) Lecture classrooms. Classroom size and equipment shall accommodate the number of students enrolled. (2) Operatories. Operatories shall be sufficient in number to allow a ratio of at least one operatory for every six students at any one time. (A) Each operatory shall replicate a modern dental office containing functional equipment including: a poweroperated chair for treating patients in a supine position; operator and assistant stools; air-water syringe; adjustable light; oral evacuation equipment; work surface; hand-washing sink; slow-speed handpiece, and all other armamentarium required to instruct in the performance of coronal polishing. (B) Each operatory must be of sufficient size to accommodate a student, an instructor, and a patient at one time. (3) Laboratories. The location and number of general use equipment shall assure that each student has the access necessary to develop minimum competency in coronal polishing. Protective eyewear is required for each student. (4) Infection Control. The program shall establish written clinical and laboratory protocols to ensure adequate asepsis, infection and hazard control, and disposal of hazardous wastes, which shall comply with the board's regulations and other Federal, State, and local requirements. The program shall provide such protocols to all students, faculty, and appropriate staff to assure compliance with such protocols. Adequate space shall be provided for preparing and sterilizing all armamentarium. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (5) Emergency Materials/Basic Life Support. (A) A written policy on managing emergency situations must be made available to all students, faculty, and staff. (B) All students, faculty, and staff involved in the direct provision of patient care must be certified in basic life support procedures, including cardiopulmonary resuscitation. Re-certification intervals may not exceed two years. The program must document, monitor, and ensure compliance by such students, faculty, and staff. (g) Program Content. (1) Sufficient time shall be available for all students to obtain laboratory and clinical experience to achieve minimum competence in the various protocols used in the performance of coronal polishing. (2) A detailed course outline shall be provided to the board which clearly states curriculum subject matter and specific instruction hours in the individual areas of didactic, laboratory, and clinical instruction. (3) General program objectives and specific instructional unit objectives shall be stated in writing, and shall include theoretical aspects of each subject as well as practical application. The theoretical aspects of the program shall provide the content necessary for students to make judgments regarding the performance of coronal polishing. The course shall assure that students who successfully complete the course can perform coronal polishing with minimum competence. (4) Objective evaluation criteria shall be used for measuring student progress toward attainment of specific course objectives. Students shall be provided with specific unit objectives and the evaluation criteria that will be used for all aspects of the curriculum including written and practical examinations. The program shall establish a standard of performance that states the minimum number of satisfactory performances that are required for each procedure. (5) Areas of instruction shall include at least the following as they relate to coronal polishing: (A) Coronal Polishing Basics i. Legal requirements ii. Description and goals of coronal polishing iii. Indications and contraindications of coronal polishing iv. Criteria for an acceptable coronal polish (B) Principles of plaque and stain formation i. Clinical description of plaque, intrinsic and extrinsic stains, and calculus ii. Etiology of plaque and stain iii. Clinical description of teeth that have been properly polished and are free of stain. iv. Tooth morphology and anatomy of the oral cavity as they relate to polishing techniques and to retention of plaque and stain (C) Polishing materials i. Polishing agent composition, storage and handling ii. Abrasive material composition, storage, and handling, and factors which affect rate of abrasion iii. Disclosing agent composition, storage and handling iv. Armamentaria for disclosing and polishing techniques. v. Contraindications for disclosing and polishing techniques. (D) Principals of tooth polishing i. Clinical application of disclosing before and after a coronal polish. ii. Instrument grasps and fulcrum techniques iii. Purpose and techniques of the mouth mirror for indirect vision and retraction. iv. Characteristics, manipulation and care of dental handpieces when performing a coronal polish. v. Pre-medication requirements for the compromised patient. vi. Use of adjunct materials for stain removal and polishing techniques vii. Techniques for coronal polishing of adults and children. viii. Procedures for cleaning fixed and removable prosthesis and orthodontic appliances. ix. Disclosing and polishing evaluation criteria. (E) Infection control protocols (6) There shall be no more than 6 students per instructor during laboratory instruction. Sufficient time shall be available for all students to obtain laboratory experience to achieve minimum competence in the performance of coronal polishing prior to the performance of procedures on patients. (7) Clinical instruction shall be of sufficient duration to allow the procedures to be performed to clinical proficiency, which may include externship instruction as provided in subdivision (h). There shall be no more than 6 students per instructor during clinical instruction. Clinical instruction shall include clinical experience on at least three patients, with two of the three patients used for the clinical examination. (h) Externship Instruction. (1) If an extramural clinical facility is utilized for clinical instruction as provided in subdivision (g)(7), students shall, as part of an organized program of instruction, be provided with planned, supervised clinical instruction in the application of coronal polishing. (2) The program director/coordinator or a dental faculty member shall be responsible for selecting extern clinical sites and evaluating student competence in performing procedures both before and after the clinical assignment. 68

California State Dental Practice Act and Administrative Rules for Dental Assistants (3) Objective evaluation criteria shall be used by the program faculty and clinic personnel. (4) Dentists who intend to provide extramural clinical practices shall be oriented by the program director/coordinator or a dental faculty member prior to the student assignment. Orientation shall include the objectives of the course, the preparation the student has had for the clinical assignment, and a review of procedures and criteria to be used by the dentist in evaluating the student during the assignment. (5) There shall be a written contract of affiliation with each extramural clinical facility utilized by the program. Such contract shall describe the settings in which the clinical training will be received, affirm that the clinical facility has the necessary equipment and armamentarium appropriate for the procedures to be performed, and affirm that such equipment and armamentarium are in safe operating condition. (i) Evaluation and Examination. (1) Upon completion of the course, each student must be able to: (A) Identify the major characteristics of oral anatomy, histology, physiology, oral pathology, normal/abnormal anatomical and physiological tooth descriptions, morphology and microbiology as they relate to coronal polishing. (B) Explain the procedure to patients. (C) Recognize decalcification and mottled enamel. (D) Identify plaque, calculus and stain formation within the oral cavity. (E) Identify the indications and contraindications for disclosing and coronal polishing. (F) Identify the pre-medications for the compromised patient. (G) Utilize proper armamentaria in an organized sequence for disclosing and polishing. (H) Perform plaque disclosure. (I) Demonstrate the proper instrument grasp, fulcrum position, and cheek/tongue retraction. (J) Select and dispense the proper amount of polishing agent. (K) Demonstrate proper polishing techniques using appropriate cup adaptation, stroke, and handpiece use. (L) Demonstrate the use of floss, tape, and abrasive strips when appropriate. (M) Demonstrate techniques for cleaning fixed and removal prosthesis and orthodontic appliances. (N) Maintain aseptic techniques including disposal of contaminated material. (2) Each student shall pass a written examination which reflects the entire curriculum content. (3) Each student shall pass a clinical examination in which the student successfully completes coronal polishing on two of the three clinical patients required for clinical instruction. Note: Authority cited: Section 1614, Business and Professions Code. Reference: Sections 1645.1 and 1753.5, Business and Professions Code. 1070.5 Approval of Ultrasonic Scaling Courses. The following minimum criteria shall be met for a course in the removal of excess cement from coronal surfaces of teeth under orthodontic treatment by means of an ultrasonic scaler, hereinafter referred to as "ultrasonic scaling", to secure and maintain approval by the Board. (a) Educational Setting. The course shall be established at the post-secondary educational level. (b) Prerequisites. Each student must possess the necessary requirements for application for RDA licensure or currently possess an RDA license. (c) Administration/Faculty. Adequate provision for the supervision and operation of the course shall be made. (1) The course director and each faculty member shall possess a valid, active, and current RDAEF, RDH, RDHEF, RDHAP, or dentist license issued by the Board, or an RDA license issued by the Board if the person has completed a board-approved course in ultrasonic scaling. All faculty shall have been licensed for a minimum of two years. All faculty shall have the education, background, and occupational experience and/ or teaching expertise necessary to teach and evaluate ultrasonic scaling. (2) The course director must have the education, background, and occupational experience necessary to understand and fulfill the course goals. He/she shall actively participate in and be responsible for the dayto-day administration of the course including the following: (A) Providing guidance of didactic and laboratory assignments. (B) Maintaining for a period of not less than 5 years: (i) Copies of curricula, course outlines, objectives, and grading criteria. (ii) Copies of faculty credentials, licenses, and certifications. (iii) Individual student records, including those necessary to establish satisfactory completion of the course. (C) Informing the board of any changes to the course content, physical facilities, and/or faculty, within 10 days of such changes. (d) Length of Course. The program shall be of sufficient duration for the student to develop minimum competence in ultrasonic scaling, but shall in no event be less than 4 clock hours, including at least 2 hours of laboratory training. (e) Evidence of Completion. A certificate or other evidence of completion shall be issued to each student who successfully completes the course.

California State Dental Practice Act and Administrative Rules for Dental Assistants (f)

Facilities and Resources. Facilities and class scheduling shall provide each student with sufficient opportunity, with instructor supervision, to develop minimum competency in ultrasonic scaling. Such facilities shall include safe, adequate and educationally conducive: (1) Lecture classrooms. Classroom size and equipment shall accommodate the number of students enrolled. (2) Operatories. Operatories shall be sufficient in number to allow a ratio of at least one operatory for every six students at any one time. (A) Each operatory shall replicate a modern dental office containing functional equipment including: a power-operated chair for treating patients in a supine position; operator and assistant stools; air-water syringe; adjustable light; oral evacuation equipment; work surface, hand-washing sink; and all other armamentarium required to instruct in the performance of ultrasonic scaling. (B) Each operatory must be of sufficient size to accommodate a student and an instructor at one time. (3) Laboratories. The location and number of general use equipment shall assure that each student has the access necessary to develop minimum competency in ultrasonic scaling. There shall be at least one ultrasonic unit and orthodontically banded typodont for every four students. This procedure shall be performed by an operator wearing gloves, mask, and safety glasses. (4) Infection Control. The program shall establish written laboratory protocols to ensure adequate asepsis, infection and hazard control, and disposal of hazardous wastes, which shall comply with the board's regulations and other Federal, State, and local requirements. The program shall provide such protocols to all students, faculty, and appropriate staff to assure compliance with such protocols. Adequate space and equipment shall be provided for preparing and sterilizing all armamentarium. (g) Program Content. (1) Sufficient time shall be available for all students to obtain laboratory experience to achieve minimum competence in the various protocols used in the performance of ultrasonic scaling. (2) A detailed course outline shall be provided to the board which clearly states curriculum subject matter and specific instruction hours in the individual areas of didactic and laboratory instruction and practical examination evaluation criteria. (3) General program objectives and specific instructional unit objectives shall be stated in writing, and shall include theoretical aspects of each subject as well as practical application. The theoretical aspects of the program shall provide the content necessary for students to make judgments regarding the performance of ultrasonic scaling. The course shall assure that students who successfully complete the course can perform ultrasonic scaling with minimum competence. (4) Objective evaluation criteria shall be used for measuring student progress toward attainment of specific course objectives. Students shall be provided with specific unit objectives and the evaluation criteria that will be used for all aspects of the curriculum including written and practical examinations. The program shall establish a standard of performance that states the minimum number of satisfactory performances that are required for each procedure. (5) Areas of instruction shall include at least the following as they relate to ultrasonic scaling: (A) Ultrasonic Scaling Basics i. Legal requirements; ii. Description and goals of ultrasonic scaling; iii. Indications and contraindication of using an ultrasonic scaler as it relates to other methods of cement removal; iv. Criteria for acceptable cement removal from orthodontically banded teeth. (B) Tooth morphology and anatomy of the oral cavity as they relate to the use of an ultrasonic scaler in cement removal of orthodontically banded teeth. (C) Armamentarium and equipment use and care. (D) Principles of cement removal from orthodontically banded teeth i. Characteristics of ultrasonic scaler units and tips for cement removal; ii. Instrument grasps and fulcrum techniques; iii. Purpose and techniques of the mouth mirror for indirect vision and retraction; iv. Characteristics, manipulation and care of ultrasonic scaler unit when removing excess cement from orthodontically banded teeth; v. Effects of ultrasonic scalers on hard and soft tissue including root damage, enamel damage, thermal damage, and soft tissue damage; vi. Patient and operator safety including systemic medical complications and managing patients with pacemakers; vii. Use of adjunct material for removal of excess cement from orthodontically banded teeth; viii. Techniques for removal of excess cement from orthodontically banded teeth on a banded typodont; ix. Evaluation criteria for removal of excess cement by an ultrasonic scaler on a banded typodont. (E) Infection control protocols 70

California State Dental Practice Act and Administrative Rules for Dental Assistants (6) There shall be no more than six (6) students per instructor during laboratory instruction. Laboratory experience will consist of practice on orthodontically banded typodonts. Sufficient time shall be available for all students to obtain laboratory experience to achieve minimum competence in the performance of ultrasonic scaling prior to examination on two orthodontically banded typodonts for evaluation of clinical competence. (h) Extramural Instruction. (1) If an extramural facility is utilized, students shall, as part of an organized program of instruction, be provided with planned, supervised instruction in the removal of excess cement from orthodontically banded teeth. (2) The program director/coordinator or a dental faculty member shall be responsible for selecting extramural sites and evaluating student competence in performing procedures both before and after the extramural assignment. (3) Objective evaluation criteria shall be used by the program faculty and extramural personnel. (4) Dentists who intend to provide extramural facilities shall be oriented by the program director/coordinator or a dental faculty member prior to the student assignment. Orientation shall include the objectives of the course, the preparation the student has had for the clinical assignment, and a review of procedures and criteria to be used by the dentist in evaluating the student during the assignment. (5) There shall be a written contract of affiliation with each extramural facility utilized by the program. Such contract shall describe the settings in which the instruction will be received, affirm that the extramural facility has the necessary equipment and armamentarium appropriate for the procedures to be performed, and affirm that such equipment and armamentarium are in safe operating condition. (i) Evaluation and Examination. (1) Upon completion of the course, each student must be able to: (A) Identify the major characteristics of oral anatomy, histology, physiology, oral pathology, normal/abnormal anatomical and physiological tooth descriptions, morphology and microbiology as they relate to the use of an ultrasonic scaler in the removal of cement from orthodontic bands. (B) Describe the necessary aspects of pre-operative instructions to patients. (C) Recognize loose appliances. (D) Recognize decalcification and mottled enamel. (E) Identify the indications and contraindications of using an ultrasonic scaler as it relates to other methods of cement removal. (F) Identify pre-medications for the compromised patient. (G) Utilize proper armamentaria in an organized sequence for the use of an ultrasonic scaler in cement removal on an orthodontically banded typodont. (H) Demonstrate, on an orthodontically banded typodont, the proper instrument grasp, fulcrum position, and cheek/tongue retraction. (I) Demonstrate the proper techniques for removal of cement from teeth under orthodontic treatment without causing damage to hard or soft tissues, removing cement from underneath appliances, or loosening appliances. (J) Maintain aseptic techniques including disposal of contaminated materials. (2) Each student shall pass a written examination which reflects the entire curriculum content. (3) Each student shall pass a laboratory examination on two orthodontically banded typodonts which represent all four quadrants which have been banded using cementation product(s) easily visible to the operator. 1070.6. Approval of Infection Control Courses. In addition to the requirements of Sections 1070 and 1070.1 of these regulations, the following criteria shall be met by a course in infection control, as required in Sections 1750, 1750.2, 1750.4, and 1752.1 of the Business and Professions Code, to secure and maintain approval by the Board: (a) Adequate provisions for the supervision and operation of the course in infection control shall be made in compliance with Section 1070. Notwithstanding Section 1070, faculty shall not be required to be licensed by the Board, but faculty shall have experience in the instruction of California Division of Occupational Safety and Health (Cal/OSHA) regulations (Cal. Code Regs., Title 8, Sections 330-344.85) and the Board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005). In addition, all faculty responsible for clinical evaluation shall have completed a two-hour methodology course in clinical evaluation. (b) A course in infection control shall be of sufficient duration for the student to develop minimum competency in all aspects of Cal/OSHA regulations (Cal. Code Regs., Title 8, Sections 330-344.85) and the Board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005), but in no event less than eight hours, including at least four hours of didactic instruction, at least two hours of laboratory or preclinical instruction, and at least two hours of clinical instruction. Preclinical instruction shall utilize instruments, surfaces, and situations where contamination is simulated, without actual contamination, from bloodborne and other pathogens being present. (c) The minimum requirements for equipment and armamentaria shall include personal protective equipment, sterilizer approved by the United States Food and Drug Administration (FDA), ultrasonic unit or instrument processing device, sharps container, selection of instruments, equipment, and armamentaria that are necessary to instruct or demonstrate proper hazardous waste disposal, consistent with Cal/OSHA regulations (Cal. Code ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(d) (e)

(f)

(g)

(h) (i)

Regs., Title 8, Sections 330-344.85), local, state, and federal mandates, and all other armamentaria required to instruct or properly demonstrate the subjects described in the course content. Areas of instruction shall include, at a minimum, the instruction specified in subdivisions (e) and (f). Didactic instruction shall include, at a minimum, the following as they relate to Cal/OSHA regulations (Cal. Code Regs., Title 8, Sections 330-344.85) and the Board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005): (1) Basic dental science and microbiology as they relate to infection control in dentistry. (2) Legal and ethical aspects of infection control procedures. (3) Terms and protocols specified in Cal. Code of Regs., Title 16, Section 1005 regarding the minimum standards for infection control. (4) Principles of modes of disease transmission and prevention. (5) Principles, techniques, and protocols of hand hygiene, personal protective equipment, surface barriers and disinfection, sterilization, sanitation, and hazardous chemicals associated with infection control. (6) Principles and protocols of sterilizer monitoring and the proper loading, unloading, storage, and transportation of instruments to work area. (7) Principles and protocols associated with sharps management. (8) Principles and protocols of infection control for laboratory areas. (9) Principles and protocols of waterline maintenance. (10) Principles and protocols of regulated and nonregulated waste management. (11) Principles and protocols related to injury and illness prevention, hazard communication, general office safety, exposure control, postexposure requirements, and monitoring systems for radiation safety and sterilization systems. Preclinical instruction shall include three experiences in the following areas, with one used for a practical examination: (1) Apply hand cleansing products and perform hand cleansing techniques and protocols. (2) Apply, remove, and dispose of patient treatment gloves, utility gloves, overgloves, protective eyewear, masks, and clinical attire. (3) Apply the appropriate techniques and protocols for the preparation, sterilization, and storage of instruments including, at a minimum, application of personal protective equipment, precleaning, ultrasonic cleaning, rinsing, sterilization wrapping, internal or external process indicators, labeling, sterilization, drying, storage, and delivery to work area. (4) Preclean and disinfect contaminated operatory surfaces and devices, and properly use, place, and remove surface barriers. (5) Maintain sterilizer including, at a minimum, proper instrument loading and unloading, operation cycle, spore testing, and handling and disposal of sterilization chemicals. (6) Apply work practice controls as they relate to the following classification of sharps: anesthetic needles or syringes, orthodontic wires, and broken glass. (7) Apply infection control protocol for the following laboratory devices: impressions, bite registrations, and prosthetic appliances. (8) Perform waterline maintenance, including use of water tests and purging of waterlines. Clinical instruction shall include two experiences in the following areas, with one used for a clinical examination: (1) Apply hand cleansing products and perform hand cleansing techniques and protocols. (2) Apply, remove, and dispose of patient treatment gloves, utility gloves, overgloves, protective eyewear, masks, and clinical attire. (3) Apply the appropriate techniques and protocols for the preparation, sterilization, and storage of instruments including, at a minimum, application of personal protective equipment, precleaning, ultrasonic cleaning, rinsing, sterilization wrapping, internal or external process indicators, labeling, sterilization, drying, storage, and delivery to work area. (4) Preclean and disinfect contaminated operatory surfaces and devices, and properly use, place, and remove surface barriers. (5) Maintain sterilizer including, at a minimum, proper instrument loading and unloading, operation cycle, spore testing, and handling and disposal of sterilization chemicals. (6) Apply work practice controls as they relate to the following classification of sharps: anesthetic needles or syringes, orthodontic wires, and broken glass. (7) Apply infection control protocol for the following laboratory devices: impressions, bite registrations, and prosthetic appliances. (8) Perform waterline maintenance, including use of water tests and purging of waterlines. Each student shall pass a written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director. To maintain approval, programs approved prior to the effective date of these regulations shall submit to the Board a completed â&#x20AC;&#x153;Notice of Compliance with New Requirements for Infection Control Courses (New 10/10)â&#x20AC;?, hereby incorporated by reference, within ninety (90) days of the effective date of these regulations. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants 1070.7. Approval of Orthodontic Assistant Permit Courses. In addition to the requirements of Sections 1070 and 1070.1, the following criteria shall be met by an orthodontic assistant permit course to secure and maintain approval by the Board. (a) The course shall be of sufficient duration for the student to develop minimum competence in all of the duties that orthodontic assistant permitholders are authorized to perform, but in no event less than 84 hours, including at least 24 hours of didactic instruction, at least 28 hours of laboratory instruction, and at least 32 hours of clinical instruction. A registered dental assistant shall not be required to complete further instruction in the duties of placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument. The course hours for a student who holds a valid and current registered dental assistant license shall be no less than 55 hours, including 11 didactic hours, 24 laboratory hours, and 20 clinical hours. A registered dental assistant who has completed a Board-approved course in the use of an ultrasonic scaler shall not be required to complete further instruction in that duty. The course hours for a student who holds a valid and current registered dental assistant license and who has completed a Board-approved course in the use of an ultrasonic scaler shall be no less than 51 hours, including 9 didactic hours, 22 laboratory hours, and 20 clinical hours. (b) The minimum requirements for equipment and armamentaria shall include banded or bonded orthodontic typodonts in the ratio of at least one for every four students, bench mount or dental chair mounted mannequin head, curing light, regular typodont with full dentition and soft gingiva in the ratio of at least one for every four students, and a selection of orthodontic instruments and adjunct material for all of the procedures that orthodontic assistant permitholders are authorized to perform under Business and Professions Code Section 1750.3. (c) In addition to the requirements of Section 1070, all faculty or instructional staff members responsible for clinical evaluation shall have completed a two-hour methodology course in clinical evaluation prior to conducting clinical evaluations of students. (d) Areas of instruction shall include, at a minimum, the instruction specified in subdivisions (e) to (j), inclusive, as well as instruction in basic background information on orthodontic practice. â&#x20AC;&#x153;Basic background information on orthodontic practiceâ&#x20AC;? means, for purposes of this subdivision, the orthodontic treatment review, charting, patient education, and legal and infection control requirements as they apply to orthodontic practice. (e) The following requirements shall be met for sizing, fitting, cementing, and removing orthodontic bands: (1) Didactic instruction shall contain the following: (A) Theory of band positioning and tooth movement. (B) Characteristics of band material: malleability, stiffness, ductility, and work hardening. (C) Techniques for orthodontic banding and removal, which shall include all of the following: (i) Armamentaria. (ii) General principles of fitting and removing bands. (iii) Normal placement requirements of brackets, tubes, lingual sheaths, lingual cleats, and buttons onto bands. (iv) Orthodontic cements and adhesive materials: classifications, armamentaria, and mixing technique. (v) Cementing bands: armamentaria, mixing technique, and band cementation procedures. (vi) Procedure for removal of bands after cementation. (2) Laboratory instruction shall include typodont experience in the sizing, fitting, cementing, and removal of four posterior first molar bands a minimum of two times, with the cementing and removal of two first molar bands used as a practical examination. (3) Clinical instruction shall include the sizing, fitting, cementing, and removal of four posterior first molar bands on at least two patients. (f) The following requirements shall be met for preparing teeth for bonding: (1) Didactic instruction shall contain the following: (A) Chemistry of etching materials and tooth surface preparation (B) Application and time factors (C) Armamentaria (D) Techniques for tooth etching. (2) Laboratory instruction shall include typodont experience with etchant application in preparation for subsequent bracket bonding on four anterior and four posterior teeth a minimum of four times each, with one of each of the four times used for a practical examination. (3) Clinical instruction shall include etchant application in preparation for bracket bonding on anterior and posterior teeth on at least two patients. (g) The following requirements shall be met for bracket positioning, bond curing, and removal of orthodontic brackets. (1) Didactic instruction shall include the following elements: (A) Characteristics and methods of orthodontic bonding. (B) Armamentaria. (C) Types of bracket bonding surfaces. (D) Bonding material characteristics, application techniques, and curing time factors. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(h)

(i)

(j) (k) (l)

(E) Procedure for direct and indirect bracket bonding. (F) Procedures for bracket or tube removal. (2) Laboratory instruction shall contain typodont experience with selecting, prepositioning, tooth etching, positioning, curing, and removing of four anterior and four posterior brackets a minimum of four times each, with one each of the four times used for a practical examination. (3) Clinical instruction shall contain selecting, adjusting, prepositioning, etching, curing, and removal of anterior and posterior brackets on at least two patients. The following requirements shall be met for archwire placement and ligation: (1) Didactic instruction shall contain the following: (A) Archwire characteristics. (B) Armamentaria. (C) Procedures for placement of archwire previously adjusted by the dentist. (D) Ligature systems, purpose, and types, including elastic, wire, and self-ligating. (2) Laboratory instruction shall contain typodont experience on the following: (A) The insertion of a preformed maxillary and mandibular archwire a minimum of four times per arch, with one of each of the four times used for a practical examination. (B) Ligation of maxillary and mandibular archwire using elastic or metal ligatures or self-ligating brackets a minimum of four times per arch, with one of each of the four times used for a practical examination. (3) Clinical instruction shall contain the following: (A) Insertion of a preformed maxillary and mandibular archwire on at least two patients. (B) Ligating both preformed maxillary and mandibular archwires using a combination of elastic and metal ligatures or self-ligating brackets on at least two patients for each. The following requirements shall be met for cement removal with a hand instrument: (1) Didactic instruction shall contain the following: (A) Armamentaria (B) Techniques of cement removal using hand instruments and related materials (2) Laboratory instruction shall contain typodont experience on the removal of excess cement supragingivally from an orthodontically banded typodont using a hand instrument four times, with one of the four times used for a practical examination. (3) Clinical instruction shall contain removal of excess cement supragingivally from orthodontic bands with a hand instrument on at least two patients. Instruction for cement removal with an ultrasonic scaler shall be in accordance with Cal. Code Regs., Title 16, Section 1070.5, which governs courses in the removal of excess cement from teeth under orthodontic treatment with an ultrasonic scaler. Each student shall pass a written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director. To maintain approval, programs approved prior to the effective date of these regulations shall submit to the Board a completed “Notice of Compliance with New Requirements for Orthodontic Assistant Permit Courses (New 10/10)”, hereby incorporated by reference, within ninety (90) days of the effective date of these regulations.

1070.8. Approval of Dental Sedation Assistant Permit Courses. In addition to the requirements of Sections 1070 and 1070.1, the following criteria shall be met by a dental sedation assistant permit course to secure and maintain approval by the Board. As used in this Section, the following definitions apply: “IV” means intravenous, “AED” means automated external defibrillator, “CO2” means carbon dioxide, and “ECG” and “EKG” both mean electrocardiogram. (a) (1) The course director, designated faculty member, or instructional staff member may, in lieu of a license issued by the Board, possess a valid, active, and current license issued in California as a physician and surgeon. (2) The course director, designated faculty member, or instructional staff member responsible for clinical evaluation shall have completed a two-hour methodology course in clinical evaluation prior to conducting clinical evaluations of students. (3) Clinical instruction shall be given under direct supervision of the course director, designated faculty member, or instructional staff member who shall be the holder of a valid, active, and current general anesthesia or conscious sedation permit issued by the Board. Evaluation of the condition of a sedated patient shall remain the responsibility of the director, designated faculty member, or instructional staff member authorized to administer conscious sedation or general anesthesia, who shall be at the patient's chairside while conscious sedation or general anesthesia is being administered. (b) The course shall be of a sufficient duration for the student to develop minimum competence in all of the duties that dental sedation assistant permitholders are authorized to perform, but in no event less than 110 hours, including at least 40 hours of didactic instruction, at least 32 hours of combined laboratory and preclinical instruction, and at least 38 hours of clinical instruction. Clinical instruction shall require completion of all of the tasks described in subdivisions (j), (k), (l), (m), and (n) of this Section during no less than twenty (20) supervised cases utilizing conscious sedation or general anesthesia. 74

California State Dental Practice Act and Administrative Rules for Dental Assistants (c) The following are minimum requirements for equipment and armamentaria: (1) One pulse oximeter for each six students; one AED or AED trainer; one capnograph or teaching device for monitoring of end tidal CO2; blood pressure cuff and stethoscope for each six students; one pretracheal stethoscope for each six students; one electrocardiogram machine, one automatic blood pressure/pulse measuring system/machine, and one oxygen delivery system including oxygen tank; one IV start kit for each student; one venous access device kit for each student; IV equipment and supplies for IV infusions including hanging device infusion containers and tubing for each six students; one sharps container for each six students; packaged syringes, needles, needleless devices, practice fluid ampules and vials for each student; stopwatch or timer with second hand for each six students; one heart/lung sounds mannequin or teaching device; tonsillar or pharyngeal suction tip, endotracheal tube forceps, endotracheal tube and appropriate connectors, suction equipment for aspiration of oral and pharyngeal cavities, and laryngoscope in the ratio of at least one for each six students; any other monitoring or emergency equipment required by Cal. Code Regs., Title 16, Section 1043 for the administration of general anesthesia or conscious sedation; and a selection of instruments and supplemental armamentaria for all of the procedures that dental sedation assistant permitholders are authorized to perform according to Business and Professions Code Section 1750.5. (2) Each operatory used for preclinical or clinical training shall contain either a surgery table or a power-operated chair for treating patients in a supine position, an irrigation system or sterile water delivery system as they pertain to the specific practice, and all other equipment and armamentarium required to instruct in the duties that dental sedation assistant permitholders are authorized to perform according to Business and Professions Code Section 1750.5. (3) All students, faculty, and staff involved in the direct provision of patient care shall be certified in basic life support procedures, including the use of an automatic electronic defibrillator. (d) Areas of instruction shall include, at a minimum, the instruction specified in subdivisions (e) to (n), inclusive, as they relate to the duties that dental sedation assistant permitholders are authorized to perform. (e) General didactic instruction shall contain: (1) Patient evaluation and selection factors through review of medical history, physical assessment, and medical consultation. (2) Characteristics of anatomy and physiology of the circulatory, cardiovascular, and respiratory systems, and the central and peripheral nervous system. (3) Characteristics of anxiety management related to the surgical patient, relatives, and escorts, and characteristics of anxiety and pain reduction techniques. (4) Overview of the classification of drugs used by patients for cardiac disease, respiratory disease, hypertension, diabetes, neurological disorders, and infectious diseases. (5) Overview of techniques and specific drug groups utilized for sedation and general anesthesia. (6) Definitions and characteristics of levels of sedation achieved with general anesthesia and sedative agents, including the distinctions between conscious sedation, deep sedation, and general anesthesia. (7) Overview of patient monitoring during conscious sedation and general anesthesia. (8) Prevention, recognition, and management of complications. (9) Obtaining informed consent. (f) With respect to medical emergencies, didactic instruction shall contain: (1) An overview of medical emergencies, including, but not limited to, airway obstruction, bronchospasm or asthma, laryngospasm, allergic reactions, syncope, cardiac arrest, cardiac dysrhythmia, seizure disorders, hyperglycemia and hypoglycemia, drug overdose, hyperventilation, acute coronary syndrome including angina and myocardial infarction, hypertension, hypotension, stroke, aspiration of vomitus, and congestive heart failure. (2) Laboratory instruction shall include the simulation and response to at least the following medical emergencies: airway obstruction, bronchospasm, emesis and aspiration of foreign material under anesthesia, angina pectoris, myocardial infarction, hypotension, hypertension, cardiac arrest, allergic reaction, convulsions, hypoglycemia, syncope, and respiratory depression. Both training mannequins and other students or staff may be used for simulation. The student shall demonstrate proficiency in all simulated emergencies during training and shall then be eligible to complete a practical examination on this Section. (g) With respect to sedation and the pediatric patient, didactic instruction shall contain the following: (1) Psychological considerations. (2) Patient evaluation and selection factors through review of medical history, physical assessment, and medical consultation. (3) Definitions and characteristics of levels of sedation achieved with general anesthesia and sedative agents, with special emphasis on the distinctions between conscious sedation, deep sedation, and general anesthesia. (4) Review of respiratory and circulatory physiology and related anatomy, with special emphasis on establishing and maintaining a patient airway. (5) Overview of pharmacology agents used in contemporary sedation and general anesthesia. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(h) (i)

(j)

(k)

(6) Patient monitoring. (7) Obtaining informed consent. (8) Prevention, recognition, and management of complications, including principles of basic life support. With respect to physically, mentally, and neurologically compromised patients, didactic instruction shall contain the following: an overview of characteristics of Alzheimer's disease, autism, cerebral palsy, Down's syndrome, mental retardation, multiple sclerosis, muscular dystrophy, Parkinson's disease, schizophrenia, and stroke. With respect to health history and patient assessment, didactic instruction shall include, at a minimum, the recording of the following: (1) Age, sex, weight, physical status as defined by the American Society of Anesthesiologists Physical Status Classification System, medication use, general health, any known or suspected medically compromising conditions, rationale for anesthesia or sedation of the patient, visual examination of the airway, and auscultation of the heart and lungs as medically required. (2) General anesthesia or conscious sedation records that contain a time-oriented record with preoperative, multiple intraoperative, and postoperative pulse oximetry and blood pressure and pulse readings, frequency and dose of drug administration, length of procedure, complications of anesthesia or sedation, and a statement of the patient's condition at time of discharge. With respect to monitoring heart sounds with pretracheal/precordial stethoscope and EKG and use of AED: (1) Didactic instruction shall contain the following: (A) Characteristics of pretracheal/precordial stethoscope. (B) Review of anatomy and physiology of circulatory system: heart, blood vessels, and cardiac cycle as it relates to EKG. (C) Characteristics of rhythm interpretation and waveform analysis basics. (D) Characteristics of manual intermittent and automatic blood pressure and pulse assessment. (E) Characteristics and use of an AED. (F) Procedure for using a pretracheal/precordial stethoscope for monitoring of heart sounds. (G) Procedure for use and monitoring of the heart with an EKG machine, including electrode placement, and the adjustment of such equipment. (H) Procedure for using manual and automatic blood pressure/pulse/respiration measuring system. (2) Preclinical instruction: Utilizing another student or staff person, the student shall demonstrate proficiency in each of the following tasks during training and shall then be eligible to complete an examination on this Section. (A) Assessment of blood pressure and pulse both manually and utilizing an automatic system. (B) Placement and assessment of an EKG. Instruction shall include the adjustment of such equipment. (C) Monitoring and assessment of heart sounds with a pretracheal/precordial stethoscope. (D) Use of an AED or AED trainer. (3) Clinical instruction: Utilizing patients, the student shall demonstrate proficiency in each of the following tasks, under supervision of faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this Section. (A) Assessment of blood pressure and pulse both manually and utilizing an automatic system. (B) Placement and assessment of an EKG. Instruction shall include the adjustment of such equipment. (C) Monitoring and assessment of heart sounds with a pretracheal/precordial stethoscope. With respect to monitoring lung/respiratory sounds with pretracheal/precordial stethoscope and monitoring oxygen saturation end tidal CO2 with pulse oximeter and capnograph: (1) Didactic instruction shall contain the following: (A) Characteristics of pretracheal/precordial stethoscope, pulse oximeter and capnograph for respiration monitoring. (B) Review of anatomy and physiology of respiratory system to include the nose, mouth, pharynx, epiglottis, larynx, trachea, bronchi, bronchioles, and alveolus. (C) Characteristics of respiratory monitoring/lung sounds: mechanism of respiration, composition of respiratory gases, oxygen saturation. (D) Characteristics of manual and automatic respiration assessment. (E) Procedure for using a pretracheal/precordial stethoscope for respiration monitoring. (F) Procedure for using and maintaining pulse oximeter for monitoring oxygen saturation. (G) Procedure for use and maintenance of capnograph. (H) Characteristics for monitoring blood and skin color and other related factors. (I) Procedures and use of an oxygen delivery system. (J) Characteristics of airway management to include armamentaria and use. (2) Preclinical instruction: Utilizing another student or staff person, the student shall demonstrate proficiency in each of the following tasks during training and shall then be eligible to complete an examination on this Section. (A) Assessment of respiration rates. (B) Monitoring and assessment of lung sounds and ventilation with a pretracheal/precordial stethoscope. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(l)

(m)

(n)

(o) (p)

(C) Monitoring oxygen saturation with a pulse oximeter. (D) Use of an oxygen delivery system. (3) Clinical instruction: Utilizing patients, the student shall demonstrate proficiency in each of the following tasks, under supervision by faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this Section. (A) Assessment of respiration rates. (B) Monitoring and assessment of lung sounds and ventilation with a pretracheal/precordial stethoscope. (C) Monitoring oxygen saturation with a pulse oximeter. (D) Use of an oxygen delivery system. With respect to drug identification and draw: (1) Didactic instruction shall contain: (A) Characteristics of syringes and needles: use, types, gauges, lengths, and components. (B) Characteristics of drug, medication, and fluid storage units: use, type, components, identification of label including generic and brand names, strength, potential adverse reactions, expiration date, and contraindications. (C) Characteristics of drug draw: armamentaria, label verification, ampule and vial preparation, and drug withdrawal techniques. (2) Laboratory instruction: The student shall demonstrate proficiency in the withdrawal of fluids from a vial or ampule in the amount specified by faculty or instructional staff and shall then be eligible to complete a practical examination. (3) Clinical instruction: The student shall demonstrate proficiency in the evaluation of vial or container labels for identification of content, dosage, and strength and in the withdrawal of fluids from a vial or ampule in the amount specified by faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this Section. With respect to adding drugs, medications, and fluids to IV lines: (1) Didactic instruction shall contain: (A) Characteristics of adding drugs, medications, and fluids to IV lines in the presence of a licensed dentist. (B) Armamentaria. (C) Procedures for adding drugs, medications, and fluids, including dosage and frequency. (D) Procedures for adding drugs, medications, and fluids by IV bolus. (E) Characteristics of patient observation for signs and symptoms of drug response. (2) Laboratory instruction: The student shall demonstrate proficiency in adding fluids to an existing IV line on a venipuncture training arm or in a simulated environment, and shall then be eligible to complete a practical examination on this Section. (3) Clinical instruction: The student shall demonstrate proficiency in adding fluids to existing IV lines in the presence of course faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this Section. With respect to the removal of IV lines: (1) Didactic instruction shall include overview and procedures for the removal of an IV line. (2) Laboratory instruction: The student shall demonstrate proficiency on a venipuncture training arm or in a simulated environment for IV removal, and shall then be eligible for a practical examination. (3) Clinical instruction: The student shall demonstrate proficiency in removing IV lines in the presence of course faculty or instructional staff as described in Section 1070.8(a)(3), and shall then be eligible to complete an examination on this Section. Each student shall pass a written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director. To maintain approval, programs approved prior to the effective date of these regulations shall submit to the Board a completed “Notice of Compliance with New Requirements for Dental Sedation Assistant Permit Courses (New 10/10)”, hereby incorporated by reference, within ninety (90) days of the effective date of these regulations.

1071. Approval of RDAEF Educational Programs. (a) All new Registered Dental Assistant in Extended Functions (RDAEF) educational programs shall apply for and receive approval prior to operation. The Board may approve, provisionally approve, or deny approval of any such program. The Board may, in lieu of conducting its own investigation, accept the findings of any commission or accreditation agency approved by the Board and adopt those findings as its own. (b) In addition to the requirements of Cal. Code Regs., Title 16, Sections 1070 and 1070.1, the following criteria shall be met by an RDAEF educational program to secure and maintain approval by the Board. (1) A program applying for approval to teach all of the duties specified in Business and Professions Code Section 1753.5 shall comply with all of the requirements of this Section. (2) A program applying for approval to teach RDAEFs licensed on or before January 1, 2010 the additional duties specified in Business and Professions Code Section 1753.6 shall comply with all of the requirements of this Section, except as follows: © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(e)

(f)

(g)

(h)

(A) The program shall be no less than 318 hours, including at least 76 hours of didactic instruction, at least 186 hours of laboratory instruction, and at least 56 hours of clinical instruction. (B) Students shall not be required to complete instruction related to the placement of gingival retraction cord, the taking of final impressions for permanent indirect restorations, or the fitting of endodontic master points and accessory points. In order to be admitted to the program, each student shall possess a valid, active, and current license as a registered dental assistant issued by the Board and shall submit documentary evidence of successful completion of a Board-approved pit and fissure sealant course. In addition to the requirements of Sections 1070 and 1070.1, all faculty members responsible for clinical evaluation shall have completed a course or certification program in educational methodology of at least six (6) hours by January 1, 2012, unless he or she holds any one of the following: a postgraduate degree in education, a Ryan Designated Subjects Vocational Education Teaching Credential, a Standard Designated Subjects Teaching Credential, or, a Community College Teaching Credential. Each faculty member employed after January 1, 2012, shall complete a course or certification program in educational methodology within six months of employment. The program director or designated administrator shall be responsible to obtain and maintain records of each faculty member showing evidence of having met this requirement. The program shall be of sufficient duration for the student to develop minimum competence in all of the duties that RDAEFs are authorized to perform, but in no event less than 410 hours, including at least 100 hours of didactic instruction, at least 206 hours of laboratory instruction, and at least 104 hours of clinical instruction. All laboratory and simulated clinical instruction shall be provided under the direct supervision of program staff. Clinical instruction shall be provided under the direct supervision of a licensed dentist and may be completed in an extramural dental facility as defined in Section 1070.1(c). The following requirements are in addition to the requirements of Sections 1070 and 1070.1: (1) Minimum requirements for equipment and armamentaria: (A) Laboratory facilities with individual seating stations for each student and equipped with air, gas and air, or electric driven rotary instrumentation capability. Each station or operatory shall allow an articulated typodont to be mounted in a simulated head position. (B) Clinical simulation facilities that provide simulated patient heads mounted in appropriate position and accommodating an articulated typodont in an enclosed intraoral environment, or mounted on a dental chair in a dental operatory. Clinical simulation spaces shall be sufficient to permit one simulation space for each two students at any one time. (C) Articulated typodonts of both deciduous and permanent dentitions with flexible gingival tissues and with prepared teeth for each procedure to be performed in the laboratory and clinical simulation settings. One of each type of typodont is required for each student. (D) A selection of restorative instruments and adjunct materials for all procedures that RDAEFs are authorized to perform. (2) Notwithstanding Section 1070, there shall be at least one operatory for every two students who are simultaneously engaged in clinical instruction. Areas of instruction shall include, at a minimum, the instruction specified in subdivisions (h) to (o), inclusive, and the following didactic instruction: (1) The following instruction as it relates to each of the procedures that RDAEFs are authorized to perform: restorative and prosthetic treatment review; charting; patient education; legal requirements; indications and contraindications; problem solving techniques; laboratory, preclinical, and clinical criteria and evaluation; and infection control protocol implementation. (2) Dental science, including dental and oral anatomy, histology, oral pathology, normal or abnormal anatomical and physiological tooth descriptions, tooth morphology, basic microbiology relating to infection control, and occlusion. "Occlusion" is the review of articulation of maxillary and mandibular arches in maximum intercuspation. (3) Characteristics and manipulation of dental materials related to each procedure. (4) Armamentaria for all procedures. (5) Principles, techniques, criteria, and evaluation for performing each procedure, including implementation of infection control protocols. (6) Tooth isolation and matrix methodology review. General laboratory instruction shall include: (1) Rubber dam application for tooth isolation in both maxillary and mandibular arches and for deciduous and permanent dentitions. A minimum of four experiences per arch is required, with two anterior and two posterior applications, with one of the applications used for a practical examination. (2) Matrix placement for amalgam, and nonmetallic restorative material restorations in both primary and permanent dentitions, with three experiences for each cavity classification and for each material. (3) Base, liner, and etchant placement on three posterior teeth for each base, liner, or etchant, with one of the three teeth used for a practical examination. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (i) With respect to preliminary evaluation of the patient's oral health, including charting of existing conditions excluding periodontal assessment, intraoral and extraoral evaluation of soft tissue, classifying occlusion, and myofunctional evaluation: (1) Didactic instruction shall contain the following: (A) Normal anatomical structures: oral cavity proper, vestibule, and lips. (B) Deviations from normal to hard tissue abnormalities to soft tissue abnormalities. (C) Overview of classifications of occlusion and myofunction. (D) Sequence of oral inspection: armamentaria, general patient assessment, review of medical history form, review of dental history form, oral cavity mouth-mirror inspection, and charting existing conditions. (2) Preclinical instruction shall include performing an oral inspection on at least two other students. (3) Clinical instruction shall include performing an oral inspection on at least two patients, with one of the two patients used for a clinical examination. (j) With respect to sizing, fitting, and cementing endodontic master points and accessory points: (1) Didactic instruction shall include the following: (A) Review of objectives, canal preparation, filling of root canal space, including the role of the RDAEF as preparatory to condensation which is to be performed by the licensed dentist. (B) Description and goals of filling technique using lateral condensation techniques. (C) Principles and techniques of fitting and cementing master points and accessory points using lateral condensation, including characteristics, manipulation, use of gutta percha and related materials, and criteria for an acceptable master and accessory points technique using lateral condensation. (2) Laboratory instruction shall include fitting and cementing master points and accessory points on extracted teeth or simulated teeth with canals in preparation for lateral condensation by the dentist, with a minimum of two experiences each on a posterior and anterior tooth. This instruction shall not include obturatorbased techniques or other techniques that employ condensation. (3) Simulated clinical instruction shall include fitting and cementing master points and accessory points in preparation for condensation by the dentist with extracted or simulated teeth prepared for lateral condensation mounted in simulated patient heads mounted in appropriate position and accommodating and articulated typodont in an enclosed intraoral environment, or mounted on a dental chair in a dental operatory. This instruction shall not include obturator-based techniques that employ condensation. Simulated clinical instruction shall include fitting and cementing master points and accessory points for lateral condensation by the dentist in at least four teeth, one of which shall be used for a practical exam. (k) With respect to gingival retraction, general instruction shall include: (1) Review of characteristics of tissue management as it relates to gingival retraction with cord and electrosurgery. (2) Description and goals of cord retraction. (3) Principles of cord retraction, including characteristics and manipulation of epinephrine, chemical salts classification of cord, characteristics of single versus double cord technique, and techniques and criteria for an acceptable cord retraction technique. (l) With respect to final impressions for permanent indirect and toothborne restorations: (1) Didactic instruction shall contain the following: (A) Review of characteristics of impression material and custom. (B) Description and goals of impression taking for permanent indirect restorations and toothborne prosthesis. (C) Principles, techniques, criteria, and evaluation of impression taking for permanent indirect restorations and toothborne prosthesis. (2) Laboratory instruction shall include the following: (A) Cord retraction and final impressions for permanent indirect restorations, including impression taking of prepared teeth in maxillary and mandibular arches, one time per arch with elastomeric impression materials. (B) Impressions for toothborne removable prostheses, including, at a minimum, taking a total of four impressions on maxillary and mandibular arches with simulated edentulous sites and rest preparations on at least two supporting teeth in each arch. (3) Clinical instruction shall include taking final impressions on five cord retraction patients, with one used for a clinical examination. (m) With respect to placing, contouring, finishing, and adjusting direct restorations: (1) Didactic instruction shall contain the following: (A) Review of cavity preparation factors and restorative material. (B) Review of cavity liner, sedative, and insulating bases. (C) Characteristics and manipulation of direct filling materials. (D) Amalgam restoration placement, carving, adjusting and finishing, which includes principles, techniques, criteria and evaluation, and description and goals of amalgam placement, adjusting and finishing in children and adults. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants

(n)

(o)

(p) (q)

(E) Glass-ionomer restoration placement, carving, adjusting, contouring and finishing, which includes, principles, techniques, criteria and evaluation, and description and goals of glass-ionomer placement and contouring in children and adults. (F) Composite restoration placement, carving, adjusting, contouring and finishing in all cavity classifications, which includes, principles, techniques, criteria, and evaluation. (2) Laboratory instruction shall include typodont experience on the following: (A) Placement of Class I, II, and V amalgam restorations in eight prepared permanent teeth for each classification, and in four deciduous teeth for each classification. (B) Placement of Class I, II, III, and V composite resin restorations in eight prepared permanent teeth for each classification, and in four deciduous teeth for each classification. (C) Placement of Class I, II, III, and V glass-ionomer restorations in four prepared permanent teeth for each classification, and in four deciduous teeth for each classification. (3) Simulated clinical instruction shall include experience with typodonts mounted in simulated heads on a dental chair or in a simulation laboratory as follows: (A) Placement of Class I, II, and V amalgam restorations in four prepared permanent teeth for each classification, with one of each classification used for a clinical examination. (B) Placement of Class I, II, III, and V composite resin restorations in four prepared permanent teeth for each classification, with one of each classification used for a clinical examination. (C) Placement of Class I, II, III, and V glass-ionomer restorations in four prepared permanent teeth for each classification, with one of each classification used for a clinical examination. (4) Clinical instruction shall require proficient completion of placing, contouring and finishing at least twenty (20) direct restorations in prepared permanent teeth with the following requirements: (A) At least fifty (50) percent of the experiences shall be Class II restorations using esthetic materials. (B) At least twenty (20) percent of the experiences shall be Class V restorations using esthetic materials. (C) At least ten (10) percent of the experiences shall use amalgam. (D) Students who complete the 20 restorations and meet all the instructional requirements of this Section may complete additional Class I, II, III or V restorations as deemed appropriate for program success. With respect to polishing and contouring existing amalgam restorations: (1) Didactic instruction shall include principles, techniques, criteria and evaluation, and description and goals of amalgam polishing and contouring in children and adults. (2) Laboratory instruction shall include typodont experience on polishing and contouring of Class I, II, and V amalgam restorations in three prepared permanent teeth for each classification, and in two deciduous teeth for each classification. (3) Simulated clinical instruction shall include experience with typodonts mounted in simulated heads on a dental chair or in a simulation laboratory in the polishing and contouring of Class I, II, and V amalgam restorations in two prepared permanent teeth for each classification, with one of each classification used for a clinical examination. With respect to adjusting and cementing permanent indirect restorations: (1) Didactic instruction shall contain the following: (A) Review of fixed prosthodontics related to classification and materials for permanent indirect restorations, general crown preparation for permanent indirect restorations, and laboratory fabrication of permanent indirect restorations. (B) Interocclusal registrations for fixed prosthesis, including principles, techniques, criteria, and evaluation. (C) Permanent indirect restoration placement, adjustment, and cementation, including principles, techniques, criteria, and evaluation. (2) Laboratory instruction shall include: (A) Interocclusal registrations using elastomeric and resin materials. Two experiences with each material are required. (B) Fitting, adjustment, and cementation of permanent indirect restorations on one anterior and one posterior tooth for each of the following materials, with one of each type used for a practical examination: ceramic, ceramometal, and cast metallic. (3) Clinical experience for interocclusal registrations shall be performed on four patients who are concurrently having final impressions recorded for permanent indirect restorations, with one experience used for a clinical examination. (4) Clinical instruction shall include fitting, adjustment, and cementation of permanent indirect restorations on at least two teeth. Each student shall pass a written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director. To maintain approval, programs approved prior to the effective date of these regulations shall submit to the Board a completed "Notice of Compliance with New Requirements for Registered Dental Assistant in Extended Functions Educational Programs (New 10/10)", hereby incorporated by reference, within ninety (90) days of the effective date of these regulations. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants Article 3. Application for Licensure 1076. General Application Requirements (a) Application for licensure as a registered dental auxiliary shall be made on a form prescribed by the board and shall be accompanied by the following: (1) The fees fixed by the board; (2) Two classifiable sets of fingerprints on forms provided by the board; (3) Where applicable, a record of any previous dental assisting or hygiene practice and verification of license status in another jurisdiction. (b) Completed applications shall be filed with the board not later than the following number of days prior to the date set for the examination for which application is made; RDH - 45 days, RDA - 60 days, RDAEF and RDHEF- 45 days An incomplete application shall be returned to the applicant together with a statement setting forth the reason for returning the application and indicating the amount of money, if any, which will be refunded. An application shall not be deemed incomplete for failure to establish compliance with educational requirements if the application is accompanied by a certification from an approved program that the applicant is expected to meet all educational requirements established for the licensure for which application has been made and if the approved program certifies not less than 30 days prior to examination that the applicant has in fact met such educational requirements. The processing times for dental auxiliary licensure are set forth in Section 1069.(c). Permission to take an examination shall be granted to those applicants who have paid the necessary fees and whose credentials have been approved by the executive officer. Nothing contained herein shall be construed to limit the board’s authority to seek from an applicant such other information as may be deemed necessary to evaluate the applicant’s qualifications. 1077. RDA Applications (a) In addition to the requirements set forth in Section 1076, an application for licensure as a registered dental assistant shall be accompanied by the following: (1) Satisfactory evidence that the applicant has been granted a diploma or certificate in dental assisting from an educational program approved by the board; or (2) Satisfactory evidence that the applicant has met the required 18 months satisfactory work experience as a dental assistant. “Satisfactory work experience” means performance of the duties specified in Section 1085(b) and/or (c) in a competent manner as determined by the dentist employer. An applicant shall obtain work experience verification forms from the board and supply such forms to those persons in whose employ the applicant obtained the required work experience. The completed form shall be returned to the board by such person. (A) The 18 months of experience, which must be gained in California while employed by a California licensed dentist(s), shall be considered qualifying only if the experience was comprised of performing duties specified in Section 1085 (b) and/or (c) during a majority of the experience hours; (B) The 18 months shall be calculated as follows: (1) experience gained while working 20 or more hours per week shall be credited on a weekly basis, with 78 weeks considered equivalent to 18 months; (2) experience gained while working less than 20 hours per week shall be credited on an hourly basis, with 1,560 hours considered equivalent to 18 months. 1077.1. RDAEF Applications In addition to the requirements, including the processing times, set forth in Section 1076, an application for licensure as an RDAEF shall be accompanied by satisfactory evidence that the applicant has successfully completed an approved RDAEF program. Article 5. Duties and Settings 1085. Dental Assistant Duties and Settings (a) Unless specifically so provided by regulation, a dental assistant may not perform the following functions or any other activity which represents the practice of dentistry or requires the knowledge, skill and training of a licensed dentist: (1) Diagnosis and treatment planning; (2) Surgical or cutting procedures on hard or soft tissue; (3) Fitting and adjusting of correctional and prosthodontic appliances; (4) Prescription of medicines; (5) Placement, condensation, carving or removal of permanent restorations, including final cementation procedures; (6) Irrigation and medication of canals, try-in cones, reaming, filing or filling of root canals; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

California State Dental Practice Act and Administrative Rules for Dental Assistants (7) Taking of impressions for prosthodontic appliances, bridges or any other structures which may be worn in the mouth; (8) Administration of injectable and/or general anesthesia; (9) Oral prophylaxis procedures. (b) A dental assistant may perform such basic supportive dental procedures as the following under the general supervision of a licensed dentist: (1) Extra-oral duties or functions specified by the supervising dentist; (2) Operation of dental radiographic equipment for the purpose of oral radiography if the dental assistant has complied with the requirements of section 1656 of the Code; (3) Examine orthodontic appliances. (c) A dental assistant may perform such basic supportive dental procedures as the following under the direct supervision of a licensed dentist when done so pursuant to the order, control and full professional responsibility of the supervising dentist. Such procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist. (1) Take impressions for diagnostic and opposing models, bleaching trays, temporary crowns and bridges, and sports guards; (2) Apply non-aerosol and non-caustic topical agents; (3) Remove post-extraction and periodontal dressings; (4) Placement of elastic orthodontic separators; (5) Remove orthodontic separators; (6) Assist in the administration of nitrous oxide analgesia or sedation; however, a dental assistant shall not start the administration of the gases and shall not adjust the flow of the gases unless instructed to do so by the dentist who shall be present at the patientâ&#x20AC;&#x2122;s chairside at the implementation of these instructions. This regulation shall not be construed to prevent any person from taking appropriate action in the event of a medical emergency. (7) Hold anterior matrices; (8) Remove sutures; (9) Take intra-oral measurements for orthodontic procedures; (10) Seat adjusted retainers or headgear, including appropriate instructions; (11) Check for loose bands; (12) Remove arch wires; (13) Remove ligature ties; (14) Apply topical fluoride, after scaling and polishing by the supervising dentist or a registered dental hygienist; (15) Place and remove rubber dams; (16) Place, wedge and remove matrices; (17) Cure restorative or orthodontic materials in operative site with light-curing device. For the purpose of this section, a supervising licensed dentist is defined as a dentist whose patient is receiving the services of a dental assistant in the treatment facility and is under the direct control of said licensed dentist. 1086. RDA Duties and Settings (a) Unless specifically so provided by regulation, the prohibitions contained in section 1085 of these regulations apply to registered dental assistants. (b) A registered dental assistant may perform all functions which may be performed by a dental assistant. (c) Under general supervision, a registered dental assistant may perform the following duties: (1) Mouth-mirror inspection of the oral cavity, to include charting of obvious lesions, existing restorations and missing teeth; (2) Placement and removal of temporary sedative dressings. (d) A registered dental assistant may perform the following procedures under the direct supervision of a licensed dentist when done so pursuant to the order, control and full professional responsibility of the supervising dentist. Such procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist. (1) Obtain endodontic cultures; (2) Dry canals, previously opened by the supervising dentist, with absorbent points; (3) Test pulp vitality; (4) Place bases and liners on sound dentin; (5) Remove excess cement from supragingival surfaces of teeth with a hand instrument or floss; (6) Size stainless steel crowns, temporary crowns and bands; (7) Fabrication of temporary crowns intra-orally; (8) Temporary cementation and removal of temporary crowns and removal of orthodontic bands; (9) Placement of orthodontic separators; (10) Placement and ligation of arch wires; 82

California State Dental Practice Act and Administrative Rules for Dental Assistants (11) Placement of post-extraction and periodontal dressings; (12) Apply bleaching agents; (13) Activate bleaching agents with non-laser light-curing device; (14) Take bite registrations for diagnostic models for case study only; (15) Coronal polishing (Evidence of satisfactory completion of a Board-approved course of instruction in this function must be submitted to the board prior to any performance thereof). The processing times for coronal polishing course approval are set forth in section 1069. This procedure shall not be intended or interpreted as a complete oral prophylaxis (a procedure which can be performed only by a licensed dentist or registered dental hygienist). A licensed dentist or registered dental hygienist shall determine that the teeth to be polished are free of calculus or other extraneous material prior to coronal polishing. (16) Removal of excess cement from coronal surfaces of teeth under orthodontic treatment by means of an ultrasonic scaler. (Evidence of satisfactory completion of a Board-approved course of instruction or equivalent instruction in an approved RDA program in this function must be submitted to the board prior to any performance thereof.) The processing times for ultrasonic scaler course approval are set forth in section 1069. (e) Settings. Registered dental assistants may undertake the duties authorized by this section in a treatment facility under the jurisdiction and control of the supervising licensed dentist, or in an equivalent facility approved by the board. 1087. RDAEF Duties and Settings (a) Unless specifically so provided by regulation, the prohibitions contained in Section 1085 apply to RDAEFs. (b) An RDAEF may perform all duties assigned to dental assistants and registered dental assistants. (c) An RDAEF may perform the procedures set forth below under the direct supervision of a licensed dentist when done so pursuant to the order, control and full professional responsibility of the supervising dentist. Such procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist. (1) Cord retraction of gingivae from impression procedures; (2) Take impressions for cast restorations; (3) Take impressions for space maintainers, orthodontic appliances and occlusal guards; (4) Prepare enamel by etching for bonding; (5) Formulate indirect patterns for endodontic post and core castings; (6) Fit trial endodontic filling points; (7) Apply pit and fissure sealants; (8) Remove excess cement from subgingival tooth surfaces with hand instrument; (9) Apply etchant for bonding restorative materials. (d) Settings. Registered dental assistants in extended functions may undertake the duties authorized by this section in a treatment facility under the jurisdiction and control of the supervising licensed dentist, or in an equivalent facility approved by the board.

p 83

Colorado DANB Certificant Counts: Colorado Certified Dental Assistant (CDA) certificants

261

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

1,128

Infection Control (ICE)

1,041

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Cheris Frailey, Program Director Colorado Dental Board 1560 Broadway, Suite 1350 Denver, CO 80202 Phone: 303-894-7800 Fax: 303-894-7764 Email: dora_dentalboard@state.co.us Website: www.colorado.gov/pacific/dora/Dental_Board

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Front Range Community College-Larimer Pickens Technical College Pikes Peak Community College

DANB CDA Certificant State of Colorado+

$19.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 25, 2020.

Source: 2018 DANB Salary Survey (state data based on 8 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Colorado State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Colorado, a dental assistant must: (1) Be at least 18 years of age AND (2) Successfully complete minimum safety, education and training for operating machine sources of ionizing radiation and administering such radiation to patients. Approved education and training includes completion of 5 hours of practical or clinical experience and 3.5 hours of lecture meeting specific Colorado content requirements (see page 87 for details) for a total of 8.5 hours from a program accredited by the Commission on Dental Accreditation, Colorado Commission on Higher Education, the State Board of Community Colleges and Occupational Education, the Private Occupational School Division (or the equivalent in any other state) OR (3) Education and training may be provided on the job by a licensed dentist or dental hygienist provided that the educational module used is approved by the Colorado Dental Board OR (4) Successfully complete the national DANB Radiation Health and Safety (RHS) exam or the national DANB Certified Dental Assistant (CDA) exam.

State Requirements For Expanded Functions Some dental assistants in Colorado may choose to complete an Expanded Duties Dental Assistant (EDDA) educational program. The EDDA designation is not recognized by the Colorado Dental Board and does not qualify a dental assistant to perform expanded duties in the state. Note: It is the responsibility of the supervising dentist to ensure that dental personnel who administer and/or monitor nitrous oxide/oxygen inhalation are appropriately trained. Note: Dental assistants who render patient care services in a dental setting where local anesthesia, analgesia (including nitrous oxide), minimal sedation, moderate sedation, deep sedation or general anesthesia are being administered, shall have successfully completed and shall maintain continuous certification in Basic Life Support (BLS) training for healthcare providers consistent with the most current science and treatment recommendations from the International Liaison Committee on Resuscitation (ILCOR). Consensus on Science and Treatment Recommendations (CoSTR), and the American Heart Association Guidelines for CPR and Emergency Cardiovascular Care (ECC).

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Colorado Dental Board

Article 220 Dentists and Dental Hygienists

Colorado Revised Statutes Title 12 Professions and Occupations

12-220-104. Definitions. As used in this article, unless the context otherwise requires: (1) “Accredited” means a program that is nationally recognized for specialized accrediting for dental, dental hygiene, and dental auxiliary programs by the United States department of education. (3) “Dental assistant” means any person not a dentist or dental hygienist licensed in Colorado who may be assigned or delegated to perform dental tasks or procedures as authorized by this article 220 or by rules of the board. (7) (a) “Direct supervision” means the supervision of those tasks or procedures that do not require the presence of the dentist in the room where performed but require the dentist’s presence on the premises and availability for prompt consultation and treatment. (b) For purposes of this subsection (7) only, “premises” means within the same building, dental office, or treatment facility and within close enough proximity to respond in a timely manner to an emergency or the need for assistance. (9) (a) “Indirect supervision” means the supervision of those tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time the tasks or procedures are being performed, but do require that the tasks be performed with the prior knowledge and consent of the dentist. (b) For purposes of this subsection (9) only, “premises” means within the same building, dental office, or treatment facility and within close enough proximity to respond in a timely manner to an emergency or the need for assistance. 12-220-110. What constitutes practicing dentistry - authority to electronically prescribe. (1) (q) A person is practicing dentistry if the person: Prescribes, induces, and sets dosage levels for inhalation anesthesia; except that nothing in this subsection (1)(q) shall be construed to prohibit the delegation of monitoring and administration to appropriately trained personnel in accordance with this article 220 and rules of the board 12-220-127 Tasks authorized to be performed by dental assistants or dental hygienists. (1) (a) (I) Except as provided in subsection (1)(a)(II) of this section, the responsibility for dental diagnosis, dental treatment planning, or the prescription of therapeutic measures in the practice of dentistry remains with a licensed dentist and may not be assigned to any dental hygienist.

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants

(II) A dental hygienist may: (A) Perform dental hygiene assessment, dental hygiene diagnosis, and dental hygiene treatment planning for dental hygiene services pursuant to section 12-220-122(1)(f); (B) Identify dental abnormalities for immediate referral to a dentist as described in section 12-220-122(1) (f); (C) In collaboration with a licensed dentist, prescribe, administer, and dispense, as described in section 12-220-122(1)(g): Fluoride; fluoride varnish; antimicrobial solutions for mouth rinsing; other nonsystemic antimicrobial agents; and resorbable antimicrobial agents pursuant to rules of the board; and (D) In collaboration with a licensed dentist, apply silver diamine fluoride pursuant to section 12-220-129. (b) A dental procedure that involves surgery or that will contribute to or result in an irremediable alteration of the oral anatomy shall not be assigned to anyone other than a licensed dentist. (2) Except as provided in subsection (1) of this section, a dental hygienist may perform any dental task or procedure assigned to the hygienist by a licensed dentist that does not require the professional skill of a licensed dentist; except that the dental hygienist may perform the task or procedure only under the indirect supervision of a licensed dentist or as authorized in sections 12-220-122 and 12-220-123. (3) (a) A dental assistant shall not perform the following tasks: (I) Diagnosis; (II) Treatment planning; (III) Prescription of therapeutic measures; (IV) Any procedure that contributes to or results in an irremediable alteration of the oral anatomy; (V) Administration of local anesthesia; (VI) Scaling (supra and sub-gingival), as it pertains to the practice of dental hygiene; (VII) Root planing; (VIII) Soft tissue curettage; (IX) Periodontal probing. (b) A dental assistant may perform the following tasks under the indirect supervision of a licensed dentist: (I) Smoothing and polishing natural and restored tooth surfaces; (II) Provision of preventive measures, including the application of fluorides and other recognized topical agents for the prevention of oral disease; (III) Gathering and assembling information including, but not limited to, fact-finding and patient history, oral inspection, and dental and periodontal charting; (IV) Administering topical anesthetic to a patient in the course of providing dental care; (V) Any other task or procedure that does not require the professional skill of a licensed dentist. (VI) Repairing and relining dentures pursuant to a dental laboratory work order signed by a licensed dentist. (c) A dental assistant may, under the direct supervision of a licensed dentist in accordance with rules promulgated by the board, administer and monitor the use of nitrous oxide on a patient. (d) (I) A dental assistant may perform intraoral and extraoral tasks and procedures necessary for the fabrication of a complete or partial denture under the direct supervision of a licensed dentist. These tasks and procedures shall include: (A) Making of preliminary and final impressions; (B) Jaw relation records and determination of vertical dimensions; (C) Tooth selection; (D) A preliminary try-in of the wax-up trial denture prior to and subject to a try-in and approval in writing of the wax-up trial denture by the licensed dentist; (E) Denture adjustments that involve the periphery, occlusal, or tissue-bearing surfaces of the denture prior to the final examination of the denture. (II) The tasks and procedures in subsection (3)(d)(I) of this section shall be performed in the regularly announced office location of a licensed practicing dentist, and the dentist shall be personally liable for all treatment rendered to the patient. A dental assistant performing these tasks and procedures shall be properly identified as a dental assistant. No dentist shall utilize more than the number of dental assistants the dentist can reasonably supervise. (III) Prior to any work being performed pursuant to subsection (3)(d)(I) of this section, the patient shall first be examined by the treating dentist licensed to practice in this state who shall certify that the patient has no pathologic condition that requires surgical correction or other treatment prior to complete denture service. (4) The board may make such reasonable rules as may be necessary to implement and enforce the provisions of this section.

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants DEPARTMENT OF REGULATORY AGENCIES Colorado Dental Board DENTISTS & DENTAL HYGIENISTS 3 CCR 709-1 Regulations 1.1 Definitions D. "Certify or Certification" means to declare in writing on the patient's record. G “Therapeutic Agents” as used in these Rules means any agent approved by the United States Food and Drug Administration (FDA) for use in controlled drug delivery systems in the course of periodontal pocket treatment. 1.3 Licensure of Dentists and Dental Hygienists G. Continuing Education Requirements for Dentists, Dentists Issued an Academic License, and Dental Hygienists 7. Current Basic Life Support (BLS) for healthcare providers is required of all licensees and all licensees will receive a maximum of two hours continuing education credit (not to be applied towards renewal of an anesthesia permit) for successful completion. a. Basic Life Support, or BLS, generally refers to the type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway. It requires knowledge and skills in cardiopulmonary resuscitation (CPR), using automated external defibrillators (AED) and relieving airway obstructions in patients of every age. b. BLS training courses shall be consistent with the most current science and treatment recommendations from the International Liaison Committee on Resuscitation (ILCOR). Consensus on Science and Treatment Recommendations (CoSTR), and the American Heart Association Guidelines for CPR and Emergency Cardiovascular Care (ECC). (1) Initial training shall include a minimum of three hours of training, including skills practice and skills testing. (2) Renewal courses shall include a minimum of two hours of training including skills practice and testing. 1.9 Record Keeping Requirements A. Treatment Provider Identification 1. Patient records shall note at the time of the treatment or service the name of any dentist, dental hygienist, or dental assistant who performs any treatment or service upon a patient. 2. When patient treatment or service is performed which requires supervision, the patient record must also note the name of the supervising dentist for the treatment or service performed on the patient. 1.10 Minimum Standards for Qualifications, Training and Education for Unlicensed Personnel Exposing Patients to Ionizing Radiation Pursuant to section 12-220-202, C.R.S., a licensed dentist or dental hygienist shall not allow an unlicensed person to operate a machine source of ionizing radiation or to administer radiation to any patient unless the person meets the requirements of this Rule and any applicable rules of the Colorado Department of Public Health and Environment. These requirements apply to all persons in dental settings other than hospitals and similar facilities licensed by the Colorado Department of Public Health and Environment pursuant to section 25-1.5-103, C.R.S. A. All unlicensed dental personnel who expose patients to ionizing radiation must: 1. Be a minimum of eighteen years of age. 2. Successfully complete minimum safety education and training for operating machine sources of ionizing radiation and administering such radiation to patients. B. Such education and training shall include at least eight-and-a-half hours in the following areas, but not limited to: 1. Dental nomenclature - half hour; 2. Machine operation exposure factors - two hours; 3. Operator and patient safety - one hour; and 4. Practical or clinical experience in: a. Intra/extra - oral techniques for exposing radiographic images - four hours; b. Appropriate film handling and storage when it applies - one-quarter hour; c. Appropriate processing procedures - half hour; and d. Appropriate patient record documentation for radiographic images - one-quarter hour. C. Written verification of education and training shall be provided by the sponsoring agency, educational institution or licensee to each participant upon completion. This written verification shall also be signed by the unlicensed person; one copy shall be kept in each unlicensed person's employment record located at the employment site, the other kept by the unlicensed person. Written verification of completion of education and training must include: 1. Name of agency, educational institution or licensee who provided such education and training; 2. Verification of hours; 3. Date of completion; and © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants 4. Exposure techniques for which education and training have been provided, i.e., bitewings, periapicals, occlusals, and panoramic. D. Satisfaction of the education and training requirements may be achieved by successfully completing one of the following: 1. Programs approved by the Commission on Dental Accreditation, Colorado Commission on Higher Education, the State Board of Community Colleges and Occupational Education, the Private Occupational School Division, or the equivalent in any other state. Such programs shall include the education and training as specified in section (B) of this Rule. 2. On the job training by a licensed dentist or dental hygienist providing a Board-approved educational module which complies with section (B) of this Rule is used as the basis for such training. 3. The “Radiation Health and Safety” (RHS) or “Certified Dental Assistant” (CDA) examination administered by the Dental Assisting National Board, Inc. (DANB). E. All Licensees must insure that newly hired untrained dental personnel comply with these Rules within three months of becoming employed in a capacity in which they will be delegated the task of exposing radiographic images. F. It shall be the duty of each licensee to ensure that: 1. Tasks are assigned only to those individuals who have successfully completed the education and training and meet the qualifications for those tasks, which are being delegated; 2. The properly executed verification documentation of all unlicensed personnel who are operating machine sources of ionizing radiation and exposing such radiation be submitted to the Colorado Dental Board upon request. 1.12 Denture Construction by Assistants and Unlicensed Technicians This Rule relates to tasks authorized to be performed by dental assistants as defined in section 12-220-127(3)(d), C.R.S., and tasks authorized to be performed by unlicensed technicians as defined in section 12-220-139, C.R.S. A. B.

Dentures are defined as fixed, removable, full, or partial appliances designed to replace teeth. Dental assistants who render direct patient treatment as allowed by section 12-220-127(3)(d) C.R.S., necessary for the construction of dentures, shall be supervised by the dentist. C. A dental assistant or unlicensed technician shall not practice dentistry as defined in section 12-220-110, unless pursuant to sections 12-220-127 and 12-220-139, C.R.S. D. All tasks authorized to be performed by a dental assistant pursuant to section 12-220-127(3)(d), C.R.S., shall be performed in the "regularly announced office location" of a dentist where the dentist is the proprietor and in which he/she regularly practices dentistry, unless that person is operating as an unlicensed technician pursuant to section 12-220-139(1)(b), C.R.S., which allows an unlicensed technician that possesses a valid laboratory work order to provide extraoral construction, manufacture, fabrication, supply, or repair of identified dental and orthodontic devices. Intraoral service in a human mouth by a dental assistant or unlicensed technician is authorized and permissible only if under the direct supervision of a dentist pursuant to section 12-220-127(3)(d), C.R.S. E. Nothing in this Rule shall prevent the filling of a valid work order pursuant to section 12-220-139, C.R.S., by any unlicensed technician, association, corporation, or other entity for the construction, reproduction, or repair of prosthetic dentures, bridges, plates, or appliances to be used or worn as substitutes for natural teeth or for restoration of natural teeth. 1.13 Limited Prescriptive Authority for Dental Hygienists H. The placement and removal of therapeutic agents in periodontal pockets and limited prescriptive authority may not be delegated or assigned to a dental assistant. 1.14 Anesthesia A. Introduction 1. This Rule 1.14 is authorized by the Dental Practice Act including, but not limited to, sections 12-220-106(1)(a) (II-III), and (f), 12-220-110(1)(p) and (q), 12-220-111, 12-220-123(1)(c), 12-220-127(3)(a)(V), 12-220-130(1)(cc) and (ll), and 12-220-146, C.R.S. 2. The purpose of this Rule 1.14 is to make the process for obtaining an anesthesia permit well defined, transparent, and consistent for the dental professionals while at the same time protecting and promoting patient safety. B. The Anesthesia Continuum 1. The anesthesia continuum represents a spectrum encompassing analgesia, local anesthesia, sedation, and general anesthesia along which no single part can be simply distinguished from neighboring parts. It is not the route of administration that determines or defines the level of anesthesia administered. The location on the continuum defines the level of anesthesia administered.

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants t————————————————— Anesthesia Continuum —————————————————u • • •

Local Anesthesia Analgesia Medication prescribed/ administered for the relief of anxiety or apprehension

Privileges included in Colorado Dental Licensure

Minimal Sedation

Minimal Sedation Permit

Moderate Sedation

Moderate Sedation Permit

Deep Sedation

General Anesthesia

Deep Sedation/General Anesthesia Permit

2. The level of anesthesia on the continuum is determined by the definitions listed under section (C) of this Rule 1.14. Elements used to determine the level of anesthesia include the level of consciousness and the likelihood of anesthesia provider intervention(s), based upon the following patient parameters: a. Responsiveness; b. Airway; c. Respiratory (breathing); and d. Cardiovascular. C. Definitions Related to Anesthesia 1. Anesthesia – The art and science of managing anxiety, pain, and awareness. It includes analgesia, local anesthesia, minimal sedation, moderate sedation, deep sedation, and general anesthesia. 2. Analgesia – The diminution or elimination of pain. 3. Local Anesthesia – The elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. 4. Minimal Sedation – A minimally depressed level of consciousness produced by a pharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. 5. Moderate Sedation – A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. 6. Deep Sedation – A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. 7. General Anesthesia – A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. 8. Monitoring – Evaluation of patients to assess physical condition and level of anesthesia. 9. Peri-anesthesia Period – The time from the beginning of the pre-anesthesia assessment until the patient is discharged from anesthesia care. 10. Anesthesia Provider – The licensed and legally authorized individual responsible for administering medications that provide analgesia, local anesthesia, minimal, moderate or deep sedation, or general anesthesia. 11. Pediatric Designation – Board-granted designation required, in addition to an anesthesia permit, if administering minimal sedation, moderate sedation, deep sedation/general anesthesia to a patient under twelve years old. D. General Rules for the Safe Administration of Anesthesia 1. The anesthesia provider’s education, training, experience, and current competence must correlate with the progression of a patient along the anesthesia continuum. 2. The anesthesia provider must be prepared to manage deeper than intended levels of anesthesia as it is not always possible to predict how a given patient will respond to anesthesia. 3. The anesthesia provider’s ultimate responsibility is to protect the patient. This includes, but is not limited to, identification and management of any complication(s) occurring during the peri-anesthesia period. 4. No dentist shall administer or employ any agent(s) with a narrow margin for maintaining consciousness including, but not limited to, ultra-short acting barbiturates, propofol, parenteral ketamine, and similarly acting drugs, or quantity of agent(s), or technique(s), or any combination thereof that would likely render a patient deeply

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants sedated, generally anesthetized or otherwise not meeting the conditions of the definition of minimal sedation or moderate sedation in section C of this Rule 1.14, unless he/she holds a valid Deep Sedation/General Anesthesia Permit issued by the Colorado Dental Board. G. Nitrous Oxide/Oxygen Inhalation Requirements 1. A dentist may delegate under direct supervision the monitoring and administration of nitrous oxide/oxygen inhalation to appropriately trained dental personnel, pursuant to sections 12-220-110(1)(p) and (q), 12-220-127(3) (c), and 12-220-146(4), C.R.S. 2. The supervising dentist is responsible for determining and documenting the maximum percent-dosage of nitrous oxide administered to the patient. Documentation shall include the length of time nitrous oxide was delivered. 3. It is the responsibility of the supervising dentist to ensure that dental personnel who administer and/or monitor nitrous oxide/oxygen inhalation are appropriately trained. 4. If nitrous oxide is used in the practice of dentistry, then the supervising dentist shall provide and ensure the following: a. Fail safe mechanisms in the delivery system and an appropriate scavenging system; b. The inhalation equipment must be evaluated for proper operation and delivery of inhalation agents; c. Any administration or monitoring of nitrous oxide/oxygen inhalation to patients by dental personnel is performed in accordance with generally accepted standards of dental or dental hygiene practice. Q. Miscellaneous Requirements 1. Life Support Certification(s) – a. Successful completion and continuous certification of Basic Life Support (BLS) training for health care providers that meets the requirements of Rule 1.3(G) is required for: (1) All dentists and dental personnel utilizing, administering or monitoring local anesthesia, analgesia (including nitrous oxide), minimal sedation, moderate sedation, deep sedation or general anesthesia; and (2) All dental hygienists utilizing, administering, or monitoring local anesthesia. b. Additionally, any dentist applying for or maintaining a Moderate Sedation Permit or a Deep Sedation/General Anesthesia Permit must have successfully completed current Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS), as appropriate for the dentist’s practice, and maintain continuous certification. 2. Personnel – a. Minimal/Moderate Sedation – During the administration of minimal or moderate sedation, the supervising dentist and at least one other individual who is experienced in patient monitoring and documentation must be present. b. Deep sedation/general anesthesia – During the administration of deep sedation or general anesthesia, the supervising dentist and at least two other individuals, one of whom is experienced in patient monitoring and documentation, must be present. 3. Monitoring and medication administration – The supervising dentist retains full accountability, but delegation to trained dental personnel may occur under: a. Direct supervision by the dentist when a patient is being monitored, or b. Direct, continuous, and visual supervision by the dentist when medication, excluding local anesthetic, is being administered to a patient. 4. Discharge – patient discharge after sedation and/or general anesthesia must be specifically authorized by the anesthesia provider. 1.15 Pediatric Case Management and Protective Stabilization The purpose of this Rule is to recognize that all infants, children, adolescents, and individuals with special health care needs are entitled to receive oral health care that meets the treatment and ethical standard of care. These groups of individuals may need special case management in order to receive timely diagnosis and treatment, as well as to ensure the safety of the patient, practitioner, and staff. The use of protective stabilization (formerly referred to as physical restraint and medical immobilization) is an advanced behavior guidance technique which must be integrated into an overall behavior guidance approach that is individualized for each patient in the context of promoting a positive dental attitude for the patient, while ensuring patient safety and quality care. This necessitates that the dentist establishes communication with the dental staff, the patient, and the parent or guardian. It is important that the dentist and dental team promote a positive attitude towards oral and dental health in order to alleviate fear and anxiety and to deliver quality dental care. A. Pediatric Case Management 1. Parents or legal guardians cannot be denied access to the patient during treatment in the dental office unless the health and safety of the patient, parent or guardian, or dental staff would be at risk. The parent(s) or guardian(s) shall be informed of the reason they are denied access to the patient and both the incident of the denial and the reason for the denial shall be documented in the patient’s dental record. 2. This provision shall not apply to dental care delivered in an accredited hospital or acute care facility.

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants C. Methods, Indications, and Considerations for Protective Stabilization 1. Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, torso, or head freely is considered protective stabilization. a. Active stabilization involves restraint by another person, such as a parent/guardian, dentist, or dental staff. This may include hand holding, head guarding, and therapeutic holding. b. Passive stabilization utilizes a restraining device. 2. The use of protective stabilization must not cause serious or permanent injury and it must involve the least possible discomfort to the patient. 3. Protective stabilization may be performed (with or without a stabilization device) by the: a. Dentist; or b. Parent or legal guardian. 4. Dental hygienists and dental assistants shall not use protective stabilization by themselves, but may assist the dentist as necessary. 1.16 Infection Control In addition to meeting applicable standards of care, dentists and dental hygienists must follow the Centers for Disease Control and Prevention (CDC) 2003 “Guidelines for Infection Control in Dental Health-Care Settings”, including the CDC’s March 2016 “Summary of Infection Prevention Practices in Dental Settings”, and the Occupational Safety and Health Administration’s (OSHA) “Bloodborne Pathogens Standard”. A licensee is also responsible for the compliance of unlicensed dental personnel. 1.26 Application of Silver Diamine Fluoride by Dental Hygienists A. The application of silver diamine fluoride may not be assigned to an unlicensed professional.

p 91

Connecticut DANB Certificant Counts: Connecticut National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

694

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Stephen B. Carragher Public Health Services Manager Connecticut Department of Public Health Connecticut State Dental Commission Practitioner Licensing and Investigations Section 410 Capitol Avenue, MS #13PHO P.O. Box 340308 Hartford, CT 06134-0308 Phone: 860-509-7603, menu option 4 Fax: 860-509-8457 Email: dph.dentalteam@ct.gov Website: www.ct.gov/dph/cwp/view.asp?a=3143&q=388884

Radiation Health and Safety (RHS)

7,474

Infection Control (ICE)

4,907

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Manchester Community College Tunxis Community College - Allied Health

DANB CDA Certificant State of Connecticut+

$21.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of April 21. 2020.

Source: 2018 DANB Salary Survey (state data based on 10 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Connecticut State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures (under the dentist’s super-

vision and control) in the Connecticut, a dental assistant must pass the national DANB Radiation Health and Safety (RHS) exam.

State Requirements For Expanded Functions To perform expanded functions under the direct or indirect supervision of a licensed dentist in Connecticut, a dental assistant must earn Expanded Function Dental Assistant (EFDA) status. To qualify, one must: (1) Maintain current DANB Certified Dental Assistant (CDA) or Certified Orthodontic Assistant (COA) certification AND (2) Have successfully completed an expanded function dental assistant program at a higher education institution accredited by the Commission on Dental Accreditation (CODA) that includes educational courses related to didactic and laboratory preclinical objectives, and at least four hours of education in ethics and professional standards for dental professionals, and a comprehensive clinical exam administered by the higher education program at the conclusion of the program, AND (3) pass DANB’s Certified Preventive Functions Dental Assistant (CPFDA) certification exam and DANB’s Certified Restorative Functions Dental Assistant (CRFDA) certification exam. Note: The provisions above are part of a new law passed by the Connecticut legislature in 2016. Additional details related to the EFDA education curriculum and allowable EFDA functions are under development.

Beginning July 1, 2018*, any dental assistant or EFDA must show successful completion of DANB’s infection control (ICE) exam or an infection control competency assessment administered by a CODA-accredited dental education program in Connecticut, and must complete at least 1 hour of training or education in infection control every two years, via in-person or online courses offered by a dental school or accredited higher education institution that is recognized by the CODA, the ADA, or any association or society affiliated with the American Dental Association or American Dental Assistants Association. *Please note: Current Connecticut dental assistants who have not passed the DANB Infection Control Exam prior to July 1, 2018 have until October 1, 2019 (fifteen months) to receive on-the-job training by a licensed dentist to prepare for and pass the exam. New Connecticut dental assistants hired after July 1, 2018 have fifteen months from the start of employment to receive on-the-job training by a licensed dentist to prepare for and pass the exam, if they have not done so already.

Connecticut State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Connecticut State Dental Commission CONNECTICUT GENERAL STATUTES Chapter 376c RADIOGRAPHERS AND RADIOLOGIC TECHNOLOGISTS Section 20-74ee. Construction of Chapter. (3) Nothing in subsection (c) of section 19a-14, sections 20-74aa to 20-74cc, inclusive, and this section shall be construed to require licensure as a radiographer or limit the activities of: (A) a dental assistant as defined in Section 20-112a, provided such dental assistant is engaged in the taking of dental x-rays under the supervision and control of a dentist licensed pursuant to chapter 379 and can demonstrate successful completion of the dental radiography portion of an examination prescribed by the Dental Assisting National Board, or (B) a dental assistant student, intern or trainee pursuing practical training in the taking of dental x-rays provided such activities constitute part of a supervised course or training program and such person is designated by a title that clearly indicates such person’s status as a student, intern or trainee. (The Connecticut Department of Health website notes that the licensed dentist should maintain appropriate documentation of the dental assistant’s successful completion of the dental radiography portion of the DANB examination.) Dental assistants interested in applying for the required examination should contact the agency indicated below: Dental Assisting National Board, Inc. (DANB) 444 N. Michigan, Suite 900 Chicago, IL 60611 1-800-FOR-DANB / (312) 642-3368 www.danb.org Please note that the Department of Public Health will not be involved in the review of credentials of dental assistants. It is the responsibility of the dental assistant, as well as the supervising dentist, to ensure that the requirements of the Public Act have been met; all documentation demonstrating compliance should be retained by the dental assistant and supervising dentist. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Connecticut State Dental Practice Act and Administrative Rules for Dental Assistants Chapter 379 DENTISTRY Sec. 38. Section 20-112a (a) As used in this section: (1) "Direct supervision" means a licensed dentist has authorized certain procedures to be performed on a patient by a dental assistant or an expanded function dental assistant with such dentist remaining onsite in the dental office or treatment facility while such procedures are being performed by the dental assistant or expanded function dental assistant and that, prior to the patient's departure from the dental office, such dentist reviews and approves the treatment performed by the dental assistant or expanded function dental assistant; (2) "Indirect supervision" means a licensed dentist is in the dental office or treatment facility, has personally diagnosed the condition, planned the treatment, authorized the procedures to be performed and remains in the dental office or treatment facility while the procedures are being performed by the dental assistant or expanded function dental assistant and evaluates the performance of the dental assistant or expanded function dental assistant; (3) "Dental assistant" means a person who: (A) Has (i) completed on-the-job training in dental assisting under direct supervision, (ii) successfully completed a dental assistant education program accredited by the American Dental Association's Commission on Dental Accreditation, or (iii) successfully completed a dental assistant education program that is accredited or recognized by any national or regional accrediting agency recognized by the United States Department of Education; and (B) meets any requirements established by the Commissioner of Public Health in regulations adopted pursuant to subsection (f) of this section. (4) "Expanded function dental assistant" means a dental assistant who has passed the Dental Assisting National Board's certified dental assistant or certified orthodontic assistant examination and then successfully completed: (A) An expanded function dental assistant program at an institution of higher education that is accredited by the Commission on Dental Accreditation of the American Dental Association that includes (i) educational courses relating to didactic and laboratory preclinical objectives for skills used by an expanded function dental assistant and that requires demonstration of such skills prior to advancing to clinical practice, (ii) not less than four hours of education in the area of ethics and professional standards for dental professionals, and (iii) a comprehensive clinical examination administered by the institution of higher education at the conclusion of such program; and (B) a comprehensive written examination concerning certified preventive functions and certified restorative functions administered by the Dental Assisting National Board; and (5) "Fluoride varnish treatment" means the application of a highly concentrated form of fluoride to the surface of the teeth. (b) Each expanded function dental assistant shall: (1) Maintain dental assistant or orthodontic assistant certification from the Dental Assisting National Board; (2) conspicuously display his or her dental assistant or orthodontic assistant certificate at his or her place of employment or place where he or she provides expanded function dental assistant services; (3) maintain professional liability insurance or other indemnity against liability for professional malpractice in an amount not less than five hundred thousand dollars for one person, per occurrence, with an aggregate liability of not less than one million five hundred thousand dollars while employed as an expanded function dental assistant; (4) provide expanded function dental assistant services only under direct or indirect supervision; and (5) meet any requirements established by the Commissioner of Public Health in regulations adopted pursuant to subsection (f) of this section. (c) (1) A licensed dentist may delegate to dental assistants such dental procedures as the dentist may deem advisable, including: (A)The taking of dental x-rays if the dental assistant can demonstrate successful completion of the dental radiation health and safety examination administered by the Dental Assisting National Board; and (B) the taking of impressions of teeth for study models; and (C) the provision of fluoride varnish treatments. Such procedures shall be performed under the direct supervision of a licensed dentist and the dentist providing direct supervision shall assume responsibility for such procedures. (2) A licensed dentist may delegate to an expanded function dental assistant such dental procedures as the dentist may deem advisable, including: (A) The placing, finishing and adjustment of temporary restorations and longterm individual fillings, capping materials and cement bases; (B) oral health education for patients; (C) dental sealants; (D) coronal polishing, provided the procedure is not represented or billed as prophylaxis; (E) administration of topical anesthetic under the direct supervision of the dentist prior to the administration of local anes-

Connecticut State Dental Practice Act and Administrative Rules for Dental Assistants

(d)

(e)

(f)

(g)

thetic by a dentist or dental hygienist; and (F) taking alginate impressions of teeth, under the direct supervision of the dentist, for use in study models, orthodontic appliances, whitening trays, mouth guards or fabrication of temporary crowns. Such procedures shall be performed under either direct or indirect supervision, except as specifically provided in this subdivision, and the dentist providing such supervision shall assume responsibility for such procedures. (3) (A) No licensed dentist may delegate dental procedures to a dental assistant or expanded function dental assistant unless the dental assistant or expanded function dental assistant provides records demonstrating successful completion of the Dental Assisting National Board's infection control examination or an infection control competency assessment administered by a dental education program in the state that is accredited by the American Dental Association's Commission on Dental Accreditation, except as provided in subdivision (2) of this subsection, (B) a dental assistant may receive not more than fifteen months of on-the-job training by a licensed dentist for purposes of preparing the dental assistant for the infection control examination or infection control competency assessment, and (C) any licensed dentist who delegates dental procedures to a dental assistant shall retain and make such records available for inspection upon request of the Department of Public Health. (4) On and after January 1, 2018, upon successful completion of the Dental Assisting National Board's infection control examination or an infection control competency assessment administered by a dental education program in the state that is accredited by the American Dental Association's Commission on Dental Accreditation, each dental assistant or expanded function dental assistant shall complete not less than one hour of training or education in infection control in a dental setting every two years, including, but not limited to, courses, including online courses, offered or approved by a dental school or another institution of higher education that is accredited or recognized by the Commission on Dental Accreditation, a regional accrediting organization, the American Dental Association or a state, district or local dental association or society affiliated with the American Dental Association or the American Dental Assistants Association. Except as provided in subsection (c) of this section, under no circumstances may a dental assistant or expanded function dental assistant engage in: (1) Diagnosis for dental procedures or dental treatment; (2) the cutting or removal of any hard or soft tissue or suturing; (3) the prescribing of drugs or medications that require the written or oral order of a licensed dentist or physician; (4) the administration of local, parenteral, inhalation or general anesthetic agents in connection with any dental operative procedure; (5) the taking of any final impression of the teeth or jaws or the relationship of the teeth or jaws for the purpose of fabricating any appliance or prosthesis; or (6) the practice of dental hygiene as defined in section 20-126l, as amended by this act. Each licensed dentist employing or otherwise engaging the services of an expanded function dental assistant shall: (1) Prior to hiring or otherwise engaging the services of the expanded function dental assistant, verify that the expanded function dental assistant meets the requirements described in subdivision (4) of subsection (a) and subdivisions (1) and (3) of subsection (b) of this section; (2) maintain documentation verifying that the expanded function dental assistant meets such requirements on the premises where the expanded function dental assistant provides services; (3) make such documentation available to the Department of Public Health upon request; and (4) provide direct or indirect supervision to not more than two expanded function dental assistants who are providing services at one time or, if the dentist's practice is limited to orthodontics, provide direct or indirect supervision to not more than four expanded function dental assistants who are providing services at one time. The Commissioner of Public Health, in consultation with the State Dental Commission, established pursuant to section 20103a, may adopt regulations in accordance with the provisions of chapter 54 to implement the provisions of this section. Such regulations, if adopted, shall include, but need not be limited to, identification of the: (1) Specific types of procedures that may be performed by a dental assistant and an expanded function dental assistant, consistent with the provisions of this section; (2) appropriate number of didactic, preclinical and clinical hours or number of procedures to be evaluated for clinical competency for each skill employed by an expanded function dental assistant; and (3) the level of supervision, that may include direct or indirect supervision, that is required for each procedure to be performed by an expanded function dental assistant. A dental therapist may directly supervise not more than two dental assistants or expanded function dental assistants, as defined in section 20-112a of the general statutes, as amended by this act, or dental hygienists licensed pursuant to chapter 379a of the general statutes to the extent permitted in the collaborative agreement.

Connecticut State Dental Practice Act and Administrative Rules for Dental Assistants Sec. 20-123a. Anesthesia and sedation: Definitions. For purposes of this section and section 20-123b: (a) "Conscious sedation" means a drug-induced state in which the patient is calmed and relaxed, capable of making rational responses to commands and has all protective reflexes intact, including the ability to clear and maintain the patient's own airway in a patent state, but does not include nitrous oxide sedation or the administration of a single oral sedative or analgesic medication in a dose appropriate for the unsupervised treatment of insomnia, anxiety or pain that does not exceed the maximum recommended therapeutic dose established by the federal Food and Drug Administration for unmonitored home use; (b) "General anesthesia" means a controlled state of unconsciousness produced by pharmacologic or nonpharmacologic methods, or a combination thereof, accompanied by a partial or complete loss of protective reflexes including an inability to independently maintain an airway and to respond purposefully to physical stimulation or verbal commands; and (c) “Commissioner” means the Commissioner of Public Health. Administrative Regulations - Public Health Code Administration and Use of Anesthesia and Conscious Sedation in Dentistry 20-123b-1. Definitions. (i) “Anesthesia Assistant” means a chairside assistant or a dentist licensed pursuant to Chapter 379 of the Connecticut General Statutes whose sole responsibility is to monitor the patient undergoing general anesthesia. 20-123b-9. Office equipment, emergency drugs, and anesthesia records (b) Except as specifically noted, all practitioners who are being evaluated pursuant to sections 20-123b-1 to 20-123b-9, inclusive, of the Regulations of Connecticut State Agencies, or who have been issued a permit pursuant to Section 20-123b of the Connecticut General Statutes, shall demonstrate and maintain the following equipment and personnel for continuous monitoring during the administration of anesthesia in any and all offices where they administer general anesthesia or conscious sedation: (1) Equipment and personnel for continuous monitoring during the administration of deep sedation or general anesthesia: (A) means of monitoring heart rate: (i) ECG; (ii) pulsemeter; (iii) pretracheal or Precordial stethoscope; or (iv) direct palpation of pulse; (B) means of following respirations and level of oxygenation: (i) pretracheal or precordial stethoscope, or capnography; and (ii) pulse oximeter; C) means of monitoring blood pressure for child and adult. (2) Equipment and personnel for continuous monitoring during the administration of conscious sedation: (A) means of monitoring heart rate: (i) ECG; (ii) pulsemeter; (iii) pretracheal or precordial stethoscope; or (iv) direct palpation of pulse; (B) means of following respirations and level of oxygenation: (i) pretracheal or precordial stethoscope, capnography or direct observation of chest; and (ii) pulse oximeter; (C) means of monitoring blood pressure for child and adult.

p 96

Delaware DANB Certificant Counts: Delaware National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Delaware Board of Dentistry and Dental Hygiene Cannon Building, Suite 203 861 Silver Lake Boulevard Dover, DE 19904 Phone: 302-744-4500 Fax: 302-739-2711 Website: www.dpr.delaware.gov/boards/dental/

1,768

Infection Control (ICE)

117

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

State Agency for Dental Radiography Regulation Delaware Division of Public Health Office of Radiation Control 417 Federal Street Dover, DE 19901 Phone: 302-744-4546 Fax: 302-739-3839 Website: http://dhss.delaware.gov/dhss/dph/hsp.orc.html

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Currently, there are no CODA-accredited dental assisting programs in Delaware. For an updated directory of CODA-accredited dental assisting programs, visit www.danb.org.

DANB CDA Certificant State of Delaware+

$26.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 2, 2020.

The pages that follow contain information about this state's requirements for dental assistants. If you have any questions about DANB-administered exams, contact DANB. For questions or further information about state requirements, contact the state board of dentistry. In this state, radiography requirements for dental assistants are established by a state regulatory body other than the state dental board. Contact the Delaware Division of Public Health, Office of Radiation Control, for information about qualifying to take dental radiographs in this state. DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

Source: 2018 DANB Salary Survey (state data based on 2 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Delaware State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures under the supervision of a licensed dentist in Delaware, a dental assistant must hold a state certificate as a Dental Radiation Technician or a state certificate recognizing DANB Certified Dental Assistant (CDA) certification from the Delaware Division of Public Health/ Office of Radiation Control (Delaware ORC). To qualify, one must: (1) FIRST Pass the DANB national Radiation Health and Safety (RHS) exam or hold current DANB CDA certification, AND THEN (2) Submit a completed state certificate application (Form R16-N) to the Delaware ORC, AND be at least 18 years of age to receive the state certificate. Currently, the State of Delaware has no provisions for recognizing certificates issued by other states. To obtain Form R16N, contact the Delaware ORC, Jesse Cooper Building, 417 Federal St., Dover, DE 19901; phone (302) 744-4546; or visit the website: www.dhss.delaware.gov/dhss/dph/hsp/orc.html. Forms can be accessed at http://dhss.delaware.gov/dhss/ dph/hsp/orcradtechs.html. Note: The Delaware ORC has discontinued the Delaware Dental Radiologic Technology (DDRT) exam, which was a state-specific exam equivalent to DANB's national RHS exam offered prior to December 31, 2015. As of January 1, 2016, individuals who wish to become certified as Delaware Dental Radiation Technicians and who do not hold DANB's CDA certification must apply to DANB to take the DANB RHS exam. Candidates who passed the DDRT or RHS exam prior to December 31, 2015 may still use their exam passing result to qualify for the Dental Radiation Technician certificate. (If you are enrolled at a Vocational Technical High School, you may be eligible to have your state certification application fee waived contact the Delaware ORC for more information.)

State Requirements For Expanded Functions In Delaware, competency of Dental Assistants in specific duties is determined by the supervising dentist. The dentist is given full responsibility in deciding the scope of work to be allocated to the dental assistant. Adequate training of dental assistants is solely the responsibility of the dentist. In summary, the Delaware Dental Board places full responsibility for the work done by dental assistants directly upon the dentist.

Delaware State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Delaware Board of Dentistry and Dental Hygiene Delaware Code TITLE 24. Professions and Occupations CHAPTER 11. Dentistry and Dental Hygiene Subchapter I. State Board of Dentistry and Dental Hygiene Section 1101. Definitions (2) “Board” shall mean the State Board of Dentistry and Dental Hygiene established in this chapter. (3) “Dental assistant” shall mean any person not licensed to practice dentistry and/or dental hygiene in this State, who aids a dentist in the performance of generalized tasks, including chair-side aid, clerical work, reception, radiography, dental laboratory work, and any other such tasks delegated by the dentist. (4) “Dental auxiliary personnel” shall mean any person not licensed to practice dentistry in this State, who works in a dental office as either a dental assistant, dental hygienist, dental technician, or otherwise. Section 1135. Certain unlawful acts; supervision by dentists. (a) No person shall repair, construct, adjust or alter any appliance, denture or dental restoration except under the authorization and responsibility of a licensed practitioner of dentistry as defined by this chapter. (b) Dentists may have direct supervision of dental assistants. Delaware Administrative Code TITLE 16 Health and Safety Department of Health and Social Services, Division of Public Health 4400 Health Systems Protection 4466 Radiation Technologists/Technicians (Certification) 4.0 Definitions As used in this regulation: "Agency" means the administrative agent of the Authority on Radiation Protection; i.e., the Office of Radiation Control, Division of Public Health, Department of Health and Social Services. 98

Delaware State Dental Practice Act and Administrative Rules for Dental Assistants "Authority" means the Authority on Radiation Protection as specified by 16 Del.C. §7404. "Certificate" means a document issued by the Agency recognizing the successful completion of an Authority approved Certification Exam. The "Certificate" allows for the practice of radiation technology as specified by the level of examination the individual has passed. Other credentials include "Temporary". "Certification Examination" means any examination satisfactory to the Authority that is used to determine the competency of Radiation Technologists/Technicians in the "principles and practice of radiation protection". “Certified Dental Assistant” or CDA means an individual holding a national credential issued by the Dental Assisting National Board (DANB). "CODA" means Commission on Dental Accreditation. "DANB" means Dental Assisting National Board which issues national credentials to eligible dental assistants. “Dentist” shall mean a person who is qualified to practice dentistry as prescribed in 24 Del.C., Ch. 11, Dentistry and Dental Hygiene, as amended. “Principal Supervisor” means the licensed practitioner responsible for use of x-ray equipment or other device generating ionizing radiation in the healing arts. "Radiation Technician" means an individual who has not graduated from an approved program in radiation technology, but has passed an Authority approved examination. "Radiation Technologist" means an individual who has successfully completed a JRCERT/JRCCVT approved or equivalent, recognized program in radiation technology and has passed a national credentialing examination in his/her field of specialization. "Radiation Technology" means the use of a radioactive substance or equipment emitting ionizing radiation on humans for diagnostic or therapeutic purposes. 5.0 Legal Titles 5.1 The Authority shall establish certification requirements for Radiation Technologists/Technicians; i.e., Certified Dental Assistant, Dental Radiation Technician, Medical Radiologic Technologist, Medical Radiation Technician, Nuclear Medicine Technologist, Medical Radiologic Technologist – Bone Densitometry Only, Medical Radiologic Technologist – CT Only, Radiation Therapist and Cardiovascular Radiologic Technologist. Individuals holding these certificates shall be recognized by such title(s). 5.2 Any technologist or technician certified under this regulation is authorized to use a source of radiation on humans for diagnostic or therapeutic purposes under the supervision of a Licensed Practitioner, and in accordance with the Delaware Radiation Control Regulations. 5.3 Holders of a certificate (legal title) under this regulation shall display in public view the official certificate or a verified copy in each place of regular employment. 6.0 Certification Process 6.2 Application 6.2.1 The Agency shall accept an application for credentialing from any Radiation Technologist/Technician who is at least 18 years of age, or who is currently enrolled in and attending an educational program in radiation technology and who pays a non-refundable application and examination fee (if applicable) established by rule of the Authority. Each application submitted must be complete, or it will be returned to the applicant. 6.2.1.1 Initial and renewal application fees shall be established at $50.00 when paid on time. Renewal fee is $100.00 when payment is received by the agency 1-180 days after expiration date on the certificate (based on post-mark). 6.2.1.2 The initial application fee shall be waived for applicants who document they are enrolled in a vocationaltechnical high school Dental Assisting Program in Delaware. 6.2.1.3 The Agency shall issue a certificate to all applicants who provide proof that they hold a current national credential from an Authority-recognized, national voluntary credentialing body, see 6.3.5 of this part. 6.3 Examinations 6.3.2 The Authority shall accept an application for certification from any applicant who discloses conviction of a felony if the application is complete and is submitted with photocopy of court documents that include charges, and disposition papers. 6.3.3 The Authority may accept, in lieu of an examination, a current credential by a recognized national voluntary credentialing body, (See 6.3.5 of this regulation) issued on the basis of an examination consistent with the requirements established by the Authority, provided that the radiation protection standards to which that body adheres are at least as stringent as those established by the Authority. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Delaware State Dental Practice Act and Administrative Rules for Dental Assistants 6.3.4 An examinee who fails to pass the Authority-approved certification examination may be re-tested two times per calendar year, provided the prescribed application is submitted and examination fees for each reexamination are paid. 6.3.5 List of National Credentialing Organizations Acceptable for Delaware Certification 6.3.5.1 American Registry of Radiologic Technologists (ARRT) 6.3.5.2 Dental Assisting National Board (DANB) 6.3.5.3 Nuclear Medicine Technologist Certification Board (NMTCB) 6.3.5.4 Cardiovascular Credentialing International (CCI) 6.3.5.5 International Society of Clinical Densitometry (ISCD) 7.0 Issuing Certification 7.1 The Agency may issue a Certificate to each qualified applicant who has successfully met the requirements under Section 6.0, is at least 18 years of age, and has paid the prescribed fees, (Schedule A). Furthermore, the Certificate shall be issued upon verifying that the applicant has passed a certification examination acceptable to the Authority [see 6.3 above]. The initial Certificate shall expire after a period of three (3) years from date of issue. Certificates based on national credentials will automatically terminate if the national credentials are permitted to lapse, or are revoked. 7.2 Temporary Certificate. The Agency may issue a Temporary Certificate to a student enrolled in a post-secondary accredited school of radiation technology who is approved to take a national credentialing exam. Only one Temporary Certificate may be issued if the Agency finds that it will not violate the purpose of this regulation or endanger the public health and safety. The Temporary Certificate shall grant the same rights as the credential for which the applicant is awaiting examination. Such Temporary Certificate may not be renewed by the Agency without the approval of the Authority and only for just cause. 7.3 Renewal of Certificate. A valid certificate may be renewed by the Agency for a period of three (3) years upon payment of a renewal fee (see Schedule A) established by the Authority. 7.3.1 Applicants for renewal of certificates based on national credentials must provide proof that the national credentials are currently valid. A photocopy of the national credential membership card or certificate in good standing is the proof required. 7.4 A Radiation Technologist/Technician whose certificate expires is not permitted to administer radiation to human patients until the expired certificate is renewed. 7.5 A Radiation Technologist/Technician whose certificate has lapsed for a period of less than 180 days shall apply for renewal provided that he/she presents evidence of having previously passed a certification examination approved by the Authority and pays the prescribed renewal fee. 7.6 Re-certification of Lapsed Certificate. A Radiation Technologist/Technician whose certificate has lapsed for more than 180 days shall: 7.6.1 Apply for re-certification, 7.6.2 Apply to take the appropriate certification examination, show proof of having passed an examination acceptable to the Authority, or show proof of currently valid national credentials, 7.6.3 Pay the re-certification fee and re-examination (if applicable) fee. 7.7 A radiation technologist/technician who has allowed his/her certificate to expire shall not expose humans to ionizing radiation until and unless he/she is re-certified. Failure to comply with this requirement will subject the technician/technologist's employer to citation under the Delaware Radiation Control Regulations. 7.8 The Agency may issue verification of certification to each applicant seeking to have their Delaware certificate recognized for licensure by another state, upon receipt of a complete, official application form, and payment of the prescribed application fee. 7.9 An approved applicant whose check for fee payment is returned marked insufficient funds, account closed, or payment stopped shall remit to the agency a money order or check for guaranteed funds (cashier’s check or money order) in the amount of the application or examination fee plus the returned check fee within 30 days of the date of receipt of the agency’s notice. Otherwise, the application and the approval shall be invalid. 8.0 Limitations of Certification 8.1 Nothing in the provisions of this regulation relating to Radiation Technology shall apply to the practice of Licensed Practitioners herein defined. 8.2 The requirement for certification shall not apply to a student enrolled in and attending an accredited school of radiation technology who applies ionizing radiation to humans in such an educational program while under the supervision of a certified Radiation Technologist. 8.3 A certificate, registration or license issued by another state will not be accepted as a valid equivalent Radiation Technologist/Technician certification by the Authority.

100

Delaware State Dental Practice Act and Administrative Rules for Dental Assistants 9.0 Discipline, Sanctions, Hearing Procedures, and Appeals 9.5 Unlawful Practice of Radiation Technology 9.5.1 No person shall practice or offer to practice radiation technology or claim to be a registered or certified radiation worker in Delaware, or shall use any title, abbreviation, sign, card, or device to indicate that such person is certified pursuant to this regulation unless such person is actually certified by the Authority. TITLE 24 Regulated Professions and Occupations Department of State Division of Professional Regulation 1100 Board of Dentistry and Dental Hygiene Section 1.0 Supervision Definitions- There are 3 recognized levels of supervision. 1.1 Direct Supervision - The dentist is present in the office, personally examines the patient and specifically authorized the work to be performed. The dentist checks the work before the patient leaves the office. 1.2 Indirect Supervision - A dentist is present in the office and generally authorizes the work to be performed. The dentist may examine the patient, either before or after work is performed. The dentist is available for consultation during the patient visit. 1.3 General Supervision - A dentist may or may not be present in the office while the work is performed. The dentist authorizes the work to be performed. Emergency care and consultant services are provided by an “on-call” dentist not present in the treatment facility, if the primary dentist is not present. Section 2.0 Auxiliary Personnel 2.1 Expanded Duties: A legally licensed and registered dentist may delegate to competent dental auxiliary personnel, those procedures for which the dentist exercises direct supervision and full responsibility except as follows: 2.1.1 Those procedures which require professional judgement and skill, such as diagnosis and treatment planning, and the cutting of hard and/or soft tissues, or any intra-oral procedure which would lead to the fabrication of an appliance and/or restoration which, when received by the patient, would come in direct contact with hard or soft tissue and which could result in tissue irritation or injury. 2.1.2 Those procedures allocated by the Dental Code to registered dental hygienists. 2.2 Interpretation of Regulation – Competency of the dental auxiliary personnel must be determined by the individual dentist in assigning specific duties. The dentist is given full responsibility in deciding the scope of work to be allocated to the auxiliary personnel. 2.3 Training of Auxiliary Personnel – Adequate training of dental auxiliary personnel will be the responsibility of the dentist. 2.4 Assignment of Duties – Following are some of the procedures that may be assigned to auxiliary personnel under the conditions and provisions stated above: - Take and develop x-rays. This involves placing an x-ray film in the patient’s mouth and exposing that film. - Give and demonstrate home-care procedures to the patient, including those procedures the patient is expected to carry out in preventive care. - Placing a rubber dam. - Placing cotton rolls. - Taking impressions for study models. - Removal of excess cements from dental restorations and appliances with hand instruments only. - Removal of temporary medicinal fillings or packs under direct orders of the dentist. 2.5 Responsibilities – In summary, the Dental Board places full responsibility for the work done by auxiliary personnel directly upon the dentist. Violations of the regulations will be subject to penalties as spelled out in 24 Del.C. §1131(5). Section 7.0 Anesthesia Regulations: 7.1 Definitions: The following definitions are taken from the Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, American Dental Association, Council on Dental Education (July 1993). These terms refer to the extent of a drug’s depressant effect upon the central nervous system and should not be confused with the route by which the drug is administered.

101

Delaware State Dental Practice Act and Administrative Rules for Dental Assistants 7.1.1 Analgesia -- the diminution or elimination of pain in the conscious patient. 7.1.2 Local Anesthesia -- the elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of a drug. 7.1.3 Conscious Sedation -- a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by a pharmacologic or non-pharmacologic method or a combination thereof. In accord with this definition, the conscious patient is also defined as “one who has intact protective reflexes, including the ability to maintain an airway, and who is capable of rational response to question or command.” The drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.

For purposes of these regulations, Conscious Sedation Permits shall be divided into two classifications: Restricted and Unrestricted Permits -- Conscious Sedation induced by parenteral or enteral or rectal routes as well as nitrous oxide inhalation. This does not preclude the use of usual and customary pre-operative oral sedation. Restricted Permit II -- Conscious Sedation induced by nitrous oxide inhalation only.

7.1.4 Deep Sedation -- is a controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to verbal command, and is produced by a pharmacologic or non-pharmacologic method or combination thereof. 7.1.5 General Anesthesia -- is a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, and is produced by a pharmacologic or non-pharmacologic method or a combination thereof. 7.2 Conscious Sedation: 7.2.2 In order to receive such a permit, the dentist shall produce evidence showing that he or she:

7.2.2.1.3 Must also have a properly equipped facility for the administration of Restricted Permit I Conscious Sedation, staffed with a supervised team of auxiliary personnel capable of reasonably handling procedures, problems and emergencies incident thereto. Adequacy of the facility and competence of the team is to be determined by the Anesthesia Advisory Consultants appointed by the Board. A certified registered nurse anesthetist may be utilized for Restricted Permit I Conscious Sedation only if the dentist also possesses such a permit.

7.3 Deep Sedation and General Anesthesia (Unrestricted Permit - Individual):

7.3.2 In order to receive such a permit, the dentist must produce evidence showing that he/she:

102

7.3.2.2 Has a properly equipped facility for the administration of deep sedation and general anesthesia, staffed with a supervised team of auxiliary personnel capable of reasonably handling procedures, problems and emergencies incident thereto. Adequacy of the facility and competence of the anesthesia team is determined by the Anesthesia Advisory Committee Consultants appointed by Delaware State Board of Dentistry and Dental Hygiene.

District of Columbia DANB Certificant Counts: District of Columbia Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

Board of Dentistry Contact Dr. Vito DelVento, Executive Director Department of Health Health Professional Licensing Administration DC Board of Dentistry 899 North Capitol Street, NE, Suite 200 Washington, DC 20002 Phone: (877) 672-2174 Fax: (202) 727-8677 Website: https://dchealth.dc.gov/node/146102

242

Infection Control (ICE)

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Currently, there are no CODA-accredited dental assisting programs in the District of Columbia. For an updated directory of CODA-accredited dental assisting programs, visit www.danb.org.

DANB Certified Assistant District of Columbia+

$22.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been updated as of February 9, 2020.

Source: D.C. salary data is from the 2016 DANB Salary Survey (state data based on 1 response from this state); an insufficient number of responses from D.C. was received for the 2018 DANB Salary Survey; national CDA salary data is from the 2018 DANB Salary Survey Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

103

Note: DANB has not received confirmation that the district-specific information that follows has been reviewed and approved by the DC Board of Dentistry. For authoritative information regarding district statutes and rules affecting dental assistants, please contact the district dental board. Specific contact information can be found on the previous page.

District of Columbia Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in the District of Columbia, a dental assistant must: (1a) Pass DANB's Radiation Health and Safety (RHS) exam or DANB's Certified Dental Assistant (CDA) exam OR (1b) Successfully complete a dental radiography training program approved by the D.C. Board of Dentistry, AND (2) Register as a dental assistant with the D.C. Board of Dentistry; OR (3a) Complete in-office training and demonstrate competency to perform the task to the supervising dentist's satisfaction AND (3b) Register as a dental assistant with the D.C. Board of Dentistry no later than 9/17/12.

Requirements For Expanded Functions The District of Columbia defines allowable functions for two levels of dental assistant—Level I Dental Assistants and Level II Dental Assistants. To be registered as a Level I Dental Assistant in the District of Columbia, one must: (1) Have graduated from high school or hold a general equivalency diploma AND (2) Complete a course in dental radiography training that the D.C. Board of Dentistry deems satisfactory (see "Radiography Requirements" section above) AND (3) Apply to the D.C. Board of Dentistry for registration. To be registered as a Level II Dental Assistant in the District of Columbia, one must: (1) Have graduated from high school or hold a general equivalency diploma AND (2a) Successfully complete a dental assisting education program approved by the D.C. Board of Dentistry or accredited by the Commission on Dental Accreditation (CODA) OR (2b) Hold current DANB Certified Dental Assistant (CDA) certification AND (3) Complete a course in dental radiography training that the D.C. Board of Dentistry deems satisfactory (see "Radiography Requirements" section above) AND (4) Apply for a registration as a Level II Dental Assistant to the D.C. Board of Dentistry. An applicant who has been performing the duties of a dental assistant on July 15, 2011 may be granted a registration if he or she fulfills the following requirements: (1) Demonstrate competency to perform the duties of a dental assistant to the satisfaction of the supervising dentist AND (2) Apply for a registration as a dental assistant to the D.C. Board of Dentistry no later than 9/17/12.

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – District of Columbia Board of Dentistry HEALTH OCCUPATIONS REVISION ACT OF 2009 CHAPTER 12 HEALTH OCCUPATIONS BOARDS SUBCHAPTER II. ESTABLISHMENT OF HEALTH OCCUPATION BOARDS AND ADVISORY COMMITTEES; MEMBERSHIP; TERMS § 3-1202.01. Board of Dentistry. (b) The Board shall regulate the practices of dentistry and dental hygiene and dental assistants, shall issue teaching licenses as provided under Subchapter III of this Title, and shall issue certifications to dentists and facilities where dentistry is practiced to permit a dentist to administer general or sedation anesthesia. SUBCHAPTER V. LICENSING, REGISTRATION, OR CERTIFICATION OF HEALTH PROFESSIONALS § 3-1205.01. License, registration, or certification required. (a) A license issued pursuant to this title is required to practice acupuncture, advanced practice addiction counseling, assisted living administration, audiology, chiropractic, dental hygiene, dentistry, dietetics, home health care administration, marriage and family therapy, massage therapy, medicine, naturopathic medicine, nutrition, nursing home administration, occupational therapy, optometry, pharmaceutical detailing, pharmacy, physical therapy, podiatry, practical nursing, professional counseling, psychology, registered nursing, respiratory care, social work, speechlanguage pathology, veterinary medicine, or to practice as an anesthesiologist assistant, athletic trainer, personal fitness trainer, physician assistant, physical therapy assistant, polysomnographic technologist, occupational therapy assistant, or surgical assistant in the District, except as otherwise provided in this chapter. Registration is required to practice as an audiology assistant, dental assistant, nursing assistive personnel, psychology associate, polysomnographic technician or trainee, speech-language pathology assistant, or speech-language pathology clinical fellow. Certification is required to practice as an addiction counselor I, addiction counselor II, advanced practice registered nursing, veterinary technician, or a veterinary euthanasia technician. Except for administering general or sedation an104

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants esthesia in a hospital as defined in D.C. Official Code§ 44-501(a)(1), a federal agency or facility, or a dental school; certification is required for a dentist, or for a facility where dentistry is practiced, to administer general or sedation anesthesia. (b) A license, registration, or certification is the property of the District of Columbia and shall be surrendered on demand of the licensor. SUBCHAPTER IX. RELATED OCCUPATIONS; REGISTRATION REQUIREMENTS; PROHIBITED ACTIONS. § 3-1209.05. Dental assistant. (a) For the purposes of this section, the term: (1) "Dental assistant" means a person who is registered by the Board of Dentistry and is authorized to assist a licensed dentist in the performance of duties related to oral care under the direct supervision of a dentist. (2) "Direct supervision" means the dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedures, remains in the dental office or treatment facility while the procedures are being performed by the dental assistant, and personally evaluates the performance of the dental assistant before dismissal of the patient. (b) A person who is engaged as a dental assistant in the District of Columbia shall be registered with the Board, renew the registration as required by rule, and pay the required registration fee established by the Board. (c) A dental assistant shall wear a name tag bearing the title "dental assistant" while acting in a professional capacity and display his or her current registration in a conspicuous place in the dental office in which he or she is employed. (d) A person shall not engage in the practice, or use the title, of dental assistant unless he or she is registered to practice as a dental assistant under this chapter and practices under the direct supervision of a dentist licensed under this chapter. Unless authorized by the Board to perform duties related to oral care in the District, an individual shall not be permitted to perform any clinical duties or engage in any physical patient contact. (e) For a period of one year following July 7, 2009, unless further time is granted by the Board through rulemaking, persons who have received appropriate training for the tasks assigned may practice as a dental assistant. (f) A dentist may delegate duties to a dental assistant that are appropriate to the training and experience of the dental assistant and within the scope of practice of the supervising dentist; provided, that the dentist shall not delegate to a dental assistant any task or function identified, through rulemaking, as a task or function that shall not be delegated. (g) The Mayor shall issue rules necessary to implement the provisions of this section, including the standards of education and experience required to qualify as a registered dental assistant and the duties that may be performed by a dental assistant. District of Columbia Municipal Regulations Title 17, Chapter 42, Dentistry 4213 STANDARDS OF CONDUCT 4213.15 A dentist shall know when and under what circumstances delegation of patient care to auxiliaries is appropriate. 4213.16 A dentist shall only assign to qualified auxiliaries those duties which can be legally delegated. 4213.17 A dentist shall prescribe and supervise the patient care provided by all auxiliary personnel working under his or her direction. 4215 DELEGATION OF DUTIES 4215.1 The following duties shall only be performed by a dentist licensed under the Act and shall not be delegated to a dental hygienist or auxiliary: (a) Performing final diagnosis and treatment planning; (b) Performing surgical or cutting procedures on hard or soft tissue; (c) Prescribing or parenterally administering drugs or medications; (d) Administering or monitoring general anesthetics and conscious sedation; (e) Administering inhalants or inhalation conscious sedation agents; (f) Administering or monitoring nitrous oxide or local anesthesia except as permitted in Chapter 43 § 4310.2 (Dental Hygiene) of this Title; (g) Authorizing work orders for any appliance or prosthetic device or restoration to be inserted into a patient’s mouth; (h) Operating high speed rotary instruments in the mouth; (i) Performing pulp capping procedures; (j) Condensing, contouring or adjusting any final, fixed or removable prosthodontic appliance or restoration in the mouth; (k) Final positioning of orthodontic bonds and bands; (I) Orthodontic arch wire activation with the exception of minor adjustments to eliminate pain or discomfort; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

105

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants (m) (n) (o) (p) (q) (r) (s) (t)

Taking impressions for master casts to be used for prosthetic restoration of teeth or oral structures; Final cementation of crowns, bridges, inlays, onlays, posts and cores, and insertion of final prosthesis; Placing sutures; Flushing root canals; Temporary wire Iigation; Application of cavity liners and bases; Placing, carving, or finishing of amalgam restorations; and Placing and finishing of composite resin/silicate restorations.

4215.2 Except as provided in § 4215.3 of this chapter, no person unless otherwise licensed by the Board shall place or expose dental x-ray film unless he or she has: (a) Satisfactorily completed a radiation course or examination recognized by the American Dental Association Continuing Education Recognition Program (CERP); (b) Been certified by the American Registry of Radiologic Technologists; or (c) Satisfactorily completed a radiation course and passed an examination given by the Dental Assisting National Board. 4215.3 For the time period beginning from the effective date of these regulations and ending December 31, 2011, a dentist may permit an auxiliary who does not meet the requirements under § 4215.2 to place or expose dental x-ray film if the auxiliary has completed in-office training and demonstrated competency to perform the task to the supervising dentist’s satisfaction. 4215.4 Except as provided in § 4215.1 of this chapter, a dentist may delegate to a dental hygienist licensed under the Act those procedures which are appropriate to the training and experience of the dental hygienist, the type of practice of the supervising dentist, and to be performed under the direct or general supervision of the dentist. 4215.5 Except as provided in § 4215.6 a dentist may delegate to an auxiliary those procedures which are: (a) Appropriate to the training and experience of the auxiliary, and the practice of the supervising dentist; (b) Reversible; and (c) To be performed under the direct or general supervision of the dentist. 4215.6 Except as provided in § 4215.7 of this chapter, the following dental procedures shall only be delegated to an auxiliary who has: (a) Satisfactorily completed training in a CERP approved program, a training program or course recognized by the American Dental Association Commission on Dental Accreditation (CODA), or by the Dental Assisting National Board; and (b) Who performs the tasks under direct supervision with the supervising dentist checking and approving the completed task prior to dismissal of the patient from the office: (1) Placement of retraction cord; (2) Placement or removal of matrices; (3) The application of a medicinal agent to a tooth for a prophylactic purpose; (4) Placement of periodontal dressings; (5) Removal of temporary restorations without the use of a rotary instrument; (6) Removal of sutures; and (7) Bleaching. 4215.7 A dentist may delegate performance of the tasks set forth in § 4215.6 of this chapter to an auxiliary who does not meet the training requirements in § 4215.6(a), if the auxiliary had been performing the tasks for at least three (3) months prior to the effective date of these regulations and has demonstrated competency to perform the tasks to the supervising dentist’s satisfaction. 4215.8 A dentist shall not delegate to an auxiliary any of the following procedures: (a) Those procedures excluded by § 4215.1 of this chapter; (b) A preliminary dental examination; a complete prophylaxis, including the removal of any deposits, diseased crevicular tissue, accretion, or stain from the surface of a tooth or a restoration; the intraoral polishing of a tooth or a restoration; (c) The charting of cavities during preliminary examination, prophylaxis, or polishing, however a dentist may permit an auxiliary to record the charting of cavities as dictated by the dentist or dental hygienist during the course of an examination or dental procedure; (d) The instruction of individuals or groups of individuals in oral health care, unless it is in the dental office and done as instructed by the dentist (e) The application of pit and fissure sealants; (f) The performing of a diagnostic screening to identify indications of oral abnormalities; (g) Administration of local anesthesia with board identified criteria and certification; (h) Administration of nitrous oxide with board identified criteria and certification; or (i) Placement of temporary restorations. 106

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants 4215.9 In all instances, the licensed dentist assumes ultimate responsibility for determining, on the basis of his or her diagnosis, the specific treatment the patient will receive and which aspects of treatment will be delegated to qualified personnel in accordance with this chapter and the Act. 4299 DEFINITIONS 4299.1 As used in this chapter, the following terms and phrases shall have the meanings ascribed: Act: The District of Columbia Health Occupation Revision Act of 1985 (“Act”), effective March 25,1986 (D.C. Law 6-99; D.C. Official Code § 3-1201.01 et seq.) Auxiliary: a person who may perform dental supportive procedures authorized by District of Columbia law or regulations under the specified supervision of a licensed dentist. Bleaching: external tooth whitening procedures. Bloodborne pathogen: pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Board: the Board of Dentistry, established by § 201 of the Act, D.C. Official Code § 3-120:2.01 (2001). Dental hygienist: a person licensed to practice dental hygiene under the Act. Dentist: a person licensed to practice dentistry under the Act. Universal precautions: means blood and body fluid precautions as defined by the Center for Disease Control. Title 17, Chapter 43, Dental Hygiene 4310 FUNCTIONS OF DENTAL HYGIENISTS [as referenced in Section 4215.1 (f)] 4310.1 In accordance with 102(4) of the Act, D.C. Official Code § 3-1201.02(4) (2001), a dental hygienist may perform the following functions under the general supervision of a licensed dentist, in his or her office or any public school or institution rendering dental services: (a) A preliminary dental examination; a complete prophylaxis, including the removal of any deposits, diseased crevicular tissue accretion, or stain from the surface of a tooth or a restoration; the polishing of a tooth or a restoration; (b) The charting of cavities during preliminary examination, prophylaxis, or polishing; (c) The application of a medicinal agent to a tooth for a prophylactic purpose; (d) The taking of a dental X-ray; (e) The instruction of individuals or groups of individuals in oral health care; (f) The application of pit and fissure sealants; and (g) The performing of a screening to identify indications of oral abnormalities. 4310.2 In addition to the functions listed in § 4310.1, a dental hygienist may perform the following functions under the direct supervision of a licensed dentist: (a) Monitoring of nitrous oxide; (b) Administration of local anesthesia with board identified criteria and authorization; (c) Administration of nitrous oxide with board identified criteria and authorization; (d) Placement of periodontal dressings; (e) Placement of temporary restorations; (f) Removal of temporary restorations; (g) Removal of periodontal dressings; (h) Removal of sutures; (i) Taking of study cast impressions; (j) Placement and removal of rubber dams; and (k) Bleaching. Title 17, Chapter 90, Dental Assistants 9000 APPLICABILITY 9000.1 This chapter applies to applicants for and holders of a registration to practice as a dental assistant. 9000.2 Chapters 40 (Health Occupations: General Rules) and 41 (Health Occupations Administrative Procedures) of Title 17 of the District of Columbia Municipal Regulations supplement this chapter. 9001 REGISTRATION REQUIRED 9001.1 No person shall perform or be permitted to perform any duties as a dental assistant without a registration issued by the Board. 9001.2 Notwithstanding Subsection 9001.1, a person who is performing the duties of a dental assistant on the effective date of this chapter shall obtain a registration no later than September 17, 2012.

107

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants 9002 TERM OF REGISTRATION 9002.1 Subject to § 9002.2, a registration issued pursuant to this chapter shall expire at 12:00 midnight of December 31 of each odd-numbered year. 9002.2 If the Director changes the renewal system pursuant to § 4006.3 of Chapter 40 of this title, a registration issued pursuant to this chapter shall expire at 12:00 midnight of the last day of the month of the birth date of the holder of the registration or other date established by the Director. 9003 EDUCATION REQUIREMENT 9003.1 No person shall be registered as a Level I Dental Assistant or Level II Dental Assistant unless he or she has graduated from high school or has a general equivalency diploma. 9003.2 Except as provided in § 9003.3, an applicant for a registration as a Level II Dental Assistant shall provide satisfactory evidence to the Board of the following: (a) That the applicant has successfully completed and graduated from an educational program for dental assistants approved by the Board or the American Dental Association’s (ADA) Commission on Dental Accreditation (CODA); (b) That the applicant possesses a current and valid certification as a Certified Dental Assistant from the Dental Assisting National Board (DANB); or (c) That the applicant has completed a dental assisting program approved by the Board. 9003.3 Notwithstanding the requirements of § 9003.2, an applicant for a registration as a Level II Dental Assistant may be granted a registration if the applicant registers no later than September 17, 2012 and provides satisfactory evidence of the following: (a) That the applicant has been performing the duties of a dental assistant on the effective date of this chapter; and (b) That the applicant has demonstrated competency to perform the duties of a dental assistant to the satisfaction of the supervising dentist. 9003.4 As a prerequisite to registration, a dental assistant shall present proof to the Board that he or she has completed a course in dental radiography training that the Board deems satisfactory. 9004 SCOPE OF PRACTICE 9004.1 Subject to the restrictions set forth in this section, a dentist may delegate to a registered dental assistant only those procedures which are: (a) Appropriate to the training and experience of the dental assistant and the practice of the supervising dentist; (b) Reversible; and (c) To be performed under the direct supervision of the dentist. 9004.2 (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (o) (p) (q) 9004.3 (a) (b) (c) (d) 108

Level I Dental Assistant may perform the following functions under direct supervision of a dentist: Placing retraction cord; Placing matrices; Applying a medicinal agent to a tooth for a prophylactic purpose; Placing periodontal dressings; Removing temporary restorations without the use of a rotary instrument; Removing sutures; Taking impression for study models or diagnostic casts; Rinsing and aspirating the oral cavity; Retracting the lips, cheek, tongue, and flaps; Placing or removing materials for the isolation of the dentition, provided that the material is not retained by the dentition; Applying topical anesthesia; Constructing athletic mouth guards in models; Performing intraoral photography; Curing by the use of halogen light; Checking for loose bands; Whitening; and Other functions as approved by the Board. Level II Dental Assistant may perform the following functions under direct supervision of a dentist: All functions permitted to Level I Dental Assistant, as enumerated in § 9004.2; Performing vitality tests; Taking alginate impressions for intraoral appliances; Applying topical fluoride; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants (e) Applying desensitizing agents; (f) Placing or removing a rubber dam; (g) Etching; (h) Fabricating indirect restorations in a dental office; (i) Placing or removing a matrix band; (j) Drying a root canal; (k) Preparing and fitting stainless steel crowns; (l) Preparing temporary crowns; (m) Removing excess cement; (n) Removing or placing a periodontal dressing (except placing the original periodontal dressing); and (o) Constructing athletic mouth guards on models. 9004.4 Level I or II Dental Assistant working under the direct supervision of an orthodontist may also perform the following functions: (a) Preparing and fitting orthodontic bands; (b) Removing excess cement from around orthodontic bands; (c) Placing and removing arch wires; (d) Cementing orthodontic bands, placing bonded attachments, or removing cemented or bonded orthodontic bands and attachments; (e) Placing elastics and ligatures; and (f) Selecting headgear. 9004.5 (a) (a) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l)

A dentist shall not delegate to a dental assistant any of the following procedures: Those procedures excluded by 17 DCMR § 4215.1; A preliminary dental examination; A complete prophylaxis, including the removal of any deposits, diseased crevicular tissue, accretion, or stain from the surface of a tooth or a restoration; The intraoral polishing of a tooth or a restoration; The charting of cavities during preliminary examination, prophylaxis, or polishing; however, a dentist may permit an assistant to record the charting of cavities as dictated by the dentist or dental hygienist during the course of a preliminary examination or dental procedure; The instruction of individuals or groups of individuals in oral health care, unless it is in the dental office and done as instructed by the dentist; The application of pit and fissure sealants; Diagnostic screening to identify indications of oral abnormalities; Administration of local anesthesia with board identified criteria and certification; Administration of nitrous oxide with Board identified criteria and certification; Placement of temporary restorations; or Taking final impressions.

9005 RADIOGRAPHY REQUIREMENTS 9005.1 Except as provided in § 9005.2, a dental assistant shall not place or expose dental x-ray film unless he or she has: (a) Successfully passed the Dental Assisting National Board’s (DANB) Radiation Health and Safety (RHS) examination or Certified Dental Assistant (CDA) examination; or (b) Successfully completed a dental radiography training program approved by the Board. 9005.2 (a) (b) (c)

Notwithstanding § 9005.1, a dentist may permit an assistant to place or expose dental x-ray film if: The assistant has completed in-office training; The assistant has demonstrated competency to perform the task to the supervising dentist’s satisfaction; and The assistant registers no later than September 17, 2012.

9006 RESPONSIBILITY OF SUPERVISING DENTIST 9006.1 In all instances, the licensed dentist assumes ultimate responsibility for determining, on the basis of his or her diagnosis, the specific treatment the patient will receive and which aspects of treatment will be delegated to a dental assistant in accordance with this chapter and the Act. 9007 CONTINUING EDUCATION REQUIREMENTS 9007.1 Except as provided in § 9007.2, this section shall apply to all applicants for the renewal, reactivation, or reinstatement of a dental assistant registration. 9007.2 This section shall not apply to applicants for the first renewal of a dental assistant registration. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

109

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants 9007.3 A continuing education credit shall be valid only if it is part of a program approved by the Board. 9007.4 An applicant shall have the burden of verifying whether a program is approved by the Board pursuant to this section prior to attending the program. 9007.5 A continuing education credit shall consist of at least sixty (60) minutes of instruction in an approved continuing education program. 9007.6 Beginning with the licensure period ending December 31, 2021, not more than five (5) continuing education credits for approved internet continuing education courses may be accepted in any renewal period, or for reinstatement or reactivation of a license. 9007.7 For the licensure period ending December 31, 2019, an applicant for renewal of a dental assistant registration shall: (a) Have completed seven (7) hours of credit within the two-year (2) period preceding the date the registration expires, which shall include at least: (1) Current certification of having completed two (2) hours in basic life support (“BLS certification”); (2) Two (2) hours of infection control in approved continuing education programs; (3) One (1) hour of ethics in an approved continuing education programs; and (4) Two (2) hours of continuing education on cultural competency or specialized clinical training focusing on patients or clients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or question their sexual orientation or gender identity and expression (“LGBTQ”) meeting the requirements of Section 510(b)(5) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.10(b)(5)); (b) Attest to completion of the required continuing education credits on the renewal application form; and (c) Be subject to a random audit. 9007.8 Beginning with the licensure period ending December 31, 2021, an applicant for renewal of a dental assistant registration shall: (a) Have completed ten (10) hours of credit within the two-year (2) period preceding the date the registration expires, which shall include at least: (1) Current certification of having completed two (2) hours in basic life support (“BLS certification”); (2) Two (2) hours of infection control in approved continuing education programs; (3) One (1) hour of ethics in an approved continuing education programs; (4) Two (2) hours of continuing education on cultural competency or specialized clinical training focusing on patients or clients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or question their sexual orientation or gender identity and expression (“LGBTQ”) meeting the requirements of Section 510(b)(5) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.10(b)(5)); and (5) At least ten percent (10%) of the total required continuing education shall be in the subjects determined by the Director as public health priorities of the District every five (5) years or less frequently, as deemed appropriate by the Director, with notice of the subject matter published in the D.C. Register. The Board shall disseminate the identified subjects to its licensees when determined by the Director via electronic communication and through publication on its website; (b) Attest to completion of the required continuing education credits on the renewal application form; and (c) Be subject to a random audit. 9007.9 For the licensure period ending December 31, 2019, to qualify for reinstatement or reactivation of a dental assistant registration, an applicant shall submit proof of having completed a minimum of seven (7) hours of credit within the year immediately preceding the date of the application, which shall include at least: (a) Current certification of having completed two (2) hours in basic life support (“BLS certification”); (b) Two (2) hours of infection control in approved continuing education programs; (c) One (1) hour of ethics in an approved continuing education programs; and (d) Two (2) hours of continuing education on cultural competency or specialized clinical training focusing on patients or clients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or question their sexual orientation or gender identity and expression (“LGBTQ”) meeting the requirements of Section 510(b)(5) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.10(b)(5)).

110

District of Columbia Dental Practice Act and Administrative Rules for Dental Assistants 9007.10 Beginning with the licensure period ending December 31, 2021, to qualify for reinstatement or reactivation of a dental assistant registration, an applicant shall submit proof of having completed a minimum of ten (10) hours of credit within the year immediately preceding the date of the application, which shall include at least: (a) Current certification of having completed two (2) hours in basic life support (“BLS certification”); (b) Two (2) hours of infection control in approved continuing education programs; (c) One (1) hour of ethics in an approved continuing education programs; (d) Two (2) hours of continuing education on cultural competency or specialized clinical training focusing on patients or clients who identify as lesbian, gay, bisexual, transgender, gender nonconforming, queer, or question their sexual orientation or gender identity and expression (“LGBTQ”) meeting the requirements of Section 510(b)(5) of the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1205.10(b)(5)); and (e) At least ten percent (10%) of the total required continuing education shall be in the subjects determined by the Director as public health priorities of the District every five (5) years or less frequently, as deemed appropriate by the Director, with notice of the subject matter published in the D.C. Register. The Board shall disseminate the identified subjects to its licensees when determined by the Director via electronic communication and through publication on its website. 9007.11 Applicants for renewal of a registration shall only be required to prove completion of the required continuing education credits by submitting proof if requested to do so as part of the random audit, or if otherwise requested to do so by the Board. 9007.12 An applicant for renewal of a registration who fails to renew the registration by the date the registration expires may renew the registration for up to sixty (60) days after the date of expiration by completing the application, submitting the required supporting documents, and paying the required late fee. Upon renewal, the applicant shall be deemed to have possessed a valid registration during the period between the expiration of the registration and the renewal thereof. 9007.13 If an applicant for renewal of a registration fails to renew the registration and pay the late fee within sixty (60) days after the expiration of applicant's registration, the registration shall be considered to have lapsed on the date of expiration. The applicant shall thereafter be required to apply for reinstatement of an expired registration and meet all requirements and fees for reinstatement. 9007.14 The Board may, in its discretion, grant an extension of the sixty (60) day period, up to a maximum of one (1) year, to renew after expiration if the applicant's failure to renew was for good cause. As used in this section, "good cause" includes the following: (a) Serious and protracted illness of the applicant; and (b) The death or serious and protracted illness of a member of the applicant's immediate family. 9007.15 An extension granted under this section shall not exempt the dental assistant from complying with the continuing education requirements for any other renewal period. 9099 DEFINITIONS 9099.1 For the purposes of this chapter, the following terms shall have the meanings ascribed: Act – the District of Columbia Health Occupation Revision Act, effective March 15, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1203.01, et seq.(2007 Repl.)). Board – the Board of Dentistry. Dental assistant – a person who is registered by the Board and is authorized to assist a licensed dentist in the performance of duties related to oral care under the direct supervision of a dentist. Direct supervision – the dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedures, remains in the dental office or dental treatment facility while the procedures are being performed by the dental assistant, and personally evaluates the performance of the dental assistant before dismissal of the patient. Director – the Director of the Department of Health or the Director’s designee.

111

Florida DANB Certificant Counts: Florida National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Jessica Sapp, Executive Director Florida Board of Dentistry 4052 Bald Cypress Way, Bin C-08 Tallahassee, FL 32399-3258 Phone: 850-245-4474 Fax: 850-921-5389 Email: info@floridasdentistry.gov Website: www.floridasdentistry.gov

Radiation Health and Safety (RHS)

7,404

Infection Control (ICE)

7,684

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Atlantic Technical College Broward College Cape Coral Technical College Charlotte Technical College College of Central Florida Daytona State College Erwin Technical College Eastern Florida State College Florida State College at Jacksonville Gulf Coast State College Hillsborough Community College Indian River State College Lorenzo Walker Technical College

2,079

Manatee Technical College Northwest Florida State College Orange Tech College - Orlando Campus Palm Beach State College Pinellas Technical College Robert Morgan Educational Center and Technical College Santa Fe College - Florida South Florida State College Tallahassee Community College Traviss Technical College

DANB CDA Certificant State of Florida+

$17.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of May 26, 2020.

112

Source: 2018 DANB Salary Survey (state data based on 24 responses in this state).

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Florida State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in Florida, a dental assistant must either (1) graduate from a Florida Board-approved dental assisting school or program OR (2) be state-certified as a dental radiographer by the Florida Department of Health (FDOH). To obtain the dental radiography certification, one must: (a) Successfully complete at least three months of continuous on-the-job training through assisting in the positioning of digital radiographic sensors and positioning and exposing of dental radiographic images under the direct supervision of a Florida-licensed dentist AND (b) Successfully complete a Florida Board-approved radiology course within 12 months of completing on-the-job training AND (c) Apply to the FDOH for certification.

State Requirements For Expanded Functions Dental assistants in Florida must have formal training to perform the expanded functions listed in the Practice Act. To earn status to perform expanded functions, one must (1) Complete a course or program administered by or developed as part of the regular curriculum at a dental, dental hygiene, or dental assisting educational program accredited by CODA that provided training in the expanded function OR (2) Successfully complete a Florida Board-approved expanded duties training program. Note: The DANB Certified Dental Assistant (CDA) certification was removed as a pathway to qualify to perform expanded functions in Florida effective May 2009. Dental Assistants who were employed in Florida and had earned the CDA prior to the effective date of this rule change are “grandfathered in” and are permitted to perform expanded functions in Florida. Contact the Florida Board of Dentistry for specific information about this rule change. Note: On-the-job trained dental assistants in Florida must be trained in the dental office under the supervision of a licensed dentist who assumes full responsibility for assuring that the dental assistant so trained is competent to perform the tasks. To monitor nitrous oxide inhalation analgesia, a dental assistant must (1) Complete a course of training of no less than two days as described in the American Dental Association's "Guidelines for Teaching and Comprehensive Control of Pain and Anxiety in Dentistry" or equivalent, AND (2) Be certified in an American Heart Association, American Red Cross, or equivalent agency sponsored CPR course at the basic life support level, to include one man CPR, two man CPR, infant resuscitation, obstructed airway, and use of either an Automated External Defibrillator or a defibrillator and electrocardiograph, with a periodic update not to exceed two years. A dentist may delegate remediable intraoral restorative functions to be performed under direct supervision to a Dental Assistant who has met the following requirements: (1) Be at least 18 years of age AND (2) Be a high school graduate or equivalent AND (3) Hold current BLS for Healthcare Provider certificate AND (4a) Graduate from a dental assisting program accredited by a dental accrediting entity recognized by the U.S. Department of Education OR (4b) Successfully complete a Florida Board-approved expanded duties formal training program AND (5) Document proof of 2,400 hours of clinical work experience in either a dental office or as a dental assisting educator AND (6) Complete a mandatory restorative functions training course offered by a dental or dental hygiene school or program that is accredited by a dental accrediting entity recognized by the United States Department of Education meeting the requirements of Florida Board of Dentistry rules and receive a course completion certificate.

Florida State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act — Florida Board of Dentistry FLORIDA STATUTES TITLE XXXII REGULATION OF PROFESSIONS AND OCCUPATIONS CHAPTER 466 DENTISTRY, DENTAL HYGIENE, AND DENTAL LABORATORIES 466.003 Definitions.--As used in this chapter: (1) “Board” means the Board of Dentistry. (2) “Dentist” means a person licensed to practice dentistry pursuant to this chapter. (3) “Dentistry” means the healing art which is concerned with the examination, diagnosis, treatment planning, and care of conditions within the human oral cavity and its adjacent tissues and structures. It includes the performance or attempted performance of any dental operation, or oral or oral-maxillofacial surgery and any procedures adjunct thereto, including physical evaluation directly related to such operation or surgery pursuant to hospital rules and regulations. It also includes dental service of any kind gratuitously or for any remuneration paid, or to be paid, directly or indirectly, to any person or agency. The term “dentistry” shall also include the following: (a) The taking of an impression of the human tooth, teeth, or jaws directly or indirectly and by any means or method. (b) Supplying artificial substitutes for the natural teeth or furnishing, supplying, constructing, reproducing, or repairing any prosthetic denture, bridge, appliance, or any other structure designed to be worn in the human mouth except on the written work order of a duly licensed dentist. (c) The placing of an appliance or structure in the human mouth or the adjusting or attempting to adjust the same. (d) Delivering the same to any person other than the dentist upon whose work order the work was performed. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

113

Florida State Dental Practice Act and Administrative Rules for Dental Assistants (e) Professing to the public by any method to furnish, supply, construct, reproduce, or repair any prosthetic denture, bridge, appliance, or other structure designed to be worn in the human mouth. (f) Diagnosing, prescribing, or treating or professing to diagnose, prescribe, or treat disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws or oral-maxillofacial region. (g) Extracting or attempting to extract human teeth. (h) Correcting or attempting to correct malformations of teeth or of jaws. (i) Repairing or attempting to repair cavities in the human teeth. (4) “Dental hygiene” means the rendering of educational, preventive, and therapeutic dental services pursuant to ss. 466.023 and 466.024 and any related extra-oral procedure required in the performance of such services. (5) “Dental hygienist” means a person licensed to practice dental hygiene pursuant to this chapter. (6) “Dental assistant” means a person, other than a dental hygienist, who, under the supervision and authorization of a dentist, provides dental care services directly to a patient. This term shall not include a certified registered nurse anesthetist licensed under part I of chapter 464. (7) “Department” means the Department of Health. (8) “Direct supervision” means supervision whereby a dentist diagnosis the condition to be treated, a dentist authorizes the procedure to be performed, a dentist remains on the premises while the procedures are performed, and a dentist approves the work performed before dismissal of the patient. (9) “Indirect supervision” means supervision whereby a dentist authorizes the procedure and a dentist is on the premises while the procedures are performed. (10) “General supervision” means supervision whereby a dentist authorizes the procedures which are being carried out but need not be present when the authorized procedures are being performed. The authorized procedures may also be performed at a place other than the dentist’s usual place of practice. The issuance of a written work authorization to a commercial dental laboratory by a dentist does not constitute general supervision. (11) “Irremediable tasks” are those intraoral treatment tasks which, when performed, are irreversible and create unalterable changes within the oral cavity or the contiguous structures or which cause an in-creased risk to the patient. The administration of anesthetics other than topical anesthesia is considered to be an “irremediable task” for purposes of this chapter. (12) “Remediable tasks” are those intraoral treatment tasks which are reversible and do not create unalterable changes within the oral cavity or the contiguous structures and which do not cause an increased risk to the patient. (13) “Oral and maxillofacial surgery” means the specialty of dentistry involving diagnosis, surgery, and adjunctive treatment of diseases, injuries, and defects involving the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial regions. This term may not be construed to apply to any individual exempt under s. 466.002(1). (14) “Health access settings” means programs and institutions of the Department of Children and Families, the Department of Health, the Department of Juvenile Justice, nonprofit community health centers, Head Start centers, federally qualified health centers (FQHCs), FQHC look-a-likes as defined by federal law, and clinics operated by accredited colleges of dentistry in this state if such community service programs and institutions immediately report to the Board of Dentistry all violations of s. 466.027, s. 466.028, or other practice act or standard of care violations related to the actions or inactions of a dentist, dental hygienist, or dental assistant engaged in the delivery of dental care in such settings. (15) “School-based prevention program” means preventive oral health services offered at a school by one of the entities defined in subsection (14) or by a nonprofit organization that is exempt from federal income taxation under s. 501(a) of the Internal Revenue Code, and described in s. 501(c)(3) of the Internal Revenue Code. 466.017 Prescription of drugs; anesthesia. (3) The board shall adopt rules which: (e) Establish an administrative mechanism enabling the board to verify compliance with training, education, experience, equipment, or certification requirements of dentists, dental hygienists, and dental assistants adopted pursuant to this subsection. The board may charge a fee to defray the cost of verifying compliance with requirements adopted pursuant to this paragraph. (5) A dental hygienist under the direct supervision of a dentist may administer local anesthesia, including intraoral block anesthesia, soft tissue infiltration anesthesia, or both, to a nonsedated patient who is 18 years of age or older, if the following criteria are met: (Editor’s note: The remainder of this subsection has been omitted.) (7) A licensed dentist may utilize an X-ray machine, expose dental X-ray films, and interpret or read such films. The provisions of part IV of chapter 468 to the contrary notwithstanding, a licensed dentist may authorize or direct a dental assistant to operate such equipment and expose such films under her or his direction and supervision, pursuant to rules adopted by the board in accordance with s. 466.024 which ensure that said assistant is competent by reason of training and experience to operate said equipment in a safe and efficient manner. The board may charge a fee not to exceed $35 to defray the cost of verifying compliance with requirements adopted pursuant to this section.

114

Florida State Dental Practice Act and Administrative Rules for Dental Assistants 466.024 Delegation of duties; expanded functions (1) A dentist may not delegate irremediable tasks to a dental hygienist or dental assistant, except as provided by law. A dentist may delegate remediable tasks to a dental hygienist or dental assistant when such tasks pose no risk to the patient. A dentist may only delegate remediable tasks so defined by law or rule of the board. The board by rule shall designate which tasks are remediable and delegable, except that the following are by law found to be remediable and delegable: (a) Taking impressions for study casts but not for the purpose of fabricating any intraoral restorations or orthodontic appliance. (b) Placing periodontal dressings. (c) Removing periodontal or surgical dressings. (d) Removing sutures. (e) Placing or removing rubber dams. (f) Placing or removing matrices. (g) Placing or removing temporary restorations. (h) Applying cavity liners, varnishes, or bases. (i) Polishing amalgam restorations. (j) Polishing clinical crowns of the teeth for the purpose of removing stains but not changing the existing contour of the tooth. (k) Obtaining bacteriological cytological specimens not involving cutting of the tissue. (l) Administering local anesthesia pursuant to s. 466.017(5). This subsection does not limit delegable tasks to those specified herein. (6) Notwithstanding subsection (1) or subsection (2), a dentist may delegate the tasks of gingival curettage and root planing to a dental hygienist but not to a dental assistant. (7) All other remediable tasks shall be performed under the direct, indirect, or general supervision of a dentist, as determined by rule of the board, and after such formal or on-the-job training by the dental hygienist or dental assistant as the board by rule may require. The board by rule may establish a certification process for expanded-duty dental assistants, establishing such training or experience criteria or examinations as it deems necessary and specifying which tasks may be delegable only to such assistants. If the board does establish such a certification process, the department shall implement the application process for such certification and administer any examinations required. (8) Notwithstanding subsection (1) or subsection (2), a dentist may not delegate to anyone other than another licensed dentist: (a) Any prescription of drugs or medications requiring the written order or prescription of a licensed dentist or physician. (b) Any diagnosis for treatment or treatment planning. (9) Notwithstanding any other provision of law, a dentist is primarily responsible for all procedures delegated by her or him. (10) No dental assistant shall perform an intraoral procedure except after such formal or on-the-job training as the board by rule shall prescribe. FLORIDA ADMINISTRATIVE CODE (F. A. C.) 64B5: Board of Dentistry Chapter 64B5-9 Prescriptions for Dental Hygiene Services and Certification of Dental Radiographers 64B5-9.011 Radiography Training for Dental Assistants. (1) Dental assistants may position and expose dental radiographic images only if they have been certified by the Department as dental radiographers or have graduated from a Board-approved dental assisting school or program. (2) Dental assistants may be certified as dental radiographers if they comply with the following requirements: (a) Apply for certification on DH-MQA 1202, Dental Radiography Certification Application (Rev. 05/2019), incorporated herein by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-11194 and available on the Department of Healthâ&#x20AC;&#x2122;s website at https://floridasdentistry.gov/licensing/dental-radiographer/, and submit the nonrefundable fee prescribed by Rule 64B5-15.015, F.A.C.; (b) Document having completed at least 3 months of continuous on-the-job training through assisting in the positioning of digital radiographic sensors and positioning and exposing of dental radiographic images under the direct supervision of a Florida licensed dentist; and (c) Document successful completion of a Board-approved course which meets the requirements of subsection 64B5-9.011(3), F.A.C. within 12 months after completion of the on-the-job training required by paragraph 64B59.011(2), F.A.C.

115

Florida State Dental Practice Act and Administrative Rules for Dental Assistants (3) Only courses which provide training in the following areas may receive Board approval: (a) Dental radiography practice and equipment; (b) Radiation biology and radiation safety techniques; (c) Hands-on instruction in the positioning of digital radiographic sensors and films through the use of appropriate mannequins that will provide the didactic objectives; (d) Radiographic anatomy; (e) Radiographic images, films, and processing; (f) Intra-oral radiographic techniques; (g) Supplemental techniques of dental radiography; and (h) Infection control and sterilization techniques. (4) A dental assistantâ&#x20AC;&#x2122;s certification as a dental radiographer must be conspicuously displayed to the public in any dental office where these services are performed. Chapter 64B5-14 Anesthesia 64B5-14.003 Training, Education, Certification, and Requirements for Issuance of Permits. (1) General Anesthesia Permit. (b) A dentist employing or using general anesthesia or deep sedation shall maintain a properly equipped facility for the administration of general anesthesia, staffed with supervised assistant/dental hygienist personnel, capable of reasonably handling procedures, problems and emergencies incident thereto. The facility must have the equipment capability of delivering positive pressure oxygen ventilation. Administration of general anesthesia or deep sedation requires at least three individuals, each appropriately trained: the operating dentist, a person responsible for monitoring the patient, and a person to assist the operating dentist. (c) A dentist employing or using general anesthesia or deep sedation and all assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one person CPR, two person CPR, infant resuscitation and obstructed airway, with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing general anesthesia or deep sedation must be currently trained in ACLS (Advanced Cardiac Life Support) or ATLS (Advanced Trauma Life Support). (2) Moderate Sedation Permit. (e) A dentist utilizing moderate sedation shall maintain a properly equipped facility for the administration of moderate sedation, staffed with supervised assistant/dental hygienist personnel, capable of reasonably handling procedures, problems, and emergencies incident thereto. The facility must have the equipment capability of delivering positive pressure oxygen ventilation. Administration of moderate sedation requires at least two individuals: a dentist, and an auxiliary trained in basic cardiac life support. It shall be incumbent upon the operating dentist to insure that the patient is appropriately monitored. (f) A dentist utilizing moderate sedation and his assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one man CPR, two man CPR, infant resuscitation, and obstructed airway with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support) or ATLS (Advanced Trauma Life Support). (3) Pediatric Moderate Sedation Permit. (a) A permit shall be issued to a dentist authorizing the use of pediatric moderate sedation at a specified practice location or locations on an outpatient basis for dental patients provided such dentist: (5) Is competent to handle all emergencies relating to pediatric moderate sedation. A dentist utilizing pediatric moderate sedation shall maintain a properly equipped facility for the administration of pediatric moderate sedation, staffed with supervised assistant/dental hygienist personnel, capable of reasonably handling procedures, problems, and emergencies incidental thereto. The facility must have the equipment capability of delivering positive pressure oxygen ventilation. Administration of pediatric moderate sedation requires at least two individuals: a dentist, and an auxiliary trained in basic cardiac life support. It shall be incumbent upon the operating dentist to insure that the patient is appropriately monitored. (b) A dentist utilizing pediatric moderate sedation and his assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one man CPR, two man CPR, infant resuscitation, and obstructed airway with a periodic update not to exceed two years. Starting with the licensure biennium 116

Florida State Dental Practice Act and Administrative Rules for Dental Assistants commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing pediatric moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support), or a course providing similar instruction which has been approved by the Board. An entity seeking approval of such a course shall appear before the Board and demonstrate that the content of such course and the hours of instruction are substantially equivalent to those in an ACLS or PALS course. (4) Nitrous-Oxide Inhalation Analgesia. (b) A dentist utilizing nitrous-oxide inhalation analgesia and such dentist’s assistant/dental hygienist personnel shall be certified in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one man CPR, two man CPR, infant resuscitation and obstructed airway with a periodic update not to exceed two years. Starting with the licensure biennium commencing on March of 2000, a dentist and all assistant/dental hygienist personnel shall also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of their cardiopulmonary resuscitation course at the basic life support level. In addition to CPR certification, a dentist utilizing pediatric moderate sedation must be currently trained in ACLS (Advanced Cardiac Life Support), ATLS (Advanced Trauma Life Support), or PALS (Pediatric Advanced Life Support). 64B5-14.0032 Itinerate/Mobile Anesthesia – Physician Anesthesiologist. The provisions of this rule control the treatment of dental patients in an outpatient dental office setting where a physician anesthesiologist has performed the sedation services. This rule shall control notwithstanding any rule provision in this Chapter that prohibits such conduct. The level of sedation is not restricted to the level of the permit held by the treating dentist. The level of sedation may be any level necessary for the safe and effective treatment of the patient. (5) Staff or Assistants: A dentist treating a patient pursuant to this rule must have at least three (3) properly credentialed individuals present as mandated in Rule 64B5-14.003, F.A.C. To fulfill the mandatory minimum required personnel requirements of Rule 64B5-14.003, F.A.C., a physician anesthesiologist assistant or a certified registered nurse anesthetist in addition to, or in lieu of a dental assistant or dental hygienist may be utilized. However, the dentist must have a dedicated member of the team to assist in the dental procedure or during dental emergencies. 64B5-14.004 Additional Requirements. (1) Office Team – A dentist licensed by the Board and practicing dentistry in Florida and who is permitted by these rules to induce and administer general anesthesia, deep sedation, moderate sedation, pediatric moderate sedation or nitrous-oxide inhalation analgesia may employ the office team approach. (2) Dental Assistants, Dental Hygienists - Dental assistants and dental hygienists may monitor nitrous-oxide inhalation analgesia under the direct supervision of a dentist who is permitted by rule to use general anesthesia, moderate sedation, pediatric moderate sedation, or nitrous-oxide inhalation analgesia, while rendering dental services allowed by Chapter 466, F.S., and under the following conditions: (a) Satisfactory completion of no less than a two-day course of training as described in the American Dental Association’s “Guidelines for Teaching and Comprehensive Control of Pain and Anxiety in Dentistry” or its equivalent; and (b) Maintenance of competency in cardiopulmonary resuscitation evidenced by certification in an American Heart Association or American Red Cross or equivalent Agency sponsored cardiopulmonary resuscitation course at the basic life support level to include one man CPR, two man CPR, infant resuscitation and obstructed airway, with a periodic update not to exceed two years. (3) After the dentist has induced a patient and established the maintenance level, the assistant or hygienist may monitor the administration of the nitrous-oxide oxygen making only adjustments during this administration and turning it off at the completion of the dental procedure. (4) Nothing in this rule shall be construed to allow a dentist or dental hygienist or assistant to administer to himself or to any person any drug or agent used for anesthesia, analgesia or sedation other than in the course of the practice of dentistry. (5) A dentist utilizing moderate sedation in the dental office may induce only one patient at a time. A second patient shall not be induced until the first patient is awake, alert, conscious, spontaneously breathing, has stable vital signs, is ambulatory with assistance, is under the care of a responsible adult, and that portion of the procedure requiring the participation of the dentist is complete. In an office setting where two or more permit holders are present simultaneously, each may sedate one patient provided that the office has the necessary staff and equipment, as set forth in paragraph 64B5-14.003(2)(d), F.A.C., for each sedated patient.

117

Florida State Dental Practice Act and Administrative Rules for Dental Assistants Chapter 64B5-16 Remediable Tasks Delegable to Dental Hygienists and Dental Assistants 64B5-16.001 Definitions of Remediable Tasks and Supervision Levels. (1) Remediable tasks, also referred to as expanded functions of dental assistants, are those intra-oral tasks which do not create unalterable changes in the oral cavity or contiguous structures, are reversible and do not expose a patient to increased risks. The use of a laser or laser device of any type is not a remediable task, unless utilized as an assessment device. (2) A dentist may delegate a remediable task to dental hygienists, and dental assistants so long as delegation of the task poses no increased risk to the patient and the requirements of training and supervision set out in Chapter 64B5-16, F.A.C., are met. (3) Remediable tasks are those specified in Section 466.024, F.S., and those designated as such by the Board. The Board hereby designates the tasks listed in Chapter 64B5-16, F.A.C., as remediable tasks. (4) Direct supervision requires that a licensed dentist examine the patient, diagnose a condition to be treated, authorize the procedure to be performed, be on the premises while the procedure is performed, and approve the work performed prior to the patient’s departure from the premises. (5) Indirect supervision requires that a licensed dentist examine the patient, diagnose a condition to be treated, authorize the procedure to be performed, and be on the premises while the procedure is performed. (6) General supervision requires that a licensed dentist examine the patient, diagnose a condition to be treated, and authorize the procedure to be performed. (7) Any authorization for remediable tasks to be performed under general supervision is valid for a maximum of 24 months; after which, no further treatment under general supervision can be performed without another clinical exam by a Florida licensed dentist. (9) Any tasks delegable to dental assistants will be delegable to dental hygienists under the same supervision level, unless otherwise stated in the rules. 64B5-16.002 Required Training. (1) Formal training which is required for the performance of certain remediable tasks consists of a dental hygienist’s or dental assistant’s successful completion of an expanded duty course or program which meets one of the following requirements: (a) The course or program is administered or was developed as a part of the regular curriculum at a school of dentistry, dental hygiene or dental assisting accredited by the American Dental Association’s Commission on Dental Accreditation, its successor agency or any other nationally recognized accrediting agency; or (b) The course or program has been approved by the Board for the purpose of providing expanded-duties training for dental hygienists and dental assistants; or (2) For the purpose of positioning and exposing radiographs by dental assistants, formal training may consist of having received certification as a dental radiographer pursuant to Rule 64B5-9.011, F.A.C. (3) The Board shall approve a course or program specified in paragraph 64B5-16.002(1)(b), F.A.C., in expanded duties only upon the application of the entity seeking to offer the course or program which establishes compliance with the following requirements. Failure to adhere to these requirements shall subject the course or program to revocation of Board approval. (a) The course or program curriculum reflects appropriate didactic and clinical training in each remediable task which requires completion of Board-approved formal training and shall be designed to meet specifically stated educational objectives; (b) Documentation of the training and experience of faculty members which establishes their qualifications to each specified subject areas. Dentists and dental hygienists shall have a minimum of one year experience in expanded duty functions and expanded duty dental assistants shall have a minimum of 5 years of hands-on experience prior to approval. The student/teacher ratio shall not exceed one instructor to ten students. Applicants who have had a professional license revoked, suspended, or otherwise acted against, in Florida or in another jurisdiction, may be disqualified from participation as instructors; (c) Submission of a detailed syllabus of the course or program which specifies the educational objectives for participants, the manner of achieving these specified objectives, including subject matter, hours of instruction and choice of instructional method (clinical or didactic) and the method of assessing a participant’s performance. Any course offered shall also include instruction regarding sterilization and disinfection procedures as stated in Rule Chapter 64B5-25, F.A.C., and instruction in the dental practice act and administrative code as it relates to dental auxiliaries. (d) The course or program requires participants to pass clinical or written examinations which adequately test competency in each subject area. Participants must obtain a score of at least 75% out of a possible score of 100%. The choice of a clinical or written examination shall be based on the specified objectives for each subject area; and (e) Each participant who successfully completes the course or program is issued a certificate which contains the following information: name of course or program sponsor; title of course; date course offered; number of hours of instruction; participant’s name; signature authorized by the sponsor which attests to the certificate’s validity; and a list of all remediable tasks in which the participant has received formal training. 118

Florida State Dental Practice Act and Administrative Rules for Dental Assistants (f) Any clinical course in which patients are treated during instruction must be supervised by a dentist licensed pursuant to Chapter 466, F.S. (g) Facilities and equipment for each course in which patients are treated during instruction shall be adequate for the subject matter and method of instruction. (4) On-the-job training required for the performance of certain remediable tasks consists of training in those tasks by a licensed dentist who assumes full responsibility for assuring that the dental hygienist or dental assistant has completed hands-on training in order that he/she is competent to perform the tasks. 64B5-16.005 Remediable Tasks Delegable to Dental Assistants. (1) The following remediable tasks may be performed by a dental assistant who has received formal training and who performs the tasks under direct supervision: (a) Placing or removing temporary restorations with non-mechanical hand instruments only; (b) Polishing dental restorations of the teeth when not for the purpose of changing the existing contour of the tooth and only with the following instruments used with appropriate polishing materials – burnishers, slow-speed hand pieces, rubber cups, and bristle brushes; (c) Polishing clinical crowns when not for the purpose of changing the existing contour of the tooth and only with the following instruments used with appropriate polishing materials – slow-speed hand pieces, rubber cups, bristle brushes and porte polishers; (d) Removing excess cement from dental restorations and appliances with non-mechanical hand instruments only; (e) Cementing temporary crowns and bridges with temporary cement; (f) Monitoring the administration of the nitrous-oxide oxygen making adjustments only during this administration and turning it off at the completion of the dental procedure; (g) Selecting and pre-sizing orthodontic bands, including the selection of the proper size band for a tooth to be banded which does not include or involve any adapting, contouring, trimming or otherwise modifying the band material such that it would constitute fitting the band; (h) Selecting and pre-sizing archwires prescribed by the patient’s dentist so long as the dentist makes all final adjustments to bend, arch form determination, and symmetry prior to final placement; (i) Selecting prescribed extra-oral appliances by pre-selection or pre-measurement which does not include final fit adjustment; (j) Preparing a tooth surface by applying conditioning agents for orthodontic appliances by conditioning or placing of sealant materials which does not include placing brackets; (k) Using appropriate implements for preliminary charting of existing restorations and missing teeth and a visual assessment of existing oral conditions; (l) Fabricating temporary crowns or bridges intra-orally which shall not include any adjustment of occlusion to the appliance or existing dentition; and (m) Packing and removing retraction cord, so long as it does not contain vasoactive chemicals and is used solely for restorative dental procedures; (n) Removing and recementing properly contoured and fitting loose bands that are not permanently attached to any appliance. (o) Inserting or removing dressings from alveolar sockets in post-operative osteitis when the patient is uncomfortable due to the loss of a dressing from an alveolar socket in a diagnosed case of post-operative osteitis; (p) Making impressions for study casts which are being made for the purpose of fabricating orthodontic retainers; (q) Taking of impressions for and delivery of at-home bleaching trays. (r) Taking impressions for passive appliance, occlusal guards, space maintainers and protective mouth guards; (2) The following remediable tasks may be performed by a dental assistant who has received formal training and who performs the tasks under indirect supervision: (a) Making impressions for study casts which are not being made for the purpose of fabricating any intra-oral appliances, restorations or orthodontic appliances; (b) Making impressions to be used for creating opposing models or the fabrication of bleaching stents and surgical stents to be used for the purpose of providing palatal coverage as well as impressions used for fabrication of topical fluoride trays for home application; (c) Placing periodontal dressings; (d) Removing periodontal or surgical dressings; (e) Placing or removing rubber dams; (f) Placing or removing matrices; (g) Applying cavity liners, varnishes or bases; (h) Applying topical fluorides which are approved by the American Dental Association or the Food and Drug Administration, including the use of fluoride varnishes; and (i) Positioning and exposing dental and carpal radiographic film and sensors; (j) Applying sealants; (k) Placing or removing prescribed pre-treatment separators; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

119

Florida State Dental Practice Act and Administrative Rules for Dental Assistants (l) Securing or unsecuring an archwire by attaching or removing the fastening device; and (m) Removing sutures. (3) The following remediable tasks may be performed by a dental assistant who has received on-the-job training and who performs the tasks under direct supervision: (a) Applying topical anesthetics and anti-inflammatory agents which are not applied by aerosol or jet spray; and (b) Changing of bleach pellets in the internal bleaching process of non-vital, endodontically treated teeth after the placement of a rubber dam. A dental assistant may not make initial access preparation. (4) The following remediable tasks may be performed by a dental assistant who has received on-the-job training and who performs the tasks under indirect supervision: (a) Retraction of lips, cheeks and tongue; (b) Irrigation and evacuation of debris not to include endodontic irrigation; (c) Placement and removal of cotton rolls; and (d) Taking and recording a patient’s blood pressure, pulse rate, respiration rate, case history and oral temperature; (e) Removing excess cement from orthodontic appliances with non-mechanical hand instruments only. (5) The following remediable tasks may be performed by a dental assistant who has received on-the-job training and who performs the tasks under general supervision: (a) Instructing patients in oral hygiene care and supervising oral hygiene care. (b) Provide educational programs, faculty or staff programs, and other educational services, which do not involve diagnosis or treatment of dental conditions. (c) Fabricating temporary crowns or bridges in a laboratory 64B5-16.0051 Delegation of Remediable Restorative Functions to Dental Assistants; Supervision Level; and Training and Experience Requirements. Notwithstanding any other rule provision to the contrary, a dentist may delegate remedial intraoral restorative functions to a Dental Assistant in strict compliance with the provisions of this rule. All functions delegated under this rule shall be performed under direct supervision. (1) Delegable Restorative Functions: After a dentist has prepared a tooth, a dentist may delegate to a dental assistant, who has met the mandatory training requirements of this rule, the task of placing, packing and contouring amalgam and composite restorations and the fitting and contouring of stainless-steel crowns (tasks). However, a dental assistant shall not permanently cement stainless steel crowns. (a) The tasks shall only be performed using a slow speed handpiece and hand instruments. (b) The delegating dentist shall not supervise more than four (4) dental hygienists or dental assistants in combination who are simultaneously performing the tasks pursuant to this rule or a rule authorizing the same or similar delegable tasks for dental hygienists. (c) The delegating dentist shall ensure that the patient’s dental chart is annotated to reflect the initials of the dental assistant who performed the tasks. (d) The delegating dentist shall also ensure that the patient’s dental chart reflects that the final restoration was verified by the delegating dentist and the result of the verification shall also be documented. (2) Mandatory Training Course Prerequisites: To be eligible to be admitted into the mandatory training course required in subsection (3), a dental assistant (Candidate) shall meet the following conditions: (a) The Candidate shall be at least 18 years of age. (b) The Candidate shall be a high school graduate or have a High School Equivalency Certificate. (c) The Candidate shall have a current Basic Life Support for Healthcare Provider certificate. (d) The Candidate shall be a graduate of a dental assisting program that is accredited by a dental accrediting entity recognized by the United States Department of Education or shall have received formal training in expanded duties pursuant to paragraph 64B5-16.002(1)(b), F.A.C. The Candidate shall have never had a dental assisting license suspended or revoked in any jurisdiction. (e) Within 24 months prior to being admitted to the mandatory training course in subsection (3), the Candidate must have documented proof of 2400 hours of clinical work experience in either a dental office or as an educator of dental assisting. (3) Mandatory Training Course: The mandatory training course shall be offered by a dental or dental hygiene school or program that is accredited by a dental accrediting entity recognized by the United States Department of Education. The training course must be specifically designed and implemented to comply with the provisions of this rule. The training program shall ensure that the candidate meets all the qualifications in subsection (2) before accepting the candidate into the training program. At a minimum, the training shall include and contain the following: (a) 105 clock hours including a minimum of 10 hours dedicated to preclinical didactic hours, and a clinical portion consisting of a minimum 70 hours dedicated to simulated lab and a minimum of 25 hours dedicated to live patients. The preclinical didactic hours, may be offered online. At the completion of the preclinical didactic hours, the course shall require the passing of an initial written examination prior to the clinical portion of the training. A passing score shall require a score of 75 percent or above. 120

Florida State Dental Practice Act and Administrative Rules for Dental Assistants (b) A clinical and lab session for Amalgam Restorations Class I, II, and V, which shall include live patients. (c) A clinical and lab session for Composite Restorations Class I, II, III, and V, which shall include live patients. (d) A clinical and lab session to size, fit and contour, but not permanently cement, stainless steel crowns, which shall include live patients. (e) The training program shall verify competency by requiring an exit or final written examination and clinical examination that includes live patients. The written portion of the examination shall include a section covering the Laws and Rules of Dentistry in Florida. A passing score shall require a 75 percent or above on both the written and clinical examination and the examinations shall not be weighted to achieve an overall score of 75 percent or better. The clock hours dedicated to the exit or final written and clinical examination shall not count towards the required minimum 105 total clock hours required by the course. (f) Upon the successful completion of the training course, a certificate of successful completion of the Restorative Function Course shall be issued. (4) Documentation of Training: A Dentist who delegates tasks pursuant to this rule shall ensure that a copy of the Restorative Function Course training certificate is immediately available at the location where tasks are delegated, and the certificate shall be produced by the dentist when requested by the Board Office or any authorized inspector. (5) Responsibility: The delegating and supervising dentist shall remain fully responsible for all delegated tasks and for ensuring that the dental assistant meets the training requirements of this rule. 64B5-16.008 Emergency Remediable Tasks. In an emergency in which a dentist of record is unable to be physically present to pre-examine the patient, and the patient will be seen by a dentist within 3 days, the following remediable tasks may be performed by both dental assistants and dental hygienists who hold current CPR certification from the American Red Cross, the American Heart Association or an equivalent CPR training agency and who are trained pursuant to Rule 64B5-16.002, F.A.C., without pre-examination by a dentist: (1) Removing and re-cementing properly contoured and fitting loose bands that are not permanently attached to any appliance; (2) Securing or unsecuring an archwire by attaching or removing the fastening device; (3) Inserting or removing dressings from alveolar sockets in post-operative osteitis when the patient is uncomfortable due to the loss of a dressing from an alveolar socket in diagnosed cases of post-operative osteitis; (4) Placing or removing periodontal dressings when the patient is uncomfortable due to the loss of a periodontal pack during the prescribed period of treatment; (5) Cementing temporary crowns or bridges using temporary cement when the patient is uncomfortable due to the loss of a temporary crown or bridge; and (6) Placing temporary medicinal restorative material when the patient is uncomfortable due to the loss of a temporary medicinal restoration. 64B5-16.009 Display of Certificates. The supervising licensee is responsible for ensuring that any dental assistant or dental hygienist who performs remediable tasks as a result of formal training shall display the certificate received at the conclusion of the training in a conspicuous public place where the tasks are performed. The supervising licensee shall also keep a copy of each such certificate on file in the dental office at which the dental assistant or dental hygienist performs remediable tasks. 64B5-16.010 Prior Certification and Training. Dental hygienists and dental assistants trained prior to April 30, 1980, who were at the time authorized to perform tasks set forth by Board Rule may continue to perform those tasks without the formal training required by Rule Chapter 64B516, F.A.C. 64B5-25.003 Required Sterilization and Disinfection Procedures. (1) At least one of the following procedures must be used in order to provide proper sterilization: (a) Steam under pressure (e.g., autoclave); (b) Dry-heat; (c) Chemical vapor; (d) Ethylene oxide; (e) Disinfectant/sterilant. U.S. Environmental Protection Agency (EPA) approved disinfectant/sterilants or U.S. Food and Drug Administration (FDA) approved sterilant may be used but are only appropriate for sterilization when used in appropriate dilution and for the time periods set forth in the manufacturerâ&#x20AC;&#x2122;s recommendation and only on non-heat tolerant instruments which do not penetrate soft tissue. (2) (a) Surgical and other instruments that normally penetrate soft tissue or bone, including, but not limited to, forceps, scalpels, bone chisels, scalers, and surgical burs, must be sterilized after each use. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

121

Florida State Dental Practice Act and Administrative Rules for Dental Assistants (b) Instruments that are not intended to penetrate soft tissue or bone, including, but not limited to, high speed dental handpieces, contra-angles, prophy angles, amalgam condensers, plastic instruments, and burs, but that may come into contact with oral tissues must be sterilized after each use. (c) However, if heat, steam under pressure, or chemical vapor sterilization of an instrument is not technically feasible, due to its size or composition, the instrument must undergo sterilization with a disinfectant/sterilant that destroys viruses and spores. Disinfectants must be registered by the U.S. Environmental Protection Agency (EPA) as a disinfectant/sterilant and must be used in accordance with the manufacturer’s recommendations and the recommendations of the Centers for Disease Control (CDC). (d) High speed dental handpieces, slow speed dental sleeves and contra-angles and prophy angles must be sterilized after each use using a heat or heat with pressure or heat with chemical method. The method used must be capable of sterilization. (e) Heat-sensitive instruments may require up to 10 hours of exposure in a liquid chemical agent registered by the U.S. Environmental Protection Agency (EPA) as a disinfectant/sterilant. (3) Before sterilization, instruments must be cleaned to remove debris. Cleaning must be accomplished by a thorough scrubbing with soap or a detergent and water or by using a mechanical device, such as an ultrasonic cleaner following the manufacturer’s recommendations. Metal or heat-stable dental instruments must be sterilized after each use by one of the procedures identified in paragraphs (a)-(d) of subsection (1) above. (4) Oral prosthetic appliances received from a dental laboratory must be washed with soap or a detergent and water, rinsed well, appropriately disinfected and rinsed well again before the prosthetic appliance is placed in the patient’s mouth. (5) At the completion of dental treatment, all surfaces that may have become contaminated with blood, saliva or other bodily fluids must be disinfected using a procedure recommended by the Centers for Disease Control (CDC). (6) Disinfectant/sterilants appropriate for use under paragraph (e) of subsection (1) above are only those disinfectant/ sterilants that are registered by the EPA. Those disinfectant/sterilants must be used in accordance with the manufacturer’s recommendations for correct use as a disinfectant/sterilant. (7) The sterilization and disinfection procedures required by this rule must be followed unless appropriate disposable items are used. Disposable items may only be used on a one time basis and may never be used on more than one dental patient. The use of disposable items is encouraged. (8) Surgical or examination gloves and surgical masks shall be worn by all dentists, dental hygienists, and dental assistants while performing or assisting in the performance of any intra-oral dental procedure on a patient in which contact with blood and/or saliva is imminent. Surgical or examination gloves must be changed between patients. Hands shall be washed with soap and water and dried immediately after removing and prior to replacing gloves. Gloves are never to be washed and reused. Surgical or examination gloves that are punctured or torn must be removed and replaced immediately with new gloves following rewashing of provider’s hands with soap and water. It is recommended that eye protection be worn by all dentists, dental hygienists, and dental assistants while performing or assisting in the performance of any dental procedure on a patient in accordance with CDC recommendations. (9) The procedures and equipment used for sterilization must have their efficacy tested periodically. Adequacy of steam under pressure (e.g. autoclave) or chemical vapor sterilization must have their efficacy verified by appropriate biological monitoring at least once every 40 hours (2400 minutes) of use or at least once every thirty days, whichever comes first. Dry heat and ethylene oxide sterilizers must have their efficacy verified with appropriate biological monitoring every 120 hours of operation at sterilization parameters or every thirty days, whichever comes first. (Use time is determined by multiplying the number of cycles by the individual cycle time.) (10) All OSHA category 2 employees must be provided with and must use the barrier techniques required by this rule when they are in situations where they may be exposed to blood, saliva, or other bodily fluids from the patient during the treatment or examination process.

122

Georgia DANB Certificant Counts: Georgia National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

530

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

1,944

Infection Control (ICE)

2,021

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Tanja Battle, Executive Director Georgia Board of Dentistry 2 Peachtree Street, NW Atlanta, GA 30303 Phone: 404-651-8000 Fax: 470-386-6137 Website: http://gbd.georgia.gov

Anatomy, Morphology and Physiology (AMP)

CODA-Accredited Dental Assisting Programs Albany Technical College Athens Technical College - Allied Health and Nursing Atlanta Technical College Augusta Technical College Columbus Technical College Georgia Northwestern Technical College Gwinnett Technical College Lanier Technical College Ogeechee Technical College Savannah Technical College Southern Crescent Technical College Wiregrass Georgia Technical College

Radiation Health and Safety (RHS)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants DANB CDA Certificant State of Georgia+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 21, 2020.

Source: 2018 DANB Salary Survey (state data based on 8 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

123

Georgia State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in Georgia, a dental assistant must complete a minimum of six hours of instruction, in the content areas defined in the Georgia Department of Human Services’ x-ray requirements. Instruction should begin within 30 days of initial employment and be completed no more than 90 days after employment begins. A record of training must be maintained by the employer. A dental assistant who shows written proof of completed x-ray training is considered to have satisfied the requirements of the Department of Human Services. A licensed dentist is required to provide direct supervision when a dental assistant is exposing x-rays. Note: The DALE Foundation's DANB RHS Review course meets the requirements of the Georgia Department of Human Services regulation 290-5-22-.04, X-Rays in the Healing Arts.

State Requirements for Certain Duties General Dental Assisting Duties with Enhanced Requirements To use rubber cup prophy on primary dentition (i.e., perform coronal polishing), a dental assistant must complete a curriculum approved by the Georgia Board of Dentistry or a minimum of eight hours of on-the-job training in the provision of rubber cup prophies by a dentist licensed to practice in Georgia. Expanded Duty Dental Assistant Requirements To perform expanded functions under the direct supervision of a licensed dentist in Georgia, a dental assistant must earn status as an Expanded Duty Dental Assistant (EDDA). To qualify as an EDDA, one must: (1) Hold a high school diploma or its equivalent AND (2) Hold a current Cardiopulmonary Resuscitation (CPR) certification AND (3) Provide a certificate documenting successful completion of a Georgia Board-approved course pertaining to the specific expanded duties outlined in that certificate. (A national DANB Certified Dental Assistant [CDA] certification is one of the ways by which an assistant may qualify to enroll in a Georgia Board-approved course.) Only those expanded duties listed on the certificate(s) may be performed by an EDDA.

Georgia State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Georgia Board of Dentistry Georgia Law TITLE 43. PROFESSIONS AND BUSINESSES CHAPTER 11. DENTISTS, DENTAL HYGIENISTS, AND DENTAL ASSISTANTS ARTICLE 4. DENTAL ASSISTANTS 43-11-74. Direct supervision required; scope of duties; exceptions to required supervision for dental screenings (n) Dental assistants may use rubber cup prophy on a patient with primary dentition under the direct supervision of a licensed dentist in accordance with any guidelines or rules established by the board. Dental assistants shall meet any education, training, or other requirements as established by the board. 43-11-80. Acts, services, practices, and procedures authorized (a) A dental assistant is one, other than a licensed dentist or licensed dental hygienist, who is employed to assist a licensed dentist by performing those acts, services, practices, and procedures as may be prescribed by rule or regulation of the board. (b) After meeting such additional education and training requirements as the board may require by rule or regulation, a dental assistant may perform such other acts, practices, services, or procedures, under the direct supervision of a licensed dentist, which the board may prescribe by rule or regulation. 43-11-81. Direct supervision required Dental assistants shall perform their duties only under the direct, personal supervision of a licensed dentist. No dental assistant shall practice dentistry, dental hygiene, or do any kind of dental work other than those acts, services, procedures, and practices prescribed by rule or regulation of the board. 43-11-82. Exceptions to application of article This article shall not apply to licensed dentists or dental hygienists, nor shall this article apply to physicians licensed in this state in extracting teeth or performing surgical operations and in charging therefore or to accredited schools of dentistry. Board Rules Rule 150-9-.01 General Duties of Dental Assistants. 1) A dental assistant shall be defined as one who is employed in a dental office to perform certain duties that assist the dentist. It is expected that the dental assistant will be familiar with the operations performed in the conduct of a dental practice; specifically, the sterilization of instruments, the general hygiene of the mouth, secretarial work, making ap124

Georgia State Dental Practice Act and Administrative Rules for Dental Assistants pointments and bookkeeping. Under no circumstances may he or she perform any of the operations catalogued as dental hygiene treatments in Board Rule 150-5-.03(5). 2) Direct supervision and control as it pertains to a dental assistant shall mean that a dentist licensed in Georgia is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedures and remains in the dental office or treatment facility while the procedures are being performed by the dental assistant and, before dismissal of the patient, evaluates the performance of the dental assistant. 3) In addition to routine duties, the general duties identified below may be delegated to dental assistants under the direct supervision of a licensed dentist. These duties may only be delegated in those instances when they are easily reversible and will not result in increased risk to the patient: (a) Make impressions for diagnostic models and opposing models. (b) Place and expose radiographs after completing the training required by Ga. Comp. R. & Regs. 290-5-22-.04 entitled X-Rays in the Healing Arts. (c) Remove sutures - other than wire sutures. (d) Remove periodontal dressing. (e) Place and remove rubber dams. (f) Apply topical anesthetic. (g) Remove visible excess cement from supramarginal areas of dental restorations and appliances with non-mechanical hand instruments. (h) Fabricate extraorally temporary crowns and bridges. (i) Cement temporary crowns and bridges with intermediate cement. (j) Remove temporary crowns and bridges seated with intermediate cement. (k) Place intracoronal temporary restorations using intermediate cement. (l) Place drying and de-oiling agents prior to the cementation of permanent crowns and bridges. (m) Remove dry socket medication. (n) Place and take off a removable prosthesis with a pressure sensitive paste after the appliance has been initially seated by the dentist. (o) Etch unprepared enamel. (p) Polish the enamel and restorations of the anatomical crown; however, this procedure may only be executed through the use of a slow speed handpiece (not to exceed 10,000 rpm), rubber cup and polishing agent. This procedure shall in no way be represented to patient as a prophylaxis. This procedure shall be used only for the purpose of enamel preparation for: 1) Bleaching, 2) Cementation of fixed restorations, 3) Bonding procedures including supramarginal enamel restorations after removal of orthodontic appliances. No direct charge shall be made to the patient for such procedure. (q) Dry canals with absorbent points and place soothing medicaments (not to include endodontic irrigation); and place and remove temporary stopping with non-mechanical hand instruments only. (r) Place matrix bands and wedges. (s) Select, pre-size and seat orthodontic arch wires with brackets which have been placed by the dentist. Adjustment of the arch wire may only be made by the dentist. (t) Select and pre-size orthodontic bands which initially must be seated by the dentist. (u) Place and remove pre-treatment separators. (v) Cut and tuck ligatures, remove ligatures and arch wires, remove loose or broken bands. (w) Remove and re-cement loose bands that previously have been contoured and fitted by a dentist, but only after a dentist has examined the affected tooth and surrounded gingiva and found no evidence of pathology. (x) Perform phlebotomy and venipuncture procedures after appropriate training is acquired. (y) Use a rubber cup prophy on a patient with primary dentition. A dental assistant may only begin providing rubber cup prophies after the dental assistant has completed a curriculum approved by the Board or a minimum of eight hours of on-the-job training in the provision of rubber cup prophies by a dentist licensed to practice in Georgia. 150-9-.02 Expanded Duties of Dental Assistants. (1) To meet the requirements of an expanded duty dental assistant, a dental assistant must have a high school diploma, or the equivalent thereof, proof of current CPR certification and a certificate documenting that he or she has successfully completed the course pertaining to the specific duties outlined in that certificate. Only those expanded duties, which are listed on the certificate(s), may be performed by an expanded duty dental assistant. An expanded duty dental assistant certificate may be issued by an accredited dental assisting program, a dental hygiene school, a dental school or a professional association recognized and approved by the Georgia Board of Dentistry to a candidate who has successfully completed the required certificate courses (each of which must be a minimum of four hours) from an accredited dental assisting program, a dental hygiene school, a dental school or professional association recognized and approved by the Georgia Board of Dentistry and met all other requirements of an expanded duty assistant; and completed an examination demonstrating competency in specific duties that is administered by a licensed dentist on behalf of the accredited dental assistant program, dental hygiene school, dental school or professional association recognized and approved by the Georgia Board of Dentistry. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

125

Georgia State Dental Practice Act and Administrative Rules for Dental Assistants (2) Eligibility for taking said courses requires that the candidate meet at least one of the following criteria: (a) Possess current certification that the candidate is a Certified Dental Assistant. (b) Be a graduate of a one (1) year accredited dental assisting program or a dental assisting program approved by the Board or be eligible for graduation. (c) Have been employed as a chair side assistant by a licensed dentist for a continuous six (6) month period within the previous three (3) years. (Note: An expanded duties certificate would be issued to a candidate only upon proper proof of graduation.) (3) The employer of the expanded duty assistant shall have readily available in the dental office a copy of the certificate(s) issued from the sponsor of the accredited course(s) of study to the expanded duty dental assistant. The expanded duties specific to the course(s) taken and in which [a] certificate(s) [has/have] been issued may be delegated to dental assistants, who are performing their duties under the direct supervision of a licensed dentist. The following expanded duties may be delegated to those assistants meeting the educational requirements established by Board Rule 150-9.02(1) and possessing a certificate(s) of the course(s) taken delineating the duties specific to that course: (a) Apply desensitizing agents to root surfaces of teeth and prepared dentinal surfaces of teeth prior to cementation of temporary restorations and crowns, bridges, or inlays. (b) Place cavity liner, base or varnish over unexposed pulp. (c) Intraoral fabrication of temporary crowns and bridges. All such adjustments must be performed extraorally. (d) Perform face bow transfer. (e) Make impressions to be used to repair a damaged prosthesis. (f) Place periodontal dressing. (g) Redressing (not initial placement of dressing) and removing dressing from alveolar sockets in post-operative osteitis when the patient is uncomfortable due to the loss of dressing from the alveolar socket in a diagnosed case of post-operative osteitis. (h) Make impressions to be used to fabricate a night guard (bruxism or muscle relaxation appliance). All adjustments must be performed extraorally. Final adjustment must be made by the dentist. (i) Monitor the administration of nitrous oxide/oxygen; turn off nitrous oxide/oxygen at the completion of the dental procedure and make adjustments to the level of nitrous oxide/oxygen, but only following the specific instructions of the dentist. (j) Apply topical anticariogenic agents. (k) Apply pit and fissure sealants, and primer and bonding agents to etched enamel or dentin; and light-cure with a fiber-optic light source (not to include the use of a laser device). (l) Packing and removing retraction cord, as prescribed by the dentist, so long as said cord is used solely for restorative dental procedures. (m) Changing of bleaching agent, following initial applications by the dentist, during the bleaching process of vital and non-vital teeth after the placement of a rubber dam; and applying the fiber-optic light source of a curing light for activation of the bleach (not to include the use of a laser device). (n) Rebond brackets after a licensed dentist has examined the affected tooth and surrounding gingiva and found no evidence of pathology. (o) Remove bonded brackets with hand instruments only. (p) Make impressions for passive orthodontic appliances. (q) Apply primer and bonding agents to etched enamel or dentin; and light cure with fiber-optic light source (not to include use of a laser device). (r) Take and record vital signs. (s) Size and fit stainless steel crowns on a primary tooth only. (t) Place springs on wires. (u) Place hooks on brackets. (v) Remove loose or broken bonds. (w) Remove ligature and arch wires. (x) Band, select, and pre-size arch wires and place arch wires after final adjustment and approval by the dentist. (y) Select, pre-fit, cement, cure, and remove ortho bands or brackets. (z) Place and remove pre-treatment separators. (aa) Digital scans for fabrication orthodontic appliances and models. 150-9-.03 Prohibited Use of Technologies by Dental Assistants. (1) General and expanded duty dental assistants shall not utilize laser equipment and technology in the course of the performance of their duties which are otherwise authorized by these rules. (2) General and expanded duty dental assistants shall not utilize intraorally micro etching and/or air polishing equipment and technologies in the course of the performance of those duties otherwise authorized by these rules. 150-13-.01 Conscious Sedation Permits. (6) The dentist issued a permit in either Moderate Enteral Conscious Sedation or Moderate Parenteral Conscious Sedation shall maintain a properly equipped facility for the administration of such sedation, staffed with appropriately 126

Georgia State Dental Practice Act and Administrative Rules for Dental Assistants trained and supervised personnel. The facility must have equipment capable of delivering positive pressure oxygen ventilation, a pulse oximeter, suction equipment that allows aspiration of the oral and pharyngeal cavities, an operating table or chair that allows for the patient to be positioned to maintain an airway, a firm platform for cardiopulmonary resuscitation, a fail-safe inhalation system if nitrous oxide/oxygen is used, equipment necessary to establish intravascular access, equipment to continuously monitor blood pressure and heart rate, appropriate emergency drugs per ACLS or PALS protocol, a manual or automatic external defibrillator, and a recovery area with available oxygen and suction. All of the aforementioned equipment, drugs, and supplies must be stationary and not subject to transfer from one facility to another. The applicant must submit verification that the facility meets the above requirements and shall be subject to an on-site inspection. The dentist and all support personnel must be certified in cardiopulmonary resuscitation at the basic life support healthcare provider level given by a board approved sponsor with update not to exceed two years per board rules 150-3-.08, 150-3-.09, 150-5-.04, 150-5-.05. Additionally, the dentist must have current certification in advanced cardiovascular life support (ACLS) for adult permits or pediatric advanced life support (PALS) for pediatric permits or an appropriate dental sedation/anesthesia emergency management course as approved by the board. (d) The dentist must be certified in cardiopulmonary resuscitation at the basic and advanced levels and all support personnel who provide direct hands-on patient care must be certified in cardiopulmonary resuscitation at the basic life support level given by a board approved provider with an update not to exceed two years. While any conscious sedation procedure is underway, a minimum of two support personnel certified in basic cardiopulmonary resuscitation must be present. 150-13-.02 Deep Sedation/General Anesthesia Permits. (3) In all areas in which this level of anesthesia is being conducted, the dentist shall maintain a properly equipped facility for the administration of deep sedation/general anesthesia, staffed with appropriately trained and supervised personnel. The facility must have equipment capable of delivering positive pressure oxygen ventilation, a pulse oximeter, suction equipment that allows aspiration of the oral and pharyngeal cavity, an operating table or chair that allows for the patient to be positioned to maintain an airway, a firm platform for cardiopulmonary resuscitation, a fail-safe inhalation system if nitrous oxide/oxygen is used, equipment to continuously monitor blood pressure and heart rate and rhythm, EKG monitor, appropriate emergency drugs per ACLS protocol including reversal agents for narcotics and/or benzodiazepines depending on which is actually utilized, a manual or automatic external defibrillator, and a recovery area with available oxygen and suction. The facility shall have continual monitoring of end tidal CO2 (expired carbon dioxide) unless invalidated by the nature of the patient, procedure or equipment. "Continual" shall mean "repeated regularly and frequently in steady rapid succession." All of the aforementioned equipment and supplies must be stationary and not subject to transfer from one facility to another. The applicant must submit verification that the facility meets the above requirements and shall be subject to an on-site inspection. (a) The dentist must be certified in cardiopulmonary resuscitation at the basic and advanced levels and all immediate support personnel who provide direct hands-on patient care must be certified in cardiopulmonary resuscitation at the basic life support level given by a board approved provider with an update not to exceed two years. While any deep sedation/general anesthesia procedure is underway, a minimum of two immediate support personnel certified in basic cardiopulmonary resuscitation must be present. 150-13-.03 Renewal of Conscious Sedation and Deep Sedation/ General Anesthesia Permits. (2) The dentist must be certified in cardiopulmonary resuscitation at the basic and advanced levels and all support personnel who provide direct hands-on patient care must be certified in cardiopulmonary resuscitation at the basic life support level given by a board approved provider with an update not to exceed two years. Department of Human Services, Public Health, X-Ray, Chapter 290-5-22 290-5-22-.04 X-Rays in the Healing Arts. (2) General Requirements. (a) Training of Operators who Administer X-ray in the Healing Arts. 1. The registrant shall assure the Department that all radiation machines and associated equipment under his control are operated only by individuals instructed in safe operating procedures. 2. The registrant shall require persons operating his radiation machine and associated equipment to receive, at a minimum, six hours of instruction. The following subject categories shall be covered: (i) Protection Against Radiation (I) Protective Clothing (II) Patient Holding (III) Time, Distance, Shielding (IV) Radiation Protection Standards (ii) Dark Room Techniques (I) Developing Chemicals (II) Film Protection ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

127

Georgia State Dental Practice Act and Administrative Rules for Dental Assistants (III) Cassettes (IV) Screens (iii) Patient Protection (I) Beam Limitation (II) Setting Up Techniques (III) Biological Effects of Radiation (iv) Machine Safety (I) Machine Functions (II) Safety Procedures (III) Recognizing Problems 3. Instruction required by .04(2)(a)2. shall begin within 30 days after employment and shall be completed no later than 90 days after date of employment. The registrant shall maintain a record of all training for each operator. Such record shall be made available for Departmental inspection. This rule shall take effect 180 days after the effective date of these regulations. 4. Persons who show written proof that they have received the required instruction are considered to meet the requirements of .04(2)(a)2. Georgia Board of Dentistry - Adopted Board Policies Coronal Polishing (“Rubber Cup Prophy”) (approved 04/30/18) Definition of Prophylaxis – Child (D1120) Removal of plaque, calculus and stains from the tooth structures in the primary and transitional dentition. It is intended to control local irritational factors. Requirements for calculus removal Calculus, if present during a “rubber cup prophy”, must be identified and removed by a Georgia-licensed DMD/DDS or RDH only. Age of primary dentition The American Dental Association (ADA) lists the presence of primary teeth from approximately one year to about age twelve. The Georgia Board of Dentistry recognizes and accepts these basic parameters as the ages when primary teeth are present in a child. Billing as a Prophylaxis The prophylaxis, D1120, includes the combined processes of examination (DMD/DDS), calculus removal if present (DMD/ DDS/RDH) and coronal polishing, “rubber cup prophy” (Trained DA). Training in Coronal Polishing (“Rubber Cup Prophy”) for Dental Assistants A dental assistant with at least one year of prior chairside experience or a graduate of an approved dental assisting program is eligible to attend an 8 hour pre-approved course of study that includes didactic and clinical applications necessary for coronal polishing (“rubber cup prophy”) and shall include: • • • • •

• •

128

Ethics and Georgia jurisprudence related to coronal polishing Identify the potential risks, indications and contraindications for coronal polishing Understand the definition of plaque, types of stain, calculus, and related terminology Dental anatomy and morphology for the proper identification of adult and child dentition Principles of coronal polishing including, but not limited to – • armamentarium; • proper positioning used/ergonomics; • preferred polishing technique using a stable fulcrum; • abrasive polishing agents commonly used in coronal polishing; • polishing coronal surfaces of teeth on a typodont using a slow speed handpiece Indications for professionally applied topical fluoride agents for caries prevention Fluoride Delivery Methods

Hawaii DANB Certificant Counts: Hawaii Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Sandra Matsushima, Executive Officer Hawaii Board of Dentistry DCCA-PVL ATTN: DENTAL P.O. Box 3469 Honolulu, HI 96801 Phone: 808-586-2702 Fax: 808-586-2689 Email: dental@dcca.hawaii.gov Website: cca.hawaii.gov/pvl/boards/dentist

Radiation Health and Safety (RHS)

362

Infection Control (ICE)

341

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Kapi'olani Community College

DANB CDA Certificant State of Hawaii+

$21.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 27, 2020.

Source: 2018 DANB Salary Survey (state data based on 4 responses from this state) Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

129

Hawaii State Radiography Requirements There are no radiography requirements for dental assistants in the state of Hawaii. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist.

State Requirements For Expanded Functions There is no designation for expanded functions dental assistants in the state of Hawaii.

Hawaii State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Hawaii State Board of Dentistry Chapter 448 Hawaii Revised Statutes Dentistry Section 448-3 Practice by unlicensed employee prohibited; penalty. (a) Except as provided in section 447-3, no person who manages or conducts as manager, proprietor, conductor, or otherwise a place where dental operations are performed, shall employ any person as operator in dental surgery or as a practitioner, or cause to permit any person to so act, who is not duly licensed to practice dentistry; provided that nothing in this chapter shall prohibit any unlicensed person from performing merely mechanical work upon inert matter in a dental laboratory. (b) A duly licensed and registered dentist may employ auxiliary personnel, other than registered dental hygienists, to assist the dentist in the practice of dentistry. These employees shall be known as dental assistants and shall perform all duties assigned to them under the supervision, direction and responsibility of the dentist. Duties of the dental assistant and regulatory directives shall be delineated under rules which the board of dentistry may from time to time adopt. (c) Any person violating this section shall be fined not less than $100 nor more than $1,000 for the first violation. Any person violating this section a second time shall be fined not less than $500 nor more than $2,000 and, in addition to the fine, the person’s license shall be revoked. Hawaii Administrative Rules Title 16, Chapter 79 Dentists and Dental Hygienists Subchapter 1. General Provisions §16-79-2 Definitions. For the purposes of this chapter, the following definitions are applicable: “ADA" means the American Dental Association. "CODA" means the American Dental Association Commission on Dental Accreditation. "CPR" means cardiopulmonary resuscitation. “Dental assistant" means a non-licensed person, who may perform dental supportive procedures authorized by the provisions of this chapter under the direct supervision of a licensed dentist. "General anesthesia" means a drug-induced, loss of consciousness accompanied by partial or complete loss of protective reflexes, including the inability to continually maintain an airway independently and to respond appropriately to physical stimulation or verbal command. Patients under general anesthesia require assistance in maintaining a patent airway and positive pressure ventilation due to inadequate spontaneous ventilatory function. "Supervision" means prescribing objectives and procedures and assigning work, provided that the person supervising shall be a licensed dentist. The levels of supervision are defined as follows: (1) "Direct supervision" means that the supervising licensed dentist examines and diagnoses the condition to be treated, authorizes each procedure, remains in the dentist's office or in any facility defined in section 447-3, HRS, while the procedures are being performed, and shall be responsible for all delegated acts and procedures performed by dental assistants and licensed dental hygienists. (2) "General supervision" means that the supervising licensed dentist has examined and diagnosed the condition to be treated, and has authorized each procedure to be carried out in accordance with the dentist's diagnosis and treatment plan. The presence of the supervising dentist is not required; provided the dentist shall be available for consultation and shall be responsible for all delegated acts and procedures performed by licensed dental hygienists. In the case of programs under the supervision and control by the department of health or in any facility specified in section 447-3, HRS, the foregoing shall not apply except that the supervising licensed dentist shall be available for consultation, shall be responsible for all delegated acts and procedures performed by licensed dental hygienists and the procedures pursuant to 447-3, HRS, shall have been prescribed by a licensed dentist or otherwise be authorized by law. "Licensed dentist" means a person who is authorized to practice dentistry in the State of Hawaii. 130

Hawaii State Dental Practice Act and Administrative Rules for Dental Assistants "Sedation" means the calming of an apprehensive individual by use of systemic drugs, without inducing loss of consciousness. Subchapter 7. Dental Assistants and Licensed Dental Hygienists §16-79-67 Definitions. For the purposes of this subchapter the following definitions are applicable: "Coronal polish" means a procedure limited to the removal of plaque biofilm and stain from exposed tooth surfaces, utilizing an appropriate instrument and polishing agent, as delegated by a licensed dentist. This procedure is not to be interpreted as a “dental prophylaxis”. "Dental prophylaxis" means the preventive supragingival and subgingival scaling and selective coronal polishing of the tooth surfaces, to remove calculus, soft deposits, plaque biofilm, and stains, using the appropriate instrumentation to create an environment in which hard and soft tissues can be maintained in good health by the patient, as delegated by a licensed dentist. "Non-surgical periodontal scaling and root planing" means the therapeutic supragingival and subgingival scaling of the teeth surfaces to remove calculus, plaque, and stains and the definitive root planing procedure to remove cementum and dentin that is rough or contaminated with toxins or microorganisms utilizing the appropriate instrumentation, including but not limited to, manual and ultrasonic instrumentation, as delegated by a licensed dentist. This procedure may include removal of necrotic tissue. §16-79-69.1 Allowable duties and training for a dental assistant. (a) A dental assistant may perform the following supportive dental procedures under the direct supervision, direction, evaluation, and responsibility of a licensed dentist: (1) Assisting the licensed dentist who is actually performing a dental procedure on the patient, that includes: preparing procedural trays/armamentaria set-ups; retracting a patient's oral tissues to maintain the field of operation during the dental procedure; removing debris, as is normally created and accumulated during or after operative procedures by the dentist; placing and removing the rubber dam; mixing dental materials; and transferring dental instruments or any other concept of four-handed dentistry the dentist requires to perform the procedure; (2) Assisting the licensed dental hygienist in the performance of their duties, provided the assistance does not include procedures included in section 16-79-69.5; (3) Collecting medical and dental histories, taking intra-oral and extraoral photographs, and recording or charting clinical findings as dictated by the licensed dentist or dental hygienist; (4) Completing prescription and authorization forms for drug or restorative, prosthodontic or orthodontic appliance for the supervising licensed dentist whereby the dentist signs the forms; (5) Conducting mouth mirror supragingival inspections and reporting observations to the supervising licensed dentist; provided that this is not interpreted as an oral cancer screening; (6) Exposing, processing, mounting, and labeling radiographs; (7) Making impressions for study casts, opposing models, occlusal appliances (e.g. splints, bite guards), mouth guards, orthodontic retainers, and medicament trays; (8) Making intra-oral measurements for orthodontic procedures, performing the preliminary selection and sizing of bands; checking for loose bands and bonded brackets; placing and removing orthodontic separators, ligature ties, and inter-arch elastics (i.e. chain elastics and rubber bands); fitting and removing head appliances; and removing arch wires; (9) Measuring and recording vital signs; (10) Monitoring the nitrous oxide/oxygen unit and reporting to the supervising dentist any adverse observations, provided the licensed dentist evaluates, initiates, and administers the sedation; (11) Placing matrix retainers; (12) Placing non-aerosol topical anesthetics; (13) Relating pre-operative and post-operative instructions, and patient education in oral hygiene as instructed by the supervising licensed dentist or dental hygienist; (14) Removing dressing and sutures; (15) Removing excess supragingival cement after a licensed dentist has placed a permanent or temporary prosthetic restoration, appliance, or orthodontic bands with hand instruments; and (16) Performing a try-in with any removable prosthetic or orthodontic appliance, provided the supervising licensed dentist makes the adjustments. (b) The board requires the supervising licensed dentist to appropriately train or provide training to dental assistants which shall include, but not be limited to, proper sterilization and disinfection procedures, ethics, proper record keeping and patient confidentiality, and cardiopulmonary resuscitation (CPR) which meets the standards and guidelines of the U.S. Department of Labor Occupational Safety and Health Administration/State of Hawaii Department of Labor and Industrial Relations Occupational Safety and Health (OSHA/HIOSH) bloodborne pathogen standards, CDC and ADA prevention guidelines and recommendations for the proper and safe execution of these delegated duties when providing dental care and treatment for their patients. The training courses shall be provided by sponsors pursuant to section 16-79-142. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

131

Hawaii State Dental Practice Act and Administrative Rules for Dental Assistants §16-79-69.5 Prohibited duties of dental assistants. A dental assistant shall not perform the following intra-oral functions or any other activity deemed to be irreversible as to cause change in the affected hard or soft tissues and is permanent or may require reconstructive or corrective procedures; and any other activity which represents the practice of dentistry and dental hygiene or requires the knowledge, skill, and training of a licensed dentist or licensed dental hygienist: (1) Administering local anesthetic, sedation, or general anesthesia; (2) Cementing, bonding, and adjusting any part of a prosthesis or appliance worn in the mouth; (3) Cementing or re-cementing, finishing margins, performing a try-in, and adjusting the occlusion of any temporary or permanent fixed prosthetic restoration; or placing cement bases; (4) Cementing bands and brackets, or activating any orthodontic appliance; (5) Establishing occlusal vertical dimension, making bite registrations, and making face-bow transfers; (6) Examining, diagnosing, or prescribing a treatment plan; (7) Making final impressions, which would lead to the fabrication of any appliance or prosthesis which, when worn by the patient, would come in direct contact with hard or soft tissues with the exception of duties listed in section 16-79-69.1(a)(7); (8) Performing any endodontic procedure to ream, file, irrigate, medicate, dry, try-in cores, or fill root canals; establishing the length of the tooth; (9) Performing any surgical or cutting procedures on hard or soft tissues, extracting teeth, and suturing; (10) Placing, condensing, carving, finishing, or adjusting the occlusion of final restorations; or placing cavity liners, medicaments, or pulp cap materials; (11) Placing materials subgingivally, including but not limited to, prescriptive medicaments, retraction cords, and other devices used for tissue displacement; (12) Prescribing medications or authorizing the fabrication of any restorative, prosthodontic, or orthodontic appliances; (13) Testing pulp vitality; and (14) Using of ultrasonic instruments and polishing natural or restored surfaces. Subchapter 8. Anesthesia §16-79-75 Definitions. For purposes of this subchapter, the following definitions are applicable: "Analgesia" means the diminution or elimination of pain in a conscious patient. "Deep sedation" means a drug-induced, depression of consciousness accompanied by a partial loss of protective reflexes during which patients cannot be easily aroused, but respond purposefully to physical stimulation or verbal command. Patients under deep sedation may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. "Moderate (conscious) sedation" means a drug-induced, depression of consciousness that allows a patient to maintain protective reflexes, retain the ability to independently and continuously maintain a patent airway, and respond purposefully to light tactile stimulation or verbal command. "Nitrous oxide analgesia" means an inhalation analgesic that allows a patient to maintain protective reflexes, retain the ability to independently and continuously maintain a patent airway, and respond appropriately to light tactile stimulation or verbal command. §16-79-78 Administration of general anesthesia and sedation. (b) In order to receive a written authorization or permit, the licensed dentist shall apply to the board, pay an application fee, and submit documentary evidence showing that the following requirements are met: (3) Facilities and staff requirements. Applicant has a properly equipped facility for the administration of general anesthesia, deep sedation, or moderate (conscious) sedation staffed with a supervised team of auxiliary personnel capable of reasonably handling anesthesia procedures, problems, and emergencies incident thereto. The current ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists and the current American Association of Oral and Maxillofacial Surgery Office Anesthesia Evaluation Manual are referenced as minimum standards of care. Adequacy of the facility and competence of the anesthesia team may be determined by the consultants appointed by the board as outlined below in this chapter. (c) Prior to the issuance of a written authorization or permit, the board may, at its discretion, require an on-site inspection of the facility, equipment, and personnel to determine whether the facilities and staff requirements have been met. This evaluation to determine whether the facility is adequate and properly equipped, may be carried out in a manner and generally following the guidelines, standards, requirements, and basic principles as described in the current American Association of Oral and Maxillofacial Surgeons Office Anesthesia Manual. The inspection and evaluation shall be carried out by a team of consultants appointed by the board.

132

Idaho DANB Certificant Counts: Idaho National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

160

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

896

Infection Control (ICE)

867

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Susan Miller, Executive Director Idaho State Board of Dentistry 350 N. 9th Street, Suite M-100 Boise, ID 83720

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

P.O. Box 83720 Boise, ID 83720-0021 Phone: 208-334-2369 Fax: 208-334-3247 Email: sbdinfo@isbd.idaho.gov Website: http://isbd.idaho.gov/

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs College of Western Idaho

DANB CDA Certificant State of Idaho+

$16.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of April 29, 2020.

Source: 2018 DANB Salary Survey (state data based on 7 responses from this state) Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

133

Idaho State Radiography Requirements There are no radiography requirements for dental assistants in Idaho. All dental assistants may legally operate dental xray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions There is no designation for expanded functions in Idaho. Dental assistants may perform dental services for which they have been trained and which are not prohibited under the direct supervision of a licensed dentist.

Idaho State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Idaho State Board of Dentistry IDAHO STATUTES TITLE 54 PROFESSIONS, VOCATIONS, AND BUSINESSES CHAPTER 9 DENTISTS 54-903 General Definitions. As used in this chapter: (4) “Dental assistant” is a person who need not be licensed under this chapter, but who is regularly employed at a dental office, who works under a dentist’s supervision, and is adequately trained and qualified according to standards established by the board to perform the dental services permitted to be performed by assistants by this chapter and applicable rules of the board. (9) “Direct supervision” is supervision of a dental therapist, dental assistant, or dental hygienist requiring that a dentist diagnose the condition to be treated, that a dentist authorize the procedure to be performed, that a dentist remain in the dental office while the procedure is performed, and that before dismissal of the patient a dentist approves the work performed by the dental therapist, dental assistant, or dental hygienist. (11) “General supervision” is supervision of a dental therapist, dental assistant, or dental hygienist requiring that a dentist authorize the procedure which is carried out, but not requiring that a dentist be in the office when the authorized procedure is performed. (12) “Indirect supervision” is supervision of a dental therapist, dental assistant, or dental hygienist requiring that a dentist authorize a procedure and that a dentist be in the dental office while the procedure is performed by the therapist, assistant, or hygienist. IDAPA 19 - BOARD OF DENTISTRY 19.01.01 - RULES OF THE IDAHO STATE BOARD OF DENTISTRY (Note: Rules are temporary through the end of the 2021 Idaho legislative session.) 010. DEFINITIONS AND ABBREVIATIONS. 06. BLS. Basic Life Support. (3-20-20)T 07. CDC. Centers for Disease Control and Prevention. (3-20-20)T 10. CRNA. Certified Registered Nurse Anesthetist. (3-20-20)T 11. Deep Sedation. A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilator function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (3-20-20)T 12. Enteral. Administration of a drug in which the agent is absorbed through the GI or mucosa. (3-20-20)T 13. EPA. United States Environmental Protection Agency. (3-20-20)T 14. General Anesthesia. A drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilator function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (3-20-20)T 18. Minimal Sedation. A minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilator and cardiovascular functions are unaffected. In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough never to render unintended loss of consciousness. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation. (3-20-20)T 134

Idaho State Dental Practice Act and Administrative Rules for Dental Assistants 19. Moderate Sedation. A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (3-20-20)T 20. Monitor or Monitoring. The direct clinical observation of a patient during the administration of sedation by a person trained to observe the physical condition of the patient and capable of assisting with emergency or other procedures. (3-20-20)T 24. Operator. The supervising dentist or another person who is authorized by these rules to induce and administer sedation. (3-20-20)T 27. Sedation. The administration of minimal, moderate, and deep sedation and general anesthesia. (3-20-20)T 031. INFECTION CONTROL. In determining what constitutes unacceptable patient care with respect to infection control, the Board may consider current infection control guidelines such as those of the CDC. Additionally, dentists, dental hygienists and dental assistants must comply with the following requirements: (3-20-20)T 01. Gloves, Masks and Eyewear. Disposable gloves must be worn whenever placing fingers into the mouth of a patient or when handling blood or saliva contaminated instruments or equipment. Appropriate hand hygiene must be performed prior to gloving. Masks and protective eyewear or chin-length shields must be worn when spattering of blood or other body fluids is likely. (3-20-20)T 02. Instrument Sterilization. Between each patient use, instruments and other equipment that come in contact with body fluids must be sterilized. (3-20-20)T 04. Sterilizing Devices Testing. Heat sterilizing devices must be tested for proper function by means of a biological monitoring system that indicates micro-organisms kill. Devices must be tested each calendar week in which scheduled patients are treated. Testing results must be retained by the licensee for the current calendar year and the two (2) preceding calendar years. (3-20-20)T 05. Non-Critical Surfaces. Environmental surfaces that are contaminated by blood or saliva must be disinfected with an EPA registered hospital disinfectant. (3-20-20)T 06. Clinical Contact Surfaces. Impervious backed paper, aluminum foil, or plastic wrap should be used to cover surfaces that may be contaminated by blood or saliva. The cover must be replaced between patients. If barriers are not used, surfaces must be cleaned and disinfected between patients by using an EPA registered hospital disinfectant. (3-20-20)T 07. Disposal. All contaminated wastes and sharps must be disposed of according to any governmental requirements. (3-20-20)T 034. DENTAL HYGIENISTS â&#x20AC;&#x201C; PROHIBITED PRACTICE. 01. Diagnosis and Treatment. Definitive diagnosis and dental treatment planning. (3-20-20)T 02. Operative Preparation. The operative preparation of teeth for the placement of restorative materials. (3-20-20)T 03. Intraoral Placement or Carving. The intraoral placement or carving of restorative materials unless authorized by issuance of an extended access restorative endorsement. (3-20-20)T 04. Anesthesia. Administration of any general anesthesia or moderate sedation. (3-20-20)T 05. Final Placement. Final placement of any fixed or removable appliances. (3-20-20)T 06. Final Removal. Final removal of any fixed appliance. (3-20-20)T 07. Cutting Procedures. Cutting procedures utilized in the preparation of the coronal or root portion of the tooth, or cutting procedures involving the supportive structures of the tooth. (3-20-20)T 08. Root Canal. Placement of the final root canal filling. (3-20-20)T 09. Occlusal Equilibration Procedures. Occlusal equilibration procedures for any prosthetic restoration, whether fixed or removable. (3-20-20)T 10. Other Final Placement. Final placement of prefabricated or cast restorations or crowns. (3-20-20)T 035. DENTAL ASSISTANTS â&#x20AC;&#x201C; PRACTICE. Pursuant to Section 54-903(4), Idaho Code, and these rules, dental assistants are authorized to perform dental services for which they are trained unless prohibited by these rules. Dental assistants must be directly supervised by a dentist when performing intraoral procedures except when providing palliative care as directed by the supervising dentist. (3-20-20)T 01. Prohibited Duties. A dental assistant is prohibited from performing the following duties: (3-20-20)T a. The intraoral placement or carving of permanent restorative materials. (3-20-20)T b. Any irreversible procedure. (3-20-20)T c. The administration of any sedation or local injectable anesthetic. (3-20-20)T d. Removal of calculus. (3-20-20)T e. Use of an air polisher. (3-20-20)T f. Any intra-oral procedure using a high-speed handpiece, except for the removal of orthodontic cement or resin. (3-20-20)T g. Any dental hygiene prohibited duty. (3-20-20)T ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

135

Idaho State Dental Practice Act and Administrative Rules for Dental Assistants 042. NITROUS OXIDE/OXYGEN. Persons licensed to practice and dental assistants trained in accordance with these rules may administer nitrous oxide/ oxygen to patients. (3-20-20)T 01. Patient Safety. A dentist must evaluate the patient to ensure the patient is an appropriate candidate for nitrous oxide/ oxygen; ensure that any patient under nitrous oxide/oxygen is continually monitored; and ensure that a second person is in the practice setting who can immediately respond to any request from the person administering the nitrous oxide/oxygen. 02. Required Facilities and Equipment. Dental offices where nitrous oxide/oxygen is administered to patients must have the following: a fail-safe nitrous oxide delivery system that is maintained in working order; a scavenging system; and a positive-pressure oxygen delivery system suitable for the patient being treated. (3-20-20)T 03. Personnel. For nitrous oxide/oxygen administration, personnel shall include an operator and an assistant currently certified in BLS. (3-20-20)T 043. MINIMAL SEDATION. Persons licensed to practice dentistry in accordance with the Idaho Dental Practice Act and these rules may administer minimal sedation to patients of sixteen (16) years of age or older. In cases where the patient weighs less than one hundred (100) pounds, or is under the age of sixteen (16) years, minimal sedation may be administered without a permit by use of nitrous oxide, or with a single enteral dose of a sedative agent administered in the dental office. (3-20-20)T 02. Personnel. At least one (1) additional person currently certified in BLS must be present in addition to the dentist. (3-20-20)T 044. MODERATE SEDATION, GENERAL ANESTHESIA AND DEEP SEDATION. 03. General Requirements. The qualified dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of moderate sedation, general anesthesia, or deep sedation and providing the equipment, drugs and protocol for patient rescue. Evaluators appointed by the Idaho State Board of Dentistry will periodically assess the adequacy of the facility and competence of the sedation team. For general anesthesia and deep sedation, the Board adopts the standards incorporated by reference in these rules, as set forth by the AAOMS in their office anesthesia evaluation manual. (3-20-20)T a. Facility, Equipment and Drug Requirements. The following facilities, equipment and drugs must be available for immediate use during the sedation and recovery phase: (3-20-20)T i. An operating room large enough to adequately accommodate the patient on an operating table or in an operating chair and to allow an operating team of at least two (2) individuals to freely move about the patient; (3-20-20)T b. Personnel (3-20-20)T i. For moderate sedation, the minimum number of personnel is two (2) including: the operator and one (1) additional individual currently certified in BLS. (3-20-20)T ii. For general anesthesia or deep sedation, the minimum number of personnel is three (3) including: the operator and two (2) additional individuals currently certified in BLS. When the same individual administering the general anesthesia or deep sedation is performing the dental procedure one (1) of the additional individuals must be designated for patient monitoring. (3-20-20)T iii. Auxiliary personnel must have documented training in BLS, will have specific assignments, and shall have current knowledge of the emergency cart inventory. The dentist and all office personnel must participate in documented periodic reviews of office emergency protocol, including simulated exercises, to assure proper equipment function and staff interaction. (3-20-20)T d. Patient Monitoring. Patients must be monitored as follows: (3-20-20)T iii. During the recovery phase, the patient shall be monitored by an individual trained to monitor patients recovering from sedation; (3-20-20)T 048. USE OF OTHER ANESTHESIA PERSONNEL. A dentist who does not hold an anesthesia permit may perform dental procedures in a dental office on a patient who receives anesthesia induced by an anesthesiologist, a CRNA, or another dentist with an anesthesia permit as follows: (3-20-20)T 01. Facility, Equipment, Drugs, and Personnel Requirements. The dentist will have the same facility, equipment, drugs and personnel available during the procedure and during recovery as required of a dentist who has a permit for the level of sedation being provided. (3-20-20)T

136

Illinois DANB Certificant Counts: Illinois National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

586

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Jerry Miller, Board Liaison Illinois Board of Dentistry Department of Financial & Professional Regulation Division of Professional Regulation 320 W. Washington, 3rd Floor Springfield, IL 62786 Phone: 855-445-7763 Phone: 217-782-7524 (direct to J. Miller) Fax: 217-524-6735 Website: http://www.idfpr.com/profs/dentist.asp

Radiation Health and Safety (RHS)

3,091

Infection Control (ICE)

3,163

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Elgin Community College Illinois Valley Community College John A. Logan College Kaskaskia College Lewis & Clark Community College

DANB CDA Certificant State of Illinois+

$18.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of May 26, 2020.

Source: 2018 DANB Salary Survey (state data based on 9 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

137

Illinois State Radiography Requirements There are no radiography requirements for dental assistants in Illinois. All dental assistants may legally operate dental xray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions To perform expanded functions under the supervision of a licensed dentist in Illinois, a dental assistant must meet state requirements for each of the desired expanded functions, as outlined below. To perform specified expanded functions in Illinois and hold oneself out as an Expanded Function Dental Assistant*, a dental assistant must complete required training in each of the allowed expanded functions. To qualify, a dental assistant must: (1a) Complete training the expanded functions from an approved continuing education sponsor OR (1b) Complete training in the expanded functions from a dental assistant training program accredited by the Commission on Dental Accreditation OR (1c) Complete a training course approved by the Illinois Department of Financial and Professional Regulation AND (2) Complete and maintain Basic Life Support certification, proof of which must be kept on file with the supervising dentist. *The Illinois Legislature passed a law in the 2017 legislative session authorizing the creation of Expanded Function Dental Assistants; the Illinois Department of Financial and Professional Regulation is in the process of developing rules to implement this new law. To qualify to perform coronal scaling and intracoronal temporization of a tooth** under the supervision of a dentist, a dental assistant must: (1) Have at least 2,000 hours of direct clinical patient care experience AND (2) Successfully complete an approved coronal polishing course prior to taking coronal scaling course AND Successfully complete a training program in coronal scaling and intracoronal temporization of a tooth approved by rule of the Illinois Department of Financial and Professional Regulation (IDFPR) that includes the following: (a) minimum 16 hours of didactic and clinical manikin or human subject instruction covering specified content, (b) an outcome assessment examination that demonstrates competency, (c) completion of 6 full-mouth scaling procedures under the observation and with approval of the supervising dentist, (d) issuance of a certificate of completion (which must be kept on file at the dental office). See the Illinois Dental Practice Act, Section 17, Paragraph (g)(7), on page 141 for additional requirements and conditions governing the performance of these functions by dental assistants. **The Illinois Legislature passed a law in the 2015 legislative session authorizing performance of these functions by dental assistants meeting specified requirements; the Illinois Department of Financial and Professional Regulation (IDFPR) is in the process of developing rules to implement this new law. To place, carve and finish amalgam restorations; place, pack and finish composite restorations; and place interim restorations under the direct supervision of a dentist, a dental assistant must: (1) Pass an approved coronal polishing course and approved dental sealants course (prior to taking restorative training program), AND (2a) Successfully complete a structured training program meeting the requirements outlined in statute provided by an educational institution accredited by the Commission on Dental Accreditation OR (2b) Have 4,000 hours of clinical patient care experience and successfully complete a structured training program meeting the requirements outlined in statute and provided by a statewide dental association approved by the Illinois Department of Financial and Professional Regulation (IDFPR), AND (3) Maintain on file at the dental office the certificate of completion of the required training program, which must be made available to IDFPR upon request. A supervising dentist must attend a required orientation class with the applicant and sign an agreement that he or she will follow the required guidelines regarding supervision and clinical application of specific techniques being taught between scheduled classes. To perform coronal polishing, place pit and fissure sealants, monitor patients under nitrous oxide, or monitor patients under sedation, a dental assistant must: (1) Be at least 18 years of age AND (2a) Complete 1,000 hours of clinical dental assisting experience or (2b) Complete a CODA-accredited dental assisting program or (2c) Hold a current national DANB Certified Dental Assistant (CDA) Certification, AND (3a) Complete an Illinois Board-approved course relative to the expanded function in question, subject to specific didactic and clinical requirements or (3b) Provide proof of completion of an Illinois Board-approved dental assisting program that contained the expanded function in the curriculum. Note: In addition to the above requirements, in order to monitor patients while nitrous oxide is being administered and to monitor patients under minimal, moderate or deep sedation, or under general anesthesia, dental assistants must maintain basic life support certification intended for healthcare providers (BLS) that includes evaluation of hands-on skills and a written exam. 138

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Illinois Board of Dentistry PROFESSIONS AND OCCUPATIONS (225 ILCS 25/) Illinois Dental Practice Act. (225 ILCS 25/4) (from Ch. 111, par. 2304) Sec. 4. Definitions. "Department" means the Department of Financial and Professional Regulation. "Board" means the Board of Dentistry. “Dental assistant” mean an appropriately trained person who, under the supervision of a dentist, provides dental services as authorized by Section 17. "Expanded function dental assistant" means a dental assistant who has completed the training required by Section 17.1 of this Act. “Supervision” means supervision of a dental hygienist or a dental assistant requiring that a dentist authorize the procedure, remain in the dental facility while the procedure is performed, and approve the work performed by the dental hygienist or dental assistant before dismissal of the patient, but does not mean that the dentist must be present at all times in the treatment room. (225 ILCS 25/17) (from Ch. 111, par. 2317) Sec. 17. Acts Constituting the Practice of Dentistry. A person practices dentistry, within the meaning of this Act: (1) Who represents himself as being able to diagnose or diagnoses, treats, prescribes, or operates for any disease, pain, deformity, deficiency, injury, or physical condition of the human tooth, teeth, alveolar process, gums or jaw; or (2) Who is a manager, proprietor, operator or conductor of a business where dental operations are performed; or (3) Who performs dental operations of any kind; or (4) Who uses an X‑Ray machine or X‑Ray films for dental diagnostic purposes; or (5) Who extracts a human tooth or teeth, or corrects or attempts to correct malpositions of the human teeth or jaws; or (6) Who offers or undertakes, by any means or method, to diagnose, treat or remove stains, calculus, and bonding materials from human teeth or jaws; or (7) Who uses or administers local or general anesthetics in the treatment of dental or oral diseases or in any preparation incident to a dental operation of any kind or character; or (8) Who takes material or digital scans for final impressions of the human tooth, teeth, or jaws or performs any phase of any operation incident to the replacement of a part of a tooth, a tooth, teeth or associated tissues by means of a filling, crown, a bridge, a denture or other appliance; or (9) Who offers to furnish, supply, construct, reproduce or repair, or who furnishes, supplies, constructs, reproduces or repairs, prosthetic dentures, bridges or other substitutes for natural teeth, to the user or prospective user thereof; or (10) Who instructs students on clinical matters or performs any clinical operation included in the curricula of recognized dental schools and colleges; or (11) Who takes material or digital scans for final impressions of human teeth or places his or her hands in the mouth of any person for the purpose of applying teeth whitening materials, or who takes impressions of human teeth or places his or her hands in the mouth of any person for the purpose of assisting in the application of teeth whitening materials. A person does not practice dentistry when he or she discloses to the consumer that he or she is not licensed as a dentist under this Act and (i) discusses the use of teeth whitening materials with a consumer purchasing these materials; (ii) provides instruction on the use of teeth whitening materials with a consumer purchasing these materials; or (iii) provides appropriate equipment on‑site to the consumer for the consumer to self‑apply teeth whitening materials. The fact that any person engages in or performs, or offers to engage in or perform, any of the practices, acts, or operations set forth in this Section, shall be prima facie evidence that such person is engaged in the practice of dentistry. The following practices, acts, and operations, however, are exempt from the operation of this Act: (a) The rendering of dental relief in emergency cases in the practice of his or her profession by a physician or surgeon, licensed as such under the laws of this State, unless he undertakes to reproduce or reproduces lost parts of the human teeth in the mouth or to restore or replace lost or missing teeth in the mouth; or (b) The practice of dentistry in the discharge of their official duties by dentists in any branch of the Armed Services of the United States, the United States Public Health Service, or the United States Veterans Administration; or (c) The practice of dentistry by students in their course of study in dental schools or colleges approved by the Department, when acting under the direction and supervision of dentists acting as instructors; or (d) The practice of dentistry by clinical instructors in the course of their teaching duties in dental schools or colleges approved by the Department:

139

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants (i)

when acting under the direction and supervision of dentists, provided that such clinical instructors have instructed continuously in this State since January 1, 1986; or (ii) when holding the rank of full professor at such approved dental school or college and possessing a current valid license or authorization to practice dentistry in another country; or (e) The practice of dentistry by licensed dentists of other states or countries at meetings of the Illinois State Dental Society or component parts thereof, alumni meetings of dental colleges, or any other like dental organizations, while appearing as clinicians; or (f) The use of X‑Ray machines for exposing X‑Ray films of dental or oral tissues by dental hygienists or dental assistants; or (g) The performance of any dental service by a dental assistant, if such service is performed under the supervision and full responsibility of a dentist. In addition, after being authorized by a dentist, a dental assistant may, for the purpose of eliminating pain or discomfort, remove loose, broken, or irritating orthodontic appliances on a patient of record. For purposes of this paragraph (g), “dental service” is defined to mean any intraoral procedure or act which shall be prescribed by rule or regulation of the Department. Dental service, however, shall not include: (1) Any and all diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury or physical condition of the human teeth or jaws, or adjacent structures. (2) Removal of, or restoration of, or addition to the hard or soft tissues of the oral cavity, except for the placing, carving, and finishing of amalgam restorations and placing, packing, and finishing composite restorations by dental assistants who have had additional formal education and certification A dental assistant may place, carve, and finish amalgam restorations, place, pack, and finish composite restorations, and place interim restorations if he or she (A) has successfully completed a structured training program as described in item (2) of subsection (g) provided by an educational institution accredited by the Commission on Dental Accreditation, such as a dental school or dental hygiene or dental assistant program,or (B) has at least 4,000 hours of direct clinical patient care experience and has successfully completed a structured training program as described in item (2) of subsection (g) provided by a statewide dental association, approved by the Department to provide continuing education, that has developed and conducted training programs for expanded functions for dental assistants or hygienists. The training program must: (i) include a minimum of 16 hours of didactic study and 14 hours of clinical manikin instruction; all training programs shall include areas of study in nomenclature, caries classifications, oral anatomy, periodontium, basic occlusion, instrumentations, pulp protection liners and bases, dental materials, matrix and wedge techniques, amalgam placement and carving, rubber dam clamp placement, and rubber dam placement and removal; (ii) include an outcome assessment examination that demonstrates competency; (iii) require the supervising dentist to observe and approve the completion of 8 amalgam or composite restorations; and (iv) issue a certificate of completion of the training program, which must be kept on file at the dental office and be made available to the Department upon request. A dental assistant must have successfully completed an approved coronal polishing and dental sealant course prior to taking the amalgam and composite restoration course. A dentist utilizing dental assistants shall not supervise more than 4 dental assistants at any one time for placing, carving, and finishing of amalgam restorations or for placing, packing, and finishing composite restorations. (3) Any and all correction of malformation of teeth or of the jaws. (4) Administration of anesthetics, except for monitoring of nitrous oxide, conscious sedation, deep sedation, and general anesthetic as provided in Section 8.1 of this Act, that may be performed only after successful completion of a training program approved by the Department. A dentist utilizing dental assistants shall not supervise more than 4 dental assistants at any one time for the monitoring of nitrous oxide. (5) Removal of calculus from human teeth. (6) Taking of material or digital scans for final impressions for the fabrication of prosthetic appliances, crowns, bridges, inlays, onlays, or other restorative or replacement dentistry. (7) The operative procedure of dental hygiene consisting of oral prophylactic procedures, except for coronal polishing or pit and fissure sealants, which may be performed by a dental assistant who has successfully completed a training program approved by the Department. Dental assistants may perform coronal polishing under the following circumstances: (i) the coronal polishing shall be limited to polishing the clinical crown of the tooth and existing restorations, supragingivally; (ii) the dental assistant performing the coronal polishing shall be limited to the use of rotary instruments using a rubber cup or brush polishing method (air polishing is not permitted); and (iii) the supervising dentist shall not supervise more than 4 dental assistants at any one time for the task of coronal polishing or pit and fissure sealants. The limitations on the number of dental assistants a dentist may supervise contained in items (2), (4), and (7) of this paragraph (g) mean a limit of 4 total dental assistants or dental hygienists doing expanded functions covered by these Sections being supervised by one dentist.

140

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants

In addition to coronal polishing and pit and fissure sealants as described in this item (7), a dental assistant who has at least 2,000 hours of direct clinical patient care experience and who has successfully completed a structured training program provided by (1) an educational institution such as a dental school or dental hygiene or dental assistant program, or (2) by a statewide dental or dental hygienist association, approved by the Department on or before the effective date of this amendatory Act of the 99th General Assembly, that has developed and conducted a training program for expanded functions for dental assistants or hygienists may perform: (A) coronal scaling above the gum line, supragingivally, on the clinical crown of the tooth only on patients 12 years of age or younger who have an absence of periodontal disease and who are not medically compromised or individuals with special needs and (B) intracoronal temporization of a tooth. The training program must: (I) include a minimum of 16 hours of instruction in both didactic and clinical manikin or human subject instruction; all training programs shall include areas of study in dental anatomy, public health dentistry, medical history, dental emergencies, and managing the pediatric patient; (II) include an outcome assessment examination that demonstrates competency; (III) require the supervising dentist to observe and approve the completion of 6 full mouth supragingival scaling procedures; and (IV) issue a certificate of completion of the training program, which must be kept on file at the dental office and be made available to the Department upon request. A dental assistant must have successfully completed an approved coronal polishing course prior to taking the coronal scaling course. A dental assistant performing these functions shall be limited to the use of hand instruments only. In addition, coronal scaling as described in this paragraph shall only be utilized on patients who are eligible for Medicaid or who are uninsured and whose household income is not greater than 200% of the federal poverty level. A dentist may not supervise more than 2 dental assistants at any one time for the task of coronal scaling. This paragraph is inoperative on and after January 1, 2026.

(225 ILCS 25/17.1) Sec. 17.1. Expanded function dental assistants. (a) A dental assistant who has completed training as provided in subsection (b) of this Section in all of the following areas may hold himself or herself out as an expanded function dental assistant: (1) Taking material or digital scans for final impressions after completing a training program that includes either didactic objectives or clinical skills and functions that demonstrate competency. (2) Performing pulp vitality test after completing a training program that includes either didactic objectives or clinical skills and functions that demonstrate competency. (3) Placing carving, and finishing of amalgam restorations and placing, packing, and finishing composite restorations as allowed under Section 17. (4) Starting the flow of oxygen and monitoring of nitrous oxide-oxygen analgesia as allowed under Section 17. (5) Coronal polishing and pit and fissure sealants as allowed under Section 17. All procedures listed in paragraphs (1) through (5) for dental assistants must be performed under the supervision of a dentist, requiring the dentist authorizes the procedure, remains in the dental facility while the procedure is performed, and approves the work performed by the dental assistant before dismissal of the patient, but the dentist is not required to be present at all times in the treatment room.

(b)

After the completion of training as provided in subsection (b) of this Section, an expanded function dental assistant may perform any of the services listed in this subsection (a) pursuant to the limitations of this Act. Certification and training as an expanded function dental assistant must be obtained from one of the following sources: (i) an approved continuing education sponsor; (ii) a dental assistant training program approved by the Commission on Dental Accreditation of the America Dental Association; or (iii) a training program approved by the Department. Training required under this subsection (b) must also include Basic Life Support certification, as described in Section 16 of this Act. Proof of current certification shall be kept on file with the supervising dentist. Any procedures listed in subsection (a) that are performed by an expanded function dental assistant must be approved by the supervising dentist and examined prior to dismissal of the patient. The supervising dentist shall be responsible for all dental services or procedures performed by the dental assistant. Nothing in this Section shall be construed to alter the number of dental assistants that a dentist may supervise under paragraph (g) of Section 17 of this Act. Nothing in this Act shall: (1) require a dental assistant to be certified as an expanded function dental assistant or (2) prevent a dentist from training dental assistants in accordance with the provisions of Section 17 or 17.1 of this Act or rules pertaining to dental assistant duties.

141

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants ADMINISTRATIVE CODE TITLE 68: PROFESSIONS AND OCCUPATIONS CHAPTER VII: DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION SUBCHAPTER b: PROFESSIONS AND OCCUPATIONS Part 1220 Illinois Dental Practice Act Section 1220.10 Definitions “AAOMS” means the American Association of Oral and Maxillofacial Surgeons. "AMP Exam" means the national Anatomy, Morphology, and Physiology exam administered by DANB. “BLS” means current basic life support certification intended for healthcare providers that includes evaluation of hands-on skills and a written exam. “CODA” means Commission on Dental Accreditation of the American Dental Association. “DANB” means Dental Assisting National Board, Inc. "IS Exam" means the national exam on oral cavity isolation techniques administered by DANB. "RF Exam" means the national Restorative Functions exam administered by DANB. Section 1220.245 Prescribed Duties of Dental Assistants a) “Dental Assistant” means an appropriately trained person who, under the supervision of a dentist, provides dental services or procedures as authorized by Section 17 of the Act or as prescribed by this Part. “Appropriately trained” means a person who: (1) Has completed formal training as a condition for administering a specific service or procedure as required by the Act or this Part; and (2) Is considered, for all other authorized or prescribed services or procedures, by the supervising dentist to be competent to render such service or procedure as a result of on-the-job training. b) Provided that dental assistant is appropriately trained pursuant to this Section and is acting under the supervision and full responsibility of a dentist, a dental assistant may perform any dental service or procedure except the following: (1) Any and all diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury or physical condition of the human teeth or jaws, or adjacent structures. (2) Removal of, restoration of, or addition to the hard or soft tissues of the oral cavity. For purposes of this Section, coronal polishing and acid etching of a tooth surface are not considered removal of hard or soft tissues. (3) Any and all correction of malformation of teeth or of the jaws. (4) Administration of anesthetics, except for monitoring of nitrous oxide, conscious sedation, deep sedation and general anesthetic as provided in Section 8.1 of the Act. (5) Removal of calculus from teeth. (6) Taking of final impressions for the fabricating of prosthetic appliances, crowns, bridges, inlays, onlays, or other restorative or replacement dentistry. (7) The operative procedure of dental hygiene consisting of oral prophylactic procedures except for coronal polishing as specified in this Section. (8) Making denture adjustments. (9) Placing and finishing composite restorations. (10) Permanently cementing permanent crowns or bridges. (11) Permanently re-cementing permanent crowns or bridges that have come loose. (12) Placement of any chemotherapeutic agent for the management of periodontal disease. (13) Applying cavity bases. (14) Cementing bands and/or bonding brackets. (15) Performing supragingival or subgingival scaling. (16) Performing pulp vitality tests. (17) Inter-oral use of a high-speed hand piece. (18) Use of a laser to remove tissue. (19) Placement or removal of implant prosthetic components and prostheses, including but not limited to the placement or removal of healing abutments, implant supported provisionals, components used in final impression procedures, and final prostheses, which include abutment, crowns, fixed and fixed detachable prostheses and fixed detachable prostheses during recare appointments. c) A dental assistant who is at least 18 years of age and has 1000 hours of clinical dental assisting experience or has graduated from a dental assistant program accredited by the CODA, or is a currently certified dental assistant as designated by the DANB, may perform the following services and procedures, but only under the following terms and conditions: 142

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants 1)

Monitoring nitrous oxide, provided: A) The dental assistant has completed an approved course of 12 hours relative to nitrous oxide analgesia and has submitted certification to the dentist of valid completion of such course. The course shall have been completed no earlier than January 1, 1998 nor later than June 1, 2014. i) A dental assistant who has not completed the 12 hour course shall complete an approved course or courses totaling 6 hours or more relative to monitoring nitrous oxide analgesia and submit certification of successful completion to the dentist. ii) Proof shall be made available to the Division upon request. iii) The required hours shall include both didactic and clinical components and have been designed by an educational institution such as a dental school, dental hygiene or dental assistant program or by an approved CE sponsor. The course shall include areas of anatomy, physiology, monitoring, pharmacology and emergency procedures with an emphasis on airway management. Courses being offered by approved CE sponsors, as provided for in Section 1220.440(b)(2)(N) must be pre-approved by the Division prior to their initial offering and must meet the requirements set forth in this subsection (c)(1); B) The dental assistant is functioning under the supervision of the dentist who must remain in the facility; C) Only a dentist or dental hygienist qualified pursuant to Section 1220.240(e) shall administer (start the flow of) nitrous oxide to the patient and control the induction of the gas so that the patient is at a level of analgesia, not anesthesia; D) Only a dentist or dental hygienist qualified pursuant to Section 1220.240(e) shall remove the patient from nitrous oxide when the dentist or dental hygienist has completed the procedures on the patient; E) If the dental assistant has completed a monitoring course or courses totaling 12 hours or more provided by AAOMS or a similar course preapproved by the Division, the dental assistant need not complete the course hours required in subsection (c)(1)(A). The course shall have been completed no earlier than December 31, 2002. Proof shall be made available to the Division upon request; F) The dental assistant maintains BLS certification or its equivalent, which will be in addition to the required courses. Monitoring minimal sedation, moderate sedation (conscious sedation), deep sedation, or general anesthesia, as defined in Section 1220.500, provided: A) The dental assistant is responsible for obtaining proof of certification validating completion of a course or courses totaling 12 hours or more, including 6 hours of didactic education and 6 hours of clinical training. i) The didactic education may be completed online, and online instruction may be used to guide the hands-on clinical training. The didactic course work shall include the areas of anatomy, physiology, pharmacology, monitoring, including nitrous oxide monitoring, and emergency procedures with an emphasis on airway management. ii) The clinical components may be conducted by the CE sponsor approved pursuant to Section 1220.440, a dental hygiene program approved by the Division pursuant to Section 1220.250 or a licensed dentist having a permit A or B who employs the dental assistant. ● The courses described in this subsection (c)(2)(A) must be approved by the Division prior to initial offering. Dental assistants who completed a 12 hour course that met course requirements in place for monitoring sedation prior to adoption of the current rules will not be required to recertify. Proof shall be provided to the Division upon request. ● If the clinical training is delivered by the supervising dentist, that dentist must attest, in writing, to the CE sponsor that the training has been completed. This attestation must be received by the CE sponsor in order for the sponsor to issue a certification of course completion. The supervising dentist must attest that the dental assistant has been thoroughly trained and has demonstrated in-office proficiency in the skills required by this subsection (c)(2)(A)(ii). The dentist's attestation, signed by both the dentist and the dental assistant, shall be maintained by the dentist. The copy sent to the CE sponsor shall be maintained by the sponsor as part of the official course record. ● The clinical component must include practical training on airway management. Other skills that must be demonstrated include manual blood pressure and pulse determination, operation of supplemental oxygen equipment, monitoring operations, including EKG, pulse oximeter and capnograph, and completion of the anesthesia record. B) If the dental assistant has complied with the provisions set forth in subsection (c)(1)(A), the dental assistant shall complete an additional 6 hour course on advanced airway management and monitoring equipment in lieu of the 12 hour course required in subsection (c)(2)(A). The courses must comply with the elements set forth in subsection (c)(2)(A) other than coursework related only to monitoring of nitrous oxide. The courses described in this subsection (c)(2)(B) must be approved by the Division prior to their initial offering. Proof shall be made available to the Division upon request. C) If the dental assistant has completed a monitoring course or courses totaling 12 hours or more provided by AAOMS or a similar course or courses preapproved by the Division, the dental assistant need not com-

143

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants

144

plete the course hours required in subsection (c)(2)(A). The course shall have been completed no earlier than December 31, 2002. Proof shall be made available to the Division upon request. D) The dental assistant is functioning under the supervision of the dentist who must remain in the facility. E) The dental assistant maintains BLS certification or its equivalent, which will be in addition to the required courses. Coronal polishing, provided: A) The dental assistant has completed an approved course of 6 hours relative to coronal polishing and has submitted certification of successful completion to the dentist. The course shall have been completed no earlier than January 1, 1998. Proof shall be made available to the Department upon request. The required hours shall include a minimum of 4 hours of didactic study in areas of anatomy, physiology, pharmacology and dental emergencies and 2 hours of clinical instruction and have been provided by an educational institution such as a dental school, dental hygiene or dental assistant program or by an approved CE sponsor. Courses being offered by CE sponsors approved pursuant to Section 1220.440(b)(2)(N) must be pre-approved by the Department prior to their initial offering and must meet the requirements set forth in this subsection (c)(3). The assistant must pass an examination in the didactic portion of the course and the clinical portion must contain experience on human subjects; B) Coronal polishing shall be limited to polishing the clinical crown of the tooth and existing restoration, supragingivally; C) Coronal polishing shall be limited to the use of slow speed rotary instruments using a rubber cup and/or brush polishing method. The use of air polish by dental assistants is not permitted; and D) A dentist shall be limited to supervising four dental assistants at any one time for the task of coronal polishing. Pit and fissure sealant application, provided: A) The dental assistant has completed a course of at least 2 hours of didactic study and 2 hours of clinical instruction; B) Prior to being permitted to place sealants in accord with this Section, the supervising dentist has personally observed the dental assistant successfully place 6 pit and fissure sealants; C) The supervising dentist must document that the training has been completed; and D) The supervising dentist is responsible for examining the patient prior to and following the placement of sealants by a dental assistant. Placing, carving and finishing amalgam restorations, provided: A) The dental assistant functions under the direct supervision of the dentist who remains in the facility and examines the work done by the assistant prior to the dismissal of the patient. B) The dental assistant is at least 18 years of age and can show proof that he or she is a DANB Certified Dental Assistant or has been employed as a dental assistant with a minimum of 2 years continuous handson experience (4,000 hours). C) The dental assistant is responsible for obtaining proof of certification, indicating successful completion of a 40 hour course that contains lecture, laboratory and manikin training relative to the placing, carving and finishing of amalgam restorations and submitting certification to the dentist. Proof of completion of education shall be made available to the Division upon request. The required hours shall include both didactic and clinical components and be given by a continuing education sponsor approved by the Division and taught in an institution that is CODA approved, such as a dental school, hygiene program or assistant program. The course shall contain, at a minimum, the following preclinical, didactic and clinical instruction: i) nomenclature; ii) caries classification; iii) oral anatomy; iv) dental morphology; v) periodontium; vi) histology; vii) basic occlusion; viii) ergonomics; ix) instrumentation; x) pulp protection liners and bases; xi) dental materials; xii) the medical history and conditions and their implication for dental treatment and office emergencies; xiii) matrix and wedge techniques; xiv) amalgam placement and carving; xv) polishing amalgams; xvi) rubber dam clamp placement; xvii) rubber dam placement and removal; xviii) amalgam class I, II, IV and V. Class II cannot involve cusp replacement or pins. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants D) All applicants must take and pass a pre-examination on basic dental procedures and techniques, as well as the basic fundamentals of dentistry. E) All applicants must pass DANB’s AMP Exam, IS Exam, and RF Exam or equivalent exams administered by DANB or DANB’s successor organization, or pass another written and clinical exam that is psychometrically sound and approved by the Board. F) All applicants must maintain proof of BLS certification. G) As a condition of acceptance into the program, a supervising dentist must attend a required orientation class with the applicant and sign an agreement that he or she will follow the required guidelines regarding supervision and clinical application of specific techniques being taught between scheduled classes. d) An individual who graduated from an approved dental assisting program after January 1, 1999 that contained monitoring nitrous oxide, coronal polishing, and sealant application in the curriculum shall not be required to complete an additional course or courses in these areas as prescribed in this Section upon proof to the dentist of having successfully completed the required curriculum. e) All intraoral procedures performed by a dental assistant must be examined by the supervising dentist prior to the dismissal of the patient from the facility that day. Section 1220.500 Definitions. “Anesthesia Case” means a situation in which the permit holder is responsible for anesthesia care on a live patient. “Deep Sedation” means a pharmacologically induced depressed state of consciousness, accompanied by partial loss of protective reflexes, including the inability to respond purposefully to oral commands. The purposeful response to painful stimulation is maintained. “General Anesthesia” means a pharmacologically induced state of unconsciousness accompanied by a partial or complete loss of protective reflexes, including the inability to independently maintain an airway and respond purposefully to painful stimulation or oral commands. “Minimal Sedation” or “Anxiolysis” means a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient’s ability to independently and continually maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. “Moderate Sedation” or “Conscious Sedation” means a pharmacologically induced depressed state of consciousness (altered consciousness; signs of sleep) under which an individual retains the ability to independently and continuously maintain an airway and respond appropriately to light tactile stimulation and oral commands. Section 1220.510 Moderate Sedation (Conscious Sedation) in the Dental Office Setting b) A licensed dentist seeking a Permit A for moderate sedation (conscious sedation) administration privileges shall file an application with the Division, on forms provided by the Division, that shall include: 2) A signed affidavit certifying that: B) the facility will be staffed with a team, supervised by the applicant, that will remain in the treatment room. For each patient, the anesthesia team will consist of at least: i) the dentist who holds the Permit A; ii) one dental hygienist or dental assistant who has completed the training prescribed in Section 1220.240(f) or 1220.245(c)(2) and is capable of assisting with procedures, problems and emergencies incident to the administration of sedation; and iii) one additional hygienist or dental assistant; C) the dentist permit holder will remain immediately available to the patient after being treated under moderate sedation. A dental hygienist or dental assistant trained to monitor a patient under moderate sedation will remain with the sedated patient until the patient is no longer sedated; D) all members of the anesthesia team are capable of assisting with procedures, problems and emergencies incident to the administration of sedation and will maintain current certification in BLS; and Section 1220.520 Deep Sedation and General Anesthesia in the Dental Office Setting a) A licensed dentist seeking a permit to administer deep sedation or general anesthesia shall make application to the Division, on forms provided by the Division, that shall include: 2) A signed affidavit certifying that: B) the facility will be staffed with an anesthesia team, supervised by the applicant, that will remain in the treatment room during the procedure on the patient. For each patient, the anesthesia team will consist of at least: i) the dentist who holds the permit B;

145

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants ii) one dental hygienist or dental assistant who has completed the training prescribed in Section 1220.240(f) or 1220.245(c)(2) and is capable of assisting with procedures, problems and emergencies incident to the administration of the sedation; and iii) one additional hygienist or dental assistant; C) the dentist permit holder will remain immediately available to the patient after being treated under deep sedation or general anesthesia. A dental hygienist or dental assistant trained to monitor a patient under deep sedation or general anesthesia will remain with the sedated patient until the patient is no longer sedated; D) all members of the anesthesia team are capable of assisting with procedures, problems and emergencies incident to the administration of sedation and will maintain current certification in BLS or its equivalent; and E) for the dentist permit holder, the BLS certification is in addition to the required 9 sedation technique CE hours (see subsection (h) required per renewal cycle; i) A treating dentist does not need to hold Permit B to perform dentistry when another dentist, who holds Permit B, or a physician assists the treating dentist by administering deep sedation or general anesthesia. Physician for purposes of this Section means a physician who is licensed to practice medicine in all of its branches under the Medical Practice Act of 1987 and is authorized to provide anesthesia services in a licensed hospital or licensed ambulatory surgical treatment center or is a Board certified anesthesiologist. 1) The treating dentist shall be prepared to provide affidavits attesting to the following if requested by the Division: B) That the dentist shall staff the facility with a team, supervised by the Permit B holder or physician, that includes a minimum of 3 individuals per patient. The team shall be composed of either: i) One dental hygienist or dental assistant who has completed the training prescribed in Section 1220.240(f) or 1220.245(c)(2) capable of assisting with procedures, problems and emergencies incident to the administration of the sedation; the treating dentist; and the dentist who holds a Permit B providing the anesthesia services; or ii) One dental hygienist or dental assistant who has completed the training prescribed in Section 1220.240(f) or 1220.245(c)(2) capable of assisting with procedures, problems and emergencies incident to the administration of the sedation; the treating dentist; and a physician. 2) All members of the anesthesia team, including the treating dentist (non-Permit B holder) must maintain certification in BLS or its equivalent.

146

Indiana DANB Certificant Counts: Indiana National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

1,298

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Indiana State Board of Dentistry 402 W. Washington St., Room W072 Indianapolis, IN 46204 Phone: 317-234-2054 Email: pla8@pla.in.gov Website: www.in.gov/pla/dental.htm

11,241

Infection Control (ICE)

4,087

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

State Agency Responsible for Radiography Regulation Division of Radiology and Weights and Measures Indiana State Department of Health 2 North Meridian Street, 4 Selig Indianapolis, IN 46204-3010 Phone: 317-233-7565 Fax: 317-233-7154 Website: http://www.in.gov/isdh/23279.htm

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs

DANB CDA Certificant State of Indiana+

$18.75 per hour

DANB CDA Certificant

$20.76

Indiana University School of Dentistry (Indianapolis and Fort National+ per hour Wayne campuses) Indiana University Northwest-Gary All Dental Assistants $18.59 International Business College ++ National per hour Ivy Tech Community College–Anderson Ivy Tech Community College–Columbus Ivy Tech Community College–Kokomo Ivy Tech Community College–Lafayette Ivy Tech Community College–South Bend DANB certificant and exam information is current as of July 1, 2020. University of Southern Indiana State-specific information on the pages that follow has been updated by DANB as of June 9, 2020. The pages that follow contain information about this state's requirements for dental assistants. If you have any questions about DANB-administered exams, contact DANB. For questions or further information about state requirements, contact the state board of dentistry. In this state, radiography requirements for dental assistants are established by a state regulatory body other than the state dental board. Contact the Division of Medical Radiology Services, Indiana State Department of Health, for information about qualifying to take dental radiographs in this state DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

Source: 2018 DANB Salary Survey (state data based on 30 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

147

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the Indiana State Board of Dentistry. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page. Radiography is regulated by the Indiana State Department of Health, which has reviewed the information pertaining to radiography on the pages that follow.

Indiana State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Indiana, a dental assistant must obtain a limited radiology license from the Indiana State Department of Health/Division of Medical Radiology Services. To obtain this license, one must have satisfactorily: (1) Completed a CODA-accredited educational program in radiography or a limited dental radiography program approved by the department, AND (2) Been certified by a licensed practitioner or licensed hygienist as proficient in performing the procedures included in the limited dental curriculum, AND (3) Passed either the DANB CDA, DANB RHS, or other exam approved by the department AND (4) Completed the requirements in 410 IAC 5.2-4 (see following pages). A student enrolled in a CODA-accredited dental assisting program is eligible for a student radiology permit. The permit expires upon the student’s withdrawal or termination from the program or six (6) months after the student’s graduation from a dental assisting program. The student must be properly supervised, and the student permit only allows the performance of procedures as part of the education program. A person enrolled in an Indiana State Department of Health-approved limited radiology program is eligible for a provisional radiography permit upon completion of the requirements under 410 IAC 5.2-4 (see 410 IAC 5.2-3-3 on page 153 for details). The permit expires six (6) months after its effective date.

State Requirements For Expanded Functions To qualify to polish the coronal surfaces of the teeth, a dental assistant must: (1a) Be employed in a dental practice for a minimum of one year and complete an educational program approved by the Indiana State Board of Dentistry that includes the following instruction in coronal polishing: 5 hours of didactic instruction meeting Board curriculum requirement; 2 hours of laboratory work; performance of the task on five patients under the observation of a licensed dentist or dental hygienist; an affidavit certifying competency signed by the supervising dentist OR (1b) Graduate from an educational program accredited by the Commission on Dental Accreditation (CODA) that included instruction meeting the above requirements, AND (2) Display certificate of completion of education program publicly in the dental office. To qualify to apply medicaments for the control or prevention of dental caries (i.e., apply topical fluoride), a dental assistant must: (1a) Be employed in a dental practice for a minimum of one year and complete an educational program approved by the Indiana State Board of Dentistry that includes the following instruction in prevention of dental caries: 9 hours of didactic instruction meeting Board curriculum requirement; 2 hours of laboratory work; performance of the task on five patients under the observation of a licensed dentist or dental hygienist; an affidavit certifying competency signed by the supervising dentist, OR (1b) Graduate from an educational program accredited by CODA that included instruction meeting the above requirements, AND (2) Display certificate of completion of education program publicly in the dental office To qualify to administer nitrous oxide, a dental assistant must: (1a) Be employed in a dental practice for a minimum of one year OR (1b) Graduate from a CODA-accredited educational program, AND (2) Complete a CODA-accredited course that includes the following: 3 hours of didactic instruction meeting state curriculum requirement; demonstration of clinical competence on at least five (5) patients under the direct supervision of a licensed Indiana dentist in good standing; an affidavit certifying competency signed by the supervising dentist, AND (3) Display certificate of completion of education program publicly in the dental office.

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Indiana State Board of Dentistry Indiana Code Article 13. Dental Hygienists 25-13-1-10.7 [EFFECTIVE JULY 1, 2020]: Sec. 10.7. (a) A dental hygienist or dental assistant (as defined in IC 25-14-1-1.5(4)) may administer nitrous oxide under the direct supervision of a licensed dentist if the dental hygienist or dental assistant has: (1) been employed in a dental practice for at least one (1) year or has graduated from a program accredited by the Commission on Dental Accreditation of the American Dental Association; (2) satisfactorily completed a three (3) hour didactic nitrous oxide administration course containing curriculum on pharmacology, biochemistry, anatomy of nitrous oxide administration, emergency procedures, and the mechanics of operating a nitrous unit, accredited by the Commission on Dental Accreditation of the American Dental Association; and (3) demonstrated clinical competency on at least five (5) patients under the direct supervision of a licensed Indiana dentist whose license is in good standing. 148

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants (b) The licensed Indiana dentist supervising the clinical competency under subsection (a)(3) shall provide to the dental hygienist or dental assistant a signed affidavit certifying the competency. (c) Upon receipt of the affidavit provided to a dental hygienist or dental assistant under subsection (b), the provider of an educational program or curriculum described in subsection (a)(2) shall issue a certificate of completion to the dental hygienist or dental assistant. The certificate of completion must be publicly displayed in the dental office of the dental hygienist or dental assistant. (d) Before permitting a dental hygienist or dental assistant to administer nitrous oxide, the supervising dentist shall: (1) verify that the dental hygienist or dental assistant has completed the requirements of subsection (a); (2) determine the maximum percent-dosage of nitrous oxide to be administered to the patient; and (3) ensure that any administration or monitoring of nitrous oxide by dental hygienists or dental assistants is done in accordance with relevant guidelines and standards developed by the American Dental Association or the American Academy of Pediatric Dentistry. IC 25-13-1-11 Practice of dental hygiene; acts performed (As noted in section IC 25-14-1-23) Sec. 11. A person is deemed to be practicing dental hygiene within the meaning of this chapter who: (1) uses the titles “Licensed Dental Hygienist”, “Dental Hygienist”, or the letters “L.D.H.” or “D.H.” in connection with his or her name; (2) holds himself or herself out to the public in any manner that he or she can or will render services as a dental hygienist; (3) removes calcific deposits or accretions from the surfaces of human teeth or cleans or polishes such teeth; (4) applies and uses within the patient’s mouth such antiseptic sprays, washes, or medicaments for the control or prevention of dental caries as his or her employer dentist may direct; (5) treats gum disease; (6) uses impressions and x-ray photographs for treatment purposes; or (7) administers local dental anesthetics or nitrous oxide, except for the administration of local dental anesthetics or nitrous oxide by: (A) a dentist as provided in IC 25-14-1-23(a)(6); or (B) a physician licensed under IC 25-22.5; or (C) a dental assistant (as defined in IC 25-14-1-1.5(4)) in compliance with section 10.7 of this chapter. IC 25-13-1-12.5 Sec. 12.5 If a dental hygienist or a dental assistant determines that treatment of a patient would result in harm to the patient, the dental hygienist, or dental assistant, the dental hygienist or dental assistant may request, and the supervision dentist may grant, a consultation between the dentist and the dental hygienist or the dental assistant to consult on the proper treatment plan for the patient to reduce the potential harm to the patient, dental hygienist, and dental assistant. IC 25-13-3-7 Release of information forms; dental assistant supervision Sec. 7(b) A dental hygienist may use or supervise a dental assistant while providing services under an access practice agreement. However, the dental assistant may not provide direct clinical services to a patient. Article 14. Dentists IC 25-14-1-1.5 Definitions Sec. 1.5. The following definitions apply throughout this article: (1) "Agency" refers to the Indiana professional licensing agency established by IC 25-1-5-3. (2) "Board" refers to the state board of dentistry established under this chapter. (3) "Deep sedation" means a drug induced depression of consciousness during which cardiovascular function is usually maintained and the individual may: (A) not be easily aroused; (B) be able to respond purposefully following repeated or painful stimulation; (C) have an impaired ability to independently maintain ventilatory function; (D) require assistance in maintaining a patent airway; and (E) have inadequate spontaneous ventilation. (4) "Dental assistant" means a qualified dental staff member, other than a licensed dental hygienist, who assists a licensed dentist with patient care while working under the dentist's direct supervision. (5) "Direct supervision" means that a licensed dentist is physically present in the facility when patient care is provided by the dental assistant. (6) "Enteral route of administration" means a technique of administering an agent so that it is absorbed through the gastrointestinal tract or oral mucosa. (7) "General anesthesia" means a drug induced loss of consciousness during which cardiovascular function may be impaired and the individual: (A) is not arousable, even by painful stimulation; (B) often has an impaired ability to independently maintain ventiliatory function; (C) often requires assistance in maintaining a patent airway; and © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

149

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants (D) may require positive pressure ventilation because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. (8) "Moderate sedation" means a drug induced depression of consciousness during which cardiovascular function is usually maintained and the individual: (A) responds purposefully to verbal commands, either alone or with light tactile stimulation; (B) does not require intervention to maintain a patent airway; and (C) has adequate spontaneous ventilation. (9) "Parenteral route of administration" means a technique of administering an agent by intravenous or intramuscular injection so that it bypasses the gastrointestinal tract IC 25-14-1-23 Practice of dentistry; delegation; procedures prohibited to be delegated; dental students; pharmacists filling prescriptions; services dental assistants may perform (c) This section shall not apply to those procedures which a legally licensed and practicing dentist may delegate to a dental assistant as to which procedures the dentist exercises direct supervision and responsibility. (d) Procedures delegated by a dentist may not include the following: (1) Those procedures which require professional judgment and skill such as diagnosis, treatment planning, the cutting of hard or soft tissues, or any intraoral impression which would lead to the fabrication of a final prosthetic appliance. (2) Except for procedures described in subsections (g) and (h), procedures delegated to a dental assistant may not include procedures allocated under IC 25-13-1 to a licensed dental hygienist (g) Notwithstanding IC 25-13-1-11(4), a dental assistant who has completed a board approved curriculum may apply medicaments for the control or prevention of dental caries under the direct supervision of a licensed dentist. The curriculum must include instruction on the following: (1) Ethics and jurisprudence. (2) Reasons for fluorides. (3) Systemic fluoride. (4) Topical fluoride. (5) Fluoride application. (6) Laboratory work on topical fluoride applications and patient competency. (h) Notwithstanding IC 25-13-1-11(3), a dental assistant who has completed a board approved curriculum may polish the coronal surface of teeth under the direct supervision of a licensed dentist. The curriculum must include instruction on the following: (1) Ethics and jurisprudence. (2) Plaque and materia alba. (3) Intrinsic and extrinsic stain. (4) Abrasive agents. (5) Use of a slow speed hand piece, prophy cup, and occlusal polishing brush. (6) Theory of selective polishing. (7) Laboratory work concerning slow speed hand piece, hand dexterity, and patient competency. Indiana Administrative Code Title 828 State Board of Dentistry Article 0.5. General Provisions Rule 1. Definitions 828 IAC 0.5-1-4 “Basic cardiac life support” defined Sec. 4. “Basic cardiac life support” means the successful completion of a course in artificial respiration and cardiac compression which enables the applicant to sustain life in an arrest state. 828 IAC 0.5-1-6.6 "Coronal polishing" defined Sec. 6.6. "Coronal polishing" means the use of a prophylaxis cup or occlusal polishing brush attached to a slow speed hand piece to polish the coronal surface of teeth. 828 IAC 0.5-1-7 "Deep sedation" defined Sec. 7. "Deep sedation" means a controlled state of consciousness, accompanied by a partial loss of protective reflexes, including inability to respond purposefully to verbal command, produced by a pharmacologic method. 828 IAC 0.5-1-7.1 "Dental assistant" defined Sec. 7.1. "Dental assistant" has the meaning set forth in IC 25-14-1-1.5. 828 IAC 0.5-1-7.4 "Direct supervision" defined Sec. 7.4. "Direct supervision" has the meaning set forth in: (1) IC 25-13-1-2(i) for dental hygienists; and (2) IC 25-14-1-1.5 for dental assistants.

150

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants 828 IAC 0.5-1-8 "General anesthesia" defined Sec. 8. "General anesthesia" means a controlled state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic method. 828 IAC 0.5-1-9 "Light parenteral conscious sedation" defined Sec. 9. "Light parenteral conscious sedation" means a minimally depressed level of consciousness, under which an individual retains the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by an intravenous pharmacological method. 828 IAC 0.5-1-9.1 "Local dental anesthetics" defined Sec. 9.1. "Local dental anesthetics" means a drug or drugs administered by an intraoral block or infiltration injection into the oral tissues of a patient for elimination of sensation, especially pain. The term does not include nitrous oxide or similar analgesics. Article 3. Anesthesia and Sedation Rule 1. General Requirements 828 IAC 3-1-6.1 Standard of care; light parenteral conscious sedation (5) In addition to the dentist who has obtained training in resuscitation protocols, there must be present during administration of light parenteral conscious sedation at least one (1) additional person who has successfully completed a course in basic cardiac life support. (6) Personnel trained in basic cardiac life support shall provide direct supervision and monitoring of the patient during the procedure and until the patient is deemed ready to leave the facility by the dentist. (7) The patient shall be monitored by the pulse oximeter throughout the procedure. (8) A blood pressure must be taken periodically throughout the procedure. (9) The skin color, movement of breathing bag, blood color, or other parameters of adequate blood oxygenation shall be monitored throughout the procedure. (11) It is strongly recommended that the dentist and trained staff hold drills on emergency procedures four (4) times per year. A record that the drills have taken place should be maintained in the office of the dentist. The record should include the date that the drill took place and the names of those persons who participated in the drill. The records may be destroyed after three (3) years. (12) The dentist shall maintain a record that the dentist has training in resuscitation protocols and that the dentist’s staff has maintained, on an annual basis, current training in basic cardiac life support. 828 IAC 3-1-6.5 Standard of care; general anesthesia and deep sedation (b) As used in this section, “anesthetic team” means the following: (1) At least one (1) dentist who holds a permit to administer general anesthesia or deep sedation. All dentists under this section shall be trained and currently competent in advanced cardiac life support. (2) At least two (2) persons who are employed in the dental office under IC 25-14-1-23(c) or who are dental hygienists licensed under IC 25-13. All such persons who are members of the anesthetic team shall be trained and currently competent in basic life support. (c) The following are the minimum standards of care when general anesthesia or deep sedation is utilized: (7) The anesthetic team must be present during the administration of general anesthesia or deep sedation, and one (1) assistant’s sole responsibility is to monitor the patient’s vital signs and/or maintain an airway. This section does not relieve the dentist of responsibility for monitoring the patient. (8) Continuous supervision and monitoring of the patient includes, but is not limited to, oxygenation and ventilation, which must be continuously monitored during the administration of the anesthetic by the following: (A) Palpation or observation of the reservoir breathing bag. (B) Monitoring of skin color, mucosa, nail beds, and surgical site for color. (C) Auscultation of breath and/or heart sounds is recommended. (D) Pulse oximeter. (E) Palpation of peripheral pulse. (F) Blood pressure taken periodically throughout the procedure. (G) Electrocardiogram (EKG) continuously displayed until the patient leaves the operating area. (9) The anesthetic team must be clinically aware of any changes in the patient’s body temperature. The equipment to take and record the patient’s body temperature should be readily available at all times. (12) It is strongly recommended that the dentist and trained staff hold drills on emergency procedures four (4) times per year. A record that the drills have taken place should be maintained in the office of the dentist. The record should include the date that the drill took place and the names of those persons who participated in the drill. The records may be destroyed after three (3) years. (13) The dentist shall maintain a record that the dentist has training in advanced cardiac life support and that the dentist’s staff has maintained, on an annual basis, current training and successful completion of a course in basic life support. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

151

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants Article 6. Dental Assistants Rule 1. Caries Prevention and Coronal Polishing; Requirements, Limitations 828 IAC 6-1-1 Caries prevention Sec. 1. (a) A dental assistant who has been employed in a dental practice for a minimum of one (1) year or has graduated from a program accredited by the Commission on Dental Accreditation of the American Dental Association and who has completed the requirements in subsection (b) may apply medicaments for the control or prevention of dental caries under the direct supervision of a licensed dentist. (b) A dental assistant may not apply medicaments for the control or prevention of dental caries until satisfactory completion of an educational program or curriculum accredited by the Commission on Dental Accreditation of the American Dental Association or approved by the board in the following order that includes, at a minimum: (1) Nine (9) hours of didactic instruction covering the following subject areas: (A) Ethics and jurisprudence. (B) Reasons for fluoride. (C) Systemic fluoride. (D) Topical fluoride. (E) Toxicity of fluoride. (F) Fluoride application. (G) Infection control. (2) Two (2) hours of laboratory work, including a mannequin and two (2) live patients, in topical fluoride applications. (3) Clinical competency demonstrated on a minimum of five (5) patients under the direct observation of an Indiana dentist or dental hygienist whose license is in good standing and an affidavit certifying the competency signed by the supervising dentist and a copy given to the employee. (4) Upon receipt of the affidavit, signed by the supervising dentist, the education program shall issue a certificate of completion to be publicly displayed in the dental office. 828 IAC 6-1-2 Coronal polishing Sec. 2. (a) A dental assistant who has been employed in a dental practice for a minimum of one (1) year or has graduated from a program accredited by the Commission on Dental Accreditation of the American Dental Association and who has completed the requirements in subsection (b) may polish the coronal surface of teeth under the direct supervision of a licensed dentist. (b) A dental assistant may not polish the coronal surface of teeth until satisfactory completion of an educational program or curriculum accredited by the Commission on Dental Accreditation of the American Dental Association or approved by the board in the following order that includes, at a minimum: (1) Five (5) hours of didactic instruction covering the following subject areas: (A) Ethics and jurisprudence. (B) Plaque and material alba. (C) Intrinsic and extrinsic stain. (D) Abrasive agents. (E) Use of a slow speed hand piece, prophy cup, and occlusal polishing brush. (F) Theory of selective polishing. (G) Infection control. (2) Two (2) hours of laboratory work, including a mannequin and two (2) live patients, in the use of a slow speed hand piece, prophy cup, and occlusal polishing brush and hand dexterity. (3) Clinical competency demonstrated on a minimum of five (5) patients under the direct observation of an Indiana dentist or dental hygienist whose license is in good standing and an affidavit certifying the competency signed by the supervising dentist and a copy given to the employee. (4) Upon receipt of the affidavit, signed by the supervising dentist, the educational program shall issue a certificate of completion to be publicly displayed in the dental office. 828 IAC 6-1-3 Verification of education by supervising dentist Sec. 3. (a) Before permitting a dental assistant to apply medicaments for the control or prevention of dental caries, the supervising dentist shall verify that the dental assistant has completed the educational requirements for caries prevention set forth in section 1 of this rule. (b) Before permitting a dental assistant to polish the coronal surface of teeth, the supervising dentist shall verify that the dental assistant has completed the educational requirements for coronal polishing set forth in section 2 of this rule. (c) The following shall be publicly displayed in the dental office: (1) Documentation that a dental assistant has completed the educational requirements to: (A) apply medicaments for the control and prevention of dental caries; or (B) polish the coronal surface of teeth. (2) The certificate of completion. 152

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants 828 IAC 6-1-4 Limitation on procedures Sec. 4. Except for the procedures described in sections 1 and 2 of this rule, procedures allocated to a licensed dental hygienist under IC 25-13-1 may not be delegated to a dental assistant. 828 IAC 6-1-5 Requirements for out-of-state programs Sec. 5. (a) A dental assistant who has completed an out-of-state dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association or an out-of-state continuing education program with the equivalent hours and curriculum as stated in sections 1 and 2 of this rule, to apply medicaments for the control or prevention of dental caries or to polish the coronal surface of teeth, must provide a syllabus of course work successfully completed by the applicant. (b) The course work must be equal to or greater than the requirements specified in sections 1 and 2 of this rule. (c) If the out-of-state curriculum is less than the Indiana requirements to apply medicaments for the control or prevention of dental caries or to polish the coronal surface of teeth, then the dental assistant must complete the laboratory work and clinical competency portion of section 1 of this rule at a board approved course in Indiana and obtain a certificate of completion from the educational program. The dental assistant shall display the diploma from the program accredited by the Commission on Dental Accreditation of the American Dental Association or certificate of completion from the board approved course. Radiology Laws and Regulations—Indiana State Department of Health INDIANA ADMINISTRATIVE CODE TITLE 410 INDIANA STATE DEPARTMENT OF HEALTH Article 5.2 Radiography, Nuclear Medicine, and Radiation Therapy Licensing Rule 3. Licensing and Permit Requirements 410 IAC 5.2-3-1 Licensing and permit requirements Sec. 1. (a) A person who does not have a current license, certificate, or permit issued by the department shall not operate a radiation machine or use radiopharmaceutical agents. (b) The following are the radiation machine operator and radioactive materials user licenses and permits issued by the department: (7) Student dental radiography permit. (8) Provisional radiography permit. (9) Limited dental radiography license. (c) The department may utilize nationally accepted testing services and review committees to assist in the administration of this article. 410 IAC 5.2-3-2 Student radiology permit requirements Sec. 2. (a) The following persons are eligible for a student radiology permit: (4) A student enrolled in an American Dental Association accredited dental assisting program. (b) A student radiology permit expires upon the student’s withdrawal or termination from the program or six (6) months after the student’s graduation from a dental assisting program. (c) Students in a program listed in subsection (a) must be appropriately supervised according to applicable educational standards by an appropriate practitioner, licensed dental hygienist, or another licensed individual approved by the department in order to assist and evaluate the student’s performance and ensure the quality of the procedure. (d) The student permit only allows the individual to perform procedures as part of the education program in which the student is enrolled. 410 IAC 5.2-3-3 Provisional permit requirements Sec. 3. (a) A person enrolled in a limited radiology program approved by the department is eligible for a provisional radiography permit upon completion of the requirement under 410 IAC 5.2-4. (b) A provisional permit expires six (6) months after its effective date. (c) A provisional permit may not be renewed. (d) Provisional permits are issued in the same limited category as the person would be licensed upon completion of requirements for that limited license. (e) An individual issued a provisional permit may perform any procedure allowed under the scope of practice for a person licensed or certified in that area. (f) If an individual has not completed the requirements for a license upon expiration of the provisional permit, the individual must cease performing radiographic procedures. Once the individual meets the requirements for a limited © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

153

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants license under this article, the individual may apply for the license but may not perform radiographic procedures until he or she is issued a license by the department. (g) The department places no limit on the number of times that an individual may attempt a qualifying examination before, during, or after the provisional period. 410 IAC 5.2-3-4 Evidence of license or permit Sec. 4. Evidence of a person’s current license or permit issued under this article must be available for public inspection within the clinical area where the person is operating a radiation machine or using radiopharmaceutical agents. A copy of the person’s current license, permit or pocket card issued by the department, or a printout of the license or permit status from the department’s on-line licensing system complies with this rule. Rule 4. Licensing and Permitting Procedures 410 IAC 5.2-4-1 Application and approval Sec. 1. (a) To obtain a license or permit, the applicant shall: (1) submit an application for a license or permit on a form and in a manner approved by the department; (2) submit documents required by the application for a license or permit; (3) furnish evidence satisfactory to the department that the qualifying requirements have been met as required by IC 16-41-35-29 and this article; and (4) submit the appropriate fee. (b) Upon receipt of a completed application for a license or permit, the department will review the application and accompanying documentation to determine that the applicant has met the requirements of this article. (c) Upon determination by the department that the applicant has failed to comply with this article, the department may request additional information concerning the application, conduct a further investigation to determine whether a license or permit should be issued, or deny the application. (d) Upon determination by the department that the applicant has complied with the licensing requirements under this article, the department will approve the application and issue the appropriate license or permit. 410 IAC 5.2-4-2 Expiration and renewal of license Sec. 2. (b) If a person becomes licensed in multiple areas, the expiration of the second and subsequent license will be the same as the original license. (c) If not renewing on-line, at least thirty (30) days prior to the expiration of a person’s license or permit, the applicant shall: (1) submit an application for renewal of a radiology license or permit on a form and in a manner approved by the department; (2) submit documents required by the application for renewal; (3) furnish evidence satisfactory to the department that the qualifying requirements have been met as required by IC16-41-35-29 and this article; and (4) submit the appropriate fee. If renewing through the on-line renewal system, the renewal should be completed on-line at least forty-eight (48) hours prior to the expiration of the license to ensure that the renewal is posted prior to the time of expiration. (d) An individual with an expired license or permit shall not perform radiography, fluoroscopy, radiation therapy or nuclear medicine procedures. (e) An application shall be deemed abandoned if, after six (6) months from the date of filing, the requirements for a license or permit have not been completed and submitted to the department. 410 IAC 5.2-4-8 Fees Sec. 8. (a) The fee for a license issued under this article is sixty dollars ($60). (b) The renewal fee for licenses issued under this article is sixty dollars ($60). (c) There is no fee for a student radiology permit or provisional radiology permit. (d) A twenty dollar ($20) fee will be charged for a retired status license. (e) A twenty dollar ($20) fee will be charged for a duplicate license or permit. (f) A twenty dollar ($20) fee will be charged for issuing a license or permit for a name change (g) A late fee of sixty dollars ($60) shall be imposed if the renewal application is received after the expiration of the previous license. Rule 9. Limited Radiography Programs 410 IAC 5.2-9-1 Procedure for limited radiography licensing Sec. 1. (a) To be eligible for a limited radiography license a person shall: (1) be a high school graduate or GED certificate holder; (2) complete a limited radiography program approved by the department; 154

Indiana State Dental Practice Act and Administrative Rules for Dental Assistants (3) obtain clinical training and obtain certification of proficiency. The person must obtain certification of proficiency prior to the expiration of the provisional limited radiography permit; and (4) complete requirements in 410 IAC 5.2-4. (b) An applicant to obtain a limited radiography license shall not operate a radiation machine before obtaining a provisional limited radiography permit or after expiration of a provisional limited radiography permit. (c) The limited radiography program may be completed prior to or after being issued a provisional limited radiography permit. (d) If a person fails to complete the limited radiography program and exam required for a limited radiography license prior to the expiration of the provisional permit, the permit expires and the person may not operate a radiation machine. Upon completion of the limited radiography program and passing of the required exam, the department may grant the individual an additional thirty (30) days to complete the certification of proficiency requirements if not previously completed. 410 IAC 5.2-9-2 Approval of limited radiography programs Sec. 2. (a) The following are the limited radiography programs authorized under this article: (1) Limited dental radiography program. 410 IAC 5.2-9-4 Procedures for certification of proficiency Sec. 4. (a) An applicant for a limited radiography license must obtain a practitioner, an educator in an approved radiologic technology program, or another licensed individual approved by the department to certify the applicantâ&#x20AC;&#x2122;s proficiency in the procedures included under the limited license for which the applicant is applying. The individual providing the certification may only certify procedures that fall under his or her license. (b) The responsibilities of the individual providing the certification are as follows: (1) The individual providing the certification must ensure that the student is instructed on the principles of radiation protection and operation of radiation machines prior to the student making radiographic exposures. (2) The individual providing the certification must provide the applicant with clinical instruction on procedures included in that limited radiography license. (3) The individual providing the certification must ensure that the applicant is under direct supervision by an appropriate practitioner, licensed radiologic technologist, or another licensed individual approved by the department in order to assist and evaluate the studentâ&#x20AC;&#x2122;s performance in terms of positioning, radiation protection, and radiographic image quality. (4) The individual providing the certification shall complete an evaluation and certification form on a form and in a manner approved by the department. (c) The certification must be achieved by the expiration of the provisional permit. (d) The applicant may select a new individual to provide the certification during the provisional license period. This shall not, however, extend the expiration date of the provisional license. Rule 10. Limited Dental Radiography License 410 IAC 5.2-10-1 License requirements Sec. 1. (a) As follows, to be eligible for a limited dental radiography license a person shall have satisfactorily: (1) Completed an educational program from a school whose radiographic program is approved by the Commission on Dental Accreditation or a limited dental radiography program approved by the department; (2) Been certified by a licensed practitioner or licensed dental hygienist in an approved educational program as proficient in performing the procedures included in the limited dental curriculum; (3) Passed one (1) or more of the following examinations: (A) The Dental Assisting National Board (DANB) Certified Dental Assistant (CDA) examination. (B) The Dental Assisting National Board (DANB) Radiation Health and Safety examination. (C) An examination approved by the department. (4) Completed the requirements in 410 IAC 5.2-4. (b) Persons issued a limited dental radiography certificate by the department prior to the effective date of this rule are deemed to be in compliance with subsection (a) and will continue to be issued a renewal upon compliance with the application requirements under 410 IAC 5.2-4. 410 IAC 5.2-10-2 Scope of practice Sec. 2. A limited dental radiography license authorizes an individual to perform any dental radiographic procedure ordered by a practitioner.

155

Iowa DANB Certificant Counts: Iowa Certified Dental Assistant (CDA) certificants

721

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Jill Stuecker, Executive Director Iowa Dental Board 400 SW 8th St., Suite D Des Moines, IA 50309-4687 Phone: 515-281-5157 Fax: 515-281-7969 Email: idb@iowa.gov Website: dentalboard.iowa.gov

Radiation Health and Safety (RHS)

2,125

Infection Control (ICE)

2,133

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Des Moines Area Community College Hawkeye Community College Indian Hills Community College Iowa Western Community College Kirkwood Community College Marshalltown Community College Northeast Iowa Community College Scott Community College Western Iowa Technical Community College

DANB CDA Certificant State of Iowa+

$18.50 per hour

DANB CDA Certificant National+

$20.73 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of July 1, 2020.

156

Source: 2018 DANB Salary Survey (state data based on 13 responses from this state) Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Iowa State Radiography Requirements To expose radiographs in Iowa, a dental assistant must be hold a current registration certificate and active radiography qualification issued by the Iowa Dental Board (IDB) and a dentist must provide general supervision. Dental Assistant Trainee Trainees are all individuals who are engaging in on-the-job training to meet the requirements for registration and who are learning the necessary skills under the personal supervision of a licensed dentist. Trainees may also engage in on-the-job training in dental radiography pursuant to 650-22.3(136C,153). To qualify for dental assistant trainee status, one must: (1a) Be a high school graduate or equivalent and (1b) Be 17 years of age or older OR (2) Be enrolled in a cooperative education or work study program through an Iowa high school, AND (3) Apply to the Iowa Dental Board and receive a certificate of dental assistant trainee status. Dental Radiography Qualification To earn dental radiography qualification, one must: (1a) Be a Dental Assistant Trainee or Registered Dental Assistant with an active registration status or (1b) Be a graduate of an accredited dental assisting program or (1c) Be a nurse who holds an active Iowa nursing license AND (2) Provide proof of successful completion of an Iowa board-approved course of study in dental radiography within the two years prior to application AND (3) Provide proof that he or she successfully completed an Iowa Board-approved exam in the area of dental radiography (the national DANB Radiation Health and Safety [RHS] exam meets this requirement, if taken after January 1, 1986) AND (4) Apply to the IDB for Qualification in Dental Radiography. Note: A dental assistant must be at least 18 years of age to perform dental radiography.

Iowa State Requirements For Assistants to Perform Expanded Functions Iowa Registered Dental Assistant (RDA) In order to be registered as a dental assistant in the state of Iowa, an individual must be 17 years of age or older, be a high school graduate or equivalent, and have successfully completed all Iowa Board-approved training and examination requirements. To qualify as a Registered Dental Assistant (RDA) in Iowa, one must (1a) Work in a dental office for six months as a Dental Assistant Trainee (see requirements shown above) OR (1b) If licensed out of state, have had at least six months prior dental assisting experience under a licensed dentist within the past two years OR (1c) Graduate from an accredited dental assisting program approved by the board; AND (2) Successfully complete an Iowa board-approved course of study in the areas of infection control, hazardous materials, and jurisprudence; the course of study may be taken at a board-approved, accredited dental assisting program or on the job using a curriculum approved by the board; AND (3) Successfully pass required examinations in infection control/hazardous materials and jurisprudence; examinations approved by the board are those administered by the board or the board's approved testing centers, or the DANB Infection Control Exam (ICE), if taken after June 1,1991 (the board may require applicants with exam scores older than five years to retest); AND (4) Hold a valid CPR card; AND (5) Apply to the IDB for registration as a dental assistant on application forms provided by the IDB, or apply online and receive a Certificate of Registration. Notes: Effective on or after May 1, 2013, a dentist supervising a person performing dental assistant duties must ensure that the person has been issued a trainee status certificate from the Board office prior to the person's first date of employment as a dental assistant. A repeat trainee is not required to retake an examination (jurisprudence, infection control/hazardous materials, radiography) if the trainee has successfully passed the examination within three years of the date of application. Basic, Certified Level 1 and Certified Level 2 Expanded Function Providers To perform expanded functions, a registered dental must meet the education and training requirements set forth below. To qualify for expanded function training, a dental assistant must be a graduate of a CODA-accredited dental assisting program, OR hold current DANB certification, OR have a minimum of one year of clinical practice as a registered dental assistant, OR have a minimum of one year of clinical practice as a dental assistant in a state that does not require registration. Basic Expanded Function Provider A Registered Dental Assistant may qualify to perform select Level 1 expanded function procedures by completing a Boardapproved training program in the procedures to be performed. A dentist may delegate to a Registered Dental Assistant only those Level 1 procedures for which the assistant has received the required expanded function training. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

157

Iowa State Requirements For Assistants to Perform Expanded Functions Certified Level 1 Provider A Registered Dental Assistant may qualify as a Certified Level 1 Provider by completing a Board-approved training program in all Level 1 expanded functions and receiving a certificate of completion. Level 1 expanded functions include the following: • Taking occlusal registrations • Placement and removal of gingival retraction material • Fabrication, temporary cementation, and removal of provisional restorations • Applying cavity liners and bases; desensitizing agents; and bonding systems, to include the placement of orthodontic brackets, following the determination of location by the supervising dentist • Monitoring of patients receiving nitrous oxide inhalation analgesia, which may include increasing oxygen levels as needed, pursuant to the following: a. A dentist shall induce a patient and establish the maintenance level b. A dental assistant may make adjustments that decrease the nitrous oxide concentration during the administration of nitrous oxide c. A dental assistant may turn off the oxygen delivery at the completion of the dental procedure • Taking final impressions • Removal of any adhesives using nonmotorized hand instrumentation • Placement of Class 1 temporary filling materials • Recementation of provisional restorations Certified Level 2 Provider A Registered Dental Assistant may qualify as a Certified Level 2 Provider by: (1) Completing a minimum of one year of clinical practice as a Certified Level 1 provider, (2) Passing an entrance examination administered by the Level 2 training program, AND (2) Completing a Board-approved training program in all Level 2 expanded function procedures offered through the University of Iowa College of Dentistry or a program accredited by CODA and receiving a certificate of completion. Level 2 expanded functions include the following: • Placement and shaping of amalgam following preparation of a tooth by a dentist; • Placement and shaping of adhesive restorative materials following preparation of a tooth by a dentist; • Fitting of stainless steel crowns on primary posterior teeth, and cementation after fit verification by the dentist • Tissue conditioning (soft reline only) • Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth • Placement of intracoronal temporary fillings following preparation of a tooth by a dentist

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act — Iowa Dental Board Iowa Code – Chapter 147 General Provisions, Health Related Professions [Statutory Excerpts, Current as of 12/13/16] 147.1 DEFINITIONS. 3. “Licensed” or “certified”, when applied to a physician and surgeon, pediatric physician, osteopathic physician and surgeon, genetic counselor, physician assistant, psychologist, chiropractor, nurse, dentist, dental hygienist, dental assistant, optometrist, speech pathologist, audiologist, pharmacist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, orthotist, prosthetist, pedorthist, respiratory care practitioner, practitioner of cosmetology arts and sciences, practitioner of barbering, funeral director, dietitian, marital and family therapist, mental health counselor, social worker, massage therapist, athletic trainer, acupuncturist, nursing home administrator, hearing aid dispenser, or sign language interpreter or transliterator means a person licensed under this subtitle. 6. “Profession” means medicine and surgery, podiatry, osteopathic medicine and surgery, genetic counseling, practice as a physician assistant, psychology, chiropractic, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, pharmacy, physical therapy, physical therapist assisting, occupational therapy, occupational therapy assisting, respiratory care, cosmetology arts and sciences, barbering, mortuary science, marital and family therapy, mental health counseling, polysomnography, social work, dietetics, massage therapy, athletic training, acupuncture, nursing home administration, practice as a hearing aid specialist, sign language interpreting or transliterating, orthotics, prosthetics, or pedorthics. 158

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 147.2 LICENSE REQUIRED. 1. A person shall not engage in the practice of medicine and surgery, podiatry, osteopathic medicine and surgery, genetic counseling, psychology, chiropractic, physical therapy, physical therapist assisting, nursing, dentistry, dental hygiene, dental assisting, optometry, speech pathology, audiology, occupational therapy, occupational therapy assisting, orthotics, prosthetics, pedorthics, respiratory care, pharmacy, cosmetology arts and sciences, barbering, social work, dietetics, marital and family therapy or mental health counseling, massage therapy, mortuary science, polysomnography, athletic training, acupuncture, nursing home administration, or sign language interpreting or transliterating, or shall not practice as a physician assistant or a hearing aid specialist, unless the person has obtained a license for that purpose from the board for the profession. Iowa Code – Chapter 153 Dentistry [Statutory Excerpts, Current as of 12/13/16] 153.13 “PRACTICE OF DENTISTRY” DEFINED. For the purpose of this subtitle the following classes of persons shall be deemed to be engaged in the practice of dentistry: 1. Persons publicly professing to be dentists, dental surgeons, or skilled in the science of dentistry, or publicly professing to assume the duties incident to the practice of dentistry. 2. Persons who perform examination, diagnosis, treatment, and attempted correction by any medicine, appliance, surgery, or other appropriate method of any disease, condition, disorder, lesion, injury, deformity, or defect of the oral cavity and maxillofacial area, including teeth, gums, jaws, and associated structures and tissue, which methods by education, background experience, and expertise are common to the practice of dentistry. 3. Persons who offer to perform or assist with any phase of any operation incident to tooth whitening, including the instruction or application of tooth whitening materials or procedures at any geographic location. For purposes of this subsection, ”tooth whitening” means any process to whiten or lighten the appearance of human teeth by the application of chemicals, whether or not in conjunction with a light source. 153.14 PERSONS NOT INCLUDED. Section 153.13 shall not be construed to include the following classes: 1. Students of dentistry who practice dentistry upon patients at clinics in connection with their regular course of instruction at an accredited dental college, students of dental hygiene who practice upon patients at clinics in connection with their regular course of instruction at state-approved schools, and students of dental assisting who practice upon patients at clinics in connection with a regular course of instruction determined by the board pursuant to section 153.39. 5. Persons registered to practice as a dental assistant. 153.31 FALSIFICATION IN APPLICATION FOR RENEWAL. A license to practice either dentistry or dental hygiene, or registration as a dental assistant, shall be revoked or suspended in the manner and upon the grounds elsewhere provided in this chapter, and also when the certificate accompanying the application of such licensee or registrant for renewal of license or registration filed with the board is not in all material respects true. 153.38 DENTAL ASSISTANTS -- SCOPE OF PRACTICE. A registered dental assistant may perform those services of assistance to a licensed dentist as determined by the board by rule. A registered dental assistant with additional education and training, as provided by the board by rule, may become certified to perform expanded functions or become qualified to participate in dental radiography. A registered dental assistant who has successfully completed expanded function training through the university of Iowa college of dentistry or a program certified by the commission on dental accreditation may place dental sealants on teeth. Services performed by a registered dental assistant shall be performed under supervision of a licensed dentist, but this section shall not be construed to authorize a dental assistant to practice dentistry or dental hygiene. The board shall not adopt rules that delegate to a dental assistant the administration of local anesthesia or the removal of plaque, stain, calculus, or hard natural material except by toothbrush, floss, or rubber cup coronal polish. Every licensed dentist who utilizes the services of a registered dental assistant for the purpose of assistance in the practice of dentistry shall be responsible for acts delegated to the registered dental assistant. A dentist shall delegate to a registered dental assistant only those acts which are authorized to be delegated to registered dental assistants by the board. 153.39 DENTAL ASSISTANTS—REGISTRATION REQUIREMENTS, RENEWAL, REVOCATION, OR SUSPENSION. 1. A person shall not practice on or after July 1, 2001, as a dental assistant unless the person has registered with the board and received a certificate of registration pursuant to this chapter. 2. Education requirements shall be determined by the board by rule, according to standards to be determined by the board. A person shall be registered upon the successful completion of either of the education and examination requirements established in paragraph “a” or “b”: a. Successful completion of a course of study and examination approved by the board and sponsored by a boardapproved postsecondary school. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

159

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants b.

4. 5.

Successful completion of on-the-job training and examination consisting of all of the following: (1) Completion of on-the-job training as specified in rule. (2) Successful completion of an examination process approved by the board. A written examination may be waived by the board pursuant to section 17A.9A, in practice situations where the written examination is deemed to be unnecessary or detrimental to the dentist’s practice. The education requirements in subsection 2, paragraphs “a” and “b” may include possession of a valid certificate in a nationally recognized course in cardiopulmonary resuscitation. Successful passage of an examination administered by the board under subsection 2, paragraph “a” or “b”, which shall include sections regarding infection control, hazardous materials, and jurisprudence, shall also be required. The board shall establish continuing education requirements as a condition of renewing registration as a registered dental assistant, as well as standards for the suspension or revocation of registration. A person employed as a dental assistant after July 1, 2005, shall have a twelve-month period following the person’s first date of employment after July 1, 2005, to comply with the provisions of subsection 1. Iowa Administrative Code - Dental Board [650] [Rule Excerpts, Current and effective as of 4/1/2020] CHAPTER 1—ADMINISTRATION

650—1.1 (153) Definitions. As used in these rules: “Accredited school” means a dental, dental hygiene, or dental assisting education program accredited by the American Dental Association Commission on Dental Accreditation. “Coronal polish” means an adjunctive procedure that must also include removal of any calculus, if present, by a dentist or dental hygienist. Coronal polishing of teeth using only a rotary instrument and a rubber cup or brush for such purpose, when performed at the direction of and under the supervision of a licensed dentist, is deemed not to be the giving of prophylactic treatment. “Direct supervision” means that the dentist is present in the treatment facility, but it is not required that the dentist be physically present in the treatment room. "General supervision of a dental assistant" means that a dentist has examined the patient and has delegated the services to be provided by a registered dental assistant, which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light and intraoral camera. The dentist need not be present in the facility while these services are being provided. “Inactive status” means the status of a practitioner licensed or registered pursuant to Iowa Code chapter 153 who is not currently engaged in the practice of dentistry, dental hygiene, or dental assisting in the state of Iowa and who has paid the required renewal fee but who has not met the requirements for continuing education. “Lapsed license,” “permit,” or “registration” means a license, permit, or registration that a person has failed to renew as required or the license, permit, or registration of a person who failed to meet stated obligations for renewal within a stated time. A person whose license, permit, or registration has lapsed continues to hold the privilege of licensure or registration in Iowa, but may not practice dentistry, dental hygiene, or dental assisting until the license, permit, or registration is reinstated. “Overpayment” means payment in excess of the required fee. Overpayment shall result in the return of the original request and payment, prior to processing, with a clarification of the total amount due. “Peer review” as defined in Iowa Code section 272C.1(7) means evaluation of professional services rendered by a licensee or registrant. “Personal supervision” means the dentist is physically present in the treatment room to oversee and direct all intraoral or chairside services of the dental assistant trainee and a licensee or registrant is physically present to oversee and direct all extraoral services of the dental assistant. “Registrant” means a person who has been issued a certificate to practice as a dental assistant under the laws of this state. “Registration” means a certificate issued to a person to practice as a dental assistant under the laws of this state. CHAPTER 11—LICENSURE TO PRACTICE DENTISTRY OR DENTAL HYGIENE Appeal procedure process also applies to Dental Assistants. (See Rule 20.9 on page 168) 650—11.10 (147) Denial of licensure—appeal procedure. 11.10(1) Preliminary notice of denial. Prior to the denial of licensure to an applicant, the board shall issue a preliminary notice of denial that shall be sent to the applicant by regular, first-class mail. The preliminary notice of denial is a public record and shall cite the factual and legal basis for denying the application, notify the applicant of the appeal process, and specify the date upon which the denial will become final if it is not appealed. 160

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 11.10(2) Appeal procedure. An applicant who has received a preliminary notice of denial may appeal the notice and request a hearing on the issues related to the preliminary notice of denial by serving a request for hearing upon the executive director not more than 30 calendar days following the date when the preliminary notice of denial was mailed. The request is deemed filed on the date it is received in the board office. The request shall provide the applicant’s current address, specify the factual or legal errors in the preliminary notice of denial, indicate if the applicant wants an evidentiary hearing, and provide any additional written information or documents in support of licensure. 11.10(3) Hearing. If an applicant appeals the preliminary notice of denial and requests a hearing, the hearing shall be a contested case and subsequent proceedings shall be conducted in accordance with 650—51.20(17A). License denial hearings are open to the public. Either party may request issuance of a protective order in the event privileged or confidential information is submitted into evidence. a. The applicant shall have the ultimate burden of persuasion as to the applicant’s qualification for licensure. b. The board, after a hearing on license denial, may grant the license, grant the license with restrictions, or deny the license. The board shall state the reasons for its final decision, which is a public record. c. Judicial review of a final order of the board to deny a license, or to issue a license with restrictions, may be sought in accordance with the provisions of Iowa Code section 17A.19. 11.10(4) Finality. If an applicant does not appeal a preliminary notice of denial, the preliminary notice of denial automatically becomes final and a notice of denial will be issued. The final notice of denial is a public record. 11.10(5) Failure to pursue appeal. If an applicant appeals a preliminary notice of denial in accordance with 11.10(2), but the applicant fails to pursue that appeal to a final decision within six months from the date of the preliminary notice of denial, the board may dismiss the appeal. The appeal may be dismissed after the board sends a written notice by first-class mail to the applicant at the applicant’s last-known address. The notice shall state that the appeal will be dismissed and the preliminary notice of denial will become final if the applicant does not contact the board to schedule the appeal hearing within 14 days after the written notice is sent. Upon dismissal of an appeal, the preliminary notice of denial becomes final. CHAPTER 14—RENEWAL AND REINSTATEMENT [Rule Excerpts, Current and effective as of 4/1/2020] 650—14.2(153) Renewal of registration as a dental assistant. A certificate of registration as a registered dental assistant must be renewed biennially. Registration certificates shall expire on August 31 of every odd-numbered year. A registrant who is not engaged in practice in the state of Iowa may place the registration on inactive status by submitting a renewal form and paying the required renewal fee. No continuing education hours are required to renew a registration on inactive status until application for reactivation is made. A request to place a registration on inactive status shall also contain a statement that the applicant will not engage in the practice of the applicant's profession in Iowa without first complying with all the rules governing reactivation of inactive registrations. 14.2(1) Renewal procedures. a. Renewal notice. The board office will send a renewal notice by email to each registrant at the registrant’s last-known email address. b. Registrant obligation. The registrant is responsible for renewing the registration prior to its expiration. Failure of the registrant to receive the notice does not relieve the registrant of the responsibility for renewing that registration in order to continue practicing in the state of Iowa. c. Renewal application form. Registrants may renew their registration online or via paper application. Paper application for renewal must be made in writing on forms provided by the board office before the current registration expires. d. Complete and timely filed application. No renewal application shall be considered timely and sufficient until received by the board office and accompanied by all material required for renewal and all applicable renewal and late fees. Incomplete applications will not be accepted. For purposes of establishing timely filing, the postmark on a paper submittal will be used, and for renewals submitted online, the electronic timestamp will be deemed the date of filing. 14.2(2) Application fee. The appropriate fee as specified in 650—Chapter 15 must accompany the application for renewal. A penalty shall be assessed by the board for late renewal, as specified in 650—Chapter 15. 14.2(3) Continuing education requirements. Completion of continuing education as specified in 650—Chapter 25 is required for renewal of an active registration. Failure to meet the requirements of renewal in the time specified by rule will automatically result in a lapsed registration. 14.2(4) CPR certification. In order to renew a registration, an applicant must submit a statement: a. Confirming that the applicant possesses a valid certificate from a nationally recognized course in cardiopulmonary resuscitation (CPR) that included a “hands-on” clinical component; b. Providing the expiration date of the CPR certificate; and c. Acknowledging that the CPR certificate will be retained and made available to board office staff as part of routine auditing and monitoring. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

161

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants This rule is intended to implement Iowa Code sections 147.10 and 153.39. 650—14.3(136C,153) Renewal of dental assistant radiography qualification. A certificate of radiography qualification must be renewed biennially. Radiography qualification certificates shall expire on August 31 of every odd-numbered year. 14.3(1) Renewal procedures. a. Renewal notice. The board office will send a renewal notice by regular mail or e-mail to each registrant at the registrant’s last-known mailing address or e-mail address. The board will notify each registrant by mail or e-mail of the expiration of the radiography qualification. b. Registrant obligation. The registrant is responsible for renewing the radiography qualification prior to its expiration. Failure of the registrant to receive the notice does not relieve the registrant of the responsibility for renewing that radiography qualification if the registrant wants to continue taking dental radiographs in the state of Iowa. c. Renewal application form. Application for renewal must be made in writing on forms provided by the board office before the current radiography qualification expires. Registrants may renew their radiography qualification online or via paper application. d. Complete and timely filed application. No renewal application shall be considered timely and sufficient until received by the board office and accompanied by all material required for renewal and all applicable renewal and late fees. Incomplete applications will not be accepted. For purposes of establishing timely filing, the postmark on a paper submittal will be used, and for renewals submitted online, the electronic timestamp will be deemed the date of filing. 14.3(2) Application fee. The appropriate fee as specified in 650—Chapter 15 must accompany the application for renewal. A penalty shall be assessed by the board for late renewal, as specified in 650—Chapter 15. 14.3(3) Continuing education requirements. In order to renew a radiography qualification, the dental assistant shall obtain at least two hours of continuing education in the subject area of dental radiography. Proof of attendance shall be retained by the dental assistant and must be submitted to the board office upon request. 14.3(4) CPR certification. In order to renew a radiography qualification, an applicant must submit a statement: a. Confirming that the applicant possesses a valid certificate from a nationally recognized course in cardiopulmonary resuscitation (CPR) that included a “hands-on” clinical component; b. Providing the expiration date of the CPR certificate; and c. Acknowledging that the CPR certificate will be retained and made available to board office staff as part of routine auditing and monitoring. This rule is intended to implement Iowa Code chapters 136C and 153. 14.5(2) Failure to renew registration. a. Failure to renew a dental assistant registration prior to September 1 following expiration shall result in a late fee in the amount specified in 650—Chapter 15 assessed by the board in addition to the renewal fee. b. Failure to renew prior to October 1 following expiration shall result in assessment of a late fee in the amount specified in 650—Chapter 15. c. Failure to renew a registration prior to November 1 following expiration shall cause the registration to lapse and become invalid. A registrant whose registration has lapsed and become invalid is prohibited from practicing as a dental assistant until the registration is reinstated in accordance with rule 650—14.6(147,153,272C). 14.5(3) Failure to renew radiography qualification. Failure to renew a radiography qualification prior to November 1 following expiration shall cause the radiography qualification to lapse and become invalid. A dental assistant whose radiography qualification is lapsed is prohibited from engaging in dental radiography until the qualification is reinstated in accordance with rule 650—14.7(136C,153). This rule is intended to implement Iowa Code sections 147.10, 147.11, and 272C.2. 650—14.6(147,153,272C) Reinstatement of a lapsed license or registration. 14.6(1) A licensee or a registrant who allows a license or registration to lapse by failing to renew may have the license or registration reinstated at the discretion of the board by submitting the following: a. A completed application for reinstatement of a lapsed license or registration to practice dentistry, dental hygiene or dental assisting, on forms provided by the board, in addition to the required fee or application for reinstatement of a lapsed registration on the form provided by the board. b. Dates and places of practice. c. A list of other states in which licensed or registered and the identifying number of each license or registration. d. Reasons for seeking reinstatement and why the license or registration was not maintained. e. Payment of all renewal fees past due, as specified in 650—Chapter 15, plus the reinstatement fee as specified in 650—Chapter 15. 162

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants f.

Evidence of completion of a total of 15 hours of continuing education for each lapsed year or part thereof in accordance with 650—Chapter 25, up to a maximum of 75 hours. Dental assistants shall be required to submit evidence of completion of a total of 10 hours of continuing education for each lapsed year or part thereof in accordance with 650—Chapter 25, up to a maximum of 30 hours, or evidence of the full-time or part-time practice of the profession in another state of the United States or the District of Columbia, for a minimum of two years within the previous fiveyear period, and a statement verifying that continuing education requirements in that state of practice have been met. g. If licensed or registered in another state, the licensee or registrant shall provide certification by the state board of dentistry or equivalent authority of such state that the licensee or registrant has not been the subject of final or pending disciplinary action. h. A statement disclosing and explaining any disciplinary actions, investigations, claims, complaints, judgments, settlements, or criminal charges. i. Evidence that the applicant possesses a current certificate in a nationally recognized course in cardiopulmonary resuscitation. The course must include a clinical component. j. For reinstatement of a lapsed license, a completed fingerprint packet to facilitate a criminal history background check by the Iowa division of criminal investigation (DCI) and the Federal Bureau of Investigation (FBI), including the fee for the evaluation of the fingerprint packet and the criminal history background checks by the DCI and FBI, as specified in 650—Chapter 15. 14.6(2) The board may require a licensee or registrant who is applying for reinstatement and has not actively practiced clinically within the previous five years, to successfully complete a regional clinical examination, or other board-approved examination or assessment, for the purpose of ensuring that the applicant possesses sufficient knowledge and skill to practice safely. 14.6(3) When the board finds that a practitioner applying for reinstatement is or has been subject to disciplinary action taken against a license or registration held by the applicant in another state of the United States, District of Columbia, or territory, and the violations which resulted in such actions would also be grounds for discipline in Iowa in accordance with rule 650—30.4(153), the board may deny reinstatement of a license or registration to practice dentistry, dental hygiene, or dental assisting in Iowa or may impose any applicable disciplinary sanctions as specified in rule 650—30.2(153) as a condition of reinstatement. 650—14.7(136C,153) Reinstatement of lapsed radiography qualification. A dental assistant who allows a radiography qualification to lapse by failing to renew may have the radiography qualification reinstated at the discretion of the board by submitting the following: 14.7(1) A completed application for reinstatement of the dental assistant radiography qualification. 14.7(2) Payment of the radiography reinstatement application fee and the current renewal fee, both as specified in 650— Chapter 15. 14.7(3) Proof of current registration as a dental assistant or proof of an active Iowa nursing license. 14.7(4) If the radiography qualification has been lapsed for less than four years, proof of two hours of continuing education in the subject area of dental radiography, taken within the previous two-year period. 14.7(5) If the radiography qualification has been lapsed for more than four years, the dental assistant shall be required to retake and successfully complete an examination in dental radiography. A dental assistant who presents proof of a current radiography qualification issued by another state and who has engaged in dental radiography in that state is exempt from the examination requirement. This rule is intended to implement Iowa Code sections 136C.3 and chapter 153. 650—14.8(153) Reinstatement of an inactive license or registration 14.8(1) Inactive practitioners shall, prior to engaging in the practice of dentistry, dental hygiene, or dental assisting in the state of Iowa, satisfy all of the following requirements for reactivation: a. Submit application for reactivation to the board upon forms provided by the board, in addition to the required fee. b. Provide evidence of one of the following: (1) The full-time or part-time practice of the profession in another state of the United States or the District of Columbia for a minimum of two years within the previous five-year period; or (2) Completion of a total number of hours of approved continuing education computed by multiplying 15 by the number of years the license has been on inactive status for a dentist or dental hygienist, up to a maximum of 75 hours for a dentist or dental hygienist, or by multiplying 10 by the number of years the registration has been on inactive status for a dental assistant, up to a maximum of 30 hours for a dental assistant. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

163

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants c.

Submit evidence that the applicant possesses a current certificate in a nationally recognized course in cardiopulmonary resuscitation (CPR). The course must include a clinical component.

14.8(2) The board may require a licensee or registrant who is applying for reactivation and has not actively practiced clinically in the previous five years to successfully complete a regional clinical examination, or other board-approved examination or assessment, to ensure the licensee or registrant is able to practice with reasonable skill and safety. 14.8(3) Applications must be filed with the board along with the following: a. Certification by the state board of dentistry or equivalent authority of the state in which the applicant has been licensed or has engaged in the practice of the applicant’s profession that the applicant has not been the subject of final or pending disciplinary action. b. Statement as to any claims, complaints, judgments or settlements made with respect to the applicant arising out of the alleged negligence or malpractice in rendering professional services as a dentist, dental hygienist, or dental assistant. CHAPTER 15—FEES [Rule Excerpts, Current and effective as of 4/1/2020] 650—15.4(153) Application fees. 15.4(7) Reactivation of an inactive license or registration. The fee for a reactivation application for inactive practitioners is $50. 15.4(8) Reinstatement of an inactive license or registration. The fee for a reinstatement application for a lapsed license or registration is $150. 15.4(12) Dental assistant trainee application. The fee for an application for registration as a dental assistant trainee is $25. 15.4(13) Dental assistant registration only application. a. Application fee. The application fee for dental assistant registration is $40. b. Initial registration period and renewal period. If an applicant applies within three months or less of a biennial renewal due date, the applicant shall pay the renewal fee along with the registration application fee. A dental assistant registration shall not be issued for a period less than three months or longer than two years and three months. Thereafter, a registrant shall pay the renewal fee as specified in rule 650—15.5(153). 15.4(14) Combined application—dental assistant registration and qualification in radiography. a. Application fee. The application fee for a combined application for both registration as a registered dental assistant and radiography qualification is $60. b. Initial combined registration and radiography qualification period and renewal period. If an applicant applies within three months or less of a biennial renewal due date, the applicant shall pay the renewal fee along with the combined registration/radiography qualification application fee. A dental assistant registration and radiography qualification shall not be issued for a period less than three months or longer than two years and three months. Thereafter, the applicant shall pay the renewal fee as specified in 650—15.5(153). 15.4(15) Dental assistant radiography qualification application fee. The fee for an application for dental assistant radiography qualification is $40. 650—15.5 (153) Renewal fees. All fees are nonrefundable. Each two-year renewal period begins on September 1 and runs through August 31. Dental licenses, moderate sedation permits, and general anesthesia permits expire in evennumbered years. Dental hygiene licenses, local anesthesia permits, dental assistant registration and qualification in dental radiography expire in odd-numbered years. To avoid late fees, paper renewal applications must be postmarked on or received in the board office by August 31. To avoid late fees, online renewal applications must be time-stamped no later than 11:59 p.m. (CST) on August 31. 15.5(6) Dental assistant registration renewal. The fee for renewal of registration as a registered dental assistant is $75. 15.5(7) Combined renewal application—dental assistant registration and qualification in radiography. The fee for a combined application to renew both a registration as a registered dental assistant and a radiography qualification is $115. 15.5(8) Dental assistant qualification in radiography renewal. The fee for renewal of a certificate of qualification in dental radiography is $40. 650—15.6 (153) Late renewal fees. All fees are nonrefundable. A licensee, registrant or permit holder who fails to renew a license, registration or permit following expiration is subject to late renewal fees as described in this rule. 164

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 15.6(1) Failure to renew a license, registration or permit prior to September 1. Failure by a licensee, registrant or permit holder to renew the license, registration or permit prior to September 1 following expiration shall result in the following late fees: a. Dental license or permit. A late fee of $100 shall be assessed, in addition to the renewal fee. b. Dental hygiene license. A late fee of $100 shall be assessed, in addition to the renewal fee. c. Dental assistant registration. A late fee of $20 shall be assessed, in addition to the renewal fee. 15.6(2) Failure to renew a license, registration or permit prior to October 1. Failure by a licensee, registrant or permit holder to renew the license, registration or permit prior to October 1 following expiration shall result in the following late fees: a. Dental license or permit. A late fee of $150 shall be assessed, in addition to the renewal fee. b. Dental hygiene license. A late fee of $150 shall be assessed, in addition to the renewal fee. c. Dental assistant registration. A late fee of $40 shall be assessed, in addition to the renewal fee. 15.6(3) Failure to renew a license, registration or permit prior to November 1. Failure by a licensee, registrant or permit holder to renew a license, registration or permit prior to November 1 following expiration shall cause the license, registration or permit to lapse and become invalid. A licensee, registrant or permit holder whose license, registration or permit has lapsed and become invalid is prohibited from the practice of dentistry, dental hygiene, or dental assisting until the license, registration or permit is reinstated. 650—15.7(147,153) Reinstatement fees. If a license, registration or permit lapses or is inactive, a licensee, registrant or permit holder may submit an application for reinstatement. Licensees, registrants or permit holders are subject to reinstatement fees as described in this rule. 15.7(3) Reinstatement of a dental assistant registration. In addition to the reinstatement application fee specified in subrule 15.4(8), the applicant must pay all back renewal fees (not to exceed $115) to reinstate a registration as a registered dental assistant. 15.7(4) Combined reinstatement application—dental assistant registration and qualification in radiography. In addition to the reinstatement application fee specified in subrule 15.4(8), the applicant must pay all back renewal fees (not to exceed $175) for a combined application to reinstate both a registration as a registered dental assistant and a radiography qualification. 15.7(5) Reinstatement of qualification in radiography. In addition to the reinstatement application fee of $40, the applicant must pay all back renewal fees (not to exceed $60) to reinstate a qualification in dental radiography without registration as a dental assistant. CHAPTER 20—DENTAL ASSISTANTS [Rule Excerpts, Current and effective as of 4/1/2020] 650—20.1(153) Registration required. A person shall not practice on or after July 1, 2001, as a dental assistant unless the person has registered with the board and received a certificate of registration pursuant to this chapter. 650—20.2(153) Definitions. As used in this chapter: “Dental assistant” means any person who, under the supervision of a dentist, performs any extraoral services including infection control or the use of hazardous materials or performs any intraoral services on patients. The term “dental assistant” does not include persons otherwise actively licensed in Iowa to practice dental hygiene or nursing who are engaged in the practice of said profession. “Dental assistant trainee” means any person who is engaging in on-the-job training to meet the requirements for registration and who is learning the necessary skills under the personal supervision of a licensed dentist. Trainees may also engage in on-the-job training in dental radiography pursuant to 650—22.3(136C,153). “Direct supervision” means that the dentist is present in the treatment facility, but it is not required that the dentist be physically present in the treatment room while the registered ental assistant is performing acts assigned by the dentist. “General supervision” means that a dentist has examined the patient and has delegated the services to be provided by a registered dental assistant, which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light, intraoral digital imaging and intraoral camera. The dentist need not be present in the facility while these services are being provided. “Personal supervision” for intraoral procedures means the dentist is physically present in the treatment room to oversee and direct all intraoral or chairside services of the dental assistant trainee. "Personal supervision" for extraoral procedures means a licensee or registrant is physically present in the treatment room to oversee and direct all extraoral services of the dental assistant trainee. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

165

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants “Public health supervision” means all of the following: 1. The dentist authorizes and delegates the services provided by a registered dental assistant to a patient in a public health setting, with the exception that services may be rendered without the patient first being examined by a licensed dentist; 2. The dentist is not required to provide future dental treatment to patients served under public health supervision; 3. The dentist and the registered dental assistant have entered into a written supervision agreement that details the responsibilities of each licensee/registrant, as specified in subrule 20.16(2); and 4. The registered dental assistant has an active Iowa registration and a minimum of one year of clinical practice experience. "Registered dental assistant" means any person who has met the requirements for registration and has been issued a certificate of registration. “Trainee status expiration date” means 12 months from the date of issuance. 650—20.3(153) Applicant responsibilities. An applicant for dental assistant trainee status or dental assistant registration bears full responsibility for each of the following: 20.3(1) Providing accurate, up-to-date, and truthful information on the application including, but not limited to, prior professional experiences, education, training, examination scores, and disciplinary history. 20.3(2) Submitting complete application materials. An application for trainee status will be considered active for 90 days from the date the application is received. An application for dental assistant registration, reactivation, or reinstatement will be considered valid for 180 days from the date the application is received. If the applicant does not submit all materials within this time period, or if the applicant does not meet the requirements for trainee status, dental assistant registration, or reinstatement, the application shall be considered incomplete and the applicant must submit a new application and application fee. 650—20.4(153) Scope of practice. 20.4(1) In all instances, a dentist assumes responsibility for determining, on the basis of diagnosis, the specific treatment patients will receive and which aspects of treatment may be delegated to qualified personnel as authorized in these rules. 20.4(2) A licensed dentist may delegate to a dental assistant those procedures for which the dental assistant has received training. This delegation shall be based on the best interests of the patient. Such services shall be delegated by and performed under the supervision of a licensed dentist and may include: a. Placement and removal of dry socket medication; b. Placement of periodontal dressings; c. Testing pulp vitality; d. Preliminary charting of existing dental restorations and teeth; e. Glucose testing; f. Phlebotomy; and g. Expanded function procedures in accordance with 650—Chapter 23. 20.4(3) The dentist shall exercise supervision and shall be fully responsible for all acts performed by a dental assistant. A dentist may not delegate to a dental assistant any of the following, unless allowed pursuant to 650—Chapter 23: a. Diagnosis, examination, treatment planning, or prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic or orthodontic appliances. b. Surgical procedures on hard and soft tissues within the oral cavity and any other intraoral procedure that contributes to or results in an irreversible alteration to the oral anatomy. c. Administration of local anesthesia. d. Placement of sealants. e. Removal of any plaque, stain, or hard natural or synthetic material except by toothbrush, floss, or rubber cup coronal polish, or removal of any calculus. f. Dental radiography, unless the assistant is qualified pursuant to 650—Chapter 22. g. Those procedures that require the professional judgement and skill of a dentist. 20.4(4) A dental assistant may perform duties consistent with these rules under the supervision of a licensed dentist. The specific duties dental assistants may perform are based upon: a. The education of the dental assistant. b. The experience of the dental assistant.

166

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 650—20.5(153) Categories of dental assistants: dental assistant trainee, registered dental assistant. There are two categories of dental assistants. Both the supervising dentist and the registered dental assistant or dental assistant trainee are responsible for maintaining documentation of training. Such documentation must be maintained in the office of practice and shall be provided to the board upon request. 20.5(1) Registered dental assistant. Registered dental assistants are individuals who have met the requirements for registration and have been issued a certificate of registration. A registered dental assistant may, under general supervision, perform dental radiography, intraoral suctioning, use of a curing light and intraoral camera, and all extraoral duties that are assigned by the dentist and are consistent with these rules. During intraoral procedures, the registered dental assistant may, under direct supervision, assist the dentist in performing duties assigned by the dentist that are consistent with these rules. The registered dental assistant may take radiographs if qualified pursuant to 650—Chapter 22. 20.5(2) Dental assistant trainee. Dental assistant trainees are all individuals who are engaging in on-the-job training to meet the requirements for registration and who are learning the necessary skills under the personal supervision of a licensed dentist. Trainees may also engage in on-the-job training in dental radiography pursuant to 650—22.3(136C,153). a. General requirements. The dental assistant trainee shall meet the following requirements: (1) Successfully complete a course of study and examination in the areas of infection control, hazardous materials, and jurisprudence. The course of study shall be prior approved by the board and sponsored by a boardapproved postsecondary school. (2) If a trainee fails to become registered by the trainee status expiration date, the trainee must stop work as a dental assistant trainee. If the trainee has not yet met the requirements for registration, the trainee may reapply for trainee status but may not work until a new dental assistant trainee status certificate has been issued by the board. b. Trainee restart. (1) Reapplying for trainee status. A trainee may “start over” as a dental assistant trainee provided the trainee submits an application in compliance with subrule 20.6(1). (2) Examination scores valid for three years. A “repeat” trainee is not required to retake an examination (jurisprudence, infection control/hazardous materials, radiography) if the trainee has successfully passed the examination within three years of the date of application. (3) New trainee status expiration date issued. If the repeat trainee application is approved, the board office will establish a new trainee status expiration date by which registration must be completed. (4) Maximum of two “start over” periods allowed. In addition to the initial 12-month trainee status period, a dental assistant is permitted up to two start over periods as a trainee. If a trainee seeks an additional start over period beyond two, the trainee shall submit a petition for rule waiver under 650—Chapter 7. c. Trainees enrolled in cooperative education or work study programs. The requirements stated in this subrule apply to all dental assistant trainees, including a person enrolled in a cooperative education or work-study program through an Iowa high school. In addition, a trainee under 18 years of age shall not participate in dental radiography. 650—20.6(153) Registration requirements. Effective July 2, 2001, dental assistants must meet the following requirements for registration: 20.6(1) Dental assistant trainee. a. On or after May 1, 2013, a dentist supervising a person performing dental assistant duties must ensure that the person has been issued a trainee status certificate from the board office prior to the person’s first date of employment as a dental assistant. A dentist who has been granted a temporary permit to provide volunteer services for a qualifying event of limited duration pursuant to 650—subrule 13.3(3), or an Iowa-licensed dentist who is volunteering at such qualifying event, is exempt from this requirement for a dental assistant who is working under the dentist’s supervision at the qualifying event. b. Applications for registration as a dental assistant trainee must be filed on official board forms and include the following: (1) The fee as specified in 650—Chapter 15. (2) Evidence of high school graduation or equivalent. (3) Evidence the applicant is 17 years of age or older. (4) Any additional information required by the board relating to the character and experience of the applicant as may be necessary to evaluate the applicant’s qualifications. (5) If the applicant does not meet the requirements of (2) and (3) above, evidence that the applicant is enrolled in a cooperative education or work-study program through an Iowa high school. c. Prior to the trainee status expiration date, the dental assistant trainee is required to successfully complete a boardapproved course of study and examination in the areas of infection control, hazardous materials, and jurisprudence. The course of study may be taken at a board-approved postsecondary school or on the job using curriculum approved by the board for such purpose. Evidence of meeting this requirement prior to the trainee status expiration date shall be submitted by the employer dentist. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

167

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants d.

Prior to the trainee status expiration date, the dental assistant trainee’s supervising dentist must ensure that the trainee has received a certificate of registration or has been issued a start-over trainee status in accordance with rule 650—20.5(153) before performing any further dental assisting duties.

20.6(2) Registered dental assistant. a. To meet this qualification, a person must: (1) Work in a dental office for six months as a dental assistant trainee; or (2) If licensed out of state, have had at least six months of prior dental assisting experience under a licensed dentist within the past two years; or (3) Be a graduate of an accredited dental assisting program approved by the board; and (4) Be a high school graduate or equivalent; and (5) Be 17 years of age or older. b. Applications for registration as a registered dental assistant must be filed on official board forms and include the following: (1) The fee as specified in 650—Chapter 15. (2) Evidence of meeting the requirements specified in 20.6(2) “a.” (3) Evidence of successful completion of a course of study approved by the board and sponsored by a board-approved accredited dental assisting program in the areas of infection control, hazardous materials, and jurisprudence. The course of study may be taken at a board-approved, accredited dental assisting program or on the job using curriculum approved by the board for such purpose. (4) Evidence of successful completion of a board-approved examination in the areas of infection control, hazardous materials, and jurisprudence. (5) Evidence of high school graduation or the equivalent. (6) Evidence the applicant is 17 years of age or older. (7) Evidence of meeting the qualifications of 650—Chapter 22 if engaging in dental radiography. (8) A statement: 1. Confirming that the applicant possesses a valid certificate from a nationally recognized course in cardiopulmonary resuscitation (CPR) that included a "hands-on" clinical component; 2. Providing the expiration date of the CPR certificate; and 3. Acknowledging that the CPR certificate will be retained and made available to board office staff as part of routine auditing and monitoring. (9) Any additional information required by the board relating to the character, education and experience of the applicant as may be necessary to evaluate the applicant’s qualifications. 20.6(3) All applications must be signed and verified by the applicant as to the truth of the documents and statements contained therein. 650—20.7(153) Review of applications. The board shall follow the procedures specified in rule 650—11.8(147,153) in reviewing applications for registration and qualification. 650—20.8(153) Registration denial. The board may deny an application for registration as a dental assistant for any of the following reasons: 1. Failure to meet the requirements for registration as specified in these rules. 2. Pursuant to Iowa Code section 147.4, upon any of the grounds for which registration may be revoked or suspended as specified in 650—Chapter 30. 650—20.9(147,153) Denial of registration—appeal procedure. The board shall follow the procedures specified in 650—11.10(147) if the board proposes to deny registration to a dental assistant applicant. This rule is intended to implement Iowa Code sections 147.3, 147.4 and 147.29. [See 650—11.10 (1)-(5) beginning on page 160.] 650—20.10(153) Examination requirements. Beginning July 2, 2001, applicants for registration must successfully pass an examination approved by the board on infection control, hazardous waste, and jurisprudence. 20.10(1) Examinations approved by the board are those administered by the board or board’s approved testing centers or the Dental Assisting National Board Infection Control Examination, if taken after June 1, 1991, in conjunction with the board-approved jurisprudence examination. In lieu of the board’s infection control examination, the board may approve an infection control examination given by another state licensing board if the board determines that the examination is substantially equivalent to the examination administered by the board. 20.10(2) Information on taking the examination may be obtained by contacting the board office at 400 S.W. 8th Street, Suite D, Des Moines, Iowa 50309-4687. 168

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 20.10(3) An examinee must meet such other requirements as may be imposed by the board’s approved dental assistant testing centers. 20.10(4) A dental assistant trainee must successfully pass the examination within 12 months of the first date of employment. A dental assistant trainee who does not successfully pass the examination within 12 months shall be prohibited from working as a dental assistant until the dental assistant trainee passes the examination in accordance with these rules. 20.10(5) A score of 75 or better on the board infection control/hazardous material exam and a score of 75 or better on the board jurisprudence exam shall be considered successful completion of the examination. The board accepts the passing standard established by the Dental Assisting National Board for applicants who take the Dental Assisting National Board Infection Control Examination. 20.10(6) The written examination may be waived by the board, in accordance with the board’s waiver rules at 650--Chapter 7, in practice situations where the written examination is deemed to be unnecessary or detrimental to the dentist’s practice. 650—20.11(153) Continuing education. Each person registered as a dental assistant shall complete continuing education requirements as specified in 650—Chapter 25. 650—20.12(252J) Receipt of certificate of noncompliance. The board shall consider the receipt of a certificate of noncompliance of a support order from the child support recovery unit pursuant to Iowa Code chapter 252J and 650—Chapter 33. Registration denial or denial of renewal of registration shall follow the procedures in the statutes and board rules as set forth in this rule. 650—20.13(153) Unlawful practice. A dental assistant who assists a dentist in practicing dentistry in any capacity other than as a person supervised by a dentist in a dental office, or who directly or indirectly procures a licensed dentist to act as nominal owner, proprietor or director of a dental office as a guise or subterfuge to enable such dental assistant to engage directly or indirectly in the practice of dentistry, or who performs dental service directly or indirectly on or for members of the public other than as a person working for a dentist shall be deemed to be practicing dentistry without a license. 650—20.14(153) Advertising and soliciting of dental services prohibited. Dental assistants shall not advertise, solicit, represent or hold themselves out in any manner to the general public that they will furnish, construct, repair or alter prosthetic, orthodontic or other appliances, with or without consideration, to be used as substitutes for or as part of natural teeth or associated structures or for the correction of malocclusions or deformities, or that they will perform any other dental service. 650—20.15(153) Public health supervision allowed. A dentist may provide public health supervision to a registered dental assistant if the dentist has an active Iowa license and the services are provided in a public or private school, public health agencies, hospitals, or the armed forces. 20.15(1) Public health agencies defined. For the purposes of this rule, public health agencies include programs operated by federal, state, or local public health departments. 20.15(2) Responsibilities. When working together in a public health supervision relationship, a dentist and registered dental assistant shall enter into a written agreement that specifies the following responsibilities. a. The dentist providing public health supervision must: (1) Be available to provide communication and consultation with the registered dental assistant; (2) Have age- and procedure-specific standing orders for the performance of services. Those standing orders must include consideration for medically compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of services; (3) Specify a period of time in which an examination by a dentist must occur prior to providing further services; (4) Specify the location or locations where the services will be provided under public health supervision. b. A registered dental assistant providing services under public health supervision may only provide services which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light and intraoral camera and must: (1) Maintain contact and communication with the dentist providing public health supervision; (2) Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient; (3) Ensure that the patient, parent, or guardian receives a written plan for referral to a dentist; (4) Ensure that each patient, parent, or guardian signs a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and (5) Ensure that a procedure is in place for creating and maintaining dental records for the patients who are treated, including where these records are to be located. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

169

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants c. The written agreement for public health supervision must be maintained by the dentist and the registered dental assistant and a copy filed with the board office within 30 days of the date on which the dentist and the registered dental assistant entered into the agreement. The dentist and registered dental assistant must review the agreement at least biennially. d. The registered dental assistant shall file annually with the supervising dentist and the bureau of oral and health delivery systems a report detailing the number of patients seen, the services provided to patients and the infection control protocols followed at each practice location. e. A copy of the written agreement for public health supervision shall be filed with the Bureau of Oral and Health Delivery Systems, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, Iowa 50319. 20.15(3) Reporting requirements. Each registered dental assistant who has rendered services under public health supervision must complete a summary report at the completion of a program or, in the case of an ongoing program, at least annually. The report shall be filed with the bureau of oral and health delivery systems of the Iowa department of public health on forms provided by the department and shall include information related to the number of patients seen and services provided so that the department may assess the impact of the program. The department will provide summary reports to the board on an annual basis. 650—20.16(153) Students enrolled in dental assisting programs. Students enrolled in an accredited dental assisting program are not considered to be engaged in the unlawful practice of dental assisting provided that such practice is in connection with their regular course of instruction and meets the following: 1. The practice of clinical skills on peers enrolled in the same program must be under the direct supervision of a program instructor with an active Iowa dental assistant registration, Iowa dental hygiene license, Iowa faculty permit, or Iowa dental license; 2. The practice of clinical skills on members of the public must be under the direct supervision of a dentist with an active Iowa dental license. CHAPTER 22—DENTAL ASSISTANT RADIOGRAPHY QUALIFICATION [Rule Excerpts, Current and effective as of 4/1/2020] 650—22.1(136C,153) Qualification required. A person who is otherwise not actively licensed by the board shall not participate in dental radiography unless the assistant holds a current registration certificate or an active nursing license and holds an active radiography qualification issued by the board, and a dentist provides general supervision. 650—22.2(136C,153) Definitions. As used in this chapter: “Dental radiography” means the application of X-radiation to human teeth and supporting structures for diagnostic purposes only. “Radiography qualification” means authorization to engage in dental radiography issued by the board. 650—22.3(136C,153) Exemptions. The following individuals are exempt from the requirements of this chapter. 22.3(1) A student enrolled in an accredited dental, dental hygiene, or dental assisting program, who, as part of the student’s course of study, applies ionizing radiation. 22.3(2) A person registered as a dental assistant trainee pursuant to 650—Chapter 20, who is engaging in on-the-job training in dental radiography and who is using curriculum approved by the board for such purpose. 650—22.4(136C,153) Application requirements for dental radiography qualification. Applications for dental radiography qualification must be filed on official board forms and include the following: 22.4(1) Evidence of one of the following requirements: a. The applicant is a dental assistant trainee or registered dental assistant with an active registration status; b. The applicant is a graduate of an accredited dental assisting program; or c. The applicant is a nurse who holds an active Iowa license issued by the board of nursing. 22.4(2) The fee as specified in 650—Chapter 15. 22.4(3) Evidence of successful completion, within the previous two years, of a board-approved course of study in the area of dental radiography. The course of study must include application of radiation to humans pursuant to Iowa Code section 136C.3 and may be taken by the applicant: a. On the job while under trainee status pursuant to 650—Chapter 20, using board-approved curriculum; b. At a board-approved postsecondary school; or c. From another program prior-approved by the board. 22.4(4) Evidence of successful completion of a board-approved examination in the area of dental radiography. 170

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 22.4(5) Any additional information required by the board relating to the character, education, and experience of the applicant as may be necessary to evaluate the applicant’s qualifications. 650—22.5(136C,153) Examination requirements. An applicant for dental assistant radiography qualification shall successfully pass a board-approved examination in dental radiography. 22.5(1) Examinations must be prior approved by the board and must be administered in a proctored setting. All boardapproved examinations must have a minimum of 50 questions. The Dental Assisting National Board Radiation Health and Safety Examination is an approved examination. 22.5(2) A score of 75 percent or better on a board-approved examination shall be considered successful completion of the examination. The board accepts the passing standard established by the Dental Assisting National Board for applicants who take the Dental Assisting National Board Radiation Health and Safety Examination. 22.5(3) Information on taking a board-approved examination may be obtained by contacting the board office at 400 SW 8th Street, Suite D, Des Moines, Iowa 50309-4687. 22.5(4) A dental assistant must meet such other requirements as may be imposed by the board’s approved dental assistant testing centers. 22.5(5) A dental assistant who fails to successfully complete a board-approved examination after two attempts will be required to submit, prior to each subsequent examination attempt, proof of additional formal education in dental radiography in a program approved by the board or sponsored by a school accredited by the Commission on Dental Accreditation of the American Dental Association. 650—22.6(136C,153) Penalties. 22.6(1) Any individual except a licensed dentist or a licensed dental hygienist who participates in dental radiography in violation of this chapter or Iowa Code chapter 136C shall be subject to the criminal and civil penalties set forth in Iowa Code sections 136C.4 and 136C.5. 22.6(2) Any licensee who permits a person to engage in dental radiography or a registrant who engages in dental radiography contrary to this chapter or Iowa Code chapter 136C shall be subject to discipline by the board pursuant to 650— Chapter 30. The rules above are intended to implement Iowa Code section 136C.3 and chapter 153. CHAPTER 23—EXPANDED FUNCTIONS [Rule Excerpts, Current and effective as of 4/1/2020] 650—23.1(153) Definitions. “Accredited school” means a dental, dental hygiene, or dental assisting education program accredited by the Commission on Dental Accreditation (CODA). “Clinical training” means training which includes patient experiences. “Didactic training” means educational instruction. “Direct supervision” means that the dentist is present in the treatment facility, but it is not required that the dentist be physically present in the treatment room. “Fabrication” means the construction or creation of an impression, occlusal registration or provisional restoration, as defined in this chapter. “General supervision of a dental assistant” means that a dentist has examined the patient and has delegated the services to be provided by a registered dental assistant, which are limited to all extraoral duties, dental radiography, intraoralsuctioning, use of a curing light, intraoral camera, and recementation of a provisional restoration. The dentist need not be present in the facility while these services are being provided. “General supervision of a dental hygienist” means that a dentist has examined the patient and has prescribed authorized services to be provided by a dental hygienist. The dentist need not be present in the facility while these services are being provided. If a dentist will not be present, the following requirements shall be met: 1.

Patients or their legal guardians must be informed prior to the appointment that no dentist will be present and therefore no examination will be conducted at that appointment.

171

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 2. 3. 4.

The hygienist must consent to the arrangement. Basic emergency procedures must be established and in place, and the hygienist must be capable of implementing these procedures. The treatment to be provided must be prior prescribed by a licensed dentist and must be entered in writing in the patient record.

“Laboratory training” means training that is hands-on, that may include simulation, and that prepares a dental hygienist or dental assistant for patient experiences. Laboratory training can be done as part of an approved course, or obtained through a supervising dentist. “Observational supervision,” for expanded functions, means the dentist is physically present in the treatment room to oversee and direct all services being provided as part of clinical training “Patient experiences” are procedures that are performed on a patient, during the course of clinical training, under the observational supervision of a dentist. “Prosthetic” means any provisional or permanent restoration intended to replace a tooth or teeth. “Provisional restoration” means a crown or bridge placed with the intention of being replaced with a permanent crown or bridge at a later date, or a permanent crown provisionally recemented to be replaced or recemented at a later date. 650—23.2(153) Expanded function requirements and eligibility. 23.2(1) Dental hygienists or dental assistants may only perform expanded function procedures upon successful completion of a board-approved course of training and certification by the board. All expanded function procedures must be delegated by and performed under the direct supervision of a dentist licensed pursuant to Iowa Code chapter 153, unless otherwise specified in this rule. A dental assistant trainee is not eligible to perform or receive training in expanded function procedures. This shall not preclude dental hygienists or dental assistants from practicing expanded function procedures for training purposes while enrolled in a board-approved course of training. 23.2(2) A dental hygienist or dental assistant shall not perform any expanded function procedures listed in this chapter unless the education and training requirements have been met and certification has been issued to the dental hygienist or dental assistant. This shall not preclude a dental hygienist or dental assistant from practicing expanded functions for training purposes while enrolled in a board-approved course of training. 23.2(3) To be eligible to train in Level 1 expanded functions, dental hygienists or dental assistants must comply with one of the following: a. Hold an active dental hygiene license in Iowa; or b. Hold an active dental assistant registration, and comply with at least one of the following: (1) Be a graduate of an accredited school; or (2) Be currently certified by the Dental Assisting National Board (DANB); or (3) Have at least one year of clinical practice as a registered dental assistant; or (4) Have at least one year of clinical practice as a dental assistant in a state that does not require registration. 23.2(4) A dentist who delegates Level 1 or Level 2 expanded functions to a dental hygienist or dental assistant under direct supervision must examine the patient to review the quality of work prior to the conclusion of the dental appointment. The following expanded functions are exempt from this requirement and may be performed under general supervision: a. Recementation of a provisional restoration. b. Taking occlusal registrations for purposes other than mounting study casts by Level 1 or Level 2 dental hygienists only. 650—23.3(153) Expanded function categories. 23.3(1) Basic Level 1. Dental hygienists or dental assistants who train in some, but not all, Level 1 expanded function procedures are deemed to be basic expanded function dental hygienists or dental assistants. Dental hygienists and dental assistants must be issued a certificate of completion for the corresponding function by a board-approved training program before performing a specific expanded function procedure. A dentist may delegate to dental hygienists or dental assistants only those Level 1 expanded function procedures for which training has been successfully completed. 23.3(2) Certified Level 1. Expanded function dental hygienists or dental assistants who have successfully completed training for all Level 1 expanded function procedures and have been issued a certificate of completion by a board-approved training program are deemed to be certified Level 1 dental hygienists or dental assistants.

172

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 23.3(3) Certified Level 2. Before beginning training to become certified in Level 2, expanded function dental hygienists or dental assistants must have a minimum of one year of clinical practice as a certified Level 1 dental hygienist or dental assistant and pass an entrance examination administered by the Level 2 training program. a. Dental hygienists or dental assistants who have successfully completed training in Level 2 expanded function procedures and have been issued a certificate of completion by a board-approved training program are deemed to be certified Level 2 dental hygienists or dental assistants. b. A dentist may delegate any Level 1 or Level 2 expanded function procedures to dental hygienists or dental assistants who are certified Level 2. 650—23.4(153) Level 1 expanded function procedures for dental assistants. Level 1 expanded function procedures for dental assistants include: 23.4(1) Taking occlusal registrations; 23.4(2) Placement and removal of gingival retraction material; 23.4(3) Fabrication, temporary cementation, and removal of provisional restorations; 23.4(4) Applying cavity liners and bases; desensitizing agents; and bonding systems, to include the placement of orthodontic brackets, following the determination of location by the supervising dentist; 23.4(5) Monitoring of patients receiving nitrous oxide inhalation analgesia, which may include increasing oxygen levels as needed, pursuant to the following: a. A dentist shall induce a patient and establish the maintenance level; b. A dental assistant may make adjustments that decrease the nitrous oxide concentration during the administration of nitrous oxide; c. A dental assistant may turn off the oxygen delivery at the completion of the dental procedure; 23.4(6) Taking final impressions; 23.4(7) Removal of any adhesives using nonmotorized hand instrumentation; 23.4(8) Placement of Class 1 temporary filling materials; and 23.4(9) Recementation of provisional restorations. 650—23.6(153) Level 2 expanded function procedures for dental hygienists and dental assistants. 23.6(2) These Level 2 expanded function procedures refer to both primary and permanent teeth except as otherwise noted. 650—23.7(153) Expanded function training. 23.7(1) Approved expanded function training programs. Training programs for Level 1 and Level 2 expanded function procedures must be board-approved. Training programs for Level 2 expanded function procedures shall be eligible for board approval if the training is offered through the University of Iowa College of Dentistry or another accredited school. 23.7(2) Certificates of completion. All board-approved training programs are authorized and required to issue certificates to dental hygienists and dental assistants who successfully complete expanded function training. A certificate shall be issued for one or more of the listed expanded function procedures completed as Basic Level 1, or a certificate shall be issued for Certified Level 1 or Certified Level 2. Dental hygienists and dental assistants shall prominently display the expanded functions certificate in each dental facility where services are provided. 23.7(3) Training requirements. Training may be completed in one or more of the listed expanded function procedures. Clinical training in expanded function procedures must be completed under observational supervision. Beginning January 1, 2020, Level 1 expanded function training must consist of the following: a. An initial assessment to determine the base entry level of all participants in the program; b. Completion of a training program that meets the following minimum standards for each function: (1) Taking occlusal registrations: Goal: To reproduce the patient’s jaw relationship accurately. Standard: Demonstrate an accurate occlusal registration confirmed by a supervising dentist. Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

173

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants (2) Placement and removal of gingival retraction material: Goal: To expose the margins of a crown by displacing tissue from the tooth. Standard: Perform the procedural steps to place and remove retraction material and recognize oral conditions and techniques that may compromise tissue displacement or patient health. Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of three experiences, and clinical training that includes a minimum of five patient experiences under observational supervision. (3) Fabrication, temporary cementation and removal of provisional restorations: Goal: To replicate the anatomy and function of the natural tooth, prior to the final restoration. Standard: Use various methods to fabricate and temporarily cement single-unit and multiunit provisional restorations. Minimum training requirement: Four hours of didactic training, the equivalent of four hours of laboratory training that includes a minimum of five experiences, and clinical training that includes a minimum of ten patient experiences under observational supervision. (4) Applying cavity liners and bases; desensitizing agents; and bonding systems, to include the placement of orthodontic brackets, following the determination of location by the supervising dentist: Goal: To apply appropriate material that protects existing tooth structure and adheres existing tooth structure to restorative materials. Standard: Manipulate and apply appropriate material to meet clinical competency. Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of 5 patient experiences in each one of these areas (for a total of 15 patient experiences under observational supervision). (5) Monitoring of patients receiving nitrous oxide inhalation analgesia, pursuant to subrule 23.4(5): Goal: Understand the equipment, recognize the signs of patient distress or adverse reaction, and know when to call for help. Standard: Exercise the ability to maintain patient safety while nitrous oxide is used. Minimum training requirement: Two hours of didactic training, one hour of laboratory training in the office where the dental hygienist or dental assistant is employed, and five patient experiences under observational supervision. (6) Taking final impressions: Goal: Reproduce soft and hard oral tissues, digitally or with impression materials. Standard: Complete the procedural steps to obtain a clinically acceptable final impression. Minimum training requirement: Three hours of didactic training, and the equivalent of clinical training that includes a minimum of six patient experiences under observational supervision. (7) Removal of adhesives using nonmotorized hand instrumentation: Goal: Remove excess adhesives and bonding materials to eliminate soft tissue irritation. Standard: Identify how, when and where to remove excessive bonding or adhesive material. Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision. (8) Placement of Class 1 temporary filling materials: Goal: Place Class 1 temporary filling materials following preparation of a tooth by a dentist. Standard: Identify how, when and where to place Class 1 temporary filling materials. Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision. (9) Recementation of provisional restorations: Goal: Secure the provisional restoration to a previously prepared tooth after the provisional restoration has become loose or dislodged. Standard: Use various methods to fabricate and temporarily cement single-unit and multiunit provisional restorations. Minimum training requirement: If this training is completed in conjunction with training in fabrication, temporary cementation and removal of provisional crown and bridge restorations, the training requirements may be combined since the procedures are related. If this training is being completed separately, the same training requirements for fabrication, temporary cementation and removal of provisional restorations applies. c. A postcourse written examination at the conclusion of the training program, with a minimum of ten questions per function, must be administered. Participants must obtain a score of 75 percent or higher on each examination administered. 23.7(4) Grandfathering. Any dental hygienist or dental assistant who has completed expanded function training prior to January 1, 2020, can continue to perform expanded function procedures for which training has been completed. For any expanded function procedures that are new, in whole or in part, additional training to satisfy the standard and minimum training requirement is required of the dental hygienist or dental assistant prior to performing the new expanded function procedure. 174

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants CHAPTER 25—CONTINUING EDUCATION [Rule Excerpts, Current and effective as of 4/1/2020] 650—25.1 (153) Definitions. For the purpose of these rules on continuing education, definitions shall apply: “Continuing dental education” consists of education activities designed to review existing concepts and techniques and to update knowledge on advances in dental and medical sciences. The objective of continuing dental education is to improve the knowledge, skills, and ability of the individual to deliver the highest quality of service to the public and professions. Continuing dental education should favorably enrich past dental education experiences. Programs should make it possible for practitioners to attune dental practice to new knowledge as it becomes available. All continuing dental education should strengthen the skills of critical inquiry, balanced judgment and professional technique. “Hour of continuing education” of continuing education means one unit of credit which shall be granted for each hour of contact instruction and shall be designated as a “clock hour.” This credit shall apply to either academic or clinical instruction. “Licensee” means any person licensed who has been issued a certificate to practice dentistry or dental hygiene in the state of Iowa. “Registrant” means any person registered to practice as a dental assistant in the state of Iowa. “Self-study activities” means the study of something by oneself, without direct supervision or attendance in a class. “Self-study activities” may include Internet-based coursework, television viewing, video programs, correspondence work or research, or computer programs that are interactive and require branching, navigation, participation and decision making on the part of the viewer. Internet-based webinars which include the involvement of an instructor and participants in real time and which allow for communication with the instructor through messaging, telephone or other means shall not be construed to be self-study activities. “Sponsor” means a person, educational institution, or organization sponsoring continuing education activities which has been approved by the board as a sponsor pursuant to these rules. During the time a person, educational institution, or organization is an approved sponsor, all continuing education activities of such person or organization may be deemed automatically approved provided the continuing education activities meet the continuing education guidelines of the board. 650—25.2 (153) Continuing education administrative requirements. 25.2(2) Each person registered to practice dental assisting in this state shall complete during the biennium renewal period a minimum of 20 hours of continuing education approved by the board. 25.2(3) Each person who holds a qualification in dental radiography in this state shall complete during the biennium renewal period a minimum of two hours of continuing education in the area of dental radiography. 25.2(4) The continuing education compliance period shall be the 24-month period commencing September 1 and ending on August 31 of the renewal cycle. 25.2(5) Hours of continuing education credit may be obtained by attending and participating in a continuing education activity either previously approved by the board or which otherwise meets the requirements herein and is approved by the board pursuant to rule 650—25.5(153). 25.2(6) It is the responsibility of each licensee or registrant to finance the costs of continuing education. 650—25.3(153) Documentation of continuing education hours. 25.3(1) Every licensee or registrant shall maintain a record of all courses attended by keeping the certificates of attendance for four years. The board reserves the right to require any licensee or registrant to submit the certificates of attendance for the continuing education courses attended. If selected for continuing education audit, the licensee or registrant shall file a signed continuing education form and submit certificates or other evidence of attendance. 25.3(2) Licensees and registrants are responsible for obtaining proof of attendance forms when attending courses. Clock hours must be verified by the sponsor with the issuance of proof of attendance forms to the licensee or registrant.

175

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 25.3(3) Each licensee or registrant shall report the number of continuing education credit hours completed during the current renewal cycle in compliance with this chapter. Such report shall be filed with the board at the time of application for renewal of a dental or dental hygiene license or renewal of dental assistant registration. 25.3(4) No carryover of credits from one biennial period to the next will be allowed. 650â&#x20AC;&#x201D;25.4(153) Required continuing education courses. 25.4(1) The following courses are required for all licensees and registrants: a. Mandatory reporter training for child abuse and dependent adult abuse. b. Cardiopulmonary resuscitation. c. Infection control. d. Jurisprudence. 25.4(2) Mandatory reporter training for child abuse and dependent adult abuse. a. Licensees or registrants who regularly examine, attend, counsel or treat children in Iowa shall indicate on the renewal application completion of two hours of training in child abuse identification and reporting in the previous five years or conditions for exemptions as identified in paragraph 25.4(2)"f", pursuant to Iowa Code chapter 232. Completion of training in this course shall result in two hours of continuing education credit. b. Licensees or registrants who regularly examine, attend, counsel or treat adults in Iowa shall indicate on the renewal application completion of two hours of training in dependent adult abuse identification and reporting in the previous five years or conditions for exemptions as identified in paragraph 25.4(2)"f", pursuant to Iowa Code chapter 235B. c. Licensees or registrants who regularly examine, attend, counsel or treat both children and adults in Iowa shall indicate on the renewal application completion of at least two hours of training on the identification and reporting of abuse in children and dependent adults in the previous five years or conditions for exemptions as identified in paragraph 25.4(2)"f", pursuant to Iowa Code chapters 232 and 235B. Training may be completed through separate courses or in one combined course that includes curricula for identifying and reporting child abuse and dependent adult abuse. Completion of training in this combined course shall result in three hours of continuing education credit. d. The licensee or registrant shall maintain written documentation for five years after completion of the mandatory training, including program date(s), content, duration, and proof of participation. The board may audit this information at any time within the five-year period. e. Training programs in child and dependent adult abuse identification and reporting that are approved by the board are those that use a curriculum approved by the abuse education review panel of the department of public health or a training program offered by the department of human services, the department of education, an area education agency, a school district, the Iowa law enforcement academy, an Iowa college or university, or a similar state agency. f. Exemptions. Licensees and registrants shall be exempt from the requirement for mandatory training for identifying and reporting child and dependent adult abuse if the board determines that it is in the public interest or that at the time of the renewal the licensee or registrant is issued an extension or exemption pursuant to rule 650â&#x20AC;&#x201D;25.10(153). 25.4(3) Cardiopulmonary resuscitation (CPR). Licensees and registrants shall furnish evidence of valid certification for CPR, which shall be credited toward the continuing education requirement for renewal of the license, faculty permit or registration. Such evidence shall be filed at the time of renewal of the license, faculty permit or registration. Valid certification means certification by an organization on an annual basis or, if that certifying organization requires certification on a less frequent basis, evidence that the licensee or registrant has been properly certified for each year covered by the renewal period. In addition, the course must include a clinical component. Credit hours awarded for certification in CPR shall not exceed three hours of required continuing education hours per biennium. Credit hours awarded for certification in pediatric advanced life support (PALS) or advanced cardiac life support (ACLS) may be claimed hour for hour. 25.4(4) Infection control. Beginning September 1, 2018, licensees and registrants shall complete continuing education in the area of infection control. Licensees and registrants shall furnish evidence of continuing education completed within the previous biennium in the area of infection control standards, as required by the Centers for Disease Control and Prevention of the United States Department of Health and Human Services. Completion of continuing education in the area of infection control shall be credited toward the required continuing education requirement in the renewal period during which it was completed. A minimum of one hour shall be submitted. 25.4(5) Jurisprudence. Beginning September 1, 2018, licensees and registrants shall complete continuing education in the area of Iowa jurisprudence related to the practice of dentistry, dental hygiene and dental assisting. Licensees and registrants shall furnish evidence of continuing education completed within the previous biennium in the area of Iowa jurisprudence. Completion of continuing education in the area of Iowa jurisprudence shall be credited toward the required continuing education requirement in the renewal period during which it was completed. A minimum of one hour shall be submitted.

176

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 650—25.5(153) Acceptable programs and activities. 25.5(1) A continuing education activity shall be acceptable and not require board approval if it meets the following criteria: a. It constitutes an organized program of learning (including a workshop or symposium) which contributes directly to the professional competency of the licensee or registrant and is of value to dentistry and applicable to oral health care; and b. It pertains to common subjects or other subject matters which relate to the practice of dentistry, dental hygiene, or dental assisting which are intended to refresh and review, or update knowledge of new or existing concepts and techniques, and enhance the dental health of the public; and c. It is conducted by individuals who have sufficient special education, training and experience to be considered experts concerning the subject matter of the program. The program must include a written outline or manual that substantively pertains to the subject matter of the program. 25.5(2) Types of activities acceptable for continuing dental education credit may include: a. A dental science course that includes topics which address the clinical practice of dentistry, dental hygiene, dental assisting and dental public health. b. Courses in record keeping, medical conditions which may have an effect on oral health, ergonomics related to clinical practice, HIPAA, risk management, sexual boundaries, communication with patients, OSHA regulations, and the discontinuation of practice related to the transition of patient care and patient records. c. Sessions attended at a multiday convention-type meeting. A multiday convention-type meeting is held at a national, state, or regional level and involves a variety of concurrent educational experiences directly related to the practice of dentistry. d. Postgraduate study relating to health sciences. e. Successful completion of a recognized specialty examination or the Dental Assisting National Board (DANB) examination. f. Self-study activities. g. Original presentation of continuing dental education courses. h. Publication of scientific articles in professional journals related to dentistry, dental hygiene, or dental assisting. 25.5(3) Credit may be given for other continuing education activities upon request and approval by the board. 650—25.6(153) Unacceptable programs and activities. 25.6(1) Unacceptable subject matter and activity types include, but are not limited to, personal development, business aspects of practice, business strategy, financial management, marketing, sales, practice growth, personnel management, insurance, collective bargaining, and events where volunteer services are provided. While desirable, those subjects and activities are not applicable to dental skills, knowledge, and competence. Therefore, such courses will receive no credit toward renewal. The board may deny credit for any course. 25.6(2) Inquiries relating to acceptability of continuing dental education activities, approval of sponsors, or exemptions should be directed to Advisory Committee on Continuing Dental Education, Iowa Dental Board, 400 S.W. 8th Street, Suite D, Des Moines, Iowa 50309-4687. 650—25.9(153) Designation of continuing education hours. Continuing education hours shall be determined by the length of a continuing education course in clock hours. For the purpose of calculating continuing education hours for renewal of a license or registration, the following rules shall apply: 25.9(1) Attendance at a multiday convention. a. Attendees at a multiday convention may receive a maximum of 1.5 hours of credit per day with the maximum of six hours of credit allowed per biennium. b. Sponsors of multiday conventions shall submit to the board for review and prior approval guidelines for awarding credit for convention attendance. 25.9(2) Presenters or attendees of table clinics at a meeting. a. Four hours of credit shall be allowed for presentation of an original table clinic at a meeting as verified by the sponsor when the subject matter conforms with rule 650—25.5(153). b. Attendees at the table clinic session of a dental, dental hygiene, or dental assisting meeting shall receive two hours of credit as verified by the sponsor when the subject matter conforms with rule 650—25.5(153). 25.9(3) Postgraduate study relating to health sciences shall receive 15 credits per semester. 25.9(4) Successful completion of a specialty examination or the Dental Assisting National Board (DANB) shall result in 15 hours of credit. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

177

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 25.9(5) Self-study activities shall result in a maximum of 12 hours of continuing education credit per biennium. 25.9(6) An original presentation of continuing dental education shall result in credit double that which the participants receive. Additional credit will not be granted for the repeating of presentations within the biennium. Credit is not given for teaching that represents part of the licensee’s or registrant’s normal academic duties as a full-time or part-time faculty member or consultant. 25.9(7) Publication of scientific articles in professional journals related to dentistry, dental hygiene,or dental assisting shall result in 5 hours of credit per article with the maximum of 20 hours allowed per biennium. 650—25.10(153) Extensions and exemptions. 25.10(1) Illness or disability. The board may, in individual cases involving physical disability or illness, grant an exemption of the continuing education requirements or an extension of time within which to fulfill the same or make the required reports. No exemption or extension of time shall be granted unless written application is made on forms provided by the board and signed by the licensee or registrant and a licensed health care professional. Extensions or exemptions of the continuing education requirements may be granted by the board for any period of time not to exceed one calendar year. In the event that the physical disability or illness upon which an exemption has been granted continues beyond the period granted, the licensee or registrant must apply for an extension of the exemption. The board may, as a condition of the exemption, require the applicant to make up a certain portion or all of the continuing education requirements. 25.10(2) Other extensions or exemptions. Extensions or exemptions of continuing education requirements will be considered by the board on an individual basis. Licensees or registrants will be exempt from the continuing education requirements for: a. Periods that the person serves honorably on active duty in the military services; b. Periods that the person practices the person’s profession in another state or district having a continuing education requirement and the licensee or registrant meets all requirements of that state or district for practice therein; c. Periods that the person is a government employee working in the person’s licensed or registered specialty and assigned to duty outside the United States; d. Other periods of active practice and absence from the state approved by the board; e. The current biennium renewal period, or portion thereof, following original issuance of the license; f. For dental assistants registered pursuant to rule 650—20.7(153), the current biennium renewal period, or portion thereof, following original issuance of the registration. 650—25.14(153) Noncompliance with continuing dental education requirements. It is the licensee’s or registrant’s personal responsibility to comply with these rules. The license or registration of individuals not complying with the continuing dental education rules may be subject to disciplinary action by the board or nonrenewal of the license or registration. 650—27.12(153) Teledentistry. This rule establishes the standards of practice for teledentistry. 27.12(1) Definition. “Teledentistry” means a dentist is providing or supervising dental services using technology when the patient is in another location. 27.12(3) License or registration required. A dentist, dental hygienist, or dental assistant who uses teledentistry for a patient located in Iowa shall hold an active Iowa license or registration issued by the board. 27.12(4) General requirements. The standard of dental care is the same whether a patient is seen in person or through a teledentistry encounter. The use of teledentistry is not an expansion of the scope of practice for dental hygienists or dental assistants. A dentist who uses teledentistry shall utilize evidence-based standards of practice and practice guidelines to ensure patient safety, quality of care, and positive outcomes. 27.12(5) Informed consent. When teledentistry will be utilized, a dentist shall ensure informed consent covers the following additional information: a. A description of the types of dental care services provided via teledentistry, including limitations on services; b. The identity, contact information, practice location, licensure, credentials, and qualifications of all dentists, dental hygienists, and dental assistants involved in the patient’s dental care, which must be publicly displayed on a website or provided in writing to the patient; and c. Precautions for technological failures or emergency situations.

178

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 27.12(8) Supervision. With the exception of administering local anesthesia or nitrous oxide inhalation analgesia, or performing expanded functions, a dentist may delegate to and supervise services to be performed by a dental hygienist or dental assistant. a. When direct supervision of a dental hygienist or dental assistant is required, a dentist may provide direct supervision using live video. A dentist is not required to directly supervise the entire delivery of dental care but must appear upon request using live video with a response time similar to what would be expected if the dentist were present in the treatment facility. b. When general supervision of a dental hygienist or dental assistant is required, a dentist may utilize teledentistry. c. When public health supervision is utilized, a supervising dentist may authorize use of teledentistry. CHAPTER 29—SEDATION AND NITROUS OXIDE INHALATION ANALGESIA [Rule Excerpts, Current as of 2/19/20] 650—29.1(153) Definitions. For the purpose of these rules, relative to the administration of deep sedation, general anesthesia, moderate sedation, minimal sedation, and nitrous oxide inhalation analgesia by licensed dentists, the following definitions shall apply: "ACC" means the anesthesia credentials committee of the board. “ASA” refers to the American Society of Anesthesiologists Patient Physical Status Classification System. Category I means normal healthy patients, and category II means patients with mild systemic disease. Category III means patients with severe systemic disease, and category IV means patients with severe systemic disease that is a constant threat to life. “Board” means the Iowa dental board established in Iowa Code section 147.14(1) "d." “Capnography” means the monitoring of the concentration of exhaled carbon dioxide in order to assess physiologic status or determine the adequacy of ventilation during anesthesia. “Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired “(MRD)” means the manufacturer’s maximum recommended dose of a drug as printed in FDA-approved labeling. “Minimal sedation” means a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. A patient whose only response reflex is withdrawal from repeated painful stimuli is not considered to be in a state of minimal sedation “Moderate sedation” means a drug-induced depression of consciousness, either by enteral or parenteral means, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. A patient whose only response reflex is withdrawal from a painful stimulus is not considered to be in a state of moderate sedation “Monitoring nitrous oxide inhalation analgesia” means continually observing the patient receiving nitrous oxide and recognizing and notifying the dentist of any adverse reactions or complications. “Nitrous oxide inhalation analgesia” refers to the administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. "Pediatric” means patients aged 12 or under.

179

Iowa State Dental Practice Act and Administrative Rules for Dental Assistants 650—29.4(153) Nitrous oxide inhalation analgesia 29.3(4) A dental assistant may monitor a patient who is under nitrous oxide after the dentist has induced a patient and established the maintenance level, provided the dental assistant has completed a board-approved expanded function course. A dental assistant may make adjustments to decrease the nitrous oxide concentration while monitoring the patient or may turn off oxygen delivery at the completion of the dental procedure . 650—29.5(153) Shared standards for moderate sedation, deep sedation and general anesthesia. 29.5(4) A dentist who administers sedation or anesthesia shall ensure that each facility where sedation services are provided is appropriately staffed to reasonably handle emergencies incident to the administration of sedation. A patient monitor shall be present in the treatment room and continually monitor the patient until the patient returns to a level of minimal sedation. 29.5(8) The dentist must establish emergency protocols which comply with the following: b. A patient monitor shall employ initial life-saving measures in the event of an emergency and shall activate the EMS system for life-threatening complications; 650—29.6(153) Moderate sedation standards. 29.6(3) A dentist administering moderate sedation in a facility shall have at least one patient monitor observe the patient while under moderate sedation. The patient monitor shall be capable of administering emergency support and shall complete one of the following: a. A minimum of three hours of on-site training in airway management that provides the knowledge and skills necessary for a patient monitor to competently assist with emergencies including, but not limited to, recognizing apnea and airway obstruction; b. Current ACLS or PALS certification; or c. Current DAANCE certification. 650—29.7(153) Deep sedation or general anesthesia standards. 29.7(2) A dentist shall have at least two patient monitors observe the patient while the patient is under deep sedation or general anesthesia. The patient monitors who observe patients under deep sedation or general anesthesia shall be capable of administering emergency support and shall have completed one of the following: a. Current ACLS or PALS certification; or b Current DAANCE certification.

180

Kansas DANB Certificant Counts: Kansas Certified Dental Assistant (CDA) certificants

244

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Lane Hemsley, Executive Director Kansas Dental Board 900 SW Jackson, Room 455-S Topeka, KS 66612-1230 Phone: 785-296-6400 Fax: 785-296-3116 Email: dental.info@ks.gov Website: www.dental.ks.gov

Radiation Health and Safety (RHS)

990

Infection Control (ICE)

982

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Flint Hills Technical College Labette Community College Salina Area Technical School Wichita Area Technical College

DANB CDA Certificant State of Kansas+

$17.06 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 18, 2020.

Source: 2018 DANB Salary Survey (state data based on 4 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

181

Kansas State Radiography Requirements There are no radiography requirements for dental assistants in Kansas. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions To perform expanded functions under the direct supervision of a licensed dentist in Kansas, a dental assistant must become qualified as follows: Coronal polishing: The dental assistant must undergo appropriate training by a licensed dentist. Coronal scaling: The dental assistant must successfully complete a Kansas Board-approved course of instruction. The supervising dentist must verify proof of completion of required training and must report to the Kansas Board the name and practice location of each dental assistant who is performing coronal scaling by April 3, 2016 or within 30 days of the dental assistant first performing coronal scaling, whichever is later. Assisting in the administration and monitoring of nitrous oxide and/or oxygen: The dental assistant must be certified in cardiopulmonary resuscitation (CPR) and successfully complete a Kansas Board-approved course of instruction which includes 16 hours of instruction at a CODA-accredited teaching institution.

Kansas State Dental Practices Act and Administrative Rules for Dental Assistants Dental Practices Act â&#x20AC;&#x201C; Kansas Dental Board Kansas Dental Board Statutes Chapter 65 - PUBLIC HEALTH Article 14 - REGULATION OF DENTISTS AND DENTAL HYGIENISTS 65-1423. Act inapplicable to certain practices, acts and operations; definitions. (a) Nothing in this act shall apply to the following practices, acts and operations: (8) except as hereinafter limited to the performance of any dental service of any kind by any person who is not licensed under this act, if such service is performed under the supervision of a dentist licensed under this act at the office of such licensed dentist except that such nonlicensed person shall not be allowed to perform or attempt to perform the following dental operations or services: (A) Any and all removal of or addition to the hard or soft tissue of the oral cavity; (B) any and all diagnosis of or prescription for treatment for disease, pain, deformity, deficiency, injury or physical condition of the human teeth or jaws, or adjacent structure; (C) any and all correction of malformation of teeth or of the jaws; (D) any and all administration of general or local anaesthesia of any nature in connection with a dental operation; or (E) a prophylaxis, except that individuals who are not licensed but who are operating under the direct supervision of a dentist may (i) coronal polish teeth as defined by rules and regulations of the board and (ii) coronal scale teeth above the gum line as long as such procedure is not performed on a patient who has undergone local or general anesthesia at the time of the procedure, is undertaken by a nonlicensed person who has successfully completed necessary training for performing such dental procedure in a course of study approved by the board, which course of study is consistent with American dental association accreditation standards and includes but is not limited to adequate instruction on scaling the teeth and recognition of periodontal disease, is undertaken by a person who has met the experience requirements for performing such procedures as established by the board; 65-1444. Drugs; surgery; anesthetics; appliances; qualifications for administering intravenous sedation and general anesthetics; sedation permits; rules and regulations; assistant administering and monitoring . oxide or oxygen, requirements; denial, revocation, suspension or limitation of sedation permit. (b) A dentist may utilize an assistant not licensed by the board in the administration and monitoring of nitrous oxide or oxygen, or both, if that person is certified in cardiopulmonary resuscitation and has satisfactorily completed a course of instruction which has been approved by the board. To be approved by the board, the course of instruction shall include a minimum of six hours of instruction at a teaching institution accredited by the American dental association** and include satisfactory completion of courses which offer both didactic and clinical instruction in: (A) Theory of pain control; (B) anatomy; (C) medical history; (D) pharmacology; and (E) emergencies and complications. **The ADA does not approve education courses, however, the Commission on Dental Accreditation (CODA) is the United States Department of Education recognized accreditation agency for dental and dentally-related education programs and accredits dental-related education programs.

182

Kansas State Dental Practices Act and Administrative Rules for Dental Assistants KANSAS DENTAL BOARD ADMINISTRATIVE REGULATIONS Article 1. - GENERAL RULES 71-1-18. Sterilization and infection control. (a) As used in this regulation, the following definitions shall apply: (1) “Dental health care worker” means dentist, dental hygienist, dental assistant, or other employee of the dentist, or any other person who performs or participates in an invasive or exposure-prone procedure or functions ancillary to invasive procedures. (2) “Exposure-prone procedure” means a procedure in which there is an increased risk of percutaneous injury to the dental health care worker by virtue of digital palpation of a needle tip or other sharp instrument in a body cavity or simultaneous presence of the dental health care worker’s fingers and a needle or other sharp instruments in a poorly visualized or highly confined anatomic site, or any other circumstance in which there is a significant risk of contact between the blood or body fluids of the dental health care worker and the blood or body fluids of the patient. (3) “HbeAg seropositive” means that the presence of the hepatitis B antigen has been confirmed by a test meeting the criteria of the federal centers for disease control. (4) “HBV” means the hepatitis B virus. (5) “HIV” means the human immunodeficiency virus. (6) “HIV seropositive” means that the presence of HIV antibodies has been confirmed by a test meeting the criteria of the federal centers for disease control. (7) “Invasive procedure” means any surgical or other diagnostic or therapeutic procedure involving manual or instrumental contact with or entry into any blood, body fluids, cavity, internal organ, subcutaneous tissue, mucous membrane, or percutaneous wound of the human body. (b) Each dental health care worker who performs or participates in an invasive or exposure-prone procedure shall observe and adhere to infection control practices and universal blood and body fluid precautions. For the purpose of infection control, all dental staff members and all patients shall be considered potential carriers of communicable diseases. Infection control procedures shall be required to prevent disease transmission from patient to doctor and staff, doctor and staff to patient, and patient to patient. Each dentist shall be required to comply with the applicable standard of care in effect at the time of treatment. Precautions shall include the following minimum standards. (1) Each dental health care worker shall routinely use protective barriers and surface decontamination. (A) Gloves shall be used by the dentist and direct care staff during any treatment involving procedures or contact with items potentially contaminated with the patient’s bodily fluids or other dental debris. Fresh gloves shall be used for each patient. Gloves that have been used for dental treatment shall not be reused for any other purpose. (B) Surgical masks and protective eyewear or chin-length plastic face shields shall be worn to protect the face, the oral mucosa, and the nasal mucosa when splashing or splattering of blood or other body fluids is likely. (C) Reusable or disposable gowns, laboratory coats, or uniforms shall be worn when clothing is likely to be soiled with blood or other body fluids. If reusable gowns are worn, they may be washed, using a normal laundry cycle. Gowns shall be changed at least daily or when visibly soiled with blood. (D) Surface decontamination and disinfection or protective barriers shall be used in areas of the dental operatory that may be contaminated by blood or saliva during treatment and are not removable to be sterilized. Contaminated surface coverings shall be removed, discarded, and then replaced with clean material between patients. Surfaces to be covered or decontaminated and disinfected shall include the following: (i) The delivery unit; (ii) chair controls; (iii) light handles; (iv) the high-volume evacuator handle; (v) x-ray heads and controls; (vi) headrests; and (vii) instrument trays. (E) Dental health care workers shall wash their hands after glove removal if the hands have been contaminated by bodily fluids or other dental debris. (F) Dental health care workers who have exudative lesions or weeping dermatitis shall refrain from all direct patient care and from handling patient care devices used in exposure-prone invasive procedures, unless covered by an effective barrier. (2) Dental health care workers shall take appropriate precautions to prevent injuries caused by needles, scalpels, and other sharp instruments during and after procedures. If during a single visit a patient needs multiple injections over time from a single syringe, the needle shall be recapped or placed in a sterile field between each use and to avoid the possibility of needlestick injury or needle contamination. Used sharp items shall be placed in puncture-resistant containers for disposal. (3) Any heat-stable instrument or device that enters tissue or contacts the mucous membranes shall be sterilized. Dental health care workers shall comply with the following sterilization requirements. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

183

Kansas State Dental Practices Act and Administrative Rules for Dental Assistants (A) Before sterilization, all instruments shall be decontaminated to remove all visible surface contamination, including blood, saliva, tooth and dental restorative material cuttings and debris, soft tissue debris, and bacterial plaque. Decontamination of instruments may be accomplished by a thorough scrubbing with soap and water or detergent, or by using a mechanical device, including an ultrasonic cleaner. Persons involved in cleaning instruments shall take reasonable precautions to prevent injuries. (B) Heat-stable dental instruments shall be routinely sterilized between patient use by one of the following methods: (i) Steam under pressure autoclaves; (ii) heat plus pressurized chemical (unsaturated formaldehyde or alcohol); (iii) vapor chemoclave; (iv) prolonged dry heat exposure; (v) dry heat convection sterilizers; (vi) ethylene oxide sterilizers; or (vii) other equivalent methods. (C) Biological spore testing devices shall be used on each sterilization until after each six days of use, but not less often than each month, to verify that all pathogens have been killed. A log of spore testing shall be kept for three years for each sterilization unit. (D) Items to be sterilized shall include the following: (i) Low-speed handpiece contra-angles and prophy-angles; (ii) high-speed handpieces; (iii) hand instruments; (iv) burs; (v) endodontic instruments; (vi) air-water syringe tips; (vii) high-volume evacuator tips; (viii) surgical instruments; and (ix) sonic and ultrasonic periodontal scalers. (E) When sterilizing the heat-stable instruments or devices listed paragraphs (b)(3)(D)(i) through (ix), each instrument or device shall be placed in a closed bag or container for sterilization and thereafter maintained in that bag or container until immediately before use. (F) Following the sterilization of heat-stable instruments or devices not listed in paragraphs (b)(3)(D)(i) through (ix), each instrument or device shall be maintained in covered storage until immediately before use. (G) Nondisposable items used in noninvasive procedures that cannot be heat sterilized shall be decontaminated and disinfected with a chemical sterilant that has been registered by the U.S. Environmental Protection Agency and is tuberculocidal. (H) Materials, impressions, and intra-oral appliances shall be decontaminated and disinfected before being sent to and upon return from a commercial dental laboratory. (I) A dental health care worker who is HbeAG seropositive or HIV seropositive, or who otherwise knows or should know that the worker carries and is capable of transmitting HBV or HIV, shall not thereafter perform or participate directly in an exposure-prone procedure unless the worker has sought counsel from an expert review panel. The expert review panel shall be composed of these individuals: (i) The dental health care worker’s personal physician; (ii) an infectious disease specialist with expertise in HIV and HBV transmission; (iii) a dentist licensed in the state of Kansas with expertise in procedures performed by the health care worker; and (iv) a state of Kansas or local public health official. (c) Reports and information furnished to the Kansas dental board relative to the HbeAg or HIV status of a dental health care worker shall not be deemed to constitute a public record but shall be deemed and maintained by the board as confidential and privileged as a medical record. These reports and this information shall not be subject to disclosure by means of subpoena in any judicial, administrative, or investigative proceeding, if the dental health care worker adheres to the regulations of the board and is willing to participate in counseling and be reviewed and monitored by the board or its designated agent. (d) When the board learns that a dental health care worker is HbeAg or HIV seropositive, contact shall be made with that dental health care worker to review the regulations of the board and develop a process of monitoring that individual’s practice. (e) The monitoring of a dental health care worker’s HIV or HBV status and discipline of the dental health care worker shall be reported to the Kansas department of health and environment, but shall remain confidential. (f) During business hours, the office of a licensed dentist may be inspected by the Kansas dental board or its duly authorized agents and employees in order to evaluate compliance with this regulation. A written evaluation shall be given to the licensed person or office representative, and a copy shall be filed with the Kansas dental board. 184

Kansas State Dental Practices Act and Administrative Rules for Dental Assistants Article 5 - SEDATIVE AND GENERAL ANESTHESIA 71-5-7. Definitions. As used in these regulations the following terms shall have the meaning specified in this regulation. (a) “Administer” means to deliver a pharmacological agent to the patient by an enteral or a parenteral route at the direction of a dentist while in a dental office. (b) “Adult patient” means a patient who is more than 12 years of age. (c) “Anxiolysis” means the diminution or elimination of anxiety through the means of a single drug or combination of agents prescribed or administered by a dentist and used so as not to induce conscious sedation when used alone or in combination with nitrous oxide. (d) “Conscious sedation” and “Conscious sedative state” means a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal commands and that is produced by any pharmacological or nonpharmacological agent or a combination of these agents. (e) “Deep sedation” means an induced state of depressed consciousness accompanied by a partial loss of protective reflexes or the ability to continuously and independently maintain an airway and to respond purposefully to physical stimulation or verbal commands. Deep sedation is produced by a pharmacological or nonpharmacological agent or a combination of these agents. (g) “End-tidal carbon dioxide monitoring” means a process to determine the percent of carbon dioxide in a patient’s breath through the use of a carbon dioxide monitor. (h) “Enteral conscious sedation” and “Combination inhalation-enteral conscious sedation” means the use of one or more sedative agents that are absorbed through the gastrointestinal tract or oral mucosa, including by oral, rectal and sublingual administration, either by themselves or in combination with nitrous oxide and oxygen to render a patient in a conscious sedative state. (i) “General anesthesia” means an induced state of unconsciousness accompanied by a partial or complete loss of productive reflexes, including the inability to continuously and independently maintain an airway and to respond purposefully to physical stimulation or verbal commands. General anesthesia is produced by a pharmacological or nonpharmacological agent or a combination of these agents. (k) “Parenteral conscious sedation” means the use of one or more sedative agents that bypass the gastrointestinal tract, including by intramuscular, intravenous, intranasal, submucosal, subcutaneous, and intraocular administration, to render a patient in a conscious sedative state. (m) “Vital signs” means blood pressure, heart rate, and respiratory rate. 71-5-10. Level I permit: enteral conscious sedation or combination inhalation-enteral conscious sedation. (e) During the administration of enteral conscious sedation or combination inhalation-enteral conscious sedation, each treating dentist shall ensure that both of the following conditions are met: (1) At least one additional staff person who has either a current “basic cardiac life support for the health care provider” certificate from the American heart association or a current certificate deemed equivalent by the board from a provider approved by the board is present. 71-5-11. Level II permit: parenteral conscious sedation. (e) During the administration of parenteral conscious sedation, each treating dentist shall meet the requirements specified in KAR 71-5-10(e), continuously monitor for the presence of exhaled carbon dioxide using a capnograph, and ensure that an automated external defibrillator or defibrillator is available and in working order. 71-5-12. Level III permit: deep sedation and general anesthesia. (e) During the administration of deep sedation or general anesthesia, each treating dentist shall meet the following requirements: (1) Ensure that at least two additional staff persons with a current certificate in cardiopulmonary resuscitation for health care providers are present in addition to the treating dentist; (2) comply with all of the requirements specified in KAR 71-5-11(e) Article 6. - DENTAL AUXILIARIES 71-6-1. Definitions. As used in these regulations, the following terms shall have the meanings indicated: (a) “Approved instruction course” means a course of instruction that the board has found to meet the requirements listed in K.A.R. 71-6-3. (b) “Coronal” means the portion of a tooth or tooth replacement visible above the gum line. (c) “Coronal polish teeth” means to remove soft accretions and stains from coronal surfaces of teeth or tooth replacements. (d) “Coronal scale teeth” means to remove hard deposits and accretions from the coronal surfaces of teeth or tooth replacements. (e) “Direct supervision” means that the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and, before dismissal of the patient, evaluates the performance or has it evaluated by another person licensed by the board. (Authorized by K.S.A. 74-1406; implementing K.S.A. 65-1423; effective Feb. 12, 1999; amended April 16, 2004.) © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

185

Kansas State Dental Practices Act and Administrative Rules for Dental Assistants 71-6-2. Acts restricted. (a) (1) A nonlicensed person shall not perform coronal scaling as part of a prophylaxis without first obtaining a certificate demonstrating successful completion of an approved course of instruction. (2) The supervising dentist shall not permit a nonlicensed person to perform coronal scaling as part of a prophylaxis until that personâ&#x20AC;&#x2122;s certificate, demonstrating successful completion of an approved course of instruction, is prominently posted at the location where the coronal scaling will be performed. (b) A nonlicensed person shall not perform coronal scaling as a part of a prophylaxis on a patient who is under local or general anesthesia. (c) A nonlicensed person may perform coronal scaling only under the direct supervision of a supervising dentist licensed and practicing in Kansas. (Authorized by K.S.A. 74-1406 and implementing K.S.A. 1997 Supp. 65-1423(h)(5), as amended by L. 1998, Ch. 141, Sec. 1; effective Feb. 12, 1999.) 71-6-3. Approved instruction course. (a) Each private or public educational entity seeking approval by the board, pursuant to L. 1998, Ch. 141, Sec. 1, of an instruction course shall demonstrate that the course meets the following minimum requirements: (1) Has a student-instructor ratio consistent with the American Dental Association's accreditation standards for dental assisting programs; (2) encourages enrollment by a geographically diverse population of prospective students; (3) includes the following course topics: (A) Dental and gingival anatomy and morphology; (B) periodontal disease, including recognition and treatment; (C) dental plaque, stain, and calculus formation; (D) sterilization and infection control; (E) oral hygiene, with an emphasis on technique, products, and devices; (F) topical fluoride application; (G) the use of instruments, including technique, position, and sharpening; (H) coronal scaling, including laboratory experience with mechanical and ultrasonic devices; and (I) coronal polishing, including laboratory experience; (4) is a minimum of 90 hours; (5) includes one or more outcome assessment examinations that demonstrate that the student has obtained technical and clinical competency in the coronal scaling of teeth; and (6) upon successful completion of the course, issuance by the offering educational entity of a certificate identifying the student and the date of successful completion. (b) Before any proposed changes are made to the required elements of an approved instruction course, the changes shall be approved by the board. (Authorized by K.S.A. 74-1406 and implementing K.S.A. 1997 Supp. 65-1423(h) (5), as amended by L. 1998, Ch. 141, Sec. 1; effective Feb. 12, 1999.) 71-6-4. Subgingival scaling. Whenever coronal scaling is performed as part of a prophylaxis by a nonlicensed person who has a certificate from an educational entity demonstrating successful completion of an approved course of instruction, all subgingival scaling shall be performed by a hygienist or dentist licensed in Kansas. (Authorized by K.S.A. 74-1406 and implementing K.S.A. 1997 Supp. 65-1423 (h)(5), as amended by L. 1998, Ch. 141, Sec. 1; effective Feb. 12, 1999.) 71-6-5 . Duty to notify board. Each supervising dentist who allows a nonlicensed person to coronal scale teeth after the effective date of this regulation shall meet the following requirements: (a) Verify that the nonlicensed person has proof of completing the training to coronal scale teeth required by K.S.A. 651423 (a)(8)(E), and amendments thereto; and (b) report to the board the name and practice location of the nonlicensed person within 30 days of the effective date of this regulation or within 30 days of the nonlicensed personâ&#x20AC;&#x2122;s first performing the coronal scaling of teeth under the supervision of the dentist, whichever is later. (Authorized by K.S.A. 74-1406; implementing K.S.A. 2014 Supp. 651423; effective Feb. 12, 1999; amended June 4, 2004; amended March 4, 2016.) 71-6-6. Coronal polishing. Any dentist licensed and practicing in Kansas may delegate to a nonlicensed person the coronal polishing of teeth if the dentist provides that person with direct supervision and has provided that person with the appropriate training in polishing techniques. (Authorized by K.S.A. 74-1406 and implementing K.S.A. 1997 Supp. 65-1423(h)(5), as amended by L. 1998, Ch. 141, Sec. 1; effective Feb. 12, 1999.)

186

Kentucky DANB Certificant Counts: Kentucky Certified Dental Assistant (CDA) certificants

214

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

874

Infection Control (ICE)

708

Coronal Polishing (CP)

Sealants (SE)

State Board of Dentistry Contact Jeff Allen, Executive Director Kentucky Board of Dentistry 312 Whittington Parkway, Suite 101 Louisville, KY 40222 Phone: 502-429-7280 Fax: 502-429-7282 Website: www.dentistry.ky.gov

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs West Kentucky Community and Technical College

DANB CDA Certificant State of Kentucky+

$17.13 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of April 1, 2020.

Source: 2018 DANB Salary Survey (state data based on 6 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

187

Kentucky State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Kentucky, a dental assistant must: (1) Pass the national DANB Radiation Health and Safety (RHS) exam OR (2) Successfully complete a CODA-approved course in radiation safety and technique OR (3a) Complete a six-hour Kentucky Board-approved course in dental radiography safety* and complete one of the following: (3b) A minimum of four hours of instruction in dental radiography technique while under the employment and supervision of the dentist in the office or (3c) A four-hour course in radiography technique approved by the Kentucky Board of Dentistry. Note: The DALE Foundation's DANB RHS Review course meets the six-hour radiography safety course requirement.

State Requirements For Expanded Functions To perform coronal polishing procedures under the direct supervision of a licensed dentist in the state of Kentucky, a dental assistant must successfully complete an eight-hour course offered by a dental assisting program accredited by the Commission on Dental Accreditation (CODA) AND obtain a certificate from the authorized institution, which the employer shall retain in the employee's personnel file. To perform starting intravenous (IV) access lines under the direct supervision of a dentist holding a sedation or anesthesia permit, a registered dental assistant must successfully complete a board-approved course in starting IV lines AND submit documentation of course completion to the supervising dentist, who shall retain such documentation in the employeeâ&#x20AC;&#x2122;s personnel file.

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Kentucky Board of Dentistry Kentucky Revised Statutes KRS Chapter 313.00 313.010 Definitions As used in this chapter, unless the context requires otherwise: (1) "Board" means the Kentucky Board of Dentistry; (3) "Delegated duties list" means the list of procedures authorized in administrative regulation which may be delegated by a dentist licensed under this chapter to a licensed dental hygienist or a registered dental assistant; (4) "Dental auxiliary personnel" means any staff member of a dental office not licensed by or registered with the board; (5) "Dental hygiene" means the treatment of the oral cavity, including but not limited to dental hygiene assessment or screening, scaling and root planing, nonsurgical therapy, removing calcareous deposits, removing accumulated accretion from beneath the free gingival margin, cavity preventive procedures, periodontal procedures that require administering antimicrobial agents along with other general dentistry activities outlined in the treatment care plan and not prohibited by this chapter or by administrative regulation promulgated by the board; (11) "Dentistry" means the evaluation, diagnosis, prevention, or surgical, nonsurgical, or related treatment of diseases, disorders, or conditions of the oral cavity, maxillofacial area, or the adjacent and associated structures and their impact on the human body provided by a dentist within the scope of his or her education, training, and experience and in accordance with the ethics of the profession and applicable law. Any person shall be regarded as "practicing dentistry" who, for a fee, salary, or other reward paid, or to be paid either to himself or herself, or to another person, performs or advertises to perform, dental operations of any kind, including the whitening of natural or manufactured teeth, or who diagnoses or treats diseases or lesions of human teeth or jaws, or attempts to correct malpositions thereof, or who diagnoses or treats disorders, or deficiencies of the oral cavity and adjacent associated structures, or who takes impressions of the human teeth or jaws to be used directly in the fabrication of any intraoral appliance, or shall construct, supply, reproduce or repair any prosthetic denture, bridge, artificial restoration, appliance or other structure to be used or worn as a substitute for natural teeth, except upon the written laboratory procedure work order of a licensed dentist and constructed upon or by the use of casts or models made from an impression taken by a licensed dentist, or who shall advertise, offer, sell, or deliver any such substitute or the services rendered in the construction, reproduction, supply, or repair thereof to any person other than a licensed dentist, or who places or adjusts such substitute in the oral cavity of another, or who uses the words "dentist," "dental surgeon," the letters "D.D.S.," "D.M.D.," or other letters or title in connection with his or her name, which in any way represents him or her as being engaged in the practice of dentistry; (12) "Direct supervision" means that the dentist is physically present in the dental office or treatment facility, personally diagnoses the condition to be treated, authorizes the procedures to be performed, remains in the dental office or treatment facility while the procedures are being performed, and evaluates the performance of the individual supervised;

188

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants (13) "General supervision" means a circumstance of treatment in which a dentist licensed under this chapter must diagnose and authorize the work to be performed on a patient by the dental hygienist authorized pursuant to administrative regulation to work under general supervision but the dentist is not required to be on the premises while the treatment is carried out; (14) "Registered dental assistant" means any person who is registered with the board and works under the direct supervision of a dentist; (16) "Volunteer community health setting" means a setting in which services are rendered at no charge to the patient or to third-party payors. 313.030 Licensing and registration of dentists, dental hygienists, and dental assistants -- Duration, expiration, and renewal -- Disciplinary action by board -- Board's power to extend license or registration. (1) The license or registration held by a dentist, dental hygienist, or dental assistant shall be valid for a period of two (2) years. (2) Each license or registration held by a dentist, dental hygienist, or dental assistant shall expire on December 31. A dentistâ&#x20AC;&#x2122;s license shall expire in odd-numbered years, while all other licenses or registrations issued by the board shall expire in even-numbered years. (3) Each license or registration held by any person issued under the provisions of this chapter shall be renewed at least biennially. Upon receipt of the application and fee, the board shall verify the accuracy of the application to determine whether the licensee or person seeking licensure or registration has met all the requirements as set forth in this chapter and in the administrative regulations promulgated by the board, and, if so, shall issue to the applicant a license or registration to practice or engage in the activity for the ensuing licensure or registration period. Such license or registration shall render the holder a legal practitioner of the practice or activity specified in the license or registration for the period stated on it. The board shall prescribe by administrative regulation promulgated in accordance with KRS Chapter 13A the beginning and ending of the licensure or registration period. (4) Any person who is licensed or registered by the board who allows his or her license or registration to lapse by failing to renew the license or registration as provided in this section may be reinstated by the board on payment of the current fee for original licensure or registration in addition to any late fees and by meeting the requirements of administrative regulations promulgated by the board. (5) An application for renewal of a license or registration shall be completed online or, if a written request is made to the board prior to November 1 of the year of expiration, a paper application shall be sent to the last known address of each licensee or certified or registered person requesting a paper application. (6) Any person engaging in any practice or activity regulated by the board during the time his or her license or registration has lapsed shall be considered practicing with an expired license or registration and shall be subject to the penalties provided for violations of this chapter. (7) Failure to receive the application for renewal of a license or registration shall not relieve a dentist, dental hygienist, or dental assistant from the duty to renew his or her license or registration prior to December 31 of the year in which the license or registration expires. (8) The duration of any license or registration issued by the board may be limited by disciplinary action of the board. (9) Every license or registration issued by the board shall have the seal of the board affixed. A holder of a license or registration shall retain it in his or her possession and be prepared to exhibit it upon demand by an employer or anyone to whom the holder of the license or registration offers treatment or any board or staff member of the Kentucky Board of Dentistry. Each license or registration issued by the board shall be posted in a conspicuous place in each place of employment of the dentist, dental hygienist, or dental assistant. (10) Failure or refusal to produce a license or registration upon demand shall be prima facie evidence that no such license or registration exists. (11) In order to ensure a proper transition during the implementation of the provisions of this section, the board may, for a period of no longer than three (3) years, extend a license or registration of any person in order to utilize the expiration date provided for in this section. The board shall, in writing, notify each person whose license or registration is extended of the extension and the new date of expiration. The extension shall be without charge. 313.045 Administrative regulations governing dental assistants. (1) The board shall promulgate administrative regulations in accordance with KRS Chapter 13A to define registration requirements, duties, training, and standards of practice that may be performed by a dental assistant who has a minimum of one (1) year of dental office experience. (2) The board shall approve the instructor and the courses of study for approving duties, training, and standards of practice that may be performed by a registered dental assistant. (3) A registered dental assistant shall practice under the supervision, order, control, and full responsibility of a dentist licensed under this chapter. (4) The registration for each registered dental assistant shall be continuously displayed in a conspicuous place in the office of the licensee. (5) Supervising dentists shall only assign to registered dental assistants procedures that do not require the professional competence of a licensed dentist or a licensed dental hygienist. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

189

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants (6) Registered dental assistant services may include coronal polishing, a cosmetic procedure that is not essential to therapeutic oral prophylaxis, if the following criteria are observed: (a) Polishing activities are limited to the use of a rubber cap attached to a slow-speed rotary dental handpiece; (b) The assistant has received a certificate from the boardâ&#x20AC;&#x2122;s approved instructor that ensures the assistant has successfully completed a dental assisting course developed by the board and a committee of dental educators from the Kentucky institutions of dental education accredited by the Council on Dental Accreditation; and (c) The dental assisting course includes basic dental assisting and coronal polishing instruction that includes didactic, preclinical, clinical training, and competency testing. (7) Registered dental assistant services shall not include the following: (a) The practice of dental hygiene or the performance of the duties of a licensed dental hygienist that require the use of any instrumentation which may elicit the removal of calcareous deposits or accretions on the crowns and roots of teeth; (b) Diagnosis; (c) Treatment planning and prescription, including prescriptions for drugs or medicaments, or authorization for restorative, prosthodontic, or orthodontic appliances; (d) Surgical procedures on hard or soft tissues of the oral cavity, or any other intraoral procedure that contributes to or results in an irreversible alteration of the oral anatomy; and (e) The making of final impressions from which casts are made to construct any dental restoration. (8) A licensed dentist may delegate the taking of radiographs to registered dental assistants who have completed a board-approved course in radiography technique and safety. The course completion certificate shall be maintained by the supervising dentist and be made available to the board upon request. 313.050 Procedures which dentist may delegate to dental auxiliary personnel. (1) A licensed dentist may delegate to competent dental auxiliary personnel those procedures for which the dentist exercises direct supervision and full responsibility as long as the delegated powers do not include any of the following: (a) Those procedures which require professional judgment and skill, such as diagnosis and treatment planning and the cutting of hard or soft tissues or any intraoral procedure which will be used directly in the fabrication of an appliance which, when worn by the patient, would come in direct contact with hard or soft tissue; (b) Those procedures allocated by this chapter to licensed dental hygienists or registered dental assistants; and (c) No injectable medication or anesthesia shall be administered by auxiliary personnel unless otherwise authorized by law. (2) A licensed dentist may delegate the taking of radiographs to dental auxiliary personnel who have completed a boardapproved course in radiography technique and safety. The course completion certificate shall be maintained by the supervising dentist and be available to the board upon request. 313.070 Persons not licensed or registered -- Prohibitions on practicing -- Penalties -- Disciplinary powers of board -- Exceptions -- Hearing in Circuit Court. (1) A person who is not licensed or registered to do so, or whose license or registration to do so has been suspended, revoked, or denied, shall not practice as a dentist, dental hygienist, or dental assistant. (2) Any person who violates subsection (1) of this section is guilty of a Class B misdemeanor for the first offense and a Class A misdemeanor for each subsequent offense. (3) The provisions of this section shall not preclude the board from revoking or increasing the suspension period of a person practicing as a dentist, dental hygienist, or dental assistant who has illegally practiced while his or her license or registration is under suspension or has been revoked. (4) The filing of criminal charges or a criminal conviction for violation of the provisions of this chapter or the administrative regulations promulgated thereunder shall not preclude the board from instituting or imposing board disciplinary action authorized by this chapter against any person or organization violating this chapter or the administrative regulations promulgated thereunder. (5) The institution or imposition of disciplinary action by the board against any person or organization violating the provisions of this chapter or the administrative regulations promulgated thereunder shall not preclude the filing of criminal charges against or a criminal conviction of any person or organization for violation of the provisions of this chapter or the administrative regulations promulgated thereunder. (6) (a) Nothing in this chapter shall prohibit students from performing dental operations under the supervision of competent instructors approved by the dental school, college, or department of a university. The board may authorize the students of any dental college, school, or department of a university to practice dentistry in any state or municipal institution or public school, or under the board of health, or in a public clinic or a charitable institution. No fee shall be accepted by the student beyond the expenses provided by the stipend. (b) Students shall be at all times under the direct supervision of a dentist licensed in this state, who is an instructor of the institution at which they are studying. (7) Nothing in this chapter shall prohibit volunteer health practitioners providing services under KRS 39A.350 to 39A.366. (8) Violations of this chapter shall be heard in the Circuit Court of the county in which the alleged offense occurred. 190

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants 313.080 Grounds for discipline or for revocation or suspension of license or registration -- Criminal prosecution. (1) No person shall: (a) Call or hold himself out as or use the title dentist, dental specialist, dental hygienist, or dental assistant unless licensed or registered under the provisions of this chapter; (b) Operate, offer to operate, or represent or advertise the operation of a dental practice of any type unless licensed by or employing individuals licensed by the board; (c) Employ a dentist, dental hygienist, or dental assistant unless that person is licensed or registered under the provisions of this chapter; or (d) Maintain any license or certificate authorized by this chapter if convicted of, having entered a guilty plea to, having entered an Alford plea to, or having completed a diversion program for a Class A, B, or C felony offense on or after the date of initial licensure or registration. (2) Persons licensed or registered by the board or who are applicants for licensure or registration by the board shall be subject to disciplinary action by the board if they: (a) If licensed or registered by the board, violate any provision of this chapter or any administrative regulation promulgated by the board; (b) Use fraud or deceit in obtaining or attempting to obtain a license or registration from the board, or are granted a license upon mistake of a material fact; (c) If licensed or registered by the board, negligently act in a manner inconsistent with the practice of the discipline for which the person is licensed or registered; (d) Are unable to practice a discipline regulated by the board with reasonable skill or safety or are unfit or incompetent to practice a discipline regulated by the board; (e) Abuse, misuse, or misappropriate any drugs placed in the custody of the licensee or certified person for administration, or for use of others, or those drugs prescribed by the licensee; (f) Falsify or fail to make essential entries on essential records; (g) Are convicted of a misdemeanor which involved acts which bear directly on the qualifications or ability of the applicant, licensee, or certified person to practice the discipline for which the person is an applicant, licensee, or certified person, if in accordance with KRS Chapter 335B; (h) Are convicted of a misdemeanor which involved fraud, deceit, breach of trust, or physical harm or endangerment to self or others, acts which bear directly on the qualifications or ability of the applicant, licensee, or certificate holder to practice acts in the license or registration held or sought, if in accordance with KRS Chapter 335B; (i) Are convicted of a misdemeanor offense under KRS Chapter 510 involving a patient; (j) Have had a license or certificate to practice as a dentist, dental hygienist, or dental assistant denied, limited, suspended, probated, revoked, or otherwise disciplined in Kentucky or in another jurisdiction on grounds sufficient to cause a license to be denied, limited, suspended, probated, revoked, or otherwise disciplined in this Commonwealth; (k) Have a license or registration to practice any activity regulated by the board denied, limited, suspended, probated, revoked, or otherwise disciplined in another jurisdiction on grounds sufficient to cause a license or registration to be denied, limited, suspended, probated, revoked, or otherwise disciplined in this Commonwealth; (l) Violate any lawful order or directive previously entered by the board; (m) Have been listed on the National Practitioner Databank with a substantiated finding of abuse, neglect, or misappropriation of property; (n) Fail to notify the board in writing of any change in the personâ&#x20AC;&#x2122;s name, residential address, employment address, preferred mailing address, or telephone number within thirty (30) days of the change; (o) Fail to comply with KRS 422.317 regarding patient records; or (p) Fail to report to the board any negative outcome related to dental treatment involving intravenous or conscious sedation beyond anxiety control that requires hospital admission. (3) A person who violates subsection (1)(a), (b), (c), or (d) of this section shall be guilty of a Class B misdemeanor for a first offense and a Class A misdemeanor for each subsequent offense. The board shall consider each individual count of a violation as a separate and subsequent offense. (4) The provisions of this section shall not preclude prosecution for the unlawful practice of dentistry by an agency of the Commonwealth. (5) The filing of criminal charges or a criminal conviction for violation of the provisions of this chapter or the administrative regulations promulgated thereunder shall not preclude the Office of the Board from instituting or imposing board disciplinary action authorized by this chapter against any person or organization violating this chapter or the administrative regulations promulgated thereunder. (6) The institution or imposition of disciplinary action by the Office of the Board against any person or organization violating the provisions of this chapter or the administrative regulations promulgated thereunder shall not preclude the filing of criminal charges against or a criminal conviction of any person or organization for violation of the provisions of this chapter or the administrative regulations promulgated thereunder.

191

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants Kentucky Administrative Regulations TITLE 201 GENERAL GOVERNMENT CABINET Chapter 8 Board of Dentistry 201 KAR 8:550. Anesthesia and sedation. Section 1. Definitions. (2) "Anesthesia" means an artificially induced insensibility to pain usually achieved by the administration of gases or drugs. (3) "Anesthesia and sedation" means: (a) Minimal sedation; (b) Moderate sedation; (c) Deep sedation; and (d) General anesthesia. (4) "Board" means the Kentucky Board of Dentistry. (6) "Conscious sedation permit" means a permit that was issued by the board prior to February 1, 2011, that authorized the dentist to whom the permit was issued to administer parenteral sedation for the practice of dentistry. (7) "Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Cardiovascular function is usually maintained. (8) "Enteral" means a technique of administration in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa (oral, rectal, or sublingual). (9) "Facility" means a location in which anesthesia or sedation is administered for the practice of dentistry. (10) "Facility inspection" means an on-site inspection by the board or its designee to determine if a facility where the applicant proposes to provide anesthesia and sedation is adequately supplied, equipped, staffed, and maintained in a condition to support the provision of anesthesia and sedation services in a manner that meets the requirements of this administrative regulation. (11) "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation, drug-induced depression, or changes in neuromuscular function. Cardiovascular function may be impaired. (12) "General anesthesia permit" means a permit that was issued by the board prior to February 1, 2011, that authorized the dentist to whom the permit was issued to administer general anesthesia for the practice of dentistry. (15) "Minimal sedation" means a drug-induced state, with or without nitrous oxide to decrease anxiety, in which patients respond normally to tactile stimulation and verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are maintained and do not require assistance. (16) "Moderate enteral sedation" means a drug-induced depression of consciousness through the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Intervention is not required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (17) "Moderate parenteral sedation" means a drug-induced depression of consciousness that bypasses the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Intervention is not required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (18) "Moderate sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Intervention is not required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (19) "Nitrous oxide sedation" means a technique of inhalation sedation with nitrous oxide and oxygen. (20) "Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal tract, that is, through an intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous technique. (22) "Sedation" means the reduction of stress or excitement by the administration of a drug that has a soothing, calming, or tranquilizing effect. Section 2. Nitrous Oxide Sedation. (1) Nitrous oxide sedation may be used by a Kentucky-licensed dentist without a specific sedation permit or by a Kentucky-licensed dental hygienist certified to administer block and infiltration anesthesia and nitrous oxide analgesia. (2) Equipment used in the administration of nitrous oxide sedation shall have functional safeguard measures that: (a) Limit the minimum oxygen concentration to thirty (30) percent; and (b) Provide for scavenger elimination of nitrous oxide gas. 192

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants (3) The dentist shall: (a) Insure that a patient receiving nitrous oxide is constantly monitored; and (b) Be present in the office while nitrous oxide is being used. (4) A dental assistant may only deliver nitrous oxide at a rate specified by direct orders of a dentist. Section 13. Anesthesia and Sedation Facility Certificates. (6) The owner or operator of a facility shall ensure that the facility: (b) Remains properly staffed in accordance with Section 15 of this administrative regulation. Section 15. Inducing a Level of Sedation for a Patient. (1) Administration of minimal pediatric sedation, moderate enteral sedation, moderate parenteral sedation, moderate pediatric sedation, deep sedation, or general anesthesia to a patient requires at least the following appropriately trained individuals: (a) The treating dentist; (b) An individual trained and competent in basic life support (BLS) or its equivalent to assist the treating dentist; and (c) Another individual trained and competent in BLS or its equivalent in close proximity to assist if needed. Section 24. Registered Dental Assistant Duties permitted when working with Sedation Permit holders: (1) A registered dental assistant working with Minimal Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia permit holders may, under direct supervision: (a) Apply noninvasive monitors; (b) Perform continuous observation of patients and noninvasive monitors appropriate to the level of sedation, during the pre-operative, intra-operative and post-operative (recovery) phases of treatment; (c) Report monitoring parameters to the operating dentist on a periodic basis and when changes in monitored parameters occur; (d) Record vital sign measurements in the sedation record; and (e) Remove IV lines (Moderate Parenteral Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia Permit holders only). (2) A registered dental assistant working with Minimal Pediatric Sedation, Moderate Enteral Sedation, Moderate Parenteral Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia Permit holders, may under direct supervision assist in the management of emergencies. (3) A registered dental assistant working with Moderate Parenteral Sedation, Moderate Pediatric Sedation and Deep Sedation or General Anesthesia Permit holders may, under direct supervision: (a) Administer medications into an existing IV line upon the verbal order and direct supervision of a dentist with a Moderate Parenteral Sedation, Moderate Pediatric or Deep Sedation or General Anesthesia permit; and (b) Establish an IV line under direct supervision if they have completed a course approved by the board of Dentistry in intravenous access. 201 KAR 8:571. Registration of dental assistants. NECESSITY, FUNCTION, AND CONFORMITY: KRS 313.045(1) requires the board to promulgate administrative regulations relating to requirements and procedures for registration, duties, training, and standards of practice for dental assistants. This administrative regulation establishes the requirements and procedures for registration, duties, training, and standards of practice for dental assistants. Section 1. Definitions. (1) "Coronal polishing" means a procedure that is the final stage of a dental prophylaxis on the clinical crown of the tooth after a dentist or a hygienist has verified there is no calcareous material. (2) "Dental assistant" mean a person who is directly involved with the care and treatment of a patient under the direct supervision of a dentist and performs reversible procedures delegated by dentist licensed in the Commonwealth. Section 2. General Registration Requirements and General Training Requirements. (1) A dentist licensed in the Commonwealth shall register all dental assistants in his or her practice on the Application for Renewal of Dental Licensure incorporated by reference in 201 KAR 8:530. (2) The dentist shall retain in the personnel file for the registered dental assistant the following: (a) A copy of the certificate of completion issued for the completion of the Coronal Polishing Course if the course has been taken by the dental assistant; (b) A copy of the certificate of completion issued for the completion of the Radiation Safety Course if the course has been taken by the dental assistant; (c) A copy of the certificate of completion issued for the completion of the Radiation Techniques Course if the course has been taken by the dental assistant; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

193

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants (d) A copy of the certificate of completion issued for the completion of the Starting Intravenous Access Lines if the course has been taken by the dental assistant; (e) A copy of proof of having current certification in cardiopulmonary resuscitation (CPR) that meets or exceeds the guidelines set forth by the American Heart Association, as incorporated by reference in 201 KAR 8:531; and (f) A statement of the competency of procedures delegated to the dental assistant from the delegated duties list that includes the name of the: (i) Individual trained; and (ii) Licensee attesting to the competency of the Dental Assistant; Section 3. Coronal Polishing Requirements. (1) A registered dental assistant may perform coronal polishing. If coronal polishing is performed by a registered dental assistant, the assistant shall have: (a) Completed the training described in subsection (2) of this administrative regulation; and (b) Obtained a certificate from the authorized institution. (2) The required training shall consist of an eight (8) hour course taught at an institution of dental education accredited by the Council on Dental Accreditation to include the following: (a) Overview of the dental team; (b) Dental ethics, jurisprudence, and legal understanding of procedures allowed by each dental team member; (c) Management of patient records, maintenance of patient privacy, and completion of proper charting; (d) Infection control, universal precaution, and transfer of disease; (e) Personal protective equipment and overview of Occupational Safety and Health Administration requirements; (f) Definition of plaque, types of stain, calculus, and related terminology and topics; (g) Dental tissues surrounding the teeth and dental anatomy and nomenclature; (h) Ergonomics of proper positioning of patient and dental assistant; (i) General principles of dental instrumentation; (j) Rationale for performing coronal polishing; (k) Abrasive agents; (l) Coronal polishing armamentarium; (m) Warnings of trauma that can be caused by improper techniques in polishing; (n) Clinical coronal polishing technique and demonstration; (o) Written comprehensive examination covering the material listed in this section, which shall be passed by a score of seventy-five (75) percent or higher; (p) Completion of the reading component as required by subsection (3) of this section; and (q) Clinical competency examination supervised by a dentist licensed in Kentucky, which shall be performed on a live patient. (3) A required reading component for each course shall be prepared by each institution offering coronal polishing education that shall: (a) Consist of the topics established in subsection (2)(a) to (n) of this section; (b) Be provided to the applicant prior to the course described in subsection (2) of this section; and (c) Be reviewed and approved by the board based on the requirements of subsection (2)(a) to (n) of this section. (4) The institutions of dental education approved to offer the coronal polishing course in Kentucky shall be: (a) University of Louisville School of Dentistry; (b) University of Kentucky College of Dentistry; (c) Western Kentucky University Dental Hygiene Program; and (d) Kentucky Community Technical College System Dental Hygiene or Dental Assisting Programs. (5) An institution of dental education from a state outside of Kentucky meeting the standards of the institutions listed in subsection (4) of this section shall be approved upon request to the Kentucky Board of Dentistry. Section 4. X-rays by Registered Dental Assistants. A registered dental assistant may take x-rays under the direct supervision of a dentist licensed in Kentucky. If a registered dental assistant takes x-rays under the direct supervision of a dentist licensed in Kentucky, the dental assistant shall have completed: (1) A six (6) hour course in dental radiography safety; and (2) Four (4) hours of instruction in dental radiography technique while under the employment and supervision of the dentist in the office or a four (4) hour course in radiography technique. Section 5. Requirements for Starting Intravenous Access Lines. (1) An individual registered as a dental assistant in Kentucky and not subject to disciplinary action under KRS Chapter 313 who desires to start intravenous (IV) access lines while under the direct supervision of a dentist who holds a sedation or anesthesia permit issued by the board shall submit documentation to the licensed dentist for whom the registered dental assistant will be providing services proving successful completion of a board-approved course in starting IV access lines based on: 194

Kentucky State Dental Practice Act and Administrative Rules for Dental Assistants (a) Patient Safety Techniques; (b) Anatomy and physiology of the patient; (c) Techniques in starting and maintaining an IV access line; and (d) Appropriate methods of discontinuing an IV access line. (2) A registered dental assistant shall not start an IV access line if the individual has not completed a Board approved course in IV access lines. Section 6. A dental assistant operating under this administrative regulation shall be under the direct supervision of the dentist licensed in the Commonwealth. The dentist licensed in the Commonwealth shall accept sole responsibility for the actions of the dental assistant or dental auxiliary personnel while in the performance of duties in the dental office. Section 7. Incorporation by Reference. (1) "Delegated Duty List", May 2014, is incorporated by reference. (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Dentistry, 312 Whittington Parkway, Suite 101, Louisville, Kentucky 40222, Monday through Friday, 8 a.m. to 4:30 p.m. This material is also available on the boardâ&#x20AC;&#x2122;s Web site at http://dentistry.ky.gov. (37 Ky.R. 1929; 2377; eff. 5-62011.) 201 KAR 8:581. Charity dental practices. Section 5. Registered Dental Assistants and Auxiliary Personnel. (1) For the purpose of a charitable dental practice an individual performing a duty in the charity event, other than a licensed dentist or licensed dental hygienist, shall be restricted to the duties of a dental auxiliary; and (2) A radiograph shall not be taken unless the person performing the x-ray has met the requirements of 201 KAR 8:571. Delegated Duties List (May 2014) NOTE: Pursuant to KRS Chapter 313 only licensed dentists are permitted to make final impressions by any method including analog and digital methods, to construct dental restorations.

Dental Assistants and Dental Auxiliaries Pursuant to KRS 313.045(5) and KRS 313.050(1), dental assistants and dental auxiliaries are permitted to perform only those procedures that do not require the professional competence of a licensed dentist or a licensed dental hygienist. Pursuant to KRS 313.045(8) and KRS 313.050(2), dental assistants and dental auxiliaries are permitted to take radiographs with the requisite education, training, and experience. Pursuant to KRS 313.045(6), dental assistants only are permitted to perform coronal polishing with the requisite education, training, and experience. Pursuant to 201 KAR 8:571, Section 5, dental assistants only are permitted to start intravenous access lines with the requisite education, training, and experience. Pursuant to KRS 313.045(7) and KRS 313.050(1), registered dental assistant and dental auxiliary services shall not include the following: (a) The practice of dental hygiene or the performance of the duties of a licensed dental hygienist that require the use of any instrumentation which may elicit the removal of calcareous deposits or accretions on the crowns and roots of teeth; (b) Diagnosis; (c) Treatment planning and prescription, including prescriptions for drugs or medicaments, or authorization for restorative, prosthodontic, or orthodontic appliances; (d) Surgical procedures on hard or soft tissues of the oral cavity, or any other intraoral procedure that contributes to or results in an irreversible alteration of the oral anatomy; and Pursuant to KRS 313.050(1), dental auxiliaries are additionally prohibited from administering injectable medication or anesthesia, unless otherwise authorized by law.

195

Louisiana DANB Certificant Counts: Louisiana Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Arthur Hickham, Jr., DDS, Esq., Executive Director Louisiana State Board of Dentistry P.O. Box 5256 Baton Rouge, Louisiana 70821-5256 Phone: 504-568-8574 Fax: 504-568-8598 Website: www.lsbd.org

Radiation Health and Safety (RHS)

232

Infection Control (ICE)

284

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Currently, there are no CODA-accredited dental assisting programs in Louisiana. For an updated directory of CODA-accredited dental assisting programs, visit www. danb.org.

DANB CDA Certificant State of Louisiana+

$20.76 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 13, 2020.

196

Source: 2018 DANB Salary Survey (state data based on 9 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Louisiana State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Louisiana, a dental assistant must complete a course in x-ray function and safety approved by the Louisiana State Board of Dentistry within six months after employment by a licensed dentist and shall perform dental x-ray functions solely under the direct supervision of a licensed dentist who is on the premises of the dental office at the time.

State Requirements For Expanded Functions To perform expanded functions under the direct supervision of a licensed dentist in the state of Louisiana, a dental assistant must earn status as an Expanded Duty Dental Assistant (EDDA). To qualify, one must: (1a) Complete an expanded duty dental assisting program approved by the Louisiana State Board of Dentistry OR (1b) Graduate from a CODAaccredited dental assisting program, providing documentation that training was provided in all functions which EDDAs are allowed to perform (If a dental assistant’s training is deemed inadequate, the assistant must undergo remediation in a Louisiana Board-approved program or complete an expanded duty dental assistant program approved by the Louisiana State Board of Dentistry), AND (2) Complete a Louisiana State Board of Dentistry-approved radiography course (see "Radiography Requirements" above) AND (3) Hold current BLS certification approved by the Louisiana State Board of Dentistry AND (4) Apply to the Louisiana State Board of Dentistry for confirmation of EDDA certification. Note: A dental assistant who has been employed by a licensed, practicing dentist and has worked as a dental assistant prior to July 30, 1992, may continue performing the following expanded duties (under the direct, on-premises supervision of the dentist) without registering as an EDDA: place and remove retraction cords; apply cavity liners, excluding capping of exposed pulpal tissue; place and remove periodontal dressings; place, wedge or remove matrices for restoration by the dentist.

Louisiana State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Louisiana State Board of Dentistry Louisiana Revised Statutes Chapter 9, Title 37 Section 751. Definitions; licensure; presumption A. As used in this Chapter: (4) “Dental assistant” means a person who is employed by a licensed practicing dentist and performs the duties authorized by the Louisiana State Board of Dentistry only under his direct on-premises supervision, direction, and responsibility. (7) “Expanded duty dental assistant” means a person who is employed by a licensed practicing dentist and has passed an expanded function for dental assistants course approved by the Louisiana State Board of Dentistry that shall not consist of less than thirty classroom hours, or who has graduated from a dental assisting program accredited by the Commission on Dental Accreditation provided the program teaches functions as provided for LAC 46:XXXIII.502 and 503. An expanded duty dental assistant may perform any functions authorized by the Louisiana State Board of Dentistry for an expanded duty dental assistant under the direct, on-premises supervision, direction, and responsibility of the dentist. Section 788. Violations C. If the board has reasonable cause to believe that an expanded duty dental assistant has violated any of the provisions of this Chapter, the board may suspend, rescind, or revoke the confirmation of the certification of the expanded duty dental assistant after a hearing is conducted. Section 792. Dental x-ray functions by dental assistants; qualifications A. Any dental assistant employed by a licensed dentist on the effective date of this Section and for a period of at least one year prior to the effective date of this Section shall be deemed to be authorized to take the dental x-rays. B.

Any dental assistant who does not meet the employment criteria set forth in R.S. 37:792(A) shall attend and successfully complete a course in x-ray function and safety approved by the Louisiana State Board of Dentistry within six months after commencement of employment by a licensed dentist. Any such assistant shall be deemed to be authorized to take dental x-rays only upon compliance with this Subsection.

C. (1) The dentist employer shall certify to the board that any dental assistant employed by him either: (a) Meets the employment criteria set forth in R.S. 37:792(A), or that the assistant has attended and completed a course in dental x-ray function and safety, or © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

197

Louisiana State Dental Practice Act and Administrative Rules for Dental Assistants (b) That the assistant has not attended such course but has been employed less than six months. (2) Such certification shall be required upon renewal of any dental license by the dentist. D. A dental assistant shall perform all dental x-ray functions solely under the direct supervision of a licensed dentist and on the premises of the dental office. Section 792.1 Duties of a dental assistant and an expanded duty dental assistant A. A dental assistant may perform only those duties in accordance with rules promulgated by the board, and then only under the direct on-premises supervision, direction, and responsibility of the dentist who employs him or her or a dentist who assumes responsibility for the treatment of that patient, and as ordered by the dentist. B.

An expanded duty dental assistant shall perform only those duties which are in accordance with rules promulgated by the board, and then only under the direct, on-premises supervision, direction, and responsibility of the dentist who employs him or her or a dentist who assumes responsibility for the treatment of that patient, and as ordered by the dentist.

C. A licensed dentist is prohibited from: (1) Delegating an act to an individual who, by order of the board, is prohibited from performing the dental procedure. (2) Delegating the performance of any of the following procedures to a person not licensed as a dentist or dental hygienist: (a) Removal of calculus, deposits, or accretions from the natural and restored surfaces of exposed teeth and restoration in the human mouth. (b) Root planing or smoothing of roughened root surfaces or exposed teeth. (c) Any other procedure the delegation of which is prohibited by the rules of the board. D. The board shall promulgate rules and regulations in accordance with the provisions of this Section, regarding the dental procedures that may be appropriately delegated by the dentist, including a determination as to which delegated dental procedures require competency testing before a person may perform the procedure and establish training requirements. E.

Any dental procedure that is delegated by a dentist to a dental assistant may also be delegated to a dental hygienist.

Section 793. Nitrous oxide inhalation analgesia; enteral moderate sedation; parenteral sedation; deep sedation; general anesthesia; definitions; permits; credentials; reporting; fees; limitations; exceptions A. As used in this Section, the following terms have the meanings ascribed to them unless the context clearly indicates otherwise: (1) "Analgesia" is the diminution or elimination of pain in the patient. (2) "Board" is the Louisiana State Board of Dentistry. (3) "Deep sedation" is a drug-induced depression of consciousness during which a patient cannot be easily aroused but responds purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. A patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (4) "General anesthesia" is a drug-induced loss on consciousness during which a patient is not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. A patient often requires assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (5) "Local anesthesia" is the elimination of sensations, especially pain, in one part of the body by the topical application or regional injection of a drug. (6) "Minimal sedation", except as provided in Paragraph (C)(9) of this Section, is a minimally depressed level of consciousness, produced by a pharmacological method, which allows the patient to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal commands. The drugs or techniques used to produce minimal sedation should have a margin of safety which is sufficient never to cause unintended loss of consciousness. A patient whose only response is reflex withdrawal from repeated painful stimuli shall not be considered to be in a state of minimal sedation. (7) "Moderate sedation", except as provided in Paragraph (C)(9) of this Section, is a drug-induced depression of consciousness during which a patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No intervention is required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The drugs or techniques used to produce moderate sedation should have a margin of safety which is sufficient to render unintended loss of consciousness unlikely.

198

Louisiana State Dental Practice Act and Administrative Rules for Dental Assistants Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the dentist. A patient whose only response is reflex withdrawal from a painful stimulus shall not be considered to be in a state of moderate sedation. B.

The following terms describing routes of administration shall have the meanings ascribed to them unless the context clearly indicates otherwise: (1) "Combined moderate sedation" is any means of obtaining moderate sedation utilizing both inhalation analgesia and either an enteral or parenteral moderate sedation technique. (2) "Enteral" is any technique of drug administration in which the drug is absorbed through the gastrointestinal (GI) tract or oral mucosa. Examples are oral, rectal, and sublingual. (3) "Inhalation" is a technique of drug administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. An example is nitrous oxide-oxygen inhalation sedation. (4) "Parenteral" is any technique of drug administration in which the drug bypasses the gastrointestinal (GI) tract. Examples are intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), and subcutaneous (SC).

C. (1) When nitrous oxide inhalation analgesia, enteral moderate sedation, parenteral moderate sedation, deep sedation, or general anesthesia are used in a dental practice, board authorization shall be obtained in compliance with board rules and regulations to ensure that these procedures are performed in a properly staffed, designed, and equipped facility capable of handling the procedures, problems, and emergency incidents thereto for the level of anesthesia administered. Adequacy of the facility and competence of the anesthesia team shall be determined by the board through the use of qualified anesthesia consultants. Section 795. Fees and costs B(1)(m) Expanded duty dental assistant certificate confirmation

Minimum Maximum $100.00 $200.00

Louisiana Administrative Code Title 46, Chapter 33. Dental Health Profession Chapter 1. General Provisions Section 108. Levels and Definitions of Supervision A. Licensed dentists who employ dental assistants, expanded duty dental assistants, and dental hygienists shall be responsible for the supervision of those employeesâ&#x20AC;&#x2122; authorized duties. Authorized duties of dental assistants, expanded duty dental assistants, and dental hygienists may also be under the supervision of a licensed dentist who assumes responsibility for the treatment of that patient. 1. Direct Supervision. A licensed dentist personally diagnoses the condition to be treated; personally authorizes the procedures; is in the dental office or treatment facility during the performance of the authorized procedures; and, before dismissal of the patient, evaluates the performance of the dental assistant, expanded duty dental assistant, or dental hygienist. 2. General Supervision. The licensed dentist has authorized the procedures, which are being carried out by the dental hygienist in accordance with the dentistâ&#x20AC;&#x2122;s treatment plan; however, the dentist is not required to be present in the dental office or treatment facility during the performance of the supervised procedures. Section 132. Administration of Botox and Dermal Fillers D. All dental auxiliaries are prohibited from administering either Botox or dermal fillers. Chapter 4. Fees and Costs Subchapter E. Fees for Expanded Duty Dental Assistant Section 420. Certificate Confirmation and Reconfirmation Fees A. For processing applications for certificate confirmations, the following fees shall be payable in advance to the board: 1. Initial certificate confirmation fee $100.00 2. Certificate reconfirmation fee $25.00 Chapter 5. Dental Assistants Section 501. Authorized Duties A. A dental assistant is one who is employed by and works in the office of a licensed, practicing dentist and performs the duties authorized by the Louisiana State Board of Dentistry under the direct on-premises supervision, direction and responsibility of the dentist.

199

Louisiana State Dental Practice Act and Administrative Rules for Dental Assistants B.

A dental assistant may only perform the following under the direct on-premises supervision of the dentist who employs her or him as directly ordered by the dentist: 1. Serve as the dentistâ&#x20AC;&#x2122;s chair side assistant; 2. Take and develop dental radiographs and intra-oral photographs; 3. Take and record pulse, blood pressure and temperature; 4. Apply; a. Non-aerosol topical anesthetics; b. Topical fluorides following prophylaxis by a dentist or dental hygienist; c. Desensitizing agents; d. Non-endodontic oxygenating agents; 5. Chart existing restorations and missing teeth, floss teeth and make preliminary inspections of the mouth and teeth with a mouth mirror and floss only; 6. Give intra-oral instructions and demonstrations on oral hygiene procedures; 7. Receive removable prostheses for cleaning or repair work; 8. Remove cement from dental restorations and appliances, with hand instruments, limited to the clinical crown; 9. Make dental plaque smears; 10. Place or remove preformed crowns or bands for determining size only when recommended by the dentist and only under his or her supervision; 11. Place or remove ligatures, cut and tuck ligatures, remove tension devices and any loose or broken bands or arch wires; 12. Place a removable retaining device in the mouth of a patient; 13. Remove final impressions; 14. Apply and remove rubber dams; 15. Make preliminary study model impressions and opposing model impressions; 16. Fabricate and remove interim crowns or bridges (interim meaning temporary while permanent restoration is being fabricated); 17. Condition teeth prior to placement of orthodontics bands or brackets; 18. Place or remove temporary orthodontic separating devices; 19. Remove sutures, post-extraction dressing and surgical ligature ties. 20. Exception: A dental assistant who has been employed by a licensed, practicing dentist and has worked as a dental assistant prior to July 30, 1992, may continue performing the following duties without registering as an expanded duty dental assistant. These duties must also be performed under the direct, on-premises supervision of the dentist: a. Apply cavity liners, excluding capping of exposed pulpal tissue; b. Place, wedge or remove matrices for restoration by the dentist; c. Place and remove periodontal dressings, except for the placement of the initial dressing; d. Place and remove retraction cords.

Section 502. Authorized Duties of Expanded Duty Dental Assistants A. A person licensed to practice dentistry in the state of Louisiana may delegate to any expanded duty dental assistant any chairside dental act that said dentist deems reasonable, using sound professional judgement. Such act must be performed properly and safely on the patient and must be reversible in nature. Furthermore, the act must be under direct supervision of the treating dentist. However, a dentist may not delegate to an expanded duty dental assistant: 1. Periodontal screening and probing, or subgingival exploration for hard and soft deposits and sulcular irrigations; 2. The removal of calculus, deposits or accretions from the natural and restored surfaces of teeth or dental implants in the human mouth using hand, ultrasonic, sonic, or air polishing instruments; 3. Root planing or the smoothing and polishing of roughened root surfaces using hand, ultrasonic, or sonic instruments; 4. Placement and removal of antimicrobial agents; 5. Comprehensive examination or diagnosis and treatment planning; 6. A surgical or cutting procedure on hard or soft tissue including laser and micro abrasion reduction of tooth material; 7. The prescription of a drug, medication, or work authorization; 8. The taking of an impression for a final fixed or removable restoration or prosthesis; 9. The final placement and intraoral adjustment of a fixed appliance; 10. The final placement and intraoral or extraoral adjustment of a removable appliance; 11. The making of any intraoral occlusal adjustment; 12. The performance of direct pulp capping or pulpotomy; 13. The placement or finishing of any final restoration; 200

Louisiana State Dental Practice Act and Administrative Rules for Dental Assistants 14. The final placement of orthodontic bands or brackets except in indirect bonding procedures in which the dentist has either performed the final placement of the brackets on the model or when the dentist has written a detailed prescription to the laboratory for placement of the bracket; 15. The administration of a local anesthetic, parenteral, Intravenous (IV), inhalation sedative agent or any general anesthetic agent. B.

The delegating dentist shall remain responsible for any dental act performed by an expanded duty dental assistant.

C. Certified expanded duty dental assistants may not hold themselves out to the public as authorized to practice dentistry or dental hygiene. Section 503. Guide to Curriculum Development for Expanded Duty Dental Assistants A. Cognitive Objectives. Before becoming registered to perform expanded duty dental assistant functions, dental assistants should be tested on the reasons for doing these procedures, the criteria for correct performance of these procedures, and the effects of improper performance of these procedures. The dental assistant shall be familiar with the state Dental Practice Act and the rules and regulations governing dental auxiliaries. This testing shall be included within at least 30 hours of instruction. B. The following is a model outline for the expanded duty dental assistant course. The hours are to be allocated by the instructor in accordance with current law: 1. introduction: What is an expanded duty dental assistant?; 2. jurisprudence: legal duties of auxiliaries; limitation of auxiliary services; responsibility of dentists for all service provided under dentist’s supervision; responsibility of auxiliaries to perform only those functions that are legally delegated; penalties for violation of Dental Practice Act; and mechanism to report to the board violations of dentists and/or auxiliaries; 3. infection control and prevention of disease transmission; dental assistants’ responsibilities in upholding universal barrier techniques; and OSHA rules; 4. handling dental emergencies; 5. charting; 6. oral anatomy; morphology of the teeth; and medical and dental history for the dentist’s review (vital signs, drug evaluation, medical laboratory reports, ascertaining the patient’s chief dental problem); 7. overview of dental materials: cavity liners, temporary crown materials, periodontal dressings, post-surgical packs and acid-etch materials; 8. coronal polishing: rationale, materials, techniques and contraindications; 9. lab on coronal polishing and performance evaluation; half of the lab period shall be spent practicing on typodonts while the second half shall be spent practicing on partners; 10. lecture on use of gingival retraction cords; types of cords placement; and removal of cords; 11. lab on placement and removal of retraction cords; and performance evaluation-lab period shall be practicing on mannequins; 12. lab on placement of cavity liners; placement of temporary restorations; fabrications and placement of temporary crowns; placement of periodontal dressings; placement of post-surgical packs; performance of acid-etch techniques; placement and removal of wedges and matrices; and performance evaluation; 13. lecture on monitoring nitrous oxide/oxygen (N20/02) sedation; 14. Cardiopulmonary Resuscitation Course “C,” Basic Life Support for Health Care Providers as defined by the American Heart Association or the Red Cross Professional Rescue Course; this course may count for three hours of instruction provided this course has been successfully completed within six months prior to certification; 15. clinical exam instructions; 16. clinical and written exams; 17. lecture on the placement of pit and fissure sealants; 18. lab on placement of pit and fissure sealants; performance evaluation lab shall be practicing on typodonts. C. All applicants for expanded duty dental assistant certificate confirmation must successfully complete a course in Xray function and safety approved by the Louisiana State Board of Dentistry. Any dental assistant who may have been grandfathered in 1984 with the amendment to R.S. 37:792 must still take a radiology course as described herein in order to seek the certificate confirmation as an expanded duty dental assistant. Section 504. Confirmation of Expanded Duty Dental Assistant Certification A.

Unless exempt in accordance with §501.C, no assistant may perform expanded duties unless the assistant has first registered with the board and received a certificate confirmation of the assistant’s expanded duty dental assistant status from the board.

201

Louisiana State Dental Practice Act and Administrative Rules for Dental Assistants B.

In order to receive a certificate confirmation, the assistant must provide to the board all of the following: 1. evidence of successful completion of a board approved EDDA course; 2. evidence of current approved BLS certification; 3. evidence of successful completion of a board approved radiology course; 4. completed certificate confirmation application; and 5. the appropriate fee listed in Chapter 4 of these rules.

Section 505. Expanded Duty Dental Assistant Certificate Confirmation Fee and Reconfirmation; Display of Certificate A. Expanded duty dental assistants shall be charged an initial certification confirmation fee. A certificate shall be reconfirmed biennially and will expire on December 31 of each calendar year of the renewal period. Said fees shall be determined according to Chapter 4 of these rules. B. All expanded duty dental assistants are required to display their certificate confirmations in a conspicuous place to be seen by all patients seen by the expanded duty dental assistant. C. Expanded duty dental assistant certificates become inactive following the failure of the holder to pay the reconfirmation fee by December 31. The expanded duty dental assistant may reactivate the certificate by paying the reconfirmation fee. Section 507. High School Diploma Requirement Repealed Section 508. Dental Assistants Graduating from Dental Assisting Schools Approved by the Commission on Dental Accreditation A. Since the inception of R.S. 37:751.A.(6) defining an expanded duty dental assistant as a graduate from a dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association, many changes in technology and dental materials have taken place, and in the interest of the protection of the public those persons seeking expanded duty dental assistant status and who have graduated from CODA-accredited schools, must comply with the following: 1. present satisfactory documentation from their dental assisting school evidencing training in all functions which expanded duty dental assistants are allowed to perform. If their training is inadequate, they must undergo remediation in a program approved by the board; or 2. complete a full expanded duty dental assistant program approved by the Louisiana State Board of Dentistry. Section 512. Sanctions Any dental assistant or expanded duty dental assistant who administers nitrous oxide inhalation anesthesia is subject to severe sanctions for practicing dentistry without a license. The dentist under whose instructions he or she performed the procedure will be subject to severe sanctions up to and including revocation of his or her dental license. Chapter 13. Dental Laser and Air Abrasion Utilization Section 1305. Air Abrasion Units Utilization of air abrasion units by licensed dental hygienists and dental auxiliaries is prohibited. However, this does not prevent the utilization of air polishing units by licensed dental hygienists Chapter 15. Anesthesia/Analgesia Administration Section 1511. Required Facilities, Personnel and Equipment for Sedation Procedures B. Personnel 1. The authorized dentist must ensure that every patient receiving nitrous oxide inhalation analgesia, moderate sedation with parenteral drugs, deep sedation or general anesthesia is constantly attended. 2. Direct supervision by the authorized dentist is required when nitrous oxide inhalation analgesia, moderate sedation with parenteral drugs, deep sedation or general anesthesia is being administered. 3. When nitrous oxide inhalation analgesia is being administered, one dentist or auxiliary who is currently certified in basic life support must be available to assist the dentist or dental hygienist in an emergency. 4. When moderate sedation with parenteral or enteral drugs is being administered one auxiliary who is currently certified in basic life support must be available to assist the dentist in an emergency. 5. When deep sedation or general anesthesia is being administered two auxiliaries who are currently certified in basic life support must be available to assist the dentist in an emergency.

202

Maine DANB Certificant Counts: Maine Certified Dental Assistant (CDA) certificants

281

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

2,399

Infection Control (ICE)

State Board of Dentistry Contact Penny Vaillancourt, Executive Director Maine Board of Dental Practice 143 State House Station 161 Capitol Street Augusta, ME 04333-0143 Phone: 207-287-3333 Fax: 207-287-8140 Website: www.maine.gov/dental Email: dental.board@maine.gov

600

Coronal Polish (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs University of Maine at Augusta-Bangor

DANB CDA Certificant State of Maine+

$23.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of June 12, 2020.

Source: 2018 DANB Salary Survey (state data based on 6 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

203

Maine State Radiography Requirements To perform dental radiographic procedures in Maine under the general supervision of a licensed dentist, an individual must be licensed as a Dental Radiographer by the Maine Board of Dental Practice (MBDP). To qualify for a license, an individual must: (1) Be at least 18 years of age AND (2) Hold a high school diploma or its equivalent AND (3) Hold current CPR certification AND (4a) Complete a course in dental radiologic technique and safety, which included a dental radiography exam, approved by the MBDP, or (4b) Successfully complete an examination in dental radiologic technique and safety approved by the Board* AND (5) Successfully complete, with a passing grade of 90 percent, the MBDP’s jurisprudence exam, and (6) Submit an application and pay applicable fee to the MBDP. *Note: DANB's Radiation Health and Safety (RHS) exam meets this requirement.

State Requirements For Expanded Functions To qualify for an expanded function dental assistant license in Maine, an individual must (1a) Be at least 18 years of age, AND (1b) Hold current CPR certification, AND (1c) Pass the jurisprudence exam administered by the Maine Board of Dental Practice (MBDP) with a grade of 90 percent, AND (1d) Hold a high school diploma or its equivalent, AND (1e) Hold a current DANB Certified Dental Assistant (CDA) certification or hold an active dental hygiene license in good standing under the laws of Maine or another U.S. state or a Canadian province, AND (1f) Successfully complete training in a school or program in expanded function dental assisting approved by the Board, AND (1g) Submit an application and pay applicable fee to the MBDP for EFDA licensure. OR, to qualify for EFDA licensure by endorsement, one must (2a) Be at least 18 years of age, AND (2b) Provide verification of current certification in CPR, (2c) Provide evidence of holding a substantially equivalent license in another U.S. state or a Canadian provice, including verification of all licenses in good standing under which the applicant practiced in the three years preceding application, documentation of the laws and rules of all jurisdictions in which the applicant practiced during the three years preceding application, and a resume/curriculum vitae describing practice during the three years prior to application, or provide evidence of substantially similar qualifications, including all application materials required for initial licensure as an EFDA (see EFDA licensure requirements above), AND (2d) Submit an application, along with all required materials, and pay applicable fee to the MBDP.

Maine State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Maine Board of Dental Practice

SUBCHAPTER 1 GENERAL PROVISIONS

STATUTES TITLE 32 PROFESSIONS AND OCCUPATIONS CHAPTER 143 DENTAL PROFESSIONS

§18302. Definitions As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. 1. Board. "Board" means the Board of Dental Practice established in Title 5, section 12004-A, subsection 10. 5. Dental auxiliary. "Dental auxiliary" means a dental radiographer, expanded function dental assistant, dental hygienist, independent practice dental hygienist, public health dental hygienist, dental therapist or denturist. 10. Dental radiographer. "Dental radiographer" means a person who holds a valid license as a dental radiographer issued by the board. 11. Dental radiography. "Dental radiography" means the use of ionizing radiation on the maxilla, mandible and adjacent structures of human beings for diagnostic purposes while under the general supervision of a dentist or an independent practice dental hygienist in accordance with this chapter. 18. Direct supervision. "Direct supervision" means the supervision required by the board by rule of those tasks and procedures requiring the physical presence of the supervisor in the practice setting at the time such tasks or procedures are being performed. In order to provide direct supervision of patient treatment, the supervisor must at least diagnose the condition to be treated, authorize the treatment procedure prior to implementation and examine the condition after treatment and prior to the patient's discharge. 19. Expanded function dental assistant. "Expanded function dental assistant" means a person who holds a valid expanded function dental assistant license issued by the board. 20. Expanded function dental assisting. "Expanded function dental assisting" means performing certain dental procedures under the supervision of a dentist in accordance with this chapter. 22. General supervision. "General supervision" means the supervision required by the board by rule of those tasks and procedures when the physical presence of the supervisor is not required in the practice setting while procedures are being performed. 27. Nitrous oxide analgesia. "Nitrous oxide analgesia" means a gas containing nitrous oxide used to induce a controlled state of relative analgesia with the goal of controlling anxiety.

204

Maine State Dental Practice Act and Administrative Rules for Dental Assistants 34. Reversible intraoral procedures. "Reversible intraoral procedures" means placing and removing rubber dams and matrices; placing and contouring amalgam, composite and other restorative materials; applying sealants; supragingival polishing; and other reversible procedures. §18304. License required 1. Unlicensed practice. Except as provided in section 18305 and section 18371, subsections 3 and 6, a person may not practice or profess to be authorized to practice the activities described in this chapter without a license or during any period when that person's license has expired or has been suspended or revoked. 2. Unlawful practice. A person may not: H. Employ an unlicensed person to provide services for which a license is required by this chapter. §18305. Persons and practices not affected; exemptions 1. Persons and practices not affected. Nothing in this chapter may be construed to limit, enlarge or affect the practice of persons licensed to practice medicine, osteopathy or dentistry in this State. Nothing in this chapter may be construed to prohibit a duly qualified dental surgeon or dental hygienist from performing work or services performed by a denturist licensed under this chapter to the extent those persons are authorized to perform the same services under other state law. 2. Exemptions. J. A student enrolled in a dental assisting program or a board-approved dental program, dental hygiene program, dental therapy program, expanded function dental assisting program, dental radiography program or denturism program practicing under the direct or general supervision of that student's instructors; SUBCHAPTER 2 BOARD OF DENTAL PRACTICE §18323. Powers and duties of the board The board has the following powers and duties in addition to all other powers and duties imposed by this chapter: 3. Fees. The authority to adopt by rule fees for purposes authorized under this chapter in amounts that are reasonable and necessary for their respective purposes, except that the fee for any one purpose may not exceed $550; SUBCHAPTER 3 LICENSING QUALIFICATIONS §18341. Application; fees; general qualifications 1. Application. An applicant seeking an initial or a renewed license must submit an application with the fee established under section 18323 and any other materials required by the board. 2. Age. An applicant must be 18 years of age or older. 3. Time limit. An applicant has 90 days after being notified of the materials needed to complete the application to submit those materials to the board. Failure to complete the application within that 90-day period may result in a denial of the application. §18343. Dental radiographer 1. Dental radiographer license. Except as provided in section 18347, an applicant for a dental radiographer license must comply with section 18341 and must provide: A. Verification of a high school diploma or its equivalent as determined by the board; and B. Verification of passing an examination in dental radiologic technique and safety required by board rule. §18344. Expanded function dental assistant 1. Expanded function dental assistant license. Except as provided in section 18347, an applicant for an expanded function dental assistant license must comply with section 18341 and must provide: A. Verification of a high school diploma or its equivalent as determined by the board; B. Verification of one of the following: (1) A current certificate as a certified dental assistant from a board-approved certificate program; (2) An active dental hygiene license in good standing issued under the laws of this State; or (3) An active dental hygiene license in good standing issued under the laws of another state or a Canadian province; and C. Verification of having successfully completed training in a school or program required by board rule; and D. Verification of passing all examinations required by board rule. §18347. Endorsement; applicants authorized to practice in another jurisdiction The board is authorized, at its discretion, to waive the examination requirements and issue a license or grant an authority to an applicant who is licensed under the laws of another state or a Canadian province who furnishes proof, satisfactory to the board, that the requirements for licensure under this chapter have been met. Applicants must comply with the provisions set forth in section 18341. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

205

Maine State Dental Practice Act and Administrative Rules for Dental Assistants 1. Applicants licensed in another jurisdiction. An applicant for licensure or seeking authority under this chapter who is licensed under the laws of another jurisdiction is governed by this subsection. A. An applicant who is licensed in good standing at the time of application to the board under the laws of another state or a Canadian province may qualify for licensure by submitting evidence to the board that the applicant has held a substantially equivalent, valid license for at least 3 consecutive years immediately preceding the application to the board at the level of licensure applied for in this State. B. An applicant who does not meet the requirements of paragraph A but is licensed in good standing at the time of application to the board under the laws of another state or a Canadian province may qualify for licensure by submitting evidence satisfactory to the board that the applicant's qualifications for licensure are substantially similar to the requirements in this chapter for the relevant license. §18349. License renewal; reinstatement 1. Renewal. Licenses under this chapter expire at such times as the commissioner may designate. In the absence of any reason or condition that might warrant the refusal of granting a license, the board shall issue a renewal license to each applicant who meets the requirements of sections 18341 and 18350 2. Late renewals. Licenses may be renewed up to 90 days after the date of expiration if the applicant meets the requirements of subsection 1 and pays a late fee established by the board pursuant to section 18323, subsection 3. 3. Reinstatement. A person who submits an application for reinstatement more than 90 days after the license expiration date is subject to all requirements governing new applicants under this chapter, except that the board may, giving due consideration to the protection of the public, waive examination if that renewal application is received,together with the penalty fee established by the board pursuant to section 18323,subsection 3, within 2 years from the date of the license expiration. §18350. Continuing education As a condition of renewal of a license to practice, an applicant must have a current cardiopulmonary resuscitation certification and complete continuing education during the licensing cycle prior to application for renewal. The board may prescribe by rule the content and types of continuing education activities that meet the requirements of this section. SUBCHAPTER 4 SCOPE OF PRACTICE; SUPERVISION; PRACTICE REQUIREMENTS §18371. Dentist 3. Delegation authorized. A dentist may delegate to an unlicensed person the activities listed in this subsection. A dentist who delegates activities as described is legally liable for the activities of that unlicensed person and the unlicensed person in this relationship is considered the dentist's agent. A. A dentist may delegate the following activities to an unlicensed person as long as these activities are conducted under the general supervision of the delegating dentist: (1) Changing or replacing dry socket packets after diagnosis and treatment planned by a dentist; (2) For instruction purposes, demonstrating to a patient how the patient should place and remove removable prostheses, appliances or retainers; (3) For the purpose of eliminating pain or discomfort, removing loose, broken or irritating orthodontic appliances; (4) Giving oral health instructions; (5) Irrigating and aspirating the oral cavity; (6) Performing dietary analyses for dental disease control; (7) Placing and recementing with temporary cement an existing crown that has fallen out as long as the dentist is promptly notified that this procedure was performed so that appropriate follow-up can occur; (8) Placing and removing periodontal dressing; (9) Pouring and trimming dental models; (10) Removing sutures and scheduling a follow-up appointment with the dentist within 7 to 10 days of suture removal; (11) Retracting lips, cheek, tongue and other tissue parts; (12) Obtaining impressions for study casts; (13) Taking and recording the vital signs of blood pressure, pulse and temperature; (14) Taking dental plaque smears for microscopic inspection and patient education; and (15) Taking intraoral photographs. B. If the unlicensed person has successfully passed a certification examination administered by a national dental assisting board, the dentist may delegate to that unlicensed person the following additional activities, as long as these activities are conducted under the general supervision of the dentist: (1) Placing temporary fillings on an emergency basis as long as the patient is informed of the temporary nature of the fillings; and (2) Removing excess cement from the supragingival surfaces of teeth. C. A dentist may delegate to an unlicensed person the following intraoral activities, which must be conducted under the direct supervision of the delegating dentist: (1) Applying cavity varnish; 206

Maine State Dental Practice Act and Administrative Rules for Dental Assistants (2) Applying liquids, pastes and gel topical anesthetics; (3) Assisting a dentist who provides orthodontic services in preparation of teeth for attaching, bonding and cementing fixed appliances in a manner appropriate and according to manufacturer's directions; (4) Delivering, but not condensing or packing, amalgam, or composite restoration material; (5) Fabricating temporary crowns and bridges, limiting handpiece rotary instrumentation used in the fabrication to extraoral use only, as long as the dentist checks the occlusion and fit prior to releasing the patient; (6) Irrigating and drying root canals; (7) Isolating the operative field; (8) Performing pulp vitality testing with confirmation by the dentist; (9) Performing electronic vitality scanning with confirmation by the dentist; (10) Performing preliminary selection and fitting of orthodontic bands, with final placement and cementing in the patient's mouth by the dentist; (11) Placing and cementing temporary crowns with temporary cement; (12) Placing and removing matrix bands, rubber dams and wedges; (13) Placing elastics and instructing in their use; (14) Placing, holding or removing celluloid and other plastic strips prior to or subsequent to the placement of a filling by the dentist; (15) Placing or removing temporary separating devices; (16) Placing wires, pins and elastic ligatures to tie in orthodontic arch wires that have been fitted and approved by the dentist at the time of insertion; (17) Preparing tooth sites and surfaces with a rubber cup and pumice for banding or bonding of orthodontic brackets. This procedure may not be intended or interpreted as an oral prophylaxis, which is a procedure specifically reserved to be performed by dental hygienists or dentists. This procedure also may not be intended or interpreted as a preparation for restorative material. A dentist or dental hygienist shall check and approve the procedure; (18) Reapplying, on an emergency basis only, orthodontic brackets; (19) Recording readings with a digital caries detector and reporting them to the dentist for interpretation and evaluation; (20) Removing composite material using slow-speed instrumentation for debonding brackets, as long as the dentist conducts a final check prior to release of the patient; (21) Removing excess cement from the supragingival surfaces of teeth; (22) Removing gingival retraction cord; (23) Removing orthodontic arch wires and tension devices and any loose bands or bonds, but only as directed by the dentist; (24) Selecting and trying in stainless steel or other preformed crowns for insertion by the dentist; (25) Obtaining impressions for opposing models and retainers; (26) Obtaining impressions for single-arch athletic mouth guards, bleaching trays, custom trays and fluoride trays; and (27) Taking intraoral measurements and making preliminary selection of arch wires and intraoral and extraoral appliances, including head gear. 4. Delegation not authorized. A dentist may not delegate any dental activity not listed in subsection 3 or 6 to an unlicensed person. Â§18372. Dental radiographer 1. Scope of practice. A licensed dental radiographer may practice dental radiography under the general supervision of a dentist or an independent practice dental hygienist. Â§18373. Expanded function dental assistant 1. Scope of practice; direct supervision. An expanded function dental assistant may perform under the direct supervision of a dentist all of the activities that may be delegated by a dentist to an unlicensed person pursuant to section 18371, subsection 3, paragraph C. An expanded function dental assistant may also perform the following activities authorized under the direct supervision of a dentist: A. Apply cavity liners and bases as long as the dentist: (1) Has ordered the cavity liner or base; (2) Has checked the cavity liner or base prior to the placement of the restoration; and (3) Has checked the final restoration prior to patient dismissal; B. Apply pit and fissure sealants after an evaluation of the teeth by the dentist at the time of sealant placement; C. Apply supragingival desensitizing agents to an exposed root surface or dentinal surface of teeth; D. Apply topical fluorides recognized for the prevention of dental caries; E. Cement provisional or temporary crowns and bridges and remove excess cement; F. Perform pulp vitality tests; G. Place and contour amalgam, composite and other restorative materials prior to the final setting or curing of the material; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

207

Maine State Dental Practice Act and Administrative Rules for Dental Assistants I. Place and remove gingival retraction cord; K. Size, place and cement or bond orthodontic bands and brackets with final inspection by the dentist; L. Supragingival polishing. A dentist or a dental hygienist must first determine that the teeth to be polished are free of calculus or other extraneous material prior to polishing. Dentists may permit an expanded function dental assistant to use only a slow-speed rotary instrument and rubber cup. Dentists may allow an expanded function dental assistant to use high-speed, power-driven handpieces or instruments to contour or finish newly placed composite materials; and M. Obtain impressions for athletic mouth guards, provisional or temporary crowns and bridges; 2. Scope of practice; general supervision. An expanded function dental assistant may perform under the general supervision of a dentist all of the activities that may be delegated by a dentist to an unlicensed person pursuant to section 18371, subsection 3, paragraphs A and B. 3. Procedures not authorized. An expanded function dental assistant may not engage in the following activities: A. Complete or limited examination, diagnosis or treatment planning; B. Surgical or cutting procedures of hard or soft tissue; C. Prescribing drugs, medicaments or work authorizations; D. Pulp capping, pulpotomy or other endodontic procedures; E. Placement and intraoral adjustments of fixed or removable prosthetic appliances; or F. Administration of local anesthesia, parenteral or inhalation sedation or general anesthesia. §18377. Dental therapist 2. Supervision responsibilities. A dental therapist may be delegated a dentist's responsibility to supervise up to 2 dental hygienists and 3 unlicensed persons in any one practice setting through a written practice agreement pursuant to subsection 3. BOARD RULES 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 313 BOARD OF DENTAL PRACTICE CHAPTER 1: DEFINITIONS A. ACLS: “ACLS” means advanced cardiac life support. B. ADA: “ADA” means the American Dental Association or its successor. D. BLS: “BLS” means basic cardiac life support. E. Certified Dental Assistant (CDA): “Certified Dental Assistant” means a dental assistant who has successfully passed a certification examination administered by the Dental Assisting National Board. F. CDC: “CDC” means the Center for Disease Control and Prevention or its successor. G. CODA: “CODA” means the ADA Commission on Dental Accreditation. H. CPR: “CPR” means cardiopulmonary resuscitation. I. Deep Sedation: “Deep Sedation” means an induced state of depressed consciousness, accompanied by a partial loss of protective reflexes, including the inability to maintain independently and continuously an airway and/ or to respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method or combination thereof. K. General Anesthesia: “General Anesthesia” means an induced state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including inability to maintain independently an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or a nonpharmacologic method, or combination thereof. L. Moderate Sedation: a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. O. PALS: “PALS” means pediatric advanced life support. N. Patient: “Patient” means an individual who has established a professional relationship with a dental professional licensed under the Maine Dental Practice Act who is responsible for the delivery of the individual’s dental care. CHAPTER 3: QUALIFICATIONS FOR EXPANDED FUNCTION DENTAL ASSISTANT LICENSURE I. General Qualifications; Application; Fees A. An applicant seeking licensure to practice under this chapter must submit an application with the appropriate fee, and any other materials required by the Board. B. An applicant has 90 days after being notified of any additional materials needed to complete the application to submit those materials to the Board. Failure to complete the application within that 90-day period may result in a denial of the application. C. Verification of passing the jurisprudence examination administered by the Board with a grade of 90 percent. Applicants who do not pass the jurisprudence examination in three attempts may be preliminarily denied licensure. 208

Maine State Dental Practice Act and Administrative Rules for Dental Assistants

II.

D. Verification of current certification in CPR. For purposes of meeting the CPR certification requirements, online trainings are not accepted, unless the applicant can verify hands-on participation with the instructor as a component of the training. Specific Qualifications for Expanded Function Dental Assistant Licensure A. Verification of a high school diploma or its equivalent as determined by the Board; B. Verification of one of the following: (1) A current certificate as a certified dental assistant from a Board-approved program; (2) An active dental hygiene license in good standing issued under the laws of this State; or (3) An active dental hygiene license in good standing issued under the laws of another state or a Canadian province; and C. Verification of successfully completed training in a school or program in expanded function dental assisting approved by the Board.

CHAPTER 4: QUALIFICATIONS FOR DENTAL RADIOGRAPHY LICENSURE I. General Qualifications; Application; Fees A. An applicant seeking licensure to practice under this chapter must submit an application with the appropriate fee, and any other materials required by the Board. B. An applicant has 90 days after being notified of any additional materials needed to complete the application to submit those materials to the Board. Failure to complete the application within that 90-day period may result in a denial of the application. C. Verification of passing the jurisprudence examination administered by the Board with a grade of 90 percent. Applicants who do not pass the jurisprudence examination in three attempts may be preliminarily denied licensure. D. Verification of current certification in CPR. For purposes of meeting the CPR certification requirements, online trainings are not accepted, unless the licensee can verify hands-on participation with the instructor as a component of the training. II. Specific Qualifications for Dental Radiography Licensure A. Verification of a high school diploma or its equivalent as determined by the Board; B. Verification of successfully completing one of the following: (1) a course in dental radiologic technique and safety with an exit examination approved by the Board, or (2) an examination in dental radiologic technique and safety approved by the Board. CHAPTER 7: ESTABLISHMENT OF FEES III. Fees To Be Charged for Licenses, Registrations and Related Fees The following fees shall be charged for the licenses, registrations and other services listed in subsections 1–14 below. For any given license or registration, the designated fee shall apply to both initial issuance and renewal unless otherwise indicated. The term of a license or registration ends on the uniform expiration or renewal date established for that license or registration by law. F.

Expanded Function Dental Assistant Fee – Initial and Renewal of License Expanded Function Dental Assistant

2 yr

$200

2 yr

$200

6 mos 6 mos

$100 $100

N/A N/A

$50 $50

2 yr 2 yr

$200 $200

2 yr 2 yr

$50 $50

G. Dental Radiographer Fee – Initial and Renewal of License Dental Radiographer H. Temporary License Fees – Initial Licenses Expanded Function Dental Assistant Dental Radiographer J.

Application Fees – Initial applications only Expanded Function Dental Assistant Dental Radiographer

Renewal of License Fees - Inactive Status only Expanded Function Dental Assistant Dental Radiographer

Late Renewal of License Fees - Within 90 Days of Expiration Expanded Function Dental Assistant Dental Radiographer

209

Maine State Dental Practice Act and Administrative Rules for Dental Assistants M. Reinstatement Fees for Licenses, Registrations, and Authorities –Between 91 days and Two Years of Expiration Expanded Function Dental Assistant Dental Radiographer

2 yr 2 yr

See Initial Fees See Initial Fees

Chapter 11: QUALIFICATIONS FOR LICENSURE BY ENDORSEMENT; REQUIREMENTS FOR RENEWAL, LATE RENEWAL, AND REINSTATEMENT OF LICENSURE AND AUTHORITIES I. General Qualifications; Requirements A. An applicant seeking licensure by endorsement, or an applicant seeking to renew, renew late, or reinstate a license or an authority must submit an application with the appropriate fee, and any other materials required by the Board. B. An applicant has 90 days after being notified of any materials needed to complete the application to submit those materials to the Board. Failure to complete the application within that 90-day period may result in a denial of the application. II. Specific Qualifications for Licensure by Endorsement; Applicants Authorized To Practice in Another Jurisdiction The Board is authorized, at its discretion, to waive the examination requirements, consider an educational equivalency in meeting the educational requirements, and issue a license or grant an authority to an applicant who is licensed under the laws of another state or a Canadian province who furnishes proof, satisfactory to the Board, that the other requirements for licensure have been met. A. Substantially Equivalent License. The Board will review materials submitted by the applicant as outlined below to determine if the applicant has actively practiced with a substantially equivalent license at the level of licensure applied for under the laws and rules of the Board. An applicant seeking licensure by endorsement pursuant to this provision must provide: (1) Verification of all licenses in good standing under which the applicant actively practiced during the 3 consecutive years immediately preceding application to the Board; (2) Documentation of the laws and rules of all jurisdictions in which the applicant actively practiced during the 3 consecutive years immediately preceding application to the Board; (3) A summary in the nature of a resume or curriculum vitae describing the applicant’s practice during the 3 consecutive years immediately preceding application for licensure to the Board. The summary must contain references with sufficient contact information to enable verification by email address, mail, and telephone; and (4) Verification of current certification in CPR. For purposes of meeting the CPR requirement, online trainings are not accepted unless the applicant can verify hands-on participation with the instructor as a component of the training. B. Substantially Similar Qualifications. The Board will review materials submitted by the applicant as outlined below to determine if the applicant’s qualifications are substantially similar to the requirements for initial licensure for the level of licensure applied for under the laws and rules of the Board. An applicant seeking licensure by endorsement pursuant to this provision must provide: (1) Verification of all licenses in good standing under which the applicant is actively licensed; (2) All application materials for qualifications required for initial licensure as a dentist, dental hygienist, dental hygienist authorities pursuant to 32 M.R.S. §18345(2), a denturist, a dental radiographer, or an expanded function dental assistant, as applicable; and (3) Verification of current certification in CPR. For purposes of meeting the CPR requirement, online trainings are not accepted unless the applicant can verify hands-on participation with the instructor as a component of the training. III. Specific Requirements for Renewal and Reinstatement of Licensure A. Renewal Requirements – Prior to the Date of Expiration (1) An applicant must apply for renewal on or before the date of expiration; and (2) An applicant must complete the continuing education requirements pursuant to Chapter 13 as a condition to renew. B. Late Renewal – Within 90 Days after Expiration (1) An applicant who applies for renewal after expiration of the license, but within 90 days of expiration, must pay the required fees. The licensee will remain subject to disciplinary action for all other violations; and (2) An applicant must complete the continuing education requirements pursuant to Chapter 13 as a condition to renew. Continuing education hours earned after the date of license expiration will not be applied to the late renewal application. C. Reinstatement Requirements – Between 91 Days and Two Years of Expiration (1) An applicant who applies for reinstatement after expiration of the license, but between 91 days and two years of expiration must pay the required fees and meet all qualifications for initial licensure. The Board may, giving due consideration to the protection of the public, waive the examination requirements. 210

An applicant whose license has been expired more than two years must submit an application for initial licensure, pay the required fee and meet all of the qualifications as outlined in Board statute and rule.

Maine State Dental Practice Act and Administrative Rules for Dental Assistants CHAPTER 12: PRACTICE REQUIREMENTS I. General Practice Requirements The following practice responsibilities apply to individuals licensed as indicated below: A. Infection Control (1) All licensees shall utilize the CDC Guidelines for Infection Control in Dental Health-Care Settings, 2003. (2) A licensee who is providing general supervision or direct supervision must ensure the supervised individualâ&#x20AC;&#x2122;s training and/or certification is completed to comply with the CDC Guidelines noted in Section I (A)(1). CHAPTER 13: CONTINUING EDUCATION Summary: This chapter sets forth the nature and amount of continuing education credit hours required for renewal of licenses issued by the Board. This chapter also establishes how to substantiate satisfaction of continuing education requirements for licenses issued by the Board. I.

Generally. As used in this chapter "directly related to dental practice" means that the continuing education must relate to professional competency and aspects of the profession for which the individual is licensed. D. Expanded Function Dental Assistants: Fifty (50) Credit Hours Required for License Renewal No license will be renewed unless the licensee has completed 50 credit hours of continuing education directly related to dental practice during the preceding five-year license term as set forth in this subsection and has a current CPR certification. The license term begins the day the license is issued and ends in five years on the last day in the month in which the license was issued. E. Dental Radiographers: Re-certification of CPR No license will be renewed unless the licensee has a current CPR certification.

II.

Eligible Continuing Education Activities Continuing education credit hours that directly relate to dental practice may be earned only by participation in the following activities: A. There is no credit hour limit on any of the following activities: (1) Presentations, lectures, seminars and workshops. (2) Study clubs pre-approved pursuant to Section VI. (3) Post-graduate academic courses related to dental practice or medical degree programs offered by a regionally accredited program recognized by the United States Department of Education. (4) Academic courses related to the administration of local anesthesia, nitrous oxide analgesia, and expanded function dental assisting. (5) Completion of a dental residency program. (6) Distance learning activities such as online courses or webinars with verification and passage of an exit examination. B. No more than ten (10) credit hours can be claimed in any one activity or any combination of activities listed below: (1) Teaching, guest lecturer, guest clinical supervisor. A licensee may only once claim continuing education credit for preparation and presentation of a course, workshop or seminar on a distinct subject matter. A licensee may only once claim continuing education credit for preparation and presentation as either a guest lecturer or a guest clinical supervisor at a dental practice educational institution or program approved by the Board. (2) Grand rounds. A licensee may claim continuing education credit for a formal meeting in hospital settings in which discussion of a clinical case of one or more patients occur. (3) Writing. A licensee may claim continuing education credit for writing articles and books for publication, as well as for reviewing and editing articles and books. (4) Pre-recorded audio/video; independent study. A licensee may claim continuing education credit only once for a particular audiotape/disk, videotape/disk or course of independent study. (5) Distance learning without exit examination. A licensee may claim continuing education credit for distance learning activities such as online courses and webinars in which an exit examination was not taken. (6) Student table clinic. A licensee may claim continuing education credit for attending a student table clinic, which is a structured presentation sponsored by an educational institution that uses oral communication and visual media to inform, clarify, and/or review material on a specific topic. (7) Reading activity. A licensee may claim continuing education credit for reading an article, a professional journal, a written publication, or a professional publication with verification and passage of an exit examination. (8) In service training sessions. A licensee may claim continuing education credit for attending in-service training sessions such as employer sponsored continuing education activities.

211

Maine State Dental Practice Act and Administrative Rules for Dental Assistants C. CPR certification; BLS certification; ACLS certification; PALS certification No more than 3 credit hours of CPR certification training completed during a license term will count towards meeting the requirements of this chapter. Online CPR trainings are not accepted unless the licensee can verify hands-on participation with the instructor as a component of the training. Basic Life Support (BLS) certification training meets the requirements of the CPR certification requirements. Online BLS trainings are not accepted unless the licensee can verify hands-on participation with the instructor as a component of the training.

No more than 6 credit hours of ACLS or PALS certification training completed during a license term will count toward meeting the requirements of this chapter. Online ACLS or PALS training are not accepted, unless the licensee can verify hands-on participation with the instructor as a component of the training.

III. Ineligible Continuing Education Activities The following activities are ineligible for continuing education credit: A. Continuing education pursuant to a Board order or consent agreement. B. General attendance at a conference. C. Business meetings of a professional association. D. The study of yoga, energy healing; exploration of personal growth; or any activity of any nature whatsoever that does not directly relate to dental practice. E. Reading of an article, a professional journal, an online or written publication, or a professional publication without an examination. F. Clinical examinations taken to obtain a license. Hands-on continuing education activities may be eligible for continuing education credit but are not eligible for double-credit. IV. Continuing Education Providers; Documentation A. Providers. Eligible continuing education activities may be offered by providers of continuing education such as departments of regionally-accredited institutions; national, state or local professional organizations or associations; public or private human services organizations; or private consultants or individuals. Such organizations include, but are not limited to: (1) Any accredited college or university. (2) Any program accredited by CODA. (3) The American Dental Association, the National Dental Association, or their component and constituent societies, associations, and local society. (4) The American Dental Hygienists Association, the National Dental Hygienists Association, or their component or constituent societies, associations, and local society. (5) The International Federation of Denturists (IFD) or its component societies. (6) The Maine Licensed Denturist Association. (7) The academies and specialty organizations recognized by the Board. (8) The Veterans Administration or the armed forces. (9) Providers who are accredited, approved, or recognized by: a. The American Academy of Dental Hygiene; b. The American Dental Association's Continuing Education Recognition Program ("ADA CERP"); c. The Academy of General Dentistry's Program Approval for Continuing Education ("PACE"); d. Accrediting agencies recognized by the American Medical Association's Council on Medical Education; or e. The Accreditation Council for Medical Education. B. Documentation. All documentation must be maintained for the time periods set forth in Section V(A). All continuing education activities completed by a licensee, including teaching, writing, independent study, and other distance learning activities, must be documented by a certificate issued by a provider of continuing education, an official academic transcript, or other reliable written proof of successful completion that is acceptable to the Board. The documentation must include the date, location, and duration of the activity; the name of the presenter; the name of the course or program; an agenda showing the content of the program; and the number of credit hours claimed.

212

Continuing education printouts or logs maintained by a third party and provided to the Board by the licensee are not acceptable unless the printout or log contains all of the following information: (1) The date, location, and duration of the activity. (2) A certificate of completion documenting the name of the course or program, and the number of credit hours earned. (3) The name of the continuing education presenter and/or organization providing the activity.

If the third party does not have a certificate of completion to document the activity, then it is the licensee's responsibility to maintain documentation to substantiate the activity in accordance with this chapter. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Maine State Dental Practice Act and Administrative Rules for Dental Assistants V. Audit A. Certification of continuing education for renewal At the time of application for renewal, each licensee must certify, on a form provided by the Board, compliance with the continuing education credit hours required during the preceding license term or during the continuing education period established in statute or by Board rule. No additional information or continuing education documentation is required to be submitted at the time of renewal. However, the licensee must retain documentation of all continuing education credit hours earned during the most recent license renewal term for two years' post-renewal. B. Verification of compliance by audit Applicants for license renewal will be selected on a random basis for audit of continuing education compliance. In addition, an individual licensee may be selected for an audit as part of an investigation or if there is reasonable cause to believe the licensee has provided a false certification concerning the completion of continuing education requirements. Licensees selected for audit will be notified to submit documentation of the continuing education activities that were certified by the licensee at the time of renewal. Continuing education credit hours that cannot be documented in accordance with the documentation requirements of Section N(B) or that do not satisfy the criteria for continuing education contained in statute or Board rule will be disallowed. VI. Pre-approval of Continuing Education Activities The Board may pre-approve courses, seminars, and workshops, to ensure the activity is directly related to dental practice only at the request of a provider of the continuing education. A seminar, workshop, or institute for which preapproval has been sought but denied is not eligible for continuing education credit. Vll. The Audit Findings If data submitted to the Board pursuant to an audit does not fulfill the requirements of this chapter, then the licensee shall be notified of the Board's failed audit finding. A failed audit constitutes unprofessional conduct and the Board may, without hearing, enter into a consent agreement with a licensee who has not met the continuing education requirements of this chapter. Vlll. Waivers, Extensions, First Renewal, Inactive Status A. Waiver/extension. Upon receipt of a written request prior to license expiration, the Board may, in its discretion, grant an extension of time or other waiver to an individual licensed or certified by the Board who, because of prolonged illness or other extenuating circumstances, e.g., military deployment, has been unable to meet the educational requirements under this chapter. B. First renewal; general requirements. Licensees who renew for the first time must complete one half of the required continuing education credit hours as outlined in this chapter and have a current CPR certification. C. First renewal for dentists. Dentists who are renewing for the first time must complete one half of the required continuing education credit hours as outlined in this chapter and must have a current CPR certification. The content of the credit hours must include completion of 3 credit hours in opioid medication prescribing as a condition to prescribe opioid medication, and completion of 6 credit hours of sedation and/or anesthesia training as a condition to administer sedation under Chapter 14 of the Board's rules. D. Active to Inactive License Status. To place an active license on inactive status, the licensee must submit a written request to the Board attesting that services will not be rendered during the remainder of the license term. Licensees with an inactive status are required to renew their licenses but are not required to complete continuing education credit hours under this chapter. E. Inactive to Active License Status. To place an inactive license on active status, the licensee must submit a written request to the Board, documented evidence of completing continuing education credit hours as outlined below, and a current CPR certification card. For purposes of this section, the Board may require dentists to comply with the opioid prescription and the sedation techniques training required under this chapter. (1) Licensees who hold an inactive license status for a period less than five years must complete one-half of the continuing education credit hours required for the license they hold under this chapter and present a current CPR certification, to return the license to active status. (2) Licensees who hold an inactive license status for a period exceeding five years must complete all of the continuing education credit hours required for the license they hold under this chapter and present a current CPR certification, to return the license to active status. IX. Transition Language Expanded function dental assistants who transition to a two-year license term on or after the effective date of this chapter are required to complete 20 credit hours of continuing education directly related to dental practice during the preceding two-year license term as set forth in this subsection and has a current CPR certification. The license term begins the day the license is issued and ends on ends December 31st of even numbered years.

213

Maine State Dental Practice Act and Administrative Rules for Dental Assistants CHAPTER 14: RULES FOR USE OF SEDATION AND GENERAL ANESTHESIA Summary: This rule prescribes the circumstances under which dentists may administer minimal sedation, moderate sedation, deep sedation, and general anesthesia, and circumstances under which operating dentists may use the services of a Maine licensed sedation provider to administer moderate sedation, deep sedation and general anesthesia in the State of Maine. V.

DENTIST RESPONSIBILITIES. A dentist providing sedation services or an operating dentist utilizing the services of a sedation provider as outlined in this chapter must comply with the following: C. Equipment Required When Administering Minimal Sedation, Moderate Sedation, Deep Sedation and/or General Anesthesia. The dentist or operating dentist must ensure that following requirements are met as it relates to the delivery of sedation: (4) Emergency Protocols: A dentist or operating dentist whose practice includes the use of moderate sedation or general anesthesia must have written emergency protocols, and must provide training at least annually to familiarize office personnel in the treatment of the following clinical emergencies: a. Laryngospasm. b. Bronchospasm. c. Emesis and aspiration. d. Airway blockage by foreign body. e. Angina pectoris. f. Myocardial infarction. g. Hypertension/Hypotension. h. Allergic and toxicity reactions. i. Seizures. j. Syncope. k. Intra-arterial injection. l. Hyperventilation/Hypoventilation. m. Cardiac arrest. n. Cardiac arrhythmias. A dentist or operating dentist must maintain for inspection a permanent record, which reflects the date, time, duration, names of attendees, and type of emergency protocol training provided. H. Miscellaneous Requirements (1) Life Support Certification(s) a. Dentists must ensure that all dental personnel successfully complete Basic Life Support for Healthcare Providers (BLS) certification and maintain current BLS certification when utilizing, administering, or monitoring local anesthesia, nitrous oxide analgesia, minimal sedation, moderate sedation, deep sedation, or general anesthesia. (2) Personnel a. Minimal/Moderate Sedation – When providing minimal or moderate sedation at a dental practice location, the operating dentist and at least one other individual who is experienced in patient monitoring and documentation, and trained to handle emergency situations must be present. b. Deep sedation/general anesthesia - During the administration of deep sedation or general anesthesia, the operating dentist and at least two other individuals, one of whom is experienced in patient monitoring and documentation, and trained to handle emergency situations, must be present. (3) Monitoring and medication administration - The dentist retains full accountability, but delegation as authorized by the Maine Dental Practice Act to dental personnel may occur under: a. Direct supervision by the dentist when a patient is being monitored, or b. Direct, continuous, and visual supervision by the dentist when medication, excluding local anesthetic, is being administered to a patient.

VIII. USE OF DEEP SEDATION AND GENERAL ANESTHESIA; PERMITS REQUIRED B. Qualifications for Initial Permits for Deep Sedation/General Anesthesia: In order to qualify, dentist applicants must submit an application, pay the required fees, and satisfy each of the following: (3) Have submitted to the Board a completed, signed certification form that attests that the office is staffed with a supervised team of auxiliary personnel capable of reasonably handling procedures, problems, and emergencies as outlined in the “ADA Sedation Guidelines”.

214

Maryland DANB Certificant Counts: Maryland National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

559

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Francis X. McLaughlin, Jr., Executive Director Maryland State Board of Dental Examiners Spring Grove Hospital Center Benjamin Rush Building 55 Wade Avenue/Tulip Drive Catonsville, MD 21228 Phone: 410-402-8501 Fax: 410-402-8505 Email: mdh.mddentalboard@maryland.gov Website: https://health.maryland.gov/dental/

12,413

Infection Control (ICE)

1,857

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Hagerstown Community College

DANB CDA Certificant State of Maryland+

$22.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of April 14, 2020.

Source: 2018 DANB Salary Survey (state data based on 10 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

215

Maryland State Radiography Requirements A dental assistant in the state of Maryland must be state certified as a Dental Radiation Technologist in order to operate dental x-ray equipment and perform dental radiographic procedures. To obtain this state certification, one must: (1) Be at least 18 years of age AND (2) be of good moral character AND (3) Hold a high school diploma or its equivalent AND (4) Complete a Board-approved course of at least 24 hours related to Maryland dental radiology; and (5) Pass the national DANB Radiation Health and Safety (RHS) exam or Certified Dental Assistant (CDA) exam AND (6) Apply for state certification to the Maryland State Board of Dental Examiners. Note: An individual holding an active radiology license or certification in another state may apply for Maryland certification if he or she has engaged in practicing dental radiation technology for at least 150 hours in the three years preceding application and meets any ADA or federal requirements. In addition, beginning in 2011, all Dental Radiation Technologists seeking to renew or reinstate their certificates shall have completed a two-hour, Maryland State Board of Dental Examiners-approved course in infection control.

State Requirements For Expanded Functions To perform expanded dental assisting functions in the state of Maryland, a dental assistant must register as a Dental Assistant Qualified in General Duties. To qualify, one must: (1) Complete a Board-approved course of at least 35 hours related to Maryland general duties dental assisting AND (2a) Pass the Maryland General Dental Assisting Expanded Functions (MDG) exam administered by DANB or (2b) Pass the national DANB Certified Dental Assistant (CDA) exam AND (3) Apply to the Maryland State Board of Dental Examiners for state recognition as a Maryland Dental Assistant Qualified in General Duties. Note: While not required by law, it is recommended that a Dental Assistant Qualified in General Duties also earn status as a Dental Radiation Technologist (see requirements above). To perform orthodontic functions in the state of Maryland, a dental assistant must register as a Dental Assistant Qualified in Orthodontics. To qualify, one must: (1) Complete a Board-approved course of at least 35 hours related to Maryland orthodontic dental assisting AND (2a) Pass the Maryland Orthodontic Assisting Expanded Functions (MDO) exam administered by DANB or (2b) Pass the national DANB Certified Orthodontic Assistant (COA) exam AND (3) Apply to the Maryland State Board of Dental Examiners for state recognition as a Maryland Dental Assistant Qualified in Orthodontics. A dental assistant working under general supervision for a sealant program must do all of the following: (1) Maintain American Heart Association Basic Life Support for Healthcare Providers (BLS) or American Red Cross CPR for Professional Rescuers AND (2) Have at least 400 hours of dental assisting clinical practice in dental patient care AND (3) Successfully complete a Board-approved course of at least two hours in infection control with OSHA protocol, or be Qualified in General Duties or Orthodontic Duties (see requirements above), or hold current DANB CDA or COA certification AND (4) Enter into a written agreement with the supervising dentist setting forth the terms and conditions of practice under general supervision

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Maryland State Board of Dental Examiners ANNOTATED CODE OF MARYLAND HEALTH OCCUPATIONS TITLE 4. DENTISTRY SUBTITLE 2. STATE BOARD OF DENTAL EXAMINERS Md. HEALTH OCCUPATIONS Code Ann. § 4-201 (2012) § 4-201. Board established There is a State Board of Dental Examiners in the Department. § 4-205. Miscellaneous powers and duties; exception related to certain use of nitrous oxide (a) In addition to the powers set forth elsewhere in this title, the Board may: (1) Adopt regulations governing: (i) The administration of general anesthesia by a licensed dentist; (ii) The administration of sedation by a licensed dentist; (iii) The use of a dental assistant by a licensed dentist in performing intraoral procedures; 216

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants SUBTITLE 5. MISCELLANEOUS PROVISIONS Md. HEALTH OCCUPATIONS Code Ann. § 4-505 (2012) § 4-505. Certification of dental radiation technologists (a) "Dental radiation technologists" and "practice dental radiation technology" defined; rules and regulations; competency requirements. -- The Board of Dental Examiners shall: (1) Define, for the purpose of this section, the terms "dental radiation technologist" and "practice dental radiation technology"; (2) Adopt rules and regulations concerning qualifications, training, certification, monitoring of, and enforcement requirements for a dental radiation technologist; and (3) Provide for a requirement to ensure competency in new safety and technological advances. (b) Qualifications of applicants. -- The qualifications required of applicants for Board certification as a dental radiation technologist shall include requirements established by: (1) The American Dental Association; or (2) Any applicable federal standards for training and certification. (c) Certification required for employment. -- After July 1, 1988, an individual must be certified by the Board as a dental radiation technologist before a licensed dentist may employ the individual to practice dental radiation technology. (d) Certification required for practice. -- After July 1, 1988, an individual may not practice dental radiation technology unless certified by the Board. Maryland Regulations TITLE 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 44 BOARD OF DENTAL EXAMINERS 10.44.01 Dental Assistants .01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Board” means State Board of Dental Examiners. (2) “Dental assistant” means a person, other than an individual licensed in the state as a dentist or dental hygienist, employed for the purpose of assisting a dentist in the performance of intraoral duties related to dental care. (3) “Direct supervision” means that the supervising dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and, before dismissal of the patient, personally evaluates the performance of the dental assistant. (4) “General Supervision” means the supervision of a dental assistant by a dentist where the dentist may or may not be present when the dental assistant performs the dental assisting procedures. .02 Exceptions. A. Notwithstanding any other provisions of this chapter, a dental assistant may provide the following dental assisting duties under the general supervision of a dentist for a dental sealant program: (1) Instructing on oral hygiene; (2) Cleaning and disinfecting environmental surfaces and equipment; (3) Preparing materials for the application of sealants; (4) Retracting lips, cheek, and tongue; (5) Placing and removing materials for the isolation of the dentition, if the material is not retained by the dentition; (6) Transferring instruments and sealants to a dentist or dental hygienist; (7) Rinsing and aspirating of the oral cavity; and (8) Sterilizing instruments. B. Under general supervision of a dentist, a dental assistant may only perform the duties enumerated in section A of this regulation: (1) For a facility that has been granted a waiver of on-site supervision for a dental hygienist under COMAR 10.44.21; and (2) While assisting a dental hygienist who has received a waiver of on-site supervision under COMAR 10.44.21. C. A dental assistant who provides dental assistant duties under this regulation shall maintain cardiopulmonary resuscitation certification from one of the following programs: (1) The American Heart Association’s Basic Life Support for Healthcare Providers; (2) The American Red Cross’s Cardiopulmonary Resuscitation for Professional Rescuers; or (3) An equivalent program approved by the Board. D. A dental assistant who provides dental assistant duties under this regulation shall have at least 400 hours of dental assisting clinical practice in dental patient care. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

217

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants E.

A dental assistant who provides dental assistant duties under this regulation shall successfully complete a Boardapproved course of at least 2 hours in infection control with OSHA protocol if the dental assistant is not: (1) Certified by the Dental Assisting National Board as qualified in general duties and recognized by the Dental Board as qualified in general duties; (2) Certified by the Dental Assisting National Board as qualified in orthodontics and recognized by the Dental Board as qualified in orthodontics; or (3) Certified by the Dental Assisting National Board as a certified dental assistant or certified orthodontic assistant. F. A facility that uses a dental assistant to provide dental assistant duties under this regulation shall ensure that there is a written agreement between the supervising dentist and the dental assistant practicing under general supervision that clearly sets forth the terms and conditions under which the dental assistant may practice, including a statement that the dental assistant may provide dental assistant duties without the supervising dentist on the premises. G. Each facility that uses the services of a dental assistant to provide dental assistant duties under this regulation shall maintain for 5 years for inspection by the Board: (1) The name of the dentist providing general supervision to the dental assistant; (2) The name and current address of the dental assistant; (3) The name and address of each institution where the dental assistant provided dental assistant duties; and (4) The date the dental assistant provided dental assistant duties. H. This regulation does not affect the duties a dental assistant may lawfully perform under the direct supervision of a dentist under this chapter. I. A violation of this regulation may result in: (1) Revocation of the facility’s right to operate under a waiver of on-site supervision for dental hygienists; or (2) Revocation of the facility’s right to utilize the services of a dental assistant under this regulation. J. Penalties. (1) For violations of this regulation, a dentist or dental assistant is subject to the penalties contained in Regulation .08 of this chapter. (2) A dental hygienist who uses the services of a dental assistant who is not qualified or for purposes other than what are permitted under this regulation may be found guilty of: (a) Unprofessional conduct under Health Occupations Article, §4-315(b)(3), Annotated Code of Maryland; or (b) Violating any rule or regulation adopted by the Board under Health Occupations Article, §4-315(b)(9), Annotated Code of Maryland. .03 Intraoral Procedures Permitted To Be Performed by a Dental Assistant. A dentist may use the services of a dental assistant to perform the following intraoral duties under the direct supervision of a dentist: A. Rinsing and aspiration of the oral cavity; B. Retraction of the lips, cheek, tongue, and flaps; C. Placement and removal of materials for the isolation of the dentition, provided that the material is not retained by the dentition; D. Instructing on oral hygiene; E. Performing intraoral photography; F. Taking impressions for study models or diagnostic casts; G. Constructing athletic mouth guards on models; H. Applying topical anesthesia; I. Curing by the use of halogen light; J. Checking for loose bands; and K. Any other duty approved by the Board. .04 Dental Assistants Recognized as Qualified in Orthodontics. A. A dentist may use the services of a dental assistant to perform certain duties if the dental assistant: (1) Has successfully completed a Board-approved course of at least 35 hours related to Maryland orthodontic dental assisting; and (2) Is certified by the Dental Assisting National Board in orthodontics or was recognized by the Board of Dental Examiners, on or before June 19, 1974, as a dental assistant qualified in orthodontics. B. If a dental assistant meets the qualifications of §A of this regulation, a dentist may permit the dental assistant qualified in orthodontics to perform the following intraoral tasks, provided that the tasks are performed only in response to a specific instruction from and under direct supervision of a licensed dentist: (1) Taking impressions for study models or diagnostic casts; (2) Applying topical fluoride; (3) Preparing and fitting orthodontic bands; (4) Etching; (5) Removing excess cement from around orthodontic bands; (6) Placing and removing arch wires; 218

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants (7) Cementing of orthodontic bands, placement of bonded attachments, or the removal of cemented or bonded orthodontic bands and attachments; (8) Placing elastics and ligatures; (9) Selecting headgear; (10) Applying desensitizing agents; (11) Applying topical anesthesia; (12) Constructing athletic mouth guards on models; (13) Taking alginate impressions for intraoral appliances; (14) Curing by the use of halogen light; and (15) Any other duty approved by the Board. C. A dentist may not use the services of a dental assistant qualified in orthodontics to perform any of the following services on the basis that the dental assistant meets the qualifications of Â§A of this regulation: (1) Examination, diagnosis, and treatment planning; (2) Surgery on hard or soft tissues; (3) Oral prophylactic procedures, including scaling, root planing, and polishing of teeth with rotary instruments; (4) Condensing, carving, or finishing any restoration; (5) Administering injectable local anesthesia; (6) Applying pit and fissure sealants; (7) Initiation of treatment at any time for the correction of malocclusions and malformations of the teeth or jaws; (8) Adjusting occlusion of natural teeth, restorations, or appliances; (9) Placing an initial surgical dressing; (10) Performing vitality tests; (11) Preparing temporary crowns; (12) Cementing temporary or permanent crowns or restorations; (13) Removing temporary crowns; (14) Placing or removing retraction cord; (15) Placing or removing a rubber dam; (16) Placing or removing a matrix band; (17) Preparing and fitting stainless steel crowns; (18) Drying a root canal; (19) Removing or placing a periodontal dressing; and (20) Adjusting prosthetic appliances. .05 Dental Assistants Recognized as Qualified in General Duties. A. A dentist may use the services of a dental assistant to perform certain duties if the dental assistant: (1) Has successfully completed a Board-approved course of at least 35 hours related to Maryland general duties dental assisting; and (2) Is certified by the Dental Assisting National Board as qualified in general duties or was recognized by the Board of Dental Examiners, on or before June 19, 1974, as a dental assistant qualified in general duties. B. If a dental assistant meets the qualifications of Â§A of this regulation, a dentist may use the services of the dental assistant qualified in general duties to perform the following intraoral tasks, provided that the tasks are performed only in response to a specific instruction from and under the direct supervision of a licensed dentist: (1) Performing vitality tests; (2) Taking impressions for study models or diagnostic casts; (3) Taking alginate impressions for intraoral appliances; (4) Applying topical fluoride; (5) Applying desensitizing agents; (6) Applying topical anesthesia; (7) Placing or removing a rubber dam; (8) Etching; (9) Curing by the use of a halogen light; (10) Fabricating indirect restorations in a dental office; (11) Placing or removing a matrix band; (12) Drying a root canal; (13) Preparing and fitting stainless steel crowns; (14) Placing or removing retraction cord; (15) Preparing temporary crowns; (16) Cementing temporary crowns or restorations; (17) Removing temporary crowns; (18) Removing excess cement; (19) Removing or placing a periodontal dressing (except placing the original periodontal dressing); (20) Removing sutures; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

219

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants (21) Constructing athletic mouth guards on models; and (22) Any other duty approved by the Board. C. A dentist may not use the services of a dental assistant qualified in general duties to perform any of the following services on the basis that the dental assistant meets the qualifications of §A of this regulation: (1) Examination, diagnosis, and treatment planning; (2) Surgery on hard or soft tissues; (3) Oral prophylactic procedures, including scaling, root planing, and polishing teeth; (4) Condensing, carving, or finishing any restoration; (5) Administering injectable local anesthesia; (6) Applying pit and fissure sealants; (7) Initiation of treatment at any time for the correction of malocclusions and malformations of the teeth or jaws; (8) Cementing of orthodontic bands, placement of bonded attachments or the removal of cemented or bonded orthodontic bands and attachments; (9) Cementing permanent crowns or restorations; (10) Adjusting occlusion of natural teeth, restorations, or appliances; (11) Registration of jaw relations; (12) Placing an initial surgical dressing; (13) Preparing or fitting orthodontic bands; (14) Placing or removing an arch wire; (15) Selecting headgear; (16) Placing elastics or ligatures; and (17) Adjusting prosthetic appliances. .06 Radiographs. A dentist may not permit a dental assistant to place and expose radiographs unless the dental assistant is a dental assistant certified to practice dental radiation technology. .07 Posting. The dentist in charge of a dental office shall post a copy of these regulations and the list of Board-approved dental assistant duties in a conspicuous place in the office for the information of office personnel. .08 Penalties for Violations of These Regulations. A. A dentist who uses the services of a dental assistant who is not qualified or for purposes other than what is permitted may be found guilty of unprofessional conduct under Health Occupations Article, §4-315(a)(16), Annotated Code of Maryland, or violating any rule or regulation adopted by the Board under Health Occupations Article, §4-315(a)(18). B. The performance of intraoral duties not authorized by these regulations by a dental assistant may constitute the illegal practice of dentistry, a misdemeanor which on conviction is subject to: (1) For a first offense, a fine not exceeding $2000 or imprisonment in jail not exceeding 6 months; or (2) For a subsequent offense, a fine not exceeding $6000 or imprisonment in the State penitentiary not exceeding 1 year. 10.44.12 Anesthesia and Sedation .03 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (4) “Anesthesia” means an artificially induced insensibility to pain usually achieved by the administration of gases or the use of drugs. (5) “Anesthesia and sedation” means: (a) Moderate sedation; (b) Deep sedation; and (c) General anesthesia. (9) “Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Cardiovascular function is usually maintained. (12) “Facility evaluation” means an on-site inspection by the Board or its designee to determine if a facility where the applicant proposes to provide anesthesia and sedation is adequately supplied, equipped, staffed, and maintained in a condition to support the provision of anesthesia and sedation services in a manner that meets the requirements of this chapter. (13) “General anesthesia” means a drug-induced loss of consciousness during which patients are not arousable even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation, drug-induced depression, or changes in neuromuscular function. Cardiovascular function may be impaired. 220

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants (17) “Moderate enteral sedation” means a drug-induced depression of consciousness through the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (18) “Moderate parenteral sedation” means a drug-induced depression of consciousness that bypasses the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (19) “Moderate sedation” means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is maintained. (20) “Parenteral” means a technique of administration in which the drug bypasses the gastrointestinal tract, that is, through an intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous technique. (26) “Sedation” means the reduction of stress or excitement by the administration of a drug that has a soothing, calming, or tranquilizing effect. .14 Inducing a Level of Sedation for a Patient. A. Administration of moderate enteral sedation, moderate parenteral sedation, deep sedation, or general anesthesia to a patient requires at least the following appropriately trained individuals: (1) The treating dentist; (2) An individual trained and competent in basic life support or its equivalent to assist the treating dentist; and (3) Another individual trained and competent in basic life support or its equivalent in close proximity to assist if needed. 10.44.19 Dental Radiation Technologist .01 Definitions. A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1) “Board” means the Maryland Board of Dental Examiners. (2) “Dental radiation technologist” means an individual other than a licensed dentist or a licensed dental hygienist who practices dental radiation technology. (3) “Direct supervision” means that the supervising dentist is in the dental office and personally: (a) Diagnoses the condition to be treated; (b) Authorizes the placement or exposure of dental radiographs; and (c) Before dismissal of the patient, evaluates the performance of the dental radiation technologists. (4) “Licensed dental hygienist” means an individual licensed by the Board to practice dental hygiene. (5) “Licensed dentist” means an individual licensed by the Board to practice dentistry. (6) “Practice of dental radiation technology” means the placement or exposure of dental radiographs by an individual other than a licensed dentist, a licensed dental hygienist, an individual permitted to practice dentistry without a license under Health Occupations Article, §4-301(b)(1), (2), or (3), Annotated Code of Maryland, or an individual enrolled in an educational program recognized by the Board for dental hygiene or dental assisting, who places or exposes dental radiographs pursuant to the educational program. .02 Certification Required. An individual shall be currently certified by the Board as a dental radiation technologist before the individual may practice dental radiation technology on a human being in this State. .03 Qualifications. A. Except as otherwise provided in these regulations, to qualify to be certified as a dental radiation technologist, an applicant shall be an individual who: (1) Is 18 years old or older; (2) Is of good moral character; (3) Holds a high school degree or the equivalent; (4) Satisfactorily completes the Board-approved educational requirements established by the Maryland State Dental Association or the Maryland Dental Society; (5) Successfully completes a Board-approved course of at least 24 hours related to Maryland dental radiology; and (6) Passes an examination administered or approved by the Board for qualifying to place and expose radiographs; and (7) Meets any requirements established by the American Dental Association or any applicable federal standards for training and certification as a dental radiation technologist. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

221

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants B.

An individual holding an active license or certification to practice dental radiation technology in another state may be granted certification in Maryland if the individual: (1) Has engaged in practicing dental radiation technology for at least 150 hours in the 3 years preceding application for certification in Maryland; and (2) Meets any requirements established by the American Dental Association or any applicable federal standards for training and certification as a dental radiation technologist.

.04 Certification. Except as otherwise provided in these regulations, the Board shall certify as a dental radiation technologist an individual who: A. Meets the qualifications for certification; B. Applies for certification on a form provided by the Board; and C. Pays a fee to the Board as set forth in COMAR 10.44.20. .05 Term and Renewal of Certification. A. Except as provided in Regulation .06 of this chapter, a certification as a dental radiation technologist expires on the second anniversary of the issuance of the certification unless it is renewed for an additional 2-year term as provided in this regulation. B. At least 2 months before a certification as a dental radiation technologist expires, the Board shall send, by first-class mail to the last known address of the individual so certified, a renewal notice that states the: (1) Date on which the current certification expires; (2) Date by which the renewal application has to be received by the Board for the renewal to be issued and mailed before the certification expires; and (3) Amount of the renewal fee. C. Before a certification as a dental radiation technologist expires, the individual so certified periodically may renew the certification for an additional 2 years if the individual: (1) Applies for renewal of the certification on a form provided by the Board; (2) Pays to the Board a fee as set forth in COMAR 10.44.20; and (3) Meets one of the following requirements: (a) Has actively practiced dental radiation technology for at least 600 hours within the 6 years before the expiration of the certification; or (b) If the applicant has not actively practiced dental radiation technology in accordance with §C(3)(a) of this regulation, provides to the Board evidence satisfactory to the Board that the individual has completed 8 classroom hours of dental continuing education, 4 hours of which shall be on the subject of radiation safety within the 1-year period preceding renewal. D. In addition to the requirements of §C of this regulation, a dental radiation technologist seeking renewal of a certificate in 2011 or thereafter shall complete a 2-hour Board-approved course on infection control. E. After the expiration date of a certificate to practice dental radiation technology in the State, the certificate holder may renew the certificate within 30 days of its expiration if the certificate holder: (1) Is otherwise entitled to be issued a certificate; (2) Complies with the requirements of §§C(3) and D of this regulation; (3) Submits to the Board a completed renewal application on the form provided by the Board; and (4) Pays to the Board the renewal fee and the late renewal fee as specified in COMAR 10.44.20. F. Certification After April 1. (1) A certificate holder who has failed to renew a certificate to practice dental radiation technology in this State by April 1 of the year in which the certificate is due for renewal is prohibited from practicing dental radiation technology in this State after the expiration date of the certificate. (2) If the Board determines that a dental radiation technologist has practiced dental radiation technology in this State after the certificate has expired, the Board may order the dental radiation technologist to immediately cease and desist the practice of dental radiation technology in this State until the dental radiation technologist’s certificate has been reinstated by the Board. (3) The Board may take action against a dental radiation technologist for unprofessional conduct if the Board determines that the dental radiation technologist has practiced dental radiation technology in this State after the dental radiation technologist’s certificate has expired. The Board may impose an administrative penalty through a nonpublic consent agreement in which the dental radiation technologist agrees to: (a) Make an anonymous donation of $100 to a charitable institution; and (b) Perform: (i) 10 hours of Board-approved pro bono community service; or (ii) 10 hours of Board-approved pro bono dental services which the applicant may lawfully perform. G. Notwithstanding the provisions of §E of this regulation, the Board may charge the dental radiation technologist with unprofessional conduct as provided in Regulation .12 of this chapter. 222

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants .06 One-Time Transitional Renewal for Even-Numbered Certificate Holders. A. A dental radiation technologist scheduled to renew a dental radiation technologist certificate on or before March 1, 2017, whose dental radiation technologist certificate number ends with an even number (0, 2, 4, 6, or 8) shall submit 1/2 of the renewal fee as specified in COMAR 10.44.20 for a 1-year certificate which shall expire on March 1, 2018, and thereafter, if renewed, shall expire biennially. B. The 1-year certificate referred to in Â§A of this regulation shall be issued one time so that the Board may transition to a staggered certification renewal program for dental radiation technologists. C. A dental radiation technologist with an even-numbered certificate who has completed the required 2-hour Boardapproved course on infection control as a condition of 2017 certificate renewal is not required to complete the course for the 2018 certificate renewal, but will thereafter be required to complete the course. D. A dental radiation technologist whose dental radiation technologist certificate number ends with an even number (0, 2, 4, 6, or 8) may not be required to demonstrate proof of active practice or continuing education as required under Regulation .05C(3) of this chapter as a condition of 2017 certificate renewal, but will thereafter be subject to that requirement. .07 Reinstatement. An individual holding an expired certification to practice dental radiation technology may apply for reinstatement if the individual: A. Completes a dental radiation technology reinstatement application; B. Provides proof of 10 hours of dental continuing education from Board-approved courses of which (1) 4 hours shall be in radiology; and (2) 2 hours shall be in infection control; and C. Pays to the Board a certification reinstatement fee as set forth in COMAR 10.44.20. .08 Prohibitions. A. An individual may not practice dental radiation technology on a human being in this State unless the individual is certified by the Board as a dental radiation technologist. B. An individual shall be certified by the Board as a dental radiation technologist before a licensed dentist may employ the individual to practice dental radiation technology. .09 Title. A certified dental radiation technologist may be referred to as a dental assistant certified to practice dental radiation technology. .10 Supervision. A certified dental radiation technologist shall perform the duties of a dental radiation technologist under the direct supervision of a licensed dentist. .11 Display of Certificate. Each holder of a certificate to practice dental radiation technology shall display the certificate conspicuously in the office where the holder is engaged in practice. .12 Penalties for Violations of These Regulations. A. Subject to the hearing provisions of this chapter, the Board may deny a certificate to practice dental radiation technology, reprimand any certified radiation technologist, place any certified radiation technologist on probation, or suspend or revoke the certificate of any certified radiation technologist, if the holder of the certificate: (1) Practices dental radiation technology in an incompetent manner; (2) Fails to conform to generally accepted standards in the practice of radiation technology; (3) Fraudulently or deceptively obtains or attempts to obtain a certificate for the applicant or for another; (4) Fraudulently or deceptively uses a certificate; (5) Is disciplined by a disciplinary authority of any other state or jurisdiction or is convicted or disciplined by a court in any other state or jurisdiction for an act that would be grounds for disciplinary action under this regulation; (6) Violates any rule or regulation adopted by the Board; (7) Is convicted of or pleads guilty or nolo contendere to a felony or a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside; (8) Provides professional services while under the influence of alcohol or any controlled dangerous substance or drug in excess of therapeutic amounts; (9) Willfully makes or files a false report or record or fails to file a report or record in the practice of dental radiation technology or willfully induces another to file a false report; (10) Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the certified individual is qualified to render because the individual is HIV positive;

223

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants (11) Except in an emergency life-threatening situation where it is not feasible or practicable, fails to comply with the Center for Disease Control’s guidelines on universal precautions; (12) Fails to comply with a Board order; (13) Is mentally or physically incompetent to practice dental radiation technology; (14) Engages in sexual misconduct as set forth in COMAR 10.44.23; or (15) Behaves dishonorably or unprofessionally. B. An individual who practices dental radiation technology without being certified under these regulations is guilty of practicing dentistry without a license, a misdemeanor which, upon conviction, may result in: (1) For a first offense, a fine not exceeding $2,000 or imprisonment in jail not exceeding 6 months; or (2) For a subsequent offense, a fine not exceeding $6,000 or imprisonment in the State penitentiary not exceeding 1 year. C. A licensed dentist who employs an individual to practice dental radiation technology who is not certified under these regulations is guilty of unprofessional conduct and may be subject to disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland. D. A licensed dentist who supervises an individual practicing dental radiation technology who is not certified under these regulations is guilty of permitting an unauthorized individual to practice dentistry under the supervision of that licensed dentist, and may be subject to disciplinary action under the Health Occupations Article, §4-315, Annotated Code of Maryland. 10.44.20 Fees .02 Fee Schedule. The following fees are established by the Board: H. Dental radiation technologist certification fee: (1) Certification renewal (2) For the renewal period ending March 1, 2017, a one-time 1-year certificate for dental radiation technologists whose certificates end in an even number (3) Certification reinstatement (8) Late renewal fee (March 2 through April 1 of the year in which the renewal is due) (9) Initial application fee for applicants holding an active license or certification to practice dental radiation technology in another state N. Dental assistant examination fee GG. Dental assistants—diskettes, labels, rosters, or tapes

$68; $34; $118; $50; $20; $20; $145;

MARYLAND STATE BOARD OF DENTAL EXAMINERS DENTAL AUXILIARIES PERMISSIBLE PROCEDURES CHART - MARCH 18, 2020 DA = DENTAL ASSISTANT (No formal classroom or certification required) DAQO = DENTAL ASSISTANT QUALIFIED IN ORTHODONTICS DAQGD = DENTAL ASSISTANT QUALIFIED IN GENERAL DENTISTRY See last page for further explanation of permissible duties

224

PROCEDURE

DAQO

DAQGD

Adjust occlusion of natural tooth, restoration or appliance – intraorally

Anesthesia, Local* – administration (infiltration & IA Block)

Anesthesia Topical – application

YES

Apply Silver Diamine Fluoride

Arch wire adjustment

Arch wire placement and removal

YES

Athletic Mouthguards, bleaching trays, fluoride trays, impression trays, nightguards – fabricate on models

YES

Bite registration

YES

Bleaching – tray

YES

Bleaching – Internal or Laser

Bleaching – High Intensity light (ie: zoom / bright smile etc.)

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants PROCEDURE

DAQO

DAQGD

Bonding agents – apply

YES

Vital signs (blood pressure /pulse readings – take and record)

YES

Cement excess – removal

YES

Cement permanent crown or restorations

Cement temporary crown or restoration

YES

Cementing of Orthodontic bands, placement of Bonded attachments or the removal of Cemented or bonded orthodontic bands and attachments

YES

Cotton rolls – place and remove

YES

Crown – stainless steel prepare and fit

YES

Crown – temporary – fabricate and or remove

YES

Curettage – (Manual)

Delivery of restorative material with dentist at chairside

YES

Dental examination – preliminary

Desensitizing agents – application

YES

Elastics and ligatures – placement

YES

Etch teeth

YES

Expose film, by pushing x-ray button

NO**

Fabricate indirect restorations in a lab

YES

Fluoride application – rinse or foam tray Fluoride varnish

YES

Fluoride application – silver diamine fluoride

Light curing

YES

Glucose Monitoring***

Handpiece – use of high speed – intraorally

Headgear selection

YES

Impressions – alginate for intraoral appliances

YES

Impressions alginate for study models / diagnostic casts

YES

Loose bands – check for

YES

Matrix bands – place and remove

YES

Nitrous Oxide – monitor ONLY*

Nitrous Oxide – administer*

Oral Hygiene instructions

YES

Oral Cancer Screenings – Luminescent Technologies ie: Velscope / Vizilite / Microlux-DL / Orascoptic DK

Oral Cancer Screenings – visual and palpation

Oral Cancer – Tissue /cell removal – biopsy procedures Brush biopsy (oral cdx)

Oral Cancer – Tissue /cell removal – biopsy procedures Scalpel / dental laser

Ortho bands prepare and fit

YES

Perio Dressing – removal

YES

Perio Dressing – original placement

225

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants PROCEDURE

DAQO

DAQGD

Perio Dressing – subsequent placement

YES

Photography (not conventional or digital x-ray)

YES

Place film in mouth

NO**

Placement and removal of materials for the isolation of the dentition, provided that the material is not retained by the dentition

YES

Placement and removal of rubber dam

YES

Placement of Liquid dam

Polish teeth or restorations

Restorative Materials – condense /carve /finish

Retraction cord – place and remove

YES

Retraction of lips/ cheek/ tongue and flaps

YES

Rinsing and aspiration

YES

Root canals – dry

YES

Scale and root plane

Sealants – pit and fissure

Socket dressing – apply and remove

Subgingival medicaments – placement

Suture placement

Suture removal

YES

Temporary restoration – intracoronal – removal

Temporary restoration placement

YES

Vitality Tests

YES

Wedges – place and remove

YES

NO**

X-rays – exposure after prescribed by a dentist IMPORTANT NOTES

DAQO and DAQGD are Maryland certifications awarded by the Dental Assisting National Board after completion of required classroom hours and passing the appropriate DANB examination. The Maryland State Board of Dental Examiners will issue certificates after notice from the DANB that the candidate has passed the examinations. No renewal of the certifications are presently required. DA: No formal classroom or certification required. On the job training permissible. DAQO: In addition to duties of DAQO, may perform duties of DA. DAQGD: In addition to duties of DAQGD, may perform duties of DA. Certified Dental Assistant (CDA): Certified by the Dental Assisting National Board (DANB) as a certified Dental Assistant. Required classroom hours and passage of DANB examination. May perform duties of DA and DAQGD. Although a CDA has passed the DANB Radiation Health and Safety Examination, a CDA may not place or expose dental radiographs until the CDA has been certified by the Maryland State Board of Dental Examiners as a Dental Radiation Technologist. See paragraph below. NOTICE REGARDING PLACEMENT AND EXPOSURE OF DENTAL RADIOGRAPHS: a DA, a DAQO, a DAQGD, and a CDA may NOT place or expose dental radiographs in Maryland without separate certification issued by the Maryland State Board of Dental Examiners as a Dental Radiation Technologist. Candidate must complete the required number of classroom hours, pass the DANB examination, apply to the Maryland State Board of Dental Examiners, pay the required fee, and receive certification by the Maryland State Board of Dental Examiners as a Dental Radiation Technologist. The 226

Maryland State Dental Practice Act and Administrative Rules for Dental Assistants Maryland State Board of Dental Examiners issues a biennial certification that must be renewed. ONLY DENTISTS AND DENTAL HYGIENISTS MAY PLACE OR EXPOSE DENTAL RADIOGRAPHS WITHOUT CERTIFICATION BY THE MARYLAND STATE BOARD OF DENTAL EXAMINERS AS A DENTAL RADIATION TECHNOLOGIST. Note that conventional digital camera photography may be taken without the need of certification by the DANB or the Maryland State Board of Dental Examiners. *With appropriate permit issued by the Dental Board. [Editor's Note: Only dental hygienists may earn permit.] **Only with a Dental Radiation Technology Certificate issued by the Board. ***Glucose Monitoring: May be performed by a dental hygienist in a private dental office under the general supervision of a dentist once the dental hygienist has been properly trained. Results must be provided to the supervising dentist who must make the final diagnosis.

227

Massachusetts DANB Certificant Counts: Massachusetts National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

1,837

Certified Orthodontic Assistant (COA) certificants

138

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Barbara A. Young, RDH, Executive Director Massachusetts Board of Registration in Dentistry 239 Causeway St., Suite 500 Boston, MA 02114 Phone: 617-973-0971 Fax: 617-973-0980 Website: http://www.mass.gov/dph/dentalboard

Radiation Health and Safety (RHS)

6,465

Infection Control (ICE)

6,294

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

CODA-Accredited Dental Assisting Programs

Median Salary of DANB CDA Certificants

Charles H McCann Technical School Massasoit Community College Middlesex Community College Mount Wachusett Community College Northern Essex Community College Quinsigamond Community College Southeastern Technical Institute Springfield Technical Community College

DANB CDA Certificant State of Massachusetts+

$25.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 14, 2020.

228

Source: 2018 DANB Salary Survey (state data based on 46 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Massachusetts State Radiography Requirements To take dental radiographs under the supervision of a dentist, a dental assistant must (1a) Be registered as a Dental Assistant Trained on the Job (OJT) and (1b) Complete a course in radiological techniques and safeguards and (1c) Pass the DANB Radiation Health and Safety (RHS) exam or other exam approved by the Massachusetts Board of Registration in Dentistry, within one year of the course completion, OR (2a) Be registered as a Massachusetts Expanded Function Dental Assistant (EFDA), Certified Assistant (CA), or Formally Trained Dental Assistant (FTDA), and (2b) Successfully complete a course with a curriculum that complies with Commission on Dental Accreditation (CODA) standards for radiological techniques and safeguards in dentistry.

State Requirements For Registration and Expanded Functions All dental assistants in Massachusetts must be registered with the Massachusetts Board of Registration in Dentistry. To qualify as an Expanded Function Dental Assistant (EFDA) in the state of Massachusetts, one must (1) Be 18 years of age or older and of good moral character, AND (2) Hold any current national DANB certification (CDA, COA, CPFDA or CRFDA) or certification from another Board-approved certifying body at the time of registration, AND (3) Complete a formal program in the Massachusetts delegable expanded functions at a CODA-accredited program, AND (4) Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or Basic Life Support for Healthcare Providers (BLS) from the American Heart Association, AND (5) Apply to the Massachusetts Board of Registration in Dentistry for registration, AND (6) Take and pass the Massachusetts Board's ethics and jurisprudence exam. To qualify as a Formally Trained Dental Assistant (FTDA), one must (1) Be 18 years of age or older and of good moral character, AND (2) Successfully complete a dental assisting program accredited by CODA or authorized, approved, accredited, licensed or certified by the Massachusetts Department of Higher Education (DHE), or the New England Association of Schools and Colleges (NEASC) or complete a state-approved vocational dental assisting program, AND (3) Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or Basic Life Support for Healthcare Providers (BLS) from the American Heart Association, AND (4) Apply to the Massachusetts Board of Registration in Dentistry for registration, AND (5) Take and pass the Massachusetts Board's ethics and jurisprudence exam.. To qualify as a Certified Assistant (CA), one must (1) Be 18 years of age or older and of good moral character, AND (2) Hold any current national certification from DANB (CDA, COA, CPFDA or CRFDA) or certification from another Boardapproved certifying body at the time of registration, AND (3) Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or Basic Life Support for Healthcare Providers (BLS) from the American Heart Association, AND (4) Apply to the Massachusetts Board of Registration in Dentistry for registration, AND (5) Take and pass the Massachusetts Board's ethics and jurisprudence exam. To qualify as a Dental Assistant Trained on the Job (OJT), one must (1) Be 18 years of age or older, of good moral character, and not licensed as a dentist or dental hygienist, AND (2) Complete a course in CDC guidelines, AND (3) Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or Basic Life Support for Healthcare Providers (BLS) from the American Heart Association, AND (4) Apply to the Massachusetts Board of Registration in Dentistry for registration, AND (5) Take and pass the Massachusetts Board's ethics and jurisprudence exam. A person who is at least 18 years of age, who has never been licensed or registered as a dentist, dental hygienist or dental assistant and who is not in violation of any rule or regulation adopted by the board may practice as a dental assistant under the supervision of a Massachusetts licensed dentist without being registered by the Board for a one-time period of up to six consecutive months to commence from the beginning of the initial period of on-the-job training. Before starting unlicensed on-the-job training, the prospective dental assistant must notify the Board of his or her intent to train on a form prescribed by the Board and submit the following documentation to the Board: • • • •

A complete, accurate, signed, and notarized notice of intent Attestation that the person named in the notice of intent has never practiced or been licensed as a dentist, dental hygienist, or dental assistant Certification by the supervising licensed dentist that such dentist is licensed to practice dentistry, is responsible for supervising the person named in the notice of intent, has verified that the person has completed education in CDC Guidelines, and is not in violation of any rule or regulation adopted by the Board Date when the six-month non-licensed on-the-job training period will start

Assisting in anesthesia administration: A dental assistant who assists a dentist holding a deep sedation/general anesthesia permit in anesthesia administration, including patient monitoring, must be appropriately trained to assist in anesthesia administration and must hold current certification in BLS for the Healthcare Provider. Note: effective December 1, 2019, all new dental assistant applicants seeking to become licensed in Massachusetts must take and pass the Board’s ethics and jurisprudence exam. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

229

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Massachusetts Board of Registration in Dentistry General Laws Part I Title XVI Public Health Chapter 112 Registration of Certain Professions and Occupations Section 43A. Definitions The following words shall have the following meanings wherever used in this chapter or in any rules and regulations promulgated by the board in accordance with the provisions of chapter thirty A:— “Aid or assist the dentist”, working simultaneously in conjoined manipulation with a dentist who is rendering treatment, as opposed to the performance of “delegated procedures” which does not require the immediate presence of a dentist. “Appropriate supervision”, the type of supervision, whether direct or general, which the board specifies by rules and regulations as necessary for the performance of various procedures delegated by the board to dental hygienists or dental assistants. “Delegated procedures”, those procedures performed under the direct supervision or the general supervision of a licensed dentist. “Dental assistant”, a person registered by the board or authorized under section 51 1/2 and working under the supervision of a licensed dentist, whose purpose is to aid or assist a dentist in the delivery of patient care, or perform such delegated procedures under the supervision of a licensed dentist as determined by the board as may be authorized by rules and regulations of the board. “Direct supervision”, a dentist shall be physically present in a dental facility. “General supervision”, supervision of dental procedures based on instructions given by a licensed dentist but not requiring the physical presence of a supervising dentist during the performance of those procedures. Section 51 1/2. Registration of dental assistants No person shall practice as a dental assistant unless registered with the board. A person who is at least 18 years of age, of good moral character and who meets the applicable qualifications and requirements for registration as a dental assistant as established and adopted by the board shall, upon application and payment of a fee, as determined annually by the secretary of administration under section 3B of chapter 7, be registered as a dental assistant. The board shall furnish to each such person a registration certificate in a form prescribed by the board. A registration certificate issued under this section shall be revoked upon the issuance to the same person of a certificate of registration under section 45 or 51. The board may adopt rules and regulations consistent with sections 43 to 53, inclusive, governing the registration and practice of dental assistants to protect the public health, safety and welfare including, without limitation, rules and regulations that establish and define the acts, services and delegated procedures that may be performed by dental assistants, the level of supervision required by a registered dentist, tiered classes or levels of practice and certification requirements for each established class or level, education and training requirements, registration and registration renewal procedures and requirements for the display of registration certificates. The continuing education requirements set forth in section 51A shall not apply to this section unless adopted by the board. A dental assistant shall not practice dentistry as defined in section 50 or perform acts or services requiring the knowledge and skill of a registered dentist, such as diagnoses, treatment planning, surgical or cutting procedures on hard or soft tissue and the prescription of medications, or perform any acts or services that require the training, knowledge or skill of a registered dental hygienist, unless specifically authorized by regulation of the board and performed under the appropriate supervision of a registered dentist; provided, however, that the board shall not authorize a dental assistant to perform dental screenings, periodontal charting, subgingival and supragingival scaling, root planting and curettage, minor emergency dental adjustments, polishing of amalgam restorations, micro disk identification applications or preliminary examinations for hygienist services. The board may, without examination, register as a dental assistant an applicant who is duly licensed or registered under the laws of a state, territory or commonwealth of the United States or the District of Colombia, where the requirements for licensure or registration are, in the opinion of the board, equivalent to those in the commonwealth. A dental assistant shall register biennially, which shall be in the year not so designated for the registration of dentists, and shall pay a biennial registration fee determined under this section; provided, however, that the board may issue an initial registration for not more than 2 years. Notwithstanding the above registration requirement, a person who is at least 18 years of age may practice as a dental assistant without being registered by the board for on-the-job training or professional education training under the supervision of a registered dentist for a preliminary and 1-time period of up to 6 consecutive months to commence from the beginning of the initial training if the 230

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants person: (i) has not been previously employed, licensed or registered as a dentist, dental hygienist or dental assistant; (ii) prior to the commencement of the training, provided written notification of such training to the board on a form prescribed by the board and a certification by the supervising dentist confirming that he will supervise the person during the training; and (iii) is not in violation of any rule or regulation adopted by the board. The board may extend the training period for an additional 6 months for a dental assistant who is enrolled in a program of professional educational training for dental assistants offered by a college, university or dental school authorized to confer degrees or by another dental institution or association recognized by the board. All registration applications and training notifications submitted to the board under this section shall be signed under the penalties of perjury by the person certifying the information contained therein. The board shall investigate all complaints relating to the practice of dental assistants. The authority granted to the board in sections 43 to 53, inclusive, shall include disciplining dental assistants who are registered or authorized to practice for training purposes, and the board may exercise such authority by conducting hearings regarding complaints or by suspending, revoking or cancelling any such registration or authorization to practice as a dental assistant to protect the health, safety and welfare of the public, in the same manner as with registered dentists and dental hygienists. A registered dentist under section 45, a dental faculty member or a dental intern under section 45A subject to a restriction on location of practice or a dental hygienist under section 51 shall not be considered to be practicing as a dental assistant for the purposes of this section. Code of Massachusetts Regulations, Title 234 Massachusetts Board of Registration in Dentistry 234 CMR 2.00: PURPOSE, AUTHORITY, DEFINITIONS 2.01: Purpose 234 CMR 2.00 governs the licensure and practice of dentistry, dental hygiene, and dental assisting in Massachusetts by establishing the eligibility and licensure requirements and by establishing the standards for the practice of dentistry, dental hygiene, and dental assisting in the Commonwealth. 2.03: Definitions The following definitions apply to all parts of 234 CMR. ADA. The American Dental Association. ADAA. The American Dental Assistants Association. Advanced Cardiac Life Support (ACLS) Certification. That an individual has successfully completed an advanced cardiac life support course offered by the American Heart Association or other Board-approved entity. Basic Life Support (BLS) Certification. Certification in Basic Life Support for the Healthcare Provider obtained through a course that follows the guidelines of the American Heart Association for BLS guidelines of the American Red Cross. Board. The Board of Registration in Dentistry or any of its committees or subcommittees established in the Massachusetts Department of Public Health pursuant to the provisions of M.G.L. c. 13, §§ 9, and 19, c. 112, §§ 43 through 53 and c. 30A. Cardiopulmonary Resuscitation/Automated External Defibrillation (CPR/AED) Certification. Certification in Cardiopulmonary Resuscitation/Automated External Defibrillation for Professional Rescuers and Health Care Providers obtained through a course that follows the guidelines of the American Red Cross for CPR/AED. CDC Guidelines. The Guidelines for Infection Control in Dental Health-Care Settings -2003, United States Centers for Disease Control and Prevention. Chapters 69- and 74-approved Program. A program that has obtained the approval, pursuant to M.G.L. c. 69 and 74, for specific secondary or vocational-technical programs by the Commissioner of the Massachusetts Department of Elementary and Secondary Education. Chapter 112-approved Program. A program that has obtained the approval, pursuant to M.G.L. c. 112, § 263 for specific private occupational school programs by the Massachusetts Division of Professional Licensure. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

231

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants CMR. The Code of Massachusetts Regulations published by the Regulations Division of the Massachusetts Office of the Secretary of the Commonwealth. CODA. The ADA's Commission on Dental Accreditation. Community Health Center. A non-profit agency licensed by the Department of Public Health under M.G.L. c. 111, § 51. CEU. Continuing education unit and means a minimum of 50 minutes of education or experience as set forth in 234 CMR 8.00: Continuing Education. Dental Assistant. An individual qualified by education, training or experience who, under the supervision of a licensed dentist, aids or assists the dentist in the performance of procedures or duties related to the provision of dental care in accordance with the provisions in 234 CMR 2.00. A dental assistant may be classified in one of four categories: (a) Certified Assistant (CA) means an individual certified by the Dental Assisting National Board, Inc., or other Board-approved, certifying body, as a dental assistant. (b) Dental Assistant Trained On the Job (OJT) means an individual trained on the job by a dentist licensed to practice dentistry in the Commonwealth who has completed the training pursuant to M.G.L. c. 112, § 51½. (c) Expanded Function Dental Assistant (EFDA) means an individual who is currently certified by the Dental Assisting National Board, Inc., or other Board-approved, certifying body, and has completed a formal program in expanded functions that provides, at a minimum, training in the delegable duties pursuant to 234 CMR 5.11, Delegable Procedures, at a CODA-accredited program. (d) Formally Trained Dental Assistant (FTDA) means an individual who is a graduate of a school or program that meets requirements for licensure pursuant to 234 CMR 4.11(3). DANB. The Dental Assisting National Board, Inc. Dental Auxiliary Personnel. A dental hygienist or a dental assistant. Good Moral Character. Those virtues of an individual generally recognized as beneficial to the public health, safety and welfare. License. As used in 234 CMR is synonymous with registration, permit and the right to renew a license, registration or permit. Licensee. An individual registered as holding or having held any type of license, registration, or permit issued pursuant to M.G.L. c. 112, §§ 43 through 53 and 234 CMR, whether or not such license is expired, surrendered, suspended, or revoked. M.G.L. The Massachusetts General Laws. OSHA Standards. The United States Occupational Safety and Health Administration's General Industry Standards at 29 CFR. Patient. Includes a parent or legal representative. Supervision. Includes three types of supervision as follows: (a) General Supervision means supervision of dental procedures based on instructions given by a licensed dentist but not requiring the physical presence of a supervising dentist during the performance of those procedures. A public health dental hygienist may perform all delegated duties permitted under general supervision as described in 234 CMR 5.00: Requirements for the Practice of Dentistry, Dental Hygiene and Dental Assisting provided the public health dental hygienist has entered into a WCA with a licensed dentist who holds a valid license or with an appropriate municipal or state agency or institution to ensure the public health and safety. (b) Direct Supervision means supervision of dental procedures based on instructions given by a licensed dentist who remains in the dental facility while the procedures are being performed by the auxiliary. (c) Immediate Supervision means the supervision of dental procedures by a licensed dentist, who remains in the dental facility, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, evaluates the treatment rendered. Valid License. A license to engage in the practice of dentistry, dental hygiene, or dental assisting in the Commonwealth issued to a licensee by the Board on the basis of truthful information related to qualifications for licensure and which is not expired, surrendered, suspended, or revoked. 232

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants Written Collaborative Agreement (WCA). A written agreement that complies with 234 CMR 5.08: Written Collaborative Agreement (WCA) with a Public Health Dental Hygienist. 234 CMR 4.00: LICENSURE AND LICENSE RENEWAL REQUIREMENTS 4.02: Reporting of Disciplinary Action, License Denial or Other Restriction of Professional Privileges For license application, disciplinary action include, but are not limited to, revocation, suspension, probation, censure, reprimand, or restriction of the license to practice dentistry, dental hygiene, or dental assisting, non-renewal, denial or restriction of privileges or termination of participation. An applicant for initial licensure or renewal of licensure shall report: (1) A denial or restriction of privileges related in any way to: (a) The applicant's competence to practice dentistry, dental hygiene, or dental assisting; or (b) A complaint or allegation regarding any violation, whether specifically cited or not, of the laws, regulations, or policies of the Board. (2) Information concerning any disciplinary action taken against an applicant by any of the following: (a) Governmental authorities, including boards of registration in other jurisdictions; (b) Hospitals; (c) Health care facilities, but not including disciplinary action taken against a student by a dental school, dental hygiene school or program, or dental assisting school or program; (d) Professional dental, dental hygiene, or dental assisting associations, but not including professional association peer review proceedings; (e) Insurance companies or other third party payors which shall only include findings of billing irregularities for any of the following as stated in M.G.L. c. 112, Â§ 52E: 1. Obtaining a total payment in excess of that usually received by the dentist for services rendered; 2. Falsely reporting treatment dates for the purpose of obtaining payment; 3. Reporting charges for services not rendered; 4. Falsely reporting services rendered for the purpose of obtaining payment; or 5. Abrogating the co-payment provisions of a contract by accepting the payment received from the third party as full payment. (3) Information concerning any civil litigation related to the practice of dentistry, dental hygiene, or dental assisting that resulted in a finding against or a settlement with the applicant, as the Board may require. (4) Information concerning any criminal proceedings commenced against the applicant but not including minor traffic offenses, as the Board may require. (5) Information concerning an applicant's privilege to possess, prescribe, or dispense controlled substances. 4.10: Minimum Requirements for Chapter 112-approved Programs and Chapters 69- and 74-approved Programs That Do Not Have CODA Accreditation All Chapter 112-approved Programs, and Chapters 69- and 74-approved Programs that are not accredited by CODA, must: (1) culminate in a diploma or certificate of completion or credential; and (2) consist of an academic program in which: (a) Students must complete a minimum of 936 hours which includes courses in the content areas specified in 234 CMR 4.10(2)(a)1. through 5.: 1. Biomedical sciences content area: a. body structure and function; b. basic concepts of microbiology pertaining to infection control; and c. basic nutrition. 2. Professional dental assisting content area: a. dental materials and instruments; b. dental radiography techniques and safety; c. basic dental and oral anatomy; d. introductory content in oral histology, embryology, pathology, and therapeutics; and e. legal and ethical aspects (dental record keeping, terminology, charting and patient confidentiality); 3. Clinical content area: a. chairside dental assisting and appropriate laboratory procedures; b. patient education and preventive dentistry; c. dental radiographic procedures; d. infection control; and e. assisting in management of dental and medical emergencies; 4. Course work in oral and written communications and basic behavioral concepts; 5. A minimum of 200 hours of clinical experience. (b) Instructors shall hold a degree in dentistry, dental hygiene or dental assisting from a CODA-accredited school or program or hold a current certificate in dental assisting from DANB or other Board-approved certifying body. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

233

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants 4.11: Initial Dental Assistant Licensure for EFDA-, CA-, and FTDA-qualified Individuals Effective January 1, 2015, no individual may practice as an EFDA, CA, or FTDA, unless that individual holds a license granted by the Board pursuant to 234 CMR 4.11. The Board may grant a license to an applicant provided the applicant is 18 years of age or older, of good moral character, has met all of the eligibility requirements, and has submitted the following information to the Board: (1) An accurate, complete and signed application, as specified by the Board for that purpose; (2) Payment of a non-refundable licensing and application fee as determined by the Executive Office of Administration and Finance, unless waived in accordance with M.G.L. c. 112. § 1B; (3) Documentation of completion of a dental assisting program as follows: (a) Proof of current certification from DANB or other Board-approved certifying body; or (b) An original transcript including the date of graduation and degree granted from a dental assisting program that has been authorized, approved, accredited, licensed or certified by the Massachusetts Department of Higher Education (DHE), or the New England Association of Schools and Colleges (NEASC) or both; or (c) An original transcript including the date of graduation and degree granted from a CODA-accredited program in dental assisting; or (d) An original transcript including the date of graduation or a letter including the school or program’s seal which is signed by the appropriate authority attesting to the applicant’s degree, diploma, or certificate, from either a Chapters 69- and 74-approved Program in dental assisting or a Chapter 112-approved Program in dental assisting, provided that such program meets the criteria set forth at 234 CMR 4.10; or (e) Such other proof of completion of a Chapter 112-approved Program in dental assisting, as the Board may declare to be acceptable via an advisory ruling, provided that such program meets the criteria set forth at 234 CMR 4.10. (4) Certified letters of standing from all jurisdictions in which the applicant has been issued a license to practice dental assisting, dental hygiene or dentistry, including a report of any past or pending disciplinary action, or any pending complaints against the applicant; (5) An attestation, signed under the pains and penalties of perjury, that the applicant has read, understands and agrees to comply with The Policy on Principles of Ethics and Code of Professional Conduct, published by the American Dental Assistants Association; (6) Documentation of current BLS certification or CPR/AED certification; (7) A statement disclosing any and all disciplinary, civil or criminal action taken or filed against the applicant at any time after reaching the age of majority and prior to the date of application, with supporting documentation as the Board may require; (8) A passport-size color photograph; (9) An attestation, signed under the pains and penalties of perjury, that the applicant has obtained, within one year prior to the date of application, a written statement from a physician attesting to the applicant's health and fitness to practice dental assisting, which applicant shall make available to the Board upon request; (10) Proof satisfactory to the Board of good moral character; and (11) An attestation, signed under pains and penalties of perjury, that the applicant has complied with all state tax laws pursuant to M.G.L. c. 62C, § 49A and child support laws pursuant to M.G.L. c. 119A, § 16(a). 4.12 Initial Licensure for Dental Assistants Trained On-the-Job (OJT) Effective January 1, 2015, no individual may practice as an OJT, unless that individual holds a license granted by the Board pursuant to 234 CMR 4.12. The Board may grant a license to an applicant to practice as a dental assistant who is trained on the job provided that the applicant is 18 years of age or older, of good moral character, is not licensed as a dentist or dental hygienist and has submitted the following information to the Board: (1) An accurate, complete and signed application, as specified by the Board for that purpose; (2) Submission of the name and Massachusetts license number of the supervising licensed dentist; (3) Payment of a non-refundable licensing and application fee as determined by the Executive Office of Administration and Finance, unless waived in accordance with M.G.L. c. 112, § 1B; (4) Certified letters of standing from all jurisdictions in which the applicant has been issued a license to practice dental assisting, dental hygiene or dentistry, including a report of any past or pending disciplinary action, or any pending complaints against the applicant; (5) An attestation, signed under the pains and penalties of perjury, that the applicant has read, understands and agrees to comply with The Policy on Principles of Ethics and Code of Professional Conduct, published by the American Dental Assistants Association; (6) Documentation of current BLS certification or CPR/AED certification; (7) Documentation of completed course on the CDC Guidelines;

234

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants (8) A statement disclosing any and all disciplinary, civil or criminal action taken or filed against the applicant at any time after reaching the age of majority and prior to the date of application, with supporting documentation as the Board may require (9) A passport-sized color photograph; (10) Proof satisfactory to the Board of good moral character; (11) An attestation signed under pains and penalties of perjury, that the applicant has complied with all state tax laws pursuant to M.G.L. c. 62C, § 49A and child support laws pursuant to M.G.L. c. 119A, §16(a); (12) An attestation, signed under the pains and penalties of perjury, that the applicant has obtained, within one year prior to the date of application, a written statement from a physician attesting to the applicant’s health and fitness to practice dental assisting, which applicant shall make available to the Board upon request; and (13) If the applicant has received on-the-job training in a language other than English, the applicant shall achieve a minimum passing score, as specified by the Board, on a Board designated test of English language proficiency. 4.13

Notice of Intent to Apply as a First-Time Dental Assistant Trained on the Job (OJT) (1) A person who 18 years of age or older, who has never been licensed or registered as a dentist, dental hygienist or dental assistant and who is not in violation of any rule or regulation adopted by the board may practice as a dental assistant under the supervision of a licensed dentist without being registered by the Board for a one-time period of up to six consecutive months to commence from the beginning of the initial period of on-the-job training. (2) Notice of Intent. Before starting non-licensed on-the-job training, an individual shall notify the Board in writing of the intent to train on a form prescribed by the Board and submit the following documentation: (a) A complete, accurate, signed, and notarized notice of intent as specified by the Board for that purpose; (b) An attestation the applicant has never practiced or been licensed as a dentist, dental hygienist, or dental assistant; (c) Certification by the supervising licensed dentist on a form prescribed by the Board that such dentist, is responsible for supervising the person named in the notice of intent to apply, has verified the person has completed education in CDC Guidelines, and is not in violation of any rule or regulation adopted by the Board; and (d) Date when the six-month unlicensed on-the-job training period will start. (3) Extension of On-the-Job Training. Upon receipt of a written request, the board may extend the on-the-job training period for up to an additional six (6) months for a dental assistant who is enrolled in a program of professional educational training for dental assistants offered by a college, university, or dental school authorized to confer degrees or by another dental institution or association recognized by the Board. The written request must be submitted on a form provided by the Board and include the following: (a) Name and signature of the supervising dentist responsible for the on-the-job training of the dental assistant; and (b) Proof satisfactory to the Board of the OJT’s enrollment in a dental assisting program that meets the requirements for licensure pursuant to 234 CMR 4.11(3).

4.14: License Renewal, Reactivation and Reinstatement (3) A licensed dental assistant shall renew a dental assistant license biennially no later than st October 31 of oddnumbered years. The first renewal date for individuals licensed as a dental assistant shall be October 31, 2015. (4) Continuing Education Required for Renewal, Reactivation or Reinstatement. A licensee shall not renew, or petition for reinstatement or reactivation of a license unless and until all continuing education required for renewal, reactivation or reinstatement set forth in 234 CMR 8.00: Continuing Education is completed. (5) Pursuant to M.G.L. c. 112, § 1B(c), the license of a dentist, dental hygienist or dental assistant who is engaged in active service in the armed forces remains valid until 90 days following the release from active duty. The continuing education requirement in 234 CMR 4.14(4) shall not apply to any biennial cycle in which the licensee was in active duty service within 90 days immediately preceding the applicable renewal deadline. (6) A licensee shall not practice dentistry, dental hygiene or dental assisting with an expired, suspended, surrendered or revoked license. A licensee who engages in such unlicensed practice may be subject to a civil administrative penalty pursuant to M.G.L. c. 112, § 65(b) and may be subject to Board discipline. (7) Renewal on or Prior to License Expiration Date. A licensee shall renew a license by filing a properly completed license renewal application and providing all related information to the Board, on forms and in accordance with instructions specified by the Board, and paying the license renewal fee(s) established by the Executive Office of Administration and Finance. (8) Renewal after License Expiration Date Within Two Renewal Cycles. (a) An individual whose license is expired for less than two renewal cycles may apply for renewal of a license only by: 1. Filing an accurate, complete, and signed license renewal application and providing all related information as required by the Board on forms and in accordance with instructions specified by the Board; 2. Paying license renewal fee for each intervening renewal cycles and paying the late renewal fee established by the Executive Office of Administration and Finance; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

235

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants 3.

Submitting to the Board required documentation to prove completion of continuing education credits required for each renewal cycle pursuant to 234 CMR 8.00: Continuing Education; and 4. Submitting to the Board a satisfactory written explanation of the reasons for the licensee's failure to renew the license in a timely manner. (b) The Board may require the licensee to submit additional information or documentation before approving or denying the licensee's renewal application. The Board may require a licensee to provide such additional information either in person or in writing. Failure to respond to or cooperate with such requests shall constitute grounds to deny the application. (9) Renewal of Expired License Greater than Two Renewal Cycles. (a) A licensee whose license is expired for longer than two renewal cycles may apply for renewal by: 1. Filing an accurate, complete, and signed license renewal application and providing all related information as required by the Board on forms and in accordance with instructions specified by the Board; 2. Paying license renewal fee(s) for each intervening renewal cycle and paying the late renewal fee established by the Executive Office of Administration and Finance; 3. Submitting to the Board certificates for continuing education credits required for each renewal cycle pursuant to 234 CMR 8.00: Continuing Education; and 4. Submitting to the Board a satisfactory written explanation of the reasons for the licensee's failure to renew the license in a timely manner. (b) The Board may require the licensee to submit additional information or documentation before approving or denying the licensee's renewal application. Failure to respond to or cooperate with such requests shall constitute grounds to deny the application. (c) The Board may, in its discretion, require a licensee to be re-examined for competency when a dentist has not practiced dentistry in the Commonwealth within five years from the date of initial licensure, or if a dentist does not maintain a current license for a period of five consecutive years. (d) A licensee shall fulfill such other conditions as the Board may require. (10) The Board may, in its discretion, decline to renew, reactivate or reinstate an expired license and may refer cases of unlicensed practice of dentistry, dental hygiene, or dental assisting to appropriate law enforcement authorities for prosecution. 4.15: Applicant and Licensee Responsibilities (1) Each licensee shall inform the Board in writing, as directed by the Board, of any change in the address where the licensee receives mail within 30 calendar days of such change. Failure to comply with 234 CMR 4.15(1) shall not excuse the licensee from timely renewing a license or responding to Board communications. (2) Applicants or licensees shall inform the Board, in writing within 30 calendar days of any change in information provided to the Board in connection with a license or application including, but not limited to, information related to 234 CMR 9.03(1)(t), (hh), (ii) or (jj).. (3) All applications for licensure or permits shall be made on forms and in compliance with instructions provided by the Board. (4) Applicants and licensees shall ensure all information provided to the Board or its designee in connection with any application for licensure or permit is accurate and complete. (5) The Board may require an applicant or licensee to submit additional information to determine whether the applicant is qualified or is of good moral character. The Board may require an applicant or licensee to provide information either in person or in writing, or both. Failure to cooperate with or submit requested information to the Board shall constitute grounds for denial of an initial or renewal application. (6) Applicants and licensees shall pay all fees and charges required for licensing examinations, processing of license applications and issuance of licenses. All such fees and charges are non-refundable. 4.16: Reinstatement of a License which has Been Revoked, Surrendered or Suspended (1) A licensee whose license has been revoked, surrendered or suspended shall petition the Board for reinstatement of the license as provided in a consent agreement or Board final decision and order. If not otherwise specified by consent agreement or Board order, the licensee shall petition the Board for license reinstatement by the following procedure: (a) Licensee shall submit a petition for reinstatement which sets forth in detail the background of the complaint and disciplinary action taken and the reasons why the license should be reinstated and shall also include: 1. Documentation acceptable to the Board of completion of the conditions of any consent agreement or final decision and order issued by the Board; 2. A detailed summary of the licensee's activities during the revocation, suspension or surrender including, but not limited to, the licensee's professional conduct, remedial actions, and academic and other continuing education pursuits; 3. Documentation acceptable to the Board of completion of CEU requirements at 234 CMR 8.00: Continuing Education and any CEUs required by a consent agreement or Board order; 4. An outline of projected professional plans for the 24 month period following reinstatement; 236

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants 5.

If requested by the Board, statements from at least three persons attesting to the character or health of the applicant as well as the applicant's work and professional history since the date of revocation, suspension or surrender and the basis of the affiant's knowledge; 6. Upon the Board's request, a licensee shall undergo assessment by a qualified medical, psychiatric or psychological professional, acceptable to the Board, and authorize the evaluating provider to release the assessment to the Board to determine the licensee's ability to practice dentistry, dental hygiene or dental assisting in a safe and competent manner; and 7. An affidavit, signed under pains and penalties of perjury, attesting to the licensee's compliance with all laws of the Commonwealth relating to the payment of state taxes pursuant to M.G.L. c. 62C, § 49A, child support pursuant to M.G.L. c. 119A, § 16(a), to the completion of all continuing education requirements pursuant to 234 CMR 8.00: Continuing Education, and to the truthfulness of all statements contained in the licensee's petition for reinstatement. (2) If requested by the Board, the applicant, any supervisor, and treating health practitioner may be required to personally appear before the Board or a subcommittee of its members. (3) Unless the Board orders otherwise, a licensee shall not petition the Board for reinstatement sooner than two months preceding the expiration of the period of revocation, suspension or surrender.. (4) No license which has been revoked, surrendered or suspended shall be reinstated prior to the licensee's compliance with the application requirements of 234 CMR 4.00 and 8.00: Continuing Education. 4.17: License Retirement (1) A licensee who meets the eligibility requirements in 234 CMR 4.17(2) may submit a petition to the Board to request that his or her license be placed on retired status. A retired status is a non-disciplinary license status. The Board will not review any petition for reinstatement or return to current status from any licensee whose status has been changed to retired status. (2) A licensee will be eligible to submit a petition for retired status, if he or she: (a) Has a license that is not surrendered, suspended or revoked at the time of the petition; and (b) Demonstrates, to the Board's satisfaction, that he or she intends to permanently retire from active practice in the Commonwealth and in all other jurisdictions. (3) A licensee with a retired status may not practice. (4) Nothing in 234 CMR 4.17 shall prevent the Board from initiating, pursuing or taking a disciplinary action against a licensee whose license is in retired status, including an action that imposes discipline or changes the license status from retired to revoked or suspended, if the Board determines such action is in the best interests of public health, safety or welfare. 234 CMR 5.00: REQUIREMENTS FOR THE PRACTICE OF DENTISTRY, DENTAL HYGIENE AND DENTAL ASSISTING 5.01: Purpose The purpose of 234 CMR 5.00 is to set forth the standards and requirements that licensees of the Board must comply with in the practice of dentistry, dental hygiene and dental assisting in the Commonwealth. 5.04: Posting of Licenses and Permits and Identification of Personnel (1) A licensee shall post his or her name and current license, or copy of said license in each location of practice in a place where it can be observed by the public. (2) A licensee shall post his or her individual anesthesia and Facility Permit, if applicable, in each practice site in a place where they can be observed by the public. (3) All licensees and dental auxiliaries providing dental services to a patient, or assisting a dentist in the direct care or treatment of a patient, shall wear a name tag with the individual's name and professional title and function. 5.05: Infection Control, Occupational Safety and Health Standards, and Radiation Control Requirements (1) Infection Control Practices. All persons licensed by the Board and all practices providing dental services are required to operate in compliance with the current Recommended Infection Control In Dental Health-Care Settings-2003, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta. (2) Occupational Health and Safety Practices. All persons licensed by the Board and all practices providing dental services are required to operate in compliance with the Occupational Safety and Health Administration Standards at 29 CFR: OSHA Standards. (3) Radiation Control. All persons licensed by the Board and all dental practices providing dental services utilizing radiological equipment are required to operate and maintain such equipment in compliance with Massachusetts Radiation Control Program statutes and regulations.

237

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants 5.07: Dental Hygiene Practice and Public Health Dental Hygienist Practice (1) A dental hygienist may provide dental services which are educational, therapeutic, prophylactic and preventive in nature as may be authorized by the Board and may perform all tasks performed by a dental assistant under the specific type of supervision set forth in 234 CMR 5.11. A dental hygienist or public health dental hygienist may not perform acts or services which require diagnosis and treatment planning for non-dental hygiene services, surgical or cutting procedures on hard or soft tissue, and/or the prescription of medications, unless specifically authorized in 234 CMR 5.07 and 5.12. 5.09: Requirements for Training in Radiology (1) A Registered Dental Hygienist (RDH), Public Health Dental Hygienist (PHDH), Expanded Function Dental Assistant (EFDA), Certified Assistant (CA), and a Formally Trained Dental Assistant (FTDA) may take dental radiographs only under the supervision of a dentist provided that the dental auxiliary has successfully completed a course with a curriculum that complies with CODA-standards for radiological techniques and safeguards in dentistry. (2) An On-the-job Trained Dental Assistant (OJT) may take radiographs only under the supervision of a dentist and must have completed a course in radiological techniques and safeguards and successfully passed the DANB Radiation Health and Safety Examination (RHS), or other examination as approved by the Board, within one year of the course completion. 5.10: Delegation of Duties (1) A dentist licensed to practice dentistry in the Commonwealth pursuant to M.G.L. c. 112, § 45 may delegate certain dental duties set forth in this section to a dental auxiliary who is properly educated, trained, and qualified as specified in M.G.L. c. 112, §§ 43 through 53, 61 and 234 CMR and any rule, advisory or written policy adopted by the Board related to the practice of dentistry, dental hygiene, or dental assisting. (2) The supervising dentist shall be responsible for all delegated acts and procedures performed by the dental auxiliary. Any dentist who delegates a procedure to an auxiliary who does not meet the requirements necessary to perform that procedure may be subject to disciplinary action by the Board. 5.11: Delegable Procedures Registered Dental Hygienists (RDH), Public Health Dental Hygienist (PHDH), Expanded Function Dental Assistant (EFDA), Certified Assistant (CA), Formally-Trained Dental Assistant (FTDA), and Dental Assistant Trained On the Job (OJT) and may perform the following dental procedures pursuant to the designated level of supervision or direction: General Supervision (G), Written Collaborative Agreement (WCA), Direct Supervision (D), Immediate Supervision (I) or Delegation Not Allowed (N/A). DELEGATED DUTY

EFDA

FTDA

OJT

(1)

Review medical and dental history and consult when necessary with medical practitioner

(2)

Perform preliminary evaluation to determine needed dental hygiene services

N/A

(3)

Make referrals to dentists, physicians, and other practitioners in consultation with a dentist

N/A

(4)

Provide oral health instruction

(5)

Perform dietary screening for dental disease prevention and control

N/A

(6)

Conduct dental screenings

N/A

(7)

Record dental screenings

(8)

Expose radiographs

(9)

Evaluate radiographs for provision of dental hygiene services

N/A

(10)

Take intra-oral photographs

(11)

Perform and record charting of the oral cavity and surrounding structures, including but not limited to, existing dental restorations, lesions and periodontal probing depths

N/A

(12)

Record charting of the oral cavity and surrounding structures, including but not limited to, dental restorations, lesions and periodontal probing depths

238

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants DELEGATED DUTY

EFDA

FTDA

OJT

Perform minor emergency denture adjustments to eliminate pain and discomfort in nursing homes and other residential or long term care facilities

N/A

(15)

Perform pulp testing

N/A

(16)

Apply anti-cariogenic agents, including fluoride varnish

(17)

Apply topical anesthetic agents

(18)

Apply and adjust dental sealants

N/A

(19)

Take impressions for study casts, bite registrations, including for identification purposes, night guards, and custom fluoride and bleaching trays pursuant to a dentistâ&#x20AC;&#x2122;s prescription or order

(20)

Take impressions for athletic mouth guards

(21)

Retract lips, cheek, tongue and other oral tissue parts

(22)

Irrigate and aspirate the oral cavity

(23)

Re-cement and adjust intact temporary restorations intra-orally

N/A

(24)

Place temporary restorations (not including temporization of inlays, on-lays, crowns, and bridges) to provide palliative treatment

(25)

Assist or monitor nitrous oxide analgesia

(26)

Place and remove gingival retraction materials

(27)

Apply cavity varnish, liner(s) and bonding agents

(28)

Apply desensitizing agents

(29)

Place restorative materials in tooth for condensation and finishing by the dentist

(30)

Remove temporary restorations with hand instruments

N/A

(31)

Place and remove wedges

(32)

Place and remove matrix bands

(33)

Place and remove dental dams

(34)

Place and remove periodontal dressings

N/A

(35)

Remove sutures

(36)

Removal of implant healing caps/cover screws for restorative procedures

(37)

Dry root canals with paper points

N/A

(38)

Place cotton pellets and temporary restorative materials into endodontic openings

(39)

Remove excess cement and bonding agents from bridges and appliances with hand instruments

(40)

Cement and remove temporary crowns and bridges

(41)

Insert and/or perform minor adjustment of night mouth guards, athletic mouth guards, and custom fluoride trays

(42)

Select and adapt stainless steel crowns or other pre-formed crown for insertion by dentist

(43)

Perform sub-gingival and supra-gingival scaling

N/A

(44)

Polish teeth, after dentist or dental hygienist has determined that teeth are free of calculus, with slow speed hand piece

N/A

(45)

Administer local anesthesia pursuant to 234 CMR 6.00

N/A

(46)

Perform gross debridement and/ or scaling and root planing

N/A

(13)

Take and record vital signs

(14)

239

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants EFDA

FTDA

OJT

(47)

Prepare and perform oral cytological smears or studies

DELEGATED DUTY

N/A

(48)

Use diagnostic and periodontic non-cutting lasers

N/A

(49)

Preliminarily fit crowns to check contacts, adjust occlusion on crowns inside the mouth

N/A

(50)

Place temporary soft liners in a removal prosthesis

N/A

(51)

Obtain endodontic cultures

N/A

(52)

Apply bleaching agents and activate with non-laser non-curing device

(53)

Fabricate provisional restorations intraorally

(54)

Place and condense amalgam restorations

N/A

(55)

Carve, contour, adjust amalgam restorations

N/A

(56)

Place and finish composite restorations

N/A

(57)

Adjust dentures on the tissue side to eliminate tissue irritation

N/A

(58)

Place temporary sedative restorations/fillings

N/A

(59)

Place Stainless Steel Crowns

N/A

(60)

Take impressions for orthodontic retainers

(61)

Preliminary intra-oral fit of bands

(62)

Preliminary oral fit of arch wire

(63)

Select size of headgear

(64)

Place and remove orthodontic separators

(65)

Place and remove orthodontic arch wires

(66)

Etch appropriate enamel surfaces before bonding of orthodontic appliances by a dentist

(67)

Place elastics and ligature wires

(68)

Remove fixed orthodontic appliances

(69)

Remove excess cement and bonding agents from orthodontic appliances with hand instruments

(70)

Perform minor emergency palliative orthodontic adjustments to eliminate pain and discomfort

(71)

Perform any other procedure approved by the Board

5.12: Non-Delegable Dental Duties Only licensed dentists shall: (1) Perform final diagnoses and treatment planning; (2) Perform surgical or cutting procedures on hard or soft tissue; (3) Prescribe or parenterally administer drugs or medicaments; (4) Prescribe dental lab work orders for any appliance or prosthetic device or restoration to be inserted into a patientâ&#x20AC;&#x2122;s mouth; (5) Operate high speed rotary instruments in the mouth; (6) Perform pulp-capping procedures; (7) Take final impressions for fixed and removable prosthetic restoration of teeth or oral structures; (8) Perform final positioning and attachment of orthodontic bonds and bands; (9) Perform final cementation of crowns and bridges; and (10) Irrigate root canals. 5.15: Emergency Protocol All dental practices shall: (1) Have a written protocol for managing medical or dental emergencies; (2) Maintain a current emergency drug kit; 240

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants (3) Have communication equipment that ensures rapid access to emergency responders and others as necessary; and (4) Ensure that all staff are trained when hired, and at least annually thereafter, to implement the emergency protocols. 5.19: Principles of Ethics and Code of Professional Conduct All dentists licensed by the Board and all practices providing dental services shall comply with the Principles of Ethics and Code of Professional Conduct, January 2004 of the American Dental Association, and all registered dental hygienists shall comply with the Code of Ethics, 2006 of the American Dental Hygienists Association, Inc. All registered dental assistants shall comply with The Policy on Principles of Ethics and Code of Professional Conduct 2011, published by the American Dental Assistants Association. 234 CMR 6.00: ADMINISTRATION OF ANESTHESIA AND SEDATION 6.02: Definitions ADA Sedation Guidelines means the American Dental Association Policy Statement: The Use of Sedation and General Anesthesia by Dentists; The Guidelines for Teaching Pain Control Sedation to Dentists and Dental Students 2007; and The Guidelines for the Use of Sedation and General Anesthesia by Dentists. AHA/ACLS Guidelines means the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Analgesia means the diminution or elimination of pain. An analgesic (colloquially known as a “painkiller”) is any member of the diverse group of drugs used to control pain. Anesthesia means an artificially induced insensibility to pain usually achieved by the administration of gases or the use of drugs. ASA I, II, III, and IV are classifications of patient physical status as determined by the American Society of Anesthesiologists (ASA). Conscious sedation means sedation in which protective reflexes are normal or minimally altered. The patient remains conscious and maintains the ability to independently maintain an airway and respond appropriately to verbal command. Conscious sedation also includes the use of other sedative agents and/or pre-medication in combination with nitrous oxide-oxygen. Continual means repeated regularly and frequently in a steady succession. Continuous means prolonged without any interruption at any time. Deep Sedation means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained (American Society of Anesthesiologists, adopted October 2009). Enteral means any technique of administration in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa (i.e., oral, rectal, sublingual). General Anesthesia means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug induced depression of neuromuscular function. Cardiovascular function may be impaired (American Society of Anesthesiologists, adopted October 2009). Local Anesthesia means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. Administration of local anesthesia requires awareness of the maximum, safe dosage limits for each patient. Maximum Recommended Dose means the maximum FDA-recommended dose of a drug as printed in FDA approved labeling for unmonitored home use.

241

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected (American Society of Anesthesiologists, adopted October 2009). Moderate Sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. American Society of Anesthesiologists, adopted October 2009. Administration of moderate sedation includes parenteral, enteral and/or combination inhalation-enteral conscious sedation. Nitrous Oxide-oxygen Sedation means conscious sedation accomplished solely by the use of nitrous oxide-oxygen. Parenteral means a technique of administration in which drugs bypass the gastrointestinal (GI) tract e.g. through intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), subcutaneous (SC), or intraosseous (IO) administration. Pediatric Advanced Life Support (PALS) Certification means that an individual has successfully completed a pediatric advanced life support course offered by the American Heart Association or other entity approved by the Board. Qualified Dentist means a dentist licensed pursuant to G. M. L. c. 112, Â§ 45 to practice dentistry in the Commonwealth who has completed the appropriate education and training and holds a current permit to administer deep sedation and general anesthesia, moderate sedation, minimal sedation, and/or nitrous oxide-oxygen pursuant to 234 CMR 6.00. Routes of Administration include parenteral, enteral, and inhalation-enteral methods. Time-oriented Anesthesia Record means documentation of drugs, doses, and physiologic data obtained during patient monitoring at appropriate time intervals. 6.11: Individual Permit A: Administration of General Anesthesia and/or Deep Sedation (2) Auxiliary Personnel Required. A qualified dentist administering deep sedation and general anesthesia must have a minimum of three individuals present during the procedure: (a) A dentist qualified in accordance with 234 CMR 6.11; and (b) Two additional individuals who have been appropriately trained to assist in anesthesia administration and have current certification in BLS for the Healthcare Provider. (c) When the same individual administering the deep sedation or general anesthesia is performing the dental procedure, one of the additional appropriately trained auxiliaries must be designated specifically for patient monitoring. 6.12: Individual Permit B-1: Administration of Moderate Sedation and Nitrous Oxide-oxygen in Conjunction with any Other Anesthetic or Enteral Sedative Agents Dispensed or Administered in a Dental Facility (2) Auxiliary Personnel Required. A qualified dentist inducing moderate sedation must have at least two additional individuals trained in BLS present during the administration of the anesthesia. 6.13: Individual Permit B-2. Administration of Minimal Sedation and/or Nitrous Oxide-oxygen in Conjunction with an Enteral Agent Dispensed or Administered in a Dental Facility (2) Auxiliary Personnel Required. A qualified dentist inducing minimal sedation must have at least one (1) additional individual trained in BLS present during the administration of the anesthesia. 6.14: Individual Permit C: Administration of Nitrous Oxide-oxygen Alone or in Conjunction with Local Anesthesia (5) Requirements for Patient Monitoring and Documentation. (a) A qualified dentist, or at the qualified dentistâ&#x20AC;&#x2122;s direction, an appropriately trained dental auxiliary, must remain in the operatory during active dental treatment to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The appropriately trained dental auxiliary must be familiar with monitoring techniques and equipment. (b) Anesthesia Chart. The Anesthesia Chart shall contain documentation of all events related to the administration of the sedative or anesthetic agents, including but not limited to the following: 1. The color of mucosa, skin or blood (monitoring only); 2. The qualified dentist and/or appropriately trained dental auxiliary must observe chest excursions continually; 3. Blood pressure, respirations, and heart rate should be evaluated pre-operatively, post-operatively and intra-operatively as necessary. If the patient is uncooperative or cannot tolerate such monitoring, this must be documented in the patient record. 242

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants (6) Requirements for Recovery and Discharge. (a) Oxygen and suction equipment must be immediately available; (b) The qualified dentist or appropriately trained dental auxiliary must monitor the patient during recovery until the patient is ready for discharge; (c) The qualified dentist must determine and document that level of consciousness, oxygenation, ventilation and circulation are satisfactorily for discharge; (d) Post-operative verbal and written instructions must be given to the patient and responsible person. 234 CMR 8.00: CONTINUING EDUCATION 8.01: Purpose 234 CMR 8.00 describes the continuing education requirement for license renewal. Each licensed dentist, dental hygienist, and dental assistant shall complete continuing education as a condition precedent to license renewal. 8.02: General Requirements (4) A dental assistant licensed pursuant to M.G.L. c. 112, § 51½, must complete a minimum of 12 CEUs during the 24 months immediately preceding October 31st in odd numbered years. (6) New Graduates. A new graduate of a CODA-accredited dental school, dental hygiene program, or Board-approved dental assisting program is exempt from the CEU requirements the licensing period in which the licensee graduates. (7) No licensee shall be eligible to renew a license without first completing the requisite number of CEUs. (8) A licensee renewing a license shall submit to the Board a statement, signed under pains and penalties of perjury, that the applicant has completed the requisite number of CEUs. (9) CEUs may not be carried over from one renewal cycle to the next. (10) CEUs required by a consent agreement or final decision and order shall not be used to satisfy the CEU requirement for license renewal. (11) A licensee seeking reinstatement of an expired, suspended or revoked license shall, upon the Board's request, submit documentation of completion of CEUs equal to the number of renewal cycles in which the license has been expired, suspended or revoked. 8.03: Required Continuing Education A licensee shall complete continuing education as a condition precedent to the biennial renewal of a license in the following areas: (a) CDC Guidelines; and (b) Continuous certification in CPR/AED, or BLS, or, if the licensee has an anesthesia permit issued pursuant to 234 CMR 6.00: Administration of Anesthesia and Sedation, then the licensee must maintain continuous certification in Advanced Cardiac Life Support or Pediatric Advanced Life Support commensurate with the level of anesthesia permit obtained. 8.04:

Criteria for Acceptance: Responsibilities of Licensees and Sponsors of Continuing Education Programs

(1) To be accepted for credit, continuing education activities shall have significant intellectual or practical content related to the practice of dentistry or dental auxiliary functions, or with the professional responsibilities or ethical obligations of the profession. Non-clinical subjects necessary to provide dental or dental auxiliary services and supportive of clinical services (e.g. patient and practice management, legal and ethical responsibilities, third party billing, stress management) may be credited in the Board's discretion. Courses not acceptable include, but are not limited to, personal financial planning or retirement planning. (2) Standards. To qualify under 234 CMR 8.00 a continuing education program shall require attendance or participation, be at least one class hour (50 minutes) in length, be conducted by an instructor qualified by education or experience and retain a written course description. (3) Certificate of Attendance and Course Description. The licensee may only receive continuing education credit for those courses in which the sponsor or its agent (e.g. a nationally recognized professional registry) certifies and maintains attendance records for at least five years. (a) Certification of attendance must include: 1. The name and address of the sponsor; 2. The name, address and license number of the licensee; 3. A brief statement of the subject matter; 4. Number of lecture and clinical or laboratory participation contact hours; 5. Whether the course fulfills CEU requirements for dentists, dental hygienists or dental assistants; 6. The date and location of the program; and 7. Verification by the sponsor that licensee completed the program. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

243

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants (b) The sponsor, or its agent, shall keep the following records for a period of five years. All records shall be furnished to the Board upon request: 1. Course description; 2. Faculty; 3. Date of the course; 4. Location of the course; 5. Number of contact hours; and 6. Roster of attendees. 8.05: Categories of Continuing Education Programs and CEUs Allowed in Each Category (1) Educational and Scientific Courses, Examinations, and Specialty Boards. A licensee may obtain CEUs in these categories: (a) Educational and scientific courses sponsored or approved by any of the following: 1. Accredited educational or service institutions; 2. Professional associations and societies; 3. Accredited postdoctoral programs; 4. Local, state and federal governmental health agencies and health institutions; and 5. Accredited community and teaching hospitals. (b) Completion of Part II of the National Board Examination for dentists or the National Board Dental Hygiene Examination for dental hygienists. (c) Completion of the CDCA Diagnosis, Oral Medicine, Radiology and Comprehensive Treatment Planning examination for dentists or the CDCA Dental Hygiene Comprehensive examination for dental hygienists, or other Board approved clinical competency examination. (d) Completion of continuing education requirements for maintaining certification of ADA-recognized board specialties. (2) Self-instruction. A dentist may earn a maximum of 20 CEUs, a dental hygienist may earn a maximum of ten CEUs and a dental assistant may earn a maximum of six CEUs per renewal cycle by completing an individual study course (home study, on-line, correspondence, audio or video). All such courses must include a test, which the licensee shall pass to obtain credit. (3) Teaching and Research. (a) Continuing Education Instructor. A dentist may earn a maximum of 20 CEUs, a dental hygienist may earn a maximum of ten CEUs and a dental assistant may earn a maximum of six CEUs per renewal cycle as an instructor of continuing education courses that satisfy criteria in 234 CMR 8.04. Two CEUs may be earned for every hour taught and only for the first presentation of the program. The Board will not accept CEUs for repeat presentations. (b) Academic Participation. A dentist, dental hygienist or dental assistant who conducts research or who is an appointed member of the faculty at a CODA-accredited dental school, dental hygiene program, or dental assisting program may receive three CEUs for the following: 1. Faculty Appointments. A dentist may receive a maximum of ten CEUs, a dental hygienist may receive a maximum of five CEUs, and a dental assistant may receive a maximum of three CEUs per renewal cycle through a faculty appointment for teaching at a CODA-accredited dental school, a dental hygiene program, or dental assisting program. 2. Research Appointments. A dentist may receive a maximum of ten CEUs, a dental hygienist may receive a maximum of five CEUs, and a dental assistant may receive a maximum of three CEUs through a research appointment at a CODA-accredited dental school, dental hygiene program, or dental assisting program or other research institution. Documentation of the research conducted by the licensee shall be provided, upon request, to the Board and may include: a. Results of research conducted; b. Publications authored by the licensee and published in a professional scientific journal; c. Presentation of research studies at professional conferences; or d. A written statement by the licensee's supervisor of the research, estimated number of hours and a description of the licensee's role in research. (4) Papers, Publications and Scientific Presentations. A dentist may receive a maximum of 20 CEUs, a dental hygienist may receive a maximum of ten CEUs, and a dental assistant may receive a maximum of six CEUs per renewal cycle in the following categories: (a) A maximum of ten CEUs for a dentist, five CEUs for a dental hygienist, and three CEUs for a dental assistant will be given for each original scientific paper authored by the licensee and published in a scientific professional journal. (b) For each original presentation of a paper, essay or formal lecture to a recognized group of fellow professionals, the presenter shall receive two hours of CEUs for every hour of presentation.

244

Massachusetts State Dental Practice Act and Administrative Rules for Dental Assistants (5) Table Clinics and Scientific Exhibits. A maximum of eight CEUs may be obtained in this category. The original presentation of a table clinic or scientific exhibit at a professional meeting will provide a maximum of two hours of CEUs per clinic or exhibit. (6) General Attendance at Conferences. A dentist may receive a maximum of five CEUs, a dental hygienist may receive a maximum of four CEUs, and a dental assistant may receive a maximum of three CEUs per renewal cycle for general attendance at a multi-day professional conference. (7) Pro bono Service. A dentist may earn a maximum of five CEUs, a dental hygienist may earn a maximum of three CEUs per renewal cycle and a dental assistant may receive a maximum of two CEUs per renewal cycle for pro bono services provided in public health settings as defined in 234 CMR 2.00: Purpose and Definitions. (a) A CEU may be earned for each hour of service, and may include, but not be limited to, direct patient care and oral health education programs. (b) A licensee seeking to earn CEU credit for pro bono service must submit, upon request of the Board, documentation from the dental facility director or person responsible for the program or institution attesting to the licensee's participation, including the date(s), location(s), and number of hours of service. (8) Non-clinical Practice-related Courses. A dentist may earn a maximum of five CEUs and a dental hygienist or dental assistant may earn a maximum of two CEUs per renewal cycle for non-clinical practice-related courses. 8.06: Certification of Compliance with CEU Requirements (1) Each licensee shall maintain documentation of CEUs for four years or two renewal cycles following renewal of the license, which shall be furnished to the Board upon request. Such documentation must comply with the requirements of 234 CMR 8.00. (2) The Board may conduct random CEU audits and initiate disciplinary proceedings after written notice to the licensee for non-compliance with CEU requirements. 8.07: Waiver of CEU Requirements (1) The Board may upon written request and a demonstration of good cause waive the CEU requirements. Good cause may include, but may not be limited to: (a) Full-time service in the armed forces of the United States or the U.S. Public Health Service; (b) Service in the armed forces of the United States during a substantial part of such period; (c) An incapacitating illness documented by a licensed physician; (d) Undue hardship (e.g., prolonged hospitalization, physical and/or psychological); (e) Disability and inability to practice dentistry, dental hygiene, or dental assisting on a temporary basis; (f) Matriculation in a program of advanced or specialty study in dentistry, dental hygiene, or dental assisting. (2) The Board may request the licensee to appear before the Board to determine whether good cause exists to waive or otherwise modify the CEU requirements.

245

Michigan DANB Certificant Counts: Michigan National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

945

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

2,962

Infection Control (ICE)

2,623

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Brian DeBano, Director, Licensing Division, Bureau of Professional Licensing Michigan Board of Dentistry P.O. Box 30670 Lansing, MI 48909-8170 Phone: 517-241-0199 Fax: 517-241-0032 Website: www.michigan.gov/healthlicense Email: bplhelp@michigan.gov

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Baker College of Clinton Township Delta College Grand Rapids Community College Lake Michigan College Mott Community College Northwestern Michigan College Washtenaw Community College Wayne County Community College District

Radiation Health and Safety (RHS)

DANB CDA Certificant State of Michigan+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 4, 2020.

246

Source: 2018 DANB Salary Survey (state data based on 24 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Michigan State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Michigan, a dental assistant must successfully complete a course in dental radiography that is substantially equivalent to a course taught in a CODA-accredited program.

State Requirements For Expanded Functions To perform the expanded functions listed in the Michigan state dental practice act, a Registered Dental Assistant must be licensed by the Michigan Board of Dentistry. To become licensed as a Registered Dental Assistant (RDA) in the state of Michigan, one must: (1) Receive a degree or certificate from a CODA-accredited dental assisting program or a school of dental assisting meeting Michigan Board of Dentistry requirements, which includes required instruction in Michigan expanded functions* AND (2) Pass the board comprehensive and clinical exam or pass an equivalent exam in another state (proof of out-of-state licensure required) AND (3) Complete the fingerprinting/criminal background check process AND (4) Apply for a license to the Michigan Board of Dentistry. Beginning January 1, 2022, RDAs will be required to complete training in identifying victims of human trafficking meeting standards set forth in R.338.11123. (*Note: Individuals who earned the RDA credential prior to March 22, 2004 must complete additional expanded functions training courses before performing certain specified expanded functions.)

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants Please note: The pages that follow contain selected excerpts from Part 166 of the Michigan Public Health Code addressing the practice of dentistry and selected excerpts from the Michigan Board of Dentistry General Rules. For the full text of Part 166 of the Public Health Code, please visit http://legislature.mi.gov/doc.aspx?mcl-368-1978-15-166. For the full text of Part 161 (General Provisions) of the Public Health Code, which contains provisions governing all Michigan licensees, including Registered Dental Assistants, please visit http://legislature.mi.gov/doc.aspx?mcl-368-1978-15-161. For the full text of the Michigan Board of Dentistry General Rules, please visit https://ars.apps.lara.state.mi.us/AdminCode/AdminCode and select "Licensing and Regulatory Affairs," and then "Bureau of Professional Licensing," and then "Dentistry - General Rules."

Dental Practice Act – Michigan Board of Dentistry PUBLIC HEALTH CODE Act 368 of 1978 PART 166 DENTISTRY MCL 333.16601 Definitions; principles of construction. Sec.16601. (1) As used in this part: (a) “Assignment” means that a dentist has designated a patient of record on whom services are to be performed and has described the procedures to be performed. The dentist need not be physically present in the office or in the treatment room at the time the procedures are being performed. (e) “Practice as a dental assistant” means assistance in the clinical practice of dentistry based on formal education, specialized knowledge, and skill at the assignment and under the supervision of a dentist. (f) “Practice as a dental hygienist” means practice at the assignment of a dentist in that specific area of dentistry based on specialized knowledge, formal education, and skill with particular emphasis on preventive services and oral health education. MCL 333.16611 Dentist, dental hygienists, or dental assistant; license or authorization required; deep scaling, root planing, and removal of calcareous deposits; qualifications for dental hygienist licensure; administration of intraoral block and infiltration anesthesia by dental hygienist; administration of local anesthesia or nitrous oxide analgesia; requirements; additional delegation of procedures; third party reimbursement; practice guidelines; definitions. (1) An individual shall not engage in the practice of dentistry, the practice as a dental hygienist, or the practice as a dental assistant unless he or she is licensed or otherwise authorized by this article. (2) Deep scaling, root planing, and the removal of calcareous deposits may only be performed by an individual licensed or otherwise authorized by this article as a dental hygienist or a dentist. (6) Monitoring and assisting the administration of nitrous oxide analgesia is at the discretion of each individual registered dental assistant who fulfills the applicable conditions imposed in subsection (7). © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

247

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (7) In addition to the rules promulgated by the department under this part, upon delegation by a dentist, under section 16215 and under the direct supervision of a dentist, a registered dental assistant may assist and monitor the administration of nitrous oxide analgesia by the dentist or dental hygienist if the registered dental assistant has successfully completed a course in the assisting and monitoring of the administration of nitrous oxide analgesia offered by a dental or dental assisting program accredited by the Commission on Dental Accreditation and approved by the department. The course must contain a minimum of 5 hours of didactic instruction and include content in all of the following: (a) Nitrous oxide analgesia medical emergencies techniques. (b) Pharmacology of nitrous oxide. (c) Nitrous oxide techniques. (9) In the assisting by a registered dental assistant otherwise qualified under this section in the administration of nitrous oxide analgesia, the nitrous oxide levels must by preset by the dentist or dental hygienist and shall not be adjusted by the registered dental assistant except in the case of an emergency, in which circumstances the registered dental assistant may turn off the nitrous oxide and administer 100% oxygen. (11) In addition to the rules promulgated by the department under this part, upon delegation by a dentist under section 16215 and under the direct supervision of a dentist, a registered dental assistant may place, condense, and carve amalgam restorations and take final impressions for indirect restorations if the registered dental assistant has successfully completed a course offered by a dental or dental assisting program accredited by the Commission on Dental Accreditation and approved by the department. For taking final impressions and placing, condensing, and carving amalgam restorations, the registered dental assistant shall have completed a course with a minimum of 20 hours’ didactic instruction followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a criterion based assessment instrument. (12) In addition to the rules promulgated by the department under this part, upon delegation by a dentist under section 16215 and under the general supervision of a dentist, a registered dental assistant may perform the following intraoral dental procedures if the registered dental assistant has successfully completed a course meeting the standards described in subsection (13) offered by a dental or dental assisting program accredited by the Commission on Dental Accreditation and approved by the department: (a) Performing pulp vitality testing. (b) Placing and removing matrices and wedges. (c) Applying cavity liners and bases. (d) Placing and packing nonepinephrine retraction cords. (e) Applying desensitizing agents. (f) Taking an impression for orthodontic appliances, mouth guards, bite splints, and bleaching trays. (g) Drying endodontic canals with absorbent points. (h) Etching and placing adhesives prior to placement of orthodontic brackets. (13) The course in subsection (12) that involves those intraoral procedures described in subsection (12) must contain a minimum of 10 hours of didactic and clinical instruction. (14) This section does not require new or additional third party reimbursement or mandated worker’s compensation benefits for services rendered by an individual licensed as a dental assistant or as a dental hygienist under this article. (15) Within 30 days after the effective date of the amendatory act that added this subsection, the board shall develop patient safety and equipment practice guidelines for dentists delegating to dental hygienists and dental assistants the administration of nitrous oxide analgesia under this part. The practice guidelines shall be consistent with national recommendations. (16) As used in this section: (a) “Assisting” means setting up equipment and placing the face mask. Assisting does not include titrating and turning on or off equipment. (b) “Direct supervision” means that a dentist complies with all of the following: (i) Designates a patient of record upon whom the procedures are to be performed and describes the procedures to be performed. (ii) Examines the patient before prescribing the procedures to be performed and upon completion of the procedures. (iii) Is physically present in the office at the time the procedures are being performed. (c) “General supervision” means that a dentist complies with all of the following: (i) Designates a patient of record upon whom services are to be performed. (ii) Is physically present in the office at the time the procedures are being performed. (d) “Monitoring” means observing levels and reporting to the dentist or dental hygienist. MCL 333.16625 Rules as to dental hygienist or dental assistant; dental hygiene services performed under supervision of dentist as part of program for dentally underserved program; designation of grantee health agency; requirements; notification; advisory committee; definitions. Sec. 16625. (1) The board may promulgate rules to prohibit or otherwise restrict the assignment of procedures to a dental hygienist or a dental assistant if the board determines that the assignment constitutes or may constitute a danger to the health, safety, or welfare of the patient or the public. 248

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants MCL 333.16626 Dental assistant as second pair of hands. Sec. 16626. (1) Subject to subsection (2), and notwithstanding section 16601(1)(f) or the rules promulgated under section 16625(1), a dental hygienist or dental therapist may utilize a dental assistant to act as his or her second pair of hands. (2) Notwithstanding section 16601(1)(e) or the rules promulgated under section 16625(1), a dental assistant may function as a second pair of hands for a dentist, dental hygienist, or dental therapist if all of the following are met: (a) The dentist or dental hygienist is actively performing services in the mouth of a patient at the time the dental assistant is assisting him or her. (b) If the dental assistant is assisting a dental hygienist, a supervising dentist has assigned the dental assistant to act as the dental hygienist's second pair of hands. (3) This section does not require new or additional third party reimbursement or mandated worker's compensation benefits for services rendered by an individual who is licensed as a dental assistant, dental hygienist, or dental therapist under this article. (4) As used in this section, "second pair of hands" means that term as defined in R 338.11101 of the Michigan administrative code. MCL 333.16656 Scope of practice; services included; prohibition on prescribing a controlled substance; "health care professional" defined. Sec. 16656. (2) A dental therapist may supervise dental assistants and dental hygienists to the extent permitted in a written practice agreement. However, a dental therapist shall not supervise more than 3 dental assistants and 2 dental hygienists in any 1 practice setting.

R 338.11101 Definitions. Rule 1101. As used in these rules:

Michigan Administrative Code DENTISTRY RULES - GENERAL RULES

(a) “Analgesia” means the diminution or elimination of pain in the conscious patient as a result of the administration of an agent including, but not limited to, local anesthetic, nitrous oxide, and pharmacological and non-pharmacological methods (b) “Approved course” means a course offered by either a dental, dental hygiene, or dental assisting program accredited by the commission on dental accreditation of the American dental association and approved by the department, or as defined in section 16611 of the code. (c) “Assistant” means a nonlicensed person who may perform basic supportive procedures under the supervision of a dentist as provided in these rules. (d) “Board” means the Michigan board of dentistry. (e) “Conscious sedation” means a minimally depressed level of consciousness that retains a patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or a non-pharmacological method or a combination of both. (f) "Code" means 1978 PA 368, MCL 333.1101 to 333.25211. (g) “Combination inhalation-enteral conscious sedation” means conscious sedation using inhalation and enteral agents. Nitrous oxide/oxygen when used in combination with sedative agents may produce conscious or deep sedation or general anesthesia. (k) “Enteral” means any technique of administration in which the agent is absorbed through the gastrointestinal or oral mucosa. (l) “General anesthesia” means the elimination of all sensations accompanied by a state of unconsciousness and loss of reflexes necessary to maintain a patent airway. (n) “Local anesthesia” means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. (o) “Office” means the building or suite in which dental treatment is performed. (p) “Parenteral” means a technique of administration in which the drug bypasses the gastrointestinal (gi) tract, such as intramuscular (im), intravenous (iv), intranasal (in), submucosal (sm), subcutaneous (sc), and intraocular (io). (s) “Registered dental assistant” means a person licensed as such by the board under the code and these rules. A dental hygienist may perform the functions of a registered dental assistant if he or she is licensed by the board as a registered dental assistant. (t) “Registered dental hygienist” means a person licensed as such by the board under the code and these rules. (u) “Second pair of hands,” as used in R 338.11109, means acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist at the direction of a dentist who is in the process of rendering dental services and treatment to a patient. The acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist are ancillary to the © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

249

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants procedures performed by the dentist and intended to provide help and assistance at the time the procedures are performed. This definition shall not be deemed to expand the duties of the dental assistant, registered dental assistant, or registered dental hygienist as provided by the code and rules promulgated by the board. (v) “Sedation” means the calming of a nervous, apprehensive individual, without inducing loss of consciousness, through the use of systemic drugs. Agents may be given orally, parenterally, or by inhalation. (w) “Titration” means the administration of small incremental doses of a drug until a desired clinical effect is observed. In accordance with this definition, titration of oral medication for the purposes of sedation is unpredictable. Repeated dosing of orally administered sedative agents may result in an alteration of the state of consciousness beyond the intent of the practitioner. The maximum recommended dose (mrd) of an oral medication shall not be exceeded. Facilities, personnel and standards for enteral sedation are the same as those for parenteral sedation. (x) “Treatment room” means the particular room or specific area in which the dental treatment is performed upon a patient. R 338.11103 Applicability of rules. Rule 1103. These rules apply to dentists, registered dental assistants, and registered dental hygienists. R 338.11123 Training standards for identifying victims of human trafficking; requirements. Rule 1123 (1) Pursuant to section 16148 of the code, MCL 333.16148, an individual seeking licensure or license renewal shall complete training in identifying victims of human trafficking that meets the following standards: (a) Training content that covers all of the following: (i) Understanding the types and venues of human trafficking in Michigan or the United States. (ii) Identifying the warning signs of human trafficking in health care settings. (iii) Identifying the warnings signs of human trafficking in health care settings for adults and minors. (iv) Identifying resources for reporting the suspected victims of human trafficking. (b) Acceptable providers or methods of training include any of the following: (i) Training offered by a nationally recognized or state-recognize health-related organization. (ii) Training offered by, or in conjunction with, a state or federal agency. (iii) Training obtained in an educational program that has been approved by the board for initial licensure, or by a college or university. (iv) Reading an article related to the identification of victims of human trafficking that meets the requirements of subdivision (a) of this subrule and is published in a peer review journal, health care journal, or professional or scientific journal. (c) Acceptable modalities of training may include any of the following: (i) Teleconference or webinar. (ii) Online presentation. (iii) Live presentation. (iv) Printed or electronic media. (2) The department may select and audit a sample of individuals and request documentation of proof of completion of training. If audited by the department, an individual shall provide an acceptable proof of completion of training, including either of the following: (a) Proof of completion certificate issued by the training provider that includes the date, provider name, name of training, and individual's name. (b) A self-certification statement by an individual. The certification statement shall include the individual's name and either of the following: (i) For the training completed pursuant to subrule (1)(b)(i) to (iii) of this rule, the date, training provider name, and name of training. (ii) For training completed pursuant to subrule (1)(b)(iv) of this rule, the title of article, author, publication name of peer review journal, health care journal, or professional or scientific journal, and date, volume, and issue of publication, as applicable. (3) Pursuant to section 16148 of the code, MCL 333.16148, the requirements specified in subrule (1) of this rule apply for license renewals beginning with the first renewal cycle after the promulgation of this rule and for initial licenses issued 5 or more years after the promulgation of this rule. R 338.11233 Registered dental hygienist; use of letters “R.D.H.”; registered dental assistant; use of letters “R.D.A.” Rule 1233. (1) Pursuant to section 16264 of the act, the registered dental hygienist who has received a bona fide degree or certificate of dental hygiene from a duly recognized and accredited school of dental hygiene and who has completed all requirements for licensure may use the letters “R.D.H.” after his or her name in connection with the practice of dental hygiene. 250

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (2) Pursuant to section 16264 of the act, a registered dental assistant who has received a bona fide degree or certificate of dental assisting from a duly recognized and accredited school of dental assisting and who has completed all requirements for licensure may use the letters â&#x20AC;&#x153;R.D.A.â&#x20AC;? after his or her name in connection with the practice of dental assisting. R 338.11235 Licensure to practice as a registered dental assistant; requirements. Rule 1235. An individual applying for a license to practice as a registered dental assistant shall meet all of the following requirements: (a) Comply with section 16174 of the act. (b) Graduate or receive a certificate from a school which meets the standards set forth in R 338.11307. (c) Pass the board comprehensive and clinical examination. R 338.11239 Registered dental assistant examination; content; time, place, passing score. Rule 1239. (1) The board shall conduct a written and clinical examination for individuals seeking licensure as a registered dental assistant. (2) Examination for licensure as a registered dental assistant shall be both written and clinical and shall include, but not be limited to, all of the following: (a) Oral anatomy. (b) Law and rules governing dental auxiliaries. (c) Instrumentation and use of dental materials. (d) Mouth mirror inspection. (e) Rubber dam application. (f) Application of anticariogenics. (g) Placement and removal of temporary crowns and bands. (h) Radiography. (i) Periodontal dressings, application and removal. (j) Removal of sutures. (k) Construction of temporary crowns. (l) Placing, condensing and carving amalgam restorations. (m) Making final impressions for indirect restorations. (n) Assisting and monitoring in the administration of nitrous oxide analgesia. (o) Placing, condensing and carving intracoronal temporaries. (3) The examination shall be given at least once a year. The passing score for the examination shall be a converted score of 75 on each section. (4) A candidate who fails to achieve a passing score on all parts within an 18-month period shall reapply to take the entire clinical and comprehensive examination. R 338.11241 Registered dental assisting licensure candidate who fails the clinical or comprehensive examination twice; requirements before reexamination. Rule 1241. (1) Before being permitted to retake the clinical examination, a registered dental assisting licensure candidate who sustains 2 successive failures in the clinical examination shall be required to meet both of the following requirements subsequent to the last examination failed: (a) The candidate shall present evidence of additional education consisting of a minimum of 20 hours of boardapproved instruction, which shall be both didactic and clinical, in a school approved by the board. (b) The course shall be satisfactorily completed as evidenced by certification by the dean or his or her appointee. (2) Before being permitted to retake the comprehensive examination, a registered dental assisting licensure candidate who sustains 2 successive failures in the comprehensive section of the examination shall be required to meet both of the following requirements subsequent to the last examination failed: (a) The candidate shall present evidence of additional education consisting of a minimum of 20 hours of boardapproved instruction in a school approved by the board. (b) The course shall be satisfactorily completed as evidenced by a certification by the dean or his or her appointee. R 338.11245 Registered dental assisting licensure candidate who fails the examination 3 times; requirements before reexamination. Rule 1245. Before being permitted to retake the examination, a registered dental assisting licensure candidate who fails any part of the examination 3 times shall be required by the board to return to an accredited school for 1 academic semester or term. The course of the 1 academic semester or term shall be satisfactorily completed as evidenced by certification by the dean or his or her appointee. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

251

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants R 338.11247 Limited licenses; issuance; requirements. Rule 1247. (1) The board may issue a limited license, under section 16182(2)(a) of the code, to an individual who is a graduate of a dental, dental hygiene, or dental assisting program approved by the board and who is enrolled or involved in a postgraduate course of study. (2) The board may issue a limited license, under section 16182(2)(b) of the code, MCL 333.16182(2)(b) to an individual who is a graduate dentist, dental hygienist, or dental assistant who is employed by a dental program or a dental auxiliary program as a faculty member, and who functions only in a nonclinical academic research setting or in an administrative setting. (3) The board may issue a limited license, under section 16182(2)(c) of the code, MCL 333.16182(2)(b) to an individual who is a graduate dentist, dental hygienist, or dental assistant and who is employed by a dental program or a dental auxiliary program as a faculty member. Both of the following apply to a limited license: (a) A limited licensed dentist or limited licensed dental hygienist may perform dental procedures upon patients while employed as a faculty member by the dental or dental auxiliary program, if the procedures are performed under the general supervision, as defined in R 338.11401(d), faculty member who is fully licensed as a dentist. (b) A limited licensed dental assistant may perform dental procedures upon patients while employed as a faculty member of a dental or dental auxiliary program, if such procedures are performed under the general supervision, as defined in R 338.11401(d), of a faculty member who is fully licensed as a dentist and the limited licensed dental assistant has satisfied the 35 hours of additional education required under section 16611(7), (11), (12), and (13) of the code, MCL 333.16611(7), (11), (12) and (13). (4) An individual licensed under this subrule shall not do either of the following: (a) Hold himself or herself out to the public as being engaged in the practice of dentistry other than as a faculty member. (b) Provide dental services outside his or her employment as a faculty member. (5) An individual applying for a limited license under section 16182(2) of the code, MCL 333.16182(2), shall meet both of the following requirements: (a) Comply with section 16174 of the code, MCL 333.16174. (b) Submit proof of graduation from an accredited school of dentistry, dental hygiene, or dental assisting or submit proof of a certified copy of the diploma and transcript from a nonaccredited school of dentistry, dental hygiene, or dental assisting. (c) Submit proof of appointment to a faculty position. (6) Limited licenses shall be renewed annually at the discretion of the board. R 338.11253 Certification of renewal; display. Rule 1253. A licensee shall display a currently renewed certificate of licensure in his or her principal place of practice. A licensee whose practice involves more than 1 office shall have his or her pocket card portion of the currently renewed certificate of licensure available for viewing upon request. R 338.11261 Licensure by endorsement of registered dental assistants; requirements. Rule 1261. (1) An applicant for licensure by endorsement shall submit a completed application on a form provided by the department, together with the requisite fee. In addition, an applicant shall meet the requirements of the act and administrative rules promulgated under the act. (2) An applicant who was first licensed or registered in another state for performance of expanded functions as described in R 338.11405 and R 338.11405(a) is presumed to have met the requirements of section 16186 of the act, if he or she meets all of the following requirements: (a) Graduated from a dental assisting school that meets the standards provided in R 338.11307 and provide for the school to submit original, official transcripts of professional education and documentation of graduation for board evaluation. (b) Passed the Michigan registered dental assistant licensing examination or show proof of successful completion of a substantially equivalent written and clinical examination as specified under R 338.11239. To determine substantial equivalency, the board shall consider factors such as the following: (i) Subject areas included. (ii) Detail of material. (iii) Comprehensiveness. (iv) Length of examination. (v) Degree of difficulty. 252

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (c) To demonstrate substantial equivalency as specified in subdivision (b) of this subrule, the applicant may be required to submit or cause to be submitted such materials as the following: (i) A certified copy of the examination. (ii) An affidavit that describes the examination and sets forth the legal standards which were in effect at the time of the examination. The affidavit shall be issued by an official who is responsible for the state agency that administered the examination. (iii) An affidavit that describes the examination and that was issued by an official with a state society or another organization that administered the examination. (iv) Other credible evidence. (d) Verification of his or her license, on a form supplied by the department, by the licensing agency of any state in which the applicant holds a current license or ever held a license for performance of expanded functions which includes, but is not limited to, showing proof of any disciplinary action taken or pending disciplinary action against the applicant. (3) A dental assistant who does not fulfill the requirements of subrule (2) of this rule shall not be eligible for licensure by endorsement in this state and shall comply with the provisions of R 338.11235. (4) The board may deny an application for licensure by endorsement upon finding the existence of a board action in any other state of the United States for a violation related to applicable provisions of section 16221 of the act or upon determining that the applicant does not fulfill the requirements of section 16186 of the act. R 338.11307 Approval of dental assisting schools; standards; adoption by reference. Rule 1307. (1) The board adopts by reference the standards of the commission on dental accreditation of the American Dental Association, as set forth in the publication entitled “Accreditation Standards for Dental Assisting Education Programs,” copyright 2013 and revised 2015, as the standards by which the board shall determine whether to approve a school that complies with these standards. Certification by the commission on dental accreditation that a school complies with these standards constitutes a prima facie showing that the school complies with the standards. (2) These standards may be obtained at no cost from the Commission on Dental Accreditation of the American Dental Association, 211 East Chicago Ave., Chicago, IL 60611-2678 or at no cost from the association’s website at http:// www.ada.org. Copies of these standards are available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Licensing and Regulatory Affairs, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. R 338.11401 Definitions Rule 1401. As used in this part. (a) “Assignment” means that a dentist designates a patient of record upon whom services are to be performed and describes the procedures to be performed. Unless assignment is designated in these rules under general or direct supervision, the dentist need not be physically present in the office at the time the procedures are being performed. (b) “Delegation” means an authorization granted by a licensee to a licensed or unlicensed individual to perform selected acts, tasks, or functions that fall within the scope of practice of the delegator and that are not within the scope of practice of the delegatee and that, in the absence of the authorization, would constitute illegal practice of a licensed profession. (c) “Direct Supervision” means that a dentist complies with all of the following: (i) Designates a patient of record upon whom the procedures are to be performed and describes the procedures to be performed. (ii) Examines the patient before prescribing the procedures to be performed and upon completion of the procedures. (iii) Is physically present in the office at the time the procedures are being performed. (d) “General Supervision” means that a dentist complies with both of the following: (i) Designates a patient of record upon whom services are to be performed. (ii) Is physically present in the office at the time the procedures are being performed. R 338.11402 Delegation or assignment of procedures by dentist to assistant, registered dental assistant, or registered dental hygienist; certain procedures prohibited. Rule 1402. (1) A dentist shall not delegate or assign any of the following functions to an assistant or a registered dental assistant unless authorized by these rules or the code: (a) Diagnosing, or prescribing for, any of the following: (i) Disease. (ii) Pain. (iii) Deformity. (iv) Deficiency. (v) Injury. (vi) Physical condition. (b) Cutting of hard and soft tissue. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

253

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (c) Removal of any of the following: (i) Accretions. (ii) Stains. (iii) Calculus deposits. (d) Deep scaling. (e) Root planing. (f) Any intra-oral restorative procedures. (g) Administration of any of the following: (i) Local anesthesia. (ii) Nitrous oxide analgesia. (iii) Acupuncture. (h) Irrigation and medication of root canals, try-in of cones or points, filing, or filling of root canals. (i) Taking impressions for any purpose other than study or opposing models. (j) Permanent cementation of any restoration or appliance. (2) A dentist shall not assign to a registered dental hygienist the procedures described in subrule (1) (a), (b), (f), (g), (h), (i), and (j) of this rule unless authorized by these rules or the code. R 338.11403 Assistant; delegation of intra-oral procedures under general supervision. Rule 1403. The following intra-oral procedures shall not be delegated to an assistant unless the procedures are performed under general supervision: (a) Trial sizing of orthodontic bands. (b) Holding the matrix for anterior resin restorations. (c) Making impressions for study and opposing models. (d) Applying of topical anesthetic solutions. (e) Instructing in the use and care of dental appliances. (f) Operating of dental radiographic equipment if the assistant has successfully completed a course in dental radiography which is substantially equivalent to a course taught in a program approved by the board pursuant to R 338.11303 or R 338.11307. This subdivision takes effect July 26, 1992. R 338.11404 Dental assistant; delegation of intra-oral procedures under direct supervision. Rule 11404. The following intra-oral procedures shall be delegated to a dental assistant only if the procedures are performed under direct supervision: (a) Placement and removing of orthodontic separators. (b) Placement and removing of orthodontic elastics, ligatures, and arch wires. (c) Dispensing aligners. R 338.11404a Registered dental assistant; assignment of intra-oral procedures. Rule 1404a. A dentist may assign the following intraoral dental procedures to a registered dental assistant only if the procedures are performed under the assignment of a dentist: (a) Operating dental radiographic equipment. (b) Making impressions for study and opposing models. (c) Placing and removing a rubber dam. (d) Removing excess cement from supragingival surfaces of a tooth with a non-tissue cutting instrument. (e) Polishing specific teeth with a slow-speed rotary hand piece immediately before a procedure that would require acid etching before placement of sealants, resin-bonded orthodontic appliances, and direct restorations. (f) Applying anticariogenic agents including, but not limited to, sealants, fluoride varnish, and fluoride applications. (g) Polishing and contouring of sealants with a slow-speed rotary hand piece immediately following the procedure for the purpose of occlusal adjustment. (h) Inspecting and charting of the oral cavity using a mouth mirror and radiographs. (i) Replacing existing temporary restorations and existing temporary crowns and temporary bridges. (j) Removing orthodontic elastics, ligatures, and elastic or wire separators. (k) Replacing elastic or wire separators. (l) Classifying occlusion. (m) Providing nutritional counseling for oral health and maintenance. (n) Applying commonly accepted emergency procedures. R 338.11405 Registered dental assistant; assignment of intra-oral procedures under general supervision. Rule 1405. A dentist shall assign the intra-oral dental procedures detailed in R 338.11403(a), (b), (d), (e), and (f) and the following additional intra-oral procedures to a registered dental assistant only if the procedures are performed under the general supervision of a dentist: (a) Placing and removing a nonmetallic temporary restoration with non-tissue cutting instruments. (b) Sizing of temporary crowns and bands.

254

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants R 338.11405a Registered dental assistant; assignment of intra-oral procedures under direct supervision. Rule 1405a. A dentist shall assign the following intra-oral dental procedures to a registered dental assistant only if the procedures are performed under the direct supervision of a dentist: (a) Placing and removing periodontal dressings. (b) Temporarily cementing and removing temporary crowns and bands. (c) Removing sutures. (d) Applying in-office bleaching. (e) Cementing orthodontic bands or initial placement of orthodontic brackets. (f) Removing orthodontic adhesive from teeth, supragingivally, after removing brackets with non-tissue cutting instruments. R 338.11405b Registered dental assistant; delegation of intra-oral procedures under general supervision. Rule 1405b. (1) Placing and removing of retraction materials shall be performed only by a registered dental assistant if the procedure is delegated by a dentist to a registered dental assistant under general supervision. (2) A dentist shall delegate the following intra-oral procedures to a registered dental assistant only if the registered dental assistant has successfully completed an approved course, as defined in section 16611(12) and (13) of the code, MCL 333.16611(12) and (13). The following procedures shall be performed under the general supervision of a dentist: (a) Performing pulp vitality testing. (b) Placing and removing matrices and wedges. (c) Applying cavity liners and bases. (d) Placing and removing nonepinephrine retraction cords. (e) Applying desensitizing agents. (f) Taking an impression for orthodontic appliances, mouth guards, bite splints, and bleaching trays. (g) Drying endodontic canals with absorbent points. (h) Etching and placing adhesives before placement of orthodontic brackets. R 338.11405c Registered dental assistant; delegation of intra-oral procedures under direct supervision. Rule 1405c. (1) A dentist shall delegate the following intra-oral procedures to a registered dental assistant only if the registered dental assistant has successfully completed an approved course, as defined in section 16611(11) of the code, MCL 333.16611(11), followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a criterion-based assessment instrument. (2) The following procedures shall be performed under the direct supervision of a dentist: (a) Placing, condensing, and carving amalgam restorations. (b) Placing Class I resin bonded restorations, occlusal adjustment, finishing, and polishing with non-tissue cutting rotary hand pieces. (c) Taking of final impressions for indirect restorations. (3) A dentist shall delegate the assisting and monitoring of the administration of nitrous oxide analgesia by the dentist or registered dental hygienist to a registered dental assistant only if the registered dental assistant has successfully completed an approved course, as defined in section 16611(7) of the code, MCL 333.16611(7), in the assisting and monitoring of the administration of nitrous oxide analgesia. This procedure shall be performed under the direct supervision of a dentist. R338.11704 License renewal for registered dental hygienists and registered dental assistants; requirements; applicability. Rule 11704. (1) This rule applies to applications for the renewal of a registered dental hygienist license or a registered dental assistant license under section 16201(1) and (2) of the code, MCL 333.16201(1) and (2). (2) An applicant for license renewal who has been licensed for the 3-year period immediately preceding the expiration date of the license shall possess current certification in basic or advanced cardiac life support for an agency or organization that grants certification pursuant to standards substantially equivalent to the standards adopted in R 338.11705(3) and shall comply with the following requirements, as applicable: (a) For a registered dental hygienist license or a registered dental assistant license, the applicant shall have completed not less than 36 hours of continuing education acceptable to the board during the 3-year period immediately preceding the date of the application. Each licensee shall complete a minimum of 12 hours of the required 36 hours of approved continuing education in programs directly related to clinical issues such as delivery of care, materials used in the delivery of care, and pharmacology. (b) For a registered dental hygienist license or a registered dental assistant license, the applicant shall complete a minimum of 12 hours of the required 36 hours of approved continuing education by attending live courses or programs that provide for direct interaction between faculty and participants, including, but not limited to, lectures, symposia, live teleconferences, workshops and provision of volunteer clinical services provided for in RÂ 338.11704a. These courses, with the exception of the volunteer clinical services, may be counted toward the required courses in clinical issues such as delivery of care, materials used in delivery of care, and pharmacology. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

255

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (c) Applicants holding both a registered dental hygienist license and a registered dental assistant license shall have completed not less than a total of 36 hours of continuing education acceptable to the board during the 3-year period immediately preceding the date of the application. The 36 hours shall include not less than 12 hours devoted to registered dental hygienist functions, and not less than 12 hours devoted to registered dental assistant functions. (d) If an organized continuation course or program is offered in segments of 50 to 60 minutes each, 1 hour of credit shall be given for each segment. (e) Each licensee shall complete at least 2 continuing education credit in pain and symptom management in each renewal period. Continuing education credits in pain and symptom management may include, but are not limited to, courses in behavior management, psychology of pain, pharmacology, behavior modification, stress management, clinical applications and drug interactions. (3) The submission of the online renewal shall constitute the applicantâ&#x20AC;&#x2122;s certification of compliance required by this rule. The board may require an applicant or licensee to submit evidence to demonstrate compliance with this rule. The applicant or licensee shall maintain evidence of complying with the requirements of this rule for a period of 4 years from the date of the submission for renewal. R 338.11704a Acceptable continuing education for registered dental hygienists and registered dental assistants; limitations. Rule 11704a. The board shall consider any of the following as acceptable continuing education for registered dental hygienists and registered dental assistants: (a) Successful completion of a course or courses offered for credit in a dental school or hospital-based dental specialty program approved by the board under R 338.11301, a dental hygiene school approved by the board under R 338.11303, or dental assisting school approved by the board under R 338.11307. Ten hours of continuing education shall be credited for each quarter credit earned and 15 hours shall be credited for each semester credit earned, without limitation. (b) Attendance at a continuing education program offered by a dental school or hospital-based dental specialty program approved by the board under R 338.11301, a dental hygiene school approved by the board under R 338.11303, or a dental assisting school approved by the board under R 338.11307. One hour of continuing education shall be credited for each hour of program attendance, without limitation. (c) Attendance at a continuing education program approved by the board under R 338.11705. One hour of continuing education shall be credited for each hour of program attendance, without limitation. (d) Development and presentation of a table clinic demonstration or a continuing education lecture offered in conjunction with the presentation of continuing education programs approved by the board. One hour of continuing education shall be credited for each hour devoted to the development and initial presentation of a table clinic demonstration or a continuing education lecture, with a maximum of 10 hours of continuing education credited for the development and presentation of the same table clinic demonstration or continuing education lecture. (e) The initial publication of an article or articles related to the practice of dentistry, dental hygiene, or dental assisting in the journal of an accredited school of dentistry, dental hygiene or dental assistant, or in a state or state component association of dentists, dental specialists, dental hygienists, or dental assistants. Twelve hours of continuing education shall be credited (f) The initial publication of an article or articles related to the practice of dentistry, dental hygiene, or dental assisting in a textbook or in the journal of a national association of dentists, dental specialists, dental hygienists, or dental assistants. Twenty-five hours of continuing education shall be credited (g) Participation in board-approved continuing education activities offered online, through electronic media, or both. A maximum of 18 hours of continuing education may be earned. (h) Reading articles and viewing or listening to media, other than online programs, devoted to dental, dental hygiene, or dental assisting education. One hour of continuing education shall be credited for each hour of participation with a maximum of 10 hours credited under this category. (i) Renewal of a license held in another state that requires continuing education for license renewal that is substantially equivalent to that required in these rules if the applicant resides and practices in another state. For a registered dental hygienist or registered dental assistant, 36 hours of continuing education shall be credited for evidence of current licensure in such other state. (j) For a registered dental assistant, meeting the requirements for recertification in R 338.11705(3). Thirty-six hours of continuing education shall be credited for evidence of current certification, other than emeritus certification, by the dental assisting national board. (k) Attendance at a continuing education program which has been granted approval by another state board of dentistry. One continuing education contact hour may be granted for each hour of program attendance. (l) Attendance by dental hygienists or registered dental assistants at dental related programs which are documented by the licensee as relevant to health care and advancement of the licenseeâ&#x20AC;&#x2122;s dental education. The board shall deny a request for approval if the continuing education request does not meet the criteria used by the board for approval of continuing education sponsors. Six hours of continuing education credited. 256

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (m) Attendance at programs related to specific dental specialty topics approved for category 1 continuing education by the boards of medicine or osteopathic medicine. A maximum of 18 credit hours per renewal period may be earned. (n) Dental hygienists and dental assistants may receive continuing education credit for providing volunteer clinical dental hygiene or assistant services within the state as provided in this rule. (i) A dental hygienist or dental assistant may provide volunteer clinical care at a board-approved program that complies with both of the following: (a) Is a public or non-profit entity, program, or event, or a school or nursing home. (b) Provides clinical dental services to the indigent or dentally underserved populations. (ii) A licensee shall not receive direct or indirect remuneration of any kind, including, but not limited to, remuneration for materials purchased or used. (iii) The program shall require a licensee to sign in and sign out daily upon commencement and termination of the provision of services. (iv) Continuing education credit shall be calculated at the ratio of 1 continuing education credit hour for each 120 minutes of patient services. (v) A dental hygienist or dental assistant may earn a maximum of 12 volunteer credit hours per renewal period. (vi) Board-approved sponsors that provide volunteer continuing education opportunities under this rule shall comply with all of the following: (a) Apply to the department to obtain approval as a sponsoring entity, pursuant to R 338.11705(7). (b) Retain patient records. (c) Retain documentation of all volunteer assignments and the hours of service provided. (d) Provide the records and a copy of the assignments and the hours of service provided to the board upon request. (e) Provide each licensee with verification of volunteer work performed by the licensee upon completion of the licenseeâ&#x20AC;&#x2122;s service. (vii) The board may revoke the approval status of any entity that fails to comply with these rules. (viii) A licensee who is employed by an entity that provides dental services to the indigent or dentally underserved populations may not obtain credit for volunteer services at the entity at which the licensee is employed, but may receive credit for qualified volunteer services at other approved entities. (ix) A licensee who provides volunteer dental services shall maintain proof of such services for at least 4 years. (x) A licensee who fails to maintain accurate and complete records of services rendered may not receive continuing education credit for those services. (xi) A licensee under a board order or agreement that provides for the provision of volunteer services may not receive continuing education credit for the provision of the volunteer services. (xii) Continuing education credit hours earned through volunteer clinical work shall not count toward the required 12 continuing education hours on clinical issues such as delivery of care, materials used in the delivery of care, and pharmacology, or the 1 continuing education hour required for pain management, as required by R 338.11704(2). R 338.11705 Standards and requirements; adoption by reference. Rule 1705. (1) The board approves and adopts by reference the standards and criteria of the national sponsor approval program of the Academy of General Dentistry for approval of continuing education sponsoring organizations, institutions, and individuals, which are set forth in the publication entitled "Program Approval for Continuing Education (PACE), Program Guidelines, Revised July 2015". Information on the PACE standards and criteria is available at no cost from the Academy of General Dentistry, 211 East Chicago Avenue, Suite 900, Chicago, IL 60611 or from the academy's internet website at http://www.agd.org. A copy of the guidebook is available for inspection and distribution at no cost from the Michigan Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. Approval of a sponsor by the Academy of General Dentistry committee on national sponsor approvals or by any Academy of General Dentistry constituent academy shall constitute prima facie evidence that the sponsor meets the standards and criteria adopted by the board. (2) The board approves and adopts by reference the standards and criteria of the National Sponsor Approval Program of the American Dental Association Continuing Education Recognition Program (ADA CERP) for approval of continuing education sponsoring organizations, which are set forth in the publication entitled "ADA CERP Recognition Standards, Procedures, and Recognition Process. Revised March 2015." A copy of this publication may be obtained at no cost from the association at ADA CERP 211 E. Chicago Avenue, Chicago, IL 60611-2678 or from the association's internet website at http://www.ada.org/381.aspx. A copy of the publication is available for inspection and distribution at cost from the Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. Approval of a sponsor by the ADA CERP or by any constituent group of ADA CERP shall constitute prima facie evidence that the sponsor meets the standards and criteria adopted by the board. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

257

Michigan State Dental Practice Act and Administrative Rules for Dental Assistants (3) The board approves and adopts by reference the requirements for recertification established by the Dental Assisting National Board and set forth in the publication entitled "DANB's Recertification Requirements, Revised April, 2015." A copy of the publication may be obtained at no cost from the Dental Assisting National Board, 444 N. Michigan Avenue, Suite 900, Chicago, IL 60611 or from the national board's internet website at http://www.danb.org. A copy of the guidelines and requirements are available for inspection and distribution at cost from the Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. (4) The board shall consider any continuing education program that is offered by a sponsor that applies to the board and demonstrates it substantially meets the standards and criteria adopted by the board as a continuing education program approved by the board. (5) The board adopts by reference the standards for certification in basic and advanced cardiac life support set forth by the American Heart Association in the standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care for professional providers and published in "2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care ("Circulation," Volume 132, Issue 18 Supplement 2). A copy of the guidelines for cardiopulmonary resuscitation and emergency cardiovascular care may be obtained at no cost from the American Heart Association's website at http://circ.ahajournals.org/. A copy of this document is available for inspection and distribution at cost from the Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. (6) The board may approve a state, regional, or national dental organization as an acceptable provider of continuing education courses if the organization presents standards, criteria, and course monitoring procedures for its courses that are acceptable to the board. The board may withdraw the approval if it determines the organization is not complying with the standards and criteria presented. The standards, criteria, and monitoring procedures will be retained in the department's board files. An organization shall update its file with the department every 5 years. (7) A sponsor seeking board approval to offer volunteer continuing education opportunities under R 338.11703(o) or R 338.11704a(n), or both, shall submit documentation evidencing compliance with the requirements of R 338.11703(o) or R 338.11704a(n), or both.

258

Minnesota DANB Certificant Counts: Minnesota Certified Dental Assistant (CDA) certificants

3,121

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Bridgett Anderson, Executive Director Minnesota Board of Dentistry University Park Plaza 2829 University Ave., SE, Suite 450 Minneapolis, MN 55414-3249 Phone: 612-617-2250 or 888-240-4762 Fax: 612-617-2260 Email: bridgett.anderson@state.mn.us Website: www.mn.gov/boards/dentistry/

Radiation Health and Safety (RHS)

6,210

Infection Control (ICE)

6,152

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs

Central Lakes College DANB CDA Certificant $23.73 Century College + State of Minnesota per hour Dakota County Technical College Hennepin Technical College DANB CDA Certificant $20.76 Herzing University + Hibbing Community College National per hour Minneapolis Community & Technical College Minnesota West Community and Technical College All Dental Assistants $18.59 Minn. State Community and Technical College, Moorhead ++ National per hour Northwest Technical College Rochester Community & Technical College St. Cloud Technical and Community College DANB certificant and exam information is current as of July 1, 2020. South Central Technical College State-specific information on the pages that follow is current as of April 17, 2020. The pages that follow contain information about this state's requirements for dental assistants. If you have any questions about DANB-administered exams, contact DANB. For questions or further information about state requirements, contact the state board of dentistry. DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

Source: 2018 DANB Salary Survey (state data based on 82 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

259

Minnesota State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Minnesota, a dental assistant must be a Licensed Dental Assistant or hold a limited-license permit. To receive a limited-license permit and perform radiography procedures under the general supervision of a dentist, one must: (1) Have completed education equal to or greater than that required of a Minnesota Licensed Dental Assistant, AND (2) Be currently qualified in Minnesota in an allied health profession, AND (3) Successfully complete a Board-approved course on dental radiography equivalent to a course offered in a CODA-accredited dental assisting program, AND (4) Pass the DANB Radiation Health and Safety (RHS) exam, AND (5) Submit an application to the MN Board of Dentistry and pay the accompanying fee.

State Requirements For Expanded Functions Licensed Dental Assistant: To earn status as a Licensed Dental Assistant in Minnesota, dental assistants must: (1) Pass the national DANB Certified Dental Assistant (CDA) exam AND (2a) Graduate from a MN CODA-accredited dental assisting program or (2b) Graduate from a CODA-accredited program in a state other than MN and, upon MN Board review of curriculum, complete additional coursework AND (3) Pass the Minnesota Dental Assistant State Licensing Exam* AND (4) Pass the MN Jurisprudence Exam AND (5) Apply for licensure to the MN Board of Dentistry. All licensed dental assistants must maintain a consecutive and current certificate in Cardiopulmonary Resuscitation (CPR) through the American Heart Association health care provider course or the American Red Cross professional rescuer course. Note: A dental assistant who received and maintained registration in MN prior to January 1, 2010, can continue to practice as a licensed dental assistant without completing any further requirements. The licensed dental assistant must submit the fee for an original license to the MN board at the time of renewal. To perform restorative procedures limited to placing, contouring and adjusting amalgam restorations, glass ionomers, and supragingival composite restorations (class I, II and V) on primary and permanent dentition, and adapting and cementing stainless steel crowns, a Licensed Dental Assistant must have completed a MN Board of Dentistry-approved course in these functions and have submitted proof of completion to the MN Board of Dentistry.

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Minnesota Board of Dentistry MINNESOTA STATUTES CHAPTER 150A. DENTISTRY 150A.01 DEFINITIONS. Subdivision 5. Dental assistant. “Dental assistant” means a person performing acts authorized under section 150A.10, subdivision 2. Subd. 8. Licensed dental assistant. “Licensed dental assistant” means a person licensed pursuant to section 150A.06. 150A.03 OFFICERS; SALARIES; EQUIPMENT AND SUPPLIES. Subdivision 1. Officers. The board shall elect from its members a president, a vice-president, and a secretary. The board shall have a common seal. It may hold meetings at such times as may be necessary and as it may determine. The board may affiliate and participate, both in and out-of-state, with regional and national testing agencies for the purpose of conducting examinations for licensure and registration. The fee charged by such an agency for conducting the examination may be in addition to the application fee established by the board pursuant to section 150A.06. 150A.06 LICENSURE. Subdivision 2a. Licensed dental assistant. A person of good moral character, who has graduated from a dental assisting program accredited by the Commission on Dental Accreditation, may apply for licensure. The applicant must submit an application and fee as prescribed by the board and the diploma or certificate of dental assisting. In the case of examinations conducted pursuant to section 150A.03, subdivision 1, applicants shall take the examination before applying to the board for licensure. The examination shall include an examination of the applicant’s knowledge of the laws of Minnesota relating to dentistry and the rules of the board. An applicant is ineligible to retake the licensure examination required by the board after failing it twice until further education and training are obtained as specified by board rule. A separate, nonrefundable fee may be charged for each time a person applies. An applicant who passes the examination in compliance with subdivision 2b, abides by professional ethical conduct requirements, and meets all the other requirements of the board shall be licensed as a dental assistant.

260

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subd. 2b. Examination. When the Board of Dentistry administers the examination for licensure, only those board members or board-appointed deputy examiners qualified for the particular examination may administer it. An examination which the board requires as a condition of licensure must have been taken within the five years before the board receives the application for licensure. Subd. 2c. Guest license. (a) The board shall grant a guest license to practice as a dentist, dental hygienist, or licensed dental assistant if the following conditions are met: (1) the dentist, dental hygienist, or dental assistant is currently licensed in good standing in another U.S. jurisdiction; (2) the dentist, dental hygienist, or dental assistant is currently engaged in the practice of that person’s respective profession in another U.S. jurisdiction; (3) the dentist, dental hygienist, or dental assistant will limit that person’s practice to a public health setting in Minnesota that (i) is approved by the board; (ii) was established by a nonprofit organization that is tax exempt under chapter 501(c)(3) of the Internal Revenue Code of 1986; and (iii) provides dental care to patients who have difficulty accessing dental care; (4) the dentist, dental hygienist, or dental assistant agrees to treat indigent patients who meet the eligibility criteria established by the clinic; and (5) the dentist, dental hygienist, or dental assistant has applied to the board for a guest license and has paid a nonrefundable license fee to the board not to exceed $75. (b) A guest license must be renewed annually with the board and an annual renewal fee not to exceed $75 must be paid to the board. Guest licenses expire on December 31 of each year. (c) A dentist, dental hygienist, or dental assistant practicing under a guest license under this subdivision shall have the same obligations as a dentist, dental hygienist, or dental assistant who is licensed in Minnesota and shall be subject to the laws and rules of Minnesota and the regulatory authority of the board. If the board suspends or revokes the guest license of, or otherwise disciplines, a dentist, dental hygienist, or dental assistant practicing under this subdivision, the board shall promptly report such disciplinary action to the dentist’s, dental hygienist’s, or dental assistant’s regulatory board in the jurisdiction in which they are licensed. Subd. 2d. Continuing education and professional development waiver. (a) The board shall grant a waiver to the continuing education requirements under this chapter for a licensed dentist, licensed dental therapist, licensed dental hygienist, or licensed dental assistant who documents to the satisfaction of the board that the dentist, dental therapist, dental hygienist, or licensed dental assistant has retired from active practice in the state and limits the provision of dental care services to those offered without compensation in a public health, community, or tribal clinic or a nonprofit organization that provides services to the indigent or to recipients of medical assistance, or MinnesotaCare programs. (b) The board may require written documentation from the volunteer and retired dentist, dental therapist, dental hygienist, or licensed dental assistant prior to granting this waiver. (c) The board shall require the volunteer and retired dentist, dental therapist, dental hygienist, or licensed dental assistant to meet the following requirements: (1) a licensee seeking a waiver under this subdivision must complete and document at least five hours of approved courses in infection control, medical emergencies, and medical management for the continuing education cycle; and (2) provide documentation of current CPR certification from completion of the American Heart Association healthcare provider course, or the American Red Cross professional rescuer course. Subd. 3. Waiver of examination. (a) All or any part of the examination for dentists, dental therapists, dental hygienists, or dental assistants, except that pertaining to the law of Minnesota relating to dentistry and the rules of the board, may, at the discretion of the board, be waived for an applicant who presents a certificate of having passed all components of the National Board Dental Examinations or evidence of having maintained an adequate scholastic standing as determined by the board. Subd. 4a. Appeal of denial of application. A person whose application for licensure by credentials has been denied may appeal the decision to the board. The board shall establish an appeals process and inform a denied candidate of the right to appeal and the process for filing the appeal. Subd. 6. Display of name and certificates. (a) The initial license and subsequent renewal certificate of every dentist, dental therapist, dental hygienist, or dental assistant shall be conspicuously displayed in every office in which that person practices, in plain sight of patients. When available from the board, the board shall allow the display of a wallet-sized initial license and wallet-sized subsequent renewal certificate only at nonprimary practice locations instead of displaying an original-sized initial license and subsequent renewal certificate. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

261

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subd. 8. Licensure by credentials. (a) Any dental assistant may, upon application and payment of a fee established by the board, apply for licensure based on an evaluation of the applicant’s education, experience, and performance record in lieu of completing a Board-approved dental assisting program for expanded functions as defined in rule, and may be interviewed by the board to determine if the applicant: (1) has graduated from an accredited dental assisting program accredited by the Commission on Dental Accreditation, and is currently certified by the Dental Assisting National Board; (2) is not subject to any pending or final disciplinary action in another state or Canadian province, or if not currently certified or licensed, previously had a certification or licensure in another state or Canadian province in good standing that was not subject to any final or pending disciplinary action at the time of surrender; (3) is of good moral character and abides by professional ethical conduct requirements; (4) at board discretion, has passed a Board-approved English proficiency test if English is not the applicant’s primary language; and (5) has met all expanded functions curriculum equivalency requirements of a Minnesota Board-approved dental assisting program. (b) The board, at its discretion, may waive specific licensure requirements in paragraph (a). (c) An applicant who fulfills the conditions of this subdivision and demonstrates the minimum knowledge in dental subjects required for licensure under subdivision 2a must be licensed to practice the applicant’s profession. (d) If the applicant does not demonstrate the minimum knowledge in dental subjects required for licensure under subdivision 2a, the application must be denied. If licensure is denied, the board may notify the applicant of any specific remedy that the applicant could take which, when passed, would qualify the applicant for licensure. A denial does not prohibit the applicant from applying for licensure under subdivision 2a. (e) A candidate whose application has been denied may appeal the decision to the board according to subdivision 4a. Subd. 10. Emeritus inactive license. A person licensed to practice dentistry, dental therapy, dental hygiene, or dental assisting pursuant to section 150A.05 or Minnesota Rules, part 3100.8500, who retires from active practice in the state may apply to the board for emeritus inactive licensure. An application for emeritus inactive licensure may be made on the biennial licensing form or by petitioning the board, and the applicant must pay a onetime application fee pursuant to section 150A.091, subdivision 19. In order to receive emeritus inactive licensure, the applicant must be in compliance with board requirements and cannot be the subject of current disciplinary action resulting in suspension, revocation, disqualification, condition, or restriction of the licensee to practice dentistry, dental therapy, dental hygiene, or dental assisting. An emeritus inactive license is not a license to practice, but is a formal recognition of completion of a person's dental career in good standing. Subd. 11. Emeritus active licensure. (a) A person licensed to practice dentistry, dental therapy, dental hygiene, or dental assisting may apply for an emeritus active license if the person is retired from active practice, is in compliance with board requirements, and is not the subject of current disciplinary action resulting in suspension, revocation, disqualification, condition, or restriction of the license to practice dentistry, dental therapy, dental hygiene, or dental assisting. (b) An emeritus active licensee may engage only in the following types of practice: (1) pro bono or volunteer dental practice; (2) paid practice not to exceed 500 hours per calendar year for the exclusive purpose of providing licensing supervision to meet the board's requirements; or (3) paid consulting services not to exceed 500 hours per calendar year. (c) An emeritus active licensee shall not hold out as a full licensee and may only hold out as authorized to practice as described in this subdivision. The board may take disciplinary or corrective action against an emeritus active licensee based on violations of applicable law or board requirements. (d) A person may apply for an emeritus active license by completing an application form specified by the board and must pay the application fee pursuant to section 150A.091, subdivision 20. (e) If an emeritus active license is not renewed every two years, the license expires. The renewal date is the same as the licensee's renewal date when the licensee was in active practice. In order to renew an emeritus active license, the licensee must: (1) complete an application form as specified by the board; (2) pay the required renewal fee pursuant to section 150A.091, subdivision 20; and (3) report at least 25 continuing education hours completed since the last renewal, which must include: (i) at least one hour in two different required CORE areas; (ii) at least one hour of mandatory infection control; (iii) for dentists and dental therapists, at least 15 hours of fundamental credits for dentists and dental therapists, and for dental hygienists and dental assistants, at least seven hours of fundamental credits; and (iv) for dentists and dental therapists, no more than ten elective credits, and for dental hygienists and dental assistants, no more than six elective credits. 262

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants 150A.08 LICENSURE AND REGISTRATION ACTIONS. Subdivision 1. Grounds. The board may refuse or by order suspend or revoke, limit or modify by imposing conditions it deems necessary, the license of a dentist, dental therapist, dental hygienist, or dental assisting upon any of the following grounds: (1) fraud or deception in connection with the practice of dentistry or the securing of a license certificate; (2) conviction, including a finding or verdict of guilt, an admission of guilt, or a no contest plea, in any court of a felony or gross misdemeanor reasonably related to the practice of dentistry as evidenced by a certified copy of the conviction; (3) conviction, including a finding or verdict of guilt, or a no contest plea, in any court of an offense involving moral turpitude as evidenced by a certified copy of the conviction; (4) habitual overindulgence in the use of intoxicating liquors; (5) improper or unauthorized prescription, dispensing, administering, or personal or other use of an legend drug as defined in chapter 151, of any chemical as defined in chapter 151, or of any controlled substance as defined in chapter 152 [Chapter 151, 152, Pharmacy]; (6) conduct unbecoming a person licensed to practice dentistry, dental therapy, dental hygiene, dental assisting, or conduct contrary to the best interest of the public, as such conduct is defined by the rules of the board; (7) gross immorality; (8) any physical, mental, emotional, or other disability which adversely affects a dentist’s, dental therapist’s, dental hygienist’s, or dental assistant’s ability to perform the service for which the person is licensed; (9) revocation or suspension of a license, registration, or equivalent authority to practice, or other disciplinary action or denial of a license or registration application taken by a licensing or credentialing authority of another state, territory, or country as evidenced by a certified copy of the licensing authority’s order, if the disciplinary action or application denial was based on facts that would provide a basis for disciplinary action under this chapter and if the action was taken only after affording the credentialed person or applicant notice and opportunity to refute the allegations or pursuant to stipulation or other agreement; (10) failure to maintain adequate safety and sanitary conditions for a dental office in accordance with the standards established by the rules of the board; (11) employing, assisting, or enabling in any manner an unlicensed person to practice dentistry; (12) failure or refusal to attend, testify, and produce records as directed by the board under subdivision 7; (13) violation of, or failure to comply with, any other provisions of sections 150A.01 to 150A.12, the rules of the Board of Dentistry, or any disciplinary order issued by the board, section 144.291 to 144.298 [Health Records Act] or 595.02, subdivision 1, paragraph (d) [Testimony of Witnesses], or for any other just cause related to the practice of dentistry. Suspension, revocation, modification or limitation of any license shall not be based upon any judgment as to therapeutic or monetary value of any individual drug prescribed or any individual treatment rendered, but only upon a repeated pattern of conduct; (14) knowingly providing false or misleading information that is directly related to the care of that patient unless done for an accepted therapeutic purpose such as the administration of a placebo; or (15) aiding suicide or aiding attempted suicide in violation of section 609.215 [Suicide] as established by any of the following: (i) a copy of the record of criminal conviction or plea of guilty for a felony in violation of section 609.215, subdivision 1 or 2; (ii) a copy of the record of a judgment of contempt of court for violating an injunction issued under section 609.215, subdivision 4; (iii) a copy of the record of a judgment assessing damages under section 609.215, subdivision 5 ; or (iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2. The board shall investigate any complaint of a violation of section 609.215, subdivision 1 or 2. Subd. 3. Reinstatement. Any licensee whose license has been suspended or revoked may have the license reinstated or a new license issued, as the case may be, when the board deems the action is warranted. Subd. 7. Self-incrimination. No person is excused from attending and testifying at any proceeding initiated by the board or from producing any document before the board on the ground that the testimony or evidence required may tend to incriminate the person; but no person may be prosecuted for any crime related to the matter about which the person testifies or produces evidence required or requested by the board if the person first claims a privilege against self-incrimination. This immunity from criminal prosecution does not apply to prosecution for perjury or contempt committed in testifying or producing the evidence. 150A.10 ALLIED DENTAL PERSONNEL. Subd. 2. Dental assistants. Every licensed dentist and dental therapist who uses the services of any unlicensed person for the purpose of assistance in the practice of dentistry or dental therapy shall be responsible for the acts of such unlicensed person while engaged in such assistance. The dentist or dental therapist shall permit such unlicensed assistant to perform only those acts which © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

263

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants are authorized to be delegated to unlicensed assistants by the Board of Dentistry. Such acts shall be performed under supervision of a licensed dentist or dental therapist. A licensed dental therapist shall not supervise more than four licensed or unlicensed dental assistants at any one practice setting. The board may permit differing levels of dental assistance based upon recognized educational standards, approved by the board, for the training of dental assistants. The board may also define by rule the scope of practice of licensed and unlicensed dental assistants. The board by rule may require continuing education for differing levels of dental assistants, as a condition to their license or authority to perform their authorized duties. Any licensed dentist or dental therapist who permits an unlicensed assistant to perform any dental service other than that authorized by the board shall be deemed to be enabling an unlicensed person to practice dentistry, and commission of such an act by such unlicensed assistant shall constitute a violation of sections 150A.01 to 150A.12. Subd. 2a. Collaborative practice authorization for dental assistants in community settings. (a) Notwithstanding subdivision 2, a dental assistant licensed under this chapter may be employed or retained by a health care facility, program, or nonprofit organization as defined in subdivision 1a to perform the dental assisting services described in paragraph (b) without the patient first being examined by a licensed dentist, without a dentist's diagnosis or treatment plan, and without the dentist being present at the location where the services are being performed, if: (1) the dental assistant has entered into a collaborative agreement with a licensed dentist, which must be part of a collaborative agreement established between a licensed dentist and a dental hygienist under subdivision 1a, that designates authorization for the services being provided by the dental assistant; and (2) the dental assistant has documented completion of a course on medical emergencies within each continuing education cycle. (b) A dental assistant operating under general supervision of a collaborating dentist under this subdivision is authorized to perform the following services: (1) provide oral health promotion and disease prevention education; (2) take vital signs such as pulse rate and blood pressure; (3) obtain informed consent, according to Minnesota Rules, part 3100.9600, subpart 9, for treatments authorized by the collaborating dentist within the licensed dental assistant's scope of practice; (4) apply topical preventative agents, including fluoride varnishes and pit and fissure sealants; (5) perform mechanical polishing to clinical crowns not including instrumentation; (6) complete preliminary charting of the oral cavity and surrounding structures, except periodontal probing and assessment of the periodontal structure; (7) take photographs extraorally or intraorally; and (8) take radiographs. (c) A collaborating dentist must be licensed under this chapter and may enter into a collaborative agreement with no more than two licensed dental assistants, unless otherwise authorized by the board. The board shall develop a process and parameters for obtaining authorization to collaborate with more than two licensed dental assistants. The collaborative agreement must include the elements listed in subdivision 1a, paragraph (b). Subd. 4.

Restorative procedures.

(a) Notwithstanding subdivisions 1, 1a, and 2, a licensed dental hygienist or a licensed dental assistant may perform the following restorative procedures: (1) place, contour, and adjust amalgam restorations; (2) place, contour, and adjust glass ionomer; (3) adapt and cement stainless steel crowns; and (4) place, contour, and adjust class I, II, and V supragingival composite restorations on primary and permanent dentition. (b) The restorative procedures described in paragraph (a) may be performed only if: (1) the licensed dental hygienist or the licensed dental assistant has completed a Board-approved course on the specific procedures; (2) the Board-approved course includes a component that sufficiently prepares the licensed dental hygienist or licensed dental assistant to adjust the occlusion on the newly placed restoration; (3) a licensed dentist or licensed advanced dental therapist has authorized the procedure to be performed; and (4) a licensed dentist or licensed advanced dental therapist is available in the clinic while the procedure is being performed. (c) The dental faculty who teaches the educators of the Board-approved courses specified in paragraph (b) must have prior experience teaching procedures in an accredited dental education program. 150A.105 DENTAL THERAPIST. Subd. 7. Use of dental assistants. (a) A licensed dental therapist may supervise dental assistants to the extent permitted in the collaborative management agreement and according to section 150A.10, subdivision 2. (b) Notwithstanding paragraph (a), a licensed dental therapist is limited to supervising no more than four licensed dental assistants or nonlicensed dental assistants at any one practice setting. 264

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Minnesota Administrative Rules Chapter 3100, Dentists, Hygienists, and Assistants 3100.0100 Definitions. Subp. 2b. Analgesia. “Analgesia” means the diminution or elimination of pain as a result of the administration of an agent including, but not limited to, local anesthetic, nitrous oxide, and pharmacological and nonpharmacological methods. Subp. 4. Assistant. “Assistant” means a person who assists a dentist in carrying out the basic duties of a dental office described in part 3100.8400. Subp. 5. Allied dental personnel. “Allied dental personnel” means an advanced dental therapist, dental therapist, dental hygienist, licensed dental assistant, dental assistant with a limited-license permit, assistant without a license or permit, and dental technician. Subp. 7. CDE. “CDE” means professional development and continuing dental education. Subp. 9a. CPR. “CPR” refers to a comprehensive hands-on course for a health care provider that includes: cardiopulmonary resuscitation on an adult, child, and infant; two-person rescuer; barrier mask or bag for ventilation; foreign body airway obstruction; and automated external defibrillation. A CPR certificate shall be obtained through the American Heart Association health care provider course or the American Red Cross professional rescuer course. Subp. 9b. Deep sedation. “Deep sedation” means a depressed level of consciousness produced by a pharmacological or nonpharmacological method or a combination thereof during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Deep sedation is characterized by impairment of the patient’s ability to independently maintain ventilatory function, spontaneous ventilation potentially being inadequate to meet a patient’s needs, and the need for assistance in maintaining a patent airway. A patient’s cardiovascular function does not typically require assistance during deep sedation. Subp. 9c. Dental assistant with a limited-license permit. “Dental assistant with a limited-license permit” means a person holding a limited-license permit as a dental assistant under part 3100.8500, subpart 3. Subp. 9d. Dental health care personnel or DHCP. “Dental health care personnel” or “DHCP” means individuals who work in a dental practice who may be exposed to body fluids such as blood or saliva. Subp. 11a. Elective activities. “Elective activities” refers to those activities directly related to, or supportive of, the practice of dentistry, dental therapy, dental hygiene, or dental assisting. Subp. 12a. General anesthesia. “General anesthesia” means an induced state of unconsciousness produced by a pharmacological or nonpharmacological method or a combination thereof during which patients are not arousable, even by painful stimulation. General anesthesia is characterized by the frequent impairment of the patient’s ability to independently maintain ventilatory function, the patient’s need for assistance in maintaining a patent airway, the need for positive pressure ventilation due to depressed spontaneous ventilation or drug-induced depression of neuromuscular function, and potential impairment of cardiovascular function. Subp. 12c. Infection control. “Infection control” means programs, procedures, and methods to reduce the transmission of agents of infection for the purpose of preventing or decreasing the incidence of infectious diseases. Subp. 12d. Inhalation. “Inhalation” means a technique of administration in which the gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. Subp. 12e. Licensed dental assistant. “Licensed dental assistant” means an assistant licensed by the board pursuant to Minnesota Statutes, section 150A.06, subdivision 2a. Subp. 13. Licensee. “Licensee” means a dentist, dental therapist, dental hygienist, licensed dental assistant, or dental assistant with a limited-license permit. Subp. 13a. Minimal sedation. “Minimal sedation” means a minimally depressed level of consciousness produced by a pharmacological or nonpharmacological method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Minimal sedation is characterized by moderate impairment to the patient’s cognitive function and coordination, but leaves unaffected the patient’s ventilatory and cardiovascular functions. Subp. 14a. Moderate sedation. “Moderate sedation” means a depressed level of consciousness produced by a pharmacological or nonpharmacological method or a combination thereof during which patients respond purposefully to verbal commands, either alone or accompanied by light tactical stimulation. Moderate sedation is characterized by unaffected cardiovascular functions, no need for intervention to maintain a patent airway for the patient, and adequate spontaneous ventilation. Subp. 15a. Nitrous oxide inhalation analgesia. “Nitrous oxide inhalation analgesia” means the administration by inhalation of a combination of nitrous oxide and oxygen, producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

265

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subp. 21. Supervision. “Supervision” means one of the following levels of supervision, in descending order of restriction. A.

“Personal supervision” means the dentist is personally operating on a patient and authorizes the allied dental personnel to aid in treatment by concurrently performing supportive procedures. B. “Direct supervision” means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and before dismissal of the patient, evaluates the performance of the allied dental personnel. C. “Indirect supervision” means the dentist is in the office, authorizes the procedures, and remains in the office while the procedures are being performed by the allied dental personnel. D. “General supervision” means the supervision of tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time the tasks or procedures are being performed but require the tasks be performed with the prior knowledge and consent of the dentist. Subp. 22. Transdermal or transmucosal. “Transdermal” or “transmucosal” means a technique of administration in which the drug is administered by patch or iontophoresis. 3100.1300 Application for License to Practice Dental Assisting. A person desiring to be licensed as a dental assistant shall submit to the board an application and credentials as prescribed by the act and shall conform to the following: A. An application on a form furnished by the board shall be completely filled out. B. The applicant shall furnish a certified copy or its equivalent of a diploma or certificate of satisfactory completion of a training program approved by the Commission on Dental Accreditation or other program which, in the judgment of the board, is equivalent. If the curriculum of the training program does not include training in the expanded duties specified in part 3100.8500, the applicant must successfully complete a course in these functions which has been approved by the board. C. Submission of evidence of satisfactorily passing both the board’s state licensing examination and the Board-approved nationally recognized examination designed to determine the applicant’s knowledge of the clinical duties in part 3100.8500, subparts 1 to 1b. D. For identification purposes, the applicant shall furnish one notarized unmounted passport-type photograph, three inches by three inches, taken not more than six months before the date of the application. E. The applicant shall furnish evidence of good moral character satisfactory to the board. F. A dental assistant who received and maintained registration in Minnesota prior to January 1, 2010, will continue to practice as a licensed dental assistant thereafter without completing any further examinations as required by this part. The licensed dental assistant must submit the applicable fee for an original license to the board at the time of the subsequent biennial renewal as specified in the board’s notice. If the applicable fee for the original license is not received by the board, the licensee’s registration will expire and the licensee’s right to practice as a licensed dental assistant will be terminated by the board. 3100.1600 Additional Information From All Applicants. Applicants must provide evidence of having fulfilled all the requirements of the act. Applicants must sign an application and swear to the truth of the statements contained in the application before a notary public or other person authorized by law to administer oaths. In order to pass on the applicant’s qualification, nothing in this chapter shall limit the board’s authority to require an applicant to provide additional information as the board deems necessary that is pertinent to the character, education, and experience of the applicant as it relates to the applicant’s ability to practice as a licensee. 3100.1700 Terms and Renewal of License or Permit; General. Subpart 1. Requirements. The requirements of this part apply to the terms and renewal of a license or limited-license permit of an applicant other than a limited faculty or resident dentist. The requirements for the terms and renewal of licensure as a limited faculty or resident dentist are specified in part 3100.1750. Subp. 1a. Initial term. An initial license or permit issued by the board is valid from the date issued until the last day of the licensee’s birth month in either the following even-numbered year for an even-numbered birthdate year or the following odd-numbered year for an odd-numbered birthdate year, or terminated according to the procedures in this part. Subp. 1b. Biennial term. A properly renewed license or permit issued by the board is valid from the first day of the month following expiration for 24 months until renewed or terminated according to the procedures in this part. Subp. 2. Biennial renewal applications. A dentist, dental hygienist, licensed dental assistant, or dental assistant with a permit under part 3100.8500, subpart 3, shall submit an application for biennial renewal of a license or permit together with the necessary fee no later than the last day of the licensee's birth month which is the application deadline. An application for renewal is deemed timely if received by the board or postmarked no later than the last day of the licensee's birth month. The application form must provide a place for the renewal applicant's signature certifying compliance with the applicable 266

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants professional development requirements including maintaining a consecutive and current CPR certification and information including the applicant's office address or addresses, the license number, whether the licensee has been engaged in the active practice of dentistry during the two years preceding the period for which renewal is sought as a licensee, and if so, whether within or without the state, and any other information that may be reasonably requested by the board. Subp. 3. Failure to submit renewal application. The procedures in this subpart shall be followed by the board for all licensees who have failed to submit the biennial renewal application according to subpart 2 and applicable fees, except as provided in subpart 5. A. Any time after the application deadline, the board will send, to the last address on file with the board, a notice to a licensee who has not made application for the renewal of a license or permit. The notice will state that licensee has failed to make application for renewal; the amount of the renewal and late fees; that licensee may voluntarily terminate the license or permit by notifying the board; and that failure to respond to the notice by the date specified, which date must be at least 33 days after the notice is sent out by the board, either by submitting the renewal application and applicable fees, or by notifying the board that licensee has voluntarily terminated the license or permit will result in the expiration of the license or permit and termination of the right to practice. B. If the application for renewal, including the applicant’s signature certifying compliance with the applicable professional development requirements, and the applicable biennial and late fees or notice of voluntary termination is not received by the board by the date specified in the notice, the license or permit will expire and the licensee’s right to practice will terminate as of the date specified in the notice. The expiration and termination will not be considered a disciplinary action against the licensee. Subp. 4. Reinstatement. A license which has expired according to this part may be reinstated according to part 3100.1850. Subp. 5. Contested case proceedings. The board, in lieu of the process in subpart 3, may initiate a contested case hearing to revoke or suspend a license or permit for failure to submit the fees or provide the applicant’s signature certifying compliance with the applicable professional development requirements on the renewal application, at the same time that it initiates disciplinary proceedings against the licensee for other grounds specified in Minnesota Statutes, section 150A.08, subdivision 1, and parts 3100.6100 to 3100.7200 and 3100.8100. 3100.1850 Reinstatement of License. Subpart 1. Requirements. A. A person desiring the reinstatement of a license must: (1). submit to the board a completed reinstatement application provided by the board; (2). submit with the reinstatement application the fee specified in Minnesota Statutes, section 150A.091, subdivision 10; (3). include with the reinstatement application a letter stating the reasons for applying for reinstatement; and (4). comply with the applicable provisions of subparts 2 to 5. B. Once the requirements of this subpart have been reviewed by the board, the board shall officially notify the applicant by letter as to whether the reinstatement of a license has been denied or granted by the board. If granted reinstatement, the person shall be assigned to the biennial term to which the licensee was assigned prior to termination of the license. An applicant denied reinstatement of a license may appeal the denial by initiating a contested case hearing pursuant to Minnesota Statutes, chapter 14. Subp. 2. Expiration or voluntary termination of six months or less. An applicant whose license has expired according to part 3100.1700, subpart 3, or who voluntarily terminated the license six months or less previous to the application for reinstatement must: A. provide evidence of having completed the professional development requirements described under part 3100.5200 that would have applied to the applicant had the license not expired. Professional development requirements must have been completed within 24 months prior to the board’s receipt of the application; and B. pay the biennial renewal fee and file a reinstatement application specified in subpart 1. Subp. 2a. Expiration or voluntary termination of more than six months but less than 24 months. An applicant whose license has expired according to part 3100.1700, subpart 3, or who voluntarily terminated the license more than six months but less than 24 months previous to the application for reinstatement must: A. provide evidence of having completed the professional development requirements in part 3100.5200 that would have applied to the applicant had the license not expired. Professional development requirements must have been completed within 24 months prior to the board’s receipt of the application; B. pay the biennial renewal fee and file a reinstatement application specified in subpart 1; C. submit evidence of having successfully completed the examination of the laws of Minnesota relating to dentistry and the rules of the board. The examination must have been completed within 12 months prior to the board’s receipt of the application; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

267

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants D. submit evidence of having had a complete physical examination to include a physician’s statement attesting to the applicant’s physical and mental condition. The physical examination must have been completed within 12 months prior to the board’s receipt of the application; and E. submit evidence of having had a complete optical examination and having complied with required optical prescriptions. The optical examination must have been completed within 12 months prior to the board’s receipt of the application. Subp. 3. Expiration or voluntary termination of 24 months or more. An applicant whose license has expired according to part 3100.1700, subpart 3, or who voluntarily terminated the license 24 months or more previous to the application for reinstatement must: A. comply with subpart 2a; B. submit either: (1) evidence of having successfully completed part II of the national board examination or the clinical examination in part 3100.1100, subpart 2, for dentists; the examinations in Minnesota Statutes, section 150A.106, subdivision 1, clauses (2) and (6), for advanced dental therapists; the clinical examination in Minnesota Statutes, section 150A.06, subdivision 1d, for dental therapists; the national board examination or the clinical examination in part 3100.1200, item C, for dental hygienists; and the two examinations in part 3100.1300, item C, for licensed dental assistants. The examination must have been completed within 24 months prior to the board’s receipt of the application; or (2) evidence of having successfully completed applicable Board-approved coursework with minimal hour requirements directly relating to the practice of dentistry, advanced dental therapy, dental therapy, dental hygiene, or dental assisting as indicated in the reinstatement application. The Board-approved coursework must have been completed within 24 months prior to the board’s receipt of the application. The coursework completed under this subpart may not be used to fulfill any of the applicable professional development requirements in part 3100.5100; and C. be available for an interview with the appropriate board committee to determine the applicant's knowledge of dental subjects and ability to practice dentistry, dental therapy, dental hygiene, or dental assisting under this subpart. 3100.3500 Examination of Licensed Dental Assistants. Subpart 1. Scope. The act provides that the examination of an applicant for licensure as a dental assistant in this state shall be sufficiently thorough to test the fitness of the candidate to practice the skills that a licensed dental assistant is authorized to perform. Subp. 2. State and national examinations. An applicant must pass both the board’s state licensing examination and the Board-approved nationally recognized examination. Subp. 2a. Additional education for two failed clinical examinations. When an applicant fails twice any part of the clinical examination required by Minnesota Statutes, section 150A.06, subdivision 2a, the applicant may not take it again until the applicant successfully completes additional education provided by an institution accredited by the Commission on Dental Accreditation or an independent instructor approved by the board. The education must cover all of the subject areas failed by the applicant in each of the two clinical examinations. The applicant may retake the examination only after the institution or independent instructor provides to the board information specifying the areas failed in the previous examinations and the instruction provided to address the areas failed, and certifies that the applicant has successfully completed the instruction. The applicant must take the additional instruction required in this subpart each time the applicant fails the clinical examination twice. Subp. 3. Additional examination content. A candidate shall be examined for general knowledge of the act and the rules of the board. Subp. 4. Examination for continued licensure. The board may administer any other examination it deems necessary to determine qualifications for continued licensure. 3100.3600 Administration of General Anesthesia, Deep Sedation, Moderate Sedation, Minimal Sedation, and Nitrous Oxide Inhalation Analgesia. Subpart 1. Prohibitions. A dental therapist, dental hygienist or licensed dental assistant may not administer general anesthesia, deep sedation, moderate sedation, or minimal sedation. Subp. 2 General anesthesia; educational training requirements. A dentist may administer general anesthesia only pursuant to items A to C. Subp. 3. Moderate sedation; educational training requirements. A dentist may administer moderate sedation only pursuant to items A to C. 268

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subp. 4. Nitrous oxide inhalation analgesia; educational training requirements. A dentist may administer nitrous oxide inhalation analgesia only according to items A to D and subpart 5, items A and C. A dental therapist may administer nitrous oxide inhalation analgesia only according to items C to F. A dental hygienist may administer nitrous oxide inhalation analgesia only according to items C to F and subpart 5, item D. A licensed dental assistant may administer nitrous oxide inhalation analgesia only after a maximum dosage has been prescribed by a dentist for a specific patient, and it is administered according to items C to F and subpart 5, item D. A. A licensed dentist who was administering nitrous oxide inhalation analgesia on or before January 1, 1993 may register that fact with the board according to subpart 5, item A. Such registered dentists may continue to administer nitrous oxide inhalation analgesia and need not comply with item B. B. A dentist who has not previously registered with the board pursuant to subpart 5, item A, may administer nitrous oxide inhalation analgesia only after satisfactorily completing a course on the administration of nitrous oxide inhalation analgesia from an institution accredited by the Commission on Dental Accreditation, and submitting to the board original documentation from the institution of successful completion of the course. The course must be a minimum of 12 hours total comprised of didactic instruction, personally administering and managing at least three individual supervised cases of analgesia, and supervised clinical experience using fail-safe anesthesia equipment capable of positive pressure respiration. C. A dentist, dental therapist, dental hygienist, or licensed dental assistant must complete CPR training and maintain current CPR certification thereafter. D. A dentist, dental therapist, dental hygienist, or licensed dental assistant must only use fail-safe anesthesia equipment capable of positive pressure respiration. E. A dental therapist, dental hygienist or licensed dental assistant may administer nitrous oxide inhalation analgesia only after satisfactorily completing a course on the administration of nitrous oxide inhalation analgesia from an institution accredited by the Commission on Dental Accreditation, and submitting to the board original documentation from the institution of successful completion of the course. The course must be a minimum of 12 hours total comprised of didactic instruction, personally administering and managing at least three individual supervised cases of analgesia, and supervised clinical experience using fail-safe anesthesia equipment capable of positive pressure respiration. F. A dental therapist, dental hygienist or licensed dental assistant may administer nitrous oxide inhalation analgesia under the appropriate level of supervision by a dentist who is current with the requirements to administer nitrous oxide inhalation analgesia according to items A to D and subpart 5, items A to C. Subp. 5. Notice to board. D. A dental hygienist or licensed dental assistant who graduated from an institution in Minnesota accredited by the Commission on Dental Accreditation or received licensure by credentials prior to September 2, 2004, may administer nitrous oxide inhalation analgesia only after the dental hygienist or licensed dental assistant has submitted the information in subitems (1) and (2) to the board on forms provided by the board: (1) the name, address, and telephone number of the institution at which the dental hygienist or licensed dental assistant successfully completed the course required by subpart 4, item E; and (2) Documentation of current CPR certification as required by subpart 4, item C. After the initial submission, the dental hygienist or licensed dental assistant shall submit on the license renewal application or other form provided by the board a statement of the most recent course completed in CPR. Subp. 6. Analgesia. A dentist who has a current license to practice dentistry in Minnesota may administer analgesia. Subp. 7. Minimal sedation. A dentist who has a current license to practice dentistry in Minnesota may administer minimal sedation. Subp. 8. Reporting of incidents required. A dentist, dental therapist, dental hygienist, or licensed dental assistant must report to the board any incident that arises from the administration of nitrous oxide inhalation analgesia, general anesthesia, deep sedation, moderate sedation, local anesthesia, analgesia, or minimal sedation that results in: A. a serious or unusual outcome that produces a temporary or permanent physiological injury, harm, or other detrimental effect to one or more of a patientâ&#x20AC;&#x2122;s body systems; or B. minimal sedation unintentionally becoming moderate sedation, deep sedation, or general anesthesia when the licensee does not have a certificate for administering general anesthesia or moderate sedation described in subparts 9 and 9b. The report must be submitted to the board on forms provided by the board within ten business days of the incident by the dentist, dental therapist, dental hygienist, or licensed dental assistant, even when another licensed health care professional who, under contract or employment with the dentist, was the actual person administering the analgesia or pharmacological or nonpharmacological method. A licensee who fails to comply with reporting of incidents is subject to disciplinary proceedings on grounds specified in parts 3100.6100 and 3100.6200 and Minnesota Statutes, section 150A.08, subdivision 1. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

269

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subp. 10. Practice and equipment requirements. (3) A dentist administering general anesthesia, deep sedation, or moderate sedation to a patient must have in attendance personnel who are currently certified in CPR. 3100.5100 Professional Development. Subpart 1. Professional development cycles. A. The initial professional development cycle must coincide with the initial licensure period for each dentist, dental therapist, dental hygienist, or licensed dental assistant. The initial cycle for each licensee begins on the date of initial licensure and ends on the last day of the licensee’s birth month in either an even-numbered or odd-numbered year that corresponds with the licensee’s year of birth. The initial cycle varies in the number of months depending on the date of initial licensure for each licensee. B. A biennial professional development cycle coincides with the biennial licensure periods for each dentist, dental therapist, dental hygienist, or licensed dental assistant. Each biennial renewal cycle consists of a 24-month period beginning on the first day of the month following expiration of the previous professional development cycle. An established biennial cycle continues to apply even if the license is revoked, suspended, conditioned, or not renewed for any reason for any length of time. Subp. 2. Professional development requirements. A. For the initial professional development requirements, each dentist, dental therapist, dental hygienist, and licensed dental assistant shall establish a portfolio to record, monitor, and retain acceptable documentation of fundamental and elective professional development activities, CPR certification, and self-assessments. B. The minimum number of required hours of fundamental and elective professional development for each biennial cycle is 50 hours for dentists and dental therapists, and 25 hours for dental hygienists and licensed dental assistants. Each dentist, dental therapist, dental hygienist, and licensed dental assistant shall establish a portfolio to record, monitor, and retain acceptable documentation of fundamental and elective professional development activities, CPR certification, and self-assessments. Any professional development hours earned in excess of the required hours for a biennial cycle must not be carried forward to the subsequent biennial cycle. The requirements for the fundamental and elective professional development activities are described in subitems (1) and (2). (1) Each dentist, dental therapist, dental hygienist, and licensed dental assistant must complete a minimum of 60 percent of the required biennial hours in fundamental activities directly related to the provision of clinical dental services as follows: a minimum of 30 hours for dentists and dental therapists, and a minimum of 15 hours for dental hygienists and licensed dental assistants. A licensee may earn all required biennial hours in fundamental activities only. (2) Dentists, dental therapist, dental hygienists, and licensed dental assistants are allowed a maximum of 40 percent of the required biennial hours in elective activities directly related to, or supportive of, the practice of dentistry, dental therapy, dental hygiene, or dental assisting as follows: a maximum of 20 hours for dentists and dental therapists, and a maximum of ten hours for dental hygienists and licensed dental assistants. C. Professional development is credited on an hour-for-hour basis. D. If a licensee fails to meet the professional development requirements because of extenuating circumstances, the licensee may apply for an extension of time to complete the requirements by making a written request to the board. The written request shall include a complete explanation of the circumstances, the renewal period, the number of hours earned, and the licensee’s plan for completing the balance of the requirement. If an extension is granted after review, the board shall establish the length of the extension to obtain the professional development requirements which must be completed concurrently with the subsequent renewal period. Subp. 3. Professional development activities. Professional development activities include, but are not limited to, continuing education, community services, publications, and career accomplishments throughout a professional’s life. Professional development activities are categorized as fundamental or elective activities as described in items A and B. A. Fundamental activities include, but are not limited to, clinical subjects, core subjects, CPR training, and the self-assessment examination. Examples of fundamental activities for an initial or biennial cycle are described in subitems (1) to (6). (1) Clinical subjects are those seminars, symposiums, lectures, college courses pertaining to basic sciences, or programs whose contents directly relate to the provision of dental care and treatment to patients. (2) Core subjects are those seminars, symposiums, lectures, or programs that relate to public safety and professionalism. Each licensee shall complete a minimum of two of the categories of core subjects for each biennial cycle. Examples of core subject categories include, but are not limited to: (a) record keeping; (b) ethics; (c) patient communications; (d) management of medical emergencies; and (e) treatment and diagnosis. 270

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants

(3) A CPR certification course is mandatory for each licensee to maintain licensure. The CPR course must be the American Heart Association healthcare provider course or the American Red Cross professional rescuer course. The licensee must maintain a consecutive and current CPR certificate when renewing a license or permit each biennial term. (4) An infection control course is mandatory for each licensee to maintain licensure. The course will primarily address patient safety and health issues as referenced in part 3100.6300 and chapter 6950. (5) A licensee must complete one self-assessment examination obtainable through the board for each cycle. (6) The board shall approve other additional fundamental activities if the board finds the activity to be a seminar, symposium, lecture, or program whose contents are directly related to dental care and treatment to patients or public safety and professionalism. Elective activities for an initial or biennial cycle include, but are not limited to, the examples described in subitems (1) to (7): (1) general attendance at a multiday state or national dental convention for a maximum of three credit hours; (2) volunteerism or community service directly relating to the practice of dentistry, dental therapy, dental hygiene, or dental assisting such as international or national mission work, voluntary clinic work, or dental health presentations to students or groups; (3) professional reading of published articles or other forms of self-study directly relating to the practice of dentistry, dental hygiene, or dental assisting; (4) scholarly activities include, but are not limited to: (a) teaching a professional course directly related to the practice of dentistry, dental therapy, dental hygiene, or dental assisting; or presenting a continuing dental education program; (b) presenting a table clinic directly related to the practice of dentistry, dental hygiene, or dental assisting; (c) authoring a published dental article or text in a recognized publication; (d) participating in test construction for an accredited state or nationally recognized dental association or organization; and (e) participating in a scientific dental research program from an accredited institution or program or an evidence-based clinical study; (5) dental practice management courses include, but are not limited to, computer, insurance claims or billing, and Health Insurance Portability and Accountability Act (HIPAA) training; (6) leadership or committee involvement with the board or a dental professional association for a maximum of three credit hours; or (7) the board shall approve other additional elective activities if the board finds the contents of the activity to be directly related to, or supportive of, the practice of dentistry, dental therapy, dental hygiene, or dental assisting.

Subp. 4. Acceptable documentation of professional development activities. A licensee must record or obtain acceptable documentation of hours in professional development activities for the licenseeâ&#x20AC;&#x2122;s portfolio. Acceptable documentation includes, but is not limited to, the following: A. B.

a completed self-assessment examination; a copy of the front and back of a completed CPR card or certificate from the American Heart Association or the American Red Cross; C. confirming documentation from the presenting organization that provides the attendeeâ&#x20AC;&#x2122;s name, license number, name of organization or presenter, course date, number of credit hours, subject matter, or program title; and D. a personal log of published articles read by the licensee including title of the article, name of author, name of journal or periodical, and date of published article. Subp. 5. Retention of documentation. A licensee must keep acceptable documentation for each fundamental and elective activity as required to meet professional development requirements. The licensee must retain the documentation for 24 months after each biennial renewal period has ended for purposes of an audit by the appropriate board committee. 3100.5200 Portfolio Contents. A licensee must establish a professional portfolio. The professional portfolio must be used to record, monitor, and retain acceptable documentation of professional development activities. Upon completion of an initial or biennial professional development cycle, a licensee must have the required number of hours, if applicable, and proof of acceptable documentation described under part 3100.5100, subpart 4, contained within the portfolio. 3100.5300 Audit Process of Portfolio. Subpart 1. Auditing for compliance. The board shall perform random audits of the portfolios. Besides random audits, the board may conduct a designated portfolio audit for a licensee who is the subject of any complaint, investigation, or proceeding under Minnesota Statutes, sections 150A.08 and 214.10. The licensee shall receive notification of being audited. A licensee who is selected for an audit shall provide a portfolio to the appropriate board committee within 60 days from the notification date. Failure to comply with the audit documentation request or failure to supply acceptable documentation ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

271

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants within 60 days may result in disciplinary action. After completion of an audit, the appropriate board committee shall officially notify the licensee by indicating the determination made regarding professional development compliance. A licensee is considered to be actively licensed during the audit process. Subp. 2. Appropriate documentation. The licensee shall submit true, complete, and accurate documentation. Falsification of any evidence for any renewal period or falsification or omission of documentation may result in disciplinary action. Subp. 3. Failure of an audit. A. Upon failure of an audit, the appropriate board committee must impose one or both of the following options: (1) grant the licensee up to six months to comply with written requirements to resolve deficiencies in professional development compliance; or (2) initiate disciplinary proceedings against the licensee on grounds specified in parts 3100.6100 and 3100.6200 and Minnesota Statutes, section 150A.08, subdivision 1. Deficiencies causing audit failure may include, but are not limited to, the following: (a) lack of proof of documentation or participation; (b) credit hours earned outside of renewal period being audited; (c) excess of earned hours in a category having a maximum if a deficiency exists; (d) lack of earned hours in a category having a minimum if a deficiency exists; (e) failure to submit the portfolio; (f) unacceptable professional development sources; or (g) fraudulently earned or reported hours. B. Failing to comply with the board committee’s requirements by the end of the grace period shall result in the expiration of the person’s license and termination of the right to practice. A license that has expired according to this part may be reinstated according to part 3100.1850. Subp. 4. Audit appeal. Upon failure of an audit, the licensee has the option to appeal the decision to the board. Subp. 5. Mandatory audit. The licensee must submit to a mandatory audit of the next renewal period by the appropriate board committee when the previous audit was failed by the licensee. Subp. 6. Audit fee. The licensee shall submit to the board the nonrefundable fee in Minnesota Statutes, section 150A.091, subdivision 16, after failing two professional development portfolio audits and thereafter for each failed professional development portfolio audit. 3100.6100 Statutory Grounds for Discipline. In general terms, the grounds for suspension or revocation of licenses of dentists, dental therapists, dental hygienists, and licensed dental assistants are in Minnesota Statutes, section 150A.08, subdivision 1. 3100.6200 Conduct Unbecoming A Licensee. “Conduct unbecoming a person licensed to practice dentistry, dental therapy, dental hygiene, or dental assisting, or conduct contrary to the best interests of the public,” as used in Minnesota Statutes, section 150A.08, subdivision 1, clause (6), shall include the act of a dentist, dental hygienist, licensed dental assistant, or applicant in: A. engaging in personal conduct that brings discredit to the profession of dentistry; B. gross ignorance or incompetence in the practice of dentistry or repeated performance of dental treatment that falls below accepted standards; C. making suggestive, lewd, lascivious, or improper advances to a patient; D. dentists charging a patient an unconscionable fee or charging for services not rendered; E. performing unnecessary services; F. dental therapists, hygienists or licensed dental assistants performing services not authorized by the dentist under this chapter or Minnesota Statutes, chapter 150A; G. accepting rebates, split fees, or, applicable to dentists only, commissions from any source associated with the service rendered to a patient; provided, however, that the sharing of profits in a dental partnership or association, or dental professional firm approved by and registered with the board, shall not be construed as splitting fees nor shall compensating allied dental personnel on the basis of a percentage of the fee received for the overall service be deemed accepting a commission; H. falsifying records relating to payment for services rendered, participation in a CDE course; or other records with respect to licensure, CDE, and the practice of dentistry; I. perpetrating fraud upon patients, third-party payers, or others relating to the practice of dentistry; J. failing to cooperate with the board, its agents, or those working on behalf of the board required by part 3100.6350; K. failing to maintain adequate safety and sanitary conditions for a dental office specified in part 3100.6300; and L. failing to provide access to and transfer of medical and dental records prescribed by Minnesota Statutes, sections 144.291 to 144.298.

272

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants 3100.6300 Adequate Safety and Sanitary Conditions for Dental Offices Subpart 11. Infection control. Dental health care personnel shall comply with the most current infection control recommendations, guidelines, precautions, procedures, practices, strategies, and techniques specified by the United States Department of Health and Human Services, Public Health Service, and the Centers for Disease Control and Prevention. Infection control standards are subject to frequent change. 3100.8200 Unlawful Practice by Allied Dental Personnel. An assistant, hygienist, dental therapist, or dental technician who assists a dentist in practicing dentistry in any capacity other than as an employee or independent contractor, who directly or indirectly procures a licensed dentist to act as nominal owner, proprietor, or director of a dental office as a guise or subterfuge to enable the assistant, hygienist, dental therapist, or dental technician to engage directly in acts defined by the act as the “practice of dentistry,” or who performs dental services within the meaning of Minnesota Statutes, section 150A.11, subdivision 1, for members of the public, other than as an employee or independent contractor for an employing dentist, shall be deemed to be practicing dentistry without a license. 3100.8400 Assistants Without a License or Permit. Subpart 1. Permissible duties. Assistants under this subpart may: A. perform all those duties not directly related with performing dental treatment or services on patients; B. retract a patient’s cheek, tongue, or other parts of tissue during a dental operation; C. assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating dentist during the course of a dental operation; D. remove debris by the use of vacuum devices, compressed air, mouthwash, and water that is normally created or accumulated during the course of treatment rendered by a licensed dentist; E. provide any assistance, including the placement of articles and topical medication in a patient’s oral cavity, in response to a specific direction by a licensed dentist who is physically engaged in performing a dental operation as defined in the act and who is physically in a position to give personal supervision to the assistant; and F. aid dental hygienists and licensed dental assistants in the performance of their duties as defined in parts 3100.8500 and 3100.8700; and G. apply fluoride varnish in a community setting under the authorization and direction of a licensed practitioner with prescribing authority such as a dentist or physician, as long as the licensed practitioner authorizing the service or the facility at which the fluoride varnish is administered maintains appropriate patient records of the treatment. Subp. 1a. Compliance with minimal requirements. The dentist is responsible for ensuring that any assistant working under the dentist’s supervision as defined in subpart 1 complies with items A and B: A. completing a CPR certification course and maintaining current CPR certification thereafter; and B. compliance with the most current infection control recommendations, guidelines, precautions, procedures, practices, strategies, and techniques specified in the United States Department of Health and Human Services, Public Health Service, Centers for Disease Control publications of the Morbidity and Mortality Weekly Report (MMWR). Subp. 3. Other duties prohibited. An assistant may not perform any dental treatment or procedure on patients not otherwise authorized by this chapter. 3100.8500 Licensed Dental Assistants. Subpart 1. Procedures under general supervision. A licensed dental assistant may perform the following procedures without the dentist being present in the dental office or on the premises if the procedures being performed are with prior knowledge and consent of the dentist: A. cut arch wires on orthodontic appliances; B. remove loose bands on orthodontic appliances; C. remove loose brackets on orthodontic appliances; D. re-cement intact temporary restorations; E. place temporary fillings, not including temporization of inlays, onlays, crowns, and bridges; F. take radiographs; G. take impressions and bite registration; H. deliver vacuum-formed orthodontic retainers; I. place and remove elastic orthodontic separators; J. complete preliminary charting of the oral cavity and surrounding structures with the exception of periodontal probing and assessment of the periodontal structure; K. take photographs extraorally or intraorally; L. take vital signs such as pulse rate and blood pressure as directed by a dentist; M. obtain informed consent, according to part 3100.9600, subpart 9, for treatments authorized by the supervising dentist pursuant to the licensed dental assistant's scope of practice; N. remove and place ligature ties and remove and replace existing arch wires on orthodontic appliances, and O. apply topical fluoride, including foam, gel or varnish. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

273

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subp. 1a. Procedures under indirect supervision. A licensed dental assistant, in addition to the services performed by an assistant described in part 3100.8400, subpart 1, may perform the following services if a dentist is in the office, authorizes the procedures, and remains in the office while the procedures are being performed: A. apply topical medications including bleaching agents and cavity varnishes as prescribed by a dentist; B. place and remove rubber dam; C. remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments only; D. perform mechanical polishing to clinical crowns not including instrumentation. Removal of calculus by instrumentation must be done by a dentist or dental hygienist before mechanical polishing; E. preselect orthodontic bands; F. place and remove periodontal dressings; G. remove sutures; H. monitor a patient who has been induced by a dentist into nitrous oxide inhalation analgesia; I. place initial arch wires on orthodontic appliances. A dentist must select and, if necessary, adjust arch wires prior to placement; J. dry root canals with paper points; K. place cotton pellets and temporary restorative materials into endodontic access openings; L. etch appropriate enamel surfaces, apply and adjust pit and fissure sealants. Before the application of pit and fissure sealants, a licensed dental assistant must have successfully completed a course in pit and fissure sealants at a dental, dental hygiene, or dental assisting school accredited by the Commission on Dental Accreditation; M. restorative procedures as permitted in Minnesota Statutes, section 150A.10, subdivision 4; N. maintain and remove intravenous lines while under indirect supervision of a dentist who holds a valid general anesthesia or moderate sedation certificate. Before managing and removing intravenous lines, a licensed dental assistant must have successfully completed Board-approved allied dental personnel courses comprised of intravenous access and general anesthesia and moderate sedation training; and O. monitor a patient during preoperative, intraoperative, and postoperative phases of general anesthesia or moderate sedation using noninvasive instrumentation such as pulse oximeters, electrocardiograms, blood pressure monitors, and capnography while under indirect supervision of a dentist who holds a valid general anesthesia or moderate sedation certificate. Before monitoring a sedated patient, a licensed dental assistant must have successfully completed Board-approved allied dental personnel courses comprised of intravenous access and general anesthesia and moderate sedation training. Subp. 1b. Procedures under direct supervision. A licensed dental assistant may perform the following services if a dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and evaluates the performance of the licensed dental assistant before dismissing the patient: A. remove excess bond material from orthodontic appliances; B. remove bond material from teeth with rotary instruments after removal of orthodontic appliances. Before utilizing rotary instruments for the removal of bond material, a licensed dental assistant must have successfully completed a course in the use of rotary instruments for the express purpose of the removal of bond material from teeth. The course must be one that is presented by a dental, dental hygiene, or dental assisting school accredited by the Commission on Dental Accreditation; C. etch appropriate enamel surfaces before bonding of orthodontic appliances by a dentist; D. fabricate, cement, and adjust temporary restorations extraorally or intraorally; E. remove temporary restorations with hand instruments only; F. place and remove matrix bands; G. administer nitrous oxide inhalation analgesia according to part 3100.3600, subparts 4 and 5; H. attach prefit and preadjusted orthodontic appliances; I. remove fixed orthodontic bands and brackets; J. initiate and place an intravenous line in preparation for intravenous medications and sedation while under direct supervision of a dentist who holds a valid general anesthesia or moderate sedation certificate. Before initiating and placing an intravenous line, a licensed dental assistant must have successfully completed Board-approved allied dental personnel courses comprised of intravenous access and general anesthesia and moderate sedation training; and K. place nonsurgical retraction material for gingival displacement. Before placing nonsurgical retraction material, a licensed dental assistant must have successfully completed a course in nonsurgical retraction material for gingival displacement at a dental, dental hygiene, or dental assisting school accredited by the Commission on Dental Accreditation. Subp. 1c. Procedures under personal supervision. A licensed dental assistant may concurrently perform supportive services if the dentist holds a valid general anesthesia or moderate sedation certificate, is personally treating a patient, and authorizes the licensed dental assistant to aid in the physical management of medications, including the preparation and administration of medications into an existing intravenous line. Before administering any medications or agents, a licensed dental assistant must have successfully completed Board-approved allied dental personnel courses comprised of general anesthesia and moderate sedation training. 274

Minnesota State Dental Practice Act and Administrative Rules for Dental Assistants Subp. 2. Other procedures prohibited. A licensed dental assistant may not perform any dental treatment or procedure on patients not otherwise authorized by this chapter. Subp. 3. Limited-license permit. A dental assistant, who by virtue of academic achievement which is equal to or greater than that of a licensed dental assistant, and is currently qualified in Minnesota in an allied health profession may take dental radiographs under the general supervision of a dentist if the person complies with the requirements of this subpart. The person shall file with the board a completed application furnished by the board and the fee prescribed in Minnesota Statutes, section 150A.091, subdivision 2. In addition, the person shall submit evidence of the successful completion of a course on dental radiographs and of passing an examination. The course must be Board-approved. The course shall be equivalent to the dental radiograph courses offered by dental assisting courses approved by the board under part 3100.1300, item B. The examination must be the radiograph part of the examination which is required of licensed dental assistant applicants.

275

Mississippi DANB Certificant Counts: Mississippi Certified Dental Assistant (CDA) certificants

340

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Chris Hutchinson, Executive Director Mississippi State Board of Dental Examiners 600 East Amite Street, Suite 100 Jackson, MS 39201-2801 Phone: 601-944-9622 Fax: 601-944-9624 Email: dental@dentalboard.ms.gov Website: www.dentalboard.ms.gov

Radiation Health and Safety (RHS)

1,436

Infection Control (ICE)

1,495

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Hinds Community College Meridian Community College Pearl River Community College

DANB CDA Certificant State of Mississippi+

$18.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of June 11, 2020.

276

Source: 2018 DANB Salary Survey (state data based on 11 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Mississippi State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Mississippi, a dental assistant must: (1a) Hold a current national DANB Certified Dental Assistant (CDA) certification or (1b) Successfully complete a Mississippi Board-approved radiology seminar and exam within 90 days prior to application or (1c) Graduate from a CODA-accredited dental assisting program within 12 months prior to application, or (1d) Graduate from a CODA-accredited dental assisting program more than 12 months prior to application for permit and provide sworn statements related to employment and administration of radiographs within the five-year period preceding application AND (2) Apply to the Mississippi State Board of Dental Examiners for a radiology permit.

State Requirements For Expanded Functions There is no designation for expanded functions dental assistants in Mississippi.

Mississippi State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Mississippi State Board of Dental Examiners MISSISSIPPI CODE OF 1972, ANNOTATED TITLE 73, CHAPTER 9: DENTISTS §73-9-3 - “DENTISTRY” DEFINED “Dentistry” is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his or her education, training and experience, in accordance with the ethics of the profession and applicable law, provided that nothing in this section shall be so construed as to prevent: (a.) The practice of his or her profession by a regularly licensed and registered physician under the laws of this state unless he or she practices dentistry as a specialty; or (b.) The performance of mechanical work upon inanimate objects by persons working in dental offices under their supervision; or (c.) The operation of dental laboratory and taking work by written work authorization from regularly licensed and registered dentists as provided for elsewhere in this chapter; or (d.) Dentists from outside the state from giving educational clinics or demonstrations before a dental society, convention or association; or (e.) Licensed dentists from outside the state from being called into Mississippi by licensed dentists of this state for consultative or operative purposes when the consultative or operative purposes have been authorized or approved by the Board of Dental Examiners for specified periods of time or as provided for by rules and regulations set forth by the board; or (f.) Applicants for a license to practice dentistry or dental hygiene in this state from working during an examination by and under the supervision and direction of the Board of Dental Examiners; or (g.) The practice of dentistry or of dental hygiene by students under the supervision of faculty in any dental school, college, or dental department of any school, college or university, or school of dental hygiene recognized by the board; or (h.) Dental or dental hygiene students enrolled in accredited dental or dental hygiene schools from participating in off-site training recognized and approved by the board, but those activities shall not be carried on for profit; or (i.) A regularly licensed and registered dentist from the delegation of procedures to a regularly licensed and registered dental hygienist or other competent dental auxiliary personnel while acting under the direct supervision and full responsibility of the dentist except as follows: Those procedures that require the professional judgement and skill of a dentist such as diagnosis, treatment planning, surgical procedures involving hard or soft tissues, or any intra-oral procedure of an irreversible nature that could result in injury to the patient. However, the dentist may delegate the removal of calcareous deposits only to a regularly licensed and registered dental hygienist as regulated by the State Board of Dental Examiners. All dentists and dental hygienists serving as faculty, as provided for in paragraphs (g) and (h) of this section, shall be required to be licensed by the Mississippi State Board of Dental Examiners. §73-9-5 “DENTAL HYGIENE” DEFINED (1.) For the purpose of this chapter, a dental hygienist shall be an individual who has completed an accredited dental hygiene education program, passed the national dental hygiene board and is licensed by the State Board of Dental © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

277

Mississippi State Dental Practice Act and Administrative Rules for Dental Assistants Examiners to provide, as an auxiliary to the dentist, preventive care services including, but not limited to, scaling and polishing. In fulfilling these services, dental hygienists provide treatment that helps to prevent oral disease such as dental caries and periodontal disease and for educating patients in prevention of these and other dental problems. (2.) The work of dental hygienists and dental assistants while working in the office of a regularly licensed and registered dentist shall at all times be under the direct supervision of the dentist. Dental hygienists in the employ of the State Board of Health or public school boards shall be limited to only performing oral hygiene instruction and screening when under the general supervision and direction of regularly licensed and registered dentists. Dental hygienists recognized by the Board of Dental Examiners when making public demonstrations of dental hygiene for educational purposes shall be under the general supervision and direction of regularly licensed and registered dentists. (3.) The Board of Dental Examiners may prohibit any dental hygienist or other auxiliary personnel from rendering service that it feels is not in the best interest of the public welfare. REGULATIONS ADOPTED BY THE BOARD BOARD REGULATION NUMBER 13 - SUPERVISION AND DELEGATION OF DUTIES TO DENTAL AUXILIARY PERSONNEL Purpose: Pursuant to the provisions of Miss. Code Ann. §§73-9-3(i), 73-9-5(2), and 73-9-13, to define the type of supervision required for dental auxiliaries and to further determine procedures which require the professional judgement and skill of a dentist and which, as such, may not be delegated to auxiliary personnel. Supervision of Dental Auxiliaries Miss. Code Ann. §§73-9-3(i) and 73-9-5(2) address areas of supervision of dental auxiliaries, and the following definitions apply to the supervision of dental auxiliaries: 1. Direct Supervision: Miss. Code Ann. §§73-9-3(i) and 73-9-5(2) state that the work of dental auxiliaries shall at all times be under the direct supervision of a licensed Mississippi dentist. This level of supervision requires that a dentist be physically present in the dental office or treatment facility, personally diagnose the condition to be treated, authorize the procedures to be performed, remain in the dental office or treatment facility while the procedures are being performed by the auxiliary, and evaluate the performance of the dental auxiliary. 2. General Supervision: Miss. Code Ann. § 73-9-5(2) provides for a limited scope of practice for dental hygienists employed by the Mississippi State Board of Health or public school boards who may be performing oral hygiene instruction and screening or making public demonstrations of dental hygiene for educational purposes, all while under the general supervision of a licensed Mississippi dentist. For this level of supervision and for the limits imposed by Miss. Code Ann. § 73-9-5(2), a dentist is not required to be in the dental office or treatment facility when procedures are being performed, and the dentist may or may not have personally diagnosed the condition to be treated, may or may not have personally authorized the procedures, and may or may not evaluate the performance of the dental hygienist. Furthermore, dental hygienists in the employ of the Mississippi State Board of Health may apply fluoride varnishes as part of any oral hygiene instruction and screening responsibilities while under the general supervision of a licensed Mississippi dentist. Delegation of Duties to Dental Auxiliaries The Board has determined that the following procedures may not be delegated to dental auxiliary personnel: 1. Periodontal screening and probing, or subgingival exploration for hard or soft deposits and sulcular irrigations to dental assistants and/or dental hygienists not licensed by the State of Mississippi; may be performed by licensed Mississippi dental hygienists. 2. The use of ultrasonic and/or sonic instruments to dental assistants and/or dental hygienists not licensed by the State of Mississippi; may be performed by licensed Mississippi dental hygienists. 3. Pursuant to Miss. Code Ann. §73-9-3, the removal of calcareous deposits with an instrument by anyone other than a licensed Mississippi dental hygienist. 4. The taking of any impression of the human mouth or oral structure that will be used in the restoration, repair, or replacement of any natural or artificial teeth or for the fabrication or repair of any dental appliance. The Board has further determined that impressions for study models and opposing models, and the construction, adjustment, and cementation of temporary crowns (temporary means crowns placed while permanent restoration is being fabricated) do not require the professional judgement and skill of a dentist and may be delegated to competent dental auxiliary personnel in accordance with §73-9-3. 5. The placement, cementation, or final torquing of inlays, permanent crowns, fixed bridges, removable bridges, partial dentures, full dentures, or implant abutments. 278

Mississippi State Dental Practice Act and Administrative Rules for Dental Assistants 6. 7. 8.

The equilibration or adjustment of occlusion on natural or artificial dentition, restoration, or sealants. The activation or adjustments of orthodontic appliances. Injections of drugs, medication, or anesthetics by those not authorized by Mississippi law and Board Regulation 29 to administer such agents. 9. Performing pulp capping, pulpotomy and other endodontic therapy. 10. Intraoral restorative procedures. 11. Placement of any subgingival medicated cords. However, the placement of periodontal treatment agents may be performed by licensed Mississippi dental hygienists. BOARD REGULATION NUMBER 25 - RADIOLOGY PERMITS 1. General Provisions: Anyone other than a licensed dentist who desires to use ionizing radiation procedures in dentistry must obtain a radiology permit from the Board or be exempt as provided below: a. Dental hygienists who are currently licensed in the State of Mississippi are considered to have satisfied the requirements of this regulation and will not be required to obtain a radiology permit. Dental hygienists who are not licensed in this State, who have graduated from a dental hygiene program accredited by the American Dental Association Commission on Dental Accreditation (ADA), will be required to apply for a radiology permit; however, these dental hygienists will not be required to successfully complete a Board-approved radiology seminar prior to making application for a radiology permit. b. Dental auxiliaries currently certified by the Dental Assisting National Board, Inc. (DANB) will be required to apply for a radiology permit; however, these dental auxiliaries will not be required to successfully complete a Boardapproved radiology seminar prior to making application for a radiology permit. c. Dental auxiliaries currently certified by the Dental Assisting National Board, Inc. (DANB) and who also are graduates of ADA-accredited dental assisting programs will be required to apply for a radiology permit; however, these dental auxiliaries are considered to have satisfied the requirements of this regulation and will not be required to successfully complete a Board-approved radiology seminar prior to making application for a radiology permit. (See Sections 1.d. and 1.e. for requirements concerning dental auxiliaries who only are graduates of ADA-accredited dental assisting programs.) d. Dental auxiliaries not currently certified by DANB who have graduated from ADA-accredited dental assisting programs within twelve (12) months prior to making application for a radiology permit will be required to apply for a radiology permit; however, these dental auxiliaries will not be required to successfully complete a Boardapproved radiology seminar prior to making application for a radiology permit. e. Dental auxiliaries not currently certified by DANB who have graduated from ADA-accredited dental assisting programs more than twelve (12) months prior to making application for a radiology permit will not be required to successfully complete a Board-approved radiology seminar prior to making application for a radiology permit provided the individual supplies sworn statements from all employers over the past five (5) years, or part thereof depending on the dental auxiliary’s date of graduation, certifying as to (1) the dental auxiliary’s period of employment; and (2) whether the dental auxiliary administered radiographs as part of his/her dental assisting duties. This documentation must be provided with the dental auxiliary’s application for a radiology permit; otherwise, the dental auxiliary will be required to successfully complete a Board-approved radiology seminar prior to making application for a radiology permit. f. Dental auxiliaries not otherwise qualified to apply for a radiology permit pursuant to Sections 1.a. through 1.e. shall, upon successful completion of a Board-approved radiology seminar, be eligible to make application for a radiology permit. g. Dental students, dental hygiene students, and dental assisting students actively enrolled in Mississippi ADAaccredited dental, dental hygiene, or dental assisting programs do not need to make application for a radiology permit to administer radiographs in dental offices or other entities lawfully authorized to provide dental services while attending the above-referenced programs. However, the Board must receive a letter from the dental, dental hygiene, or dental assisting dean or program head certifying as to a student’s successful completion of the program’s radiology coursework prior to that student administering radiographs in dental offices or other entities lawfully authorized to provide dental services while attending the above-referenced programs. 2. Board-Approved Radiology Seminars and Issuance of Radiology Permits: a. All radiology seminars must be approved in advance by the Board and include a clinical component which adequately tests the dental auxiliary’s ability to administer radiographs. b. All radiology seminars must be a minimum of eight (8) hours in length. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

279

Mississippi State Dental Practice Act and Administrative Rules for Dental Assistants c. d.

All radiology seminars must include a written examination at the conclusion of the seminar. To make application for a radiology permit, a dental auxiliary must submit proof of successful completion of a Board-approved radiology seminar and the proper credentials as outlined hereafter to the Board within ninety (90) days following completion of the radiology seminar. If the dental auxiliary does not submit such proof on a timely basis, the dental auxiliary shall be required to receive a passing grade on a radiology examination administered by the Board or attend and successfully complete another Board-approved radiology seminar and afterwards submit the proper credentials within ninety (90) days as outlined hereafter To apply for a radiology permit, an applicant must submit the following: 1. Fully completed and signed application for a radiology permit; 2. Certified check or money order to cover the application fee and first year’s renewal fee; and 3. Proof of compliance with the appropriate requirements set forth in Section 1.

3. Re-Issuance of Expired Permits: A person who previously has held a permit to administer radiographs in this state but has not kept the permit current will be required to complete all requirements as set out herein for original applicants. 4. Renewal of Radiology Permits: a. The State Board of Dental Examiners shall maintain a compiled list of names and post office addresses for all persons who have applied for and been issued a radiology permit. Every person holding a radiology permit shall promptly keep the Board advised of any change of mailing address, home telephone number, employer, and office telephone number. b. Every person who holds a radiology permit shall, together with the required information and specified renewal fee, apply for renewal of such permit in accordance with the renewal requirements stipulated in Board Regulation 37. Any permit not renewed by the deadlines set forth in Board Regulation 37 will be voided for a failure to re-register. c. If the payment of the renewal fee is not received by the Board on or before the deadline stipulated in Board Regulation 37, the Board may enact and enforce a penalty for the delinquent payment of the renewal fee, such penalty to be established by Board Regulation 37. d. Refer to Board Regulation 37 for the current fee schedule for applications for radiology permits, renewal of radiology permits, and penalties for delinquent renewal of radiology permits. 5. Enforcement: Licensed dentists who allow dental auxiliaries to expose radiographs without complying with this regulation shall be considered in violation of Section 73-9-61 of the Mississippi Code of 1972, Annotated, and may, at the Board’s discretion, be subject to license revocation, suspension, or other action thereon. BOARD REGULATION NUMBER 29 - ADMINISTRATION OF ANESTHESIA Purpose: Pursuant to Miss. Code Ann. 73-9-13, to promulgate rules for the administration of anesthesia in the dental office to allow dentists to provide patients with the benefits of anxiety and pain control in a safe and efficacious manner. 1.

280

Definitions of Terminology Used Herein c. Anxiolysis (Minimal Sedation) - pharmacological reduction of anxiety through the administration of a minor psychosedative/tranquilizer, which allows for uninterrupted interactive ability in a totally awake patient with no compromise in the ability to maintain a patent airway continuously and without assistance. The total dosage cannot exceed 1.5 MRD (maximum recommended dosage). Dentists administering anxiolysis (minimal sedation) shall prescribe only a single agent to each patient (no multiple drugs or combination drug regimens). *When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the MRD of a drug that can be prescribed for unmonitored home use. g. Combination Inhalation Enteral Anxiolysis - when nitrous-oxide is used in combination with an enteral agent with the intent of achieving anxiolysis only, and the appropriate dosage of agents is administered. i. Conscious Sedation (Moderate Sedation) - a minimally depressed level of consciousness beyond anxiolysis that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, and that is produced by pharmacologic or non-pharmacologic agents, or a combination thereof. In accordance with this particular definition, the drugs or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely (also see definitions for Combination Inhalation Enteral Anxiolysis, Enteral Conscious Sedation, General Anesthesia, and Parenteral Conscious Sedation.) l. Direct Supervision - the dentist responsible for the sedation/anesthesia procedure shall be physically present in the office and shall be continuously aware of the patient’s physical status and well being. m. Enteral Conscious Sedation - conscious sedation that is achieved by administration of pharmacological agents through the alimentary tract either orally or rectally. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Mississippi State Dental Practice Act and Administrative Rules for Dental Assistants n. u. v.

General Anesthesia - the intended controlled state of depressed consciousness produced by pharmacologic agents and accompanied by a partial or complete loss of protective reflexes, including the ability to maintain an airway and respond purposefully to physical stimulation or verbal commands. Nitrous-Oxide Inhalation Anxiolysis - the inhalational use of nitrous oxide for anxiolysis and/or analgesia. Parenteral Conscious Sedation - the intravenous, intramuscular, subcutaneous, intranasal, or transdermal administration of pharmacological agents with the intent to obtain a depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal commands.

3. Board Permits Not Required For the following, Board permits are not required: b. Nitrous-Oxide Inhalation Anxiolysis. A licensed dentist may employ or use nitrous-oxide inhalation anxiolysis on an outpatient basis for dental patients without making application to the Board, provided such dentist satisfies one or more of the following criteria prior to administration of nitrous-oxide inhalation anxiolysis: (1) Completion of not less than a two-day course of training as described in the American Dental Association's (hereinafter referred to as “ADA”) "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students,” or its equivalent. (2) Completion of training equivalent to that described above while a student in an ADA-accredited undergraduate dental school program. A licensed dentist may instruct a competent dental auxiliary as to the placement and monitoring of nitrous-oxide inhalation anxiolysis under his/her direct supervision, such supervision as defined in Board Regulation 13. 6. Facilities Wherein Anesthesia Is Administered a. All facilities wherein any anesthesia is administered must be properly equipped for the administration of anesthesia and staffed with a supervised team of auxiliary personnel capable of reasonably assisting the dentist with procedures, problems, and emergencies incident thereto. The adequacy of the dental facility and competence of the anesthesia team shall be determined by the Board 8.

Advanced Cardiac Life Support and Cardiopulmonary Resuscitation a. Any dentist using enteral conscious sedation, parenteral conscious sedation, and/or general anesthesia shall at all times be ACLS certified or hold a certificate from a Board-approved course, and his/her auxiliary personnel must meet the requirements for Cardiopulmonary Resuscitation (hereinafter referred to as “CPR”) as set forth in Board Regulation 45. b. A dentist utilizing nitrous-oxide inhalation anxiolysis and his/her auxiliary personnel must meet the requirements for CPR as set forth in Board Regulation 45.

Renewal of Enteral Conscious Sedation, Parenteral Conscious Sedation, and/or General Anesthesia Permits c. At the time the dentist renews his/her enteral conscious sedation, parenteral conscious sedation, and/or general anesthesia permit, he/she shall submit proof of current ACLS certification and current CPR certification for all dental auxiliaries who have direct patient care responsibilities.

BOARD REGULATION NUMBER 45 - CARDIOPULMONARY RESUSCITATION Purpose: To establish Cardiopulmonary Resuscitation requirements for dentists, dental hygienists, and all other dental auxiliary personnel. 2. Effective July 1, 2012, all dental offices in the State of Mississippi shall be required to have a minimum of one (1) properly functioning Automated External Defibrillator (AED), or equivalent defibrillator, on the premises of each dental office. Each AED, or equivalent defibrillator, shall be maintained in a properly functioning capacity at all times. Proof of the availability of a properly functioning AED, or equivalent defibrillator, shall be made available for review at any time by any member of the Board or by any designated agent of the Board. 3.

All dentists and dental hygienists licensed by the State of Mississippi and holding active licenses shall be currently certified in Cardiopulmonary Resuscitation. Further, all auxiliary personnel involved in direct patient care must be certified in Cardiopulmonary Resuscitation. All auxiliaries must be certified in CPR within one hundred eighty (180) days of employment.

6. Participation in approved Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), American Heart Association (AHA), or American Red Cross (ARC) courses may be used to fulfill the requirements of this Regulation. All other equivalent courses shall be approved by the Board on a case-by-case basis; however, in no instance shall any course be approved by the Board that does not contain a hands-on mannequin component. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

281

Missouri DANB Certificant Counts: Missouri National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

1,116

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

2,851

Infection Control (ICE)

3,088

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Brian Barnett, Executive Director Missouri Dental Board 3605 Missouri Blvd., P.O. Box 1367 Jefferson City, MO 65102-1367 Phone: 573-751-0040 Fax: 573-751-8216 Email: dental@pr.mo.gov Website: http://pr.mo.gov/dental.asp

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Metropolitan Community College-Penn Valley Ozarks Technical Community College St. Louis Community College-Forest Park State Technical College of Missouri

DANB CDA Certificant State of Missouri+

$19.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 14, 2020.

282

Source: 2018 DANB Salary Survey (state data based on 27 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Missouri State Radiography Requirements There are no radiography requirements for dental assistants in Missouri. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions A dental assistant or holder of DANB's CDA certification may, under direct supervision, assist in the administration of and monitor nitrous oxide analgesia in Missouri if he or she meets the following requirements: (1a) Successfully complete formal certified training in a course approved by the Missouri Dental Board and pass an approved competency test regarding clinical and didactic training OR (1b) Submit proof to the Missouri Dental Board of having been certified in another state to assist the administration of and monitoring of nitrous oxide subsequent to equivalent training and testing AND (2) Obtain a permit from the Missouri Dental Board. To perform expanded functions under the direct supervision of a licensed dentist in Missouri, an expanded-functions dental assistant must hold an expanded functions permit from the Missouri Dental Board. To earn the expanded functions permit, one must: (1a) Hold DANB Certified Dental Assistant (CDA) certification and graduate from a CODA-accredited dental assisting program in which competency testing in the appropriate expanded functions category was completed, OR (1b) Hold DANB CDA certification and complete a Missouri Dental Board-approved expanded functions training course, OR (1c) Pass the Missouri Test of Basic Dental Assisting Skills (i.e., the Missouri Basic exam administered by DANB, or another exam approved by the Missouri Dental Board) and complete a Missouri Dental Board-approved expanded functions training course AND (2) Hold current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS), or an equivalent certification approved by the Missouri Dental Board AND (3) Submit proof of meeting requirements along with application form and established fee to the Missouri Dental Board. Expanded functions permits are issued in five categories: Restorative I, Restorative II, Orthodontics, Fixed Prosthodontics, and Removable Prosthodontics. Note: Any dental assistant or certified dental assistant to whom a dentist could legally delegate expanded functions duties prior to December 1, 2012, or any dental assistant or certified dental assistant who meets the qualifications for a board-issued expanded functions permit prior to December 1, 2012, may submit their proof of competence to the Missouri Dental Board and be issued an expanded functions permit prior to December 1, 2012.

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Missouri Dental Board Missouri Revised Statutes Chapter 332 Dentists Section 332.011 Definitions. 332.011. As used in this chapter, the following words and terms mean: (4) “Certified dental assistant”, a dental assistant who is currently certified by the Dental Assisting National Board, Inc.; (5) “Dental assistant”, an employee of a duly registered and currently licensed dentist in Missouri, other than either a dental hygienist or a certified dental assistant; (6) “Expanded-functions dental assistant”, any dental assistant who has passed a basic dental assisting skills mastery examination or a certified dental assistant, either of whom has successfully completed a Board-approved expanded-functions course, passed a competency examination, and has obtained a permit authorizing them to perform expanded-functions duties from the Missouri dental board; (7) “Expanded-functions duties”, reversible acts that would be considered the practice of dentistry as defined in section 332.071 that the board specifies by rule may be delegated to a dental assistant or dental hygienist who possesses an expanded-functions permit. Section 332.093 Practice as a dental assistant defined. 332.093. Any person “practices as a dental assistant” within the meaning of this chapter who provides patient services in cooperation with and under the direct supervision of a currently registered and licensed dentist in Missouri. A currently registered and licensed dentist may delegate to a dental assistant, certified dental assistant or expanded functions dental assistant, under their direct supervision, such reversible acts that would be considered the practice of dentistry as defined in section 332.071 provided such delegation is done pursuant to the terms and conditions of a rule © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

283

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants adopted by the Missouri dental board pursuant to section 332.031; except that, no such rule may allow delegation of acts that conflict with the practice of dental hygiene as defined in section 332.091, with the exception that polishing of teeth, placement of pit or fissure sealants, and application of topical fluoride may be delegated to a dental assistant, certified dental assistant or expanded-functions dental assistant. Section 332.098 Expanded-function duties, delegation of--requirements--rulemaking authority. 332.098. 1. Dentists delegating expanded-functions duties to dental assistants or dental hygienists shall do so in accordance with rules set forth by the board. No person shall perform expanded-functions duties in this state except under his or her own name and unless the board has issued to such person a permit to perform expanded-functions duties in this state; however, no provision of this section or this chapter shall be construed to make it unlawful for a duly registered and currently licensed dentist in this state to perform dental services that would be considered expandedfunctions duties in this state or to make it unlawful for dental assistants, certified dental assistants, or expanded-functions dental assistants to perform polishing of teeth. Under section 332.093, the board shall not promulgate any rule allowing the delegation of acts to a dental assistant that would conflict with the practice of dental hygiene as defined in section 332.091. Expanded-functions permits shall be renewed every five years. The board may promulgate rules specifying the criteria by which expanded-functions permits may be issued and renewed. Expanded-functions permits shall be subject to discipline as provided in section 332.321. 2. Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028. This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2010, shall be invalid and void. Code of State Regulations – Missouri Dental Board Chapter 2 - General Rules

20 CSR 2110-2.001 Definitions PURPOSE: This rule provides definitions for specific terms used throughout the rules.

(3) “Direct supervision”—a level of supervision in which the dentist has authorized the procedure for a patient of record, remains in the treatment facility while the procedure is performed and evaluates the procedure prior to patient dismissal. (4) “Indirect supervision”—a level of supervision in which the dentist has authorized the procedure for a patient of record and remains in the treatment facility while the procedure is performed. (5) “General supervision”—a level of supervision in which the dentist has authorized the procedure for a patient of record and which does not require the physical presence of the dentist in the treatment facility during the performance of the procedure. The patient must be informed that the dentist is not in the treatment facility. The authorization may be verbal or written in the patient’s record and is valid from the date of the most recent examination for a maximum of twelve (12) months. If the dentist gives verbal authorization for dental hygiene care, that authorization shall be documented in the patient’s record following the delivery of that care. The authorization is not renewable without an examination of the patient by the dentist. 20 CSR 2110-2.120 Dental Assistants PURPOSE: This rule expands the functions a dental assistant may perform under the dentist’s direct supervision (1) Definitions. (A) Accredited dental assisting program—A dental assisting educational program accredited by the Commission on Dental Accreditation of the American Dental Association. (B) Certified dental assistant—A dental assistant who is currently certified by the Dental Assisting National Board, Inc. (C) Dental assistant—An employee of a duly registered and currently licensed dentist in Missouri, other than either a dental hygienist or a certified dental assistant. (D) Dental auxiliary—Either a dental assistant or certified dental assistant as defined in subsections (1) (B) and (C). (E) Direct supervision—The following conditions must be satisfied for direct supervision to apply: 1. The dentist is in the dental office or treatment facility; 2. The dentist has personally diagnosed the condition to be treated; 3. The dentist has personally authorized the procedures; 4. The dentist remains in the dental office or treatment facility while the procedures are being performed by the dental auxiliary; and 5. The dentist evaluates the performance of the dental auxiliary before the dismissal of the patient. 284

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants (F) Expanded functions approved course provider—A provider of expanded functions curriculum and competency testing approved by the Missouri Dental Board. (G) Expanded functions permit—A permit issued by the Missouri Dental Board authorizing a dental assistant, certified dental assistant, or Missouri licensed dental hygienist to perform expanded functions duties upon delegation from a Missouri licensed dentist. Expanded functions permits will be issued in the following categories: restorative I, restorative II, removable prosthodontics, fixed prosthodontics, and orthodontics. (H) Missouri Test of Basic Dental Assisting Skills—A test of basic knowledge of dental assisting approved by the board including terminology, principles of asepsis, disinfection and sterilization, and other concepts of dental assisting deemed necessary to master courses in more advanced assisting functions. (I) Proof of competence—Documentation, such as a diploma, a certificate of mastery, or a letter from an approved course provider or competency testing agent stating that the dental auxiliary has successfully completed a board-approved course of training and competency testing of that training. (2) Prohibited Acts (A) A registered and currently licensed dentist may not delegate to a dental assistant or certified dental assistant, as defined in subsections (1)(B) and (C) respectively, the performance of the following procedures: 1. Diagnosis, including interpretation of dental radiographs and treatment planning; 2. Cutting of tooth structure; 3. Surgical procedures on hard and soft tissues including, but not limited to, the removal of teeth and the cutting and suturing of soft tissues; 4. The prescription, injection and parenteral administration of drugs; 5. The final bending of archwire prior to ligation; 6. The scaling of teeth; and 7. Administration of nitrous oxide-oxygen analgesia except that a dental assistant may assist in the administration of and monitor nitrous oxide-oxygen analgesia with specific training as provided in section (3) of this rule. (3) Permitted Acts (A) A dental assistant or certified dental assistant may assist in the administration of and monitor nitrous oxide analgesia under direct supervision if s/he— 1. Has successfully completed formal certified training in a course approved by the Missouri Dental Board; and 2. Has successfully passed an approved competency test regarding the clinical and didactic training; or 3. Has been certified in another state to assist in the administration of and monitor nitrous oxide subsequent to equivalent training and testing. The dental assistant may qualify to perform this function by presenting proof of competence of this equivalent training and testing to the Missouri Dental Board; (4) Expanded Functions Permits. (A) Effective December 1, 2012, a currently licensed dentist may delegate, under direct supervision, functions listed in subsection (4)(H) of this rule to a dental assistant possessing a board-issued permit authorizing the dental assistant to perform expanded functions duties. To qualify for a board-issued permit to perform expanded functions duties, the dental assistant must provide the board with the following: 1. Proof of certification as a certified dental assistant from the Dental Assisting National Board and proof of competence as defined in subsection (1)(I) showing graduation from an accredited dental assisting program in which competency testing in the appropriate expanded functions category was completed; or 2. Proof of certification as a certified dental assistant from the Dental Assisting National Board and proof of competence as defined in subsection (1)(I) showing the dental assistant has completed a board-approved expanded functions training course; or 3. Proof of competence as defined in subsection (1)(I) showing that the dental assistant has passed the board’s Missouri Test of Basic Dental Assisting Skills and that the dental assistant has completed a boardapproved expanded functions training course; and 4. Evidence of current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS), or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement. (B) The board shall issue the appropriate expanded functions permit upon receipt of a completed application form, payment of the appropriate fee specified in 20 CSR 2110-2.170, and proof of competence as defined in subsection (1)(I) that the dental assistant has complied with the requirements of subsection (4)(A) of this rule. The requirements of this section must be completed within one (1) year of the date of submission of the application form. The board-issued expanded functions permit must be displayed in plain view in any facility where the dental assistant will be providing expanded functions prior to delegation of expanded functions to that dental assistant. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

285

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants (C) Any dental assistant or certified dental assistant to whom a dentist could legally delegate expanded functions du ties prior to December 1, 2012, or any dental assistant or certified dental assistant who meets the qualifications for a board-issued expanded functions permit prior to December 1, 2012, may submit their proof of competence to the Missouri Dental Board and be issued an expanded functions permit prior to December 1, 2012. (D) Beginning March 1, 2013, every expanded functions permit issued by the board shall be renewed every five (5) years. In order to renew an expanded functions permit, the dental assistant shall submit to the board— 1. A completed renewal application form provided by the board for each permit the permit holder wishes to renew; 2. The renewal fee specified in 20 CSR 2110-2.170 payable to the Missouri Dental Board for each permit the permit holder wishes to renew; 3. Satisfactory evidence of completion of sixteen (16) hours of continuing education from board-approved sponsors as specified in 20 CSR 2110-2.240(1)(C) during the five- (5-) year period immediately preceding the expiration date. All sixteen (16) hours of continuing education for renewal must be directly related to the updating and maintaining of knowledge and skills in the treatment, health, and safety of the individual dental patient. Permit holders shall only be required to complete sixteen (16) hours of continuing education regardless of the number of permits the permit holder wishes to renew. For any permits that are issued twelve (12) months or less from the expiration date of that permit, the permit holder shall only be required to obtain four (4) hours of board-approved continuing education to renew those permits. Each permit holder shall maintain documentation of completion of the required continuing education hours for five (5) years after the completion of the permit period in which the continuing education was earned; and 4. Evidence of current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS), or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement. (E) An expanded functions permit shall expire if not renewed on or before the permit expiration date. An expired permit can be renewed at any time within one (1) year of the permit expiration date. Any expired expanded functions permit that is not renewed within one (1) year of the expiration date shall be void. (5) Categories. (A) Functions delegable to a dental assistant possessing a board-issued permit to perform expanded functions are divided into five (5) categories; restorative I, restorative II, removable prosthodontics, fixed prosthodontics, and orthodontics and are listed below by category. 1. Restorative I— A. Sizing and cementing of prefabricated crowns; B. Placing, condensing, and carving amalgam for Class I, V, and VI restorations; C. Placing composite for Class I, V, and VI restorations; and D. Minor palliative care of dental emergencies (place sedative filling). 2. Restorative II— A. Sizing and cementing of prefabricated crowns; B. Placing, condensing, carving, and finishing amalgam for Class I, II, III, IV, V, and VI restorations; C. Placing and finishing composite for Class I, II, III, IV, V, and VI restorations; and D. Minor palliative care of dental emergencies (place sedative filling). 3. Orthodontics— A. Preliminary bending of archwire; B. Removal of orthodontic bands and bonds; C. Final cementation of any permanent appliance or prosthesis; D. Making impressions for the fabrication of any removable or fixed prosthesis/appliance; and E. Placement and cementation of orthodontic brackets and/or bands. 4. Prosthodontics—Fixed— A. Place retraction cord in preparation for fixed prosthodontic impressions; B. Extra-oral adjustments of fixed prosthesis; C. Extra-oral adjustments of removable prosthesis during and after insertion; D. Final cementation of any permanent appliance or prosthesis; and E. Making impressions for the fabrication of any removable or fixed prosthesis/appliance. 5. Prosthodontics—Removable— A. Placement of temporary soft liners in a removable pros-thesis; B. Extra-oral adjustments of removable prosthesis during and after insertion; C. Minor palliative care of dental emergencies (place sedative filling); and D. Making impressions for the fabrication of any removable or fixed prosthesis/appliance. 286

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants (6) Expanded Functions Course Providers. (A) The board may approve expanded functions course providers that satisfy the following minimum criteria: 1. Uses course curriculum approved by the board; 2. Demonstrates that faculty at each course include at least one (1) dentist and that the student to faculty ratios do not exceed one (1) faculty member per ten (10) students; 3. Demonstrates that adequate faculty calibration occurs to insure that educational standards are maintained; 4. Demonstrates that adequate testing, monitoring, and evaluation is in place to assure that graduates can be certified as having attained mastery of the component skills and concepts in a laboratory setting; and 5. Demonstrates that mechanisms are in place to provide the board with data on the outcomes of expanded functions duty dental assisting training by reporting on follow-up blind surveys of certificated assistants, supervising dentists, and patients. (7) Delegated Acts. (A) A currently licensed dentist may delegate under direct supervision to a dental assistant or certified dental assistant any functions not specifically referenced in sections (2)–(4) of this rule and not considered either the practice of dentistry or the practice of dental hygiene as defined in sections 332.071 and 332.091, RSMo, and 4CSR 110-2.130. (B) The licensed dentist is responsible for determining the appropriateness of delegation of any specific functions based upon knowledge of the skills of the auxiliary, the needs of the patient, the requirements of the task, and whether proof of the competence is required. (C) Pursuant to section 332.031.2., RSMo, the licensed dentist is ultimately responsible for patient care. Nothing contained in the authority given the licensed dentist by this rule to delegate the performance of certain procedures shall in any way relieve the supervising licensed dentist from liability to the patient for negligent performance by a dental assistant or certified dental assistant. Expanded functions permits shall be subject to discipline as provided in section 332.321, RSMo. 20 CSR 2110-2.170 Fees 3. Dental Assistants A. Monitoring Nitrous Oxide Analgesia B. Expanded Functions Permit (I) Restorative I Permit Fee $ (II) Restorative II Permit Fee (III) Removable Prosthodontics Permit Fee (IV) Fixed Prosthodontics Permit Fee (V) Orthodontics Permit Fee

$ 10 $ 10 $ 10 $ 10 $ 10 $ 10

20 CSR 2110-2.240 Continuing Dental Education PURPOSE: This rule details the board’s minimum requirements for continuing dental education for dentists and dental hygienists. (1) Definitions. (C) Board-approved sponsors are— 1. American Dental Association (ADA) and its constituent and component societies; 2. Academy of General Dentistry (AGD) and its state and local affiliates; 3. ADA recognized dental specialty organizations and their state and local affiliates; 4. National Dental Association and its state and local affiliates; 5. American Dental Hygienists’ Association and its constituents and component societies; 6. National Dental Hygienists’ Association and its state and local affiliates; 7. American Medical Association and American Osteopathic Association and their respective state and local societies; 8. American Nurses Association and its state and local affiliates; 9. ADA Commission on Dental Accreditation approved dental, dental hygiene, and dental assisting schools; 10. ADA continuing education recognition program; 11. AGD national sponsor approved program; 12. Federal and state government agencies, including any of the branches of the military; 13. Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations; 14. Missouri Public Health Association; 15. American Red Cross; 16. American Heart Association; 17. Central Regional Dental Testing Service, Inc. (CRDTS); 18. Dental Assisting National Board, Inc. (DANB); © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

287

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants 19. American Dental Assistants Association and its constituents and component societies; and 20. Any other sponsor approved by the board pursuant to subsection (2)(B). Chapter 4 - Sedation 20 CSR 2110-4.010 Definitions PURPOSE: This rule defines terms used throughout the rules of Chapter 4. (1) The following words and terms, when used in this chapter, shall have the following meanings. (E) Deep sedation—A drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (F) Deep sedation/general anesthesia permit—A document issued by the Missouri Dental Board to a dentist that allows the dentist to administer deep sedation/general anesthesia. (G) Deep sedation/general anesthesia site certificate—A document issued by the Missouri Dental Board to a specific dental office where deep sedation/general anesthesia is administered. (H) Dental office—A facility where dentistry is practiced in accordance with the pro-visions of section 332.071, RSMo. (I) Dentist—One who is currently licensed to practice as a dentist in Missouri and is ultimately responsible for the sedation procedure of a dental patient under his/her care. (J) Dentist-in-charge—A dentist duly licensed by the board to practice at a facility in which sedation anesthesia services are to be offered and who assumes the responsibility to assure that the facility is properly equipped and the sedation team is properly trained. (U) Moderate sedation—A drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Generally, no interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Note: In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the dentist. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation. (W) On-site evaluation—A performance evaluation of the competency of the sedation team by consultants appointed by the board to ensure public safety. (DD) Sedation team—Those individuals, including the qualified sedation provider and operating dentist, qualified pursuant to 20CSR 2110-4.030(7)(B) involved with the treatment and/or monitoring of a sedation patient. (7) If the primary administrator of enteral, parenteral, or pediatric moderate sedation in a dental office is an anesthesiologist or a certified registered nurse anesthetist, the operating dentist must order the anesthesia services and is responsible for the readiness of the dental office, preoperative patient evaluation and appropriate medical consultations, the coordination of and emergency preparedness of the sedation team, and the maintenance of appropriate records. The dentist must evaluate the patient prior to the procedure, remain in the dental office, and evaluate the patient prior to discharge. (11) To qualify for a moderate sedation site certificate— (A) The dentist-in-charge of the dental office shall document that— 2. All moderate sedation team members (two (2) minimum) and the dentist, possess and maintain current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS), or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement or ACLS; 3. All moderate sedation team members, including the dentist, have completed a board-approved course in monitoring sedated patients during the past five (5) years; (B) The dental office shall undergo a facility inspection as set forth in 20 CSR 2110-4.030 to confirm the adequacy of the dental office and the qualifications of the sedation team.

288

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants (15) To renew a moderate sedation site certificate the dentist-in-charge shall, at least ninety (90) days prior to the expiration of the current site certificate— (D) Document that the sedation team, as well as the permitted dentist, possess and maintain current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS) or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement, or the American Red Cross recognized equivalent certification, or ACLS; (E) Document that all moderate sedation team members, including the operating dentist, have completed a boardapproved course in monitoring sedated patients during the past five (5) years; and (F) Undergo a facility inspection as set forth in 20 CSR 2110-4.030 to confirm the adequacy of the dental office and the qualifications of the sedation team. (21) The dentist-in-charge of a dental office in receipt of a moderate sedation site certificate must ensure that the moderate sedation team meets the clinical requirements and the dental office meets the standards for utilization as set forth in 20 CSR 2110-4.030. 20 CSR 2110-4.030 Guidelines for Administration of Moderate Sedation PURPOSE: This rule provides for the requirements and guidelines dentists are required to follow in the administration of sedative drugs. (6) Sedation Documentation Requirements. (B) At a minimum, the anesthetic record must contain the following: 1. Names of the qualified sedation provider and sedation team members (dentist, anesthetist, assistants); (7) Monitoring Procedures. (A) Moderate sedation patients shall be monitored under the direct and continuous supervision of a sedation team member. (B) For the purpose of supervising and monitoring a moderately sedated patient, members of the sedation team shall be— 1. Capable of physical assessment of a sedated patient; 2. Certified in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS) or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement or Advanced Cardiopulmonary Life Support (ACLS); 3. Certified in monitoring moderate sedation from a board-approved course provider (certification of non-dentists shall be approved by their respective licensing authorities); and 4. Knowledgeable about medical emergency response incident to the use of enteral, parenteral, and pediatric moderate sedation, including the use of resuscitation equipment and emergency medications. (9) Personnel. (A) The minimum number of individuals available to support a sedated patient shall be three (3): the dentist and two (2) members of the sedation team, which may include a certified registered nurse anesthetist or an anesthesiologist. (B) All individuals that may be called upon to be responsible for supervising and monitoring sedated patients shall be qualified as set forth in (7)(B). (12) Site Certificate (D) Sedation team members shall be capable of safely executing procedures associated with enteral and/or parenteral and pediatric moderate sedation. The dentist-in-charge shall verify the following via notarized affidavit: 1. The primary administrator of enteral, parenteral, or pediatric moderate sedation is a qualified sedation provider as defined in subsection (1)(CC)of 20 CSR 2110-4.010 who maintains current certification and licensure in their field of practice; 2. Appropriate patient records are maintained as set forth in section (2) of this rule; 3. Appropriate patient selection criteria are employed as set forth in sections (3) and (4) of this rule. The dentist-in-charge and permitted dentists should be prepared to demonstrate knowledge of physical evaluation of patients, American Society of Anesthesiologists (ASA) classifications, and their application to appropriate patient selection; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

289

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants 4. Appropriate informed consent is utilized as set forth in section (5) of this rule; 5. Time oriented anesthesia records are appropriately maintained as set forth in section (6) of this rule; 6. Direct and continuous monitoring of sedated patients is accomplished by sedation team members through recovery until discharge as set forth in section (7) of this rule; 7. Appropriate documentation occurs for the management and treatment of sedated patients; and 8. Appropriate criteria are in place to determine when a patient can be safely discharged and appropriate post-operative instructions are given to responsible individuals who will supervise the sedated patient after discharge as set forth in section (8) of this rule. (E) The sedation team shall be capable of responding to emergencies incident to the administration of enteral, parenteral, or pediatric moderate sedation. The sedation team should be prepared for the following emergencies and be competent in simulated responses: 1. General emergency response protocol; 2. Laryngospasm; 3. Acute airway obstruction; 4. Cardiopulmonary arrest; 5. Allergic reaction to drugs; 6. Hypotension; 7. Angina pectoris; 8. Possible myocardial infarction; 9. Emesis and aspiration of vomitus; and 10. Convulsions. (13) Board-Approved Courses. (B) The sedation monitoring course content shall include, but not be limited to: 1. Appropriate definitions; 2. Appropriate patient records; 3. Basic pharmacology, including but not limited to drug interactions with sedatives; 4. Basic anatomy and physiology as it pertains to the sedated patient; 5. Reviewing patient records for essential data and screening medical histories; 6. ASA classification and appropriate patient selection; 7. Properly maintained and equipped facilities; 8. Informed consent; 9. Time oriented anesthesia record; 10. Monitoring and assessment of the sedated patient during treatment and recovery; 11. Appropriate documentation of the management and treatment of sedated patients; 12. Appropriate discharge criteria; 13. DEA record keeping; 14. Auxiliary roles in response to most common emergencies incident to administration of moderate sedation; and 15. An examination measuring knowledge necessary for safe, effective monitoring of a sedated dental patient. 20 CSR 2110-4.040 Deep Sedation/General Anesthesia PURPOSE: This rule provides for the regulation of the administration of deep sedation/general anesthesia. (8) To qualify for a deep sedation/general anesthesia site certificate the dental office mustâ&#x20AC;&#x201D; (B) Have and maintain personnel capable of handling procedures and emergencies incident to the administration of deep sedation/general anesthesia including but not limited to: 1. All deep sedation/general anesthesia sedation team members (two (2) minimum) and the operating dentist possess and maintain current certification in the American Heart Associationâ&#x20AC;&#x2122;s Basic Life Support for the Healthcare Provider (BLS), or an equivalent certification approved by the Missouri Dental Board. Boardapproved courses shall meet the American Heart Association guide-lines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement or ACLS; and 2. All deep sedation/general anesthesia sedation team members, including the operating dentist, have completed a board-approved course in monitoring sedated patients during the past five (5) years. Certification of non-dentists shall be approved by their respective licensing authorities; (C) Undergo and successfully complete a facility inspection by consultants appointed by the board or other qualified personnel approved by the board to confirm the adequacy of the facility and the qualifications of the deep sedation/general anesthesia sedation team; and 290

Missouri State Dental Practice Act and Administrative Rules for Dental Assistants (D) The dentist in charge of the dental office shall document that— 1. The administrator of deep sedation/general anesthesia is a qualified sedation provider as defined in 20 CSR 2110-4.010; and 2. All anesthesia team members, including the operating dentist, possess and maintain current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS) or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement or ACLS. (13) To renew a site certificate for deep sedation/general anesthesia the dentist-in-charge shall, at least ninety (90) days prior to the expiration of the current site certificate— (D) Document that anesthesia team members, including the operating dentist, possess and maintain current certification in the American Heart Association’s Basic Life Support for the Healthcare Provider (BLS) or an equivalent certification approved by the Missouri Dental Board. Board-approved courses shall meet the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) and provide written and manikin testing on the course material by an instructor who is physically present with the students. Online only courses will not be accepted to satisfy the BLS requirement or ACLS; (E) Document that all deep sedation/general anesthesia sedation team members, including the operating dentist, have completed aboard-approved course in monitoring sedated patients during the past five (5) years; and (F) Undergo and successfully complete a facility inspection by consultants appointed by the board or other qualified personnel approved by the board to confirm the adequacy of the facility and the qualifications of the deep sedation/general anesthesia sedation team.

291

Montana DANB Certificant Counts: Montana Certified Dental Assistant (CDA) certificants

189

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Kevin Bragg, Executive Officer Montana Board of Dentistry 301 South Park, 4th Floor P.O. Box 200513 Helena, MT 59620-0513 Phone: 406-841-2390 Fax: 406-841-2305 Email: dlibsdden@mt.gov Website: www.dentistry.mt.gov

1,667

Infection Control (ICE)

546

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Great Falls College - Montana State University Salish Kootenai College

DANB CDA Certificant State of Montana+

$19.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of April 22, 2020.

292

Source: 2018 DANB Salary Survey (state data based on 5 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Montana State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a dentist in Montana, a dental assistant must: (1) Successfully complete the national DANB Radiation Health and Safety (RHS) exam. After successful completion of the RHS exam, DANB will issue the assistant a DANB RHS certificate of knowledge-based competency. Dental assistants are not legally allowed to expose radiographs in Montana until they receive the RHS certificate from DANB OR (2) Graduate from a CODA-accredited dental assisting program OR (3) Be certified in dental radiography as a result of military experience. Dental auxiliaries holding DANB CDA certfication may expose radiographs under the general supervision of a licensed dentist. Note: Effective Jan. 1, 2016, radiology certification from other states will no longer be accepted, with the exception of a board-approved written examination. Dental auxiliaries who acquired radiology certification in other states and were employed as dental auxiliaries in Montana prior to Jan. 1, 2016, will be grandfathered.

State Requirements For Expanded Functions There is no designation for expanded functions dental assistants in Montana. A dental auxiliary in the state of Montana may perform basic supportive dental procedures specified by the state dental practice act under the direct supervision of a licensed dentist. To qualify, one must: (1) Graduate from a CODA-accredited dental assisting program OR (2) Receive instruction and training by a licensed dentist OR (3) Receive instruction and training in a Montana Board-approved continuing education course. A dental auxiliary may work under general supervision of a licensed dentist if the auxiliary holds the Certified Dental Assistant (CDA) certification from DANB.

Montana State Dental Practice Act and Administrative Rules for Dental Assistants Note: The following pages contain excerpts of selected Montana statutes and regulations and are intended to highlight those Montana laws and rules that govern the practice of dental assisting. Statutes and regulations are current as of the date indicated, but are subject to change at any time; dental assistants and their employers are responsible for reading, understanding, and complying with all current statutory and regulatory requirements. For the full text of the current Montana statutes and regulations governing dentistry, please go to www.dentistry.mt.gov and click the “Regulations” tab.

Dental Practice Act – Montana Board of Dentistry Montana Code Annotated (MCA) Title 37. Professions and Occupations Chapter 4. Dentistry and Dental Hygiene Part 4. Dental Hygienists and Auxiliary Personnel 37-4-408. Auxiliary personnel – employment, duties, and limitations. (1) A dental auxiliary is a person other than a licensed dental hygienist employed by a licensed dentist. The board may, within the limitations of this chapter, adopt rules that define the qualifications and outline the tasks of any unlicensed auxiliary personnel to be employed by a licensed dentist, except that this section may not be construed to allow the board by rule to permit a licensed dentist to delegate to any auxiliary personnel prophylaxis or any of the duties prohibited to dental hygienists under 37-4-401. The performance of intraoral tasks by a dental auxiliary, as permitted by board rules, must be under the direct supervision of a licensed dentist, except as provided in subsection (2). (2) A dental auxiliary who holds a certified dental assistant certification from the dental assisting national board may be supervised under general supervision. Administrative Rules Chapter 24 Labor and Industry 24.138: Board of Dentistry

Subchapter 3 24.138.301 Definitions (3) "Certified dental assistant" is a dental auxiliary who has successfully completed all of the following exams and holds current certification from the Dental Assisting National Board: (a) general chairside assisting (GC); (b) radiation health and safety (RHS); and (c) infection control (ICE). © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

293

Montana State Dental Practice Act and Administrative Rules for Dental Assistants (4) "Coronal polishing" is a dental procedure limited to the utilization of abrasive agents on the coronal surfaces of natural and restored teeth for the purpose of plaque and extrinsic stain removal. (5) "Direct supervision", for the purpose of ARM 24.138.406, means the provisions of allowable functions by dental auxiliaries with the intent and knowledge of the dentist and while the supervising dentist is on the premises. (7) "General supervision," for the purpose of ARM 24.138.406, means the provision of allowable functions by dental auxiliaries provided to a current patient of record, with the intent and knowledge of the dentist licensed and residing in the state of Montana. The supervising dentist need not be on the premises. Subchapter 4 General Provisions 24.138.406 Functions For Dental Auxiliaries (1) Dental auxiliaries may work under the direct supervision of a licensed dentist per ARM 24.138.301 if the auxiliary: (a) was instructed and qualified to perform in a dental assisting program accredited by the Commission on Dental Accreditation or its successor; or (b) was instructed and trained by a licensed dentist; or (c) was instructed and trained in a Board-approved continuing education course. (2) A certified dental assistant may work under the general supervision of a licensed dentist per ARM 24.138.301. (3) A dental auxiliary working under the direct supervision of a licensed dentist per ARM 24.138.301 may perform the following dental procedures including, but not limited to: (a) making radiographic exposures as prescribed by the supervising dentist as referenced in (12); (b) initiating, adjusting and monitoring nitrous oxide flow for a patient who has been prescribed and administered nitrous oxide by a licensed dentist; (c) taking impressions for study or working casts; (d) removing sutures and dressings; (e) applying topical anesthetic agents; (f) providing oral health instructions; (g) applying topical fluoride agents; (h) removing excess cement from coronal surfaces; (i) placing and removing rubber dams; (j) placing and removing matrices; (k) collecting patient data; (l) polishing amalgam restorations; (m) placing and removing temporary restoration with hand instruments only; (n) placing pit and fissure sealants; and (o) coronal polishing. (4) A certified dental assistant working under the general supervision of a licensed dentist per ARM 24.138.301 is prohibited from performing the following functions: (a) initiating, adjusting, and monitoring nitrous oxide flow for a patient who has been prescribed and administered nitrous oxide by a licensed dentist; (b) applying silver diamine fluoride agents; (c) placing and removing rubber dams; (d) placing and removing matrices; (e) polishing amalgam restorations; and (f) applying topical anesthetic agents. (5) A certified dental assistant working under the general supervision of a licensed dentist may place pit and fissure sealants following an in-person comprehensive oral examination or periodic examination within the preceding 30 days. (6) Dental auxiliaries performing any intraoral procedure must be under the direct supervision of a licensed dentist, except that a certified dental assistant may work under the general supervision of a licensed dentist. (7) No dentist shall allow any dental auxiliary to perform the following: (a) diagnosis and treatment planning as per 37-4-401, MCA; (b) cutting hard or soft tissue or extracting teeth; (c) prescribing any drugs as per 37-4-401, MCA; (d) administering or dispensing any drug, without the prior authorization of the supervising dentist; (e) administering intravenous and intramuscular injections or local anesthetic; (f) placing, carving or condensing any permanent restorations; (g) taking final impressions of the involved arch for crowns, bridges, implant prosthesis, partial dentures, or complete dentures; 294

Montana State Dental Practice Act and Administrative Rules for Dental Assistants (h) bonding or cementing any fixed prosthesis, including veneers, except for provisionals; (i) bonding or cementing orthodontic brackets or orthodontic appliances that would provide activation upon cementation; (j) placing sulcular medicinal or therapeutic materials; (k) periodontal probing; (l) air polishing; or (m) prophylaxis as defined in ARM 24.138.301. (8) Dentists shall not delegate to dental auxiliaries any duties or responsibilities regarding patient care that cannot be delegated to dental auxiliaries under 37-4-408, MCA, and board rules. (9) The assignment of tasks and procedures to dental auxiliaries shall not relieve the dentist from liability for all treatment rendered the patient. (10) A dentist shall not employ, supervise or otherwise use more dental auxiliaries than the dentist can reasonably supervise in keeping with the dentist’s ethical and professional responsibilities. (11) The employing dentist shall verify that a dental auxiliary’s qualifications comply with the statutes and rules of the board. (12) A dentist licensed to use or direct the use of an x-ray producing device must assure that the radiation source under the dentist’s jurisdiction is used only by individuals competent to use it, as per ARM 37.14.1003. Only a licensed dentist may prescribe radiation dosage and exposure. (a) A dental auxiliary, under the direct supervision of a licensed dentist, may expose radiographs only if the auxiliary: (i) has graduated from an accredited program of dental assisting, dental hygiene or dentistry accredited by the Commission on Dental Accreditation or its successor; or (ii) has been certified in dental radiology as a result of military experience; or (iii) has successfully completed a board-approved radiology written examination. (b) (b) A certified dental assistant may expose radiographs under the general supervision of a licensed dentist. (c) For dental auxiliaries beginning work in Montana after January 1, 2016, radiology certification from other states will no longer be accepted, with the exception of a board-approved written examination. Dental auxiliaries who acquired radiology certification in other states and were employed as dental auxiliaries in Montana prior to January 1, 2016, will be grandfathered. (13) Proof of current certification must be readily available for review by the public or the board upon request. 24.138.3211 Definitions Related to Anesthesia (11) "Trained healthcare professional" means a person who serves as an anesthesia monitor in a dental office. Such person shall maintain current certification in the American Heart Association's Basic Life Support for Healthcare Providers or its equivalent, shall be trained in monitoring patient vital signs, and shall be competent in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. (The term "competent" as used in these rules means displaying special skill or knowledge derived from training and experience). 24.138.3223 Minimum Monitoring Standards (3) Minimum standards for monitoring minimal sedation patients shall include the following: (b) when the dentist who administers the nitrous oxide/oxygen and/or is not in the operatory, there must be a dental auxiliary who remains with the patient and provides direct observation. The dental auxiliary must have specific instruction in the observation of nitrous oxide/oxygen sedated patients and shall monitor the patient until discharged. (4) During dental procedures, the facility must be staffed by supervised monitoring personnel, all of whom are capable of handling procedures, problems, and emergency incidents, and have successfully completed the American Heart Association's Basic Life Support for Healthcare Providers, or its equivalent. (a) With respect to a deep sedation/general anesthesia facility, in addition to the dentist and dental assistant, there must be at least one person present to monitor vital signs. That person must be: (i) a physician anesthesiologist licensed to practice medicine in Montana; (ii) a certified registered nurse anesthetist recognized in that specialty by the Montana Board of Nursing; (iii) a dentist who has successfully completed an accredited advanced dental education program in dental anesthesiology; (iv) an oral and maxillofacial surgeon who has successfully completed an accredited oral and maxillofacial training program; or (v) a trained healthcare professional (b) When moderate sedation is used, the dentist shall be qualified and permitted to administer the drugs and appropriately monitor the patient, and have successfully completed a course in advanced cardiac life support. In addition to the dentist, at least one other person on staff and present in the office must have successfully completed the American Heart Association Basic Life Support for Healthcare Providers, or its equivalent. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

295

Montana State Dental Practice Act and Administrative Rules for Dental Assistants 24.138.3227 Onsite Inspection of Facilities (2) The onsite inspection shall include a test of the applicant and the applicant's staff on their abilities to recognize and manage complications likely to occur, considering the techniques being used. Early recognition of complications will be emphasized. The facility must be inspected for the presence of drugs and equipment appropriate for the level of sedation or anesthesia to be provided. Monitoring assistants shall be examined for their knowledge of their respective roles in normal operating procedures and in various emergency situations. The inspector shall evaluate office staff in proficiency in handling emergency procedures and evaluate the accuracy of anesthesia record-keeping.

296

Nebraska DANB Certificant Counts: Nebraska Certified Dental Assistant (CDA) certificants

352

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Vonda Apking, Health Licensing Coordinator Nebraska Board of Dentistry DHHS, Public Health, Licensure Unit 301 Centennial Mall South, 1st Floor 14th and M Streets PO Box 94986 Lincoln, NE 68509-4986 Phone: 402-471-2118 Fax: 402-742-8355 Email: dhhs.medicaloffice@nebraska.gov Website: http://dhhs.ne.gov/licensure/Pages/DentalAssistant.aspx

Radiation Health and Safety (RHS)

1,005

Infection Control (ICE)

1,031

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Central Community College Metropolitan Community College Mid-Plains Community College Southeast Community College

DANB CDA Certificant State of Nebraska+

$18.25 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 25, 2020.

Source: 2018 DANB Salary Survey (state data based on 12 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

297

Nebraska State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Nebraska, a dental assistant must: (1) Successfully complete a two-day course approved by the Nebraska Board of Dentistry and the Nebraska Department of Health and Human Services Regulation and Licensure OR (2) Pass the national DANB Certified Dental Assistant (CDA) exam OR (3) Successfully complete a dental assisting course from a CODA-accredited technical school or community college which provides training in dental radiography as part of its curriculum. Note: All dental assistants must be at least 18 years of age.

State Requirements For Expanded Functions All dental assistants must be at least 18 years of age. Dental assistants who assist in the administration of general anesthesia, deep sedation, moderate sedation or minimal sedation must hold current basic life support skills (BLS) certification or the equivalent. Dental assistants with current and valid certification for cardiopulmonary resuscitation (CPR) approved by the Nebraska Board of Dentistry may monitor nitrous oxide under indirect supervision of a licensed dentist. To perform coronal polishing procedures under the indirect supervision of a licensed dentist in the state of Nebraska, a dental assistant must: (1) Be at least 18 years of age AND (2a) Graduate from a CODA-accredited dental assisting program which includes a coronal polishing course OR (2b) Complete one year (1,500 hours minimum) of clinical work experience as a dental assistant and a Nebraska Board-approved course in polishing procedures. To qualify as a Licensed Dental Assistant (LDA)* in the state of Nebraska, one must (1) Hold a high school diploma or equivalent, AND (2a) Successfully complete a dental assisting program accredited by CODA OR (2b) Complete a minimum of 1,500 hours of dental assisting experience in the five years preceding application, AND (3) Pass DANB's CDA Certification or an equivalent exam approved by the Nebraska Board of Dentistry, AND (4) Pass a jurisprudence exam approved by the Board covering Nebraska statutes, rules, and regulations governing dental assisting, AND (5) Apply to the Nebraska Department of Health and Human Services for a license, AND (6) Complete any continuing education if required by the Board. A licensed dental assistant, upon completion of education and testing approved by the Board and with a permit from the department for the respective expanded scope function, may perform the following under indirect supervision: (1) Take dental impressions for fixed prostheses; (2) Take dental impressions and make minor adjustments for removable prostheses; (3) Cement prefabricated fixed prostheses on primary teeth, and (4) Monitor and administer nitrous oxide analgesia. To qualify as an Expanded Function Dental Assistant (EFDA)*, one must (1) Hold valid licensure as a licensed dental assistant at the time of application, AND (2) Complete a minimum of 1,500 hours of work experience as a licensed dental assistant, AND (3) Complete courses and exams in expanded function dental assisting as approved by the Board, AND (4) Pass a jurisprudence exam approved by the Board covering Nebraska statutes, rules and regulations governing expanded function dental assisting, AND (5) Complete any continuing education requirements if required by the Board. An EFDA, upon completion of education and testing approved by the Board and with a permit from the department for the respective expanded function, may perform the following under indirect supervision: (1) Place restorative level one simple restorations (one surface), and (2) Place restorative level two complex restorations (multiple surfaces). *The Nebraska Legislature passed a law in the 2017 legislative session authorizing the creation of these categories of dental assistant; the Nebraska Board of Dentistry is in the process of developing rules to regulate these categories.

Nebraska State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Nebraska Board of Dentistry DENTISTRY PRACTICE ACT 38-1102. Definitions, where found. For purposes of the Dentistry Practice Act and elsewhere in the Uniform Credentialing Act, unless the context otherwise requires, the definitions found in sections 38-1102.01 to 38-1113 apply. 38-1102.01. Accredited dental assisting program, defined. Accredited dental assisting program means a program that is accredited by the American Dental Association Commission on Dental Accreditation, which is an agency recognized by the United States Department of Education as an accrediting body, that is within a school or college approved by the board, and that requires a dental assisting curriculum of not less than one academic year. 38-1105. Analgesia, defined. Analgesia means the diminution or elimination of pain in the conscious patient. 298

Nebraska State Dental Practice Act and Administrative Rules for Dental Assistants 38-1106.01. Deep sedation, defined. Deep sedation means a drug-induced depression of consciousness during which (1) a patient cannot be easily aroused but responds purposefully following repeated or painful stimulation, (2) the ability to independently maintain ventilator function may be impaired, (3) a patient may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate, and (4) cardiovascular function is usually maintained. 38-1107. Dental assistant, defined. Dental assistant means a person, who does not hold a license under the Dentistry Practice Act and who is employed for the purpose of assisting a licensed dentist in the performance of his or her clinical and clinical-related duties as described in section 38-1135. 38-1107.01. Expanded function dental assistant, defined. Expanded function dental assistant means a licensed dental assistant who has met the requirements to practice as an expanded function dental assistant pursuant to section 381118.03. 38-1108. General anesthesia, defined. General anesthesia means a drug-induced loss of consciousness during which (1) a patient is not arousable, even by painful stimulation, (2) the ability to independently maintain ventilatory function is often impaired, (3) a patient often requires assistance in maintaining a patent airway and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function, and (4) cardiovascular function may be impaired 38-1109. General supervision, defined. General supervision means the directing of the authorized activities of a dental hygienist or dental assistant by a licensed dentist and shall not be construed to require the physical presence of the supervisor when directing such activities. 38-1110. Indirect supervision, defined. Indirect supervision means supervision when the licensed dentist authorizes the procedure to be performed by a dental hygienist or dental assistant and the licensed dentist is physically present on the premises when such procedure is being performed by the dental hygienist pursuant to section 38-1132 or the dental assistant. 38-1111. Inhalation analgesia, defined. Inhalation analgesia means the administration of nitrous oxide and oxygen to diminish or eliminate pain in a conscious patient. 38-1111.01. Licensed dental assistant, defined. Licensed dental assistant means a dental assistant who holds a license to practice as a dental assistant under the Dentistry Practice Act. 38-1112. Minimal sedation, defined. Minimal sedation means a drug-induced depression of consciousness during which (1) a patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command, (2) cognitive function and coordination may be modestly impaired, and (3) ventilatory and cardiovascular functions are unaffected. 38-1113. Moderate Sedation, defined. Moderate sedation means a drug-induced depression of consciousness during which (1) a patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation, (2) no intervention is required to maintain a patent airway and spontaneous ventilation is adequate, and (3) cardiovascular function is usually maintained. 38-1116. Dentistry practice; exceptions. The Dentistry Practice Act shall not require licensure as a dentist under the act for: (8) The performance, under the supervision of a licensed dentist, by a dental assistant, a licensed dental assistant, or an expanded function dental assistant, of duties prescribed in accordance with rules and regulations adopted by the department; (13) Dental assisting students who practice dental assisting or expanded function dental assisting upon patients in clinics in the regular course of instruction at an accredited dental assisting program. Such dental assisting students are also not engaged in the unauthorized practice of dental assisting, expanded function dental assisting, dental hygiene, or expanded function dental hygiene. 38-1118.02. Licensed dental assistant, application for license; qualifications. (1) Every applicant for a license to practice as a licensed dental assistant shall (a) have a high school diploma or its equivalent, (b) present proof of (i) graduation from an accredited dental assisting program or (ii) a minimum of one thousand five hundred hours of experience as a dental assistant during the five-year period prior to the application for a license, (c) pass the examination to become a certified dental assistant administered by the Dental Assisting National Board or an equivalent examination approved by the Board of Dentistry, ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

299

Nebraska State Dental Practice Act and Administrative Rules for Dental Assistants (d) pass a jurisprudence examination approved by the board that is based on the Nebraska statutes, rules, and regulations governing the practice of dental assisting, and (e) complete continuing education as a condition of licensure if required by the board. (2) Upon completion of these requirements, the department, with the recommendation of the board, shall issue the applicant a license to practice as a licensed dental assistant. 38-1118.03. Expanded function dental assistant; application for permit; qualifications. (1) Every applicant for a permit to practice as an expanded function dental assistant shall (a) present proof of current, valid licensure under the Dentistry Practice Act as a licensed dental assistant at the time of application, (b) present proof of at least one thousand five hundred hours of experience as a licensed dental assistant, (c) present proof of successful completion of courses and examinations in expanded function dental assisting approved by the board, (d) pass a jurisprudence examination approved by the board that is based on the Nebraska statutes, rules, and regulations governing the practice of expanded function dental assisting, and (e) complete continuing education as a condition of the permit if required by the board. (2) Upon completion of these requirements, the department, with the recommendation of the board, shall issue the applicant the applicable permit to practice as an expanded function dental assistant. 38-1119. Reexamination; requirements. Any person who applies for a license to practice dentistry, dental hygiene, or dental assisting and who has failed on two occasions to pass any part of the practical examination shall be required to complete a course in clinical dentistry, dental hygiene, or dental assisting approved by the board before the department may consider the results of a third examination as a valid qualification for a license to practice dentistry, dental hygiene, or dental assisting in the State of Nebraska. 38-1121. Dental hygienist; licensed dental assistant; reciprocity; requirements; military license; temporary license. (3) Every applicant for a license to practice as a licensed dental assistant based on a license in another state or territory of the United States or the District of Columbia shall meet the standards set by the board pursuant to section 38-126 and shall have been actively engaged in practice as a licensed dental assistant for at least three years, one of which must be within the three years immediately preceding the application, under a license in another state or territory of the United States or the District of Columbia. Practice in an accredited dental assisting program for the purpose of completing a postgraduate or residency program in dental assisting also serves as active practice toward meeting this requirement. 38-1127.01. Expanded function dental assistant; expanded function dental hygienist; display of permit. Every person who owns, operates, or controls a facility in which an expanded function dental assistant or an expanded function dental hygienist is practicing shall display the permit of such person issued by the board for expanded functions in a conspicuous place in such facility. 38-1135. Dental assistants, licensed dental assistants, and expanded function dental assistants; employment; duties performed; rules and regulations. (1) Any licensed dentist, public institution, or school may employ dental assistants, licensed dental assistants, and expanded function dental assistants. Such dental assistants, under the supervision of a licensed dentist, may perform such duties as are prescribed in the Dentistry Practice Act in accordance with rules and regulations adopted and promulgated by the department, with the recommendation of the board. (2) The department, with the recommendation of the board, shall adopt and promulgate rules and regulations pursuant to section 38-126 governing the performance of duties by dental assistants, licensed dental assistants, and expanded function dental assistants. The rules and regulations shall include the degree of supervision which must be provided by a licensed dentist and the education and proof of competency requirements that must be met for any procedures performed by a dental assistant, a licensed dental assistant, or an expanded function dental assistant. (3) A dental assistant may perform duties delegated by a licensed dentist for the purpose of assisting the licensed dentist in the performance of the dentistâ&#x20AC;&#x2122;s clinical and clinical-related duties as allowed in the rules and regulations adopted and promulgated under the Dentistry Practice Act. (4) Under the indirect supervision of a licensed dentist, a dental assistant may (a) monitor nitrous oxide if the dental assistant has current and valid certification for cardiopulmonary resuscitation approved by the board and (b)Â place topical local anesthesia. (5) Upon completion of education and testing approved by the board, a dental assistant may: (a) Take X-rays under the general supervision of a licensed dentist; and (b) Perform coronal polishing under the indirect supervision of a licensed dentist. (6) A licensed dental assistant may perform all procedures authorized for a dental assistant. Upon completion of education and testing approved by the board and with a permit from the department for the respective competency, a licensed dental assistant may, under the indirect supervision of a licensed dentist, (a) take dental 300

Nebraska State Dental Practice Act and Administrative Rules for Dental Assistants impressions for fixed prostheses, (b) take dental impressions and make minor adjustments for removable prostheses, (c) cement prefabricated fixed prostheses on primary teeth, and (d) monitor and administer nitrous oxide analgesia. (7) Upon completion of education and testing approved by the board and with a permit from the department for the respective competency, an expanded function dental assistant may, under the indirect supervision of a licensed dentist, place (a) restorative level one simple restorations (one surface) and (b) restorative level two complex restorations (multiple surfaces). (8) A dental assistant may be a graduate of an accredited dental assisting program or may be trained on the job. (9) No person shall practice as a licensed dental assistant in this state unless he or she holds a license as a licensed dental assistant under the Dentistry Practice Act. (10) No person shall practice as an expanded function dental assistant in this state unless he or she holds a permit as an expanded function dental assistant under the act. (11) A licensed dentist shall only delegate duties to a dental assistant, a licensed dental assistant, or an expanded function dental assistant in accordance with rules and regulations adopted and promulgated pursuant to the Dentistry Practice Act. The licensed dentist supervising a dental assistant, a licensed dental assistant, or an expanded function dental assistant shall be responsible for patient care for each patient regardless of whether the patient care is rendered personally by the dentist or by a dental assistant, a licensed dental assistant, or an expanded function dental assistant. 38-1136.01. Licensed dental assistant; additional functions, procedures, and services. The department, with the recommendation of the board, may, by rule and regulation, prescribe functions, procedures, and services in addition to those in section 38-1135 which may be performed by a licensed dental assistant under the supervision of a licensed dentist when intended to attain or maintain optimal oral health. 38-1142. Presence of licensed dental hygienist or dental assistant required. General anesthesia, deep sedation, moderate sedation, and minimal sedation shall not be administered by a dentist without the presence and assistance of a licensed dental hygienist or a dental assistant. 38-1143. Assistant; certification required. Any person who assists a dentist in the administration of general anesthesia, deep sedation, moderate sedation, or minimal sedation shall be currently certified in basic life-support skills or the equivalent thereof.

Note: The following sections of the Nebraska Administrative Code are current at the time of publication; however, the Nebraska Board of Dentistry is in the process of significantly revising these rules to implement a new law affecting dental assistants that passed in the 2017 legislative session. Please contact the Nebraska Board of Dentistry with any questions about the practice of dental assisting in Nebraska under the new law (see contact information on page 297).

TITLE 172 NEBRASKA ADMINISTRATIVE CODE Chapter 53 RULES AND REGULATIONS GOVERNING THE PERFORMANCE OF DUTIES BY LICENSED DENTAL HYGIENISTS AND OTHER DENTAL AUXILIARIES 001 DEFINITIONS. As used in these Rules and Regulations unless the context otherwise requires: 001.01 Board shall mean the Board of Examiners in Dentistry of the State of Nebraska. 001.02 Dental hygienist shall mean a dental auxiliary who is licensed by the Department of Health to perform, under the supervision of a licensed dentist, the scaling and polishing of teeth in the oral prophylaxis procedures prescribed in these rules and regulations. 001.03 Department shall mean the Department of Health of the State of Nebraska. 001.04 Other dental auxiliary shall mean any person who assists a licensed dentist in carrying out the basic duties of a dental office but who is not licensed as a dental hygienist. 001.05 General supervision shall mean the directing of the authorized activities of a dental hygienist or other dental auxiliary by a licensed dentist and shall not be construed to require the physical presence of the supervisor when directing such activities. 001.06 Indirect supervision shall mean supervision when the licensed dentist authorizes the procedure to be performed by a dental hygienist or dental auxiliary and the licensed dentist is physically present on the premises when such procedure is being performed by the dental auxiliary. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

301

Nebraska State Dental Practice Act and Administrative Rules for Dental Assistants 002 SCOPE OF PRACTICE OF DENTAL HYGIENE. 002.02 Other Prohibited Services. A licensed dental hygienist or any other dental auxiliary, under no circumstances, is ever authorized to perform, whether under the supervision of a licensed dentist or not, the following clinical services: 002.02A Diagnosis and treatment planning. 002.02B Surgery on hard or soft tissue. 002.02C Administering of local or general anesthetics. 002.02D Any other irreversible dental procedure or procedures which require the professional judgement and skill of a licensed dentist. 002.03 Prohibited Services. Except in accredited colleges of dentistry, licensed dental hygienists and other dental auxiliaries are prohibited from performing the following clinical services: 002.03A Any intra-oral procedure which would lead to the fabrication of any prosthesis. 002.03B Placing or contouring of a final restoration. 003 SCOPE OF PRACTICE OF DENTAL AUXILIARIES. 003.01 Authorized Services. A licensed dentist is authorized to delegate to a dental auxiliary, other than a dental hygienist, only those procedures for which the dentist exercises supervision, for which he assumes full responsibility and which do not conflict with these regulations. The phrase “other than a dental hygienist” is used in this section of Subsection 003 to specifically differentiate between “dental hygienist” and any other dental auxiliary, and for no other purpose. 003.02 Prohibited Services. Other dental auxiliaries are not authorized to perform any of the clinical services which may be performed by a licensed dental hygienist pursuant to Subsections 002.01A and 002.01C or any of the clinical services which are prohibited to dental auxiliaries pursuant to Subsection 002.03. 004 DENTAL ROENTGENOGRAMS. Any licensed dental hygienist, by virtue of training and professional ability, is hereby authorized, under the supervision of a licensed dentist, to take dental roentgenograms. Any other dental auxiliary is hereby authorized under the supervision of a licensed dentist to take dental roentgenograms, but they shall not be authorized to do so, on or after January 1, 1973, unless they have satisfactorily completed a course in dental radiology approved by the Board and the Department. 005 CORONAL POLISHING. A dental auxiliary is hereby authorized, under the indirect supervision of a licensed dentist, to polish all exposed tooth surfaces with a rubber cup or brush driven by a conventional slow-speed hand piece, but they shall not be authorized to do so on or after January 1, 1997, unless they have met the following requirements: 005.01 Attained the age of eighteen (18); and 005.02 One of the following: 005.02A Have graduated from a dental assisting training program which is accredited by the American Dental Association (ADA) and includes a coronal polishing course; or 005.02B Have one (1) year (a minimum of 1500 hours) of clinical work experience as a dental assistant and have successfully completed a course in polishing procedures which is approved by the Board and Department. 005.03 Criteria for Approval of a Course on Polishing Procedures for Dental Assistants. 005.03A The institution administering the course on coronal polishing must be accredited by the American Dental Association; 005.03B The course must have a minimum of fourteen (14) contact hours of instruction to include ten (10) hours of didactic instruction and four (4) hours of clinical participation; 005.03C The didactic course content must include, but not be limited to, instruction in dental anatomy and physiology of the hard and soft tissues of the deciduous and permanent oral facial complex, the correct management of the hard and soft tissues during coronal polishing procedures, demonstration of appropriate patient and operator positions, instruction in universal precautions and infection control, laboratory exercises utilizing manikins or extracted teeth, indications and contraindications for coronal polishing, armamentarium, and principles of polishing agents; 005.03D The clinical course content must include, but not be limited to, four (4) contact hours of rotary coronal polishing on a minimum of two (2) patients; 005.03E The course shall include written and clinical examinations for the purpose of determining competency of the dental assistant, demonstrating the necessary skills and proficiency to perform coronal polishing; and 005.03F Upon successful completion of the course, the sponsoring institution will provide the attendee with written verification of competency. 006 VIOLATIONS. Any violation of these Rules and Regulations by a licensed dentist or by a licensed dental hygienist shall be considered “unprofessional conduct” and due cause for revocation or suspension of a license to practice dentistry or dental hygiene.

302

Nevada DANB Certificant Counts: Nevada Certified Dental Assistant (CDA) certificants

137

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Frank DiMaggio, Executive Director Nevada State Board of Dental Examiners 6010 S. Rainbow Blvd., Suite A-1 Las Vegas, NV 89118 Phone (local): 702-486-7044 Phone (toll-free): 1-800-DDS-EXAM (1-800-337-3926) Fax: 702-486-7046 Email: nsbde@nsbde.nv.gov Website: dental.nv.gov

Radiation Health and Safety (RHS)

564

Infection Control (ICE)

545

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs College of Southern Nevada Truckee Meadows Community College

DANB CDA Certificant State of Nevada+

$22.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 30, 2020.

Source: 2018 DANB Salary Survey (state data based on 5 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

303

Nevada State Radiography Requirements The Nevada State Board of Dental Examiners does not license dental assistants in radiation health, safety, and administration. Rather, each licensed dentist must, with his or her application for license renewal, include a certified statement containing the name and position of each dental assistant who assists in radiographic procedures, the date each dental assistant began to assist in radiographic procedures, and a statement attesting that each such dental assistant is qualified to operate radiographic equipment and has received all of the following: (1) Adequate instruction in radiographic procedures, AND (2) Training in CPR at least every two years while employed, AND (3) A minimum of four hours of continuing education in infection control every two years while employed, AND (4) Before commencing performance of radiographic procedures, a copy of the Nevada statutes and regulations governing dentistry.

State Requirements For Expanded Functions There is no designation for expanded function dental assistants in Nevada. A licensed dentist who owns a dental office or treatment facility must, on his or her application for license renewal, list the name and address of each dental assistant who assists in procedures for infection control, the date the dental assistant began to assist in infection control procedures, and a statement that each employee listed has received adequate instruction in infection control and is qualified to operate sterilization and other equipment, and to perform all other applicable activities, in compliance with CDC guidelines.

Nevada State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Nevada State Board of Dental Examiners Nevada Revised Statutes Chapter 631- Dentistry and Dental Hygiene NRS 631.005 Definitions. As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 631.015 to 631.105, inclusive, and section 20 of this act, have the meanings ascribed to them in those sections. NRS 631.078 “Minimal sedation” means a minimally depressed level of consciousness, produced by a pharmacologic or nonpharmacologic method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command, and during which cognitive function and coordination may be modestly impaired, but ventilatory and cardiovascular functions are unaffected. NRS 631.025 “Moderate sedation” defined. “Moderate sedation” means a drug-inducted depressed level of consciousness, produced by a pharmacologic or nonpharmacologic method or a combination thereof, during which: 1. The patient retains the ability to respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation; 2. Spontaneous ventilation is adequate and no interventions are required to maintain a patent airway; and 3. Cardiovascular function is usually maintained. NRS 631.027 “Deep sedation” defined. “Deep sedation” means a controlled state of depressed consciousness, produced by a pharmacologic or nonpharmacologic method or a combination thereof, and accompanied by a partial loss of protective reflexes and the inability to respond purposefully to verbal commands. NRS 631.055 “General anesthesia” defined. “General anesthesia” means a controlled state of unconsciousness, produced by a pharmacologic or nonpharmacologic method or a combination thereof, and accompanied by partial or complete loss of protective reflexes and the inability independently to maintain an airway and respond purposefully to physical stimulation or verbal commands. NRS 631.105 “Supervision by a dentist” defined. “Supervision by a dentist” means that a dentist is: 1. Physically present in the office where the procedures to be supervised are being performed, while these procedures are being performed; and 2. Capable of responding immediately if any emergency should arise. NRS 631.215 Persons deemed to be practicing dentistry; regulations regarding clinical practice of dentistry. 2. Nothing in this section: (a) Prevents a dental assistant, dental hygienist, dental therapist or qualified technician from making radiograms or X-ray exposures for dental treatment or dental diagnostic purposes upon the direction of a licensed dentist. NRS 631.313 Assignment of dental hygienist or dental assistant to perform intraoral tasks under supervision of dentist; exception; administration of local anesthesia or nitrous oxide by dental hygienist. 1. Except as otherwise provided in NRS 454.217 and 629.086, a licensed dentist may assign to a person in his or her employ who is a dental hygienist, dental therapist, dental assistant or other person directly or indirectly involved in 304

Nevada State Dental Practice Act and Administrative Rules for Dental Assistants

the provision of dental care only such intraoral tasks as may be permitted by a regulation of the Board or by the provisions of this chapter. The performance of these tasks must be: (a) If performed by a dental assistant or a person, other than a dental therapist or dental hygienist, who is directly or indirectly involved in the provision of dental care, under the supervision of the licensed dentist who made the assignment. No such assignment is permitted that requires: (a) The diagnosis, treatment planning, prescribing of drugs or medicaments, or authorizing the use of restorative, prosthodontic or orthodontic appliances. (b) Surgery on hard or soft tissues within the oral cavity or any other intraoral procedure that may contribute to or result in an irremediable alteration of the oral anatomy. (c) The administration of general anesthesia, minimal sedation, moderate sedation or deep sedation except as otherwise authorized by regulations adopted by the Board. (d) The performance of a task outside the authorized scope of practice of the employee who is being assigned the task.

NRS 631.3124 Dental therapists: Authorized services; referral of patient to authorizing dentist for certain purposes; supervision of dental assistants and dental hygienists. 3. A dental therapist may supervise dental assistants and dental hygienists to the extent permitted in a written practice agreement. Nevada Administrative Code Chapter 631- Dentistry and Dental Hygiene NAC 631.045 Renewal of license: Certified statement required. (NRS 631.190) A licensed dentist who owns an office or facility where dental treatments are to be performed in this State must, on the application for renewal of his or her license, execute a certified statement that includes: 1. The location of each office or facility owned by the licensed dentist where dental treatments are to be performed; 2. The name and address of each employee, other than a licensed dentist or dental hygienist, who assists at the office or facility in procedures for infection control and the date the employee began to assist in procedures for infection control at the office or facility; 3. A statement that each employee identified in subsection 2: (a) Has received adequate instruction concerning procedures for infection control; and (b) Is qualified to: (1) Operate sterilization equipment and other equipment in compliance with the guidelines adopted by reference in NAC 631.178; and (2) Perform all other applicable activities in compliance with the guidelines adopted by reference in NAC 631.178; and 4. If the licensed dentist is registered to dispense controlled substances with the State Board of Pharmacy pursuant to chapter 453 of NRS, an attestation that the licensed dentist has conducted annually a minimum of one self-query regarding the issuance of controlled substances through the Prescription Monitoring Program of the State Board of Pharmacy. NAC 631.178 Adoption by reference of certain guidelines; compliance with guidelines required. (NRS 631.190) 1. Each person who is licensed pursuant to the provisions of chapter 631 of NRS shall comply with: (a) The provisions of the Guidelines for Infection Control in Dental Health-Care Settings-2003 adopted by the Centers for Disease Control and Prevention which is hereby adopted by reference. The publication is available, free of charge, from the Centers for Disease Control and Prevention at the Internet address http://www.cdc.gov/ mmwr/preview/mmwrhtml/rr5217a1.htm; and (b) As applicable to the practice of dentistry, the provisions of the Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, adopted by the Centers for Disease Control and Prevention which is hereby adopted by reference. The publication is available, free of charge, from the Centers for Disease Control and Prevention at the Internet address http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Disinfection_Nov_2008.pdf. 2. The Board will periodically review the guidelines adopted by reference in this section and determine within 30 days after the review whether any change made to the guidelines is appropriate for application in this State. If the Board does not disapprove a change to the guidelines within 30 days after the review, the change is deemed to be approved by the Board. NAC 631.220 Dental assistants; authorization to perform certain services; supervision by dental hygienist for certain purposes 1. A dentist who is licensed in the State of Nevada may authorize a dental assistant in his or her employ and under his or her supervision only to do one or more of the following procedures before the patient is examined by the dentist: ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

305

Nevada State Dental Practice Act and Administrative Rules for Dental Assistants

(a) Expose radiographs; and (b) Take impressions for the preparation of diagnostic models A dentist who is licensed in the State of Nevada may authorize a dental assistant in his or her employ and under his or her supervision only to do one or more of the following procedures after the patient has been examined by the dentist: (a) Retract a patient’s cheek, tongue or other tissue during a dental operation. (b) Remove the debris which normally accumulates during or after a cleaning or operation by the dentist by using mouthwash, water, compressed air or suction. (c) Place or remove a rubber dam and accessories used for its placement. (d) Place and secure an orthodontic ligature. (e) Remove sutures. (f) Place and remove a periodontal pack. (g) Remove excess cement from cemented restorations and orthodontic appliances. A dental assistant may not use a rotary cutting instrument to remove excess cement from restorations or orthodontic appliances. (h) Administer a topical anesthetic in any form except aerosol. (i) Train and instruct persons in the techniques of oral hygiene and preventive procedures. (j) Take the following types of impressions: (1) Those used for the preparation of counter or opposing models; (2) Those used for the fabrication of temporary crowns or bridges; and (3) Those used for the fabrication of temporary removable appliances, provided no missing teeth are replaced by those appliances. (k) Fabricate and place temporary crowns and bridges. This procedure must be checked and approved by the supervising dentist before dismissal of the patient from the office of the dentist. (l) Retract gingival tissue if the retraction cord contains no medicaments that have potential systemic side effects. (m) Remove soft plaque and stain from exposed tooth surfaces, utilizing an appropriate rotary instrument with a rubber cup or brush and a suitable polishing agent. A licensed dentist or dental hygienist shall determine that the teeth to be polished are free of calculus or other extraneous material. (n) Administer a topical fluoride. (o) Apply pit and fissure sealant to the dentition for the prevention of decay. This procedure must be checked and approved by the supervising dentist before dismissal of the patient from the office of the dentist. (p) Fit orthodontic bands and prepare teeth for orthodontic bands if the bands are cemented or bonded, or both, into the patient’s mouth by the dentist who authorized the dental assistant to perform this procedure. A dentist who is licensed in the State of Nevada may authorize a dental hygienist to supervise a dental assistant in the assistance of the hygienist’s performance of one or more of the following: (a) Retract a patient’s cheek, tongue or other tissue during a dental operation. (b) Remove the debris that normally accumulates during or after a cleaning or operation by the dental hygienist by using mouthwash, water, compressed air or suction. (c) Train and instruct persons in the techniques of oral hygiene and preventive procedures. (d) Remove soft plaque and stain from exposed tooth surfaces, utilizing an appropriate rotary instrument with a rubber cup or brush and a suitable polishing agent. A licensed dentist or dental hygienist shall determine that the teeth to be polished are free of calculus or other extraneous material. (e) Administer a topical fluoride. A dental hygienist, who is authorized by the Board to perform the services described in subsection 6 of NAC 631.210, may authorize a dental assistant under his supervision to assist the hygienist in the performance of the services described in paragraphs (a) to (e), inclusive, of subsection 3.

NAC 631.2239 Properly equipped facility required; qualifications of auxiliary personnel. (NRS 631.190, 631.265) 1. A dentist using general anesthesia, deep sedation or moderate sedation shall maintain a properly equipped facility for the administration of the anesthesia or sedation which is staffed with supervised auxiliary personnel who are capable of reasonably handling procedures, problems and emergencies incident thereto. 2. A dentist using general anesthesia, deep sedation or moderate sedation shall ensure that his auxiliary personnel are certified in basic cardiopulmonary resuscitation by the American Heart Association or a course providing similar instruction approved by the Board. NAC 631.260 Radiographic procedures: Lead apron required; certified statement and proof of qualifications required for certain persons who assist in procedures. (NRS 631.190) 1. Each patient who is undergoing a radiographic procedure must be covered with a lead apron. 2. Each licensee who employs any person, other than a dental hygienist, to assist him or her in radiographic procedures shall include with his or her application for renewal of his or her license a certified statement: (a) Containing the name of each person so employed, his or her position and that date he or she began to assist the licensee in radiographic procedures; and 306

Nevada State Dental Practice Act and Administrative Rules for Dental Assistants (b) Attesting that each such employee has received: (1) Adequate instruction concerning radiographic procedures and is qualified to operate radiographic equipment as required pursuant to subsection 3 of NAC 459.552; (2) Training in cardiopulmonary resuscitation at least every 2 years while so employed; (3) A minimum of 4 hours of continuing education in infection control every 2 years while so employed; and (4) Before beginning such employment, a copy of this chapter and chapter 631 of NRS in paper of electronic format.

307

New Hampshire DANB Certificant Counts: New Hampshire Certified Dental Assistant (CDA) certificants

523

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Christine Senko, Administrator New Hampshire Board of Dental Examiners NH Office of Professional Licensure and Certification 121 South Fruit Street, Suite 302 Concord, NH 03301-2412 Phone: 603-271-4561 Fax: 603-271-6702 Website: www.oplc.nh.gov/dental Email: dental.board@oplc.nh.gov

Radiation Health and Safety (RHS)

2,029

Infection Control (ICE)

1,174

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs NHTI, Concord’s Community College

DANB CDA Certificant State of New Hampshire+

$23.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of May 19, 2020.

308

Source: 2018 DANB Salary Survey (state data based on 18 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

New Hampshire State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist in New Hampshire, one must: (1) Be 18 years of age or older AND (2a) Be a Graduate Dental Assistant or hold DANB Certified Dental Assistant (CDA) certification or (2b) Complete 200 hours of experience in clinical dental assisting and pass an introduction to dental assisting course and qualify in infection control (see requirements below) AND (3) Successfully complete an expanded duty course in dental radiology meeting requirements established by rule of the New Hampshire Board of Dental Examiners (NHBDE), with a minimum of eight lecture hours and eight laboratory hours AND (5) Pass the national DANB Radiation Health and Safety (RHS) exam. See administrative rule Den 302.06(h)-(j) for complete details.

State Requirements For Expanded Functions New Hampshire allows dental assistants who hold the national DANB Certified Dental Assistant (CDA) certification or are Graduate Dental Assistants to perform specified duties (for some functions, CDA certificants must also have 400 hours of clinical dental assisting experience before performing the function). Dental assistants in New Hampshire can earn status as a Graduate Dental Assistant by graduating from a CODA-accredited program of dental assisting. The following table summarizes requirements for Graduate Dental Assistants, for holders of DANB CDA certification and for Traditional Dental Assistants to qualify to perform the expanded dental assistant functions permitted under New Hampshire regulations. All dental assistants performing expanded functions must be at least 18 years of age. Summary of Expanded Functions Summary of Expanded Functions Requirements for Traditional Requirements for Graduate Dental Assistants Dental Assistants or for Holders of DANB CDA Certification Introduction to Dental Assisting

For more detailed information, see New Hampshire administrative rule Den 302.06(e)-(f) on page 313. • No further requirements beyond those to earn • Have at least 200 hours of clinical dental assisting experience prior to status as a Graduate Dental Assistant or to hold course AND DANB CDA certification • Successfully complete a course and exam in Introduction to Dental Assisting meeting requirements established by rule of the NHBDE

Function: Infection control in the dental office

For more detailed information, see New Hampshire administrative rule Den 302.06(b) on page 313. • No further requirements beyond those to earn • Successfully complete a NHBDE-approved course and exam in infection status as a Graduate Dental Assistant or to hold control DANB CDA certification (Note: The DALE Foundation's DANB ICE Review course meets this requirement. Successful performance on DANB's Infection Control exam [ICE] also meets this requirement.)

Function: Provisional crown and bridge restorations

For more detailed information, see New Hampshire administrative rule Den 302.06(k)-(m) on page 314. • Successfully complete a course and exam in • Have at least 200 hours of clinical dental assisting experience prior to provisional crown and bridge restorations meeting course, AND requirements established by rule of the NHBDE • Meet Introduction to Dental Assisting course requirements (see requirements above), AND

• Qualify in infection control (see requirements above), AND • Successfully complete a course and exam in provisional crown and bridge restorations meeting requirements established by rule of the NHBDE

Function: Orthodontic duties

For more detailed information, see New Hampshire administrative rule Den 302.06(n)-(p) on page 314. • Successfully complete a course and exam in orth- • Have at least 200 hours of clinical dental assisting experience prior to odontic duties meeting requirements established course, AND by rule of the NHBDE • Meet Introduction to Dental Assisting course requirements (see requirements above), AND

• Qualify in infection control (see requirements above), AND • Successfully complete a course and exam in orthodontic duties meeting requirements established by rule of the NHBDE

309

State Requirements For Expanded Functions Summary of Expanded Functions Summary of Expanded Functions Requirements for Traditional Requirements for Graduate Dental Assistants Dental Assistants or for Holders of DANB CDA Certification Function: Dental sealants

For more detailed information, see New Hampshire administrative rule Den 302.06(q)-(s) on page 314. • Successfully complete a course and exam in • Have at least 400 hours of clinical dental assisting experience prior to dental sealants meeting requirements established course, AND by rule of the NHBDE • Meet Introduction to Dental Assisting course requirements (see requirements on prior page), AND • Qualify in infection control (see requirements on prior page), AND • Successfully complete a NHBDE-approved course and exam in dental sealants

Function: Coronal polishing

For more detailed information, see New Hampshire administrative rule Den 302.06(t)-(v) beginning on page 314. • Successfully complete a course and exam in • Have at least 400 hours of clinical dental assisting experience, AND coronal polishing meeting requirements estab• Meet Introduction to Dental Assisting course requirements (see requirelished by rule of the NHBDE ments on prior page), AND • Qualify in infection control (see requirements on prior page), AND • Successfully complete a course and exam in coronal polishing meeting requirements established by rule of the NHBDE

Function: Monitoring nitrous oxide administration

For more detailed information, see New Hampshire administrative rule Den 302.06(w)-(y) on page 315. • Successfully complete a course and exam in • Hold DANB's CDA certification or have at least 400 hours of clinical nitrous oxide meeting requirements established dental assisting experience prior to course, AND by rule of the NHBDE, AND • Meet Introduction to Dental Assisting course requirements (see require• Be currently certified in BLS-HCP ments on prior page), AND • Qualify in infection control (see requirements on prior page), AND • Successfully complete a course and exam in monitoring the administration of nitrous oxide anesthesia meeting requirements established by rule of the NHBDE, AND • Be currently certified in BLS-HCP.

Function: In-office tooth whitening

For more detailed information, see New Hampshire administrative rule Den 302.06(z)-(ab) beginning on page 315. • Successfully complete a course and exam in • Have at least 400 hours of clinical dental assisting experience prior to in-office tooth whitening meeting requirements course, AND established by rule of the NHBDE • Meet Introduction to Dental Assisting course requirements (see requirements on prior page), AND • Qualify in infection control (see requirements on prior page), AND • Successfully complete a course and exam in in-office tooth whitening meeting requirements established by rule of the NHBDE

Function: Place, contour, and adjust direct restorative materials within the oral cavity

For more detailed information, see New Hampshire administrative rule Den 302.07 on page 316. Register as an Expanded Function Dental Auxiliary Register as an Expanded Function Dental Auxiliary (EFDA) after meeting (EFDA) after meeting the following requirements: the following requirements: • Have a minimum of 4,500 hours of dental clinical experience, AND • Obtain a recommendation for the EFDA course from a NH-licensed dentist; AND • Complete an EFDA course in dental restorations meeting requirements established by rule of the NHBDE; AND • Be currently certified in BLS-HCP; AND • Apply to the NHBDE for an EFDA permit (Note: A registered dental hygienist who meets the above requirements may also qualify as an EFDA.)

310

Hold current DANB certification, AND Be qualified to perform preliminary inspection of the oral cavity, AND Have a minimum of 4,500 hours of dental clinical experience; AND Obtain a recommendation for the EFDA course from a NH-licensed dentist; AND • Complete an EFDA course in dental restorations meeting requirements established by rule of the NHBDE; AND • Be currently certified in BLS-HCP; AND • Apply to the NHBDE for an EFDA permit • • • •

(Note: A dental auxiliary qualified in these restorative functions in another jurisdiction may qualify for endorsement by the Board by presenting written documentation of equivalent training and a letter from a supervising dentist attesting to experience with direct restorations within the previous two years.)

State Requirements For Public Health Supervision To perform specified duties under public health supervision to assist a Certified Public Health Dental Hygienist (CPHDH), a dental assistant must meet Introduction to Dental Assisting course requirements and qualify in infection control in the dental office (see requirements on page 309).

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants Note: The following pages contain excerpts of selected New Hampshire statutes and regulations and are intended to highlight those New Hampshire laws and rules that govern the practice of dental assisting. Statutes and regulations are current as of the date indicated on page 308, but are subject to change at any time; dental assistants and their employers are responsible for reading, understanding, and complying with all current statutory and regulatory requirements. For the full text of the current New Hampshire statutes and regulations governing dentistry, please go to http://www.oplc.nh.gov/dental and click “Laws and Rules.”

Dental Practice Act – New Hampshire Board of Dental Examiners New Hampshire Statutes CHAPTER 317-A DENTISTS AND DENTISTRY Dental Hygienist 317-A:12 Rulemaking Authority The board shall adopt rules, pursuant to RSA 541-A, relative to: XII-a. The use of general anesthesia, deep sedation, and moderate sedation, in dental treatment under RSA 317-A:20, including: XII-b. Procedures which may be assigned by a licensed dentist to dental hygienists, public health dental hygienists, dental assistants, and to persons not licensed to practice dentistry. Such rules shall include additional requirements regarding monitoring patients undergoing general anesthesia, deep sedation, moderate sedation, and subsequent recovery from anesthesia; (f) A requirement that a minimum of one staff member, in addition to the dentist, trained in the monitoring and resuscitation of pediatric patients shall be present; XII-d. Notwithstanding any other provision of law, rules, as the board deems necessary, relative to qualified dental assistants performing coronal polishing. Such rules shall not authorize a qualified dental assistant to perform a complete oral prophylaxis; XII-e. The requirements for a dental assistant or dental hygienist to be permitted to provide services as an expanded function dental auxiliary as provided in RSA 317-A:21-g; 317-A:21-g Expanded Function Dental Auxiliary. – I. A dental hygienist licensed under this chapter or a dental assistant may obtain a permit from the board to practice as an expanded function dental auxiliary by submitting an application to the board in writing and completing additional educational and training requirements as required in rules adopted by the board. II. An expanded function dental auxiliary shall work under the supervision of an actively licensed dentist. III. The board shall adopt rules under RSA 317-A:12, XII-d regarding application and permit requirements, educational requirements, level of supervision requirements, and scope of practice requirements relating to expanded function dental auxiliaries. 317-A:23 Non-practice. – I. None of the following procedures may be assigned to a dental hygienist or assistant or to any other person not licensed to practice dentistry: (a) Diagnosis, treatment planning and prescriptions (including prescriptions for drugs and medicaments or authorization for restorative, prosthodontic, or orthodontic appliances). (b) Surgical procedures on hard or soft tissues within the oral cavity; or any other inter-oral procedure that contributes to, or results in, an irremediable alteration of the oral anatomy. II. Under the public health supervision of an actively licensed dentist and in accordance with a written practice agreement, a certified public health dental hygienist may provide services pursuant to RSA 317-A:21-e, I for which certified public health dental hygienists have been trained and which have been authorized by a supervising dentist in writing. Services may be provided to an individual patient without the patient first seeing a dentist for an examination, diagnosis, and treatment planning if the supervising dentist has provided written general authorization and standing protocols for the certified public health dental hygienist.

311

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants Administrative Rules CHAPTER Den 100 ORGANIZATIONAL RULES PART Den 101 Definitions Den 101.03 “Board” means the New Hampshire board of dental examiners established pursuant to RSA 317-A:2. Den 101.05 "Certified dental assistant" means a dental assistant who holds current certified dental assistant certification from the Dental Assisting National Board (DANB). Den 101.07 “Dental assistant” means any person who assists the dentist in carrying out the clinical duties of a dental office. Den 101.11 "Direct supervision" means a dentist with an active license is in the dental office, authorizes the procedure and remains in the dental office while the procedures are being performed and evaluates the performance of the dental hygienist or dental assistant before dismissal of the patient. Den 101.13 "Graduate dental assistant" means a dental assistant who has graduated from a Commission on Dental Accreditation (CODA) accredited school of dental assisting. Den 101.14 "Indirect supervision" means a dentist with an active license is in the dental office, authorizes the procedures, and remains in the dental office while the procedures are being performed by the dental hygienist or dental assistant and evaluates the performance of the dental hygienist or dental assistant at a subsequent appointment. Den 101.25 "Qualified" means meeting the requirements of Den 302.05. Den 101.27 "Supervision" means oversight by a dentist of the performance of duties authorized by the board to dental hygienists and dental assistants. Den 101.29 "Traditional Dental Assistant" means a dental assistant who is neither a certified dental assistant nor a graduate dental assistant. CHAPTER Den 300 LICENSING REQUIREMENTS PART Den 301 APPLICATION PROCEDURE Den 301.08 Board Fees. The board of dental examiners shall establish the following fees cited in Table 3.1.1 below: Table 3.1.1 Fees Type of Fee

Fee

Expanded Function Dental Auxiliary (EFDA) Application and certificate for EFDA

25.00

PART Den 302 Qualifications and Supervision Den 302.02 Supervision (a) "Direct supervision" means a dentist with an active license is in the dental office, authorizes the procedure, and remains in the dental office while the procedures are being performed, and evaluates the performance of the dental hygienist or dental assistant before dismissal of the patient. (b) "Indirect supervision" means a dentist with an active license is in the dental office, authorizes the procedures, and remains in the dental office while the procedures are being performed by the dental hygienist or dental assistant, and evaluates the performance of the dental hygienist or dental assistant at a subsequent appointment. (c) "General supervision" means a dentist with an active license has authorized the procedures, and the procedures are being carried out in accordance with the dentist’s diagnosis and treatment plan, and the procedures will be personally evaluated and reviewed by the dentist with the patient at least once in a 12 month period. (d) “Public health supervision” means a dentist with an active license authorizes procedures which are to be carried out by: (1) A dental hygienist with an active license practicing in a school, hospital or other institution, or for a homebound person without the dentist having to be present, provided the dentist has reviewed the records once in a 12 month period; or (2) A dental assistant in a school, hospital or other institution, or for a homebound person who shall be supervised by a CPHDH as set forth in Den 401.01 (d). (e) For purposes of (c) above, at the time the procedures performed under general supervision are evaluated, dentists shall use their professional judgment to determine whether a more extensive oral examination is appropriate. 312

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants Den 302.06 Dental Assistant Qualification in Specific Area. (a) Any dental assistant who is 18 years of age or older shall be considered qualified in a specific area if he or she has successfully completed an expanded duty course, or successfully challenged an examination in same, or both, as stated in Den 302.06 (a) through (ac). A course or exam given by an entity other than the board itself shall include the passing grade or other standard for successful completion of said course or exam set by the entity giving said course or exam. Course records, pursuant to Den 403.06, and a certificate of course completion shall be retained by the course participant and provided to the board upon request by the board. Traditional dental assistants, before qualifying in any other area addressed in Den 302.06, shall have taken and passed an introduction to dental assisting course and qualify for infection control in the dental office as stated in Den 302.06(b)(1)c. (b) Traditional dental assistants shall qualify in infection control in the dental office after successfully completing a course in the topic, as follows: (1) The expanded duty course shall: a. Be offered by a course provider as defined in Den 403.07(a)(1); b. Be a minimum of 4 hours; c. Pursuant to RSA 317-A:17, II(g), follow the current Centers for Disease Control "Infection Control Recommendations for the Dental Office and the Dental Laboratory"; and d. Require the passing of a written exam administered by the continuing education provider; and (2) Written evidence certifying that the infection control course has been successfully completed shall be signed by the course provider and given to the dental assistant. (c) Any dental assistant may petition the board for approval of an expanded duty course or equivalent training course. The petition shall include all information that the petitioner wishes the board to consider in evaluating the proposed course, such as the entity giving the course, an outline of the topics to be covered, the number of hours of lectures and hours of practical experience and the textbooks to be used. The board shall, within 60 days of receipt of such petition, send written notice of approval or a written request for further information from the petitioner. (d) No dental assistant shall be considered qualified prior to the date that he or she is officially informed by the course or examination provider that he or she has successfully completed an expanded duty course approved by the board. (e) A traditional dental assistant shall have 200 hours of experience in clinical dental assisting in order to qualify to take a course in introduction to dental assisting, which course shall be a prerequisite to any other expanded duty course described in this section. (f) Any introduction to dental assisting course shall: (1) Be offered by a course provider as defined in Den 403.07(a)(1); (2) Be a minimum of 6 hours; (3) Contain at least the following subjects: a. The taking of medical and dental histories; b. Obtaining and reading vital signs; c. Oral and dental anatomy; d. Charting existing restorations and teeth; e. Inspection of the oral cavity; and f. The Health Insurance Portability and Accountability Act of 1996 (HIPAA): (4) Require the passing of a written examination administered by the continuing education provider; and (5) Provide to the dental assistant written evidence certifying that the course has been successfully completed, which is signed by the course provider. (g) Any dental assistant who successfully completes the introduction to dental assisting course shall be qualified to perform those duties set forth in Den 401.01 and Den 401.02. (h) Any traditional dental assistant shall have 200 hours of experience in clinical dental assisting in order to qualify to take a radiology course. (i) Any dental assistant shall be considered qualified in dental radiology after successfully completing an expanded duty course in dental radiology which: (1) Is offered by a continuing education provider as specified in Den 403.07(a)(1); (2) Is a minimum of 8 lecture hours, which may be taken online, and 8 laboratory hours; (3) Includes at least the following: a. Asepsis, radiation safety; b. Parallel and bi-secting techniques; c. Full mouth projections, panoramic projections, projections, and extra-oral projections; d. Dark room procedures; e. Radiographic landmarks, interpretation, and mounting; and f. Passing the radiology written examination of the Dental Assisting National Board, provided that dental assistants who have been practicing since before December 9, 1998 shall be exempt from taking and passing the DANB exam; and g. Passing of a written exam administered by the continuing education provider; and (4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

313

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants (j) The duty of dental radiology shall be performed only under the direct supervision of a licensed dentist. (k) Any traditional dental assistant shall have 200 hours experience in clinical dental assisting in order to qualify to take a course in provisional crown and bridge restorations. (l) Any dental assistant shall be considered qualified in provisional crown and bridge restorations after successfully completing an expanded duty course in provisional crown and bridge restorations which: (1) Is offered by a continuing education provider as defined in Den 403.07(a)(1); (2) Is a minimum of 8 hours; (3) Includes at least the following: a. Provisional restoration anatomy; b. Occlusal requirements; c. Cementation; and d. Passing of a written exam administered by the continuing education provider; and (4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. (m) The duty of provisional crown and bridge restorations shall be performed with the following conditions: (1) A dental assistant qualified in provisional crown and bridge restorations shall perform this service only under the direct supervision of a licensed dentist; (2) The provisional restoration may be fabricated intraorally, however all occlusal adjustments and modifications shall be completed extraorally; (3) The completed provisional restoration shall be examined by the dentist prior to cementation by a qualified dental assistant. (n) Any traditional dental assistant shall have at least 200 hours of experience in clinical dental assisting in order to qualify to take a course in orthodontics. (o) Any traditional dental assistant shall be considered qualified in orthodontic duties after successfully completing an expanded duty course in orthodontic duties which: (1) Is offered by a continuing education provider as defined in Den 403.07(a)(1); (2) Is a minimum of 8 hours; (3) Includes at least the following: a. Placement and removal of orthodontic separators; b. Preparation of teeth for bonding of brackets; c. Removal of orthodontic bands or brackets; d. Trial fitting of orthodontic bands; e. Using hand instruments to remove excess cement from bands on the coronal surfaces of the teeth; f. Trial fitting of head gear; g. Simple emergency adjustment of orthodontic appliances to relieve pain; h. Taking impressions for orthodontic appliances; i. Attachment or tying in and removal of orthodontic wires; j. Bending arch wires; and k. Passing of a written exam administered by the continuing education provider; and (4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. (p) If qualification in orthodontics is determined, the duty shall be only be performed under the direct supervision of a licensed dentist. (q) Any traditional dental assistant shall have 400 hours experience in clinical dental assisting in order to qualify to take a sealants course. (r) Any traditional dental assistant shall be considered qualified in dental sealants after successfully completing an expanded duty course in dental sealants which: (1) Is offered by a continuing education provider as specified in Den 403.07(a)(1); (2) Is a minimum of 8 hours; (3) Includes at least the following: a. Use of chemical and light cured sealants; b. Proper techniques of applying sealants; c. Isolation techniques; d. Practice in applying sealants in a laboratory setting; e. Application of sealants on an actual patient in a clinical setting; and f. Passing an exam administered by the continuing education provider; and (4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. (s) The duty of dental sealants shall only be performed under the direct supervision of a licensed dentist. (t) Traditional dental assistants shall have experience consisting of at least 400 hours in clinical dental assisting in order to qualify to take a course in coronal polishing. 314

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants (u) Any dental assistant other than a graduate dental assistant shall be considered qualified in coronal polishing after meeting the eligibility requirements and successfully completing an expanded duty course in coronal polishing which: (1) Is offered by a continuing education provider as set forth in Den 403.07(a); (2) Is a minimum of 8 hours; and (3) Includes at least the following subjects: a. Handpiece maintenance and sterilization; b. Polishing agents; c. Polishing techniques; d. Infection control; e. Medical and dental history indications and contraindications; f. Hands-on polishing in a clinical setting: and g. Passing of a written examination administered by the continuing education provider; and (4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. (v) The duty of coronal polishing shall be performed with the following conditions: (1) Coronal polishing by dental assistants shall be accomplished by a combination of a slow speed handpiece, not to exceed 10,000 rpm, and appropriate polishing agents with a rubber cup or bristle brush; (2) Coronal polishing shall be accomplished by dental assistants only after a dentist or dental hygienist has determined that the teeth are free of calculus; (3) A dental assistant qualified in coronal polishing shall perform this service only under the direct supervision of a licensed dentist or dental hygienist; and (4) Coronal polishing shall in no way be represented as a prophylaxis unless a dentist or dental hygienist has determined the teeth are free of calculus immediately prior to the polishing. (w) Any traditional dental assistant shall have 400 hours experience in clinical dental assisting prior to taking an expanded duty course in monitoring the administration of nitrous oxide anesthesia. (x) Any traditional dental assistant shall be considered qualified to monitor the administration of nitrous oxide (N2O) to patients after successfully completing an expanded duty course in monitoring the administration of nitrous oxide which: (1) Is offered by a course provider as defined in Den 403.07(a)(1); (2) Is a minimum of 6 hours; (3) Includes at least the following: a. Aspects of pain and anxiety; b. Anatomy and physiology of respiration; c. Stages of drug induced central nervous system depression; d. Pharmacology and physiological effects of nitrous oxide; e. Advantages and disadvantages of inhalation sedation using nitrous oxide; f. Medical assessment of patient prior to using nitrous oxide; and g. Proper administration of nitrous oxide to include: 1. Description and use of inhalation equipment; 2. Patient monitoring; 3. Possible reactions of patients under nitrous oxide; 4. Hazards of nitrous oxide for patients and operator; and 5. Management of complications; (4) Requires the passing of a written examination administered by the continuing education provider; (5) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. (y) If qualification in monitoring the administration of nitrous oxide is determined, the duty shall be performed with the following conditions: (1) A dental assistant qualified in the monitoring of nitrous oxide shall monitor nitrous oxide only under the direct supervision of a dentist; (2) A dental assistant qualified to monitor the administration of nitrous oxide shall monitor only after a dentist has initiated the administration and brought the patient to the intended level of nitrous oxide inhalation sedation; and (3) A dental assistant qualified to monitor the administration of nitrous oxide shall be currently certified in BLS-HCP; and (4) A dental assistant who has qualified to monitor nitrous oxide in another jurisdiction shall qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (x) above and a letter from a supervising dentist attesting to the assistant's experience monitoring nitrous oxide within the previous 2 years. (z) Any traditional dental assistant shall have at least 400 hours in clinical dental assisting in order to qualify to take a course in office whitening. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

315

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants (aa) A dental assistant shall be qualified to perform in-office tooth whitening after successfully completing an expanded duty course in in-office tooth whitening which: (1) Is offered by a course provider as defined in Den 403.07(a)(1); (2) Is a minimum of 4 hours; (3) Includes at least the following; a. An overview of prescription and non-prescription whitening systems; b. Mechanisms of action; c. Treatment methods; and d. Safety considerations, including: 1. Contraindications; and 2. Side effects; and e. Passing of a written examination administered by the continuing education provider; and (4) Provides to the dental assistant written evidence certifying that the course has been successfully completed and which is signed by the course provider. (ab) The duty of in-office tooth whitening shall only be performed under the direct supervision of a licensed dentist. Den 302.07 Expanded Function Dental Auxiliary (EFDA). (a) Any dental hygienist, or certified or graduate dental assistant as defined in Den 401.02, shall be considered qualified to place, contour and adjust direct restorative materials within the oral cavity after successfully completing an expanded function dental auxiliary (EFDA) course in dental restorations, as follows: (1) The direct dental restorations course shall have the following prerequisites: a. Course candidates shall be a registered dental hygienist, or a dental assistant who is certified by the Dental Assistant National Board or is a graduate of a CODA accredited school of dental assisting; b. All candidates shall have a minimum of 4,500 hours of dental clinical experience; c. All candidates shall be recommended for the course by a dentist with an active NH dental license; d. Dental assistants, other than graduate dental assistants, shall be qualified to perform a preliminary inspection of the oral cavity, pursuant to Den 302.05 (d); and e. All candidates shall be currently certified in BLS-HCP; and (2) The EFDA course in direct dental restorations shall: a. Be offered by an institution accredited by CODA; b. Be a minimum of 50 didactic hours and 100 hours of pre-clinical training in a curriculum approved by the board; c. Include at least the following subjects: 1. Dental materials; 2. Use of the low speed hand piece and high speed hand piece; 3. Placement and finishing of amalgams, and composite resins; 4. Dental occlusion; and 5. Dental jurisprudence; d. Include assessment certifying successful course completion and provide written evidence signed by the course provider and given to the hygienist or dental assistant; and e. Be followed by 6 weeks, minimum of 120 hours, of training in a dental office under the direct supervision and monitoring by the faculty of a school accredited by CODA or its designate. (b) The following shall apply to all EFDA's: (1) The EFDA shall register with the board and submit proof of the required EFDA training and experience, as well as a fee to obtain an EFDA permit from the board; (2) The EFDA shall renew the EFDA permit in odd numbered years before May 1st, if EFDA employment is continued; (3) The EFDA shall prominently display the permit where the EFDA works; (4) A maximum of 2 EFDA’s shall be employed in a dental practice regardless of the number of dentists; (5) Dentists shall inform the board of EFDA’s employed within 10 days of employment; (6) EFDA’s shall complete 10 CEU’s each biennium in restorative dentistry; (7) A dental auxiliary who has qualified in the placement, contouring and adjustment of direct dental restorations in another jurisdiction may qualify for endorsement by the board to perform that function by presenting written documentation of training equivalent to (a) above and a letter from a supervising dentist attesting to the auxiliary’s experience with direct restorations within the previous 2 years; and (8) EFDA’s shall practice under the direct supervision of a New Hampshire licensed dentist.

316

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants PART Den 304 Use of General Anesthesia and Sedation by Dentists Den 304.01 Definitions (a) “General anesthesia” means a controlled state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including inability to maintain an airway independently and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method, or combination thereof. (b) “Deep sedation” means an induced state of depressed consciousness, accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to verbal command, and is produced by a pharmacologic or nonpharmacologic method, or combination thereof. (c) “Moderate sedation”, formerly known as conscious sedation, means a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method, or combination thereof. (d) “Minimal sedation”, formerly known as anxiolysis, means a drug induced state during which patients respond normally to verbal commands. Although cognitive function and coordination might be impaired, ventilatory and cardiovascular functions are unaffected. Den 304.03 Permits for Use of General Anesthesia, Deep Sedation and Moderate Sedation. (b) In order to receive a permit to use general anesthesia, deep sedation and moderate sedation the dentist shall: (3) Provide evidence showing that he or she: b. Has a properly staffed and equipped facility as set forth in: 1. The 8th edition of the “Office Anesthesia Evaluation Manual” of the American Association of Oral and Maxillofacial Surgeons, 2012, as specified in Appendix II; or 2. Part IV C. of the American Dental Association 2016 “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, as specified in Appendix II. Den 304.04 Permits for Moderate Sedation Only. (a) In order to receive an unrestricted permit or a restricted permit to use moderate sedation only, the dentist shall: (3) Provide evidence that he or she: b. Has a properly staffed and equipped facility as set forth in: 1. The 8th edition of the “Office Anesthesia Evaluation Manual” of the American Association of Oral and Maxillofacial Surgeons, 2012, as specified in Appendix II; or 2. Part IV B. of the American Dental Association 2016 “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, as specified in Appendix II; Den 304.06 Minimal Sedation. (a) Dentists administering minimal sedation shall: (3) Follow the guidelines set forth in Part IV A. of the American Dental Association 2016 “Guidelines for the Use of Sedation and General Anesthesia by Dentists”, as specified in Appendix II including having a properly staffed and equipped facility. CHAPTER Den 400 DENTAL ASSISTANTS AND HYGIENISTS DUTIES PART Den 401 Assistants Den 401.01 Assistants’ Duties. (a) A dental assistant shall perform the following duties under general supervision, as defined in Den 101.11 and arranged by degree of supervision in Den 302.02: (1) Sterilize instruments; (2) Organize and arrange instruments on bracket tables; (3) Seat patient, place protective materials or garments including the lubrication of such patient’s lips; (4) Reorganize instruments and equipment after the patient has departed; (5) Process dental radiographs; (6) Function as a dental laboratory technician; (7) Perform tests on saliva; (8) Train or instruct groups or individual patients in techniques of oral hygiene and mouth care; and (9) Take the blood pressure of a patient. (b) A dental assistant shall perform the following duties under direct supervision, as defined in Den 101.10 and arranged by degree of supervision in Den 302.02: (1) Retract a patient’s cheek, tongue or other oral tissues during a dental operation; (2) Assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating dentist during the course of a dental operation; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

317

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants (3) Remove such debris as is normally created or accumulated during the course of treatment being rendered by a licensed dentist by the use of vacuum devices, compressed air, mouth washes and water; and (4) Place cotton rolls and topical anesthesia prior to delivery of local anesthesia by a dentist or dental hygienist. (c) Before qualifying to perform the duties delineated in Den 401.01 (d), any dental assistant, other than a certified dental assistant or graduate dental assistant, shall qualify in infection control in the dental office as stated in Den 302.06 (b). (d) A dental assistant shall perform the following duties pursuant to the definition of "Public Health Supervision" as set forth in Den 302.02 (d)(2) to assist a CPHDH: (1) Process and sterilize instruments and perform infection control; (2) Organize and arrange instruments on bracket tables; (3) Seat patient, place protective materials or garments including the lubrication of such patient's lips; (4) Reorganize instruments and equipment after the patient has departed the healthcare facility; (5) Process dental radiographs; (6) Train or instruct groups or individual patients in techniques of oral hygiene and mouth care; (7) Retract a patient's cheek, tongue or other oral tissues during a dental hygiene and remove such debris as is normally created or accumulated during the course of treatment being rendered by a CPHDH by the use of vacuum devices, compressed air, mouthwashes and water; and (8) Assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating CPHDH during the course of a dental hygiene operation. (e) If qualified pursuant to Den 302.06, a dental assistant shall be eligible to: (1) Take dental and medical histories; (2) Apply topical fluoride after prophylaxis by a licensed professional; [See note*] (3) Apply non-prescription topical anesthesia; (4) Apply non-prescription desensitizing agents to the cementum and dentin; (5) Take and record blood pressure; (6) Select impression trays, seat, hold, remove, and pour impressions for study models; single arch athletic mouthguards, and custom fluoride trays; (7) Insert athletic mouthguards; (8) Perform dental radiography; (9) Pit and fissure sealants; (10) Perform coronal polishing; and (11) Conduct preliminary oral inspection. Den 401.02 Certified Dental Assistantsâ&#x20AC;&#x2122; and Graduate Dental Assistantsâ&#x20AC;&#x2122; Duties. Certified dental assistants as defined in Den 101.05 and graduate dental assistants as defined in Den 101.13 may, in addition to the duties of assistants, perform the following duties under direct supervision as defined in Den 101.11 and arranged by degree of supervision in Den 302.02: (a) Take dental and medical histories; (b) Place and remove rubber dams; (c) Place and remove matrices; (d) Apply topical fluoride after prophylaxis by a licensed professional [See note*]; (e) Apply non-prescription topical anesthesia; (f) Apply non-prescription desensitizing agents to the cementum and dentin; (g) Take and record blood pressure; (h) Select impression trays, seat, hold, remove and pour impressions for study models, single arch athletic mouth guards, custom fluoride trays and whitening trays; (i) Insert athletic mouthguards; (j) Perform pulpal vitality testing procedures; (k) Remove sutures and dressings; and (l) After at least 400 hours work experience in clinical dental assisting: (1) Make final impressions; (2) Place periodontal dressings; (3) Place amalgam prior to condensing by a dentist; (4) Place cavity liners and bases. (5) Place and remove gingival retraction cord; (6) Place and remove temporary restorations, not to include temporary crowns and bridges, unless qualified pursuant to Den 302.06, and not to include the use of intraoral rotary instruments; (7) Cement bands and bond brackets, not to include the use of rotary instruments to remove excess cement or bonding material; (8) Make bite registrations when maximum intercuspation can be achieved; and (9) Place and remove dry socket medications. 318

New Hampshire State Dental Practice Act and Administrative Rules for Dental Assistants Den 401.03 Qualified Dental Assistantsâ&#x20AC;&#x2122; Duties. Any dental assistant, who has qualified pursuant to Den 302.05, shall perform the following duties under direct supervision as defined in Den 101.10 and arranged by degree of supervision in Den 302.02: (a) Dental radiography; (b) Pit and fissure sealants; (c) Orthodontic duties; (d) Fabrication of provisional crown and bridge restorations; (e) Coronal polishing; (f) Preliminary oral inspection; (g) Monitor nitrous oxide administration; and (h) In-office tooth whitening. PART Den 403 Continuing Education Den 403.07 Categories of Credit. (a) A licensee shall be entitled to obtain up to 100% of the required CEUs in any or all of the following categories: (1) Education and scientific courses sponsored or approved by the following: a. American Dental Association, component societies and constituent societies; b. Academy of General Dentistry; c. American Dental Hygienists Association, component societies, and constituent societies; d. State or local dental or dental hygiene professional associations or societies; e. Dental schools, medical schools and dental hygiene schools; f. Hospital sponsored courses and conferences; g. Governmental health agencies and health institutions; and h. Postgraduate dental schools or postgraduate dental hygiene schools; (2) Courses required to maintain certification in any nationally recognized professional specialty board; and (3) A licensee shall receive credit for 100% of required CEUs for passing the written portion of the American Board of Dental Examiners (ADEX), or other similar U.S. regional or state board clinical examination for dentists or dental hygienists. (b) A licensee shall receive credit for 3 CEUs per biennium for successful completion of BLS-HCP course(s) given by an American Heart Association, Red Cross, National Safety Council, American Safety, Health Institute, American College of Emergency Physician, or Military Training Network qualified instructor, or sponsored or approved by organizations referenced in Den 403.07 (a)(1). BLS-HCP shall be considered a clinical care subject. All BLS-HCP courses shall include a hands-on component. * Note: In July 2016, the New Hampshire Board of Dental Examiners issued a Declaratory Ruling indicating that, at its June 7, 2016 meeting, the Board voted that dental assistants may not apply Silver Diamine Fluoride because it is not a topical fluoride; it is an antimicrobial agent.

319

New Jersey DANB Certificant Counts: New Jersey National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

3,543

Certified Orthodontic Assistant (COA) certificants

211

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Jonathan Eisenmenger, Executive Director New Jersey State Board of Dentistry 124 Halsey St., 6th Floor P.O. Box 45005 Newark, NJ 07101 Phone: 973-504-6405 Fax: 973-273-8075 Website: www.njconsumeraffairs.gov/den

17,941

Infection Control (ICE)

8,472

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

State Agency Responsible for Radiography Regulation Al Orlandi, Supervisor Technologist Education and Licensing Section Bureau of X-Ray Compliance New Jersey Dept. of Environmental Protection 25 Arctic Parkway P.O. Box 420, Mail Code 25-01 Trenton, NJ 08625-0420 Phone: 609-984-5890 Fax: 609-984-5811 Website: www.xray.nj.gov

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs

DANB CDA Certificant State of New Jersey+

$23.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

Burlington County Institute of Technology Camden County College Cape May County Technical Institute DANB certificant and exam information is current as of July 1, 2020. Fortis Institute-Wayne State-specific information on the pages that follow has been reviewed by DANB as of February 17, 2020. The pages that follow contain information about this state's requirements for dental assistants. If you have any questions about DANB-administered exams, contact DANB. For questions or further information about state requirements, contact the state board of dentistry. In this state, radiography requirements for dental assistants are established by a state regulatory body other than the state dental board. Contact the New Jersey Dept. of Environmental Protection, Bureau of X-Ray Compliance, for information about qualifying to take dental radiographs in this state. DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

320

Source: 2018 DANB Salary Survey (state data based on 67 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the New Jersey State Board of Dentistry. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page. Radiography is regulated by the New Jersey Department of Environmental Protection, which has reviewed the information pertaining to radiography on the pages that follow.

New Jersey State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in New Jersey, a dental assistant must be licensed as a Dental Radiologic Technologist (DRT) by the New Jersey Radiologic Technology Board of Examiners. To obtain this license, one must: (1) Successfully complete high school or its equivalent, AND (2) Be at least 18 years of age, AND (3) Be of good moral character, AND (4a) Successfully complete a New Jersey state-approved dental radiography course or its equivalent within five years prior to application and pass the national DANB Radiation Health and Safety (RHS) exam within the five years prior to application, OR (4b) Successfully complete a New Jersey state-approved dental radiography course or its equivalent more than five years prior to application and pass the national DANB RHS exam within the five years prior to application and document competent work experience in performing dental radiography procedures within 5 years prior to application (Note: It is illegal to obtain this work experience in New Jersey without the permission of the NJ Bureau of X-Ray Compliance.), OR (4c) Successfully complete a New Jersey state-approved dental radiography course or its equivalent and hold current DANB Certified Dental Assistant (CDA) certification, AND (5) Apply for licensure to the State of New Jersey Bureau of X-Ray Compliance. Note: A licensed DRT is not permitted to perform conebeam CT procedures unless he or she has met the requirements in the 12/31/13 exemption. Please contact the Bureau of X-Ray Compliance at 609-984-5890 for details.

State Requirements For Expanded Functions To perform expanded functions under the direct supervision of a licensed dentist in New Jersey, dental assistants must be licensed by the New Jersey State Board of Dentistry as a Registered Dental Assistant (RDA). To register as an RDA, one must: (1) Successfully complete high school or its equivalent AND (2) Pass DANB’s national Certified Dental Assistant (CDA) or Certified Orthodontic Assistant (COA) exam (within 10 years prior to application) AND (3a) Graduate from a New Jersey Board-approved CODA-accredited dental assisting program (within 10 years prior to application) or (3b) Obtain at least two years’ work experience as a dental assistant (within five years prior to application), successfully complete a New Jersey Board-approved program in expanded functions and pass the New Jersey Expanded Duties – General (NJXDG) Exam, administered by DANB, or (3c) Obtain at least two years’ work experience as a dental assistant (within five years prior to application) and pass the New Jersey Expanded Duties - General (NJXDG) Exam, administered by DANB, AND (4) Apply for licensure as a Registered Dental Assistant to the New Jersey State Board of Dentistry. To perform specified orthodontic functions under the direct supervision of a licensed dentist in New Jersey, a dental assistant must be licensed by the New Jersey State Board of Dentistry as a Limited Registered Dental Assistant in Orthodontics (LRDA-O). To register as an LRDA-O, one must: (1a) Satisfactorily complete, within the past 10 years, a training program for dental assistants approved by the Board and accredited by the Commission on Dental Accreditation (CODA) AND (1b) Have passed, within the past 10 years, DANB’s Certified Orthodontic Assistant (COA) Exam, Topical Fluoride (TF) Exam, and the Coronal Polishing (CP) Exam AND (1c) Apply to the New Jersey State Board of Dentistry for registration as an LRDA-O, OR (2a) Be a high school graduate (or its equivalent) AND (2b) Have at least two years’ work experience as a dental assistant under the supervision of a licensed dentist holding a specialty permit in orthodontics during the five-year period prior to application AND (2c) Have passed, within the past 10 years, DANB’s Certified Orthodontic Assistant (COA) Exam, Topical Fluoride (TF) Exam, and the Coronal Polishing (CP) Exam AND (2d) Apply to the New Jersey State Board of Dentistry for registration as an LRDA-O. Note: To satisfy the work experience requirement for the second pathway, a dental assistant must complete the work experience requirements needed to sit for the COA examination.

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – New Jersey State Board of Dentistry New Jersey Permanent Statutes Title 45: Professions and Occupations Chapter 1: Prescription Monitoring Program 45:1-46 Access to prescription information. 26. Access to prescription information. h. (6) The division shall provide online access to prescription monitoring information to as many registered dental assistants as are authorized by a licensed dentist to access that information and for whom the licensed dentist is responsible for the use or misuse of that information. The director shall establish, by regulation, the terms and conditions under which a licensed dentist may delegate that authorization, including proce© 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

321

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants dures for authorization and termination of authorization, provisions for maintaining confidentiality, provisions regarding the duration of a registered dental assistant's authorization to access prescription monitoring information, and such other matters as the division may deem appropriate. Chapter 6: State Board of Dentistry 45:6-48. Short title This act shall be known and may be cited as “The Dental Auxiliaries Act.” 45:6-49. Definitions 2. For the purposes of this act: a. “Board” means the New Jersey State Board of Dentistry. b. “Registered dental assistant” means any person who has fulfilled the requirements for registration established by this act and who has been registered by the board. A registered dental assistant shall work under the direct supervision of a licensed dentist. c. “Dental assistant” means any person who is trained by formal education or office internship to perform, under the direct supervision of a dentist, any routine office procedure, not including an intra-oral procedure, in the office of a dentist. e. “Direct supervision” means acts performed in the office of a licensed dentist wherein he is physically present at all times during the performance of such acts and such acts are performed pursuant to his order, control and full professional responsibility. f. “Supervision” means acts performed pursuant to a dentist’s written order, control and full professional responsibility, whether or not he is physically present. g. “Limited registered dental assistant” means any person who has fulfilled the requirements for registration established by this amendatory and supplementary act and who has been registered by the board. A limited registered dental assistant shall be limited to working under the direct supervision of a dentist who conducts a limited dental practice in the dental specialty for which the assistants has been trained and registered, and in performing those intra-oral procedures as defined by the board which are involved in that specialty. 45:6-50. Additional powers and duties of board 3. The board shall have the following additional powers and duties, under this act: a. To examine, admit, and deny persons applying for admission to the practice of dental hygiene; b. To issue licenses to practice dental hygiene; c. To certify academic and clinical institutions and hospitals which educate and train persons for the practice of dental hygiene or dental assisting in accordance with standards substantially similar to those of the American Dental Association’s Commission on Accreditation of Dental and Dental Auxiliary Educational Programs and Council on Hospital Dental Service and taking into consideration the advice of the New Jersey Department of Higher Education and the New Jersey Department of Education; d. To issue certificates of good standing to dental hygienists who hold a valid subsisting license to practice in this State; e. To establish by rule or regulation, standards for the training and utilization of registered dental assistants and limited registered dental assistants; f. To establish and recognize councils and committees which may advise and make recommendations to the board on various aspects of the education and practice for dental hygienists, registered dental assistants, limited registered dental assistants or dental assistants; g. To prescribe expanded functions to be performed solely by dental hygienists and to be performed by dental hygienists, registered dental assistants and limited registered dental assistants under a single standard of proficiency necessary and proper to protect and promote the public health and welfare of the citizens of this State, and impose such restrictions and requirements, including the setting of educational prerequisites to the performance of such functions and the administration of examinations, as are necessary to insure adherence to the adopted standard of proficiency. Expansion and assignment of such functions, training and examination procedures shall be developed in consultation with the relevant advisory councils; h. To adopt rules and regulations to achieve the objectives contemplated by this act, pursuant to the Administrative Procedure Act, P.L. 1968, c. 410 (C. 52:14B-1 et seq.); i. To do any and all other things which may be appropriate to achieve the objectives contemplated by this act, or which may be useful in executing any of the duties, powers or functions of the board. 45:6-50.1. Dental assistant internship program; training required The board shall establish by rule or regulation the required training which shall be included in dental assistant internship programs. An internship program for an individual seeking registration as a dental assistant shall include training in the intra-oral procedures that are formed in the office of a dentist licensed for general practice. The board shall establish a committee consisting of two board members and three licensed dentists which shall develop and monitor a satisfactory internship program for individuals seeking registration as a dental assistant. 322

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 45:6-50.2. Limited dental assistant internship program; training required Upon the request of a recognized professional dental specialty society, the board shall establish by rule or regulation the required training which shall be included in a limited dental assistant internship program. An internship program for an individual seeking registration as a limited dental assistant shall include training in those intra-oral procedures that are performed in the office of a dentist who has received from the board a permit of limited dental practice in the specialty area for which the assistant seeks registration. The board shall establish a committee consisting of two board members and three licensed dentists which shall develop and monitor a satisfactory internship program for individuals seeking registration as a limited dental assistant. 45:6-55. Rules, procedure for registration 8. a. The board shall adopt rules and regulations for the registration of dental assistants and limited dental assistants. Every applicant for registration shall satisfactorily complete an examination approved by the board and a nationally recognized accrediting agency, which examination shall require the applicant to demonstrate that the applicant is capable of performing the functions of a registered dental assistant or limited registered dental assistant, as the case may be, and shall be administered within the State at least once each year at such time and place as the board designates, and (1) Have satisfactorily completed and graduated from a training program for dental assistants accredited by the Commission on Accreditation of Dental and Dental Auxiliary Educational Programs and approved by the board, or (2) Have a high school diploma or its equivalent and at least two years work experience as a dental assistant. b. For three years from the date the first internship program is implemented pursuant to the provisions of sections 10 or 11 of P.L.1995, c. 367 (C. 45:6-50.1 or 45:6-50.2), a dental assistant or limited dental assistant may satisfy the work experience requirement of paragraph (2) of subsection a. of this section by completing at least six months’ work experience as a dental assistant and have successfully completed a board approved internship in the office and under the direct supervision of a licensed New Jersey dentist. The internship for a registered dental assistant shall consist of three months’ training in the office of a dental practitioner under a licensed dentist’s direct supervision and the internship for a limited registered dental assistant shall consist of three months’ training in the office of a dentist under a licensed dentist’s direct supervision who has received a permit of limited dental practice in a specialty area from the board. c. The board by rule or regulation shall specify those intra-oral procedures which may be performed by registered dental assistants and limited registered dental assistants, provided that such procedures shall not include those procedures which are traditionally performed by dental hygienists. 45:6-56. Requirement of continuing education. 9. a. (2) Every two years, at the time of registration renewal, each person registered as a registered dental assistant or limited registered dental assistant in this State shall provide the board with a certified statement, upon a form issued and distributed by the board, that such registered person has attended, or participated in not less than 10 hours of continuing education in dental assisting as follows: lectures or study club sessions dealing with clinical subjects, college post-graduate courses, scientific sessions of conventions, research on clinical subjects, service as a clinician or any other such evidence of continuing education which the board may approve. b. The board shall notify each licensed or registered person of any failure to comply with this requirement, and shall further notify said person that upon continued failure to comply for a period of three months from the date of notice, the board may, at its discretion take action pursuant to section 11 of this act. c. The board, in its discretion, may waive any of the requirements of this section in cases of certified illness or undue hardship to be determined on an individual basis. 45:6-58. Violations; penalties Any person practicing dental hygiene in this State without first having obtained a license as provided by this act, or without the current biennial certificate of registration, or contrary to any of the provisions of this act, or any person who fails to comply with the provisions of section 9 of P.L.1979,c. 46 (C. 45:6-56), except a person on the inactive status list, or who practices dental hygiene or works as a registered dental assistant or limited registered dental assistant under a false or assumed name, or buys, sells or fraudulently obtains a diploma or certificate showing or purporting to show graduation or completion of a course in dental hygiene or dental assisting, or who violates any of the provisions of this act, shall be liable to a penalty of $300.00 for the first offense and of $500.00 for the second and each subsequent offense. 45:6-69. Compliance with law on radiologic technology 23. Nothing herein shall be construed to exempt registered dental assistants, limited registered dental assistants, dental assistants or other dental office personnel from compliance with P.L. 1981, c.295 (C.26:2D-24 et seq.).

323

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 45:6-73 License to practice dentistry required under certain circumstances 6. Except as otherwise provided in P.L.1964, c.186 (C.45:6-16.1 et seq.), R.S.45:6-19 and R.S.45:6-20, no person other than a person duly licensed to practice dentistry in this State shall: a. make any diagnosis or develop any treatment plan with respect to the dental condition or treatment of any living person in this State; b. perform any surgical or irreversible procedure, including, but not limited to, the cutting of hard or soft tissue or the extraction of any tooth on any living person in this State; c. either bill or submit a claim for any service rendered involving the practice of dentistry or dental hygiene in this State; or d. receive payment for the performance of dental or dental hygienist services from any source other than an employer authorized by law to practice dentistry in this State or any dental clinic, institution, or employment agency, as defined pursuant to section 1 of P.L.1989, c.331 (C.34:8-43), that employs licensed dental hygienists to provide temporary dental hygiene services. New Jersey Administrative Code Title 13. Law and Public Safety Chapter 30. New Jersey Board of Dentistry SUBCHAPTER 2. DENTAL ASSISTANTS 13:30-2.1 Definitions For purposes of this subchapter, the following words and terms, shall have the following meanings, unless the context clearly indicates otherwise: “Direct supervision” means that a licensed dentist is physically present in the office at all times during the performance of any act and that such acts are performed pursuant to the licensed dentist’s order, control and full professional responsibility. “Institution” means any nursing home, veterans home, hospital or prison, or any State or county facility providing inpatient care, supervision and treatment for the mentally disabled. “Supervision” means that a licensed dentist shall provide a written order and shall maintain control and full professional responsibility for the performance of any act, whether or not the licensed dentist is physically present. 13:30-2.2 Application for registration as dental assistant (a) An applicant desiring to secure registration as a dental assistant shall have: 1. Satisfactorily completed and graduated, within the past 10 years, from an educational program for dental assistants approved by the Board and the Commission on Dental Accreditation and shall have taken the Registered Dental Assistant Certification Examination administered by the Dental Assisting National Board (DANB) within 10 years prior to the date of application; or 2. Successfully completed high school (or its equivalent) and shall have: i. Obtained at least two years work experience as a dental assistant during the five-year period prior to making application for registration, passed the Registered Dental Assistant Certification Examination administered by DANB within 10 years prior to the date of application, successfully completed a Board-approved program in expanded functions, and passed the New Jersey Expanded Functions Examination administered by DANB; or ii. Obtained at least two years work experience as a dental assistant during the five-year period prior to making application for registration, passed the Registered Dental Assistant Certification Examination administered by DANB within 10 years prior to application, and passed the New Jersey Expanded Functions Examination administered by DANB. (b) An applicant for registration as a dental assistant shall submit a completed application to the Board which contains the following information and materials: 1. A certification by the board of dentistry in every state or jurisdiction in which the applicant is a registered dental assistant verifying that the applicant’s registration in that state or jurisdiction is in good standing; 2. Proof of the following, if applicable pursuant to (a) above: i. A certificate of graduation from an approved educational program in dental assisting in which the expanded functions or duties listed in N.J.A.C. 13:30-2.4 are taught; ii. A certificate of successful completion of an examination for clinical competency in expanded functions in dental assisting administered by DANB; iii. A certificate of successful completion of an approved program in expanded functions in dental assisting. The Board shall recognize the following as providers of approved programs in expanded functions: (1) An institution approved by the Commission on Dental Accreditation; (2) Institutions of higher education which have met the standards of the Commission on Higher Education or a regional agency recognized by the Council on Post-Secondary Accreditation; or (3) In-service training programs conducted at the graduate level by agencies of the Federal, State, or local government, which are substantially similar to programs described in (b)2iii(1) and (2) above; and 324

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants iv. 3. 4.

A certificate of successful completion of the Registered Dental Assistant Certification Examination administered by DANB; Results from a criminal history background check conducted by the State of New Jersey pursuant to N.J.S.A. 45:1-28 et seq.; and The application fee set forth in N.J.A.C. 13:30-8.1.

13:30-2.3 Application for registration as limited registered dental assistant in orthodontics (a) An applicant desiring to secure registration as a limited registered dental assistant in orthodontics shall have: 1. Satisfactorily completed and graduated, within the past 10 years, from a training program for dental assistants approved by the Board and accredited by the Commission on Dental Accreditation (CODA), and within 10 years prior to the date of application passed the Certified Orthodontic Assistant (COA) Examination, or successor examination, the Topical Fluoride examination, or successor examination, and the Coronal Polish Examination, or successor examination, which are administered by the Dental Assisting National Board (DANB); or 2. Successfully completed high school (or its equivalent) and shall have obtained at least two years work experience as a dental assistant under the supervision of a licensed dentist holding a specialty permit in orthodontics during the five-year period prior to making application for registration, passed the Certified Orthodontic Assistant (COA) Examination, or successor examination, the Topical Fluoride Examination, or successor examination and the Coronal Polish Examination, or successor examination, which are administered by the Dental Assisting National Board (DANB) within 10 years prior to the date of application. i. To satisfy the work experience required pursuant to this section, the applicant shall satisfy the work experience requirements to sit for the COA examination as set forth in DANB's COA examination application packet, and which is available at www.danb.org ii. An applicant obtaining work experience pursuant to this section shall not perform the duties of a registered dental assistant or a limited registered dental assistant. An applicant may perform the duties of an unregistered dental assistant as set forth in N.J.A.C. 13:30-2.6. Nothing in this subparagraph shall be construed to preclude an applicant from observing any tasks or duties performed in a dental office. (b) An applicant for registration as a limited registered dental assistant in orthodontics shall submit a completed application to the Board, which contains the following information and materials: 1. A certification by the board of dentistry in every state or jurisdiction in which the applicant is a registered dental assistant verifying that the applicantâ&#x20AC;&#x2122;s registration in that state or jurisdiction is in good standing; 2. Proof of the following, if applicable pursuant to (a) above: i. A certificate of graduation from an approved educational program in dental assisting in which the expanded functions or duties as listed in N.J.A.C. 13:30-2.5 are taught; ii. A certificate of successful completion of an approved program in expanded functions in orthodontics. The Board shall recognize the following as providers of approved programs in expanded functions: (1) An institution approved by the Commission on Dental Accreditation; (2) Institutions of higher education which have met the standards of the Commission on Higher Education or a regional agency recognized by the Council on Post-Secondary Accreditation; or (3) In-service training programs conducted at the graduate level by agencies of the Federal, State, or local government, which are substantially similar to programs described in (b)2ii(1) and (2) above; or iii. A certification of work experience from the licensee(s) who possess(es) the specialty permit in orthodontics under whose supervision the applicant obtained the required work experience. The certification shall be on a form provided by the Board; 3. A certificate of successful completion of the Certified Orthodontic Assistant (COA) Examination, or successor examination, administered by DANB, the Topical Fluoride Examination, or successor examination, administered by DANB, and the Coronal Polish Examination, or successor examination, administered by DANB; 4. Results from a criminal history background check conducted by the State of New Jersey pursuant to N.J.S.A. 45:1-28 et seq.; and 5. The application fee set forth in N.J.A.C. 13:30-8.1. 13:30-2.4 Scope of practice of registered dental assistant (a) A registered dental assistant may perform the following duties under the direct supervision of a licensed dentist: 1. Isolate the operative field, including the placement and removal of rubber dams; 2. Place and remove matrices and wedges; 3. Place temporary restorations; 4. Remove excess cement from crowns or other restorations and orthodontic appliances. Such removal shall not include any subgingival cement or debris; 5. Remove sutures; 6. Fabricate and cement temporary crowns and bridges after preparation of tooth (teeth) by a dentist. This does not include intra-oral occlusal adjustment; 7. Etch teeth in preparation for bonding, sealants and desensitizing agents; 8. Place caries detecting agents; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

325

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 9.

Use instruments for caries detection. Such instruments shall not include lasers that are capable of altering, cutting, burning or damaging hard or soft tissue; 10. Perform hand removal of soft temporary restorations; 11. Perform hand removal of crowns and bridges that have been temporarily cemented; 12. Prepare coronal surfaces for bonding and restoration, with pumice and water only, not to include a prophylaxis; 13. Take alginate impressions; 14. Place amalgam, composite or gold foil in a tooth for condensation by the dentist; 15. Place and remove retraction cords and medicated pellets. This shall not include electrosurgery or the use of laser for tissue retraction; 16. Perform bite registration procedures; 17. Place and remove periodontal dressings and other surgical dressings; 18. Trial size (pre-select) orthodontic bands, wires, stainless steel crowns and temporary crowns intra-orally or on diagnostic models; 19. Place and remove arch wires and ligature wires; 20. Take impressions for and perform laboratory fabrication of mouth guards. This shall not include insertion of the appliance; 21. Make radiographic exposures as permitted by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq.; 22. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health; 23. Apply topical anesthetic agents; 24. Take and record vital signs; 25. Retract patientâ&#x20AC;&#x2122;s cheek, tongue or other tissue parts during a dental procedure; 26. Remove such debris as is normally created in the course of treatment during or after dental procedures by vacuum devices, compressed air, mouthwashes and water; 27. Use a curing light for any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning or damaging hard or soft tissue or for electrosurgery for tissue retraction; 28. Take dental photographs including the use of intra-oral cameras; 29. Select shades of prosthetic appliances; 30. Demonstrate home-use bleaching systems and apply bleaching agents; 31. Apply hot or cold packs pursuant to the direction of a licensed dentist; 32. Administer a topical treatment on a patient after a licensed dentist or licensed dental hygienist has performed a prophylaxis; 33. Assist a licensed dentist in the administration of nitrous oxide, provided the licensed dentist is physically present in the operatory at all times during the procedure; 34. Provide prophylactic and preventive measures, such as the application of fluorides and pit and fissure sealants and other recognized topical agents for the prevention of oral disease or discomfort. This shall not include prophylaxis; 35. Take impressions for orthodontic appliances. The supervising licensed dentist shall review and evaluate the impression prior to its use for fabrication; 36. Place orthodontic separators. The supervising licensed dentist shall ensure proper placement; 37. Remove bands and brackets without the use of rotary instruments; and 38. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket. (b) A registered dental assistant practicing under the direct supervision of a licensed dentist pursuant to N.J.A.C. 13:30-8.20 may monitor a patient to whom the supervising dentist has administered nitrous oxide/oxygen inhalation analgesia provided the registered dental assistant does not perform any other function while monitoring the patient, and provided that: 1. The registered dental assistant has successfully completed a Board approved course offered in a CODA (Commission on Dental Accreditation) approved college or university clinical setting or hospital setting which emphasizes the administration of nitrous oxide simultaneous with the administration of oxygen and safe and effective patient monitor: i. The course shall be submitted to the Board for review and approval of course outline, content and objectives, curriculum vitae of instructors and whether the training is visual, hands-on or lecture; ii. The nitrous oxide/oxygen administration course shall be at least 14 hours in length, which shall include at least seven hours of didactic training and seven hours of clinical training; and iii. The clinical training shall include, at a minimum, 10 monitored administrations of nitrous oxide/oxygen inhalation analgesia. 2. The registered dental assistant holds a current certification in Basic or Advanced Cardiac Life Support by the American Heart Association, the American Red Cross or an equivalent association approved by the Board; 3. The registered dental assistant completes a three-hour didactic or clinical course in nitrous oxide/oxygen inhalation analgesia in every other registration renewal period. Completion of the recertification course shall be in addition to the continuing education requirements set forth at N.J.A.C. 13:30â&#x20AC;&#x201D;5.3. 326

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 4. The registered dental assistant monitors the patient and maintains the therapeutic level of the nitrous oxide/oxygen inhalation analgesia as established by the dentist; and 5. Upon any untoward reaction of the patient, the registered dental assistant immediately turns off the flow of nitrous oxide, maintains the established oxygen level, and immediately summons the dentist. (c) The monitoring of nitrous oxide/oxygen inhalation analgesia by a registered dental assistant without first having met the minimum standards of training and procedures as contained in this section shall constitute a deviation from normal standards of practice required of a licensee. (d) A registered dental assistant who engages in the activities outlined in (a), (b) and (c) above without direct supervision shall be deemed to be engaging in the unauthorized practice of dental assisting and professional misconduct, and shall be subject to the penalties set forth in N.J.S.A. 45:1—22 and 45:1—25. (e) A dental assistant may provide a written work authorization for emergency repair of a dental prosthesis provided that the prosthesis shall not require any intra-oral procedure and shall be thereafter inserted by a licensed dentist. 13:30-2.5 Scope of practice of limited registered dental assistant in orthodontics (a) A limited registered dental assistant in orthodontics may perform the following duties under the direct supervision of a New Jersey licensed dentist who has obtained a Board permit number to announce a specialty in orthodontics pursuant to N.J.A.C. 13:30-6.1: 1. Take alginate impressions; 2. Fabricate mouth guard appliances. This shall not include insertion of the appliance; 3. Make radiographic exposures as permitted by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq.; 4. Isolate the operative field, not to include rubber dams; 5. Trial size (pre-select) orthodontic bands, wires, stainless steel crowns and temporary crowns intra-orally or on diagnostic models; 6. Take dental photographs including the use of intra-oral cameras; 7. Perform bite registration procedures; 8. Remove excess cement from crowns and other restorations and orthodontic appliances. Such removal shall not include any subgingival cement or debris; 9. Remove arch wires and ligature wires; 10. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health; 11. Remove such debris as is normally created in the course of treatment during or after dental procedures by vacuum devices, compressed air, mouthwashes and water; 12. Use a curing light for any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning, or damaging hard or soft tissue or for electrosurgery for tissue retraction; 13. Apply topical anesthetic agents; 14. Apply topical fluoride; 15. Etch teeth in preparation for bonding, sealants, and desensitizing agents; 16. Place and ligate arch wires. Before a limited registered dental assistant in orthodontics places the arch wire, the supervising licensed dentist shall verify the fit. Only the supervising licensed dentist shall customize the arch wire for the patient; 17. Take impressions for orthodontic appliances. The supervising licensed dentist shall review and evaluate the impression prior to its use for fabrication; 18. Place orthodontic separators. The supervising licensed dentist shall ensure proper placement; 19. Remove bands and brackets without the use of rotary instruments; 20. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket; and 21. Apply hot or cold packs pursuant to the direction of a licensed dentist. (b) A limited registered dental assistant in orthodontics may provide a written work authorization for emergency repair of a dental prosthesis provided that the prosthesis shall not require any intra-oral procedure and shall be thereafter inserted by a licensed dentist. (c) A limited registered dental assistant in orthodontics who engages in the activities outlined in (a) above without direct supervision shall be deemed to be engaging in the unauthorized practice of limited registered dental assisting in orthodontics and professional misconduct, and shall be subject to the penalties set forth in N.J.S.A. 45:1–22 and 45:1–25. 13:30-2.6 Scope of practice of unregistered dental assistant (a) A dental assistant who has not obtained a registration from the Board may perform the following duties under the direct supervision of a licensed dentist: 1. Make radiographic exposures as permitted by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq.; 2. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health; 3. Apply topical anesthetic agents; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

327

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 4. 5. 6.

Take and record vital signs; Retract patientâ&#x20AC;&#x2122;s cheek, tongue or other tissue parts during a dental procedure; Remove such debris as is normally created in the course of treatment during or after dental procedures by vacuum devices, compressed air, mouthwashes and water; 7. Isolate the operative field, not to include rubber dams; 8. Trial size (pre-select) orthodontic bands, wires, stainless steel crown, and temporary crowns on a diagnostic model only; 9. Use a curing light in any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning or damaging hard or soft tissue or for electrosurgery for tissue retraction; 10. Take dental photographs including the use of intra-oral cameras; 11. Select shades for prosthetic appliances; 12. Apply hot or cold packs pursuant to the direction of a licensed dentist; and 13. Assist a licensed dentist in the administration of nitrous oxide, provided the licensed dentist is physically present in the operatory at all times during the procedure. (b) An unregistered dental assistant may provide a written work authorization for emergency repair of a dental prosthesis provided that the prosthesis shall not require any intra-oral procedure and shall be thereafter inserted by a licensed dentist. 13:30-2.7 Credit towards registration as a dental assistant for education, training, and experience received while serving as a member of the Armed Forces (a) An applicant who has served in the Armed Forces of the United States (Armed Forces) and who does not meet all of the training, education, and experience requirements for registration as a dental assistant under N.J.A.C. 13:30-2.2 may apply to the Board for recognition of the applicant's training, education, and/or experience received while serving as a member of the Armed Forces, which the Board shall consider together with any training, education, and/or experience obtained outside of the Armed Forces, for determining substantial equivalence to the training, education, and/or experience required for registration as a dental assistant. (b) The Board shall issue a registration as a dental assistant to the applicant if the applicant presents evidence to the Board that: 1. The applicant has been honorably discharged from active military service; 2. The relevant training, experience, and/or education the applicant has received in the military, together with any training, education, and/or experience obtained outside of the Armed Forces, is substantially equivalent in scope and character to the training, experience, and/or education required for registration under N.J.A.C. 13:30-2.2; i. An applicant seeking credit for military training and/or experience shall submit to the Board the applicant's Verification of Military Experience and Training (VMET) Document, DD Form 2586 or a successor form, as amended and supplemented; ii. An applicant seeking credit for education courses and/or training completed while in the military that are not part of an educational program for dental assistants approved by the Board and the Commission on Dental Accreditation shall submit to the Board a Joint Services Transcript of his or her education courses and/or training for a determination that the education courses and/or training completed are substantially equivalent in level, scope, and intent to those in an educational program for dental assistants approved by the Board and the Commission on Dental Accreditation as required for registration under N.J.A.C. 13:302.2. For the purpose of determining substantial equivalence of the applicant's military education courses and/or training, the Board shall consider only those education courses and/or training relevant to the practice of a registered dental assistant that have been evaluated by the American Council on Education for substantial equivalence to civilian postsecondary curricula; iii. An applicant seeking credit for education courses and/or training completed while in the military that are not part of a Board-approved program in expanded functions as set forth in N.J.A.C. 13:30-2.2(b) shall submit to the Board a Joint Services Transcript of his or her education courses and/or training for a determination that the education courses and/or training completed are substantially equivalent in level, scope, and intent to those of a Board-approved program in expanded functions as set forth in N.J.A.C. 13:302.2(b) as required for registration under N.J.A.C. 13:30-2.2. For the purpose of determining substantial equivalence of the applicant's military education courses and/or training, the Board shall consider only those education courses and/or training relevant to the practice of a dental assistant that have been evaluated by the American Council on Education for substantial equivalence to civilian postsecondary curricula; and 3. The applicant complies with all other requirements for registration, including successful completion of the Registered Dental Assistant Certification Examination administered by the Dental Assisting National Board (DANB) and the New Jersey Expanded Functions Examination administered by DANB, as applicable, as set forth in N.J.A.C. 13:30-2.2. (c) It is the applicant's responsibility to provide timely and complete evidence of the education, training, and/or experience gained in the military for review and consideration. 328

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants (d) If the applicant's military training, education, and/or experience, or a portion thereof, is not deemed to be substantially equivalent to that required for registration as a dental assistant, the Board shall credit whatever portion of the military training, education, and/or experience that is substantially equivalent towards meeting the requirements under N.J.A.C. 13:30-2.2 for the issuance of the registration as a dental assistant. (e) Satisfactory evidence of such education, training, and/or experience shall be assessed on a case-by-case basis. 13:30-2.8 Credit towards registration as a limited registered dental assistant in orthodontics for education, training, and experience received while serving as a member of the Armed Forces (a) An applicant who has served in the Armed Forces of the United States (Armed Forces) and who does not meet all of the training, education, and experience requirements for registration as a limited registered dental assistant in orthodontics under N.J.A.C. 13:30-2.3 may apply to the Board for recognition of the applicant's training, education, and/or experience received while serving as a member of the Armed Forces, which the Board shall consider together with any training, education, and/or experience obtained outside of the Armed Forces, for determining substantial equivalence to the training, education, and/or experience required for registration as a limited registered dental assistant in orthodontics. (b) The Board shall issue a registration as a limited registered dental assistant in orthodontics to the applicant if the applicant presents evidence to the Board that: 1. The applicant has been honorably discharged from active military service; 2. The relevant training, experience, and/or education the applicant has received in the military, together with any training, education, and/or experience obtained outside of the Armed Forces, is substantially equivalent in scope and character to the training, experience, and/or education required for registration under N.J.A.C. 13:30-2.3. i. An applicant seeking credit for military training and/or experience shall submit to the Board the applicant's Verification of Military Experience and Training (VMET) Document, DD Form 2586 or a successor form, as amended and supplemented. ii. An applicant seeking credit for education courses and/or training completed while in the military that are not part of a Board-approved educational program in dental assisting in which the expanded functions or duties as listed in N.J.A.C. 13:30-2.5 are taught, as set forth in N.J.A.C. 13:30-2.3(b), shall submit to the Board a Joint Services Transcript of his or her education courses and/or training for a determination that the education courses and/or training completed are substantially equivalent in level, scope, and intent to those of a Board-approved educational program in dental assisting in which the expanded functions or duties as listed in N.J.A.C. 13:30-2.5 are taught as required for registration under N.J.A.C. 13:30-2.3. For the purpose of determining substantial equivalence of the applicant's military education courses and/or training, the Board shall consider only those education courses and/or training relevant to the practice of a limited registered dental assistant in orthodontics that have been evaluated by the American Council on Education for substantial equivalence to civilian postsecondary curricula. iii. An applicant seeking credit for education courses and/or training completed while in the military that are not part of a Board-approved program in expanded functions in orthodontics as set forth in N.J.A.C. 13:302.3(b) shall submit to the Board a Joint Services Transcript of his or her education courses and/or training for a determination that the education courses and/or training completed are substantially equivalent in level, scope, and intent to those in a program in expanded functions in orthodontics approved by the Board as required for registration under N.J.A.C. 13:30-2.3. For the purpose of determining substantial equivalence of the applicant's military education courses and/or training, the Board shall consider only those education courses and/or training relevant to the practice of a limited registered dental assistant in orthodontics that have been evaluated by the American Council on Education for substantial equivalence to civilian postsecondary curricula; and 3. The applicant complies with all other requirements for registration, including successful completion of the examination requirements as set forth in N.J.A.C. 13:30-2.3. (c) It is the applicant's responsibility to provide timely and complete evidence of the education, training, and/or experience gained in the military for review and consideration. (d) If the applicant's military training, education, and/or experience, or a portion thereof, is not deemed to be substantially equivalent to that required for registration as a limited registered dental assistant in orthodontics, the Board shall credit whatever portion of the military training, education, and/or experience that is substantially equivalent towards meeting the requirements under N.J.A.C. 13:30-2.3 for the issuance of the registration as a limited registered dental assistant in orthodontics. (e) Satisfactory evidence of such education, training, and/or experience shall be assessed on a case-by-case basis. 13:30-5.3 Continuing education requirements for registered dental assistants and limited registered dental assistants in orthodontics (a) All registered dental assistants and limited registered dental assistants in orthodontics shall submit a certification verifying the completion of 10 hours of continuing education every two years at the time of registration renewal. No more than one-half of the required continuing education hours in the two-year period may be obtained through written or electronic media distance learning courses. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

329

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants (b) The following shall be considered acceptable forms of continuing education: 1. Scientific courses applicable to the delivery of dental care by dental auxiliaries, including preventive services, radiography, dental photography, nutrition, patient counseling, community health, Cardiopulmonary Resuscitation or Advanced Cardiac Life Support certification, and infection control; 2. Courses which directly relate to or concern the practice of dentistry, including organization and office management, office design, communication skills, behavioral science, dental-legal matters and methods of health care delivery; and 3. Teaching and research appointments: i. A registrant involved in teaching or research activities at least one full day or the equivalent of one full day per week per academic year and who holds at least a part-time faculty or research appointment shall receive two hours of continuing education credit annually for each full day of teaching or research up to a maximum of four hours of credit per biennial period and one credit annually for each half day of teaching or research up to a maximum of two hours of credit per biennial period. (c) The Board shall recognize as acceptable the courses of study and amount of hours credited in continuing education programs approved by the following, provided that the courses satisfy the minimum requirements set forth in this subchapter: 1. The American Dental Association and its constituents and components; 2. The Academy of General Dentistry and its constituents and components; 3. The American Dental Hygienists Association and its constituents and components; 4. The American Dental Assistants’ Association and its constituents and components; 5. The American Academy of Dental Hygiene and its constituents and components; and 6. Accredited colleges or universities. (d) A registrant shall maintain a record of all continuing education activity completed and shall submit a certification verifying the completion of the continuing education credit requirements to the Board upon request. Records shall be maintained for two full biennial periods from the date of completion of the continuing education activity. Each registrant shall obtain from the continuing education course sponsor a record of attendance which shall include, at a minimum, the following: 1. The participant’s name; 2. The title or subject area of the course; 3. The instructor’s name; 4. The course sponsor; 5. The date and location of the course; 6. The number of hours; and 7. Verification of successful completion by the course sponsor. (e) The Board may inspect the registrant’s records upon request as may be necessary to insure that the continuing education requirements have been satisfied. 13:30-8.1 Fee schedules (a) The application fees charged by the New Jersey State Board of Dentistry shall be the following: 3. Registered Dental Assistants, Limited Registered Dental Assistants and Limited Registered Orthodontic Assistants -$35.00 (b) The biennial license and registration fees charged by the New Jersey State Board of Dentistry shall be the following: i. Initial registration fee: 3. Registered Dental Assistants, Limited Registered Dental Assistants and Limited Registered Orthodontic Assistants: (1) If paid during the first year of a biennial renewal period -$90.00 (2) If paid during the second year of a biennial renewal period -$45.00 ii. Active registration renewal -$90.00 iii. Inactive registration renewal -$50.00 (c) Late fee for dentists, registered dental hygienists, registered dental assistants and limited registered dental assistants -$100.00 (d) Reinstatement fee for dentists, registered dental hygienists, registered dental assistants and limited registered dental assistants -$100.00 13:30-8.2 Parenteral Conscious Sedation f) An applicant for a PCS permit shall certify to the Board upon application for a permit and upon biennial renewal of the p ermit that the dentist employs no fewer than two persons who will be present in the office, at least one of whom shall assist in monitoring the patient whenever PCS is employed. The applicant shall further certify that these persons are trained in and capable of monitoring vital signs and of assisting in emergency procedures and that they maintain current certification in "Basic Life Support: Course C" or its equivalent or in Advanced Cardiac Life Support or its equivalent. 330

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 13:30-8.3 Use of General Anesthesia e) Every applicant for a general anesthesia permit must certify that he or she employs no fewer than two persons who must be present in the office, at least one of whom shall assist in monitoring the patient under general anesthesia. Such personnel shall be certified by the permit holder as being trained in and capable of monitoring vital signs, and of assisting in emergency procedures. n) Every applicant for a permit to use general anesthesia must obtain emergency training by completing the "Basic Life Support: Course C" of the American Heart Association or its equivalent and must maintain current certification in said course. This training also shall be required of all persons who assist in monitoring a patient under general anesthesia. The permit applicant must furnish proof of said training and certification to the Board. 13:30-8.4 Enteral Sedation with Single or Multiple Pharmacological Agents i) A dentist may administer, dispense or prescribe enteral sedation only in a dental treatment setting and shall: 1) Provide for appropriate monitoring of the patient during the administration of the enteral sedation; j) An applicant for an enteral sedation permit shall certify to the Board upon application for a permit and upon biennial renewal of the permit that the dentist employs a licensed health care professional who will be present in the office, trained to assist in the monitoring of the patient whenever enteral sedation is employed. The applicant shall further certify such health care professional is trained in, and capable of, monitoring vital signs and assisting in emergency procedures and that the health care professional maintains current certification in "Basic Life Support: Course C" or its equivalent or in Advanced Cardiac Life Support or its equivalent. 13:30-8.14 Dental X-rays; lead shields Every licensee, as well as any employee or agent of such licensee duly licensed by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq. shall use a lead shield to provide protection to the greatest extent possible to the torso and thyroid areas of patients during all dental X-ray procedures. 13:30-8.17 Delegation of physical modalities (a) A dentist may delegate the administration of certain physical modalities to licensed dental hygienists, registered dental assistants, limited registered dental assistants and unregistered dental assistants consistent with their particular scopes of practice as set forth in N.J.A.C. 13:30-1A.2, 2.4, 2.5 and 2.6 and set forth in this section. (b) Physical modalities, for the purpose of this section, shall be limited to hot and cold packs, ultrasound, electrogalvanic stimulation, transcutaneous electrical nerve stimulation (“T.E.N.S.”) and phonophoresis. (c) A dentist may delegate the administration of the physical modalities set forth in (b) above to licensed dental hygienists, registered dental assistants and limited registered dental assistants consistent with their particular scopes of practice as set forth in N.J.A.C. 13:30-1a.2, 2.4 and 2.5 provided all of the following conditions are satisfied: 1. The dentist shall examine the patient to ascertain the nature of the dental condition or disease; to determine whether the application of physical modality will encourage the alleviation of dentally related pain and the promotion of healing; to assess the risks of the modality for a given patient and the diagnosed condition, injury or disease, and to decide that the anticipated benefits are likely to outweigh those risks. 2. The dentist shall examine the patient prior to each visit and shall determine all components of the treatment to be performed. This determination shall include all types of modalities to be employed, a delineation of the precise area to which the application of each modality shall be limited, the dosage, wattage, or other applicable setting, the length of the treatment, and any and all other factors peculiar to the risks of that modality such as strict avoidance of certain parts of the body or static placement of the applicator. This information shall be written on the patient’s chart prior to each patient’s treatment after the dentist has examined the patient, and it shall be made available at all times to the licensed dental hygienist, registered dental assistant or limited registered dental assistant who is responsible for administering the modality. 3. The dentist shall evaluate the patient prior to any subsequent scheduled application of the modality to ascertain that continued treatment is appropriate and that no contraindications to treatment have become apparent. 4. The dentist shall be physically present in the dental office at all times that treatment orders are being carried out and shall be within reasonable proximity to the treatment room. (d) A dentist may delegate the administration of hot or cold packs to unlicensed assistants. No other physical modalities as set forth in (b) above shall be performed by an unlicensed assistant. (e) On a health insurance claim form pertaining to physical modalities and requiring certification by the dentist, the dentist shall identify the specific modality applied and shall not generically identify the treatment as physical therapy. 13:30-8.20 Nitrous oxide/oxygen inhalation analgesia; duties of a licensed dentist, delegation to licensed dental hygienist and registered dental assistant (a) The following words and terms, as used in this section, shall have the following meanings, unless the context clearly indicates otherwise: © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

331

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants “Administration” means the determination and introduction of a therapeutic level of nitrous oxide/oxygen inhalation analgesia. "Direct supervision” means acts performed in the office of a licensed dentist wherein the dentist is physically present on the premises at all times during the performance of such acts and such acts are performed pursuant to the dentist’s order, control, and full professional responsibility. “Monitoring” means observing or checking a patient’s condition to assess the safety and comfort of the patient receiving nitrous oxide/oxygen inhalation analgesia. “Nitrous oxide/oxygen inhalation analgesia” means the introduction by inhalation of a combination of nitrous oxide and oxygen gases to a conscious patient. “Supervising dentist” means the dentist who induces or administers the nitrous oxide/oxygen inhalation analgesia to the patient. (b) If a patient is to receive nitrous oxide/oxygen inhalation analgesia, a supervising dentist shall induce or administer the nitrous oxide/oxygen inhalation analgesia and shall exercise direct supervision and full responsibility for the patient. (c) A supervising dentist may delegate the monitoring of the nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist during the performance of dental hygiene procedures provided that the patient is stabilized and that the licensed dental hygienist satisfies the requirements set forth in N.J.A.C. 13:30-1A.2. (d) A supervising dentist may delegate the monitoring of the nitrous oxide/oxygen inhalation analgesia to a registered dental assistant who will perform no other function while monitoring the patient provided the patient is stabilized and the registered dental assistant satisfies the requirements set forth in N.J.A.C. 13:30-2.4. (e) If a supervising dentist delegates the monitoring of the nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist pursuant to N.J.A.C. 13:30-1A.2, or to a registered dental assistant pursuant to N.J.A.C. 13:30-2.4, the supervising dentist shall ensure that: 1. The nitrous oxide/oxygen inhalation delivery system is a fail-safe unit which shall not deliver nitrous oxide unless oxygen is continuously flowing at a minimum of 30 percent and includes a scavenging system operating while the nitrous oxide is in use; and 2. The dental office is equipped, at a minimum, with the following: i. A high speed vacuum source; ii. Suction equipment; iii. Equipment to deliver positive pressure oxygen; and iv. Blood pressure monitoring equipment. (f) A supervising dentist shall not delegate the monitoring of nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist or to a registered dental assistant if a patient is taking any medications, whether prescribed by the dentist or by another licensed practitioner, that in the professional judgment of the dentist may potentiate the effects of the nitrous oxide/oxygen inhalation analgesia, or may change the level of consciousness of the patient. (g) The supervising dentist shall be responsible for ensuring that the patient records are documented to reflect the nitrous oxide and oxygen flow rates and the analgesia duration and clearing times. (h) The supervising dentist shall personally discharge the patient following the administration of nitrous oxide/oxygen inhalation analgesia. (i) The delegation of the monitoring of nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist pursuant to N.J.A.C. 13:30-1A.2 or registered dental assistant pursuant to N.J.A.C. 13:30-2.4 who has not yet met the minimum standards of training and procedures as stated therein shall constitute a deviation from normal standards of practice required of a licensee. Chapter 45A. Administrative Rule of the Division of Consumer Affairs Subchapter 35. Prescription Monitoring Program §13:45A-35 13:45A-35.1 PURPOSE AND SCOPE (a) The rules in this subchapter implement the provisions of P.L. 2007, c. 244, as amended by P.L. 2015, c. 74 (N.J.S.A. 45:1-44 through 51), establishing a Prescription Monitoring Program (PMP) in the Division of Consumer Affairs. (b) The rules in this subchapter shall apply to the following: (10) A registered dental assistant authorized by a licensed dentist to access the prescription monitoring information, subject to the limitations and requirements of this subchapter; and (c) The reporting requirements of this subchapter shall not apply to the direct administration of a controlled dangerous substance or human growth hormone to the body of an ultimate user; or to the administration or dispensing of a controlled dangerous substance that is otherwise exempted as determined by the Secretary of Health and Human Services pursuant to the National All Schedules Prescription Electronic Reporting Act of 2005, Pub.L. 109-60. (d) The reporting requirements of this subchapter shall not apply to any prescriptions filled by a pharmacy for a Schedule II, III, IV, or V controlled dangerous substance or for human growth hormone dispensed to an inpatient at a hospital, long-term care, or other facility in which the resident is provided with 24-hour nursing care. 332

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 13:45A-35.2 DEFINITIONS The following words and terms, when used in this subchapter, shall have the following meaning unless the context clearly indicates otherwise: “Acute pain” means the normal, predicted physiological response to a noxious chemical or thermal or mechanical stimulus, typically associated with invasive procedures, trauma, or disease and is generally persistent for up to one month, but no more than three months. “Chronic pain” means pain that persists for three or more consecutive months and after reasonable medical efforts have been made to relieve the pain or its cause and that continues, either continuously or episodically. “Current patient” means any person who is the recipient of a professional service rendered by the practitioner for purposes of diagnosis, treatment, or a consultation related to treatment. “Delegate” means a person authorized to access the PMP information of the practitioner’s current or new patient on behalf of a practitioner who is an authorized user of the PMP. “Misuse” means the use of a prescribed medication in a manner that is contrary to directions, regardless of whether a harmful outcome occurs. “New patient” means a person who for the first time seeks from or is rendered professional services by the practitioner for purposes of diagnosis, treatment, or a consultation related to a treatment. “Director” means the Director of the Division of Consumer Affairs in the Department of Law and Public Safety. “Registered dental assistant” is a person who has fulfilled the requirements for registration established by the Dental Auxiliaries Act, P.L. 1979, c. 46 (N.J.S.A. 45:6-48 et seq.), as set forth in N.J.A.C. 13:30-2.2, and works under the direct supervision of a licensed dentist. 13:45A-35.6 ACCESS TO PRESCRIPTION MONITORING INFORMATION; RETENTION OF INFORMATION (a) The Division shall provide online access to prescription monitoring information submitted to the PMP to the following: (3) A delegate authorized by a practitioner to access the PMP information for the purpose of providing health care to a new or current patient of the delegating practitioner who certifies that the request is for the purpose of providing health care to or verifying information with respect to a new or current patient of the delegating practitioner, or verifying information with respect to a prescriber, consistent with the requirements of this subchapter; (c) All persons authorized to have online access to PMP information shall, in accordance with N.J.A.C. 13:45A-35.7, register with the Division and shall receive a login ID and password. Such persons shall complete all forms and statements required by the Division. (1) All persons authorized to have online access to PMP information who become aware or suspect that their login ID and password to the PMP were compromised or used without authorization shall, within five business days of discovering the unauthorized access, notify the Division through the PMP and submit supporting documentation evidencing the unauthorized use. (d) All persons authorized to have online access to PMP information shall, in accordance with (a) above, prior to each look-up certify to the purpose for which the requested information will be used. The certification shall be completed online in the PMP system. (e) All persons granted access to PMP information, either through online access or by request, shall comply with all Federal and State laws, rules, and regulations concerning the confidentiality of patient information, including the Federal Health Insurance Portability and Accountability Act of 1996, specifically the Federal health privacy rule set forth at 45 CFR Parts 160 and 164. (1) A delegate shall share PMP information with only his or her delegating practitioner. (3) In accordance with N.J.A.C. 13:45A-35.8(f), all persons granted online access to the PMP shall not share their PMP login ID and password with any other person or entity. 13:45A-35.7 REGISTRATION (a) All persons authorized to have online access to PMP information shall register with the Division. To register, all persons shall: (1) Provide the Division with a unique individual e-mail address. (2) Complete an online tutorial upon initial access to the PMP and as deemed necessary by the Director. (3) Submit all documentation required by the Division to verify the person’s identity and credentials. The required documentation shall be listed on the New Jersey Prescription Monitoring Program website at www.njconsumeraffairs.gov.

333

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants 13: 45A-35.8 DELEGATES (a) A practitioner or a faculty member authorized by a medical or dental teaching facility may designate a delegate or delegates for the purpose of accessing PMP information for a new or current patient, or a prescriber, consistent with the requirements of this subchapter. (1) As set forth in this subsection, for each designated delegate, a practitioner or a faculty member authorized by a medical or dental teaching facility is responsible for the use or misuse of the PMP and the prescription monitoring information, ensuring compliance with the recordkeeping requirements, conducting a bi-annual audit, and verifying the education, training, and licensure or certification requirements for each delegate. (2) A delegate may be an authorized delegate for more than one practitioner. (b) The director of the medical or dental residency program shall designate the faculty members who are authorized to designate medical or dental residents, as applicable, as delegates. The director of the medical or dental residency program shall comply with the recordkeeping provisions of N.J.A.C. 13:45A-35.10. (c) Delegates may be designated as follows: 2) A licensed dentist may designate as a delegate a registered dental assistant who is employed at the practice setting at which the licensed dentist practices dentistry. i) An individual who is no longer employed at the practice setting at which the licensed dentist practices dentistry is no longer authorized to be a delegate or to access the PMP on behalf of that dentist. (f) All persons authorized to have online access to PMP information shall not share access to the PMP with any other person or entity. (1) All persons granted access to the PMP shall access the PMP using their own unique user login ID and password. The login ID and password shall not be shared with any other person or entity. (2) All delegates shall identify the practitioner on whose behalf they are accessing the prescription monitoring information. (3) All persons authorized to have online access to PMP information may share such information as set forth in N.J.A.C. 13:45A-35.6. 13:45A-35.9 MANDATORY LOOK-UP (a) Except as provided in (c) below, a practitioner or the practitioner’s delegate shall access prescription monitoring information for a new or current patient consistent with the following: (1) The first time the practitioner prescribes a Schedule II controlled dangerous substance to a new or current patient for acute or chronic pain; (i) When the practitioner or the practitioner’s delegate accesses the prescription monitoring information for a new patient in advance of the scheduled appointment, the practitioner or delegate shall document the new patient’s request for professional services; and (2) On a quarterly basis during the period of time a current patient continues to receive a prescription for a Schedule II controlled dangerous substance for acute or chronic pain. (i) For purposes of this paragraph, “quarterly” means every three months from the date the initial prescription is issued. 13:45A-35.10 RECORDKEEPING (a) Each practitioner and each authorized faculty member of a medical or dental teaching facility who designates a delegate shall establish, retain, and follow written procedures to document, as part of the patient record, the PMP look-up as required in N.J.A.C. 13:45A- 35.9 and any PMP information accessed for the patient. (1) Each delegate shall follow the documentation procedures established by his or her delegating practitioner. 13:45A-35.11 PROFESSIONAL MISCONDUCT (a) Noncompliance with the rules in this subchapter may be deemed professional misconduct and may subject the pharmacy permit holder, an out-of-State pharmacy that is subject to this subchapter, pharmacist, practitioner, licensed health care professional, registered dental assistant, or mental health practitioner to disciplinary action pursuant to the provisions of N.J.S.A. 45:1-21 and to the penalties set forth in N.J.S.A. 45:1-49. (f) The Division shall refer to law enforcement, which may result in a criminal conviction and a civil penalty in accordance with N.J.S.A. 45:1-49 the following persons: (1) A person who is authorized to obtain prescription monitoring information from the PMP who knowingly discloses such information in violation of the provisions of N.J.S.A. 45:1- 45 through 50. (i) The production of a patient record in response to a lawful request by the patient, an authorized representative of the patient, or pursuant to a subpoena or other court order shall not be deemed a knowing disclosure within the meaning of the statute; (2) A person who is authorized to obtain prescription monitoring information who uses this information in the course of committing, attempting to commit, or conspiring to commit any criminal offense; and (g) Notwithstanding the provisions of this subchapter and the person’s CDS registration status or employment status, the Division shall retain the right to take action for noncompliance with the rules in this subchapter or violations of the provisions of N.J.S.A. 45:1-45 through 50. 334

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants Title 7: Environmental Protection Chapter 28: Radiation Protection Programs SUBCHAPTER 19. RADIOLOGIC TECHNOLOGY N.J.A.C. 7-28-19 Note: The following is an excerpt of selected regulations and is intended to provide an overview of requirements for dental radiologic technologists. This excerpt does not contain the full text of regulations governing the practice of dental radiologic technology. Dental radiologic technologists and their employers are responsible for reading, understanding and complying with all regulatory requirements published in N.J.A.C. 7:28-19, including those sections not reproduced here. For a full copy of this regulation, please go to www.xray.nj.gov. 7:28-19.2 Definitions In addition to the terms defined at N.J.A.C. 7:28-1 and N.J.S.A. 26:2D-1 et seq., the following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. “Dental radiologic technologist (LRT(D))” means a person licensed in accordance with this subchapter whose scope of practice of radiologic technology is limited to dental radiography for diagnostic purposes, as set forth at N.J.A.C. 7:28-19.4(a) and (e). “Limited license” means a license with a scope of practice that is limited pursuant to N.J.A.C. 7:28-19.4. "Operate ionizing radiation-producing equipment" or "operating ionizing radiation-producing equipment" means the use or manipulation of ionizing radiation-producing equipment in any way that leads to or causes the application of radiation to humans or affects the amount or quality of radiation that is received by a human. The term "operate" or "operating" includes activating or terminating the radiation exposure, setting or adjusting technical factors, setting the mode of imaging, setting the camera rate, and setting or adjusting the size of the exposure field. "Position patients" or "positioning patients" means the placement and alignment of the x-ray tube, image receptor (to include cassette, film, digital detector, image intensifier) and the area of the patient to be exposed to ionizing radiation. “Radiologic technologist" means a person who is licensed pursuant to this subchapter, which shall include chest radiologic technologist (LRT(C)), dental radiologic technologist (LRT(D)), diagnostic radiologic technologist (LRT(R)), radiation therapist (LRT(T)), podiatric radiologic technologist (LRT(P)), orthopedic radiologic technologist (LRT(O)), and urologic radiologic technologist (LRT(U)). 7:28-19.4 Scopes of practice (a) Any person who possesses a valid license in radiologic technology shall exercise proper principles of radiation protection with regard to radiological examinations. (e) Any person who possesses a valid license to practice dental radiologic technology issued in accordance with this subchapter may engage in the following activities, which constitute the scope of practice of dental radiologic technology; however, the scope of practice does not include any type of fluoroscopy, tomography or computed tomography procedure: 1. Operate ionizing radiation-producing equipment for dental radiographic procedures only; 2. Position patients for intra-oral and extra-oral dental radiographic procedures only; 3. Set the correct technique factors for dental radiographic procedures only; and 4. Set the source-to-image receptor distance for dental radiographic procedures only. * Note: A special exemption approved in December 2013 permits an LRT(D) to perform cone beam computed tomography (CBCT) procedures using certain types of CBCT equipment provided certain educational and clinical requirements are fulfilled. Please contact the Bureau of X-Ray Compliance at 609-984-5890 for details. 7:28-19.7 Requirements of applicants for licensure (a) Subject to (d) below, the Board shall issue a license to any applicant who has paid to the Department a fee as specified in N.J.A.C. 7:28-19.10(a)2 and has submitted satisfactory evidence to the Board, verified by oath or affirmation, that the applicant: 1. Has met the requirements in N.J.A.C. 7:28-19.6(a) and (b) [Editor's note: See "Radiography Requirements" on page 321 for detailed list of requirements.], and 2. Has passed the Board's examination in the license category for which the applicant has applied.

335

New Jersey State Dental Practice Act and Administrative Rules for Dental Assistants (c) In lieu of its own examination for a dental radiologic technologist LRT(D), required by (a)2 above, the Board may accept: 1. A valid registration as a dental assistant issued by the New Jersey Board of Dentistry, provided the applicant passed the certification examination including the “Radiation Health and Safety” examination given by the Dental Assisting National Board and any education requirements as may be prescribed by the New Jersey Board of Dentistry, and provided the Board determines that the above standards are equivalent to those established by the Board; or 2. A valid active certificate issued by the Dental Assisting National Board demonstrating that the applicant has successfully passed the “Radiation Health and Safety” examination, provided the Board determines that the above standards are equivalent to those established by the Board. (d) The Board may determine that an applicant is ineligible for licensure if the applicant does not fulfill the requirements of (a), (b) and (c) or has violated any provision of this chapter, the Radiation Protection Act or the Radiologic Technologist Act. The applicant may request a hearing in accordance with N.J.A.C. 7:28-19.17(a), if aggrieved by the Board’s actions. 7:28-19.9 License expiration, reissuance and renewal (a) Except as provided at N.J.A.C. 7:28-19.1(c), no person or radiologic technologist shall engage in any scope of practice of radiologic technology without a valid and effective radiologic technology license issued under this subchapter authorizing the licensee to engage in that scope of practice. (b) A license issued in accordance with this subchapter is effective as of the date of issuance, or January 1st of an odd numbered year, whichever is later, and expires on the immediately following December 31st of an even numbered year. No license is valid longer than two years. It is the Board’s practice, but not its obligation, to mail license renewal applications to all licensees at least 60 calendar days prior to the license expiration date. (c) A radiologic technologist shall inform the Department of any change in his or her name and/or address no later than 30 calendar days after the change. (d) To maintain a valid license, a radiologic technologist shall renew his or her license any time prior to its expiration by submitting a renewal application for a radiologic technology license and the required renewal fee specified in N.J.A.C. 7:28-19.10(a)3. (e) The Board may deny an application for renewal if the Board has determined that the radiologic technologist is not of good moral character or has violated any provision of this subchapter, the Radiation Protection Act or the Radiologic Technologist Act. The applicant may request a hearing as provided by N.J.A.C. 7:28-19.17(b) if aggrieved by the Board’s action. (f) A radiologic technologist who possesses an expired license may apply to have the license reissued, provided that the license has not been expired for five years or more. An individual who wishes to have a license reissued that has been expired less than five years shall submit an application for reissuance and the fee specified in N.J.A.C. 7:2819.10(a)3. If such individual has not engaged in the practice of radiologic technology at any time in New Jersey during the period the license was expired, the individual is required only to pay the reissuance fee for the current license period. If such individual has engaged in the practice of radiologic technology at any time in New Jersey during the period the license was expired, in addition to the reissuance fee for the current license period, the individual shall pay the reissuance fee for each previous renewal period, in addition to other sanctions that may be imposed under the Radiation Protection Act or the Radiologic Technologist Act for practicing radiologic technology without a license. (g) A radiologic technologist who possesses a license that has been expired for five or more years may not have that license renewed, but may apply for a license in accordance with N.J.A.C. 7:28-19.7.

336

New Mexico DANB Certificant Counts: New Mexico Certified Dental Assistant (CDA) certificants

398

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Roberta Perea, Board Administrator New Mexico Board of Dental Health Care Toney Anaya Building (Physical) 2550 Cerrillos Road, 2nd Floor (Mailing) P.O. Box 25101 Santa Fe, NM 87505 Phone: 505-476-4622 Fax: 505-476-4545 Email: Dental.Board@state.nm.us Website: www.rld.state.nm.us/boards/Dental_Health_Care. aspx

5,762

Infection Control (ICE)

898

Coronal Polishing (CP)

145

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Central New Mexico Community College Luna Community College-Las Vegas New Mexico State University - Dona Ana Community College Santa Fe Community College-New Mexico University of New Mexico-Gallup

DANB CDA Certificant State of New Mexico+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been reviewed by DANB as of April 10, 2020.

Source: 2018 DANB Salary Survey (state data based on 9 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

337

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the New Mexico Board of Dental Health Care. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

New Mexico State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in New Mexico, a dental assistant must be New Mexico state-certified. To obtain this certification, one must: (1) Study by independent preparation or in a training course on radiation health and safety within the past 36 months AND (2) Have assisted with or observed five cases of full mouth series intraoral radiographs (or five extraoral radiographs, if applying for limited certificate) AND (3) Pass the national DANB Radiation Health and Safety (RHS) exam AND (4) Apply to the New Mexico Board of Dental Health Care for a training permit, valid for six months AND (5) Pass a state clinical exam, within six months of passing the DANB RHS exam AND (6) Pass the New Mexico state jurisprudence exam (take-home) AND (7) Apply to the New Mexico Board of Dental Health Care for certification to perform radiography.

State Requirements For Expanded Functions To perform expanded functions under the general supervision of a licensed dentist in New Mexico, a dental assistant must earn state certification in each of the desired expanded functions. To qualify, one must: Rubber cup coronal polishing and application of topical fluoride: (1) Study by independent preparation or in a training course in the functions and (assist with/observe five cases of rubber cup coronal polishing on children and adults and five applications of topical fluoride, AND (2) Pass DANB’s Coronal Polishing (CP) exam and DANB's Topical Fluoride (TF) exam, AND (3) Apply to the New Mexico Board of Dental Health Care for advanced certification in coronal polishing and application of topical fluoride, AND (4) Pass the New Mexico Jurisprudence exam (take-home) AND (5) Pass a clinical exam - perform rubber cup coronal polishing on five adults and children and application of topical fluoride on five children while being personally observed by a licensed dentist, dental hygienist, or dental assistant certified in rubber cup coronal polishing and application of topical fluoride. Pit and Fissure Sealants: (1) Have 2,080 hours of dental assisting chairside experience in the two years prior to application, AND (2) Study by independent preparation or in a training course in the function, AND (3) Assist with/observe 12 cases of application of pit and fissure sealants, AND (4) Pass DANB's Sealants (SE) exam, AND (5) Apply to the New Mexico Board of Dental Healthcare for advanced certification in pit and fissure sealants AND (6) Pass the New Mexico Jurisprudence exam (take-home) AND (7) Pass a clinical exam - apply pit and fissure sealants on five patients while being personally observed by a licensed dentist or dental hygienist. Note: The DANB Certified Dental Assistant (CDA) Certification automatically qualifies a dental assistant to apply for state certification for each of these expanded functions. A dental assistant who is certified to perform dental radiography, coronal polishing, pit and fissure sealants, and/or topical fluoride procedures in another state with requirements not less stringent than those in New Mexico may apply for state certification based on credentials. New Mexico Expanded Function Dental Auxiliaries (EFDAs) may perform specified restorative and orthodontic expanded functions (in addition to the expanded functions listed above) under a dentist’s supervision. To earn certification as a New Mexico EFDA, one must: (1a) Complete an accepted EFDA course in a program approved by the New Mexico Board of Dental Health Care or accredited by CODA OR (1a) Complete a minimum of five years, 1000 hours per year, continuous employment as a dental assistant or dental hygienist and (1c) Complete a course of study in subject areas prescribed by the New Mexico Board of Dental Health Care, including a post-test approved by the New Mexico board and (1d) obtain a recommendation for EFDA certification from a supervising dentist, AND (2) Earn state certification in radiography, rubber cup coronal polishing and application of topical fluoride and pit and fissure sealant expanded functions*, AND (3) Pass a clinical exam accepted by the New Mexico Board of Dental Health Care for EFDA certification, AND (4) Earn a 75% score on the New Mexico jurisprudence exam, AND (5) Apply for an apprenticeship permit from the New Mexico Board of Dental Health Care, AND (6) Complete an apprenticeship within 180 days, AND (7) Return permit and a signed affidavit to the New Mexico Board of Dental Health Care, which will then issue the EFDA certificate. * Note: A new rule effective 3/13/18 specifies that all current EFDA permit holders must earn the four state certificates in expanded functions no later than 7/1/19. EFDA permits will suspend automatically if the expanded functions certifications are not current, and once they are earned, the EFDA permit will become valid until its regular expiration date. New Mexico also issues a separate certification for Community Dental Health Coordinators (CDHCs), who may perform specified preventive, restorative, and palliative procedures under general supervision of a dentist. To qualify, one must (1) Have a high school diploma or equivalent, or a college degree AND (2) Have New Mexico certification in radiography, rubber cup coronal polishing and application of topical fluoride and pit and fissure sealant expanded functions AND (3) Earn a 75% score on the New Mexico jurisprudence exam AND (4) Successfully complete a CDHC program approved by the New Mexico Board of Dental Health Care. Holders of state-certification in dental assisting expanded functions, EFDAs, and CDHCs must have formal training in infection control from a course approved in accordance with Board of Dental Health Care rules and regulations. 338

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - New Mexico Board of Dental Health Care New Mexico Statutes CHAPTER 61 OCCUPATIONAL AND PROFESSIONAL LICENSES ARTICLE 5A DENTAL HEALTH CARE 61-5A-3. Definitions. (Repealed effective July 1, 2024.) As used in the Dental Health Care Act: C. "certified dental assistant" means an individual certified by the dental assisting national board; F. "community dental health coordinator" means a dental assistant, a dental hygienist or other trained personnel certified by the board as a community dental health coordinator to provide educational, preventive and limited palliative care and assessment services working collaboratively under the general supervision of a licensed dentist in settings other than traditional dental offices and clinics; I. "dental assistant certified in expanded functions" means a dental assistant who meets specific qualifications set forth by rule of the board; Q. "direct supervision" means the process under which an act is performed when a dentist licensed pursuant to the Dental Health Care Act: (1) is physically present throughout the performance of the act; (2) orders, controls and accepts full professional responsibility for the act performed; and (3) evaluates and approves the procedure performed before the patient departs the care setting; R. "expanded-function dental auxiliary" means a dental assistant, dental hygienist or other dental practitioner that has received education beyond that required for licensure or certification in that individual's scope of practice and that has been certified by the board as an expanded-function dental auxiliary who works under the direct supervision of a dentist; U. "general supervision" means the authorization by a dentist of the procedures to be used by a dental therapist, community dental health coordinator, dental hygienist, dental assistant or dental student and the execution of the procedures in accordance with a dentist's diagnosis and treatment plan at a time the dentist is not physically present and in facilities as designated by rule of the board; V. "indirect supervision" means that a dentist, or in certain settings a dental therapist, dental hygienist or dental assistant certified in expanded functions, is present in the treatment facility while authorized treatments are being performed by a dental hygienist, dental assistant or dental student; 61-5A-4. Scope of practice. (Repealed effective July 1, 2024.) H. An expanded-function dental auxiliary may perform the following procedures under the direct supervision of a dentist (1) placing and shaping direct restorations; (2) taking final impressions, excluding those for fixed or removable prosthetics involving multiple teeth; (3) cementing indirect and provisional restorations for temporary use; (4) applying pit and fissure sealants without mechanical alteration of the tooth; (5) placing temporary and sedative restorative material in hand-excavated carious lesions and unprepared tooth fractures; (6) removal of orthodontic bracket cement; and (7) fitting and shaping of stainless steel crowns to be cemented by a dentist. I. An expanded-function dental auxiliary may re-cement temporary or permanent crowns with temporary cement under the general supervision of a dentist in a situation that a dentist deems to be an emergency. J. An expanded-function dental auxiliary may perform other related functions for which the expanded-function dental auxiliary meets the training and educational standards established by the board and that are not expressly prohibited by the board. 61-5A-5. License required; exemptions. (Repealed effective July 1, 2024.) B.

The following, under the stipulations described, may practice dentistry or an area of dentistry without a New Mexico dental license: (2) New Mexico licensed dental hygienists and community dental health coordinators may provide those services within their scope of practice that are also within the scope of the practice of dentistry; (4) any dental hygiene or dental assisting student duly enrolled in an accredited school of dental hygiene or dental assisting engaged in procedures within or outside the scope of dental hygiene that are part of the curriculum of that program in the school setting and under the indirect supervision of a faculty member of the accredited program who is a licensed dentist, dental hygienist or dental assistant certified in the procedures being taught; (5) unlicensed persons performing for a licensed dentist merely mechanical work upon inert matter in the construction, making, alteration or repairing of any artificial dental substitute, dental restorative or corrective appliance,

339

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants when the casts or impressions for the work have been furnished by a licensed dentist and where the work is prescribed by a dentist pursuant to a written authorization by that dentist; (7) dental assistants performing adjunctive services to the provision of dental care, under the indirect supervision of a dentist, as determined by rule of the board if such services are not within the practice of dental hygiene as specifically listed in Subsection B of Section 61-5A-4 NMSA 1978, unless allowed in Subsection E of this section. E. The following, under the stipulations described, may practice dental hygiene or the area of dental hygiene outlined without a New Mexico dental hygiene license: (2) dental assistants and community dental health coordinators working under general supervision who: (a) expose dental radiographs after being certified in expanded functions by the board; (b) perform rubber cup coronal polishing, which is not represented as a prophylaxis, having satisfied the educational requirements as established by rules of the board; (c) apply fluorides as established by rules of the board; and (d) perform those other dental hygienist functions as recommended to the board by the committee and set forth by rule of the board; and (3) dental assistants certified in expanded functions, working under the indirect supervision of a dental hygienist certified for collaborative practice and under the protocols established in a collaborative practice agreement with a consulting dentist. F. Dental assistants working under the indirect supervision of a dentist and in accordance with the rules and regulations established by the board may: (1) expose dental radiographs; (2) perform rubber cup coronal polishing that is not represented as a prophylaxis; (3) apply fluoride and pit and fissure sealants without mechanical alteration of the tooth; (4) perform those other dental hygienist functions as recommended to the board by the committee and set forth by rule of the board; and (5) perform such other related functions that are not expressly prohibited by statute or rules of the board. G. A community dental health coordinator working under the general supervision of a dentist and in accordance with the rules established by the board may: (1) place temporary and sedative restorative material in unexcavated carious lesions and unprepared tooth fractures; (2) collect and transmit diagnostic data and images via telemetric connection; (3) dispense and apply medications on the specific order of a dentist; (4) provide limited palliative procedures for dental emergencies in consultation with a supervising dentist as allowed by the rules the board has promulgated; and (5) perform other related functions for which the community dental health coordinator meets training and educational standards established by the board and that are not expressly prohibited by statute or rules promulgated by the board. 61-5A-6. Certification of dental assistants, expanded-function dental auxiliaries and community dental health coordinators. (Repealed effective July 1, 2024.) A. A certified dental assistant, an expanded-function dental auxiliary, a community dental health coordinator or a dental assistant certified in expanded functions shall be required to adhere to the educational requirements, examinations, recertification criteria and fees as established by rules and regulations of the board. The fee shall be the same for one or more expanded functions. B. Certificates granted by the board may be revoked, suspended, stipulated or otherwise limited, and a certificate holder may be fined or placed on probation if found guilty of violation of the Dental Health Care Act. C. No individual shall use the title "C.D.A." unless granted certification by the dental assistant national board. D. Unless certified to practice as a dental assistant certified in expanded functions or an expanded-function dental auxiliary, no person shall: (1) practice as a dental assistant certified in expanded functions as defined by rules of the board; or (2) use the title or represent oneself as an assistant certified in expanded functions or an expanded-function dental auxiliary or use any title, abbreviation, letters, figures, signs or devices that indicate the person is a dental assistant certified in expanded functions or an expanded-function dental auxiliary. 61-5A-6.1. Expanded-function dental auxiliary; certification. (Repealed effective July 1, 2024.) A. The board shall establish academic standards and criteria for certifying dental assistants, dental hygienists or other dental personnel to practice as expanded-function dental auxiliaries. Those standards and criteria shall include a formal curriculum and a certifying examination. B. The board shall promulgate rules relating to the certification of expanded-function dental auxiliaries pursuant to the State Rules Act. 340

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 61-5A-16. License and certificate renewals. (Repealed effective July 1, 2024.) B. All dental assistants certified in expanded functions, expanded-function dental auxiliaries and community dental health coordinators shall be required to renew their certificates triennially as established by rules of the board. 61-5A-29. Licensure or certification under prior law. (Repealed effective July 1, 2024.) B. Any person certified under any prior laws of this state, whose certificate is valid on the effective date of the Dental Health Care Act, is held to be certified under the Dental Health Care Act and is entitled to renewal of his certificate as provided in that act. New Mexico Board of Dental Health Care Rules & Regulations TITLE 16 OCCUPATIONAL AND PROFESSIONAL LICENSING CHAPTER 5 DENTISTRY (DENTISTS, DENTAL HYGIENISTS, ETC.) PART 1 GENERAL PROVISIONS 16.5.1.7 DEFINITIONS: AA. “Provider” means a provider of dental health care services, including but not limited to dentists, dental hygienists, and dental assistants 16.5.1.16 CONTROL AND PREVENTION OF BLOODBORNE INFECTIONS: The following rules are enacted to prevent transmission of the human immunodeficiency virus (HIV), hepatitis B infectious state (i.e. acute infection and chronic carriers only) (HBV), the hepatitis C virus (HCV), and other blood borne infections. A. Requirements for providers. Any provider licensed or certified by the New Mexico board of dental health care must comply with the guidelines established in this rule. A provider who fails to use appropriate infection control techniques and sterilization procedures to protect patients may be subject to disciplinary action by the board. B. Infection control as a standard of care. In offices and facilities providing dental services, compliance with the following policies and procedures are required to further reduce the low risk of infection: (1) implementation of policies and procedures to minimize occupational exposure to potentially infectious materials (e.g. blood); guidelines or recommendations of the American dental association, American dental hygienists’ association, center for disease control, and the occupational safety and health administration must be followed; (2) strict adherence to infection control practices and universal barrier precautions are mandatory in all dental care settings and shall include sterilization of instruments and hand pieces, after each use, by any acceptable sterilization technique as currently recognized by the center for disease control; and (3) policies and procedures must be implemented to report and manage patient and provider exposure to blood; affected individuals must be notified when exposure may constitute a significant risk of transmission of blood borne infection; the notification must include the nature of possible infection, but need not include the identity of the provider should the provider be the known source of infection. C. Infection control training. All providers shall have formal training in infection control techniques. Training is a requirement for licensure, as well as for renewal of all licenses and certificates. The course must be approved in accordance with Section 16.5.1.15 NMAC or sponsored by the occupational safety and health administration. D. Evaluation of provider with blood borne infection. (1) Counseling and testing recommended. The board and committee strongly recommend counseling and testing of any provider for HIV, HBV, HCV and other blood borne infections. (2) Evaluation of individual cases. Providers who have transmissible blood borne infections and who perform invasive procedures which might cause increased risk of transmission are strongly urged to submit to a voluntary evaluation process established by the New Mexico department of health. Individual evaluations conducted under the auspices of the New Mexico department of health will be strictly confidential unless that agency recommends practice restrictions. The New Mexico department of health will notify the board and committee of recommended practice restrictions. Any violation of practice restrictions will be considered grounds for disciplinary action by the board and committee. (3) Impairment evaluation. If a dental health care provider licensed or certified by the board has a functional impairment due to blood borne infection or other medical impairment, they must contact the impaired committee of the board. E. Confidentiality for dental health care workers. (1) The board and committee recognize providers are not required to disclose blood borne infections to patients or employers unless they cannot perform the essential duties of their job or practice, or unless the provider poses a danger to patient safety. (2) Any retrospective studies of New Mexico providers shall be carried out under the guidance and direction of the New Mexico department of health. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

341

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants PART 15 DENTISTS, ANESTHESIA/SEDATION ADMINISTRATION 16.5.15.7 DEFINITIONS: A. “Anxiolysis” the diminution or elimination or reduction of anxiety without a concomitant reduction of the patient's awareness or ability to react to stimuli. For the purposes of these rules, only a single dose of a single drug within the normal therapeutic dose is allowed. C. “Combination inhalation-enteral sedation (combined conscious sedation)” - conscious sedation using inhalation and enteral agents. Nitrous oxide/oxygen when used in combination with sedative agents may produce anxiolysis, conscious or deep sedation or general anesthesia. E. “Conscious sedation” means a minimally depressed level of consciousness that retains the patients' ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command. Conscious sedation is produced by a pharmacologic or non-pharmacologic method or combination thereof. In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would be considered to be in a deeper state of anesthesia than conscious sedation. For the purposes of this chapter, conscious sedation is further defined as minimal and moderate sedation. F. “Deep sedation” means a induced state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to verbal command. Deep sedation is produced by a pharmacologic or non- pharmacologic method or combination thereof. G. “Enteral” means any technique of administration in which the agent is absorbed through the gastrointestinal tract or oral mucosa (ie oral, rectal, sublingual). I. “General anesthesia” means a induced state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including the inability to continually maintain an airway independently and respond purposefully to physical stimulation or verbal command. General anesthesia is produced by a pharmacologic or non-pharmacologic method or combination thereof. J. Minimal sedation means a minimally depressed level of consciousness, produced by a pharmacological method that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile and verbal commands. Although cognitive function and coordination may be modestly impaired, ventilation and cardiovascular functions are unaffected. If more than one enteral drug is administered to achieve the desired effect, with or without concurrent use of nitrous oxide inhalation, the guidelines for moderate sedation must apply. The administration of an enteral drug exceeding the maximum recommended single dose during a single appointment is considered to be moderate sedation. Concomitant use of nitrous oxide with any sedative agent may produce minimal, moderate or deep sedation or general anesthesia. K. Moderate sedation means a drug induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain patent airway, spontaneous ventilation is adequate, cardiovascular function is usually maintained. In accord with this particular definition, the drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. A patient whose response is reflex withdrawal from painful stimuli is considered to be in a deeper state than that moderate sedation. L. “Monitor” means to constantly watch or check on the condition of the patient. M. “Nitrous oxide inhalation analgesia” means the administration by inhalation of a combination of nitrous oxide and oxygen, producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. O. “Prescribed administration” means the nitrous oxide is administered by a dental hygienist or dental assistant under the indirect supervision of the dentist with the dentist’s authorization. 16.5.15.10 PEDIATRIC GUIDELINES: Unless otherwise described in this section, all anesthesia for patients 12 years and under shall follow the American academy of pediatric dentistry's "guideline for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures." 16.5.15.11 ADMINISTRATION OF ENTERAL ANXIOLYSIS: B. Education/training: (2) Each dentist who administers or auxiliary personnel who monitors enteral anxiolysis shall have current basic life support certification; C. (3) All administration of anxiolytic drugs shall be under the indirect supervision or prescription of a dentist. 16.5.15.12 ADMINISTRATION OF NITROUS OXIDE INHALATION ANALGESIA: B. Education/qualifications: (2) each dentist and auxiliary personnel who monitors the use of, or administers nitrous oxide shall have current basic life support certification. C. (1) all use of nitrous oxide inhalation analgesia shall be under the indirect supervision of a licensed dentist holding a nitrous oxide permit. 342

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants (2) the patientâ&#x20AC;&#x2122;s records shall reflect evidence of appropriate monitoring by qualified dental personnel of vital signs, including blood pressure, pulse, and respiratory rate. Dose (percent) of nitrous oxide time of administration and time of release of patient should be recorded. 16.5.15.13 ADMINISTRATION OF MINIMAL SEDATION: C. Education/qualifications: (3) Each dentist administering and auxiliary monitoring, minimal sedation shall have current basic life support certification 16.5.15.14 ADMINISTRATION OF MODERATE SEDATION (Formerly conscious sedation I and II): F. Auxiliary clinical personnel must have current certification in basic life support. I. Facility/records: (1) the dentist must maintain a properly equipped facility for the administration of moderate sedation, staffed with supervised auxiliary personnel capable of handling procedures, problems and emergencies that may arise; 16.5.15.15 ADMINISTRATION OF DEEP SEDATION/GENERAL ANESTHESIA: D Facility/records: (2) the office is staffed with supervised clinical auxiliary personnel capable of handling procedures, problems and emergencies incident thereto; (3) the dentist must have current advanced cardiac life support certification (ACLS) and auxiliary clinical personnel have current basic life support certification; PART 17 DENTISTS AND DENTAL HYGIENISTS, COLLABORATIVE PRACTICE 16.5.17.2 SCOPE: The provisions of 16.5.17 NMAC apply to all dentists, dental hygienists and dental assistants who work in a collaborative practice arrangement. 16.5.17.14 DENTAL ASSISTANTS IN COLLABORATIVE DENTAL HYGIENE PRACTICE: Collaborative practice dental hygienists may work with and supervise dental assistants, including dental assistants certified to perform functions as defined in 16.5.39 NMAC of these rules. PART 32 DENTAL ASSISTANTS, FEES 16.5.32.2 SCOPE: The provisions of Part 32 of Chapter 5 apply to all applicants for certification; to active, expired and suspended certificate holders; and to anyone who requests a list of certified dental assistants or other public records. 16.5.32.8 FEES: A. all fees are non-refundable; B. application fee: $50.00; C. examination fee not to exceed $100 per exam; D. triennial renewal fee; $50.00; E. late penalty fee: $25.00; F. duplicate certificate fee: $10.00 G. list of current certificate holders: $300; an annual list of current certificate holders is available to the professional association upon request at no cost; H. labels of current certificate holders: $300; I. reinstatement fee: $15; J. DXTR rental fee, per day: $15.00. K. copies cost $0.25 per page. PART 33 DENTAL ASSISTANTS, REQUIREMENTS FOR CERTIFICATION 16.5.33.2 SCOPE: The provisions of 16.5.33 NMAC apply to all applicants for certification as a dental assistant in New Mexico. 16.5.33 NMAC also applies to dental assistants previously certified in New Mexico who have allowed their certificate to expire. 16.5.33.6 OBJECTIVE: To establish the requirements for certification for dental assistants to perform expanded functions. These rules address applicants being certified via the following tracks: A. Independent preparation for the requirements; B. Attendance in a dental assisting program; C. Attendance in an accredited dental hygiene school; and D. New residents of New Mexico with current certificates in expanded functions in their previous state (credentials). ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

343

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.33.7 DEFINITIONS: A. “DANB” means the dental assisting national board. B. “Direct supervision” means the process under which an act is performed when a dentist licensed pursuant to the Dental Health Care Act: (1) is physically present throughout the performance of the act; (2) orders, controls and accepts full professional responsibility for the act performed; (3) evaluates and approves the procedure performed before the patient departs the care setting; and (4) is capable of responding immediately if any emergency should arise. C. “General supervision” means the authorization by a dentist of the procedures to be used by a dental hygienist, dental assistant, expanded function dental auxiliary, dental student, or community dental health coordinator and the execution of the procedures in accordance with a dentist’s diagnosis and treatment plan at a time the dentist is not physically present and in facilities as designated by the rules of the board. D. “Indirect supervision” means that a dentist, or in certain settings a dental hygienist or dental assistant certified in expanded functions, is present in the treatment facility while authorized treatments are being performed by a dental hygienist, dental assistant or dental student as defined in 61-5A-3. E. “Limited certificate” means a radiographic certificate that limits the holder to take only extra oral dental films. F. “Rubber cup coronal polishing” means the use of a rubber cup or a bristle brush to remove soft debris and stain from above the gingival margin. G. “Supervision” means the dentist shall adequately monitor the performance of all personnel, licensed or unlicensed, that he or she supervises. The dentist is ultimately responsible for quality patient care and may be held accountable for all services provided by administrative and clinical individuals that the dentist supervises. H. “Training program” means a course of study resulting in applicant eligibility for expanded function certification. 16.5.33.8 REQUIREMENTS: A. A licensee shall not allow dental assistants to perform oral radiography under any level of supervision that are not certified or in authorized training by the New Mexico board of dental health care. B. A licensee shall not allow dental assistants to perform coronal polishing, topical fluoride application, or application of pit and fissure sealants under general supervision without certification by the board. C. Dental assistants who perform oral radiography under any level of supervision are required to be certified by the board. Dental assistants who perform coronal polishing, application of topical fluoride, or application of pit and fissure sealants under general supervision are required to be certified by the board except those enrolled in a recognized dental assisting program & complying with the following: (1) have completed the didactic portion of the radiography curriculum; (2) are exposing radiograph with supervision of a licensee or an assistant certified in radiography; and (3) if exposing x-rays on a human must have a written prescription from a dentist. D. Expanded function certification offered by the board is distinct from certification offered by DANB. DANB certification gives the individual the right to use the initials C.D.A. after their name, but does not qualify the individual to perform expanded functions without being certified by the board. 16.5.33.9 EDUCATION AND EXAMINATION REQUIREMENTS FOR DENTAL RADIOGRAPHY: A. Education Requirements: (1) study by independent preparation or in a training course on radiation health and safety within the past 36 months; and (2) have assisted with or observed five cases of full mouth intra oral radiographic series or five extra oral radiographs if applying for a limited certificate. B. Examination Requirements: (1) Pass the board or DANB written examination on radiation health and safety. (2) After passing the board or DANB written exam must apply to the board for a training permit which allows the dental assistant to perfect radiography technique. The permit is valid for six months after passing the written exam. (3) Pass the technique test demonstrating proficiency in the exposure of a full-mouth intra oral radiographic series or panoramic film as established by the board within six months of passing the written exam. (4) If an applicant chooses to provide only a panoramic film the certificate holder is limited to taking only extra oral films. (5) The technique test will be taken on a phantom or human patient. The applicant shall expose a full mouth intra oral radiographic series of radiographs, or a panoramic film, develop, mount, and label the films. The exam must be done independently and submitted to the board office with an affidavit signed by the dentist, dental hygienist, or dental assistant certified in radiography attesting to the independent exam. The radiographs must be of diagnostic quality and will be graded by at least two board or committee members and serve as the technique test required for certification. (6) Pass the take home jurisprudence examination. 344

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants (7) When extenuating circumstances exist as defined in 16.5.1.7 NMAC, and the dental assistant cannot submit to the board exposed radiographs, the dental assistant may request an extension of time. The request must be put in writing and submitted to the board office prior to the deadline. C. Exemptions: (1) A dental hygiene student enrolled in an accredited school of dental hygiene who having passed a curriculum in dental radiography, may be granted a certificate to expose radiographs without an examination. (2) A dental assistant certified to perform dental radiography in another state with requirements not less stringent than those in New Mexico may be certified based on credentials. 16.5.33.10 EDUCATION AND EXAMINATION REQUIREMENTS FOR RUBBER CUP CORONAL POLISHING AND APPLICATION OF TOPICAL FLUORIDE CERTIFICATION: A. Education Requirements: Study by independent preparation or in a training course on rubber cup coronal polishing and application of topical fluoride and have assisted with or observed five cases of rubber cup coronal polishing on children and adults and five applications of topical fluoride. B. Examination Requirements: (1) Pass a board or DANB written examination on rubber cup coronal polishing and application of topical fluoride; (2) Perform the technique while being personally observed by a dentist, dental hygienist, or dental assistant certified in rubber cup coronal polishing and application of topical fluoride on five adults and children and five applications of topical fluoride on children; and (3) Pass the take home jurisprudence examination. C. Exemptions: (1) A dental hygiene student enrolled in an accredited school of dental hygiene having passed a curriculum for rubber cup coronal polishing and application of topical fluoride, may be granted a certificate without meeting the other requirements of this section. (2) A dental assistant who is certified to perform rubber cup coronal polishing and application of topical fluoride in another state with requirements not less stringent than those in New Mexico may be certified based on credentials. (3) A dental assistant who holds a current CDA certification issued by DANB may be issued a certificate for rubber cup coronal polishing and application of topical fluoride without meeting the other requirements of this section. 16.5.33.11 EDUCATION, EXPERIENCE AND EXAMINATION REQUIREMENTS FOR APPLICATION OF PIT AND FISSURE SEALANTS CERTIFICATION: A. Experience Requirements: The applicant must have 2080 hours of clinical chair side dental assisting within the two years prior to applying for certification. B. Education Requirements: (1) Study by independent preparation or a training course on pit and fissure sealant application; and (2) Assisted with and observed application of twelve pit and fissure sealants. C. Examination Requirements: (1) Pass a board or DANB examination on the application of pit and fissure sealants. (2) Following successful completion of the examination, apply pit and fissure sealants while being personally observed by a licensed dentist or dental hygienist on five patients. (3) Pass the take home jurisprudence examination. D. Exemptions: (1) A dental hygiene student enrolled in an accredited school of dental hygiene having passed a curriculum for pit and fissure sealants and rubber cup coronal polishing, may be granted a certificate without meeting the other requirements of this section. (2) A dental assistant who is certified to perform application of pit and fissure sealants in another state with requirements not less stringent than those in New Mexico may be certified based on credentials. 16.5.33.12 REQUIRED DOCUMENTATION: Each applicant for an expanded function dental assistant certificate must submit to the board or its agent the required fees and following documentation. A. Completed application with a passport quality photo taken within 6 months affixed to the application and the completed jurisprudence take home exam. Applications are valid for 1 year from the date of receipt; B. Dental Radiography: (1) proof of passing the board or DANB written examination on radiation health and safety. (2) an affidavit from a supervising dentist, dental hygienist, or dental assistant certified in radiography verifying the applicant has: (a) assisted with and observed five (5) cases of full-mouth intra oral radiographic series or five (5) panoramic films if applying for a limited certification; and (b) that upon reaching competency, the applicant independently exposed the radiographs submitted for technique examination. (3) the completed full mouth intra oral radiographic series or a panoramic film as required for the technique exam described in 16.5.33.9 NMAC 7. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

345

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants C. Rubber cup coronal polishing and application of topical fluoride: (1) proof of passing the board or DANB written examination for rubber cup coronal polishing and application of topical fluoride. (2) an affidavit from a supervising dentist, dental hygienist, or dental assistant certified in rubber cup coronal polishing and topical fluoride application that the applicant has: (a) assisted with and observed five cases of rubber cup coronal polishing on adults and children and five applications of topical fluoride on children; and (b) while being personally observed by a dentist, dental hygienist, or dental assistant certified in rubber cup coronal polishing, application of topical fluoride provided rubber cup coronal polishing on five adults and/or children; and, provide applications of topical fluoride on five (5) children. D. Pit and fissure sealants: (1) proof of passing the board approved examination on application of pit and fissure sealants. (2) an affidavit from a supervising dentist or dental hygienist verifying that the applicant has: (a) assisted with and observed placement of twelve (12) pit and fissure sealants; and (b) while being personally observed by a dentist or dental hygienist, the applicant successfully place pit and fissure sealants on six (6) patients. (3) Proof of 2080 hours of chair side dental assisting experience within two years immediately prior to application for certification. (4) The completed jurisprudence exam. 16.5.33.13 CERTIFICATION BY CREDENTIALS: Applicants for certification by credentials must possess the following qualifications: A. verification of certification in all states where the applicant holds or has held a certificate to practice dental assisting; verification must be sent directly to the board office from the other state(s) board, must include a seal, and must attest to the status, issue date, expiration date, certification number, and other information contained on the form; B. an official letter from the director of an accredited dental hygiene program indicating the applicant has completed coursework in the requested expanded function; or C. proof of current, valid, certification as a CDA issued by DANB; and D. all certifications, letters and validations must be received directly by the board office from the state, institution, or DANB; E. the board may deny, stipulate, or otherwise limit a certification if is determined the applicant is guilty of violating any of the provisions of the act, the Uniform Licensing Act, the Impaired Dentists and Hygienists Act, or the rules; F. pass the jurisprudence exam with a score of a least 75%; G. all certificates held by the applicant must have been in good standing for two years prior to application; and I. the board may deny, stipulate, or otherwise limit a certification if it is determined the applicant holds or has held a certification in another jurisdiction that is not in good standing, if proceedings are pending against the applicant in another jurisdiction, or information is received indicating the applicant is of danger to patients or is guilty of violating any of the provisions of the act, the Uniform Licensing Act or these rules. 16.5.33.14 RE-EXAMINATION PROCEDURE: A. An applicant who does not obtain a passing score on the required written exam must re-apply and pay the required fees in order to retake the examination. B. Applicants for certification in radiography will be allowed to submit radiographs for the technique exam three times. With each failure the supervising dentist, dental hygienist, or dental assistant certified in dental radiography will be notified of their responsibility for training the applicant. C. After a third failure, the applicant and supervising dentist, dental hygienist, or dental assistant certified in radiography will be required to submit to the NMBODHC a plan for remediation, including steps that will be taken to assure clinical competency. 16.5.33.15 CERTIFICATION PROCEDURE: Upon receipt of a completed application, including all required documentation and fees the Secretary-Treasurer or delegate of the Board will review the application and determine eligibility for certification. The certificate must be displayed so that it is visible to the public. PART 35

DENTAL ASSISTANTS, CERTIFICATE EXPIRATION AND RENEWAL

16.5.35.6 OBJECTIVE: To establish the requirements and procedures for renewal and expiration of expanded function certificates for dental assistants. 16.5.35.8 CERTIFICATE EXPIRATION: Initial certificates will expire on July 1 following the second year of certification. No certificate will be issued for longer than 36 months or less than 25 months.

346

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.35.9 RENEWAL PERIOD AND EXPIRATION: After the initial license period, certifications for expanded function expire every three years on June 30. Certificates that are not renewed by July 1 are considered expired. 16.5.35.10 RENEWAL PROCESS: A completed renewal application, accompanied by the required fee as set forth in 16.5.32.8 NMAC, along with the required proof of completion of 30 hours of continuing education as set forth in 16.5.1.15 NMAC. The completed renewal application must be post-marked on or before July 1 of the renewal year. 16.5.35.11 CERTIFICATE HOLDER RESPONSIBILITY: The board assumes no responsibility for renewal applications not received for any reason. It is the certificate holders responsibility to make timely request for the renewal form if one has not been received thirty days prior to certificate expiration. 16.5.35.12 RENEWAL AFTER JUNE 30: Renewal applications post-marked after July 1 and prior to August 1 of the renewal year must be accompanied by the completed renewal application with the required proof of completion of 30 hours of continuing education as set forth in 15.5.36.8 NMAC, along with the triennial renewal fee and late fee as set forth in 16.5.32.8 NMAC. 16.5.35.13 RENEWAL AFTER AUGUST 1 AND BEFORE SEPTEMBER 1: Renewal applications post-marked on or after August 1, but before September 1, of the renewal year, must be accompanied by the completed renewal application with the required proof of completion of 30 hours of continuing education as set forth in 16.5.36.8 NMAC, along with the triennial renewal fee and a late fee as set forth in 16.5.32.8 NMAC. 16.5.35.14 RENEWAL APPLICATION UNDELIVERABLE: If the notice of renewal is returned to the office and the certificate holder has not sent a change of address, the revocation order will be considered undeliverable and will not be mailed. PART 36 DENTAL ASSISTANTS, CONTINUING EDUCATION REQUIREMENTS 16.5.36.6 O BJECTIVE: To establish the requirements for the renewal of expanded function certificates for dental assistants. 16.5.36.8 HOURS REQUIRED: Thirty hours of continuing education are required during each triennial renewal cycle. Continuing education received after submission of renewal materials but prior to actual expiration date may be used for the requirements of the next renewal cycle. Continuing education requirements are pro-rated at ten hours per year for individuals licensed for less than three years. 16.5.36.9 COURSES REQUIRED: Continuing education coursework must contribute directly to the practice of dental assisting. The following courses are required for license renewal: A. three hours of radiographic technique or safety and protection; B. as further defined in 16.5.1.16 NMAC, a course in infection control techniques and sterilization procedures per renewal period; and C. proof of current certification in basic life support (BLS) or cardiac pulmonary resuscitation (CPR) accepted by the American Heart Association or the American Red Cross; cannot be a self-study course. 16.5.36.10 VERIFICATION OF CONTINUING EDUCATION: The board will select renewal applications for verification of continuing education. Audit requests will be included with the renewal notice and those selected individuals will be asked to submit proof of compliance with the continuing education requirements. Continuing education records may be audited by the board at any time. The records identified in subsection F of 16.5.1.15 NMAC are considered acceptable forms of documentation. Continuing education records must be maintained for one year following the renewal cycle in which they are earned. 16.5.36.11 EMERGENCY DEFERRAL: A certificate holder who is unable to fulfill the continuing education requirements may apply to the board for an emergency deferral of the requirements. Additional deferrals of up to four months may be granted by a designee of the board. PART 37 DENTAL ASSISTANTS, CERTIFICATE REVOCATION FOR NON-RENEWAL 16.5.37.6 OBJECTIVE: To establish the procedures and policies for revocation of expired expanded function dental assisting certificates and the reinstatement of certificates revoked for non-renewal. 16.5.37.8 REVOCATION OF CERTIFICATE FOR NON-RENEWAL: Unless an application for certificate renewal is received by the board office, or post-marked, before September 1, the certificate shall be revoked for non-renewal. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

347

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.37.9 REINSTATEMENT OF REVOKED CERTIFICATE: Within one year of the revocation notice, the certificate may be reinstated by payment of renewal, late and reinstatement fees, compliance with continuing education for the previous renewal cycle and for the year of the revocation. Applicants for reinstatement after one year of revocation must re-apply as a new applicant and meet all requirements for initial certification. A. Applicants for reinstatement must provide verification of licensure in all states where the applicant holds or has held a license to practice dental assisting, or other health care profession within the previous year. Verification must be sent directly to the board office from the other state(s) board, must include a raised seal, and must attest to the status, issue date, license number, and other information contained on the form. B. Upon receipt of a completed reinstatement of revoked license application, including all documentation and fees, the secretary-treasurer or delegate of the board, will review and may approve the application. The board may formally accept the approval of the application at the next scheduled meeting. PART 39

DENTAL ASSISTANTS, PRACTICE AND SUPERVISION

16.5.39.6 OBJECTIVE: To establish those procedures, which may be provided by dental assistants, the procedures which require expanded function certification, and the procedures which may not be performed by dental assistants, regardless of certification or supervision. 16.5.39.8 PRACTICE AND REQUIRED SUPERVISION: Dental assistants may provide any basic supportive dental procedure, not excluded elsewhere in rule or in statute if the procedure is performed under the indirect supervision of a dentist. The following expanded function procedures may be performed without certification under indirect supervision as long as the procedure is approved by the dentist or dental hygienist upon completion: A. Rubber cup coronal polishing (not to be represented as a prophylaxis); B. Application of topical fluoride; C. Pit and fissure sealant application 16.5.39.9 PROCEDURES REQUIRING CERTIFICATION: The following procedures are allowable under general supervision if the dental assistant is certified by the Board: A. Place and expose dental radiographs; B. Rubber cup coronal polishing; C. Application of topical fluoride; and D. Pit and fissure sealants. 16.5.39.10 NON-ALLOWABLE PROCEDURES: Licensees may not delegate the performance of the following procedures to auxiliary personnel: A. Removal of, or addition to, the hard or soft tissue of the oral cavity; B. Diagnosis and treatment planning; C. Final impressions to include physical and digital impressions for restorations or prosthetic appliances; D. Initial fitting and adaptation of prostheses; E. Final fitting, adaptation, seating and cementation of any fixed or removable dental appliance or restoration, including but not limited to inlays, crowns, space maintainers, habit devices, anti-snoring or sleep apnea appliances, or splints; F. Irrigation and medication of canals, cone try-in, reaming, filing or filling of root canals; G. Other services defined as the practice of dentistry or dental hygiene in Section 61-5A-4, A, B, and C; and H. Bleaching or whitening teeth without direct or indirect supervision of a dentist. I. Laser-assisted non-surgical periodontal treatment PART 40 DENTAL ASSISTANTS, DISCIPLINARY PROCEEDINGS 16.5.40.2 SCOPE: The provisions of Part 40 of Chapter 5 apply to all active certificate holders and applicants for certification. These provisions may also be of interest to anyone who may wish to file a complaint against a dental assistant certified by the board. 16.5.40.6 OBJECTIVE: To establish the procedures for filing complaints against certificate holders, the disciplinary actions available to the board, the authority to issue investigative subpoenas and to further define actions by a certificate holder which are considered incompetent or unprofessional practice. 16.5.40.8 COMPLAINTS: Disciplinary proceedings may be instituted by sworn complaint of any person, including members of the board and committee. Any hearing held pursuant to the complaint shall conform with the provisions of the Uniform Licensing Act and the Dental Health Care Act. 348

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.40.9 ACTIONS: A. The board may issue fines, deny, revoke or suspend, or otherwise limit a certificate if the board determines the certificate holder is guilty of violating any of the provisions outlined in the Act, the Uniform Licensing Act, or these rules. B. The board may reprimand, censure, stipulate and may require certificate holders to fulfill additional continuing education hours within limited time constraints for violations of the act or the rules. C. The board shall take into consideration the role of dental assistants as employees when taking disciplinary action against a certificate holder. In the event the complaint is ruled to be based primarily on the assistant’s role as employee, the board may consider appropriate action against the employer/dentist. 16.5.40.10 GUIDELINES: The board shall define the following as guidelines for disciplinary action: “unprofessional conduct” means, but is not limited to because of enumeration: A. performing, or holding oneself out as able to perform, professional services beyond the scope of ones certification and field or fields of competence as established by education, experience, training, or any combination thereof; this includes, but is not limited to, the use of any instrument, device or material in a manner that is not in accordance with the customary standards and practices of dental assisting; B. Sexual misconduct; C. Failure to use appropriate infection control techniques and sterilization procedures; D. Fraud, deceit or misrepresentation in any application; E. Cheating on an examination for expanded function certification; F. Performing any procedure which requires certification unless so certified; G. Injudicious administration of any drug or medicine; H. Conviction of either a misdemeanor or a felony punishable by incarceration; and I. Failure to be in compliance with the Parental Responsibility Act NMSA1978, Section 40-5A-3 seq. 16.5.40.11 INVESTIGATIVE SUBPOENAS: The complaint committee of the board is authorized to issue investigative subpoenas and to employ experts with regard to pending investigations. PART 41 EXPANDED FUNCTION DENTAL AUXILIARY, FEES 16.5.41.2 SCOPE: The provisions of Part 41 of Chapter 5 apply to all applicants for certification; to active, expired and suspended certificate holders; and to anyone who requests a list of certified expanded function dental auxiliary or other public records. 16.5.41.6 OBJECTIVE: To establish fees to generate revenue to support the cost of program administration. 16.5.41.8 FEES: A. all fees are non-refundable; B. application fee: $100; C. board examination fee not to exceed $100 per exam; D. triennial renewal fee: $100; E. late penalty fee: $25.00; F. duplicate certificate fee: $10.00; G. list of current certificate holders: $300; an annual list of current certificate holders is available to the professional association upon request at no cost; H. labels of current certificate holders: $300; I. reinstatement fee: $15.00; J. copies cost $0.25 per page. PART 42 EXPANDED FUNCTION DENTAL AUXILIARY, REQUIREMENTS FOR CERTIFICATION 16.5.42.2 SCOPE: The provisions of Part 42 of Chapter 5 apply to all applicants for certification; to active, expired and suspended certificate holders; and to anyone who requests a list of certified expanded function dental auxiliary or other public records. 16.5.42.6 OBJECTIVE: To establish the requirements for certification for expanded function dental auxiliary to perform expanded functions. These rules address applicants being certified via the following tracks. A. Completed an expanded function dental auxiliary program at an institution where the dental assisting program is accredited by the joint commission on dental accreditation (CODA). B. Independent preparation for dental assistants that have five years experience and prepare independently for the requirements. C. Candidates who possess a current certificate in good standing in expanded function dental auxiliary from another state or jurisdiction (credentials). © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

349

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.42.7 DEFINITIONS: A. “Apprenticeship” means a period of time in which an EFDA candidate is closely supervised by a supervising dentist and demonstrates competency on patients in EFDA duties as defined under 16.5.46.9 NMAC. The supervising dentist assumes all responsibility and liability for the training and actions of an EFDA candidate and must attest to their competency. B. “Close personal supervision” means a New Mexico licensed dentist directly observes, instructs and certifies in writing the training and expertise of a EFDA candidate to the board. C. “Continuous employment” means 1,000 hours per year for any five consecutive years. D. “Direct supervision” means the process under which an act is performed when a dentist licensed pursuant to the Dental Health Care Act: (1) is physically present throughout the performance of the act; (2) orders, controls and accepts full professional responsibility for the act performed; and (3) evaluates and approves the procedure performed before the patient departs the care setting. E. “Expanded function dental auxiliary” EFDA means a dental assistant, dental hygienist or other dental auxiliary that has received education specific to the duties delineated by the board for an EFDA, and has met the educational and certifying exam standards set by the board for an EFDA, and works under the direct supervision of a NM licensed dentist to perform the functions allowed under this section. F. “Placing and shaping restorations” means the act of placing dental filling material(s) directly into a cavity preparation previously prepared by a dentist, and shaping, finishing and polishing the restoration so that it has proper occlusal form, contacts, anatomy and margins prior to final approval by the dentist. G. “Supervising dentist” means a New Mexico licensed dentist who has no current action or inquires pending by the board and who provides supervision, instruction and recommendation for an EFDA candidate to the board. 16.5.42.8 REQUIREMENTS: EFDA who performs the duties defined under 16.5.46.9 NMAC are required to be certified by the board. 16.5.42.9 EDUCATION AND EXAMINATION REQUIREMENTS FOR EXPANDED FUNCTION DENTAL AUXILIARY: A. satisfactory completion of an expanded function dental auxiliary course at an institution. Where the dental assisting program is accredited by the joint commission on dental accreditation, and approved by the board. The applicant must be certified in all 4 expanded functions as defined in Section 16.5.33 NMAC; or B. for dental auxiliaries that have five years experience and “independent preparation” for the requirements: (1) applicant must have a minimum of five years of continuous employment as a dental assistant or dental hygienist with a minimum of 1,000 hours per year; (2) achieved certification in all expanded functions as defined in 16.5.33 NMAC; (3) taken a course of study in dental anatomy, dental materials, placing and shaping direct restorations, fitting and shaping of stainless steel crowns, and occlusion function and passed a post-test approved by the board verifying readiness for taking the certification examination; (4) recommended for an expanded function dental auxiliary (EFDA) certification by the supervising dentist as defined in Subsection G of 16.5.42.7 NMAC; (5) instructors must have higher or same level of licensure or certification in respective courses they are teaching; C. pass a clinical examination accepted by the board for certification of EFDA; D. completed the jurisprudence examination with a score of at least 75 percent; E. exemptions; an expanded function dental auxiliary who is certified to perform EFDA duties in another state or jurisdiction with requirements not less stringent than those in New Mexico may be certified based on credentials; F. after passing a board accepted examination or being certified by credentials, EFDA candidates must complete an apprenticeship under the close personal supervision of a supervising dentist (1) the board will send to the EFDA candidate upon receipt of the completed application the following: (a) permit to start apprenticeship to be displayed during apprenticeship; and (b) affidavit form to be signed by supervising dentist at start and completion of apprenticeship; (2) the affidavit shall state that the supervising dentist assures that the EFDA candidate is competent in the procedures allowed by an EFDA and that the supervising dentist assumes full responsibility and liability for the training and actions of the EFDA; (3) once the permit is issued by the board office the EFDA candidate has 180 days to complete the apprenticeship; (a grace period of no more than 60 days may be granted by the board chair or vice-chair) and (4) upon completion of the apprenticeship the candidate must return the EFDA permit and the signed affidavit to the board; once the permit and signed affidavit have been received and verified by the board a certificate for EFDA may be issued.

350

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.42.10 REQUIRED DOCUMENTATION: Each applicant for an expanded function dental auxiliary certification shall submit to the board or its agent the required fees and the following documentation. Applications are valid for one year from the date of receipt by the board; after one year, the applicant shall submit to the board a new application. A. Each application for licensure who completed an EFDA program as defined in Subsection A of Section 16.5.42.9 NMAC must submit the following documentation: (1) completed application with a passport quality photo taken within six months affixed to the application; (2) official transcripts or certification verifying successful completion of an EFDA program accredited by the commission on dental accreditation; (3) copy of a clinical examination accepted by the board for certification as EFDA; the results of the exam are valid in New Mexico for a period not to exceed five years: (a) the applicant shall apply directly to a board approved testing agency for examination; (b) results of the clinical examination shall be sent directly to the board office; and (4) affidavit letter from supervising dentists. (5) proof of certifications in all 4 expanded functions as defined in Section 16.5.33 NMAC no later than July 1, 2019. B. An applicant who has not graduated from a program as defined in Subsection A of Section 16.5.42.9 NMAC can apply for certification if they meet all requirements in Subsection B, C, D and F of 16.5.42.9 NMAC and must submit the following: (1) completed application with a passport quality photo taken within six months affixed to the application; (2) shall provide proof of five years of continuous employment as a dental assistant or dental hygienist with a minimum of 1,000 hours per year; (3) shall have achieved certification in all expanded function as defined in 16.5.33 NMAC; (4) shall provide proof of successful completion of courses in dental anatomy, dental materials, placing and shaping direct restorations, fitting and shaping of stainless steel crowns, and occlusion function; (5) shall provide an affidavit executed on dentist letterhead from a supervising dentist recommending the applicant for EFDA certification; and (6) copy of a clinical examination score card or certificate. C. Certification by credentials. Applicants can apply for certification by credentials if they meet all requirements as defined in Subsections A, C, D and F of 16.5.42.9 NMAC and must submit the following: (1) completed application with a passport quality photo taken within six months affixed to the application; (2) verification of a current active certification in good standing from another state; and (3) copy of clinical examination score card or certificate; the results of the examination are valid in New Mexico for a period not to exceed five years: (a) the applicant shall apply directly to a board approved testing agency for examination, and (b) the results of the clinical examination must be sent directly to the board office; and (4) affidavit letter from the supervising dentist of competency. 16.5.42.11 CERTIFICATION PROCEDURE: Upon receipt of a completed application, including all required documentation, signed affidavit and fees, the secretary-treasurer or delegate of the board will review the application and determine eligibility for certification. A. Initial certificates are issued for a period not to exceed three years. B. The certificate must be displayed so that it is visible to the public. 16.5.42.12 TIMELINE FOR PREVIOUSLY ISSUED EFDA PERMITS AND EXPANDED FUNCTIONS: All current EFDA certification permit holders must have all four expanded functions as defined in Section 16.5.33 NMAC no later than July 1, 2019. EFDA permits will suspend automatically if such expanded functions certifications are not current. Once those expanded functions are certified, the EFDA permit will become valid until its regular expiration period. PART 43 EXPANDED FUNCTION DENTAL AUXILIARY, CERTIFICATION EXPIRATION AND RENEWAL 16.5.43.2 SCOPE: The provisions of Part 43 of Chapter 5 apply to all expanded function dental auxiliary with a certificate to practice expanded functions in New Mexico. 16.5.43.6 OBJECTIVE: To establish the requirements and procedures for renewal and expiration of certificates for expanded function dental auxiliary. 16.5.43.8 CERTIFICATE EXPIRATION: Initial certificates will expire on July 1 following the second year of certification. No certificate will be issued for longer than 36 months or less than 25 months. 16.5.43.9 RENEWAL PERIOD AND EXPIRATION: After the initial certification period, certifications for expanded function expire every three years on June 30. Certificates that are not renewed by July 1 are considered expired. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

351

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.43.10 RENEWAL PROCESS: A completed renewal application, accompanied by the required fee as set forth in 16.5.41.8 NMAC, along with the required proof of completion of 36 hours of continuing education as set forth in 16.5.1.15 NMAC. The completed renewal application must be post-marked on or before July 1 of the renewal year. 16.5.43.11 CERTIFICATE HOLDER RESPONSIBILITY: The board assumes no responsibility for renewal applications not received for any reason. It is the certificate holders responsibility to make timely request for the renewal form if one has not been received 30 days prior to certificate expiration. 16.5.43.12 RENEWAL AFTER JUNE 30: Renewal applications post-marked after July 1 and prior to August 1 of the renewal year must be accompanied by the completed renewal application with the required proof of completion of 36 hours of continuing education as set forth in 16.5.44.8 NMAC, along with the triennial renewal fee and late fee as set forth in 16.5.41.8 NMAC. 16.5.43.13 RENEWAL AFTER AUGUST 1 AND BEFORE SEPTEMBER 1: Renewal applications post-marked on or after August 1, but before September 1, of the renewal year, must be accompanied by the completed renewal application with the required proof of completion of 36 hours of continuing education as set forth in 16.5.44.8 NMAC, along with the triennial renewal fee and late fee as set forth in 16.5.41.8 NMAC. 16.5.43.14 RENEWAL APPLICATION UNDELIVERABLE: If the notice of renewal is returned to the office and the certificate holder has not sent a change of address, the revocation order will be considered undeliverable and will not be mailed. PART 44 EXPANDED FUNCTION DENTAL AUXILIARY, CONTINUING EDUCATION REQUIREMENTS 16.5.44.2 SCOPE: The provisions of Part 44 of Chapter 5 apply to all expanded function dental auxiliary with current expanded function dental auxiliary certification who are applying to renew their certificate. 16.5.44.6 OBJECTIVE: To establish the requirements for the renewal of expanded function dental auxiliary certificates. 16.5.44.8 HOURS REQUIRED: 36 hours of continuing education, a maximum of 12 hours can be on-line, webinars or self-study, are required during each triennial renewal cycle as defined in 16.5.1 NMAC. Continuing education received after submission of renewal materials but prior to actual expiration date may be used for the requirements of the next renewal cycle. Continuing education requirements are pro-rated at 12 hours per year for individuals certified for less than three years. 16.5.44.9 COURSES REQUIRED: Continuing education coursework must contribute directly to the practice of expanded function dental auxiliary. The following courses are required for certification renewal: A. as further defined in 16.5.1.16 NMAC, a course in infection control techniques and sterilization procedures per renewal period; B. proof of current certification in basic life support (BLS) or cardiac pulmonary resuscitation (CPR) accepted by the American heart association, the American red cross, or the American safety and health institute (ASHI); cannot be a self-study course; and C. 12 hours in restorative dentistry. 16.5.44.10 VERIFICATION OF CONTINUING EDUCATION: The board will select renewal applications for verification of continuing education. Audit requests will be included with the renewal notice and those selected individuals will be asked to submit proof of compliance with the continuing education requirements. Continuing education records may be audited by the board at any time. The records identified Subsection F of 16.5.1.15 NMAC are considered acceptable forms of documentation. Continuing education records must be maintained for one year following the renewal cycle in which they are earned. 16.5.44.11 EMERGENCY DEFERRAL: A certificate holder who is unable to fulfill the continuing education requirements may apply to the board for an emergency deferral of the requirements due to extenuating circumstances as defined in 16.5.1.7 NMAC. Deferrals of up to four months may be granted by a designee of the board. PART 45 EXPANDED FUNCTION DENTAL AUXILIARY, CERTIFICATE REVOCATION FOR NON-RENEWAL 16.5.45.2 SCOPE: The provisions of Part 45 of Chapter 5 apply to all expanded function dental auxiliary with expanded function certification who do not submit an application for certificate renewal within 60 days of the expiration date. 16.5.45.6 OBJECTIVE: To establish the procedures and policies for revocation of expired expanded function dental auxiliary certificates and the reinstatement of certificates revoked for non-renewal.

352

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.45.8 REVOCATION OF CERTIFICATE FOR NON-RENEWAL: Unless an application for certificate renewal is received by the board office, or post-marked, before September 1, the certificate shall be revoked for non-renewal. 16.5.45.9 REINSTATEMENT OF REVOKED CERTIFICATE: Within one year of the revocation notice, the certificate may be reinstated by payment of renewal, late and reinstatement fees, compliance with continuing education for the previous renewal cycle and for the year of the revocation. Applicants for reinstatement after one year of revocation must re-apply as a new applicant and meet all requirements for initial certification. A. Applicants for reinstatement must provide verification of certification in all states where the applicant holds or has held a certificate to practice expanded function dental auxiliary, or other health care profession within the previous year. Verification must be sent directly to the board office from the other state(s) board, must include a raised seal, and must attest to the status, issue date, expiration date, certificate number, and other information contained on the form. B. Upon receipt of a completed reinstatement of revoked certification application, including all documentation and fees, the secretary-treasurer or delegate of the board, will review and may approve the application. The board may formally accept the approval of the application at the next scheduled meeting. PART 46 EXPANDED FUNCTION DENTAL AUXILIARY, PRACTICE AND SUPERVISION 16.5.46.2 SCOPE: The provisions of Part 46 of Chapter 5 apply to all expanded function dental auxiliary with current certification. 16.5.46.6 OBJECTIVE: To establish those procedures which shall be provided by an expanded function dental auxiliary, the procedures which require expanded function dental auxiliary certification, and the procedures which shall not be performed by an expanded function dental auxiliary, regardless of certification or supervision. 16.5.46.7 DEFINITIONS: “Direct supervision” means the process under which an act is performed when a dentist licensed pursuant to the Dental Health Care Act: A. is physically present throughout the performance of the act; B. orders, controls and accepts full professional responsibility for the act performed; and C. evaluates and approves the procedure performed before the patient departs the care setting. 16.5.46.8 PRACTICE AND REQUIRED SUPERVISION: EFDA duties set forth in 16.5.46.9 NMAC are allowed under the direct supervision of a NM licensed dentist, provided the dentist has: A. prepared the cavity or tooth for the restorative procedure; B. instructed the EFDA on the particular elements of this individual case; C. fully examined and evaluated the procedure carried out by the EFDA, and corrected or replaced any deficiency found in the EFDA work, before allowing the patient to leave the treatment facility; D. the dentist is ultimately responsible for the quality of care and the quality of the final restorative procedure carried out by the EFDA as defined in 16.5.16 NMAC and Subsection N of Section 61-5A-3 of the Dental Health Care Act; and E. not more than two EFDA, performing expanded functions, per licensed dentist present in office. 16.5.46.9 ALLOWABLE DUTIES UNDER DIRECT SUPERVISION: The following EFDA procedures are allowable under direct supervision as set forth in 16.5.46.8 NMAC. A. Placing and shaping of direct restorative materials into cavity preparations completed by a dentist; EFDA may use instrumentation as necessary and proper for this purpose. B. Taking of impressions for permanent fixed or removable prosthetics involving single teeth, to include digital impressions. These include single crowns or single tooth replacement prosthetics. EFDA shall NOT take final impressions for multiple units of single crowns, bridges, cast framework partial dentures or full dentures final impressions. C. Cement permanent or provisional restorations with temporary or provisional cement, provided the permanent cementation will be completed or monitored by the dentist within six months. D. Place pit and fissure sealants under supervision as certification or licensure allows. E. Place temporary or sedative restorations in open carious lesions after hand excavation of gross decay and debris. If pain is perceived by the patient dentist shall evaluate lesion before completion by EFDA. The EFDA shall NOT use any automated method to clean out the lesion or prepare the tooth, including but not limited to high speed, slow speed, air abrasion, ultrasonic, laser etc. F. The EFDA may place temporary or sedative restorative material into unprepared tooth fractures as a palliative measure. The EFDA shall NOT use any automated method to clean out the fracture or prepare the tooth, including but not limited to high speed, slow speed, air abrasion, ultrasonic, laser etc. G. Remove residual orthodontic bracket or band cement or resin from teeth after the brackets or bands have been removed by the dentist performing the orthodontic treatment, or to prepare the tooth or teeth for re-cementation © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

353

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants of a debonded bracket or band. This removal of cement/resin may include the use of instrumentation, as necessary and proper for this purpose. H. Perform preliminary fitting and shaping of stainless steel crowns which shall undergo final evaluation and cementation by a dentist. I. In emergency situation recement temporary or permanent crowns or bridges using provisional cement under the general supervision of a dentist and when instructed to do so by the dentist provided the permanent cementation will be completed or monitored by the dentist within six months. 16.5.46.10 NON-ALLOWABLE PROCEDURES: EFDA shall not perform any other procedure, duty or function as an EFDA under any level of supervision that is not expressly listed in 16.5.46.9 NMAC. PART 47 EXPANDED FUNCTION DENTAL AUXILIARY, DISCIPLINARY PROCEEDINGS 16.5.47.10 GUIDELINES: The board shall define the following as guidelines for disciplinary action: “unprofessional conduct” means, but is not limited to because of enumeration: A. performing, or holding oneself out as able to perform, professional services beyond the scope of ones certification and field or fields of competence as established by education, experience, training, or any combination thereof; this includes, but is not limited to, the use of any instrument, device or material in a manner that is not in accordance with the customary standards and practices of expanded function dental auxiliary; B. sexual misconduct; C. failure to use appropriate infection control techniques and sterilization procedures; D. fraud, deceit or misrepresentation in any application; E. cheating on an examination for expanded function dental auxiliary certification; F. performing any procedure which requires certification unless so certified; G. injudicious administration of any drug or medicine; H. conviction of either a misdemeanor or a felony punishable by incarceration; and I. failure to be in compliance with the Parental Responsibility Act NMSA1978, Section 40-5A-3 seq. 16.5.47.11 INVESTIGATIVE SUBPOENAS: The complaint committee of the board is authorized to issue investigative subpoenas and to employ experts with regard to pending investigations. PART 49 COMMUNITY DENTAL HEALTH COORDINATOR, FEES 16.5.49.2 SCOPE: The provisions of Part 49 of Chapter 5 apply to all applicants for certification; to active, expired and suspended certificate holders; and to anyone who requests a list of certified community dental health coordinators or other public records. 16.5.49.6 OBJECTIVE: To establish fees to generate revenue to support the cost of program administration. 16.5.49.8 FEES: A. all fees are non-refundable; B. application fee: $100; C. board examination fee not to exceed $100 per exam; D. triennial renewal fee: $100; E. late penalty fee: $25.00; F. duplicate certificate fee: $10.00; G. list of current certificate holders: $300; an annual list of current certificate holders is available to the professional association upon request at no cost; H. labels of current certificate holders: $300; I. reinstatement fee: $15.00; J. copies cost $0.25 per page. PART 50

COMMUNITY DENTAL HEALTH COORDINATOR, REQUIREMENTS FOR CERTIFICATION

16.5.50.2 SCOPE: The provisions of Part 50 of Chapter 5 apply to all applicants for certification; to active, expired and suspended certificate holders; and to anyone who requests a list of community dental health coordinators or other public records. 16.5.50.6 OBJECTIVE: To establish the requirements for certification as a community dental health coordinator for applicants from various educational backgrounds and professional tracks. 16.5.50.7 DEFINITIONS: A. “Community based field experience” means a hands on internship/apprenticeship where the CDHC gets to use their skills under supervision of a licensed New Mexico dentist or hygienist. 354

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants B.

D. E.

G. H.

“Community dental health coordinator” CDHC means a dental assistant, dental hygienist or other trained personnel certified by the board as a community dental health coordinator to provide educational, preventive and limited palliative care and assessment services working collaboratively under the general supervision of a licensed New Mexico dentist. “Community health promotion” means courses that teach social work skills such as, building social networks, health advocacy for individuals and communities, mapping out social and health support networks, cultural competency, communication skills, interpersonal skills, interviewing skills, behavioral assessment and management, developing community programs, teaching and training skills, legal and ethical issues. “Continuous employment” means 1,000 hours per year for five consecutive years. “Dental skills” means courses in basic dental knowledge, emergency vs. routine care needs, recognition of dental conditions, gross anatomy of head and neck and oral structures, gathering and recording information, clinical record keeping, caries, periodontal disease, oral and external cancer evaluation,palliative care, and financing dental care. “General supervision” means the authorization by a dentist of the procedures to be used by a dental hygienist, dental assistant, expanded function dental auxiliary, dental student, or community dental health coordinator and the execution of the procedures in accordance with a dentist’s diagnosis and treatment plan at a time the dentist is not physically present and in the facility as designated by the rules of the board. “Limited palliative procedures” means procedures ordered by the dentist to help relieve pain or to improve an emergency situation that a patient is experiencing. These procedures must be within the scope of the community dental health coordinator. “Teledentistry” means a dentist’s use of health information technology in real time to provide limited diagnostic and treatment planning services in cooperation with another dentist, a dental hygienist, a community dental health coordinator or a student enrolled in a program of study to become a dental assistant, dental hygienist or dentist.

16.5.50.8 REQUIREMENTS: Community dental health coordinator who performs the duties defined under 16.5.54 NMAC are required to be certified by the board. 16.5.50.9 EDUCATION AND EXAMINATION REQUIREMENTS FOR COMMUNITY DENTAL HEALTH COORDINATOR: Each applicant for a certification for community dental health coordinator must possess the following qualifications, through one of the following pathways: A. Applicants for CDHC shall meet the following requirements for certification: (1) shall have high school diploma (or equivalent) or college level degree; (2) shall have board certification in radiography, rubber cup coronal polishing and topical fluoride and pit and fissure expanded functions; (3) completed the jurisprudence exam with a score of at least 75 percent; and (4) successful completion of CDHC program approved by the board. B. Pathways/educational tracks: applicants may have earned other college level degree(s) and certifications in their respective field(s) of study, such as, but not limited to, registered dental hygienists, certified dental assistant, dental assistant, expanded function dental auxiliary and other non-dental professionals. Credits earned in these educational fields may be applied for credit towards the CDHC education program as determined by the sponsoring institution. C. Approved programs: board approved CDHC programs shall include the following guidelines for course study in order to prepare the applicant to a level consistent with the definitions as listed in 16.5.50.7 NMAC and duties as outlined in 16.5.54.9 NMAC: (1) education in community health promotion; (2) education in dental skills; and (3) education in community-based field experience. D. Credit shall be given by the approved program of coursework, certifications, or degrees already earned. Proof of these credits is the responsibility of the institution of the approved program. 16.5.50.10 REQUIRED DOCUMENTATION: Each applicant for community dental health coordinator certification must submit to the board or its agent the required fees and following documentation. Applications are valid for one year from the date of receipt: A. proof of official transcripts with required courses for certification; official transcripts verifying successfully passing all required coursework as defined in 61-5A-6 of the act; B. passed the jurisprudence exam with a score of at least 75 percent; C. submit to the board the names of the dentists(s) working in a supervisory capacity to the CDHC coordinator. 16.5.50.11 CERTIFICATION PROCEDURE: Upon receipt of a completed application, including all required documentation and fees the secretary-treasurer or delegate of the board will review the application and determine eligibility for certification. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

355

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants A. B.

Initial certificates are issued for a period not to exceed three years. The certificate must be displayed so that it is visible to the public

PART 51 COMMUNITY DENTAL HEALTH COORDINATOR, CERTIFICATION EXPIRATION AND RENEWAL 16.5.51.2 SCOPE: The provisions of Part 51 of Chapter 5 apply to all community dental health coordinators with a certificate to practice as a community dental health coordinator in New Mexico. 16.5.51.6 OBJECTIVE: To establish the requirements and procedures for renewal and expiration of certificates for community dental health coordinator. 16.5.51.8 CERTIFICATE EXPIRATION: Initial certificates will expire on July 1 following the second year of certification. No certificate will be issued for longer than 36 months or less than 25 months. 16.5.51.9 RENEWAL PERIOD AND EXPIRATION: After the initial certification period, certifications for community dental health coordinator expire every three years on June 30. Certificates that are not renewed by July 1 are considered expired. 16.5.51.10 RENEWAL PROCESS: A completed renewal application, accompanied by the required fee as set forth in 16.5.49.8 NMAC, along with the required proof of completion of 36 hours of continuing education as set forth in 16.5.1.15 NMAC. The completed renewal application must be post-marked on or before July 1 of the renewal year. 16.5.51.11 CERTIFICATE HOLDER RESPONSIBILITY: The board assumes no responsibility for renewal applications not received for any reason. It is the certificate holders responsibility to make timely request for the renewal form if one has not been received 30 days prior to certificate expiration. 16.5.51.12 RENEWAL AFTER JUNE 30: Renewal applications post-marked after July 1 and prior to August 1 of the renewal year must be accompanied by the completed renewal application with the required proof of completion of 36 hours of continuing education as set forth in 16.5.52.8 NMAC, along with the triennial renewal fee and late fee as set forth in 16.5.49.8 NMAC. 16.5.51.13 RENEWAL AFTER AUGUST 1 AND BEFORE SEPTEMBER 1: Renewal applications post-marked on or after August 1, but before September 1, of the renewal year, must be accompanied by the completed renewal application with the required proof of completion of 36 hours of continuing education as set forth in 16.5.52.8 NMAC, along with the triennial renewal fee and late fee as set forth in 16.5.49.8 NMAC. 16.5.51.14 RENEWAL APPLICATION UNDELIVERABLE: If the notice of renewal is returned to the office and the certificate holder has not sent a change of address, the revocation order will be considered undeliverable and will not be mailed. PART 52 COMMUNITY DENTAL HEALTH COORDINATOR, CONTINUING EDUCATION REQUIREMENTS 16.5.52.2 SCOPE: The provisions of Part 52 of Chapter 5 apply to all community dental health coordinators with current expanded function certification who are applying to renew their certificate. 16.5.52.6 OBJECTIVE: To establish the requirements for the renewal of community dental health coordinator certificates. 16.5.52.8 HOURS REQUIRED: 36 hours of continuing education, a maximum of 12 hours can be on-line, webinars or self-study, are required during each triennial renewal cycle as defined in 16.5.1 NMAC. Continuing education received after submission of renewal materials but prior to actual expiration date may be used for the requirements of the next renewal cycle. Continuing education requirements are pro-rated at 12 hours per year for individuals certified for less than three years. 16.5.52.9 COURSES REQUIRED: Continuing education coursework must contribute directly to the practice of community dental health coordinator. The following courses are required for certificate renewal: A. as further defined in 16.5.1.16 NMAC, a course in infection control techniques and sterilization procedures per renewal period; B. proof of current certification in basic life support (BLS) or cardiac pulmonary resuscitation (CPR) accepted by the American heart association, the American red cross, or the American safety and health institute (ASHI); cannot be a self-study course; and C. 12 hours in preventive or emergency dentistry. 16.5.52.10 VERIFICATION OF CONTINUING EDUCATION: The board will select renewal applications for verification of continuing education. Audit requests will be included with the renewal notice and those selected individuals will be 356

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants asked to submit proof of compliance with the continuing education requirements. Continuing education records may be audited by the board at any time. The records identified Subsection F of 16.5.1.15 NMAC are considered acceptable forms of documentation. Continuing education records must be maintained for one year following the renewal cycle in which they are earned. 16.5.52.11 EMERGENCY DEFERRAL: A certificate holder who is unable to fulfill the continuing education requirements may apply to the board for an emergency deferral of the requirements due to extenuating circumstances as defined in 16.5.1.7 NMAC. Deferrals of up to four months may be granted by a designee of the board. PART 53 COMMUNITY DENTAL HEALTH COORDINATOR, CERTIFICATE REVOCATION FOR NON-RENEWAL 16.5.53.2 SCOPE: The provisions of Part 53 of Chapter 5 apply to all community dental health coordinators with certification who do not submit an application for certificate renewal within 60 days of the expiration date. 16.5.53.6 OBJECTIVE: To establish the procedures and policies for revocation of expired community dental health coordinator certificates and the reinstatement of certificates revoked for non-renewal. 16.5.53.8 REVOCATION OF CERTIFICATE FOR NON-RENEWAL: Unless an application for certificate renewal is received by the board office, or post-marked, before September 1, the certificate shall be revoked for non-renewal. 16.5.53.9 REINSTATEMENT OF REVOKED CERTIFICATE: Within one year of the revocation notice, the certificate may be reinstated by payment of renewal, late and reinstatement fees, compliance with continuing education for the previous renewal cycle and for the year of the revocation. Applicants for reinstatement after one year of revocation must re-apply as a new applicant and meet all requirements for initial certification. A. Applicants for reinstatement must provide verification of certification in all states where the applicant holds or has held a certificate to practice as a community dental health coordinator, or other health care profession within the previous year. Verification must be sent directly to the board office from the other state(s) board, must include a raised seal, and must attest to the status, issue date, expiration date, certification number, and other information contained on the form. B. Upon receipt of a completed reinstatement of revoked certification application, including all documentation and fees, the secretary-treasurer or delegate of the board, will review and may approve the application. The board may formally accept the approval of the application at the next scheduled meeting. PART 54 COMMUNITY DENTAL HEALTH COORDINATOR, PRACTICE AND SUPERVISION 16.5.54.2 SCOPE: The provisions of Part 54 of Chapter 5 apply to all community dental health coordinators with current certification. 16.5.54.6 OBJECTIVE: To establish those procedures which may be provided by a community dental health coordinator, the procedures which require community dental health coordinator certification, and the procedures which may not be performed by an community dental health coordinator, regardless of certification or supervision. 16.5.54.7 DEFINITIONS: A. “Cavitation” means a break in the continuous, solid surface of the enamel of a tooth, created either by genetic formation or demineralization. B. “Direct supervision” means the process under which an act is performed when a dentist licensed pursuant to the Dental Health Care Act: (1) is physically present throughout the performance of the act; (2) orders, controls and accepts full professional responsibility for the act performed; and (3) evaluates and approves the procedure performed before the patient departs the care setting. C. “General supervision” means the authorization by a dentist of the procedures to be used by a dental hygienist, dental assistant, expanded function dental auxiliary, community dental health coordinator or dental student and the execution of the procedures in accordance with a dentist’s diagnosis and treatment plan at a time the dentist is not physically present and in facilities as designated by the rules of the board. D. “Limited palliative procedure(s)” means procedures ordered by the dentist to help relieve pain or to improve an emergency situation that a patient is experiencing. These procedures must be within the scope of practice of the CDHC. E. “Supervising dentist” means a dentist that maintains the records of a patient, is responsible for their care, has reviewed their current medical history and for purposes of authorization, has examined that patient within the previous 11 months or will examine that patient within 30 days of giving authorization. F. “Teledentistry” means a dentist’s use of health information technology in real time to provide limited diagnostic treatment planning services in cooperation with another dentist, a dental hygienist, a community health coordinator or a student enrolled in a program of study to become a dental assistant, dental hygienist or dentist. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

357

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants G. “Tooth fracture” means the fracture or loss of tooth structure due to trauma or chewing. The defect has little or no caries present. H. “Unexcavated carious lesion” means an open carious lesion in a tooth that is cleaned of loose debris by rinsing or use of cotton pellets. Caries attached to the tooth will not be removed. 16.5.54.8 PRACTICE AND REQUIRED SUPERVISION: Community dental health coordinator duties set forth in 16.5.54.9 NMAC are allowed under the general supervision of a New Mexico licensed dentist. The community dental health coordinator may provide educational preventive and limited palliative care and assessment services while working collaboratively under the general supervision of a dentist. 16.5.54.9 ALLOWABLE DUTIES UNDER GENERAL SUPERVISION: The following community dental health coordinator procedures are allowable under general supervision as set forth in 16.5.54.8 NMAC: A. take a complete health and dental history; B. expose and develop necessary radiographs as ordered by the supervising dentist or as established in protocol by a supervising dentist; C. observe and transmit patient data through teledentistry means to a dentist; D. place temporary and sedative restorative materials in unexcavated carious lesions and unprepared tooth fractures; E. transmit prescription or medication orders on the direct order of a dentist; F. CDHC may provide the following limited palliative procedures: (1) application of hot/cold compresses to the face or mouth; (2) instruct patient in the uses of various rinses containing salt, sodium bicarbonate, chlorhexidine, etc. as ordered by the dentist; (3) instruct patients as to the proper use and dosage of over the counter or prescribed medications recommended by the supervising dentists; (4) place avulsed teeth in the proper preservation solution for transport to a dentist; (5) apply pressure compresses to intraoral wounds; (6) performance of any other palliative procedures as directly instructed by the supervising dentist, and within the scope of practice of the CDHC; (7) instruct the patient on brushing, flossing, gingival massage or cleaning for gingival inflammation or infection; G. patient and community education on an individual basis or with groups within the community to improve dental health and dental health awareness; H. act as an advocate for patients and the community in accessing dental care; and I. rubber cup coronal polishing, which is not to be represented as a prophylaxis, topical application of fluorides; application of pit and fissure sealants when previously authorized by the supervising dentist or dental hygienist and cavitation of the enamel is not present. 16.5.54.10 NON-ALLOWABLE PROCEDURES: CDHC may not perform any other procedure, duty or function under any level of supervision that is not expressly listed in 16.5.54.9 NMAC. PART 55 COMMUNITY DENTAL HEALTH COORDINATOR, DISCIPLINARY PROCEEDINGS 16.5.55.2 SCOPE: The provisions of Part 55 of Chapter 5 apply to all active certificate holders and applicants for certification. These provisions may also be of interest to anyone who may wish to file a complaint against a community dental health coordinator certified by the board. 16.5.55.6 OBJECTIVE: To establish the procedures for filing complaints against certificate holders, the disciplinary actions available to the board, the authority to issue investigative subpoenas and to further define actions by a certificate holder which are considered incompetent or unprofessional practice. 16.5.55.8 COMPLAINTS: Disciplinary proceedings may be instituted by sworn complaint of any person, including members of the board and committee. Any hearing held pursuant to the complaint shall conform with the provisions of the Uniform Licensing Act and the Dental Health Care Act. 16.5.55.9 ACTIONS: A. The board may issue fines, deny, revoke or suspend, or otherwise limit a certificate if the board determines the certificate holder is guilty of violating any of the provisions outlined in the act, the Uniform Licensing Act, or these rules. B. The board may reprimand, censure, stipulate and may require certificate holders to fulfill additional continuing education hours within limited time constraints for violations of the act or the rules. C. The board shall take into consideration the role of community dental health coordinator as employees when taking disciplinary action against a certificate holder. In the event the complaint is ruled to be based primarily on the community dental health coordinator’s role as employee, the board may consider appropriate action against the employer/dentist. 358

New Mexico State Dental Practice Act and Administrative Rules for Dental Assistants 16.5.55.10 GUIDELINES: The board shall define the following as guidelines for disciplinary action: “unprofessional conduct” means, but is not limited to because of enumeration: A. performing, or holding oneself out as able to perform, professional services beyond the scope of ones certification and field or fields of competence as established by education, experience, training, or any combination thereof; this includes, but is not limited to, the use of any instrument, device or material in a manner that is not in accordance with the customary standards and practices of community dental health coordinator; B. sexual misconduct; C. failure to use appropriate infection control techniques and sterilization procedures; D. fraud, deceit or misrepresentation in any application; E. cheating on an examination for community dental health coordinator certification; F. performing any procedure which requires certification unless so certified; G. injudicious administration of any drug or medicine; H. conviction of either a misdemeanor or a felony punishable by incarceration; and I. failure to be in compliance with the Parental Responsibility Act NMSA1978, Section 40-5A-3 seq. 16.5.55.11 INVESTIGATIVE SUBPOENAS: The complaint committee of the board is authorized to issue investigative subpoenas and to employ experts with regard to pending investigations. PART 59 LICENSURE FOR MILITARY SERVICE MEMBERS, SPOUSES AND VETERANS 16.5.59.7 DEFINITIONS: A. “Military service member” means a person who is serving in the armed forces of the United States or in an active reserve component of the armed forces of the United States, including the national guard. B. “Recent veteran” means a person who has received an honorable discharge or separation from military service within the two years immediately preceding the date the person applied for an occupational or professional license pursuant to this section. 16.5.59.8 APPLICATION REQUIREMENTS: A. Applications for registration shall be completed on a form provided by the department. B. Completed application shall include: (1) application fee; and (2) satisfactory evidence that the applicant holds a license that is current and in good standing, issued by another jurisdiction, including a branch of armed forces of the United States, that has met the minimal licensing requirements that are substantially equivalent to the licensing requirements for the occupational or professional license the applicant applies for pursuant to Chapter 61, Articles 5A NMSA 1978. C. Electronic signatures will be acceptable for applications submitted pursuant to section 14-16-1 through section 14-16-19 NMSA 1978. 16.5.59.9 FEES: An applicant seeking licensure under Part 59 of Chapter 5 NMAC shall refer to the following parts for applicable fees: A. for a dentist applicant, refer to 16.5.5 NMAC; B. for a dental hygiene applicant, refer to 16.5.18 NMAC; C. for a dental assistant applicant, refer to 16.5.32 NMAC; D. for an expanded function dental auxiliary applicant, refer to 16.5.41 NMAC; and E. for a community dental health coordinator applicant, refer to 16.5.49 NMAC. 16.5.59.10 RENEWAL REQUIREMENTS: A. A license or certificate issued pursuant to this section shall not be renewed unless the license or certificate holder satisfies the requirements for the issuance and for the renewal of a license or certificate pursuant to Chapter 61, Articles 5A NMSA 1978. B. The licensee or certificate holder issued under Part 59 of Chapter 5 shall submit the documentation required under the following parts: (1) for a dentist, refer to 16.5.8 NMAC for required documentation; (2) for a dental hygienist, refer to 16.5.20 NMAC for required documentation; (3) for a dental assistants, refer to 16.5.33 NMAC for required documentation; (4) for an expanded function dental auxiliary, refer to 16.5.42 NMAC for required documentation; and (5) for a community dental health coordinator, refer to 16.5.50 NMAC for required documentation. C. All licenses and certificates issued under Part 59 of Chapter 5 shall be valid for a period not to exceed three years. D. Prior to the expiration of the license, all licensees or certificate holders shall apply for registration renewal and shall pay the renewal fee as set forth in 16.5.59.9 NMAC. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

359

New York DANB Certificant Counts: New York National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

1,263

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

The foregoing list contains counts of individuals in New York who hold DANB certification. DANB certification does not confer any legal authorization to work as a dental assistant in New York. To work in New York, dental assistants must meet the state requirements summarized on the following page.

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

5,115

Infection Control (ICE)

4,996

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Dolores Cottrell, DDS, MSHA, Executive Secretary New York State Board for Dentistry 89 Washington Avenue, 2nd Floor West Wing Albany, NY 12234-1000 Phone: 518-474-3817 ext. 550 Fax: 518-473-0567 Email: dentbd@nysed.gov Website: http://www.op.nysed.gov/prof/dent/

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs State University of New York (SUNY) Educational Opportunity Center-Buffalo

DANB CDA Certificant State of New York+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 6, 2020.

360

* RHS and ICE: cumulative totals since 1997, excluding inactive records archived for data migration purposes in 20; CP, SE, TA and TF: cumulative totals since 2010; AMP, IM, TMP and IS: cumulative totals since 2012 +

Source: 2018 DANB Salary Survey (state data based on 37 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

New York State Radiography Requirements There are no radiography requirements for dental assistants in the state of New York. All dental assistants may legally operate routine oral radiography and panoramic dental equipment under the supervision of a licensed dentist. A dental assistant may operate conebeam computed tomography (CBCT) equipment under the direct supervision of a dentist after demonstrating satisfactory completion of a training program approved by the Department of Health or provided by the manufacturer.

State Requirements For Registered Dental Assistants A dental assistant in the state of New York must be licensed as a Registered Dental Assistant in order to perform supportive services under the direct supervision of a licensed dentist. To be licensed in the state of New York, one must: (1) Be at least 18 years of age AND (2) Be a high school graduate or its equivalent AND (3) Successfully complete one of these two education options: (3a) a New York State-registered one-year course of study in dental assisting, consisting of 24 semester hours, in a degree-granting institution or a Board of Cooperative Educational Services (BOCES) program that includes at least 200 hours of clinical experience or (3b) an alternate course of study in dental assisting acceptable to the New York State Education Department that includes at least 1,000 hours of relevant work experience in accordance with the Commissioner’s regulations AND (4) Successfully complete one of the two exam pathways listed below: (4a) PATHWAY I: Pass all three components of the national DANB Certified Dental Assistant (CDA) Exam: Radiation Health and Safety (RHS), Infection Control (ICE), and General Chairside (GC) or (4b) PATHWAY II: Pass DANB’s RHS and ICE component exams along with the New York Professional Dental Assisting (NYPDA) component exam AND (5) Apply for licensure as a Registered Dental Assistant from the New York State Education Department after completing all of the above requirements. ***Note on Sterilization Certification Requirement Affecting Some Dental Assistants*** In its 2013 session, the New York State legislature passed a law requiring technicians who perform instrument sterilization in hospitals and in diagnostic and treatment centers offering ambulatory surgical services to hold one of two central services certifications – the Certified Registered Central Service Technician (CRCST) credential from the International Association of Healthcare Central Service Materiel Management (IAHCSMM) or the Certified Sterile Processing and Distribution Technician (CSPDT) certification from the Certification Board for Sterile Processing and Distribution (CBSPD). Licensed healthcare professionals, including dental assistants, working within their scope of practice are exempt from this requirement, which became effective January 1, 2015. The New York State Dental Association has issued a memo to its members indicating that dental assistants who perform instrument sterilization in a hospital or ambulatory surgical center and who are not Registered Dental Assistants must earn one of the required certifications and complete annual continuing education requirements. The New York State Dental Association does not believe that dental assistants working in private dental offices are subject to these requirements.

New York State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – New York State Board for Dentistry New York State Law Article 133, Dentistry and Dental Hygiene and Registered Dental Assisting § 6608. Definition of practice of registered dental assisting. The practice of registered dental assisting is defined as providing supportive services to a dentist in his or her performance of dental services authorized under this article. Such support shall include providing patient education, taking preliminary medical histories and vital signs to be reviewed by the dentist, placing and removing rubber dams, selecting and prefitting provisional crowns, selecting and prefitting orthodontic bands, removing orthodontic arch wires and ligature ties, placing and removing matrix bands, taking impressions for study casts or diagnostic casts, removing periodontal dressings, and such other dental supportive services authorized by the dentist consistent with regulations promulgated by the commissioner, provided that such functions are performed under the direct personal supervision of a licensed dentist in the course of the performance of dental services. Such services shall not include diagnosing and/or performing surgical procedures, irreversible procedures or procedures that would alter the hard or soft tissue of the oral and maxillofacial area or any other procedures determined by the department. The practice of registered dental assisting may be conducted in the office of any licensed dentist or in any appropriately equipped school or public institution but must be done under the © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

361

New York State Dental Practice Act and Administrative Rules for Dental Assistants direct personal supervision of a licensed dentist. Direct personal supervision, for purposes of this section, means supervision of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, who remains the responsibility of the licensed dentist, evaluates the services performed by the dental assistant. Nothing herein authorizes a dental assistant to perform any of the services or functions defined as part of the practice of dental hygiene in accordance with the provisions of subdivision one of section sixty-six hundred six of this article, except those functions authorized pursuant to this section. All dental supportive services provided in this section may be performed by currently registered dental hygienists either under a dentist’s supervision, as defined in regulations of the commissioner, or in the case of a registered dental hygienist working for a hospital as defined in article twenty-eight of the public health law, pursuant to a collaborative arrangement with a licensed dentist in accordance with subdivision one of section sixty-six hundred six of this article. Such collaborative arrangement shall not obviate or supersede any law or regulation which requires identified services to be performed under the personal supervision of a dentist. § 6608-a. Practice of registered dental assisting and use of the title “registered dental assistant.” Only a person certified under section sixty-six hundred eight-b of this article or exempt pursuant to section sixty-six hundred ten of this article shall practice registered dental assisting. Only a person certified pursuant to section sixty-six hundred eight-b of this article shall use the title “registered dental assistant.” § 6608-b. Requirements for certification as a registered dental assistant. To qualify for certification as a registered dental assistant, an applicant shall fulfill the following requirements: 1. Application: file an application with the department; 2. Age: be at least eighteen years of age; 3. Fees: pay a fee of forty-five dollars to the department for initial certification and a fee of fifty dollars for each triennial registration period; 4. Education and experience: (A) have received a high school diploma, or its equivalent, and (B) have successfully completed, in accordance with the commissioner’s regulations, (i) an approved one-year course of study in dental assisting in a degree-granting institution or a board of cooperative educational services program which includes at least two hundred hours of clinical experience, or an equivalent approved course of study in dental assisting in a non-degree granting institution which shall not be a professional association or professional organization or (ii) an alternate course of study in dental assisting acceptable to the department which shall be provided by a degree-granting institution or a board of cooperative educational services program which includes at least one thousand hours of relevant work experience; 5. Examination: pass an examination in dental assisting given by an organization which administers such examinations and which is acceptable to the department; and 6. Character: be of good moral character as determined by the department. § 6608-c. Exempt persons. Nothing in this article shall be construed to affect or prevent a student from engaging in any procedure authorized under section sixty-six hundred eight of this article in clinical practice as part of a course of study approved by the department pursuant to subdivision four of section sixty-six hundred eight-b of this article. § 6608-d. Limited permits. The department shall issue a limited permit to an applicant who meets all requirements for admission to the licensing examination. All practice under a limited permit shall be under the direct personal supervision of a licensed dentist. Limited permits shall be for one year and may be renewed at the discretion of the department for one additional year. The fee for each limited permit and for each renewal shall be forty dollars. REGULATIONS OF THE COMMISSIONER [Editor's Note: The New York State legislature passed a law in the 2019 session changing the title of the certified level of dental assistant in New York to "Registered Dental Assistant." The regulations related to dental assisting practice have not yet been updated to reflect this change.] Part 52, Registration of Curricula §52.26 Certified Dental Assisting [See Editor's Note above.] a. Definitions. As used in this section: 1. Biomedical sciences content area shall mean course work, accompanied where appropriate by laboratory and/ or equivalent clinical experiences, which includes, but is not limited to, the following curricular areas: i. body structure and function; ii. basic concepts of microbiology pertaining to infection control; and iii. basic nutrition. 362

New York State Dental Practice Act and Administrative Rules for Dental Assistants 2.

Professional dental assisting content area shall mean course work relevant to the practice of certified dental assisting, accompanied where appropriate by laboratory and/or equivalent clinical experiences, which includes, but is not limited to, the following curricular areas: i. dental materials and instruments; ii. dental radiography techniques and safety; iii. basic dental and oral anatomy; iv. introductory content in oral histology, embryology, pathology, and therapeutics; and v. legal and ethical aspects of dentistry, consisting of dental record keeping, terminology, and charting and issues related to patient confidentiality. Clinical content area shall mean course work in clinical procedures which includes, but is not limited to, the following curricular areas: i. chairside dental assisting and dental laboratory procedures appropriate to the practice of certified dental assisting which shall include, but not be limited to, specific course work in the following clinical procedures subject to the restrictions set forth in subdivision (c) of section 61.13 of this title: a. placing and removing temporary restorations; b. placing, condensing, and carving amalgam restorations; and c. placing, condensing, and finishing non-metallic restorations. ii. patient education and preventive dentistry; iii. dental radiographic procedures; iv. infection control; and v. assisting in management of dental and medical emergencies. Direct personal supervision shall mean supervision by a licensed dentist of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, evaluates the services performed by the dental assistant.

Curriculum. In addition to meeting all applicable provisions of this Part, to be registered as a program recognized as leading to licensure in certified dental assisting which meets the requirements of section 61.11 of this Title, it shall be 1. either: i. a one-year program in certified dental assisting, consisting of at least 24 semester hours or its equivalent, which is offered in an educational setting prescribed in section 6608-b(4)(b)(i) of the Education Law, such program to include: a. the biomedical sciences content area, the professional dental assisting content area, the clinical content area and course work in oral and written communications and basic behavioral concepts; and b. at least 200 hours of clinical experience in the practice of certified dental assisting, as defined in section 6608 of the Education Law and section 61.13 of this Title, under the direct personal supervision of a licensed dentist; or ii. An alternate course of study in certified dental assisting, which requires the student to complete equivalent study as that required in a program prescribed in sub-paragraph (i) of this paragraph and in an educational setting prescribed in section 6608-b(4)(B)(ii) of the Education Law, such course of study to include: a. The biomedical sciences content area, the professional dental assisting content area, and the clinical content area; and b. At least 1000 hours of relevant work experience constituting a clinical experience in the practice of certified dental assisting, as defined in section 6608 of the Education Law and section 61.13 of this Title, under the direct personal supervision of a licensed dentist. 2. The programs prescribed in paragraph (1) of this sub-division shall have sufficient content, scope and depth to prepare a student for the practice of certified dental assisting, as defined in section 6608 of the Education Law and section 61.13 of this Title. 3. Clinical facilities. A written contract or agreement shall be executed between the educational institution conducting the certified dental assisting program and the clinical facility or agency which is designated to cooperate in providing the clinical experience, which shall set forth the responsibilities of each party, and shall be signed by the responsible officer of each party.

Part 61, Dentistry, Dental Hygiene, and Certified Dental Assisting [See Editor's Note on page 362.] [Note: Section 61.10 of Part 61 addresses anesthesia certification for dentists. Subsection 61.10(c)(5)(i) indicates that, during the administration of deep sedation or general anesthesia, a minimum of three individuals shall be present in the operatory, one of whom is the practitioner qualified to administer anesthesia and deep sedation and two of whom are additional individuals who have current documentation that they have successfully completed a course in BLS or its equivalent, as determined by the New York State Education Department. Subsection 61.10(c)(5)(ii) indicates that, during the administration of conscious sedation using the enteral or parenteral route, with or without inhalation agents, a minimum of two individuals shall be present in the operatory, one of whom is the practitioner qualified to administer conscious sedation and the other of whom is an additional individual who has current documentation that he or she has successfully completed a course in BLS or its equivalent, as determined by the Department.] ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

363

New York State Dental Practice Act and Administrative Rules for Dental Assistants §61.11 Professional study of certified dental assisting. [See Editor's Note on page 362.] a. As used in this section, acceptable accrediting agency shall mean an organization accepted by the department as a reliable authority for the purpose of accreditation at the postsecondary level, applying its criteria for granting accreditation in a fair, consistent and nondiscriminatory manner, such as an agency recognized for these purposes by the United States Department of Education. b. To meet the professional education requirement for licensure as a certified dental assistant in this State, the applicant shall present satisfactory evidence of: 1. graduation from high school, or its equivalent; and 2. completion of a program in certified dental assisting that is either registered by the department pursuant to Part 52 of this Title, or accredited by an acceptable accrediting agency, or determined by the department to be the equivalent of such a registered or accredited program. §61.12 Licensing examination for certified dental assistant. [See Editor's Note on page 362.] a. Each candidate for licensure as a certified dental assistant shall pass an examination that the department has determined measures the applicant's knowledge of curricular areas attained in a program prescribed in section 52.26 of this Title and other matters of law, ethics, or practice deemed appropriate by the department. b. Passing standard. The passing standard for each examination shall be determined by the State Board for Dentistry. §61.13 Practice of certified dental assisting. [See Editor's Note on page 362.] a. The practice of certified dental assisting shall be that practice defined in section 6608 of the Education Law. In accordance with section 6608 of the Education Law, the practice of certified dental assisting must be supportive services to a licensed dentist in the dentist's performance of dental services and must be performed under the direct personal supervision of a licensed dentist. For purposes of this section, under the direct personal supervision of a licensed dentist shall mean supervision of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, who remains the responsibility of the licensed dentist, evaluates the services performed by the dental assistant. Such practice shall include the dental supportive service prescribed in subdivision (b) of this section and shall exclude the dental supportive services prescribed in subdivision (c) of this section. b. The practice of certified dental assisting shall include the following supportive services to a licensed dentist while under the direct personal supervision of the licensed dentist: 1. providing patient education; 2. taking preliminary medical histories and vital signs to be reviewed by the dentist; 3. placing and removing rubber dams; 4. selecting and prefitting provisional crowns; 5. selecting and prefitting orthodontic bands; 6. removing orthodondic arch wires and ligature ties; 7. placing and removing matrix bands; 8. taking impressions for study casts or diagnostic casts; 9. removing periodontal dressings; 10. removal of sutures placed by a licensed dentist; 11. taking impressions for space maintainers, orthodontic appliances, and occlusal guards; 12. removing temporary cement; 13. applying topical anticariogenic agents to the teeth; 14. applying desensitizing agents to the teeth; 15. placing and removing temporary separating devices; 16. placing orthodontic ligatures; 17. taking x-rays in accordance with the requirements of section 3515(4)(c) of the Public Health Law; and 18. other dental supportive services authorized by the licensed dentist while the certified dental assistant is under the direct personal supervision of the licensed dentist, provided that such other dental supportive services are not excluded in subdivision (c) of this section. c. Excluded dental supportive services. The practice of certified dental assisting shall not include the following dental supportive services: 1. diagnosing; 2. performing surgical procedures; 3. performing irreversible procedures; 4. performing procedures that would alter the hard or soft tissue of the oral and maxillofacial area; 5. dental supportive services prescribed in section 61.9 of this Part which are services that a dental hygienist may perform, unless such services are expressly permitted as dental supportive services in paragraphs (1) through (17) of subdivision (b) of this section; and 6. such dental supportive services that a certified dental assistant would not reasonably be qualified to perform based upon meeting the requirements for certification as a certified dental assistant in section 6608-b of the Education Law, and/or obtaining additional legally authorized experience in the practice of certified dental assisting. 364

New York State Dental Practice Act and Administrative Rules for Dental Assistants d.

In accordance with section 29.1(b)(9) and (10) of this Title, a certified dental assistant is not permitted to provide dental supportive services that the certified dental assistant knows or has reason to know that he or she is not competent to perform, and a licensed dentist is not permitted to delegate to a certified dental assistant dental supportive services the licensed dentist knows or has reason to know that the certified dental assistant is not qualified by training, experience or by licensure to perform.

§61.14 Limited permits in certified dental assisting. [See Editor's Note on page 362.] a. As used in this section, direct personal supervision shall mean supervision by a licensed dentist of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, evaluates the services performed by the limited permittee. b. In accordance with section 6608-d of the Education Law, permits limited as to eligibility, practice, and duration shall be issued by the department to eligible applicants as follows: 1. A person who meets all requirements for admission to the licensure examination for certified dental assisting shall be eligible for a limited permit as a certified dental assistant. 2. A certified dental assistant permittee shall be authorized to practice only under the direct personal supervision of a licensed dentist. 3. An application for a limited permit in certified dental assisting shall be submitted on a form provided by the department and shall be accompanied by the statutory fee. 4. Limited permits in certified dental assisting shall expire one year from the date granted, except that such permits may be renewed for one additional one-year period. Title 10 Department of Health Chapter II, Subchapter M, Part 89, Practice of Radiologic Technology §89.1 Definitions. a. As used in this Part, unless the context otherwise requires: 1. Department means the New York State Department of Health. 2. Direct supervision means that a physician must be present in the section of the facility where the procedure is being performed and is not concurrently encumbered by responsibilities that would preclude the physician from responding to a request for assistance within a timeframe that poses no risk to the patient. The physician shall be immediately available to furnish assistance and direction throughout the performance of the procedure, and is professionally responsible for the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. §89.30 Persons exempt. a. Dental assistants. 1. A person acting as a dental assistant shall be exempt from licensure as a radiologic technologist when operating the following equipment under the supervision of a dentist for the sole purpose of routine oral radiography in which the x-ray beam is limited to the patient’s head. (i) conventional radiographic dental equipment in which the diameter of the x-ray beam at the patient’s face is limited to not more than three inches; (ii) panoramic radiographic dental equipment; and (iii) conebeam computed tomography equipment after demonstrating satisfactory completion of a training program approved by the department or one provided by the equipment manufacturer. Conebeam computed tomography equipment must be performed under the direct supervision of a dentist. General Requirements Any use of the title "Registered Dental Assistant" within New York State requires licensure. To be licensed as a registered dental assistant in New York State you must: - be at least 18 years of age: - be of good moral character: - meet education requirements; and - meet examination requirements You must file an application for licensure in addition to the other forms indicated, along with the appropriate fee, to the Office of the Professions at the address specified on each form. It is your responsibility to follow up with anyone you have requested to send material. The specific requirements for licensure are contained in Article 133, Section 6608 of New York’s Education Law and Part 61 of the Commissioner’s Regulations. You should also read the general licensing information applicable for all professions. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

365

New York State Dental Practice Act and Administrative Rules for Dental Assistants Fees The fee for licensure and first registration is $103. The fee for a limited permit is $40 (the limited permit fee is not refundable). Fees are subject to change. The fee due is the one in law when your application is received (unless fees are increased retroactively). You will be billed for the difference if fees have been increased. • • •

Do not send cash. Make your personal check or money order payable to the New York State Education Department. Your cancelled check is your receipt. Mail your application and fee to: NYS Education Department Office of the Professions PO Box 22063 Albany, NY 12201

NOTE: Payment submitted from outside the United States should be made by check or draft on a United States bank and in United States currency; payments submitted in any other form will not be accepted and will be returned. Partial Refunds Individuals who withdraw their licensure application may be entitled to a partial refund. •

For the procedure to withdraw your application, contact the Registered Dental Assisting Unit at opunit3@nysed.gov or by calling 518-474-3817 ext. 270 or by fax at 518-402-5354. • The State Education Department is not responsible for any fees paid to an outside testing or credentials verification agency. If you withdraw your application, obtain a refund, and then decide to seek New York State licensure at a later date, you will be considered a new applicant and you will be required to pay the licensure and registration fees and meet the licensure requirements in place at the time you reapply. Education Requirements To meet the education requirements for licensure as a Registered dental assistant you must have: - Earned a high school diploma or G.E.D. (You may be required to provide verification of your high school diploma or G.E.D., see the instructions for completing the Certification of Professional Education (Form 2) for more information.) - Completed a licensure-qualifying program in dental assisting or an equivalent program as determined by the State Education Department. A list of New York State registered, licensure-qualifying dental assisting programs is available through the Education Department's Inventory of Registered Programs. To be considered “equivalent,” your educational program must culminate in a degree or credential from an institution acceptable to the State Education Department. It must include courses as specified below. You must complete either A or B below: A. A one-year program consisting of 24 semester hours or the equivalent including: 1. the biomedical sciences content area: - body structure and function, - basic concepts of microbiology pertaining to infection control, - basic nutrition; and 2. the professional dental assisting content area: - dental materials and instruments, - dental radiography techniques and safety, - basic dental and oral anatomy, - introductory content in oral histology, embryology, pathology, and therapeutics, - legal and ethical aspects (dental record keeping, terminology, charting, and patient confidentiality); and 3. the clinical content area: - chairside dental assisting and appropriate laboratory procedures, 1. placing and removing temporary restorations; 2. placing, condensing, and carving amalgam restorations; and 3. placing, condensing, and finishing non-metallic restorations - patient education and preventive dentistry, - dental radiographic procedures, 366

New York State Dental Practice Act and Administrative Rules for Dental Assistants

4. 5.

- infection control, - assisting in management of dental and medical emergencies; and course work in oral and written communications and basic behavioral concepts; and at least 200 hours of clinical experience.

OR B. An alternate course of study in dental assisting acceptable to the New York State Education Department including: 1. the biomedical sciences content area, the professional dental assisting content area, and the clinical content area; and 2. an alternate course of study in dental assisting acceptable to the department which shall be provided by a degree-granting institution or a board of cooperative educational services program which includes at least one thousand hours of relevant work experience. NOTE: In addition to meeting these education requirements, you must satisfy the examination requirements outlined in the next section. Examination Requirements Passing scores on appropriate examinations administered by the Dental Assisting National Board (DANB), Inc. are required for licensure in New York. There are two (2) pathways to qualify to take the required DANB examinations. See below to determine which examination section(s) you must complete. Pathway I: Applicants who meet DANB’s eligibility requirements If you meet DANB's eligibility requirements, you must take and pass the current DANB CDA examination consisting of the following three components: Radiation Health and Safety (RHS), Infection Control (ICE), and General Chairside (GC). •

If you have passed DANB’s CDA examination after June 1, 1993, you have met New York State’s examination requirement.

•

If you have passed DANB’s CDA examination between June 1, 1985 and June 1, 1993, you must take and pass the Infection Control (ICE) component of the current DANB examination.

•

If you have passed DANB’s CDA examination prior to June 1, 1985, you must take and pass the Radiation Health and Safety (RHS) and Infection Control (ICE) components of the current DANB examination.

Pathway II: Applicants who do not meet DANB’s eligibility requirements An applicant who graduates from a New York registered dental assisting program, or the equivalent, but does not meet DANB's requirement to take the DANB CDA exam (because the program was not accredited by the Commission on Dental Accreditation and the applicant has less than two years’ experience) must pass New York State's three-part examination in registered dental assisting (administered by DANB), which consists of DANB's Radiation Health and Safety (RHS) and Infection Control (ICE) component exams, and the New York Professional Dental Assisting (NYPDA) exam. NOTE: Even if you fulfill the examination requirement, you will not be licensed until the Department approves your education. Both the education and examination requirements must be fulfilled. For examination application, dates and scheduling information, visit the DANB Web site at www.danb.org, or contact DANB by phone at 1-800-FOR-DANB (1-800-367-3262) or fax at 312-642-8507. Reasonable Testing Accommodations General information about reasonable testing accommodations and details on what to provide is available on the DANB Web site at www.danb.org/Meet-State-Requirements/State-Exam-Applications.aspx. Limited Permits A limited permit in registered dental assisting allows an individual who has completed a dental assisting program or an alternative course of study in dental assisting acceptable to the New York State Education Department to practice registered dental assisting only under the direct personal supervision of a New York State licensed dentist. You may apply for a limited permit by submitting the Application for Limited Permit (Form 5) and the limited permit fee of $40 at the same time or any time after you submit your Application for Licensure (Form 1), the $103 fee for licensure and first registration, and evidence of satisfactory education using the Certification of Professional Education (Form 2). The limited permit cannot be issued until the Department has approved your education. If you did not complete a program registered by New York State as licensure-qualifying, consider waiting to apply for a limited permit until the Bureau of Comparative Education has approved your education.

367

New York State Dental Practice Act and Administrative Rules for Dental Assistants The limited permit is valid for a period of one year and may be renewed once, at the discretion of the Department, for one additional year. If your employer or supervising dentist changes during the one-year period, you must reapply for a new limited permit by submitting a new Form 5. No additional fee is required. If you want to renew your limited permit for a second year, you must submit a new Form 5 with the $40 fee. Direct personal supervision means supervision by a licensed dentist of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, who remains the responsibility of the licensed dentist, evaluates the services performed by the limited permittee.

368

North Carolina DANB Certificant Counts: North Carolina Certified Dental Assistant (CDA) certificants

2,540

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Bobby D. White, Chief Executive Officer North Carolina State Board of Dental Examiners 2000 Perimeter Park Drive, Suite 160 Morrisville, NC 27560 Phone: 919-678-8223 Fax: 919-678-8472 Email: info@ncdentalboard.org Website: www.ncdentalboard.org

Radiation Health and Safety (RHS)

6,512

Infection Control (ICE)

6,793

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

CODA-Accredited Dental Assisting Programs Alamance Community College Asheville-Buncombe Technical Community College Cape Fear Community College Central Carolina Community College Central Piedmont Community College Coastal Carolina Community College Fayetteville Technical Community College Forsyth Technical Community College Guilford Technical Community College Martin Community College Miller-Motte College Miller-Motte College-Raleigh Montgomery Community College Rowan-Cabarrus Community College Wake Technical Community College Wayne Community College Western Piedmont Community College Wilkes Community College

Median Salary of DANB CDA Certificants DANB CDA Certificant State of North Carolina+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been updated by DANB of April 3, 2020.

Source: 2018 DANB Salary Survey (state data based on 51 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

369

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the North Carolina State Board of Dental Examiners. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

North Carolina State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of North Carolina, a dental assistant must: (1) Pass the national DANB Certified Dental Assistant (CDA) exam OR (2) Pass a radiological equivalency exam recognized by the North Carolina State Board of Dental Examiners (The equivalency exam may be taken by an assistant who can show evidence of seven hours of instruction in the production and use of dental x-rays and an educational program of not less than seven hours in clinical dental radiography) OR (3) Successfully complete a CODA-accredited dental assisting program OR (4) Qualify as a DA II (see requirements below).

State Requirements For Expanded Functions The classifications for dental assistants in the state of North Carolina are: Dental Assistant I (DA I), Dental Assistant II in Training (DA II in Training) and Dental Assistant II (DA II). It is up to the dentist/employer to determine an assistant’s classification and the functions the assistant is allowed to perform. To perform expanded functions under the direct supervision of a licensed dentist in North Carolina, one must be classified as a DA II. To qualify as a DA II, one must: (1) Hold and maintain a current unexpired Cardiopulmonary Resuscitation (CPR) certification, AND (2a) Successfully complete a CODA-accredited dental assisting program or one academic year or longer in a CODA-accredited dental hygiene program OR (2b) Pass the national DANB Certified Dental Assistant (CDA) exam OR (2c) Complete full-time employment as a DAI for two years of the preceding five consisting of at least 3,000 hours total and complete a 3-hour course in sterilization and infection control and complete a 3-hour course in dental office emergencies and, after completing these courses and Item (1) above, receive training in any dental delivery setting and perform the functions of a Dental Assistant II under the direct control and supervision of a licensed dentist. To qualify to perform coronal polishing, a DA II must successfully complete a course in coronal polishing identical to that taught in a CODA-accredited dental assisting program, or by a licensed North Carolina hygienist or dentist lasting at least seven clock hours and meeting content requirements established by the North Carolina Board, before using a slow speed handpiece with rubber cup or bristle brush attachment. To qualify to monitor patients under nitrous oxide, a DA II must successfully complete a North Carolina Board-approved seven-hour course in nitrous oxide-oxygen conscious sedation. A Dental Assistant II in Training (DA II in Training) in North Carolina is an individual who is participating in on the job training to become a DAII. During the training period, which consists of at least two years (3,000 hours) of chairside assisting, the assistant may be trained and allowed to perform most of the functions of a DAII under the direct control and supervision of a North Carolina licensed dentist. A DAII in Training may not monitor patients under nitrous oxide, take radiographs, or perform coronal polishing until he or she successfully completes the required courses in these topics. A Dental Assistant I (DA I) in the state of North Carolina is an individual who may perform basic supportive dental procedures under the direct control and supervision of a licensed dentist. To qualify to monitor patients under nitrous oxide, a DA I must successfully complete a North Carolina Board-approved seven-hour course in nitrous oxide-oxygen conscious sedation.

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants Classification of Dental Assistants In North Carolina Delegable Functions │Radiography Requirements Dental Assistant I and Dental Assistant II In North Carolina, there are two classifications for Dental Assistants (DAI and DAII). North Carolina does NOT certify assistants. Classification is based on experience and/or training as listed below. It is up to the employer to verify an assistant’s qualifications and determine if he/she is a DAI or DAII. To be classified as a Dental Assistant II, an assistant shall meet one (1) of the following criteria: (1) Completion of: a) an ADA-accredited dental assisting program and current certification in CPR; or b) one academic year or longer in an ADA-accredited dental hygiene program, and current certification in CPR (2) completion of the Dental Assistant certification examination(s) administered by the Dental Assisting National Board and current certification in CPR; or (3) completion of: (a) a 3-hour course in sterilization and infection control; (b) a 3-hour course in dental office emergencies; and (c) current certification in CPR. 370

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (d) after completing Sub-Items (3)(a), (b), and (c) of this Rule, dental assistants may be trained in any dental delivery setting and allowed to perform the functions of a Dental Assistant II under the direct control and supervision of a licensed dentist, except as listed in Sub-Item 3(e) of this Rule. (e) dental assistants may take radiographs after completing radiology training consistent with G.S. 90-29(c)(12). (f) full-time employment and experience as a chairside assistant for two years (3,000 hours) of the preceding five, during which period the assistant may be trained in any dental delivery setting and allowed to perform the functions of a Dental Assistant II under the direct control and supervision of a licensed dentist. Radiography Requirement A certified dental assistant [one who successfully completes the DANB CDA exam (see (2) above)] or an assistant who completes an ADA-accredited dental assisting or dental hygiene program may take radiographs without further examination. All others, including those who move to North Carolina from out-of-state, must successfully pass an equivalency exam. This exam may be challenged after completing “seven hours of instruction in the production and use of dental x-rays and an education program of not less than seven hours in clinical dental radiology.” You must be able to prove that you have the minimal amount of training to be eligible to take the radiology equivalency exam, or you may take a course prior to taking the exam. Any Board approved radiography course is acceptable and any approved course’s final examination is recognized as the equivalency exam. Dental Practice Act - North Carolina State Board of Dental Examiners North Carolina General Statutes Chapter 90: Medicine and Allied Occupations Article 2 - Dentistry § 90-29. Necessity for license; dentistry defined; exemptions. (c) The following acts, practices, or operations, however, shall not constitute the unlawful practice of dentistry: (9) Any act or acts performed by an assistant to a dentist licensed to practice in this State when said act or acts are authorized and permitted by and performed in accordance with rules and regulations promulgated by the Board; (10) Dental assisting and related functions as a part of their instructions by students enrolled in a course in dental assisting conducted in this State and approved by the Board, when such functions are performed under the supervision of a dentist acting as a teacher or instructor who is either duly licensed in North Carolina or qualified for the teaching of dentistry pursuant to the provisions of subdivision (3) above; (12) The use of a dental x-ray machine in the taking of dental radiographs by a dental hygienist, certified dental assistant, or a dental assistant who can show evidence of satisfactory performance on an equivalency examination, recognized by the Board of Dental Examiners, based on seven hours of instruction in the production and use of dental x rays and an educational program of not less than seven hours in clinical dental radiology. (13) A dental assistant, or dental hygienist who shows evidence of education and training in Nitrous Oxide – Oxygen Inhalant Conscious Sedation within a formal educational program may aid and assist a licensed dentist in the administration of Nitrous Oxide – Oxygen Inhalant Conscious Sedation. Any dental assistant who can show evidence of having completed an educational program recognized by the Board of not less than seven clock hours on Nitrous Oxide – Oxygen Inhalant Conscious Sedation may also aid and assist a licensed dentist in the administration of Nitrous Oxide – Oxygen Inhalant Conscious Sedation. Any dental hygienist or dental assistant who has been employed in a dental office where Nitrous Oxide – Oxygen Inhalant Conscious Sedation was utilized, and who can show evidence of performance and instruction of not less than one year prior to July 1, 1980, qualifies to aid and assist a licensed dentist in the administration of Nitrous Oxide – Oxygen Inhalant Conscious Sedation. Article 16 - Dental Hygiene Act § 90-221. Definitions. (f) "Supervision" as used in this Article shall mean that acts are deemed to be under the supervision of a licensed dentist when performed in a locale where a licensed dentist is physically present during the performance of such acts, except those acts performed under direction and in compliance with G.S. 90-233(a) or G.S. 90-233(a1), and such acts are being performed pursuant to the dentist's order, control and approval. § 90-233. Practice of dental hygiene. (c) Dental hygiene may be practiced only by the holder of a license or provisional license currently in effect and duly issued by the Board. The following acts, practices, functions or operations, however, shall not constitute the practice of dental hygiene within the meaning of this Article: (3) Any act or acts performed by an assistant to a dentist licensed to practice in this State when said act or acts are authorized and permitted by and performed in accordance with rules and regulations promulgated by the Board. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

371

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (4) Dental assisting and related functions as a part of their instructions by students enrolled in a course in dental assisting conducted in this State and approved by the Board, when such functions are performed under the supervision of a dentist acting as a teacher or instructor who is either duly licensed in North Carolina or qualified for the teaching of dentistry pursuant to the provisions of G.S. 90-29(c)(3). Amended Rules & Regulations CHAPTER 16 – BOARD OF DENTAL EXAMINERS SUBCHAPTER 16A – ORGANIZATION 21 NCAC 16A .0101 DEFINITIONS As used in this Chapter: (5) "CPR certification" means that the licensee has completed a CPR course that meets American Red Cross or American Heart Association standards for certification and that provides manikin testing on the subjects of cardiopulmonary resuscitation. The course must also cover the use of an automatic external defibrillator, unconscious and conscious choking and rescue breathing, provided that the foregoing requirements shall not be interpreted in any way that violates the Americans with Disabilities Act. The manikin testing shall be provided by an instructor who is present with the students; (8) Except where otherwise defined by these Rules or by statute, "supervision," "direct supervision," and "supervision and direction" means that the dentist overseeing treatment is present in the same facility or location and available during the performance of the acts that are being performed pursuant to that dentist's order, control, and approval and that the dentist must examine and evaluate the results of such acts; and (9) Except where otherwise defined by these Rules or by statute, "direction" or "under direction" means that the dentist ordering treatment does not have to be present in the same facility or location during the performance of the acts that are being performed pursuant to that dentist's order, control, and approval, but that dentist shall be responsible for all consequences or results arising from such acts. SUBCHAPTER 16G - DENTAL HYGIENISTS SECTION .0100 - FUNCTIONS THAT MAY BE DELEGATED 21 NCAC 16G .0103 PROCEDURES PROHIBITED Those procedures that require the professional education and skill of a dentist and may not be delegated to a dental hygienist shall include: (1) performing comprehensive examination, diagnosis, and treatment planning; (2) performing surgical or cutting procedures on hard or soft tissues, including laser, air abrasion, or micro-abrasion procedures; (3) placing or removing therapeutic sulcular nonresorbable agents; (4) issuing prescription drugs, medications, or work authorizations; (5) performing the final placement or intraoral adjustment of a fixed or removable appliance; (6) performing intraoral occlusal adjustments that affect function, fit, or occlusion of any temporary or permanent restoration or appliance; (7) performing direct pulp capping or pulpotomy; (8) placing sutures; (9) performing final placement or cementation of orthodontic bands or brackets; (10) performing the placement or cementation of final restorations; (11) administering any anesthetic by any route except administering topically-applied agents intended to anesthetize only cutaneous tissue; (12) using a high-speed handpiece intraorally; (13) performing cementation of endodontic posts; (14) condensing Amalgam; (15) using a transcutaneous electrical nerve stimulation (TENS) unit; (16) applying formocresol; (17) placing stainless steel crown on permanent or primary teeth; (18) performing pulp vitality testing; (19) performing curettage; (20) placing periodontal or surgical dressing; (21) performing oral brush biopsy; (22) taking bite registration or Elastometrics; (23) placing eugenol wick in dry socket; (24) fabricating or delivering sleep apnea appliance; and (25) removing, replacing, or torqueing either impression or prosthetic implant abutments. 372

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants SUBCHAPTER 16H – DENTAL ASSISTANTS SECTION .0100 – CLASSIFICATION AND TRAINING 21 NCAC 16H .0101 CLASSIFICATION Based upon education, training, and experience, a dental assistant shall be categorized as a Dental Assistant I or a Dental Assistant II. [See note on page 378.*] 21 NCAC 16H .0102 DENTAL ASSISTANT I (a) A Dental Assistant I is anyone performing any of the permitted or delegable functions under 21 NCAC 16H .0201, who does not satisfy the training and experience requirements for classification as a Dental Assistant II set forth in 21 NCAC 16H .0104, and is not licensed by the Board as a dentist or dental hygienist. (b) A Dental Assistant I shall have an unexpired CPR certification in effect at all times while performing any of the permitted functions under 21 NCAC 16H .0201. (c) No Dental Assistant I may take radiographs before completing radiology training consistent with G.S. 90-29(c)(12). 21 NCAC 16H .0103 DENTAL ASSISTANT II A Dental Assistant II is an expanded duty assistant who has completed training in accordance with Rule .0104 of this Section. Under direct control and supervision, a Dental Assistant II may be delegated intra-oral procedures in accordance with 21 NCAC 16H .0203 the supervising dentist deems appropriate, with the dentist personally and professionally responsible for any and all consequences or results arising from the performance of said acts. All delegated procedures must be reversible in nature. 21 NCAC 16H .0104 APPROVED EDUCATION AND TRAINING PROGRAMS* (a) To be classified as a Dental Assistant II, an assistant shall have and maintain an unexpired CPR certification and also shall meet one of the following criteria: (1) completion of: (A) an ADA-accredited dental assisting program; or (B) one academic year or longer in an ADA-accredited dental hygiene program; or (2) completion of the Dental Assistant certification examination(s) administered by the Dental Assisting National Board; or (3) completion of: (A) full-time employment as a Dental Assistant I for two years of the preceding five, consisting of at least 3,000 hours total; (B) a 3-hour course in sterilization and infection control; and (C) a 3-hour course in dental office emergencies. (b) A Dental Assistant who has completed the requirements of sections (a)(3)(B)-(C) but not completed the training pursuant to section (a)(3)(A) may be trained in any dental delivery setting and allowed to perform the functions of a Dental Assistant II, as specified in 21 NCAC 16H .0203, under the direct control and supervision of a licensed dentist. (c) An unexpired CPR certification as used herein is one that is in effect and valid at the time of classification as a Dental Assistant II and remains so at all times while employed as a Dental Assistant II or while performing any of the permitted functions under 21 NCAC 16H .0203. (d) No Dental Assistant may take radiographs before completing radiology training consistent with G.S. 90-29(c) (12). SECTION .0200 – PERMITTED FUNCTIONS OF DENTAL ASSISTANT 21 NCAC 16H .0201 GENERAL PERMITTED FUNCTIONS OF DENTAL ASSISTANT I (a) A Dental Assistant I may assist a dentist as a chairside assistant as long as the acts and functions of the Dental Assistant I do not constitute the practice of dentistry or dental hygiene as set out in G.S. 90-29(b) and G.S. 90221(a). (b) A Dental Assistant I may do and perform only routine dental assisting procedures such as oral hygiene instruction, chairside assisting, application of topical fluorides or topical anesthetics, and exposure of radiographs, provided that the assistant can show evidence of compliance with radiography training consistent with G.S. 9029(c)(12). (c) Functions of a Dental Assistant II also may be delegated to a Dental Assistant I in accordance with 21 NCAC 16H .0104(b). 21 NCAC 16H .0203 PERMITTED FUNCTIONS OF DENTAL ASSISTANT II (a) A Dental Assistant II may perform any and all acts or procedures which may be performed by a Dental Assistant I as set forth in 21 NCAC 16H .0201. In addition, a Dental Assistant II may be delegated the following functions to be performed under the direct control and supervision of a dentist who shall be responsible for any and all consequences or results arising from the performance of such acts and functions, provided that the dentist first examined the patient and prescribed the procedure: © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

373

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (1) taking impressions for study models and opposing casts that may be used for construction of temporary or permanent dental appliances, adjustable orthodontic appliances, nightguards and the repair of dentures or partials; (2) applying sealants to teeth that do not require mechanical alteration prior to the application of such sealants; (3) inserting matrix bands and wedges; (4) placing cavity bases and liners; (5) placing and removing rubber dams; (6) cementing temporary restorations using temporary cement; (7) applying acid etch materials and rinses; (8) applying bonding agents; (9) removing periodontal and surgical dressings; (10) removing sutures; (11) placing and removing gingival retraction cord; (12) removing excess cement with hand scaler supragingivally; (13) flushing, drying and temporarily closing root canals or pulpotomies; (14) placing and removing temporary restorations; (15) placing and tying in or untying and removing orthodontic arch wires ligature wires, or lock pins; (16) inserting interdental spacers; (17) fitting (sizing) orthodontic bands or brackets; (18) applying dentin desensitizing solutions; (19) performing extra-oral adjustments that affect function, fit, or occlusion of any restoration or appliance; (20) initially forming and sizing orthodontic arch wires and placing arch wires after final adjustment and approval by the dentist; (21) polishing the clinical crown, pursuant to Paragraph (b) of this Rule using only: (A) a hand-held brush and polishing agents; or (B) a combination of a slow speed handpiece (not to exceed 10,000 rpm) with attached rubber cup or bristle brush, and polishing agents; (22) exposing radiographs and cone beam images; (23) polishing removable appliances extra-orally; (24) preparing and loading amalgam in carrier; (25) measuring pulse, blood pressure, and temperature; (26) using micro-etcher extra-orally; (27) placing a throat shield in oropharynx during administration of general anesthesia; (28) delivering dentures to patient for insertion, provided the dentist approves the denture placement; or (29) removing or replacing healing abutments or cover screws for implants that may be accessed supragingivally. (b) A Dental Assistant II shall complete a course in coronal polishing identical to that taught in an ADA accredited dental assisting program, or by a licensed North Carolina hygienist or dentist lasting at least seven clock hours before using a slow speed handpiece with rubber cup or bristle brush attachment. The course shall include instruction on dental morphology, the periodontal complex, operation of handpieces, polish aids, and patient safety. A list of ADA accredited programs offering courses in coronal polishing, which is incorporated by reference along with its subsequent amendments and editions, is available at no cost on the American Dental Association's website at http://www.ada.org/en/coda/find-a-program. A coronal polishing procedure shall not be represented to the patient as a prophylaxis. No coronal polishing procedure may be billed as a prophylaxis unless the dentist has performed an evaluation for calculus, deposits, or accretions and a dentist or dental hygienist has removed any substances detected. 21 NCAC 16H .0205 SPECIFIC PROHIBITED FUNCTIONS OF DENTAL ASSISTANTS I AND II Those specific functions which shall not be delegated to either a Dental Assistant I or a Dental Assistant II include those procedures prohibited in 21 NCAC 16G .0103 for Dental Hygienists. In addition, those procedures that require the professional education and skill of a Dentist or Dental Hygienist and may not be delegated to a Dental Assistant I or Dental Assistant II shall include: (1) performing prophylaxis; (2) performing periodontal screening; (3) performing periodontal probing; (4) performing subgingival exploration for or removal of hard or soft deposits; (5) performing sulcular irrigation; (6) using ultrasonic scalers for prophylaxis; (7) applying antibiotic-coated materials; (8) applying resorbable antimicrobial agents; (9) performing root planing; (10) applying oral cancer screening products; 374

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (11) using laser fluorescence detectors in preparation for the dentist's examination and diagnosis of cavities; or (12) applying resin infiltration treatment for incipient smooth surface lesions, following the dentist's diagnosis that the lesion is non-penetrable. 21 NCAC 16H .0206 DIRECT CONTROL AND SUPERVISION DEFINED In any instance in which the rules adopted by the Board or any portion of the North Carolina Dental Practice Act shall require or direct that any act or function be performed by a Dental Assistant I or II under the direct control and supervision of a dentist, the term “direct control and supervision of a dentist” means that the dentist must be present in the office when the act or function is being performed and that the dentist must directly and personally supervise, examine, and evaluate the results of any and all acts and functions lawfully done or performed by any person other than the dentist. 21 NCAC 16H .0208 LIMITED EXCEPTION FOR ASSISTING HYGIENISTS A Dental Assistant II may assist a Limited Supervision Hygienist, who is qualified and practicing pursuant to 21 NCAC 16Z .0101-.0103, in providing oral hygiene instruction, applying sealants, applying topical fluorides, applying fluoride varnishes, and while the Hygienist is performing prophylaxis, provided: (1) The treatment is provided to children in school-based oral health programs under the "ECU School-based Oral Health Expansion Readiness" grant, proposal number 19-0786 and related project number A19-0231, developed by the East Carolina University School of Dental Medicine and funded by The Duke Endowment; and (2) Prior to any treatment being provided, a licensed North Carolina dentist has: (a) examined the patient; (b) ordered in writing the treatment provided to the patient; and (c) agreed to provide the patient with any necessary additional treatment resulting from the treatment rendered in accordance with this Rule. SUBCHAPTER 16J - SANITATION 21 NCAC 16J .0103 STERILIZATION All instruments or equipment used in the treatment of dental patients shall be sterilized according to usage. All dental health care settings shall follow the most current guidelines on infection control for the dental office and the dental laboratory adopted by the American Dental Association. Effective control techniques and precautions to prevent the cross contamination and transmission of infection to all persons is the professional responsibility of all dentists. All licensees are required to maintain and provide a safe, therapeutic environment for patients and employees and to follow a comprehensive and practical infection control program at all times. SUBCHAPTER 16O – NITROUS-OXIDE-OXYGEN CONSCIOUS SEDATION SECTION .0300 - DEFINITIONS 21 NCAC 16O .0301 CONSCIOUS SEDATION "Conscious sedation" means the use of drugs for controlling pain or apprehension without rendering the patient unconscious. 21 NCAC 16O .0302 MONITORING "Monitoring" means observation of the patient during the flow of sedation agents and includes reducing the flow of sedation or shutting off equipment controlling such flow. Monitoring does not include increasing the flow of sedation agents. SECTION .0400 - QUALIFICATIONS TO PERFORM FUNCTIONS NCAC 16O .0401 NON-DELEGABLE FUNCTIONS Conscious sedation shall not be induced by anyone other than a dentist or a lawfully qualified nurse or anesthetist who does so under the supervision and direction of a dentist or physician. 21 NCAC 16O .0402 EDUCATIONAL REQUIREMENTS A Dental Assistant may aid and assist a licensed dentist in the monitoring of nitrous oxide-oxygen inhalant sedation by completing a Board-approved course totaling at least seven hours that covers the following topics: (1) definitions and descriptions of physiological and psychological aspects of pain and anxiety; (2) the states of drug-induced central nervous system depression through all levels of consciousness and unconsciousness, with special emphasis on the distinction between the conscious and unconscious state; (3) respiratory and circulatory physiology and related anatomy; (4) pharmacology of agents used in the nitrous oxide techniques being taught, including drug interaction and incompatibility; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

375

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (5) patient monitoring, with particular attention to vital signs and reflexes related to consciousness; (6) prevention, recognition and management of complications and life threatening situations that may occur during the use of the conscious sedation techniques, including cardio pulmonary resuscitation; (7) description and use of ventilation sedation equipment; and (8) potential health hazards of trace anesthetics, and proposed techniques for elimination of these potential health hazards. SUBCHAPTER 16Q – GENERAL ANESTHESIA AND SEDATION SECTION .0200 - GENERAL ANESTHESIA 21 NCAC 16Q .0101 GENERAL ANESTHESIA AND SEDATION DEFINITIONS For the purpose of these Rules relative to the administration of minimal conscious sedation, moderate conscious sedation, moderate pediatric conscious sedation, or general anesthesia by or under the direction of a dentist, the following definitions shall apply: (5) "Administer" – to direct, manage, supervise, control, and have charge of all aspects of selection, dosage, timing, and method of delivery to the patient of any pharmacologic agent intended to reduce anxiety or depress consciousness. (7) "Auxiliaries" – non-dentist staff members involved in general anesthesia or sedation procedures. (8) "BLS" – Basic Life Support. (17) "Emergencies manual" – a written manual that documents: (a) the location of all emergency equipment and medications in each facility; (b) each staff member's role during medical emergencies; and (c) the appropriate treatment for laryngospasm, bronchospasm, emesis and aspiration, respiratory depression and arrest, angina pectoris, myocardial infarction, hypertension, hypotension, allergic reactions, convulsions, syncope, bradycardia, hypoglycemia, cardiac arrest, and airway obstruction. (35) "Sedation Procedure" – process begins when any pharmacological agent is first administered to a patient to induce general anesthesia or sedation and continues until the dentist permit holder determines that the patient has met the recovery and discharge criteria set forth in the applicable rules in this Subchapter. 21 NCAC 16Q .0202 GENERAL ANESTHESIA EQUIPMENT AND CLINICAL REQUIREMENTS (a) (3) The permit holder shall maintain written emergency and patient discharge protocols and training to familiarize auxiliaries in the treatment of clinical emergencies shall be provided; (6) The facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording general anesthesia or sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding general anesthesia or sedation throughout the sedation procedure and is not performing the surgery or other dental procedure. (b) During an inspection or evaluation, the applicant or permit holder shall demonstrate the administration of anesthesia while the evaluator observes, and shall demonstrate competency in the following areas: (5) use of BLS certified auxiliaries; 21 NCAC 16Q .0206 ITINERANT (MOBILE) GENERAL ANESTHESIA PERMIT, EQUIPMENT AND EVALUATION (f) Prior to administering general anesthesia or sedation at another provider's office, the mobile permit holder shall inspect the host facility within 24 business hours before each procedure and shall ensure that: (5) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording general anesthesia or sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding general anesthesia or sedation throughout the sedation procedure and is not performing the surgery or other dental procedure. 21 NCAC 16Q .0207 ANNUAL RENEWAL OF GENERAL ANESTHESIA AND ITINERANT (MOBILE) GENERAL ANESTHESIA PERMIT REQUIRED (e) As a condition for renewal of the general anesthesia and itinerant general anesthesia permit, the general anesthesia permit holder shall meet the clinical equipment and requirements set out in Rule .0202 of this Section and the itinerant general anesthesia permit holder shall maintain the clinical equipment and requirements set out in Rule.0206 of this Section and shall document the following: (1) six hours of continuing education each year in one or more of the following areas, which may be counted toward fulfillment of the continuing education required each calendar year for license renewal: (A) sedation; (B) medical emergencies; (C) monitoring IV sedation and the use of monitoring equipment; (D) pharmacology of drugs and agents used in general anesthesia and IV sedation; 376

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants

(2) (3) (4) (5)

(E) physical evaluation, risk assessment, or behavioral management; or (F) airway management; unexpired ACLS certification, which shall not count towards the six hours of continuing education required in Subparagraph (e)(1) of this Rule; that the permit holder and all auxiliaries involved in anesthesia or sedation procedures have practiced responding to dental emergencies as a team at least once every six months in the preceding year; that the permit holder and all auxiliaries involved in anesthesia or sedation procedures have read the practice's emergency manual in the preceding year; and that all auxiliaries involved in sedation procedures have completed BLS certification and three hours of continuing education annually in any of the areas set forth in Subparagraph (e)(1) of this Rule.

21 NCAC 16Q .0301 CREDENTIALS AND PERMITS FOR MODERATE PARENTERAL AND ENTERAL CONSCIOUS SEDATION (c) A dentist applying for a permit to administer moderate conscious sedation shall document the following: (3) That all auxiliaries involved in sedation procedures have unexpired BLS certification. 21 NCAC 16Q .0302 MODERATE PARENTERAL AND ENTERAL CONSCIOUS SEDATION CLINICAL REQUIREMENTS AND EQUIPMENT (a) A dentist administering moderate conscious sedation or supervising any CRNA employed to administer or RN employed to deliver moderate conscious sedation shall be responsible to ensure that the facility where the sedation is administered meets the following requirements: (3) The permit holder shall maintain written emergency and patient discharge protocols and training to familiarize auxiliaries in the treatment of clinical emergencies shall be provided; (6) The following conditions shall be satisfied during a sedation procedure: (A) The facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure. (b) During an inspection or evaluation, the applicant or permit holder shall demonstrate the administration of moderate conscious sedation on a patient, including the deployment of an intravenous delivery system, while the evaluator observes. During the demonstration, the applicant or permit holder shall demonstrate competency in the following areas: (5) use of BLS certified auxiliaries; 21 NCAC 16Q .0304 ITINERANT (MOBILE) MODERATE PERMIT, EQUIPMENT AND EVALUATION (e) Prior to administering moderate conscious sedation or other sedation services at another provider's office, the mobile permit holder shall inspect the host facility within 24 business hours before each procedure and shall ensure that: (5) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording moderate conscious sedation or other sedation services data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure. 21 NCAC 16Q .0305 ANNUAL RENEWAL OF MODERATE PARENTERAL AND ENTERAL CONSCIOUS SEDATION PERMIT REQUIRED (e) As a condition for renewal of the moderate conscious sedation permit and itinerate moderate conscious sedation permit, the permit holder shall meet the clinical and equipment requirements of Rules .0302 and .0304 of this Section and shall document the following: (1) six hours of continuing education each year in one or more of the following areas, which may be counted toward fulfillment of the continuing education required each calendar year for license renewal: (A) sedation; (B) medical emergencies; (C) monitoring IV sedation and the use of monitoring equipment; (D) pharmacology of drugs and agents used in IV sedation; (E) physical evaluation, risk assessment, or behavioral management; or (F) airway management; (2) unexpired ACLS certification, which shall not count towards the six hours of continuing education required in Subparagraph (e)(1) of this Rule; (3) that the permit holder and all auxiliaries involved in sedation procedures have practiced responding to dental emergencies as a team at least once every six months in the preceding year; (4) that the permit holder and all auxiliaries involved in sedation procedures have read the practice's emergency manual in the preceding year; and ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

377

North Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (5) that all auxiliaries involved in sedation procedures have completed BLS certification and three hours of continuing education annually in any of the areas set forth in Subparagraph (e)(1) of this Rule. 21 NCAC 16Q .0405 MODERATE PEDIATRIC CONSCIOUS SEDATION CLINICAL REQUIREMENTS AND EQUIPMENT (a) A dentist administering moderate pediatric conscious sedation shall be responsible to ensure that the facility where the sedation is administered meets the following requirements: (3) The permit holder shall maintain written emergency and patient discharge protocols and training to familiarize auxiliaries in the treatment (6) The following conditions shall be satisfied during a sedation procedure: (A) the facility shall be staffed with at least two BLS certified auxiliaries, one of whom shall be dedicated to patient monitoring and recording sedation data throughout the sedation procedure. This Subparagraph shall not apply if the dentist permit holder is dedicated to patient care and monitoring regarding sedation throughout the sedation procedure and is not performing the surgery or other dental procedure; and (c) During the demonstration, all applicants and permit holders shall demonstrate competency in the following areas: (5) use of BLS certified auxiliaries; 21 NCAC 16Q .0407 ANNUAL RENEWAL OF MODERATE PEDIATRIC CONSCIOUS SEDATION PERMIT REQUIRED (e) As a condition for renewal of the moderate pediatric conscious sedation permit and itinerant moderate pediatric conscious sedation permit, the permit holder shall meet the clinical and equipment requirements of Rule .0405 of this Section and shall document the following: (1) six hours of continuing education each year in one or more of the following areas, which may be counted toward fulfillment of the continuing education required each calendar year for license renewal: (A) sedation; (B) medical emergencies; (C) monitoring IV sedation and the use of monitoring equipment; (D) pharmacology of drugs and agents used in IV sedation; (E) physical evaluation, risk assessment, or behavioral management; or (F) airway management; (2) unexpired PALS certification, which shall not count towards the six hours of continuing education required in Subparagraph (e)(1) of this rule; (3) that the permit holder and all auxiliaries involved in sedation procedures have practiced responding to dental emergencies as a team at least once every six months in the preceding year. (4) that the permit holder and all auxiliaries involved in sedation procedures have read the practice's emergency manual in the preceding year; and (5) that all auxiliaries involved in sedation procedures have completed BLS certification and three hours of continuing education annually in any of the areas set forth in Subparagraph (e)(1) of this Rule. SUBCHAPTER 16W – PUBLIC HEALTH HYGIENISTS SECTION .0100 - PUBLIC HEALTH HYGIENISTS 21 NCAC 16W .0104 DENTAL ACCESS SHORTAGE AREAS (a) Public health hygienists who are practicing under Rule .0101(a) of this Section and who perform procedures in public schools, nursing homes, rest homes, long-term care facilities, and rural and community clinics provided through federal, State, county, or local governments in areas identified by the Office of Rural Health in the Department of Health and Human Services as dental access shortage areas may: (1) perform clinical hygiene procedures as described in G.S. 90-221 under the direction of a dentist based on a written standing order, rather than an in-person evaluation by the dentist as set forth in Rule .0101(c) of this Section; and (2) supervise a Dental Assistant who assists the public health hygienists in the procedures described in Subparagraph (a)(1) of this Rule. For purposes of this Rule, Dental Assistant means any person classified as a Dental Assistant II or permitted to perform functions of a Dental Assistant II pursuant to 21 NCAC 16H .0104(a) or (b). *Note: According to the Chief Operations Officer of the North Carolina State Board of Dental Examiners (personal communication, 2/19/09), North Carolina also recognizes a “DA II in training” [Sec. 21.NCAC 16H.0104 (2)(a)]. A DA II in training is a DA I with two years (3,000 hours) of work experience as a dental assistant. A DA II in training may perform all DA II functions except coronal polishing. A dental assistant must be a DA II (no longer in training) to qualify to enroll in a coronal polishing course. In addition, to expose radiographs and monitor nitrous oxide, a DA II in training must successfully complete required courses as described in Subchapter 16H Section .0200.

378

North Dakota DANB Certificant Counts: North Dakota Certified Dental Assistant (CDA) certificants

377

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Rita Sommers, RDH, MBA, Executive Director North Dakota State Board of Dental Examiners P.O. Box 7246 Bismarck, ND 58507-7246 Phone: 701-258-8600 Fax: 701-224-9824 Email: info@nddentalboard.org Website: www.nddentalboard.org

Radiation Health and Safety (RHS)

889

Infection Control (ICE)

876

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs North Dakota State College of Science

DANB CDA Certificant State of North Dakota+

$23.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been reviewed by DANB as of April 1, 2020.

Source: 2018 DANB Salary Survey (state data based on 9 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

379

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the North Dakota State Board of Dental Examiners. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

North Dakota State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of North Dakota, one must be a Registered Dental Assistant (RDA) or Qualified Dental Assistant (QDA) (see requirements below).

State Requirements For Expanded Functions To earn status as a Registered Dental Assistant (RDA) in the state of North Dakota, one must: To earn status as a Registered Dental Assistant (RDA) in the state of North Dakota, one must: (1a) Within one year prior to application, have passed DANB's national Certified Dental Assistant (CDA) exam or have completed a CODA-accredited or North Dakota board-approved dental assisting program, OR (1b) Have passed DANB's national CDA exam or have completed a CODAaccredited or North-Dakota board-approved dental assisting program (more than one year prior to application), AND have completed 16 hours of continuing education within two years prior to application, AND (2) Pass a written examination of the laws and rules governing the practice of dentistry in North Dakota within one year of application, AND (3) Maintain current CPR certification AND (4) Provide verification of completing an infection control course within two years prior to application (if graduation from approved program or passing DANB's CDA exam occurred more than two years prior to application) AND (5) Apply for registration to the North Dakota State Board of Dental Examiners (NDSBDE). To earn status as a Qualified Dental Assistant (QDA) in the state of North Dakota, one must: (1a) Pass the national DANB Radiation Health and Safety (RHS) and Infection Control (ICE) exams within one year of application OR (1b) Pass the national DANB RHS and ICE exams and, within two years of application, complete 16 hours of continuing education, AND (2) Complete 650 hours of dental assistance instruction including on-the-job training, AND (3) Pass a written examination of the laws and rules governing the practice of dentistry in North Dakota within one year of application, AND (4) Maintain current CPR certification, AND (5) Provide verification of completing an infection control course within two years prior to application (if passing DANB's ICE exam occurred more than two years prior to application), AND (6) Apply to the North Dakota State Board of Dental Examiners. To apply pit and fissure sealants in the state of North Dakota under the direct supervision of a licensed dentist, a dental assistant must: (1) Be an RDA, AND (2) Successfully complete a North Dakota Board-approved sealant course. To be authorized to perform specified anesthesia assisting functions under the supervision of a dentist authorized by permit to administer parenteral sedation, a Registered Dental Assistant may earn a Class I or a Class II anesthesia assistant permit. To earn a Class I anesthesia assistant permit, a Registered Dental Assistant must: (1) Complete a board-approved dental anesthesia assistant education and training course, AND (2) Submit proof of current certification status from the American Association of Oral and Maxillofacial Surgeons dental anesthesia assistant national certification, or a board-approved competency examination, AND (3) Hold current and valid certification for health care provider basic life support, or advanced cardiac life support or pediatric advanced life support, AND (4) Provide a copy of a valid North Dakota general anesthesia or parenteral permit of the dentist where the registered dental assistant will be performing anesthesia assistant services, AND (5) Apply to the North Dakota Board of Dental Examiners for a Class I anesthesia assisting permit. To earn a Class II anesthesia assistant permit, a Registered Dental Assistant must: (1) Complete all requirements for a Class I anesthesia assistant permit AND (2) Complete training in intravenous access or phlebotomy that includes live experience starting and maintaining intravenous lines, AND (3) Apply to the North Dakota Board of Dental Examiners for a Class II anesthesia assisting permit. To earn a permit to perform specified restorative functions under the direct supervision of a dentist, a Registered Dental Assistant must: (1a) Complete a board-approved curriculum from a program accredited by the Commission on Dental Accreditation or other board-approved course AND (1b) Pass the Western Regional Examining Board (WREB) Restorative Examination or other equivalent examinations approved by the board within the last five years AND (1c) Complete the Restorative Function (RF) component of DANB’s Certified Restorative Functions Dental Assistant (CRFDA) certification exam, OR (2a) Pass the WREB Restorative Examination or other board-approved examination over five years from the date of application AND (2b) Complete the RF component of DANB’s CRFDA certification examination AND (2c) Provide evidence from another state or jurisdiction where the applicant legally is or was authorized to perform restorative functions and certification from the supervising dentist of successful completion of at least 25 restorative procedures within the immediate five years prior to the date of application. Note: Every dental assistant, qualified dental assistant, or registered dental assistant practicing in North Dakota must have a current certificate of proficiency in cardiopulmonary resuscitation.

380

North Dakota State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – North Dakota State Board of Dentistry North Dakota Century Code Hygienist and Dental Assistant CHAPTER 43-20 DENTAL HYGIENISTS AND ASSISTANTS 43-20-01.1. Definitions. As used in this chapter and chapter 43-28, unless the context otherwise requires: 1. "Dental assistant" means an individual who provides dental assistance under the supervision of a dentist and within the scope of practice established by rule and section 43-20-13. 3. "Qualified dental assistant" means an individual registered as a qualified dental assistant to provide dental assistance as established by rule. 4. "Registered dental assistant" means an individual registered as a registered dental assistant to provide dental assistance as established by rule. 43-20-08. Unlawful to practice without license or registration. A person may not practice dental hygiene or practice as a registered or qualified dental assistant in the state, without first obtaining from the board a license or registration. A person may not practice as a dental assistant outside the scope of practice established by the board by rule and section 43-20-13. 43-20-13. Dental assistant - Scope of permitted practice. A dental assistant is an auxiliary to the practice of dentistry. To the extent applicable and to the extent they are not inconsistent with this chapter, the requirements and rules adopted by the board of dental examiners under chapter 43-28 apply to the practice of dental assistants. [Note: Chapter 43-28 has not been included in this publication because it does not contain sections specific to dental assistants. For the full statute, please visit www.nddentalboard.org.] A dentist may delegate to a dental assistant who is under that dentist’s direct, indirect, or general supervision procedures over which the dentist exercises full responsibility as provided by rules adopted by the board of dental examiners. 43-20-13.1. Registration Renewal. 1. All registrations of registered and qualified dental assistants expire on December thirty-first of every even-numbered year. 2. A registration may be renewed by submitting a renewal application, renewal fee established by the board by rule, and proof of completion of the continuing education requirements established by the board by rule, provided the registration is not revoked or grounds for denial under section 43-20-05 do not exist. 3. If the renewal application, renewal fee, and proof of completion of continuing education are not received by December thirty-first of the even-numbered year, the registration expires and the registered or qualified dental assistant may not practice as a registered or qualified dental assistant. 4. Within sixty days after December thirty-first of the even-numbered year, an expired registration may be renewed by submitting the renewal application, renewal fee, proof of completion of continuing education, and a late fee established by the board by rule. 5. If the renewal application, renewal fee, proof of completion of continuing education, and late fee are not received within sixty days after December thirty-first of the even-numbered year, the registration may not be renewed, and the registered or qualified dental assistant must apply for and meet the requirements for registration to be granted registration. 6. The board may extend the renewal deadline for a registered or qualified dental assistant providing proof of medical or other hardship rendering the registered or qualified dental assistant unable to meet the deadline. 43-20-13.2. Registered and qualified dental assistant registration. To be registered as a registered or qualified dental assistant, an individual shall apply and meet the requirements established by the board by rule. North Dakota Administrative Code Title 20 Article 20-01 General Administration 20-01-02-01. Definitions. Unless specifically stated otherwise, the following definitions are applicable throughout this title: 7. "Cardiopulmonary resuscitation course" means the American heart association’s health care provider course, the American red cross professional rescuer course, or an equivalent course. 8. "Certified dental assistant" means a dental assistant who meets the education or experience prerequisites, or both, established by the dental assisting national board and passes the dental assisting national board’s certified dental © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

381

North Dakota State Dental Practice Act and Administrative Rules for Dental Assistants

13.

14. 16.

17. 20. 22. 28.

29.

assistant examination, is currently cardiopulmonary resuscitation-certified, and continues to maintain the credential by meeting the dental assisting national board requirements. A certified dental assistant must be registered by the board as a qualified dental assistant or registered dental assistant to perform expanded duties. “Contiguous supervision” means that the dentist whose patient is being treated and has personally authorized that procedures to be performed. The supervising dentist is continuously onsite and physically present in the treatment facility while the procedures are performed by the dental anesthesia auxiliary and capable of responding immediately in the event of an emergency. The term does not require a supervising dentist to be physically present in the operatory. "Coronal polishing" is the mechanical polishing of clinical crowns using a rubber cup or brush only and not to include any instrumentation. "Direct supervision" means the dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedures and remains in the dental office or treatment facility while the procedures are being performed by the dental hygienist or dental assistant, and before dismissal of the patient, evaluates the performance of the dental hygienist or dental assistant. "Direct visual supervision" means supervision by an oral and maxillofacial surgeon by verbal command and under direct line of sight. "General supervision" means the dentist has authorized the procedures and they are carried out in accordance with the dentist’s diagnosis, if necessary, and treatment plan. The dentist is not required to be in the treatment facility. Limitations are contained in North Dakota Century Code section 43-20-03. "Indirect supervision" means that a dentist is in the dental office or treatment facility, has personally diagnosed the condition to be treated, authorizes the procedures, and remains in the dental office or treatment facility while the procedures are being performed by the dental hygienist or dental assistant. "Qualified dental assistant" means a dental assistant who has been employed and trained as a dental assistant and has received at least six hundred fifty hours of on-the-job training, has completed a board-approved infection control seminar and passed the x-ray and infection control portions of the dental assistant national board examination, and has applied to the board and paid the certificate fee and met any other requirements of section 20-03-01-05. "Registered dental assistant" means a dental assistant who is a graduate of a dental assistant program accredited by the commission on dental accreditation of the American dental association or a substantially equivalent curriculum approved by the board or has been certified by the dental assistant national board, and has applied to the board and paid the registration fee and met any other requirements of section 20-03-01-05.

Article 20-02 Dentists 20-02-01-02. Office emergency. Every dentist, dental hygienist, qualified dental assistant, or registered dental assistant practicing in North Dakota must have a current certificate of proficiency in cardiopulmonary resuscitation. 20-02-01-03. Nitrous oxide. A duly licensed dentist may use nitrous oxide for treating patients only when the following conditions are met: 2. A dentist who induces a patient into a state of psychosedation or relative analgesia using nitrous oxide shall ensure that the patient will be continually and personally monitored by a dentist. A dentist may delegate the monitoring tasks to a licensed dental hygienist or a registered dental assistant utilizing indirect supervision only after the patient has been stabilized at the desired level of conscious sedation or relative analgesia by the action of the dentist. The licensed dental hygienist or registered dental assistant who is assigned the monitoring task shall remain in the treatment room with the patient at all times. A dental hygienist or a dental assistant may not initiate the administration of nitrous oxide to a patient. A dental hygienist or a registered dental assistant may terminate or reduce the amount of nitrous oxide previously administered by the dentist. 3. The dentist must provide and document training for the dental hygienist or registered dental assistant in the proper and safe operation of the analgesia machine being used prior to the registered dental hygienist or registered dental assistant monitoring the patient. Training shall include emergency procedures to be employed if required. Article 20-03 Dental Assistants 20-03-01-01. Duties. A dental assistant may perform the duties listed in subsections 1 through 5 under direct, indirect or general supervision of a dentist as follows: 1. A dental assistant who is not registered with the board employed by a dentist may perform the following duties under direct supervision: a. Take and record pulse, blood pressure, and temperature. b. Take and record preliminary dental and medical history for the interpretation by the dentist. c. Apply topical medications and drugs to oral tissues, including topical anesthetic, but not including desensitizing or caustic agents or anticariogenic agents. d. Receive removable dental prosthesis for cleaning or repair. e. Take impressions for study casts. f. Hold impression trays in the mouth (e.g. reversible hydrocolloids, rubber base). 2. A qualified dental assistant may perform the duties set forth in subsection 1 and take dental radiographs under the direct supervision of a dentist. 382

North Dakota State Dental Practice Act and Administrative Rules for Dental Assistants 3. A registered dental assistant may perform the duties set forth in subsection 2 and the following duties under the direct supervision of a dentist: a. Place and remove arch wires or appliances that have been activated by a dentist. b. Acid etch enamel surfaces prior to direct bonding of orthodontic brackets or composite restorations. c. Place orthodontic brackets using an indirect bonding technique by seating the transfer tray loaded with brackets previously positioned in the dental laboratory by a licensed dentist. d. Take face bow transfers. e. Place and remove matrix bands and wedges. f. Adjust permanent crowns outside of the mouth. g. Orally transmit a prescription that has been authorized by the supervising dentist. h. Administer emergency medications to a patient in order to assist the dentist in an emergency. 4. A registered dental assistant may perform the following duties under the direct or indirect supervision of a dentist: a. Apply anticariogenic agents topically. b. Apply desensitizing solutions to the external surfaces of the teeth. c. Dry root canal with paper points. d. Place and remove rubber dams. e. Take occlusal bite registration for study casts. f. Place retraction cord in the gingival sulcus of a prepared tooth prior to the dentist taking an impression of the tooth. g. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments only. h. Perform nonsurgical clinical and laboratory diagnosis tests, including pulp testing, for interpretation by the dentist. i. Place and remove periodontal dressings, dry socket medications, and packing. j. Monitor a patient who has been inducted by a dentist into nitrous oxide relative analgesia. k. Take impressions for fixed or removable orthodontic appliances, athletic mouth guards, bleaching trays, bite splints, flippers, and removable prosthetic repairs. l. Preselect and prefit orthodontic bands. m. Place, tie, and remove ligature wires and elastic ties, and place orthodontic separators. n. Take dental radiographs 5. A registered dental assistant may perform the following duties under the direct, indirect, or general supervision of a dentist: a. Take and record pulse, blood pressure, and temperature. b. Take and record preliminary dental and medical history for the interpretation by the dentist. c. Apply topical medications and drugs to oral tissues, including topical anesthetic, but not including desensitizing or caustic agents or anticariogenic agents. d. Receive removable dental prosthesis for cleaning or repair. e. Take impressions or occlusal bite registrations for study casts. f. Fabricate, adjust, place, recement, or remove a temporary crown, bridge, or onlay or temporary restorative material. This applies only to dentitions actively under treatment for which a permanent restoration is being fabricated. g. Remove sutures. h. Cut and remove arch wires or replace loose bands, loose brackets, or other orthodontic appliances for palliative treatment. i. Provide oral hygiene education and instruction. j. Provide an oral assessment for interpretation by the dentist. k. Repack dry socket medication and packing for palliative treatment. l. Apply pit and fissure sealants if the registered dental assistant has provided documentation of a boardapproved sealant course. Adjust sealants with slow-speed handpiece. m. Polish the coronal surfaces of the teeth with a rubber cup or brush. n. Polish restorations with a slow-speed handpiece. 20-03-01-01.1. Expanded duties of registered dental assistants. A registered dental assistant shall apply for a permit to perform the following duties: 1. A registered dental assistant under the direct supervision of a dentist may perform the following restorative functions: a. Place, carve, and adjust class I, II, and class V amalgam or glass ionomer restorations with hand instruments or a slow-speed handpiece; b. Adapt and cement stainless steel crowns; and c. Place, contour, and adjust class I, II, and class V composite restorations where the margins are entirely within the enamel with hand instruments or a slow-speed handpiece. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

383

North Dakota State Dental Practice Act and Administrative Rules for Dental Assistants 2. A registered dental assistant authorized by permit and under the contiguous supervision of a dentist authorized by permit to provide parenteral sedation may provide anesthesia duties as follows: a. Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation or general anesthesia; and b. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open. c. Prepare anesthesia equipment and perform patient monitoring; and d. Assist with emergency treatment and protocols. 3. A registered dental assistance authorized by permit and under the direct visual supervision of a dentist authorized by permit to provide parenteral sedation shall provide anesthesia duties as follows: a. Draw up and prepare medications; b. Follow instructions to deliver medication into an intravenous line upon verbal command of the supervising dentist; c. Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal command of the supervising dentist; and d. Adjust an electronic device to provide medications, such as an infusion pump upon verbal command of the supervising dentist. 20-03-01-02. Prohibited Services. A dental assistant, qualified dental assistant or registered dental assistant may not perform the following services: 1. Diagnosis and treatment planning. 2. Surgery on hard or soft tissue. 3. Administer local anesthetics, sedation or general anesthesia drugs or titrate local anesthetics, sedation or general anesthesia drugs without a board authorized permit. 4. Any irreversible dental procedure or procedures which require the professional judgment and skill of a licensed dentist. 5. Adjust a crown which has been cemented by a dentist.â&#x20AC;Š6. Activate any type of orthodontic appliance. 7. Cement or bond orthodontic bands or brackets that have not been previously placed by a dentist. 8. Place bases or cavity liners. 9. Scaling, root planing, or gingival curettage. 10. Measure the gingival sulcus with a periodontal probe. 11. Use a high-speed handpiece inside the mouth. 20-03-01-05. Registration of registered and qualified dental assistants. An individual seeking registration as a registered or qualified dental assistant shall apply on forms prescribed by the board. The application must be notarized and include the application fee. 1. The board may grant registration as a registered dental assistant to an applicant meeting all the following requirements: a. The applicant meets any of the following requirements: (1) The applicant successfully completed a dental assisting program, accredited by the commission on dental accreditation of the American dental association or approved by the board, within one year of application. (2) The applicant was certified by the dental assisting national board within one year of application. (3) The applicant successfully completed a dental assisting program, accredited by the commission on dental accreditation of the American dental association or approved by the board, and completed, within two years before application, sixteen hours of continuing education in accordance with section 20-03-01-06. (4) The applicant was certified by the dental assisting national board, and completed, within two years before application, sixteen hours of continuing education in accordance with section 20-03-01-06. b. The applicant passed a written examination on the laws and rules governing the practice of dentistry in North Dakota within one year of application. c. The applicant successfully completed a cardiopulmonary resuscitation course within two years of application. d. Grounds for denial of the application under North Dakota Century Code section 43-20-05 do not exist. 2. The board may grant registration as a qualified dental assistant to an applicant meeting all the following requirements: a. The applicant meets any of the following requirements: (1) The applicant passed the infection control and radiation parts of the dental assisting national board examination within one year of application. (2) The applicant passed the infection control and radiation parts of the dental assisting national board examination and completed, within two years before application, sixteen hours of continuing education in accordance with section 20-03-01-06. b. The applicant completed six hundred fifty hours of dental assistance instruction, including on the job training. c. The applicant passed a written examination on the laws and rules governing the practice of dentistry in North Dakota within one year of application. d. The applicant successfully completed a cardiopulmonary resuscitation course within two years of application. e. Grounds for denial of the application under North Dakota Century Code section 43-20-05 do not exist. 384

North Dakota State Dental Practice Act and Administrative Rules for Dental Assistants 20-03-01-05.1. Additional expanded duties of registered dental assistants. The board may grant a permit to a registered dental assistant for the following: 1. The board may issue or renew a class I dental anesthesia assistant permit authorizing a registered dental assistant to provide anesthesia assistance under the supervision of a dentist authorized by permit to provide parenteral sedation, upon successful completion of the following: a. The applicant submits evidence of a board-approved dental anesthesia assistant education and training course. b. Submits proof of current certification status from the American association of oral and maxillofacial surgeons dental anesthesia assistant national certification or a board-approved competency examination. c. The applicant holds current and valid certification for health care provider basic life support, or advanced cardiac life support or pediatric advanced life support; and d. The applicant provides a copy of a valid North Dakota general anesthesia permit or parenteral sedation permit of the dentist where the registered dental assistant will be performing anesthesia assistant services. 2. The board may issue or renew a class II dental anesthesia assistant permit authorizing a registered dental assistant to provide anesthesia assistance under the supervision of a dentist authorized by permit to provide parenteral sedation, upon successful completion of the following: a. The applicant submits evidence of a board-approved dental anesthesia assistant education and training course and submitting proof of current certification status from the American association of oral and maxillofacial surgeons dental anesthesia assistant national certification or a board-approved competency examination; b. The applicant has successfully completed hands-on training in intravenous access or phlebotomy that includes live experience starting and maintaining intravenous lines; c. The applicant holds current and valid certification for health care provider basic life support, or advanced cardiac life support or pediatric advanced life support; and d. The applicant provides a copy of a valid North Dakota general anesthesia or parenteral sedation permit of the dentist where the registered dental assistant will be performing anesthesia assistant services. 3. The board may issue or renew a permit on forms prescribed by the board authorizing a registered dental assistant under the direct supervision of a dentist to provide restorative functions under the following conditions: a. The applicant meets any of the following requirements: (1) The applicant has successfully completed a board-approved curriculum from a program accredited by the commission on dental accreditation of the American dental association or other board-approved course and successfully passed the western regional examining board’s restorative examination or other equivalent examinations approved by the board within the last five years. The board may require successful completion of the restorative function component of the dental assisting national board’s certified restorative functions dental assistant certification examination; or (2) The applicant has successfully passed the western regional examining board’s restorative examination or other board-approved examination over five years from the date of application and successfully completed the restorative function component of the dental assisting national board’s certified restorative functions dental assistant certification examination and provide evidence from another state or jurisdiction where the applicant legally is or was authorized to perform restorative functions and certification from the supervising dentist of successful completion of at least twenty-five restorative procedures within the immediate five years from the date of application. b. A registered dental assistant may perform the placement and finishing of direct alloy or direct composite restorations, under the direct supervision of a licensed dentist, after the supervising dentist has prepared the dentition for restoration. c. The restorative functions shall only be performed after the patient has given informed consent for the placement of the restoration by a restorative functions dental assistant. d. Before the patient is released, the final restorations shall be checked and documented by the supervising dentist. 20-03-01-06. Continuing dental education for qualified and registered dental assistants. Each qualified or registered dental assistant shall provide evidence on forms supplied by the board that the qualified or registered dental assistant has attended or participated in continuing dental education in accordance with the following conditions: 1. Continuing education activities include publications, seminars, symposiums, lectures, college courses, and online education. 2. The continuing dental education hours will accumulate on the basis of one hour of credit for each hour spent in education. Subject matter directly related to clinical dentistry will be accepted by the board without limit. 3. The minimum number of hours required within a two-year cycle is sixteen. Of these hours, a qualified or registered dental assistant may earn no more than eight hours self-study. Self-study is an educational process designed to permit a participant to learn a given subject without involvement of a proctor. Cardiopulmonary resuscitation courses must provide hands-on training. All other continuing education requirements may be satisfied from online education. The continuing education must include:

385

North Dakota State Dental Practice Act and Administrative Rules for Dental Assistants a. Two hours of ethics or jurisprudence. Passing the laws and rules examination is the equivalent of two hours of ethics or jurisprudence. b. Two hours of infection control. c. A cardiopulmonary resuscitation course. d. For registered dental anesthesia assistant permitholders, two hours related to sedation or anesthesia. e. For registered dental restorative assistant permitholders, two hours related to restorative dentistry. 4. Mere registration at a dental convention without specific attendance at continuing education presentations will not be creditable toward the continuing dental education requirement. 5. All qualified or registered dental assistants must hold a current cardiopulmonary resuscitation certificate. 6. The board may audit continuing education credits of a registered dental assistant. Proof of continuing education shall be maintained from the previous renewal cycle. Upon receiving notice of an audit from the board, a registered dental assistant shall provide satisfactory documentation of attendance at, or participation in, the continuing education activities listed on the licenseeâ&#x20AC;&#x2122;s continuing education form. Failure to comply with the audit is grounds for nonrenewal of or disciplinary action against the registration. Article 20-05 Fees 20-05-01-01. Fees. The board shall charge the following nonrefundable fees: 3. For registered and qualified dental assistants: a. Application fee.............................................................. $130.00 b. Renewal fee ................................................................. $100.00 c. Late fee ........................................................................ $100.00 5. For a duplicate license, registration, or permit .......................... $45.00

386

Ohio DANB Certificant Counts: Ohio National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

2,139

Certified Orthodontic Assistant (COA) certificants

119

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Harry Kamdar, MBA, Executive Director Ohio State Dental Board The Vern Riffe Center for Government & the Arts 77 South High St., 17th Floor Columbus, OH 43215-6135 Phone: 614-466-2580 Fax: 614-752-8995 Website: www.dental.ohio.gov Email: dental.board@den.ohio.gov

CODA-Accredited Dental Assisting Programs Choffin Career and Technical Center Eastern Gateway Community College

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State Radiation Health and Safety (RHS)

9,840

Infection Control (ICE)

4,298

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants DANB CDA Certificant State of Ohio+

$22.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of June 18, 2020.

The pages that follow contain information about this state's requirements for dental assistants. If you have any questions about DANB-administered exams, contact DANB. For questions or further information about state requirements, contact the state board of dentistry. DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification * RHS and ICE: cumulative totals since 1997, excluding inactive records archived for data migration programs, has evaluated DANB national certification programs (CDA and purposes in 2018; CP, SE, TA and TF: cumulative totals since 2010; AMP, IM, TMP and IS: cumuCOA), including DANB component exams (RHS, ICE, GC and OA), and lative totals since 2012 finds that DANB programs meet NCCA’s highest standards, thus helping to + Source: 2018 DANB Salary Survey (state data based on 35 responses from this state) assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC ++ Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet 17024:2012 standards through the International Accreditation Service (IAS). at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

387

Ohio State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Ohio under the direct supervision of a dentist, a dental assistant must be state certified as a Dental X-ray Machine Operator. To obtain this certification, one must: (1a) Be a Certified Assistant (see requirements below) or (1b) Complete an Ohio Board-approved training course, including a clinical section** or (1c) Hold a license, certificate, or other credential issued by another state that the Ohio State Dental Board deems equivalent to Ohio’s standards for Dental X-ray Machine Operator certification AND (2) Apply to the Ohio State Dental Board for certification as a Dental X-Ray Machine Operator. ** Applicants may complete the DALE Foundation's DANB RHS Review course and obtain an affidavit of clinical training from a licensed dentist to meet this requirement.

A Dental X-Ray Machine Operator may perform radiologic procedures when the supervising dentist is not physically present at the location where the radiologic procedures are performed if the supervising dentist examined the patient not more than one year prior to the date the Dental X-Ray Machine Operator performs the radiologic procedures and the supervising dentist has ordered the radiologic procedures.

State Requirements For Expanded Functions The Ohio State Dental Board (OSDB) recognizes the following two dental assisting certifications: (1) DANB CDA certification or (2) Certified Ohio Dental Assistant certification administered by the Ohio Commission on Dental Assistant Certification (OCDAC). Current holders of either of these certifications are considered Certified Assistants. Certified Assistants may qualify to perform placement of pit and fissure sealants and to earn a state certificate in coronal polishing by meeting the additional requirements shown below. Certified Assistants may perform specified functions when the supervising dentist is not physically present (for not more than 15 consecutive business days), subject to the conditions listed below. To perform expanded functions under the direct supervision of a licensed dentist in the state of Ohio, a dental assistant must qualify as an Expanded Function Dental Auxiliary (EFDA). To qualify as an EFDA, one must: (1a) Be an unlicensed dentist who has graduated from an accredited dental college and does not have a dental license under suspension or revocation by the OSDB, OR (1b) Be a dental student who is enrolled in an accredited dental college and is in good standing as a dental student, OR (1c) Be a graduate of an unaccredited dental college located outside the United States OR, (1d) Be a current Certified Assistant (See definition and requirements above), OR, (1e) Be a dental hygienist licensed by the OSDB in good standing OR (1f) Be a dental hygienist who has graduated from an accredited dental hygiene program and does not have a dental hygiene license under suspension or revocation by the OSDB, AND (2) Complete an EFDA training course that is accredited by either the Commission on Dental Accreditation (CODA) or the Higher Learning Commission, AND (3) Pass the EFDA exam administered by the Commission on Dental Testing in Ohio (CODT) or the Commission on Dental Competency Assessments (CDCA), AND (4) Complete a basic life support (BLS) training course certified by the American Red Cross, American Heart Association or American Safety and Health Institute, AND (5) Apply to the Ohio State Dental Board for registration as.an EFDA. Coronal Polishing: In order to receive a certificate from the Ohio State Dental Board permitting a current Certified Assistant to perform coronal polishing procedures, a Certified Assistant** must (1) Successfully complete an OSDB-approved training program AND (2) Successfully pass standardized testing immediately following successful completion of a skills assessment component of an approved training program or pass DANB's Coronal Polishing exam AND (3) Apply to the Ohio State Dental Board for certification to perform coronal polishing. **Please note: Holders of the Ohio coronal polishing certificate must maintain DANB CDA certification or Certified Ohio Dental Assistant certification through OCDAC to perform coronal polishing.

Pit and Fissure Sealants: A Certified Assistant may perform pit and fissure sealants upon successfully completing a course containing a minimum of two hours of didactic instruction and six hours of clinical instruction. In addition, the supervising dentist must observe the assistant successfully apply at least six sealants. Perform specified functions when the supervising dentist is not physically present (for not more than 15 consecutive business days): A Certified Assistant or EFDA, may perform specified functions when the supervising dentist is not physically present at the location where the services are provided if the following conditions are met: (1) The Certified Assistant or EFDA has at least 1 year/1,500 hours dental assisting or EFDA experience, AND (2) The Certified Assistant or EFDA successfully completes a board-approved course in identification and prevention of potential medical emergencies, AND (3) The supervising dentist has evaluated the skills of the Certified Assistant or EFDA and made a determination that the Certified Assistant or EFDA is competent to treat patients without the dentist being physically present, AND (4) The supervising dentist examined the patient not more than one year prior to the date that the Certified Assistant or EFDA provides the services to the patient, AND (5) The supervising dentist has established written protocols or written standing orders for the Certified Assistant or EFDA to follow during and in the absence of an emergency, AND (6) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date that the Certified 388

State Requirements For Expanded Functions - continued Assistant or EFDA provides services to the patient, and the supervising dentist determines that the patient is in a medically stable condition, AND (7) The patient is notified, in advance of the appointment for services, that the supervising dentist will be absent from the location and that the Certified Assistant or EFDA cannot diagnose the patient's dental health care status, AND (8) The Certified Assistant or EFDA is employed by, or under contract with, the supervising dentist, a licensed Ohio dentist who meets one of the criteria specified in division (C)(11)(b) of section 4715.22 of the Revised Code, or a government entity that employs the Certified Assistant or EFDA to provide services in a public school or in connection with other programs the government entity administers. For a list of the specified functions for Certified Assistants, see Ohio Revised Code 4715.39(D) and (E) and Ohio Administrative Code 4715-11-03.2 on the pages that follow; for a list of specified functions for EFDAs, see Ohio Revised Code 4715.64(A) and (C) and Ohio Administrative Code 4715-11-04.4 on the pages that follow. An EFDA, a dental assistant holding CDA certification from DANB, or a dental assistant certified by OCDAC who meets all other requirements and conditions may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis if the certified assistant or EFDA is providing the service as part of a program operated through any of the following: a school district board of education or the governing board of an educational service center; the board of health of a city or general health district or the authority having the duties of a board of health; a national, state, district, or local dental association; or any other public or private entity recognized by the state dental board. The supervising dentist for the program must be employed by or a volunteer for, and the patients must be referred by, the entity through which the program is operated and must be available for consultation by telephone, videoconferencing, or other means of electronic communication. The application of sealants must be limited to erupted permanent posterior teeth without suspicion of dentinal cavitation and, for minor patients, a parent or other person responsible for the patient must be notified that a dentist will not be present and that the dental assistant is not trained to diagnose or treat other serious dental concerns that could exist. An (EFDA) may perform specified functions when the supervising dentist is not physically present, by authorization of a dentist working under a teledentistry permit, if the conditions outlined in Sec. 4715.431 of the Ohio Revised Code are met. For details, see Sec. 4715.431 beginning on page 391. Monitor Nitrous Oxide-oxygen (N2O-O2) Minimal Sedation: Basic qualified personnel (BQP) may monitor nitrous oxideoxygen (N2O-O2) minimal sedation if they are at least 18 years of age AND have completed a basic life-support training course and remain current at all times when monitoring N2O-O2 AND have successfully completed a six-hour course in N2O-O2 monitoring (unless exempt due to prior education or existing credential) AND have at least two years of active practice and at least 3,000 hours of experience in the practice of dental assisting. NOTE: All dental health care workers in Ohio must show evidence of immunity to or immunization against the hepatitis B virus, unless a waiver has been granted.

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act â&#x20AC;&#x201C; Ohio State Dental Board OHIO REVISED CODE Sec. 4715.22. Supervision of licensed dentist. (C) A dental hygienist may provide, for not more than fifteen consecutive business days, dental hygiene services to a patient when the supervising dentist is not physically present at the location at which where the services are provided if all of the following requirements are met: (10) The dental hygienist is employed by, or under contract with, one of the following: (a) The supervising dentist; (b) A dentist licensed under this chapter who is one of the following: (i) The employer of the supervising dentist; (ii) A shareholder in a professional association formed under Chapter 1785. of the Revised Code of which the supervising dentist is a shareholder; (iii) A member or manager of a limited liability company formed under Chapter 1705. of the Revised Code of which the supervising dentist is a member or manager; (iv) A shareholder in a corporation formed under division (B) of section 1701.03 of the Revised Code of which the supervising dentist is a shareholder; (v) A partner or employee of a partnership or a limited liability partnership formed under Chapter 1775. or 1776. of the Revised Code of which the supervising dentist is a partner or employee. (c) A government entity that employs the dental hygienist to provide dental hygiene services in a public school or in connection with other programs the government entity administers. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

389

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants 4715.39 Permitted Duties. (A) The state dental board may define the duties that may be performed by dental assistants and other individuals designated by the board as qualified personnel. If defined, the duties shall be defined in rules adopted in accordance with Chapter 119 of the Revised Code. The rules may include training and practice standards for dental assistants and other qualified personnel. The standards may include examination and issuance of a certificate. If the board issues a certificate, the recipient shall display the certificate in a conspicuous location in any office in which the recipient is employed to perform the duties authorized by the certificate. (B) A dental assistant may polish the clinical crowns of teeth if all of the following requirements are met: (1) The dental assistantâ&#x20AC;&#x2122;s polishing activities are limited to the use of a rubber cup attached to a slow-speed rotary dental hand piece to remove soft deposits that build up over time on the crowns of teeth. (2) The polishing is performed only after a dentist has evaluated the patient and any calculus detected on the teeth to be polished has been removed by the dentist or dental hygienist. (3) The dentist supervising the assistant supervises not more than two dental assistants engaging in polishing activities at any given time. (4) The dental assistant is certified by the dental assisting national board or the Ohio commission on dental assistant certification. (5) The dental assistant receives a certificate from the board authorizing the assistant to engage in the polishing activities. The board shall issue the certificate only if the individual has successfully completed training in the polishing of clinical crowns through a program accredited by the commission on dental accreditation or equivalent training approved by the board. The training shall include courses in basic dental anatomy and infection control, followed by a course in coronal polishing that includes didactic, preclinical, and clinical training; any other training required by the board; and a skills assessment that includes successful completion of standardized testing. The board shall adopt rules pursuant to division (A) of this section establishing standards for approval of this training. (C) A dental assistant may apply pit and fissure sealants if all of the following requirements are met: (1) A dentist evaluates the patient and designates the teeth and surfaces that will benefit from the application of sealant on the day the application is to be performed. (2) The dental assistant is certified by the dental assisting national board or the Ohio commission on dental assistant certification. (3) The dental assistant has successfully completed a course in the application of sealants consisting of at least two hours of didactic instruction and six hours of clinical instruction through a program provided by an institution accredited by the American dental association commission on dental accreditation or a program provided by a sponsor of continuing education approved by the board. (4) The dentist supervising the assistant has observed the assistant successfully apply at least six sealants. (5) Except as provided in division (D) or (E) of this section, the dentist supervising the assistant checks and approves the application of all sealants placed by the assistant before the patient leaves the location where the sealant application procedure was performed. (D) (1) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification may provide, for not more than fifteen consecutive business days, all of the following services to a patient when the supervising dentist is not physically present at the location where the services are provided if the conditions specified in division (D)(2) of this section have been satisfied: (a) Recementation of temporary crowns or recementation of crowns with temporary cement; (b) Application of fluoride varnish; (c) Application of disclosing solutions; (d) Application of desensitizing agents, excluding silver diamine fluoride; (e) Caries susceptibility testing; (f) Instruction on oral hygiene home care, including the use of toothbrushes and dental floss. (2) The conditions that must be satisfied before a dental assistant may provide the services specified in division (D) (1) of this section are all of the following: (a) The dental assistant has at least one year and a minimum of one thousand five hundred hours of experience practicing as a dental assistant. (b) The dental assistant has successfully completed a course approved by the state dental board in the identification and prevention of potential medical emergencies. (c) The supervising dentist has evaluated the dental assistant's skills. (d) The supervising dentist has established written protocols or written standing orders for the dental assistant to follow during and in the absence of an emergency. (e) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date that the dental assistant provides services to the patient, and the supervising dentist determines that the patient is in a medically stable condition. (f) The patient is notified, in advance of the appointment for services, that the supervising dentist will be absent from the location and that the dental assistant cannot diagnose the patient's dental health care status. (g) The dental assistant is employed by, or under contract with, the supervising dentist, a dentist licensed under this chapter who meets one of the criteria specified in division (C)(10)(b) of section 4715.22 of the 390

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants Revised Code, or a government entity that employs the dental assistant to provide services in a public school or in connection with other programs the government entity administers. (3) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification may apply, for not more than fifteen business days, pit and fissure sealants when the supervising dentist is not physically present at the location where the sealants are to be applied if the dental assistant meets the requirements in divisions (C)(3) and (4) of this section and all of the conditions specified in division (D)(2) of this section have been satisfied. (E) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, and when a dentist is not physically present at the location where the service is provided, if all of the following are the case: (1) The dental assistant meets the requirements in divisions (C)(3) and (4) of this section. (2) The conditions specified in divisions (D)(2)(a), (b), (c), (d), (f), and (g) of this section have been satisfied. (3) The dental assistant is providing the service as part of a program operated through any of the following: a school district board of education or the governing board of an educational service center; the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code; a national, state, district, or local dental association; or any other public or private entity recognized by the state dental board. (4) A supervising dentist for the program described in division (E)(3) of this section meets both of the following conditions: (a) Is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated; (b) Is available for consultation by telephone, videoconferencing, or other means of electronic communication. (5) The application of pit and fissure sealants is limited to erupted permanent posterior teeth without suspicion of dentinal cavitation. (6) If the patient is a minor, a parent, guardian, or other person responsible for the patient has been notified that a dentist will not be present at the location and that the dental assistant is not trained to diagnose or treat other serious dental concerns that could exist. (F) Subject to this section and the applicable rules of the board, licensed dentists may assign to dental assistants and other qualified personnel dental procedures that do not require the professional competence or skill of the licensed dentist or dental hygienist, or an expanded function dental auxiliary as this section or the board by rule authorizes dental assistants and other qualified personnel to perform. Except as provided in division (D) or (E) of this section, the performance of dental procedures by dental assistants and other qualified personnel shall be under direct supervision and full responsibility of the licensed dentist. (G) Nothing in this section shall be construed by rule of the state dental board or otherwise to do the following: (1) Authorize dental assistants or other qualified personnel to engage in the practice of dental hygiene as defined by sections 4715.22 and 4715.23 of the Revised Code or to perform the duties of a dental hygienist, including the removal of calcareous deposits, dental cement, or accretions on the crowns and roots of teeth other than as authorized pursuant to this section; (2) Authorize dental assistants or other qualified personnel to engage in the practice of an expanded function dental auxiliary as specified in section 4715.64 of the Revised Code or to perform the duties of the expanded function dental auxiliary other than as authorized pursuant to this section. (3) Authorize the assignment of any of the following: (a) Diagnosis; (b) Treatment planning and prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic, or orthodontic appliances; (c) Surgical procedures on hard or soft tissue of the oral cavity, or any other intraoral procedure that contributes to or results in an irremediable alteration of the oral anatomy; (d) The making of final impressions from which casts are made to construct any dental restoration. (H) No dentist shall assign any dental assistant or other individual acting in the capacity of qualified personnel to perform any dental procedure that the assistant or other individual is not authorized by board rule to perform. No dental assistant or other individual acting in the capacity of qualified personnel shall perform any dental procedure other than in accordance with board rule or any dental procedure that the assistant or other individual is not authorized by board rule to perform. Sec. 4715.431. (A) If all of the conditions in division (B) of this section are met, an authorizing dentist may do either of the following under a teledentistry permit without examining a patient in person: (1) Authorize a dental hygienist or expanded function dental auxiliary to perform services as set forth in division (E) or (F) of this section, as applicable, at a location where no dentist is physically present; (2) Prescribe a drug that is not a controlled substance for a patient who is at a location where no dentist is physically present . ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

391

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (B) The conditions that must be met under division (A) of this section are the following: (1) The authorizing dentist must prepare a written authorization that includes all of the following: (a) The authorizing dentist's name and permit number; (b) The name of the dental hygienist or expanded function dental auxiliary; (c) The patient's name; (d) The name and address of the location where the services are to be provided; (e) The date of the authorization; (f) A statement signed by the dental hygienist or expanded function dental auxiliary agreeing to comply with the written protocols or written standing orders the authorizing dentist establishes , including those for dealing with emergencies; (g) Any other information the dentist considers appropriate . (2) Before any dental services are provided all of the following must occur: (a) The patient is notified that an authorizing dentist will perform a clinical evaluation through teledentistry. (b) The patient is given an explanation of alternatives to, and the capabilities and limitations of, teledentistry. (c) (i) Subject to division (B)(2)(c)(ii) of this section, the patient consents to the provision of services through teledentistry and the consent is documented in the patient's record . (ii) If the services to be provided are the placement of interim therapeutic restorations or the application of silver diamine fluoride, the requirements for informed consent in rules adopted under division (C) of section 4715.436 of the Revised Code have been met . (3) The authorizing dentist establishes the patient's identity and physical location through synchronous, real-time communication . (4) The authorizing dentist provides dental services through teledentistry only as is appropriate for the patient and in accordance with appropriate standards of care. (5) The authorizing dentist establishes a diagnosis and treatment plan and documents it in the patient's record. (6) The authorizing dentist specifies the services the dental hygienist or expanded function dental auxiliary is authorized to provide to the patient. (7) The dental hygienist or expanded function dental auxiliary is employed by, or under contract with, one of the following: (a) The authorizing dentist; (b) A dentist who is any of the following: (i) The authorizing dentist's employer; (ii) A shareholder in a professional association formed under Chapter 1785. of the Revised Code of which the authorizing dentist is a shareholder; (iii) A member or manager of a limited liability company formed under Chapter 1705. of the Revised Code of which the authorizing dentist is a member or manager; (iv) A shareholder in a corporation formed under division (B) of section 1701.03 of the Revised Code of which the authorizing dentist is a shareholder; (v) A partner or employee of a partnership, formed under Chapter 1775. of the Revised Code, of which the authorizing dentist is a partner or employee; (vi) A partner or employee of a limited liability partnership, formed under Chapter 1775. of the Revised Code, of which the authorizing dentist is a partner or employee. (C) A dentist retains responsibility for ensuring the safety and quality of services provided to patients through teledentistry. Services delivered through teledentistry must be consistent with in person services. Persons involved with providing services through teledentistry must abide by laws addressing the privacy and security of the patient's dental and medical information . (D) An authorizing dentist may not have more than a total of three dental hygienists and expanded dental function auxiliaries working under the dentist's authorization pursuant to this section at any time. (E) (1) If authorized to do so by an authorizing dentist in accordance with this section, a dental hygienist may provide dental hygiene services at a location where no dentist is physically present if all of the following requirements are met: (a) The dental hygienist has at least one year and a minimum of one thousand five hundred hours of experience in the practice of dental hygiene . (b) The dental hygienist has completed a course described in division (C)(2) of section 4715.22 of the Revised Code on the identification and prevention of potential medical emergencies. (c) The authorizing dentist has evaluated the dental hygienist's skills . (d) The dental hygienist complies with written protocols or written standing orders established by the authorizing dentist, including written protocols established for emergencies . (2) If authorized to do so by an authorizing dentist in accordance with this section, a dental hygienist may place interim therapeutic restorations when a dentist is not physically present at the location where the dental hygienist is practicing if the requirements of division (E)(1) of this section are met and the dental hygienist has successfully completed a state dental board-approved course in the proper placement of interim therapeutic restorations. (3) If authorized to do so by an authorizing dentist in accordance with this section, a dental hygienist may apply silver diamine fluoride when a dentist is not physically present at the location where the dental hygienist is 392

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants

(F) (1)

(2)

(3)

(4)

practicing if the requirements of division (E)(1) of this section are met and the dental hygienist has successfully completed a state dental board-approved course in the application of silver diamine fluoride . If authorized to do so by an authorizing dentist in accordance with this section, an expanded function dental auxiliary may provide the services listed in divisions (A)(2) to (10) of section 4715.64 of the Revised Code, and any additional procedures authorized pursuant to division (A)(11) of that section, when a dentist is not physically present at the location where the expanded function dental auxiliary is practicing if all of the following requirements are met: (a) The expanded function dental auxiliary has at least one year and a minimum of one thousand five hundred hours of experience practicing as an expanded function dental auxiliary. (b) The expanded function dental auxiliary has completed a course described in division (C)(2) of section 4715.64 of the Revised Code on the identification and prevention of potential medical emergencies. (c) The authorizing dentist has evaluated the expanded function dental auxiliary's skills. (d) The expanded function dental auxiliary complies with written protocols or written standing orders established by the authorizing dentist, including written protocols for emergencies . If authorized to do so by an authorizing dentist in accordance with this section, an expanded function dental auxiliary who meets the requirements of division (F)(1) of this section and has successfully completed a state dental board- approved course in the proper placement of interim therapeutic restorations may place interim therapeutic restorations when a dentist is not physically present at the location where the expanded function dental auxiliary is practicing. If authorized to do so by an authorizing dentist in accordance with this section, an expanded function dental auxiliary who meets the requirements of division (F)(1) of this section and has successfully completed a state dental board- approved course in the application of silver diamine fluoride may apply silver diamine fluoride when a dentist is not physically present at the location where the expanded function dental auxiliary is practicing. If authorized to do so by an authorizing dentist in accordance with this section, an expanded function dental auxiliary who meets the requirements of division (F)(1) of this section and holds a current, valid dental x-ray machine operator certificate issued by the board pursuant to section 4715.53 of the Revised Code may perform, for the purpose of contributing to the provision of dental care to a dental patient, standard, diagnostic radiologic procedures when a dentist is not physically present at the location where the expanded function dental auxiliary is practicing

Sec. 4715.432. A teledentistry permit issued under section 4715.43 of the Revised Code expires on the thirty-first day of December of the first odd-numbered year occurring after the permit's issuance. A dentist who desires to renew a permit shall apply, under oath, to the state dental board on a form prescribed by the board and pay a renewal fee of twenty dollars. The board shall renew a teledentistry permit for a two- year period if the dentist is in good standing with the board and meets all of the following conditions: (A) Submits a complete application; (B) Pays the renewal fee; (C) Verifies with the board the locations where dental hygienists and expanded function dental auxiliaries have provided services pursuant to the dentist's authorization since the teledentistry permit was most recently issued or renewed. Sec. 4715.433 . The state dental board may, in accordance with Chapter 119. of the Revised Code, suspend or revoke a permit issued under section 4715.43 of the Revised Code if the permit holder fails to comply with sections 4715.431 to 4715.437 of the Revised Code, including any rules adopted by the board under section 4715.346 of the Revised Code. Sec. 4715.434. At the request of the state dental board, an authorizing dentist, or a dental hygienist or expanded function dental auxiliary who has been authorized to perform services in accordance with section 4715.431 of the Revised Code, shall make available to the board a list of all locations where the dental hygienist or expanded function dental auxiliary provided services, the locations where the hygienist or auxiliary is expected to provide services in the future, or both, as specified in the board's request. Sec. 4715.435 (A) No person shall provide services under section 4715.431 of the Revised Code unless one of the following applies: (1) The person is a dentist who holds a current, valid teledentistry permit issued under section 4715.43 of the Revised Code . (2) The person is providing services in accordance with section 4715.431 of the Revised Code and is either a dental hygienist or an expanded function dental auxiliary. (B) No person shall authorize a dental hygienist or expanded function dental auxiliary to provide services under section 4715.431 of the Revised Code unless the person is a dentist who holds a current, valid teledentistry permit issued under section 4715.43 of the Revised Code and the dental hygienist or expanded function dental hygienist will provide the services in accordance with division (E) or (F) of section 4715.431 of the Revised Code, as appropriate. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

393

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (C) No authorizing dentist shall authorize a dental hygienist or expanded function dental auxiliary to diagnose a patient's oral health care status. No dental hygienist or expanded function dental auxiliary shall diagnose a patient's oral health care status as part of services provided under section 4715.431 of the Revised Code 4715.51 Dental x-ray machine operator definitions. As used in sections 4715.52 to 4715.57 of the Revised Code, “dental x-ray machine operator” means an individual who, under the direct supervision of a dentist, performs standard, diagnostic, radiologic procedures for the purpose of contributing to the provision of dental care to a dental patient. As used in this section, “standard, diagnostic, radiologic procedures” means those procedures involved in using dental equipment that emits ionizing radiation, as defined in section 4773.01 of the Revised Code. 4715.52 Unlicensed practice (A) Except as provided in division (B) of this section, no person shall practice or hold that person out as a dental x-ray machine operator without a valid certificate issued under section 4715.53 of the Revised Code. (B) Division (A) of this section does not apply to any of the following: (1) Dentists or dental hygienists licensed under this chapter; (2) As specified in 42 C.F.R. 75, radiologic personnel employed by the federal government or serving in a branch of the armed forces of the United States; (3) Students engaging in any of the activities performed by dental x-ray machine operators as an integral part of a program of study leading to receipt of a license or certificate issued under this chapter, a license issued under Chapter 4734. or Chapter 4773. of the Revised Code, or a certificate issued under Chapter 4731 of the Revised Code. 4715.53 License qualifications. (A) Each individual seeking a certificate to practice as a dental x-ray machine operator shall apply to the state dental board on a form the board shall prescribe and provide. The application shall be accompanied an application fee of thirty-two dollars. (B) The board shall review all applications received and issue a dental x-ray machine operator certificate to each applicant who submits evidence satisfactory to the board of one of the following: (1) The applicant holds certification from the dental assisting national board or the Ohio commission on dental assistant certification. (2) The applicant holds a license, certificate, permit, registration, or other credential issued by another state that the board determines uses standards for dental x-ray machine operators that are at least equal to those established under this chapter. (3) The applicant has successfully completed an educational program consisting of at least seven hours of instruction in dental x-ray machine operation that meets either of the following requirements: (a) Has been approved by the board in accordance with section 4715.57 of the Revised Code; (b) Is conducted by an institution accredited by the American dental association commission on dental accreditation. (C) A certificate issued under this section expires two years after it is issued and may be renewed if the certificate holder does both of the following: (1) Certifies to the board that the certificate holder has completed at least two hours of instruction in dental x-ray machine operation approved by the board in accordance with section 4715.57 of the Revised Code during the two-year period preceding the date the renewal application is received by the Board. (2) Submits a renewal fee of thirty-two dollars to the board. Renewals shall be made in accordance with the standard renewal procedure established under Chapter 4745. of the Revised Code. 4715.56 Dentist supervision of radiologic procedures. (A) Except as provided in division (B) of his section, a dental x-ray machine operator may perform radiologic procedures only if a dentist is providing direct supervision. Direct supervision does not require the dentist to observe each radiologic procedure performed by the operator, but does require that he be present at the location where the operator is performing radiologic procedures for purposes of consulting with and directing the operator while performing the procedures. (B) A dental x-ray machine operator may perform radiologic procedures for a patient when the supervising dentist is not physically present at the location where the radiologic procedures are performed if either of the following applies: (1) The supervising dentist examined the patient not more than one year prior to the date the dental x-ray machine operator performs the radiologic procedures and the supervising dentist has ordered the radiologic procedures. (2) The radiologic procedures are performed in accordance with section 4715.431 of the Revised Code. 4715.57 Continuing education accreditation. (A) Each person seeking approval for an educational program in dental x-ray machine operation shall apply to the state dental board on a form the board shall prescribe and provide. The application shall be accompanied by the fee established in rules adopted under division (C) of this section. 394

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (B) The board shall approve educational programs that meet the standards established in rules adopted under division (C) of this section. The approval shall be valid until surrendered by the program or suspended or revoked by the board. A programâ&#x20AC;&#x2122;s approval may be suspended or revoked if the program does not comply with applicable requirements of this chapter or rules adopted under it. (C) The board shall adopt rules to implement and administer this section. The rules shall be adopted in accordance with Chapter 119. of the Revised Code and shall be no less stringent than any applicable standards specified in 42 C.F.R.75. The rules shall do at least both of the following: (1) Establish the fee that must accompany each application for approval of an educational program; (2) Establish standards that an educational program must meet to be approved by the board. 4715.61 Registration as expanded function dental auxiliary required. (A) Except as provided in division (B) of this section, no person shall practice as an expanded function dental auxiliary without being registered under this chapter as an expanded function dental auxiliary. (B) Division (A) of this section does not apply to any of the following: (1) A dentist licensed under this chapter; (2) A dental student who engages in any activities performed by expanded function dental auxiliaries as an integral part of a program of study leading to the receipt of a license to practice as a dentist under this chapter; (3) An expanded function dental auxiliary student when the student participates in an educational or training activity of an accredited educational institution or a training program that does both of the following: (a) Provides the education or training necessary to practice as an expanded function dental auxiliary; (b) Ensures that a dentist licensed under this chapter, or a dentist who holds a limited teaching license issued under this chapter, is physically present in the facility where the expanded function dental auxiliary performs clinical dental procedures on patients. 4715.62 Application to register as expanded function dental auxiliary. (A) Each individual seeking to register with the state dental board as an expanded function dental auxiliary shall file with the secretary of the board a written application for registration, under oath, on a form the board shall prescribe and provide. An applicant shall include with the completed application all of the following: (1) An application fee of twenty-five dollars; (2) Proof satisfactory to the board that the applicant has successfully completed, at an educational institution accredited by the commission on dental accreditation of the American dental association or the higher learning commission of the north central association of colleges and schools, the education or training specified by the board in rules adopted under section 4715.66 of the Revised Code as the education or training that is necessary to obtain registration under this chapter to practice as an expanded function dental auxiliary, as evidenced by a diploma or other certificate of graduation or completion that has been signed by an appropriate official of the accredited institution that provided education or training; (3) Proof satisfactory to the board that the applicant has passed an examination that meets the standards established by the board in rules adopted under section 4715.66 of the Revised Code to be accepted by the board as an examination of competency to practice as an expanded function dental auxiliary; (4) Proof that the applicant holds current certification to perform basic life-support procedures, evidenced by documentation showing the successful completion of a basic life-support training course certified by the American red cross, the American heart association, or the American safety and health institute. (B) If an applicant complies with division (A) of this section, the board shall register the applicant as an expanded function dental auxiliary. 4715.63 Expiration and renewal of expanded function dental auxiliary registration. (A) Registration under section 4715.62 of the Revised Code expires on the thirty-first day of December of the year following the year in which the registration occurs. An individual may renew a registration for subsequent two-year periods by submitting both of the following to the secretary of the state dental board each time the individual seeks to renew a registration: (1) A completed application for renewal, under oath, on a form the board shall prescribe and provide; (2) A renewal fee of twenty-five dollars; (B) If an individual complies with division (A) of this section and is not in violation of any section of this chapter or rule adopted under it, the board shall renew the individualâ&#x20AC;&#x2122;s registration for a two-year period that expires on the thirty-first day of December of the year following the year in which the registration was renewed. (C) Registration renewals shall be made in accordance with the standard renewal procedure established under Chapter 4745. of the Revised Code. 4715.64 Practice as expanded function dental auxiliary. (A) Subject to divisions (B), (C), and (D) of this section and section 4715.431 of the Revised Code, the practice of an expanded function dental auxiliary shall consist of the following; (1) Procedures involved in the placement of restorative materials limited to amalgam restorative materials and nonmetallic restorative materials, including direct-bonded restorative materials; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

395

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants

(B)

(C)

(D)

(E)

396

(2) Application of pit and fissure sealants; (3) Recementation of temporary crowns or recementation of crowns with temporary cement; (4) Application of topical fluoride; (5) Application of fluoride varnish; (6) Application of disclosing solutions; (7) Except as provided in division (A)(10) of this section, application of desensitizing agents; (8) Caries susceptibility testing; (9) Instruction on oral hygiene home care, including the use of toothbrushes and dental floss; (10) Application of silver diamine fluoride, but only when the expanded function dental auxiliary's supervising dentist has examined the patient and diagnosed the need for such treatment and the expanded function dental auxiliary has completed a course approved in accordance with rules adopted under division (B) of section 4715.436 of the Revised Code; (11) Any additional procedures authorized by the state dental board in rules adopted under section 4715.66 of the Revised Code. An expanded function dental auxiliary shall perform the services specified in (A)(1) and (11) of this section only under the supervision, order, control, and full responsibility of a dentist licensed under this chapter. At no time shall more than two expanded function dental auxiliaries be practicing as expanded function dental auxiliaries under the supervision of the same dentist. Except as provided in divisions (C) and (D) and section 4715.431 of the Revised Code, an expanded function dental auxiliary shall not practice as an expanded function dental auxiliary when the supervising dentist is not physically present at the location where the expanded function dental auxiliary is practicing. An expanded function dental auxiliary may perform, for not more than fifteen consecutive business days, application of pit and fissure sealants when the supervising dentist is not physically present at the location where the expanded function dental auxiliary is practicing if all of the following conditions have been satisfied: (1) The expanded function dental auxiliary has at least one year and a minimum of one thousand five hundred hours of experience practicing as an expanded function dental auxiliary or dental assistant. (2) The expanded function dental auxiliary has successfully completed a course approved by the board in the identification and prevention of potential medical emergencies. (3) The supervising dentist has evaluated the expanded function dental auxiliary's skills. (4) The supervising dentist has established written protocols or written standing orders for the expanded function dental auxiliary to follow during and in the absence of an emergency. (5) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date that the expanded function dental auxiliary provides services to the patient, and the supervising dentist determines that the patient is in a medically stable condition. (6) In advance of the appointment for services, the patient is notified that the supervising dentist will be absent from the location and that the expanded function dental auxiliary cannot diagnose the patient's dental health care status. (7) The expanded function dental auxiliary is employed by, or under contract with, the supervising dentist, a dentist licensed under this chapter who meets one of the criteria specified in division (C)(10)(b) of section 4715.22 of the Revised Code, or a government entity that employs the expanded function dental auxiliary to provide services in a public school or in connection with other programs the government entity administers. An expanded function dental auxiliary may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, and when a dentist is not physically present at the location where the service is provided, if all of the following are the case: (1) The conditions specified in divisions (C)(1), (2), (3), (4), (6), and (7) of this section have been satisfied. (2) The expanded function dental auxiliary is providing the service as part of a program operated through any of the following: a school district board of education or the governing board of an educational service center; the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code; a national, state, district, or local dental association; or any other public or private entity recognized by the state dental board. (3) A supervising dentist for the program described in division (D)(2) of this section meets both of the following conditions: (a) Is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated; (b) Is available for consultation by telephone, videoconferencing, or other means of electronic communication. (4) The application of pit and fissure sealants is limited to erupted permanent posterior teeth without suspicion of cavitation. (5) If the patient is a minor, a parent, guardian, or other person responsible for the patient has been notified that a dentist will not be present at the location and that the expanded function dental auxiliary is not trained to diagnose or treat other serious dental concerns that could exist. An expanded function dental auxiliary may perform the services specified in division (A)(3) to (9) of this section when the supervising dentist is not physically present at the location where the services are provided, regardless of whether the dentist has examined the patient, if the expanded function dental auxiliary is employed by, or under contract with, the supervising dentist, a dentist licensed under this chapter who meets one of the criteria specified in division (C)(10) ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (b) of section 4715.22 of the Revised Code, or a government entity that employs the expanded function dental auxiliary to provide services in a public school or in connection with other programs the government entity administers. (F) Nothing in this section shall be construed by rule of the board or otherwise to authorize an expanded function dental auxiliary to engage in the practice of dental hygiene as defined by sections 4715.22 and 4715.23 of the Revised Code. 4715.65 Record of expanded dental auxiliary registrants. The secretary of the state dental board shall keep record of all persons registered under this chapter as expanded function dental auxiliaries. For each expanded function dental auxiliary, the record shall identify the location where the person primarily practices and the person’s one or more supervising dentists. 4715.66 Rules governing expanded function dental auxiliaries. (A) The state dental board shall adopt rules as the board considers necessary to implement and administer sections 4715.61 to 4715.64 of the Revised Code. The rules shall be adopted in accordance with Chapter 119. of the Revised Code. (B) In adopting rules under this section, all of the following apply: (1) The board shall adopt rules specifying the education or training necessary for an individual to register as an expanded function dental auxiliary under this chapter. (2) The board shall adopt rules specifying the standards that must be met for an examination to be accepted by the board as an examination of competency to practice as an expanded function dental auxiliary. In specifying the standards, the board shall provide that an examination will be accepted only if the entity that administered the examination required an individual to be one of the following as a condition of admission to the examination: (a) An unlicensed dentist who has graduated from an accredited dental college, as specified in section 4715.10 of the Revised Code, and does not have a dental license under suspension or revocation by the board; (b) A dental student who is enrolled in an accredited dental college, as specified in section 4715.10 of the Revised Code, and is considered by the dean of the college to be in good standing as a dental student; (c) A graduate of a dental college located outside of the United States; (d) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification; (e) A dental hygienist licensed under this chapter whose license is in good standing; (f) An unlicensed dental hygienist who has graduated from an accredited dental hygiene school, as specified in section 4715.21 of the Revised Code, and does not have a dental hygienist license under suspension or revocation by the board. (3) The board may adopt rules specifying procedures an expanded function dental auxiliary may perform that are in addition to the procedures specified in divisions (A)(1) and (10) of section 4715.64 of the Revised Code. OHIO ADMINISTRATIVE CODE 4715-3-01 Definitions. (B) Anesthesia/sedation terms (1) "Administration" - providing, applying, or injecting a drug or other therapeutic agent for a patient of record, including providing a patient with a single dose of a controlled substance or other dangerous drug that is to be used incidental to, or contemporaneously with, a planned procedure, with the intent of being an integral and indicated action to properly initiate and complete the dental procedure within the standard of care in dentistry. (2) “Analgesia” - the diminution or elimination of pain. (3) “Anxiolysis” - the diminution or elimination of anxiety. (4) “Enteral/oral conscious sedation” - The use of a single drug administered orally or sublingually at one time on a given treatment day, or combination of drugs administered concomitantly orally or sublingually at one time on a given treatment day, in order to provide sedation or anxiolysis for dentistry. If the dosage is determined to be inadequate and an increased dosage is required to sufficiently provide sedation or anxiolysis, the practitioner must reschedule the patient for a subsequent appointment on a different day. All enteral/oral sedatives shall be administered at the same time and only once during any given treatment day unless the administering dentist is permitted to provide intravenous conscious sedation or general anesthesia. (5) “Combination inhalation-enteral conscious sedation (combined conscious sedation)” - conscious sedation using enteral agents, as indicated in paragraph (B)(3) of rule 4715-3-01 of the Administrative Code, and nitrous oxide/ oxygen inhalation sedation. Nitrous oxide/oxygen used in combination with sedative agents may produce conscious or deep sedation or general anesthesia. (6) “Conscious sedation” - a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, and that is produced by a pharmacologic or non-pharmacologic method, or a combination thereof. In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

397

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants enough to render unintended loss of consciousness unlikely. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of conscious sedation. (7) “Continual” - repeated regularly and frequently in a steady succession. (8) “Continuous” - prolonged without any interruption at any time. (9) “Deep sedation” - an induced state of depressed consciousness, accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to physical stimulation or verbal command, and is produced by a pharmacologic or non-pharmacologic method, or combination thereof. (10) “Enteral” - any technique of administration in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa [i.e., oral, rectal, sublingual]. (11) “General anesthesia” - an induced state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the inability to continually maintain an airway independently and respond purposefully to physical stimulation or verbal command, and is produced by a pharmacologic or non-pharmacologic method, or combination thereof. (12) “Immediately available” - on site in the facility and available for immediate use. (13) “Inhalation” - a technique of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. (14) “Local anesthesia” - the elimination of sensation, especially pain, in one part of the body by regional injection of a drug. (15) “Minimal sedation” - a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. (16) “Moderate sedation” - a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (17) "Parenteral" - a technique of administration in which the drug bypasses the gastrointestinal (GI) tract (i.e., intramuscular (IM, intravenous (IV, intranasal (IN), submucosal (SM), subcutaneous (SC), intraocular (IO)]. (18) "time-oriented anesthesia record" - documentation at appropriate intervals of drugs, doses and physiologic data obtained during patient monitoring. (19) "Topical anesthesia" - the elimination of sensation, especially pain, in one part of the body by skin or mucous membrane surface application of a drug. (20) "Transdermal/transmucosal" - a technique of administration in which the drug is administered by a patch or iontophoresis. (D) Dental personnel (7) “Certified assistant” - a dental assistant who maintains current certification by completion of the continuing education requirements upon successfully passing the "Certified Dental Assistant" (CDA) certification examination of the Dental assisting national board (DANB) or the certification examination of the Ohio commission on dental assistant certification (OCDAC). (8) “Basic qualified personnel” - basic qualified personnel are those persons who are adjudged by the licensed dentist to be capable and competent of performing basic remediable intra-oral and extra-oral dental tasks and/or procedures under his or her direct supervision and full responsibility. These persons must be trained directly via an employer-dentist, via a planned sequence of instruction in an educational institution or via in-office training. (9) “Advanced qualified personnel” (hereinafter referred to as expanded function dental auxiliaries or EFDA’s) those persons who have passed the Ohio state dental board designated examination for expanded function dental auxiliaries who may perform advanced remediable intra-oral dental tasks and/or procedures under the direct supervision and full responsibility of a licensed dentist. Upon submitting proof of successful completion of acceptable training on a form prescribed by the board and signed by the chief administrative officer of the program at the accredited institution, the following applicants shall be admitted to the state board designated examination for expanded function dental auxiliary: (a) “Unlicensed dentist” - a graduate of an accredited dental school unless his license is under suspension or revocation by the board. (b) “Dental student” - a dental student in good standing and currently enrolled in an accredited institution, upon recommendation from the dean. (c) “Graduates of unaccredited dental colleges located outside the United States” - a graduate of a dental school located outside the United States that is not accredited by the Commission on dental accreditation and after admission to an accredited educational institution or program. (d) “Certified assistant” - a certified assistant if he or she has satisfactorily completed training in advanced remediable intra-oral dental tasks and/or procedures through an accredited educational institution or program whose educational standards are recognized and/or accredited by the Commission on dental accreditation or the Higher learning commission (formerly known as the Higher learning commission of the 398

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants north central association of colleges and schools). The curriculum must include clinical experience. (e) “Licensed dental hygienist” - a graduate of an accredited dental hygiene program if she has satisfactorily completed training in advanced remediable intra-oral dental tasks and/or procedures through an accredited educational institution or program whose educational standards are recognized and/or accredited by the American dental association commission on dental accreditation, unless her license is under suspension or revocation. The curriculum must include clinical experience. (f) “Unlicensed dental hygienist” - a graduate of an accredited dental hygiene program if she has satisfactorily completed training in advanced remediable intra-oral dental tasks and/or procedures through an accredited educational institution or program whose educational standards are recognized and/or accredited by the Commission on dental accreditation or the Higher learning commission (formerly known as the Higher learning commission of the north central association of colleges and schools). The curriculum must include clinical experience. (10) “Dental auxiliaries” - dental auxiliaries are all persons, not licensed to practice dentistry in Ohio, who assist in the dental practice. (a) Subject to those more specific laws or rules regulating the functions of basic qualified personnel, expanded function dental auxiliaries and hygienists, a dental auxiliary may, under the personal supervision and full responsibility of a licensed dentist, assist in the concurrent performance of supportive procedures, and may assist with the administration of drugs, medications, and inhalation anesthetic agents, including nitrous oxide. (b) Further, parenteral injections for the administration of drugs, including local anesthetic agents may not be delegated to dental auxiliaries unless they are appropriately licensed in the state of Ohio. (11) “Dental health care workers” - dental health care workers are all personnel utilized by a licensed dentist who assist in a dental practice and who may be exposed to body fluids such as blood or saliva. (F) Educational terms (5) "Accredited dental assisting program" - a dental assisting program accredited by the Commission on dental accreditation. (P) Supervision (1) “Supervision” - acts are deemed to be under the supervision of a licensed dentist when performed in a dental facility wherein a licensed dentist is physically present at all times during the performance of such acts and such acts are performed pursuant to his or her order, control and full professional responsibility. Such acts shall be performed only after examination and diagnosis by said dentist and in accordance with said dentist’s treatment plan for the procedure to be performed by the licensed dental hygienist, certified assistant, expanded function dental auxiliary, and/or dental x-ray machine operator. This definition is subject to the exceptions noted in sections 4715.22, 4715.39, 4715.56, and 4715.64 of the Revised Code. (2) “Direct supervision” - acts are deemed to be under the direct supervision of a licensed dentist when performed in a dental facility wherein a licensed dentist is physically present at all times during the performance of such acts and such acts are performed pursuant to his order, control and full professional responsibility, and are checked and approved by the licensed dentist before the patient upon whom such act has been performed departs from the dental facility of said dentist. (3) “Personal supervision” - acts are deemed to be under the personal supervision of the licensed dentist when the dentist is personally operating on a patient and authorizes an auxiliary to aid treatment by concurrently performing supportive procedures. (4) “Under the direction of” - pursuant to division (A) of section 4715.16 of the Revised Code, acts are deemed to be under the direction of a licensed dentist when performed in a dental facility wherein a licensed dentist is physically present at all times during the performance of such acts and performed pursuant to his or her control and oversight. Acts are also deemed to be under the direction of a licensed dentist when performed in connection with residency programs approved by the Commission on dental accreditation and operated in accordance with the guidelines for the supervision of residents as set forth in the accreditation standards. (Q) Tasks and/or procedures categories (1) “Basic remediable intra-oral and extra-oral dental tasks and/or procedures” - those dental tasks and/or procedures which do not create irreparable changes within the oral cavity and/or the contiguous structures and which are set forth in rule 4715-11-01 of the Administrative Code. (2) “Advanced remediable intra-oral dental tasks and /or procedures” - all tasks and/or procedures involved in the art or placement of preventive or restorative materials limited to the following: (a) Placement of sealants; (b) Amalgam restorative materials; and (c) Non-metallic restorative materials, including direct-bonded restorative materials. (3) “Irremediable tasks and/or procedures” - irremediable tasks and/or procedures are those which, when performed, may create irreparable changes within the oral cavity or contiguous structures. Further, parenteral injections for the administration of drugs, including local anesthetic agents, are considered to be irremediable tasks under agency 4715 of the Administrative Code. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

399

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants 4715-11-01 Dentists may supervise dental auxiliaries, basic qualified personnel, certified assistants, expanded function dental auxiliary. (A) Dental auxiliaries (1) A licensed dentist may, in accordance with board rules, assign under the dentist's personal supervision and full responsibility, the concurrent performance of supportive procedures, to include assisting with the administration of drugs, medications, and inhalation anesthetic agents, including nitrous oxide-oxygen (N2O-O2) minimal sedation. (2) A licensed dentist shall not delegate parenteral injections for the administration of drugs, including local anesthetic agents, to dental auxiliaries unless they are appropriately licensed in the state of Ohio. (B) Basic qualified personnel (1) A licensed dentist may, in accordance with board rules, assign under the dentist's direct supervision and full responsibility, basic remediable intra-oral and extra-oral tasks and/or procedures to basic qualified personnel. (2) A licensed dentist may utilize, under his direct supervision and full responsibility, no more than one basic qualified personnel appropriately trained as set forth in paragraph (A)(40) of rule 4715-11-02 of the Administrative Code in the monitoring of N2O-O2 minimal sedation, at any given time. This restriction is independent of the limitation on the number of licensed dental hygienists appropriately trained as set forth in paragraph (A)(2) of rule 4715-9-01 of the Administrative Code who may be employed to perform the administration of N2O-O2 minimal sedation. (3) A licensed dentist may, in accordance with board rules, assign under the dentist's personal supervision and full responsibility, the concurrent performance of supportive procedures, to include assisting with the administration of drugs, medications, and inhalation anesthetic agents, including N2O-O2 minimal sedation to basic qualified personnel. (4) A licensed dentist must maintain in the office a record of the training received by dental assistants who wish to perform the monitoring of N2O-O2 minimal sedation as set forth in paragraph (A)(40) of rule 4715-11-02 of the Administrative Code. (C) Certified assistant (1) A licensed dentist may, in accordance with board rules, assign under the dentist's direct supervision and full responsibility, basic remediable intra-oral and extra-oral tasks and/or procedures to currently certified assistants. (2) A licensed dentist may utilize, under the dentist's direct supervision and full responsibility, no more than one certified assistant appropriately trained as set forth in paragraph (A)(40) of rule 4715-11-02 of the Administrative Code in the monitoring of N2O-O2 minimal sedation, at any given time. This restriction is independent of the limitation on the number of licensed dental hygienists appropriately trained as set forth in paragraph (A)(2) of rule 4715-901 of the Administrative Code who may be employed to perform the administration of N2O-O2 minimal sedation. (3) A licensed dentist may, in accordance with board rules, assign under the dentist's direct supervision and full responsibility, the following dental tasks and procedures in addition to those basic remediable intra-oral and extra-oral dental tasks and/or procedures defined in rule 4715-11-02 of the Administrative Code to appropriately trained certified assistants pursuant to rule 4715-11-03 of the Administrative Code: (a) Application of pit and fissure sealants; and (b) Coronal polishing activities. (4) A licensed dentist may utilize, under the dentist's direct supervision and full responsibility, no more than two certified assistants appropriately trained as set forth in rule 4715-11-03.1 of the administrative code to perform coronal polishing activities, at any given time. This restriction is independent of the limitation on the number of licensed dental hygienists who may be employed to perform the duties of a licensed dental hygienist as defined in sections 4715.22 and 4715.23 of the Revised Code. (5) A licensed dentist must maintain in the office a record of the training received by certified assistants who wish to perform the monitoring of N2O-O2 minimal sedation as set forth in paragraph (A)(38) of rule 4715-11-02 of the Administrative Code. (D) Expanded function dental auxiliary (1) A licensed dentist may, in accordance with board rules, assign under the dentist's direct supervision and full responsibility, basic remediable intra-oral and extra-oral tasks and/or procedures to currently registered expanded function dental auxiliary. (2) A licensed dentist may utilize, under the dentist's direct supervision and full responsibility, no more than one expanded function dental auxiliary appropriately trained as set forth in paragraph (A)(40) of rule 4715-11-02 of the Administrative Code in the monitoring of N2O-O2 minimal sedation, at any given time. This restriction is independent of the limitation on the number of licensed dental hygienists appropriately trained as set forth in paragraph (A)(2) of rule 4715-9-01 of the Administrative Code who may be employed to perform the administration of N2OO2 minimal sedation. (3) A licensed dentist may utilize, under the dentist's direct supervision, no more than two expanded function dental auxiliaries at any given time. This restriction is independent of the limitation on the number of licensed dental hygienists who may be employed to perform the duties of a licensed dental hygienist as defined in sections 4715.22 and 4715.23 of the Revised Code. (4) A licensed dentist may, in accordance with board rules, assign under the dentist's direct supervision and full responsibility the following dental tasks and/or procedures in addition to those basic remediable intra-oral and 400

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants extra-oral dental tasks and/or procedures defined in rule 4715-11-02 of the Administrative Code to registered expanded function dental auxiliaries: (a) Advanced remediable intra-oral and extra-oral tasks and/or procedures with consideration of the soft tissues involved in the art or placement of preventative or restorative materials limited to the following: (i) Application of pit and fissure sealants; (ii) Amalgam restorative materials; and (iii) Non-metallic restorative materials, including direct-bonded restorative materials. (5) A licensed dentist must maintain in the office a current record of the training received by expanded function dental auxiliaries who wish to perform the monitoring of N2O-O2 minimal sedation as set forth in paragraph (A) (40) of rule 4715-11-02 of the Administrative Code. 4715-11-02 Basic qualified personnel; functions. (A) Basic qualified personnel must be trained directly via an employer/dentist, via in-office training, and/or via a planned sequence of instruction in an educational institution. (B) Under the direct supervision of the licensed dentist, the basic qualified personnel may perform basic remediable intra-oral and extra-oral tasks and/or procedures including the following, but do not include any advanced remediable intra-oral tasks and/or procedures as defined in rule 4715-11-04 of the Administrative Code. (1) Aspiration and retraction. (2) Intra-oral instrument transfer. (3) Preliminary charting of missing and filled teeth. (4) Elastomeric impressions for diagnostic models and models to be used for opposing models in the construction of appliances and restorations. (5) Taking impressions for the construction of custom athletic mouth protectors/mouthguards, and trays for application of medicaments. (6) Application of disclosing solutions. (7) Caries susceptibility testing. (8) Periodontal susceptibility and detection (excluding procedures that enter the gingival sulcus: eg. periodontal probing paper points). (9) Demonstration of oral hygiene procedures, including, but not limited to, use of toothbrushes and dental floss. (10) Shade selection for fabrication of appliances or restorations. (11) Application of topical anesthetics. (12) Pulp testing. (13) Fluoride application. (14) Topical applications of desensitizing agents to teeth. (15) Application and removal of periodontal dressings. (16) Suture removal. (17) Placement of rubber dam over preplaced clamp, and removal of clamp and rubber dam. (18) Application of cavity varnish. (19) Impression, fabrication, cementation and removal of provisional restorations, not to include palliative or sedative restorations. (20) Retraction of the gingival tissue prior to the final impression which is performed by the licensed, supervising dentist. (21) Preliminary selection and sizing of stainless steel crowns. (22) Preliminary selection and sizing of orthodontic bands and arch wires. (23) Checking for and removal of loose orthodontic bands and loose brackets. (24) Intra-oral bite registrations for diagnostic model articulation, restorations, and appliances. (25) Irrigation and drying of canals during endodontic procedures. (26) Placement of medication in the pulp chamber(s) of teeth with non-vital pulp or instrumented root canals. (27) Placement and removal of surgical dressings. (28) Placement and removal of orthodontic arch wires, auxiliary arch wires, and ligation of same to orthodontic bands and/or brackets. (29) Placement and removal of orthodontic separators and ties. (30) Polymerization of light-activated restorative or bonding materials. (31) All supportive services necessary to the maintenance of a hygienic practice environment, including, but not limited to, all sterilizing procedures. (32) All supportive services or procedures necessary to protect the physical well-being of the patient during routine treatment procedures and during periods of emergencies, including, but not limited to: (a) Physical positioning of the patient; (b) Monitoring of vital signs; (c) Assistance during administration of life-support activities; and (d) Any other non-invasive procedures deemed necessary by the supervising dentist to maintain the health and safety of the patient. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

401

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (33) All non-invasive supportive services and procedures necessary to the gathering and maintaining of accurate and complete medical and dental history of the patient, including, but not limited to: (a) Taking photographs; (b) Recording patient treatment; (c) Measurement of blood pressure and body temperature; and (d) Other common tests deemed necessary by the supervising dentist. (34) All extra-oral supportive laboratory procedures, including, but not limited to: (a) Repair, construction and finishing of metallic and plastic prosthetic devices; and (b) Compilation of radiographic data for interpretation by the dentist, i.e., tracings, etc. (35) The preparation of materials, drugs and medications for use in dental procedures, including, but not limited to: (a) Palliative materials; (b) Impression materials; and (c) Restorative materials. (36) All patient education services, including, but not limited to: (a) Progress reports; (b) Consultations (oral or written); (c) Oral hygiene instructions; (d) Use of intra-oral hygiene devices: (e) Normal nutrition information as it relates to dental health; (f) Behavioral modification; (g) Self adjustment of orthodontic appliances; and (h) All other post-operative and post-insertion instructions, as deemed appropriate by the supervising dentist. (37) All non-invasive supportive services normally utilized in conjunction with the treatment by the dentist of fascia pain or TMJ syndrome. (38) Preparing the teeth for restorations or for the bonding of orthodontic brackets by treating the supragingival coronal surfaces of the teeth to be bonded with a conditioning or etching agent and by the placement of a bonding agent adhesive. (39) Impressions for removable or fixed orthodontic appliances. (40) Nitrous oxide-oxygen (N2O-O2) minimal sedation monitoring - A dental assistant may monitor N2O-O2 minimal sedation as defined in rule 4715-3-01 of the Administrative Code if all of the following requirements are met: (a) The dental assistant must be at least eighteen years of age. (b) The dental assistant has at least two years and three thousand hours of experience in the practice of dental assisting. (c) The dental assistant has completed a basic life-support training course certified by the American heart association, the American red cross, or the American safety and health institute, and remains current at all times when monitoring N2O-O2 minimal sedation. (d) The dental assistant has successfully completed a six-hour course in N2O-O2 minimal sedation monitoring as defined in rule 4715-11-02.1 of the Administrative Code. A certificate, documenting successful completion of the course, must be provided to the dental assistant by the permanent sponsor within ten days. This original certificate or a copy must be maintained in the office(s) wherein the dental assistant is employed. The course must be taken through a permanent sponsor. (e) Under no circumstances may the dental assistant administer, adjust, or terminate N2O-O2 minimal sedation. (f) The dental assistant shall not monitor more than one patient at a time. (g) The dental assistant shall physically remain with the patient at all times. (h) The supervising dentist approves discharge of the patient. (i) Nothing in this rule shall be construed to allow the dental assistant to administer N2O-O2 minimal sedation. 4715-11-02.1 Monitoring nitrous oxide-oxygen (N2O-O2) minimal sedation; education, training and examination required. Each dental auxiliary seeking to monitor nitrous oxide-oxygen (N2O-O2) minimal sedation in accordance with rule 471511-02 of the Administrative Code must have completed a basic life-support training course certified by the American heart association, the American red cross, or the American safety and health institute, and remain current at all times when monitoring N2O-O2 minimal sedation. In order to monitor N2O-O2 minimal sedation the dental auxiliary must have completed the requirements set forth in paragraphs (A) or (B) of this rule. (A) The dental auxiliary has successfully completed a six-hour course in N2O-O2 minimal sedation monitoring. The course must be taken through a permanent sponsor and shall, at a minimum, include the following: (1) The history, philosophy and psychology of N2O-O2 minimal sedation (2) Definition and descriptions of the physiological and psychological aspects of pain and anxiety (3) Concepts and management of pain and anxiety (4) Indications and contraindications for N2O-O2 minimal sedation (5) Anatomy and physiology of respiration (6) Medical assessment of the patient prior to administration of N2O-O2 minimal sedation (7) Moderate and deep sedation/general anesthesia versus minimal sedation 402

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (8) Pharmacological and physiological effects of nitrous oxide (9) A description of the stages of drug induced central nervous system depression through all levels of consciousness and unconsciousness with special emphasis on the distinction between the conscious and unconscious state (10) Monitoring of N2O-O2 minimal sedation (11) Management of complications and medical emergencies (12) Legal and ethical considerations (13) Occupational exposure (14) Successful completion of a written examination, provided by the board-approved permanent sponsor. (B) A dental auxiliary shall be exempt from the six-hour course and the examination requirements provided in paragraph (A) of this rule for either of the following: (1) The dental auxiliary holds a current license, certificate, permit, registration, or other credential issued by another state for the monitoring of N2O-O2 minimal sedation if the training received is substantially equivalent, as determined by the board, to the required hours, content and examination requirements of the course described in paragraph (A) of this rule. (2) The dental auxiliary was graduated on or after January 1, 2015 from a Commission on dental accreditation approved program and has completed the equivalent training within the curriculum. Completion of basic life-support and all education and examination requirements for the monitoring of N2O-O2 minimal sedation shall be documented on a form supplied by the board, with any necessary supporting information attached. This form shall be maintained in the facility(s) where the dental auxiliary is working. The board retains the right and authority, upon notification, to audit, monitor or request evidence demonstrating adherence to Chapter 4715 of the Revised Code and/or agency 4715 of the Administrative Code. 4715-11-03 Certified assistant; functions; education, training and supervision requirements. (A) A licensed dentist may assign to certified assistants under the dentist's direct supervision and full responsibility those basic remediable intra-oral dental tasks and/or procedures as defined in rule 4715-11-02 of the Administrative Code. (B) A licensed dentist may assign to currently certified assistants under the dentist's direct supervision and full responsibility the following dental tasks and/or procedures in addition to those basic remediable intra-oral dental tasks and/or procedures as defined in rule 4715-11-02 of the Administrative Code: (1) “Pit and fissure sealants” - The certified assistant may apply pit and fissure sealants if all the following requirements are met: (a) The dental assistant has successfully completed a course in the application of sealants consisting of at least two hours of didactic instruction and six hours of clinical instruction through a program provided by an institution accredited by the American dental association commission on dental accreditation or a program provided by a sponsor of continuing education approved by the board; and (b) The dentist evaluates the patient and designates the teeth and surfaces that will benefit from the application of sealant on the day the application is to be performed; and (c) The dentist supervising the assistant has observed the assistant successfully apply at least six sealants; and (d) The dentist supervising the assistant checks and approves the application of all sealants placed by the assistant before the patient leaves the location where the sealant application procedure is performed. (2) “Coronal polishing” - The certified assistant may perform polishing of the enamel and restorations on the anatomical crowns of human teeth by utilizing only a combination of a polishing agent, a slow speed hand piece, a prophy angle and a rubber cup, if all the following requirements are met: (a) The dental assistant receives a certificate from the board authorizing the assistant to engage in coronal polishing activities pursuant to completion of the education, training, assessment and examination requirements set forth in division (B) of section 4715.39 of the Revised Code and rule 4715-11-03.1 of the Administrative Code; and (b) The polishing is performed only after the supervising dentist has evaluated the patient and any calculus detected on the teeth to be polished has been removed by a dentist or dental hygienist; and (c) The dentist supervising the assistant supervises not more than two dental assistants engaging in polishing activities at any given time. Nothing in paragraph (B)(2) of this rule authorizes the mechanical removal of calculus or authorizes a certified assistant to perform a complete oral prophylaxis. 4715-11-03.1 Coronal polishing certification. Pursuant to section 4715.39 of the Revised Code and this rule, certified assistants shall receive certification to perform coronal polishing and may do so under the restrictions set forth in rule 4715-11-02 of the Administrative Code. (A) Qualifications - Within ninety days from receipt of successfully passing the standardized examination required pursuant to division (B)(5) of section 4715.39 of the Revised Code, an applicant to be considered for issuance of coronal polishing certification shall furnish satisfactory proof of all the following on a form prescribed and provided by the state dental board: (1) Be currently certified by the dental assisting national board or the Ohio commission on dental assistant certification; and © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

403

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants

(B)

(C)

(D) (E)

404

(2) Have successfully completed an approved training program as defined by division (B)(5) of section 4715.39 of the Revised Code and paragraph (B) of this rule; and (3) Have successfully passed standardized testing as required by division (B)(5) of section 4715.39 of the Revised Code and paragraph (C) of this rule immediately following successful completion of a skills assessment component of an approved training program. The board executive office shall issue a coronal polishing certificate to those certified assistants who have provided a completed application along with an application fee of fifteen dollars, the appropriate documentation of current certification and approved training program, and successful completion of standardized testing. Certified assistants who do not submit the application and appropriate documentation for a coronal polishing certificate within ninety days after successful completion of the standardized testing required pursuant to division (B)(5) of section 4715.39 of the Revised Code and paragraph (C) of this rule, must retake the training program in its entirety including, but not limited to, successful completion of standardized testing. Approved training program - Training in the polishing of the clinical crowns of teeth through an approved program accredited by the American dental association commission on dental accreditation or equivalent Board-approved training through a college or university accredited by the higher learning commission of the North central association of colleges and schools. The college or university must have a classroom and a (pre)clinical facility with the proper armamentarium and equipment to support the educational objectives. (1) The board-approved training program must include a minimum of seven hours of coursework of which three are didactic and four are (pre)clinical. The training shall include courses in: (a) Basic dental anatomy; and (b) Infection control; and (c) Coronal polishing which consists of didactic, preclinical, and clinical instruction; and (d) A clinical skills assessment that includes successful completion of a standardized examination. (2) The faculty who participate in a coronal polishing course shall be full or part-time. Faculty must be competent educators with educational methodology, professional training, and have experience in coronal polishing. The participating faculty must be associated with an educational institution who is accredited by the American dental association commission on dental accreditation. There shall be a supervising dentist or dental hygienist faculty present for all (pre)clinical portions of the course. This person will be responsible for the learning experiences. Only course faculty will be responsible for final evaluation of students. (3) This course shall include an evaluation component, mechanism, or procedure which assesses competence in coronal polishing. Minimal competency level shall be at seventy-five percent and must be demonstrated by the student prior to sitting for the standardized examination. The skills assessment must be on a clinical patient and disclosing solution must be utilized as an evaluation tool. (4) An applicant shall not be permitted to take the standardized examination until the instructor certifies that the applicant has successfully completed all components of the training program and that the applicant is deemed capable of safely performing coronal polishing. The board reserves the right to make an independent determination on the issue of completion. (5) The board retains the right and authority, upon notification, to audit, monitor, or request evidence demonstrating adherence to Chapter 4715. of the Revised Code for training programs approved by board action. The board may rescind approval status if the career college or school has disseminated any false or misleading information in connection with the training program, or if the career college or school has failed to conform to Chapter 4715. of the Revised Code or agency 4715 of the Administrative Code. Standardized testing - A board-approved examination to be administered by the dental assisting national board, the Ohio commission on dental assistant certification, or the educational institution in which the applicant has obtained successful completion of an approved training program. (1) The examination shall be conducted within sixty days after the conclusion of the training program and shall be governed in format, content and subject matter by the testing agency and/or educational institution. (2) The minimum passing score for the standardized testing is seventy-five percent. (3) An applicant must submit the examination fee established by the testing entity each time the applicant takes the examination. (4) An applicant who fails to successfully complete the examination after the third attempt must retake the training program. (5) An applicant must file a new application for each examination to be taken and submit a new examination fee as provided for in paragraph (C)(3) of this rule. The board shall issue a certificate to perform coronal polishing to currently certified assistants who, within one year immediately preceding the date of application, have completed the requirements set forth in paragraphs (A)(2) and (A)(3) of this rule. A certified assistant shall be exempt from the approved training program and standardized testing requirements provided in paragraphs (A)(2) and (A)(3) of this rule if the dental assistant holds a current license, certificate, or other credential issued by another state that the board determines uses standards that are at least equal to those established by agency 4715 of the Administrative Code. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants 4715-11-03.2 Certified assistant; practice when the dentist is not physically present. (A) Subject to the requirements set forth in paragraph (B) of this rule, the certified assistant may provide all of the following services to a patient when the supervising dentist is not physically present at the location where the services are provided: (1) Recementation of temporary crowns or recementation of crowns with temporary cement; (2) Application of fluoride varnish; (3) Application of disclosing solutions; (4) Application of desensitizing agents; (5) Caries susceptibility testing; (6) Instruction on oral hygiene home care, including the use of toothbrushes and dental floss; and (7) Pit and fissure sealants if the educational requirement of paragraph (B)(1)(a) and the observation requirement in paragraph (B)(1)(c) of rule 4715-11-03 of the Administrative Code have been satisfied. (B) A currently certified assistant may provide the dental assistant services in paragraph (A) of this rule for not more than fifteen consecutive business days, to a patient when the supervising dentist is not physically present at the location at which the services are provided if all of the following requirements are met: (1) The certified assistant has at least two years and a minimum of three thousand hours of experience practicing as a dental assistant. This experience shall be documented on a form supplied by the board, with any necessary supporting documentation attached, and the form shall be maintained in the facility(s) where the certified assistant is working. (2) The certified assistant has successfully completed a course approved by the state dental board in the identification and prevention of potential medical emergencies. This board approved course shall be taken through a permanent sponsor, shall be at least four hours in duration, and shall include, at a minimum, the following topics: (a) Medical history; (b) Recognition of common medical emergency situations; (c) Office emergency protocols; (d) Basic airway management; (e) Prevention of emergency situations during dental appointments; and (f) Recognition of symptoms, first aid treatment and possible outcomes for patients who exhibit bleeding injuries, cardiovascular disease, insulin reaction, diabetic coma, shock, syncope, epileptic seizures and allergic reactions. Completion of this course shall be documented on a form supplied by the board, with all necessary supporting information attached, and the form shall be maintained in the facility(s) where the certified assistant is working. (3) The supervising dentist has evaluated the certified assistant's skills and has made a determination that the certified assistant is competent to treat patients without the dentist being physically present. This determination shall be documented on a form supplied by the board, and the form shall be maintained at the facility(s) where the certified assistant is working. (4) The supervising dentist examined the patient not more than one year prior to the date the certified assistant provides the dental assisting services to the patient. (5) The supervising dentist has established written protocols or written standing orders for the dental assistant to follow during and in the absence of an emergency. (6) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date the certified assistant provides dental assisting services to the patient, and the supervising dentist determines that the patient is in a medically stable condition. (7) In advance of the appointment for dental assistant services, the patient is notified that the supervising dentist will be absent from the location and that the certified assistant cannot diagnose the patient's dental health care status. This notification must be documented in the patient record. (8) The dental assistant is employed by, or under contract with, one of the following: (a) The supervising dentist; (b) A dentist licensed under this chapter who is one of the following: (i) The employer of the supervising dentist; (ii) A shareholder in a professional association formed under Chapter 1785. of the Revised Code of which the supervising dentist is a shareholder; (iii) A member or manager of a limited liability company formed under Chapter 1705. of the Revised Code of which the supervising dentist is a member or manager; (iv) A shareholder in a corporation formed under division (B) of section 1701.03 of the Revised Code of which the supervising dentist is a shareholder; (v) A partner or employee of a partnership or a limited liability partnership formed under Chapter 1775. or 1776. of the Revised Code of which the supervising dentist is a partner or employee. (c) A government entity that employs the dental assistant to provide services in a public school or in connection with other programs the government entity administers.

405

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (C) A certified assistant may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, and when a dentist is not physically present at the location where the service is provided, if all of the following are the case: (1) The educational requirement in paragraph (B)(1)(a) of rule 4715-11-03 of the Administrative Code has been satisfied. (2) All of the conditions specified in paragraph (B) of this rule have been satisfied, except for paragraphs (B)(4) and (B)(6) of this rule. (3) The dental assistant is providing the service as part of a program operated through any of the following: a school district board of education or the governing board of an educational service center; the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code; a national, state, district, or local dental association; or any other public or private entity recognized by the state dental board. (4) A supervising dentist for the program described in paragraph (C)(3) of this rule meets both of the following conditions: (a) Is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated; (b) Is available for consultation by telephone, video conferencing, or other means of electronic communication. (5) The application of pit and fissure sealants is limited to erupted permanent posterior teeth without suspicion of dentinal cavitation. (6) If the patient is a minor, a parent, guardian, or other person responsible for the patient has been notified that a dentist will not be present at the location and that the dental assistant is not trained to diagnose or treat other serious dental concerns that could exist. 4715-11-04 Expanded function dental auxiliaries; functions. (A) A licensed dentist may assign to an expanded function dental auxiliary under his direct supervision and full responsibility the following tasks and/or procedures in addition to those basic remediable intra-oral and extra-oral dental tasks and/or procedures as defined in rule 4715-11-02 of the Administrative Code. (B) “Advanced remediable intra-oral dental tasks and/or procedures” - all tasks and/or procedures, with consideration of the soft tissue, involved in the art or placement of preventive or restorative materials limited to the following: (1) Pit and fissure sealants; (2) Amalgam restorative materials; and (3) Non-metallic restorative materials, including direct-bonded restorative materials. 4715-11-04.1 Application for registration as expanded function dental auxiliary; requirements; renewal; exemptions. (A) Each individual seeking to practice as an expanded function dental auxiliary shall register with the board in accordance with section 4715.62 of the Revised Code. An applicant for registration shall file with the secretary of the board a written application for registration, under oath, on a form the board shall prescribe and provide. An applicant shall include with the completed application all of the following: (1) An application fee of twenty dollars; (2) Proof that the applicant is one of the following: (a) An unlicensed dentist who has graduated from an accredited dental college, as specified in 4715.10 of the Revised Code, and does not have a dental license under suspension or revocation by the board; (b) A dental student who is enrolled in an accredited dental college, as specified in section 4715.10 of the Revised Code, and as is considered by the dean of the college to be in good standing as a dental student; (c) A graduate of an unaccredited dental college located outside the United States; (d) A dental assistant who is certified by the Dental assisting national board or the Ohio commission on dental assistant certification; (e) A dental hygienist licensed under this chapter whose license is in good standing; or (f) A dental hygienist who has graduated from an accredited dental hygiene program, as specified in section 4715.21 of the Revised Code, and does not have a dental hygiene license under suspension or revocation by the board. (3) Proof satisfactory to the board that the applicant has successfully completed, at an educational institution accredited by the American dental association commission on dental accreditation or the higher learning commission of the north central association of colleges and schools, the education or training specified in rule 471511-04.2 of the Administrative Code. Proof of completion of the education or training may be evidenced by a diploma or certificate of graduation or completion that has been signed by an appropriate official of the accrediting institution that provided education or training; (4) Proof satisfactory to the board that the applicant has passed an examination that meets the standards established in rule 4715-11-04.3 of the Administrative Code; (5) Proof that the applicant holds current certification to perform basic life-support procedures, evidenced by documentation showing the successful completion of a basic life-support training course certified by the American red cross, the American heart association, or the American safety and health institute. 406

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (B) Registration as an expanded function dental auxiliary expires on the thirty-first day of December of the year following the year in which the registration occurs. An individual may renew a registration for subsequent two-year periods in accordance with the standard renewal procedures established under Chapter 4745. of the Revised Code by submitting all of the following to the secretary of the state dental board each time the individual seeks to renew a registration: (1) A renewal fee of twenty dollars. (2) A completed application for renewal, under oath, on a form the board shall prescribe and provide; (3) Proof that the registrant holds current certification to perform basic life-support procedures, evidenced by documentation showing the successful completion of a basic life-support training course certified by the American red cross, the American heart association, or the American safety and health institute. (C) Paragraph (A) of this rule does not apply to any of the following: (1) A dentist licensed under this chapter; (2) A dental student who engages in any activities performed by expanded function dental auxiliaries as an integral part of a program of study leading to receipt of a license to practice as a dentist under this chapter; (3) An expanded function dental auxiliary student when the student participates in an educational or training activity of an accredited education institution or a training program that does both of the following: (a) Provides the education or training necessary to practice as an expanded function dental auxiliary; and (b) Ensures that a dentist licensed under this chapter, or a dentist who holds a limited teaching license issued under this chapter, is physically present in the facility where the expanded function dental auxiliary performs clinical dental procedures on patients. 4715-11-04.2 Education or training necessary to register as an expanded function dental auxiliary. (A) In order to register with the board as an expanded function dental auxiliary, an individual must complete an educational program that meets all of the following requirements: (1) The program is offered by an educational institution accredited by the American dental association commission on dental accreditation or the higher learning commission of the north central association of colleges and schools. (2) The program must include a minimum of one hundred eighty hours of coursework, of which one hundred hours are preclinical and didactic, and eighty hours are clinical, and includes training in all of the following areas: (a) Nomenclature (b) Caries classification (c) Oral anatomy (d) Dental morphology (e) Periodontium (f) Histology (g) Basics of occlusion (h) Ergonomics (i) Instrumentation (j) Pulp protection (k) Dental materials (l) Posterior amalgam and non-metallic restorations (m) Matrix and wedge techniques (n) Temporization (o) Amalgam placement and carving (p) Polishing amalgams (q) Non-metallic restorative material placement (r) Non-metallic restorative material finishing and polishing utilizing both low and high speed handpieces (s) Pit and fissure sealant placement (t) Rubber dam clamp placement and removal (u) Rubber dam placement and removal (3) A dentist licensed under section 4715.10 of the Revised Code or a dentist holding a limited teaching license under section 4715.16 of the Revised Code is physically present in the facility when clinical procedures associated with the education or training of expanded function dental auxiliary are performed on patients. (B) An unlicensed dentist who does not have a dental license under suspension or revocation by the board and who seeks to register with the board as an expanded function dental auxiliary shall fulfill the requirements of paragraph (A) of this rule upon submission of proof of graduation from an accredited dental college as specified in section 4715.10 of the Revised Code. (C) A dental student seeking to register with the board as an expanded function dental auxiliary shall fulfill the requirements of paragraph (A) of this rule upon submission to the board proof that the dental student is currently enrolled in an accredited dental college and is considered by the dean of the college to have completed sufficient clinical training as set forth in paragraph (A) of this rule, and be in good standing as a dental student. (D) A graduate of an unaccredited dental college located outside the United States seeking to register with the board as an expanded function dental auxiliary shall fulfill the requirements of paragraph (A) of this rule upon submission of proof ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

407

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants that the individual has completed sufficient clinical training at an accredited dental college as evidenced by a letter signed by the dean of the college to have completed sufficient clinical training as set forth in paragraph (A) of this rule. 4715-11-04.3 Examination of applicants. (A) Each individual seeking to register with the board as an expanded function dental auxiliary must successfully pass the examination administered by the commission on dental testing in Ohio or an examination accepted by the board as an examination of competency to practice as an expanded function dental auxiliary. (B) An examination may be accepted by the board only if the entity that administers the examination requires an individual to be one of the following as a condition of admission to the examination: (1) An unlicensed dentist who has graduated from an accredited dental college, as specified in section 4715.10 of the Revised Code, and does not have a dental license under suspension or revocation by the board; (2) A dental student who is enrolled in an accredited dental college, as specified in section 4715.10 of the Revised Code, and is considered by the dean of the college to be in good standing as a dental student; (3) A graduate of an unaccredited dental college located outside the United States; (4) A dental assistant who is certified by the dental assisting national board or the Ohio commission on dental assistant certification; (5) A dental hygienist licensed under this chapter whose license is in good standing; or (6) An unlicensed dental hygienist who has graduated from an accredited dental hygiene program, as specified in section 4715.21 of the Revised Code, and does not have a dental hygiene license under suspension or revocation by the board. 4715-11-04.4 Expanded function dental auxiliary; practice when the dentist is not physically present. (A) Subject to the requirements set forth in paragraph (B) of this rule, an expanded function dental auxiliary may provide all of the following services to a patient when the supervising dentist is not physically present at the location where the services are provided: (1) Application of pit and fissure sealants; (2) Recementation of temporary crowns or recementation of crowns with temporary cement; (3) Application of topical fluoride; (4) Application of fluoride varnish; (5) Application of disclosing solutions; (6) Application of desensitizing agents; (7) Caries susceptibility testing; and (8) Instruction on oral hygiene home care, including the use of toothbrushes and dental floss. (B) An expanded function dental auxiliary may provide the services in paragraph (A) of this rule for not more than fifteen consecutive business days to a patient when the supervising dentist is not physically present at the location at which the services are provided if all of the following requirements are met: (1) The expanded function dental auxiliary has at least two years and a minimum of three thousand hours of experience practicing as an expanded function dental auxiliary. This experience shall be documented on a form supplied by the board, with any necessary supporting information attached, and the form shall be maintained in the facility(s) where the expanded function dental auxiliary is working. (2) The expanded function dental auxiliary has successfully completed a course approved by the state dental board in the identification and prevention of potential medical emergencies. This board approved course shall be taken through a permanent sponsor, shall be at least four hours in duration, and shall include, at a minimum, the following topics: (a) Medical history; (b) Recognition of common medical emergency situations; (c) Office emergency protocols; (d) Basic airway management; (e) Prevention of emergency situations during dental appointments; and (f) Recognition of symptoms, first aid treatment and possible outcomes for patients who exhibit bleeding injuries, cardiovascular disease, insulin reaction, diabetic coma, shock, syncope, epileptic seizures and allergic reactions. Completion of this course shall be documented on a form supplied by the board, with all necessary supporting information attached, and the form shall be maintained in the facility(s) where the expanded function dental auxiliary is working (3) The supervising dentist has evaluated the expanded function dental auxiliary's skills and has made a determination that the expanded function dental auxiliary is competent to treat patients without the dentist being physically present. This determination shall be documented on a form supplied by the board, and the form shall be maintained at the facility(s) where the expanded function dental auxiliary is working. (4) The supervising dentist examined the patient not more than one year prior to the date the expanded function dental auxiliary provides the services to the patient. 408

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (5) The supervising dentist has established written protocols or written standing orders for the expanded function dental auxiliary to follow during and in the absence of an emergency. (6) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date the expanded function dental auxiliary provides services to the patient and the supervising dentist determines that the patient is in a medically stable condition. (7) In advance of the appointment for dental services, the patient is notified that the supervising dentist will be absent from the location and that the expanded function dental auxiliary cannot diagnose the patient's dental health care status. This notification must be documented in the patient record. (8) The expanded function dental auxiliary is employed by, or under contract with, one of the following: (a) The supervising dentist; (b) A dentist licensed under this chapter who is one of the following: (i) The employer of the supervising dentist; (ii) A shareholder in a professional association formed under Chapter 1785. of the Revised Code of which the supervising dentist is a shareholder; (iii) A member or manager of a limited liability company formed under Chapter 1705. of the Revised Code of which the supervising dentist is a member or manager; (iv) A shareholder in a corporation formed under division (B) of section 1701.03 of the Revised Code of which the supervising dentist is a shareholder; (v) A partner or employee of a partnership or a limited liability partnership formed under Chapter 1775. or 1776. of the Revised Code of which the supervising dentist is a partner or employee. (c) A government entity that employs the expanded function dental auxiliary to provide services in a public school or in connection with other programs the government entity administers. (C) An expanded function dental auxiliary may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, and when a dentist is not physically present at the location where the service is provided, if all of the following are the case: (1) All of the conditions specified in paragraph (B) of this rule have been satisfied, except for paragraphs (B)(4) and (B)(6) of this rule. (2) The expanded function dental auxiliary is providing the service as part of a program operated through any of the following: a school district board of education or the governing board of an educational service center; the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code; a national, state, district, or local dental association; or any other public or private entity recognized by the state dental board. (3) A supervising dentist for the program described in paragraph (C)(2) of this rule meets both of the following conditions: (a) Is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated; (b) Is available for consultation by telephone, videoconferencing, or other means of electronic communication. (4) The application of pit and fissure sealants is limited to erupted permanent posterior teeth without suspicion of dentinal cavitation. If the patient is a minor, a parent, guardian, or other person responsible for the patient has been notified that a dentist will not be present at the location and that the expanded function dental auxiliary is not trained to diagnose or treat other serious dental concerns that could exist. 4715-11-05 Non-dental licensed healthcare provider; supervision. (A) A licensed dentist may assign to non-dental healthcare providers under the dentists direct supervision and full responsibility those functions within the scope of their individual non-dental license when said functions are within the scope of dental practice and part of the delivery of dental care. 4715-11-06 Non-delegable dental tasks and/or procedures. The following dental tasks and/or procedures shall not be delegated by any licensed dentists: (A) Definitive diagnosis and treatment planning. (B) The final placement of any fixed or removable appliances. (C) The final removal of any fixed appliance. (D) The therapeutic intra-oral adjustment of any fixed or removable appliance. (E) Cutting procedures utilized in the preparation of the coronal or root portion of the tooth. (F) Cutting procedures involving the supportive structures of the tooth. (G) The placement of the final root canal filling. (H) Final impressions of any tissue-bearing area, whether it be hard or soft tissue, upon which a prosthetic restoration is to be placed. Taking of impressions for athletic mouthguards or other similar appliances is not to be construed as a final impression. (I) Occlusal registration procedures for any prosthetic restoration, whether it be fixed or removable. (J) The final placement of prefabricated or cast restorations or crowns. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

409

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (K) Procedures utilizing light amplification by stimulated emission or radiation (LASER) technologies (excluding caries susceptibility testing devices). (L) Any other dental tasks and/or procedures which are prohibited by law or agency-level 4715 rules of the Administrative Code. 4715-12-01 Permissible practices of a dental x-ray machine operator; supervision required; certificate to be displayed. (A) A dental x-ray machine operator may perform standard, diagnostic, radiologic procedures for the purpose of contributing to the provision of dental care to a dental patient. (B) Except as provided in paragraph (C) of this rule, a dental x-ray machine operator may perform radiologic procedures only under the direct supervision of the supervising dentist. (C) A dental x-ray machine operator may perform radiologic procedures for a patient when the supervising dentist is not physically present at the location where the radiologic procedures are performed if the supervising dentist examined the patient not more than one year prior to the date the dental x-ray machine operator performs the radiologic procedures and the supervising dentist has ordered the radiologic procedures. (D) The original or copy of the certificate and/or renewal receipt card shall be displayed in a conspicuous place in the office wherein the dental assistant radiographer is employed and be made immediately available upon the request of an agent of the board. 4715-12-02 Application for certificate; requirements; exceptions. (A) Each person who desires to perform the duties of a dental x-ray machine operator shall file with the secretary of the state dental board a written application for a dental x-ray machine operator’s certificate. Each applicant for a dental x-ray machine operator’s certificate shall pay an application fee of thirty-two dollars. Each applicant shall furnish satisfactory proof of the following on a form prescribed and provided by the state dental board: (1) Except as provided in paragraph (B) of this rule, he or she has completed a Board-approved dental radiography training program presented by either of the following: (a) an accredited educational institution or program; or (b) a permanent sponsor of continuing education as listed in paragraph (A)(1) to (A)(9) of rule 4715-8-02 of the Administrative Code (B) A dental x-ray machine operator shall be exempt from the initial training requirements provided in paragraph (A) of this section if either of the following apply: (1) They hold a current certification as an assistant which included required examination in radiography as a component from the “Dental Assisting National Board” or the “Ohio Commission on Dental Assistant Certification”; or (2) They hold a current license, certificate, or other credential issued by another state that the board determines uses standards for dental x-ray machine operators that are at the least equal to those established by these rules. 4715-12-03 Certificate renewal. (A) Each person who is certified as a dental x-ray machine operator shall on or before the first day of January of each odd-numbered year, register with the state dental board. The registration shall be made on a form prescribed by the board, and shall include the certificate holder’s name, address, certificate number, proof of having completed at least two hours of continuing education in radiation technology from a Board-approved biennial or permanent sponsor during the two-year period immediately preceding renewal, and such other reasonable information as the board may consider necessary, and shall include payment of a biennial registration fee of thirty-two dollars. This certificate shall be in effect for the two-year period beginning on the first day of January of the odd-numbered year, and ending on the last day of December of the following even-numbered year, and shall automatically expire if not renewed. (B) Any dental x-ray machine operator whose certificate has expired under this section must immediately cease taking x-rays until said certificate has been renewed. 4715-12-04 Accreditation of education programs; examination; application; fee; suspension; revocation. (A) Any permanent sponsor wishing to offer dental x-ray machine operator training must offer a curriculum of at least seven hours to include the following subjects: (1) Radiation physics; (2) Radiation biology; (3) Radiation health, safety and protection; (4) X-ray films and radiographic film quality; (5) Radiographic techniques, processing and storage. This curriculum may be presented as a correspondence course. (B) Clinical experience making a variety of radiographs and radiographic surveys must be part of the course curriculum. The clinical experience must be completed within sixty days of completing the seven subjects of the curriculum. The clinical experience may be performed in the dental office in which the dental assistant is employed or is serving an externship. The employing/supervising dentist must certify to the sponsor of the dental x-ray machine operator training program that the clinical experience was completed. 410

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (C) Permanent sponsors wishing to obtain accreditation of radiologic education programs must apply on a form prescribed and provided by the state dental board, and must submit a fee of sixty-seven dollars and fifty cents. (D) All programs submitted will be reviewed by the board. The accreditation or approval shall be valid until surrendered by the program, or suspended or revoked by the board. A program’s accreditation or approval may be suspended or revoked if the program does not comply with applicable requirements of the Revised Code or state dental board rules. 4715-12-05 Continuing education requirements. (A) Every person certified to practice as a dental x-ray machine operator and required to register with the state dental board shall provide proof to the board at the time of applying for a renewal of registration that in the preceding two years the registrant has completed a minimum of two hours of continuing education in dental radiation technology. Certification shall be made upon the application for registration prescribed by the board pursuant to section 4715.53 of the Revised Code. (B) Continuing education programs may be developed and offered to dental x-ray machine operator by any of the following agencies or organizations: (1) National, state, district, or local dental associations affiliated with the American dental association or National dental association; (2) National, state, district, or local dental hygienists’ associations affiliated with the American dental hygienists’ association; (3) National, state, district, or local dental assistants associations affiliated with the American dental assistant association. (4) Accredited dental colleges or schools; (5) Accredited dental hygiene colleges or schools; (6) Other organizations, schools, paraprofessional programs, or agencies approved by the state dental board. (C) Continuing radiation technology programs include, but are not limited to, programs that address any of the following: (1) Radiation physics; (2) Radiation biology; (3) Radiation health, safety and protection; (4) X-ray films and radiographic film quality; (5) Radiographic techniques, processing and storage. (D) A dental x-ray machine operator shall retain in his or her records for a period of at least four years such receipts, vouchers, or certificates as may be necessary to document completion of continuing education programs. With cause, the board may request such documentation from dental assistant radiographers, and the board may request such documentation from dental assistant radiographers at random without cause. (E) The board may excuse dental x-ray machine operators, as a group or as individuals, from all or any part of the requirements of this rule because of an unusual circumstance, emergency, or special hardship. (F) Failure to comply with the requirements of this rule constitutes a failure to renew registration pursuant to section 4715-20-01 Patient and personnel protection. (A) Immunization – All dentists and dental health care workers must show evidence of immunity to or immunization against the hepatitis B virus as specified by board guidelines. Such immunization must begin prior to patient contact. Medical documentation must be maintained in the dental facility for each dentist and dental health care worker providing care in that facility. This medical documentation must be made available immediately upon request by an authorized agent of the state dental board. (D) Waiver – The board may waive the requirements set forth in paragraph (A) of this rule if the board determines that such waiver is justified based on medical documentation indicating that such immunization threatens their health and well being. Any board-approved waiver must be renewed according to the discretion of the board. 4715-23-01 Requirements for teledentistry permit. (A) Each applicant for a teledentistry permit shall submit the statutory fee and an application to the Board. (1) On this application, the dentist applicant for a teledentistry permit shall state under oath whether, (a) The applicant has read all laws and rules governing teledentistry in the state of Ohio, including but not limited to sections 4715.43 -.437 of the Revised Code and this section of the Administrative Code. (b) The applicant has the necessary equipment required to safely and securely deliver dental services through teledentistry, specifically regarding synchronous, real-time communication. (c) The applicant has established all necessary policies, protocols, and orders to safely deliver dental services through teledentistry at all locations where dental services will be provided through teledentistry. (d) The applicant’s Ohio license to practice dentistry is in good standing. (e) The license or registration of dental hygienists and expanded function dental auxiliaries who will provide dental services through teledentistry for the applicant are in good standing. (f) Any dental hygienist or expanded function dental auxiliary who provides placement of interim therapeutic restorations and application of silver diamine fluoride, has completed the appropriate course prescribed by the Board. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

411

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants (g) The applicant understands that: (i) The applicant retains responsibility for ensuring the safety and quality of services provided to patients through teledentistry, (ii) Dental services delivered through teledentistry must conform to accepted standards for the profession, and (iii) Persons involved with providing services through teledentistry must abide by laws addressing the privacy and security of the patientâ&#x20AC;&#x2122;s dental and medical information as well as other information required to be kept confidential as required by law. (2) The applicant shall provide on the application form the following information: (a) Address where dental services will be provided through teledentistry. (b) Name and license or registration number of each dental hygienist or expanded function dental auxiliary who will perform dental services through teledentistry when the dentist is not physically present and the location where they will provide these services. (c) A description of all equipment used to establish and maintain synchronous, real-time communication during the provision of dental services through teledentistry. Any description must include manufacturer name and model number. (B) Each holder of a teledentistry permit shall: (1) Before providing dental services through teledentistry, notify the Board via e-mail or regular U.S. mail within seven calendar days of: (a) The address where dental services will be provided through teledentistry, if not included on permit application. (b) Name and license or registration number of each dental hygienist and expanded function dental auxiliary who will perform dental services through teledentistry when the dentist is not physically present and the location where they will provide these services, if not included on permit application. 4715-23-02 Courses on proper placement of interim therapeutic restorations and application of silver diamine fluoride. (A) Any course that meets the following criteria shall satisfy the requirements of R.C. section 4715.431 for a Boardapproved course on either placement of interim therapeutic restorations or application of silver diamine fluoride. (1) Each course must be: (a) A two-hour continuing education course with at least one continuing education hour of didactic education and at least one continuing education hour of clinical hands-on training. (b) Provided by a Board-approved sponsor of continuing education under rule 4715-8 of the Administrative Code, and (c) Dedicated solely to the proper placement of interim therapeutic restorations or application of silver diamine fluoride. (2) For a course on the proper placement of interim therapeutic restorations, course content shall include: (a) Biological background information, including, but not limited to, materials used in and the scientific basis for the proper placement of interim therapeutic restorations. (b) Proper isolation and placement technique, including, but not limited to, the use of cotton rolls and iso-vac. (c) Knowledge of poor seal with interim restorations, including, but not limited to, the consequences of a poor seal, leakage, and re-cavitation. (d) Detection of arresting dental caries and the use of a periodontal probe. (e) Replacement of treatment, including, but not limited to, the necessity of a new diagnosis by a dentist before reapplication. (3) For a course on the application of silver diamine fluoride, course content shall include: (a) Biological background information, including, but not limited to, materials used in and the scientific basis for the application of silver diamine fluoride. (b) Proper isolation and placement technique, including, but not limited to, the use of cotton rolls and iso-vac. (c) Knowledge of potential problems associated with silver diamine fluoride, including, but not limited to, staining, need for treatment, and failure to arrest caries. (d) Detection of arresting dental caries and the use of periodontal probe. (e) Reapplication of treatment, including, but not limited to, the necessity of a new diagnosis by a dentist before reapplication. (B) To meet the course requirements for both proper placement of interim therapeutic restoration and application of silver diamine fluoride, a dental hygienist or expanded function dental auxiliary must complete both courses dedicated to each respective subject. (C) No course shall instruct that the use of a dental explorer or sickle probe is appropriate during the application of silver diamine fluoride or placement of interim therapeutic restorations.

412

Ohio State Dental Practice Act and Administrative Rules for Dental Assistants 4715-23-03 Requirements for obtaining informed consent. (A) When services are provided under a teledentistry permit and the patient is not examined in person by the authorizing dentist, informed consent must be obtained before the placement of interim therapeutic restorations or the application of silver diamine fluoride. (B) To obtain informed consent, the authorizing dentist must: (1) Determine that the patient is mentally capable of giving informed consent to the provision of the diagnosis, care, or treatment and is not subject to duress or under undue influence, (2) Inform the patient that the authorizing dentist will perform a clinical evaluation and diagnosis of caries through teledentistry, (3) For the application of silver diamine fluoride, (a) inform the patient of the potential for staining teeth by providing color photos of the result of application, (b) inform the patient that application is permanent and may only be reversed through loss or restoration of the tooth, (c) inquire whether the patient has an allergy to silver, and (d) inform the patient that the treatment will require active monitoring and possible reapplication. (4) Explain alternatives to, and the capabilities and limitations of, teledentistry, (5) Explain that the patient may decline to receive services through teledentistry, (6) Document in the patient record any discussion with the patient about teledentistry and whether informed consent was obtained, and (7) Comply with the requirements set forth in section 4715.431(B) of the Revised Code. (C) If the patient is less than eighteen years of age, a parent or legal guardian must provide informed consent for the patient and meet the same requirements as provided in section B above. 4715-23-04 Procedures not permitted. No authorizing dentist shall authorize a dental hygienist or expanded function dental auxiliary to provide a dental service or any other function prohibited by law or rule, including section 4715.435 of the Revised Code. 4715-23-06 Authorization. (A) An authorizing dentist who is providing dental services through teledentistry may not at any time have more than a total of three dental hygienists and expanded function dental auxiliaries working under the dentistâ&#x20AC;&#x2122;s authorization pursuant to section 4715.431 of the Revised Code. Because teledentistry requires synchronous, real-time communication, an authorizing dentist must remain attentive and available to attend to the health and safety of all patients regardless of whether the dentist is physically present or not physically present with the patient. If an authorizing dentist supervises any dental hygienist or expanded function dental auxiliary on the same day as the authorizing dentist authorizes any dental hygienist or expanded function dental auxiliary to provide dental services through teledentistry, the authorizing dentist should not have more than a total of: (1) four dental hygienists practicing clinical hygiene under the supervision of the authorizing dentist pursuant to section 4715.23 of the Revised Code or three dental hygienists providing dental services through teledentistry pursuant to section 4715.431 of the Revised Code. (2) two expanded function dental auxiliaries practicing as expanded function dental auxiliaries under the supervision of the authorizing dentist pursuant to section 4715.64 of the Revised Code or three expanded function dental auxiliaries providing dental services through teledentistry pursuant to section 4715.431 of the Revised Code, except that the total number practicing under the supervision of the authorizing dentist pursuant to section 4715.64 of the Revised Code shall not exceed two. (B) Nothing in this rule shall prohibit: (1) any dental hygienist to practice as a dental hygienist when the authorizing dentist is not physically present at the location where the dental hygienist is practicing, under section 4715.22 of the Revised Code, (2) any expanded function dental auxiliary to practice as an expanded function dental auxiliary when the authorizing dentist is not physically present at the location where the expanded function dental auxiliary is practicing, under section 4715.64 of the Revised Code, (3) any dental assistant or qualified personnel to practice as a dental assistant or qualified personnel when the authorizing dentist is not physically present at the location where the dental assistant or qualified personnel is practicing, under section 4715.39 of the Revised Code, (4) any dental x-ray machine operator to practice as a dental x-ray machine operator when the authorizing dentist is not physically present at the location where the dental x-ray machine operator is practicing, under section 4715.56 of the Revised Code, or (5) any dental hygienists to practice in accordance with a permit issued pursuant to section 4715.363 of the Revised Code authorizing practice under the oral health access supervision of a dentist.

413

Oklahoma DANB Certificant Counts: Oklahoma Certified Dental Assistant (CDA) certificants

278

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Susan Rogers, Esq., Executive Director Oklahoma Board of Dentistry 2920 N. Lincoln Blvd., Suite B Oklahoma City, OK 73105 Phone: 405-522-4844 Fax: 405-522-4614 Email: Susan.Rogers@dentistry.ok.gov Website: www.ok.gov/dentistry

Radiation Health and Safety (RHS)

833

Infection Control (ICE)

828

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Francis Tuttle Technology Center Moore Norman Technology Center Rose State College Tulsa Technology Center Western Technology Center

DANB CDA Certificant State of Oklahoma+

$24.13 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been updated by DANB as of April 14, 2020.

414

Source: 2018 DANB Salary Survey (state data based on 4 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the Oklahoma Board of Dentistry. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

Oklahoma State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Oklahoma, a dental assistant must obtain a permit from the Oklahoma Board of Dentistry (OBD). To qualify, one must: (1) Complete a course of study in radiation safety and protection, consisting of a minimum of seven hours, approved by the OBD AND (2) Submit written verification to the OBD from the applicant’s current employing dentist attesting to competent clinical experience AND (3) Apply for a Radiation Safety permit from the OBD and pass a background check with criteria established by the OBD.

State Requirements For Expanded Functions Every dental assistant in Oklahoma must obtain a Dental Assistant permit from the Board of Dentistry within 30 days of beginning employment. To obtain a permit, one must (1) Submit a completed application form and the required fee to the Oklahoma Board of Dentistry (OBD) AND (2) Pass a background check with criteria established by the OBD. Prior to receiving the permit, the dental assistant must work under the dentist's direct visual supervision at all times. To perform expanded functions in Oklahoma under the direct supervision of a licensed dentist, a dental assistant must obtain a permit for each expanded duty he or she desires to perform. Permit applicants must complete expanded duty training in each of the desired functions at a Commission on Dental Accreditation (CODA)-accredited dental assisting program or a course approved by the OBD. Available expanded function permits are: •

Radiation Safety. See the "Oklahoma State Radiography Requirements" section above.

•

Coronal polishing/Topical fluoride. A dental assistant must successfully complete an OBD-approved course of study, including a clinical component, consisting of a minimum of 14 hours.

•

Sealants. A dental assistant must successfully earn the coronal polishing/topical fluoride permit and complete an OBD-approved course of study, consisting of a minimum of 12 hours.

•

Assisting in the administration of nitrous oxide. A dental assistant must successfully complete an OBD-approved course of study, consisting of a minimum of 12 hours.

•

Assisting a dentist who holds a parenteral or pediatric anesthesia permit: The OBD will be developing rules to establish requirements for this permit. (Note: Only a dentist may administer anesthesia and assess the patient's level of sedation.)

A dental assistant who holds an out-of-state dental assistant permit with expanded duties may apply for credentialing and reciprocity for a dental assistant permit including any expanded duty by demonstrating that he or she has: 1. Held a valid dental assistant permit in another state for a minimum of two years and is in good standing AND 2. Held a valid expanded duty in another state for a minimum of one year AND 3. Completed an educational class for the expanded duty and that the dental assistant been providing this treatment to dental patients while working as a dental assistant in a dental office for a minimum of one year. Any person having served in the military as a dental assistant shall receive credentialing and reciprocity for expanded functions by providing: 1. Proof of military service in excess of two years with any certifications or training in the expanded function areas AND 2. Verification from the commanding officer of the medical program or the appropriate supervisor stating that the dental assistant provided the expanded functions on patients in the military dental facility for a minimum of one year within the past five years. To earn an Oral Maxillofacial Surgery Assistant permit in Oklahoma, one must: (1) Pass a background check with criteria established by the OBD AND (2) Be supervised by an oral maxillofacial surgeon with a current Oklahoma license, AND (3) Be employed and complete a minimum of six months of training under the direct supervision of a licensed oral maxillofacial surgeon prior to starting the DAANCE program (see below), AND (4) Complete the Dental Anesthesia Assistant National Certification Examination (DAANCE) program provided by the American Association of Oral Maxillofacial Surgeons (AAOMS), AND (5) Hold valid BLS certification, AND (6) Complete a standardized course approved by the OBD including a minimum of four hours of didactic training that includes the required content, AND (7) Complete an infection control course approved by the Board, AND (8) Meet any other requirements established by the OBD, AND (9) Apply to the OBD for an Oral Maxillofacial Surgery Assistant permit. Note: The OBD’s anesthesia committee may make a recommendation to the OBD for an oral maxillofacial surgery assistant holding a temporary training permit to substitute training received from another state university, dental school or technical training institute or training acquired in a surgery center or hospital while working under the authority of a licensed physician, to qualify as a partial substitute for the requirements to attain an oral maxillofacial surgery assistant permit. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

415

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Oklahoma Board of Dentistry Oklahoma Statutes Title 59, Chapter 7, Part 1 State Dental Act Section 328.3. Definitions. As used in the State Dental Act, the following words, phrases, or terms, unless the context otherwise indicates, shall have the following meanings: 3. "Accredited dental assisting program" means a dental assisting program which is accredited by the Commission on Dental Accreditation of the American Dental Association; 4. “Board” means the Board of Dentistry; 5. "Certified dental assistant" means a dental assistant who has earned and maintains current certified dental assistant certification from the Dental Assisting National Board (DANB); 6. "Coronal polishing means a procedure limited to the removal of plaque and stain from exposed tooth surfaces, utilizing a slow speed hand piece with a prophy/polishing cup or brush and polishing agent and is not prophylaxis. To be considered prophylaxis, examination for calculus and scaling must be done by a hygienist or dentist; 9. "Dental ambulatory surgical center (DASC)" means a facility that operates exclusively for the purpose of furnishing outpatient surgical services to patients. A DASC shall have the same privileges and requirements as a dental office and additionally must be an accredited facility by the appropriate entity; 10. "Dental office" means an establishment owned and operated by a dentist for the practice of dentistry, which may be composed of reception rooms, business offices, private offices, laboratories, and dental operating rooms where dental operations are performed; 13. “Dental assistant or oral maxillofacial surgery assistant” means an individual working for a dentist, under the dentist’s direct supervision or direct visual supervision, and performing duties in the dental office or a treatment facility, including the limited treatment of patients in accordance with the provisions of the State Dental Act; the dental assistant or oral maxillofacial surgery assistant may assist the dentist with the patient; provided, this shall be done only under the direct supervision or direct visual supervision and control of the dentist and only in accordance with the educational requirements and rules promulgated by the Board; 18. “Direct supervision” means the supervisory dentist is in the dental office or treatment facility and, during the appointment, personally examines the patient, diagnoses any conditions to be treated, and authorizes the procedures to be performed by a dental hygienist, dental assistant, or oral maxillofacial surgery assistant. The supervising dentist is continuously on site and physically present in the dental office or treatment facility while the procedures are being performed and, before dismissal of the patient, evaluates the results of the dental treatment; 19. "Direct visual supervision" means the supervisory dentist has direct ongoing visual oversight which shall be maintained at all times during any procedure authorized to be performed by a dental assistant or an oral maxillofacial surgery assistant; 22. “General supervision” means the supervisory dentist has diagnosed any conditions to be treated within the past thirteen (13) months, has personally authorized the procedures to be performed by a dental hygienist, and will evaluate the results of the dental treatment within a reasonable time as determined by the nature of the procedures performed, the needs of the patient, and the professional judgment of the supervisory dentist. General supervision may only be used to supervise a hygienist and may not be used to supervise an oral maxillofacial surgery assistant or dental assistant; 23. “Indirect supervision” means the supervisory dentist is in the dental office or treatment facility and has personally diagnosed any conditions to be treated, authorizes the procedures to be performed by a dental hygienist, remains in the dental office or treatment facility while the procedures are being performed, and will evaluate the results of the dental treatment within a reasonable time as determined by the nature of the procedures performed, the needs of the patient, and the professional judgment of the supervisory dentist. Indirect supervision may not be used for an oral maxillofacial surgery assistant or a dental assistant; 33. "Supervision" means direct supervision, direct visual supervision, indirect supervision, or general supervision; Section 328.17. Committees and Examining Boards for Dental Specialists and Hygienists - Advisory Board on Laboratories A. 1. The Board of Dentistry shall have the following standing committees that shall meet once per year and other times as needed to study issues affecting the practice of dentistry and the safety of the public and to make recommendations to the Board: e. Assistants, Dental Labs and Other Auxiliary Personnel Committee. C. There shall be an Allied Dental Education Committee. 1. The Board President shall appoint all members of the Allied Dental Education Committee upon approval by the Board; 416

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants 2. The Allied Dental Education Committee shall: a. review the standards and equivalency of in-state and out-of-state dental and auxiliary program requirements and make recommendations to the Board, b. evaluate individual credentials and programs for the purpose of issuing dental assistant expanded duty permits and dental hygiene advanced procedure permits from persons holding out-of-state licenses and permits based on CODA or DANB programs and criteria as defined by the State Dental Act and other statutes and shall make recommendations to the Board, c. recommend standards and guidelines and review criteria for all expanded duty programs or courses for dental assistants from CODA approved programs and non-CODA approved providers and advanced procedures of dental hygienists from CODA approved programs to the Board, and d. recommend and develop guidelines for classroom, electronic media and other forms of education and testing; 3. The Committee shall meet as deemed necessary by the Board President; 4. The Committee may have up to ten (10) members of whom three shall have a background in dental education. The Committee shall be composed of: a. the Board President or his or her designee who must be a current or past Board Member, b. the hygiene member of the Board or their designee who must be a current or past Board Member, c. the Dean of the University of Oklahoma College of Dentistry or his or her designee, d. up to seven at-large members, one of which must be an educator and one of which must have a current Certified Dental Assistant Permit. E. All Committee members of standing committees, the Hygiene Committee and the Allied Dental Education Committee shall serve staggered three-year terms and serve at the pleasure of the Board. Section 328.19. Acts constituting practice of dentistry - Acts not prevented. A. The following acts by any person shall be regarded as practicing dentistry within the meaning of the State Dental Act: 1. Representing oneself to the public as being a dentist or as one authorized to practice dentistry; 2. Representing oneself to the public as being able to diagnose or examine clinical material and contract for the treating thereof; 3. Representing oneself as treating or professing to treat by professional instructions or by advertised use of professional equipment or products; 4. Representing oneself to the public as treating any of the diseases or disorders or lesions of the oral cavity, teeth, gums, maxillary bones, and associate structures; 5. Removing human teeth; 6. Repairing or filling cavities in human teeth; 7. Correcting or attempting to correct malposed teeth; 8. Administering anesthetics, general or local; 9. Treating deformities of the jaws and adjacent structures; 10. Using x-ray and interpreting dental x-ray film; 11. Offering, undertaking or assisting, by any means or methods, to remove stains, discolorations, or concretions from the teeth;â&#x20AC;Š 12. Operating or prescribing for any disease, pain, injury, deficiency, deformity, or any physical condition connected with the human mouth; 13. Taking impressions of the teeth and jaws; 14. Furnishing, supplying, constructing, reproducing, or repairing, or offering to furnish, supply, construct, reproduce, or repair, prosthetic dentures, sometimes known as plates, bridges, or other substitutes for natural teeth for the user or prospective user thereof; 15. Adjusting or attempting to adjust any prosthetic denture, bridge, appliance, or any other structure to be worn in the human mouth; 16. Diagnosing, making, and adjusting appliances to artificial casts of malposed teeth for treatment of the malposed teeth in the human mouth, without instructions; 17. Writing a laboratory prescription to a dental laboratory or dental laboratory technician for the construction, reproduction or repair of any appliance or structure to be worn in the human mouth; or 18. Owning, maintaining, or operating an office or offices by holding a financial interest in same for the practice of dentistry; or 19. Any other procedure otherwise defined in the State Dental Act requiring a valid license or permit to perform while the person does not hold such valid license or permit issued by the Board. B. The fact that a person uses any dental degree, or designation, or any card, device, directory, poster, sign or other media representing oneself to be a dentist shall be prima facie evidence that the person is engaged in the practice of dentistry; provided that nothing in this section shall be so construed as to prevent the following: 6. The performing of acts by a dental assistant or oral maxillofacial surgery assistant who performs the acts under the direct supervision or direct visual supervision of a dentist and in accordance with the provisions of the State Dental Act and the rules promulgated by the Board; or ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

417

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants Section 328.21 - Registration and Display of Licenses and Certificates J. All licensees and permit holders shall display their current permit or license in a visible place within the dental office or treatment facility. Section 328.23a. Volunteer License to Treat Indigent and Needy - Restriction on Compensation - Requirements of Volunteer Service C. The Board of Dentistry shall have jurisdiction over dentists, dental hygienists, dental assistants, and dental technicians who volunteer their professional services in the state. Dental assistants and dental technicians shall work under the direct supervision of a dentist. D. Dental assistants and dental technicians shall not be required to obtain a volunteer license may be issued a volunteer permit at the request of an entity that provides dental services to the needy. Volunteers in a volunteer initiative who are not dentists or dental hygienists shall be named and provided on a list to the Board by the entity hosting the volunteer initiative with any other requirements as set forth by the Board. The Board shall provide written documentation to the host entity designating all persons who may participate in the volunteer initiative, including authorization of the timetable requested by the host entity for granting licensure exemption. Any person working under a volunteer dental assistant permit shall not receive payment or compensation for any services rendered under the volunteer dental assistant permit. Volunteer dental assistant permits shall be limited to specific dates and locations of services to be provided. E. All persons providing care shall do so under the provisions specified in Section 328.1 et seq. of this title or rules promulgated by the Board. Only those functions authorized by law or administrative rule shall be performed by the named person approved by the Board. Section 328.23b Retired Volunteer Licenses â&#x20AC;&#x201C; Eligibility A dentist, dental hygienist or dental assistant who has been licensed or permitted in good standing with the Board in excess of twenty (20) years who has reached the age of sixty-five (65) years or who has practiced for thirty (30) years on a consecutive basis may apply for a retired volunteer dentist, dental hygienist or dental assistant license or permit on a yearly basis to provide volunteer services. There shall be no continuing education requirements. A retired dentist, dental hygienist or dental assistant with a retired volunteer license or permit shall not receive payment either directly or indirectly for work provided. Section 328.24. - Dental Assistant and Oral Maxillofacial Surgery Assistant Permits - Application - Expanded Duty Permits A. No person shall practice as a dental assistant or oral maxillofacial surgery assistant for more than one (1) day in a calendar year without having applied for a permit as a dental assistant or oral maxillofacial surgery assistant from the Board of Dentistry within thirty (30) days of beginning employment. During this time period, the dental assistant shall work under the direct visual supervision of a dentist at all times. B. The application shall be made to the Board in writing and shall be accompanied by the fee established by the Board, together with satisfactory proof that the applicant passes a background check with criteria established by the Board. C. Beginning January 1, 2020, every dental assistant receiving a permit shall complete a class on infection control as approved by the Board within one (1) year from the date of receipt of the permit. Any person holding a valid dental assistant permit prior to January 1, 2020, shall complete an infection-control class as approved by the Board before December 31, 2020. Failure to complete the class shall be grounds for discipline pursuant to Section 328.29a of this title. D. There shall be five types of expanded duty permits available for dental assistants upon completion of a program approved by the Commission on Dental Accreditation (CODA) or a course that has been approved by the Board: 1. Radiation safety; 2. Coronal polishing and topical fluoride; 3. Sealants; 4. Assisting in the administration of nitrous oxide; or 5. Assisting a dentist who holds a parenteral or pediatric anesthesia permit; provided, only the dentist may administer anesthesia and assess the patient's level of sedation. E. The training requirements for all five expanded duty permits shall be set forth by the Board. A program that is not CODA-certified must meet the standards set forth and be approved by the Board. F. An applicant for a dental assistant permit who has graduated from a dental assisting program accredited by CODA and has passed the jurisprudence test shall receive all five expanded duty permits provided for in subsection D of this section if the course materials approved by the Board are covered in the program. G. A dental assistant who holds an out-of-state dental assistant permit with expanded duties may apply for credentialing and reciprocity for a dental assistant permit including any expanded duty by demonstrating the following: 1. The dental assistant has had a valid dental assistant permit in another state for a minimum of two (2) years and is in good standing; 2. The dental assistant has had a valid expanded duty in another state for a minimum of one (1) year; and 3. The dental assistant provides a certificate or proof of completion of an educational class for the expanded duty and that the dental assistant has been providing this treatment to dental patients while working as a dental assistant in a dental office for one (1) year. 418

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants H. Any person having served in the military as a dental assistant shall receive credentialing and reciprocity for expanded functions by demonstrating the following: 1. Proof of military service in excess of two (2) years with any certifications or training in the expanded function areas; and 2. Verification from the commanding officer of the medical program or the appropriate supervisor stating that the dental assistant provided the expanded functions on patients in the military dental facility for a minimum of one (1) year within the past five (5) years. Section 328.25. - Oral Maxillofacial Surgery Assistant Permit - Application and Requirements - Temporary Training Permit - Requirement of Supervision - Continuing Education A. No person shall practice as an oral maxillofacial surgery assistant without having obtained a permit as an oral maxillofacial surgery assistant from the Board of Dentistry. B. Any person seeking to obtain an oral maxillofacial surgery assistant permit must have a supervising oral maxillofacial surgeon with a current Oklahoma license and complete the requirements set forth by the Board. C. The application shall be made to the Board in writing and shall be accompanied by the fee established by the Board, together with the satisfactory proof that the applicant: 1. Passes a background check with criteria established by the Board; and 2. Has completed all of the training requirements for the oral maxillofacial surgery assistant permit as established by the Board. D. An oral maxillofacial surgery assistant permit shall be considered a temporary training permit until all of the training requirements, as established by the Board for each oral maxillofacial surgery assistant, have been completed and approved by the Board. E. A temporary training permit for each oral maxillofacial surgery assistant shall not be extended beyond two (2) years. F. All oral maxillofacial surgery assistants are required to be under direct supervision or direct visual supervision at all times by a licensed oral maxillofacial surgeon. G. If an oral maxillofacial surgery assistant is not currently employed by an oral maxillofacial surgeon, the oral maxillofacial surgery assistant permit shall automatically revert to a dental assistant permit as set forth in Section 328.24 of this title and may be eligible for an expanded function assisting a dentist who holds a parenteral or pediatric anesthesia permit; provided, only the dentist may administer anesthesia and assess the patient's level of sedation. The oral maxillofacial surgery assistant permit may be reinstated upon employment under a licensed oral maxillofacial surgeon. H. Any oral maxillofacial surgeon shall notify the Board within thirty (30) days of an oral maxillofacial surgery assistant no longer under his or her supervision. I. An applicant for an oral maxillofacial surgery assistant permit shall provide satisfactory proof of: 1. Successful completion of the Dental Anesthesia Assistant National Certification Examination (DAANCE) provided by the American Association of Oral Maxillofacial Surgeons (AAOMS) or another program or examination as approved by the Board; 2. A valid BLS certification; 3. Employment and completion of a minimum of six (6) months of training under the direct supervision of a licensed oral maxillofacial surgeon prior to starting DAANCE or another program or examination as approved by the Board; 4. A standardized course approved by the Board including a minimum of four (4) hours of didactic training that must include anatomy, intravenous access or phlebotomy, technique, risks and complications, and hands-on experience starting and maintaining intravenous lines on a human or simulator/manikin, and pharmacology; 5. Completion of an infection-control course as approved by the Board. J. An oral maxillofacial surgery assistant who has completed all the requirements shall receive a permit to practice as an oral maxillofacial surgery assistant within a dental office, surgery center, dental ambulatory surgery center or hospital. K. Oral maxillofacial surgery assistants shall be required to complete twelve (12) hours of continuing education every three (3) years in classes approved by AAOMS that are certified by the American Dental Association CERP program or another program approved by the Board. The continuing education requirement shall include at least one (1) hour on infection control. L. The anesthesia committee provided pursuant to Section 328.17 of this title may make a recommendation to the Board for an oral maxillofacial surgery assistant holding a temporary training permit to substitute training received from another state university, dental school or technical training institute or training acquired in a surgery center or hospital while working under the authority of a licensed physician, to qualify as a partial substitute for the requirements to attain an oral maxillofacial surgery assistant permit. M. An oral maxillofacial surgery assistant may only accept delegation from an oral and maxillofacial surgeon: 1. Under direct supervision: a. initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation or general anesthesia, or b. draw up and prepare medications; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

419

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants 2. Under direct visual supervision: a. follow instructions of the oral surgeon while acting as an accessory hand on behalf of the oral surgeon that is administering the medication and actively treating the patient. For the purposes of this section, "administer" means to have the sole responsibility for anesthesia care, including determining medicines to be used and the dosage, timing, route of delivery and administration of medication and the assessment of the level of anesthesia and monitoring the physiological results of such care; provided, only an oral surgeon or dentist possessing a current general anesthesia permit may administer or assess the level of sedation or general anesthesia and monitor the results of such care, b. follow instructions of the oral surgeon to adjust the rate of intravenous fluids to maintain or keep the line patent or open and adjust an electronic device to provide medications such as an infusion pump, and c. assist the oral surgeon by reading, recording vital signs of a patient receiving deep sedation or general anesthesia; provided, only an oral surgeon may assess the level of sedation; and 3. Only an oral surgeon shall be responsible to diagnose, treat, monitor, determine and administer the selection of the drug, dosage, and timing of all anesthetic medications and care of the patient through the perioperative period shall rest solely with the supervising oral and maxillofacial surgeon. 4. Nothing in this act shall be construed as to allow an oral surgery assistant or dental assistant to administer anesthesia care to a patient. Section 328.26 - Issuance of Dental Intern or Resident Permit H. Students currently enrolled at the University of Oklahoma College of Dentistry or an accredited dental hygiene or dental assisting program shall be exempted from Sections 328.19 and 328.21 of this title while participating in an educational program located at the University of Oklahoma College of Dentistry or the clinic of an accredited dental hygiene or dental assisting program. A licensed dentist, hygienist or faculty license holder shall be physically present in the facility whenever students of dentistry, dental hygiene or dental assisting are performing a clinical dental procedure on patients. Section 328.27 - Faculty licenses and faculty specialty licenses E. Courses for expanded duties for dental assistants pursuant to the administrative rules of the Board may be taught in an online, interactive online, in-classroom, lab or blended format. All expanded-duty courses shall include a dentist or dental hygienist that is employed full- or part-time by an educational program approved by the Commission on Dental Accreditation and currently on file with the Board. Courses offered pursuant to this subsection shall meet all criteria in administrative rules approved by the Board. Section 328.29a - Revocation or Suspension Dental Assistant Permit - Discipline by Probation or Censure, Public or Private A. The following acts or occurrences by a dental assistant or oral maxillofacial surgery assistant shall constitute grounds for which the penalties specified in Section 328.44a of this title may be imposed by the Board of Dentistry or be the basis for denying a new applicant any license or permit issued by the Board: 1. Any of the causes now existing in the laws of the State of Oklahoma 2. A violation of the provisions of the State Dental Act; or 3. A violation of the rules of the Board promulgated pursuant to the State Dental Act. B. The board shall also have the power to act upon a petition by a dental assistant or oral maxillofacial surgery assistant for reinstatement to good standing. The Board shall keep a record of the evidence and proceedings in all matters involving the revocation or suspension of a permit, censure or probation of a dental assistant or oral maxillofacial surgery assistant. The Board shall make findings of fact and a decision thereon. The Board shall immediately forward a certified copy of the decision to the dental assistant or oral maxillofacial surgery assistant involved by registered mail to the last-known official address as recorded by the Board. C. The decision shall be final unless the dental assistant or oral maxillofacial surgery assistant appeals the decision as provided by the State Dental Act. D. The Board shall have power to revoke or suspend the permit , censure, or place on probation a dental assistant or oral maxillofacial surgery assistant for a violation of one or more of the following: 1. Pleading guilty or nolo contendere to, or being convicted of, a felony crime that substantially relates to the occupation of a dental assistant or oral maxillofacial surgery assistant and poses a reasonable threat to public safety, or a violation of federal or state controlled dangerous substances laws; 2. Presenting to the Board a false application or documentation for a permit; 3. Being, by reason of persistent inebriety or addiction to drugs, incompetent to continue to function as a dental assistant or oral maxillofacial surgery assistant; 4. Functioning outside the direct or direct visual supervision of a dentist; 5. Performing any function prohibited by Chapter 15 of the Oklahoma Administrative Code or any violation that would be a violation for a dentist or hygienist under Section 328.32 or 328.33 of this title, or any other duty not assignable to a dental assistant; or 6. Failure to secure an annual registration as specified in Section 328.41 of this title. 420

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants E.

The Board's review panel, as set forth in Section 328.43a of this title, upon concurrence with the president of the Board, may determine that an emergency exists to temporarily suspend the permit of a dental assistant or oral maxillofacial surgery assistant if the panel finds that public health, safety or welfare imperatively requires emergency action. The panel may conduct a hearing pursuant to Section 314 of Title 75 of the Oklahoma Statutes for the temporary suspension. F. As used in this section: 1. "Substantially relates" means the nature of criminal conduct for which the person was convicted has a direct bearing on the fitness or ability to perform one or more of the duties or responsibilities necessarily related to the occupation; and 2. "Poses a reasonable threat" means the nature of criminal conduct for which the person was convicted involved an act or threat of harm against another and has a bearing on the fitness or ability to serve the public or work with others in the occupation. Section 328.32. Dentists - Grounds for penalties. A. The following acts or occurrences by a dentist shall constitute grounds for which the penalties specified in Section 328.44a of this title may be imposed by order of the Board of Dentistry or be the basis for denying a new applicant any license or permit issued by the Board. 7. Authorizing or aiding a dental assistant or oral maxillofacial surgery assistant to perform any procedure prohibited by the State Dental Act or the rules of the Board; 23. Having more than the equivalent of three full-time dental hygienists for each dentist actively practicing in the same dental office; 24. Allowing a person not holding a permit or license issued by the Board to assist in the treatment of a patient without having a license or permit issued by the Board; 26. Authorizing or aiding a dental hygienist, dental assistant, oral maxillofacial surgery assistant, dental laboratory technician, or holder of a permit to operate a dental laboratory to violate any provision of the State Dental Act or the rules of the Board; Section 328.34 - Dental Hygienists - Scope of Practice B. 1. A dentist may delegate to a dental hygienist the following procedures: e. prophylaxis, which means the removal of any and all calcareous deposits, stains, accretions, or concretions from the supragingival and subgingival surfaces of human teeth, utilizing instrumentation by scaler or periodontal curette on the crown and root surfaces of human teeth, including rotary or power-driven instruments. This paragraph shall not be construed to prohibit the use of a prophy/polishing cup or brush on the crowns of human teeth by a dental assistant who holds a current expanded duty permit for Coronal Polishing/Topical Fluoride issued by the Board, H. Nothing in the State Dental Act shall be construed to allow a dental assistant to work under the supervision of a dental hygienist while acting under direct, indirect or general supervision. Section 328.41 - Renewal certificate – Fee – Waiver – Automatic cancellation. A. 1. On or before the last day of December of each year, every dentist, dental hygienist, dental assistant, oral maxillofacial surgery assistant and other licensee or permit holders previously licensed or permitted by the Board to practice in this state, with the exception of those listed in paragraph 2 of this subsection, shall submit a completed renewal application with information as may be required by the Board, together with an annual renewal fee established by the rules of the Board. Upon receipt of the annual renewal fee, the Board shall issue a renewal certificate authorizing the dentist, dental hygienist, dental assistant, or oral maxillofacial surgery assistant to continue the practice of dentistry or dental hygiene, respectively, in this state for a period of one (1) year. Every license or permit issued by the Board shall begin on January 1 and expire on December 31 of each year. 2. Beginning July 1, 2017, resident and fellowship permits shall be valid from July 1 through June 30 of each year and dental student intern permits shall be valid from August 1 through July 31 of each year. B. Continuing education requirements shall be due at the end of each three-year period ending in 2019 as follows: 1. Beginning July 1, 2019, through June 30, 2021, continuing education requirements shall be due at the end of each two-year period as follows: c. oral maxillofacial surgery assistants shall complete eight (8) hours, d. dental assistants shall have two (2) hours of infection control, and 3. Beginning in 2020, continuing education requirements shall be due at the end of each two-year period as follows: c. OMS assistants shall complete eight (8) hours, and d. dental assistants shall have two (2) hours of infection control. C. Upon failure of a dentist, dental hygienist, dental assistant, or oral maxillofacial surgery assistant to pay the annual renewal fee within two (2) months after January 1, the Board shall notify the dentist, or dental hygienist, dental assistant, or oral maxillofacial surgery assistant in writing by certified mail to the last-known mailing address of the dentist, dental hygienist, dental assistant, or oral maxillofacial surgery assistant as reflected in the records of the Board. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

421

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants D. Any dentist, dental hygienist, dental assistant, or oral maxillofacial surgery assistant whose license or permit is automatically canceled by reason of failure, neglect or refusal to secure the renewal certificate may be reinstated by the Board at any time within one (1) year from the date of the expiration of the license, upon payment of the annual renewal fee and a penalty fee established by the rules of the Board. If the dentist, dental hygienist, dental assistant, or oral maxillofacial surgery assistant does not apply for renewal of the license or permit and pay the required fees within one (1) year after the license has expired, then the dentist, dental hygienist, dental assistant, or oral maxillofacial surgery assistant shall be required to file an application for and take the examination or other requirements provided for in the State Dental Act or the rules promulgated by the Board before again commencing practice. G. A dentist, dental hygienist, oral maxillofacial surgery assistant or dental assistant that is in good standing and not under investigation that notifies the Board in writing of a voluntary nonrenewal of license or requests retirement status shall have a right to renew or reinstate his or her license within five (5) years from the date of notice. The Board may require any training or continuing education requirements to be met prior to reinstatement. H. A dentist, dental hygienist, oral maxillofacial dental assistant or dental assistant that has not had an active license or permit in excess of five (5) years shall be required to apply as a new applicant. I. Any application for a license or permit that has remained inactive for more than one (1) year shall be closed. Section 328.51a. Fees. A. The Board of Dentistry is authorized to charge the following fees for the purpose of implementing and enforcing the State Dental Act. The penalty and late fee shall be twice the amount of the original fee for license renewals. Notwithstanding any other provisions of the State Dental Act, the fees established by the Board shall be not less nor more than the range created by the following schedule: Minimum

Maximum

1. LICENSE AND PERMIT APPLICATION FEES: h.

Dental Assistant or Oral Maxillofacial Surgery Assistant Permit

$50.00

$100.00

Dental Assistant with Expanded Duty or Duties by Credential

$100.00

$200.00

$50.00

$100.00

3. ANNUAL RENEWAL FEES: f.

Dental Assistant, Oral Maxillofacial Surgery Assistant, or Dental Student Intern Permit Oklahoma Administrative Code Title 195 - Board of Dentistry

CHAPTER 15. Duties for Dental Assistants and the Rules Regulating the Practice of Dental Hygiene 195:15-1-1. Purpose The purpose of this Chapter is to set forth the duties and procedures that a dentist may properly delegate to dental assistants and the rules regulating the practice of dental hygiene. 195:15-1-1.1 Definitions The following words and terms, when used in this Chapter, shall have the following meanings, unless the context clearly indicates otherwise: “Advanced procedure” means a dental procedure for which a dental hygienist has received special training in a course of study approved by the Board. “Dental hygiene” means the science and practice of the promotion of oral health and prevention and treatment of oral disease through the provision of educational, therapeutic, clinical and preventive services. “Direct supervision” is defined by Title 59 O.S. Section 328.3 (State Dental Act). “Expanded duty” means a dental procedure for which a dental assistant has received special training in a course of study approved by the Board. “General supervision” is defined by Title 59 O.S. Section 328.3 (State Dental Act). “Indirect supervision” is defined by Title 59 O.S. Section 328.3 (State Dental Act). “Patient” or “patient of record” means an individual who has given a medical history, and has been examined and accepted for dental care by a dentist. “Supervision” means direct supervision, indirect supervision, or general supervision. 195:15-1-2. Responsibility of employing dentist for dental hygienists and dental assistants Every dentist who employs one or more dental hygienists or dental assistants has the primary responsibility to ensure that the dental hygienists or dental assistants do not perform any procedure or duty except as authorized by this Chapter or the State Dental Act. No dentist shall delegate to a dental hygienist or dental assistant, nor shall any dental hygienist or dental assistant perform, any procedure or duty not authorized by this Chapter or the State Dental Act. 422

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants 195:15-1-3. Duties that may be delegated to dental assistants (a) It is the determination of the Board that many duties performed by a dental assistant are of a nature which do not require formal training or a permit from the Board in order to protect the health, safety, and welfare of the public. Except as otherwise provided in 195:15-1-4 and 195:15-1-5, a dentist may delegate to a dental assistant any duty for which the dental assistant has received adequate office-based training by the supervisory dentist to ensure that the dental assistant is properly aware of all requirements and responsibilities of each duty to be performed. (b) Duties delegated to a dental assistant may be performed only on a patient of record and only under the direct supervision of a dentist. 195:15-1-4. Expanded duty permits for dental assistants; fees (a) It is the determination of the Board that certain duties may be performed by a dental assistant who has satisfactorily completed a course of study regarding the performance of such duties. Applicants who successfully complete recognized expanded duty training at a formal dental assisting program approved by the Board and the Commission on Dental Accreditation shall be eligible for permits. Pursuant to paragraph 9 of subsection B of 59 O.S., Section 328.15, the Board hereby establishes four (4) expanded duty permits for dental assistants with definitions, requirements, and course guidelines as follows: (1) Radiation Safety. (A) Definition: A dental assistant holding this expanded duty permit may expose intra-oral and extra-oral radiographs. (B) Requirement: Satisfactory completion of a course of study in radiation safety and protection, consisting of a minimum of seven (7) hours, approved by the Board. After satisfactory completion of the course of study, each applicant shall submit written verification from the applicantâ&#x20AC;&#x2122;s current employing dentist attesting to competent clinical experience. All applications shall contain both signatures of the employing dentist and the student. (C) Course Guidelines: (i) Minimum standards for courses to train dental assistants to expose intra-oral and extraoral radiographs are as follows: (I) The instruction level shall meet level 4 of the Board's Guide to Curriculum Development for Expanded Duties. (II) Courses shall be taught by licensed dentists, licensed dental hygienists or dental assistants who have been issued expanded duty permits in radiation safety by the Board. Further, instructors shall have a minimum of one year of experience exposing radiographs. (III) The course shall be a minimum of seven (7) hours in length for the instructional portion. (IV) Expanded duty permits will require a clinical portion in which each student shall complete 200 radiographs, no more than five can be panoramic, as certified by employing dentist. (ii) The course shall be designed and conducted to provide each student with a thorough knowledge about the exposure of radiographs. Upon completion of the course, students shall be able to apply this knowledge to expose radiographs safely as instructed. (iii) The instruction portion of the course shall include instruction in: (I) Radiation physics; (II) Radiation biology; (III) Radiation health, safety and protection; (IV) Radiographic films and film quality; (V) Principles of radiographic techniques; (VI) Darkroom and processing techniques; (VII) Film mounting. (iv) Students shall be provided a course outline setting forth materials to be presented in the course and evaluation criteria established by the course provider for the course. (v) At one point during the course and upon completion of the class, students shall be evaluated by the course presenters by written examination. The examination shall cover the didactic portion of the course. Each student's written examinations shall be maintained by the course provider for a minimum period of one (1) year following completion of the examination. Each course provider shall, prior to beginning a course, allow a member of the Board or its designee to review the examination. The passing grade is set at 70%. (vi) Each course provider shall, within thirty (30) days after completion of a course, submit to the Board a list of the names of each of the students at the course and each student's final grade in the course. (vii) The course provider shall create and maintain records on each student, including test score for a one (1) year period. The director of the educational portion of the program shall sign a statement in the scholastic record attesting to the student's proficiency in the expanded duty.

423

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants (viii) Courses offered pursuant to this rule are subject to unannounced audits by the Board. Any Board member or designee of the Board shall be provided full access to course materials or the classroom or clinic during instruction. Failure to provide access pursuant to this provision may subject the provider to invalidation of course results. (2) Coronal Polishing/Topical Fluoride (A) Definition: A dental assistant holding this expanded duty permit may: (i) Polish coronal surfaces of teeth, or prepare teeth for band cementation or bonding of brackets utilizing a slow speed rotary handpiece and rubber cup or brush (examination for calculus and scaling must be done by a dentist or dental hygienist), and (ii) Apply topical fluoride and desensitizing agents. (B) Requirement: Satisfactory completion of a course of study, including a clinical component, in coronal polishing and the application of topical fluoride and desensitizing agents, consisting of a minimum of fourteen (14) hours, approved by the Board. (C) Course Guidelines: (i) For the purposes of this section, training necessary to prepare teeth for band cementation is accomplished by proper training in coronal polishing, as set forth in this section. Training for coronal polishing and applying topical fluoride and desensitizing agents shall be undertaken only in a single course which complies with all provisions of this section. Minimum standards for courses to train dental assistants to perform coronal polishing or to apply topical fluoride or desensitizing agents are as follows: (I) The course shall be open only to applicants with a minimum of one year of active chair side experience as a dental assistant, of which no less than six (6) months shall be in any one practice. (II) The instruction level shall meet level 4 of the Board's Guide to Curriculum Development. (III) The course shall be taught by licensed dentists, licensed dental hygienists or dental assistants who have been issued expanded duty permits in coronal polishing/topical fluoride or preparing teeth for band cementation by the Board. Dental assistants shall not conduct didactic portions of the class, but may undertake clinical training or evaluation. (IV) The course shall be a minimum of fourteen (14) hours in length for the instructional portion. (ii) The course shall be designed and conducted to provide each student the ability to manipulate polishing instruments correctly and remove all plaque and extrinsic stains that do not require scaling from the exposed surfaces of teeth without trauma to the teeth or gingiva. The course shall further provide each student with necessary knowledge about currently accepted topical fluoride and desensitizing agents and the ability to apply such fluoride agents to accomplish caries prevention. (iii) The didactic portion of the course shall include instruction in: (I) Principles of plaque and stain formation; (II) The clinical appearance of plaque, intrinsic and extrinsic stains and calculus (removal of calculus and scaleable stains shall be accomplished only by a dentist or dental hygienist); (III) The clinical appearance of clean and polished teeth; (IV) Tooth morphology and the anatomy of the oral cavity as they relate to the retention of plaque, stain and polishing techniques; (V) Principles of selecting abrasives and polishing agents and their effect on tooth structure and restorative materials; (VI) Principles of polishing, including the selection and care of the armamentarium, instrumentation techniques and precautions, including the care of the mouth with fixed or removable prostheses and/or orthodontic appliances; (VII) Principles of aseptic technique, including the sterilization of instruments, sanitation of equipment, and control of disease transmission; (VIII) Principles of selecting and applying disclosing agents, including armamentarium, technique and precautions; (IX) Principles of the preparation of teeth and the oral cavity for fluoride application; (X) The reaction of fluorides with tooth structure; (XI) Available fluoride agents; (XII) Principles of the preparation and storage of fluoride agents; (XIII) Principles of application techniques, including the selection and care of armamentarium, the isolation of teeth, adaptation of trays, techniques and precautions. (iv) The clinical portion of the course shall include hands on experience in: (I) Identifying calculus, plaque, and intrinsic and extrinsic stains; (II) Polishing exposed surfaces of teeth; (III) Applying disclosing agents to the exposed surface of teeth; (IV) Evaluating the extent of plaque and stain removal; (V) Maintaining the polishing armamentarium; (VI) Maintaining aseptic techniques; 424

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants (VII) Applying various fluoride agents; (VIII) Applying various desensitizing agents. (v) Students shall be provided a course outline setting forth materials to be presented in the course and evaluation criteria by the course provider for the course. (vi) The course shall include jurisprudence aspects, as follow: (I) Legal limitations of dental assistants; (II) Limitations on assistant services; (III) Penalties for violation of the State Dental Act or rules of the Board; (IV) Mechanisms by which a person can report violations of the State Dental Act or rules of the Board to the Board. (vii) The course provider shall conduct clinical experience of at least two (2) hours, including at least a onehalf hour demonstration by an instructor. The clinical experience shall include all significant portions of the didactic instruction. Student/Faculty ratio shall be no greater than 1-6 on all clinical requirements. (viii) Upon completion of the course, students shall be evaluated by written examination. The examination shall cover the didactic portion of the course. The passing grade is set at 70%. A student who fails the examination may retake the examination no more than two (2) times. In the event a student takes the examination three (3) times and fails each time, the student shall not sit for the examination for a period of one (1) year. At that time, the student may retake the course and retake the examination pursuant to this rule. Results of the examination shall be retained by the course provider for a minimum period of one (1) year following successful completion of the examination. Each course provider shall, prior to beginning a course, allow a member of the Board or its designee to review the examinations. (ix) Each course provider shall, within thirty (30) days after completion of a course, submit to the Board a list of the names of each of the students at the course and each student's final grade in the course. (x) The course provider shall create and maintain records on each student, including test score of clinical testing, in the clinical test for a one (1) year period. The director of the educational portion of the program shall sign a statement in the scholastic record attesting to the student's proficiency in the expanded duty. (xi) Courses offered pursuant to this section are subject to unannounced audits by the Board. Any Board member or designee shall be provided full access to course materials or the classroom or clinic during instruction. Failure to provide access may subject the course provider to invalidation of course results. (3) Sealants (A) Definition: A dental assistant holding this expanded duty permit may place pit and fissure sealants. (B) Requirement: Satisfactory completion of a course of study in the placement of pit and fissure sealants, consisting of a minimum of twelve (12) hours, approved by the Board. A dental assistant must hold a current expanded duty permit in Coronal Polishing/Topical Fluoride prior to enrolling in a course of study in the placement of pit and fissure sealants. (C) Course Guidelines: (i) Minimum standards to train dental assistants in the placement of pit and fissures sealants are as follows (I) The instruction level shall meet level 4 of the Board's Guide to Curriculum Development for Expanded Duties. (II) Courses shall be taught by licensed dentists or dental hygienists. Instructors shall have a minimum of one year clinical experience in the placement of pit and fissure sealants. (III) The course shall be a minimum of twelve (12) hours in length. (IV) Expanded duty permits will require a clinical portion in which each student shall complete pit and fissure sealants on at least four teeth on at least one patient. (V) Each applicant who completes the clinical portion will be required to submit verification from employing dentist that he/she has completed eight additional sealants on patients under the direct supervision in a dental office. Verification shall be submitted within one year of completion of the course. (VI) Applicants shall have a minimum of one year clinical experience as a dental assistant. (ii) The Course shall be designed to provide the student with a thorough knowledge of placement of pit and fissure sealants. (iii) The didactic portion of the course shall include instruction in (I) Indication/contraindications for sealants; (II) Preparation of teeth for sealants; (III) Proper isolation of teeth for sealants; (IV) Education of patient and/or parent regarding sealants; (V) Dental materials; (VI) Infection control; (VII) Tooth anatomy; and (VIII) Armamentarium; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

425

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants (iv) The clinical portion of the course shall include: (I) Patient assessment; (II) Proper tooth isolation and preparation for sealants; (III) Infection control; (IV) Evaluation of proper technique in the placement of sealants; (V) Evaluation by instructors of completed sealants; and (VI) Patient education; (v) The clinical experience shall be at least five (5) hours, including a one (1) hour demonstration by an instructor. The clinical experience shall include all applicable portions of the didactic instruction. Each student shall complete eight sealants on eight additional teeth. Student/faculty ratio shall be no greater than 1-6 on all clinical requirements. (vi) Upon completion of the course, students shall be evaluated by written examination. The passing grade is set at 70%. A student who fails the examination may retake the examination no more than two (2) times. In the event a student takes the examination three (3) times and fails, the student shall not sit for the examination again for at least one (1) year. At that time the student may retake the course and retake the examination pursuant to this rule. (vii) Each course provider shall, within thirty (30) days after completion of a course, submit to the Board a list of the names of each student attending the course and each student's final grades. (viii) The course provider shall create and maintain records on each student, including all test scores for one (1) year. The director of the educational program shall sign a statement in the scholastic record attesting to the student's proficiency in the expanded duty. (ix) Courses offered pursuant to this section are subject to unannounced audits by the Board. Any Board member or designee shall be provided full access to course materials or the classroom or clinic during instruction. Failure to provide access may subject the course provider to invalidation of course results. (4) Nitrous Oxide (A) Definition: A dental assistant holding this expanded duty permit may assist a dentist or a dental hygienist who holds an advanced procedure permit in the administration of nitrous oxide. (B) Requirement: Satisfactory completion of a course of study in nitrous oxide administration, consisting of a minimum of twelve (12) hours, approved by the Board. (C) Course Guidelines: (i) The courses shall be open only to applicants with a minimum of one (1) year of active experience as a dental assistant. (ii) The instruction shall meet level 3 of the Board's Guide to Curriculum Development. (iii) The course shall be taught by licensed dentists or licensed dental hygienists with a minimum of one (1) year experience in teaching advanced education in comprehensive pain and anxiety control and with one (1) year of clinical experience in nitrous oxide administration. (iv) The minimum course length shall be twelve (12) hours. (v) The ratio of faculty to student shall be no greater than 1 to 10. (vi) The course shall be designed and conducted to provide the student with detailed knowledge of nitrous oxide oxygen inhalation sedation and its use in dentistry. Upon successful completion of the course, the student shall be trained to assist in the administration of nitrous oxide in an office setting safely and as needed. (vii) The didactic portion of the course shall include: (I) The history, philosophy and psychology of nitrous oxide-oxygen inhalation sedation; (II) Definition and descriptions of the physiological and psychological aspects of pain and anxiety; (III) A description of the stages of drug induced central nervous system depression through all levels of consciousness and unconsciousness, with special emphasis on the distinction between the conscious and unconscious state; (IV) The anatomy and physiology of respiration; (V) The pharmacological and physiological effects of nitrous oxide for analgesia and sedation, including physical properties, action, side effects, absorption, excretion and toxicity; (VI) The advantages and disadvantages of inhalation sedation with nitrous oxide; (VII) The management of reaction to, or complications of nitrous oxide; (VIII) Matters regarding patient status assessment, including: a. Taking and reviewing a thorough health history, including vital signs; b. Implications of health history problems related to sedation; c. Indications and contra-indications of conscious sedation; (IX) The description and use of inhalation sedation equipment; (X) Introduction of nitrous oxide to the patient; (XI) Precautions for the successful introduction of nitrous oxide to the patient; (XII) Dosages and needs of the patient; (XIII) Patient monitoring, specifically to include vital signs and reflexes related to consciousness; 426

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants

(b) (c) (d) (e) (f) (g) (h)

(XIV) Possible reaction to nitrous oxide; (XV) Return of the patient to pre-sedation status and instructions for post-operative care; (XVI) Hazards of nitrous oxide to the patient and operator; (XVII) The recognition, prevention and management of complications and life threatening situations related to nitrous oxide; (XVIII) Legal considerations of nitrous oxide; and (XIX) The introduction to potential health hazards of trace anesthetics and proposed techniques for the elimination thereof. (viii) The clinical portion of the course shall include: (I) Patient status assessment; (II) Use of various nitrous oxide machines; (III) Introduction of nitrous oxide to the patient; (IV) Monitoring of the patient; (V) Return of the patient to pre-sedation status; (VI) Post-operative care of the patient and provision of instructions to the patient; and (VII) C.P.R. (ix) The clinical experience shall be at least two (2) hours, including at least a one-half hour demonstration by an instructor. The clinical experience shall include all significant portions of the didactic instruction. When not medically inappropriate, each student shall be afforded the opportunity to experience the effects of nitrous oxide. Student/faculty ratio shall be no greater than 1-10 on all clinical requirements. (x) Upon completion of the course, students shall be evaluated by written examination. The examination shall cover the didactic portion of the course. The passing grade is set at 70%. A student who fails the examination may retake the examination no more than two (2) times. In the event a student takes the examination three (3) times and fails each time, the student shall not sit for the examination for a period of one (1) year. At that time, the student may retake the course and retake the examination pursuant to this rule. Results of the examination shall be retained by the course provider for a minimum period of one (1) year following successful completion of the examination. Each course provider shall, prior to beginning a class, allow a member of the Board or its designee to review the examinations. (xi) Each course provider shall, within thirty (30) days after completion of a course, submit to the Board a list of the names of each of the students at the course and each student's final grade in the course. (xii) The course provider shall create and maintain records on each student, including test score of clinical testing, in the clinical test for a one (1) year period. The director of the educational portion of the program shall sign a statement in the scholastic record attesting to the student's proficiency in the expanded duty. An application by a dental assistant for an expanded duty permit shall be made on a form prescribed by the Board, which shall be accompanied by the fee set forth in 195: 2-1-7. Except as provided in (e), an expanded duty permit shall be automatically revoked if the holder thereof fails to secure an annual renewal of the permit within three (3) months from the 31st day of December of each year. The expanded duties specified in (a) may be performed by a dental assistant only on a patient of record and only under the direct supervision of a dentist. Expanded duty permits for Radiation Safety need not be renewed. Dental assistants performing expanded duties shall prominently display the expanded duty permit at their place of employment. All students who successfully complete expanded duty courses shall have one (1) year to secure a permit. Failure to submit an application within one (1) year from the date of the course shall result in the student being denied a permit and required to retake the approved expanded duty course. All expanded duty permit holders shall provide proof of current CPR provided by the American Heart Association/ Health Care Provider Level or the American Red Cross/Professional Rescuer.

195:15-1-5. Duties not assignable to dental assistants A dentist shall not delegate to a dental assistant, nor shall a dental assistant perform, any of the following procedures and duties: (1) Diagnosis; (2) Treatment planning; (3) Prescription of medications; (4) Final placement or removal of orthodontic brackets and bands; (5) Removal of fully hardened cement; (6) Surgery or the cutting or severance of hard and soft tissue; (7) Placement or adjustment of any removable or fixed prosthesis; (8) Placement or removal of restorative materials in a human oral cavity; (9) Administration of injectable local anesthesia; (10) Utilization of a laser; (11) Administration of nitrous oxide; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

427

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants (12) Any procedure that may contribute to or result in an irreversible alteration of the human oral anatomy; (13) An expanded duty as set forth in 195:15-1-4, when the dental assistant does not hold a current permit issued by the Board for the expanded duty; and (14) Those procedures allocated exclusively to dental hygienists by 195:15-1-6 or the State Dental Act. CHAPTER 20. Rules Governing the Administration of Anesthesia 195:20-1-2. Definitions The following words and terms, when used in this chapter, shall have the following meaning, unless the context clearly indicates otherwise. These words and terms are as defined in the Guidelines for “Teaching the Comprehensive Control of Pain and Anxiety in Dentistry,” approved by the American Dental Association. “Analgesia” means the diminution or elimination of pain in the conscious patient. The conscious patient is defined as one with intact protective reflexes; including the ability to maintain an airway, and who is capable of rational response to questions or command. “Anxiolysis” means the diminution or elimination of anxiety. “Combination inhalation-enteral conscious sedation” (combined conscious sedation) means conscious sedation using inhalation and enteral agents except when the only intent is anxiolysis. “Conscious sedation” means a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method, or combination thereof. The caveat that loss of consciousness should be unlikely is a particularly important aspect of the definition of conscious sedation, and the drugs and techniques utilized should carry a margin of safety wide enough to render unintended loss of consciousness highly unlikely. “Deep sedation” means a controlled state of depressed consciousness, accompanied by partial or complete loss of protective reflexes, including the inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination thereof. “Direct Supervision” means the dentist responsible for the sedation/anesthesia procedure shall be physically present in the office and shall be continuously aware of the patient’s physical status and well being. “Enteral” means any technique of administration in which the agent is absorbed through the gastrointestinal tract (oral, rectal, sublingual). “General anesthesia” means a controlled state of unconsciousness, accompanied by partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination thereof. “Parenteral” means a technique of administration in which the drug bypasses the gastrointestinal tract and includes intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), subcutaneous (SC), or intraocular (IO). 195:20-1-3.1 Pediatric conscious sedation utilizing enteral methods (oral, rectal, sublingual) (c) Current training. A dentist who holds a permit for pediatric enteral conscious sedation shall satisfy all of the following: (1) Current certification in Basic Life Support (BLS). (2) At least one (1) assistant involved in the procedure currently certified in Basic Life Support for Health Care Providers by the American Heart Association. (3) Complete every three (3) years at least six (6) hours of courses related to the administration of sedation and medical emergencies. These six (6) hours are in addition to those accrued completing certification or re-certification in BLS. 195:20-1-4. Conscious sedation utilizing parenteral methods (c) Current training. A dentist who holds a permit for parenteral conscious sedation shall satisfy all of the following: (1) Current certification in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) by the American Heart Association. (2) Two (2) assistants involved in the procedure currently certified in Basic Life Support for Health Care Providers by the American Heart Association. (3) Complete every three (3) years at least six (6) hours of courses related to the administration of sedation, anesthesia or medical emergencies in the dental office. These six (6) hours are in addition to those accrued completing certification or re-certification in BLS and ACLS or PALS. 195:20-1-5. General anesthesia (to include deep sedation) (c) Current training. A dentist who holds a permit to provide general anesthesia (including deep sedation) shall Satisfy all of the following: (1) Current certification in Basic Life Support (BLS) and Advanced Life Support (ACLS) or Pediatric Advanced Life Support (PALS) by the American Heart Association. 428

Oklahoma State Dental Practice Act and Administrative Rules for Dental Assistants (2) Two (2) assistants involved in the procedure currently certified in Basic Life Support for Health Care Providers by the American Heart Association. (3) Complete every three years at least six (6) hours of courses related to the administration of anesthesia, sedation or medical emergencies in the dental office. These hours are in addition to those accrued completing certification or re-certification in BLS and ACLS or PALS. CHAPTER 35. Infection Control 195:35-1-2. Definitions “Barrier techniques” means the use of protective items against infection transmission during any intraoral or invasive procedure to include appropriate gloves for the procedure performed. This definition shall include protective eye wear and nasal/oral masks when “splash” splatter, or aerosol of body fluids is possible or expected. “Dental Health Care Worker” means a dentist or dental specialist, dental hygienist, dental assistant, dental laboratory technician, dental student, dental hygiene student, or dental assisting student. “Disinfection” means the partial elimination of active growth stage bacteria and the inactivation of some viruses. The potential for infection remains after disinfection, including infection with M tuberculosis, hepatitis A virus (HAV) and hepatitis B virus (HBV). The human immunodeficiency virus (HIV) may also remain active following disinfection. “Sterilization” means a process by which all forms of life within a defined environment are completely destroyed. 195:35-1-4. Dental health care workers (a) All dental health care workers shall comply with the following: (1) The universal precautions; recommended for dentistry by the Centers for Disease Control and Prevention (CDC); (2) The Guidelines on HIV Infected Health Care Workers adopted by the State Department of Health; and (3) The Guidelines on Hepatitis B Infected Health Care Workers adopted by the State Department of Health in the care, handling, and treatment of patients in the dental office or other setting where dental procedures of any type may be performed. (b) All dental health care workers who have infected or exudative lesions or weeping dermatitis shall; (1) Refrain from contact with equipment, devices and appliances that may be used for or during patient care, where such contact holds potential for blood or body fluid contamination, and (2) Refrain from all patient care and contact; until the condition(s) resolves. 195:35-1-5. Assessment and practice management of HIV and HBV infected dental health care workers (a) A dental health care worker who is subject to the counsel and prescribed conditions for practice of the State Department of Health Advisory Committee for HIV and/or HBV Infected Health Care Workers (henceforth known as the Advisory Committee), and who is allowed to continue to practice in whole or in part, shall comply with all terms and conditions of the Advisory Committee’s determinations and conditions for practice. (b) A dental health care worker who experiences a break in a barrier technique while treating a patient is required to temporarily cease treatment until the barrier technique can be fully restored. If bleeding or body fluid exposure to the patient presents a continued potential exposure after barrier techniques restoration, the dental health care worker must cease further direct contact with or treatment of the patient and shall be responsible for arranging for completion of the procedure being performed on the patient. (c) Following a break in a barrier technique, a dental health care worker who exposes the mucous membrane or non–intact skin of a patient to his or her blood shall undergo HIV and HBV surface antigen testing and ensure that the patient is notified of the exposure. The patient must be notified of the dental health care worker’s test results, observing the provisions of the Oklahoma Public Health Code regarding confidentiality of communicable disease test results. (d) A dental health care worker infected with HIV or HBV must notify the State Epidemiologist or his designee when a risk exposure noted in (c) has occurred.

429

Oregon DANB Certificant Counts: Oregon National Entry Level Dental Assistant (NELDA)

Certified Dental Assistant (CDA) certificants

827

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Stephen Prisby, Executive Director Oregon Board of Dentistry 1500 SW 1st Avenue, Suite 770 Portland, OR 97201 Phone: 971-673-3200 Fax: 971-673-3202 Email: information@oregondentistry.org Website: www.oregon.gov/dentistry

12,626

Infection Control (ICE)

4,109

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Central Oregon Community College Chemeketa Community College Lane Community College Linn-Benton Community College Portland Community College Umpqua Community College

DANB CDA Certificant State of Oregon+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 19, 2020.

430

Source: 2018 DANB Salary Survey (base on 15 responses in this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Oregon State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under general supervision* in Oregon, a dental assistant must: (1) Complete all of the following three requirements and apply to DANB for a state certificate of radiologic proficiency: (1a) complete a course approved by the Oregon Board of Dentistry (OBD)**, or submit evidence of equivalent training recognized by the Oregon Health Authority, Center for Health Protection, Radiation Protection Services and (1b) pass the national DANB Radiation Health and Safety (RHS) exam‡ and (1c) submit verification from an Oregon licensed dentist or Oregon licensed dental hygienist that the dental assistant is proficient to take radiographs, OR (2) Complete one of the following two requirements and apply to DANB for a state certificate of radiologic proficiency by credential: (2a) be certified in another state that has training and certification requirements substantially similar to Oregon’s or (2b) Obtain verification from an employer-dentist that the assistant has been employed for at least 1,000 hours in the past two years as a dental assistant (in a state other than Oregon) and is competent to take radiographs. * Note: A dentist or dental hygienist may authorize a dental assistant who has completed the course and written exam requirements described above to perform radiographic procedures under the indirect supervision of a dentist, dental hygienist, or dental assistant who holds an Oregon Radiologic Proficiency Certificate. Within six months of beginning to expose radiographs, as authorized by an Oregon licensed dentist or Oregon licensed dental hygienist, the dental assistant must submit verification from an Oregon licensed dentist or dental hygienist that the assistant is proficient to take radiographs. ** The DALE Foundation’s DANB RHS® Review course is approved by the Oregon Board of Dentistry and meets the course requirement to earn the Oregon Radiologic Proficiency Certificate. For a complete list of accepted radiography courses, please contact the Oregon Board of Dentistry at information@oregondentistry.org.

State Requirements For Expanded Functions I. Expanded Functions – Dental Assisting. To perform expanded functions in Oregon under the supervision of a licensed dentist, a dental assistant must earn status as an Expanded Function Dental Assistant (EFDA). To qualify, one must meet the requirements of one of the following pathways: Pathway I: (1a) Hold an Oregon Certificate of Radiologic Proficiency (see requirements above), AND (1b) Successfully complete a CODA-accredited dental assisting program, AND (1c) Apply for the Oregon EFDA certificate (administered by DANB) Pathway II: (2a) Hold an Oregon Certificate of Radiologic Proficiency (see requirements above), AND (2b) Pass the national DANB Certified Dental Assistant (CDA) exam‡, AND (2c) Pass the Oregon Expanded Functions - General Dental Assisting exam‡ (ORXG) administered by DANB, AND (2d) Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements, AND (2e) Apply for the Oregon EFDA certificate (administered by DANB) Pathway IIIA: (3a-1) Hold an Oregon Certificate of Radiologic Proficiency (see requirements on above), AND (3a-2) Pass the Oregon Basic Dental Assisting (ORB) exam‡, AND (3a-3) Pass the Oregon Expanded Functions - General Dental Assisting (ORXG) exam‡, AND (3a-4) Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements, AND (3b-5) Apply for the Oregon EFDA certificate (administered by DANB) Pathway IIIB: (3b-1) Hold an Oregon Certificate of Radiologic Proficiency (see requirements on above), AND (3b-2) Pass the DANB Infection Control (ICE) exam‡, AND (3b-3) Pass the Oregon Expanded Functions - General Dental Assisting exam (ORXG)‡, AND (3b-4) Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements, AND (3b-5) Apply for the Oregon EFDA certificate (administered by DANB) ‡

The Oregon state dental practice act specifies that, in addition to the exams, courses and programs listed on this page, a dental assistant may complete any successor or otherwise Board-approved exams, courses, or programs. For more information, please contact the Oregon Board of Dentistry at 971-673-3200 or www.oregon.gov/dentistry. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

431

State Requirements For Expanded Functions, continued Pathway IV: (4a) Be certified in another state that has training and certification requirements substantially similar to Oregon's requirements or obtain verification from a licensed dentist of having been employed (outside the state of Oregon) for at least 1,000 hours in the past two years as a dental assistant performing expanded functions, AND (4b) Apply for the Oregon EFDA certificate, administered by DANB. Note: An EFDA may apply pit and fissure sealants, apply temporary soft relines to complete dentures for the purpose of tissue conditioning, and place retraction material subgingivally upon successful completion of a course of instruction (in the desired expanded function) in a CODA-accredited program or other course of instruction approved by the Oregon Board of Dentistry, provided that the procedure is checked by the supervising dentist or dental hygienist prior to dismissal of the patient. Sealants must be placed within 45 days of the procedure being authorized by a dentist or dental hygienist. Restorative Functions Certificate An EFDA may qualify to perform placement and finishing of direct restorations, except gold foil, under the indirect supervision of a dentist, subject to Oregon Board of Dentistry (OBD) regulations, by meeting the following requirements: (1a) Complete an OBD-approved curriculum from a CODA-accredited program or other course of instruction approved by the OBD, AND (1b) Pass the Western Regional Examining Board (WREB) Restorative Exam or other equivalent exam approved by the OBD within the five years preceding application, AND (1c) Apply for the Oregon Restorative Functions certificate (administered by DANB) OR (2a) If the applicant passed the WREB Restorative Exam or other equivalent OBD-approved exam was passed more than five years before application, the applicant must submit verification from another state or jurisdiction where the applicant is legally authorized to perform restorative functions and verification from the supervising dentist of successful completion of at least 25 restorative procedures within the immediate five years preceding application, AND (2b) Apply for the Oregon Restorative Functions certificate (administered by DANB). II. Expanded Functions – Orthodontic Assisting. To perform expanded orthodontic functions in Oregon, a dental assistant must earn status as an Expanded Function Orthodontic Dental Assistant (EFODA). To qualify, one must meet the requirements of one of the following pathways: Pathway I: (1a) Complete a course of instruction in a CODA-accredited dental assisting program, AND (1b) Apply for Oregon EFODA certification (administered by DANB) Pathway II: (2a) Pass the national DANB Certified Dental Assistant (CDA) or Certified Orthodontic Assistant (COA) exam‡, AND (2b) Pass the Oregon Expanded Functions—Orthodontic Assisting exam‡ (ORXO) administered by DANB, AND (2c) Provide endorsement from an Oregon licensed dentist stating that the applicant has successfully completed the clinical requirements, AND (2d) Apply for the Oregon EFODA certificate (administered by DANB) Pathway IIIA: (3a-1) Pass the Oregon Basic Dental Assisting (ORB) exam‡, AND (3a-2) Pass the Oregon Expanded Functions—Orthodontic Assisting exam‡ (ORXO) administered by DANB, AND (3a-3) Provide endorsement from an Oregon licensed dentist stating that the applicant has successfully completed the clinical requirements, AND (3a-4) Apply for the Oregon EFODA certificate (administered by DANB) Pathway IIIB: (3b-1) Pass the DANB Infection Control (ICE) exam, AND (3b-2) Pass the Oregon Expanded Functions—Orthodontic Assisting (ORXO) exam‡ administered by DANB, AND (3b-3) Provide endorsement from an Oregon licensed dentist stating that the applicant has successfully completed the clinical requirements, AND (3b-4) Apply for the Oregon EFODA certificate (administered by DANB) Pathway IV: (4a) Be certified in another state that has training and certification requirements substantially similar to Oregon's requirements or obtain verification from a licensed dentist of having been employed (outside the state of Oregon) for at least 1,000 hours in the past two years as a dental assistant performing expanded orthodontic functions, AND (4b) Apply to DANB for state EFODA certification by credential. ‡

432

State Requirements For Expanded Functions, continued III. Expanded Functions - Preventive To perform expanded preventive functions in Oregon under the supervision of a licensed dentist, a dental assistant who is not an EFDA must earn status as an Expanded Function Preventive Dental Assistant (EFPDA). To qualify, one must: Pathway I. (1a) Hold an Oregon Certificate of Radiologic Proficiency (see requirements on previous page), AND (1b) Successfully complete a course of instruction in a program accredited by CODA, AND (1c) Apply for the Oregon EFPDA certificate (administered by DANB) Pathway II. (2a) Hold an Oregon Certificate of Radiologic Proficiency (see requirements on previous page), AND (2b) Pass the DANB Infection Control (ICE) exam‡ AND (2c) Pass one of the following exams: (i) DANB Coronal Polishing (CP) exam‡, or (ii) DANB Certified Preventive Functions Dental Assistant (CPFDA) exam‡, or (iii) the Oregon Expanded Functions—General Dental Assisting Exam‡ (administered by DANB), AND (2d) Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements, AND (2e) Apply for the Oregon EFPDA certificate (administered by DANB) Pathway III. (3a) Hold an Oregon Certificate of Radiologic Proficiency (see requirements on previous page), AND (3b) Pass the Oregon Basic Dental Assisting exam‡ (administered by DANB), AND (3c) Pass one of the following exams: (i) DANB Coronal Polishing (CP) exam‡, or (ii) DANB Certified Preventive Functions Dental Assistant (CPFDA) exam‡, or (iii) the Oregon Expanded Functions—General Dental Assisting Exam‡ (administered by DANB), AND (3d) Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements, AND (3e) Apply for the Oregon EFPDA certificate (administered by DANB) Pathway IV. (4a) Be certified in another state that has training and certification requirements substantially similar to Oregon’s requirements or obtain verification from a licensed dentist of having been employed (outside the state of Oregon) for at least 1,000 hours in the past two years as a dental assistant performing the permitted expanded preventive functions, AND (4b) Apply for the Oregon EFPDA certificate by credential (administered by DANB) Note: An EFPDA may apply pit and fissure sealants under the indirect supervision of a dentist or dental hygienist upon successful completion of a course of instruction in a CODA-accredited program or other course of instruction approved by the Oregon Board of Dentistry, provided that the procedure is checked by the supervising dentist or dental hygienist prior to dismissal of the patient and the sealant is placed within 45 days of the procedure being authorized by a dentist or dental hygienist. IV. Expanded Functions – Anesthesia Assisting. A dental assistant in Oregon must hold state certification as an Anesthesia Dental Assistant in order to perform the functions listed in the state dental practice act. To qualify, one must: (1) Hold a current Healthcare Provider Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) certification or equivalent AND (2a) Successfully complete the Oral and Maxillofacial Surgery Anesthesia Assistants Program‡ conducted by the American Association of Oral and Maxillofacial Surgeons or (2b) Successfully complete the Oral and Maxillofacial Surgery Assistants Course‡ conducted by the California Association of Oral and Maxillofacial Surgeons or (2c) Have passed the DANB Certified Oral and Maxillofacial Surgery Assistant (COMSA) exam‡ (prior to the discontinuation of the COMSA exam in 2000) or (2d) The Resuscitation Group – Anesthesia Dental Assistant course or (2e) Other course approved by the Oregon Board of Dentistry AND (3) Apply for the Oregon Anesthesia Dental Assistant certificate (administered by DANB)

‡

433

State Requirements For Expanded Functions, continued Anesthesia Assisting – IV Therapy Certificate To initiate intravenous (IV) lines in Oregon for a patient being prepared for IV medications, sedation or general anesthesia under the indirect supervision of a dentist holding the appropriate anesthesia permit, an Anesthesia Dental Assistant must earn an additional endorsement. To qualify, an Anesthesia Dental Assistant must: (1) Complete a course in intravenous access or phlebotomy approved by the OBD, AND (2) Apply for the Anesthesia Dental Assistant with IV Therapy certificate (administered by DANB) Anesthesia Monitor Persons serving as anesthesia monitors in a dental office shall (1) Receive training in monitoring patients under sedation and be capable of assisting with procedures, problems and emergency incidents that may occur as a result of the sedation or secondary to an unexpected medical complication, AND (2) Maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training or its equivalent AND (3) Receive training in monitoring vital signs, AND (4) Be competent in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. The term "competent" means displaying special skill or knowledge derived from training and experience.

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act - Oregon Board of Dentistry Oregon Revised Statutes OCCUPATIONS AND PROFESSIONS Chapter 679 — Dentists GENERAL PROVISIONS 679.010 Definitions. As used in this chapter and ORS 680.010 to 680.205, unless the context requires otherwise: (1) “Dental assistant” means a person who, under the supervision of a dentist, renders assistance to a dentist, dental hygienist, dental technician or another dental assistant or who, under the supervision of a dental hygienist, renders assistance to a dental hygienist providing dental hygiene. (8) “Direct supervision” means supervision requiring that a dentist diagnose the condition to be treated, that a dentist authorize the procedure to be performed, and that a dentist remain in the dental treatment room while the procedures are performed. (9) “Expanded practice dental hygienist” means a dental hygienist who performs dental hygiene services in accordance with ORS 680.205 as authorized by an expanded practice dental hygienist permit issued by the board under ORS 680.200. (10) “General supervision” means supervision requiring that a dentist authorize the procedures by standing orders, practice agreements or collaboration agreements, but not requiring that a dentist be present when the authorized procedures are performed. The authorized procedures may also be performed at a place other than the usual place of practice of the dentist. (11) “Indirect supervision” means supervision requiring that a dentist authorize the procedures and that a dentist be on the premises while the procedures are performed. 679.025 License required to practice dentistry; exemptions. (1) A person may not practice dentistry or purport to be a dentist without a valid license to practice dentistry issued by the Oregon Board of Dentistry. (2) The requirements of this section do not apply to: (L) Dental hygienists, dental assistants or dental technicians performing services under the supervision of a licensed dentist in accordance with the rules adopted by the board. Chapter 680 — Dental Hygienists 680.172 Oral health screening by dental hygienists and dental assistants. Oral health screenings may be performed by dental hygienists and dental assistants under written training and screening protocols adopted by the Oregon Board of Dentistry. Screening results must be provided to individuals screened or to the parents or guardians of minors needing a dental referral for diagnosis. Screening results are not a diagnosis for purposes of ORS chapter 679 or ORS 680.010 to 680.205.

434

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants

Division 26: Anesthesia

Oregon Administrative Rules Chapter 818

818-026-0010 Definitions As used in these rules: (1) “Anesthesia Monitor” means a person trained in monitoring patients under sedation and capable of assisting with procedures, problems and emergency incidents that may occur as a result of the sedation or secondary to an unexpected medical complication. (2) “Anxiolysis” means the diminution or elimination of anxiety. (3) “General Anesthesia” means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (4) “Deep Sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (5) “Moderate Sedation” means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. (6) “Minimal Sedation” means minimally depressed level of consciousness, produced by non-intravenous pharmacological methods, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. When the intent is minimal sedation for adults, the appropriate initial dosing of a single non-intravenous pharmacological method is no more than the maximum recommended dose (MRD) of a drug that can be prescribed for unmonitored home use. Nitrous oxide/oxygen may be used in combination with a single non-intravenous pharmacological method in minimal sedation. (7) “Nitrous Oxide Sedation” means an induced, controlled state of minimal sedation, produced solely by the inhalation of a combination of nitrous oxide and oxygen in which the patient retains the ability to independently and continuously maintain an airway and to respond purposefully to physical stimulation and to verbal command. 818-026-0040 Nitrous Oxide Permit (5) A patient under nitrous oxide sedation shall be visually monitored by the permit holder or by an anesthesia monitor at all times. The patient shall be monitored as to response to verbal stimulation, oral mucosal color and preoperative and postoperative vital signs. (6) The permit holder or anesthesia monitor shall record the patient's condition. The record must include documentation of all medications administered with dosages, time intervals and route of administration. (7) Persons serving as anesthesia monitors in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) 818-026-0050 Minimal Sedation Permit Minimal sedation and nitrous oxide sedation. (5) While the patient is being treated under minimal sedation, an anesthesia monitor shall be present in the room in addition to the treatment provider. The anesthesia monitor may be the dental assistant. After training, a dental assistant, when directed by a dentist permit holder, may administer oral sedative agents or anxiolysis agents calculated and dispensed by a dentist permit holder under the direct supervision of a dentist permit holder. (6) A patient under minimal sedation shall be visually monitored at all times, including recovery phase. The record must include documentation of all medications administered with dosages, time intervals and route of administration. The dentist permit holder or anesthesia monitor shall monitor and record the patient’s condition. (7) Persons serving as anesthesia monitors for minimal sedation in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.)

435

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants 818-026-0055 Dental Hygiene and Dental Assistant Procedures Performed Under Nitrous Oxide or Minimal Sedation (2) Under indirect supervision, a dental assistant may perform those procedures for which the dental assistant holds the appropriate certification for a patient who is under nitrous oxide or minimal sedation under the following conditions: (a) A licensee holding the Nitrous Oxide, Minimal, Moderate, Deep Sedation or General Anesthesia Permit administers the sedative agents; (b) The permit holder, or an anesthesia monitor, monitors the patient; and (c) The permit holder performs the appropriate pre- and post-operative evaluation and discharges the patient in accordance with 818-026-0050(7) and (8). 818-026-0060 Moderate Sedation Permit Moderate sedation, minimal sedation, and nitrous oxide sedation. (4) During the administration of moderate sedation, and at all times while the patient is under moderate sedation, an anesthesia monitor, and one other person holding a current BLS for Healthcare Providers certificate or its equivalent, shall be present in the operatory, in addition to the dentist permit holder performing the dental procedures. (6) A patient under moderate sedation shall be visually monitored at all times, including the recovery phase. The dentist permit holder or anesthesia monitor shall monitor and record the patient's condition. (7) Persons serving as anesthesia monitors for moderate sedation in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (8) The patient shall be monitored as follows: (b) During the recovery phase, the patient must be monitored by an individual trained to monitor patients recovering from moderate sedation. (12) After adequate training, an assistant, when directed by a dentist permit holder, may dispense oral medications that have been prepared by the dentist permit holder for oral administration to a patient under direct supervision. Pursuant to OAR 818-042-0115, a Certified Anesthesia Dental Assistant, when directed by a dentist permit holder, may introduce additional anesthetic agents to an infusion line under the direct supervision of a dentist permit holder. 818-026-0065 Deep Sedation Permit Deep sedation, moderate sedation, minimal sedation, and nitrous oxide sedation (4) During the administration of deep sedation, and at all times while the patient is under deep sedation, an anesthesia monitor, and one other person holding a current BLS for Healthcare Providers certificate or its equivalent, shall be present in the operatory, in addition to the dentist permit holder performing the dental procedures. (6) A patient under deep sedation shall be visually monitored at all times, including the recovery phase. The dentist permit holder or anesthesia monitor shall monitor and record the patient's condition. (7) Persons serving as anesthesia monitors for deep sedation in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (12) Pursuant to OAR 818-042-0115 a Certified Anesthesia Dental Assistant, when directed by a dentist, may administer oral sedative agents calculated by a dentist permit holder or introduce additional anesthetic agents to an infusion line under the direct visual supervision of a dentist permit holder. 818-026-0070 General Anesthesia Permit General anesthesia, deep sedation, moderate sedation, minimal sedation and nitrous oxide sedation. (4) During the administration of deep sedation or general anesthesia, and at all times while the patient is under deep sedation or general anesthesia, an anesthesia monitor and one other person holding a current BLS for Healthcare Providers certificate or its equivalent, shall be present in the operatory in addition to the dentist performing the dental procedures. (6) A patient under deep sedation or general anesthesia shall be visually monitored at all times, including recovery phase. A dentist permit holder who induces deep sedation or general anesthesia or anesthesia monitor trained in monitoring patients under deep sedation or general anesthesia shall monitor and record the patient's condition on a contemporaneous record. (7) Persons serving as anesthesia monitors for general anesthesia in a dental office shall maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training, or its equivalent, shall be trained and competent in monitoring patient vital signs, in the use of monitoring and emergency equipment appropriate for the level of sedation utilized. ("competent" means displaying special skill or knowledge derived from training and experience.) (12) Pursuant to OAR 818-042-0115 a Certified Anesthesia Dental Assistant, when directed by a dentist permit holder, may introduce additional anesthetic agents to an infusion line under the direct visual supervision of a dentist permit holder. 436

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants 818-026-0080 Standards Applicable When a Dentist Performs Dental Procedures and a Qualified Provider Induces Anesthesia (4) A dentist, a dental hygienist or an Expanded Function Dental Assistant (EFDA) who performs procedures on a patient who receives anesthesia induced by a physician anesthesiologist, another dentist holding an anesthesia permit or a CRNA shall not schedule or treat patients for non emergent care during the period of time of the sedation procedure. (6) The qualified anesthesia provider who induces moderate sedation, deep sedation or general anesthesia shall monitor the patient until easily arousable and can independently and continuously maintain their airway with stable vital signs. Once this has occurred the patient may be monitored by a qualified anesthesia monitor until discharge criteria is met. The patient’s dental record shall document the patient's condition at discharge as required by the rules applicable to the level of anesthesia being induced. A copy of the anesthesia record shall be maintained in the patient's dental record and is the responsibility of the dentist who is performing the dental procedures. Division 35 Dental Hygiene 818-035-0030 Additional Functions of Dental Hygienists (1) In addition to functions set forth in ORS 679.010, a dental hygienist may perform the following functions under the general supervision of a licensed dentist: (c) Remove periodontal dressings or direct a dental assistant to remove periodontal dressings; (d) Perform all functions delegable to dental assistants and expanded function dental assistants providing that the dental hygienist is appropriately trained; Division 42 Dental Assisting 818-042-0010 Definitions (1) “Dental Assistant” means a person who, under the supervision of a dentist, renders assistance to a dentist, dental hygienist, dental technician or another dental assistant or renders assistance under the supervision of a dental hygienist providing dental hygiene services. (2) “Expanded Function Dental Assistant” means a dental assistant certified by the Board to perform expanded function duties. (3) “Expanded Function Orthodontic Assistant” means a dental assistant certified by the Board to perform expanded orthodontic function duties. (4) “Direct Supervision” means supervision requiring that a dentist diagnose the condition to be treated, that a dentist authorize the procedure to be performed, and that a dentist remain in the dental treatment room while the procedures are performed. (5) “Indirect Supervision” means supervision requiring that a dentist authorize the procedures and that a dentist be on the premises while the procedures are performed. (6) “General Supervision” means supervision requiring that a dentist authorize the procedures, but not requiring that a dentist be present when the authorized procedures are performed. The authorized procedures may also be performed at a place other than the usual place of practice of the dentist. 818-042-0020 Dentist and Dental Hygienist Responsibility (1) A dentist is responsible for assuring that a dental assistant has been properly trained, has demonstrated proficiency, and is supervised in all the duties the assistant performs in the dental office. Unless otherwise specified, dental assistants shall work under indirect supervision in the dental office. (2) A dental hygienist who works under general supervision may supervise dental assistants in the dental office if the dental assistants is rendering assistance to the dental hygienist in providing dental hygiene services and the dentist is not in the office to provide indirect supervision. A dental hygienist with an Expanded Practice Permit may hire and supervise dental assistants who will render assistance to the dental hygienist in providing dental hygiene services. (3) The supervising dentist or dental hygienist is responsible for assuring that all required licenses, permits or certificates are current and posted in a conspicuous place. (4) Dental assistants who are in compliance with written training and screening protocols adopted by the Board may perform oral health screenings under general supervision. 818-042-0030 Infection Control The supervising dentist shall be responsible for assuring that dental assistants are trained in infection control, bloodborne pathogens and universal precautions, exposure control, personal protective equipment, infectious waste disposal, Hepatitis B and C and post exposure follow-up.

437

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants 818-042-0040 Prohibited Acts No licensee may authorize any dental assistant to perform the following acts: (1) Diagnose or plan treatment. (2) Cut hard or soft tissue. (3) Any Expanded Function duty (OAR 818-042-0070 and OAR 818-042-0090) or Expanded Orthodontic Function duty (818-042-0100) or Restorative Functions (OAR 818-042-0095) or Expanded Preventive Duty (OAR 818-042-0113 and OAR 818-042-0114) or Expanded Function Anesthesia (OAR 818-042-0115) duty without holding the appropriate certification. (4) Correct or attempt to correct the malposition or malocclusion of teeth except as provided by OAR 818-042-0100. (5) Adjust or attempt to adjust any orthodontic wire, fixed or removable appliance or other structure while it is in the patient’s mouth. (6) Administer any drug except fluoride, topical anesthetic, desensitizing agents, over the counter medications per package instructions or drugs administered pursuant to OAR 818-026-0050(5)(a), OAR 818-026-0060(11), OAR 818-0260065(11), OAR 818-026-0070(11) and as provided in OAR 818-042-0070, OAR 818-042-0090 and OAR 818-042-0115. (7) Prescribe any drug. (8) Place periodontal packs. (9) Start nitrous oxide. (10) Remove stains or deposits except as provided in OAR 818-042-0070. (11) Use ultrasonic equipment intra-orally except as provided in OAR 818-042-0100. (12) Use a high-speed handpiece or any device that is operated by a high-speed handpiece intra-orally except as provided in OAR 818-042-0095, and only for the purpose of adjusting occlusion, contouring, and polishing restorations on the tooth or teeth that are being restored. (13) Use lasers, except laser curing lights. (14) Use air abrasion or air polishing. (15) Remove teeth or parts of tooth structure. (16) Cement or bond any fixed prosthesis or orthodontic appliance including bands, brackets, retainers, tooth moving devices, or orthopedic appliances except as provided in OAR 818-042-0100. (17) Condense and carve permanent restorative material except as provided in OAR 818-042-0095. (18) Place any type of retraction material subgingivally, except as provided by in OAR 818-042-0090. (19) Apply denture relines except as provided in OAR 818-042-0090(2). (20) Expose radiographs without holding a current Certificate of Radiologic Proficiency issued by the Board (OAR 818042-0050 and OAR 818-042-0060) except while taking a course of instruction approved by the Oregon Health Authority, Oregon Public Health Division, Office of Environmental Public Health, Radiation Protection Services, or the Oregon Board of Dentistry. (21) Use the behavior management techniques known as Hand Over Mouth (HOM) or Hand Over Mouth Airway Restriction (HOMAR) on any patient. (22) Perform periodontal probing. (23) Place or remove healing caps or healing abutments, except under direct supervision. (24) Place implant impression copings, except under direct supervision. (25) Any act in violation of Board statute or rules. 818-042-0050 Taking of X-Rays – Exposing of Radiographic Images (1) A dentist may authorize the following persons to place films/sensors, adjust equipment preparatory to exposing films/ sensors, and expose the films and create the images under general supervision: (a) A dental assistant certified by the Board in radiologic proficiency; (b) A radiologic technologist licensed by the Oregon Board of Medical Imaging and certified by the Oregon Board of Dentistry (OBD) who has completed ten (10) clock hours in a Board approved dental radiology course. (2) A dentist or dental hygienist may authorize a dental assistant who has completed a course of instruction approved by the Oregon Board of Dentistry, and who has passed the written Dental Radiation Health and Safety Examination administered by the Dental Assisting National Board, or comparable exam administered by any other testing entity authorized by the Board, or other comparable requirements approved by the Oregon Board of Dentistry to place films/sensors, adjust equipment preparatory to exposing films/sensors, and expose the films and create the images under the indirect supervision of a dentist, dental hygienist, or dental assistant who holds an Oregon Radiologic Proficiency Certificate. The dental assistant must submit within six months of an Oregon licensed dentist or Oregon licensed dental hygienist authorizing the assistant to expose radiographs, certification from the Oregon licensed dentist or dental hygienist that the assistant is proficient to take radiographic images. 818-042-0060 Certification – Radiologic Proficiency (1) The Board may certify a dental assistant in radiologic proficiency by credential in accordance with OAR 818-0420120, or if the assistant: 438

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants (2) Submits an application on a form approved by the Board, pays the application fee and: (a) Completes a course of instruction approved by the Oregon Board of Dentistry in accordance with OAR 333-1060055 or submits evidence that the Oregon Health Authority, Center for Health Protection, Radiation Protection Services recognizes that the equivalent training has been successfully completed; (b) Passes the written Dental Radiation Health and Safety Examination administered by the Dental Assisting National Board, Inc. (DANB), or comparable exam administered by any other testing entity authorized by the Board, or other comparable requirements approved by the Oregon Board of Dentistry; and (c) Certification by an Oregon licensed dentist or Oregon licensed dental hygienist that the assistant is proficient to take radiographs. 818-042-0070 Expanded Function Dental Assistants (EFDA) The following duties are considered Expanded Function Duties and may be performed only after the dental assistant complies with the requirements of 818-042-0080: (1) Polish the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis to remove stains providing the patient is checked by a dentist or dental hygienist after the procedure is performed, prior to discharge; (2) Remove temporary crowns for final cementation and clean teeth for final cementation; (3) Preliminarily fit crowns to check contacts or to adjust occlusion outside the mouth; (4) Place temporary restorative material in teeth providing that the patient is checked by a dentist before and after the procedure is performed; (5) Place and remove matrix retainers for any type of direct restorations; (6) Polish amalgam or composite surfaces with a slow speed handpiece; (7) Remove excess supragingival cement from crowns, bridges, bands or brackets with hand instruments providing that the patient is checked by a dentist after the procedure is performed; (8) Fabricate temporary crowns and fixed partial dentures (bridges), and temporarily cement the temporary crown or fixed partial dentures (bridges). The cemented crown or fixed partial dentures (bridge) must be examined and approved by the dentist prior to the patient being released; (9) Under general supervision, when the dentist is not available and the patient is in discomfort, an EFDA may recement a temporary crown or recement a permanent crown with temporary cement for a patient of record providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate. 818-042-0080 Certification â&#x20AC;&#x201C; Expanded Function Dental Assistant (EFDA) The Board may certify a dental assistant as an expanded function assistant: (1) By credential in accordance with OAR 818-042-0120, or (2) If the assistant submits a completed application, pays the fee and provides evidence of; (a) Certification of Radiologic Proficiency (OAR 818-042-0060); and satisfactory completion of a course of instruction in a program accredited by the Commission on Dental Accreditation; or (b) Certification of Radiologic Proficiency (OAR 818-042-0060); and passage of the Oregon Basic, Infection Control or Certified Dental Assisting (CDA) examination, and the Expanded Function Dental Assistant examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and certification by a licensed dentist that the applicant has successfully polished six (6) amalgam or composite surfaces, removed supra-gingival excess cement from four (4) crowns and/or fixed partial dentures (bridges) with hand instruments; placed temporary restorative material in three (3) teeth; preliminarily fitted four (4) crowns to check contacts or to adjust occlusion outside the mouth; removed four (4) temporary crowns for final cementation and cleaned teeth for final cementation; fabricated four (4) temporary crowns and/or fixed partial dentures (bridges) and temporarily cemented the crowns and/or fixed partial dentures (bridges); polished the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis in six (6) patients; placed matrix bands on four (4) teeth prepared for Class II restorations. 818-042-0090 Additional Functions of EFDAs Upon successful completion of course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association, or other course of instruction approved by the Board, a certified Expanded Function Dental Assistant may perform the following functions under the indirect supervision of a dentist or dental hygienist providing that the procedure is checked by the dentist or dental hygienist prior to the patient being dismissed: (1) Apply pit and fissure sealants provided the patient is examined before the sealants are placed. The sealants must be placed within 45 days of the procedure being authorized by a dentist or dental hygienist. (2) Apply temporary soft relines to complete dentures for the purpose of tissue conditioning. (3) Place retraction material subgingivally. 818-042-0095 Restorative Functions of Dental Assistants (1) The Board shall issue a Restorative Functions Certificate (RFC) to a dental assistant who holds an Oregon EFDA Certificate, and has successfully completed: ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

439

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants (a) A Board approved curriculum from a program accredited by the Commission on Dental Accreditation or other course of instruction approved by the Board, and successfully passed the Western Regional Examining Board’s Restorative Examination or other equivalent examinations approved by the Board within the last five years, or (b) If successful passage of the Western Regional Examining Board’s Restorative Examination or other equivalent examinations approved by the Board occurred over five years from the date of application, the applicant must submit verification from another state or jurisdiction where the applicant is legally authorized to perform restorative functions and certification from the supervising dentist of successful completion of at least 25 restorative procedures within the immediate five years from the date of application. (2) A dental assistant may perform the placement and finishing of direct restorations, except gold foil, under the indirect supervision of a licensed dentist, after the supervising dentist has prepared the tooth (teeth) for restoration(s): (a) These functions can only be performed after the patient has given informed consent for the procedure and informed consent for the placement of the restoration by a Restorative Functions dental assistant. (b) Before the patient is released, the final restoration(s) shall be checked by a dentist and documented in the chart. 818-042-0100 Expanded Functions — Orthodontic Assistant (EFODA) (1) An EFODA may perform the following duties while under the indirect supervision of a licensed dentist: (a) Remove orthodontic bands and brackets and attachments with removal of the bonding material and cement. An ultrasonic scaler, hand scaler or slow speed handpiece may be used. Use of a high speed handpiece is prohibited; (b) Select or try for the fit of orthodontic bands; (c) Recement loose orthodontic bands; (d) Place and remove orthodontic separators; (e) Prepare teeth for bonding or placement of orthodontic appliances and select, pre-position and cure orthodontic brackets, attachments and/or retainers after their position has been approved by the supervising licensed dentist; (f) Fit and adjust headgear; (g) Remove fixed orthodontic appliances; (h) Remove and replace orthodontic wires. Place and ligate archwires. Place elastic ligatures or chains as directed; (i) Cut arch wires; and (j) Take impressions for study models or temporary oral devices such as, but not limited to, space maintainers, orthodontic retainers and occlusal guards. (2) An EFODA may perform the following duties while under the general supervision of a licensed dentist: (a) An expanded function orthodontic assistant may remove any portion of an orthodontic appliance causing a patient discomfort and in the process may replace ligatures and/or separators if the dentist is not available, providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate. (b) An EFODA may recement orthodontic bands if the dentist is not available and the patient is in discomfort, providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate. 818-042-0110 Certification - Expanded Function Orthodontic Assistant (EFODA) The Board may certify a dental assistant as an expanded function orthodontic assistant (1) By credential in accordance with OAR 818-042-0120, or (2) Completion of an application, payment of fee and satisfactory evidence of; (a) Completion of a course of instruction in a program in dental assisting accredited by the American Dental Association Commission on Dental Accreditation; or (b) Passage of the Oregon Basic, Infection Control, Certified Dental Assistant (CDA) or Certified Orthodontic Assistant (COA) examination, and Expanded Function Orthodontic Assistant examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and certification by a licensed dentist that the applicant has successfully placed and ligated orthodontic wires on ten (10) patients and removed bands/brackets and remaining adhesive using an ultrasonic, hand scaler or a slow speed hand piece from teeth on four (4) patients. 818-042-0112 Expanded Function Preventive Dental Assistants (EFPDA) The following duties are considered Expanded Function Preventive Duties and may be performed only after the dental assistant complies with the requirements of 818-042-0113: (1) Polish the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis to remove stains providing the patient is checked by a dentist or dental hygienist after the procedure is performed, prior to discharge. 818-042-0113 Certification — Expanded Function Preventive Dental Assistants (EFPDA) The Board may certify a dental assistant as an expanded function preventive dental assistant: (1) By credential in accordance with OAR 818-042-0120, or (2) If the assistant submits a completed application, pays the fee and provides evidence of; (a) Certification of Radiologic Proficiency (OAR 818-042-0060); and satisfactory completion of a course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association; or (b) Certification of Radiologic Proficiency (OAR 818-042-0060); and passage of the Oregon Basic or Infection Con440

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants trol examination, and Certified Preventive Functions Dental Assistant (CPFDA) examination, or the Expanded Function Dental Assistant examination, or the Coronal Polishing (CP) examination, or equivalent successor examinations, administered by the Dental Assisting National Board, Inc. (DANB), or any other testing entity authorized by the Board; and certification by an Oregon licensed dentist that the applicant has successfully polished the coronal surfaces of teeth with a brush or rubber cup as part of oral prophylaxis to remove stains on six patients. 818-042-0114 Additional Functions of EFPDAs (1) Upon successful completion of a course of instruction in a program accredited by the Commission on Dental Accreditation of the American Dental Association, or other course of instruction approved by the Board, a certified Expanded Function Preventive Dental Assistant may perform the following functions under the indirect supervision of a dentist or dental hygienist providing that the procedure is checked by the dentist or dental hygienist prior to the patient being dismissed: (2) Apply pit and fissure sealants provided the patient is examined before the sealants are placed. The sealants must be placed within 45 days of the procedure being authorized by a dentist or dental hygienist. 818-042-0115 Expanded Functions – Certified Anesthesia Dental Assistant (1) A dentist holding the appropriate anesthesia permit may verbally authorize a Certified Anesthesia Dental Assistant, who possesses a Certified Anesthesia Dental Assistant Certificate from the Oregon Board of Dentistry to: (a) Administer medications into an existing intravenous (IV) line of a patient under sedation or anesthesia under direct visual supervision. (b) Administer emergency medications to a patient in order to assist the licensee in an emergent situation under direct visual supervision. (2) A dentist holding the appropriate anesthesia permit may verbally authorize a Certified Anesthesia Dental Assistant to dispense to a patient, oral medications that have been prepared by the dentist and given to the anesthesia dental assistant by the supervising dentist for oral administration to a patient under Indirect Supervision. 818-042-0116 Certification – Anesthesia Dental Assistant The Board may certify a person as an Anesthesia Dental Assistant if the applicant submits a completed application, pays the certification fee and shows satisfactory evidence of: (1) Successful completion of: (a) The “Oral and Maxillofacial Surgery Anesthesia Program” or successor program, conducted by the American Association of Oral and Maxillofacial Surgeons; or (b) The “Oral and Maxillofacial Surgery Assistants Course”, or successor course conducted by the California Association of Oral & Maxillofacial Surgeons (CALAOMS), or a successor entity; or (c) The “Certified Oral and Maxillofacial Surgery Assistant” examination, or successor examination, conducted by the Dental Assisting National Board, or other Board approved examination; or (d) The Resuscitation Group – Anesthesia Dental Assistant course; or (e) Other course approved by the Board; and (2) Holding valid and current documentation showing successful completion of a Healthcare Provider BLS/CPR course, or its equivalent. 818-042-0117 Initiation of IV Line Upon successful completion of a course in intravenous access or phlebotomy approved by the Board, a Certified Anesthesia Dental Assistant may initiate an intravenous (IV) infusion line for a patient being prepared for IV medications, sedation, or general anesthesia under the Indirect Supervision of a dentist holding the appropriate anesthesia permit. 818-042-0120 Certification by Credential (1) Dental Assistants who wish to be certified by the Board in Radiologic Proficiency or as Expanded Function Dental Assistants, Expanded Function Orthodontic Dental Assistants, or as Expanded Function Preventative Dental Assistants shall: (a) Be certified by another state in the functions for which application is made. The training and certification requirements of the state in which the dental assistant is certified must be substantially similar to Oregon’s requirements; or (b) Have worked for at least 1,000 hours in the past two years in a dental office where such employment involved to a significant extent the functions for which certification is sought; and (c) Shall be evaluated by a licensed dentist, using a Board approved checklist, to assure that the assistant is competent in the expanded functions. (2) Applicants applying for certification by credential in Radiologic Proficiency must obtain certification from the Oregon Health Authority, Radiation Protection Services, of having successfully completed training equivalent to that required by OAR 333-106-0055 or approved by the Oregon Board of Dentistry. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

441

Oregon State Dental Practice Act and Administrative Rules for Dental Assistants 818-042-0130 Application for Certification by Credential An applicant for certification by credential shall submit to the Board: (1) An application form approved by the Board, with the appropriate fee; (2) Proof of certification by another state and any other recognized certifications (such as CDA or COA certification) and a description of the examination and training required by the state in which the assistant is certified submitted from the state directly to the Board; or (3) Certification that the assistant has been employed for at least 1,000 hours in the past two years as a dental assistant performing the functions for which certification is being sought; (4) If applying for certification by credential as an EFDA, EFODA or EFPDA certification by a licensed dentist that the applicant is competent to perform the functions for which certification is sought; and (5) If applying for certification by credential in Radiologic Proficiency, certification from the Oregon Health Authority, Radiation Protection Services, or the Oregon Board of Dentistry, that the applicant has met that agencyâ&#x20AC;&#x2122;s training requirements for x-ray machine operators, or other comparable requirements approved by the Oregon Board of Dentistry.

442

Pennsylvania DANB Certificant Counts: Pennsylvania National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

834

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact

12,054

Infection Control (ICE)

3,619

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Lisa M. Burns, Board Administrator Pennsylvania State Board of Dentistry P.O. Box 2649 Harrisburg, PA 17105-2649 Phone: 717-783-7162 Fax: 717-787-7769 Email: st-dentistry@pa.gov Website: www.dos.pa.gov/dent

216

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Harcum College Harrisburg Area Community College Manor College Westmoreland County Community College

DANB CDA Certificant State of Pennsylvania+

$21.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of June 25, 2020.

Source: 2018 DANB Salary Survey (state data based on 12 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

443

Pennsylvania Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist in the state of Pennsylvania, a dental assistant must take and pass the national DANB Radiation Health and Safety (RHS) exam. Evidence of having passed the required exam* should be retained by the dental assistant and the licensed dentist as evidence of the individual’s authority to perform radiologic procedures. *Note: Prior to December 12, 2009, a Pennsylvania-specific radiography exam administered by an entity other than DANB was required. If a dental assistant qualified to perform radiography procedures by taking the former Pennsylvania exam prior to Dec. 12, 2009, both the dental assistant and his her employer should retain evidence of the dental assistant's passing the former Pennsylvania radiography exam.

State Requirements For Expanded Functions To perform expanded functions in the state of Pennsylvania under the direct supervision of a licensed dentist, a dental assistant must hold a state certification as an Expanded Function Dental Assistant (EFDA). To obtain this state certification, one must: (1a) Graduate from an expanded function dental assisting program at a two-year college or other Pennsylvania Board-approved institution which offers an associate degree or (1b) Graduate from a CODA-accredited dental hygiene school, which requires the successful completion of at least 75 hours of clinical and didactic instruction in restorative functions or (1c) Complete a state certification program in expanded function dental assisting of at least 200 hours of clinical and didactic instruction from either a CODA-accredited dental assisting program or a Pennsylvania Board-approved dental assisting program AND (2) Apply for state certification in expanded functions to the Pennsylvania State Board of Dentistry AND (3) Pass a Pennsylvania Board-acceptable written exam. NOTE: Expanded function dental assistants who are currently licensed or certified in another state or territory, or in Canada, may be granted licensure or certification in Pennsylvania if their credentials meet the requirements of the Pennsylvania dental practice act.

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Pennsylvania State Board of Dentistry Pennsylvania Unconsolidated Statutes The Dental Law Section 2. Definitions The word “Board,” as used in this act, means the State Board of Dentistry. “General Anesthesia” is a controlled state of unconsciousness, including deep sedation, accompanied by the partial or complete loss of protective reflexes which includes the patient’s inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method, or combination thereof. “Analgesia” means the diminution or elimination of pain in the conscious patient. “Conscious Sedation” means a minimally depressed level of consciousness which retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command, produced by a pharmacologic or nonpharmacologic method, or combination thereof. “Expanded Function Dental Assistant” means an individual who holds a current valid certification under this act to perform reversible intraoral procedures authorized by this act under the direct supervision of a licensed dentist and under an assignment of duties by a dentist, as defined in section 11.8. An expanded function dental assistant may, under direct supervision, perform those procedures specified in section 11.10 and other reversible procedures not designated by this act to be performed by licensed dentists or dental hygienists. For purposes of this definition, “direct supervision” shall mean that a dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedure and remains in the dental office or treatment facility while the procedure is being performed and, before dismissal of the patient, personally evaluates the work performed. Section 11.4. Radiologic Procedures; Education and Training Required. (a) On and after January 1, 1987, no auxiliary personnel, except dental hygienists and public health dental hygiene practitioners, shall perform radiologic procedures on the premises of the dentist unless such person is under the direct 444

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants supervision of a dentist who is on the premises at the time the x-ray is taken and unless such person has passed an examination approved by the board and administered in accordance with section 812.1 of the act of April 9, 1929 (P.L.177, No.175) known as “The Administrative Code of 1929.” (b) The board shall, by regulation, provide for the exclusion of auxiliary personnel from performing radiologic procedures if the continued performance of radiologic procedures by the auxiliary personnel is determined by the board to pose a threat to the health, safety or welfare of the public. (c) It shall be unlawful under this act to knowingly permit radiologic procedures to be performed in violation of this section or in violation of the regulations promulgated on orders issued in accordance with this section. (d) No auxiliary personnel who has or obtains a license, certificate or registration issued by, or on behalf of, a board within the Bureau of Professional and Occupational Affairs shall be required to undergo any additional education or testing pursuant to this section if radiologic procedures were included in the education or the examination which he or she was required to complete successfully in order to be eligible for such license, certificate or registration. Section 11.8. Additional Definition. As used in this act, “Assignment of Duties” shall mean the assignment by a dentist to another person of services and procedures which are performed in the office of a dentist. A dentist may assign to such competent person or persons as the dentist deems appropriate those services and procedures performed in the dental office in which the dentist is practicing but which do not require the professional competence and skill of a dentist or dental hygienist or expanded function dental assistant. Such assignment of services and procedures shall be under the direct supervision of a licensed dentist. This section shall not be construed as authorizing the delegation or assignment of diagnosing, treatment planning and writing prescriptions for drugs or writing authorizations for restorative, prosthetic or orthodontic appliances. Section 11.10. Scope of Practice for Expanded Function Dental Assistant. (a) An expanded function dental assistant may perform the following procedures: (1) Placing and contouring amalgam and other restorative materials. (2) Perform coronal polishing. (3) Perform fluoride treatments, including fluoride varnish. (4) Take impressions of teeth for athletic appliances. (b) An expanded function dental assistant may not perform the following procedures: (1) Complete or limited examination, diagnosis and treatment planning. (2) Surgical or cutting procedures of hard or soft tissue. (3) Prescribing drugs, medicaments or work authorizations. (4) Taking impressions other than for study models, diagnostic casts or athletic appliances. (5) Final inspection and approval of restorative and other treatment which affects occlusion and any necessary occlusal adjustments. (6) Pulp capping, pulpotomy and other endodontic procedures. (7) Placement and intraoral adjustments of fixed and removable prosthetic appliances. (8) Administration of local anesthesia, parenteral or inhalational sedation or general anesthesia. Pennsylvania Consolidated Statutes Title 23 Domestic Relations Code Subchapter E. Miscellaneous Provisions Section 6383 Education and Training (b) Duties of Department of State (3) Each licensing board with jurisdiction over professional licensees identified as mandated reporters under this chapter shall: (i) Require all persons applying for a license or certification issued by the licensing board to submit documentation acceptable to the licensing board of the completion of at least three hours of approved child abuse recognition and reporting training. Training shall address, but shall not be limited to, recognition of the signs of child abuse and the reporting requirements for suspected child abuse in this Commonwealth. Training shall be approved by the department. The training may occur as part of the continuing education requirement of the license. (ii) Require all persons applying for the renewal of a license or certification issued by the licensing board to submit documentation acceptable to the licensing board of the completion of at least two hours of approved continuing education per licensure cycle. Continuing education shall address, but shall not be limited to, recognition of the signs of child abuse and the reporting requirements for suspected child abuse in this Commonwealth. Continuing education curricula shall be approved by the licensing board in consultation with the department. The two hours of continuing education on child abuse recognition and reporting shall be completed by each licensee as a portion of the total continuing education required for biennial license renewal. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

445

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants Rules and Regulations Title 49 — Professional and Vocational Chapter 33. State Board of Dentistry Subchapter A: GENERAL PROVISIONS Section 33.1 Definitions. Auxiliary personnel—Persons who perform dental supportive procedures authorized by the act and this chapter under the general or direct supervision of a dentist. Continuing education certificate—A document prepared by the program sponsor which contains the title of the course, the dates attended or completed and the hours of education completed. Coronal polishing— (i) A procedure limited to the supragingival removal of light plaque and extrinsic stain form the exposed natural and restored surfaces of the teeth using a rotary instrument with a rubber cup or brush and a polishing agent. (ii) The term does not include calculus removal. Credit hour—A minimum unit of continuing education consisting of 60 minutes of instruction. Programs longer than 60 minutes will be credited in 30 minute increments. Direct supervision—Supervision by a dentist who examines the patient, authorizes the procedure to be performed, is physically present in the dental facility and available during performance of the procedure, and examines and takes full professional responsibility for the completed procedure. EFDA program—An expanded function dental assisting training program. General supervision—In a dental facility, supervision by a dentist who examines the patient, develops a treatment plan, authorizes the performance of dental hygiene services to be performed within 1 year of the examination, and takes full professional responsibility for the performance of the dental hygienist. In facilities identified in § 33.205(c)(2) and (3) (relating to practice as a dental hygienist), general supervision is defined in § 33.205(d)(2). Local anesthesia—The elimination of sensations, especially pain, in one part of the body by regional injection of an anesthetic agent. Subgingival agents—Therapeutic agents, including antimicrobials, antibiotics, antiseptics or anesthetics, placed below the free margin of the gingiva by a local delivery system or device, including injectable systems for ointments, gels or pastes, and degradable or nondegradable devices, such as fibers, films, strips, slabs, spheres, discs or chips. Section 33.3. Fees. (a) Following is the schedule of fees charged by the Board: Application fee—expanded function dental assistants Criteria approval application fee expanded function dental assistants Verification of license, permit or registration fee—dentists, dental hygienists and expanded function dental assistants Certification of scores, permit or registration fee—dentists, dental hygienists and expanded function dental assistants EFDA program approval application fee Biennial renewal fee—expanded function dental assistants Biennial renewal fee—EFDA program approval Application fee--dental radiology authorization

$75 $75 $15 $25 $200 $26 $100 $75

Subchapter B. LICENSURE OF DENTISTS AND DENTAL HYGIENISTS AND CERTIFICATION OF EXPANDED FUNCTION DENTAL ASSISTANTS Section 33.102. Professional education. (c) Expanded function dental assistants. (1) Candidates for certification as expanded function dental assistants shall show compliance with section 3(d.1) of the act by submitting verification of one of the following: (i) Graduation from a Board-approved EFDA program at a 2-year college or other institution accredited or provisionally accredited by an accrediting agency approved by the United States Department of Education Council on Postsecondary Accreditation which offers an Associate Degree. 446

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants (ii) Graduation from a dental hygiene school which required the successful completion of at least 75 hours of clinical and didactic instruction in restorative functions accredited or provisionally accredited by the Commission on Dental Accreditation (CODA) of the American Dental Association. (iii) Completion of a Board-approved EFDA program, which offers a certificate or diploma, of at least 200 hours of clinical and didactic instruction from a dental assisting program accredited by one of the following: (A) The Commission on Dental Accreditation (CODA) of the American Dental Association. (B) An accrediting agency approved by the United States Department of Education Council on Postsecondary Accreditation whose expanded function educational standards are approved by the Board. (2) The Board will approve EFDA programs that meet the criteria in § 33.117 (relating to EFDA program approval). A list of Board-approved EFDA programs will be maintained on the Board’s web site. (3) Candidates for certification who receive their professional education outside the United States or from a nonaccredited program may satisfy the education requirement by submitting their credentials to a program listed in paragraph (1) and obtaining additional training that will lead to the awarding of a degree by that school. (4) This subsection does not apply to persons who are not required to meet the educational requirements under section (3)(d.1)(2) of the act. Section 33.103. Examinations. (c) Expanded function dental assistants. Candidates for certification shall pass a written examination acceptable to the Board. (d) Additional requirement. The Board will recognize successful completion of the dental or dental hygiene clinical examinations or the expanded function dental assistant examination approved by the Board for up to 5 years from the date scores are reported to the Board. After 5 years, the Board will accept passing scores on the examinations only if the candidate has been engaged in postgraduate training or in the practice of dentistry, as a dental hygienist or as an expanded function dental assistant in another jurisdiction. Section 33.105. Biennial renewal of licenses and certificates. (a) Licenses and certificates are renewable for a 2-year period beginning April 1 of each odd-numbered year. The fee for the biennial renewal is set by the Board. See § 33.3 (relating to fees). Upon renewal, licensees and certificate holders receive new biennial renewal licenses or certificates, as appropriate, and wallet-size cards which include the expiration date. (b) As a condition of biennial renewal, commencing with the 2001-2003 renewal period, licensees and certificate holders shall maintain current certification in infant, child and adult cardiopulmonary resuscitation and continuing education requirements specified in Subchapter F (relating to continuing dental education). Licensees and certificate holders shall certify their compliance with this subsection when renewing their licenses on and after April 1, 2001. Courses for certification in cardiopulmonary resuscitation (CPR) shall be substantially similar in content to the CPR courses offered by the American Heart Association and the American Red Cross and have a similar renewal period. (c) Dentists and dental hygienists who fail to renew their licenses and expanded function dental assistants who fail to renew their certificates are prohibited from practicing their profession in this Commonwealth. Section 33.106. Reactivation of licenses and certificates. (a) Dentists and dental hygienists who have failed to renew their licenses and expanded function dental assistants who have failed to renew their certificates may apply for reactivation on forms prescribed by the Board. The applicant for reactivation shall pay the current biennial renewal fee, provide evidence of current certification in cardiopulmonary resuscitation, and shall submit a notarized affidavit identifying the period of time in which the applicant did not practice in this Commonwealth. Effective with the 1999-2001 renewal period, licensees and certificate holders shall also complete the continuing education requirements for the renewal periods during which the license or certificate was not renewed. (b) In addition to the requirements in subsection (a), an applicant for reactivation who has failed to renew for more than 5 years may be subject to reexamination under section 3.1(b) of the act (63 P. S. § 122.1.(b)). (c) An applicant for reactivation who practiced in this Commonwealth without a current license or certificate shall pay a later renewal fee of $5 for each month or part of a month during which the unauthorized practice occurred, as provided in section 225 of the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. § 1401-225). In addition, the applicant shall pay the biennial renewal fee for each biennium during which unauthorized practice occurred. The payment of late fees and biennial renewal fees does not preclude the Board from taking disciplinary action against a dentist or dental hygienist who practice without a current license or an expanded function dental assistant who practice without a current certificate. Section 33.107. Licensure and certification by criteria approval. Dentists, dental hygienists and expanded function dental assistants who are currently licensed or certified in another state or territory or in Canada may be granted licensure or certification in this Commonwealth if the credentials submitted meet the requirements of the act and of this subchapter. Licensure and certification by criteria approval will be granted only to applicants whose licensing boards confirm that they reciprocate with the Commonwealth. An applicant shall cause the © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

447

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants licensing authority of each state where the applicant has practiced to submit to the Board a letter of good standing. The Board may grant a personal interview to resolve questions concerning an applicant’s qualifications. Section 33.117. EFDA program approval. (a) Definitions. The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise: Clinical evaluation—An evaluation system based on observation of a student’s performance of clinical skills in contexts that resemble those the student will be expected to encounter as an expanded function dental assistant in a dental office. Clinical instruction—A learning experience in a clinical setting where the student performs expanded functions on patients under the supervision of an instructor. Clinical setting— (i) A setting in which expanded function dental assisting procedures are performed through direct patient care. (ii) The term does not include a setting where procedures are performed on typodonts, manikins or by other simulation methods. Competencies—Statements describing the necessary requirements to perform each procedure in § 33.205a (relating to practice as an expanded function dental assistant) to the level required to meet the acceptable and prevailing standard of care within the dental community in this Commonwealth. Competent—Having sufficient knowledge, skill and expertise in performing expanded functions to meet and maintain the acceptable and prevailing standard of care within the dental community in this Commonwealth. Laboratory or preclinical instruction—A learning experience in which students perform expanded functions using study models, typodonts, manikins or other simulation methods under the supervision of the instructor. (b) Application. EFDA programs shall apply for Board approval on forms to be provided by the Board and pay the fee in § 33.3 (relating to fees). The application must include the following information: (1) The EFDA program goals and objectives. (2) The criteria for measuring competencies. (3) Documentation of accreditation as required under section 3(d.1) of the act (63 P. S. § 122(d.1)). (4) The curriculum vitae and job description of the EFDA program director. (5) The curriculum vitae and job description of each faculty member assigned to the EFDA program. (6) A description of the physical facilities and equipment used by the EFDA program for laboratory, preclinical and clinical instruction. (7) A copy of the formal written agreement for the use of off-campus laboratory, preclinical or clinical facilities, if applicable. (8) Course outlines, course descriptions or syllabi for the EFDA program curriculum. (9) Other information related to the EFDA program requested by the Board. (c) Requirements for approval. The Board will approve EFDA programs that meet the following requirements: (1) Planning and assessment. (i) The EFDA program shall delineate its program goals and objectives for preparing individuals in the expanded function dental assisting procedures in § 33.205a to a level consistent with the acceptable and prevailing standard of care within the dental community in this Commonwealth. (ii) The EFDA program shall develop specific criteria for measuring levels of competency for the procedures in Section 33.205a which reflect the acceptable and prevailing standards and expectations of the dental community. Students shall be evaluated by faculty according to these predetermined criteria. (iii) The EFDA program shall record and retain student clinical evaluations as documentation of student competency for a minimum of 5 years from the student’s graduation or completion of the EFDA program. (2) Institutional accreditation. The EFDA program shall comply with the accreditation requirements of section 3(d.1) of the act and § 33.102(c) (relating to professional education). (3) Program director. The EFDA program shall identify a program director who is responsible for and involved in the following: (i) Student selection. (ii) Curriculum development and implementation. (iii) Ongoing evaluation of program goals, objectives, content and outcomes assessment. (iv) Annual evaluations of faculty performance including a discussion of the evaluation with each faculty member. 448

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants (v) Evaluation of student performance and maintenance of competency records for 5 years from graduation or completion of the EFDA program. (vi) Participation in planning for and operation of facilities used in the EFDA program. (vii) Evaluation of the clinical training and supervision provided in affiliated offices and off-campus facilities, as applicable. (viii) Maintenance of records related to the EFDA program, including instructional objectives and course outcomes. (ix) Instruction of licensed dentists overseeing off-campus clinical procedures performed by expanded function dental assistant students to ensure that the policies and procedures of the off-campus facility are consistent with the philosophy and objectives of the EFDA program. (4) Faculty. An EFDA program faculty member shall either be a dentist who holds a current license in good standing from the Board or meets the following criteria: (i) Holds a current expanded function dental assistant certificate issued by the Board. (ii) Has a minimum of 2 years of practical clinical experience as an expanded function dental assistant. (iii) Holds National certification as a certified dental assistant issued by the Dental Assisting National Board. (iv) Has completed a course in education methodology of at least 3 credits or 45 hours offered by an accredited institution of postsecondary education or complete a course in educational methodology no later than 18 months after employment as a faculty member. (5) Facilities and equipment. (i) The EFDA program shall provide physical facilities which provide space adequate to the size of its student body and sufficient to enable it to meet its educational objectives for laboratory, preclinical and clinical instruction. (ii) The EFDA program shall provide equipment suitable to meet the training objectives of the course or program and shall be adequate in quantity and variety to provide the training specified in the course curriculum or program content. (iii) If the EFDA program contracts for off-campus laboratory, preclinical or clinical instruction facilities, the following conditions must be met: (A) There must be a formal written agreement between the EFDA program and the laboratory, preclinical or clinical facility. (B) In off-campus clinical facilities, a licensed dentist shall oversee dental procedures performed on patients by EFDA program students. The licensed dentist shall receive instruction to ensure that the policies and procedures of the off-campus facility are consistent with the philosophy and objectives of the EFDA program. (iv) The standards in this paragraph are equally applicable to extramural dental offices or clinic sites used for clinical practice experiences, such as internships or externships. (6) Curriculum. The curriculum of an EFDA program must consist of the following components: (i) General education. The EFDA program shall include general education subjects as determined by the educational institution with a goal of preparing the student to work and communicate effectively with patients and other health care professionals. (ii) Dental sciences. The EFDA program shall include content in general dentistry related to the expanded functions in section 11.10(a) of the act (63 P. S. § 130k(a)) and as set forth in § 33.205a, including courses covering the following topics: (A) Dental anatomy. (B) Occlusion. (C) Rubber dams. (D) Matrix and wedge. (E) Cavity classification and preparation design. (F) Bases and liners. (G) Amalgam restoration. (H) Composite restoration. (I) Sealants. (J) Crown and bridge provisional fabrication. (K) Dental law and ethics. (L) Coronal polishing. (M) Fluoride treatments, including fluoride varnish. (N) Taking impressions of teeth for study models, diagnostic casts and athletic appliances. (iii) Clinical experience component. The EFDA program shall include a minimum of 120 hours of clinical experience performing expanded function dental assisting procedures as an integral part of the EFDA program. The clinical experience component shall be designed to achieve a student’s clinical competence in each of the expanded function dental assisting procedures in § 33.205a.

449

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants (7) Demonstrating competency. (i) General education. Students of the EFDA program shall be required to demonstrate competency in general education subjects by attaining a passing grade on examinations. (ii) Laboratory and preclinical instruction. Students in the EFDA program shall be required to demonstrate competency by attaining a score of at least 80% in laboratory and preclinical courses. Students shall be required to demonstrate the knowledge and skills required to: (A) Carve the anatomy of all teeth. (B) Establish proper contact areas, embrasures, marginal adaptation, as well as facial and lingual heights of contour to restore the proper tooth form and function in restorative materials commonly used for direct restorations, such as amalgam and composite resin. (C) Apply the basic concepts and terms of occlusion and carving concepts in the restoration of proper occlusal relationships. (D) Describe the problems associated with improper contouring of restorations. (E) Identify and differentiate G.V. Black’s cavity classifications. (F) Select, prepare, assemble, place and remove a variety of matrices and wedges. (G) Place and finish Class I—VI restorations with correct marginal adaptation contour, contact and occlusion. (H) Assemble, place and remove rubber dams. (I) Place sealants. (J) Crown and bridge provisional fabrication. (K) Understand the act and this chapter as they apply to an expanded function dental assistant’s responsibilities. (L) Perform coronal polishing. (M) Perform fluoride treatments, including fluoride varnish. (N) Take impressions of teeth for study models, diagnostic casts and athletic appliances. (iii) Clinical experience. EFDA program students shall be evaluated and deemed clinically competent by at least one licensed dentist evaluator in a clinical setting. The EFDA program director shall instruct the dentist clinical evaluators regarding the required competencies to ensure consistency in evaluation. Clinical competency is achieved when the dentist evaluator confirms the student has sufficient knowledge, skill and expertise in performing expanded functions to meet and maintain the acceptable and prevailing standard of care within the dental community in this Commonwealth. (iv) Documenting competency. (A) The EFDA program faculty and program director shall document the student’s general education, preclinical and laboratory competency attainment. (B) The licensed dentist evaluator shall document the student’s clinical competency attainment prior to graduation from the EFDA program. (C) The EFDA program director shall sign a statement certifying the student’s competency attainment in general education, laboratory and preclinical instruction, and clinical experience to the Board as part of the student’s application for certification as an expanded function dental assistant. (D) The EFDA program shall retain supporting documentation evidencing the student’s competency attainment for a minimum of 5 years from graduation or completion of the EFDA program. (d) Refusal or withdrawal of approval. The Board may refuse to approve an EFDA program or may remove an EFDA program from the approved list if it fails to meet and maintain the requirements set forth in this section, in accordance with the following: (1) The Board will give an EFDA program notice of its provisional denial of approval or of its intent to remove the program from the approved list. (2) The notice will set forth the requirements that are not being met or maintained by the EFDA program. (3) A program served with a provisional denial or notice of intent to remove will be given 45 days in which to file a written answer to the notice. (4) The EFDA program will be provided an opportunity to appear at a hearing to demonstrate why approval should not be refused or withdrawn. (5) The Board will issue a written decision. (6) The Board’s written decision is a final decision of a governmental agency subject to review under 2Pa.C.S. § 702 (relating to appeals). (e) Biennial renewal of EFDA program approval. EFDA program approvals are renewable for a 2-year period beginning on April 1 of each odd-numbered year. An EFDA program shall apply for renewal of Board approval on forms provided by the Board and pay the fee for biennial renewal in Section 33.3. Upon applying for renewal, the EFDA program shall update all of the information required under subsection (b)(1)—(9) or certify that there have not been changes to the EFDA program.

450

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants Subchapter C: MINIMUM STANDARDS OF CONDUCT AND PRACTICE Section 33.201. Use of titles and other designations. (a) Dentists, dental hygienists and expanded function dental assistants may use only the following titles when formally holding themselves out to the public as members of their respective professions: (3) Expanded function dental assistants. ‘‘Expanded function dental assistant’’ or ‘‘EFDA’’ when preceded by the certificate holder’s name. Section 33.204. Assignment of duties. Dental procedures shall be assigned to a competent person who the dentist deems appropriate as defined by and consistent with the act. Section 33.205a. Practice as an expanded function dental assistant. (a) Scope of professional practice. (1) An expanded function dental assistant may offer to perform or perform the following: (i) Placing and removing rubber dams. (ii) Placing and removing matrices. (iii) Placing and removing wedges. (iv) Applying cavity liners and bases. (v) Placing and condensing amalgam restoration (vi) Carving and contouring amalgam restorations. (vii) Placing and finishing composite resin restorations and/or sealant material or both. (viii) Performing coronal polishing AS DEFINED IN § 33.1(RELATING TO DEFINITIONS), (ix) Performing fluoride treatments, including fluoride varnish. (x) Taking impressions of teeth for study models, diagnostic casts or athletic appliances. (2) Each of the professional services identified in paragraph (1) shall be performed under the direct supervision of a dentist. (b) Prohibitions. An expanded function dental assistant may not perform the following procedures: (1) Complete or limited examination, diagnosis and treatment planning. (2) Surgical or cutting procedures of hard or soft tissue. (3) Prescribing drugs, medicaments or work authorizations. (4) Final inspection and approval of restorative and other treatment which affects occlusion and any necessary occlusal adjustments. (5) Pulp capping, pulpotomy and other endodontic procedures. (6) Placement and intraoral adjustments of fixed and removable prosthetic appliances. (7) Administration of local anesthesia, parenteral or inhalational sedation, nitrous oxide analgesia or general anesthesia. (8) Take impressions other than for study models, diagnostic casts or athletic appliances. (c) Supervision. Expanded function dental assistants shall perform under the direct supervision of a dentist. Direct supervision means that a dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedure and remains in the dental office or treatment facility while the procedure is being performed by the expanded function dental assistant, and, before dismissal of the patient, personally evaluates the work performed by the expanded function dental assistant. Section 33.211. Unprofessional conduct. (c) Expanded function dental assistants. Unprofessional conduct, as defined in section 4.1(a)(8) of the act includes the following conduct by an expanded function dental assistant: (1) Practicing as an expanded function dental assistant without the direct supervision of a dentist. (2) Performing a service that the expanded function dental assistant is not competent or not authorized to perform. (3) Physically, sexually or verbally abusing a patient. (4) Failing to follow current infection-control recommendations issued by the Federal Centers for Disease Control. (5) Providing ionizing radiation in violation of § 33.302 (relating to auxiliary personnel performing radiologic procedures).

451

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants Subchapter D. PERFORMANCE OF RADIOLOGIC PROCEDURES BY AUXILIARY PERSONNEL Section 33.301. Definitions. The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise: Ionizing radiation - (i) Gamma rays and X-rays; alpha and beta particles, high-speed electrons, neutrons, protons and other nuclear particles. (ii) The term does not include ultrasound, sound or radio waves or visible, infrared or ultraviolet light. Premises of the dentist - A location at which a dentist practices dentistry, other than a health care facility regulated by the Department of Health, Department of Public Welfare or the Federal government. Radiologic procedure - A dental diagnostic procedure that utilizes ionizing radiation. Radiologic procedure examination - The Radiation Health and Safety examination administered by The Dental Assisting National Board, Inc. (DANB). Section 33.302. Requirements for personnel performing radiologic procedures. (c) Auxiliary personnel who have passed the radiologic procedure examination adopted by the Board may perform radiologic procedures on the premises of a dentist under the direct supervision of a dentist. The dentist shall be on the premises when a radiologic procedure is performed, but is not required to personally observe performance of the procedure. Section 33.303. Applications for examination. The testing organization charged with administering the radiologic procedure examination will provide examination application materials to licensed dentists in this Commonwealth and to educational institutions and professional associations designated by the Bureau for distribution to auxiliary personnel who wish to apply to take the examination. Section 33.304. Radiologic procedure examination fees. Examination candidates shall pay fees directly to the testing organization charged with administering the radiologic procedure examination. Subchapter E. ADMINISTRATION OF GENERAL ANESTHESIA, DEEP SEDATION, CONSCIOUS SEDATION AND NITROUS OXIDE/OXYGEN ANALGESIA Section 33.331. Definitions. ACLS—Advanced Cardiac Life Support. BLS—Basic Life Support. Conscious sedation—A minimally depressed level of consciousness that is produced by a pharmacologic method, a nonpharmacologic method, or a combination of both, in which the patient retains the ability to maintain an airway independently and continuously and to respond appropriately to physical stimulation or verbal command. Deep sedation—A controlled, pharmacologically induced state of depressed consciousness from which the patient is not easily aroused and which may be accompanied by a partial loss of protective reflexes, including the ability to maintain a patent airway independently or respond purposefully to physical stimulation or verbal command, or both. General anesthesia—A controlled state of unconsciousness that is produced by a pharmacologic method, a nonpharmacologic method, or a combination of both, and that is accompanied by a complete or partial loss of protective reflexes that include the patient’s inability to maintain an airway independently and to respond purposefully to physical stimulation or verbal command. Nitrous oxide/oxygen analgesia—The diminution or elimination of pain in the conscious patient through the use of nitrous oxide/oxygen. Section 33.340. Duties of dentists who are unrestricted permitholders. (3) Auxiliary personnel who assist the permitholder in the administration of general anesthesia, deep sedation or conscious sedation: (i) Are trained to perform the duties that the permitholder delegates to them, if the duties do not require the professional judgment and skill of the permitholder and do not involve the actual administration of general anesthesia, deep sedation or conscious sedation. 452

Pennsylvania State Dental Practice Act and Administrative Rules for Dental Assistants (ii) Perform their duties under the direct on-premises supervision of the permitholder, who shall assume full responsibility for the performance of the duties. (iii) Do not render assistance in areas that are beyond the scope of the permitholder’s authority. (iv) Are currently certified in BLS. Section 33.340a. Duties of dentists who are restricted permit I holders. (3) Auxiliary personnel who assist the permitholder in the administration of conscious sedation: (i) Are trained to perform the duties that the permitholder delegates to them, if the duties do not require the professional judgment and skill of the permitholder and do not involve the actual administration of conscious sedation. (ii) Perform their duties under the direct on-premises supervision of the permitholder, who shall assume full responsibility for the performance of the duties. (iii) Do not render assistance in areas that are beyond the scope of the permitholder’s authority. (iv) Are currently certified in BLS. Subchapter F. CONTINUING DENTAL EDUCATION Section 33.401. Credit-hour requirements. (a) An applicant shall complete the following continuing education credit hours during the preceding biennial period: (3) Expanded function dental assistants - 10 hours. Section 33.402. Continuing education subject areas. (a) Except as provided in subsections (c)—(e), the required credit hours shall be completed in subjects which contribute directly to the maintenance of clinical competence of a dentist, dental hygienist, public health dental hygiene practitioner, or expanded function dental assistant. Examples of acceptable subjects include: (1) Diagnosis and treatment of oral pathosis. (2) Clinical and technological subjects. (3) Emergency procedures excluding hours required for cardiopulmonary resuscitation (CPR) certification. (4) Infection control. (5) Abuse and neglect. (6) Medical and scientific subjects. (7) Laws and regulations pertaining to dentists, dental hygienists and expanded function dental assistants. (b) Credit hours will not be awarded in nonclinical subjects, including: (1) Billing. (2) Office management. (3) Practice building. (4) Insurance reimbursement. (5) Communication skills, except as provided in subsection (c). [(c) A dental hygienist may complete no more than three of the required 20 hours of continuing education in courses relating to communication skills.] (g) Expanded function dental assistants shall comply with the following: (1) Except as provided in paragraph (2), expanded function dental assistants shall complete 3 of the 10 required hours of continuing education in the area of coronal polishing as follows: (i) Unless an exemption applies, an expanded function dental assistant certified by the Board by March 31, 2011, shall complete the 3 hours of continuing education in the area of coronal polishing as a condition of renewal for the biennial period which begins on April 1, 2013. (ii) Unless an exemption applies, an expanded function dental assistant certified by the Board after March 31, 2011, shall complete the 3 hours of continuing education in the area of coronal polishing as a condition of renewal for the first complete biennial renewal period after initial certification. (2) The following expanded function dental assistants are exempt from the requirement to complete 3 hours of continuing education in coronal polishing in paragraph (1): (i) Expanded function dental assistants who are also licensed as dental hygienists. (ii) Expanded function dental assistants who can document that they have completed coursework including coronal polishing as part of their education at a Board-approved EFDA education program at any time after June 28, 2010. (iii) Expanded function dental assistants who can document that they have completed a course in coronal polishing of at least 3 hours offered by an approved program sponsor at any time after June 28, 2010. (3) The requirements of this subsection may not be met through video, online or distance education, but shall be completed by physical attendance at a hands-on clinical training course offered by an approved program sponsor or an approved EFDA education program.

453

Rhode Island DANB Certificant Counts: Rhode Island Certified Dental Assistant (CDA) certificants

377

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Robert Bartro, DDS, Administrator Rhode Island Board of Examiners in Dentistry Department of Health Three Capitol Hill, Room 205 Providence, RI 02908 Phone: 401-222-1962 Website: http://health.ri.gov/licenses/detail.php?id=251

Radiation Health and Safety (RHS)

918

Infection Control (ICE)

872

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Community College of Rhode Island

DANB CDA Certificant State of Rhode Island+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been reviewd by DANB as of June 11, 2020.

454

Source: 2018 DANB Salary Survey (state data based on 10 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Rhode Island State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Rhode Island, a dental assistant must complete a course in dental radiography from an educational institution with a CODA-accredited program.

State Requirements For Expanded Functions To perform expanded functions in the state of Rhode Island under the direct supervision of a licensed dentist, a dental assistant must be a DANB-Certified assistant, holding one of the following DANB national certifications: Certified Dental Assistant (CDA), Certified Orthodontic Assistant (COA), Certified Preventive Functions Dental Assistants (CPFDA), Certified Restorative Functions Dental Assistants (CRFDA), Certified Oral and Maxillofacial Surgery Assistant (COMSA) or Certified Dental Practice Management Administrator (CDPMA). In Rhode Island, DANB-Certified assistants may perform the expanded functions listed in the state dental practice act or state regulations provided they have graduated from a dental assisting education program that incorporated academic training in these procedures or completed academic clinical training to clinical competence. Note: Individuals who have passed a DANB certification exam but have not renewed certification are no longer DANBCertified assistants. To perform specified maxillofacial surgery assisting functions, an assistant must be licensed by the Rhode Island Board of Examiners in Dentistry as a DAANCE Certified Maxillofacial Surgery Assistant. To qualify for licensure, one must: (1) Be of good moral character; AND (2) Be 18 years of age or over; AND (3) Have successfully completed an approved program for Dental Anesthesia Assistants National Certification Examination (DAANCE) accredited by the American Association of Oral and Maxillofacial Surgeons or its designated agency; AND (4) Be certified as a dental anesthesia assistant by the American Association of Oral and Maxillofacial Surgeons or its designated agency; AND (5) Hold a current certificate of completion of an approved course in Advanced Cardiac Life Support (ACLS); AND (6) Be in good standing in each state in which he/she holds a license; AND (7) Apply to the Rhode Island Board of Examiners in Dentistry for licensure.

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Rhode Island Board of Examiners in Dentistry State of Rhode Island General Laws TITLE 5: Businesses and Professions CHAPTER 5-31.1: Dentists and Dental Hygienists § 5-31.1-1 Definitions. (7.1) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon (with a permit to administer deep sedation and general anesthesia) by verbal command and under direct line of sight. § 5-31.1-6 License to Practice – Qualifications of applicants – Fee—Reexamination. (a) Authority to practice dentistry or dental hygiene under this chapter is by a license, issued by the director of the department of health, to any reputable dentist, or dental hygienist or DAANCE certified maxillofacial surgery assistant who intends to practice dentistry, or dental hygiene or DAANCE certified maxillofacial surgery assisting in this state, and who meets the requirements for licensure prescribed in this chapter and regulations established by the board or the director. (d) Any dentist and any dental hygienist or DAANCE certified maxillofacial surgery assistant applying for licensure shall pay an application fee as set forth in section 23-1-54. Application fees shall in no case be returned. Applicants requiring reexamination for dentistry, for dental hygiene or for DAANCE certified maxillofacial surgery assisting shall submit fees as set forth in section 23-1-54 for each reexamination. (f) Applicants for licensure as certified maxillofacial surgical assistants shall: (1) Present satisfactory evidence of completion of the DAANCE oral surgery assistant training course prepared and administered by the American Association of Oral and Maxillofacial Surgeons or its designated agency and approved by the board; (2) Meet any other requirements that the board or director by regulation establishes; (3) Pass in a satisfactory manner any examination that the board requires; and (4) Complete a Board of Examiners in Dentistry-approved advanced cardiac life support course and current certification. § 5-31.1-7. Recertification -- Continuing dental education. (a) Effective beginning in the calendar year 2006, every dentist, or dental hygienist or DAANCE certified maxillofacial surgery assistant licensed to practice within this state, on or before the first day of May in each even numbered year, shall apply to the Rhode Island board of examiners in dentistry for a biennial license with the board. The applicant © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

455

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants shall include satisfactory evidence to the board of examiners in dentistry that in the preceding two years the practitioner has completed a prescribed course of continuing dental or dental hygiene education established by the appropriate dental or dental hygiene association and approved by rule or regulation of the director or by the board of examiners in dentistry. If the applicant submits satisfactory evidence to the board that he or she has completed a prescribed course of continuing dental education, or dental hygiene or DAANCE certified maxillofacial surgery assisting education and has complied with the provisions of section 5-31.1-6, the board shall issue the applicant a license registration for a two year period commencing on July 1. The board may extend for only one six (6) month period those educational requirements if the board is satisfied that the applicant has suffered hardship, which prevented meeting the educational requirement. No license to practice dentistry or dental hygiene in this state shall be refused, nor any license suspended or revoked, except as: (1) Provided for in this chapter; and (2) For failure to provide satisfactory evidence of continuing dental, or dental hygiene or DAANCE certified maxillofacial surgery assisting education as provided for in this section. (b) Licensees shall apply for recertification by submitting evidence of continuing dental, or dental hygiene or DAANCE certified maxillofacial surgery assisting education on a biennial basis. Application for biennial registration shall continue as provided in this section and section 5-31.1-21. § 5-31.1-31 Dental assistant – Definition – Practices allowed. (a) As used in this chapter, a "dental assistant" is any person not licensed under the provisions of this chapter who performs dental services, procedures, or duties in aid of a licensed and registered dentist. (b) No dental assistant shall perform any service, procedure, or duty which constitutes the practice of dentistry unless authorized by rules and regulations adopted by the board of examiners in dentistry, and unless that dental service, procedure, or duty is performed under the supervision of a dentist licensed and registered in this state. The board of examiners in dentistry shall establish any classification of dental assistants that are recognized by the American Dental Association, American Dental Assistants Association, and the American Association of Oral and Maxillofacial Surgeons, and to each class the board applies any of the rules and regulations permitted under this section that the board deems appropriate. (c) Nothing in this section is construed to authorize a dental assistant to perform the following: diagnosis and treatment planning, surgical procedures on hard or soft tissue, prescribe medication, or administer injectable and/or general anesthesia, except as set forth in subsection (d) of this section. (d) An oral and maxillofacial surgeon holding a permit issued by the board for the administration of general anesthesia/ deep sedation may employ and utilize the services of a DAANCE-certified maxillofacial surgery assistant in accordance with following criteria: (1) Satisfactory evidence of completion of a DAANCE certified maxillofacial surgery assistant training course prepared and administered by the American Association of Oral and Maxillofacial Surgeons and recertification in the DAANCE training program every five (5) years; and (2) Completion of a board of examiners in dentistry-approved advanced cardiac life support course and recertification in advanced cardiac life support every two (2) years; and (3) The valid general anesthesia permit by the oral and maxillofacial surgeon where the assistant will be performing his or her services; and (4) Direct supervision by an oral and maxillofacial surgeon holding a valid general anesthesia/deep sedation permit; and (5) The oral and maxillofacial surgeon shall remain immediately available in the facility for the patient, and the DAANCE certified maxillofacial surgery assistant for evaluation and treatment until the patient meets discharge criteria; and (6) The member of the surgical team who is assigned to monitoring the patient may not have any other responsibilities while monitoring the patient under general anesthesia/deep sedation; and (7) The licensed provider will be responsible for the patient’s recovery; and (8) Peri-operative monitoring consisting of at least continuous electrocardiogram, monitoring of blood pressure, pulse oximetry, and end tidal carbon dioxide consistent with published national standards adopted by the American Association of Oral and Maxillofacial Surgeons in conjunction with the American Society of Anesthesiologists; and (9) The conclusion of the peri-operative monitoring period shall be at the discretion of the licensed provider, using the modified Aldrete scale/scoring system. The patient may then be transferred to a discharge area and shall no longer require continuous monitoring. (e) Authorized functions - Supervision. – (1) Any DAANCE certified maxillofacial surgery assistant meeting the criteria of this section shall perform the functions authorized in this chapter only by delegation of authority from the oral and maxillofacial surgeon and under the supervision, as described in §§ 5-31.1-31(e)(2) and 5-31.1-31-(e)(3), and provided the oral and maxillofacial surgeon is acting within the scope of his or her license. The responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications rests solely with the oral and maxillofacial surgeon. 456

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants (2) Under direct supervision, the DAANCE certified maxillofacial surgery assistant may: (i) Discontinue an intravenous line for a patient who has received intravenous medications, sedation, or general anesthesia; (ii) Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open; and (iii) Make medications readily available for review, inspection and use by the oral and maxillofacial surgeon. (3) Under direct visual supervision, the DAANCE certified maxillofacial surgery assistant may: (i) Follow instructions to prepare and assist in the administration of medications; and (ii) Adjust the rate of intravenous fluids infusion beyond a keep open rate; (iii) Adjust an electronic device to provide medications, such as an infusion pump; (iv) Assist with preparation/delivery/infusion/administration of emergency medications to a patient in order to assist the oral and maxillofacial surgeon in an emergency. (4) Any oral and maxillofacial surgeon delegating duties under this section must have a valid general anesthesia/ deep sedation permit. Title 216 – Department of Health Chapter 40 – Professional Licensing and Facility Regulation Sub Chapter 5 – Professional Licensing Part 02 – Rules and Regulations Pertaining to Dentists, Dental Hygienists, and Dental Assistants PART 02 RULES AND REGULATIONS PERTAINING TO DENTISTS, DENTAL HYGIENISTS, AND DENTAL ASSISTANTS Section 2.3 Definitions A. Wherever used in this Part the following terms shall be construed to mean: 9. "DAANCE-certified Maxillofacial Surgery Assistant" means a person currently certified by the American Association of Oral and Maxillofacial Surgeons to provide supportive anesthesia care. 10. “DANB-Certified assistant" means a person currently certified by the Dental Assisting National Board, Inc. (DANB), or its successor agency, holding the certified Dental Assistant (CDA) certification in general dental assisting duties or another DANB certification in a specific area of advanced or specialty practice, and employed for the purpose of assisting a dentist in the performance of procedures/duties related to dental care in accordance with the provisions of this Part. 12. “Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. 13. “Dental assistant” means a person not currently certified by the Dental Assisting National Board, Inc. (DANB) holding the certified Dental Assistant (CDA) certification in general dental assisting duties or another DANB certification in a specific area of advanced or specialty practice, and employed for the purpose of assisting a dentist in the performance of procedures/duties related to dental care in accordance with the provisions of this Part. 14. “Dental auxiliary personnel” refers to a dental hygienist, a public-health dental hygienist, a DANB-certified assistant, a DAANCE-certified maxillofacial surgery assistant or a dental assistant. 20. “Digital scan” means a virtual computer generated replica of the hard and soft tissue of the mouth using lasers or other optical scanning devices. 23. "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. 26. “Impression” means an imprint or negative likeness of teeth and/or other tissues of the oral cavity from which a positive reproduction may be made. 27. “Infection Control” refers to policies and procedures used to minimize the risk of spreading infections, within the dental healthcare setting. Compliance is based on conformance with current recommendations developed by the Centers for Disease Control and Prevention (CDC) and published in the document entitled “Guidelines for Infection Control in Dental Health-Care Settings” and incorporated in this Part. 28. “Inhalation” means a technique of administration in which a gaseous or volatile agent is introduced into the lungs and whose primary effect is due to the absorption through the gas/blood interface. 30. “Local anesthesia” means the elimination of sensation, especially pain, in one part of the body by the topical

457

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants application or regional injection of a drug. 31. "Minimal sedation" means a state of sedation in which the patient is at a minimally depressed level of consciousness. This state is produced through a pharmacological dosage less than or equal to the U.S. FDA maximum recommended dose along with nitrous oxide. Characteristics of minimal sedation include: a. Patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command; b. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected; c. Patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation; d. If more than one enteral drug is administered to achieve the desired effect, with or without the concomitant use of nitrous oxide, the guidelines for moderate sedation must apply. 35. "Moderate sedation" means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. 36. “Nitrous oxide sedation” means the administration of nitrous oxide to diminish or eliminate the sensibility to pain in the conscious patient, designating in particular the relief of pain without loss of consciousness. However, consciousness may be moderately impaired. 44. “Supervision” includes four (4) types of supervision for all dental auxiliary personnel as follows: a.

“Direct supervision” means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure(s)/duty(ies), remains in the dental office while the procedure(s)/duty(ies) are being performed and examines the patient before his/her dismissal.

“General supervision” means the dentist has authorized the procedure/duty and such is being carried out in accordance with his/her diagnosis and treatment plan. The dentist does not have to be physically present in the dental office when such treatment is being performed under general supervision.

“Indirect supervision” means the dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure(s)/duty(ies), and remains in the dental office while the procedure(s)/duty(ies) is being performed by the dental auxiliary.

“Direct visual supervision” means supervision by an oral and maxillofacial surgeon (with a permit to administer deep sedation and general anesthesia) by verbal command and under direct line of sight.

PART 2.4 Dentist/Licensing Requirements 2.4.3 Latex Any dentist, dental hygienist, a public health dental hygienist, dental assistant, or a DAANCE-certified maxillofacial surgery assistant who utilizes latex gloves shall do so in accordance with the provisions of the rules and regulations pertaining to the Use of Latex Gloves by Health Care Workers, in Licensed Health Care Facilities, and by Other Persons, Firms, or Corporations Licensed or Registered by the Department (Part 20-15-3 of this Title) promulgated by the Department. PART 2.7 Dental Hygienists Licensing Requirements 2.7.1 License Requirements A. No person shall perform any act which constitutes the practice of dental hygiene or public health dental hygiene in Rhode Island unless such person is duly licensed in accordance with the Act and this Part as a dentist, dental hygienist, or a public health dental hygienist. 1. Furthermore, dental hygienists, dental assistants and DANB-certified assistants, DAANCE-certified maxillofacial surgery assistants or dental assistants, shall perform only those auxiliary dental services, procedures/duties, and under the specified type of supervision, as set forth in § 2.10.2 of this Part. Exempt from these requirements, are those persons listed in R.I. Gen. Laws §5-31.1-37. 2.7.8 Continuing Education and Training of Dental Assistants A. All dental assistants practicing in a dental setting shall hold a current certificate of completion. Basic Life Support (BLS) for the Healthcare Provider that includes a hands-on skill component and conforms to the current American Heart Association Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) offered by any accredited agency approved by the Board. Additionally, all dental assistants practicing in a dental setting shall receive a minimum of one (1) hour per year of training on the CDC Infection Control Guidelines. PART 2.8 DAANCE-Certified Maxillofacial Surgery Assistant Licensing Requirements © 2003-2020 Dental Assisting National Board, Inc. All rights reserved. 458

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants 2.8.1 License Requirements A. No person shall perform any act which constitutes the practice of certified maxillofacial surgery assisting in Rhode Island unless such person is duly licensed in accordance with the Act and this Part as a DAANCE-certified maxillofacial surgery assistant. 1. Furthermore, dental hygienists, public health dental hygienists, DAANCE-certified maxillofacial surgery assistants, DANB-certified dental assistants and dental assistants, shall perform only those auxiliary dental services, procedures/duties, and under the specified type of supervision, as set forth in § 2.8 of this Part. Those persons listed in R.I. Gen. Laws § 5- 31.1-37 are exempt from these requirements 2.8.2 Qualifications for Licensure - DAANCE-certified Maxillofacial Surgery Assistant A. An applicant seeking licensure to practice maxillofacial surgery assisting in Rhode Island shall: 1. Be of good moral character; 2. Be eighteen (18) years of age or over; 3. Have successfully completed an approved program for Dental Anesthesia Assistants National Certification Examination (DAANCE) accredited by the American Association of Oral and Maxillofacial Surgeons or its designated agency; 4. Be certified as a dental anesthesia assistant by the American Association of Oral and Maxillofacial Surgeons or its designated agency; 5. Hold a current certificate of completion of an approved course in Advanced Cardiac Life Support (ACLS); and be in good standing in each state in which he/she holds a license. 2.8.3 Application for Licensure and Fee A. Application for licensure shall be made on forms provided by the Board which shall be completed and submitted to the Board thirty (30) days prior to the scheduled date of the Board meeting. Such application shall be accompanied by the following documents (non-returnable): 1. A copy of the applicant's state driver's license, a state-issued identification card or such other identification papers acceptable to the Director that include birthdate and a picture; 2. Supporting official documentation of certification by Dental Anesthesia Assistants National Certification Examination; 3. Supporting documentation of certificate of completion of an approved course in Advanced Cardiac Life Support (ACLS); 4. Verification that the licensee is in good standing in state(s) where licensed [if licensed in another state(s)]; and 5. The application fee as set forth in the Rules and Regulations Pertaining to the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department (Part 10-05-2 of this Title) in accordance with R.I. Gen. Laws § 5-31.1-6. 2.8.4. Continuing Education--DAANCE-Certified maxillofacial surgery assistants A. Continuing education for DAANCE-certified maxillofacial surgery assistants requires those professionals to maintain a systematic course of continual learning as a condition to maintain their professional license. In addition, continuing education is an effective way for dental professionals to sustain knowledge of current and evolving tools, techniques, technology, innovative medications and in-depth information on emerging topics that will enhance their professional skills and abilities. B. Pursuant to the provisions of § 5-31.1-7 of the Act, all DAANCE-certified maxillofacial surgery assistants licensed to practice in Rhode Island under the provisions of the Act and this Part, shall, on or before the first (1st day of May of each even-numbered year, maintain evidence that in the preceding two (2) years he or she has satisfactorily completed at least twenty (20) hours of continuing education courses relevant to the practice of certified maxillofacial surgery assistants, according to the criteria in § 2.16 of this Part. Continuing education requirements cited in this Part shall be prorated for a licensee whose license is in effect for a period of less than two (2) years (i.e., an average of ten (10) hours of continuing education shall be required each year the license is in effect). C. All DAANCE-certified maxillofacial surgery assistants practicing in a dental setting shall receive a minimum of one (1) hour per year of training on the CDC Infection Control Guidelines. D. All DAANCE-certified maxillofacial surgery assistants practicing in a dental setting shall hold a current certificate of completion of an approved course in Advanced Cardiac Life Support (ACLS) for the Healthcare Provider that includes a hands-on skill component and conforms to the current American Heart Association Guidelines Update for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) offered by any accredited agency approved by the Board. E. If the applicant attests to completion of prescribed course(s) of continuing education and is in compliance with the provisions of R.I. Gen. Laws § 5.31.1-6, the Board shall issue the applicant a license registration for a two (2) year period in accordance with the requirements of § 2.6.1 of this Part. F. It shall be the sole responsibility of the individual DAANCE-certified maxillofacial surgery assistant to obtain docu© 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

459

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants mentation from the approved sponsoring or co-sponsoring organization, agency or other, of his or her participation in the learning experience, including the date and number of hours earned. G. These documents shall be safeguarded by the DAANCE-certified maxillofacial surgery assistant for a minimum of five (5) years for random audit by the Board, if requested. At the time of license renewal, each licensee shall be required to attest that he/she has complied with the continuing education requirements stated in this Part. Failure to produce satisfactory documentation of completion of continuing education requirements upon request by the Board may constitute grounds for disciplinary action. H. Licensure renewal shall be denied to any applicant who fails to attest to completion of continuing education courses relevant to the practice of maxillofacial surgery assisting as required by these Regulations. I. Notwithstanding the provisions of § 2.8.4.(F) and 2.8.4(G) of this Part, no license to practice dentistry or dental hygiene or maxillofacial surgery assisting in Rhode Island shall be refused, nor shall any license be suspended or revoked, except as: 1. Provided for in the Act; and 2. Failure to attest to completion of continuing education as provided by this Part. J. The Board may, however, extend for only one (1) six (6) month period such educational requirements, if the Board is satisfied that the applicant has suffered hardship which prevented the applicant from meeting the requirements of this Part. 2.8.5 Issuance and Renewal of License -- DAANCE-Certified Maxillofacial Surgery Assistant A. A license shall be issued by the Board to an applicant found to have satisfactorily met all the requirements of this Part. Said license unless sooner suspended or revoked shall expire biennially on the 30th of June of each even-numbered year. B. Every person so licensed who desires to renew his or her license shall file with the Board by the 1st of May in each even-numbered year, a renewal application duly executed together with attestation to completion of continuing education requirements and the renewal fee as determined biennially by the Director in consultation with the Board, and as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title). Upon receipt of such application and payment of said fee, a license renewal shall be granted effective for the biennial licensure period unless sooner suspended or revoked. 1. For those licensees who shall have attained the age of not less than seventy (70) years ("emeritus active") as of June 30th of the year of licensure, the renewal fee (non-refundable) shall be as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title). C. Pursuant to the provisions of R.I. Gen. Laws § 5-31.1-21, the registration certificate of all DAANCE-certified maxillofacial surgery assistants whose renewals accompanied by the prescribed fee are not filed on or before the 1st day of July of each even numbered year, shall be automatically revoked. The Board may in its discretion and upon the payment by the DAANCE-certified maxillofacial surgery assistant of the current licensure (registration) fee plus an additional fee as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title), reinstate any license (certificate) revoked under the provisions of the Act and this Part. D. Inactive Status 1. DAANCE-Certified maxillofacial surgery assistants not intending to practice in Rhode Island may request on a biennial basis to be placed on inactive status. Such requests shall be made in writing to the dental administrator and shall be accompanied by a fee as set forth in the Fee Structure for Licensing, Laboratory and Administrative Services Provided by the Department of Health (Part 10-05-2 of this Title). 2. Persons on inactive status may be reinstated by paying the current annual registration fee and shall meet such requirements established by the Act and as prescribed in this Part, including attesting to completion of the required continuing dental education courses relevant to the practice of maxillofacial surgery assisting as specified in § 2.8.4 of this Part. 2.10 Delegable Procedures/Duties to Dental Hygienists, DANB-Certified Assistants and Dental Assistants with Specific Type of Supervision 2.10.1 General Requirements B. DANB-Certified Assistants, DAANCE-Certified Maxillofacial Surgery Assistants and Dental Assistants. A dentist may delegate to a DANB-certified assistant, DAANCE-Certified maxillofacial surgery assistant or a dental assistant, based on the individual's competency and/or training, reversible intraoral dental services, procedures or duties which are to be performed under the supervision of the dentist as approved by the Board and set forth in § 2.10.2 of this Part. Provided, however, oral prophylaxis shall be performed only by a licensed dentist or a licensed dental hygienist. 1. Nothing in this section shall authorize a DANB-certified assistant or a dental assistant to perform any of the nondelegable (exclusionary) procedures/duties as set forth in § 2.10.3 of this Part. C. All procedures/duties performed by dental auxiliaries shall be performed under the direct supervision of a dentist, unless otherwise specified in § 2.10.2 of this Part. 460

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants D. Any reversible intraoral procedure not specifically enumerated as delegable or nondelegable (exclusionary) pursuant to § 2.10.2 and § 2.10.3 of this Part, may be delegated to any category of dental auxiliary, (dental hygienist, public health dental hygienist, DANB-certified assistant, DAANCE-certified maxillofacial surgery assistant and dental assistant) based on the discretion of the delegating dentist, the education and training and competency of the dental auxiliary. E. The supervising dentist shall be accountable and fully responsible for all dental services, procedures and duties performed by any dental auxiliary under his or her supervision. However, a dental auxiliary is responsible for his/her own professional behavior and shall be guided by existing professional standards. 2.10.2. Delegable Procedures/Duties A. A dentist may delegate to auxiliary personnel those procedures which the dentist may deem advisable, except for those procedures excluded in § 2.10.3 of this Part. Any delegated procedures shall be both the responsibility of and under the specific supervision of the dentist. 2. DANB-Certified Assistant a. A DANB-certified assistant may perform reversible intraoral procedures under the direct supervision of a dentist. b. Such procedures may include the application of pit and fissure sealants, coronal polishing, placing and/ or removing retraction cord; fluoride treatments; and placement or removal of bonded orthodontic attachments and/or cementation or removal of orthodontic bands provided: 1. Such procedures were incorporated into the academic training from which the DANB-certified assistant graduated; OR 2. Provided he/she has completed academic clinical training to clinical competence. 3. The DANB-certified assistant may not perform any of the procedures specifically listed for a dental hygienist, nor any irreversible intraoral procedures. 4. Dental Assistant. A dental assistant may perform reversible intraoral procedures under the direct supervision of the dentist. He/she may not perform any of the procedures listed specifically for a licensed dental hygienist or DANB-certified assistant nor any irreversible intraoral procedures. a. A dental assistant may perform a final digital scan with final inspection and approval of the dentist. C. Delegable procedures and duties for DAANCE-certified maxillofacial surgery assistants are set forth in R.I. Gen. Laws § 5-31.1-31. 2.10.3 Non-Delegable (Exclusionary) Procedures/Duties A. Notwithstanding the provisions of § 2.14 of this Part, nothing in this Part authorizes a dental hygienist, public health dental hygienist, DANB-certified assistant or dental assistant, to perform any of the following procedures or duties: 1. Diagnosis and treatment planning; 2. Surgical procedures on hard or soft tissue; 3. Prescribing medications; 4. Administering general anesthesia/deep sedation, moderate sedation and/or minimal sedation, or nitrous oxide plus medication; 5. Administering sedative inhalants; 6. Taking conventional/ physical impressions for models upon which full or partial dentures, or permanent crowns, bridges, inlays, onlays, posts and cores will be fabricated; 7. Adjusting occlusion of fixed and removable prosthodontic appliances; 8. Final cementation of permanent crowns, bridges, inlays, onlays and posts and cores; and insertion of final prosthesis. 9. Condensing and carving restorative materials in teeth, except temporary restoratives; 10. Placement of sutures; 11. Exposure of radiographs without successful completion of a course in dental radiography which is offered by an education institution with a program accredited by the Commission on Dental Accreditation and which fulfills institutional requirements as set forth in R.I. Gen. Laws § 40-20-1; 12. Perform direct pulp capping procedures; 13. Orthodontic arch wire detailing with the exception of minor adjustments to eliminate pain or discomfort; 14. Flush root canal; 15. Temporary wire ligation; and 16. Use of a rotary instrument in the oral cavity unless licensed or certified under the provisions of the Act and this Part. (See also § 2.10.2(A)(2)(b) of this Part). 2.11 Administration of Anesthesia in Dental Offices

461

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants 2.11.9 Personnel Requirements for Nitrous Oxide Sedation, Minimal Sedation, Moderate Sedation, and General Anesthesia/Deep Sedation A. Personnel 1. A dentist administering or permitting the administration of nitrous oxide sedation, minimal sedation, moderate sedation, and general anesthesia/deep sedation must ensure that there is a sufficient number of members on the team of auxiliary personnel to assist in handling procedures and emergencies. B. Minimal Sedation: 1. At least one additional person trained in Basic Life Support (BLS) for providers must be present in addition to the dentist. C. Moderate Sedation: 1. During the administration of moderate sedation, the dentist must ensure that there are a minimum of three (3) trained individuals present and on the team of auxiliary personnel: a. At least one staff member shall be designated as the patient monitor. The patient monitor may assist in the delivery of anesthesia under the personal supervision of the operating dentist. The provider must be trained in Advanced Cardiac Life Support (ACLS) and if they are treating a patient less than thirteen (13) years old they must be trained in Pediatric Advanced Life Support (PALS). b. The second staff member must have ACLS and PALS training. c. The third member of the team must be trained in BLS for providers and must be present in the facility. This staff member must be immediately available in case of emergency or if the staff member in charge of monitoring is involved in interruptible patient related tasks of short duration. D. General Anesthesia/Deep Sedation: 2. An Oral and Maxillofacial Surgeon holding a Permit issued by the Board for the administration of general anesthesia/deep sedation may employ and utilize the services of a DAANCE-certified maxillofacial surgery assistant in accordance with the following criteria: a. Satisfactory evidence of completion of a Dental Anesthesia Assistants National Certification Examination (DAANCE)-certified surgical assistant training course prepared and administrated by the American Association of Oral and Maxillofacial Surgeons and recertification in the DAANCE training program every five (5) years; and b. Completion of a board of examiners in dentistry-approved Advanced Cardiac Life Support (ACLS) course and/or Pediatric Advanced Life Support (PALS) and recertification in advanced cardiac Life Support (ACLS) and/or Pediatric Advanced Life Support (PALS) every two (2) years; and c. The valid Deep Sedation/ General Anesthesia Individual Permit by the Oral and Maxillofacial Surgeon where the DAANCE assistant will be performing his or her services; and d. Direct supervision by an Oral and Maxillofacial Surgeon holding a valid General Anesthesia/Deep Sedation Permit; and e. Direct visual supervision by an Oral and Maxillofacial Surgeon holding a valid General Anesthesia/Deep Sedation Permit where the DAANCE- certified maxillofacial assistant is performing the following tasks: (1) Following instructions to prepare and assist in the administration of medications: (2) Adjusting the rate of intravenous fluid infusion beyond a keep-open rate; (3) Adjusting an electronic device to provide medications, such as an infusion pump; or (4) Assisting with preparation/delivery/infusion/administration of emergency medications in order to assist the Oral and Maxillofacial Surgeon in an emergency. f. The Oral and Maxillofacial Surgeon shall remain immediately available in the facility for the patient, and the DAANCE-certified maxillofacial surgery assistant for evaluation and treatment until the patient meets discharge criteria; and g. The DAANCE-certified maxillofacial surgery assistant who is assigned to monitoring the patient may not have any other responsibilities while monitoring the patient under general anesthesia/Deep Sedation; and h. The licensed provider will be responsible for the patientâ&#x20AC;&#x2122;s recovery; and i. Peri-operative monitoring consisting of at least continuous electrocardiogram, monitoring of blood pressure, pulse oximetry, and end-tidal carbon dioxide consistent with published national standards adopted by the American Association of Oral and Maxillofacial Surgeons in conjunction with the American Society of Anesthesiologists; and j. The conclusion of the peri-operative monitoring period shall be at the discretion of the licensed provider, using the modified Aldrete scale/scoring system. The patient may then be transferred to a discharge area and shall no longer require continuous monitoring. 3. Supervision. A DAANCE-certified maxillofacial surgery assistant shall perform the functions authorized by the Act and this Part only by delegation or authority from the Oral and Maxillofacial Surgeon and under the appropriate level of direct or direct visual supervision, and provided the Oral and Maxillofacial Surgeon is acting within the scope of his or her license. The responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic mediations rests solely with the Oral and Maxillofacial surgeon. 4. A dentist administering or permitting the administration of deep sedation/general anesthesia to pediatric patients must ensure that at least three (3) trained individuals are present, one of whom may be the dentist operator: 462

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants a. An individual, trained in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS), other than the dentist operator, to continually observe vital signs, airway patency, and adequacy of ventilation; b. An individual who is trained in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) and is skilled in airway management; and c. An individual, trained in Basic Life Support (BLS), who must remain in attendance in the discharge area until the patient is approved for discharge by a Qualified Provider. 5. A Qualified Provider administering anesthesia in a host facility must attest to the adequacy and competency of the host facility and staff. 6. The dentist administering or permitting the administration of general anesthesia/ deep sedation shall hold a current certificate in Advanced Cardiac Life Support, as described in the Guidelines for the Use of Sedation and General Anesthesia by Dentists (October 2016) incorporated by reference in Â§ 2.2(C) of this Part. 10. Each member of the team of auxiliary personnel shall hold a current certificate in Basic Life Support (BLS). E. Management of Services: 1. Written policies and procedures shall be established regarding: c. qualifications and supervision of the team of auxiliary personnel involved in the general anesthesia/deep sedation, moderate sedation, minimal sedation or nitrous oxide sedation service. PART 2.13 Physical Facility, Equipment and Safety 2.13.2 Clinical Guidelines A. General Anesthesia/Deep Sedation 4. Recovery and Discharge b. The patient shall have continuous supervision until oxygenation, ventilation, and circulation are stable and the patient is appropriately responsive for discharge from the facility. c. The Qualified Dentist or Qualified Provider or appropriately trained clinical staff must continually monitor the patient's blood pressure, heart rate, oxygenation and level of consciousness. e. The Qualified Dentist or Qualified Provider or his or her designee shall provide explanation and documentation of postoperative instructions to the patient and/or responsible adult at the time of discharge. B. Moderate Sedation 3. Monitoring and Documentation a. Monitoring (1) A Qualified Dentist or Qualified Provider administering moderate sedation must remain in the operatory room to monitor the patient continuously until the patient meets the criteria for recovery. When active treatment concluded and the patient recovers to a minimally sedated level a qualified auxiliary may be directed by the dentist to remain with the patient and continue to monitor them as explained in the guidelines until they are discharged from the facility. The dentist must not leave the facility until he or she has personally observed that the patient meets the criteria for discharge and has signed off on the patient's release. Monitoring must include: (AA) Consciousness: Level of sedation (e.g., responsiveness to verbal command) must be continually assessed. (BB) Oxygenation: Oxygen saturation must be evaluated by pulse oximetry continuously. (CC) Ventilation: The dentist must observe chest excursions continually. The dentist must monitor ventilation and/or breathing by monitoring end-tidal CO2 unless precluded or invalidated by the nature of the patient, procedure or equipment Ventilation should be monitored by continuous observation of qualitative signs, including auscultation of breath sounds with precordial or pretracheal stethoscope or as needed if CO2 capnograph is used. (DD) Vital signs including blood pressure must be obtained and recorded continually. (EE) Circulation: The Qualified Dentist or Qualified Provider or appropriately trained clinical staff must continually monitor the patient's blood pressure and level of consciousness. Oxygenation and heart rate must be continuously monitored. 4. Recovery and Discharge b. The Qualified Dentist or Qualified Provider or appropriately trained clinical staff must continuously oxygenation and continually monitor the patient's blood pressure, heart rate, and level of consciousness. C. Minimal Sedation 3. Monitoring and Documentation a. Monitoring. A dentist, or at the dentist's direction, an appropriately trained individual, must remain in the operatory during active sedation to monitor the patient on a continual basis until the patient meets the criteria for discharge. The appropriately trained individual must be familiar with monitoring techÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

463

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants niques and equipment. Monitoring must include: (1) Consciousness: Level of sedation (e.g., responsiveness to verbal command) must be continually assessed. (2) Oxygenation: Oxygen saturation by pulse oximetry may be clinically useful and should be considered. (3) Ventilation: The dentist and/or appropriately trained individual must observe chest excursions. The dentist and/or appropriately trained individual must verify respirations. (4) Circulation: Blood pressure and heart rate must be evaluated pre-operatively, post-operatively and intraoperatively as necessary (unless patient is unable to tolerate such monitoring). b. When administering nitrous oxide, the gas must be turned off when the dentist or dental hygienist administering the drug leaves the room. A dental assistant must stay in the room to monitor the patient if the dentist or dental hygienist is not physically present. 4. Recovery and Discharge b. The Qualified Dentist or Qualified Provider or appropriately trained clinical staff must monitor the patient during recovery until the patient is ready for discharge by the dentist. D. Nitrous Oxide Sedation. When administering nitrous oxide, the gas must be turned off when the dentist or dental hygienist administering the drug leaves the room. A dental assistant must stay in the room to monitor the patient if the dentist or dental hygienist is not physically present. E. Dental Pediatric Anesthesia. 4. Personnel a. In addition to the dentist, at least one other person trained in PALS, and capable of providing advanced airway skills must be present in the operatory at all times. It is required that at least one of the practitioners present in the room be skilled at obtaining vascular access in children. The individual assigned for monitoring may be responsible for assisting with interruptible patient-related tasks of short duration, such as holding an instrument or troubleshooting equipment for the monitoring of appropriate physiologic parameters. b. A third individual trained in BLS Basic Life Support for Providers must be present in the facility. This staff member should be immediately available in case of emergency or if the staff member-in-charge of monitoring is involved in the dental treatment rendered, beyond interruptible patient-related tasks of short duration. 5. Discharge a. Oxygen and suction equipment must be immediately available immediately available in the discharge area and operatory. b. The patient shall have continuous supervision until oxygenation, ventilation, and circulation are stable and the patient is appropriately responsive for discharge from the facility. c. The dentist or clinical staff must continually monitor the patient's blood pressure, heart rate, oxygenation and. level of consciousness. e. The dentist or his or her designee shall provide explanation and documentation of postoperative instructions to the patient and/or responsible adult at the time of discharge. PART 2.16 Continuing Education Criteria 2.16.1 Criteria for continuing education credits developed by the Rhode Island Dental Association and approved by the Board A. Introduction 4. Certified maxillofacial surgery assistant licensees shall obtain a total of twenty (20) continuing education credits every two years. B. Continuing Education Credit will be given only for the time the course was attended. C. One (1) continuing education credit for each hour of attendance at lectures, seminars, institutes, meetings approved for credit by: 1. Accredited educational institutions. 2. Board recognized professional associations and societies. Accredited post-doctoral programs. 3. Federal, state, local governmental health agencies and health institutions. 4. Accredited community and teaching hospitals. Credit will be given only for the time the course was attended. D. Two (2) continuing education credits for each hour of attendance at clinical or laboratory participating courses approved for credit by: 1. Accredited educational institutions. 2. Board recognized professional associations and societies (Accredited post-doctoral programs. 3. Federal, state, local governmental health agencies and health institutions. 4. Accredited community and teaching hospitals. 464

Rhode Island State Dental Practice Act and Administrative Rules for Dental Assistants 5. Responsibility of the Licensee. It is the responsibility of each licensee to maintain an authenticated record of all continuing education activities completed, and to submit documentation as evidence of completion of the above requirement, when requested. 2.16.2 Categories of Credit A. The following guidelines will assist the licensee in identifying acceptable courses of continuing education activity. The licensee is free to select areas of study from within the stated categories, keeping in mind the restriction of minimum/maximum number of hours allowed in each category. 1. Educational and Scientific Courses. a. The following amounts of continuing education credits per biennial accrual period may be obtained in this category by licensee as follows: (3) Certified maxillofacial surgery assistants: twenty (20) hours. b. This category includes educational and scientific courses sponsored by or approved by any of the following: (1) Accredited educational institutions. (2) Board recognized professional associations and societies. Accredited post-doctoral programs. (3) Federal, state, local governmental health agencies and health institutions. (4) Accredited community and teaching hospitals. 2. Self-instructed Courses a. Successful completion of a post-test is necessary to obtain credit for self-instructional courses. b. The number of continuing education credits will be determined by sponsor. c. The following amounts of continuing education credits per biennial accrual period may be obtained in this category by licensee as follows: (3) Certified maxillofacial surgery assistants: twenty (20) hours. d. This category includes home study courses, correspondence courses, educational television courses, audio, and video cassettes, and Internet (web-based) courses sponsored by or approved by any of the following: (1) Accredited educational institutions. (2) Board recognized professional associations and societies. (3) Accredited post-doctoral programs. (4) Federal, state, local government health agencies and health institutions. (5) Accredited community and teaching hospitals. 3. Papers, Publications and Scientific Presentations. A maximum of twenty eight (28) continuing education credits per biennial accrual period may be obtained in this category. a. Eight (8) continuing education credits for authoring an original scientific paper published in a scientific professional journal. b. Two (2) continuing education credits for each hour of a presentation (paper, essay or formal lecture) to a recognized group of health professionals. 4. Teaching and Research Appointments. A maximum of twelve (12) continuing education credits per biennial accrual period may be obtained in this category. Any dental professional involved in teaching or research activities may receive two (2) continuing education credits for each one (1) hour of documented teaching or research time per semester in an accredited dental or dental auxiliary educational program. 5. Table Clinics, Scientific and Product Exhibits. A maximum of six (6) continuing education credits per biennial accrual period may be obtained in this category. a. Two (2) continuing education credit hours for each presenter in a table clinic. b. One (1) continuing education credit hour for attendance at product exhibits. Examples of product exhibits include Yankee Dental Conference Exhibits. 6. Community Service. A maximum of six (6) continuing education credits per biennial accrual period may be obtained in this category. The number of continuing education credits will be approved in advance by: a. Accredited educational institutions. b. Board recognized professional associations and societies. Accredited post-doctoral programs. c. Federal, state, local governmental health agencies and health institutions. d. Accredited community and teaching hospitals. 7. Cardio-Pulmonary Resuscitation (CPR). A maximum of three (3) continuing education credits per biennial accrual period – one (1) continuing education credit for each hour of participation – may be obtained by completion of the CPR for Healthcare Providers course.

465

South Carolina DANB Certificant Counts: South Carolina Certified Dental Assistant (CDA) certificants

1,323

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Meredith Buttler, Administrator South Carolina Board of Dentistry 110 Centerview Drive Columbia, SC 29210 Phone: 803-896-4599 Fax: 803-896-4719 Email: contact.dentistry@llr.sc.gov Website: https://llr.sc.gov/bod/

3,792

Infection Control (ICE)

3,914

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Aiken Technical College Florence-Darlington Technical College Greenville Technical College Horry-Georgetown Technical College Midlands Technical College Spartanburg Community College Tri-County Technical College Trident Technical College York Technical College

Radiation Health and Safety (RHS)

DANB CDA Certificant State of South Carolina+

$18.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been reviewed by DANB as of April 30, 2020.

466

Source: 2018 DANB Salary Survey (state data based on 33 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

South Carolina State Radiography Requirements To legally place and expose radiographic films in a dental office, a dental assistant must hold a certificate documenting training acceptable to the South Carolina Department of Health and Environmental Control (DHEC). Acceptable certificates include the following: (1) Diploma from a CODA-accredited dental assisting program OR (2) DANB CDA certification or the DANB RHS certificate of competency OR (3) Certificate in radiation safety from the South Carolina Dental Association (SCDA) OR (4) Certificate documenting completion of a structured course of training in radiation safety (accepted courses include but are not limited to radiation safety training through a technical school). Note: At its July 8, 2016 meeting, the South Carolina Board of Dentistry voted that ex-active duty military dental assistants entering the public sector be given a waiver for exemption from taking the radiography certification course, based on their documenting evidence of their military training and certification credentials.

State Requirements For Expanded Functions To perform expanded functions under the direct supervision of a licensed dentist in the state of South Carolina, a dental assistant must earn status as an Expanded Duty Dental Assistant (EDDA). To qualify, one must: (1) Graduate from a CODA-accredited dental assisting program OR (2) Complete two years of continuous full-time employment as a chairside dental assistant. Note: In order to monitor nitrous oxide conscious sedation (analgesia), an EDDA must earn state certification by completing a course approved by the South Carolina Board of Dentistry, successfully completing the state board examination, submitting proof of Board-approved CPR certification within the three years preceding application, and applying for state certification from the South Carolina Board of Dentistry.

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act â&#x20AC;&#x201C; South Carolina Board of Dentistry South Carolina Code of Laws Title 40 - Professions and Occupations CHAPTER 15 Dentists, Dental Hygienists, and Dental Technicians Article 1 General Provisions Section 40-15-80. Practicing dental hygiene. (G) No person other than a licensed dentist or dental hygienist may use the title "dental hygienist", present themselves as being a dental hygienist, or perform oral prophylaxis. This does not preclude an expanded duty dental assistant from polishing restorations and supra-gingival tooth structure. Dental hygienists practicing under general supervision must maintain professional liability insurance. Section 40-15-85. Definitions For purposes of this chapter: (1) 'Analgesia' means the diminution or elimination of pain with full consciousness maintained by the patient. (2) 'Deep sedation' means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. The ability to independently maintain ventilator function may be impaired. Patients may require assistance in maintaining patients' airways. Spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (3) 'Direct supervision' means that a dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and before the dismissal of the patient, evaluates the performance of the auxiliary. This requirement does not mandate that a dentist be present at all times, but he or she must be on the premises actually involved in supervision and control. (5) 'General anesthesia' means a drug-induced loss of consciousness during which patients are not aroused, even by painful stimulation. The ability to independently maintain ventilatory functions is often impaired. Patients often require assistance in maintaining patients' airways; positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (b) For all levels of sedation, the practitioner must have the training, skills, drugs, and equipment to identify and manage such an occurrence until either assistance arrives or the patient returns to the intended level of sedation without airway or cardiovascular complications. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

467

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (6) 'General supervision' means that a licensed dentist or the South Carolina Department of Health and Environmental Control's public health dentist has authorized the procedures to be performed but does not require that a dentist be present when the procedures are performed. (9) 'Minimal sedation' means a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive functions and coordination may be modestly impaired, ventilator and cardiovascular functions are unaffected. (f) Nitrous oxide, oxygen, or both, when used in combination with a sedative agent may produce minimal, moderate, or deep sedation/general anesthesia. (10) 'Moderate sedation' means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain patients' airways, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Section 40-15-105. Administration of certain anesthetic by dental hygienist or dental assistant. Upon certification, as provided by the board in regulation, and when under direct supervision of a licensed dentist, a dental hygienist or an expanded duty dental assistant is authorized to monitor nitrous oxide inhalation conscious sedation (dental analgesia). Section 40-15-110. Exemptions from chapter. (A) Nothing in this chapter may be construed to prevent: (7) a person from making roentgenograms or X-ray exposures under the supervision of a licensed dentist or prevents persons licensed to practice dental hygiene from performing an intra-oral dental hygiene procedure if it is performed under the direction and control of a licensed dentist present on the premises; (9) a certified or qualified dental assistant or licensed dental hygienist from taking impressions for dental study casts under the direct supervision of a licensed dentist present on the premises; (D) Unlicensed personnel in a dental office may perform those tasks as authorized by the board and for which minimal training standards and qualifications are established by regulation. All tasks permitted to be performed by other than licensed personnel must be under the direct supervision of a dentist present on the premises and licensed in this State. (E) The Department of Health and Environmental Control shall target services in a public health setting to under-served populations. A public health setting is defined as a hospital, nursing home, long term care facility, rural or community health clinic, health facility operated by federal, state, county, or local governments, hospice, an educational institution, a bona fide charitable institution, or a mobile delivery program operated in one of these settings under the direction of the Department of Health and Environmental Control. Mobile delivery programs are defined as those that are not confined to a single building and can be transported from place to place. (F) Dental assistants may perform oral screenings utilizing the Department of Health and Environmental Control approved screening system in school and public health settings under direction of the Department of Health and Environmental Control public health dental program. (G) Dental assistants employed within or contracted through the public health system may assist in the delivery of public health dental program services as defined in this section. Program activities are performed under the direction of the Department of Health and Environmental Control State Dental Coordinator or the department's designee but do not require that the coordinator be present when services are performed. (H) Licensed dental hygienists and dental assistants within the public health system may perform other duties authorized by regulations of the State Board of Dentistry. Article 3 Dental Sedation Act Section 40-15-400. Permits; applications; fees. (A) For purposes of this section, 'current' means the certification course has been taken within two years. Other life support certifications approved by the board may be accepted. Section 40-15-410. Requirements for sedation permit. (D) (1) In a facility offering minimal sedation under this chapter: (a) a qualified dentist or an appropriately trained individual, at the discretion of the dentist, must continuously assess the patient's level of consciousness and remain in the operatory during active dental treatment to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The appropriately trained individual must be familiar with monitoring techniques and equipment. Monitoring must include: (i) continuous evaluation of the color of mucosa, skin, or blood; (ii) required oxygen saturation by pulse oximetry; 468

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (iii) continuous observation of chest excursions by the dentist, an appropriately trained individual, or both; (iv) continuous verification of respiration by the dentist, an appropriately trained individual, or both; (v) preoperative, intraoperative, and postoperative evaluation of blood pressure and heart rate as necessary, unless the patient is unable to tolerate the monitoring; (vi) maintenance of an appropriate sedative record, including the names of all drugs administered, including local anesthetics, dosages, and monitored physiological parameters; (vii) immediate availability of oxygen and suction equipment if a separate recovery area is used; (viii) monitoring of the patient during recovery by a qualified dentist or appropriately trained clinical staff until the patient is ready for discharge by the dentist; (ix) determination and documentation by the qualified dentist of the patient's satisfactory level of consciousness, oxygenation, ventilation, and circulation before discharge; (x) provision of postoperative verbal and written instructions to the patient, parent, escort, guardian, or caregiver; and (xi) cessation of the dental procedure if a patient enters a deeper level of sedation than the dentist is qualified to provide, until the patient returns to the intended level of sedation; (b) a qualified dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis, and treatment of emergencies related to the administration of minimal sedation and providing the equipment and protocols for patient rescue; and (c) for children under thirteen years of age, the board supports the American Dental Association's stance that supports the use of the American Academy of Pediatrics/American Academy of Pediatric Dentistry 'Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures'. (F) (1) In a facility offering moderate sedation under this chapter: (a) a qualified dentist or an appropriately trained individual, at the discretion of the dentist, must remain in the operatory during active dental treatment to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The appropriately trained individual must be familiar with monitoring techniques and equipment. Monitoring must include: (i) continuous assessment of level of consciousness, such as responsiveness to verbal commands; (ii) continuous evaluation of color of mucosa, skin, or blood and oxygen saturation by pulse oximetry; (iii) continuous observation by the dentist of chest excursions and ventilation monitoring, which can be accomplished by auscultation of breath sounds, monitoring end-tidal CO2, or by verbal communication with the patient; (iv) continuous evaluation of blood pressure and heart rate if tolerable by the patient and if noted in the time-oriented anesthesia record; (v) continuous EKG monitoring for patients with significant cardiovascular disease; (vi) maintenance of an appropriate time-oriented anesthetic record, including the names of all drugs, dosages, and their administration times, including local anesthetics, dosages, and monitored physiological parameters; (vii) continuous documentation of pulse oximetry, heart rate, respiratory rate, blood pressure, and level of consciousness; and (viii) cessation of the dental procedure if a patient enters a deeper level of sedation than the dentist is qualified to provide, until the patient returns to the intended level of sedation; (2) a qualified dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of moderate sedation, and providing the equipment, drugs, and protocol for patient rescue; and (3) for children under thirteen years of age, the board supports the American Dental Association's stance that supports the use of the American Academy of Pediatrics/American Academy of Pediatric Dentistry 'Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures'. (H) In a facility offering deep sedation/general anesthesia under this chapter: (1) a dentist or an appropriately trained individual, in the discretion of the dentist, must remain in the operatory during active dental treatment to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The appropriately trained individual must be familiar with monitoring techniques and equipment. Monitoring must include: (a) continuous evaluation of color of mucosa, skin, or blood and oxygen saturation by pulse oximetry; (b) continuous monitoring and evaluation of: (i) end-tidal CO2 for intubated patient; and (ii) breath sounds by means of auscultation, end-tidal CO2, or both for nonintubated patient; (c) continuous monitoring and evaluation of respiration rate; (d) continuous evaluation of heart rate and rhythm by means of EKG throughout the procedure, as well as pulse rate by means of pulse oximetry and blood pressure; ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

469

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (e) ready availability of a device capable of measuring body temperature during the administration of deep sedation/general anesthesia; (f) availability and use of equipment to continuously monitor body temperature whenever triggering agents associated with malignant hyperthermia are administered; (g) maintenance of an appropriate time-oriented anesthetic record, including the names of all drugs, dosages, and their administration times, including local anesthetics and monitored physiological parameters; and (h) continuous recording of: (i) pulse oximetry and end-tidal CO2 measurements, if taken; (ii) heart rate; (iii) respiratory rate; and (iv) blood pressure; (2) when a mental or physical challenge precludes a dental patient from having a comprehensive physical examination or appropriate laboratory tests before undergoing deep sedation/general anesthesia, the dentist responsible for administering that anesthesia should document the reasons preventing the recommended preoperative management; and (3) use of deep sedation/general anesthesia without establishing an indwelling intravenous line may be warranted in selected circumstances, including very brief procedures or the establishment of intravenous access after deep sedation/general anesthesia has been induced because of poor patient cooperation. Section 40-15-420. Staff must be certified in cardiopulmonary resuscitation and the basic life support level; training; continuing education. (A) All dental staff who provide direct, hands-on patient care must be certified in cardiopulmonary resuscitation and the basic life support level by a board-approved training course. The certification must have been received in the immediately preceding two years. (B) The operating dentist shall provide training for staff with hands-on patient care commensurate with the level and mode of sedation administered. This training must be documented and available for inspection by the department upon request. Section 40-15-430. Presence of trained personnel required; recovery and discharge. (A) For minimal sedation and moderate sedation, at least one person trained in Basic Life Support for Healthcare Providers must be present in addition to the dentist. (B) For deep sedation/general anesthesia, at least two support personnel adequately trained in Basic Life Support for Healthcare Providers must be present in addition to the dentist. If the same individual administering the deep sedation/general anesthesia is performing the dental procedure, one of the additional appropriately trained team members must be designated for patient monitoring. (C) During recovery and discharge the dentist must determine and document whether the patient: (1) has stable vital signs, is mentally alert, and has stable levels of oxygenation, ventilation, circulation, and temperature; (2) has a minimum of one adequately trained support personnel who must be present with the patient; (3) is fully recovered from anesthetic drugs before discharged to the care of a responsible adult available to provide assisted care to the patient; (4) support personnel assists the patient into the vehicle transporting him from the facility; and (5) written postoperative instructions are given to and are reviewed with the patient and the adult responsible for the patient. CODE OF REGULATIONS Title 40 - Professions and Occupations CHAPTER 15. DENTISTS, DENTAL HYGIENISTS AND DENTAL TECHNICIANS SECTION 40-15-105. Administration of certain anesthetic by dental hygienist or dental assistant. Upon certification, as provided by the board in regulation, and when under direct supervision of a licensed dentist, a dental hygienist or an expanded duty dental assistant is authorized to monitor nitrous oxide inhalation conscious sedation (dental analgesia). SECTION 40-15-110. Exemptions from chapter. (F) Dental assistants may perform oral screenings utilizing the Department of Health and Environmental Control approved screening system in school and public health settings under direction of the Department of Health and Environmental Control public health dental program. (G) Dental assistants employed within or contracted through the public health system may assist in the delivery of public health dental program services as defined in this section. Program activities are performed under the direction of the Department of Health and Environmental Control State Dental Coordinator or the departmentâ&#x20AC;&#x2122;s designee but do not require that the coordinator be present when services are performed. 470

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants (H) Licensed dental hygienists and dental assistants within the public health system may perform other duties authorized by regulations of the State Board of Dentistry. CHAPTER 39. DEPARTMENT OF LABOR, LICENSING AND REGULATION -- STATE BOARD OF DENTISTRY 39â&#x20AC;&#x201C;5. Registration of Licenses or Certificates. F. (1) (b) It is the responsibility of all dentists to ensure that their auxiliary staff who may be exposed to blood and other body fluids require and provide two (2) hours biennially of continuing education on sterilization and infection control and maintain records of such training. 39-10. Sanitary Standards. A. All dental offices and dental laboratories shall provide and maintain sanitary facilities and conditions in accordance with the following regulations: (1) All dental practices shall conform to and comply with the current recommendations and guidelines of the Centers for Disease Control and Prevention (C.D.C.) relating to infection control practices for dentistry and/or dental offices. (2) It is the responsibility of all dentists and dental hygiene licensed by the State and all other personnel who are utilized by a licensed dentist and who assist in a dental practice and may be exposed to body fluids such as blood or saliva to maintain familiarity with these recommendations and guidelines. (6) Sterilization: (a) All instruments or equipment used in the treatment of dental patients shall be sterilized according to usage, i.e., autoclave, boiling water sterilization, or cold sterilizer solutions as indicated. (b) Each facility shall ensure compliance by all personnel with existing federal and state infection control procedures. 39-11. Ethics. CODE OF PROFESSIONAL CONDUCT 1-F Use of Auxiliary Personnel Dentists shall be obliged to protect the health of their patient by only assigning to qualified auxiliaries those duties which can be legally delegated. Dentists shall be further obliged to prescribe and supervise the work of all auxiliary personnel working under their direction and control. 39-12. Approved Procedures of Dental Assistants. The Board has approved performance of the following procedures by dental assistants in South Carolina. No formal academic dental training is required for dental assistants. These procedures must be performed under the direct supervision of a dentist present on the premises and licensed in South Carolina. (1) Assist in basic supportive chairside procedures. (2) Chart existing restorations, clinically missing teeth, and appliances within the oral cavity. (3) Apply topical drugs as prescribed by the dentist. (4) Place and remove rubber dam. (5) Place and remove matrix. (6) Place and remove orthodontic ligatures. (7) Take and record vital signs (blood pressure, pulse, respiration, etc.). (8) Expose radiographs upon completion of a Board approved radiation safety course. (9) Place and remove periodontal packs. (10) Remove sutures. 39-13. Approved Procedures of Expanded Duty Dental Assistants. An Expanded Duty Dental Assistant is a dental assistant who is a graduate of an American Dental Association accredited dental assisting program, or one who has completed two (2) years of continuous full-time employment as a chairside dental assistant. In addition to the procedures listed for dental assistants, Expanded Duty Dental Assistants may perform the following procedures under the direct supervision of a dentist present on the premises and licensed in South Carolina. (1) Take impressions for study models. (2) Place and remove socket dressing. (3) Place gingival retraction cord. (4) Place temporary restorations. (5) Cement temporary crowns or bridges. (6) Remove excess cement from restoration and/or appliances. (7) Polish restorations and supra-gingival tooth structure. (8) Application of pit and fissure sealant. (9) Monitor nitrous oxide anesthesia upon completion of a Board approved course and certification by the Board. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

471

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants 39-16. Dental Radiography. On or after July 1, 1985, all personnel in a dental office who place and expose radiographic films shall have successfully completed a structured course of training in radiation safety. Every dentist shall certify to the Board that any person employed by him, who shall place and expose radiographic films, has successfully completed the training required herein. BOARD POLICIES AIR ABRASION SYSTEM Pursuant to S.C. Code Ann. Section 40-15-80; Regs. 39-12; 39-13; 39-14 Dental Hygienists and Dental Assistants are not authorized to use an air abrasion system (i.e., KCP) at settings that could remove a tooth structure or cause irreversible harm to the tooth structure. CERTIFICATION FOR MONITORING OF NITROUS OXIDE SEDATION Pursuant to S.C. Code Ann. Section 40-15-105 Policy S.C. Code Ann. Section 40-15-105 authorizes a dental hygienist or expanded duty dental assistant to monitor nitrous oxide anesthesia (conscious sedation) “upon certification, as provided by the board in regulation, and when under the direct supervision of a licensed dentist.” To reasonably assure that dental hygienists or expanded duty dental assistants monitoring nitrous oxide sedation have received appropriate professional training, this Board has been delegated responsibility for reviewing and approving courses and other training. The Board will review on a case by case basis all courses submitted for approval for this purpose. Procedure Course Approval Course sponsors requesting Board approval must provide staff with all documentation requested by the Board including, but not limited to: (1) a description of the faculty and their professional qualifications; (2) the location(s) for the course and equipment to be used in training; (3) the maximum class size(s); (4) the dates, times, and fees to be charged; (5) a detailed course outline; (6) a copy of any handouts or other materials to be distributed to attendees; (7) a copy of any textbooks or publications used as primary course materials or a bibliography of supporting authorities, and (8) a copy of a test on which attendees will be tested for proficiency at the conclusion of the course of instruction. If a test has not yet been devised and a copy made available for review, a list of topics on which attendees will be tested for proficiency at the conclusion of the course of instruction must be provided. Staff will safeguard the confidentiality of and access to tests submitted by course sponsors. Additional information requested by the Board must be promptly provided by the course sponsor for the Board’s review and consideration. Approval of the course shall be in the form of a letter from the Board administrator. If any substantive changes are proposed once a course has been approved, such proposal shall be submitted to the Board for review and approval. The administrator will provide sponsors of courses that are not approved with a letter so advising of the Board’s decision and relating any comments from the Board regarding deficiencies noted. Applications for Certification Applicants may apply for certification to monitor nitrous oxide conscious sedation provided they meet the following requirements: (1) must hold a current license to practice dental hygiene in S.C. or qualify as an “expanded duty dental assistant” in accordance with Board Reg. 39-13; (2) must be currently certified in cardiopulmonary resuscitation (CPR) at the time they file an application; (3) must have successfully completed an approved course in nitrous oxide monitoring within the past three years; or been certified in another state to monitor nitrous oxide sedation within the past three years, and (4) must successfully complete the State Board Nitrous Oxide Monitoring Examination. Applicants shall document satisfactory completion of an approved training course and exit examination upon an application form approved by the Board with proper payment of any fee required to cover the administration of the certification program. Upon receipt of a satisfactory application and required fee, the Board of Dentistry shall issue an appropriate certificate to the applicant authorizing the monitoring of nitrous oxide sedation when under the direct supervision of a practicing dentist. Renewal of Certificate There is no requirement for renewal of the nitrous oxide monitoring certificate. IV LINE ESTABLISHMENT Pursuant to S.C. Code Ann. Section 40-15-80 and Regs. 39-12; 39-13 and 39-14 Dental Hygienists and Dental Assistants are not authorized to establish an IV line. They are not authorized to draw sedative drugs into a syringe, nor are they authorized to deliver drugs into an established IV line. (policy revised 10/31/08) LASER Pursuant to S.C. Code Ann. Section 40-15-80 and Regs. 39-12; 39-13 and 39-14 Dental Hygienists and Dental Assistants are not authorized to use lasers in performing bleaching of teeth procedures; they may, however, perform the isolation and clean-up procedures. 472

South Carolina State Dental Practice Act and Administrative Rules for Dental Assistants MONITORING OF NITROUS OXIDE ANALGESIA Pursuant to S.C. Code Ann. Section 40-15-80 and Regs. 39-12; 39-13 and 39-14 Licensed Dental Hygienists and Expanded Duty Dental Assistants are authorized to monitor nitrous oxide conscious sedation (analgesia) upon: 1) successful completion of a Board-approved course; 2) successful completion of the State Board Examination, and 3) certification by the Board. NOTE: The Board has defined the term “Monitor” to mean carrying out the orders of the dentist, to include the initiation of the flow of the nitrous oxide component. The certified auxiliary may then maintain that flow or decrease the level of nitrous oxide component when oxygenating the patient, without the specific direction of the dentist. The dentist must determine the need and level of nitrous oxide sedation regarding a particular patient. The dentist must diagnose the need for a patient to receive nitrous oxide and may designate the certified auxiliary to place the mask and set the nitrous oxide component at a level specified for that patient. S.C. X-Ray Regulations No. 61-64 - Title B - Rules and Regulations for Radiation Control PART IV- USE OF X-RAY IN THE HEALTH PROFESSIONS RHB 4.2 General Safety Provisions. 4.2.2 The registrant shall assure that all X-ray machines under his control are operated only by a radiologic technologist possessing a current, valid certificate from the South Carolina Radiation Quality Standards Association, or a licensed practitioner. For the purpose of this Part, a radiologic technologist is defined as a person who is a limited practice radiographer, radiographer, podiatric limited practice radiographer or limited chest radiographer certified by the American Registry of Radiologic Technologists or who is certified by the South Carolina Radiation Quality Standards Association or who has obtained a certificate acceptable to the South Carolina Radiation Quality Standards Association. A person who applies ionizing radiation to humans or performs x-ray exam setups, including, but not limited to, patient positioning and technique selection shall be considered a radiologic technologist. 4.2.2.8 Dentists and their auxiliaries who meet the requirements of the South Carolina Dental Practice Act are exempt from the requirements of 4.2.2.1 through 4.2.2.6. South Carolina Department of Health and Environmental Control Regulatory Guide B3 Complying with Title B – Dental Facilities Training Plans (See RHB 4.2.2) Each dental facility is required by RHB 4.2.2.8 to ensure that all x-ray operators meet the requirements of the South Carolina Dental Practice Act. Regulation 39-6 Dental Radiography states, “On or after July 1, 1985, all personnel in a dental office who place and expose radiographic films shall have successfully completed a structured course of training in radiation safety." Employees who are certified Dental Assistants, registered Dental Hygienist or are certified by the South Carolina Board of Dentistry or the Dental Assisting National Board are considered to meet the basic training requirements. Other structured courses of training include, but are not limited to, x-ray certification through the South Carolina Dental Association, radiation safety training through Landauer and radiation safety training through a technical school. Valid certificates must be available documenting this structured training. Checklist for DHEC Inspection Please have available the following records for the DHEC Inspector: X-Ray operators must have: • A South Carolina Dental Hygiene license or, • A diploma from an American Dental Association (ADA) accredited school in Dental Hygiene or Dental Assisting or, • A South Carolina State Board of Dentistry Certification or, • Certificate from Dental Assisting National Board (DANB) or, • Certificate from South Carolina Dental Association (SCDA) or, • Certificate documenting completion of a structured course of training in radiation safety

473

South Dakota DANB Certificant Counts: South Dakota Certified Dental Assistant (CDA) certificants

275

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Brittany Novotny, J.D., MBA, Executive Secretary South Dakota State Board of Dentistry P.O. Box 1079 1351 N. Harrison Ave Pierre, SD 57501-1079 Phone: 605-224-1282 Fax: 888-425-3032 Email: contactus@sdboardofdentistry.com Website: www.sdboardofdentistry.com

Radiation Health and Safety (RHS)

507

Infection Control (ICE)

519

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Lake Area Technical Institute

DANB CDA Certificant State of South Dakota+

$19.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been updated by DANB as of August 12, 2020.

474

Source: 2018 DANB Salary Survey (state data based on 5 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the South Dakota State Board of Dentistry. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

South Dakota State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in South Dakota, a dental assistant must register to practice as a dental radiographer. To qualify for registration as a dental radiographer, one must (1) Meet one of the following requirements within 13 months prior to application: (1a) Complete a dental radiography course taken through a dental assisting, dental hygiene or dental program accredited by the Commission on Dental Accreditation or (1b) Pass DANB's Radiation Health and Safety (RHS) exam or (1c) Complete a South Dakota State Board of Dentistry-approved radiography training program or (1d) Hold DANB Certified Dental Assistant (CDA) certification, AND (2) Submit application for registration, required documentation, and fee to the South Dakota State Board of Dentistry. Or, to qualify for dental radiographer registration by endorsement, one must (1) Have been legally practicing dental radiography in another state within the three years prior to application, AND (2) Provide verification of completing a course including at least 16 hours of training in areas outlined in South Dakota rules, AND (3a) provide verification of registration number and status from the board of dentistry in each state in which the applicant is or has been registered to practice as a dental radiographer or (3b) if not currently registered as a dental radiographer, verification of having legally practices dental radiography for a period of time during the three years preceding application (written documentation from an employing/supervising dentist attesting to current clinical proficiency of the applicant may be required), AND (4) Submit application for registration, required documentation, and fee to the South Dakota State Board of Dentistry.

State Requirements For Expanded Functions To perform expanded functions under the direct supervision of a licensed dentist in South Dakota, a dental assistant must earn status as a Registered Dental Assistant. To qualify, one must: (1) Be at least 18 years of age AND (2) Hold a current American Heart Association Healthcare Provider, American Red Cross Professional Rescuer, or South Dakota State Board of Dentistry (SDSBD)-approved equivalent CPR certification AND (3a) Graduate from a CODA-accredited dental assisting program or (3b)Â Hold current national DANB Certified Dental Assistant (CDA) certification, or (3c) Complete a dental assisting education program approved by the SDSBD resulting in a registered dental assistant certificate of competency, or (3d) Hold or have held registration to perform expanded functions in another state AND (4) Apply to the SDSBD for registration as a Registered Dental Assistant. Applicants who have completed a CODA accredited dental assisting program or obtained a certificate of competency must apply within five years of completion of the program or, if the program was completed more than five years prior to application, must have legally provided expanded functions within five years preceding application. Written documentation verifying the current clinical proficiency of the applicant to perform expanded functions may be required from a dentist who has employed or supervised the applicant within the five years prior to application. Administration of Nitrous Oxide Inhalation Analgesia: A Registered Dental Assistant may apply for a permit to administer nitrous oxide inhalation analgesia under the direct supervision of a dentist. To qualify, a Registered Dental Assistant must: (1) Be certified in administering basic life support by the American Heart Association for the Healthcare Provider or the American Red Cross for the Professional Rescuer program, AND (2a) Have completed an SDSBD-approved educational course meeting specified requirements within 13 months of application OR (2b) Have complete an SDSBD-approved educational course more than 13 months prior to application and have legally administered nitrous oxide inhalation analgesia for a period of time during the three years preceding application and provide written documentation from an employing/ supervising dentist attesting to clinical proficiency. Monitoring Patients Under General Anesthesia, Deep Sedation, or Moderate Sedation: Registered Dental Assistants and dental assistants may apply for a permit to monitor patients under general anesthesia, deep sedation or moderate sedation. To qualify, an assistant must: (1) Be certified in administering basic life support by the American Heart Association for the Healthcare Provider or the American Red Cross for the Professional Rescuer program, AND (2a) Have completed an SDSBD-approved educational course in anesthetic assisting of at least eight hours within 13 months of application OR (2b) Have completed an SDSBD-approved educational course in anesthetic assisting of at least eight hours more than 13 months prior to application and have legally monitored patients receiving analgesic or anesthetic agents for a period of time during the two years preceding application and provide written documentation from an employing/supervising dentist attesting to clinical proficiency. Injection of Medication: A dentist holding a permit to administer general anesthesia/deep sedation or moderate sedation may authorize a Registered Dental Assistant or dental assistant, under the personal and direct visual supervision of the dentist and upon the dentist's verbal command, to inject medication that the supervising dentist has drawn up through an intravenous (IV) site if the following requirements have been met: (1) The assistant holds a permit to monitor patients under general anesthesia, deep sedation or moderate sedation, AND (2) The assistant has passed the Dental Anesthesia Assistant National Certification Examination (DAANCE) administered by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and be currently DAANCE-certified, AND (3) The supervising dentist holds a permit to administer general anesthesia and deep sedation or moderate sedation. Intravenous Line Administration: Registered Dental Assistants and dental assistants may start an intravenous line if they have taken a board-approved anesthesia assisting course and received intravenous line training. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

475

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act â&#x20AC;&#x201C; South Dakota State Board of Dentistry South Dakota Codified Laws CHAPTER 36-6A DENTISTS, DENTAL HYGIENISTS AND DENTAL AUXILIARIES 36-6A-26. Definition of terms. Terms used in this chapter mean: (1) "Allied dental educational program," a dental hygiene, dental assisting, or laboratory technology educational program; (2) "Board," the State Board of Dentistry; (8) "Dental assistant," a person who, under the supervision of a dentist or dental hygienist, renders assistance as authorized by this chapter; (9) "Dental auxiliary," any person, other than a dental hygienist, that works under the supervision of a dentist and provides dental services to a patient; (12) "Dental radiographer," a person registered as a dental radiographer pursuant to this chapter; (18) "Direct supervision," the supervision of a dental hygienist or registered dental assistant requiring that a dentist diagnose the condition to be treated, a dentist authorize the procedure to be performed, a dentist remain in the dental clinic while the procedure is performed, and before dismissal of the patient a dentist approve the work performed by the dental hygienist or registered dental assistant; (19) "Expanded functions," reversible procedures which require professional proficiency and specific training, performed under the direct supervision of a dentist; (20) "General supervision," the supervision of a dental hygienist requiring that a dentist authorize the procedures to be carried out, and that the patient to be treated is a patient of record of the supervising dentist, or a dentist practicing within the same entity or clinic as the supervising dentist, and has had a complete evaluation within the previous thirteen months of the delegation of procedures. A written treatment plan contained within the patient's record shall accompany any authorization of treatment procedures; (21) "Indirect supervision," the supervision of a dental hygienist or registered dental assistant requiring that a dentist authorize the procedures and a dentist be in the dental clinic while the procedures are performed by the registered dental assistant or dental hygienist; (26) "Personal supervision," a level of supervision whereby the dentist or dental hygienist is personally treating a patient and authorizes the dental assistant to aid the treatment by concurrently performing a supportive procedure; (27) "Practitioner," a licensed dentist or dental hygienist; (28) "Registered dental assistant," a person registered as a registered dental assistant pursuant to this chapter who is authorized to perform expanded functions under the direct supervision of a dentist as authorized by this chapter; (29) "Registrant," a dental radiographer or registered dental assistant; 36-6A-14. Powers and duties of board. The board may: (4) Examine, or cause to be examined, for competency, an eligible applicant for a license to practice as a dentist or a dental hygienist or a registration to practice as a dental radiographer or registered dental assistant; (6) Issue a registration to practice as a dental radiographer or a registered dental assistant to an applicant who has met the registration standards of this chapter and renew the registrations of dental radiographers and registered dental assistants that continue to meet the registration standards of this chapter; (7) Establish minimum educational, training and competency standards governing the practice of dental radiographers, registered dental assistants, and dental assistants; (10) Permit dental hygienists and dental assistants to perform, under the supervision of a dentist, additional procedures established by rules promulgated pursuant to chapter 1-26; (11) Establish continuing education and continuing competency requirements for dentists, dental hygienists, dental radiographers, and registered dental assistants; 36-6A-28. Unauthorized practice or representation as dentist or dental hygienist, radiographer, registered assistant, or specialist--Misdemeanor. Each person who practices as, attempts to practice as, or purports to be a dentist, dental hygienist, dental radiographer, or registered dental assistant in this state without being licensed or without being registered for that purpose or without being exempted from this chapter is guilty of a Class 1 misdemeanor. 36-6A-41. Dentist responsible for dental hygienist or dental auxiliary--Differing levels of assistance based upon education. Each dentist who uses the services of a dental hygienist or dental auxiliary to assist the dentist in the practice of dentistry is responsible for the acts of the dental hygienist or dental auxiliary while engaged in such assistance. The dentist shall permit the dental hygienist or dental auxiliary to perform only those acts which the dentist is authorized under this chapter to delegate to a dental hygienist or dental auxiliary. The acts shall be performed under supervision of a dentist. The board may permit differing levels of dental assistance based upon recognized educational standards, approved by the board, for the training of dental hygienists or dental auxiliaries. 476

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants 36-6A-52. Annual renewal of license or registration--Information and fee--Notice. As a condition of annual renewal of a license or registration, each licensee or registrant shall, on or before the first day of July each year, transmit to the board, upon a form prescribed by the board, information reasonably related to the administration of a licensure or registration system in the interest of public health and safety, together with the fee established by the board. Failure of a licensee or registrant to renew a license or registration on or before the first day of July constitutes a suspension of the license or registration held by the licensee or registrant. At least thirty days before July first, the board shall cause a written notice stating the amount and due date of the fee and the information to be provided by the licensee or registrant, to be sent to each licensee and registrant. Each licensee and registrant shall report the information as a condition of the license or registration renewal. 36-6A-54. Display of certificates. Each licensee or registrant shall post and keep conspicuously his or her name, annual license certificate, and annual registration certificate in each dental clinic in which he or she practices, in plain sight of the patients. 36-6A-55. Proof of continuing education or continuing competency. Every five years of licensure or registration, each licensee or registrant shall provide the board evidence, of a nature suitable to the board that a licensee or registrant has attended, or participated in an amount of board approved continuing education or continuing competency as shall be required by the board. 36-6A-60. Proof of licensure or registration in prosecution for violation. In the prosecution of any person for violation of this chapter, it is not necessary to allege or prove lack of a valid license to practice as a dentist or a dental hygienist or a valid registration to practice as a dental radiographer or a registered dental assistant but such proof of licensure or registration is a matter of defense to be established by the defendant. South Dakota Administrative Rules Article 20:43 - Dentists 20:43:07 Dental Radiography. 20:43:07:01. Dental radiography -- Definition. Dental radiography is the application of X-radiation to human teeth and supporting structures for diagnostic purposes only. 20:43:07:05. Dental radiographers -- Qualification by endorsement. A person who has been legally practicing dental radiography in a state within the three years prior to application shall submit to the board the following: (1) A completed application form and an application fee of $40; (2) A copy of government-issued documentation sufficient to identify the applicant; (3) Verification that the applicant successfully completed a course that included at least sixteen hours of training in the areas outlined in § 20:43:07:06; and (4) One of the following: (a) If currently registered as a dental radiographer, verification of the registration number and status of the registration from the board of dentistry in each state in which the applicant is or has been registered to practice as a dental radiographer; or (b) If not currently registered as a dental radiographer, verification that the applicant has legally practiced dental radiography for a period of time during the three years preceding application. Written documentation from a dentist that has employed or supervised the applicant attesting to the current clinical proficiency of the applicant to practice dental radiography may be required. The board may issue a registration to practice as a dental radiographer if an applicant meets the requirements in this section. 20:43:07:06. Dental radiography training programs -- Board approval. The board may approve a dental radiography program of learning leading to a dental radiographer certificate of competency if the program meets the following requirements: (1) The program constitutes an organized program of learning which contributes to the proficiency and skills of an indi vidual operating radiation emitting equipment or otherwise engaged in dental radiography; (2) The program is conducted by individuals who are qualified by special education, training, and experience to conduct the program in dental radiography; and (3) The program includes at least sixteen hours of training in the areas outlined in § 44:03:01:14.02 plus practice in placement techniques on a training manikin, exposing radiographs, and identification of common technique errors. Application for approval of a program of learning shall be made to the board. 20:43:07:07. Dental radiographers -- Application for registration. An applicant for a registration to practice as a dental radiographer shall submit to the board the following: (1) A completed application form and an application fee of $40; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

477

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants (2) A copy of government-issued documentation sufficient to identify the applicant; (3) Proof of one of the following within the thirteen months prior to application: (a) Successful completion of a dental radiography course taken through a dental assisting, dental hygiene, or dental program accredited by the American Dental Association Commission on Dental Accreditation. If the radiography course is taken as part of an ongoing dental assisting program, the thirteen-month period prior to application begins after completion of the dental assisting program; (b) Passage of the Radiation Health and Safety Examination administered by the Dental Assisting National Board, Incorporated (DANB); (c) Successful completion of a program approved pursuant to § 20:43:07:06; or (d) Certification as a Certified Dental Assistant through DANB; and (4) If applicable, verification of the registration number and status of the registration from the board of dentistry in each state in which the applicant is or has been registered to practice as a dental radiography. The board may issue a registration to practice as a dental radiographer if an applicant meets the requirements in this section. 20:43:07:09. Dental radiographers -- Certificate of registration -- Renewal fee and display. By July 1 of each year, a dental radiographer shall submit a renewal fee of $20. The registrant shall display the registration in the office. 20:43:07:10. Dental radiographers -- Continuing education requirements. A dental radiographer shall complete at least five hours of board approved continuing education in dental radiography in each five-year licensure cycle. One hour of continuing education may be earned for each hour of attendance at a board approved continuing education course. The board shall review the continuing education guidelines annually. 20:43:07:12. Permitted use of radiation. Only a person registered to practice as a dental radiographer or licensed to practice as a dentist or dental hygienist may perform dental radiography. No person may be exposed to an ionizing radiation beam except for dental diagnostic purposes and only if exposure has been authorized by the supervising dentist. Any person operating a dental radiographic machine shall follow all safety instructions provided by the manufacture of the radiographic machine. 20:43:08 Dental Assistants 20:43:08:01. Definitions. Terms used in this chapter mean: (1) “Certificate of competency,” a certificate attesting that a dental assistant is qualified to perform expanded functions by successfully completing a program as described in §20:43:08:05; (2) "Dental assistant" means a person who performs duties or procedures as authorized by this article that does not need to be registered or licensed with the board; (3) "Expanded functions" means reversible procedures which require professional proficiency and specific training, performed under the direct supervision of a dentist; (4) "Registered dental assistant," means a person registered as a registered dental assistant who is authorized to perform expanded functions under the direct supervision of a dentist as authorized by this article. 20:43:08:02. Dental assistant -- Duties. Subject to the supervising dentist exercising full responsibility, a dental assistant may perform duties or procedures incidental to patient care, including intraoral services or assisting in the performance of clinical or clinical-related duties, if the duties or procedures are performed under direct or indirect supervision of a dentist or personal supervision of a dental hygienist. Subject to the supervising dentist exercising full responsibility, a dental assistant may perform the following duties or procedures if the supervising dentist is not present in the dental clinic, but has prior knowledge of and has authorized the performance: (1) Making impressions or obtaining digital records for casts and appliances; (2) Creating or delivering vacuum-formed orthodontic retainers; (3) Taking photographs extraorally or intraorally; (4) Cutting long or broken wires; (5) Removing loose bands, clasps, or brackets on orthodontic appliances or retainers; (6) Removing and replacing existing ligature ties and arch wires on orthodontic appliances; (7) Removing existing and replacing lost or missing elastic orthodontic separators; (8) Recementing existing provisional restorations; (9) Manipulating dental software for designing restorations; (10) Duties or procedures that involve infection control; and (11) Taking vital signs and updating health history. 478

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants 20:43:08:02.01. Dental assistant -- Prohibited duties. The following list of duties or procedures may not be performed by a dental assistant: (1) Placing sealants; (2) Placing nonsurgical retraction materials for gingival displacement; (3) Fabricating provisional restorations; (4) Using electronic instruments for caries detection; (5) Adjusting dentures or partials; (6) Intraoral use of rotary hand instruments or ultrasonic instruments; (7) Any duty or procedure that falls outside of the relevant education, training, and experience of the dental assistant; (8) Any procedure that cannot be performed by a registered dental assistant; and (9) Other duties or procedures prohibited by the board. 20:43:08:03. Registered dental assistant -- Requirements. An applicant for a registration to practice as a registered dental assistant must be at least eighteen years of age and shall submit to the board: (1) A completed application form and an application fee of $40; (2) A copy of the applicant’s birth certificate or equivalent documentation; (3) Proof of one of the following: (a) Graduation from an American Dental Association Commission on Dental Accreditation (CODA) accredited dental assisting program; (b) Current certification as a Certified Dental Assistant through the Dental Assisting National Board, Inc.; or (c) Completion of a program approved pursuant to § 20:43:08:05 resulting in a registered dental assistant certificate of competency; (4) A certified letter verifying the registration number and status of the registration from the board of dentistry in each state in which the applicant is or has been registered to perform expanded functions; and (5) A copy of the applicant’s current board approved cardiopulmonary resuscitation card. The board accepts only the American Heart Association for the Healthcare Provider, American Red Cross for the Professional Rescuer, or an equivalent program approved by the board. Applicants who have completed a CODA accredited dental assisting program or obtained a certificate of competency must apply within five years of completion of the program or, if the program was completed more than five years prior to application, must have legally provided expanded functions within five years preceding application. Written documentation verifying the current clinical proficiency of the applicant to perform expanded functions may be required from a dentist who has employed or supervised the applicant within the five years prior to application. The board may issue a registration to practice as a registered dental assistant if an applicant meets the requirements in this section. A registered dental assistant may perform expanded functions under the direct supervision of a dentist as authorized by this article. 20:43:08:04. Knowledge of infection control and applicable Occupational Safety and Health Administration standards. Dental assistants and registered dental assistants must be knowledgeable in the following: (1) Occupational Safety and Health Administration Hazard Communication Standard as outlined in 29 CFR §1910.1200 (May 25, 2012); (2) Occupational Safety and Health Administration Bloodborne Pathogens Standard as outlined in 29 CFR §1910.1030 (April 3, 2012); and (3) Centers for Disease Control and Prevention Guidelines for Infection Control in Dental Health Care Settings, 2003. 20:43:08:05. Registered dental assistant training programs -- Application. The board may approve a program of learning leading to a registered dental assistant certificate of competency if the program meets the following requirements: (1) The program is conducted by an entity that administers an American Dental Association Commission on Dental Accreditation (CODA) accredited dental assisting program or has applied for and is completing the application process to obtain CODA accreditation for its dental assisting program; and (2) The program verifies the competency of participants on areas generally included in the curriculum of a CODA accredited dental assisting program. Application for approval of programs shall be made to the board. 20:43:08:06. Certificate of competency -- Examination. Repealed. 20:43:08:07. Student exemption. An individual who does not hold a registration to practice as a registered dental assistant may perform dental assisting duties or procedures and expanded functions, if the following requirements are met: (1) The individual is enrolled in an American Dental Association Commission on Dental Accreditation accredited dental assisting program or board approved dental assisting educational program, and is performing the dental assisting duty, procedure, or expanded function under the auspices of that program; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

479

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants (2) The duty, procedure, or expanded function is performed under the supervision of a faculty member of that program who is appropriately registered or licensed in the state where the program is located; and (3) The faculty member authorizes the dental assisting duty, procedure, or expanded function to be performed, remains in the dental clinic while it is performed, and before dismissal of a patient, the faculty member approves the work that was performed. 20:43:08:08. Application for registration. Repealed. 20:43:08:09. Registered dental assistant -- Renewal. Each person registered to practice as a registered dental assistant shall annually procure a certificate of registration from the board by July first. Each person registered as a registered dental assistant shall maintain a current board approved cardiopulmonary resuscitation card. The board accepts only the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board. A registered dental assistant shall pay an annual renewal fee of $20. A registered dental assistant shall display the registration in the office. 20:43:08:09.01. Registered dental assistant -- Continuing education requirements. A registered dental assistant shall complete at least 60 hours of board approved continuing education in each five-year licensure cycle. One hour of continuing education may be earned for each hour of attendance at a board approved continuing education course. Credit for nutrition continuing education is limited to 15 hours per five-year licensure cycle. Credit for practice management continuing education is limited to 10 hours per five-year licensure cycle. Credit for home study continuing education is limited to 30 hours per five-year licensure cycle. Credit for cardiopulmonary resuscitation continuing education is limited to 15 hours per five-year licensure cycle. Credit for clinical continuing education is unlimited per fiveyear licensure cycle. Up to five hours of clinical continuing education may be earned for attendance at exhibits at each state, regional, or national dental conference with a limit of 20 hours per five-year licensure cycle. The board's continuing education guidelines shall be reviewed annually. 20:43:08:10. Registered dental assistant -- Duties. If the supervising dentist exercises full responsibility, a registered dental assistant may perform expanded functions under the direct supervision of a dentist. A registered dental assistant may not perform the following procedures: (1) Irreversible procedures; (2) Cutting of hard or soft tissue; (3) Using lasers that are capable of altering, cutting, burning or damaging hard or soft tissue; (4) Intraoral placing, finishing, and adjusting of final restorations; (5) Supra and subgingival scaling and periodontal probing as it pertains to dental hygiene and those procedures dental hygienists may perform as provided in SDCL 36-6A-40 and in § 20:43:04:04 with the exception of placing sealants and coronal polishing; (6) Injecting medication other than as permitted in § 20:43:09:10.01; (7) Administering nitrous oxide analgesia other than as permitted in § 20:43:09:06; (8) Monitoring patients under general anesthesia, deep sedation, or moderate sedation other than as permitted in § 20:43:09:10; (9) Applying X-radiation to human teeth and supporting structures other than as permitted in chapter 20:43:07; (10) Establishing a final diagnosis or treatment plan; (11) Any procedure that falls outside of the relevant education, training, and experience of the registered dental assistant; and (12) Other procedures prohibited by the board. 20:43:09 Anesthesia and Analgesia. 20:43:09:01 Definitions. Terms used in this chapter mean: (1) "Minimal sedation," a minimally depressed level of consciousness, produced by a single enteral drug administered in a dose appropriate for the unsupervised treatment of anxiety, insomnia, or pain that does not exceed the maximum recommended dose. Incremental dosing may be utilized. Patient retains the ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected; (2) “Nitrous oxide inhalation analgesia,” the administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond purposefully to physical or verbal command; (3) "Moderate sedation," a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. Moderate sedation can be administered either orally or parenterally; 480

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants (4) "Deep sedation," a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to maintain ventilatory function independently may be impaired. Reflex withdrawal from a painful stimulus is not considered a purposeful response. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained; (5) "General anesthesia," a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to maintain ventilatory function independently is often impaired. Patients frequently require assistance maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. 20:43:09:03. General anesthesia and deep sedation permit requirements. The board may issue a permit to a licensed dentist to use general anesthesia and deep sedation for dental patients on an outpatient basis if the dentist meets the following requirements: (4) Employs auxiliary personnel who hold a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation. A dentist with a general anesthesia and deep sedation permit may not administer general anesthesia or deep sedation or monitor a patient without the presence and assistance of qualified auxiliary personnel. A dentist shall apply the current standard of care to continuously monitor and evaluate the patient's blood pressure, pulse, respiratory function, and cardiac activity.

A general anesthesia and deep sedation permit precludes the need for a moderate sedation or a nitrous oxide inhalation analgesia permit.

20:43:09:04. Moderate sedation permit requirements. The board may issue a permit to a licensed dentist to use moderate sedation for dental patients on an outpatient basis if the dentist meets the following requirements: (4) Employs auxiliary personnel who hold a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation. A dentist with a moderate sedation permit may not administer moderate sedation or monitor a patient without the presence and assistance of qualified auxiliary personnel. 20:43:09:04.01.Â Â Employing or contracting with licensed anesthesia provider that provides general anesthesia, deep sedation, or moderate sedation in dental office. If a dentist employs or contracts with a licensed anesthesia provider that provides general anesthesia, deep sedation, or moderate sedation for dental patients in a dental office on an outpatient basis, the dentist must: (3) Employ auxiliary personnel that are certified in administering basic life support by the American Health Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board; 20:43:09:05. Nitrous oxide inhalation analgesia permit requirements - Dentists. The board may issue a permit to a dentist to use nitrous oxide inhalation analgesia sedation for dental patients on an outpatient basis if the dentist meets the following requirements: (4) Employs auxiliary personnel who are certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board. 20:43:09:06. Nitrous oxide inhalation analgesia permit requirements - Dental hygienists and registered dental assistants. The board may issue a permit to a dental hygienist or a registered dental assistant to use nitrous oxide inhalation analgesia for dental patients on an outpatient basis under the direct supervision of a dentist if the dental hygienist or registered dental assistant has met the following requirements: (1) Is certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board; and (2) Has successfully completed a board approved educational course that substantially meets the objectives and content as described in Part 4 of the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students and either: (a) Completed the course within thirteen months of application; or (b) Completed the course more than thirteen months prior to application, has legally administered nitrous oxide inhalation analgesia for a period of time during the three years preceding application, and provides written documentation from a dentist that has employed or supervised the applicant, attesting to the current clinical proficiency of the applicant to administer nitrous oxide inhalation analgesia. 20:43:09:08. Application for permits -- Renewal. The application for a permit to administer general anesthesia and deep sedation or moderate sedation must include a fee of $50. The application for a permit for a dentist, dental hygienist ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

481

South Dakota State Dental Practice Act and Administrative Rules for Dental Assistants or registered dental assistant to administer nitrous oxide inhalation analgesia must include a fee of $40. The application for a permit for a dental hygienist to administer local anesthesia must include a fee of $40. The board may issue a temporary permit to an applicant that has met the applicable requirements of this chapter, but before all processing and any applicable inspection have been completed. The duration of this temporary permit shall be determined by the board, but may not exceed one year. The temporary permit of an applicant who fails an inspection is automatically suspended. Upon suspension, the applicant may request another inspection. A nitrous oxide inhalation analgesia permit, local anesthesia permit, and permit to monitor patients under general anesthesia, deep sedation or moderate sedation must be renewed annually. The annual fee for a nitrous oxide inhalation analgesia permit for a dentist is $40. The annual fee for a nitrous oxide inhalation analgesia permit for a dental hygienist is $20. The annual fee for a nitrous oxide inhalation analgesia permit for a registered dental assistant is $20. The annual fee for a permit to administer local anesthesia for a dental hygienist if $20. There is no annual fee for a permit to monitor patients under general anesthesia, deep sedation or moderate sedation. Failure to properly renew a general anesthesia and deep sedation permit, moderate sedation permit, nitrous oxide inhalation analgesia permit, local anesthesia permit, or a permit to monitor patients under general anesthesia, deep sedation or moderate sedation constitutes an automatic suspension of the permit. 20:43:09:10. Permit requirements to monitor patients under general anesthesia, deep sedation, or moderate sedation. The board may issue a permit to a dental hygienist, registered dental assistant, or dental assistant to monitor patients under general anesthesia, deep sedation, or moderate sedation while under the direct supervision of a dentist who holds a current permit to administer general anesthesia and deep sedation or moderate sedation if the dental hygienist, registered dental assistant, or dental assistant has met the following requirements: (1) Is certified in administering basic life support by the American Heart Association for the Healthcare Provider, the American Red Cross for the Professional Rescuer, or an equivalent program approved by the board; and (2) Has successfully completed at least an eight-hour board approved course in anesthetic assisting and either: (a) Completed the course within thirteen months prior to application; or (b) Completed the course more than thirteen months prior to application, has legally monitored patients receiving analgesic or anesthetic agents for a period of time during the two years preceding application, and provides written documentation from a dentist that has employed or supervised the applicant, attesting to the current clinical proficiency of the applicant to monitor patients under general anesthesia, deep sedation, or moderate sedation. 20:43:09:10.01. Delegation of injection of medication. A dentist may authorize a dental hygienist, registered dental assistant, or dental assistant to inject medication through an intravenous site if the following requirements have been met: (1) The dental hygienist, registered dental assistant, or dental assistant holds a permit to monitor patients under general anesthesia, deep sedation, or moderate sedation; (2) The dental hygienist, registered dental assistant, or dental assistant has successfully passed the Dental Anesthesia Assistant National Certification Examination administered by the American Association of Oral and Maxillofacial Surgeons and is currently certified in Dental Anesthesia Assisting by the American Association of Oral and Maxillofacial Surgeons; (3) The supervising dentist holds a current permit to administer general anesthesia and deep sedation or moderate sedation; (4) The supervising dentist draws up the medications that will be utilized during the procedure; (5) The dental hygienist, registered dental assistant, or dental assistant is operating under the personal supervision of the supervising dentist and the supervising dentist maintains direct visual supervision during the injection of the medication through an intravenous site; and (6) The supervising dentist authorizes the procedure by verbal command, clearly articulating the specific medication and the amount of the medication to be administered and the dental hygienist, registered dental assistant, or dental assistant repeats the verbal command back to the supervising dentist before injecting medication through an intravenous site. 20:43:09:15. Intravenous line. A dental hygienist, registered dental assistant, or dental assistant may start an intravenous line if he or she has met the following requirements: (1) Taken a board approved anesthesia assisting course; and (2) Received intravenous line training.

482

Tennessee DANB Certificant Counts: Tennessee National Entry Level Dental Assistant (NELDA)

Certified Dental Assistant (CDA) certificants

665

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Dea Smith, Executive Director Tennessee Board of Dentistry 665 Mainstream Drive Nashville, TN 37243 Phone: 800-778-4123 ext. 5235073 or 615-532-5073 Fax: 615-770-7444 Website: https://www.tn.gov/health/health-program-areas/ health-professional-boards/dentistry-board.html

Radiation Health and Safety (RHS)

3,224

Infection Control (ICE)

2,926

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Chattanooga State Community College Northeast State Community College South College Tennessee College of Applied Technology-Knoxville Tennessee College of Applied Technology-Memphis Volunteer State Community College

DANB CDA Certificant State of Tennessee+

$16.40 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of April 22, 2020.

Source: 2018 DANB Salary Survey (state data based on 13 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

483

Tennessee State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist in the state of Tennessee, a dental assistant hold a certificate in dental radiology from the Tennessee Board of Dentistry. To qualify, one must: (1) Be a Registered Dental Assistant (see requirements below), AND (2a) Successfully complete a Tennessee Board-approved radiology certification course (to qualify, one must be a current Tennessee RDA) OR (2b) Successfully complete a comparable training program in dental radiology in another state OR (2c) Be enrolled in a CODA-accredited or Board-approved dental assisting program that offers a dental radiology course as part of its curriculum, OR (2d) Hold current DANB Certified Dental Assistant (CDA) certification or pass the Radiation Health and Safety (RHS) component of the DANB CDA exam, AND (3) Receive a certificate in dental radiology from the Tennessee Board of Dentistry.

State Requirements For Expanded Functions Registered Dental Assistants in the state of Tennessee may perform the procedures listed for this level in the state dental practice act under the direct supervision of a licensed dentist. To register as an RDA, one must: (1) Have a high school diploma or GED certificate, AND (2) Be at least 18 years of age, AND (3) Successfully complete BLS for Healthcare Providers, CPR/AED for Professional Rescuers, or equivalent course, AND (4) Successfully complete the Tennessee Board of Dentistry Ethics and Jurisprudence exam, AND (5) Apply for registration to the Tennessee Board of Dentistry. To perform expanded functions in the state of Tennessee under the direct supervision of a licensed dentist, Registered Dental Assistants (RDAs) must earn state certification by completing the following requirements for each of the desired expanded functions: Perform coronal polishing procedures: (1) Successfully complete a Tennessee Board-approved coronal polishing course including both a written and a clinical exam (to qualify for the course, an individual must be an RDA in Tennessee) or complete a CODA-accredited dental assisting program that included coronal polishing in the curriculum, AND (2) Receive a certificate in coronal polishing from the Tennessee Board of Dentistry. Apply sealants: (1) Successfully complete a Tennessee Board-approved course in sealant application (to qualify, one must be a current RDA) or be enrolled in a CODA-accredited or Tennessee Board-approved program which offers such a course, AND (2) Receive a certificate in sealant application from the Tennessee Board of Dentistry. Monitor nitrous oxide: (1) Successfully complete a Tennessee Board-approved nitrous oxide monitoring course (to qualify, one must be a current RDA) or be enrolled in a CODA-accredited or Tennessee Board-approved program which offers such a course as part of its curriculum, AND (2) Receive a certificate in monitoring nitrous oxide from the Tennessee Board of Dentistry. Perform expanded restorative and/or prosthetic functions: (1) Have a minimum of two years of continuous, full-time registered dental assisting employment in the three years prior to enrolling in course AND (2) Complete a Tennessee Boardapproved certification course, AND (3) Receive a certificate in expanded restorative and/or prosthetic functions from the Tennessee Board of Dentistry. Expose dental radiographs: (See "Tennessee State Radiography Requirements" above.) NOTE: RDAs who have successfully completed a comparable training program in expanded functions in another state may be eligible to apply directly to the Board for an expanded functions certificate without additional training. The expanded functions course must have been approved by the dental board in the other state and the Tennessee Board of Dentistry consultant must determine that the course is equivalent to the Tennessee Board-approved course. The information regarding content of the course and proof of completion must be sent directly from the course provider to the Board’s administrative office. If a certification or permit was issued by the other state, verification of the certificate or permit must be received directly from the other board. For more information, contact the Tennessee Board of Dentistry.

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Tennessee Board of Dentistry Tennessee Code Title 63

Chapter 5. Dentists 63-5-108. Practice of dentistry and dental hygiene defined. (d) Any duly licensed and registered dentist may assign to duly licensed and registered dental hygienists, registered dental assistants and/or practical dental assistants, as defined by the board in rules and regulations, any tasks or procedures to be performed in the dentist’s office for which a licensed and registered dentist exercises direct supervision and full responsibility, except those procedures requiring the professional judgment or skill of a dentist; provided, 484

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants that duties involving the removal of hard and soft deposits by scaling or curettage from the surfaces of human teeth are assigned only to duly licensed and registered dental hygienists. The board has the authority to permit registered dental assistants to apply sealants to and to polish human teeth, and the board has the discretion to establish criteria and curricula as necessary to ensure that such registered dental assistants are qualified to apply sealants and perform polishing. For eligibility to perform polishing, passage of a clinical and didactic examination is required. The board is authorized to permit licensed and registered dental hygienists and registered dental assistants to insert, pack, carve and finish amalgam and intracoronal nonmetallic restorations and take final impressions for fixed and removable prosthetic appliances, under the direct supervision and full responsibility of a licensed dentist, and the board shall establish such criteria and curricula as it determines in its discretion are necessary or appropriate to ensure that such hygienists and assistants are qualified to perform such procedures. Tasks and procedures assignable to licensed and registered dental hygienists shall include those enumerated in the board’s regulations as of January 1, 1990, and such other additional tasks and procedures as the board may deem appropriate in the future. Procedures requiring professional judgment or skill not assignable to such dental hygienists and dental assistants include the following: (1) Diagnosis and treatment planning; oral surgery, the cutting of hard and/or soft tissues, excluding any cutting of such tissues involved in subgingival scaling, root planing and gingival curettage, and any intra-oral procedures that would affect the function and/or efficiency of an appliance that, when worn by the patient, would come in direct contact with hard or soft tissue and that could result in tissue irritation or injury; (2) The placing of permanent fillings or restorations in or on teeth except as provided in this subsection (d); and (3) Administration of a general or local anesthetic, except for a topical anesthetic in connection with a dental operation; provided, however, that dental hygienists who possess a permit issued pursuant to subdivision (b)(12) may administer a local anesthetic but only under the direct supervision of a licensed and registered dentist who is physically present at the same office location and time and in accordance with rules and regulations of the board. 63-5-115. Employment of and practice by hygienists and assistants. (a) A duly licensed and registered dentist may employ licensed and registered dental hygienists, registered dental assistants and practical dental assistants. Such licensed and registered dental hygienists may practice as authorized in this section or § 63-5-108 only in the office of and under the direct and/or general supervision of a licensed and registered dentist except in authorized public health programs. Such registered and/or practical dental assistants may practice as authorized in this section or § 63-5-108 only in the office of and under the direct supervision of a licensed and registered dentist except in authorized public health programs. No provisions in this chapter shall be construed as authorizing any licensed and registered dental hygienists, registered dental assistants or practical dental assistants to practice as such except as provided in this section. (b) Definitions. (1) Direct Supervision. As used in this chapter regarding supervision of licensed and registered dental hygienists or registered dental assistants, “direct supervision” means the continuous presence of a supervising dentist within the physical confines of the dental office when licensed and registered dental hygienists or registered dental assistants perform lawfully assigned duties and functions; (2) General Supervision. As used in this chapter, “general supervision” is defined as those instances when the dentist is not present in the dental office or treatment facility while procedures are being performed by the dental hygienist, but the dentist has personally diagnosed the condition to be treated, has personally authorized the procedures being performed and will evaluate the performance of the dental hygienist. (c) Licensed and registered dental hygienists and registered dental assistants are specifically permitted to participate unsupervised in educational functions involving organized groups or health care institutions regarding preventive oral health care. Dental hygienists are permitted to participate in health screenings and similar activities; provided, that no remuneration is given by the organized group to any hygienist or the hygienist’s employer for participating in these activities. CHAPTER 0460-01 GENERAL RULES

Rules and Regulations

0460-01-.01 DEFINITIONS. As used in Chapters 1 through 5 of Rule 0460, the following terms and acronyms shall have the following meanings ascribed to them: (2) Board - The Tennessee Board of Dentistry. (4) Certified Dental Assistant - A designation for an individual who has obtained certification from the Dental Assisting National Board, and with such designation, the individual may apply for registration to practice as a registered dental assistant in this State. All certified dental assistants must be registered by the State, pursuant to Rule 0460-04-.02, before they are eligible to practice as registered dental assistants in this State. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

485

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants (6) Coronal Polishing - The polishing of the enamel and restorations on the clinical crown of human teeth by utilizing a combination of a polishing agent and a slow speed handpiece, a prophy angle, a rubber cup, or any home care cleaning device. (20) Practical Dental Assistant - An auxiliary employee of a licensed dentist(s) who performs supportive chairside procedures under the direct supervision and full responsibility of that licensed dentist or who is a dental assistant student in an educational institution accredited by the Commission on Dental Accreditation, as defined by Rule 0460-4-.01. (23) Registered Dental Assistant - An auxiliary employee of a licensed dentist(s) who has been issued a registration to practice intraoral dental assisting procedures in accordance with the statutes and rules of the Board, and is eligible to seek certification and training in advanced dental assisting areas, and who practices under the direct supervision and full responsibility of a licensed dentist. (24) Registrant - Any person who has been lawfully issued a registration from the Board to practice as dental assistants. (25) Restorative Function – Dental procedure involving the repairing, restoring, or reforming the shape, form, and function of part or all of a tooth. (26) Sealant Application - The application of an organic polymer to the enamel surfaces of teeth. 0460-01-.02 FEES. The fees authorized by the Tennessee Dental Practice Act (T.C.A. §§ 63-5-101, et seq.) and other applicable statutes are established and assessed by the Board as non-refundable fees, as follows: (3) Dental Assistants (a) Registration Application Fee - Payable each time an application for a registration to practice as a dental assistant is filed. $ 30.00 (b) Registration Renewal Fee - Payable biennially by all registrants. $50.00 (c) State Regulatory Fee - Payable upon application for registration and biennially thereafter by all registrants $ 10.00 (d) Reinstatement Fee - Payable when a registration is not timely renewed and which is paid in addition to all current and past due registration renewal fees. $100.00 (e) Duplicate Registration Fee - Payable when a registrant requests a replacement for a lost or destroyed “artistically designed” wall registration or renewal certificate. $ 20.00 (f) Coronal Polishing Certification Fee – To be paid to the Board’s Administrative Office. $ 15.00 (g) Sealant Application Certification Fee - To be paid to the Board’s Administrative Office. $15.00 (h) Radiology Certification Fee – To be paid to the Board’s Administrative Office $ 15.00 (i) Nitrous Oxide Monitoring Certification Fee – To be paid to the Board’s Administrative Office$ 15.00 (j) Expanded Restorative Functions Certification Fee – To be paid to the Board’s Administrative Office $ 15.00 (k) Expanded Prosthetic Functions Certification Fee – To be paid to the Board’s Administrative Office $ 15.00 (4) Fees may be paid in the following manner: (a) All fees paid by money order, certified, personal, or corporate check must be submitted to the Board’s Administrative Office and made payable to the Tennessee Board of Dentistry. 0460-01-.05 CONTINUING EDUCATION AND C.P.R. (1) Continuing Education - Hours Required (c) Beginning January 3, 2003, each registered dental assistant must successfully complete twenty-four (24) hours of continuing education in courses approved by the Board during the two (2) calendar years (January 1st of an odd-numbered year through December 31st of the subsequent even-numbered year) that precede the registration renewal year. At least two (2) hours of the twenty-four (24) hour requirements shall pertain to chemical dependency education. (2) Continuing Education. Proof of Compliance (a) The due date for successful completion of the required continuing education hours is December 31st of the two (2) calendar years (January 1st of an odd-numbered year through December 31st of the subsequent even-numbered year) that precede the licensure or registration renewal year. (b) Each dentist, dental hygienist, and registered dental assistant must, on their biennial renewal application, attest to attendance and successful completion of the required continuing education hours and that such hours were obtained during the calendar years of report. (c) Each dentist, dental hygienist, and registered dental assistant must retain independent documentation of attendance and completion of all continuing education courses. This documentation must be retained for a period of three (3) years from the end of the calendar year in which the course is completed. This documentation must be produced for inspection and verification, if requested in writing by the Board during its verification process. (d) Further, it is the responsibility of the practitioner to obtain documentation in the form of a certificate indicating the name of the practitioner attending such course, title of the course taken, date of the course, number of hours obtained for attending the course, and verification of the approved organization sponsoring the course. (e) Any practitioner who, on their biennial renewal application, attests to attendance and successful completion of the required continuing education which in any way is not true will be subject to disciplinary action pursuant to T.C.A. 63-5-124 (a) (1), (2), (3), (7) and (18). 486

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants (4)

Cardio Pulmonary Resuscitation (CPR) (a) Each dentist, dental hygienist, and dental assistant must attest, check a box, and/or enter signature when applying for biennial renewal of licensure or registration, which indicates current training in basic CPR. (b) The hours necessary to obtain or maintain C.P.R. may be counted as continuing education hours. (c) Each dentist, dental hygienist and registered dental assistant must retain independent documentation of CPR training for a period of three (3) years from the end of the calendar year in which the training is received. Such proof must be produced for inspection and verification, if requested in writing by the Board during its verification process. (d) The following organizations are approved by the Board for CPR training: 1. The American Red Cross 2. The American Heart Association 3. Programs offered in hospital settings 4. Any organization which receives approval of specially designed CPR courses from the Board after its review.

0460-01-.11 INFECTION CONTROL (12) All dentists, dental hygienists, and dental assistants shall follow hand hygiene guidelines in accordance with current CDC recommendations. Hand hygiene guidelines include, but are not limited to: (a) Hands shall be washed with soap and water when hands are visibly dirty or contaminated with proteinaceous material, are visibly soiled with blood or other body fluids, before eating, and after using a restroom. (b) Use alcohol-based hand rubs for routine decontamination of hands for all clinical indications, except as provided in subparagraph (a). (c) Indications for hand hygiene include contact with a patient’s intact skin, contact with environment surfaces/inanimate objects in the immediate vicinity of patients, before donning surgical or examination gloves, and after removal of gloves. 0460-01-.14 MOBILE DENTAL CLINICS. (6) All dental hygienists and dental assistants assisting the dentists must be currently licensed and registered with the Tennessee Board of Dentistry. CHAPTER 0406-02 RULES GOVERNING THE PRACTICE OF DENTISTRY 0460-02-.07 ANESTHESIA AND SEDATION. (1) Definitions. (c) Antianxiety premedication (anxiolysis). The prescription of pharmacologic substances for the relief of anxiety and apprehension. (e) Conscious sedation. A minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or non-pharmacological method or a combination thereof. (f) Deep sedation. An induced state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to physical stimulation or verbal command, and is produced by a pharmacological or non-pharmacological method or a combination thereof. (k) General anesthesia. An induced state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the inability to continually maintain an airway independently and respond purposefully to physical stimulation or verbal command, and is produced by a pharmacological or non-pharmacological method or a combination thereof. (l) Hospital. A hospital licensed by the Department of Health’s Division of Health Care Facilities. (m) Inhalation. A technique of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. (o) Nitrous oxide inhalation analgesia. The administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. (4) Nitrous oxide inhalation analgesia. (b) An authorized person must constantly monitor each patient receiving nitrous oxide. In addition to dentists, any licensed dental hygienist or registered dental assistant who has complied with rules 0460-03-.06 or 0460-04-.05 is an authorized person and may monitor patients who are receiving nitrous oxide. (c) Monitoring nitrous oxide. Monitoring patients receiving nitrous oxide inhalation analgesia as an adjunct to dental or to dental hygiene procedures consists of continuous direct clinical observation of the patient and begins after the dentist or dental hygienist has initiated the analgesia. The dentist must be notified of any change in the patient which might indicate an adverse effect on the patient. Those certified in nitrous oxide monitoring may terminate the administration of nitrous oxide inhalation analgesia. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

487

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants (5) Antianxiety premedication (anxiolysis). (b) A dentist using antianxiety premedication must employ auxiliary personnel who are certified in BLS for Healthcare Providers, or CPR/AED for Professional Rescuers, or an equivalent course, which provides training for healthcare professionals in CPR and the use of an AED by a Board approved training organization. The course must be conducted in person and include a skills examination on a manikin with a certified instructor. (6) Conscious sedation. (b) General rules for conscious sedation. 2. Personnel. (i) During conscious sedation at least one (1) person, in addition to the operating dentist, must be present. (ii) Members of the operating team must be trained for their duties according to protocol established by the dentist and must be currently certified in BLS for Healthcare Providers, or CPR/AED for Professional rescuers, or an equivalent course, which provides training for healthcare professionals in CPR and the use of an AED by a Board approved training organization. The course must be conducted in person and include a skills examination on a manikin with a certified instructor. (iii) All operatory room and/or recovery personnel who provide clinical care shall hold a current, appropriate Tennessee license/registration pursuant to Tennessee Code Annotated, Title 63. (iv) Unlicensed/unregistered personnel may not be assigned duties or responsibilities that require professional licensure. (v) Notwithstanding the provisions of part (iv), duties assigned to unlicensed/unregistered personnel shall be in accordance with their training, education, and experience and under the direct supervision of a licensed dentist. 5. Monitoring. (i) Direct clinical observation of the patient must be continuous; (ii) Interval recording of blood pressure and pulse must occur; (iii) Oxygen saturation must be evaluated continuously by a pulse oximeter; (iv) The patient must be monitored during recovery by trained personnel until stable for discharge; (v) If monitoring procedures are prevented by the patientâ&#x20AC;&#x2122;s age, physical resistance or emotional condition, the reason(s) should be documented; and (vi) If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation. (7) Deep sedation/general anesthesia. (b) General rules for deep sedation/general anesthesia. 2. Personnel. (i) During deep sedation/general anesthesia at least two (2) persons, in addition to the operating dentist, must be present. (ii) Members of the operating team must be trained for their duties according to protocol established by the dentist and must be currently certified in CPR/AED for Professional Rescuers, or an equivalent course, which provides training for healthcare professionals in CPR and the use of an AED by a Board approved training organization. The course must be conducted in person and include a skills examination on a manikin with a certified instructor. (iii) When the same individual administering the deep sedation/general anesthesia is performing the dental procedure, there must be a second (2nd) individual trained in patient monitoring. (iv) All operatory room and/or recovery personnel who provide clinical care shall hold a current, appropriate Tennessee license/registration pursuant to Tennessee Code Annotated, Title 63. (v) Unlicensed/unregistered personnel may not be assigned duties or responsibilities that require professional licensure. (vi) Notwithstanding the provisions of subpart (v), duties assigned to unlicensed/unregistered personnel shall be in accordance with their training, education, and experience and under the direct supervision of a licensed dentist. 5. Monitoring. (i) Direct clinical observation of the patient must be continuous; (ii) Interval recording of blood pressure and pulse must occur; (iii) Oxygen saturation must be monitored continuously by pulse oximeter; (iv) Continuous EKG monitoring with electrocardioscope must occur; (v) Respirations must be monitored by end tidal CO2 unless precluded or invalidated by the nature of the patient, procedure, or equipment; (vi) If anesthetic agents implicated in the etiology of malignant hyperthermia are used, body temperature must continuously be monitored; and (vii) The patient must be monitored during recovery by trained personnel until stable for discharge.

488

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants CHAPTER 0460-04 RULES GOVERNING THE PRACTICE OF DENTAL ASSISTANTS 0460-04-.01 LEVELS OF PRACTICE. It is the intent of the Board to authorize two distinct levels of practice for dental assistants in dental offices in Tennessee. (1) Practical Dental Assistants (a) Definition – A practical dental assistant is an auxiliary employee of a licensed dentist(s) who is receiving practical chairside dental assisting training from a licensed dentist(s) or is a dental assistant student in an educational institution accredited by the Commission on Dental Accreditation. (b) Scope of Practice 1. A practical dental assistant must be under the direct supervision of a licensed dentist. 2. It is the intent of this rule that practical dental assistants not invade the practice procedures only allowed to be assigned or delegated to registered dental assistants or licensed dental hygienists. (2) Registered Dental Assistant (a) Definition – A dental assistant who has received a registration from the Board pursuant to rule 0460-4-.02. (b) Scope of Practice – A registered dental assistant may perform those additional procedures for which they have received Board certification as provided by rule 0460-4-.08 under direct supervision of a dentist. 0460-04-.02 REGISTRATION PROCESS. To practice as a dental assistant beyond the scope of a practical dental assistant a person must possess a lawfully issued registration from the Board. The process for obtaining a registration is as follows: (1) An applicant shall obtain a Board application form from the Board Administrative Office, respond truthfully and completely to every question or request for information contained in the form and submit it along with all documentation and fees required by the form and this rule to the Board Administrative Office. It is the intent of this rule that all activities necessary to accomplish the filing of the required documentation be completed prior to filing a registration application and that all documentation be filed simultaneously. (2) An applicant shall submit: (a) proof of having graduated from a high school or submit proof of possession of a general educational development (g.e.d.) certificate; and (b) proof of having attained at least eighteen (18) years of age; and (c) a signed “passport” style photograph taken within the preceding twelve (12) months. (3) An applicant shall submit evidence of good moral character. Such evidence shall include at least two (2) letters attesting to the applicant’s character from dental professionals on the signator’s letterhead. (4) An applicant shall submit proof of United States or Canadian citizenship or evidence of being legally entitled to live in the United States. Such evidence may include copies of birth certificates, naturalization papers, or current visa status. (5) An applicant shall submit the registration application fee and state regulatory fee provided in rule 0460-1-.02 (3). (6) An applicant shall disclose the circumstances surrounding any of the following: (a) Conviction of any criminal law violation of any country, state, or municipality, except minor traffic violations. (b) The denial of registration application by any other state or the discipline of registration in any state. (c) Failure of any professional licensure examinations. (7) An applicant shall cause to be submitted to the Board’s administrative office directly from the vendor identified in the Board’s registration application materials, the result of a criminal background check. (8) If an applicant has ever held a registration of any kind to practice dental assistance in any other state or Canada, the applicant shall submit or cause to be submitted the equivalent of the Tennessee Certificate of Endorsement from each such licensing board which indicates the applicant either holds a current active registration which is in good standing, or holds a registration which is currently inactive and whether it was in good standing at the time it became inactive. (9) An applicant shall submit evidence of current training in cardiopulmonary resuscitation (CPR) which is defined as successful completion of a BLS for Healthcare Providers, or CPR/AED for Professional Rescuers, or an equivalent course, which provides training for healthcare professionals in CPR and the use of an AED by a Board approved training organization. The course must be conducted in person and include a skills examination on a manikin with a certified instructor. (10) An applicant must successfully complete the Tennessee Board of Dentistry Ethics and Jurisprudence examination. (11) Application review and registration decisions required by this rule shall be governed by rule 0460-01-.04. 0460-04-.04 CORONAL POLISHING CERTIFICATION. Dental assistants who, pursuant to this rule and T.C.A. § 63-5108 (d), receive certification to perform coronal polishing may only do so under the restrictions contained in this rule. (1) Definition - Coronal Polishing shall mean the polishing of the enamel and restorations on the clinical crown of human teeth by utilizing a combination of a polishing agent and a slow speed handpiece, a prophy angle, a rubber cup, or any home care cleaning device. (2) Qualifications – An applicant for a coronal polishing certification must be registered as a dental assistant in Tennessee prior to applying for admission to an education course in coronal polishing. The sequence of the certification process is as follows: © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

489

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants

(3) (4)

(5)

(6)

(a) An applicant must apply for and successfully complete an educational course, as provided in this rule, as a prerequisite for certification; or (b) An applicant who has successfully completed a coronal polishing course in another state which was approved by the board in the other state, which the Board consultant has determined as equivalent to the Board-approved course in Tennessee, is eligible to apply directly to the Board for certification. If a certification or permit was issued by the other state, verification of the certificate or permit must be received directly from that state. The information regarding content of the course and proof of completion must be sent directly from the course provider to the Board’s administrative office; or (c) Applicants who have successfully completed an ADA accredited dental assisting program which included coronal polishing in the curriculum are eligible to apply for the certification upon completion of the program. Within thirty (30) days of an applicant’s completion of the program, the program director/instructor must submit a letter to the Board administrator verifying that coronal polishing was included in the curriculum and a written and clinical examination was passed by the applicant. Upon receipt of the letter from the program director/instructor and the application and fees, the certification for coronal polishing will be issued. Retention of Certification - Certification for coronal polishing is only valid as long as the registered dental assistant has a current registration. If the registration expires or is retired, the certification is also considered expired or retired, and the dental assistant may not engage in coronal polishing until the registration is reinstated or reactivated. Examination - The certification course must contain both a written and a clinical examination that covers the curriculum in Rule 0460-05-.03(2)(c)4(i) and (ii). The passing grade for each examination is set at seventy-five percent (75%). A student who fails either examination may retake the examination two (2) additional times before having to repeat the course in order to retake the examination. Supervision (a) Any time a dental assistant is allowed to perform coronal polishing after receiving certification, the employer dentist must be physically on the office premises at all times during the polishing and must also: 1. Examine each patient immediately prior to the polishing to determine health, calculus and scalable stain free and to certify the need for coronal polishing; and 2. Examine each patient immediately after the polishing is completed to evaluate the results. (b) A dental assistant may not perform coronal polishing for patients who have not been examined immediately prior to being assigned for polishing. Application review and decisions required by this rule shall be governed by Rule 0460-01-.04.

0460-04-.05 NITROUS OXIDE CERTIFICATION. Dental assistants may not administer nitrous oxide to patients but may monitor nitrous oxide sedation (as defined in rule 0460-2-.07) upon becoming certified pursuant to the following process: (1) A dental assistant must be currently registered, pursuant to Rule 0460-4-.02, by the Board in order to be eligible to attend a certification course in monitoring nitrous oxide and/or qualify for certification. (2) To be eligible for certification, the registered dental assistant must successfully complete a Board-approved nitrous oxide monitoring certification course, or have successfully completed a comparable training course in another state, or be currently enrolled in a CODA-accredited or Board-approved program which offers this course as part of their curriculum. Once eligible for certification, the registered dental assistant shall not monitor nitrous oxide until certification has been issued by the Board. (3) If the registered dental assistant completed a nitrous oxide monitoring course in another state which was approved by the board in the other state, the Board consultant must determine the course to be equivalent to the Board-approved course in Tennessee. The information regarding content of the course and proof of completion must be sent directly from the course provider to the Board’s administrative office. If a certification or permit was issued by the other state, verification of the certificate or permit must be received directly from the other board. Once eligible for certification, the registered dental assistant shall not monitor nitrous oxide until certification has been issued by the Board. (4) Nitrous oxide monitoring certification shall be added to the registration of the registered dental assistant, if the registered dental assistant has successfully completed a Board-approved certification course and notification of completion has been submitted to the Board’s Administrative Office by the course director on a form provided by the Board. (5) Registered dental assistants with nitrous oxide monitoring certification shall only monitor patients under the direct supervision of a licensed Tennessee dentist. This assistant shall not monitor more than one (1) patient at a time and shall physically remain with the patient at all times. (6) Registered dental assistants with nitrous oxide monitoring certification are not permitted to administer nitrous oxide. This assistant is only permitted to adjust the dosage or terminate the nitrous oxide at the specific direction and under the protocol of the supervising dentist or in cases of patient distress. (7) Registered dental assistants with nitrous oxide monitoring certification shall prominently display their current registration certificate, which is received upon registration and renewal, at their place of employment. (8) Certification in monitoring nitrous oxide is only valid as long as the registered dental assistant has a current registration. If the registration expires or is retired, the certification is also considered expired or retired and the dental assistant may not monitor nitrous oxide until the registration is reinstated or reactivated. (9) Application review and decisions required by this Rule shall be governed by 0460-01-.04. 490

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants 0460-04-.06 REGISTRATION RENEWAL. All dental assistants issued registrations by the Board must renew those registrations to be able to legally continue in practice. Registration renewal is governed by the following: (1) Renewal application (a) The due date for registration renewal is the last day of the month in which a registrant’s birthday falls pursuant to the Division of Health Related Boards “birthday renewal system” contained on the renewal certificate as the expiration date. (b) Methods of Renewal 1. Internet Renewals – Individuals may apply for renewal and pay the necessary fees via the Internet. The application to renew can be accessed at https://apps.tn.gov/hlrs/. 2. Paper Renewals – For individuals who have not renewed their registration online via the Internet, a renewal application form will be mailed to each individual registered by the Board to the last address provided to the Board. Failure to receive such notification does not relieve the registrant from the responsibility of meeting all requirements for renewal. (c) A registration issued pursuant to these rules is renewable by the expiration date. To be eligible for renewal an individual must submit to the Division of Health Related Boards on or before the expiration date the following: 1. A completed renewal application form. 2. The renewal and state regulatory fees as provided in Rule 0460-01-.02. 3. Proof of successful completion of the Tennessee Board of Dentistry Ethics and Jurisprudence examination. (d) Registrants who fail to comply with the renewal rules or notification received by them concerning failure to timely renew shall have their registrations processed pursuant to Rule 1200-10-01-.10. (2) Reinstatement of an Expired Registration – Reinstatement of a registration that has expired may be accomplished upon meeting the following conditions: (a) Payment of all past due renewal fees, state regulatory fees and the reinstatement fee as established in Rule 0460-01-.02; and (b) Provide documentation of successfully completing continuing education requirements for the entire time the registration was expired, pursuant to Rule 0460-01-.05; and (c) Submit proof of successful completion of the Tennessee Board of Dentistry Ethics and Jurisprudence examination. (d) Any registrant who fails to renew registration prior to the expiration of the second (2nd) year after which renewal is due may be required to meet other conditions as the Board may deem necessary to protect the public. (3) Anyone submitting a renewal form, reinstatement/reactivation application, or letter which is found to be untrue may be subject to disciplinary action as provided in T.C.A. §63-5-124. (4) Renewal issuance decisions pursuant to this rule may be made administratively, upon review by the Board. (5) Application review and decisions required by this rule shall be governed by Rule 0460-01-.04. 0460-04-.07 REGISTRATION RETIREMENT AND REACTIVATION. (1) Registrants who wish to retain their registration but not actively practice may avoid compliance with the registration renewal process, continuing education and CPR requirements by doing the following: (a) Obtain from, complete and submit to the Board Administrative Office an affidavit of retirement form. (b) Submit any documentation which may be required by the form to the Board Administrative Office. (2) Any registrant whose registration has been retired may reenter active practice by doing the following: (a) Submit a written request for reactivation to the Board Administrative Office; and (b) Pay the registration renewal fee and state regulatory fee as provided in rule 0460-01-.02(3). If retirement was pursuant to rule 0460-04-.06(5) and reactivation was requested prior to the expiration of one (1) year from the date of retirement, the Board may require payment of the late renewal fee and past due renewal and state regulatory fees as provided in rule 0460-01-.02(3). (c) If requested, after review by the Board, a designated Board member, or the Board consultant, appear before the Board, a designated Board member, or the Board consultant, for an interview regarding continued competence in the event of retirement in excess of two (2) years. (d) Comply with the continuing education provisions of rule 0460-01-.05 (6) applicable to reactivation of retired registrations. (e) Submit proof of successful completion of the Tennessee Board of Dentistry Ethics and Jurisprudence examination. (3) Application review and decisions required by this rule shall be governed by rule 0460-01-.04. 0460-04-.08 SCOPE OF PRACTICE (1) A lawfully licensed and duly registered dentist may delegate to dental assistants those procedures for which they have received adequate training and for which the dentist exercises direct supervision and full responsibility, except as follows: (a) Those procedures which require professional judgement and skill of a dentist as defined in the Dental Practice Act or rules of the Board. (b) Those clinical procedures which are primarily concerned with the practice of dentistry or dental hygiene and which are allocated by the Dental Practice Act or Rules of the Tennessee Board of Dentistry specifically and solely to licensed dentists and/or licensed dental hygienists. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

491

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants (2) Registered dental assistants, with additional Board-approving training, may, under the direct supervision of a licensed dentist perform the following procedures: (a) Coronal polishing, pursuant to Rule 0460-04-.04; and (b) Monitoring nitrous oxide, pursuant to Rule 0460-04-.05; and (c) Application of sealants, pursuant to Rule 0460-04-.09. (d) Performance of expanded restorative functions, pursuant to Rule 0460-04-.10. (e) Performance of expanded prosthetic functions, pursuant to Rule 0460-04-.10. (f) Exposure of dental radiographs, pursuant to Rule 0460-04-.11. (3) Delegable or Assignable Procedures – In addition to those duties of the practical dental assistant or registered dental assistant which are commonly recognizable by the dental profession for safe performance, pursuant to T.C.A. §63-5108 a practical dental assistant or registered dental assistant may perform the following duties which are assigned or delegated by the employer/supervising dentist: (a) The processing of radiographs, including digital, of the mouth, gums, jaws, teeth or any portion thereof for dental diagnosis. (b) The application of topical fluorides. (c) The instruction of patients in dietary principles. (d) The taking and recording of a patient’s blood pressure, pulse, temperature, and medical history, and charting of oral conditions. (e) The maintenance of instrument and operatory infection control. (f) The preparation of instrument trays. (g) The placement and removal of matrices for restoration. (h) The removal of cement from restorations and bands. (i) The removal of sutures and staples. (j) The fabrication, placement and removal of temporary restorations. (k) The placement and removal of rubber dam. (l) The placement and removal of socket dressings. (m) The placement and removal of periodontal dressings. (n) The taking of dental plaque smears. (o) The taking of alginate impressions for any purpose other than permanent restorations. (p) The removal of ligature and arch wires. (q) Bending, selecting and pre-sizing arch wires and placing arch wires after final adjustment and approval by the dentist. (r) The selection, prefitting, cementation, curing, and removing of orthodontic bands or brackets. (s) Placement and removal of pre-treatment separators. (t) Removal of loose or broken bands or brackets. (u) Placement of springs on wires. (v) Placement of hooks on brackets. (w) Placement of chain elastics on brackets. (x) Ligation of arch wires to brackets. (y) Packing and removing retraction cord, with or without vasoactive chemicals, for restorative dental procedures. (z) Removal of cement excess from supragingival surface of teeth by hand instruments only. (aa) The placement of amalgam in prepared cavities for condensation by the dentist. (bb) The application of topical anesthetics. (cc) The application of desensitizing agents. (dd) Placement of cavity bases and liners. (ee) Application of tooth conditioners for bonding. (ff) Selecting and pre-fitting of stainless steel crowns or other pre-formed crowns for insertion by the dentist. (gg) The taking of oral cytologic smears. (hh) Performing pulp testing. (ii) Packing of pulpotomy paste. (jj) Drying canals with absorbent paper points. (kk) Demonstration of oral hygiene procedures and oral health care regimen. (ll) Calling in prescriptions to the pharmacist as instructed by the employer/dentist. (mm) Fitting, adjusting and cementation of correctional appliances. (nn) Wound care as directed. (oo) Irrigating extraction site. (pp) Placement of exposure chains and attachments. (qq) Other duties specifically approved by the Board at a regularly scheduled meeting of the Board. (4) Prohibited Procedures—In addition to the duties defined as the practice of dentistry or dental hygiene by T.C.A. § 635-108, dental assistants are not permitted to perform the following: (a) Examination, diagnosis and treatment planning; 492

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants (b) Surgical or cutting procedures on hard or soft tissue, including laser, air abrasion or micro-abrasion procedures, including curettage or root planing; (c) Fitting, adjusting, and placement of prosthodontic appliances; (d) Issuance of prescription medications or medications not authorized by T.C.A. § 63-5-108(b) or Rule.0460-4-.08 (3), or work authorizations; (e) Performance of direct pulp capping, pulpotomy, and other endodontic procedures not authorized by T.C.A. § 635-108(b) or Rule 0460-04-.08 (3); (f) Approving the final occlusion; (g) Placement of sutures; (h) Administration of local anesthesia, nitrous oxide, conscious sedation, or general anesthesia; (i) Monitoring of nitrous oxide without certification as provided in Rule 0460-4-.05 and 0460-4-.08 (2); (j) Coronal polishing without certification as provided in Rule 0460-4-.04 and 0460-4-.08 (2); (k) Application of sealants without certification as provided by Rule 0460-4-.09 and 0460-4-.08 (2); (l) Use of a high-speed handpiece intraorally; (m) Utilization of laser equipment and technology in the course of the performance of their duties unless specifically authorized by T.C.A. § 63-5-108(b) or Rule 0460-04-.08 (3). Only dentists licensed by the Tennessee Board of Dentistry shall be authorized to perform procedures involving laser technology. (n) The exposure of radiographs without certification as provided by Rule 0460-04-.11 and Rule 0460-04-.08. (o) Expanded restorative or prosthetic functions without certification as provided by Rule 0460-04-.10 and Rule 0460-04-.08(2). (5) Dental assistants who perform procedures not delegable pursuant to this rule, or who perform procedures specifically prohibited by T.C.A. § 63-5-108, or who perform procedures without the direct supervision of a dentist, or who perform coronal polishing, application of sealants or nitrous oxide monitoring without the applicable certification or in violation of the rules governing those procedures, may be subject to disciplinary action pursuant to T.C.A. § 63-5-116(b). 0460-04-.09 SEALANT APPLICATION CERTIFICATION. A registered dental assistant with this certification may only practice sealant application under the direct supervision of a licensed dentist. (1) Definition – Sealant application shall mean the application of an organic polymer to the enamel surfaces of teeth. (2) Qualifications for Certification (a) Registered dental assistants in good standing with the Tennessee Board of Dentistry, pursuant to Rule 0460-04.02, are eligible to take a Board-approved sealant application certification course. (b) Individuals enrolled in either a CODA-accredited or Board-approved dental assisting program, which has elected to include in its curriculum the Board-approved sealant application certification course, will be qualified to perform the application of sealants upon issuance of the certification. All such programs shall adhere to the requirements of Rule 0460-5-.03(3). (c) Registered dental assistants, who have also successfully completed a comparable assistant training program in another state in the application of sealants are eligible to apply directly to the Board of Dentistry for a sealant application certificate without additional training, provided the course is determined by the Board consultant to be equivalent to the Board-approved course in Tennessee. The information regarding content of the course and proof of completion must be sent directly from the course provider to the Board’s administrative office. If a certification or permit was issued by the other state, verification of the certificate or permit must be received directly from the other board. (d) After successful completion of a Board-approved certification course, if required, and receipt of proper notification from the course/instructor, an applicant will be issued an initial approval letter. The applicant’s certification will be ratified at the next scheduled meeting of the Board. (3) Supervision (a) Sealant application may only be performed under the direct supervision of a Tennessee licensed dentist. (b) The dentist must examine the patient immediately before and after sealant application to determine the need for, and evaluate the results of, sealant application. (4) Retention of Certification – Certification in sealant application is only valid as long as the registered dental assistant has a current registration to practice registered dental assisting. If the registration expires or is retired, the certification is also considered expired or retired, and the dental assistant may not apply sealants until the registration is reinstated or reactivated. 0460-04-.10 RESTORATIVE AND PROSTHETIC CERTIFICATIONS. (1) Dental assistants who have a minimum of two (2) years continuous full-time employment within the past three (3) years in a dental practice as a dental assistant are eligible for admission to a Board-approved certification course in restorative and/or prosthetic functions. A registered dental assistant must apply for and complete a Board-approved certification course in restorative or prosthetic functions and obtain the appropriate certification, issued by the Board, before he/she can perform expanded restorative or prosthetic functions on any patient. (2) Certification in restorative or prosthetic functions is only valid as long as the registered dental assistant has a current authorization to practice as a registered dental assistant. If the authorization expires or is retired, the certification is © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

493

Tennessee State Dental Practice Act and Administrative Rules for Dental Assistants

(3) (4) (5)

(6)

also considered expired or retired and the dental assistant may not perform restorative or prosthetic functions until the authorization to practice is reinstated or reactivated. Registered dental assistants who possess a certification in restorative or prosthetic functions shall prominently display their current renewal certificate at their place of employment. Registered dental assistants with certification in restorative or prosthetic functions may perform restorations or prosthetic functions only under the direct supervision and full responsibility of a licensed dentist. Prohibited Procedures - The following procedures are prohibited for all dental assistants, including those who have certification in restorative or prosthetic functions: (a) Restorative Functions 1. Diagnosing of need for restorations; 2. Preparation/Cutting of the tooth or soft tissue; 3. Modifying existing structure; 4. Removal of caries, bases and liners; and 5. Use of high-speed handpieces intraorally. (b) Prosthetic Functions 1. Diagnosing need for any prosthetic appliance; 2. Establishing vertical dimension of occlusion and interocclusal records; 3. Delivering and/or adjusting appliance; and 4. Use of high-speed handpieces intraorally. Registered dental assistants, who have also successfully completed a comparable assistant training program in another state in expanded restorative or prosthetic functions, are eligible to apply directly to the Board for an expanded functions certificate without additional training, provided the course is determined by the Board consultant to be equivalent to the Board-approved course in Tennessee. The information regarding content of the course and proof of completion must be sent directly from the course provider to the Board’s administrative office. If a certification or permit was issued by the other state, verification of the certificate or permit must be received directly from the other board. If it is determined that the course is not equivalent, the registered dental assistant will be required to comply with the provisions of paragraph (1) before certification can be issued.

0460-4-.11 DENTAL RADIOLOGY CERTIFICATION. Registered dental assistants with this certification may expose dental radiographs under the direct supervision of a licensed dentist. (1) A dental assistant must be currently registered, pursuant to Rule 0460-04-.02, by the Board before attending a certification course in dental radiology and/or qualifying for certification, except as follows: (a) Dental assistants who are registered, pursuant to Rule 0460-04-.02, before the original effective date of this rule shall be issued dental radiology certification without having to complete the course required in paragraph (2). (b) Registered dental assistants, who have successfully completed a comparable assistant training program in another state in dental radiology, are eligible to apply directly to the Board for dental radiology certification without having to complete the course required in paragraph (2), provided the course is determined by the Board consultant to be equivalent to the Board-approved course in Tennessee. The information regarding content of the course and proof of completion must be sent directly from the course provider to the Board’s administrative office. If a certification or permit was issued by the other state, verification of the certificate or permit must be received directly from the other board. If it is determined that the course is not equivalent, the registered dental assistant will be required to comply with the provisions of paragraph (2) before certification can be issued. (c) Assistants who have passed the radiology portion of the certified dental assistant examination given by the Dental Assisting National Boards, Inc. (DANB) or hold a current certification from DANB as a certified dental assistant are eligible to apply directly to the Board for dental radiology certification without having to complete the course required in paragraph (2). Proof of passage of the radiology portion of the DANB exam or proof of current DANB certification must be sent directly from the DANB to the Board’s administrative office. (2) To be eligible for certification, the registered dental assistant must successfully complete a Board-approved dental radiology training course or be currently enrolled in an ADA-accredited or Board-approved program which offers this course as part of their curriculum. Once eligible for certification, the registered dental assistant shall not expose dental radiographs until certification has been issued by the Board. (3) Dental radiology certification shall be added to the registration of the registered dental assistant, if the registered dental assistant has successfully completed a Board-approved certification course and notification of completion has been submitted to the Board’s Administrative Office by the course director on a form provided by the Board. (4) Registered dental assistants with radiology certification shall prominently display their current registration certification, which is received upon registration and renewal, at their place of employment. (5) Certification in dental radiology is only valid as long as the registered dental assistant has a current registration. If the registration expires or is retired, the certification is also considered expired or retired and the dental assistant may not expose dental radiographs until the registration is reinstated or reactivated. (6) Application review and decisions required by this rule shall be governed by 0460-01-.04.

494

Texas DANB Certificant Counts: Texas National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

745

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact W. Boyd Bush, Jr., Ed.D., Executive Director Texas State Board of Dental Examiners 333 Guadalupe Street, Tower 3, Suite 800 Austin, TX 78701-3942 Phone: 512-463-6400 Fax: 512-463-7452 Website: www.tsbde.texas.gov

Radiation Health and Safety (RHS)

2,456

Infection Control (ICE)

2,312

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Amarillo College Coleman College for Health Sciences, Houston Community College System Del Mar College El Paso Community College Grayson College San Antonio College Tyler Junior College Medical Education and Training Campus-Air Force Dental Assisting Program

DANB CDA Certificant State of Texas+

$18.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 27, 2020.

Source: 2018 DANB Salary Survey (state data based on 11 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

495

Texas State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Texas, one must be a Registered Dental Assistant (see requirements below). A dental assistant will not be considered to be positioning, exposing or otherwise making dental x-rays if the dental assistant only performs radiological procedures in the course of training (or for other educational purposes) and is at all times under the direct supervision of the employer dentist. A dental assistant performing radiological procedures in the course of on-the-job training may only do so for a period of one year.

State Requirements for Expanded Functions To perform expanded functions under the general or direct supervision of a licensed dentist in Texas, a dental assistant must successfully complete the requirements listed below: Monitor the administration of nitrous oxide: (1) Hold a TSDBE certificate of registration as a dental assistant that has not expired and is not under a probated or enforced suspension AND (2) Successfully complete a current course in Basic Life Support AND (3) Complete a minimum of eight hours of didactic education and testing in monitoring the administration of nitrous oxide taken through a CODA-accredited dental, dental hygiene or dental assisting program and approved by the TSBDE. Note: A dental assistant who held a nitrous oxide monitoring certificate and renews that certificate prior to September 1, 2019, will be issued, upon renewal, a nitrous oxide monitoring registration without the dental assistant having to meet the new requirement of having to hold a TSBDE certificate of registration as a dental assistant. After September 1, 2019, these dental assistants may continue to renew their nitrous oxide monitoring registrations without becoming a registered dental assistant unless they allow their nitrous oxide monitoring registrations to expire for more than one year. Perform pit and fissure sealant procedures: (1) Work at least two years as a dental assistant AND (2) Complete a current course in Basic Life Support AND (3) Complete a minimum of eight hours clinical and didactic education in pit and fissure sealants taken through a CODA-accredited dental, dental hygiene, or dental assistant program and approved by the TSBDE. Perform coronal polishing procedures: (1) Work at least two years as a dental assistant, AND (2a) Complete a minimum of eight hours clinical and didactic education in coronal polishing taken through a dental school, dental hygiene school or dental assisting program accredited by CODA and approved by the TSBDE OR (2b) Earn DANB's Coronal Polishing (CP) certificate of knowledge-based competence OR (2c) Graduate from a CODA-accredited dental assisting program approved by the TSBDE that includes clinical and didactic education in coronal polishing. Registered Dental Assistant: A dental assistant in Texas can earn status as a Registered Dental Assistant (RDA) by formally registering with the Texas State Board of Dental Examiners (TSBDE). To qualify, one must: (1) Graduate from an accredited high school or hold a GED, AND (2) Successfully complete a current hands-on course in basic life support, AND (3a) Successfully complete a mandatory course of training specified by the TSBDE that includes procedures for positioning and exposing dental x-rays, jurisprudence and infection control OR (3b) Earn the national DANB CDA Certification and complete the Texas jurisprudence assessment, AND (4) Apply to the TSBDE for registration, AND (5) Submit fingerprints for the retrieval of criminal history record information. Note: To renew a certificate of registration, a dental assistant must complete six hours of continuing education each year in areas covering dental assistant duties. At least three of these six hour must be clinical continuing education.

Texas State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Texas State Board of Dental Examiners Texas Occupations Code TITLE 3 CHAPTER 258 PRACTICE BY A DENTIST SUBCHAPTER A. DELEGATION BY DENTIST Sec. 258.001. IMPERMISSIBLE DELEGATIONS A dentist may not delegate: (1) an act to an individual who, by board order, is prohibited from performing the act; (2) any of the following acts to a person not licensed as a dentist or dental hygienist: (A) the removal of calculus, deposits, or accretions from the natural and restored surfaces of exposed human teeth and restorations in the human mouth; 496

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (B) root planing or the smoothing and polishing of roughened root surfaces or exposed human teeth; or (C) any other act the delegation of which is prohibited by board rule; (3) any of the following acts to a person not licensed as a dentist: (A) comprehensive examination or diagnosis and treatment planning; (B) a surgical or cutting procedure on hard or soft tissue; (C) the prescription of a drug, medication, or work authorization; (D) the taking of an impression for a final restoration, appliance, or prosthesis; (E) the making of an intraoral occlusal adjustment; (F) direct pulp capping, pulpotomy, or any other endodontic procedure; (G) the final placement and intraoral adjustment of a fixed or removable appliance; or (H) the placement of any final restoration; or (4) the authority to an individual to administer a local anesthetic agent, inhalation sedative agent, parenteral sedative agent, or general anesthetic agent if the individual is not licensed as: (A) a dentist with a permit issued by the board for the procedure being performed, if a permit is required; (B) a certified registered nurse anesthetist licensed by the Texas Board of Nursing, only if the delegating dentist holds a permit issued by the board for the procedure being performed, if a permit is required; or (C) a physician anesthesiologist licensed by the Texas Medical Board. Sec. 258.002. DELEGATION TO DENTAL ASSISTANT (a) A licensed dentist may delegate to a qualified and trained dental assistant acting under the dentist’s general or direct supervision any dental act that a reasonable and prudent dentist would find is within the scope of sound dental judgment to delegate if: (1) in the opinion of the delegating dentist, the act: (A) can be properly and safely performed by the person to whom the dental act is delegated; and (B) is performed in a customary manner and is not in violation of this subtitle or any other statute (2) the person to whom the dental act is delegated does not represent to the public that the person is authorized to practice dentistry; and (3) the person to whom the dental act is delegated is registered under Chapter 265, if registration is required to perform the act. (b) Repealed by Acts 2009, 81st Leg., R.S., Ch. 476, Sec. 8(1), eff. September 1, 2009. (c) The board by rule shall establish guidelines regarding the types of dental acts that may be properly or safely delegated by a dentist, including a determination of which delegated dental acts, if any, require competency testing before a person may perform the act. Sec. 258.003. RESPONSIBILITY OF DELEGATING DENTIST A delegating dentist is responsible for a dental act performed by the person to whom the dentist delegates the act. SUBCHAPTER B. GENERAL PRACTICE PROVISIONS Sec. 258.054. USE OF X-RAY EQUIPMENT (c) A dentist may not authorize a dental assistant, other than a dental assistant described by Section 265.001(d), to make a dental x-ray unless the dental assistant is registered under Chapter 265. CHAPTER 265 REGULATION OF DENTAL ASSISTANTS Sec. 265.0001. DEFINITIONS. In this chapter: (1) “Coronal polishing” means the removal of plaque and extrinsic stain from exposed natural and restored tooth surfaces using an appropriate rotary instrument with rubber cup or brush and polishing agent, including the use of a toothbrush. (2) “Interim treatment of a minor emergency dental condition” means treatment of a condition that: (A) arises unexpectedly; (B) causes pain or discomfort to the patient; (C) is considered reversible; (D) does not require cutting hard or soft tissue; and (E) in the opinion of the treating dentist, may be performed by a properly trained dental assistant. Sec. 265.001. REGISTRATION REQUIRED FOR CERTAIN DENTAL ACTS (a) Unless the dental assistant is registered under this chapter, a dental assistant may not: (1) make a dental x-ray; or (2) monitor the administration of nitrous oxide. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

497

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (b) The board may adopt and enforce rules requiring a dental assistant to register with the board to perform other dental acts as necessary to protect the public health and safety. (c) The board shall maximize the efficient administration of this chapter by: (1) developing a system to track the number of registrations held by a dental assistant under this chapter; and (2) coordinating the times at which a dental assistant â&#x20AC;&#x2122;s registrations must be renewed so that the times of registration, payment, notice, and imposition of penalties for late payment are similar and the administrative burden to the board and to the dental assistant is reduced. (d) Notwithstanding Subsection (a)(1), a dental assistant who is hired as a dental assistant for the first time and who has not previously been issued a registration to make dental x-rays may make dental x-rays without complying with this chapter until the first anniversary of the date the dental assistant is hired. Sec. 265.002. SUPERVISION, DIRECTION, AND RESPONSIBILITY (a) In this subtitle, a dental assistant is under the direct supervision, direction, and responsibility of a dentist if the dentist: (1) employs the dental assistant or is in charge of the dental assistant; and (2) is physically present in the dental office when the dental assistant performs a delegated dental act. (b) For purposes of Subsection (a)(2), physical presence does not require that the supervising dentist be in the treatment room when the dental assistant performs the service as long as the dentist is in the dental office. (c) In this subtitle, a dental assistant is under the general supervision, direction, and responsibility of a dentist if the dentist: (1) employs the dental assistant or is in charge of the dental assistant; and (2) is responsible for supervising the services to be performed by the dental assistant. Sec. 265.0015. ELIGIBILITY REQUIREMENTS FOR REGISTRATION. (a) The board by rule shall establish the requirements for each type of registration issued under this chapter, including requiring a dental assistant to: (1) hold a high school diploma or its equivalent; (2) complete an educational program approved by the board that provides instruction on: (A) a dental act that requires a registration under this chapter; (B) basic life support; (C) infection control; and (D) jurisprudence; (3) pass an examination approved or administered by the board; and (4) meet any additional qualifications established by the board. (b) The board may approve courses on instruction and examinations that are provided by private entities for the purposes of this section. Sec. 265.0017. REGISTRATION EXPIRATION AND RENEWAL. (a) A registration under this chapter is valid for two years. (b) A dental assistant may renew a registration by paying the required renewal fee and complying with any other renewal requirements established by the board. (c) A dental assistant whose registration has expired may not engage in an activity that requires registration until the registration has been renewed. (d) The board by rule may adopt a system under which registrations expire on various dates during the year. For the year in which the expiration date is changed, the board shall prorate registration fees on a monthly basis so that each registration holder pays only that portion of the registration fee that is allocable to the number of months during which the registration is valid. On renewal of the registration on the new expiration date, the total renewal fee is payable. Sec. 265.003. PERMITTED DUTIES (a) A dental assistant who is not registered under this chapter may be employed by and work in the office of a licensed and practicing dentist and perform one or more delegated dental acts under: (1) the direct supervision, direction, and responsibility of the dentist, including the application of fluoride varnish; or (2) the general supervision, direction, and responsibility of the dentist, limited to: (A) the making of dental x-rays in compliance with Section 265.001(d); and (B) the provision of interim treatment of a minor emergency dental condition to an existing patient of the treating dentist. (a-1) A treating dentist who delegates the provision of interim treatment of a minor emergency dental condition to a dental assistant under Subsection (a)(2) shall: (1) delegate the procedure orally or in writing before the dental assistant performs the procedure; 498

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (2) retain responsibility for the procedure; and (3) schedule a follow-up appointment with the patient within a reasonable time. (b) Repealed by Acts 2017, 85th Leg., R.S., Ch. 295 (S.B. 313), Sec. 48(8), eff. September 1, 2017. (c) A delegating dentist remains responsible for the dental acts of a registered or nonregistered dental assistant performing the delegated dental acts. (d) A dental assistant to whom a delegation is made may not represent to the public that the dental assistant is authorized to practice dentistry or dental hygiene. Sec. 265.008. CONTINUING EDUCATION REQUIRED FOR REGISTRATION RENEWAL. The board by rule shall establish continuing education requirements for dental assistants registered under this chapter, including a minimum number of hours of education required to renew registration. Texas Administrative Code Title 22 Examining Boards Part 5 State Board of Dental Examiners CHAPTER 101 DENTAL LICENSURE Rule 101.6 Dental Licensing for Military Service Members, Military Veterans, and Military Spouses (a) Definitions. (1) "Active duty" means current full-time military service in the armed forces of the United States or active duty military service as a member of the Texas military forces, as defined by Â§471.001, Government Code, or similar military service of another state. (2) "Armed forces of the United States" means the army, navy, air force, coast guard, or marine corps of the United States or a reserve unit of one of those branches of the armed forces. (3) "Military service member" means a person who is on active duty. (4) "Military spouse" means a person who is married to a military service member. (5) "Military veteran" means a person who has served on active duty and who was discharged or released from active duty. (b) A licensee is exempt from any penalty or increased fee imposed by the Board for failing to renew the license in a timely manner if the individual establishes to the satisfaction of Board staff that the individual failed to renew the license in a timely manner because the individual was serving as a military service member. (c) A licensee who is a military service member is entitled to two years of additional time to complete: (1) any continuing education requirements; and (2) any other requirement related to the renewal of the military service member's license. (d) Alternative Licensing. (1) A military service member, military veteran, or military spouse applicant may demonstrate competency by alternative methods in order to meet the requirements for obtaining a dental license issued by the Board if the applicant: (A) holds a current license issued by another jurisdiction that has licensing requirements that are substantially equivalent to the licensing requirements in this state; or (B) within the five years preceding the application date held the license in this state. (2) For purposes of this section, the standard method of demonstrating competency is the specific examination, education, and or/experience required to obtain a dental license. In lieu of the standard method(s) of demonstrating competency for a dental license and based on the applicant's circumstances, the alternative methods for demonstrating competency may include any combination of the following as determined by the Board: (A) education; (B) continuing education; (C) examinations (written and/or practical); (D) letters of good standing; (E) letters of recommendation; (F) work experience; or (G) other methods required by the Executive Director. (3) The executive director may waive any prerequisite to obtaining a license for an applicant described in paragraph (1) of this subsection after reviewing the applicant's credentials. (e) The Board shall give credit to an applicant who is a military service member or military veteran for any verified military service, training, or education toward the licensing requirements, other than an examination requirement, including, but not limited to, education, training, certification, or a course in basic life support. The Board may not give credit if the applicant holds a restricted license issued by another jurisdiction or has an unacceptable criminal history according to Texas Occupations Code, Chapter 53 (relating to Consequences of Criminal Conviction) or Â§101.8 of this title (relating to Persons with Criminal Backgrounds). (f) The Board shall process an application from a military service member, military veteran, or military spouse as soon as practicable after receiving the application. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

499

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (g) All applicants shall submit an application and proof of any relevant requirements on a form and in a manner prescribed by the Board. (h) All applicants shall submit fingerprints for the retrieval of criminal history record information. (i) All fees associated with a license application shall be waived for an applicant who is: (1) a military service member or military veteran whose military service, training, or education substantially meets all of the requirements for the license; or (2) a military service member, military veteran, or military spouse who holds a current license issued by another jurisdiction that has licensing requirements that are substantially equivalent to the requirements for licensure in this state. (j) Licenses granted under this chapter have the terms established by §101.5 of this title (related to Staggered Dental Registrations), or a term of 12 months from the date the license is issued, whichever term is longer. The Board shall notify the licensee in writing or by electronic means of the requirements for renewal. Rule 101.8 Persons with Criminal Backgrounds (a) The purpose of this section is to establish automatic sanctions, mandatory sanctions, recommended sanctions, guidelines and criteria for the disciplinary actions to be taken by the Board against applicants and licensees with criminal backgrounds. (b) Definitions. In this section, the following terms shall apply: (1) "Applicant" means a person applying for a license, certificate, registration, permit, or other authorization that is issued by the Board under the Dental Practice Act. (2) "Conviction" shall mean a conviction under federal law or the law of any state, district, or territory of the United States. A conviction shall be considered "final" upon the imposition of a sentence of imprisonment, parole, probation, community supervision, or other punishment after such conviction. Pursuant to Texas Occupations Code §53.021(e)(1), the Board shall consider placement of a defendant under deferred adjudication community supervision, or a similar deferral of adjudication of guilt under federal or state law, as a final conviction for all licensing and disciplinary purposes under the Texas Occupations Code and Board rules. (3) "Final Disposition" shall mean the date on which the applicant or licensee completed the imposed sentence after conviction, including any period of parole or probation, or completed the conditions of deferred adjudication community supervision or similar deferral of adjudication of guilt, as shown by the certified records of the court or supervising government authority. (4) "Health Care Professional" shall have the meaning provided in Texas Occupations Code §108.051. (5) "License" means a license, certificate, registration, permit, or other authorization that is issued by the Board under the Dental Practice Act. (6) "Licensee" means the holder of a license, certificate, registration, permit, or other authorization that is issued by the Board under the Dental Practice Act. (7) "Offense Relating to the Regulation of Dentists, Dental Hygienists or Dental Assistants" means any criminal violation of the Texas Dental Practice Act; any criminal violation of a law related to the billing and payment for dental care services; any criminal violation of a law related to the treatment and care of patients; and any criminal violation of a law related to the preservation and protection of patient records or patient protected health information. (c) Automatic Denial or Revocation of Dental or Dental Hygiene License. Based upon Chapter 108, Subchapter B, of the Texas Occupations Code, certain convictions shall result in automatic denial of an application for a dental or dental hygiene license, or revocation of a current dental or dental hygiene license. A person who is denied or a licensee who has their license revoked under this subsection may reapply for the license, or apply for reinstatement of the revoked license, if the conviction or deferred adjudication is reversed, set aside, or vacated on appeal, or after the expiration of the period for which the person is required to register as a sex offender under Chapter 62, Code of Criminal Procedure. (1) Automatic Denial of Application. The following convictions shall result in automatic denial of an application for licensure as a dentist or dental hygienist submitted on or after September 1, 2019. (A) Any conviction resulting in the requirement that the applicant register as a sex offender under Chapter 62, Code of Criminal Procedure. (B) Any previous conviction of or placement on deferred adjudication community supervision for the commission of a felony offense involving the use or threat of force. (C) Any previous conviction or placement on deferred adjudication community supervision for the commission of an offense under Texas Penal Code §§22.011, 22.02, 22.021, or 22.04, or an offense under the laws of another state or federal law that is equivalent to an offense under one of those sections: (i) committed when the applicant held a license as a health care professional in this state or another state; (ii) committed in the course of providing services within the scope of the applicant's health care professional license; and (iii) in which the victim of the offense was a patient of the applicant. 500

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (2) Automatic Revocation of License. The following convictions shall result in automatic proceedings to revoke the license of a dentist or dental hygienist. The Board shall revoke a license and update the Board's records to reflect the revocation immediately on receiving notification pursuant to Texas Occupations Code §108.053(b). If the Board receives notice through another source, the Board shall pursue a revocation action through Texas Occupations Code §263.003. (A) Any conviction resulting in the requirement that the licensee register as a sex offender under Chapter 62, Code of Criminal Procedure. (B) Any conviction of or placement on deferred adjudication community supervision for the commission of a felony offense involving the use or threat of force. (C) Any conviction or placement on deferred adjudication community supervision for the commission of an offense under Texas Penal Code §§22.011, 22.02, 22.021, or 22.04, or an offense under the laws of another state or federal law that is equivalent to an offense under one of those sections: (i) committed while the licensee held a license as a health care professional in this state or another state; (ii) committed in the course of providing services within the scope of the licensee's health care professional license; and (iii) in which the victim of the offense was a patient of the licensee. (d) Imposition of Mandatory Sanctions for Criminal Convictions. Based upon Texas Occupations Code §263.006 and the interests of public health and safety, the Board shall impose the following mandatory sanctions on licensees for the following offenses. In the event that a sanction from subsection (c) of this section is also applicable to a licensee, the Board shall impose the automatic sanction instead of the sanction under this subsection. The Board may not reinstate or reissue a license suspended or revoked under this section unless an express determination is made that the reinstatement or reissuance of the license is in the best interests of the public and the licensee whose license was suspended or revoked. The Board must base that determination on substantial evidence contained in an investigative report. (1) Felony Convictions. The Board shall revoke the license of a current licensee who receives a final felony conviction under federal law or the law of any state, district, or territory of the United States. (2) Assaultive Offenses. The Board shall revoke the license of a current licensee who receives a misdemeanor final conviction under Chapter 22 of the Texas Penal Code, other than a misdemeanor punishable by fine only. (3) Mandatory Registration as Sex Offender. The Board shall revoke the license of a current licensee who receives a final conviction requiring the licensee register as a sex offender under Chapter 62, Texas Code of Criminal Procedure. (4) Violation of Certain Court Orders, Protective Orders, or Conditions of Bond. The Board shall revoke the license of a current licensee who receives a Class A or Class B misdemeanor final conviction under Section 25.07 or Section 25.071 of the Texas Penal Code. (e) Imposition of Recommended Sanctions for Criminal Convictions. Based upon statutory authorization and the interests of public health and safety, the Board shall impose the following recommended sanctions for the following offenses, based on the Board's determination that these offenses relate to the practice of dentistry, and the Board's determination that allowing a licensee to practice dentistry or provide dental services under a license issued by the Board provides an opportunity for further criminal conduct. In the event that a sanction from subsections (c) or (d) of this section is also applicable to a licensee, the Board shall impose the automatic or mandatory sanction instead of the recommended sanction under this subsection. If more than one recommended sanction applies to the conviction of a licensee or applicant, the Board shall apply the highest recommended sanction applicable. The Board may only increase these recommended sanctions upon an affirmative finding that persuasive aggravating factors require elevation of the sanction for the protection of public health and safety. The Board shall reduce the following sanctions only upon an affirmative finding of persuasive mitigating factors presented by the applicant or licensee, as applicable. The Board shall articulate these aggravating or mitigating factors in any order adopting the sanctions to be imposed on the licensee. (1) Current Licensees. The Board shall impose the following disciplinary sanctions based upon convictions which occurred after the Board issued a license. (A) Conviction for Offense Relating to the Regulation of Dentists, Dental Hygienists or Dental Assistants. Pursuant to Texas Occupations Code §263.002(a)(10), the Board shall take disciplinary action for convictions related to the practice of dentistry. The Board has determined that violations of law relating to the practice of dentistry and dental hygiene are directly related to patient safety and care, and holding a license allows for the opportunity to engage in further criminal activity causing harm to the public. As a result, the Board shall impose a five-year probated suspension for a final conviction for an offense relating to the regulation of dentists, dental hygienists or dental assistants. (B) Conviction of Misdemeanor Involving Fraud. Pursuant to Texas Occupations Code §263.002(a)(2), the Board shall take disciplinary action for misdemeanor convictions involving fraud. The Board has determined that holding a license allows access to sensitive patient records and information, which requires the licensee to demonstrate the ability and capacity required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. As a result, the Board shall impose a one-year © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

501

Texas State Dental Practice Act and Administrative Rules for Dental Assistants probated suspension for a final conviction of a misdemeanor under Chapter 32 of the Texas Penal Code, or an equivalent section of federal law or the law of any state, district, or territory of the United States. (C) Offenses under the Texas Controlled Substances Act, Texas Dangerous Drugs Act and Related Offenses. The Board has determined that holding a license allows access to controlled substances, dangerous drugs and other substances that represent the potential for abuse and drug diversion, which requires the licensee to demonstrate the ability and capacity required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. As a result, the Board shall impose a one-year probated suspension on a current licensee who receives a Class A misdemeanor final conviction under Chapter 481, 483, or 485, Texas Health and Safety Code. The Board may impose a Reprimand for a Class B misdemeanor final conviction pursuant to subsection (e)(1)(D) of this section. (D) Other Class A and B Misdemeanor Offenses. The Board shall not automatically impose a disciplinary sanction, but may impose a disciplinary sanction after weighing the considerations required by Texas Occupations Code Chapters 53 and 263, and as listed in subsections (g) - (i) of this section. (2) License Applicants. The Board shall impose the following disciplinary sanctions based upon convictions that occurred prior to the submission of an application for a license. (A) Felony Convictions. The Board has determined that holding a license allows access to confidential patient records and information, controlled substances and dangerous drugs, and patients in sensitive and compromised physical conditions, which requires the applicant to demonstrate the ability and capacity required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. Pursuant to Texas Occupations Code §263.001(a)(5), the Board shall deny an applicant who received a final felony conviction under federal law or the law of any state, district, or territory of the United States that is still pending final disposition. The Board shall impose a five-year probated suspension on an applicant with a final conviction for a felony that is less than five years from the date of final disposition. From five to ten years after the date of final disposition, the Board shall impose a one-year probated suspension. After ten years from the date of final disposition, the Board shall take no action. (B) Conviction for Offense Relating to the Regulation of Dentists, Dental Hygienists or Dental Assistants. The Board has determined that violations of Texas law relating to the practice of dentistry are directly related to patient safety and care, and holding a license allows for the opportunity to engage in further criminal activity causing harm to the public. Pursuant to Texas Occupations Code §263.001(a)(4) and (a)(6), the Board shall deny an applicant who received a final conviction for an offense relating to the regulation of dentists, dental hygienists or dental assistants within the twelve months preceding the date the applicant filed an application for a license. The Board shall impose a five-year probated suspension on an applicant who received a final conviction for an offense relating to the regulation of dentists, dental hygienists or dental assistants that is still pending final disposition, but which occurred prior to the twelve months preceding the date the applicant filed an application for a license. The Board shall impose a one-year probated suspension on an applicant with a final conviction for an offense relating to the regulation of dentists, dental hygienists or dental assistants that is less than five years from the date of final disposition. After five years from the date of final disposition, the Board shall take no action. (C) Mandatory Registration as Sex Offender. The Board has determined that holding a license allows access to controlled substances and dangerous drugs, and patients in sensitive and compromised physical conditions, including minor patients and patients with mental and physical disabilities, which requires the ability and capacity required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. As a result, if the applicant is not subject to Texas Occupations Code §108.052, the Board shall deny an applicant who received a final conviction requiring the applicant register as a sex offender under Chapter 62, Texas Code of Criminal Procedure. (D) Assaultive Offenses. The Board has determined that holding a license allows access to patients in sensitive and compromised physical conditions, which requires the applicant to demonstrate the ability, capacity, and fitness required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. As a result, if the applicant is not subject to Texas Occupations Code §108.052, the Board shall deny an applicant who received a misdemeanor final conviction under Chapter 22 of the Texas Penal Code, other than a misdemeanor punishable by fine only, within the twelve months preceding the date the applicant filed an application for a license. The Board shall impose a five-year probated suspension on an applicant who received a final conviction for an assaultive offense, other than a misdemeanor punishable by fine only, that is less than five years from the date of final disposition. After five years from the date of final disposition, the Board shall take no action. (E) Violation of Certain Court Orders, Protective Orders, or Conditions of Bond. The Board has determined that holding a license allows access to confidential patient records and information, and patients in sensitive and compromised physical conditions, which requires the applicant to demonstrate the ability and capacity required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. As a result, the Board shall deny an applicant who received a Class A or Class B misdemeanor final conviction under Section 25.07 or Section 25.071 of the Texas Penal Code, within the 502

Texas State Dental Practice Act and Administrative Rules for Dental Assistants twelve months preceding the date the applicant filed an application for a license. The Board shall impose a five-year probated suspension on an applicant who received a final conviction under Section 25.07 or Section 25.071 of the Texas Penal Code that is less than five years from the date of final disposition. After five years from the date of final disposition, the Board shall take no action. (F) Offenses under the Texas Controlled Substances Act, Texas Dangerous Drugs Act and Related Offenses. The Board has determined that holding a license allows access to confidential patient records and information, controlled substances, and dangerous drugs, which requires the applicant to demonstrate the ability and capacity required to perform the duties and discharge the responsibilities of a licensee acting in the best interests of the public. As a result, the Board shall impose a one-year probated suspension on an applicant who received a Class A misdemeanor final conviction under Chapter 481, 483, or 485, Texas Health and Safety Code that is less than five years from the date of final disposition. The Board may impose a Reprimand for a Class B misdemeanor final conviction that is less than five years from the date of final disposition, pursuant to subsection (e)(2)(G) of this section. After five years from the date of final disposition, the Board shall take no action. (G) Other Class A and B Misdemeanor Offenses. The Board shall not automatically impose a disciplinary sanction, but may impose a disciplinary sanction after weighing the considerations required by Texas Occupations Code Chapters 53 and 263, and as listed in subsections (g) - (i) of this section. (f) Pursuant to Texas Occupations Code §53.021(b), the Board shall revoke a license upon the imprisonment of the licensee following a felony conviction or deferred adjudication, felony community supervision revocation, revocation of parole, or revocation of mandatory supervision. (g) The Board may impose any authorized disciplinary action on an applicant or licensee because of a person's conviction of a crime, other than a Class C misdemeanor, that: (1) serves as a ground for discipline under the Dental Practice Act; or other Texas law applicable to the applicant or licensee, or (2) the Board has determined directly relates to the duties and responsibilities of a licensee, after consideration of each of the following factors: (A) the nature and seriousness of the crime; (B) the relationship of the crime to the purposes for requiring a license; (C) the extent to which a license might offer an opportunity to engage in further criminal activity of the same type as that in which the applicant or licensee previously had been involved; and (D) the relationship of the crime to the ability and capacity required to perform the duties and discharge the responsibilities of the license; and (E) any correlation between the elements of the crime and the duties and responsibilities of the license. (h) In determining the appropriate disciplinary action to take where the Board is not mandated to take a certain disciplinary action, the Board shall consider the following factors listed in paragraphs (1) - (7) of this subsection when determining whether to impose any authorized discipline: (1) the extent and nature of the person's past criminal activity; (2) the age of the person when the crime was committed; (3) the amount of time that has elapsed since the person's last criminal activity; (4) the conduct and work activity of the person before and after the criminal activity; (5) evidence of the person's rehabilitation or rehabilitative effort while incarcerated or after release; (6) evidence of the person's compliance with any conditions of community supervision, parole, or mandatory, supervision, and (7) other evidence of the person's fitness, including letters of recommendation. (i) The applicant or licensee has the responsibility, to the extent possible, to obtain and provide to the Board the recommendations described by subsection (h)(7) of this section. (j) An applicant or licensee shall disclose in writing to the Board any arrest, conviction or deferred adjudication against him or her at the time of initial application and renewal. Additionally, an applicant or licensee shall provide information regarding any arrest, conviction or deferred adjudication to the Board within 30 days of a Board request. An application shall be deemed withdrawn if the applicant has failed to respond to a request for information or to a proposal for denial of eligibility or conditional eligibility within 30 days. Pursuant to Texas Government Code §2005.052, making a false statement or material misrepresentation when applying or renewing a license, refusing to provide requested information to the Board, or failing to provide all of the criminal history requested by the Board represents grounds for denial of the application or suspension or revocation of the license. (k) Notice of Pending Denial of License. Prior to denying a license application for prior criminal convictions as permitted by Texas Occupations Code Chapter 53, the Board shall provide written notice to the person of the reason for the intended denial and allow the person not less than 30 days to submit any relevant information to the Board, as required by Texas Occupations Code §53.0231.

503

Texas State Dental Practice Act and Administrative Rules for Dental Assistants CHAPTER 102 FEES Rule 102.1 Fees (a) Effective September 1, 2019, the Board has established the following reasonable and necessary fees for the administration of its function. Upon initial licensure or registration, and at each renewal, the fees provided in this subsection and subsections (b) - (d) of this section shall be due and payable to the Board. TSBDE Board Fee

DENTAL ASSISTANT Initial Application Nitrous Oxide monitoring Renewal Registration only Renewal Renewal - Late 1 to 90 days

$38.00 $33.00 $67.00 $82.00

Renewal - Late 90 to 365 days

$98.00

Duplicate License / Renewal

$27.00

Nitrous Oxide Monitoring Application Nitrous Oxide Monitoring Duplicate Certificate

$25.00 $27.00

CHAPTER 110 SEDATION AND ANESTHESIA Rule 110.1 Definitions Unless the context clearly indicates otherwise, the following words and terms shall have the following meaning when used in this chapter. (1) Analgesia--the diminution or elimination of pain. (3) Board/Agency--the Texas State Board of Dental Examiners, also known as the State Board of Dental Examiners, and, for brevity, the Dental Board, the Agency, or the Board. (6) Deep sedation--a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (7) Direct supervision--the dentist responsible for the sedation/anesthesia procedure shall be physically present in the facility and shall be continuously aware of the patient's physical status and well-being. (8) Enteral--any technique of administration of sedation in which the agent is absorbed through the gastrointestinal (GI) tract or oral mucosa (i.e., oral, rectal, sublingual). (11) General anesthesia--a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (14) Local anesthesia--the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. (15) Maximum recommended dose (applies to minimal sedation)--FDA maximum recommended dose (MRD) of a drug, as printed in FDA-approved labeling for unmonitored home use. (16) Minimal sedation--a minimally depressed level of consciousness, produced by a pharmacological method, which retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected. Medication administered for the purpose of minimal sedation shall not exceed the maximum doses recommended by the drug manufacturer. Nitrous oxide/oxygen may be used in combination with a single enteral drug in minimal sedation. During longer periods of minimal sedation in which the total amount of time of the procedures exceeds the effective duration of the sedative effect of the drug used, the supplemental dose of the sedative shall not exceed total safe dosage levels based on the effective half-life of the drug used. The total aggregate dose must not exceed one and one-half times the MRD on the day of treatment. The use of prescribed, previsit sedatives for children aged twelve (12) or younger should be avoided due to the risk of unobserved respiratory obstruction during the transport by untrained individuals. (17) Moderate sedation--drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. A Level 2 permit is required for moderate sedation limited to enteral routes of administration. A Level 3 permit is required for moderate sedation including parenteral routes of administration. In accordance with this particular definition, the drugs or techniques used shall carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the dentist. A patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation. 504

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (18) Parenteral--the administration of pharmacological agents intravenously, intraosseously, intramuscularly, subcutaneously, submucosally, intranasally, or transdermally. (23) Supplemental dosing (applies to minimal sedation)--during minimal sedation, supplemental dosing is a single additional dose of the initial dose of the initial drug that may be necessary for prolonged procedures. The supplemental dose should not exceed one-half of the initial dose and should not be administered until the dentist has determined the clinical half-life of the initial dosing has passed. The aggregate dose must not exceed one and one-half times the MRD on the day of treatment. (24) Time-oriented anesthesia record--documentation at appropriate time intervals of drugs, doses, and physiologic data obtained during patient monitoring. Physiologic data for moderate sedation, deep sedation and general anesthesia must be taken and recorded at required intervals unless patient cooperation interferes or prohibits compliance. (25) Titration (applies to moderate sedation)--administration of incremental doses of a drug until the desired effect is reached. Knowledge of each drug's time of onset, peak response and duration of action is essential to avoid over-sedation. When the intent is moderate sedation, one must know whether the previous dose has taken full effect before administering an additional drug increment. Rule 110.3 Nitrous Oxide/Oxygen Inhalation Sedation (b) Standard of Care Requirements. A dentist performing nitrous oxide/oxygen inhalation sedation shall maintain the minimum standard of care for anesthesia, and in addition shall: (2) maintain under continuous direct supervision auxiliary personnel who shall be capable of reasonably assisting in procedures, problems, and emergencies incident to the use of nitrous oxide/oxygen inhalation sedation; (3) maintain current certification in Basic Life Support (BLS) for Healthcare Providers for the assistant staff by having them pass a course that includes a written examination and a hands-on demonstration of skills; and (c) Clinical Requirements. A dentist must meet the following clinical requirements to utilize nitrous oxide/oxygen inhalation sedation: (3) Personnel and Equipment Requirements. (A) In addition to the dentist, at least one member of the assistant staff should be present during the administration of nitrous oxide/oxygen inhalation sedation in nonemergency situations. (4) Monitoring. (B) After pharmacologic and physiologic vital sign stability has been established, the dentist may delegate the monitoring of the nitrous oxide/oxygen inhalation sedation to a dental auxiliary who has been certified to monitor the administration of nitrous oxide/oxygen inhalation sedation by the State Board of Dental Examiners. (7) Emergency Management. Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation. The dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of the nitrous oxide, and providing the equipment and protocols for patient rescue. A dentist must be able to rescue patients who enter a deeper state of sedation than intended. The dentist, personnel and facility must be prepared to treat emergencies that may arise from the administration of nitrous oxide/oxygen inhalation sedation. Rule 110.4 Minimal Sedation (b) Standard of Care Requirements. A dentist performing minimal sedation shall maintain the minimum standard of care for anesthesia, and in addition shall: (1) adhere to the clinical requirements as detailed in this section; (2) maintain under continuous direct supervision auxiliary personnel who shall be capable of reasonably assisting in procedures, problems, and emergencies incident to the use of minimal sedation; (3) maintain current certification in Basic Life Support (BLS) for Healthcare Providers for the assistant staff by having them pass a course that includes a written examination and a hands-on demonstration of skills; and (c) Clinical Requirements. A dentist must meet the following clinical requirements for utilization of minimal sedation: (3) Personnel and Equipment Requirements. (A) In addition to the dentist, at least one additional person trained in Basic Life Support (BLS) for Healthcare Providers must be present. (4) Monitoring. The dentist administering the sedation must remain in the operatory room to monitor the patient until the patient meets the criteria for discharge to the recovery area. Once the patient meets the criteria for discharge to the recovery area, the dentist may delegate monitoring to a qualified dental auxiliary. Monitoring during the administration of sedation must include: (A) Oxygenation. (i) Color of mucosa, skin, or blood must be evaluated continually. (ii) Oxygen saturation monitoring by pulse-oximetry should be used when a single drug minimal sedative is used. The additional use of nitrous oxide has a greater potential to increase the patient's level of sedation to moderate sedation, and a pulse oximeter must be used. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

505

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (B) Ventilation. The dentist (or appropriately qualified individual) must observe chest excursions and must verify respirations continually. (C) Circulation. Blood pressure and heart rate should be evaluated preprocedurally, post-procedurally and intra-procedurally as necessary. (5) Documentation. (A) Documentation must be made in accordance with §108.7 and §108.8 of this title and must include the names and dosages of all drugs administered and the names of individuals present during administration of the drugs. (B) A time-oriented sedation record may be considered for documentation of all monitoring parameters. (C) Pulse oximetry, heart rate, respiratory rate, and blood pressure are the parameters which may be documented at appropriate intervals of no more than 10 minutes. (6) Recovery and Discharge. (B) The qualified dentist must monitor the patient during recovery until the patient is ready for discharge by the dentist. The dentist may delegate this task to an appropriately qualified dental auxiliary. (7) Emergency Management. Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation. The dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of minimal sedation, and providing the equipment and protocols for patient rescue. A dentist must be able to rescue patients who enter a deeper state of sedation than intended. Rule 110.5 Moderate Sedation (b) Standard of Care Requirements. A dentist must maintain the minimum standard of care as outlined in §108.7 of this title and in addition shall: (1) adhere to the clinical requirements as detailed in this section; (2) maintain under continuous personal supervision auxiliary personnel who shall be capable of reasonably assisting in procedures, problems, and emergencies incident to the use of moderate sedation; (3) maintain current certification in Basic Life Support (BLS) for Healthcare Providers for the assistant staff by having them pass a course that includes a written examination and a hands-on demonstration of skills; and (c) Clinical Requirements. (3) Personnel and Equipment Requirements. (A) In addition to the dentist, at least one additional person trained in Basic Life Support (BLS) for Healthcare Providers must be present. (4) Monitoring. The dentist administering moderate sedation must remain in the operatory room to monitor the patient continuously until the patient meets the criteria for recovery. When active treatment concludes and the patient recovers to a minimally sedated level, the dentist may delegate a qualified dental auxiliary to remain with the patient and continue to monitor the patient until he/she is discharged from the facility. The dentist must not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. Monitoring must include: (A) Consciousness. Level of consciousness (e.g., responsiveness to verbal command) must be continually assessed. (B) Oxygenation. (i) Color of mucosa, skin, or blood must be evaluated continually. (ii) Oxygen saturation must be evaluated by pulse-oximetry continuously. (C) Ventilation. (i) Chest excursions must be continually observed. (ii) Ventilation must be continually evaluated. This can be accomplished by auscultation of breath sounds, monitoring end-tidal CO2 or by verbal communication with the patient. (D) Circulation. (i) Blood pressure and heart rate must be continually evaluated. (ii) Continuous EKG monitoring of patients sedated under moderate parenteral sedation is required. (5) Documentation. (A) Documentation must be made in accordance with §108.7 and §108.8 of this title. (B) A written time-oriented anesthetic record must be maintained and must include the names and dosages of all drugs administered and the names of individuals present during administration of the drugs. (C) Pulse-oximetry, heart rate, respiratory rate, and blood pressure must be continually monitored and documented at appropriate intervals of no more than ten (10) minutes. (6) Recovery and Discharge. (B) While the patient is in the recovery area, the dentist or qualified clinical staff must continually monitor the patient's blood pressure, heart rate, oxygenation, and level of consciousness. 506

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (7) Emergency Management. (A) The dentist is responsible for the sedation management, adequacy of the facility and staff, diagnosis and treatment of emergencies associated with the administration of moderate sedation, and providing the equipment and protocols for patient rescue. This includes immediate access to pharmacologic antagonists and equipment for establishing a patent airway and providing positive pressure ventilation with oxygen. Rule 110.6 Deep Sedation or General Anesthesia (b) Standard of Care Requirements. A dentist must maintain the minimum standard of care for the administration of anesthesia as outlined in §108.7 of this title and in addition shall: (1) adhere to the clinical requirements as detailed in this section; (2) maintain under continuous direct supervision a minimum of two qualified dental auxiliary personnel who shall be capable of reasonably assisting in procedures, problems, and emergencies incident to the use of deep sedation and/or general anesthesia; (3) maintain current certification in Basic Life Support (BLS) for Healthcare Providers for the assistant staff by having them pass a course that includes a written examination and a hands-on demonstration of skills; and (c) Clinical Requirements. (3) Personnel and Equipment Requirements. (A) Personnel. A minimum of three (3) individuals must be present during the procedure: (i) a dentist who is qualified to administer the deep sedation or general anesthesia who is currently certified in ACLS and/or PALS; and (ii) two additional individuals who have current certification of successfully completing a course in Basic Life Support (BLS) for Healthcare Providers, one of which must be dedicated to assisting with patient monitoring. (4) Monitoring. A qualified dentist administering deep sedation or general anesthesia must remain in the operatory room to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The dentist must not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. Monitoring must include: (A) Oxygenation. (i) Color of mucosa, skin, or blood must be continually evaluated. (ii) Oxygenation saturation must be evaluated continuously by pulse oximetry. (B) Ventilation. (i) Intubated patient: End-tidal CO2 must be continuously monitored and evaluated. (ii) Non-intubated patient: Breath sounds via auscultation and/or end-tidal CO2 must be continually monitored and evaluated. (iii) Respiration rate must be continually monitored and evaluated. (C) Circulation. (i) Heart rate and rhythm via EKG and pulse rate via pulse oximetry must be evaluated throughout the procedure. (ii) Blood pressure must be continually monitored. (D) Temperature. (i) A device capable of measuring body temperature must be readily available during the administration of deep sedation or general anesthesia. (ii) The equipment to continuously monitor body temperature should be available and must be performed whenever triggering agents associated with malignant hyperthermia are administered. (5) Documentation. (A) Documentation must be made in accordance with §108.7 and §108.8 of this title and must include the names, times and dosages of all drugs administered and the names of individuals present during administration of the drugs. (B) A written time-oriented anesthetic record must be maintained. (C) Pulse oximetry and end-tidal CO2 measurements (if taken with an intubated patient), heart rate, respiratory rate, and blood pressure must be continually recorded at five (5) minute intervals. (6) Recovery and Discharge. (B) The dentist or clinical staff must continually monitor the patient's blood pressure, heart rate, oxygenation, and level of consciousness. (8) Emergency Management. (A) The dentist is responsible for the sedation management, adequacy of the facility and staff, diagnosis and treatment of emergencies associated with the administration of deep sedation or general anesthesia, and providing the equipment and protocols for patient rescue. This includes immediate access to pharmacologic antagonists and equipment for establishing a patent airway and providing positive pressure ventilation with oxygen. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

507

Texas State Dental Practice Act and Administrative Rules for Dental Assistants CHAPTER 114 EXTENSION OF DUTIES OF AUXILIARY PERSONNEL DENTAL ASSISTANTS Rule 114.1 Permitted Duties (a) A dentist may delegate to a dental assistant the authority to perform only acts or procedures that are reversible. An act or procedure that is reversible is capable of being reversed or corrected. (b) A dentist may not delegate or otherwise authorize a dental assistant to perform any task for which a certificate is required under this section, unless the dental assistant holds the required certificate or has obtained the additional training. (c) A dental assistant may perform tasks under a dentist’s general or direct supervision. For the purposes of this section: (1) “General supervision” means that the dentist employs or is in charge of the dental assistant and is responsible for supervising the services to be performed by the dental assistant. The dentist may or may not be present on the premises when the dental assistant performs the procedures. (2) “Direct supervision” means that the dentist employs or is in charge of the dental assistant and is physically present in the office when the task is performed. Physical presence does not require that the supervising dentist be in the treatment room when the dental assistant performs the service as long as the dentist is in the dental office. (d) The dentist shall remain responsible for any delegated act. (e) The clinical tasks that a dental assistant can perform under general supervision are limited to: (1) the making of dental x-rays in compliance with the Occupations Code, §265.005; and (2) the provision of interim treatment of a minor emergency dental condition to an existing patient of the treating dentist in accordance with the Occupations Code, §265.003(a-1). For purposes of this paragraph only, “existing patient” means a patient that the supervising dentist has examined in the twelve (12) months prior to the interim treatment. A treating dentist who delegates the provision of interim treatment of a minor emergency condition to a dental assistant shall schedule a follow-up appointment with the patient within 30 days. It is not a violation if the dentist makes a good faith attempt to schedule a follow-up appointment with the patient within 30 days but is unable to because of circumstances outside the dentist's control and those circumstances are clearly noted in the patient's record. Rule 114.2 Registration of Dental Assistants (a) A dental assistant may not position or expose dental x-rays unless the dental assistant holds a dental assistant radiology certificate issued by the State Board of Dental Examiners under this section. (b) To be eligible for a dental assistant radiology certificate under this section, an applicant must present on or accompanying an application form approved by the State Board of Dental Examiners proof satisfactory to the Board that the applicant has: (1) Paid all application, examination and licensing fees required by law and Board rules and regulations; (2) Graduated from an accredited high school or holds a certificate of high school equivalency, General Equivalency Diploma (GED); (3) Submitted fingerprints for the retrieval of criminal history record information; (4) Successfully completed a current hands-on course in basic life support; and, (5) Either: (A) taken and passed a course of instruction and an examination administered by the State Board of Dental Examiners or its designated agent, that fulfills the requirements in subsection (h) of this section; or, (B) if the applicant is certified as a dental assistant by the Dental Assisting National Board, taken and passed a jurisprudence examination administered by the State Board of Dental Examiners or its designated agent. (c) The State Board of Dental Examiners has established a staggered dental assistant registration system comprised of initial registration periods followed by biennial registrations (i.e., renewals). The initial, staggered registration periods will range from 18 months to 30 months. The length of the initial registration period will be determined by the registrant's birth month, but will be no less than 18 months. The expiration of the initial registration will be based on the registrants' birth month. (d) Subsequent to the initial registration period, a registered dental assistant's biennial renewal will occur on the first day of the month that follows the last month of the dental assistant initial registration period. (1) Approximately 60 days prior to the expiration date of the initial dental assistant registration period, renewal notices will be mailed to all registered dental assistants who have that expiration date. (2) A dental assistant registered under this section who wishes to renew his or her registration must: (A) Pay a renewal fee set by Board rule; (B) Submit proof that the applicant has successfully completed a current hands-on course in basic life support; and, (C) Complete continuing education as required by §114.12 of this chapter. (3) A registration expired for one year or more may not be renewed. 508

Texas State Dental Practice Act and Administrative Rules for Dental Assistants

(e) (f)

(g)

(h)

(4) Up to 6 hours of continuing education may be carried forward from the year preceding the current renewal period. Applications for registration or for renewal of registration must be submitted to the office of the State Board of Dental Examiners. An application for registration is filed with the State Board of Dental Examiners when it is actually received, date-stamped, and logged-in by the State Board of Dental Examiners along with all required documentation and fees. An incomplete application for registration and fee will be returned to applicant within three working days with an explanation of additional documentation or information needed. A dental assistant shall display a current registration certificate in each office where the dental assistant provides services for which registration is required by this chapter. When a dental assistant provides such services at more than one location, a duplicate registration certificate issued by the Board may be displayed. Photocopies are not acceptable. The duplicate may be obtained from the State Board of Dental Examiners for a fee set by the Board. Radiology. Courses administered to fulfill the requirements of a Dental Assistant Radiology Certificate must cover the following course objectives identified by the Dental Assistant Advisory Committee: (1) At the end of this course of instruction, the student should be able to: (A) Apply principles of radiation safety in the operation of radiographic equipment. (i) Explain factors affecting x-ray production. (ii) Explain x-ray machine factors that influence radiation safety. (iii) Identify differences between primary radiation and scattered (secondary) radiation. (iv) Describe protocol in suspected x-ray machine malfunctions. (B) Practice safety measures for patient protection. (i) Explain major cause of unnecessary radiation exposure. (ii) Identify short and long-term effects of radiation on cells and tissues. (iii) Identify ways to reduce radiation exposure to patients. (iv) Explain guidelines to determine frequency of radiation exposure. (C) Practice safety measures for operator protection. (i) Explain basic radiation physics and biology related to operator exposure. (ii) Explain sources of radiation to operators while exposing radiographs. (iii) Identify safety measures to reduce operator radiation exposure. (D) Identify and select infection control techniques and barriers to minimize cross-contamination according to ADA/CDC guidelines. (E) Utilize patient management techniques before, during, and after radiographic exposure. (i) Address patient concerns regarding radiation exposure. (ii) Select appropriate patient management techniques for radiographic exposure. (F) Select appropriate intraoral radiographic technique. (i) Identify appropriate armamentarium for radiographic techniques. (ii) Select appropriate film size and film speed. (iii) Expose radiographs. (G) Practice infection control procedures for radiographic processing. (H) Prepare, maintain, and replenish radiographic solutions for manual and automatic processors. (I) Process exposed intra- and extraoral radiographs manually and with automatic processors. (i) Identify optimum conditions and procedures for processing radiographs. (ii) Identify and correct errors related to radiographic processing and improper film handling. (J) Store film and chemical agents used in radiographic procedures according to regulatory guidelines. (K) Dispose of all chemical agents and other materials used in dental radiographic procedures. (L) Mount radiographs using facial view. (i) Identify anatomical landmarks to aid in correct mounting. (ii) Match specific tooth views to specified tooth mount windows. (iii) Utilize optimum viewing techniques. (iv) Label the radiographic mount appropriately. (M) Identify anatomical structures, dental materials and patient characteristics observed on radiographs. (N) Evaluate radiographs for diagnostic value. (i) Identify diagnostically acceptable radiographs. (ii) Identify and correct causes of errors on intraoral radiographs. (O) Understand basic principles of extraoral radiology. (P) Select the appropriate film and equipment. (Q) Prepare patient for exposure. (R) Expose extraoral radiographs. (S) Identify and correct causes of errors on extraoral radiographs. (T) Explain the concept of digital radiography. (U) Select appropriate equipment.

509

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (V) Expose digital radiographs. (W) Identify and correct causes of errors on digital radiographs. (X) Utilize quality assurance procedures in the dental office for radiographic procedures. (Y) Prepare radiographs to comply with legal requirements for viewing and duplication. (i) Explain methods for duplicating radiographs. (ii) Explain reasons for exposing and retaining radiographs. (Z) Comply with HIPAA/Patient Privacy Rules and Regulations. (2) Infection control. At the end of this course of instruction, the student should be able to: (A) Follow standards and guidelines of occupational safety for dental office personnel. (i) Utilize regulations in the OSHA/CDC Bloodborne Pathogens Standard. (ii) Utilize regulations in the OSHA/CDC Hazard Communication Standard. (B) Identify infectious diseases in the dental setting and available immunizations. (C) Prevent cross-contamination and disease transmission in the dental setting. (i) Perform proper hand washing. (ii) Use disposable items whenever possible. (iii) Utilize barrier techniques and personal protective equipment (PPE). (D) Perform disinfection procedures. (i) Select appropriate PPE. (ii) Select, prepare and use chemical agents following manufacturer’s directions. (iii) Prepare surfaces for disinfection. (iv) Disinfect the treatment room, darkroom, instrument processing area, and all associated equipment. (E) Perform sterilization procedures. (i) Select appropriate PPE. (ii) Prepare dental instruments and equipment for sterilization. (iii) Apply appropriate method for sterilization of dental instruments, equipment and supplies. (iv) Label and store all instruments properly. (v) Monitor effectiveness of sterilization process for dental instruments, equipment and supplies. (F) Maintain infection control of dental unit and equipment. (G) Practice safety measures when handling all hazardous materials. (i) Identify and dispose of biohazardous waste. (ii) Identify and dispose of non-regulated waste. (iii) Identify and manage potential chemical and physical hazards in accordance with MSDS sheets. (H) Practice infection control in handling and transporting dental items. (i) Select appropriate PPE. (ii) Identify conditions for potential cross-contamination. (iii) Select and apply appropriate disinfectant. (iv) Label biohazardous material. (I) Utilize and maintain a quality assurance program for infection control throughout the dental setting. (3) Jurisprudence. At the end of this course of instruction, the student should be able to: (A) State the mission, philosophy and composition of the State Board of Dental Examiners. (B) Differentiate between the Texas Occupations Code and the rules of the State Board of Dental Examiners. (C) Comply with Texas law and the rules of the State Board of Dental Examiners as they relate to dental assistant duties. (i) This subsection as well as subsections (j) and (k) of this section apply to certificates issued on or after September 1, 2009. A dental assistant who holds a certificate of registration issued under this chapter shall display the person’s current certificate of registration in each office in which the person makes dental x-rays. If the person makes dental x-rays at more than one location, the person may display a duplicate of the original registration certificate obtained from the Board on payment of a duplicate certificate fee set by the Board. (j) A dental assistant who holds a certificate of registration issued under this chapter shall timely notify the Board of: (1) any change of address of the registrant’s place of business; (2) any change of the registrant’s employer; and (3) any change of the registrant’s mailing address. (k) The Board may issue a registration to a dental assistant applicant who is a Military service member, Military veteran, or Military spouse in compliance with §101.6 of this title (relating to Dental Licensing for Military Service Members, Military Veterans and Military Spouses. (l) An applicant for registration is ineligible if they are in violation of a board order at the time of application. Rule 114.3 Pit and Fissure Sealant (a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise: (1) "Didactic education" requires the presentation and instruction of theory and scientific principles. 510

Texas State Dental Practice Act and Administrative Rules for Dental Assistants

(b)

(e) (f)

(2) "Clinical education" requires providing care to patient(s) under the direct supervision of a dentist or dental hygienist instructor. (3) "Direct Supervision" requires that the instructor responsible for the procedure shall be physically present during patient care and shall be aware of the patient's physical status and well-being. In addition to application of pit and fissure sealants a dental assistant who meets the requirements in this section may use a rubber prophylaxis cup and appropriate polishing materials to cleanse the occlusal and smooth surfaces of teeth that will be sealed or to prepare teeth for application of orthodontic bonding resins. Cleansing is intended only to prepare the teeth for the application of sealants or bonding resins and should not exceed the amount needed to do so. The dentist may not bill for a cleansing provided hereunder as a prophylaxis. A Texas-licensed dentist may delegate the application of pit and fissure sealants to a dental assistant if the dental assist has: (1) at least two years of experience as a dental assistant; (2) successfully completed a current course in basic life support; and (3) completed a minimum of 8 hours of education that includes clinical and didactic education in pit and fissure sealants taken through a CODA-accredited dental, dental hygiene, or dental assistant program approved by the Board whose course of instruction includes: (A) infection control; (B) cardiopulmonary resuscitation; (C) treatment of medical emergencies; (D) microbiology; (E) chemistry; (F) dental anatomy; (G) ethics related to pit and fissure sealants; (H) jurisprudence related to pit and fissure sealants; and (I) the correct application of sealants, including the actual clinical application of sealants. Application of pit and fissure sealants must be in accordance with the minimum standard of care and limited to the dental assistant's scope of practice. The dental assistant must comply with the Dental Practice Act and Board Rules in the application of pit and fissure sealants. Pursuant to §258.003 of the Dental Practice Act, the delegating dentist is responsible for all dental acts delegated to a dental assistant, including application of pit and fissure sealant.

Rule 114.4 Monitoring the Administration of Nitrous Oxide (a) Previous Nitrous Oxide Monitoring Certificate Holders. (1) Until September 1, 2019, the State Board of Dental Examiners shall issue a "nitrous oxide monitoring registration" to a dental assistant who holds a current nitrous oxide monitoring certificate issued by the board before that date and who meets the continuing education requirements established by the board under 22 TAC §114.12 (relating to Continuing Education for Certificate Holders). These persons will not be required to meet the requirements of subsection (d) of this section to obtain or renew the nitrous oxide monitoring registration. A nitrous oxide monitoring registration must be renewed biennially in accordance with the requirements of Tex. Occ. Code §265.0017 and 22 TAC §114.2(d) (relating to Registration of Dental Assistants). (2) Beginning on September 1, 2019, the board shall cease issuing nitrous oxide monitoring registrations to any person who does not comply with the provisions of subsection (d) of this section. Persons who have obtained a nitrous oxide monitoring registration under paragraph (a)(1) of this subsection may continue to practice and renew their nitrous oxide monitoring registrations. Nitrous oxide monitoring registrations which have been expired more than one year may not be renewed, and instead shall require qualification under subsection (d) of this section. (b) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise: (1) "Dental industry professional organization" any organization, the primary mission of which is to represent and support dentists, dental hygienists, and/or dental assistants. (2) "Didactic education" requires the presentation and instruction of theory and scientific principles. (3) "Direct Supervision" requires that the dentist responsible for the procedure shall be physically present during patient care and shall be aware of the patient's physical status and well-being. (c) A Texas-licensed dentist may delegate the monitoring of the administration of nitrous oxide to a dental assistant, if the dental assistant: (1) works under the direct supervision of the licensed dentist; and (2) holds a current nitrous oxide monitoring registration granted by the provisions of this rule. (d) A dental assistant wishing to obtain nitrous oxide monitoring registration under this section must: (1) pay an application fee set by board rule; and (2) on a form prescribed by the board, provide proof that the applicant has: © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

511

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (A) a dental assistant registration issued by the board pursuant to 22 TAC §114.2 that is not expired and is not under probated or enforced suspension; (B) successfully completed a current course in basic life support; and (C) completed a minimum of 8 hours of didactic education and testing in monitoring the administration of nitrous oxide taken through a CODA-accredited dental, dental hygiene or dental assisting program, approved by the board, whose course of instruction includes: (i) Texas jurisprudence, including but not limited to: anesthesia standard of care, anesthesia/analgesia, enteral conscious sedation, and this rule, regarding monitoring the administration of nitrous oxide; (ii) dental anatomy and physiology; (iii) pharmacology; (iv) sedation equipment; (v) infection control; (vi) patient monitoring; and (vii) recognition and management of medical emergencies. (e) The jurisprudence assessment may be completed to satisfy the requirements set out in subsection (d)(2)(C)(i) of this section. (f) A program seeking to offer a course in monitoring the administration of nitrous oxide must submit a written request for approval to the board demonstrating that it meets the requirements set forth in subsection (d)(2)(C) of this section. Additionally, all courses must include a mandatory competency evaluation with a minimum of 50 test items. Course documentation must be maintained by the course provider for no less than three years. (g) Approved courses may be offered at annual meetings of dental industry professional organizations. (h) Courses taken to satisfy the requirements of this section are valid for five (5) years from the date of course completion for nitrous oxide monitoring registration purposes. (i) Applicants for nitrous oxide monitoring registration under this rule are ineligible if they are in violation of a board order at the time of application. Rule 114.5 Coronal Polishing (a) "Coronal polishing" means the removal of plaque and extrinsic stain from exposed natural and restored tooth surfaces using an appropriate rotary instrument with rubber cup or brush and polishing agent. This includes the use of a toothbrush. (b) A Texas-licensed dentist may delegate coronal polishing to a dental assistant if the dental assistant: (1) works under the direct supervision of the licensed dentist; and has (2) at least two years experience as a dental assistant; and either (A) completed a minimum of eight (8) hours of clinical and didactic education in coronal polishing taken through a dental school, dental hygiene school, or dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the Board. The education must include courses on: (i) oral anatomy and tooth morphology relating to retention of plaque and stain; (ii) indications, contraindications, and complications of coronal polishing; (iii) principles of coronal polishing, including armamentarium, operator and patient positioning, technique, and polishing agents; (iv) infection control procedures; (v) polishing coronal surfaces of teeth; and (vi) jurisprudence relating to coronal polishing; or (B) has either: (i) graduated from a dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association and approved by the board that includes specific didactic course work and clinical training in coronal polishing; or (ii) received certification of completion of requirements specified by the Dental Assisting National Board and approved by the Board. (c) The delegated duty of polishing by a dental assistant may not be billed as a prophylaxis. (d) Coronal polishing must be in accordance with the minimum standard of care and limited to the dental assistant's scope of practice. (e) The dental assistant must comply with the Dental Practice Act and Board Rules in the act of coronal polishing. Pursuant to §258.003 of the Dental Practice Act, the delegating dentist is responsible for all dental acts delegated to a dental assistant, including coronal polishing. Rule 114.6 General Qualifications for Registration or Certification (a) Any person who desires to provide dental assistant services requiring registration or certification must obtain the proper registration or certification issued by the Board before providing the services, except as provided in Texas Occupations Code §265.005(l) and §114.11 of this chapter. 512

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (b) Any applicant for registration or certification must meet the requirements of this chapter. (c) To be eligible for registration or certification, an applicant must provide with an application form approved by the Board satisfactory proof to the Board that the applicant: (1) has fulfilled all requirements for registration or certification outlined in this chapter; (2) has met the requirements of Â§101.8 of this title; (3) has not had any disciplinary action taken in this state or any other jurisdiction; (4) has successfully completed a current course in basic life support; (5) has taken and passed the jurisprudence assessment administered by the Board or an entity designated by the Board within one year immediately prior to application; and (6) has paid all application, examination and fees required by law and Board rules and regulations. (d) Applications for dental assistant registration and certification must be delivered to the office of the State Board of Dental Examiners. (e) An application for dental assistant registration or certification is filed with the Board when it is actually received, date-stamped, and logged-in by the Board along with all required documentation and fees. An incomplete application will be returned to the applicant with an explanation of additional documentation or information needed. (f) The Board may refuse to issue registration or certificate or may issue a conditional registration or certificate to any individual who does not meet the requirements of subsections (c)(2) or (c)(3) of this section, or who: (1) presents to the Board fraudulent or false evidence of the person's qualification for registration or certification; (2) is guilty of any illegality, fraud, or deception during the process to secure a registration or certification; (3) is habitually intoxicated or is addicted to drugs; (4) commits a dishonest or illegal practice in or connected to dentistry; (5) is convicted of a felony under federal law or law of this state; or (6) is found to have violated a law of this state relating to the practice of dentistry within the 12 months preceding the date the person filed an application for a registration or certification. (g) If the Board chooses to issue a conditional registration or certificate, the individual may be required to enter into an agreed settlement order with the Board at the time the registration or certificate is issued. In determining whether to issue a conditional registration or certificate, the Board shall consider the following factors, as applicable: (1) the nature and seriousness of the crime or violation; (2) the relationship of the crime or violation to the purposes for requiring a registration/certification to engage in the occupation; (3) the extent to which a registration/certification might offer an opportunity to engage in further criminal activity or violations of the same type as that in which the person previously had been involved; (4) the relationship of the crime or violation to the ability, capacity, or fitness required to perform the duties and discharge the responsibilities of the registered occupation; (5) the extent and nature of the person's past criminal activity or disciplinary history; (6) the age of the person when the crime or violation was committed; (7) the amount of time that has elapsed since the person's last criminal activity or violation; (8) the conduct and work activity of the person before and after the criminal activity or violation; (9) evidence of the person's rehabilitation or rehabilitative effort while incarcerated or after release; and (10) other evidence of the person's fitness, including letters of recommendation from: (A) prosecutors and law enforcement and correctional officers who prosecuted, arrested, or had custodial responsibility for the person; (B) the sheriff or chief of police in the community where the person resides; and (C) any other person in contact with the convicted person. (11) The applicant shall, to the extent possible, obtain and provide to the Board the recommendations of the prosecution, law enforcement, and correctional authorities. The applicant shall also furnish proof in such form as may be required by the Board that he or she has maintained a record of steady employment and has supported his or her dependents and has otherwise maintained a record of good conduct and has paid all outstanding court costs, supervision fees, fines, and restitution as may have been ordered in all criminal cases in which he or she has been convicted or received a deferred order or in all administrative cases in which the applicant has been the subject of a final disciplinary action. (12) The order may include limitations including, but not limited to, practice limitations, stipulations, compliance with court ordered conditions, notification to employer or any other requirements the Board recommends to ensure public safety. (13) In the event an applicant is uncertain whether he or she is qualified to obtain a dental assistant registration or certification due to criminal conduct, the applicant may request a Criminal History Evaluation Letter in accordance with Â§114.9 of this chapter, prior to application. (14) Should the individual violate the terms of his or her conditional registration or certificate, the Board may take additional disciplinary action against the individual. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

513

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (h) An applicant whose application is denied by the Board may appeal the decision to the State Office of Administrative Hearings. (i) An individual whose application for dental assistant registration/certification is denied is not eligible to file another application for registration/certification until the expiration of one year from the date of denial or the date of the Board's order denying the application for registration/certification, whichever date is later. Rule 114.9 Criminal History Evaluation Letter (a) A person enrolled or planning to enroll in an educational program that prepares the person for initial certification as a dental assistant and who has reason to believe that he or she may be ineligible for licensure due to a conviction or deferred adjudication for a felony or a misdemeanor offense, may petition the Board for a Criminal History Evaluation Letter. (b) The requestor must submit a petition that includes: (1) a statement by the requestor indicating the reason(s) and basis of potential ineligibility; (2) any applicable court documents including, but not limited to, indictments, orders of deferred adjudication, judgments, probation records and evidence of completion of probation; (3) any other documentation requested by the Board; and (4) the required fee. (c) An investigation of the requestor's eligibility shall be conducted. (d) If the Board determines that a ground for ineligibility does not exist, it shall notify the requestor in writing of the Board's determination on each ground of potential ineligibility. (e) If the Board determines that the requestor is ineligible for a license, it shall issue a letter setting out each basis for potential ineligibility and the Board's determination as to eligibility. In the absence of new evidence known to but not disclosed by the requestor or not reasonably available to the Board at the time the letter is issued, the Board's ruling on the request determines the requestor's eligibility with respect to the grounds for potential ineligibility set out in the letter. (f) The Board shall provide notice under subsection (d) of this section or issue a letter under subsection (e) of this section no later than the ninetieth (90th) day after the date the Board receives the request. (g) The Board shall charge a person requesting an evaluation a fee not to exceed $100.00 to cover the cost of administering this section. The fee shall be non-refundable. Rule 114.10 Dishonorable Conduct The dishonorable conduct section is intended to protect the public from dangerous, unethical, and illegal conduct of licensees and registrants. The purpose of this section is to identify unprofessional or dishonorable behaviors of a dental assistant which the Board believes are likely to pose a threat to the public. Actual injury to a patient need not be established for a dental assistant to be in violation of this section. Behavior constituting dishonorable conduct includes, but is not limited to: (1) Criminal conduct--including but not limited to conviction of a misdemeanor involving fraud or a felony under federal law or the law of any state as outlined in Chapter 101 of this title. (2) Deception or misrepresentation--engages in deception or misrepresentation: (A) in soliciting or obtaining patronage; or (B) in obtaining a fee. (3) Fraud in obtaining a license, registration, or certification--obtains a registration or certification by fraud or misrepresentation or participates in a conspiracy to procure a license, registration, or certification for an unqualified person. (4) Misconduct involving drugs or alcohol--actions or conduct that include, but are not limited to: (A) providing dental services to a patient while the dental assistant is impaired through the use of drugs, narcotics, or alcohol; (B) addicted to or habitually intemperate in the use of alcoholic beverages or drugs; or (C) improperly obtained, possessed, or used habit-forming drugs or narcotics. (5) Failure to comply with applicable laws, rules, regulations, and orders--violates or refuses to comply with a law relating to the regulation of dentists, dental hygienists, or dental assistants; fails to cooperate with a Board investigation; or fails to comply with the terms of a Board Order. (6) Inability to practice safely--is physically or mentally incapable of practicing in a manner that is safe for the person's dental patients. (7) Discipline of a licensee or registrant by another state board--holds a license, registration, or certificate to practice dentistry, dental hygiene, or dental assisting in another state and the examining board of that state: (A) reprimands the person; (B) suspends or revokes the person's license, registration, or certificate or places the person on probation; or (C) imposes another restriction on the person's practice. (8) Unprofessional conduct--engages in conduct that has become established through professional experience as likely to disgrace, degrade, or bring discredit upon the licensee/registrant or the dental profession. 514

Texas State Dental Practice Act and Administrative Rules for Dental Assistants Rule 114.11 Exemption (a) A dental assistant will not be considered to be positioning, exposing, or otherwise making dental x-rays if the dental assistant only performs radiological procedures; (1) In the course of training or for other educational purposes; and, (2) Is at all times under the direct supervision of the employer dentist. (b) A dental assistant performing radiological procedures under this section in the course of on-the-job training may only do so for a period of one year. Rule 114.12 Continuing Education for Certificate Holders (a) To renew a certificate of registration issued under this chapter, a dental assistant must complete six (6) hours of continuing education each year in areas covering dental assistant duties. At least three (3) of these six (6) hours must be clinical continuing education. (b) A dental assistant may fulfill the continuing education requirement through board-approved self-study, interactive computer courses, or lecture courses. All continuing education must be offered by providers approved under 22 Texas Administrative Code §104.2. Rule 114.21 Requirements for Dental Assistant Registration Courses and Examinations (a) The following words and terms, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise: (1) “Dental industry professional organization” - any organization, the primary mission of which is to represent and support dentists, dental hygienists, and/or dental assistants; (2) “Dental Assistant Advisory Committee” - a committee consisting of dental professionals and educators, created by the Board under the authority of Tex. Occ. Code Section 265.005; (3) “Jurisprudence” - the body of statutes and regulations pertaining to and governing practice by dental assistants, including relevant portions of the Texas Occupations Code, and the rules enacted by the SBDE. (b) Any school or program accredited by the Commission on Dental Accreditation or any dental industry professional organization may offer a course and examination to fulfill the requirements for dental assistant registration outlined in Section 114.20 of this chapter, so long as the course and examination are compliant with the requirements of this section, and have been approved by the SBDE. (c) Courses administered to fulfill the requirements of this chapter must: (1) Cover all the course objectives outlined by the SBDE and the Dental Assistant Advisory Committee and set forth in Section 114.22 of this chapter; and, (2) Comply with other requirements established by the SBDE and the Dental Assistant Advisory Committee. (d) Course providers administering examinations to fulfill the requirements of this chapter must: (1) Employ a minimum of 50 questions per examination that adequately cover the course objectives identified by the Dental Assistant Advisory Committee and set forth in Section 114.22 of this chapter; (2) Establish a minimum passing score of 70%; and, (3) Maintain safeguards to ensure the integrity and security of the examinations, their content, and the physical examination environment, as outlined in Section 114.23 of this chapter. (e) Any course and examination administered under this section may be offered through self-study, interactive computer courses, or lecture courses, and may be offered through the Internet. (f) Course and examination approval. A provider seeking approval of a dental assistant course must submit the following materials to the SBDE prior to offering the course: (1) A complete, signed, and notarized Dental Assistant Course Provider Application, as promulgated by the SBDE; (2) An application fee in the amount established by the SBDE, payable by check or money order made payable to the State Board of Dental Examiners; and (3) Documentation pertaining to the course, including: (A) All course materials to be provided to course attendees; (B) The complete pool of examination questions to be drawn from; (C) An examination integrity plan that meets the requirements of Section 114.23 of this chapter; (D) A copy of the certificate to be issued on course completion; and, (E) A copy of the provider’s reexamination policy, which notifies course attendees in advance how many reexaminations shall be allowed without retaking the course, the cost of reexamination, and other pertinent information. (g) Following course approval, the following information must be submitted to the SBDE: (1) An internet URL address for a website containing information about the approved course, or, if no such website exists, contact information for the course provider; (2) A schedule of courses to be offered, including dates, times and locations for each; (3) Prompt notification of any changes to the published course schedule; and, (4) Notification of any substantive changes to the course curriculum or materials following SBDE approval. Such changes must be submitted in writing to the SBDE for approval prior to their implementation in the course. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

515

Texas State Dental Practice Act and Administrative Rules for Dental Assistants (h) The course provider shall provide all course registrants with their examination results within 30 days of the completion of the examination. (i) All course providers are subject to audit by the State Board of Dental Examiners for purposes of ensuring compliance with the requirements of this chapter. (j) Documentation of course attendance and course completion shall be kept by the course provider for a period of not less than two (2) years. (k) Failure to comply with any of the requirements of this section may result in withdrawal of course approval. Rule 114.23 Dental Assistant Examination Integrity (a) Course providers shall employ reasonable methods to ensure the integrity of examinations administered under this chapter, including, but not limited to: (1) Employing at least three (3) forms of each examination, with substantially distinct selection and ordering of questions; (2) Utilizing a pool of examination questions sufficiently large to comply with the requirements of this section; (3) Allowing examinees a reasonable and appropriate maximum amount of time to complete an examination; and, (4) Securing the pool of examination questions, actual examinations, and any other source of specific examination data. (b) Course providers shall establish and maintain a physical environment for examinations to ensure the accessibility, integrity, and security of examinations administered under this chapter, including, but not limited to: (1) Uninterrupted proctoring of the examination site; (2) A distribution of distinct forms of the examinations that limits the potential for examination item compromise; (3) Prohibiting the use of books, notes, or other reference aids, and taking reasonable steps to prevent access to impermissible assistance; (4) Removal of teaching aids and posters from areas accessible to examinees; (5) Providing reasonable accommodations for examinees with disabilities. (6) Requiring examinees to sign a statement of confidentiality with respect to disclosure of information on the examination; (7) Verified identification of students and examinees; and, (8) Enforcement of reasonable policies regarding issues including, but not limited to, noise, illness, and breaks. (c) In addition to the foregoing requirements, course providers shall employ reasonable methods to ensure accessibility, integrity, and security of internet- or intranet-based examinations administered under this chapter, including, but not limited to: (1) Identification of each examinee via a unique login and the use of periodic security questions that should reasonably confirm the examinee’s identity; (2) Maintaining the security of student information; (3) Maintaining a comprehensive student and examinee database; (4) Imposing time limits for inactivity during examinations; (5) Imposing reasonable and equitable maximum time limits for completion of examinations; (6) Disabling access to other websites, software, or data during examinations; (7) Disabling the ability to print or otherwise copy examination items; and, (8) Providing reasonable accommodations for examinees with disabilities. CHAPTER 115 EXTENSION OF DUTIES OF AUXILIARY PERSONNEL - DENTAL HYGIENE Rule 115.4 Placement of Site Specific Subgingival Medicaments Pursuant to §262.002(a)(6), the placement and removal of site specific subgingival medicaments may be delegated to a Texas licensed dental hygienist under the general supervision of, and in the office of, a Texas licensed dentist, only after scaling and root planing. (1) The responsibility for diagnosis, treatment planning, the prescription of therapeutic measures, and re-evaluation, shall remain with a Texas licensed dentist and may not be delegated to any dental hygienist or dental assistant. (2) Site specific subgingival medicaments are considered to be of "topical" nature and are agents approved for use by the Food and Drug Administration (FDA). (3) The placement of site specific subgingival medicaments may not be assigned to a dental assistant. (4) The Texas licensed dentist shall be responsible for identifying, selecting, and obtaining training that, in the dentist's reasoned opinion, will bring the dentist and dental hygienist to clinical competency prior to delegating the application of site specific subgingival medicaments to a dental hygienist.

516

Utah DANB Certificant Counts: Utah Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Larry Marx, Bureau Manager Utah Dentist and Dental Hygienist Licensing Board Division of Occupational & Professional Licensing 160 East 300 South Salt Lake City, Utah 84111 Telephone: 801-530-6628 Fax: 801-530-6511 www.dopl.utah.gov/licensing/dentistry.html

Radiation Health and Safety (RHS)

751

Infection Control (ICE)

753

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Currently, there are no CODA-accredited dental assisting programs in the Virgin Islands. For an updated directory of CODA-accredited dental assisting programs, visit www.danb.org.

DANB CDA Certificant State of Utah+

$17.25 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been reviewed by DANB as of February 11, 2020.

Source: 2018 DANB Salary Survey (state data based on 10 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

517

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the Utah Dentist and Dental Hygienist Licensing Board. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

Utah State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Utah, a dental assistant must: (1) Complete a dental assisting course accredited by the Commission on Dental Accreditation (CODA) OR (2) Pass one of the following: (2a) The national DANB Radiation Health and Safety (RHS) exam OR (2b) A radiology exam approved by the Utah Board that meets the criteria established in Section R156-69-604 (see page 520). Note: All dental assistants must have current Cardiopulmonary Resuscitation (CPR) or Basic Cardiac Life Support (BCLS) certification.

State Requirements For Expanded Functions There is no designation for expanded functions dental assistants in Utah.

Utah State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Utah Dentist and Dental Hygienist Licensing Board Utah Code Title 58, Chapter 69

Part 1 - General Provisions 58-69-102. Definitions. (2) “Dental assistant” means an unlicensed individual who engages in, directly or indirectly, supervised acts and duties as defined by division rule made in collaboration with the board. (3) “Direct supervision” means the supervising dentist is present and available for face-to-face communication with the person being supervised when and where professional services are being provided. (4) “General supervision” means that the supervising dentist is available for consultation regarding work the supervising dentist has authorized, without regard as to whether the supervising dentist is located on the same premises as the person being supervised. (5) “Indirect supervision” means that the supervising dentist is present within the facility in which the person being supervised is providing services and is available to provide immediate face-to-face communication with the person being supervised. (6) “Practice of dental hygiene” means, regarding humans: (d) to direct a dental assistant when the supervising dentist is not on the premises. (7) “Practice of dentistry” means the following, regarding humans: (d) to supervise the practice of a dental hygienist or dental assistant as established by division rule made in collaboration with the board. (9) “Supervising dentist” means a licensed dentist who has agreed to provide supervision of a dental hygienist or unlicensed individual in accordance with the provisions of this chapter. Part 8 - Practice Standards 58-69-803. Use of unlicensed individuals. The standards regulating the use of unlicensed individuals as dental assistants shall be established by division rule made in collaboration with the board. Utah Administrative Code R156-69. Dentist and Dental Hygienist Practice Act Rule R156-69-102. Definitions. (5) “BCLS” means Basic Cardiac Life Support. (7) "CPR” means cardiopulmonary resuscitation. (9) “Competency” means displaying special skill or knowledge derived from training and experience. (10) “Conscious sedation” means a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination thereof. (11) “DANB” means the Dental Assisting National Board, Inc. (12) “Deep sedation” means a controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including inability to respond purposefully to verbal command, produced by a pharmacologic or non-pharmacologic method, or combination thereof. (13) “General anesthesia” means a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method or a combination thereof. 518

Utah State Dental Practice Act and Administrative Rules for Dental Assistants (16) “Practice of dentistry” in regard to administering anesthesia is further defined as follows: (a) a Class I permit allows for local anesthesia which is the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug; (b) a Class II permit allows for minimal sedation which is a minimally depressed level of consciousness induced by nitrous oxide, or by a pharmacological method, or by both, that retains the patient’s ability to independently and consciously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected; (c) a Class III permit allows for moderate sedation in which a drug induced depression of consciousness occurs during which a patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient’s airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained; and (d) a Class IV permit allows for deep sedation in which a drug induced depression of consciousness occurs from which a patient cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. A patient may require assistance in maintaining an airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. R156-69-601. Scope of Practice - Anesthesia and Analgesia Permits. In accordance with Subsection 58-69-301(4)(a), the scope of practice permitted under each classification of anesthesia and analgesia permit includes the following: (1) A dentist with a class I permit: (a) may administer or supervise the administration of any legal form of non-drug induced conscious sedation or drug induced conscious sedation except: (i) the administration of inhalation agents including nitrous oxide; and (ii) the administration of any drug for sedation by any parenteral route; and (b) shall maintain and ensure that all patient care staff maintain current CPR certification. (2) A dentist with a class II permit: (a) may administer or supervise the administration of nitrous oxide induced conscious sedation in addition to the privileges granted one holding a Class I permit; and (b) shall ensure that: (i) every patient under nitrous oxide administration is under continuous in-operatory observation by a member of the dental patient care staff; (ii) nitrous oxide and oxygen flow rates and sedation duration and clearing times are appropriately documented in patient records; (iii) reasonable and prudent controls are in place and followed in regard to nitrous oxide to ensure the health and safety of patients, dental office personnel, and the general public; (iv) the dental facility is equipped with adequate and appropriate equipment, in good working order, to assess vital signs; and (v) equipment used in the administration of nitrous oxide has a scavenging system and that all gas delivery units have an oxygen fail-safe system. (3) A dentist with a class III permit: (a) may administer or supervise the administration of parenteral conscious sedation in addition to the privileges granted one holding a Class I and Class II permit; and (b) shall ensure that: (vi) a minimum of two persons, with one person constantly monitoring the patient, are present during the administration of parenteral conscious sedation as follows: (A) an operating permittee dentist and a BCLS certified assistant trained and qualified to monitor appropriate and required physiologic parameters; (B) an operating dentist and a permittee dentist; or (C) an operating permittee dentist and another licensed professional qualified to administer this class of anesthesia. (4) A dentist with a class IV permit; (a) may administer or supervise the administration of general anesthesia or deep sedation in addition to the privileges granted one holding a class I, II and III permit; and (b) shall ensure that: (i) the dental facility is equipped with precordial stethoscope for continuous monitoring of cardiac function and respiratory work, electrocardiographic monitoring and pulse oximetry, means of monitoring blood pressure, and temperature monitoring; the preceding or equivalent monitoring of the patient will be used for all patients during all general anesthesia or deep sedation procedures; in addition, temperature monitoring will be used for children; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

519

Utah State Dental Practice Act and Administrative Rules for Dental Assistants (ii) the dental facility is equipped to treat emergencies providing immediate access to advanced airway equipment, resuscitation medications, and defibrillator; (iii) the above equipment is inspected annually by a certified technician and is calibrated and in good working order; and (iv) three qualified and appropriately trained individuals are present during the administration of general anesthesia or deep sedation as follows: (A) an operating dentist holding a permit under this classification, an anesthesia assistant trained to observe and monitor the patient using the equipment required above, and an individual to assist the operating dentist; (B) an operating dentist, an assistant to the dentist and a dentist holding a permit under this classification; or (C) another licensed professional qualified to administer this class of anesthesia and an individual to assist the operating dentist. (5) Any dentist administering any anesthesia to a patient which results in, either directly or indirectly, the death or adverse event resulting in hospitalization of a patient shall submit a complete report of the incident to the Board within 30 days. R156-69-603. Use of Unlicensed Individuals as Dental Assistants. In accordance with Section 58-69-803, the standards regulating the use of unlicensed individuals as dental assistants are that an unlicensed individual shall not, under any circumstance: (1) render definitive treatment diagnosis; (2) place, condense, carve, finish or polish restorative materials, or perform final cementation; (3) cut hard or soft tissue or extract teeth; (4) remove stains, deposits, or accretions, except as is incidental to polishing teeth coronally with a rubber cup; (5) initially introduce nitrous oxide and oxygen to a patient for the purpose of establishing and recording a safe plane of analgesia for the patient, except under the direct supervision of a licensed dentist; (6) remove bonded materials from the teeth with a rotary dental instrument or use any rotary dental instrument within the oral cavity except to polish teeth coronally with a rubber cup; (7) take jaw registrations or oral impressions for supplying artificial teeth as substitutes for natural teeth, except for diagnostic or opposing models for the fabrication of temporary or provisional restorations or appliances; (8) correct or attempt to correct the malposition or malocclusion of teeth, or make an adjustment that will result in the movement of teeth upon an appliance which is worn in the mouth; (9) perform sub-gingival instrumentation; (10) render decisions concerning the use of drugs, their dosage or prescription; or (11) expose radiographs without meeting the following criteria: (a) completing a dental assisting course accredited by the ADA Commission on Dental Accreditation; or (b) passing one of the following examinations: (i) the DANB Radiation Health and Safety Examination (RHS); or (ii) a radiology exam approved by the Board that meets the criteria established in Section R156-69-604; or (12) work without a current CPR or BCLS certification R156-69-604. Radiology Course for Unlicensed Individuals as Dental Assistants. In accordance with Section 58-69-803 and Subsection 58-54-4.3(2), the radiology course in Subsection R156-69-603(11) shall include radiology theory consisting of: (1) orientation to radiation technology; (2) terminology; (3) radiographic dental anatomy and pathology (cursory); (4) radiation physics (basic); (5) radiation protection to patient and operator; (6) radiation biology including interaction of ionizing radiation on cells, tissues and matter; (7) factors influencing biological response to cells and tissues to ionizing radiation and cumulative effects of x-radiation; (8) intraoral and extraoral radiographic techniques; (9) processing techniques including proper disposal of chemicals; and (10) infection control in dental radiology.

520

Vermont DANB Certificant Counts: Vermont Certified Dental Assistant (CDA) certificants

146

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Diane Lafaille, Licensing Board Specialist Vermont Board of Dental Examiners Office of Professional Regulation 89 Main Street, 3rd Floor Montpelier, VT 05620-3402 Phone: 802-828-2390 Fax: 802-828-2465 Website: https://sos.vermont.gov/dental-examiners/

Radiation Health and Safety (RHS)

340

Infection Control (ICE)

317

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Center for Technology, Essex

DANB CDA Certificant State of Vermont+

$22.47 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 2, 2020.

Source: 2018 DANB Salary Survey (state data based on 9 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

521

Vermont State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Vermont, a dental assistant must be an Expanded Function Dental Assistant or a DANB Certified Dental Assistant (see requirements below). Traditional Dental Assistants can earn a special endorsement to perform dental radiographic procedures by completing the following requirements: (1a) Be at least 18 years of age AND (1b) Successfully complete a CODA-accredited radiology course within 10 years of application for endorsement AND (1c) Work for at least six months as a dental assistant OR (2) Hold a radiography endorsement equivalent to that required in Vermont AND ALL MUST THEN (3) Apply to the Vermont Board of Dental Examiners for endorsement.

State Requirements For Expanded Functions To perform expanded functions in Vermont under the direct supervision of a licensed dentist, a dental assistant must earn status as an Expanded Function Dental Assistant. To qualify, one must: (1a) Hold a current national DANB CDA certification and (1b) Be employed by a Vermont-licensed dentist OR (2) Be a licensed dental hygienist, AND (3) Successfully complete a formal program in each of the desired expanded functions at a CODA-accredited school of dental assisting AND (4) Apply to the Vermont Board of Dental Examiners for registration. Dental assistants who hold the national DANB Certified Dental Assistant (CDA) certification can also earn Vermont state certification. To qualify, one must: (1) Hold a current national DANB CDA certification AND (2) Be employed by a Vermont-licensed dentist AND (3) Apply to the Vermont Board of Dental Examiners for registration. Dental assistants in Vermont can earn status as a Traditional Dental Assistant by becoming employed as a Traditional Dental Assistant in a dental office and notifying the Vermont Board of Dental Examiners within 30 days of being hired. All dental assistants must complete emergency office procedures training within six months of their date of hire.

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Vermont Board of Dental Examiners STATUTES TITLE 26: PROFESSIONS and OCCUPATIONS Chapter 12: Dentists, Dental Therapists, Dental Hygienists, and Dental Assistants Subchapter 1. General Provisions § 561. DEFINITIONS As used in this chapter: (1) “Board” means the Board of Dental Examiners. (3) “Practicing dentistry” means an activity in which a person: (A) undertakes by any means or method to diagnose or profess to diagnose or to treat or profess to treat or to prescribe for or profess to prescribe for any lesions, diseases, disorders, for deficiencies of the human oral cavity, teeth, gingiva, maxilla, or mandible or adjacent associated structures; (B) extracts human teeth or corrects malpositions of the teeth or jaws; (C) furnishes, supplies, constructs, reproduces, or repairs prosthetic dentures, bridges, appliances, or other structures to be used or worn as substitutes for natural teeth or adjusts those structures, except on the written prescription of a duly licensed dentist and by the use of impressions or casts made by a duly licensed and practicing dentist; (D) administers general dental anesthetics; (E) administers local dental anesthetics, except dental hygienists as authorized by Board rule; or (F) engages in any of the practices included in the curricula of recognized dental colleges. (4) "Dental therapist" means an individual licensed to practice as a dental therapist under this chapter. (5) “Dental hygienist” means an individual licensed to practice as a dental hygienist under this chapter. (6) “Dental assistant” means an individual registered to practice as a dental assistant under this chapter. (7) “Direct supervision” means supervision by a licensed dentist who is readily available at the dental facility for consultation or intervention. 522

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants § 562. PROHIBITIONS (c) No person may practice as a dental assistant unless currently registered under the provisions of this chapter. (d) A person who violates this section shall be subject to the penalties provided in 3 V.S.A. § 127. § 563. EXEMPTIONS The provisions of this chapter shall not apply to the following: (1) the rights and privileges of physicians licensed under the laws of this state. (2) an unlicensed person from performing merely mechanical work upon inert matter in a dental office or laboratory. (3) a dental student currently enrolled in a dental school or college accredited by the Commission on Dental Accreditation of the American Dental Association who: (A) provides dental treatment under the supervision of a licensed dentist at a state hospital or under licensed instructors within a dental school, college, or dental department of a university recognized by the board; (B) serves as an intern in any hospital approved by the board; or (C) participates in a supervised externship program authorized by a dental school recognized by the board in order to provide dental treatment under the direct supervision of a dentist licensed under the provisions of this chapter. (4) upon prior application and approval by the board, a student of a dental school or college accredited by the Commission on Dental Accreditation of the American Dental Association who provides dental treatment for purposes of clinical study under the direct supervision and instruction and in the office of a licensed dentist. (5) a dentist licensed in another state from consulting with a dentist licensed under the provisions of this chapter. § 565. DISPLAY OF LICENSE OR REGISTRATION Every dentist, dental therapist, dental hygienist, and dental assistant shall display a copy of his or her current license or registration at each place of practice and in such a manner so as to be easily seen and read. § 616. USE OF DENTAL HYGIENISTS AND DENTAL ASSISTANTS (a) A dental therapist may supervise dental assistants and dental hygienists directly to the extent permitted in the collaborative agreement. (b) At any one practice setting, a dental therapist may have under his or her direct supervision no more than a total of two assistants or hygienists or a combination thereof. Subchapter 5. Dental Assistants § 641. REGISTRATION (a) No person shall practice as a dental assistant in this state unless registered for that purpose by the board. (b) On a form prepared and provided by the board, each applicant shall state, under oath, that the dental assistant shall practice only under the supervision of a dentist. (c) The supervising dentist shall be responsible for the professional acts of dental assistants under his or her supervision. § 642. PRACTICE (a) Except as provided in subsection (b) of this section, a dental assistant may perform duties in the office of any licensed dentist consistent with rules adopted by the board and in public or private schools or institutions under the supervision of a licensed dentist or other dentist approved for the purpose by the board. The performance of any intraoral tasks shall be under the direct supervision of a dentist. (b) The following tasks may not be assigned to a dental assistant: (1) Diagnosis, treatment planning, and prescribing, including for drugs and medicaments or authorization for restorative, prosthodontic, or orthodontic appliances; or (2) Surgical procedures on hard or soft tissues within the oral cavity or any other intraoral procedure that contributes to or results in an irremediable alteration of the oral anatomy. Subchapter 6. Renewals, Continuing Education, and Fees § 661. RENEWAL OF LICENSE (a) Licenses and registrations shall be renewed every two years on a schedule determined by the Office of Professional Regulation. (b) No continuing education reporting is required at the first biennial license renewal date following licensure. (g) Dental assistants. To renew a registration, a dental assistant shall meet the requirements established by the Board by rule.

523

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants § 662. FEES (a) Applicants and persons regulated under this chapter shall pay the following fees: (1) Application (D) Dental assistant $ 70.00 (2) Biennial renewal (D) Dental assistant $ 90.00 (b) The licensing fee for a dentist, dental therapist, or dental hygienist or the registration fee for a dental assistant who is otherwise eligible for licensure or registration and whose practice in this State will be limited to providing pro bono services at a free or reduced-fee clinic or similar setting approved by the Board shall be waived. ADMINISTRATIVE RULES PART 1. GENERAL INFORMATION 1.11 Permitted Practices (a) Dentists: The following tasks may be performed by licensed dentists only: (1) Practices permitted by Chapter 13 of Title 26 including diagnosis, treatment planning and prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic or orthodontic appliances; or (2) Surgical procedures on hard and soft tissues within or ancillary to them related to the treatment of the maxillofacial complex and any other intraoral procedure that contributes to and results in an irreversible alteration to the oral anatomy. (3) Dentists are responsible for general supervision of dental hygienists and “direct supervision” of dental hygienists where specifically required elsewhere in these rules. (4) Dentists are responsible for the direct supervision of dental assistants. (b) Clarifications, Limitations on Scope of Practice, Dentists or Dental Hygienists: Oral prophylaxis, oral debridement, periodontal descriptions and charting, including periodontal probing and placement of subgingival chemotherapeutic agents shall be performed only by a licensed dentist or dental hygienist. PART 2. DEFINITIONS 2.1 Definitions As used in these rules: (e) “CODA” - means Commission on Dental Accreditation of the American Dental Association. (g) “CPR” - means Cardio-Pulmonary Resuscitation. (j) “DANB” - means Dental Assisting National Board. (k) “Direct Supervision” - means a dentist agreeing to procedures or treatment performed by appropriate personnel by being readily available at the dental facility for consultation or intervention. (m) “Emergency Office Procedures” - means courses in external cardiopulmonary resuscitation which are approved by the Vermont Heart Association or the American Red Cross, or courses which include a review of health conditions and factors which might produce emergencies. Acceptable courses will be consistent with current educational curricula in schools of dentistry and dental hygiene accredited by the Commission on Accreditation of the American Dental Association. (n) “General Supervision” - (1) in the office of a licensed dentist means a dentist with the responsibility to periodically examine patients, agreeing to procedures or treatment performed by appropriate personnel. The dentist must be available for consultation, but does not necessarily have to be physically present at the dental facility when providing general supervision. “General supervision” (2) in a public or private school or public or private institution means supervision by dentist with no less than three years experience in accordance with a general supervision agreement as set forth in Part 10 of these rules. When providing general supervision the dentist must be available for consultation but does not have to be physically present at the site where dental hygiene services are provided. (x) “Unrestricted license” - means that the licensed or registered professional is not subject to a sanction following a completed disciplinary action which resulted in a finding of unprofessional conduct. PART 5. SEDATION, ANALGESIA, ANESTHESIA: SPECIAL ENDORSEMENTS, INCIDENT REPORTS 5.3 Anesthesia Definitions and Guidelines (a) “Administering nitrous oxide analgesia” means: the dispensing, applying, or offering of nitrous oxide analgesia to a dental patient.

524

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants (b) “Anxiolysis” means: the reduction of anxiety through the administration of pharmacological agent or agents. The administered dose should be within the guidelines for dosage on the manufacturer’s package insert, or using techniques taught by CODA approved programs. When anxiolysis is achieved, the patient (1) is conscious; (2) can and does respond to conversation appropriately without extra stimulation; and (3) is fully able to independently and continuously maintain an unimpeded airway. (c) “Conscious Sedation” means a depressed level of consciousness achieved through the administration of a pharmaceutical/pharmacological agent or agents in which: (1) the patient retains the ability to independently and continuously maintain an airway; (2) the patient’s ability to comprehend questions and conversation and react appropriately is suppressed; (3) protective reflexes remain active; and (4) the patient is easily aroused. (f) “Deep Sedation” - Deep sedation is a controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including the inability to continually maintain an airway independently and/or to respond purposefully to verbal command, and is produced by a pharmacologic or non-pharmacologic method or combination thereof. Deep sedation may not be employed without a General Anesthesia Endorsement issued by the board. (g) “General Anesthesia” - General anesthesia is a controlled state of unconsciousness accompanied by a partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, and is produced by a pharmacologic or non-pharmacologic method or combination thereof. (h) “Monitoring” - For purposes of these rules, monitoring patients who have received analgesic or anesthetizing drugs or otherwise mind altering drugs means observing the patient and evaluating through clinical evaluation, electronic and mechanical means, recognizing adverse reactions or complications, and reporting any adverse reaction or complication to the supervising dentist, where applicable, immediately. The degree of monitoring necessary depends on the level of sedation or anesthesia achieved. 5.5 When No Endorsement Required A dentist needs no special endorsement to employ the following: (a) Nitrous Oxide: Use of nitrous oxide in a dental office does not require a special license or endorsement. (1) Under direct supervision of a licensed dentist, registered dental assistants and licensed dental hygienists instructed and trained by the dentist may monitor nitrous oxide analgesia during a dental procedure. Administration of nitrous oxide analgesia, as well as prescription, initiation, and determination of nitrous oxide analgesia levels and release and discharge of the patient after administration of nitrous oxide analgesia, shall be performed by and shall be the responsibility of the supervising dentist. (2) All individuals administering and monitoring nitrous oxide analgesia must, in addition to required emergency office procedures, have annual CPR training. 5.8 Conscious Sedation: Special Endorsement Required Dentists Who Do Not Have a General Anesthesia Endorsement and Who Wish to Employ Conscious Sedation as Defined by These Rules must Obtain a Conscious Sedation Privilege Endorsement from the Board. 5.13 Facility and Personnel Requirements (b) Staffing Requirements: (1) In addition to the dentist or other professional permitted under these rules to administer pharmaceuticals to achieve conscious sedation, there must be a minimum of one assistant licensed or registered under Chapter 13 of Title 26 who possesses a current certification in cardio pulmonary resuscitation and is capable of assisting with procedures, problems and emergencies incident to the administration of such sedation. (2) A licensed or registered dental assistant or hygienist trained in airway management must remain with the patient until the patient’s escort arrives, and the patient is able to maintain a patent airway unassisted. 5.15 Monitoring Requirements To minimize risks to patients, a dentist who uses conscious sedation shall: (a) Ensure that monitoring of a patient under conscious sedation begins prior to the administration of sedation, and takes place continuously during the procedure and recovery from sedation. The person who administers the sedation or another licensed practitioner qualified to administer conscious sedation shall remain on the premises until the patient is responsive and discharged; (b) Ensure that monitoring includes: (1) continuous direct clinical observation of the patient; (2) interval recording of blood pressure and pulse; (3) continuous evaluation of oxygen saturation; and (4) additional devices such as EKG for monitoring when dictated by the medical needs of the patient; (c) Ensure that alarms on devices used for monitoring are enabled. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

525

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants 5.16 Conscious Sedation Protocols The dental office shall develop written protocols for sedation of dental patients addressing the following: (a) preoperative patient evaluation and selection prior to conscious sedation, (b) informed consent, (c) sedation monitoring procedures, (d) sedation record keeping procedures, and (e) patient discharge assessment. 5.17 Emergency Protocols (a) The dental office shall develop written protocols for sedation-related emergencies addressing the following: (1) Laryngospasm, (2) Bronchospasm, (3) Aspiration of emesis, (4) Angina Pectoris, (5) Myocardial infarction, (6) Hypotension, (7) Hypertension, (8) Cardiac arrest, (9) Hyperventilation, (10) Hypoventilation, (11) Convulsions, (12) Allergic and toxic reaction, and (13) Airway occlusion by foreign body. (b) Training to educate assistants with respect to these protocols must be provided to all sedation team assistants and updated periodically. PART 6. INFORMATION FOR DENTAL HYGIENISTS 6.12 Dental Hygienists, Expanded Function Duties (a) A licensed dental hygienist may qualify for registration as an expanded function dental assistant and may perform the expanded function dental assisting duties for which the dental hygienist has been trained in a formal program in expanded function dental assisting accredited by the Commission on Dental Accreditation of the American Dental Association. (b) A dental hygienist trained as an expanded function dental assistant may be registered by substantiating the adequacy of training. PART 7. INFORMATION FOR DENTAL ASSISTANTS 7.1 Dental Assistant Registration. This registration allows a person to practice as a dental assistant in Vermont. A dental assistant assists the dentist in providing care directly to the patient. 7.2 Limitation on Practice. A dental assistant may perform duties in the office of any licensed dentist consistent with these rules, and in public or private schools or public or private institutions under the supervision of a licensed dentist. The performance of any intraoral tasks by a dental assistant shall be under the direct supervision of a dentist. 7.3 (a) (b) (c)

Duties of Dental Assistants. The specific duties dental assistants may perform are based upon: Their education; Their experience; and An agreement with the employing dentist whose goal as a team is to promote the efficiency and reduce the cost of dental services in the state consistent with the highest possible standards of dental care.

7.4 (a) (b) (c)

Three categories of dental assistants. There are three categories of dental assistants: Traditional Dental Assistants Certified Dental Assistants Expanded Function Dental Assistants

7.5 How to Become Registered as a Traditional Dental Assistant. All persons employed as traditional dental assistants in a dental office must register with the Board. A person who has not previously registered with the Board and who is hired to be a dental assistant must register within 30 days of the first day of employment. Any person employed as a traditional dental assistant in a dental office in this state is subject to these rules immediately upon commencing such employment. 526

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants 7.6 Traditional Dental Assistants, Scope of Practice. A traditional dental assistant who is not a graduate of a CODA accredited program may perform all extraoral duties in the dental office or dental clinic which are assigned by the dentist. During intraoral procedures, the traditional dental assistant may assist the dentist or clinical staff as assigned by the dentist. The traditional dental assistant may take radiographs under a special endorsement of the registration. 7.7 Traditional Dental Assistants, Limitations. A traditional dental assistant not a graduate of a CODA accredited dental assisting program may not perform coronal polishing or apply dental sealants until the traditional dental assistant has worked as a traditional dental assistant for at least six consecutive months. 7.8 How to Become Registered as a Certified Dental Assistant. (a) A person may become registered as a certified dental assistant if the person is certified by the Dental Assisting National Board. A traditional dental assistant who has already obtained radiology privileges may register as a certified dental assistant upon successfully completing the Dental Assisting National Board (DANB) examination. (b) Certification must be renewed in accordance with DANB requirements. Certified Dental Assistants whose certification status has changed, for any reason, must notify the Board of the change in status within 30 days of the change. 7.9 Certified Dental Assistants, Scope of Practice. Except as limited by statute, for example 26 V.S.A. Â§864, a certified dental assistant may perform all the duties for which the certified dental assistant has received training. 7.10 How to Become Registered as an Expanded Function Dental Assistant. A certified dental assistant or a licensed dental hygienist who has successfully completed a formal program in expanded function duties at a program accredited by the Commission on Dental Accreditation may be registered as an expanded function dental assistant. 7.11 Expanded Function Dental Assistants, Training. The training program shall have the minimal requirements of 50 hours of didactic training and five weeks of clinical training, followed by six weeks of field training in dental offices, all under supervision of the faculty of the accredited school or its designates. 7.12 Expanded Function Dental Assistants, Scope of Practice. (a) An expanded function dental assistant may perform those functions for which the certified dental assistant or licensed dental hygienist has been trained upon becoming employed by a licensed dentist. (b) As permitted by statute and these rules an expanded function dental assistant may perform the dental duties for which he or she is trained. 7.13 Dental Assistants, Radiographic Endorsement: The Board will issue a radiographic endorsement to an applicant who: (a) is at least 18 years of age, (b) has within the previous ten years, successfully completed a didactic and clinical or practical radiology course provided by a school accredited by the Commission on Dental Accreditation. A student enrolled in a radiology course may take radiographs necessary to course completion, in the office of the employing or supervising dentist, but in no event more than 100 radiographs; and (c) has documented six months lawful employment as a dental assistant, or, (d) has a radiography endorsement from another U.S. or Canadian jurisdiction having substantially equivalent standards to those of this state. 7.14 Radiology Courses, Advisory. Potential applicants, especially those new to Vermont, should be aware that acceptable radiology courses are not frequently offered in Vermont. Finding and taking an acceptable radiology course in another jurisdiction may shorten or eliminate any delay before a radiologic endorsement can be issued. 7.15 Dental Assistants, Certificate Display. Dental assistant registration certificates or a photo copy if the dental assistant practices at more than one location, must be conspicuously displayed in the registrantâ&#x20AC;&#x2122;s place(s) of practice. Dental assistants may black out or cover their residence address if it appears on the certificate. 7.16 Emergency Office Procedures. All dental assistants, shall complete emergency office procedures training required in Rule 7.17 within six months of their date of hire.

527

Vermont State Dental Practice Act and Administrative Rules for Dental Assistants 7.17 Renewal of Dental Assistant Registration. All dental assistants shall as a condition of every registration renewal complete a course in emergency office procedures. The Board will accept the following types of courses as satisfying this requirement: (a) courses in external cardiopulmonary resuscitation which are approved by the Vermont Heart Association or the American Red Cross; or (b) courses which include a review of health conditions and factors which might produce emergencies. Acceptable courses will be consistent with current educational curricula in schools of dentistry and dental hygiene accredited by the Commission on Dental Accreditation. 7.18 Dental Assistant Transient Practice Permit. A person who is not registered in Vermont may obtain a transient practice permit from the Board to perform acts constituting the practice of dental assisting, provided that: (a) The practice in Vermont does not exceed 10 days in any calendar year. (b) The person is registered or certified as a dental assistant in another state which, in the opinion of the Board, has regulatory standards substantially equivalent to those currently in effect in Vermont; and (c) The practice is for educational or volunteer purposes only. PART 8. LICENSE or REGISTRATION RENEWALS, ALL PROFESSIONS 8.1 Renewing a License or Registration (a) Licenses and registrations must be renewed before they expire. The expiration date is stated on the license or registration certificate. Before the expiration date, the Office will mail a renewal application and notice of the renewal fee. Evidence of having taken a course in emergency office procedures as required by these rules must accompany the renewal application. A license or registration which is not renewed will be considered as lapsed as of the expiration date. 8.5 Traditional Dental Assistants, No Active Practice Traditional dental assistants have no active practice requirement. 8.6 Reinstating an Expired License or Registration If a license or registration has expired because it was not renewed on time, the licensee may apply for reinstatement, meet all reinstatement requirements, and pay the renewal fee for the current renewal period and late penalty. 8.7 Lapsed Radiography Endorsement A registrant applying to reinstate dental radiography privileges after a lapse of ten years must successfully complete an approved radiography course.

528

Virginia DANB Certificant Counts: Virginia National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

562

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

4,006

Infection Control (ICE)

2,754

Coronal Polishing (CP)

Sealants (SE)

State Board of Dentistry Contact

Topical Fluoride (TF)

Sandra Reen, Executive Director Virginia Board of Dentistry Perimeter Center 9960 Mayland Drive, Suite 300 Henrico, VA 23233-1463 Phone: 804-367-4538 E-Fax: 804-698-4266 Email: denbd@dhp.virginia.gov Website: www.dhp.virginia.gov/dentistry

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Centura College-Norfolk Fortis College-Richmond Germanna Community College Northern Virginia Community College J. Sargeant Reynolds Community College

DANB CDA Certificant State of Virginia+

$18.13 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 9, 2020.

Source: 2018 DANB Salary Survey (state data based on 14 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

529

Virginia State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Virginia, a dental assistant must: (1) Satisfactorily complete a radiation safety course and exam given by an institution that maintains a CODA-accredited dental assisting, dental hygiene, or dentistry program OR (2) Earn certification from the American Registry of Radiologic Technologists (ARRT) OR (3) Satisfactorily complete the DANB RHS Review course offered by the DALE Foundation and pass the national DANB Radiation Health and Safety (RHS) exam. Any person who was qualified to place or expose dental x-ray film by satisfactorily completing a course and passing an examination in compliance with guidelines provided by the board prior to May 11, 2011 continues to be so qualified.

State Requirements For Expanded Functions To perform expanded functions in Virginia under the direct supervision of a licensed dentist, one must be registered as Dental Assistant II (DA II) by education or endorsement. To qualify for registration as a DA II by education, one must: (1) Hold current DANB Certified Dental Assistant (CDA) certification AND (2) Successfully complete board-approved expanded functions requirements from a CODA-accredited program AND (3) Apply to the Virginia Board of Dentistry for registration. To qualify for registration as a DA II by endorsement, one must: (1) Hold current DANB CDA certification or certification from another national credentialing organization recognized by the American Dental Association, AND (2) Be currently authorized to perform expanded duties in a jurisdiction of the United States, AND (3) Hold a credential with qualifications substantially equivalent to the Virginia DA II requirements or document experience in the Virginia DA II functions for at least 24 of the 48 months preceding application, AND (4) Be certified to be in good standing in each U.S. jurisdiction where currently or formerly credentialed, AND (5) Not have committed any prohibited act, AND (6) Apply to the Virginia Board of Dentistry for registration. All DA II applicants must attest that they have read and understood and will remain current with Virginia laws and regulations governing the practice of dentistry and dental assisting. Renewing Dental Assistants II must show proof of current DANB CDA certification and successful completion of training in basic CPR. 18VAC60-30-120(B)(2), (3) and (4) of the Regulations Governing the Practice of Dental Assistants specifies four modules of laboratory training, clinical experience and examination that may be completed in order to qualify for registration as a dental assistant II. The board interprets these provisions to permit someone to complete one or more of the modules to qualify for registration. An applicant does not have to complete all four modules. However, the educational institution offering the dental assistant II program has the discretion to decide how to structure its program. A dental assistant (DA I or DA II) in Virginia who assists in the administration of or monitors inhalation analgesia, minimal sedation, moderate sedation, deep sedation or general anesthesia must meet one of the following requirements: (1) Training and current certification in basic resuscitation techniques with hands-on airway training for health care providers, such as Basic Cardiac Life Support for Health Professionals or a clinically-oriented course devoted primarily to responding to clinical emergencies offered by an approved provider of continuing education OR (2) Current certification as a certified anesthesia assistant by the American Association of Oral and Maxillofacial Surgeons (AAOMS) or the American Dental Society of Anesthesiology (ADSA).

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Virginia Board of Dentistry Code of Virginia Chapter 27 of Title 54.1 54.1-2712. Permissible practices. The following activities shall be permissible: 1. Dental assistants or dental hygienists aiding or assisting licensed dentists, or dental assistants aiding or assisting dental hygienists under the general supervision of a dentist in accordance with regulations promulgated pursuant to section 54.1-2729.01. 54.1-2729.01. Practice of dental assistants. A. A person who is employed to assist a licensed dentist or dental hygienist by performing duties not otherwise restricted to the practice of a dentist, dental hygienist, or dental assistant II, as prescribed in regulations promulgated by the Board may practice as a dental assistant I. 530

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants B. A person who (i) has met the educational and training requirements prescribed by the Board; (ii) holds a certification from a credentialing organization recognized by the American Dental Association; and (iii) has met any other qualifications for registration as prescribed in regulations promulgated by the Board may practice as a dental assistant II. A dental assistant II may perform duties not otherwise restricted to the practice of a dentist or dental hygienist under the direction of a licensed dentist that are reversible, intraoral procedures specified in regulations promulgated by the Board. Virginia Administrative Code Title 18: Professional and Occupational Licensing Agency 60. Board of Dentistry Chapter 21. Regulations Governing the Practice of Dentistry Part I. General Provisions 18VAC60-21-10. Definitions. B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise: "CODA" means the Commission on Dental Accreditation of American Dental Association. "Code" means the Code of Virginia. "Dental assistant I" means any unlicensed person under the direction of a dentist or dental hygienist who renders assistance for services provided to the patient as authorized under this chapter but shall not include an individual serving in purely an administrative, secretarial or clerical capacity. "Dental assistant II" means a person under the direction and direct supervision of a dentist who is registered by the board to perform reversible, intraoral procedures as specified in 18VAC60-21-150 and 18VAC60-21-160. "Mobile dental facility" means a self-contained unit in which dentistry is practiced that is not confined to a single building and can be transported from one location to another. "Portable dental operation" means a nonfacility in which dental equipment used in the practice of dentistry is transported to and utilized on a temporary basis at an out-of-office location, including patients' homes, schools, nursing homes, or other institutions. "Radiographs" means intraoral and extraoral radiographic images of hard and soft tissues used for purposes of diagnosis. C. The following words and terms relating to supervision as used in this chapter shall have the following meanings unless the context clearly indicates otherwise: "Direct supervision" means that the dentist examines the patient and records diagnostic findings prior to delegating restorative or prosthetic treatment and related services to a dental assistant II for completion the same day or at a later date. The dentist prepares the tooth or teeth to be restored and remains immediately available in the office to the dental assistant II for guidance or assistance during the delivery of treatment and related services. The dentist examines the patient to evaluate the treatment and services before the patient is dismissed. "Direction" means the level of supervision (i.e., immediate, direct, indirect, or general) that a dentist is required to exercise with a dental hygienist, a dental assistant I, or a dental assistant II or that a dental hygienist is required to exercise with a dental assistant to direct and oversee the delivery of treatment and related services. "General supervision" means that a dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment that states the specific services to be provided by a dental hygienist during one or more subsequent appointments when the dentist may or may not be present. Issuance of the order authorizes the dental hygienist to supervise a dental assistant performing duties delegable to dental assistants I. "Immediate supervision" means the dentist is in the operatory to supervise the administration of sedation or provision of treatment. "Indirect supervision" means the dentist examines the patient at some point during the appointment and is continuously present in the office to advise and assist a dental hygienist or a dental assistant who is (i) delivering hygiene treatment, (ii)Â preparing the patient for examination or treatment by the dentist, or (iii) preparing the patient for dismissal following treatment. D. The following words and terms relating to sedation or anesthesia as used in the chapter shall have the following meanings unless the context clearly indicates otherwise: "Analgesia" means the diminution or elimination of pain. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

531

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants "Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. "General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilator function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. "Inhalation" means a technique of administration in which a gaseous or volatile agent, including nitrous oxide, is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. “Inhalation analgesia” means the inhalation of nitrous oxide and oxygen to produce a state of reduced sensation of pain with minimal alteration of consciousness. "Local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. "Minimal sedation" means a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilator and cardiovascular functions are unaffected. Minimal sedation includes "anxiolysis" (the diminution or elimination of anxiety through the use of pharmacological agents in a dosage that does not cause depression of consciousness) and includes "inhalation analgesia" when used in combination with any anxiolytic agent administered prior to or during a procedure. "Moderate sedation" means a drug-induced depression of consciousness, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. "Monitoring" means to observe, interpret, assess, and record appropriate physiologic functions of the body during sedative procedures and general anesthesia appropriate to the level of sedation as provided in Part IV (18VAC60-21-260 et seq.) of this chapter. "Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal tract (i.e., intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraocular). “Topical oral anesthetic ” means any drug, available in creams, ointments, aerosols, sprays, lotions, or jellies, that can be used orally for the purpose of rendering the oral cavity insensitive to pain without affecting consciousness. Part III. Direction and Delegation of Duties 18VAC60-21-110. Utilization of Dental Hygienists and Dental Assistants II. A. A dentist may utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction at one and the same time. In addition, a dentist may permit through issuance of written orders for services, additional dental hygienists to practice under general supervision in a free clinic or a public health program, or on a voluntary basis. 18VAC60-21-130. Nondelegable Duties; Dentists. Only licensed dentists shall perform the following duties: 1. Final diagnosis and treatment planning; 2. Performing surgical or cutting procedures on hard or soft tissue except a dental hygienist performing gingival curettage as provided in 18VAC60-21-140; 3. Prescribing or parenterally administering drugs or medicaments, except a dental hygienist, who meets the requirements of 18VAC60-25-100, may parenterally administer Schedule VI local anesthesia to patients 18 years of age or older; 4. Authorization of work orders for any appliance or prosthetic device or restoration that is to be inserted into a patient's mouth; 5. Operation of high speed rotary instruments in the mouth; 6. Administering and monitoring moderate sedation, deep sedation, or general anesthetics except as provided for in § 54.1-2701 of the Code and Part VI (18VAC60-21-260 et seq.) of this chapter; 7. Condensing, contouring, or adjusting any final, fixed, or removable prosthodontic appliance or restoration in the mouth with the exception of packing and carving amalgam and placing and shaping composite resins by dental assistants II with advanced training as specified in 18VAC60-30-120; 8. Final positioning and attachment of orthodontic bonds and bands; and 9. Final adjustment and fitting of crowns and bridges in preparation for final cementation. 532

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants 18VAC60-21-140. Delegation to Dental Hygienists. A. The following duties shall only be delegated to dental hygienists under direction and may only be performed under indirect supervision: 1. Scaling, root planing, or gingival curettage of natural and restored teeth using hand instruments, slow-speed rotary instruments, ultrasonic devices, and nonsurgical lasers, with any sedation or anesthesia administered. 2. Performing an initial examination of teeth and surrounding tissues including the charting of carious lesions, periodontal pockets, or other abnormal conditions for assisting the dentist in the diagnosis. 3. Administering nitrous oxide or local anesthesia by dental hygienists qualified in accordance with the requirements of 18VAC60-25-100. B. The following duties shall only be delegated to dental hygienists and may be performed under indirect supervision or may be delegated by written order in accordance with §§ 54.1-2722 D and 54.1-3408 J of the Code to be performed under general supervision: 1. Scaling, root planing, or gingival curettage of natural and restored teeth using hand instruments, slow-speed rotary instruments, ultrasonic devices, and nonsurgical lasers with or without topical oral anesthetics. 2. Polishing of natural and restored teeth using air polishers. 3. Performing a clinical examination of teeth and surrounding tissues including the charting of carious lesions, periodontal pockets, or other abnormal conditions for further evaluation and diagnosis by the dentist. 4. Subgingival irrigation or subgingival application of topical Schedule VI medicinal agents pursuant to § 54.1-3408 J of the Code. 5. Duties appropriate to the education and experience of the dental hygienist and the practice of the supervising dentist, with the exception of those listed as nondelegable in 18VAC60-21-130, those restricted to indirect supervision in subsection A of this section, and those restricted to delegation to dental assistants II in 18VAC60-21-150. 18VAC60-21-150. Delegation to Dental Assistants II. The following duties may only be delegated under the direction and direct supervision of a dentist to a dental assistant II who has completed the coursework, corresponding module of laboratory training, corresponding module of clinical experience, and examinations specified in 18VAC60-30-120: 1. Performing pulp capping procedures; 2. Packing and carving of amalgam restorations; 3. Placing and shaping composite resin restorations with a slow speed handpiece; 4. Taking final impressions; 5. Use of a non-epinephrine retraction cord; and 6. Final cementation of crowns and bridges after adjustment and fitting by the dentist. 18VAC60-21-160. Delegation to Dental Assistants I and II. A. Duties appropriate to the training and experience of the dental assistant and the practice of the supervising dentist may be delegated to a dental assistant I or II under indirect supervision, with the exception of those listed as nondelegable in 18VAC60-21-130, those which may only be delegated to dental hygienists as listed in 18VAC60-21-140, and those which may only be delegated to a dental assistant II as listed in 18VAC60-21-150. B. Duties delegated to a dental assistant under general supervision shall be performed under the direction and indirect supervision of the dental hygienist who supervises the implementation of the dentist's orders by examining the patient, observing the services rendered by an assistant, and being available for consultation on patient care. 18VAC60-21-170. Radiation Certification. No dentist or dental hygienist shall permit a person not otherwise licensed by this board to place or expose dental x-ray film unless he has one of the following: (i) satisfactory completion of a radiation safety course and examination given by an institution that maintains a program in dental assisting, dental hygiene, or dentistry accredited by CODA; (ii) certification by the American Registry of Radiologic Technologists; or (iii) satisfactory completion of the Radiation Health and Safety Review Course provided by the Dental Assisting National Board or its affiliate and passage of the Radiation Health and Safety Exam given by the Dental Assisting National Board. Any certificate issued pursuant to satisfying the requirements of this section shall be posted in plain view of the patient. Part VI. Controlled Substances, Sedation, and Anesthesia 18VAC60-21-260. General Provisions. I. Ancillary personnel. Dentists who employ unlicensed, ancillary personnel to assist in the administration and monitoring of any form of minimal sedation, moderate sedation, deep sedation, or general anesthesia shall maintain documentation that such personnel have: 1. Training and hold current certification in basic resuscitation techniques with hands-on airway training for health care providers, such as Basic Cardiac Life Support for Health Professionals or a clinically oriented course devoted primarily to responding to clinical emergencies offered by an approved provider of continuing education as set forth in 18VAC60-21-250 C; or © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

533

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants 2. Current certification as a certified anesthesia assistant (CAA) by the American Association of Oral and Maxillofacial Surgeons or the American Dental Society of Anesthesiology (ADSA). J. Assisting in administration. A dentist, consistent with the planned level of administration (i.e., local anesthesia, minimal sedation, moderate sedation, deep sedation, or general anesthesia) and appropriate to his education, training, and experience, may utilize the services of a dentist, anesthesiologist, certified registered nurse anesthetist, dental hygienist, dental assistant, or nurse to perform functions appropriate to such practitioner's education, training, and experience and consistent with that practitioner's respective scope of practice. K. Patient monitoring. 1. A dentist may delegate monitoring of a patient to a dental hygienist, dental assistant, or nurse who is under his direction or to another dentist, anesthesiologist, or certified registered nurse anesthetist. The person assigned to monitor the patient shall be continuously in the presence of the patient in the office, operatory, and recovery area (i) before administration is initiated or immediately upon arrival if the patient self-administered a sedative agent, (ii) throughout the administration of drugs, (iii) throughout the treatment of the patient, and (iv) throughout recovery until the patient is discharged by the dentist. 2. The person monitoring the patient shall: a. Have the patient's entire body in sight; b. Be in close proximity so as to speak with the patient; c. Converse with the patient to assess the patient's ability to respond in order to determine the patient's level of sedation; d. Closely observe the patient for coloring, breathing, level of physical activity, facial expressions, eye movement, and bodily gestures in order to immediately recognize and bring any changes in the patient's condition to the attention of the treating dentist; and e. Read, report, and record the patient's vital signs and physiological measures. L. A dentist who allows the administration of general anesthesia, deep sedation, or moderate sedation in his dental office is responsible for assuring that: 2. The person administering the anesthesia or sedation is appropriately licensed and the staff monitoring the patient is qualified. 18VAC60-21-270. Administration of Local Anesthesia. A dentist may administer or use the services of the following personnel to administer local anesthesia: 6. A dental assistant or a registered or licensed practical nurse to administer Schedule VI topical oral anesthetics under indirect supervision. 18VAC60-21-279. Administration of only inhalation analgesia (nitrous oxide) C. Delegation of administration 1. Qualified dentist may administer or use the services of the following personnel to administer nitrous oxide: a. A dentist; b. An anesthesiologist; c. A certified registered nurse anesthetist under his medical direction and indirect supervision; d. A dental hygienist with the training required by 18VAC60-25-100 B and under indirect supervision; or e. A registered nurse upon his direct instruction and under immediate supervision. 2. Preceding the administration of nitrous oxide, a dentist may use the services of the following personnel working under indirect supervision to administer local anesthesia to numb an injection or treatment site: a. A dental hygienist with the training required by 18VAC60-25-100 C to parenterally administer Schedule IV local anesthesia to persons 18 years of age or older; or b. A dental hygienist, dental assistant, registered nurse, or licensed practical nurse to administer Schedule VI topical oral anesthetics. E. Required staffing. When only nitrous oxide/oxygen is administered, a second person in the operatory is not required. Either the dentist or qualified dental hygienist under the indirect supervision of a dentist may administer the nitrous oxide/oxygen and treat and monitor the patient. F. Monitoring requirements. 3. Once the administration of nitrous oxide has begun, the dentist shall ensure that a licensed health care professional or a person qualified in accordance with 18VAC60-21-260 I monitors the patient at all times until discharged as required in subsection G of this section. 4. Monitoring shall include making the proper adjustments of nitrous oxide/oxygen machines at the request of or by the dentist or by another qualified licensed health professional identified in subsection C of this section. Only the dentist or another qualified licensed health professional identified in subsection C of this section may turn the nitrous oxide machines on or off. 18VAC60-21-280. Administration of minimal sedation. C. Delegation of administration. 2. Preceding the administration of minimal sedation, a dentist may use the services of the following personnel working under indirect supervision to administer local anesthesia to numb an injection or treatment site: 534

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants b.

A dental hygienist, dental assistant, registered nurse, or licensed practical nurse to administer Schedule VI topical oral anesthetics. E. Required staffing. The treatment team for minimal sedation shall consist of the dentist and a second person in the operatory with the patient to assist the dentist and monitor the patient. The second person shall be a licensed health care professional or a person qualified in accordance with 18VAC60-21-260 I. F. Monitoring requirements. 1. Baseline vital signs to include blood pressure, respiratory rate, and heart rate shall be taken and recorded prior to administration of sedation and prior to discharge. 2. Blood pressure, oxygen saturation, respiratory rate, and pulse shall be monitored continuously during the procedure. 3. Once the administration of minimal sedation has begun by any route of administration, the dentist shall ensure that a licensed health care professional or a person qualified in accordance with 18VAC60-21-260 I monitors the patient at all times until discharged as required in subsection G of this section. 4. If nitrous oxide/oxygen is used, in addition to any other pharmacological agent, monitoring shall include making the proper adjustments of nitrous oxide/oxygen machines at the request of or by the dentist or by another qualified licensed health professional identified in subsection C of this section. Only the dentist or another qualified licensed health professional identified in subsection C of this section may turn the nitrous oxide/oxygen machines on or off. 5. If any other pharmacological agent is used in addition to nitrous oxide/oxygen and a local anesthetic, requirements for the induced level of sedation must be met. 18VAC60-21-291. Requirements for Administration of Moderate Sedation. A. Delegation of administration. 4. Preceding the administration of moderate sedation, a permitted dentist may use the services of the following personnel under indirect supervision to administer local anesthesia to anesthetize the injection or treatment site: b. A dental hygienist, dental assistant, registered nurse, or licensed practical nurse to administer Schedule VI topical oral anesthetics. 5. A dentist who delegates administration of moderate sedation shall ensure that: b. Qualified staff is on site to monitor patients in accordance with requirements of subsection D of this section. C. Required staffing. At a minimum, there shall be a two person treatment team for moderate sedation. The team shall include the operating dentist and a second person to monitor the patient as provided in 18VAC60-21-260 K and assist the operating dentist as provided in 18VAC60-21-260 J, both of whom shall be in the operatory with the patient throughout the dental procedure. If the second person is a dentist, an anesthesiologist, or a certified registered nurse anesthetist who administers the drugs as permitted in subsection A of this section, such person may monitor the patient. D. Monitoring requirements. 1. Baseline vital signs shall be taken and recorded prior to administration of any controlled drug at the facility and prior to discharge. 2. Blood pressure, oxygen saturation, and pulse shall be monitored continually during the administration and recorded every five minutes. 3. Monitoring of the patient under moderate sedation is to begin prior to administration of sedation or, if pre-medication is self-administered by the patient, immediately upon the patient's arrival at the dental facility and shall take place continuously during the dental procedure and recovery from sedation. The person who administers the sedation or another licensed practitioner qualified to administer the same level of sedation must remain on the premises of the dental facility until the patient is evaluated and is discharged. 18VAC60-21-301. Requirements for Administration of Deep Sedation or General Anesthesia. B. Delegation of administration. 3. Preceding the administration of deep sedation or general anesthesia, a dentist who meets the requirements of 18VAC60-20-300 may use the services of the following personnel under indirect supervision to administer local anesthesia to anesthetize the injection or treatment site: b. A dental hygienist, dental assistant, registered nurse, or licensed practical nurse to administer Schedule VI topical oral anesthetics. D. Required staffing. At a minimum, there shall be a three-person treatment team for deep sedation or general anesthesia. The team shall include the operating dentist, a second person to monitor the patient as provided in18VAC60-21-260 K, and a third person to assist the operating dentist as provided in 18VAC60-21-260 J, all of whom shall be in the operatory with the patient during the dental procedure. If a second dentist, an anesthesiologist, or a certified registered nurse anesthetist administers the drugs as permitted in 18VAC60-21-301 B, such person may serve as the second person to monitor the patient. E. Monitoring requirements. 1. Baseline vital signs shall be taken and recorded prior to administration of any controlled drug at the facility to include: temperature, blood pressure, pulse, oxygen saturation, and respiration. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

535

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants 2. The patient's vital signs and EKG readings shall be monitored, recorded every five minutes, and reported to the treating dentist throughout the administration of controlled drugs and recovery. When depolarizing medications are administered, temperature shall be monitored constantly. 3. Monitoring of the patient undergoing deep sedation or general anesthesia is to begin prior to the administration of any drugs and shall take place continuously during administration, the dental procedure, and recovery from anesthesia. The person who administers the anesthesia or another licensed practitioner qualified to administer the same level of anesthesia must remain on the premises of the dental facility until the patient has regained consciousness and is discharged. Part VIII. Mobile Dental Clinics 18VAC60-21-410. Registration of a Mobile Dental Clinic or Portable Dental Operation. A. An applicant for registration of a mobile dental facility or portable dental operation shall provide: 2. The name, address, and license number of each dentist and dental hygienist or the name, address, and registration number of each dental assistant II who will provide dental services in the facility or operation. The identity and license or registration number of any additional dentists, dental hygienists, or dental assistants II providing dental services in a mobile dental facility or portable dental operation shall be provided to the board in writing prior to the provision of such services; and 18VAC60-21-420. Requirements for a Mobile Dental Clinic or Portable Dental Operation. A. The registration of the facility or operation and copies of the licenses of the dentists and dental hygienists or registrations of the dental assistants II shall be displayed in plain view of patients. Chapter 25. Regulations Governing the Practice of Dental Hygiene Part II, Practice of Dental Hygiene 18VAC60-25-40. Scope of Practice. B. The following duties of a dentist shall not be delegated: 1. Final diagnosis and treatment planning; 2. Performing surgical or cutting procedures on hard or soft tissue, except as may be permitted by subdivisions C 1 and D 1 of this section; 3. Prescribing or parenterally administering drugs or medicaments, except a dental hygienist who meets the requirements of 18VAC60-25-100 C may parenterally administer Schedule VI local anesthesia to patients 18 years of age or older; 4. Authorization of work orders for any appliance or prosthetic device or restoration that is to be inserted into a patient's mouth; 5. Operation of high speed rotary instruments in the mouth; 6. Administration of deep sedation or general anesthesia and moderate sedation; 7. Condensing, contouring, or adjusting any final, fixed, or removable prosthodontic appliance or restoration in the mouth with the exception of packing and carving amalgam and placing and shaping composite resins by dental assistants II with advanced training as specified in 18VAC60-30-120; 8. Final positioning and attachment of orthodontic bonds and bands; and 9. Final adjustment and fitting of crowns and bridges in preparation for final cementation. E. The following duties may only be delegated under the direction and direct supervision of a dentist to a dental assistant II: 1. Performing pulp capping procedures; 2. Packing and carving of amalgam restorations; 3. Placing and shaping composite resin restorations with a slow speed handpiece; 4. Taking final impressions; 5. Use of a non-epinephrine retraction cord; and 6. Final cementation of crowns and bridges after adjustment and fitting by the dentist. 18VAC60-25-50. Utilization of Dental Hygienists and Dental Assistants. A dentist may utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction at one and the same time. In addition, a dentist may permit through issuance of written orders for services additional dental hygienists to practice under general supervision in a free clinic, a public health program, or a voluntary practice. 18VAC60-25-70. Delegation of Services to a Dental Assistant. A. Duties appropriate to the training and experience of the dental assistant and the practice of the supervising dentist may be delegated to any dental assistant under the direction of a dental hygienist practicing under general supervision as permitted in subsection B of this section, with the exception of those listed as nondelegable and those that 536

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants may only be delegated to dental hygienists as listed in 18VAC60-25-40 and those that may only be delegated to a dental assistant II as listed in 18VAC60-21-150. B. Duties delegated to a dental assistant under general supervision shall be under the direction of the dental hygienist who supervises the implementation of the dentist's orders by examining the patient, observing the services rendered by an assistant, and being available for consultation on patient care. 18VAC60-25-80. Radiation Certification. No dentist or dental hygienist shall permit a person not otherwise licensed by this board to place or expose dental x-ray film unless he has one of the following: (i) satisfactory completion of a radiation safety course and examination given by an institution that maintains a program in dental assisting, dental hygiene, or dentistry accredited by CODA; (ii) certification by the American Registry of Radiologic Technologists; or (iii) satisfactory completion of the Radiation Health and Safety Review Course provided by the Dental Assisting National Board or its affiliate and passage of the Radiation Health and Safety Exam given by the Dental Assisting National Board. Any certificate issued pursuant to satisfying the requirements of this section shall be posted in plain view of the patient. Chapter 30. Regulations Governing the Practice of Dental Assistants Part I. General Provisions 18VAC60-30-10. Definitions. B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise: "CODA" means the Commission on Dental Accreditation of the American Dental Association. "Code" means the Code of Virginia. "Dental assistant I" means any unlicensed person under the direction of a dentist or a dental hygienist who renders assistance for services provided to the patient as authorized under this chapter but shall not include an individual serving in purely an administrative, secretarial, or clerical capacity. "Dental assistant II" means a person under the direction and direct supervision of a dentist who is registered by the board to perform reversible, intraoral procedures as specified in 18VAC60-30-60 and 18VAC60-30-70. "Direct supervision" means that the dentist examines the patient and records diagnostic findings prior to delegating restorative or prosthetic treatment and related services to a dental assistant II for completion the same day or at a later date. The dentist prepares the tooth or teeth to be restored and remains immediately available in the office to the dental assistant II for guidance or assistance during the delivery of treatment and related services. The dentist examines the patient to evaluate the treatment and services before the patient is dismissed. "Direction" means the level of supervision (i.e., immediate, direct, indirect or general) that a dentist is required to exercise with a dental hygienist, a dental assistant I, or a dental assistant II or that a dental hygienist is required to exercise with a dental assistant to direct and oversee the delivery of treatment and related services. "General supervision" means that a dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment that states the specific services to be provided by a dental hygienist during one or more subsequent appointments when the dentist may or may not be present. Issuance of the order authorizes the dental hygienist to supervise a dental assistant performing duties delegable to dental assistants I. "Immediate supervision" means the dentist is in the operatory to supervise the administration of sedation or provision of treatment. "Local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. "Monitoring" means to observe, interpret, assess, and record appropriate physiologic functions of the body during sedative procedures and general anesthesia appropriate to the level of sedation as provided in Part VI (18VAC60-21-260 et seq.) of Regulations Governing the Practice of Dentistry. "Radiographs" means intraoral and extraoral radiographic images of hard and soft tissues used for purposes of diagnosis. 18VAC60-30-20. Address of Record; Posting of Registration. A. Address of record. Each registered dental assistant II shall provide the board with a current address of record. All required notices and correspondence mailed by the board to any such registrant shall be validly given when mailed to the address of record on file with the board. Each registrant may also provide a different address to be used as the public address, but if a second address is not provided, the address of record shall be the public address. All changes of address shall be furnished to the board in writing within 30 days of such changes. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

537

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants B. Posting of registration. A copy of the registration of a dental assistant II shall either be posted in an operatory in which the person is providing services to the public or in the patient reception area where it is clearly visible to patients and accessible for reading. If a dental assistant II is employed in more than one office, a duplicate registration obtained from the board may be displayed. 18VAC60-30-30. Required Fees. A. Initial registration fee. B. Renewal fees. 1. Dental assistant II registration - active 2. Dental assistant II registration - inactive C. Late fees. 1. Dental assistant II registration - active 2. Dental assistant II registration - inactive D. Reinstatement fees. 1. Expired registration 2. Suspended registration 3. Revoked registration E. Administrative fees. 1. Duplicate wall certificate 2. Duplicate registration 3. Registration verification 4. Returned check fee

$100 $50 $25 $20 $10 $125 $250 $300 $60 $20 $35 $35

F. No fee will be refunded or applied for any purpose other than the purpose for which the fee is submitted. G. For the renewal of a dental assistant II registration in 2021, fees for renewal of an active dental assistant II registration shall be prorated according to the registrant's birth month as follows: January birth month February birth month March birth month April birth month May birth month June birth month July birth month August birth month September birth month October birth month November birth month December birth month

$30 $33 $36 $39 $42 $45 $48 $51 $54 $57 $60 $63

Part II. Practice of Dental Assistants II 18VAC60-30-40. Practice of Dental Hygienists and Dental Assistants II under Direction. A. A dentist may utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction at one and the same time. In addition, a dentist may permit through issuance of written orders for services additional dental hygienists to practice under general supervision in a free clinic, a public health program, or a voluntary practice. B. In all instances and on the basis of his diagnosis, a licensed dentist assumes ultimate responsibility for determining with the patient or his representative the specific treatment the patient will receive, which aspects of treatment will be delegated to qualified personnel, and the direction required for such treatment, in accordance with this chapter, Part III (18VAC60-21-110Â et seq.) of the Regulations Governing the Practice of Dentistry, and the Code. 18VAC60-30-50. Nondelegable Duties; Dentists. Only licensed dentists shall perform the following duties: 1. Final diagnosis and treatment planning; 538

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants 2. Performing surgical or cutting procedures on hard or soft tissue except a dental hygienist performing gingival curettage as provided in 18VAC60-21-140; 3. Prescribing or parenterally administering drugs or medicaments, except a dental hygienist who meets the requirements of 18VAC60-25-100 may parenterally administer Schedule VI local anesthesia to patients 18 years of age or older; 4. Authorization of work orders for any appliance or prosthetic device or restoration that is to be inserted into a patient's mouth; 5. Operation of high speed rotary instruments in the mouth; 6. Administering and monitoring conscious/moderate sedation, deep sedation, or general anesthetics except as provided for in § 54.1-2701 of the Code and subsections J and K of 18VAC60-21-260; 7. Condensing, contouring, or adjusting any final, fixed, or removable prosthodontic appliance or restoration in the mouth with the exception of packing and carving amalgam and placing and shaping composite resins by dental assistants II with advanced training as specified in 18VAC60-30-120; 8. Final positioning and attachment of orthodontic bonds and bands; and 9. Final adjustment and fitting of crowns and bridges in preparation for final cementation. 18VAC60-30-60. Delegation to Dental Assistants II. The following duties may only be delegated under the direction and direct supervision of a dentist to a dental assistant II who has completed the coursework, corresponding module of laboratory training, corresponding module of clinical experience, and examinations specified in 18VAC60-30-120: 1. Performing pulp capping procedures; 2. Packing and carving of amalgam restorations; 3. Placing and shaping composite resin restorations with a slow speed handpiece; 4. Taking final impressions; 5. Use of a non-epinephrine retraction cord; and 6. Final cementation of crowns and bridges after adjustment and fitting by the dentist. 18VAC60-30-70. Delegation to Dental Assistants I and II. A. Duties appropriate to the training and experience of any dental assistant and the practice of the supervising dentist may be delegated to a dental assistant I or II under indirect supervision, with the exception of those listed as nondelegable in 18VAC60-30-50, those which may only be delegated to dental hygienists as listed in 18VAC60-21-140, and those which may only be delegated to a dental assistant II as listed in 18VAC60-30-60. B. Duties delegated to any dental assistant under general supervision shall be under the direction of the dental hygienist who supervises the implementation of the dentist's orders by examining the patient, observing the services rendered by an assistant, and being available for consultation on patient care. 18VAC60-30-80. Radiation Certification. A dental assistant I or II shall not place or expose dental x-ray film unless he has one of the following: (i) satisfactory completion of a radiation safety course and examination given by an institution that maintains a program in dental assisting, dental hygiene, or dentistry accredited by CODA; (ii) certification by the American Registry of Radiologic Technologists; or (iii) satisfactory completion of the Radiation Health and Safety Review Course provided by the Dental Assisting National Board or its affiliate and passage of the Radiation Health and Safety Exam given by the Dental Assisting National Board. Any certificate issued pursuant to satisfying the requirements of this section shall be posted in plain view of the patient. 18VAC60-30-90. What Does Not Constitute Practice. The following are not considered the practice of dental hygiene and dentistry: 1. General oral health education. 2. Recording a patient's pulse, blood pressure, temperature, presenting complaint, and medical history. 3. Conducting preliminary dental screenings in free clinics, public health programs, or a voluntary practice. Part III. Standards of Conduct 18VAC60-30-100. Patient Records; Confidentiality. A. A dental assistant II shall be responsible for accurate and complete information in patient records for those services provided by the assistant under direction to include the following: 1. Patient's name on each page in the patient record; 2. Radiographs, digital images, and photographs clearly labeled with the patient name, date taken, and teeth identified; and 3. Notation of each treatment rendered, date of treatment and the identity of the dentist, the dental hygienist, or the dental assistant providing service. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

539

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants B. A dental assistant shall comply with the provisions of § 32.1-127.1:03 of the Code related to the confidentiality and disclosure of patient records. A dental assistant shall not willfully or negligently breach the confidentiality between a practitioner and a patient. A breach of confidentiality that is required or permitted by applicable law or beyond the control of the assistant shall not be considered negligent or willful. 18VAC60-30-110. Acts Constituting Unprofessional Conduct. The following practices shall constitute unprofessional conduct within the meaning of § 54.1-2706 of the Code: 1. Fraudulently obtaining, attempting to obtain, or cooperating with others in obtaining payment for services. 2. Performing services for a patient under terms or conditions that are unconscionable. The board shall not consider terms unconscionable where there has been a full and fair disclosure of all terms and where the patient entered the agreement without fraud or duress. 3. Misrepresenting to a patient and the public the materials or methods and techniques used or intended to be used. 4. Committing any act in violation of the Code reasonably related to dental practice. 5. Delegating any service or operation that requires the professional competence of a dentist, dental hygienist, or dental assistant II to any person who is not authorized by this chapter. 6. Certifying completion of a dental procedure that has not actually been completed. 7. Violating or cooperating with others in violating provisions of Chapter 1 (§ 54.1-100 et seq.) or 24 (§ 54.12400 et seq.) of Title 54.1 of the Code or the Drug Control Act (§ 54.1-3400 et seq. of the Code). Part IV. Entry Requirements for Dental Assistants II 18VAC60-30-115. General Application Requirements. A. All applications for registration as a dental assistant II shall include: 1. Evidence of a current credential as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board or another certification from a credentialing organization recognized by the American Dental Association and acceptable to the board that was granted following passage of an examination on general chairside assisting, radiation health and safety, and infection control; 2. Verification of completion of educational requirements set forth in 18VAC60-30-120; and 3. Attestation of having read and understood the laws and regulations governing the practice of dentistry and dental assisting in Virginia and of the applicant's intent to remain current with such laws and regulations. 18VAC60-30-120. Educational Requirements for Dental Assistants II. A. A prerequisite for entry into an educational program preparing a person for registration as a dental assistant II shall be current certification as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board. B. To be registered as a dental assistant II, a person shall complete the following requirements from an educational institution that maintains a program in dental assisting, dental hygiene, or dentistry accredited by CODA: 1. At least 50 hours of didactic course work in dental anatomy and operative dentistry that may be completed online. 2. Laboratory training that may be completed in the following modules with no more than 20% of the specified instruction to be completed as homework in a dental office: a. At least 40 hours of placing, packing, carving, and polishing of amalgam restorations and pulp capping procedures; b. At least 60 hours of placing and shaping composite resin restorations and pulp capping procedures; c. At least 20 hours of taking final impressions and use of a non-epinephrine retraction cord; and d. At least 30 hours of final cementation of crowns and bridges after adjustment and fitting by the dentist. 3. Clinical experience applying the techniques learned in the preclinical coursework and laboratory training that may be completed in a dental office in the following modules: a. At least 80 hours of placing, packing, carving, and polishing of amalgam restorations; b. At least 120 hours of placing and shaping composite resin restorations; c. At least 40 hours of taking final impressions and use of a non-epinephrine retraction cord; and d. At least 60 hours of final cementation of crowns and bridges after adjustment and fitting by the dentist. 4. Successful completion of the following competency examinations given by the accredited educational programs: a. A written examination at the conclusion of the 50 hours of didactic coursework; b. A practical examination at the conclusion of each module of laboratory training; and c. A comprehensive written examination at the conclusion of all required coursework, training, and experience for each of the corresponding modules. C. All treatment of patients shall be under the direct and immediate supervision of a licensed dentist who is responsible for the performance of duties by the student. The dentist shall attest to successful completion of the clinical competencies and restorative experiences. 540

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants 18VAC60-30-140. Registration by Endorsement As a Dental Assistant II. A. An applicant for registration by endorsement as a dental assistant II shall provide evidence of the following: 1. Hold current certification as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association; 2. Be currently authorized to perform expanded duties as a dental assistant in each jurisdiction of the United States; 3. Hold a credential, registration, or certificate with qualifications substantially equivalent in hours of instruction and course content to those set forth in 18VAC60-30-120 or if the qualifications were not substantially equivalent the dental assistant can document experience in the restorative and prosthetic expanded duties set forth in 18VAC60-30-60 for at least 24 of the past 48 months preceding application for registration in Virginia. B. An applicant shall also: 1. Be certified to be in good standing from each jurisdiction of the United States in which he is currently registered, certified, or credentialed or in which he has ever held a registration, certificate, or credential; 2. Not have committed any act that would constitute a violation of § 54.1-2706 of the Code; and 3. Attest to having read and understand and to remain current with the laws and the regulations governing dental practice in Virginia. Part V. Requirements for Renewal and Reinstatement 18VAC60-30-150. Registration Renewal Requirements. A.

B. C. D. E.

Prior to 2022, every person holding an active or inactive registration shall annually, on or before March 31, renew his registration. Beginning in January of 2022, every person holding an active or inactive registration shall annually renew his registration in his birth month. Any person who does not return the completed form and fee by the deadline shall be required to pay an additional late fee. The registration of any person who does not return the completed renewal form and fees by the deadline shall automatically expire and become invalid and his practice as a dental assistant II shall be illegal. Practicing in Virginia with an expired registration may subject the registrant to disciplinary action by the board. In order to renew registration, a dental assistant II shall be required to maintain and attest to current certification from the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association. A dental assistant II shall also be required to maintain evidence of successful completion of training in basic cardiopulmonary resuscitation. Following the renewal period, the board may conduct an audit of registrants to verify compliance. Registrants selected for audit shall provide original documents certifying current certification.

18VAC60-30-160. Inactive Registration. A. Any dental assistant II who holds a current, unrestricted registration in Virginia may upon a request on the renewal application and submission of the required fee be issued an inactive registration. The holder of an inactive registration shall not be entitled to perform any act requiring registration to practice as a dental assistant II in Virginia. B. An inactive registration may be reactivated upon submission of evidence of current certification from the Dental Assisting National Board or a national credentialing organization recognized by the American Dental Association. An applicant for reactivation shall also provide evidence of continuing clinical competence, which may include 1) documentation of active practice in another state or in federal service or 2) a refresher course offered by a CODA accredited educational program. C. The board reserves the right to deny a request for reactivation to any registrant who has been determined to have committed an act in violation of § 54.1-2706 of the Code. 18VAC60-30-170. Registration Reinstatement Requirements. A. The board shall reinstate an expired registration if the renewal form, renewal fee, and late fee are received within one year of the deadline required in subsection A of 18VAC60-30-150, provided that no grounds exist to deny said reinstatement pursuant to § 54.1-2706 of the Code and 18VAC60-30-110. B. A dental assistant II who has allowed his registration to lapse or who has had his registration suspended or revoked must submit evidence of current certification from the Dental Assisting National Board or a credentialing organization recognized by the American Dental Association to reinstate his registration. C. The executive director may reinstate such expired registration provided that the applicant can demonstrate continuing competence, the applicant has paid the reinstatement fee and any fines or assessments, and no grounds exist to deny said reinstatement pursuant to § 54.1-2706 of the Code and 18VAC60-30-110. D. An applicant for reinstatement shall provide evidence of continuing clinical competence, which may include: 1) documentation of active practice in another state or in federal service or 2) a refresher course offered by a CODA accredited educational program. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

541

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants Guidance Document 60-7 Adopted December 3, 2010; Re-adopted June 8, 2018 DELEGATION TO DENTAL ASSISTANTS DUTIES THAT MAY BE DELEGATED TO DENTAL ASSISTANTS I AND II UNDER INDIRECT SUPERVISION OF A DENTIST GENERAL SERVICES Prepare patients for treatment/seating/positioning chair/placing napkin Perform health assessment Preventive education and oral hygiene instruction Perform mouth mirror inspection of the oral cavity Chart existing restorations and conditions as instructed by the dentist Take, record and monitor vital signs Transfer dental instruments Prepare procedural trays/armamentaria set-ups Maintain emergency kit Sterilization and disinfection procedures Compliance with OSHA Regulations and Centers for Disease Control Guidelines Prep lab forms for signature by the dentist Maintenance of dental equipment Select and manipulate gypsums and waxes RADIOLOGY AND IMAGING Mount and label images Place x-ray film and expose radiographs ONLY WITH REQUIRED TRAINING Use intraoral camera or scanner to take images for tooth preparation and CAD CAM restorations RESTORATIVE SERVICES Provide pre- and post operative instructions Place and remove dental dam Maintain field of operation through use of retraction, suction, irrigation, drying Acid Etch - Apply/wash/dry remove only when reversible Amalgam: Place only Amalgam: Polish only with slow-speed handpiece and prophy cup Apply pit and fissure sealants Apply and cure primer and bonding agents Fabricate, cement, and remove temporary crowns/restorations Make impressions and pour and trim study/diagnostic models and opposing models Make impressions for athletic/night/occlusal/snore mouthguards and fluoride/bleaching trays Matrices - place and remove Measure instrument length Remove excess cement from coronal surfaces of teeth Remove sutures Dry canals with paper points Mix dental materials Place and remove post-extraction dressings/monitor bleeding 542

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants Rubber Dams: Place and remove Sterilization and disinfection procedures Take bite and occlusal registrations HYGIENE Apply dentin desensitizing solutions Apply fluoride varnish, gels, foams and agents Apply pit and fissure sealant Address risks of tobacco use Give oral hygiene instruction Polish coronal portion of teeth with rotary hand piece and rubber prophy cup or brush Place and remove periodontal dressings Clean and polish removable appliances and prostheses ORTHODONTICS Place and remove elastic separators Check for loose bands and brackets Remove arch wires and ligature ties Place ligatures to tie in archwire Select and fit bands and brackets for cementation by dentist Instruct patients in placement and removal of retainers and appliances after dentist has fitted and made adjustments in the mouth Take impressions and make study models for orthodontic treatment and retainers BLEACHING Take impressions and fabricate bleaching trays Apply bleach/whitener Bleach with light but not laser Instruct patient on bleaching procedures SEDATION AND ANESTHESIA SERVICES Apply topical Schedule VI anesthetic Monitor patient under nitrous oxide Monitor patient under minimal sedation/anxiolysis Monitor patient under moderate/conscious sedation ONLY WITH REQUIRED TRAINING Monitor patient under deep sedation/general anesthesia ONLY WITH REQUIRED TRAINING Take blood pressure, pulse and temperature DUTIES THAT MAY BE DELEGATED TO DENTAL ASSISTANTS I AND II UNDER INDIRECT SUPERVISION OF A DENTAL HYGIENIST Prepare patients for treatment/seating/positioning chair/placing napkin Perform health assessment Preventive education and oral hygiene instruction Transfer dental instruments Prepare procedural trays/armamentaria set-ups Maintain emergency kit Sterilization and disinfection procedures Compliance with OSHA Regulations and Centers for Disease Control Guidelines ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

543

Virginia State Dental Practice Act and Administrative Rules for Dental Assistants Maintenance of dental equipment Polish coronal portion of teeth with rotary hand piece and rubber prophy cup or brush Place and remove periodontal dressings Clean and polish removable appliances and prostheses Mount and label images Place x-ray film and expose radiographs ONLY WITH REQUIRED TRAINING DUTIES THAT MAY ONLY BE DELEGATED TO DENTAL ASSISTANTS II UNDER DIRECT SUPERVISION OF A DENTIST Condense/pack and carve amalgam Place, cure and finish composite resin restorations only with slow-speed handpiece Apply base and cavity liners/perform pulp capping procedures Final cementation of crowns and bridges after adjustment and fitting by the dentist Make final impressions and fabricate master casts Place and remove non-epinephrine retraction cord Guidance Document: 60-8 Adopted: December 2, 2011; Revised: December 11, 2015 Educational Requirements for Dental Assistants II •

§54.1-2729.01 of the Code of Virginia permits the Board to prescribe the education and training requirements that must be completed for a person to qualify for registration as a dental assistant II.

•

Every applicant for registration must complete 50 hours of didactic coursework in dental anatomy and operative dentistry required by 18VAC60-30-120.B.1 and the written examinations required by 18VAC60-30-120.B.4.

•

18VAC60-30-120.B.2 and 3, of the Regulations Governing the Practice of Dental Assistants specifies four modules of laboratory training, clinical experience and examination that may be completed in order to qualify for registration as a dental assistant II. The Board interprets these provisions to permit someone to complete one or more of the modules to qualify for registration. An applicant does not have to complete all four modules. However, the educational institution offering the dental assistant II program has the discretion to decide how to structure its program.

•

The registration issued by the Board to a dental assistant II shall specify which of the six delegable duties listed in 18VAC60-30-60 may be delegated to the registrant as follows:

544

○

Completion of the laboratory training, clinical experience module on placing, packing, carving, and polishing amalgam restorations qualifies a registrant to perform pulp capping procedures and to pack and carve amalgam restorations.

○

Completion of the laboratory training and clinical experience module on placing and shaping composite resin restorations qualifies a registrant to perform pulp capping procedures and to place and shape composite resin restorations.

○

Completion of the laboratory training and clinical experience module on taking final impressions and using nonepinephrine retraction cord qualifies a registrant to take final impressions and to use non-epinephrine retraction cord.

○

Completion of the laboratory training and clinical experience module on final cementation of crowns and bridges after adjustment and fitting by a dentist qualifies a registrant to perform final cementation of crowns and bridges.

Washington DANB Certificant Counts: Washington National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

1,236

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Jennifer Santiago, Program Manager Washington State Dental Quality Assurance Commission P.O. Box 47852 Olympia, WA 98504 Phone: 360-236-4700 (customer service) Fax: 360-236-2901 Website: www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist

Radiation Health and Safety (RHS)

5,825

Infection Control (ICE)

5,013

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants CODA-Accredited Dental Assisting Programs Bates Technical College Bellingham Technical College Clover Park Technical College Lake Washington Institute of Technology Renton Technical College Seattle Vocational Institute South Puget Sound Community College Spokane Community College

DANB CDA Certificant State of Washington+

$22.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of February 24, 2020.

Source: 2018 DANB Salary Survey (state data based on 32 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

545

Washington State Radiography Requirements Individuals operating x-ray equipment in the state of Washington shall be adequately instructed in safe operating procedures and shall be able to demonstrate competence, upon request from the department, in the correct use of the equipment.

State Requirements for Each Level of Dental Assistant Every dental assistant in the state of Washington must be registered. To be eligible for registration as a dental assistant, one must: (1) Provide a completed application on forms provided by the Washington State Dental Quality Assurance Commission AND (2) Pay applicable fees AND (3) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC, Part 8, AND (4) Provide any other information determined by the Washington State Dental Quality Assurance Commission. The dental assistant registration must be renewed annually on or before the dental assistant’s birthday. A dental assistant in the state of Washington may earn an endorsement in sealant/fluoride varnish solely for the purpose of treating children in school-based and school-linked programs. Applicants must: (1) Have had 200 hours of employment by a Washington State-licensed dentist that has included theoretical and clinical training in the application of dental sealants and fluoride varnish treatments, verified by a declaration provided by the licensed dentist who provided the training AND (2) Meet one of the following requirements (which must have incorporated the Washington State Department of Health program guidelines): (2a) graduation from a CODA-accredited dental assisting, dental hygiene, or dental educational program or (2b) continuing education courses or (2c) Individual training provided by a Washington-licensed dentist AND (3) Apply to the Washington State Dental Quality Assurance Commission (DQAC) for endorsement. Dental assistants monitoring patients receiving deep sedation or general anesthesia must receive a minimum of fourteen hours of documented training in a course specifically designed to include instruction and practical experience in the use of equipment. A volunteer dental assistant is an individual who, without compensation, provides supportive services in a charitable dental clinic. To become an Expanded Function Dental Auxiliary (EFDA) in Washington, a registered dental assistant must: (1) Graduate from a CODA-accredited dental assisting program or be DANB CDA Certified (after meeting DANB CDA/GC pathway II eligibility requirements, and completing an additional dental assisting review course) AND (2) Complete an EFDA course approved by DQAC AND (3) Pass the Washington State Restorative Exam (WARE administered by DANB) AND (4) Pass the clinical exam administered by the Western Regional Examining Board (WREB) or the Central Regional Dental Testing Service (CRDTS) AND (5) Apply to DQAC for an EFDA license. To earn state certification as a Dental Anesthesia Assistant in Washington, one must submit the following to the Washington State Dental Quality Assurance Commission (DQAC): (1) An application, on a form provided by the department AND (2) An application fee AND (3) Evidence of completion of one of the following: (3a) The “Dental Anesthesia Assistant National Certification Examination (DAANCE)” or predecessor program, provided by the American Association of Oral and Maxillofacial Surgeons (AAOMS) or (3b) The “Oral and Maxillofacial Surgery Assistants Course” course provided by the California Association of Oral and Maxillofacial Surgeons (CALAOMS) or (3c) Substantially equivalent education and training approved by DQAC AND (4a) Evidence of completion of training in intravenous access or phlebotomy that includes 8 hours of didactic training and hands on experience starting and maintaining intravenous lines with at least ten successful intravenous starts on a human or simulator/manikin or (4b) Evidence of completion of substantially equivalent education and training approved by DQAC AND (5) A current and valid certification for health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS) AND (6) A valid Washington state general anesthesia permit of the oral and maxillofacial surgeon or dental anesthesiologist where the dental anesthesia assistant will be performing his or her services, AND (7) Completion of seven clock hours of AIDS education and training AND (8) Any other information determined by DQAC. Note: A certified dental anesthesia assistant shall notify DQAC in writing on a form provided by DQAC of any changes in his or her supervisor. DQAC must be notified of the change prior to the certified dental anesthesia assistant accepting delegation from another supervisor. All dental assistants must hold current and valid health care provider basic life support (BLS) certification. Note: DANB administers the Washington State Dental Hygiene Drug and Law Examination under agreement with the Washington State Department of Health. To obtain an application or for additional information, contact the Washington State Dental Hygiene Program at 360-236-4700 (customer service). 546

Washington State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Washington State Dental Quality Assurance Commission Revised Code of Washington Chapter 18.260 RCW Dental Professionals RCW 18.260.010 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) “Close supervision” means that a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervising dentist is continuously on-site and physically present in the treatment facility while the procedures are performed by the assistive personnel and capable of responding immediately in the event of an emergency. The term does not require a supervising dentist to be physically present in the operatory. (2) “Commission” means the Washington state dental quality assurance commission created in chapter 18.32 RCW. (3) “Dental assistant” means a person who is registered by the commission to provide supportive services to a licensed dentist to the extent provided in this chapter and under the close supervision of a dentist. (4) “Dentist” means an individual who holds a license to practice dentistry under chapter 18.32 RCW. (6) “Expanded function dental auxiliary” means a person who is licensed by the commission to provide supportive services to a licensed dentist to the extent provided in this chapter and under the specified level of supervision of a dentist. (7) “General supervision” means that a supervising dentist has examined and diagnosed the patient and provided subsequent instructions to be performed by the assistive personnel, but does not require that the dentist be physically present in the treatment facility. (9) “Supervising dentist” means a dentist licensed under chapter 18.32 RCW that is responsible for providing the appropriate level of supervision for dental assistants and expanded function dental auxiliaries. RCW 18.260.020 Registration or license required. (1) No person may practice or represent himself or herself as a registered dental assistant by use of any title or description without being registered by the commission as having met the standards established for registration under this chapter unless he or she is exempt under RCW 18.260.110. (2) No person may practice or represent himself or herself as a licensed expanded function dental auxiliary by use of any title or description without being licensed by the commission under this chapter unless he or she is exempt under RCW 18.260.110. RCW 18.260.030 Dental assistants — Registration. The commission shall issue a registration to practice as a dental assistant to any applicant who pays any applicable fees, as established by the secretary in accordance with RCW 43.70.110 and 43.70.250, and submits, on forms provided by the secretary, the applicant’s name, address, and other information as determined by the secretary. RCW 18.260.040 Dental assistants — Scope of practice. (1) (a) The commission shall adopt rules relating to the scope of dental assisting services related to patient care and laboratory duties that may be performed by dental assistants. (b) In addition to the services and duties authorized by the rules adopted under (a) of this subsection, a dental assistant may apply topical anesthetic agents. (c) All dental services performed by dental assistants under (a) or (b) of this subsection must be performed under the close supervision of a supervising dentist as the dentist may allow. (2) In addition to any other limitations established by the commission, dental assistants may not perform the following procedures: (a) Any scaling procedure; (b) Any oral prophylaxis, except coronal polishing; (c) Administration of any general or local anesthetic, including intravenous sedation; (d) Any removal of or addition to the hard or soft tissue of the oral cavity; (e) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth, jaw, or adjacent structures; and (f) The taking of any impressions of the teeth or jaw or the relationships of the teeth or jaws, for the purpose of fabricating any intra-oral restoration, appliance, or prosthesis, other than impressions allowed as a delegated duty for dental assistants pursuant to rules adopted by the commission. (3) A dentist may not assign a dental assistant to perform duties until the dental assistant has demonstrated skills necessary to perform competently all assigned duties and responsibilities.

547

Washington State Dental Practice Act and Administrative Rules for Dental Assistants RCW 18.260.050 Expanded function dental auxiliary — License. (1) The commission shall issue a license to practice as an expanded function dental auxiliary to any applicant who: (a) Pays any applicable fees as established by the secretary in accordance with RCW 43.70.110 and 43.70.250; (b) Submits, on forms provided by the secretary, the applicant’s name, address, and other applicable information as determined by the secretary; and (c) Demonstrates that the following requirements have been met: (i) Successful completion of a dental assisting education program approved by the commission. The program may be an approved online education program; (ii) Successful completion of an expanded function dental auxiliary education program approved by the commission; and (iii) Successful passage of both a written examination and a clinical examination in restorations approved by the commission. (2) (a) A n applicant that holds a limited license to practice dental hygiene under chapter 18.29 RCW is considered to have met the dental assisting education program requirements of subsection (1)(c)(i) of this section. (b) An applicant that holds a full license to practice dental hygiene under chapter 18.29 RCW is considered to have met the requirements of subsection (1)(c) of this section upon demonstrating the successful completion of training in taking final impressions as approved by the commission. RCW 18.260.060 Expanded function dental auxiliary — License — Reciprocity. An applicant holding a license in another state may be licensed as an expanded function dental auxiliary in this state without examination if the commission determines that the other state’s licensing standards are substantially equivalent to the standards in this state. RCW 18.260.070 Expanded function dental auxiliary — Scope of practice. (1) The commission shall adopt rules relating to the scope of expanded function dental auxiliary services related to patient care and laboratory duties that may be performed by expanded function dental auxiliaries. (2) The scope of expanded function dental auxiliary services that the commission identifies in subsection (1) of this section includes: (a) In addition to the dental assisting services that a dental assistant may perform under the close supervision of a supervising dentist, the performance of the following services under the general supervision of a supervising dentist as the dentist may allow: (i) Performing coronal polishing; (ii) Giving fluoride treatments; (iii) Applying sealants; (iv) Placing dental x-ray film and exposing and developing the films; (v) Giving patient oral health instruction; and (b) Notwithstanding any prohibitions in RCW 18.260.040, the performance of the following services under the close supervision of a supervising dentist as the dentist may allow: (i) Placing and carving direct restorations; and (ii) Taking final impressions. (3) A dentist may not assign an expanded function dental auxiliary to perform services until the expanded function dental auxiliary has demonstrated skills necessary to perform competently all assigned duties and responsibilities. RCW 18.260.080 Supervising dentist — Responsibilities. A supervising dentist is responsible for: (1) Maintaining the appropriate level of supervision for dental assistants and expanded function dental auxiliaries; and (2) Ensuring that the dental assistants and expanded function dental auxiliaries that the dentist supervises are able to competently perform the tasks that they are assigned. RCW 18.260.090 Initial or renewal credentials — Issuance and denial. The commission shall issue an initial credential or renewal credential to an applicant who has met the requirements for a credential or deny an initial credential or renewal credential based upon failure to meet the requirements for a credential or unprofessional conduct or impairment governed by chapter 18.130 RCW. RCW 18.260.100 Examinations. (1) The commission may approve a written examination prepared or administered by a private testing agency or association of licensing agencies for use by an applicant in meeting the licensing requirements under RCW 18.260.050. The requirement that the examination be written does not exclude the use of computerized test administration. (2) The commission, upon consultation with the dental hygiene examining committee, may approve a clinical examination prepared or administered by a private testing agency or association of licensing agencies for use by an applicant in meeting the licensing requirements under RCW 18.260.050.

548

Washington State Dental Practice Act and Administrative Rules for Dental Assistants RCW 18.260.110 Limitation of chapter. Nothing in this chapter may be construed to prohibit or restrict: (1) The practice of a dental assistant in the discharge of official duties by dental assistants in the United States federal services on federal reservations, including but not limited to the armed services, coast guard, public health service, veterans’ bureau, or bureau of Indian affairs; (2) Expanded function dental auxiliary education and training programs approved by the commission and the practice as an expanded function dental auxiliary by students in expanded function dental auxiliary education and training programs approved by the commission, when acting under the direction and supervision of persons licensed under chapter 18.29 or 18.32 RCW; (3) Dental assistant education and training programs, and the practice of dental assisting by students in dental assistant education and training programs approved by the commission or offered at a school approved or licensed by the workforce training and education coordinating board, higher education coordinating board, state board for community and technical colleges, or Washington state skill centers certified by the office of the superintendent of public instruction, when acting under the direction and supervision of persons registered or licensed under this chapter or chapter 18.29 or 18.32 RCW; or (4) The practice of a volunteer dental assistant providing services under the supervision of a licensed dentist in a charitable dental clinic, as approved by the commission in rule. (5) The performance of dental health aide therapist services to the extent authorized under chapter 70.350 RCW. RCW 18.260.120 Rules. The commission may adopt rules under chapter 34.05 RCW as required to implement this chapter. Chapter 18.350 RCW DENTAL ANESTHESIA ASSISTANTS RCW 18.350.010 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) "Close supervision" has the same meaning as in RCW 18.260.010. (2) "Commission" means the dental quality assurance commission established in RCW 18.32.0351. (3) "Department" means the department of health. (4) "Direct visual supervision" means supervision by an oral and maxillofacial surgeon or dental anesthesiologist by verbal command and under direct line of sight. (5) "Oral and maxillofacial surgeon" has the same meaning as in RCW 18.32.020. (6) "Secretary" means [the] secretary of health. RCW 18.350.020 Use of title — Certification or registration required. (1) No person may practice or represent himself or herself as a certified dental anesthesia assistant by use of any title or description without being certified by the commission as having met the standards established for certification under this chapter. (2) A certified dental anesthesia assistant may not practice or represent himself or herself as a registered dental assistant without being registered by the commission as having met the standards for registration under chapter 18.260 RCW. RCW 18.350.030 Application for certification. (1) Each applicant for certification as a dental anesthesia assistant must submit to the department: (a) An application, on a form provided by the department, with the applicant's name, address, and name and location of the oral and maxillofacial surgeon or dental anesthesiologist where the assistant will be performing his or her services; (b) An application fee, as determined by the secretary of health as provided in RCW 43.70.250 and 43.70.280; and (c) Satisfactory evidence of: (i) Completion of a commission-approved dental anesthesia assistant training course, to include intravenous access or phlebotomy. This training must include experience starting and maintaining intravenous lines; (ii) Completion of a commission-approved basic life support/cardiac pulmonary resuscitation course; and (iii) The valid general anesthesia permit of the oral and maxillofacial surgeon or dental anesthesiologist where the assistant will be performing his or her services. (2) The commission may adopt rules for the requirements for renewal of the certification, including continuing education requirements consistent with national oral and maxillofacial surgery requirements. (3) The secretary shall establish the administrative procedures, administrative requirements, and fees for renewal of certifications as provided in RCW 43.70.250 and 43.70.280. RCW 18.350.040 Authorized functions — Supervision. (1) Any dental anesthesia assistant certified pursuant to this chapter shall perform the functions authorized in this chapter only by delegation of authority from the oral and maxillofacial surgeon or dental anesthesiologist and under the supervision, as described in subsections (2) and (3) of this section, of the oral and maxillofacial surgeon or dental an© 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

549

Washington State Dental Practice Act and Administrative Rules for Dental Assistants esthesiologist acting within the scope of his or her license. The responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications rests solely with the oral and maxillofacial surgeon or dental anesthesiologist. (2) Under close supervision, the dental anesthesia assistant may: (a) Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia; and (b) Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open. (3) Under direct visual supervision, the dental anesthesia assistant may: (a) Draw up and prepare medications; (b) Follow instructions to deliver medications into an intravenous line upon verbal command; (c) Adjust the rate of intravenous fluids infusion beyond a keep open rate; (d) Adjust an electronic device to provide medications, such as an infusion pump; (e) Administer emergency medications to a patient in order to assist the oral and maxillofacial surgeon or dental anesthesiologist in an emergency. (4) Any oral and maxillofacial surgeon or dental anesthesiologist delegating duties under this section must have a valid general anesthesia permit and, if the dental anesthesia assistant does not possess advanced cardiac life support training, must be current in such training. Washington Administrative Code Chapter 246-814 WAC ACCESS TO DENTAL CARE FOR CHILDREN WAC 246-814-010 Purpose. The purpose of this chapter is to implement RCW 18.29.220 and 18.32.226. These laws are intended to improve access to dental care for low-income, rural, and other at-risk children by enhancing the authority of dental hygienists and dental assistants to provide dental sealant and fluoride varnish treatments in school-based and school-linked programs. The department encourages partnerships with geographical regions and among participants in the oral health care community in implementing this law. WAC 246-814-020 Practices authorized. (1) Dental hygienists. Solely for purposes of providing services under this chapter, dental hygienists holding endorsements under this chapter may assess by determining the need for (i.e., the absence of gross carious lesions and sealants) and acceptability of dental sealantor fluoride varnish treatment for children in school-based and schoollinked programs. Dental hygienists may apply dental sealants and fluoride varnish treatments and may remove deposits and stains from the surfaces of teeth, without the supervision of a licensed dentist. This determination does not include or involve diagnosing conditions or constitute a dental examination. (2) Dental assistants. A dental assistant is currently defined in RCW 18.260.010 as a person who is registered by the dental quality assurance commission to provide supportive services to a licensed dentist to the extent provided in chapter 18.260 RCW and under the close supervision of a dentist. Solely for purposes of this chapter, authorized dental assistants may apply dental sealants and fluoride varnish treatments to children in school-based and schoollinked programs under the general supervision of a Washington state licensed dentist, as described in this chapter. (a) Close supervision requires the supervising dentist to first determine the need for and acceptability of dental sealant and fluoride varnish treatments, refer the treatment and the dentist is continuously on-site and physically present in the treatment facility when the treatment is provided. (b) General supervision requires the supervising dentist to first determine the need for and acceptability of dental sealant and fluoride varnish treatments, refer the treatment and the dentist does not have to be in the treatment facility when the treatment is provided. (3) Dental assistants and their supervising dentists, as well as dental hygienists shall coordinate with local public health jurisdictions and local oral health coalitions prior to providing services under this chapter, consistent with RCW 18.29.220 and 18.32.226. WAC 246-814-030 Application process and documentation of training required to qualify for endorsement. (1) The department has issued endorsements to all dental hygienists holding valid licenses on or before April 19, 2001, the effective date of RCW 18.29.220. (2) Dental hygienists licensed after April 19, 2001, must obtain an endorsement to provide services under this chapter. Applicants must meet the additional requirements in RCW 18.29.220 and must submit the following to the department: (a) Application for endorsement; (b) Fee; (c) Information of having a valid Washington state dental hygiene license for reference; and (d) Proof of the completion of training that has incorporated the Washington state department of health sealant/fluoride varnish program guidelines as described in WAC 246-814-040(3). 550

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (3) Dental assistants employed by a Washington state licensed dentist on or before April 19, 2001, are not required to obtain an endorsement but may voluntarily do so without having to meet the additional requirements in RCW 18.32.226. (4) Dental assistants employed by a Washington state licensed dentist for two hundred hours after April 19, 2001, must obtain an endorsement to provide services under this chapter. Applicants must meet the additional requirements in RCW 18.32.226 and must submit the following to the department: (a) Application for endorsement; (b) Fee; (c) Proof of two hundred hours of employment as a dental assistant by a Washington state licensed dentist that has included theoretical and clinical training in the application of dental sealants and fluoride varnish treatments, verified by a declaration provided by the licensed dentist who provided the training; and (d) Proof of completion of training that has incorporated the Washington state department of health sealant/fluoride varnish program guidelines as described in WAC 246-814-040(3). (5) Dental assistants and their supervising dentists, as well as dental hygienists should use the Washington state department of health sealant/fluoride varnish guidelines described in WAC 246-814-040 and other protocols that may be in place for the geographic region when coordinating with local public health jurisdictions. (6) Dental assistants and their supervising dentists, as well as dental hygienists shall coordinate with established local oral health coalitions by participating in oral health coalition meetings that may be held in the geographical region. WAC 246-814-040 Training and the provision of services. (1) The â&#x20AC;&#x153;Washington state department of health sealant/fluoride varnish program guidelinesâ&#x20AC;? (sealant/fluoride varnish program guidelines) have been developed, maintained and distributed by the department in partnership with the oral health community and health care practitioners. To obtain copies of the sealant/fluoride varnish program guidelines contact the department. (2) The sealant/fluoride varnish program guidelines are designed to assist the local public health jurisdictions and oral health care communities in the planning, implementation, and evaluation of school-based dental sealant and fluoride varnish programs. Every school-based dental sealant and fluoride varnish program should design their program to provide, at minimum, for the following: (a) Assessing and targeting the population. (b) Establishing community capacity and infrastructure. (c) Determining staffing needs and training. (d) Securing equipment and supplies. (e) Developing policies, procedures and data collection forms. (f) Scheduling schools/sites. (g) Preparing sites for implementation. (h) Providing services. (i) Evaluating the process and outcomes. (3) The sealant/fluoride varnish program guidelines also provides the training required for dental hygienists and dental assistants providing services under this chapter. Applicants for endorsement must obtain training as contained in these specific guidelines, which can be met through any one of the following methods: (a) Graduation from a dental assisting, dental hygiene or dental educational program, accredited by the commission on dental accreditation (CODA), which has incorporated the sealant/fluoride varnish program guidelines. (b) Continuing education courses which teach the sealant/fluoride varnish program guidelines. (c) Individual training provided by a Washington licensed dentist, which has incorporated the sealant/fluoride varnish program guidelines. WAC 246-814-990 Endorsement fees for dental assistants and dental hygienists, renewal of endorsement not required. (1) Endorsements do not require renewal. (2) Endorsement documents are issued to the qualified applicant, and are not the property of the employer or the supervisor. (3) The following one-time, nonrefundable fee will be charged: Dental assistant application/endorsement $50 Dental hygiene application/endorsement $50

551

Washington State Dental Practice Act and Administrative Rules for Dental Assistants Chapter 246-817 WAC DENTAL QUALITY ASSURANCE COMMISSION Licensure : Application and Eligibility Requirements WAC 246-817-185 Temporary practice permits--Eligibility. Fingerprint-based national background checks may cause a delay in credentialing. Individuals who satisfy all other licensing requirements and qualifications may receive a temporary practice permit while the national background check is completed. (1) A temporary practice permit, as defined in RCW 18.130.075, shall be issued at the written request of an applicant for dentists, expanded function dental auxiliaries, dental anesthesia assistants, and dental assistants. The applicant must be credentialed in another state, with credentialing standards substantially equivalent to Washington. (2) The conditions of WAC 246-817-160 must be met for applicants who are graduates of dental schools or colleges not accredited by the American Dental Association Commission on Dental Accreditation. WAC 246-817-190 Dental assistant registration. To be eligible for registration as a dental assistant you must: (1) Provide a completed application on forms provided by the secretary; (2) Pay applicable fees as defined in WAC 246-817-99005; (3) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246 12 WAC Part 8; and (4) Provide any other information determined by the secretary. WAC 246-817-195 Licensure requirements for expanded function dental auxiliaries (EFDAs). To be eligible for licensure as an EFDA in Washington an applicant must: (1) Provide a completed application on forms provided by the secretary; (2) Pay applicable fees as defined in WAC 246-817-99005; (3) Provide evidence of: (a) Completion of a dental assisting education program accredited by the Commission on Dental Accreditation (CODA); or (b) Obtain the Dental Assisting National Board (DANB) certified dental assistant credential, earned through pathway II, which includes: (i) A minimum of three thousand five hundred hours of experience as a dental assistant within a continuous twenty-four through forty-eight month period; (ii) Employer-verified knowledge in areas as specified by DANB; (iii) Passage of DANB certified dental assistant examination; and (iv) An additional dental assisting review course, which may be provided on-line, in person or through selfstudy; or (c) A Washington limited license to practice dental hygiene; or (d) A Washington full dental hygiene license and completion of a course in taking final impressions affiliated with or provided by a CODA accredited dental assisting program, dental hygiene school or dental school. (4) Except for applicants qualified under subsection (3)(d) of this section, provide evidence of completing an EFDA education program approved by the commission where training includes: (a) In a didactic, clinical and laboratory model to the clinically competent level required for close supervision: (i) In placing and finishing composite restorations on a typodont and on clinical patients; and (ii) In placing and finishing amalgam restorations on a typodont and on clinical patients; and (iii) In taking final impressions on a typodont; and (b) In a didactic, clinical and laboratory model to the clinically competent level required for general supervision: (i) In performing coronal polish, fluoride treatment, and sealants on a typodont and on clinical patients; and (ii) In providing patient oral health instructions; and (iii) In placing, exposing, processing, and mounting dental radiographs; and (c) The basic curriculum shall require didactic, laboratory, and clinical competency for the following: (i) Tooth morphology and anatomy; (ii) Health and safety (current knowledge in dental materials, infection control, ergonomics, mercury safety, handling); (iii) Placement and completion of an acceptable quality reproduction of restored tooth surfaces -- laboratory and clinic only; (iv) Radiographs (covered in path II) -- laboratory and clinic only; (v) Ethics and professional knowledge of law as it pertains to dentistry, dental hygiene, dental assisting, and EFDA; (vi) Current practices in infection control; (vii) Health history alerts; 552

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (viii) Final impression; (ix) Matrix and wedge; (x) Rubber dam; (xi) Acid etch and bonding; (xii) Occlusion and bite registration; (xiii) Temporary restorations; (xiv) Dental emergencies; (xv) Risk management and charting; (xvi) Intra-oral anatomy; (xvii) Pharmacology; and (xviii) Bases, cements, liners and sealers. (5) Except for applicants qualified under subsection (3)(d) of this section, attain a passing score on: (a) A written restorations examination approved by the commission; and (b) A clinical restorations examination approved by the commission. (6) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC Part 8. (7) Provide any other information determined by the secretary. WAC 246-817-200 Licensure without examination for expanded function dental auxiliary (EFDA). To be eligible for a license as an EFDA without examination you must: (1) Provide a completed application on forms provided by the secretary; (2) Pay applicable fees as defined in WAC 246-817-990; (3) Provide evidence of: (a) A current license in another state with substantially equivalent licensing standards as determined by the commission; or (b) A Washington full dental hygiene license and completion of a course in taking final impressions affiliated with or provided by a CODA accredited dental assisting program, dental hygiene school or dental school. (4) Provide evidence of completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC Part 8; and (5) Provide any other information determined by the secretary. WAC 246-817-205 Dental anesthesia assistant certification requirements. An applicant for certification as a dental anesthesia assistant must submit to the department: (1) A completed application on forms provided by the secretary; (2) Applicable fees as defined in WAC 246-817-99005; (3) Evidence of: (a) Completion of a commission approved dental anesthesia assistant education and training. Approved education and training includes: (i) Completion of the “Dental Anesthesia Assistant National Certification Examination (DAANCE)” or predecessor program, provided by the American Association of Oral and Maxillofacial Surgeons (AAOMS); or (ii) Completion of the “Oral and Maxillofacial Surgery Assistants Course” course provided by the California Association of Oral and Maxillofacial Surgeons (CALAOMS); or (iii) Completion of substantially equivalent education and training approved by the commission. (b) Completion of training in intravenous access or phlebotomy. Training must include: (i) Eight hours of didactic training that must include: (A) Intravenous access; (B) Anatomy; (C) Technique; (D) Risks and complications; and (ii) Hands on experience starting and maintaining intravenous lines with at least ten successful intravenous starts on a human or simulator/manikin; or (iii) Completion of substantially equivalent education and training approved by the commission; (c) A current and valid certification for health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS); (d) A valid Washington state general anesthesia permit of the oral and maxillofacial surgeon or dental anesthesiologist where the dental anesthesia assistant will be performing his or her services; (e) Completion of seven clock hours of AIDS education and training as required by chapter 246-12 WAC, Part 8; and (4) Any other information determined by the commission. WAC 246-817-445 Dental anesthesia assistant continuing education requirements. (1) To renew a certification a certified dental anesthesia assistant must complete a minimum of twelve hours of continuing education every three years and follow the requirements of chapter 246-12 WAC, Part 7. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

553

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (2) Continuing education must involve direct application of dental anesthesia assistant knowledge and skills in one or more of the following categories: (a) General anesthesia; (b) Moderate sedation; (c) Physical evaluation; (d) Medical emergencies; (e) Health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS); (f) Monitoring and use of monitoring equipment; (g) Pharmacology of drugs; and agents used in sedation and anesthesia. (3) Continuing education is defined as any of the following activities: (a) Attendance at local, state, national, or international continuing education courses; (b) Health care provider basic life support (BLS), advanced cardiac life support (ACLS), or pediatric advanced life support (PALS), or emergency related classes; (c) Self-study through the use of multimedia devices or the study of books, research materials, or other publications. (i) Multimedia devices. The required documentation for this activity is a letter or other documentation from the organization. A maximum of two hours is allowed per reporting period. (ii) Books, research materials, or other publications. The required documentation for this activity is a two-page synopsis of what was learned written by the credential holder. A maximum of two hours is allowed per reporting period. (d) Distance learning. Distance learning includes, but is not limited to, correspondence course, webinar, print, audio/video broadcasting, audio/video teleconferencing, computer aided instruction, e-learning/on-line-learning, or computer broadcasting/webcasting. A maximum of four hours of distance learning is allowed per reporting period. Delegations of Duties to Persons Not Licensed as Dentists WAC 246-817-501 Purpose. The purpose of WAC 246-817-501 through 246-817-570 is to establish guidelines on delegation of duties to persons who are not licensed to practice dentistry. The dental laws of Washington state authorized the delegation of certain duties to nondentist personnel and prohibit the delegation of certain other duties. By statute, the duties that may be delegated to a person not licensed to practice dentistry may be performed only under the supervision of a licensed dentist. The degree of supervision required to assure that treatment is appropriate and does not jeopardize the systemic or oral health of the patient varies with, among other considerations, the nature of the procedure and the qualifications of the person to whom the duty is delegated. The dentist is ultimately responsible for the services performed in his/her office and this responsibility cannot be delegated. In order to protect the health and well-being of the people of this state, the DQAC finds it necessary to adopt the following definitions and regulations. WAC 246-817-510 Definitions. The definitions in this section apply throughout WAC 246-817-501 through 246-817570 unless the context clearly requires otherwise. (1) “Close supervision” means that a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervising dentist is continuously on-site and physically present in the treatment facility while the procedures are performed by the assistive personnel and capable of responding immediately in the event of an emergency. Close supervision does not require a supervising dentist to be physically present in the operatory. (2) “Coronal polishing” means a procedure limited to the removal of plaque and stain from exposed tooth surfaces, using an appropriate instrument and polishing agent. This procedure is not intended or interpreted to be an oral prophylaxis as defined in subsection (8) of this section a procedure specifically reserved to be performed by a licensed dentist or dental hygienist. Coronal polishing may, however, be a portion of the oral prophylaxis procedure. (3) “Debridement at the periodontal surgical site” means curettage or root planing after reflection of a flap by the supervising dentist. This does not include cutting of osseous tissues. (4) “Elevating soft tissues” means part of a surgical procedure involving the use of the periosteal elevator to raise flaps of soft tissues. Elevating soft tissue is not a separate and distinct procedure in and of itself. (5) “General supervision” means that a supervising dentist has examined and diagnosed the patient and provided subsequent instructions to be performed by the assistive personnel, but does not require the dentist to be physically present in the treatment facility. (6) “Incising” means part of the surgical procedure of which the end result is removal of oral tissue. Incising, or the making of an incision, is not a separate and distinct procedure in and of itself. (7) “Luxation” means an integral part of the surgical procedure of which the end result is extraction of a tooth. It is the dislocation or displacement of a tooth or of the temporomandibular articulation.

554

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (8) “Oral prophylaxis” means the preventive dental procedure of scaling and polishing which includes complete removal of calculus, soft deposits, plaque, stains and the smoothing of unattached tooth surfaces. The objective of this treatment is to create an environment in which hard and soft tissues can be maintained in good health by the patient. (9) “Periodontal soft tissue curettage” means the closed removal of tissue lining the periodontal pocket, not involving the reflection of a flap. (10) “Root planing” means the process of instrumentation by which the unattached surfaces of the root are made smooth by the removal of calculus or deposits. (11) “Supportive services” means services that are related to clinical functions in direct relationship to treating a patient. (12) "Suturing” is defined as the readaption of soft tissue by use of stitches as a phase of an oral surgery procedure. (13) “Treatment facility” means a dental office or connecting suite of offices, dental clinic, room or area with equipment to provide dental treatment, or the immediately adjacent rooms or areas. A treatment facility does not extend to any other area of a building in which the treatment facility is located. (14) “Volunteer dental assistant” means an individual who, without compensation, provides the supportive services under WAC 246-817-520 in a charitable dental clinic. WAC 246-817-520 Supportive services that may be performed by registered dental assistants. (1) A supervising dentist may delegate the supportive services in subsection (4) of this section under the dentist's close supervision, provided the registered dental assistant has demonstrated skills necessary to perform each task competently. (2) Delegation of supportive services not in subjection (4) of this section may be subject to disciplinary action. (3) In addition to supportive services in subsection (4) of this section, registered dental assistants may perform nonclinical tasks. (4) Supportive services allowed under close supervision: (a) Oral inspection, with no diagnosis. (b) Take and record blood pressure and vital signs. (c) Place, expose, and process radiographs. (d) Take intra-oral and extra-oral photographs. (e) Perform coronal polish. A licensed dentist shall determine the teeth are free of calculus or other extraneous material prior to dismissing the patient. (f) Give fluoride treatments. (g) Give patient education in oral hygiene. (h) Give preoperative and postoperative instructions. (i) Deliver an oral sedative drug to patient. (j) Assist in the administration of inhalation minimal sedation (nitrous oxide) analgesia, including starting and stopping the flow as directed by the supervising dentist. (k) Place topical anesthetics. (l) Place and remove the rubber dam. (m) Apply tooth separators as for placement for Class III gold foil. (n) Apply sealants. (o) Place a matrix and wedge for a direct restorative material after the dentist has prepared the cavity. (p) Place cavity liners and bases. (q) Perform acid etch and apply bonding agents. (r) Polish restorations but may not intra-orally adjust or finish permanent restorations. (s) Sterilize equipment and disinfect operatories. (t) Place retraction cord. (u) Hold in place and remove impression materials after the dentist has placed them. (v) Take impressions, bite registrations, or digital scans of the teeth and jaws for: i. Diagnostic and opposing models; ii. Fixed and removable orthodontic appliances, occlusal guards, bleaching trays, and fluoride trays; and iii. Temporary indirect restorations such as temporary crowns. (w) Take digital scans of prepared teeth for fabrication of permanent indirect restorations. (x) Take a facebow transfer for mounting study casts. (y) Fabricate and deliver bleaching and fluoride trays. (z) Fabricate, cement, and remove temporary crowns or temporary bridges. (aa) Remove the excess cement after the dentist has placed a permanent or temporary inlay, crown, bridge or appliance, or around orthodontic bands. (bb) Place a temporary filling (as zinc oxide-eugenol (ZOE)) after diagnosis and examination by the dentist. (cc) Pack and medicate extraction areas. (dd) Place periodontal packs. (ee) Remove periodontal packs or sutures. (ff) Select denture shade and mold. (gg) Place and remove orthodontic separators. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

555

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (hh) Select and fit orthodontic bands, try in fixed or removable orthodontic appliances prior to the dentist cementing or checking the appliance. (ii) Prepare teeth for the bonding of orthodontic appliances. (jj) Bond attachments for clear removable orthodontic aligners. (kk) Remove and replace archwires and orthodontic wires. (ll) Fit and adjust headgear. (mm) Remove fixed orthodontic appliances, orthodontic cement, and orthodontic bonded resin materials. WAC 246-817-525 Supportive services that may be performed by licensed expanded function dental auxiliaries (EFDAs). (1) A supervising dentist may delegate the supportive services in subsection (5) of this section under the dentist's close supervision, provided the EFDA has demonstrated skills necessary to perform each task competently. (2) A dentist may delegate the supportive services in subsection (6) of this section under the dentist's general supervision, provided the EFDA has demonstrated skills necessary to perform each task. (3) Delegation of supportive services not in subsection (5) or (6) of this section may be subject to disciplinary action. (4) In addition to supportive services in subsections (5) and (6) of this section, licensed EFDAs may perform nonclinical tasks. (5) Supportive services allowed under close supervision: (a) Supportive services under WAC 246-817-520(4), except for supportive services in subsection (6) of this section. (b) Place, carve, finish, and polish direct restorations. (c) Take preliminary and final impressions and bite registrations, to include computer assisted design and computer assisted manufacture applications. (6) Supportive services allowed under general supervision are: (a) Perform coronal polishing. (b) Give fluoride treatments. (c) Apply sealants. (d) Place, expose, and process radiographs. (e) Give patient oral health instructions. WAC 246-817-530 An act that may be performed by unlicensed persons outside the treatment facility. Unlicensed persons may select shade for crowns or fixed prostheses with the use of a technique which does not contact the oral cavity to avoid contamination with blood or saliva. The procedure shall be performed pursuant to the written instructions and order of a licensed dentist. WAC 246-817-540 Acts that may not be performed by registered dental assistants. This list is not all inclusive. Delegation of procedures not in subsection (1) through (22) of this section should not be assumed to be allowed. Supportive services approved for delegation to registered dental assistants are under WAC 246817-520. A dentist may not allow registered dental assistants who are in his or her employ or are acting under his or her supervision or direction to perform any of the following procedures: (1) Any removal of or addition to the hard or soft natural tissue of the oral cavity. (2) Any placing of permanent restorations in natural teeth. (3) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure. (4) Any administration of general or local anesthetic, including intravenous sedation. (5) Any oral prophylaxis, except coronal polishing as a part of oral prophylaxis as defined under WAC 246-817-510 and 246-817-520(4)(e). (6) Any scaling procedure. (7) The taking of any impressions of the teeth or jaws, or the relationships of the teeth or jaws, for the purpose of fabricating any intra-oral restoration, appliances, or prosthesis, other than impressions allowed as a delegated task under WAC 246-817-520. (8) Intra-orally adjust and finish permanent restorations. (9) Cement or recement any permanent restoration or stainless steel crown. (10) Incise gingiva or other soft tissue. (11) Elevate soft tissue flap. (12) Luxate teeth. (13) Curette to sever epithelial attachment. (14) Suture. (15) Establish occlusal vertical dimension for dentures. (16) Try-in of dentures set in wax. (17) Insertion and post-insertion adjustments of dentures. (18) Endodontic treatment - Open, extirpate pulp, ream and file canals, establish length of tooth, and fill root canal. 556

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (19) Use of any light or electronic device for invasive procedures. (20) Intra-oral air abrasion or mechanical etching devices. (21) Place direct pulp caps. (22) Fit and adjust occlusal guards. WAC 246-817-545 Acts that may not be performed by licensed expanded function dental auxiliaries (EFDAs). This list is not all inclusive. Delegation of procedures not in subsections (1) through (20) of this section should not be assumed to be allowed. Supportive services approved for delegation to licensed expanded function dental auxiliaries are under WAC 246-817-525. A dentist may now allow EFDAs who are in his or her employ or are acting under his or her supervision or direction to perform any of the following procedures: (1) Any removal of or addition to the hard or soft natural tissue of the oral cavity except for placing and carving direct restorations. (2) Any diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure. (3) Any administration of general or local anesthetic, including intravenous sedation. (4) Any oral prophylaxis, except coronal polishing as a part of oral prophylaxis as defined under WAC 246-817-510 and 246-817-520(4)(e). (5) Any scaling procedure. (6) Intra-orally adjust and finish permanent inlays, crowns, and bridges. (7) Cement or recement any permanent restoration or stainless steel crown. (8) Incise gingiva or other soft tissue. (9) Elevate soft tissue flap. (10) Luxate teeth. (11) Curette to sever epithelial attachment. (12) Suture. (13) Establish occlusal vertical dimension for dentures. (14) Try-in of dentures set in wax. (15) Insertion and postinsertion adjustments of dentures. (16) Endodontic treatment - Open, extirpate pulp, ream and file canals, establish length of tooth, and fill root canal. (17) Use of any light or electronic device for invasive procedures. (18) Intra-oral air abrasion or mechanical etching devices. (19) Place direct pulp caps. (20) Fit and adjust occlusal guards. Administration of Anesthetic Agents for Dental Procedures WAC 246-817-710 Definitions. The definitions in this section apply throughout WAC 246-817-701 through 246-817790 unless the context clearly requires otherwise. (3) “Anesthesia monitor” means a credentialed health care provider specifically trained in monitoring patients under sedation and capable of assisting with monitoring patients under sedation and capable of assisting with procedures, problems and emergency incidents that may occur as a result of the sedation or secondary to an unexpected medical complication. (5) “Close supervision” means that a supervising dentist whose patient is being treated has personally diagnosed the condition to be treated and has personally authorized the procedures to be performed. The supervising dentist is continuously on-site and physically present in the treatment facility while the procedures are performed by the assistive personnel and capable of responding immediately in the event of an emergency. The term does not require a supervising dentist to be physically present in the operatory. (7) “Dental anesthesia assistant” means a health care provider certified under chapter 18.350 RCW and specifically trained to perform the functions authorized in RCW 18.350.040 under supervision of an oral and maxillofacial surgeon or dental anesthesiologist. (8) “Direct visual supervision” means supervision by an oral and maxillofacial surgeon or dental anesthesiologist by verbal command and under direct line of sight. WAC 246-817-720 Basic life support requirements. Dental staff providing direct patient care in an in-office or out-patient setting must hold a current and valid health care provider basic life support (BLS) certification. Dental staff providing direct patient care include: Licensed dentists, licensed dental hygienists, licensed expanded function dental auxiliaries, and registered dental assistants. Newly hired office staff providing direct patient care are required to obtain the required certification within forty-five days from the date hired.

557

Washington State Dental Practice Act and Administrative Rules for Dental Assistants WAC 246-817-745 Minimal sedation. (2) Procedures for administration: (b) A second individual must be on the office premises and able to immediately respond to any request from the person administering the drug; (c) The patient must be continuously observed while in the office under the influence of the drug; WAC 246-817-755 Moderate sedation. (2) Procedures for administration: (b) A second individual must be on the office premises who can immediately respond to any request from the person administering the drug. (c) The patient must be continuously observed while in the office under the influence of the drug. WAC 246-817-760 Moderate sedation with parenteral agents. (4) Procedures for administration of moderate sedation with parenteral agents by a dentist and an individual trained in monitoring sedated patients: (b) A patient may not be left alone in a room and must be continually monitored by a dentist with a valid moderate sedation with parenteral agent permit or trained anesthesia monitor. (d) When the operative dentist is also the person administering the moderate sedation with parenteral agents, the operative dentist must be continuously assisted by at least one individual experienced in monitoring sedated patients. If treating an adult, the additional individual must have experience or training in adult sedation. If treating a minor, the additional individual must have experience or training in pediatric sedation. WAC 246-817-770 General Anesthesia and deep sedation. (3) Procedures for administration: (c) During deep sedation or general anesthesia, the person administering the anesthesia and the person monitoring the patient may not leave the immediate area; (d) During the recovery phase, the patient must be continually observed by the anesthesia provider or credentialed personnel. WAC 246-817-771 Dental anesthesia assistant. (1) A dental anesthesia assistant must be certified under chapter 18.350 RCW and WAC 246-817-205. (2) A dental anesthesia assistant may only accept delegation from an oral and maxillofacial surgeon or dental anesthesiologist who holds a valid Washington state general anesthesia permit. (3) Under close supervision, the dental anesthesia assistant may: (a) Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia; and (b) Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open. (4) Under direct visual supervision, the dental anesthesia assistant may: (a) Draw up and prepare medications; (b) Follow instructions to deliver medications into an intravenous line upon verbal command; (c) Adjust the rate of intravenous fluids infusion beyond a keep open rate; (d) Adjust an electronic device to provide medications, such as an infusion pump; (e) Administer emergency medications to a patient in order to assist the oral and maxillofacial surgeon or dental anesthesiologist in an emergency. (5) The responsibility for monitoring a patient and determining the selection of the drug, dosage, and timing of all anesthetic medications rests solely with the supervising oral and maxillofacial surgeon or dental anesthesiologist. (6) A certified dental anesthesia assistant shall notify the commission in writing, on a form provided by the department, of any changes in his or her supervisor. (a) The commission must be notified of the change prior to the certified dental anesthesia assistant accepting delegation from another supervisor. The certified dental anesthesia assistant may not practice under the authority of this chapter unless he or she has on file with the commission such form listing the current supervisor. (b) A supervisor must be an oral and maxillofacial surgeon or dental anesthesiologist who holds a valid Washington state general anesthesia permit. (c) For the purposes of this subsection â&#x20AC;&#x153;any changeâ&#x20AC;? means the addition, substitution, or deletion of supervisor from whom the certified dental anesthesia assistant is authorized to accept delegation. WAC 246-817-772 Requirements for anesthesia monitor. (1) When the dentist is also administering the deep sedation or general anesthesia, one additional appropriately trained team member must be designated for patient monitoring. (2) When deep sedation or general anesthesia is administered by a dedicated anesthesia provider, the anesthesia provider may serve as the monitoring personnel.

558

Washington State Dental Practice Act and Administrative Rules for Dental Assistants (3) The dentist cannot employ an individual to monitor patients receiving deep sedation or general anesthesia unless that individual has received a minimum of fourteen hours of documented training (such as national certification American Association of Oral and Maxillofacial Surgeons “AAOMS”) in a course specifically designed to include instruction and practical experience in use of equipment to include, but not be limited to, the following equipment: (a) Sphygmomanometer; or a device able to measure blood pressure; (b) Pulse oximeter; or other respiratory monitoring equipment; (c) Electrocardiogram; (d) Bag-valve-mask resuscitation equipment; (e) Oral and nasopharyngeal airways; (f) Defibrillator; automatic external defibrillator. (4) The course referred to in subsection (3) of this section must also include instruction in: (a) Basic sciences; (b) Evaluation and preparation of patients with systemic diseases; (c) Anesthetic drugs and techniques; (d) Anesthesia equipment and monitoring; and (e) Office anesthesia emergencies. WAC 246-817-99005 Dental assistant, dental anesthesia assistant, and expanded function dental auxiliary fees and renewal cycle. (1) Credentials must be renewed every year on the practitioner's birthday as provided in chapter 246-12 WAC, Part 2. (2) The following nonrefundable fees will be charged for dental assistant, dental anesthesia assistant, and expanded function dental auxiliary credentials: Title of Fee - Dental Professionals Registered dental assistant application

Fee $40.00

Registered dental assistant renewal

21.00

Registered dental assistant late renewal

21.00

Registered dental assistant expired reactivation

20.00

Certified dental anesthesia assistant application

100.00

Certified dental anesthesia assistant renewal

75.00

Certified dental anesthesia assistant late renewal

50.00

Certified dental anesthesia assistant expired reactivation

75.00

Licensed expanded function dental auxiliary application

175.00

Licensed expanded function dental auxiliary renewal

160.00

Licensed expanded function dental auxiliary late renewal

80.00

Licensed expanded function dental auxiliary expired reactivation

50.00

Duplicate credential

15.00

Certification of credential

25.00

559

West Virginia DANB Certificant Counts: West Virginia National Entry Level Dental Assistant (NELDA) certificants

Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

488

Infection Control (ICE)

365

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Susan M. Combs, Executive Director West Virginia Board of Dentistry 1319 Robert C. Byrd Drive P.O. Box 1447 Crab Orchard, WV 25827-1447 Phone: 877-914-8266 Fax: 304-253-9454 Email: wvbde@suddenlinkmail.com Website: www.wvdentalboard.org

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Mercer County Technical Education Center

DANB CDA Certificant State of West Virginia+

$17.85 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of March 5, 2020.

560

Source: 2018 DANB Salary Survey (state data based on 7 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

West Virginia State Radiography Requirements There are no radiography requirements for dental assistants in the state of West Virginia. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions To qualify to perform specified expanded duties in West Virginia, a dental assistant must complete the requirements below. To qualify to perform visual monitoring of nitrous oxide analgesia units in West Virginia, a dental assistant must: (1) Successfully complete a course and exam in monitoring nitrous oxide; the course must be approved by the West Virginia Board of Dentistry (WVBD) AND (2) Be currently certified in health care provider CPR through the American Red Cross or the American Heart Association AND (3) Apply to the WVBD for a certificate. To qualify to perform coronal polishing on children under age 21 in West Virginia, a dental assistant must: (1) Complete two years, at least 3,000 hours, of clinical experience in a dental office, as attested to by the supervising dentist AND (2) Hold the expanded duties certificate issued by the WVBD (see requirements below) AND (3) Successfully complete a coronal polishing course approved by the WVBD AND (4) Complete required clinical experiences under the observation of the supervising dentist, who attests to the dental assistant’s competent performance of the function AND (5) Apply to the WVBD for a certificate. To qualify to perform all other specified expanded duties, a dental assistant must: (1) Successfully complete a course and exam in each of the desired expanded duties; the course must be approved by the West Virginia Board of Dentistry (WVBD) AND (2) Complete required clinical experiences under the observation of the supervising dentist, who attests to the dental assistant’s competent performance of the function AND (3) Apply to the WVBD for a certificate. Any individual, including a dental assistant, acting as a qualified monitor during sedation procedures must have received training and be competent in the recognition and treatment of medical emergencies, monitoring vital signs, the operation of nitrous oxide delivery systems and the use of the sphygmomanometer and stethoscope and must meet the following requirements: For relative analgesia/minimal sedation: Possess a current health care provider BLS/CPR certification (qualified monitor certificate is not required). For anxiolysis/minimal sedation: (1) Possess a current health care provider BLS/CPR certification AND (2) Apply to the WVBD for a qualified monitor certificate. For conscious sedation/moderate sedation (limited enteral or comprehensive parenteral) and general anesthesia/deep conscious sedation: (1) Possess a current health care provider BLS/CPR certification AND (2) successfully complete an American Association of Oral and Maxillofacial Surgeons (AAOMS) or American Academy of Pediatric Dentistry (AAPD) anesthesia assistants certification program or equivalent AND (3) Apply to the WVBD for a qualified monitor certificate. In addition to the above requirements for a qualified monitor, for all levels of sedation, including relative analgesia/minimal sedation, when monitoring a nitrous oxide unit, a certificate to monitor nitrous oxide must be obtained from the Board, as described below.

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – West Virginia Board of Dentistry West Virginia Code CHAPTER 30. PROFESSIONS AND OCCUPATIONS. ARTICLE 4. WEST VIRGINIA DENTAL PRACTICE ACT. §30-4-3. Definitions. As used in articles four, four-a and four-b, the following words and terms have the following meanings: “AAOMS” means the American Association of Oral and Maxillofacial Surgeons; “AAPD” means the American Academy of Pediatric Dentistry; “ACLS” means advanced cardiac life support; “Anxiolysis/minimal sedation” means removing, eliminating or decreasing anxiety by the use of a single anxiety or analgesia medication that is administered in an amount consistent with the manufacturer’s current recommended dosage for the unsupervised treatment of anxiety, insomnia or pain, in conjunction with nitrous oxide and oxygen. This does not include multiple dosing or exceeding current normal dosage limits set by the manufacturer for unsupervised use by the patient at home for the treatment of anxiety; “Authorize” means that the dentist is giving permission or approval to dental auxiliary personnel to perform delegated procedures in accordance with the dentist’s diagnosis and treatment plan;

561

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants “BLS” means basic life support; “Board” means the West Virginia Board of Dentistry; “Central nervous system anesthesia” means an induced, controlled state of unconsciousness or depressed consciousness produced by a pharmacologic method; “CPR” means cardiopulmonary resuscitation; “Conscious sedation/moderate sedation” means an induced, controlled state of depressed consciousness, produced through the administration of nitrous oxide and oxygen and/or the administration of other agents whether enteral or parenteral, in which the patient retains the ability to independently and continuously maintain an airway and to respond purposefully to physical stimulation and to verbal command; “Delegated procedures” means those procedures specified by law or by rule of the board and performed by dental auxiliary personnel under the supervision of a licensed dentist; “Dental assistant” means a person qualified by education, training or experience who aids or assists a dentist in the delivery of patient care in accordance with delegated procedures as specified by the board by rule or who may perform nonclinical duties in the dental office; “Dental auxiliary personnel” or “auxiliary” means dental hygienists and dental assistants who assist the dentist in the practice of dentistry; “Dental office” means the place where the licensed dentist and dental auxiliary personnel are practicing dentistry; “Dentistry” means the evaluation, diagnosis, prevention and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures provided by a dentist; “Direct supervision” means supervision of dental auxiliary personnel provided by a licensed dentist who is physically present in the dental office or treatment facility when procedures are being performed; “Facility Permit” means a permit for a facility where sedation procedures are used that correspond with the level of anesthesia provided; “General anesthesia” means an induced, controlled state of unconsciousness in which the patient experiences complete loss of protective reflexes, as evidenced by the inability to independently maintain an airway, the inability to respond purposefully to physical stimulation or the inability to respond purposefully to verbal command. “Deep conscious sedation/general anesthesia” includes partial loss of protective reflexes and the patient retains the ability to independently and continuously maintain an airway; “General supervision” means a dentist is not required to be in the office or treatment facility when procedures are being performed by the auxiliary dental personnel, but has personally diagnosed the condition to be treated, has personally authorized the procedures and will evaluate the treatment provided by the dental auxiliary personnel; “Health care provider BLS/CPR” means health care provider basic life support/cardiopulmonary resuscitation; “Qualified monitor” means an individual who by virtue of credentialing and/or training is qualified to check closely and document the status of a patient undergoing anesthesia and observe utilized equipment; “Relative analgesia /minimal sedation” means an induced, controlled state of minimally depressed consciousness, produced solely by the inhalation of a combination of nitrous oxide and oxygen or single oral premedication without the addition of nitrous oxide and oxygen in which the patient retains the ability to independently and continuously maintain an airway and to respond purposefully to physical stimulation and to verbal command. “Subcommittee” means West Virginia Board of Dentistry Subcommittee on Anesthesia; ARTICLE 4A. ADMINISTRATION OF ANESTHESIA BY DENTISTS. §30-4A-1. Requirement for anesthesia permit; qualifications and requirements for qualified monitors. (d) Permit holders shall report the names and qualifications of each qualified monitor providing services to that permit holder. A qualified monitor may not perform the functions and responsibilities specified in this article for any level of anesthesia, other than relative analgesia/minimal sedation, without certification by the board. Qualified monitors shall apply for certification and pay the appropriate application fees and renewal fees. Qualified monitors are required to renew annually by the 30th day of June. To be certified as a qualified monitor, the applicant must meet the following minimum qualifications: (1) Possess a current health care provider BLS/CPR certification; (2) For monitoring, conscious sedation/moderate sedation or general anesthesia/deep conscious sedation procedures, successful completion of an AAOMS or AAPD anesthesia assistants certification program; and (3) For monitoring a nitrous oxide unit, successful completion of a board-approved course in nitrous oxide monitoring. §30-4A-3. Classes of anesthesia permits. (a) The board shall issue the following permits: (1) Class 2 Permit: A Class 2 Permit authorizes a dentist to induce anxiolysis/minimal sedation. (2) Class 3 Permit: A Class 3 Permit authorizes a dentist to induce conscious sedation/moderate sedation as limited enteral (3a) and/or comprehensive parenteral (3b) and anxiolysis/minimal sedation. (3) Class 4 Permit: A Class 4 Permit authorizes a dentist to induce general anesthesia/ deep conscious sedation, conscious sedation/moderate sedation and anxiolysis/minimal sedation.

562

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants §30-4A-4. Qualifications, standards and continuing education requirements for relative analgesia/minimal sedation use. (e) A practitioner who administers relative analgesia/minimal sedation shall see that the patient’s condition is visually monitored. At all times, the patient shall be observed by a qualified monitor until discharge criteria have been met. (f) A qualified monitor’s record shall include documentation of all medications administered with dosages, time intervals and route of administration including local anesthesia. (g) A discharge entry shall be made in the patient’s record indicating the patient’s condition upon discharge. (h) A qualified monitor shall hold valid and current documentation: (1) Showing successful completion of a Health Care Provider BLS/CPR course; and (2) Have received training and be competent in the recognition and treatment of medical emergencies, monitoring vital signs, the operation of nitrous oxide delivery systems and the use of the sphygmomanometer and stethoscope. §30-4A-5. Qualifications, standards, and continuing education requirements for a Class 2 Permit. (d) The dentist shall monitor and record the patient’s condition or shall use a qualified monitor to monitor and record the patient’s condition. The documented requirements of a qualified monitor monitoring anxiolysis/minimal sedation cases are as specified by rule. A Class 2 Permit holder may have no more than one person under anxiolysis/minimal sedation at the same time. (e) The patient shall be monitored as follows: (1) Patients shall have continuous monitoring using pulse oximetry. The patient’s blood pressure, heart rate and respiration shall be recorded at least once before, during and after the procedure and these recordings shall be documented in the patient record. At all times, the patient shall be observed by a qualified monitor until discharge criteria have been met. If the dentist is unable to obtain this information, the reasons shall be documented in the patient’s record. The record shall also include documentation of all medications administered with dosages, time intervals and route of administration including local anesthesia. (2) A discharge entry shall be made by the dentist in the patient’s record indicating the patient’s condition upon discharge. (f) A permit holder who uses anxiolysis/minimal sedation shall see that the patient’s condition is visually monitored. The patient shall be monitored as to response to verbal stimulation, oral mucosal color and preoperative and postoperative vital signs. §30-4A-6. Qualifications, standards, and continuing education requirements for Class 3 Anesthesia Permit. (d) The dentist shall ensure that the patient’s condition is monitored and recorded on a contemporaneous record. The dentist shall use a qualified monitor to monitor and record the patient’s condition in addition to the chair side dental assistant. A qualified monitor shall be present to monitor the patient at all times. (e) The patient shall be monitored as follows: (1) Patients shall have continuous monitoring using pulse oximetry and/or equipment required for the standard of care or as specified by rule by a qualified monitor until discharge criteria have been met. The documented requirements of a qualified monitor monitoring limited enteral or comprehensive parenteral sedations cases are as specified by rule. The patient’s blood pressure, heart rate and respiration shall be recorded every five minutes and these recordings shall be documented in the patient record. The record shall also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration including local anesthesia. If the dentist is unable to obtain this information, the reasons shall be documented in the patient’s record. (2) During the recovery phase, the patient shall be monitored by a qualified monitor. (3) A discharge entry shall be made by the dentist in the patient’s record indicating the patient’s condition upon discharge and the name of the responsible party to whom the patient was discharged. (i) A dentist who induces conscious sedation shall employ the services of a qualified monitor and a chair side dental assistant at all times who each shall hold a valid BLS/CPR certification and maintains certification as specified by rule. §30-4A-7. Qualifications, standards, and continuing education requirements for Class 4 Anesthesia Permit. (a) A Class 4 Permit permits the use of general anesthesia/deep conscious sedation, conscious sedation/moderate sedation and anxiolysis/minimal sedation. (e) A dentist who induces general anesthesia/deep conscious sedation shall ensure that the patient’s condition is monitored and recorded on a contemporaneous record. The dentist shall use a qualified monitor to monitor and record the patient’s condition on a contemporaneous record and a chair side dental assistant. The documented requirements of a qualified monitor monitoring general anesthesia/deep conscious sedation cases are as specified by rule. No permit holder may have more than one patient under general anesthesia at the same time. (f) The patient shall be monitored as follows: (1) Patients shall have continuous monitoring using pulse oximetry and/or equipment required for the standard of care or as specified by rule by a qualified monitor until discharge criteria have been met. The patient’s blood pressure, heart rate and oxygen saturation shall be assessed every five minutes and shall be contempora© 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

563

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants neously documented in the patient record. The record shall also include documentation of preoperative and postoperative vital signs, all medications administered with dosages, time intervals and route of administration including local anesthesia. The person administering the anesthesia may not leave the patient while the patient is under general anesthesia; (2) During the recovery phase, the patient shall be monitored, including the use of pulse oximetry, by a qualified monitor; and (3) A dentist may not release a patient who has undergone general anesthesia/deep conscious sedation except to the care of a responsible adult third party. (h) A dentist who induces general anesthesia shall employ the services of a qualified monitor and a chair side dental assistant at all times, who each shall hold a valid BLS/CPR certification and maintains certification as specified by rule. TITLE 5 LEGISLATIVE RULE SERIES 3 FEES ESTABLISHED BY THE BOARD §5-3-5. Schedule of Fees for Dental Assistants 5.1. Nitrous Oxide Monitoring Certificate Application fee 5.2. Orthodontic and/or Restorative Expanded Duties Certificate Application fee

$25.00 $25.00

§5-3-7. Schedule of fees for Anesthesia. 7.5. Qualified Monitor Application Fee 7.6. Qualified Monitor Annual Renewal Fee

$50.00 $25.00

PROCEDURAL RULE SERIES 9 APPLICATION PROCEDURES FOR LICENSURE OR CERTIFICATE §5-9-8. Certificate to Perform Expanded Duties 8.1. Dental Hygienists or Dental Assistants seeking a certificate to perform expanded duties that require a board approved course and examination shall submit an application to the Board prescribed by the Board. 8.2. Each applicant shall submit a fee for application as set forth in the Board’s fee schedule. 8.3. Each applicant shall submit evidence of successful completion of a board approved course by being attached to the appropriate section of the application or submitting a copy of a certificate of completion of a board approved course along with their application. 8.4. Each applicant shall submit evidence of passage of a board approved examination by being attached to the appropriate section of the application or being sent directly by the examining entity to the Board’s office. 8.5. Each applicant for local anesthesia or nitrous oxide monitoring shall submit a copy of a current health provider BLS/ CPR card with their application. §5-9-11. Application for a Qualified Monitor Certificate 11.1. Persons seeking a qualified monitor certificate shall submit an application to the Board prescribed by the Board. 11.2. Each applicant shall submit a fee for application as set forth in the Board’s fee schedule. 11.3. Each applicant shall submit evidence of training as set forth in the W.Va. Code of State Rules §5- 12-1 et seq. 11.4. Each applicant shall submit current documentation showing successful completion of a Health Care Provider BLS/ CPR course. 11.5. Each applicant shall obtain a certificate to monitor nitrous oxide from the Board unless nitrous oxide is not used in the office where the applicant will be a qualified monitor. §5-9-12. Certificate to Perform Expanded Duties 12.1. Dental Hygienists or Dental Assistants seeking a certificate to perform expanded duties that require a board approved course and examination shall submit an application to the Board prescribed by the Board. 12.2. Each applicant shall submit a fee for application as set forth in the Board’s fee schedule. 12.3. Each applicant shall submit evidence of successful completion of a board approved course by being attached to the appropriate section of the application or submitting a copy of a certificate of completion of a board approved course along with their application. 12.4. Each applicant shall submit evidence of passage of a board approved examination by being attached to the appropriate section of the application or being sent directly by the examining entity to the Board’s office. 12.5. Each applicant for local anesthesia and/or nitrous oxide monitoring shall submit a copy of a current health care provider BLS/CPR card with their application. 564

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants LEGISLATIVE RULE SERIES 12 ADMINISTRATION OF ANESTHESIA BY DENTISTS

§5-12-2. Definitions. As used in this rule and unless the context clearly requires a different meaning, the following terms shall have the meanings ascribed in this section. 2.1. “AAOMS” means the American Association of Oral and Maxillofacial Surgeons. 2.2. “AAPD” means the American Academy of Pediatric Dentistry. 2.3. “ACLS” means Advanced Cardiac Life Support. 2.6. “Anxiolysis/minimal sedation” or premedication for anxiety- means removing, eliminating or decreasing anxiety by the use of a single anxiolytic or analgesia medication that is administered in an amount consistent with the manufacturer’s current recommended dosage for the unsupervised treatment of anxiety, insomnia or pain, in conjunction with nitrous oxide and oxygen. This does not include multiple dosing or exceeding current normal dosage limits set by the manufacturer for unsupervised use by the patient (at home), for the treatment of anxiety. 2.8. “BLS” means Basic Life Support. 2.9. “Board” means West Virginia Board of Dentistry. 2.10. “Central Nervous System Anesthesia” means an induced controlled state of unconsciousness or depressed consciousness produced by a pharmacologic method. 2.11. Class 2 Permit means a licensed dentist is authorized to induce anxiolysis/minimal sedation. 2.12. Class 3 Permit means a licensed dentist is authorized to induce conscious sedation/moderate sedation as limited enteral (3a) and/or comprehensive parenteral (3b ), and anxiolysis/minimal sedation. 2.13. Class 4 Permit means a licensed dentist is authorized to induce general anesthesia/deep conscious sedation, conscious sedation/moderate sedation, and anxiolysis/minimal sedation. 2.14. “Conscious sedation/moderate sedation” means an induced controlled state of depressed consciousness, produced through the administration of nitrous oxide and oxygen and/or the administration of other agents whether enteral or parenteral, in which the patient retains the ability to independently and continuously maintain an airway and to respond purposefully to physical stimulation and to verbal command. 2.15. “CPR” means Cardiopulmonary Resuscitation. 2.18 “Dental Assistant” means a personal qualified by education, training or experience who aids or assists a dentist in the delivery of patient care. 2.19. “Facility Permit” means a permit for a facility where sedation procedures are used that correspond with the level of anesthesia provided. 2.20. “General anesthesia/deep conscious sedation” means an induced controlled state of unconsciousness in which the patient experiences complete loss of protective reflexes, as evidenced by the inability to independently maintain an airway, the inability to respond purposefully to physical stimulation, or the inability to respond purposefully to verbal command. “Deep conscious sedation/general anesthesia” includes partial loss of protective reflexes and the patient retains the ability to independently and continuously maintain an airway. 2.21. “Health Care Provider BLS/CPR” means Health Care Provider Basic Life Support/Cardiopulmonary Resuscitation. 2.22. “Operating Team” means the dentists, physicians, certified registered nurse anesthetists, qualified monitors or dental assistants participating in a dental procedure wherein levels of sedation are being administered. 2.26. “Qualified Monitor” means an individual who by virtue of credentialing and/or training checks closely and documents the status of a patient undergoing anesthesia and observes utilized equipment; 2.27. “Qualified Monitor Certificate” certifies an individual is authorized to act as a qualified monitor during sedation procedures. 2.28. “Relative analgesia/minimal sedation” means an induced controlled state of minimally depressed consciousness, produced solely by the inhalation of a combination of nitrous oxide and oxygen, or single oral pre-medication without the addition of nitrous oxide and oxygen in which the patient retains the ability to independently and continuously maintain an airway and to respond purposefully to physical stimulation and to verbal command. Dosage of oral premedication is not to exceed the recommended dosage limits set by the manufacturer for the treatment of anxiety, insomnia or pain. §5-12-6. Qualified Monitors 6.1. All individuals acting as a qualified monitor during sedation procedures shall apply to the Board for a qualified monitor certificate, on a form provided by the Board. The application shall be accompanied by the appropriate application fees and/or renewal fees, no part of which are refundable. The certification shall be renewed annually. Qualified monitor certificates are to be posted in the facility and supporting documentation be available for inspection. 6.2. Qualified monitors shall complete the following educational or certification requirements: (a) Relative analgesia/minimal sedation - the qualified monitor shall possess a current health care provider BLS/ CPR certification, qualified monitor certification is not required for this level of sedation. (b) Anxiolysis/minimal sedation - the qualified monitor shall possess a current health care provider BLS/CPR certification. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

565

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants (c) Conscious sedation/moderate sedation as limited enteral (3a) or comprehensive parenteral (3b) - the qualified monitor shall possess a current health care provider BLS/CPR certification and successful completion of an AAOMS or AAPD anesthesia assistants certification program or an equivalent. (d) General anesthesia/deep conscious sedation -the qualified monitor shall possess a current health care provider BLS/CPR certification and successful completion of an AAOMS or AAPD anesthesia assistants certification program or an equivalent. (e) In addition to the above requirements for a qualified monitor, for all levels of sedation, including relative analgesia/minimal sedation, when monitoring a nitrous oxide unit, a certificate to monitor nitrous oxide must be obtained from the Board, on a form provided by the Board. The application shall be accompanied by the appropriate application fees, no part of which are refundable. Qualified monitors shall have received training and be competent in the recognition and treatment of medical emergencies, monitoring vital signs, the operation of nitrous oxide delivery systems and the use of the sphygmomanometer and stethoscope. 6 .3. A licensed dentist acting as a dentist anesthesiologist with a permit to induce any level of anesthesia, who is only administering anesthesia during a dental procedure, may act as the qualified monitor without a qualified monitor certificate. 6.4. A licensed physician anesthesiologist or certified registered nurse anesthetist, who is only administering anesthesia during a dental procedure, may act as the qualified monitor without a qualified monitor certificate. 6.5. A licensed dentist inducing relative analgesia/minimal sedation, may act as the qualified monitor without a qualified monitor certificate. §5-12-7. Continuous Monitoring 7 .1. A patient undergoing any level of sedation must be continually monitored until discharge criteria have been met. §5-12-8. Change of Employment or Address; Change of or additional facilities 8.1. Every qualified monitor certified by the Board shall report a change of employment to the Board office within twentyfour hours. A change of residence shall be reported within thirty days. LEGISLATIVE RULE SERIES 13 EXPANDED DUTIES OF DENTAL HYGIENISTS AND DENTAL ASSISTANTS

§5-13-2. Definitions. 2.1 “Board” means West Virginia Board of Dentistry. 2.2. “Dental auxiliary personnel” or “auxiliary” means dental hygienists or dental assistants who assist the dentist in the practice of dentistry 2.3. “Direct supervision” means supervision of dental auxiliary personnel provided by a licensed dentist who is physically present in the dental office or treatment facility when procedures are being performed. 2.4. “Final evaluation” means the supervising dentist has evaluated the dental auxiliary's work to ensure expanded duties are performed to the standard of care for the practice of dentistry. 2.5. “General supervision” means a dentist is not required to be in the office or treatment facility when procedures are being performed by the auxiliary dental personnel, but has personally diagnosed the condition to be treated, has personally authorized the procedures and will evaluate the treatment provided by the dental auxiliary personnel. 2.6. “Prior approval” means the supervising dentist has determined the dental auxiliary is competent to perform expanded duties requiring prior approval and has approved these duties be performed before they are necessary. §5-13-3. General Assignment of Duties. 3.1. Licensed dentists may assign to their employed dental hygienists or assistants intraoral tasks as set out in this section for dental hygienists or assistants, subject to the following conditions: (a) The performance of intraoral tasks by dental hygienists or assistants shall be under the direct supervision of the employer-dentist; (b) The following procedures may not be assigned to a dental hygienist or assistant or to any other person not licensed to practice dentistry: (1) Diagnosis, treatment planning and prescription (including prescriptions for drugs and medicaments or authorizations for restorative, prosthodontic or orthodontic appliances); or (2) Surgical procedures on hard and soft tissue within the oral cavity or any other intraoral procedure that contributes to or results in an irremediable alteration of the oral anatomy; and (c) The licensed dentist assigning expanded duties to a dental hygienist or assistant is solely responsible for evaluating the dental hygienist or assistant to determine that he or she is competent to handle assigned duties. No licensed dentist shall assign additional duties to a dental hygienist or assistant until he or she is assured that the dental hygienist or assistant is fully competent and completely qualified to perform the assigned expanded duty or duties. 566

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants §5-13-4. Expanded Duties of Dental Assistants. 4.1. (a) The following duties and/or intra-oral tasks may be assigned by a licensed dentist to a dental hygienist and/or assistant in the licensed dentist’s employment, provided that under no circumstances can an assistant use a power-driven instrument of any type intra-orally except as specifically set forth hereinafter: (1) Placing, exposing, developing, and mounting dental radiographs; (2) Placing and removing rubber dams; (3) Charting existing restorations and missing teeth; (4) Holding and removing materials, trays, strips, and sutures previously placed in the patient’s mouth by the dentist; (5) Removing excess cement from coronal surfaces of teeth without the use of rotating, power-driven or scaling instruments; (6) Taking impressions for study cast and pouring models; (7) Recording medical and dental histories for interpretation by the supervising dentist; (8) Providing pre- and post-treatment instructions: (9) Viewing the oral cavity and reporting the symptoms/problems to the supervising dentist; (10) Performing pulp vitality testing (thermal or electrical) with a final evaluation by the supervising dentist; (11) Inserting and adjusting athletic mouth guards and bleaching trays with a final evaluation by the supervising dentist; (12) Removing periodontal dressings with a final evaluation by the supervising dentist; (13) Placing and removing matrices after a final evaluation by the supervising dentist; (14) Applying topical anesthetic agents with prior approval by the supervising dentist; (15) Applying topical anticariogenic agents after successful completion of a board-approved course and examination and with prior approval of the supervising dentist; (16) Applying pit and fissure sealants after successful completion of a board-approved course and examination and with a final evaluation by the supervising dentist; (17) Applying cavity liners and bases with a final evaluation by the supervising dentist; (18) Removing soft tissue dressings with a final evaluation by the supervising dentist; (19) Fabricating and cementing temporary crowns and bridges with a final evaluation by the supervising dentist; (20) Placing and removing temporary restorations by a non power-driven method with a final evaluation by the supervising dentist; (21) Taking intra- and extra-oral photographs; (22) Chemical conditioning of the tooth to accept a restoration and/or bracket by topical application after successful completion of a board-approved course and examination; (23) Using a power-driven hand piece with rubber cup and/or brush only for preparing a tooth for accepting a restoration and/or appliance, which shall in no way be represented to the patient as a prophylaxis, after successful completion of a board-approved course and examination; (24) Placing retraction cords for crown impressions after successful completion of a board approved course and examination and with prior approval of the supervising dentist; (25) Taking final impressions for fixed or removable prosthesis and/or appliance with a final evaluation by the supervising dentist; (26) Checking for loose orthodontic appliances with a final evaluation by the supervising dentist; (27) Taking orthodontic measurements with a final evaluation by the supervising dentist; (28) Fitting bands and brackets prior to final cementation and/or bonding by the supervising dentist; (29) Bending archwires with a final evaluation by the supervising dentist at the time of placement; (30) Placing or removing temporary space maintainers, orthodontic separating devices, ligatures, brackets and bands with a final evaluation by the supervising dentist at the time of placement or removal, after completion of a board-approved course and examination; (31) Removing loose or broken bands, brackets or archwires when directed by the supervising dentist; and (32) Visually monitoring a nitrous oxide analgesia unit. A dental assistant or hygienist must successfully complete a board-approved course, and examination, and maintain current certification in accordance with the American Red Cross’ or the American Heart Association’s Cardio-Pulmonary Resuscitation (CPR) program to perform this duty. (b) A dental assistant who has completed two years and at least three thousand hours of clinical experience in a dental office, as attested to by the supervising dentist, and who has a restorative expanded duties course or orthodontic expanded duties certificate issued by the Board, and has completed a coronal polishing course approved by the Board, may apply to the Board for a certificate to perform supragingival and coronal polishing on children under age 21 years of age using a slow speed hand piece with a rubber cup.

567

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants Course Guidelines Published by the West Virginia Board of Dentistry CORONAL POLISHING COURSE REQUIREMENTS Course outline, objectives, evaluation mechanism and curriculum vitae of the faculty member must be submitted to the Board at least thirty (30) days before date of scheduled course for approval. The program of education shall include a minimum of three (3) hours of coursework and successful completion of a written examination by a score of at least 75%. Clinical competence will be assessed through documented clinical experiences by the supervising dentist. Objectives for the course must include: - Review of patient’s medical history to determine any contraindications; - Review of infection control, standard precautions and transfer of diseases; - Dental tissues surrounding the teeth and dental anatomy and nomenclature; - Rationale for performing coronal polishing and selective polishing theory; - Beneficial and adverse effects of coronal polishing; - Definition of plaque, types of stain, calculus, and related terminology and topics; - Principles of selecting abrasives and polishing agents and their effect on tooth structure and restorative materials; - Types of equipment and materials used and proper maintenance of equipment; - Proper use of auxiliary polishing aids, their functions and correct flossing technique; - Correct technique for coronal polishing to include: correct positioning for patient/operator (ergonomics), grasp, use of fulcrum, use of dental light and mirror vision, speed of handpiece, use of rheostat and correct rubber cup stroke and procedure; - Procedures to follow in case of medical emergencies; and - Dental ethics, jurisprudence and legal understanding of procedures allowed by each dental team member. Requirement for clinical competency assessment: - After successful completion of the coronal polishing course and exam by the candidate, the supervising dentist shall personally observe the following successful tasks by a dental assistant on five (5) separate patients. - Identifying calculus, plaque, intrinsic and extrinsic stains; - Selection of appropriate abrasives and polishing agents; - Polishing exposed surfaces of the teeth; - Evaluate the extent of plaque and stain removal; and - Adherence to infection control protocols. NITROUS OXIDE ANALGESIA FOR DENTAL HYGIENISTS/DENTAL ASSISTANTS IN WEST VIRGINIA DEFINITIONS “Monitoring” means observing the receiving of nitrous oxide analgesia, recognizing adverse reactions or complications, and reporting them to the supervising dentist immediately. “Approved course” means a course which the Board has approved for the education and training of dental hygienists/ dental assistants to monitor nitrous oxide analgesia. “Board” means the West Virginia Board of Dental Examiners. “Clock hour” means 50 to 60 minutes of instruction. “Dental Hygienist” means a person licensed by the Board who provides preventative oral health care services to patients in the dental office: Provided, that no occupational title other than dental hygienist may be used to describe this auxiliary. “Dentist” means an individual licensed by the Board to practice dentistry. “Dental Assistant” means a person qualified by education, training, and experience who aids or assists a dentist in the delivery of patient care in accordance with delegated procedures or who may perform non-clinical duties in the dental office: Provided, that no occupational title other than dental assistant shall be used to describe this auxiliary. NITROUS OXIDE ANALGESIA PRIVILEGES FOR DENTAL HYGIENISTS AND DENTAL ASSISTANTS A. After satisfying the Board’s requirements to visually monitor nitrous analgesia, a dental hygienist/dental assistant may visually monitor nitrous oxide analgesia under the direct supervision of a dentist.

568

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants B.

Competence to monitor nitrous oxide analgesia must be demonstrated by successfully completing a board-approved course consisting of at least 2 hours of didactic instruction and passing an examination with a 75%. The course content must include, but not be limited to: 1. Nitrous oxide administration 2. Pharmacology of nitrous oxide conscious sedation 3. Nitrous oxide armamentarium/equipment including demonstration 4. Reactions and complications 5. Response to possible emergency situations 6. Removal of nitrous oxide 7. Discontinue use of nitrous oxide analgesia 8. Post-operative instruction C. The course must be taught: 1. On location at a dental or dental hygiene program accredited by the Commission on Dental Accreditation and/or approved by the Board. 2. By the faculty of an accredited dental or dental hygiene institution who are trained and actively involved in clinical instruction. 3. After a written request is submitted to the Board including all course content as specified herein. All institutions with approved courses shall keep the Board informed prior to any changes in course objectives, and/or content, at the time such changes occur. The Board at any time may deny or rescind approval of an approved course for failure to meet or continue to meet the criteria for approval of a course. Courses offered pursuant to this rule are subject to unannounced audits by the Board. Any Board member or designee of the Board shall be provided full access to course materials or the classroom or clinic during instruction. D. A dental hygienist/dental assistant who has been trained to administer/monitor nitrous oxide in another State may qualify for nitrous oxide monitoring by presenting written documentation on licensure and training to the Board providing they meet the requirements set forth herein. REQUIREMENTS FOR APPROVAL OF A DENTAL HYGIENIST/DENTAL ASSISTANT FOR MONITORING OF NITROUS OXIDE SEDATION Dental hygienists/dental assistants must: 1. Submit an application to the Board for approval to monitor nitrous oxide. 2. Provide proof of current certification in health care provider CPR through the American Heart Association or the American Red Cross. This is a pre-requisite to the nitrous oxide course and proof of passage must be presented to the course instructor before admittance into the class. 3. Applicants taking out-of-state courses must: a. Provide course syllabus, name and location of institution, date of course, certificate of completion of a minimum of a 2-hour course. b. Meet or exceed the basic course requirements set forth for didactic instruction. c. Take and pass a Board approved written examination with a score of 75% and fulfill all other requirements stated herein. BOARD APPROVED COURSES REQUIRED FOR DENTAL ASSISTANTS TO PERFORM DUTIES UNDER TITLE 5, SERIES 1, SECTION 8.2 Upon submission of proof of successful completion of a program of education approved by the WV Board of Dentistry, a dental assistant may perform the following functions under the direct supervision of a dentist: (15) Applying topical anticariogenic agents after successful completion of a board-approved course and examination and with prior approval by the supervising dentist; (16) Applying pit and fissure sealants after successful completion of a board-approved course and examination and with a final evaluation by the supervising dentist; (22) Chemical conditioning of the tooth to accept a restoration and/or bracket by topical application after successful completion of a board-approved course and examination; (23) Using a power-driven hand piece with rubber cup and/or brush only for preparing a tooth for accepting a restoration and/or appliance, which shall in no way be represented to the patient as a prophylaxis, after successful completion of a board-approved course and examination; (24) Placing retraction cords for crown impressions after successful completion of a board-approved course and examination and with prior approval by the supervising dentist;

569

West Virginia State Dental Practice Act and Administrative Rules for Dental Assistants The program of education shall include a minimum of six (6) hours of didactic instruction, successful completion of a written examination by a score of at least 75% (both of which have to be reviewed and approved by the Board prior to implementation), and documented clinical experiences by the supervising dentist. The supervising dentist shall personally observe the following successful tasks by a dental assistant after successful completion of an approved program and exam: (a) the application of topical anticariogenic agents on four (4) patients (subparagraph 15.) (b) the application of six (6) pit and fissure sealants (subparagraph 16.) (c) the topical chemical conditioning of six (6) teeth to accept a restoration and/or bracket (subparagraph 22.) (d) using a power-driven hand piece with rubber cup and/or brush for preparing six (6) teeth for accepting a restoration and/or appliance (subparagraph 23.) (e) placing retraction cord for crown impressions on six (6) teeth (subparagraph 24.) Upon submission of proof of successful completion of a program of education approved by the WV Board of Dentistry Examiners, a dental assistant may perform the following functions under the direct supervision of a dentist: (a) placing or removing temporary space maintainers, orthodontic separating devices, ligatures, brackets and bands with a final evaluation by the supervising dentist at the time of placement or removal (subparagraph 30) (b) the topical chemical conditioning of six (6) teeth to accept a restoration and/or bracket (subparagraph 22.) (c) using a power-driven hand piece with rubber cup and/or brush for preparing six (6) teeth for accepting a restoration and/or appliance (subparagraph 23.) The program of education shall include a minimum of four (4) hours of didactic instruction, successful completion of a written examination by a score of at least 75% (both of which have to be reviewed and approved by the Board prior to implementation), and documented clinical experiences by the supervising dentist. The supervising dentist will personally observe and attest that the dental assistant is competent in performing the delegated intraoral tasks after successful completion of an approved program and exam. Please note that after July 28, 2005, a dental assistant will have to successfully complete a program approved by the WV Board of Dental Examiners in order to visually monitor a nitrous oxide analgesia unit (subparagraph ff.). The Board is currently developing these guidelines.

570

Wisconsin DANB Certificant Counts: Wisconsin Certified Dental Assistant (CDA) certificants

604

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Christian Albouras, Executive Director Wisconsin Dentistry Examining Board Department of Safety & Professional Services P.O. Box 8366 Madison, WI 53708-8366 Phone: 608-266-2112 Fax: 608-267-0644 Email: dsps@wi.gov Website: https://dsps.wi.gov/Pages/BoardsCouncils/ Dentistry/Default.aspx

Radiation Health and Safety (RHS)

1,642

Infection Control (ICE)

1,682

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Blackhawk Technical College Fox Valley Technical College Gateway Technical College Northeast Wisconsin Technical College Western Technical College Wisconsin Indianhead Technical College

DANB CDA Certificant State of Wisconsin+

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow has been updated by DANB as of January 10, 2020.

Source: 2018 DANB Salary Survey (state data based on 9 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

571

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the Wisconsin Dentistry Examining Board. For authoritative information regarding state statutes and rules affecting dental assistants, please contact the state dental board. Specific contact information can be found on the previous page.

Wisconsin State Radiography Requirements There are no radiography requirements for dental assistants in Wisconsin. All dental assistants may legally operate dental x-ray equipment and perform dental radiographic procedures.

State Requirements For Expanded Functions There is no designation for expanded functions dental assistants in Wisconsin.

Wisconsin State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Wisconsin Dentistry Examining Board Wisconsin Statutes and Annotations CHAPTER 447 - DENTISTRY EXAMINING BOARD 447.03 License Required (3) EXCEPTIONS. No license or certificate under this chapter is required for any of the following: (g) Any individual who provides remediable procedures that are delegated under s. 447.065 (1). 447.065 Delegation of remediable procedures and dental practices. (1) A dentist who is licensed to practice dentistry under this chapter may delegate to an individual who is not licensed under this chapter only the performance of remediable procedures, and only if all of the following conditions are met: (a) The unlicensed individual performs the remediable procedures in accordance with a treatment plan approved by the dentist. (b) The dentist is on the premises when the unlicensed individual performs the remediable procedures. (c) The unlicensed individual's performance of the remediable procedures is subject to inspection by the dentist. (3) A dentist who delegates to another individual the performance of any practice or remediable procedure is responsible for that individual's performance of that delegated practice or procedure. Wisconsin Administrative Code Chapter DE 11 ANESTHESIA DE 11.02 Definitions. In this chapter, (1) “Analgesia” means the diminution or elimination of pain in a conscious patient. (1m) “Anxiolysis” means the use of medication to relieve anxiety before or during a dental procedure which produces a minimally depressed level of consciousness, during which the patient’s eyes are open and the patient retains the ability to maintain an airway independently and to respond appropriately to physical and verbal command. (2) “Conscious sedation” means a depressed level of consciousness during which the patient mimics physiological sleep, has vitals that are not different from that of sleep, has his or her eyes closed most of the time while still retaining the ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination of pharmacologic and non-pharmacologic methods. (3) “Deep sedation” means a controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including the ability to independently and continuously maintain an airway and to respond purposefully to verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination of pharmacologic and non-pharmacologic methods. (4) “General anesthesia” means a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the ability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination of pharmacologic and non-pharmacologic methods. (6) “Nitrous oxide inhalation” means analgesia by administration of a combination of nitrous oxide and oxygen in a patient. (7) “Operative supervision” means the dentist is in the operatory performing procedures with the aid of qualified staff. (8) “Qualified staff” means a person is certified in the administration of basic life support in compliance with the standards set forth by the American Heart Association, the American Red Cross, or other organization approved by the board, and has training in how to monitor vital signs, and how to use a pulse oximeter, blood pressure cuff, and a precordial or a pretracheal stethoscope. If the dentist is administering deep sedation and general anesthesia under s. DE 11.07, a person shall also be trained in how to use an EKG.

572

Wisconsin State Dental Practice Act and Administrative Rules for Dental Assistants (9) “Routes of administration” include the following: (a) “Enteral” means administration by which the agent is absorbed through the gastrointestinal tract or through the oral, rectal or nasal mucosa. (b) “Inhalation” means administration by which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. (c) “Parenteral” means administration by which the drug bypasses the gastrointestinal tract through either intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), subcutaneous (SC), or intraocular (IO) methods. (d) “Transdermal or transmucosal” means administration by which the drug is administered by patch or iontophoresis. (10) “Time-oriented anesthesia record” means documentation at appropriate intervals of drugs, doses and physiologic data obtained during patient monitoring. DE 11.09 Standards of care. (4) A patient shall be continually observed during the anesthesia period for conscious sedation-enteral, conscious sedation-parenteral, deep sedation, and general anesthesia either by the treating dentist or by qualified staff. No permit holder shall have more than one person in conscious sedation-enteral, conscious sedation-parenteral, deep sedation, or general anesthesia at one time, notwithstanding patients in recovery. (5) Operative supervision is required for deep sedation and general anesthesia. (6) Qualified staff shall continuously monitor post-treatment patients before final evaluation and discharge by the dentist. Written post-operative instructions shall be given to each patient or to a responsible adult who accompanies the patient for those individuals having undergone conscious sedation-enteral, conscious sedation-parenteral, deep sedation, or general anesthesia. Documentation of the post-operative instructions shall be noted in the patient’s chart. (10) Dentists shall maintain verifiable records of the successful completion of any and all training of staff. Chapter DE 12 DELEGATION OF FUNCTIONS TO UNLICENSED PERSONS DE 12.01 Nondelegated Functions. A dentist may not delegate any dental procedure of any description to an unlicensed person if the procedure to be delegated is any of the following: (1) Of a character which may cause damage to the patient’s teeth or oral cavity which cannot be remedied without professional intervention. (2) Of a character which may cause adverse or unintended general systemic reaction. (3) Intended, interpreted, or represented to be preliminary assessments, dental hygiene treatment planning, oral screenings, supragingival, or subgingival calculus removal. DE 12.02 Training. A dentist who delegates any remediable dental procedure or function to an unlicensed person shall first provide training to or verify competency of the person in the performance of the procedure or function. DE 12.03 Reporting violations. (1) A licensee shall report to the board any dentist who is improperly delegating the performance of any dental procedure or function to an unlicensed person, or is delegating to a person performing any dental procedure or function in a manner which is less than minimally competent. (2) A licensee who fails to report the circumstances as specified in sub. (1) constitutes aiding and abetting the violation of a law substantially related to the practice of dentistry or dental hygiene, and shall be in violation of s. DE 5.02 (20), (21), or (22).

573

Wyoming DANB Certificant Counts: Wyoming Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in This State

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

State Board of Dentistry Contact Emily Cronbaugh, Executive Director Wyoming Board of Dental Examiners 2001 Capitol Avenue Emerson Building, Room 105 Cheyenne, WY 82002 Phone: 307-777-7387 Fax: 307-777-3508 Email: emily.cronbaugh@wyo.gov Website: http://dental.wyo.gov

101

Infection Control (ICE)

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Currently, there are no CODA-accredited dental assisting programs in Wyoming. For an updated directory of CODA-accredited dental assisting programs, visit www. danb.org.

DANB CDA Certificant State of Wyoming+

$25.65 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant and exam information is current as of July 1, 2020. State-specific information on the pages that follow is current as of May 22, 2020.

574

Source: 2018 DANB Salary Survey (state data based on 3 responses from this state)

Source: U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, Dental Assistants, on the Internet at www.bls.gov/ooh/healthcare/dental-assistants.htm (visited 4/14/19)

Wyoming State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the indirect supervision of a dentist in Wyoming, a dental assistant must: (1) Complete a course or examination in dental radiography approved by the Wyoming Board of Dental Examiners (WBDE), AND (2) Apply to the WBDE for a dental radiography permit. DANB's Radiation Health and Safety (RHS) exam meets the examination requirement.

State Requirements For Expanded Functions To perform placement of pit and fissure sealants under the direct supervision of a licensed dentist in Wyoming, a dental assistant must: (1a) Complete a WBDE-approved pit and fissure sealants course meeting specified didactic and clinical requirements OR (1b) Complete a CODA-accredited dental hygiene or dental assisting program, AND (2) Submit an application for a Pit and Fissure Sealant Certificate and completed checklist demonstration competency and completion of course to the WBDE. The WBDE accepts successful performance on DANB's Sealants (SE) exam to meet requirements to earn the Wyoming Pit and Fissure Sealants permit. In settings where nitrous oxide anxiolysis, sedation and/or anesthesia are administered, all dental personnel shall be certified in administering Basic Life Support (BLS) for Healthcare Providers. A dentist, operating dentist or sedation/anesthesia permit holder may delegate patient monitoring to qualified dental personnel.

Wyoming State Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Wyoming Board of Dental Examiners STATUTES Title 33 - Professions and Occupations Chapter 15 – Dentists and Dental Hygienists 33-15-123. Duties of other dental auxiliary. Duties of all other dental auxiliary personnel not mentioned in this act shall be set and governed by the rules and regulations of the board. 33-15-128. Definitions. (a) As used in this act: (vi) "Dental assistant" means a person who is supervised by a dentist and renders assistance to a dentist, dental hygienist, dental technician or another dental assistant as described in this act; (ix) "Dental auxiliary" means any person who works under the supervision of a dentist and who provides dental care services to a patient; (x) "Supervision" of a dental auxiliary means the act of directing or overseeing duties performed by a dental auxiliary, as defined by rules and regulations of the board; (xiii) “Expanded duties” means those patient’s services which are beyond those regularly practiced by dental hygienists or dental technicians or other dental auxiliaries functions and which require additional education which shall be approved by the board of dental examiners of Wyoming and are to be performed under direct supervision of a licensed dentist. (xv) “Radiograph” means the film used with an x-ray machine includes the product of a film exposed by an x-ray machine. 33-15-129. Radiograph use permits. (a) Any dental assistant who places or exposes radiographs shall hold a radiograph use permit. RULES AND REGULATIONS Chapter 1

GENERAL PROVISIONS

Section 3. Definitions. (k) “CODA” means Commission on Dental Accreditation. (n) "DANB" means Dental Assisting National Board. (w) “Supervision” of dental auxiliary means the act of overseeing or directing duties performed by a dental auxiliary. Types of supervision may include: (i) “General Supervision” of a dental auxiliary means that a dentist has diagnosed and authorized the procedures which are being carried out; however, a dentist need not be present when the authorized procedures are being performed; © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

575

Wyoming State Dental Practice Act and Administrative Rules for Dental Assistants “Direct Supervision” of a dental auxiliary means that a dentist is physically present in the dental office, a dentist has diagnosed the condition to be treated, a dentist has authorized the procedure to be performed, and before dismissal of the patient, a dentist has approved the work performed by the auxiliary; or (iii) “Indirect Supervision” of a dental auxiliary means that a dentist is physically present in the dental office, a dentist has diagnosed the condition to be treated, and a dentist has authorized the procedure to be performed. (ii)

Section 6. Reference by Incorporation. (a) Each rule and code incorporated by reference is further identified as follows: (iii) Dental Assisting National Board’s Code of Professional Conduct, adopted by and revised April 2015, found at: http://dental.wyo.gov/board/rules. (iv) Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, adopted by Centers for Disease Control and Prevention and revised March 2016, found at: http://dental.wyo.gov/board/rules. Chapter 5 ANESTHESIA ADMINISTRATION AND SEDATION PERMIT PROCEDURES Section 2. Definitions. For the purpose of this chapter, the following definitions shall apply: (b) “Anxiolysis” means the diminution or elimination of anxiety. The relief of patient anxiety or fear should produce minimum somnolence. The technique should be appropriately chosen to render the patient relaxed but have an adequate margin of safety so that excessive somnolence/unconsciousness is not likely. (e) “Combination inhalation” means using an inhalation agent and a sedative agent at the same time. (f) “Competent” means displaying special skill or knowledge derived from training and experience. (g) “Deep sedation” means a drug-induced depression of consciousness during which the patient cannot be easily aroused but responds purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. The patient may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. (j) “Enteral” means a route of administration in which the agent is absorbed through the gastrointestinal tract or mucosa [i.e., oral, rectal, nasal, or sublingual]. (l) “General anesthesia” means a drug-induced loss of consciousness during which the patient is not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. The patient often requires assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. (m) “Inhalation” means a route of administration in which a gaseous or volatile agent is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed. (n) “Local anesthesia” means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug. (o) “Minimal sedation” means a minimally depressed level of consciousness produced by a pharmacological method that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory, and cardiovascular functions are unaffected. (p) “Moderate sedation” previously known as “conscious sedation and/or twilight sedation” means a drug-induced depression of consciousness during which the patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the permit holder. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation. (r) “Nitrous oxide anxiolysis” means the administration by inhalation of a combination of nitrous oxide and oxygen producing an altered level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. (u) “Parenteral” means a route of administration in which the drug bypasses the gastrointestinal tract [i.e., intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous]. Section 3. Standard of Care. (b) A dentist, operating dentist, or permit holder shall be responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of moderate sedation, deep sedation, and/or general anesthesia and providing the equipment, drugs, and protocol for patient rescue. Section 14. Dental Personnel Requirements. (a) All dental personnel shall be certified in administering Basic Life Support for Healthcare Providers. A dentist, operating dentist, or permit holder may delegate patient monitoring to qualified dental personnel. 576

Wyoming State Dental Practice Act and Administrative Rules for Dental Assistants (b) Nitrous Oxide Anxiolysis and Minimal Sedation. During a procedure where nitrous oxide anxiolysis or minimal sedation is administered, at least one (1) dental personnel shall be present. (c) Moderate Sedation. During a procedure where moderate sedation is administered, the operating dentist or permit holder and at least one (1) other dental personnel shall be present. (d) Deep Sedation and/or General Anesthesia. During a procedure where deep sedation and/or general anesthesia is administered, the operating dentist or permit holder and at least two (2) other dental personnel shall be present and at least one (1) shall be experienced in patient monitoring and documentation. Chapter 7 DENTAL AUXILIARIES Section 2. Dental Auxiliary Personnel. Except as otherwise provided, dental auxiliary personnel shall not perform irreversible procedures. Section 6. Dental Assistants. The following applies to all dental assistants: (a) Dental Assistant. A dentist holding a current Wyoming license may employ persons designated as â&#x20AC;&#x153;Dental Assistants.â&#x20AC;? They may be trained by their employer or by an accredited or Board approved program for dental assistants. (b) General Supervision. The following procedures require general supervision: (i) Take vital statistics and health histories; (ii) Instruct patients in proper dental health care; (iii) Process radiographs; (iv) Fabricate and cement temporary crowns; (v) Replace ligature wires and/or place elastic ties; (vi) Remove ligature wire and/or elastic ties; (vii) Place and remove orthodontic separators; and (viii) Remove broken bands, brackets, wires and appliances in emergency situations or as needed for operative or prophylactic purposes. (c) Indirect Supervision. The following procedures require indirect supervision: (i) Take impressions other than final or master impressions and/or digital scan impressions. (ii) Apply topical medications, excluding pit and fissure sealants. (iii) Mix dental materials to be used by the dentist. (iv) Place and expose x-ray image receptors (either film or digital); and (v) Insert arch wires that have been adjusted by the dentist into the brackets or attachments and secured in place. (d) Direct Supervision. The following procedures require direct supervision: (i) Remove sutures; (ii) Assist the dentist in all operative and surgical procedures; (iii) Place and remove rubber dams; (iv) Place and remove matrices; (v) Remove excess cement from the coronal surfaces of the teeth; (vi) Prepare and remove periodontal packs; (vii) Polish the surfaces of the teeth, rubber cup only. A procedure performed by a dental assistant under this subsection may not be billed as a prophylaxis; (viii) Perform whitening procedures; (ix) Place and remove orthodontic wires and/or appliances that have been activated by the dentist; (x) Take impressions for orthodontic retainers and removable appliances; (xi) Remove direct bond attachments and bands; (xii) Place pit fissure sealants; and (xiii) Treat diagnosed dry socket. (e) Prohibitions. The following procedures may not be performed by dental assistants: (i) Remove tooth structure; (ii) Diagnose for treatment; (iii) Take final impressions either digital or conventional or deliver a permanent prosthesis of any type; or (iv) Any procedure billed as a prophylaxis. Section 7. Exposure of Radiographic Images by Dental Assistants. (a) Eligibility. An applicant may seek a permit to expose dental radiographs under the indirect supervision of a dentist, if the applicant demonstrates competency. (b) Application Requirements. Applicant shall: (i) Submit a completed application and payment of fee; and (ii) Demonstrate competency by completion of a course or examination in dental radiography approved by the Board. (c) Renewal. A permit to expose radiographs shall expire December 31 annually, unless renewed. ÂŠ 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

577

Wyoming State Dental Practice Act and Administrative Rules for Dental Assistants Section 8. Placement of Pit and Fissure Sealants by Dental Assistants. (a) Eligibility. An applicant may apply for a pit and fissure sealant permit if the applicant has successfully completed a Board approved course which may include: (i) Board approved course meeting the requirements identified in subsection (c); or (ii) CODA accredited dental hygiene program or a dental assisting program. (b) Application Requirements. Applicant shall submit: (i) Completed application and payment of fee; and (ii) Completed checklist demonstrating competency and completion of course. (c) Education. The education program shall include: (i) Didactic Education including: (A) Infection Control; (B) Microbiology; (C) Chemistry; (D) Dental anatomy; (E) Ethics related to pit and fissure sealant application; (F) Jurisprudence related to pit and fissure sealant application; and (ii) Clinical Instruction including supervised application of sealants. (d) Renewal. A permit to place pit and fissure sealants shall expire December 31 annually, unless renewed. Section 9. Code of Ethics for Dental Hygienists and Dental Assistants. Each dental hygienist and dental assistant practicing in the state of Wyoming shall: (a) Provide oral health care utilizing highest professional knowledge, judgment, and ability. (b) Serve all patients without discrimination. (c) Hold professional patient relationships in confidence. (d) Utilize every opportunity to increase public understanding of oral health practices. (e) Generate public confidence in members of the dental health profession. (f) Cooperate with all health professions in meeting the health needs of the public. (g) Recognize and uphold the laws and regulations governing this profession. (h) Maintain professional competence through continuing education. (i) Exchange professional knowledge with other health professions. (j) Represent dental hygiene and/or dental assisting with high standards of personal conduct. (k) Comply with the provisions of ADHA’s Code of Ethics or Dental Assisting National Board’s Code of Professional Conduct as referenced in Chapter 1. Chapter 10

FEES

Section 3. Fees. Services for which the Board charges a fee shall include, but not be limited to, the following fee schedule (d) Dental Assistants: (i) Application for Radiograph Permit $30 (ii) Application for Pit and Fissure Permit $30 (iii) Radiography and Pit and Fissure Permit Renewal $15

578

United States Military DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

CODA-Accredited Dental Assisting Programs Medical Education and Training Campus, Air Force Dental Assisting Program - Fort Sam Houston, San Antonio, Texas

DANB Exams for the Military DANB exams are administered on computer at authorized on-base military test centers and are accessible to military personnel and civilians with appropriate governmentissued ID and base authorization. Per a federal government mandate, the Army, Air Force and Navy integrated their various dental assisting curricula into one standard curriculum October 1, 2010. DANB and the Air Force Dental Service (AFDS) are collaborating on the administration of DANB’s Infection Control (ICE) and Radiation Health and Safety (RHS) exams. DANB began administering the ICE exam in early 2009 and the RHS exam in early 2010 to AFDS students. Earning the DANB ICE and RHS certificates of knowledge-based competence positions AFDS students to earn DANB’s Certified Dental Assistant (CDA) certification; to do so, they must pass the General Chairside Assisting

(GC) component exam within five years of passing the first of the three component exams. AFDS students who pass the ICE exam are also wellpositioned to earn DANB’s Certified Orthodontic Assistant (COA) certification, which requires that they pass the Orthodontic Assisting (OA) component exam within five years of passing the ICE exam. By administering DANB exams within the AFDS dental technician curriculum, the Air Force gains an independent verification of military personnel knowledge-based competence in these two important curricular areas. For information on dental assisting duties or requirements in the military, contact the chief dental officer in the military unit of interest.

Military Education and Career Information Passed in March 2001, the Montgomery G.I. to Jobs Bill designates reimbursements of up to $2,500 for certification or licensure examinations approved by the VA for active duty or retired army personnel. DANB’s national exams received approval under this program in January 2002; this approval was renewed in 2020. For more information, visit www.benefits.va.gov/gibill DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

Credentialing Opportunities On-Line (COOL) provides information on how military personnel can meet civilian certification and licensing requirements related to their Military Occupational Specialties (MOS). Visit the applicable COOL site for more information: Army: https://www.cool.osd.mil/army/ Navy and Marine Corps: https://www.cool.navy.mil Air Force: https://afvec.us.af.mil/afvec/Public/COOL/

579

Puerto Rico DANB Certificant Counts: Puerto Rico Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

State Board of Dentistry Contact Glimmer Osorio, Secretary of the Board Puerto Rico Board of Dental Examiners Department of Health, Division of Examining Boards P.O. Box 10200 San Juan, PR 00908 Phone: 787-999-8989 ext. 6585 Fax: 787-725-7903 Website: www.salud.gov.pr Email: contactus@salud.pr.gov

DANB Certificates of Knowledge-Based Competence & Component Exams* in Puerto Rico Radiation Health and Safety (RHS)

Infection Control (ICE)

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

CODA-Accredited Dental Assisting Programs University of Puerto Rico - College of Health Related Professions

DANB certificant and exam information is current as of July 1, 2020. Territory-specific information on the pages that follow has been reviewed by DANB as of May 8, 2020. DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

580

Note: DANB has not received confirmation that the state information that follows has been reviewed and approved by the Puerto Rico Board of Dental Examiners. For authoritative information regarding this territory's statutes and rules affecting dental assistants, please contact the territory dental board. Specific contact information can be found on the previous page.

Puerto Rico Radiography Requirements Dental assistants in Puerto Rico must be licensed. See requirements below.

Puerto Rico Requirements for Licensure as a Dental Assistant Any person working as a dental assisting in Puerto Rico must obtain a license from the Puerto Rico Board of Dental Examiners. Dental assisting licensure applicants must meet the following requirements: (1) Be at least 18 years of age, a U.S. citizen and a permanent resident of Puerto Rico, AND (2) Be a high school graduate or equivalent, AND (3) complete a dental assisting program from a school, college or institution in Puerto Rico recognized by the Puerto Rico Department of Education or from a U.S. school, college or institution approved by the Puerto Rico Board of Dental Examiners, AND (4) Pass an exam administered by the Puerto Rico Board of Dental Examiners, AND (5) Have a good moral reputation in the community of habitual residence, AND (6) Pay the required fee.

Puerto Rico Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – Puerto Rico STATUTES Laws of Puerto Rico Annotated TITLE TWENTY Examining Boards and Professional Colleges Chapter 5. Board of Dental Examiners and College of Dental Surgeons Subchapter I. Board of Dental Examiners (From free English Translation located at http://www.lexisnexis.com/hottopics/lawsofpuertorico/.) § 94j. Dental assistants—Practice authorized Dental assistants are hereby authorized to practice in Puerto Rico, subject to the provisions of §§ 81—94u of this title. [It] is hereby understood [that] “dental assistant” [is] the auxiliary dental personnel who works directly with the dentist while the latter is rendering his services to patients in his office. His function and work are aimed at attaining a greater efficiency in the rendering of dental services [by] relieving the dentist from those tasks which do not require a higher degree of academic preparation characteristic of the dentist. § 94k. Dental assistants—Requirements for license Any person aspiring to practice as dental assistant in Puerto Rico shall obtain a license which shall be issued by the Board of Dental Examiners if the applicant meets and fulfills the following requirements: (1) Is eighteen (18) years of age, a citizen of the United States or permanent resident of Puerto Rico; (2) to have graduated from a high school recognized by the Department of Education or to have an equivalent accepted by said Department; (3) has passed a course [in] dental assistance from a school, college or institution in Puerto Rico recognized by the Department of Education or from a school, college or institution of a state of the United States accredited by the Board of Dental Examiners; (4) enjoys [a] good moral reputation in the community of his habitual residence, and (5) pays two dollars ($2) for examination fee and three dollars ($3) for license fee payable by an internal revenue voucher. § 94l. Dental assistants—Examinations The examination to be admitted to practice as dental assistant shall be offered by the Board of Dental Examiners at least twice a year and shall consist of such matters and tests as the Board of Dental Examiners may deem essential to guarantee the good health of the people. § 94m. Dental assistants—License; registration Every person who passes the examination and meets all the qualifications shall be certified by the Board and shall be issued a dental assistant’s license upon proper recording in the registry created which shall be under the control and custody of the Board of Dental Examiners. § 94n. Dental assistants—Term of license; renewal The dental assistant’s license shall be issued every four (4) years, renewable for a like term, without examination, upon payment of a two-dollar ($2) internal revenue voucher for renewal fee. If a dental assistant fails to renew his license, same shall be suspended by the Board of Dental Examiners but he may rehabilitate himself as such by paying the renewal fee, plus a surcharge of two dollars ($2) through an internal revenue voucher. © 2003-2020 Dental Assisting National Board, Inc. All rights reserved.

581

Puerto Rico Dental Practice Act and Administrative Rules for Dental Assistants After a period of four (4) years, on and from the date of expiration of the license, without same having been renewed, the dental assistant shall comply with all the qualifications required by §§ 81—94u of this title for person applying for a license for the first time. § 94o. Dental assistants—Cancellation or suspension of license The Board of Dental Examiners may suspend or cancel the license of a dental assistant, subject to the proceeding provided in § 87a of this title, on the occurrence of one or various of the causes hereinafter set forth: (1) The following cause shall be sufficient for the suspension of a license: (a) Failure to renew license upon expiration of the term fixed by §§ 81—94u of this title. (2) The following causes shall be sufficient for the cancellation of a license: (a) Violation of any of the provisions of §§ 81—94u of this title; (b) conviction of a crime implying moral turpitude; (c) having obtained said license by deceit, fraud or false representation and imposture; (d) addicted to the habitual use of narcotic drugs or intoxicating beverages to the point of being unfit for the practice of dental assistant; (e) manifest negligence in the practice of the profession; (f) to advertise in violation of the provisions of §§ 81—94u of this title, and (g) to perform any work prohibited to dental assistants by §§ 81—94u of this title or by the Board of Dental Examiners. § 94p. Dental assistants—Conditions of practice Dental assistants duly authorized and registered to practice in Puerto Rico may only practice or work under the direction and/or supervision of a duly authorized odontologist either in the latter’s office, or in any other place duly qualified for such practice or in any other place duly qualified in a government department, agency or organization or of a municipality. The work of the dental [assistant] does not include oral pathology diagnostic, prescriptions of medicines and oral prosthesis, nor clinical procedure of irreversible character. The Board of Dental Examiners shall assign, by regulation, the work that the dental assistant may practice, which shall be approved and promulgated in accordance with the Rules and Regulations Act of 1958, and which shall be available within the two (2) months following the date of effectiveness of § 141 and following sections of this Act. The Board of Dental Examiners shall publish said regulations at least during two (2) days in a newspaper of general circulation in Puerto Rico so that the persons concerned may be duly informed of its contents. § 94q. Dental assistants—Advertisements Dental assistants are hereby prohibited to advertise as such. § 94s. Dental assistants—Regulation The Board of Dental Examiners shall be empowered to approve and amend such norms and regulations as may be necessary to enforce the provisions of §§ 81—94u of this title as to the practice of the profession by dental hygienists and by dental assistants, subject to the provisions of the Rules and Regulations Act of 1958. The Board of Dental Examiners shall publish such rules and regulations at least during two (2) days in a newspaper of general circulation in Puerto Rico so that the dentists, dental hygienists and dental assistants be duly informed of the applicable norms and regulations. Those rules and regulations approved by the Board of Dental Examiners relative to dental hygienists under Act No. 6 of April 8, 1954, as amended, hereby repealed, shall continue in force in all that which is compatible until the Board approves new regulations and same shall take effect. § 94t. Dental assistants—Reciprocity The Board of Dental Examiners may establish [reciprocity] with fellow organizations of any of the states of the United States to permit the practice of the profession and to issue licenses without examination to those dental assistants holding a certificate or license of the state concerned and who meet the qualifications provided herein. In order to establish [reciprocity], qualifications fixed in the state concerned shall be similar or equivalent to those required in Puerto Rico and there shall be offered equal opportunity in said state to dental assistants licensed in Puerto Rico by the Board of Dental Examiners. § 94u. Dental assistants—Violations; penalties Any person who violates any of the provisions of §§ 81—94u of this title and of the regulations promulgated thereunder relative to dental hygiene and dental assistance in Puerto Rico shall be guilty of a misdemeanor and upon conviction thereof shall be punished by a fine of not less than fifty dollars ($50) nor more than five hundred dollars ($500) or imprisonment in jail for a term of not less than fifteen (15) days nor more than six (6) months, or both penalties [at] the discretion of the court.

582

U.S. Virgin Islands DANB Certificant Counts: U.S. Virgin Islands Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

DANB Certificates of Knowledge-Based Competence & Component Exams* in U.S. Virgin Islands

Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Board of Dentistry Contact Deborah Richardson-Peter, MPA Director, Professional Licensure and Health Planning Virgin Islands Board of Dental Examiners 3500 Estate Richmond Christiansted, VI 00820-4370 Phone: 340-713-6920 Email: deborah.richardson-peter@doh.vi.gov

Radiation Health and Safety (RHS)

Infection Control (ICE)

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

DANB certificant and exam information is current as of July 1, 2020. Territory-specific information on the pages that follow is current as of July 5, 2020. DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

583

U.S. Virgin Islands Radiography Requirements The U.S. Virgin Islands passed a new law in its 2014 legislative session recognizing dental assistants and authorizing the Board of Dental Examiners to regulate dental auxiliaries. However, at present, the Virgin Islands Board of Dental Examiners has not yet established regulations governing delegation of duties to dental assistants under the new law.

U.S. Virgin Islands Requirements For Expanded Functions The U.S. Virgin Islands passed a new law in its 2014 legislative session recognizing dental assistants and authorizing the Board of Dental Examiners to regulate dental auxiliaries. However, at present, the Virgin Islands Board of Dental Examiners has not yet established regulations governing delegation of duties to dental assistants under the new law.

U.S. Virgin Islands Dental Practice Act and Administrative Rules for Dental Assistants Dental Practice Act – U.S. Virgin Islands Board of Dental Examiners Virgin Islands Code Title 27 Section 1, Subchapter III Board of Dental Examiners – Dental Healthcare Act 62. Definitions. For the purposes of this subchapter: (b) “Auxiliary personnel” means all dental assistants, dental technicians, dental x-ray technicians and other persons employed by dentists or firms and businesses providing dental services to dentists; (c) “Board” means the Board of Dental Examiners; (d) “Commissioner” means the Commissioner of the Department of Health; (e) "Dental assistant” means a person who may perform basic supportive procedures as authorized by this subchapter under direct supervision of a licensed dentist; (j) “Direct supervision” means the supervision of those tasks or procedures that do not require the presence of the dentist in the room where performed but require the dentist’s presence on the premises and availability for prompt consultation, treatment and evaluation; (k) “Indirect supervision” means the supervision of those tasks or procedures that do not require the presence of the dentist in the office or on the premises at the time such tasks or procedures are being performed, but do require that the tasks be performed with the prior knowledge and consent of the dentist; (n) “Premises” for purposes subsection (j) and (k) only, means within the same building, dental office, or treatment facility and within close enough proximity to respond in a timely manner to an emergency or the need for assistance; and 64. Powers and Duties of the Board. The powers conferred on the Board by this subchapter must be liberally construed to protect the health, safety and welfare of the public. The Board, within the context of this subchapter and the requirements of due process, has the following powers and duties to: (5) Regulate auxiliary personnel; (13) Report all final disciplinary actions, license denials and voluntary license limitations or surrenders related to dentists, dental hygienists and other auxiliaries, with any accompanying license limitations or surrenders related to dentists, dental hygienists and other auxiliaries, with any accompanying Board orders, findings of fact and conclusions of law, to the National Practitioners Data Bank and to any other data repository as is appropriate, or as required by law, and report all such actions, denials and limitations or surrenders related to other licensees, with the same supporting documentation, to the appropriate national, practitioner, data repositories recognized by the Board or required by law; Chapter 4B. Mandatory Criminal Background Checks for Applicants Licensed by the Boards of Medical Examiners, Dental Examiners, Nurse Licensure, Pharmacy, Optometrical Examiners, Physical Therapy, Chiropractic Examiners, Podiatry Examiners, Psychology Examiners, Board of Veterinary Medicine, and Board of Naturopathic Physicians 221. Criminal background check requirement. (a) The Virgin Islands Board of Medical Examiners, the Board of Dental Examiners, the Board of Nurse Licensure, the Board of Pharmacy, the Board of Optometrical Examiners, the Board of Physical Therapy, the Board of Chiropractic Examiners, the Board of Podiatry Examiners, the Board of Psychology Examiners, the Board of Veterinary Medicine and the Board of Naturopathic Physicians shall conduct, with the assistance of the Virgin Islands Police Department or any entity qualified to conduct certified criminal background checks, a criminal background check by exchanging fingerprint data with and receiving criminal history record information from the Federal 584

U.S. Virgin Islands Dental Practice Act and Administrative Rules for Dental Assistants Bureau of Investigation for every applicant licensed by the respective board, and every such applicant who is seeking an initial license under this title must pass a criminal background check as a condition of licensure. (b) The requirement to pass a criminal background check also applies to dental assistants regulated by the Board of Dental Examiners under chapter 1, subchapter III and certified nursing assistants regulated by the Board of Nurse Licensure under chapter 1, subchapter IV. (c) All information obtained as a result of the criminal background check made under subsections (a) and (b) must be used for official governmental purposes only. The information must be kept confidential and may not be disseminated to or shared with any private entity for any purpose.

585

Canada DANB Certificant Counts: Canada Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

DANB Certificates of Knowledge-Based Competence & Component Exams* in Canada Radiation Health and Safety (RHS)

Infection Control (ICE)

DANB certificant and exam information is current as of July 1, 2020.

National Examining Board Contact Chief Administrator National Dental Assisting Examining Board 204-2283 St. Laurent Blvd. Ottawa, Ontario, Canada K1G 5A2

Phone: 613-526-3424 Fax: 613-526-5560 Website: www.ndaeb.ca Email: office@ndaeb.ca

Accredited Dental Assisting Programs** **By reciprocal agreement, Level II dental assisting programs that are accredited by the Commission on Dental Accreditation of Canada (CDAC) are recognized by the Commission on Dental Accreditation. The following list of CDAC-accredited programs is current as of December 2019. Alberta: CDI College - Calgary North CDI College - Edmonton Columbia College - Calgary KDM Dental College - Calgary KDM Dental College - Edmonton Northern Alberta Institute of Technology - Edmonton Southern Alberta Institute of Technology - Calgary British Columbia: Camosun College - Victoria CDI College - Burnaby CDI College - Surrey College of New Caledonia - Prince George College of the Rockies - Cranbrook Okanagan College - Kelowna University of the Fraser Valley - Chilliwack Vancouver Community College - Vancouver Vancouver Community College (DADDP)- Vancouver Vancouver Island University - Malaspina Campus - Nanaimo

DANB is a member of the Institute for Credentialing Excellence. The National Commission for Certifying Agencies (NCCA), an Institute for Credentialing Excellence commission with responsibility for accrediting certification programs, has evaluated DANB national certification programs (CDA and COA), including DANB component exams (RHS, ICE, GC and OA), and finds that DANB programs meet NCCA’s highest standards, thus helping to assure validity, reliability and objectivity in the testing process. DANB’s national CDA and COA certification programs are accredited to the ISO/IEC 17024:2012 standards through the International Accreditation Service (IAS).

586

Manitoba: CDI College - Winnipeg Red River College - Winnipeg New Brunswick: Collège communautaire du Nouveau Brunswick - Campbellton (CCNB) Oulton College - Moncton Newfoundland & Labrador: Keyin College - St. John’s Nova Scotia: Cape Breton Business College – Sydney Nova Scotia Community College - Halifax Ontario: Algonquin College - Ottawa Cambrian College of Applied Arts and Technology - Sudbury Confederation College of Applied Arts and Tech. - Thunder Bay Durham College of Applied Arts and Technology- Oshawa Fanshawe College - London George Brown College - Toronto Georgian College of Applied Arts & Technology - Barrie Niagara College - Welland St. Clair College of Applied Arts and Technology - Windsor Prince Edward Island: Holland College - Charlottetown Saskatchewan: Saskatchewan Polytechnic - Regina

* Cumulative totals since 1997. RHS and ICE: cumulative totals since 1997, excluding inactive records archived for data migration purposes in 2018.

International DANB Certificant Counts Outside the United States and Canada Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Certificates of Knowledge-Based Competence & Component Exams* Outside the United States and Canada

DANB Contact Dental Assisting National Board, Inc. (DANB) 444 N. Michigan Ave., Suite 900 Chicago, IL 60611 1-800-367-3262 • Fax: 312-642-8507 www.danb.org • danbmail@danb.org

Radiation Health and Safety (RHS)

Infection Control (ICE)

DANB certificant and exam information is current as of July 1, 2020.

Dental Assisting Programs There are many dental assisting/dental nurse programs outside of the United States and Canada. For information on the programs with which DANB is in contact, call 1-800-367-3262, ext. 431.

* Cumulative totals since 1997. RHS and ICE: cumulative totals since 1997, excluding inactive records archived for data migration purposes in 2018.

587