2022 State Career Ladder Templates by Dental Assisting National Board

2022

State Career Ladder Templates

A publication of easy-to-read, state-specific career ladders reflecting 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

DANB’s State Career Ladder Templates for Dental Assistants: Note on the 2022 Edition The past several years have been remarkable and challenging in many ways. DANB continues to marvel at the diligence and resilience of our colleagues in oral health and to commend the unwavering commitment to patient safety exhibited by the oral healthcare community. In 2020, we made our state publications – DANB’s State Career Ladder Templates for Dental Assistants, and its companion resource, DANB’s State Fact Booklet – available online to all stakeholders, at no cost, using the Issuu online publishing platform. In 2022, we are continuing to provide these materials at no cost to you, to show our strong support for the dental assisting profession and those charged with ensuring that dental assistants are competent and qualified to perform the duties delegated to them. 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 2022. The online editions are not downloadable, but if you would like to receive a copy of either publication or both in PDF format, you may send a request to DANB’s Government Relations team at gr@danb.org. As in previous years, the individual state pages of DANB’s State Career Ladder Templates are available for download from DANB’s website in the “Meet State Requirements” section and by navigating to the individual state through the search-by-state map. We will continue to evaluate stakeholder feedback, environmental considerations and practical factors to determine whether to produce print and online versions of its state publications in the future 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 Landsberg, DANB’s Director, Government Relations, at klandsberg@danb.org. We express our gratitude to all members of the dental community who have continued to provide quality and compassionate care during the last few difficult years. We are pleased and proud to work with you to protect the public.

TABLE OF CONTENTS About DANB ......................................................................... 2

Montana............................................................................... 97

DANB National Certifications and Exams ............................ 3

Nebraska............................................................................. 99

State and Federal Recognition.............................................. 4

Nevada.............................................................................. 102

Additional DANB Services and Resources............................ 5

New Hampshire................................................................. 104

The DALE Foundation........................................................... 7

New Jersey........................................................................ 109

About Each State’s information.............................................. 7

New Jersey (Orthodontic)...................................................113

2022 State Career Ladder Templates for Dental Assistants.. 8

New Mexico........................................................................114

DANB/ADAA Core Competencies Study............................. 10

New Mexico (Community Dental Health Coordinator)........118

Dental Assisting Functions List.............................................11

New York.............................................................................119

Levels of Supervision........................................................... 12

North Carolina.................................................................... 121

DANB and Its Relationship to State Regulatory Bodies...... 12

North Dakota...................................................................... 125 North Dakota (Anesthesia Assisting)................................. 130

STATE CAREER LADDER TEMPLATES

Ohio ................................................................................... 131

Alabama............................................................................... 14

Oklahoma.......................................................................... 136

Alaska.................................................................................. 16

Oklahoma (Oral Maxillofacial Surgery Assistant)............... 139

Arizona................................................................................. 18

Oregon............................................................................... 140

Arkansas.............................................................................. 21

Oregon (orthodontic).......................................................... 144

California.............................................................................. 23

Oregon (Preventive).......................................................... 145

California (Orthodontic)........................................................ 28

Oregon (Anesthesia).......................................................... 146

California (Dental Sedation Assistant)................................. 30

Pennsylvania..................................................................... 148

Colorado.............................................................................. 32

Rhode Island...................................................................... 150

Connecticut.......................................................................... 34

Rhode Island (DAANCE Certified Maxillofacial Surgery

Delaware.............................................................................. 36

Assistant)........................................................................... 152

District of Columbia.............................................................. 38

South Carolina................................................................... 153

Florida.................................................................................. 41

South Dakota..................................................................... 156

Georgia................................................................................ 45

South Dakota (Analgesia, Sedation and Anesthesia)........ 159

Hawaii.................................................................................. 48

Tennessee......................................................................... 161

Idaho.................................................................................... 50

Texas................................................................................. 164

Illinois................................................................................... 52

Utah ................................................................................... 167

Indiana................................................................................. 56

Vermont............................................................................. 169

Iowa ..................................................................................... 58

Virginia............................................................................... 172

Kansas................................................................................. 64

Washington........................................................................ 177

Kentucky.............................................................................. 66

Washington (Dental Anesthesia Assistant)........................ 181

Louisiana............................................................................. 69

West Virginia...................................................................... 182

Maine................................................................................... 72

Wisconsin.......................................................................... 186

Maryland.............................................................................. 74

Wyoming............................................................................ 188

Maryland (Orthodontic)........................................................ 77 State Regulation of Dental Assistants’ Roles

Massachusetts..................................................................... 78 Michigan.............................................................................. 84

in Sedation and Anesthesia....................................... 191

Minnesota............................................................................ 87

State Dental Board Contact Information............................ 203

Mississippi............................................................................ 92 Missouri................................................................................ 94 © 2006-2022 Dental Assisting National Board, Inc. All rights reserved.

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 38 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®)

Certified Preventive Functions Dental Assistant (CPFDA®)

Includes component exams in:

• Anatomy, Morphology and Physiology (AMP)* • Radiation Health and Safety (RHS®)* • Infection Control (ICE®)*

• Coronal Polish (CP)* • Sealants (SE)* • Topical Fluoride (TF)*

Certified Dental Assistant™ (CDA®) Includes component exams in:

Certified Restorative Functions Dental Assistant (CRFDA®)

• Radiation Health and Safety (RHS)* • Infection Control (ICE)* • General Chairside Assisting (GC)

Includes component exams in: • • • •

Certified Orthodontic Assistant (COA®)

Impressions (IM)* Temporaries (TMP)* Sealants (SE)* Restorative Functions (RF)

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

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 Certifying Bodies for its CDA and COA certification programs.

Launched in 2022: OSAP-DANB Dental Infection Prevention and Control Certifications DANB has collaborated with the Organization for Safety, Asepsis and Prevention (OSAP) on two new certifications in dental infection prevention and control: •

Certified in Dental Infection Prevention and Control (CDIPC)® Clinically focused and intended for dental team members, educators, consultants and supervisors

•

Dental Industry Specialist in Infection Prevention and Control (DISIPC)® Intended for non-clinical dental industry personnel, such sales representatives, dental practice managers, state regulatory board inspectors/investigators, and anyone else who meets eligibility requirements

Both certifications were launched in 2022 and provide a rigorous and comprehensive assessment of infection prevention and control knowledge. Visit www.dentalinfectioncontrol.org for details.

DANB exams and OSAP-DANB certification exams are available at more than 250 proctored, secure computerized testing sites nationwide through Pearson VUE. DANB also delivers selected exams via online remote proctoring.

STATE AND FEDERAL RECOGNITION CDA certification is recognized or required** to perform specified functions or to earn advanced status 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 Wisconsin

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

Massachusetts Minnesota Mississippi Nebraska New Jersey North Carolina North Dakota

Ohio South Carolina South Dakota Tennessee Texas Vermont

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

Massachusetts New Jersey

Oregon Rhode Island

Oregon

Massachusetts

Maryland Massachusetts Minnesota Montana New Hampshire New Jersey New Mexico North Dakota Oregon

New Mexico Ohio

Oregon Texas

Wyoming

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

New Mexico

DANB's RF exam is recognized** in: North Dakota

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

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

Rhode Island

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

North Dakota Oregon

DANB’s SE exam is recognized** in:

Arizona

Rhode Island

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

Arizona New Jersey

New Mexico

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

New Hampshire New York

DANB’s CP exam is recognized** in:

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

DANB exams are recognized or required in 38 states and D.C.

Pennsylvania South Carolina South Dakota Tennessee Utah Virginia Wyoming

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.

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

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

Credential Verification and Protection 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. 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

State Fact Booklet DANB’s State Fact Booklet is a comprehensive companion to this publication and provides facts, figures, summarized requirements and excerpts from statutes and regulations pertaining to dental assistants for each state. This annual resource contains state-specific dental assisting information for all 50 states, including: • State board of dentistry contact information • Accepted and/or required DANB examinations • Requirements for performing radiography procedures and expanded functions • Excerpts from the state dental practice act and state administrative rules pertaining to dental assistants 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 2022 State Fact Booklet uses information from the 2020-21 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. 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.

DANB’s Website DANB’s website at www.danb.org provides resources that support every member of the dental community. DANB’s Search by State section provides state-specific dental assisting information in an easy-to-use, 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 may meet: • State CE requirements • Advanced training prerequisites • Infection control requirements • Radiography didactic education requirements THE OFFICIAL DANB AFFILIATE www.dalefoundation.org Featured Advertisement

ABOUT EACH STATE’S INFORMATION Each state’s entry in this publication contains DANB’s summary of the information contained in the dental practice acts and administrative rules published by the state boards of dentistry. The staff of each state's board of dentistry received a copy of that state's career ladder pages for review and approval prior to publication. If DANB did not receive a reply from a state’s board of dentistry or other governing agency as of the time of publication, then that state’s career ladder template contains a note indicating that DANB has not received confirmation of approval from the state agency. Contents of state dental practice acts and administrative rules are subject to change by the relevant state entities at any time. Information is current only as of the date indicated on the first page for each state. DANB has no involvement with, nor is it responsible for, additions, deletions, changes, or modifications to individual state practice acts/administrative rules. If you have any questions about the information contained in this publication, please contact your state dental board. DANB has provided state dental board contact information on page 203. DANB encourages readers to visit the state websites and/or contact the relevant state entities for the complete dental practice act and related provisions, which provide information in addition to the summaries pertaining to dental assistants and dental assisting functions contained in this volume. 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. © 2006-2022 Dental Assisting National Board, Inc. All rights reserved.

DANB’S 2022 STATE CAREER LADDER TEMPLATES FOR DENTAL ASSISTANTS In these pages, you will find easy-to-use charts containing essential information to guide you to a clearer understanding of how your state defines the job titles/categories and the legal practice of dental assistants and, in some states, orthodontic assistants, sedation/anesthesia assistants or other specialized assistants. This volume will also contain charts outlining duties and requirements for emerging workforce models along the dental assisting career ladder, such as New Mexico’s Community Dental Health Coordinator. DANB has published its State Career Ladder Templates for Dental Assistants annually since 2006. In response to feedback from our stakeholders, DANB unveiled a new design for the 2020 and later editions. The new design is not constrained by the former two-page format and allows us to display information in a way that better accommodates that expanding field of dental assisting.

New Design Snapshot, First Page MD

MARYLAND: OVERVIEW State-approved April 14, 2020

Other Levels

State Job Titles

State Career Ladder There are two recognized levels of general dental assistants in Maryland. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant Qualified in General Duties

Dental Assistant

The numbers shown here are used to identify the specific section defining each level on the pages that follow.

Other Specialized Dental Assistant Categories This state allows dental assistants meeting requirements in the following specialized categories to perform sets of functions specific to those categories. See requirements and functions for these categories on the indicated pages.

Orthodontic

See page 74

State Radiography Requirements

Be at least 18 years of age AND II. Be of good moral character AND III. Hold a high school diploma or its equivalent AND IV. Successfully complete a Board-approved course of at least 24 hours related to Maryland dental radiology AND V. Pass the national DANB Radiation Health and Safety (RHS) exam or Certified Dental Assistant (CDA) exam AND

Any specialized dental assistant categories are listed here, with page numbers for charts with information about those categories Requirements for dental assistants to perform radiography procedures are listed next.

VI. 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.

Functions NOT Permitted by Dental Assistants in Maryland Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 10 for more information.

Prohibited

The state’s job titles are listed in ascending order from bottom to top, demonstrating the career ladder for dental assistants.

The following functions are not permitted* by a Dental Assistant and a Dental Assistant Qualified in General Duties: 9, 20. Oral prophylactic procedures, including scaling, root planing and polishing teeth 15. Placing or removing an arch wire 15. Placing elastics or ligatures 29. Preparing or fitting orthodontic bands 33, 51. Condensing, carving or finishing any restoration 35. Placing an initial surgical dressing

Functions that may not be delegated to dental assistants (prohibited functions) are listed here.

40. Apply pit and fissure sealants 59. Monitoring nitrous oxide • Examination, diagnosis and treatment planning • Surgery on hard or soft tissues • Administering injectable local anesthesia Prohibited Functions list continued on next page.

DANB’S 2022 STATE CAREER LADDER TEMPLATES FOR DENTAL ASSISTANTS New Design Snapshot, Second Page MARYLAND

State-approved April 14, 2020

Functions NOT Permitted by Dental Assistants in Maryland, continued

Prohibited Duties

• • • • • • • • • • • •

Initiation of treatment at any time for the correction of malocclusions and malformations of the teeth or jaws Adjusting occlusion of natural teeth, restorations or appliances Registration of jaw relations Perform manual curettage Selecting headgear Adjusting prosthetic appliances Cementing of orthodontic bands, placement of bonded attachments or the removal of cement or bonded orthodontic bands and attachments Cementing permanent crowns or restorations Administering nitrous oxide Apply silver diamine fluoride Glucose monitoring Arch wire adjustment

• • • • • • • • • • • •

Bleaching (internal, laser or high-intensity light) Use a high speed handpiece intraorally Oral cancer screenings Oral cancer tissue biopsy Placing initial periodontal dressing Placement of liquid dam Apply and remove socket dressing Placement of subgingival medicaments Remove intracoronal temporary restoration Polish restorations Place sutures Any other duty prohibited by the Maryland State Board of Dental Examiners (for additional prohibited duties, see the “Dental Auxiliaries Procedures Chart” on the Maryland Board’s website at https://health.maryland.gov/dental)

Dental Assistant

For each level of dental assistant, there is a pair of two boxes.

Requirements

Education, Training and Credential Requirements A dental assistant in the state of Maryland may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting. A dental assistant working under general supervision for a sealant program must do all of the following: • • • •

Maintain American Heart Association Basic Life Support for Healthcare Providers (BLS) or American Red Cross CPR for Professional Rescuers Have at least 400 hours of dental assisting clinical practice in dental patient care Successfully complete a Board-approved course of at least two hours in infection control with OSHA protocol, or be Qualified in General Duties (see requirements above) or Orthodontic Duties (see requirements on p. <?>), or hold current DANB CDA or COA certification Enter into a written agreement with the supervising dentist setting forth the terms and conditions of practice under general supervision

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page XX for more information. Under Direct Supervision* 12. Delivering restorative material with dentist at chairside 18. Applying topical fluoride rinse or foam tray; apply fluoride varnish 24. Instructing on oral hygiene 27, 25, 48. Placement and removal of materials for the isolation of the dentition, provided that the material is not retained by the dentition 37. Take and record vital signs 44. Taking impressions for study models or diagnostic casts 48 Rinsing and aspiration of the oral cavity 48. Retraction of the lips, cheek, tongue and flaps 48. Place and remove cotton rolls 56. Applying topical anesthesia 64. Constructing athletic mouth guards on models • Performing intraoral photography • Curing by the use of halogen light • Checking for loose bands • Any other duty approved by the Maryland State Board of Dental Examiners (see the “Dental Auxiliaries Procedures Chart” on the Maryland Board of Dental Examiners’ website at https://health.maryland.gov/dental for additional duties)

Under General Supervision* for a dental sealant program** 24. Instructing on oral hygiene 25. Cleaning and disinfecting environmental surfaces and equipment 25. Sterilizing instruments 27, 45, 48. Placing and removing materials for the isolation of the dentition, if the material is not retained by the dentition 30. Transferring instruments and sealants to a dentist or dental hygienist 41. Preparing materials for the application of sealants 48. Retracting lips, cheek, and tongue 48. Rinsing and aspirating the oral cavity ** A dental assistant may only perform these duties under general supervision of a dentist for a facility that has been granted a waiver of onsite supervision for a dental hygienist or while assisting a dental hygienist who has received a waiver of onsite supervision, pursuant to applicable Maryland State Board of Dental Examiners regulations.

*Direct Supervision: 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. General Supervision: 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.

The top, darker blue box contains a summary of the education, training and credential requirements for that level.

The lower, lighter blue box contains a list of functions that may be delegated to dental assistants who have met the requirements for that level, and the supervision level required for delegation of these functions The numbers beside some functions indicate that the functions were included in a 2002-2005 study of dental assisting core competencies (see page 11 for more information).

Definitions of supervision levels, specific to each state, are provided.

This resource will prove invaluable to anyone who is just entering the field of dental assisting, to those seeking career guidance, or to those wanting to understand the often-complex rules and regulations for each state. It will help assistants who plan to relocate, who are interested in continuing their education, or who seek to develop their professional responsibilities and skills. It will also aid state dental board members and officials who are interested in comparing their state’s requirements to others.

DANB’S STATE CAREER LADDER TEMPLATES AND THE DANB/ADAA STUDY TO DEFINE AND RANK CORE COMPETENCIES FOR DENTAL ASSISTANTS DANB’s 2022 State Career Ladder Templates for Dental Assistants draws upon research conducted as part of the DANB/ADAA Study to Define and Rank Core Competencies for Dental Assistants. While the concept of a national set of dental assisting tasks has been considered periodically over the years, the initiation of such an undertaking came about in 2000, when DANB teamed up with the American Dental Assistants Association (ADAA) to form the ADAA/DANB Alliance (formerly the ADAA/DANB Ad Hoc Committee to Enhance the Dental Assisting Profession). Formed to address many issues related to the dental assisting profession, one of the primary goals of this collaboration was to define and rank core dental assisting competencies (from most basic to most complex) in support of one national set of tasks, levels and minimum requirements to perform these tasks, and to reinforce the concept of a viable career ladder for assistants. The Alliance determined that quantitative research was necessary to support qualitative “think tank” studies conducted by the ADAA in the early 1990s (“Position Paper of the ADAA Task Force to Investigate Mandatory Education and Credentialing for Dental Assistants,” 1994). The DANB/ADAA Study to Define and Rank Core Competencies for Dental Assistants was conducted from March 2002 until June 2005. The ADAA/DANB Alliance received and evaluated responses from dental assistants holding DANB’s Certified Dental Assistant (CDA) certification, non-certified assistants, program directors from accredited dental assisting programs, and dentists. Because the ultimate goal of the DANB/ADAA Core Competencies Study was to define and rank order dental assistant responsibilities, the definitions had to be clearly defined by experience level, yet sufficiently broad in the educational requirements to reflect the estimate that at least 50 percent and perhaps as many as 90 percent of the approximately 300,000 dental assistants nationwide receive all or the majority of their training on the job. The ADAA/DANB Alliance developed a list of 70 dental assisting tasks (see following page) that were representative of a broad range of core competencies and created a survey in which respondents were asked to determine the job level (categories A, B, C and D) based on training, education and/or experience that should be (not what currently is) required to perform each task. Job titles were assigned to each level: Expanded Functions Dental Assistant (EFDA), DANB Certified Dental Assistant (CDA) or Registered Dental Assistant (RDA), Dental Assistant, and Entry Level Assistant. In addition, DANB has matched the dental assisting tasks from each of the state practice acts to the 70 Core Competency tasks used in the survey. If a state references a task not represented in the 70 Core Competency tasks, it appears in the career ladder template without a number designation. This numbering system facilitates easier job title/task comparisons among states. While the publication of DANB’s State Career Ladder Templates for Dental Assistants is part of the initiative to support the development of a national career ladder model for dental assistants, it is also a useful tool with which to view a state’s existing career ladder in a simple, easy-to-read format.

DENTAL ASSISTING FUNCTIONS LIST The following is a list of 70 dental assisting tasks developed by the ADAA/DANB Alliance in the course of its research. These selected tasks were determined to be representative of a broad range of dental assisting core competencies. Functions in each state that correspond to the national Core Competencies Study functions are numbered in the Career Ladder Template, using language directly from the state’s dental practice act or regulations. Functions listed with bullets in the Career Ladder Template are part of the state’s dental practice act or regulations but are not specific matches to DANB research. 1.

Perform mouth mirror inspection of the oral cavity

25. Perform sterilization and disinfection procedures

49. Perform vitality tests

Chart existing restorations or conditions

26. Provide pre- and post-operative instructions

51. Carve amalgams

Phone in prescriptions at the direction of the dentist

27. Place and remove dental dam

Receive and prepare patients for treatment, including seating, positioning chair and placing napkin

Complete laboratory authorization forms

Place and remove retraction cord

Perform routine maintenance of dental equipment

Monitor and respond to post- surgical bleeding

Perform coronal polishing procedures

10. Apply effective communication techniques with a variety of patients

28. Pour, trim and evaluate the quality of diagnostic casts 29. Size and place orthodontic bands and brackets 30. Using the concepts of fourhanded dentistry, assist with basic restorative procedures, including prosthodontics and restorative dentistry 31. Identify intraoral anatomy 32. Demonstrate understanding of the OSHA Hazard Communication Standard 33. Place, cure and finish composite resin restorations

50. Place temporary fillings 52. Process dental radiographs 53. Mount and label dental radiographs 54. Remove temporary crowns and cements 55. Remove temporary fillings 56. Apply topical anesthetic to the injection site 57. Demonstrate understanding of the Centers for Disease Control and Prevention Guidelines 58. Using the concepts of fourhanded dentistry, assist with basic intraoral surgical procedures, including extractions, periodontics, endodontics and implants

34. Place liners and bases

11. Transfer dental instruments

59. Monitor nitrous oxide/oxygen analgesia

35. Place periodontal dressings

12. Place amalgam for condensation by the dentist

60. Maintain emergency kit

36. Demonstrate understanding of the OSHA Bloodborne Pathogens Standard

61. Remove permanent cement from supragingival surfaces

13. Remove sutures 14. Dry canals 15. Tie in arch wires 16. Demonstrate knowledge of ethics/ jurisprudence/patient confidentiality 17. Identify features of rotary instruments 18. Apply topical fluoride 19. Select and manipulate gypsums and waxes 20. Perform supragingival scaling 21. Mix dental materials 22. Expose radiographs 23. Evaluate radiographs for diagnostic quality 24. Provide patient preventive education and oral hygiene instruction

37. Take and record vital signs 38. Monitor vital signs 39. Clean and polish removable appliances and prostheses 40. Apply pit and fissure sealants 41. Prepare procedural trays/ armamentaria setups 42. Place orthodontic separators 43. Size and fit stainless steel crowns 44. Take preliminary impressions 45. Place and remove matrix bands 46. Take final impressions 47. Fabricate and place temporary crowns 48. Maintain field of operation during dental procedures through the use of retraction, suction, irrigation, drying, placing and removing cotton rolls, etc.

62. Remove periodontal dressings 63. Place post-extraction dressings 64. Fabricate custom trays, to include impression and bleaching trays, and athletic mouthguards 65. Recognize basic medical emergencies 66. Recognize basic dental emergencies 67. Respond to basic medical emergencies 68. Respond to basic dental emergencies 69. Remove post-extraction dressings 70. Place stainless steel crown

LEVELS OF SUPERVISION An important consideration in the discussion of the delegation of tasks to dental assistants is that of supervision of dental assistants by their dentist-employers. The American Dental Association (ADA) has identified five levels of supervision for allied dental personnel, including dental assistants, which it defines in its “Comprehensive Policy Statement on Allied Dental Personnel,” (2010: 505) which is part of its Current Policies, last updated in 2020. Note that “allied dental personnel” refers to dental assistants, dental hygienists and dental laboratory technicians. The five levels of supervision defined by the ADA are as follows: Personal supervision. A type of supervision in which the dentist is personally operating on a patient and authorizes the allied dental personnel to aid treatment by concurrently performing a supportive procedure. Direct supervision. A type of supervision in which a dentist is in the dental office or treatment facility, personally diagnoses and treatment plans 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 allied dental personnel, and evaluates their performance before dismissal of the patient. Indirect supervision. A type of supervision in which a dentist is in the dental office or treatment facility, has personally diagnosed and treatment planned 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 allied dental personnel, and will evaluate the performance of the allied dental personnel. General supervision. A type of supervision in which a dentist is not required to be in the dental office or treatment facility when procedures are provided, but has personally diagnosed and treatment planned the condition to be treated, has personally authorized the procedures, and will evaluate the performance of the allied dental personnel. Public Health Supervision. A type of supervision in which a licensed dental hygienist may provide dental hygiene services, as specified by state law or regulations, when such services are provided as part of an organized community program in various public health settings, as designated by state law, and with general oversight of such programs by a licensed dentist designated by the state. Furthermore, the ADA’s “Comprehensive Policy Statement on Allied Dental Personnel” stipulates that intraoral expanded functions should be performed by allied dental personnel “under the supervision of a dentist.” Because the study of dental assisting core competencies undertaken by the ADAA/DANB Alliance did not address the question of supervision, the ADAA/DANB Alliance has not made any recommendations as to the levels of supervision that should be necessary for the delegation of the tasks included in the study to dental assistants. However, the ADAA/DANB Alliance believes it is important to call attention to the fact that while the ADA has defined supervision levels in the aforementioned policy statement, which governs the ADA’s own activities and the activities of its members, these definitions have not been uniformly adopted by the dental boards of every U.S. state or district. For the purposes of this volume, if a state’s dental practice act specifically defines levels of supervision, the state-specific definition is noted in the template.

DANB AND ITS RELATIONSHIP TO STATE REGULATORY BODIES DANB is frequently approached by state dental boards seeking information about the rules and regulations governing dental assistants in other states. When requested, DANB acts as a resource to state dental boards by providing information and research results. DANB is independent of state regulatory agencies and has no authority over legislative or regulatory decisions. DANB views licensure as an issue best addressed at the state level. However, DANB does support mandatory education and credentialing of dental assistants and believes it is in the public’s and profession’s best interest that these requirements be as uniform across states as possible. DANB’s career ladder project is part of a larger initiative to support the development of a national career ladder model for dental assistants, based on one set of core tasks, levels and requirements. Understanding that state practice act provisions are the purview of each state, if dental assistants who are qualified to perform certain duties in one state are recognized as competent in other states, recruitment, employment and job satisfaction of qualified assistants will improve. This will also allow dentists to focus on dentistry while assistants perform delegated duties under the state-defined supervision levels, thus increasing access to care.

ALABAMA: OVERVIEW

Reviewed by DANB 3/30/2022†

† DANB has not received confirmation that the information in this state’s overview has been reviewed and approved by the appropriate state office. The charts in this volume contain summaries reflecting DANB’s understanding of the state dental practice act and administrative rules. For authoritative information, please contact this state’s dental board (contact information is on the last page of this volume).

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Alabama. See the following pages for details about requirements and allowed functions for this level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant

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

Functions NOT Permitted by Dental Assistants in Alabama Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 20. Remove extrinsic stains, accretions and calcareous deposits from teeth 40. Place Pit and Fissure Sealant 70. Place stainless steel crowns with intentions of reasonable permanency • Apply oxygenating agents during endodontic therapy • Remove wire sutures • Capping of exposed pulpal tissues • Gingival curettage • Root planing • Polish completed restorations • Place resorbable chlorhexidine chips • Place topical or subgingival antimicrobial or antibacterial agents • Periodontal probing • Furnish, construct, supply or repair any prosthetic denture, bridge, appliance or structure to be worn in the mouth • Repair or fill cavities • Give interpretations or readings or x-rays or roentgenograms • Administer anesthetics • Bleaching of teeth

ALABAMA

Reviewed by DANB 3/30/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Alabama may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 1, 2. Preliminary charting and inspection of the oral cavity (final • Apply desensitizing agents examination and diagnosis must be made by a dentist before • Apply light-cured medicinal bonding agents treatment can be instituted) • Apply etchant materials 6. Place and remove gingival retraction materials • Insert into the mouth of the patient wax models of dentures, 13. Remove intraoral sutures (excluding wire sutures) partial dentures, or any other structures and make adjustments 18. Apply topical fluoride outside the mouth of the patient to such wax models pursuant 22, 52. Make dental radiographs or digital images to written or verbal instructions or directions from the dentist; 24. Give oral hygiene instructions including plaque staining, flossprovided, however, (1) the dental hygienist or dental assistant ing, brushing, and caries susceptibility tests shall not use these wax models of dentures, partial dentures or 27. Place and remove rubber dam any other structure to register the jaw relationships or occlu29. Pre-fit and pre-contour orthodontic appliances either extraorally sal relationships of the patient, and (2) that before such wax or intra-orally for final adaptation by the dentist models may be used for the manufacture of dentures, partial 34. Place cavity liners and bases (excluding capping of exposed dentures or other structures the dentist shall personally consult pulpal tissues) with the patient, examine such wax models, and make such 35, 62. Place and remove periodontal dressings additional adjustments as may be required 37. Take and record case history, blood pressure, pulse and oral • Insert into the mouth of the patient dentures, partial dentures, temperature removable orthodontic appliances, prostheses or any other 43. Contour stainless steel or chrome crowns but cannot cement structures and make adjustments outside the mouth of the them patient to the dentures, prostheses (fixed or removable), re44. Make impressions for diagnostic casts or opposing casts movable orthodontic appliances, prosthetic appliances, bridges, 45. Place, wedge, and remove matrices for operative dentistry or other structures pursuant to written or verbal instructions or 46. Make final impressions for removable and fixed prostheses, directions from the dentist; provided, however, (1) that before orthodontic appliances, retainers, devices to treat sleep apnea such prostheses (fixed or removable), removable orthodontic or anti-snoring devices, and medicament/whitening delivery appliances, or other structures are delivered to the patient trays; however, before said impressions may be used for the leaving the dental office with such prostheses (fixed or removmanufacture of prostheses and appliances, the dentist shall able), removable orthodontic appliances, or other structures examine and approve such impressions for accuracy the dentist shall personally consult with the patient, examine 47. Construct and place temporary crowns (excluding stainless such prostheses (fixed or removable), removable orthodontic steel crowns placed with intentions of reasonable permanency) appliances, or other structures, and make such additional ad47, 50, 54, 55. Construct and remove with hand instruments only justments as may be required; and (2) that final placement and interim restorations (interim restorations being any restoration cementation of all fixed appliances, fixed prostheses and other placed while a more permanent restoration is being completed) fixed structures shall be performed by the dentist 56. Apply topical anesthetics • Apply reversible liners and bases to prostheses, orthodontic 59. Assist in the administering of N2O and O2 appliances, or any other structures; however, the dentist shall 61. Remove excess cement with hand instruments from around personally consult with the patient and examine such liners permanent dental restorations and orthodontic appliances and bases, and make such additional adjustments as may be 63, 69. Place and remove alveolar socket dressings necessary • Apply topical oxygenating agents (excluding endodontic • Use laser and/or narrow band (light) imaging technology for therapy) preliminary diagnostic purposes only with the dentist’s final • Apply anti-inflammatory agents examination and diagnosis • Apply astringents

*Direct Supervision: 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 responsibility for the completed procedure.

ALASKA: OVERVIEW

Reviewed by DANB 4/29/2022†

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Alaska. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant qualified in coronal polishing procedures/ Dental Assistant qualified in restorative functions

Dental Assistant

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.

Functions NOT Permitted by Dental Assistants in Alaska

Prohibited Duties

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 2. Perform preliminary charting and triage to formulate a dental hygiene assessment and dental hygiene treatment plan 20. Remove calcareous deposits, accretions, and stains from the exposed surfaces of the teeth beginning at the epithelial attachment by scaling and polishing techniques 59. Administer and monitor nitrous oxide-oxygen conscious sedation • Remove marginal overhangs • Use local periodontal therapeutic agents • Perform nonsurgical periodontal therapy • Administer local anesthetic agents • Dental diagnosis, comprehensive treatment planning, and writing prescriptions for drugs • Writing authorizations for restorative, prosthetic, or orthodontic appliances • Operative or surgical procedures on hard or soft tissues • Other procedures that require the professional competence and skill of a dentist or licensed dental hygienist

ALASKA

Reviewed by DANB 4/29/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Alaska may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable

Allowable Functions

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* In Alaska, all dental assistants may: 18. Apply topical preventive agents 22, 52. Expose and develop dental radiographs 40. Apply pit and fissure sealants • Perform infection control and occupational safety procedures • Perform other duties not specified by this state’s dental practice act

Dental Assistant qualified in coronal polishing procedures / qualified in restorative functions

Requirements

Education, Training and Credential Requirements To perform coronal polishing procedures in Alaska under the direct supervision of a licensed dentist, a dental assistant must hold a certificate in coronal polishing.

To perform specified restorative functions in Alaska under the direct supervision of a licensed dentist, a dental assistant must hold a certificate in restorative functions.

An applicant for certification must: I. a. Submit to the Alaska Board of Dental Examiners a complete, notarized application form AND b. Pay applicable fee AND c. Successfully complete a program of instruction approved by the Alaska Board of Dental Examiners OR II. Be currently licensed or certified in another jurisdiction to perform coronal polishing and provide documentation to the board

To qualify, one must: I. Successfully complete a course offered by or under the auspices of a program accredited by the Commission on Dental Accreditation (CODA) or other equivalent course or program approved by the Alaska Board of Dental Examiners AND II. a. 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 b. Have legal authorization from another state or jurisdiction to perform restorative functions

Note: The Alaska Board of Dental Examiners maintains a registry of dental assistants who hold certificates in coronal polishing and/or restorative functions.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Coronal polishing on teeth without calculus, if the dental assistant holds the Alaska coronal polishing certificate

12, 33, 51. Placement of a restoration into a cavity prepared by a licensed dentist and the subsequent carving, contouring, and adjustment of the contacts and occlusion of the restoration, if the dental assistant holds the Alaska restorative functions certificate

*Direct Supervision: “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. Indirect Supervision: “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.

ARIZONA: OVERVIEW

State-approved 2/8/2022

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Arizona. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3 Expanded Function Dental Assistant (EFDA) 2

Dental Assistant qualified in coronal polishing procedures

State Radiography Requirements

1 Dental Assistant

State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures under the general supervision of a licensed dentist in Arizona, a dental assistant must: I. Pass the national DANB Radiation Health and Safety (RHS) exam OR II. a. Be currently certified in another U.S. jurisdiction that requires successful completion of a written dental radiography exam AND b. Apply to the Arizona State Board of Dental Examiners (ASBDE) for Dental Assistant Radiography Certification by Credential and receive the Arizona Radiologic Proficiency Certificate, issued by the ASBDE

Functions NOT Permitted by Dental Assistants in Arizona Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited

The following functions are not permitted by any level of dental assistant: 46. Taking final impressions for any activating orthodontic appliance, fixed or removable prosthesis* 51. Intraoral carvings of dental restorations or prostheses** • A procedure which by law only licensed dentists, licensed dental hygienists, or certified denturists can perform • Final jaw registrations • Activating orthodontic appliances • An irreversible procedure *At its March 6, 2020 meeting, the Arizona State Board of Dental Examiners issued a substantive policy statement announcing that the Board does not interpret state rules as prohibiting a dental assistant from taking digital impressions, provided the digital impression is done under the direct supervision of a dentist, and the dentist approves the impression and is the one who submits it for processing. ** Under an Arizona law passed in the 2015 legislative session, a dental assistant who has met the requirements for an Expanded Function Dental Assistant may perform contouring and finishing of direct restorations (See EFDA Requirements on page 20).

ARIZONA

State-approved 2/8/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant may perform basic supportive dental procedures specified by the state dental practice act (see below) under direct supervision of a licensed dentist.) There are no education or training requirements for this level of dental assisting.

Allowable

Allowable Functions Under Direct Supervision* 13. Remove sutures 18. Apply topical fluorides 27,45. Place and remove dental dams and matrix bands 40. Apply sealants 47, 50. Fabricate and place interim restorations with temporary cement 54, 55. Remove temporary cement and interim restorations with hand instruments 59. Observe a patient during nitrous oxide and oxygen analgesia as instructed by the dentist 61. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments 62. Remove periodontal dressings with hand instruments • Prepare a patient for nitrous oxide and oxygen analgesia administration upon the direct instruction and presence of a dentist • Place dental material into a patient’s mouth in response to a licensed dentist’s instruction

•

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 d. Removal of dressings and packs Take digital impressions, provided the dentist approves the impression and is the one who submits it for processing

Under General Supervision* 2. Collect and record information pertaining to extraoral conditions 2. Collect and record information pertaining to existing intraoral conditions 24, 26. 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

Dental Assistant qualified in coronal polishing procedures

Requirements

Education, Training and Credential Requirements To perform coronal polishing procedures in Arizona under the general supervision of a licensed dentist, a dental assistant must hold an AZ Coronal Polishing Certificate. To qualify, one must: I. Pass DANB’s Coronal Polish (CP) exam found in the “Coronal Polish Exam for AZ Residents” application packet AND II. Submit an AZ Coronal Polishing Clinical Skills Affidavit (completed by a licensed dentist or a coronal polishing educator/course instructor) to DANB AND

Allowable

III. Receive the AZ Coronal Polishing Certificate, sent upon successful completion of the DANB CP exam and submission of the Arizona Coronal Polishing Clinical Skills Affidavit to DANB

*Direct supervision: “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 supervision: “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.

AZ 3

ARIZONA State-approved 2/8/2022

Expanded Function Dental Assistant (EFDA)

Education, Training and Credential Requirements

Requirements

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: I. a. Hold the AZ Coronal Polishing certificate (see requirements on prior page), and either hold the AZ Radiologic Proficiency certificate or pass the DANB RHS exam (see requirements on p.18) AND b. Successfully complete an EFDA training course approved by the AZ State Board of Dental Examiners (ASBDE) at a Commission on Dental Accreditation (CODA)-accredited program AND . c. Pass DANB’s AMP, TMP and RF exams AND . d. 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 . e. Apply to DANB for the Arizona Expanded Functions – Restorative Certificate OR II. a. 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 b. Document clinical experience in the specified expanded functions on a Licensed Dentist Endorsement form AND c. Apply to DANB for the Arizona Expanded Functions – Restorative Certificate **A registered dental hygienist may qualify to perform expanded functions by meeting the same requirements, with the exception that the registered dental hygienist is not required to take the RHS, CP and AMP exams.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 18. Apply fluoride varnish 40. Apply sealants • Place interim therapeutic restorations under the direction of a licensed dentist following a consultation conducted through teledentistry Level of Supervision Not Specified 12, 33, 51, 70. Perform 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

ARKANSAS: OVERVIEW State-approved 3/31/2022

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Arkansas. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Registered Dental Assistant (RDA)

Dental Assistant

State Radiography Requirements

State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in Arkansas, a dental assistant must be an RDA who holds a permit for radiography from the Arkansas State Board of Dental Examiners. To obtain this permit, one must: I. a. Hold a current national DANB Certified Dental Assistant (CDA) certification OR b. Graduate from a CODA-accredited dental assisting program OR c. Successfully complete and submit a certificate of completion of a radiography course approved by the Board AND II. Hold current Basic Life Support-level CPR certificate AND III. Apply for registration to the Arkansas State Board of Dental Examiners AND IV. Successfully complete the Arkansas jurisprudence exam Note: A dental assistant holding a current radiography permit dated prior to 11/1/11 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.

Functions NOT Permitted by Dental Assistants in Arkansas

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 20. Scaling, root planing and curettage 29. Final placement of orthodontic brackets 33. Placement, seating, or removal of any final or permanent restorations • Diagnosis and treatment planning • Surgical or cutting procedures on hard or soft tissue • Prescription, injection, inhalation, and parenteral administration of drugs (except where permitted by the Arkansas Board) • Any procedure that contributes to or results in irreversible alteration of the oral anatomy • Those functions relegated to a dental hygienist: 9. Using air driven electric, sonic, ultrasonic, or otherwise powered scalers or polishers (except by dental assistants possessing an expanded duties permit for polishing) • Oral examination • Oral prophylaxis • Placing medicaments into the sulcus or periodontal pockets, for periodontal disease • Place silver diamine fluoride

ARKANSAS

State-approved 3/31/2022

Allowable

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Arkansas may perform basic supportive dental procedures specified by the state dental practice act (see below) under the personal supervision of a licensed dentist. Training in standard precautions and other infection control standards required by OSHA and as recommended by the CDC and set forth in Arkansas rule shall be provided to all dental healthcare personnel 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. There are no education or training requirements for this level of dental assisting.

Allowable Functions Under Personal Supervision* • Any reversible dental task or procedure assigned by the supervising dentist that does not require a permit or the professional skills of a licensed dentist or licensed dental hygienist

Registered Dental Assistant

Education, Training and Credential Requirements A Registered Dental Assistant in Arkansas is an individual who holds a permit from the Arkansas State Board of Dental Examiners (ASBDE) to perform one or more of the expanded functions listed below.

Requirements

To be issued a permit for any of the expanded functions (except Sedation Monitoring, which has additional requirements), one must: I. a. Hold a current national DANB Certified Dental Assistant (CDA) certification OR b. Graduate from a CODA-accredited dental assisting program OR c. Complete an ASBDE-approved course in the desired expanded function(s) OR d. Receive on-the-job training from an Arkansas licensed dentist AND II. Hold current Basic Life Support-level CPR certificate AND III. Provide proof of competency in the desired expanded function(s) and apply for registration to the ASBDE AND IV. 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, Registered Dental Assistants must provide the ASBDE proof of completing two hours of continuing education in infection control every two years.

Allowable

Allowable Functions Under Personal Supervision* 9. Perform coronal polishing** 22. Operate dental radiographic equipment** 40. Place sealants (if the dental assistant holds a coronal polishing permit) 59. Induce and monitor nitrous oxide/oxygen analgesia**

• •

Monitor patients who are under deep sedation or general anesthesia only in offices where the dentist is permitted to perform those services** All duties designated to Dental Assistants, under the same level of required supervision

** A dental assistant must obtain a permit in each of these expanded duties before performing the duty; see requirements for each corresponding permit above.

* Personal Supervision: The dentist is in the office or treatment facility, has personally diagnosed the condition to be treated, has personally authorized the procedures, remains in the office or treatment facility while the procedures are being performed, and evaluates the performance of the Dental Assistant before the dismissal of the patient.

CALIFORNIA: OVERVIEW State-approved 3/27/2022

State Job Titles

State Career Ladder There are four recognized levels of dental assistants in California. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Registered Dental Assistant in Extended Functions (RDAEF)

Registered Dental Assistant (RDA)

State Radiography Requirements

Other Levels

1 Unlicensed Dental Assistant

Orthodontic

See pages 28-29

Dental Sedation Assistant

See pages 30-31

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in California, a dental assistant must be state certified in radiography. To obtain state radiation safety certification, a dental assistant must: I. Successfully complete a California Board-approved radiation safety course which includes theory and clinical application in radiographic technique OR II. Have passed a radiation exam conducted by the California Board prior to Jan. 1, 1985

Functions NOT Permitted by Dental Assistants in California Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited

The following functions are not permitted by a dental assistant, an orthodontic assistant or a dental sedation assistant: 33, 70. Placing, finishing, or removing permanent restorations • Diagnosis and comprehensive treatment planning • Surgical or cutting procedures on hard or soft tissue including, but not limited to, the removal of teeth and the cutting and suturing of soft tissue • Prescribing medication • 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 • Supragingival and subgingival scaling • Fitting and adjusting of correctional and prosthodontics appliances • Irrigation and medication of canals, try-in cones, reaming, filing or filling of root canals • Oral prophylaxis procedures • Taking of impressions for prosthodontic appliances, bridges or any other structures which may be worn in the mouth, unless specifically permitted in law or regulation

CA 1

CALIFORNIA State-approved 3/27/2022

Unlicensed Dental Assistant

Requirements

Education, Training and Credential Requirements An unlicensed dental assistant in California may perform basic supportive dental procedures under the supervision of a licensed dentist specified by the state dental practice act. The employer dentist must ensure that all unlicensed dental assistants maintain BLS certification, and that all unlicensed 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: I. A California Board-approved 2-hour course in the California Dental Practice Act AND II. A California Board-approved 8-hour course in infection control AND III. An AHA or ARC-approved course in Basic Life Support which includes hands-on simulated clinical scenarios

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 13. Remove sutures after inspection of the site by the dentist 18. Apply topical fluoride 27. Place and remove rubber dams or other isolation devices 29. After adjustment by the dentist, examine and seat removable orthodontic appliances and deliver care instructions to the patient 42. Place orthodontic separators 44. Take intraoral impressions for all nonprosthodontic appliances 45. Place, wedge and remove matrices for restorative procedures 56. Apply non-aerosol and non-caustic topical agents 59. 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. 62. Remove periodontal dressings 69. Remove post-extraction dressings after inspection of the surgical site by the supervising licensed dentist • Remove orthodontic separators • Remove arch wires • Remove ligature ties • Cure restorative or orthodontic materials in operative site with light-curing device • Examine orthodontic appliances • Take facebow transfers and bite registrations.

• • •

Perform measurements for the purposes of orthodontic treatment. Place patient monitoring sensors 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.

Under General Supervision* 18. Apply topical fluoride, when operating in a school-based setting or government public health program 22. Operation of radiographic equipment (see “Radiography Requirements” on previous page) • Perform intraoral and extraoral photography • Extraoral duties or functions specified by the supervising dentist, provided that these duties are basic supportive procedures (technically elementary characteristics, completely reversible, and are unlikely to cause potentially hazardous conditions for the patient) Under Direct Supervision of a Registered Dental Hygienist (RDH) in Alternative Practice* 48. Intraoral retraction 48. Suctioning • Any extraoral duty

*Direct Supervision: 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. General Supervision: 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. All procedures shall be checked and approved by the supervising dentist prior to dismissal of the patient from the office of said dentist. Direct Supervision by RDH or RDH in Alternative Practice: Dental assistants may perform these duties while employed by or practicing in a licensed primary care clinic or specialty clinic, a primary care clinic exempt from licensure, or a contracted clinic owned and operated by a hospital.

CA 2

CALIFORNIA State-approved 3/27/2022

Registered Dental Assistant (RDA)

Education, Training and Credential Requirements

Requirements

To be licensed as a Registered Dental Assistant (RDA) in California, one must: I. a. Graduate from a California Board-approved RDA educational program OR b. Complete 15 months of work experience as a dental assistant OR c. Complete a combination of a non-approved educational program and work experience AND II. Successfully complete California Board-approved courses in radiation safety and coronal polishing AND III. Successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour course in infection control within 5 years prior to application for licensure AND IV. Successfully complete an AHA or ARC-approved course in Basic Life Support AND V. Apply to the Dental Board of California for licensure as an RDA AND VI. Pass the state RDA Combined Written and Law and Ethics exam (Note: Prior to 2015, a practical exam was required for RDA licensure. The practical exam was suspended in 2015 and permanently discontinued in November 2017. Beginning in May 2018, the state written RDA exam and the state written exam in law and ethics, formerly separate exams, have been combined.)

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct or General Supervision* The supervising licensed dentist is responsible for determining level of supervision. 1, 2. Mouth-mirror inspection of oral cavity, including charting of obvious lesions, existing restorations, and missing teeth 9. Coronal polishing 14. Dry endodontically treated canals with paper absorbent points 15. Place ligature ties and archwires 18. Apply topical fluoride, when operating in a school-based setting or government run public health program 34. Place bases, liners, and bonding agents 35. Place periodontal dressings 40. Apply pit and fissure sealants (board-approved course required) 47, 54, 55. Fabricate, adjust, cement, and remove indirect provisional restorations, including stainless steel crowns when used as a provisional restoration 49. Test pulp vitality and record findings 50. Place, adjust and finish direct provisional restorations 61. Remove excess cement from surfaces of teeth with a hand instrument 61. Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment (under direct supervision; board-approved course required)

63. Place post-extraction dressings after inspection of the surgical site by the supervising licensed dentist • Remove orthodontic bands • Apply bleaching agents and activate with non-laser light-curing device • Use of automated caries detection devices and materials to gather information for diagnosis by the dentist • Obtain intraoral images for computer-aided design (CAD), milled restorations • Chemically prepare teeth for bonding • Adjust dentures extraorally • All duties a dental assistant is allowed to perform • The allowable duties of an orthodontic assistant permit holder, if additional requirements have been met (see pages 28-29 for requirements and duties) • The allowable duties of a dental sedation assistant permit holder, if additional requirements have been met (see pages 30-31 for requirements and duties) Under Direct Supervision of a Registered Dental Hygienist (RDH) or RDH in Alternative Practice* 9. Coronal Polishing 18. Application of topical fluoride 40. Application of sealants (board-approved course required)

CA 3

CALIFORNIA State-approved 3/27/2022

Registered Dental Assistant in Extended Functions (RDAEF)

Education, Training and Credential Requirements

Requirements

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: I. Complete the requirements for RDA licensure (see previous page for requirements) AND II. Successfully complete a California Board-approved course in the application of pit and fissure sealants AND III. Successfully complete a California Board-approved extended functions educational program AND IV. Apply to the Dental Board of California for licensure as a Registered Dental Assistant in Extended Functions AND V. Pass the California RDAEF written exam To qualify to perform the additional functions listed under “Functions Requiring Additional Training,” one must: I. Provide evidence, satisfactory to the Dental Board of California, of having completed a board-approved course in those functions

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 1, 2. Conduct preliminary evaluation of the patient’s oral health, including, but not limited to, charting, intraoral and extraoral evaluation of soft tissue, classifying occlusion, and myofunctional evaluation 6. Cord retraction of gingivae for impression procedures 12, 33, 51. Place, contour, finish, and adjust all direct restorations 46. Take final impressions for permanent indirect restorations 46. Take final impressions for tooth-borne removable prosthesis • Fit trial endodontic filling points • Formulate indirect patterns for endodontic post and core castings • Remove excess cement from subgingival tooth surfaces with hand instruments • Perform oral health assessments in school-based, community health project settings • Size and fit endodontic master points and accessory points. • Cement endodontic master points and accessory points • Polish and contour existing amalgam restorations • Adjust and cement permanent indirect restorations

Under Direct or General Supervision* The supervising dentist is responsible for determining the level of supervision. • All duties a registered dental assistant is allowed to perform Under Direct Supervision of a Registered Dental Hygienist (RDH) or RDH in Alternative Practice* • Perform oral health assessments in school-based, community health project settings • All duties a registered dental assistant is allowed to perform under RDH/RDHAP supervision

Allowable functions for this level continued on next page

CALIFORNIA State-approved 3/27/2022

Allowable Functions (for Registered Dental Assistant in Extended Functions), continued

Allowable

Functions Requiring Additional Training (see “Education, Training and Credential Requirements on previous page for training requirements) Under Supervision* • 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, following protocols established by the supervising dentist, in the following settings: (A) In a dental office setting (B) In public health settings, using telehealth 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

•

Place protective restorations, 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 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.

CALIFORNIA (ORTHODONTIC) State-approved 3/27/2022

Orthodontic Assistant Education, Training and Credential Requirements

Requirements

To qualify for an Orthodontic Assistant permit by work experience in California, one must: I. Complete at least 12 months of work experience as a dental assistant AND II. Successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour course in infection control AND III. Successfully complete an AHA or ARC-approved course in Basic Life Support, or any other course approved by the California board as equivalent AND IV. Successfully complete a California Board-approved orthodontic assistant course (may begin after six months of work experience as a dental assistant) and demonstrate successful completion of a California Board-approved ultrasonic scaling course AND V. Apply to the Dental Board of California for Orthodontic Assistant permit AND VI. Pass the California Orthodontic Assistant Written Exam

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* • Remove only orthodontic brackets and attachments with 15. Place and ligate archwires removal of the bonding material by the supervising licensed 29. Prepare teeth for bonding, and select, preposition and cure dentist orthodontic brackets after their position has been approved by • Remove orthodontic bands the supervising licensed dentist • All duties that a dental assistant is allowed to perform 29. Size, fit and cement orthodontic bands 61. Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment

Registered Dental Assistant (RDA) with Orthodontic Assistant Permit

Requirements

Education, Training and Credential Requirements A Registered Dental Assistant (RDA) in California may apply for an orthodontic assistant permit by completing the following: I. First be an RDA (see California RDA requirements on page 25) AND II. Successfully complete a California Board-approved orthodontic assistant course and demonstrate successful completion of a California Board-approved ultrasonic scaling course AND III. Apply to the Dental Board of California for an orthodontic assistant permit AND IV. Pass the California Orthodontic Assistant Written Exam Note: A registered dental assistant with an orthodontic assistant permit shall be referred to as an “RDA with orthodontic assistant permit,” for reference purposes only. This does not create an additional category of licensure.

Allowable

Allowable Functions Under Direct Supervision* • All allowable duties of an RDA (see page 25) • All allowable duties of an Orthodontic Assistant permit holder (see above)

CALIFORNIA (ORTHODONTIC) State-approved 3/27/2022

Registered Dental Assistant in Extended Functions (RDAEF) with Orthodontic Assistant Permit Education, Training and Credential Requirements

Requirements

A Registered Dental Assistant in Extended Functions (RDAEF) in California may apply for an orthodontic assistant permit by completing the following: I. First be an RDAEF (see California RDAEF requirements on page 26) AND II. Successfully complete a California Board-approved orthodontic assistant course and demonstrate successful completion of a California Board-approved ultrasonic scaling course AND III. Apply to the Dental Board of California for an orthodontic assistant permit AND IV. Pass the California Orthodontic Assistant Written Exam Note: A registered dental assistant in extended functions with an orthodontic assistant permit shall be referred to as an “RDAEF with orthodontic assistant permit,” for reference purposes only. This does not create an additional category of licensure.

Allowable

Allowable Functions Under Direct Supervision* • All allowable duties of an RDAEF (see page 26) • All allowable duties of an Orthodontic Assistant permit holder (see previous page)

CALIFORNIA (DENTAL SEDATION ASSISTANT) State-approved 3/27/2022

Dental Sedation Assistant Education, Training and Credential Requirements

Requirements

To qualify for a Dental Sedation Assistant permit in California by work experience, one must: I. Complete at least 12 months of work experience as a dental assistant AND II. Successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour course in infection control AND III. Successfully complete an AHA or ARC-approved course in Basic Life Support AND IV. Successfully complete a Board-approved dental sedation assistant course (may begin after six months of work experience as a dental assistant) AND V. Apply to the Dental Board of California for Dental Sedation Assistant permit AND VI. Pass the California Dental Sedation Assistant Written Exam

Allowable

Allowable Functions Under Direct Supervision* • All duties that a dental assistant is allowed to perform • 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 healthcare 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.

•

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 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 (except the initial dose of a drug or medication shall be administered by the supervising licensed dentist) Removal of intravenous lines

*Direct Supervision: A licensed dentist is physically present in the office at all times during the performance of any act, and such acts are performed pursuant to the licensed dentist’s order, control, and full professional responsibility.

CALIFORNIA (DENTAL SEDATION ASSISTANT) State-approved 3/27/2022

Registered Dental Assistant (RDA) with Dental Sedation Assistant Permit Education, Training and Credential Requirements Requirements

A Registered Dental Assistant (RDA) in California may apply for a dental sedation assistant permit by completing the following: I. First be an RDA (see California RDA requirements on page 25) AND II. Successfully complete a California Board-approved dental sedation assistant course AND III. Apply to the Dental Board of California for a dental sedation assistant permit AND IV. Pass the California Dental Sedation Assistant Written Exam Note: A registered dental assistant with a dental sedation assistant permit shall be referred to as an “RDA with dental sedation assistant permit,” for reference purposes only. This does not create an additional category of licensure.

Allowable

Allowable Functions Under Direct Supervision* • All allowable duties of an RDA (see page 25) • All allowable duties of a Dental Sedation Assistant permit holder (see previous page)

Registered Dental Assistant in Extended Functions (RDAEF) with Dental Sedation Assistant Permit Education, Training and Credential Requirements Requirements

A Registered Dental Assistant in Extended Functions (RDAEF) in California may apply for a dental sedation assistant permit by completing the following: I. First be an RDAEF (see California RDAEF requirements on page 26) AND II. Successfully complete a California Board-approved dental sedation assistant course AND III. Apply to the Dental Board of California for a dental sedation assistant permit AND IV. Pass the California Dental Sedation Assistant Written Exam Note: A registered dental assistant in extended functions with a dental sedation permit shall be referred to as an “RDAEF with dental sedation assistant permit,” for reference purposes only. This does not create an additional category of licensure.

Allowable

Allowable Functions Under Direct Supervision* • All allowable duties of an RDAEF (see page 26) • All allowable duties of a Dental Sedation Assistant permit holder (see previous page)

* Direct Supervision: A licensed dentist is physically present in the office at all times during the performance of any act, and such acts are performed pursuant to the licensed dentist’s order, control, and full professional responsibility.

COLORADO: OVERVIEW State-approved 2/15/2022

State Job Titles

State Career Ladder There is one recognized level of dental assistants in Colorado. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

State Radiography Requirements

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Colorado, a dental assistant must: I. Be at least 18 years of age AND II. Successfully complete minimum safety, education and training for operating machine sources of ionizing radiation and administering such radiation to patients. Education and training requirements may be satisfied by one of the following: a. Completion of 5 hours of practical or clinical experience and 3.5 hours of lecture meeting specific Colorado content requirements 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 b. Completion of education and training 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 c. Successful completion of the national DANB Radiation Health and Safety (RHS) exam or the national DANB Certified Dental Assistant (CDA) exam

Functions NOT Permitted by Dental Assistants in Colorado Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 20. Scaling (supra- and sub-gingival), as it pertains to the practice of dental hygiene • Diagnosis • Treatment planning • Prescription of therapeutic measures • Any procedure that contributes to or results in an irremediable alteration of the oral anatomy • Administration of local anesthesia • Root planing • Soft tissue curettage • Periodontal probing • Placement of local therapeutic agents • Use protective stabilization • Application of silver diamine fluoride Limited prescriptive authority for local therapeutic agents may not be delegated or assigned to a dental assistant.

COLORADO State-approved 2/15/2022

Dental Assistant

Education, Training and Credential Requirements Requirements

A dental assistant in the state of Colorado may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting. 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. Dental assistants who administer and/or monitor nitrous oxide/oxygen inhalation must successfully complete current Basic Life Support (BLS) training. 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).

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct Supervision* 59. Monitor the use of nitrous oxide/oxygen conscious analgesia (see requirements above) • Assist the dentist in using protective stabilization as necessary 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 the following: 44, 46. Making of preliminary and final impressions • Jaw relation records and determination of vertical dimensions • Tooth selection • 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 • Denture adjustments that involve the periphery, occlusal, or tissue-bearing surfaces of the denture prior to the final examination of the denture

Under Indirect Supervision* 1-2. Gathering and assembling information including, but not limited to, fact-finding and patient history, oral inspection, and dental and periodontal charting 9. Smoothing and polishing natural and restored tooth surfaces 18. Provision of preventive measures including the application of fluorides and other recognized topical agents for the prevention of oral disease 56. Administering topical anesthetic to a patient in the course of providing dental care • Repairing and relining of dentures pursuant to a dental laboratory work order signed by a licensed dentist • Any other task or procedure that does not require the professional skill of a licensed dentist

*Direct Supervision: 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 Indirect Supervision: Supervision of those asks 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.

CONNECTICUT: OVERVIEW State-approved 3/25/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Connecticut. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Function Dental Assistant (EFDA)

Dental Assistant

State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in Connecticut, a dental assistant must pass the national DANB Radiation Health and Safety (RHS) exam.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Connecticut Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 44, 46. The taking of any impression of the teeth or jaws or the relationship of the teeth or jaws for the purpose of fabricating any appliance or prosthesis • Diagnosis for dental procedures or dental treatment • Prescribing of drugs or medications that require the written or oral order of a licensed dentist or physician • Administration of local, parenteral, inhalation or general anesthetic agents in connection with any dental operative procedure • The cutting or removal of any hard or soft tissue or suturing • The practice of dental hygiene as defined in the Connecticut Dental Practice Act

CONNECTICUT State-approved 3/25/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements A dental assistant in Connecticut may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. Effective July 1, 2018*, any dental assistant 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. *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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 18. Provision of fluoride varnish treatments 22. Taking of dental x-rays (see “Radiography Requirements” on previous page)

44. Taking of impressions for study models • A licensed dentist may delegate to dental assistants such dental procedures as he/she may deem advisable

Expanded Function Dental Assistant

Education, Training and Credential Requirements

Requirements

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: I. Maintain current DANB Certified Dental Assistant (CDA) or Certified Orthodontic Assistant (COA) certification AND II. Successfully complete 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 III. Pass DANB’s Certified Preventive Functions Dental Assistant (CPFDA) certification exam and DANB’s Certified Restorative Functions Dental Assistant (CRFDA) certification exam Effective July 1, 2018*, any 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. Note: The provisions above related to EFDAs 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.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct or Indirect Supervision* 9. Coronal polishing, provided the procedure is not represented or billed as prophylaxis 12, 33, 34, 50, 51. The placing, finishing and adjustment of temporary restorations and longterm individual fillings, capping materials and cement bases 24. Oral health education for patients 40. Dental sealants

Under Direct Supervision* 44. Taking alginate impressions of teeth for use in study models, orthodontic appliances, whitening trays, mouth guards or fabrication of temporary crowns 56. Administration of topical anesthetic prior to the administration of local anesthetic by a dentist or dental hygienist

Note: The EFDA functions listed 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. *Direct supervision: 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 Indirect supervision: 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

DELAWARE: OVERVIEW Updated by DANB 2/16/2022†

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Delaware. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant

State Radiography Requirements

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: I. a. Pass the DANB national Radiation Health and Safety (RHS) exam OR b. Hold current DANB CDA certification AND II. Submit a completed state certificate application (Form R16-N) to the Delaware ORC AND III. 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. Note: The Delaware ORC has discontinued the Delaware Dental Radiologic Technology (DDRT) exam, which was a state-specific exam equivalent to DANB’s 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 exam prior to December 31, 2015 may still use their DDRT exam passing result to qualify for the Dental Radiation Technician certificate. Former certificate holders who took the DDRT exam and who have let their Dental Radiation Technician certificate expire must take DANB’s RHS exam to reinstate 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.)

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Delaware The following functions are not permitted by any level of dental assistant: • • • •

Diagnosis and treatment planning Cutting of hard and/or soft tissues Any intraoral 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 Those procedures allocated by the Dental Code to registered dental hygienists

† DANB has not received confirmation that the information on the pages that follow has been reviewed and approved by the appropriate state office. The charts in this volume contain summaries reflecting DANB’s understanding of the state dental practice act and administrative rules. For authoritative information, please contact this state’s dental board (contact information is on the last page of this volume).

DELAWARE

Updated by DANB 2/16/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements 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 Board of Dentistry and Dental Hygiene places full responsibility for the work done by dental assistants directly upon the dentist.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct Supervision* 22, 52. Take and develop x-rays (placing an x-ray film in the patient’s mouth and exposing that film) (see “Radiography Requirements” on previous page) 24, 26. Give and demonstrate home-care procedures to the patient, including those procedures the patient is expected to carry out in preventive care 27. Placing a rubber dam 44. Taking impressions for study models 48. Placing cotton rolls 54. Removal of excess cements from dental restorations and appliances with hand instruments only 62, 63. Removal of temporary medicinal fillings or packs under direct orders of the dentist • Other duties as delegated by the supervising dentist

*Direct Supervision: The dentist is present in the office, personally examines the patient, and specifically authorizes the work to be performed. The dentist checks the work before the patient leaves the office.

DISTRICT OF COLUMBIA: OVERVIEW State-approved 5/24/2022

Radiography Requirements

Job Titles

District of Columbia Career Ladder There are two recognized levels of dental assistants in the District of Columbia. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Level 2 Dental Assistant

Level 1 Dental Assistant

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: I. a. Pass DANB’s Radiation Health and Safety (RHS) exam or DANB’s Certified Dental Assistant (CDA) exam OR b. Successfully complete a dental radiography training program consisting of at least twenty-four (24) hours of coursework in radiology, radiation safety, biology, and physics, and has successfully passed the examination(s) required for successful completion of the program. AND II. Register as a Level II Dental Assistant with the D.C. Board of Dentistry (see additional requirements in “Requirements” sections on the pages that follow)

Functions NOT Permitted by Dental Assistants in District of Columbia Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions shall not be delegated to dental auxiliaries: 2. The charting of cavities during preliminary examination, prophylaxis, or polishing 9. The intraoral polishing of a tooth or a restoration 12, 51. Placing, carving, or finishing of amalgam restorations 15. Temporary wire ligation 24. 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 29. Final positioning of orthodontic bonds and bands 33. Condensing, contouring or adjusting any final, fixed or removable prosthodontic appliance or restoration in the mouth 33. Placing and finishing of composite resin/silicate restorations 34. Application of cavity liners and bases 40. The application of pit and fissure sealants 46. Taking final impressions 47, 50. Placement of temporary restorations 59. Administering or monitoring nitrous oxide • Performing final diagnosis and treatment planning • Performing surgical or cutting procedures on hard or soft tissue • Prescribing or parenterally administering drugs or medications • Administering inhalants or inhalation conscious sedation agents • Authorizing work orders for any appliance or prosthetic device or restoration to be inserted into a patient’s mouth

• • • • • • • • • • • •

Operating high speed rotary instruments in the mouth Performing pulp capping procedures Orthodontic arch wire activation with the exception of minor adjustments to eliminate pain or discomfort 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 The performing of a diagnostic screening to identify indications of oral abnormalities 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 Administering or monitoring general anesthetics and conscious sedation Administering or monitoring local anesthesia

DISTRICT OF COLUMBIA State-approved 5/24/2022

Level 1 Dental Assistant

Requirements

Education, Training and Credential Requirements To be registered as a Level I Dental Assistant in the District of Columbia, one must: I. Have graduated from high school or hold a general equivalency diploma AND II. Apply to the D.C. Board of Dentistry for registration Note: All current dental assistants and applicants for registration must be fully vaccinated against COVID-19 unless granted an exemption (see D.C. Municipal Regulations Title 22, Chapter 2, Subtitle B, Sections 230-231 for details).

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under Direct Supervision* of an Orthodontist 6. Placing retraction cord 15. Placing and removing arch wires 13. Removing sutures 29. Preparing and fitting orthodontic bands 27, 45, 48. Placing or removing materials for the isolation of the • Removing excess cement from around orthodontic bands dentition, provided that the material is not retained by the • Cementing orthodontic bands, placing bonded attachments, or dentition removing cemented or bonded orthodontic bands and attach35. Placing periodontal dressings ments 44. Taking impression for study models or diagnostic casts • Placing elastics and ligatures 45. Placing matrices • Selecting headgear 48. Rinsing and aspirating the oral cavity 48. Retracting the lips, cheek, tongue, and flaps 54, 55. Removing temporary restorations without the use of a rotary instrument 56. Applying topical anesthesia 64. Constructing athletic mouth guards in models • Applying a medicinal agent to a tooth for a prophylactic purpose • Performing intraoral photography • Curing by the use of halogen light • Checking for loose bands • Ying • Other functions as approved by the Board

*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 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.

DISTRICT OF COLUMBIA State-approved 5/24/2022

Level 2 Dental Assistant

Requirements

Education, Training and Credential Requirements To be registered as a Level II Dental Assistant in the District of Columbia, one must: I. Have graduated from high school or hold a general equivalency diploma AND II. a. 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 b. Hold current DANB Certified Dental Assistant (CDA) certification or other dental assisting certification approved by the Board. AND III. Complete a course in dental radiography training consisting of at least twenty-four (24) hours of coursework in radiology, radiation safety, biology, and physics, and has successfully passed the examination(s) required for successful completion of the program AND IV. Apply for a registration as a Level II Dental Assistant to the D.C. Board of Dentistry Note: All current dental assistants and applicants for registration must be fully vaccinated against COVID-19 unless granted an exemption (see D.C. Municipal Regulations Title 22, Chapter 2, Subtitle B, Sections 230-231 for details).

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under Direct Supervision* of an Orthodontist 14. Drying a root canal 15. Placing and removing arch wires 18. Applying topical fluoride 29. Preparing and fitting orthodontic bands 27. Placing or removing a rubber dam • Removing excess cement from around orthodontic bands 35. Removing or placing a periodontal dressing (except placing the • Cementing orthodontic bands, placing bonded attachments, or original periodontal dressing) removing cemented or bonded orthodontic bands and attach43. Preparing and fitting stainless steel crowns ments 44. Taking alginate impressions for intraoral appliances • Placing elastics and ligatures 45. Placing or removing a matrix band • Selecting headgear 47. Fabricating indirect restorations in a dental office 47. Preparing temporary crowns 49. Performing vitality tests 54, 61. Removing excess cement 55. Removal of temporary restorations without the use of a rotary instrument 4. Constructing athletic mouth guards on models • Applying desensitizing agents; • Etching • All functions permitted to Level I Dental Assistant

FLORIDA: OVERVIEW

State-approved 5/9/2022

Prohibited Duties

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Florida. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Dental Assistant trained in restorative functions

Dental Assistant formally trained in expanded functions

On-the-Job Trained Dental Assistant

State Radiography Requirements In order to legally operate dental x-ray equipment and perform dental radiographic procedures in Florida, a dental assistant must: I. Graduate from a Florida Board of Dentistry-approved dental assisting school or program OR II. Be state-certified as a dental radiographer by the Florida Department of Health (FDOH) To obtain the dental radiography certification, a dental assistant who has not graduated from a Board-approved dental assisting school or program must: II. 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

Functions NOT Permitted by Dental Assistants in Florida Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. • • • • • •

Gingival curettage and root planing Taking impressions for the purpose of fabricating any intraoral restorations or orthodontic appliance Initial access preparation Any prescription of drugs or medications requiring the written order of a licensed dentist or physician Any diagnosis for treatment or treatment planning Use of a laser or laser device of any type, unless utilized as an assessment device

Requirements

FLORIDA State-approved 5/9/2022

On-the-Job Trained Dental Assistant

Education, Training and Credential Requirements A dental assistant in Florida may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. 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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under General Supervision* 56. Applying topical anesthetics and anti-inflammatory agents 24. Instructing patients in oral hygiene care and supervising oral which are not applied by aerosol or jet spray hygiene care • Change bleach pellets in the internal bleaching process of 47. Fabricating temporary crowns or bridges in a laboratory non-vital, endodontically treated teeth after the placement of a • Provide educational programs, faculty or staff programs, and rubber dam other educational services, which do not involve diagnosis or treatment of dental conditions Under Indirect Supervision* 48. Retraction of lips, cheeks, and tongue 37. Taking and recording a patient’s blood pressure, pulse rate, respiration rate, case history and oral temperature 48. Irrigation and evacuation of debris not to include endodontic irrigation 48. Placement and removal of cotton rolls 54. Removing excess cement from orthodontic appliances with non-mechanical hand instruments only

*Direct Supervision: A licensed dentist must 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. Indirect Supervision: A licensed dentist must 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. General Supervision: A licensed dentist must examine the patient, diagnose a condition to be treated, and authorize the procedure to be performed.

FL 2

FLORIDA State-approved 5/9/2022

Dental Assistant formally trained in expanded functions

Education, Training and Credential Requirements Dental assistants in the state of Florida must have formal training to perform the expanded functions listed below.

Requirements

To qualify to perform expanded functions, one must: I. a. 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 b. Successfully complete a Florida Board-approved expanded duties formal 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. To monitor nitrous oxide inhalation analgesia, a dental assistant must: I. Complete a course of training of no less than two days as described in the American Dental Association’s “Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students” or equivalent AND II. 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 person CPR, two person 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

Allowable

Allowable Functions (for Dental Assistant formally trained in expanded functions) Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 1-2. Using appropriate implements for preliminary charting of exist54. Removing excess cement from dental restorations and appliing restorations and missing teeth and a visual assessment of ances with non-mechanical hand instruments only existing oral conditions 59. Monitor the administration of nitrous oxide oxygen making 6. Packing and removing retraction cord, so long as it does not diminishing adjustments only during this administration and contain vasoactive chemicals and is used solely for restorative turning it off at the completion of the dental procedure (with dental procedures completion of appropriate training and CPR certification; see 9. Polishing clinical crowns when not for the purpose of changrequirements above) ing the existing contour of the tooth and only with burnishers, 63, 69. Inserting or removing dressings from alveolar sockets in slow-speed handpieces, rubber cups, bristle brushes, and porte post-operative osteitis polishers, used with appropriate polishing materials 64. Taking of impressions for and delivery of at-home bleaching 29. Selecting and pre-sizing orthodontic bands, including the setrays lection of the proper size band for a tooth to be banded which • Polishing dental restorations of the teeth when not for the purdoes not include or involve any adapting, contouring, trimming, pose of changing the existing contour of the tooth and only with cementing, or otherwise modifying the band material such that burnishers, slow-speed handpieces, rubber cups, and bristle it would constitute fitting the band brushes, used with appropriate polishing materials 29. Removing and recementing properly contoured and fitting loose • Selecting and pre-sizing archwires prescribed by the patient’s bands that are not permanently attached to any appliance dentist so long as the dentist makes all final adjustments to 44. Making impressions for study casts which are being made for bend, arch form determination, and symmetry prior to final the purpose of fabricating orthodontic retainers placement 47. Fabricating temporary crowns or bridges intraorally which shall • Selecting prescribed extraoral appliances by pre-selection or not include any adjustments of occlusion to the appliance or pre-measurement, not including final fit adjustment existing dentition • Preparing a tooth surface by applying conditioning agents for 50. Cementing temporary crowns and bridges with temporary orthodontic appliances by conditioning or placing of sealant cement materials which does not include placing brackets 50, 54, 55. Placing or removing temporary restoration with non-mechanical hand instruments only Allowable functions for this level continued on next page

FLORIDA State-approved 5/9/2022

Allowable

Allowable Functions (for Dental Assistant formally trained in expanded functions), continued Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* 13. Removing sutures 40. Applying sealants 15. Securing or unsecuring an archwire by attaching or removing 42. Placing or removing prescribed pre-treatment separators the fastening device 44. Making impressions for study casts which are not being made 18. Applying topical fluorides which are approved by the ADA or the for the purpose of fabricating any intraoral appliances, restoFDA rations or orthodontic appliances 22. Positioning and exposing dental and carpal radiographic film 45. Placing or removing matrices and sensors 46. Making impressions to be used for creating opposing models 27. Placing or removing rubber dams or the fabrication of bleaching stents and surgical stents to be 34. Applying cavity liners, varnishes, or bases used for the purpose of providing palatal coverage 35. Placing periodontal dressings 62. Removing periodontal or surgical dressings

Dental Assistant formally trained in restorative functions

Education, Training and Credential Requirements

Requirements

A dentist may delegate remediable intraoral restorative functions to be performed under direct supervision to a Dental Assistant who has met the following requirements: I. Be at least 18 years of age AND II. Be a high school graduate or equivalent AND III. Hold current BLS for Healthcare Provider certificate AND IV. a. Graduate from a dental assisting program accredited by a dental accrediting entity recognized by the U.S. Department of Education OR b. Successfully complete a Florida Board-approved expanded duties formal training program AND V. Document proof of 2,400 hours of clinical work experience in either a dental office or as a dental assisting educator AND VI. 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

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 12, 33, 51. Placing, packing and contouring amalgam and compos43. Fitting and contouring (but not permanently cementing) stainite restorations less steel crowns (The tasks shall only be performed using a slow speed handpiece and hand instruments.)

GEORGIA: OVERVIEW

Updated by DANB 4/28/2022†

There are two recognized levels of dental assistants in Georgia. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Duty Dental Assistant (EDDA)

Dental Assistant

State Radiography Requirements

Prohibited Duties

State Job Titles

State Career Ladder

Functions NOT Permitted by Dental Assistants in Georgia

In order to legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist 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. *Note: The DALE Foundation’s DANB RHS Review course meets the requirements of the Georgia Department of Community Health regulation 111-8-90-.04, X-Rays in the Healing Arts.

The following functions are not permitted by any level of dental assistant: • • •

Utilize laser equipment and technology Utilize intraorally micro etching and/or air polishing equipment and technologies Any operations catalogued as dental hygiene treatments

GEORGIA

Updated by DANB 4/28/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements A dental assistant in Georgia may perform basic supportive dental procedures specified by the state dental practice act (see below) and by rule of the Georgia Board of Dentistry under the direct supervision of a licensed dentist. A dental assistant must complete Georgia Board of Dentistry-approved training in phlebotomy, intravenous access, infection control, the handling of any associated medical or dental emergencies, and any other safety related topics required by the Board before performing phlebotomy and venipuncture procedures. To use rubber cup prophy (i.e., perform coronal polishing**) on primary dentition, 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. There are no other education or training requirements for this level of dental assisting.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Use a rubber cup prophy on a patient with primary dentition** 56. Apply topical anesthetic (see note below) 61. Remove visible excess cement from supramarginal areas of 13. Remove sutures (other than wire sutures) dental restorations and appliances with non-mechanical hand 14. Dry canals with absorbent points and place soothing medicainstruments ments (not to include endodontic irrigation); and place and 62. Remove periodontal dressing remove temporary stopping with non-mechanical hand instru69. Remove dry socket medication ments only • Place drying and de-oiling agents prior to the cementation of 15. Select, pre-size and seat orthodontic arch wires with brackets permanent crowns and bridges which have been placed by the dentist • Place and take off a removable prosthesis with a pressure 15. Cut and tuck ligatures, remove ligatures and arch wires, resensitive paste after the appliance has been initially seated by move loose or broken bands the dentist 22. Place and expose radiographs with such training as may be • Etch unprepared enamel required by law • Polish the enamel and restorations of the anatomical crown 27. Place and remove rubber dams through the use of a slow speed handpiece (not to exceed 29. Select and pre-size orthodontic bands which initially must be 10,000 rpm), rubber cup and polishing agent; this procedure seated by the dentist shall be used only for the purpose of enamel preparation for: 42. Place and remove pre-treatment separators 1) Bleaching, 2) Cementation of fixed restorations, 3) Bonding 44. Make impressions diagnostic models and opposing models procedures including supramarginal enamel restorations after 45. Place matrix bands and wedges removal of orthodontic appliances 47. Fabricate extraorally temporary crowns and bridges • Remove and re-cement loose bands that have previously been 47, 50. Cement temporary crowns and bridges with intermediate contoured and fitted by a dentist, but only after a dentist has cement examined the affected tooth and surrounded gingiva and found 50. Place intracoronal temporary restorations using intermediate no evidence of pathology cement • Perform phlebotomy and venipuncture procedures (after 54. Remove temporary crowns and bridges seated with intermediBoard-approved training in phlebotomy, intravenous access, ate cement infection control, the handling of any medical or dental emergencies associated with such procedures, and any other safety related topics required by the board is acquired) **The Georgia Board of Dentistry has issued a policy addendum clarifying that “rubber cup prophy” refers to coronal polishing.

* Direct Supervision: 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.

GA 2

GEORGIA

Updated by DANB 4/28/2022

Expanded Duty Dental Assistant (EDDA)

Education, Training and Credential Requirements

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: I. Hold a high school diploma or its equivalent AND II. Hold a current Cardiopulmonary Resuscitation (CPR) certification AND III. 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.) Note: Only those expanded duties that are listed on the certificate(s) may be performed by an EDDA.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Packing and removing retraction cord, as prescribed by the dentist, so long as said cord is used solely for restorative dental procedures 15. Band, select, and pre-size arch wires and place arch wires after final adjustment and approval by the dentist 18. Apply topical anticariogenic agents 29. Select, pre-fit, cement, cure, and remove ortho bands or brackets 34. Place cavity liner, base or varnish over unexposed pulp 35. Place periodontal dressing 35. 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 37. Take and record vital signs 40. 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 a laser device) 42. Place and remove pre-treatment separators 43. Size and fit stainless steel crowns on a primary tooth only 44. Make impressions to be used to repair a damaged prosthesis or to fabricate a night guard (bruxism or muscle relaxation appliance); or for passive orthodontic appliances (all adjustments must be performed extraorally; final adjustments must be made by the dentist) 47. Intraoral fabrication of temporary crowns and bridges (all such adjustments must be performed extraorally)

59. 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 • 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 • 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 a laser device) • Re-bond brackets after a licensed dentist has examined the affected tooth and surrounding gingiva and found no evidence of pathology • Remove bonded brackets with hand instruments only • 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) • Perform face bow transfer • Place springs on wires • Place hooks on brackets • Remove loose or broken bonds • Remove ligature and arch wires • Digital scans for fabrication of orthodontic appliances and models • All duties designated to dental assistants, under the same levels of required supervision

HAWAII: OVERVIEW

State-approved 3/30/2022

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Hawaii. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant

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

Functions NOT Permitted by Dental Assistants in Hawaii Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 6. Placing materials subgingivally, including but not limited to, prescriptive medicaments, retraction cords, and other devices used for tissue displacement 9. Using of ultrasonic instruments and polishing natural or restored surfaces 12, 33, 34, 51. Placing, condensing, carving, finishing, or adjusting the occlusion of final restorations; or placing cavity liners, medicaments, or pulp cap materials 14. Performing any endodontic procedure to ream, file, irrigate, medicate, dry, try-in cores, or fill root canals; establishing the length of the tooth 34. 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 46. 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 impressions for study casts, opposing models, occlusal appliances (e.g., splints and bite guards), mouth guards, orthodontic retainers, and medicament trays 49. Testing pulp vitality • Administering local anesthetic, sedation, or general anesthesia • Cementing, bonding, and adjusting any part of a prosthesis or appliance worn in the mouth • Cementing bands and brackets, or activating any orthodontic appliance • Establishing occlusal vertical dimension, making bite registrations, and making face-bow transfers • Examining, diagnosing, or prescribing a treatment plan • Performing any surgical or cutting procedures on hard or soft tissues, extracting teeth, and suturing • Prescribing medications or authorizing the fabrication of any restorative, prosthodontic, or orthodontic appliances

HI 1

HAWAII

State-approved 3/30/2022

Dental Assistant

Education, Training and Credential Requirements

Requirements

A dental assistant in the state of Hawaii may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. The supervising dentist must appropriately train or provide training to dental assistants, including but not limited to training in the following: • proper sterilization and disinfection procedures • ethics • proper record keeping and patient confidentiality • cardiopulmonary resuscitation (CPR) Training must meet the OSHA and the Hawaii Occupational Safety and Health (OSHA/HIOSH) bloodborne pathogen standards and CDC and ADA prevention guidelines and recommendations, and must be provided by a Hawaii Board of Dentistry approved continuing education sponsoring organization. Approved sponsoring organizations include but are not limited to providers approved by the American Dental Association Continuing Education Recognition Program (ADA CERP) and the Academy of General Dentistry Program Approval for Continuing Education (AGD PACE).

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 1. Conducting mouth mirror supragingival inspections and report59. Monitoring the nitrous oxide/oxygen unit and reporting to the ing observations to the supervising licensed dentist; provided supervising dentist any adverse observations, provided the lithat this is not interpreted as an oral cancer screening censed dentist evaluates, initiates, and administers the sedation 2. Collecting medical and dental histories, taking intra-oral and ex• Completing prescription and authorization forms for drug or tra-oral photographs, and recording or charting clinical findings restorative, prosthodontic or orthodontic appliance for the suas dictated by the licensed dentist or dental hygienist pervising licensed dentist whereby the dentist signs the forms 13, 62, 69. Removing dressing and sutures • Performing a try-in with any removable prosthetic or orthodontic 22, 52, 53. Exposing, processing, mounting, and labeling radioappliance, provided the supervising licensed dentist makes the graphs adjustments 24, 26. Relating pre-operative and post-operative instructions, and • Assisting the licensed dental hygienist in the performance of patient education in oral hygiene as instructed by the supervistheir duties ing licensed dentist or dental hygienist • Assisting the licensed dentist who is actually performing a 29, 42. Making intra-oral measurements for orthodontic procedental procedure on the patient, including: dures, performing the preliminary selection and sizing of bands; 11. Transferring dental instruments checking for loose bands and bonded brackets; placing and 21. Mixing dental materials removing orthodontic separators, ligature ties, and inter-arch 27. Placing and removing the rubber dam elastics (i.e. chain elastics and rubber bands); fitting and re30, 58. Any other concept of four-handed dentistry the dentist moving head appliances; and removing arch wires requires to perform the procedure 37. Measuring and recording vital signs 41. Preparing procedural trays/armamentaria set-ups 44. Making impressions for study casts, opposing models, occlusal 48. Retracting a patient’s oral tissues to maintain the field of appliances (e.g. splints, bite guards), mouth guards, orthodonoperation during the dental procedure tic retainers, and medicament trays 48. Removing debris, as is normally created and accumulated 45. Placing matrix retainers during or after operative procedures by the dentist 54, 61. Removing excess supragingival cement after a licensed dentist has placed a permanent or temporary prosthetic restoration, appliance, or orthodontic bands with hand instruments 56. Placing non-aerosol topical anesthetics

* Direct Supervision: The supervising licensed dentist examines and diagnoses the condition to be treated, personally authorizes each procedure, remains in the dentist’s office or facility while the procedures are being performed, and shall be responsible for all delegated acts and procedures performed by dental assistants.

IDAHO: OVERVIEW State-approved 2/7/2022

State Job Titles

State Career Ladder There is one recognized levels of dental assistants in Idaho. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

State Radiography Requirements

Dental Assistant

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

Functions NOT Permitted by Dental Assistants in Idaho Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 33, 51. Intraoral placement or carving of permanent restorative materials 70. Final placement of prefabricated or cast restorations or crowns • Any irreversible procedure • Administration of any sedation or local injectable anesthetic • Removal of calculus • Use of an air polisher • Any intra-oral procedure using a high-speed handpiece, except for the removal of orthodontic cement or resin • Any dental hygiene prohibited duty: • Definitive diagnosis and dental treatment planning • Operative preparation of teeth for the placement of restorative materials • Final placement of any fixed or removable appliances • 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 • Placement of the final root canal filling • Occlusal equilibration procedures for any prosthetic restoration, whether fixed or removable

IDAHO

State-approved 2/7/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements Dental assistant in Idaho may perform dental services for which they are trained and which are not prohibited under the direct supervision of a licensed dentist (see previous page for prohibited functions). There are no specific education or training requirements. To administer nitrous oxide/oxygen to patients, a dental assistant must be trained in accordance with Idaho Board of Dentistry rules.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 61. Removal orthodontic cement or resin using a high-speed handpiece • Administer nitrous oxide/oxygen to patients (with training) • Perform dental services for which the dental assistant has been trained and which are not prohibited

*Direct Supervision: A dentist must diagnose the condition to be treated, authorize the procedure to be performed, remain in the dental office while the procedure is performed, and, before dismissal of the patient, approves the work performed.

ILLINOIS: OVERVIEW

Updated by DANB 2/7/2022†

State Radiography Requirements

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Illinois. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Expanded Function Dental Assistant (EFDA)

Dental Assistant qualified in expanded functions

Dental Assistant

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

Functions NOT Permitted by Dental Assistants in Illinois Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 20. Removal of calculus from teeth 20. Performing supragingival or subgingival scaling 34. Applying cavity bases 46. Taking of material or digital scans for final impressions for the fabricating of prosthetic appliances, crowns, bridges, inlays, onlays or other restorative or replacement dentistry 49. Performing pulp vitality tests • Diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury or physical condition of the human teeth or jaws, or adjacent structures • Removal of, 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 as outlined in statute • Any and all correction of malformation of teeth or of the jaws • Administration of anesthetics except for monitoring of nitrous oxide, minimal sedation, moderate sedation, deep sedation and general anesthesia after completion of an approved training program

• • • • • • • • • •

The operative procedure of dental hygiene consisting of oral prophylactic procedures except for coronal polishing or pit and fissure sealants, as specified Making denture adjustments Permanently cementing permanent crowns or bridges Permanently re-cementing permanent crowns or bridges that have come loose Placement of any chemotherapeutic agent for the management of periodontal disease Cementing bands and/or bonding brackets Air polishing Inter-oral use of a high-speed hand piece Use of a laser to remove tissue 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.

ILLINOIS

Updated by DANB 2/7/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Illinois may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Supervision* DANB’s Note on Allowable Dental Assisting Functions • Any authorized or prescribed services or procedures for which In the state of Illinois, all dental assistants may: the dental assistant is considered competent by the supervising dentist as a result of on-the-job training • Expose, process and evaluate dental radiographs • After being authorized by a dentist, remove loose, broken, or • Perform infection control and occupational safety procedures irritating orthodontic appliances on a patient of record for the • Perform other duties not specified by this state’s dental practice purpose of eliminating pain or discomfort act At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

*Supervision: A dentist must authorize the procedure, remain in the dental facility while the procedure is performed, and approve the work performed by the dental assistant before dismissal of the patient. The dentist does not need to be present at all times in the treatment room.

IL 2

ILLINOIS

Updated by DANB 2/7/2022

Dental Assistant qualified in expanded functions

Coronal Scaling and Intracoronal Temporization

Restorative (Amalgams, Composites and Interim Restorations)

Coronal Polishing, Sealants, Monitor Nitrous, Monitor Sedation

Education, Training and Credential Requirements 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 qualify to perform coronal scaling and intracoronal temporization of a tooth** under the direct supervision of a dentist, a dental assistant must:

Requirements

I. Have at least 2,000 hours of direct clinical patient care experience AND II. Successfully complete an approved coronal polishing course prior to taking coronal scaling course AND III. Successfully complete a structured training program in coronal scaling and intracoronal temporization of a tooth provided by an educational institution (such as a dental school or a dental hygiene or dental assisting program) or by a statewide dental or dental hygienist association approved by the Department, that includes: • minimum 16 hours of didactic and clinical manikin or human subject instruction covering specified content • an outcome assessment examination that demonstrates competency • completion of 6 full-mouth scaling procedures under the observation and with approval of the supervising dentist • issuance of a certificate of completion (which must be kept on file at the dental office)

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:

To perform coronal polishing, place pit and fissure sealants, monitor patients under nitrous oxide, or monitor patients under sedation, a dental assistant must:

I. Pass approved coronal polishing course and approved dental sealants course (prior to taking restorative training program)

AND II. a. Complete 1,000 hours of clinical dental assisting experience OR b. Complete a CODA-accredited dental assisting program OR c. Hold a current national DANB Certified Dental Assistant (CDA) certification AND III. a. Complete approved course addressing the expanded function in question, subject to specific didactic and clinical requirements OR b. Provide proof of completion of an approved dental assisting program that contained the expanded function in the curriculum

AND II. a. Successfully complete a structured training program meeting the requirements outlined in statute provided by an educational institution accredited by CODA OR b. Have at least 4,000 hours of clinical patient care experience and successfully complete a structured training program meeting the requirements outlined in statute provided by a statewide dental association approved by the Illinois Department of Financial and Professional Regulation (IDFPR) AND III. 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

I. Be at least 18 years of age

Note: For nitrous, sedation, and anesthesia monitoring, dental assistants must maintain basic life support certification intended for healthcare providers (BLS) that includes evaluation of hands-on skills and a written exam.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Supervision” Under Direct Supervision* Under Supervision” 20. Perform coronal scaling (using hand 12, 51. Placing, carving, and finishing amal9. Coronal polishing instruments) above the gum line, gam restorations 40. Application of pit and fissure sealants supragingivally, on the clinical crown of 33. Place, pack, and finish composite resto59. Monitor the patient while nitrous oxide is the tooth only on patients 12 years of rations being administered age or younger who have an absence 50. Place interim restorations • Monitor a patient under minimal sedaof periodontal disease and who are not tion, moderate sedation, deep sedation medically compromised or individuals or general anesthesia with special needs** • All duties designated to Dental Assis• Perform intracoronal temporization of a tants, under the same level of required tooth (using hand instruments) supervision ** Coronal scaling 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 *Supervision: A dentist must authorize the procedure, remain in the dental facility while the procedure is performed, and approve the work performed by the dental assistant before dismissal of the patient. The dentist does not need to be present at all times in the treatment room.

IL 3

ILLINOIS

Updated by DANB 2/7/2022

Expanded Function Dental Assistant

Education, Training and Credential Requirements

Requirements

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: I. a. Complete training in the expanded functions from an approved continuing education sponsor OR b. Complete training in the expanded functions from a dental assistant training program accredited by the Commission on Dental Accreditation OR c. Complete a training course approved by the Illinois Department of Financial and Professional Regulation AND II. Complete and maintain Basic Life Support certification, proof of which must be kept on file with the supervising dentist Note: The Illinois General Assembly passed a law in the 2017 legislative session authorizing the creation of an Expanded Function Dental Assistant who may perform the functions listed below. The Illinois General Assembly further amended the law in 2018. The Illinois Department of Financial and Professional Regulation (IDFPR) is in the process of developing rules to implement this new law.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Supervision* 9, 40. Coronal polish and pit and fissure sealants** 46. Take material or digital scans for final impressions‡ 12, 33, 51. Place, carve, and finish amalgam restorations and place, carve, and finish composite restorations** 49. Perform pulp vitality test‡ 59. Start the flow of oxygen and monitoring of nitrous oxide-oxygen analgesia‡ ** As allowed pursuant to requirements summarized on the previous page ‡ After completing a training program that includes either didactic objectives or clinical skills and functions that demonstrate competency

INDIANA: OVERVIEW Updated by DANB 3/31/2022†

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Indiana. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant qualified in coronal polishing /

2 Dental Assistant qualified in applying medicaments for the control and prevention of dental caries /

Dental Assistant qualified in administering nitrous oxide

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Indiana, a dental assistant must obtain a limited dental radiographic license from the Indiana State Department of Health/Division of Radiology and Weights & Measures.

State Radiography Requirements

To obtain this license, one must: I. a. Successfully complete a CODA-accredited program in radiography OR b. Successfully complete an Indiana State Department of Health-approved program in radiography AND II. Be 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 AND III. Pass one or more of the following examinations: (a) The national DANB Certified Dental Assistant (CDA) exam (b) The national DANB Radiation Health and Safety (RHS) exam (c) An exam approved by the Indiana State Department of Health/ Division of Radiology and Weights & Measures AND IV. Apply to the IN State Department of Health/Division of Radiology and Weights & Measures for a limited dental radiographic license The Indiana State Department of Health also issues student permits and provisional permits in dental radiography. 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 of the Indiana Administrative Code for details). The permit expires six (6) months after its effective date.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Indiana Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 46. Any intraoral impression which would lead to the fabrication of a final prosthetic appliance • Diagnosis and treatment planning • Cutting of hard or soft tissues • Removing calcific deposits or accretions from the surfaces of human teeth or cleaning or polishing such teeth (except coronal polishing, as permitted by meeting the requirements) • Applying and using within the patient’s mouth such antiseptic sprays, washes or medicaments for the control or prevention of dental caries (except for applying medicaments, as permitted by meeting the requirements) • Treating gum disease • Using impressions and x-ray photographs for treatment purposes • Administering local dental anesthetics

INDIANA

Updated by DANB 3/31/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Indiana may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting, except for radiography requirements.

Allowable

Allowable Functions DANB’s Note on Allowable Dental Assisting Functions In Indiana, all dental assistants may: • Perform infection control and occupational safety procedures • Perform other duties not specified by this state’s dental practice act At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

Dental Assistant qualified in coronal polishing

Dental Assistant

Dental Assistant qualified in administering nitrous oxide

qualified in applying medicaments for the control and prevention of dental caries

Education, Training and Credential Requirements

Requirements

To qualify to polish the coronal surfaces of the teeth, a dental assistant must: I. a. 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: i. 5 hours of didactic instruction meeting Board curriculum requirements ii. 2 hours of laboratory work iii. Performance of the task on five patients under the observation of a licensed dentist or dental hygienist iv. An affidavit certifying competency signed by the supervising dentist OR b. Graduate from an educational program accredited by the Commission on Dental Accreditation (CODA) that included instruction meeting the above requirements AND II. 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: I. a. 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: i. 9 hours of didactic instruction meeting Board curriculum requirements ii. 2 hours of laboratory work iii. Performance of the task on five patients under the observation of a licensed dentist or dental hygienist iv. An affidavit certifying competency signed by the supervising dentist OR b. Graduate from an educational program accredited by CODA that included instruction meeting the above requirements AND II. Display certificate of completion of education program publicly in the dental office

To qualify to administer nitrous oxide, a dental assistant must: I. Be employed in a dental practice for a minimum of one year OR graduate from a CODA-accredited educational program AND II. Complete a CODA-accredited course that includes the following: a. 3 hours of didactic instruction meeting state curriculum requirements b. Demonstration of clinical competence on at least five (5) patients under the direct supervision of a licensed Indiana dentist in good standing c. An affidavit certifying competency signed by the supervising dentist AND III. Display certificate of completion of education program publicly in the dental office

Allowable

A dental assistant who has completed an out-of-state dental assisting program in applying medicaments for the control and prevention of dental caries must provide a syllabus of coursework successfully completed; coursework must be equal to or greater than that required by Indiana rules, or the dental assistant must complete laboratory and clinical requirements in Indiana and obtain a certificate of completion from an Indiana CODA-accredited or Board-approved program; the dental assistant must display CODA-accredited program diploma or certificate of completion from Board-approved course publicly in the dental office.

18. Apply medicaments for the control or prevention of dental caries

* Direct Supervision: A licensed dentist is physically present in the facility when patient care is provided by the dental assistant

•

Administer nitrous oxide (dentist must determine the maximum percent-dosage)

IOWA: OVERVIEW State-approved 3/10/2022

State Career Ladder

State Radiography Requirements

State Job Titles

There are five recognized levels of dental assistants in Iowa. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 5

Certified Level 2 Provider

Certified Level 1 Provider

Basic Expanded Function Provider

Registered Dental Assistant (RDA)

Dental Assistant Trainee

State Radiography Requirements To expose radiographs in Iowa, a dental assistant must hold a current registration certificate and active radiography qualification issued by the Iowa Dental Board (IDB) and a dentist must provide general supervision. To earn dental radiography qualification, one must: I. a. Be a Dental Assistant Trainee or Registered Dental Assistant with an active registration status OR b. Be a graduate of an accredited dental assisting program OR c. Be a nurse who holds an active Iowa nursing license AND II. Provide proof of successful completion of an Iowa Board-approved course of study in dental radiography within the two years prior to application AND III. 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 IV. Apply to the IDB for Qualification in Dental Radiography Note: A dental assistant trainee must be 18 years of age to perform dental radiography.

Functions NOT Permitted by Dental Assistants in Iowa Prohibited

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. 20. Removal of any plaque, stain, or hard natural material except by toothbrush, floss or rubber cup coronal polish, or removal of any calculus • Diagnosis, examination, treatment planning, or prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic or orthodontic appliances • 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 • Administration of local anesthesia • Procedures that require the professional judgment and skill of a dentist

IA 1

IOWA

State-approved 3/10/2022

Dental Assistant Trainee

Education, Training and Credential Requirements Requirements

To qualify as a Dental Assistant Trainee in Iowa, one must: I. Graduate from high school or equivalent. AND II. a. Be 17 years of age or older OR b. Be enrolled in a cooperative education or work-study program through an Iowa high school AND III. Apply to the Iowa Dental Board and receive a certificate of dental assistant trainee status A dental assistant trainee must have certification of Dental Assistant Trainee status issued prior to beginning work as a dental assistant trainee.

Allowable

Allowable Functions Under Personal Supervision*

DANB’s Note on Allowable Dental Assisting Functions

All Dental Assistant Trainees who are engaging in on-the-job training to meet the requirements for registration and are learning the necessary skills are considered to be under the personal supervision of a licensed dentist, licensed dental hygienist or registered dental assistant.

In the state of Iowa, all dental assistants may:

No allowable functions are specified in the state practice act, with the exception of dental radiography (see “State Radiography Requirements” on previous page for additional requirements).

At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

• •

Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act

*Direct Supervision: 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: The dentist has examined the patient and has delegated services to be provided by a registered dental assistant, which are limited to 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. Personal Supervision: For intraoral procedures, the dentist is physically present in the treatment room to oversee and direct all intraoral or chairside services of the dental assistant trainee; for extraoral procedures, a licensee or registrant is physically present in the treatment room to oversee and direct all extraoral services of the dental assistant trainee. Public Health Supervision: (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’s 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.

IA 2

IOWA

State-approved 3/10/2022

Registered Dental Assistant

Education, Training and Credential Requirements

Requirements

To qualify as a Registered Dental Assistant (RDA) in Iowa, one must: I. a. Work in a dental office for six months as a Dental Assistant Trainee (see requirements on previous page) OR b. If licensed out of state, have at least six months prior dental assisting experience under a licensed dentist within the past two years OR c. Graduate from an accredited dental assisting program approved by the Iowa Dental Board (IDB) AND II. Successfully complete an IDB-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 IDB AND III. Pass required exams in infection control/hazardous materials and jurisprudence; exams approved by the IDB are those administered by the IDB or the IDB’s approved testing centers, or the DANB ICE exam (if taken after June 1,1991); the IDB may require applicants with exam scores older than five years to retest AND IV. Hold a valid CPR card AND V. Apply to IDB for registration as a dental assistant A dental assistant may seek registration by verification if the person is currently licensed or registered as a dental assistant in at least one other jurisdiction that has a scope of practice substantially similar to that of Iowa, the person has been licensed or registered for a minimum of one year in the other jurisdiction, and either: I. The person relocates and establishes residency in Iowa; or II. The person is married to an active duty member of the military forces of the United States and is accompanying the member on an official permanent change of station to a military installation located in Iowa. The applicant must submit a completed application for registration and fee, verification form completed by the licensing authority that issued applicant’s license, proof of Iowa residency, proof of successful completion of jurisprudence exam, disciplinary record, criminal record, and documents related to scope of practice in the other state. Applicants who satisfy all requirements except for passing jurisprudence exam may be issued a temporary registration.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 2. Preliminary charting of existing dental restorations and teeth 9. Removal of plaque, stain, or hard natural or synthetic material by toothbrush, floss, or rubber cup coronal polish 30. During intraoral procedures, assist the dentist in performing duties assigned by the dentist 35. Placement of periodontal dressings 49. Testing pulp vitality 63. Placement and removal of dry socket medication • Glucose testing • Phlebotomy

Under General Supervision* 22, 52. Dental radiography (see “Radiography Requirements” on previous page) 48. Intraoral suctioning • Use of a curing light • Use of an intraoral camera • Intraoral digital imaging • All extraoral duties Under Public Health Supervision* in a public or private school, public health agencies, hospitals or the armed forces (and subject to additional conditions set forth in Iowa Administrative Code 650-20.16) 22, 52. Dental radiography (see “Radiography Requirements” on previous page) 48. Intraoral suctioning • Use of a curing light • Use of an intraoral camera • All extraoral duties

IA 3

IOWA

State-approved 3/10/2022

Basic Expanded Function Provider

Requirements

Education, Training and Credential Requirements A Registered Dental Assistant may qualify to perform select Level 1 expanded function procedures as a Basic Expanded Function Provider by completing a Board-approved training program. A dentist may delegate to an RDA only those Level 1 procedures for which the assistant has received the required expanded function training. To qualify for expanded function training, a dental assistant must: I. Be a graduate of a CODA-accredited dental assisting program OR II. Hold current DANB certification OR III. Have a minimum of one year of clinical practice as a registered dental assistant OR IV. Have a minimum of one year of clinical practice as a dental assistant in a state that does not require registration.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct Supervision* Registered Dental Assistants may perform select Level 1 procedures permitted for Basic Expanded Function Providers if they have met the education and training requirements for those procedures. 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. Level 1 Expanded Functions: 6. Placement and removal of gingival retraction 34. 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 46. Taking final impressions 47, 50. Fabrication, temporary cementation, and removal of provisional restorations 50. Placement of Class 1 temporary filling materials

59. Monitoring 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 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 oxygen delivery at the completion of the dental procedure • Taking occlusal registrations • Removal of any adhesives using nonmotorized hand instrumentation

Under General Supervision* • Recementation of a provisional restoration

IA 4

IOWA

State-approved 3/10/2022

Certified Level 1 Provider

Requirements

Education, Training and Credential Requirements To qualify as a Certified Level 1 provider, a Registered Dental Assistant must complete a Board-approved training program in all Level 1 expanded functions and receive a certificate of completion. To qualify for expanded function training, a dental assistant must: I. Be a graduate of a CODA-accredited dental assisting program OR II. Hold current DANB certification OR III. Have a minimum of one year of clinical practice as a registered dental assistant OR IV. Have a minimum of one year of clinical practice as a dental assistant in a state that does not require registration.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct Supervision* Certified Level 1 are registered dental assistants who have completed training in all Level 1 procedures. Level 1 Expanded Functions 6. Placement and removal of gingival retraction 34. 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 46. Taking final impressions 47, 50. Fabrication, temporary cementation, and removal of provisional restorations 50. Placement of Class 1 temporary filling materials

Under General Supervision* • Recementation of a provisional restoration

IA 5

IOWA

State-approved 3/10/2022

Certified Level 2 Provider

Requirements

Education, Training and Credential Requirements Certified Level 2 Provider To qualify as a Certified Level 2 Provider, a Registered Dental Assistant must: I. Complete a minimum of one year of clinical practice as a Certified Level 1 provider AND II. Pass an entrance examination administered by the Level 2 training program AND III. Complete 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 receive a certificate of completion

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* A Registered Dental Assistant who has qualified as a Certified Level 2 provider (see requirements on previous page) may perform Level 2 expanded functions. Level 2 Expanded Functions: 12, 51. Placement and shaping of amalgam following preparation of a tooth by a dentist 33. Placement and shaping of adhesive restorative materials following preparation of a tooth by a dentist 40. Placement of sealants 50. Placement of intracoronal temporary fillings following preparation of a tooth by a dentist

70. Fitting of stainless steel crowns on primary posterior teeth, and cementation after fit verification by the dentist • Polishing of adhesive restorative material using a slow-speed handpiece; • Tissue conditioning (soft reline only) • Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth

KANSAS: OVERVIEW

State-approved 2/21/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Kansas. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant with expanded duties training

Dental Assistant

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 under the supervision of a licensed dentist.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Kansas The following functions are not permitted by any level of dental assistant: • • • • •

Any and all removal of or addition to the hard or soft tissue of the oral cavity 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 Any and all correction of malformation of teeth or of the jaws Any and all administration of general or local anesthesia of any nature in connection with a dental operation A prophylaxis (except coronal polishing and scaling as defined in “Allowable Functions”; see next page)

Requirements

KANSAS

State-approved 2/21/2022

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Kansas may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable Functions Allowable

DANB’s Note on Allowable Dental Assisting Functions In the state of Kansas, all dental assistants may: • • •

Expose, process, and evaluate dental radiographs under the supervision of a licensed dentist Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act.

Dental Assistant with expanded duties training

Education, Training and Credential Requirements To perform expanded functions under the direct supervision of a licensed dentist in the state of Kansas, a dental assistant must become qualified as follows:

Requirements

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: I. Be certified in CPR AND II. Successfully complete a Kansas Board-approved course of instruction which includes 16 hours of instruction at a CODA-accredited teaching program which includes both didactic and clinical instruction in: i. Theory of pain control ii. Anatomy iii. Medical History iv. Pharmacology v. Emergencies and complications

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Coronal polishing procedures 59. Assisting in the administration and monitoring of nitrous oxide 20. Coronal scaling (not including subgingival scaling) and/or oxygen (Note: The dental assistant must be certified in CPR and have passed a Board-approved course.)

* Direct Supervision: 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.

KENTUCKY: OVERVIEW State-approved 3/1/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Kentucky. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Registered Dental Assistant qualified in coronal polishing/ Registered Dental Assistant qualified in IV placement/ Registered Dental Assistant qualified in radiography

Registered Dental Assistant (RDA)

Dental Auxiliary

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Kentucky, a dental assistant must: I. Pass the national DANB Radiation Health and Safety (RHS) exam OR II. Successfully complete a CODA-approved course in radiation safety and technique OR III. Complete a six-hour Kentucky Board-approved course in dental radiography safety* and complete one of the following: a. A minimum of four hours of instruction in dental radiography technique while under the employment and supervision of the dentist in the office OR b. 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.

Functions NOT Permitted by Dental Assistants in Kentucky

Prohibited Duties

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 46. The making of final impressions from which casts are made to construct any dental restoration • Diagnosis • Deliver teledentistry services • 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 • Treatment planning and prescription, including prescriptions for drugs or medicaments, or authorization for restorative, prosthodontic or orthodontic appliances • 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 • Administration of injectable medication or anesthesia unless otherwise authorized by law • Cutting of hard or soft tissues • Any intraoral procedure which will be used directly in the fabrication of an appliance which, when worn by the patient, would come into direct contact with hard or soft tissue

KENTUCKY

State-approved 3/1/2022

Allowable

Requirements

Dental Auxiliary

Education, Training and Credential Requirements A dental auxiliary in Kentucky may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable Functions Under Direct Supervision* •

Those procedures that do not require the professional competence of a licensed dentist or licensed dental hygienist

Registered Dental Assistant

Requirements

Education, Training and Credential Requirements To be recognized as a registered dental assistant in Kentucky, a dental assistant must have current certification in cardiopulmonary resuscitation (CPR) that meets or exceeds the guidelines of the American Heart Association (AHA). In addition, the dental assistant’s employer dentist must do the following: I. Register the dental assistant on his or her Application for Renewal of Dental Licensure AND II. Maintain a personnel file for the registered dental assistant containing the following: a. A copy of proof of having current CPR certification b. A copy of the certificates of completion of the Coronal Polishing, Radiation Safety, Radiation Techniques Course, and Starting IV Access Lines courses, if the dental assistant has completed these courses c. The licensee’s statement attesting to the competence of the dental assistant in the procedures delegated the assistant from the Delegated Duty List

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under Direct Supervision of a Sedation Permit Holder* 22. Expose radiographs (see “Radiography Requirements” on 37. Record vital sign measurements in the sedation record previous page) • Apply noninvasive monitors on the patient • Perform continuous observation of patients and noninvasive Under Direct Supervision* and Dentist’s Direct Orders monitors appropriate to the level of sedation, during the pre• Initiate nitrous oxide sedation if given specific instructions operative, intra-operative and post-operative (recovery) phases regarding the mode of administration and the titration, rate, and of treatment dosage of the anesthetic agent • Report monitoring parameters at pre-determined intervals, and if changes in monitored parameters occur • Assist in the management of a patient emergency • Adminster medications into an existing intravenous line upon the verbal order and direct supervision of a qualified dentist in accordance with this administrative regulation.

*Direct Supervision: 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 office or treatment facility while the procedures are being performed, and evaluates the performance of the individual supervised.

Registered Dental Assistant qualified in coronal polishing

KENTUCKY State-approved 3/1/2022

Registered Dental Assistant qualified in IV placement

Registered Dental Assistant. . qualified in radiography. .

Requirements

Education, Training and Credential Requirements To perform coronal polishing procedures under the direct supervision of a licensed dentist in Kentucky, a registered dental assistant must:

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:

I. Successfully complete an eight-hour course at a CODA-accredited institution

I. Successfully complete a board-approved course in starting IV lines

AND II. Obtain a certificate of completion from the authorized institution, which the employer dentist shall retain in the employee’s personnel file

To perform radiography procedures under the direct supervision of a licensed dentist in Kentucky, a registered dental assistant must complete the requirements listed under State Radiography Requirements on page 66.

AND II. Submit documentation of course completion to the supervising dentist, who shall retain such documentation in the employee’s personnel file

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Perform coronal polishing procedures (see requirements above) 22. Take radiographs (see requirements on page 66) • Establish and remove intravenous lines (see requirements above)

LOUISIANA: OVERVIEW State-approved 5/11/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Louisiana. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Duty Dental Assistant (EDDA)

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in 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.

Functions NOT Permitted by Dental Assistants in Louisiana Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 20. 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 29. 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 12, 33, 51. Placement or finishing of any final restoration 46. The taking of an impression for a final fixed or removable restoration or prosthesis • Periodontal screening and probing, or subgingival exploration for hard and soft deposits and sulcular irrigations • Root planing or the smoothing and polishing of roughened root surfaces using hand, ultrasonic or sonic instruments • Placement and removal of antimicrobial agents • Comprehensive examination or diagnosis and treatment planning • A surgical or cutting procedure on hard or soft tissue including laser and micro abrasion reduction of tooth material • Prescription of a drug, medication or work authorization • Final placement and intraoral adjustment of a fixed appliance • Final placement and intraoral or extraoral adjustment of a removable appliance • Making of any intraoral occlusal adjustment • Performance of direct pulp capping or pulpotomy • Administration of a local anesthetic, parenteral, Intravenous (IV), inhalation sedative agent or any general anesthetic agent • Administration of Botox and dermal fillers • Utilizing air abrasion units

LOUISIANA

State-approved 5/11/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Louisiana may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct, On-Premises Supervision* 1, 2. Chart existing restorations and missing teeth, floss teeth and 43. Place or remove preformed crowns or bands for determining make preliminary inspections of the mouth and teeth with a size only when recommended by the dentist and only under his mouth mirror and floss only or her supervision 13, 69. Remove sutures, post-extraction dressing and surgical 44. Make preliminary study model and opposing model impressions ligature ties 47, 54. Fabricate and remove interim crowns or bridges (interim 15. Place or remove ligatures, cut and tuck ligatures, remove meaning temporary while permanent restoration is being tension devices and any loose or broken bands or arch wires fabricated) 18. Apply topical fluorides following prophylaxis by a dentist or 54, 61. Remove cement from dental restorations and appliances, dental hygienist with hand instruments, limited to the clinical crown 22, 52. Take and develop dental radiographs and intraoral photo56. Apply non-aerosol topical anesthetics graphs (See “Radiography Requirements” on previous page) • Apply desensitizing agents 24. Give intraoral instructions and demonstrations on oral hygiene • Apply non-endodontic oxygenating agents procedures • Make dental plaque smears 27. Apply and remove rubber dams • Place a removable retaining device in the mouth of a patient 30. Serve as the dentist’s chair side assistant • Remove final impressions 37. Take and record pulse, blood pressure and temperature • Condition teeth prior to placement or orthodontics bands or 39. Receive removable prostheses for cleaning or repair work brackets 42. Place or remove temporary orthodontic separating devices

*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.

LA 2

LOUISIANA State-approved 5/11/2022

Expanded Duty Dental Assistant

Education, Training and Credential Requirements To perform expanded functions under the direct supervision of a licensed dentist in Louisiana, a dental assistant must earn status as an Expanded Duty Dental Assistant (EDDA).

Requirements

To qualify, one must: I. a. Complete an expanded duty dental assisting program approved by the Louisiana State Board of Dentistry OR b. Graduate from a CODA-accredited 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.) AND II. Complete a Louisiana State Board of Dentistry-approved radiography course (see “Radiography Requirements” to the right) AND III. Hold current approved BLS certification AND IV. Apply to the Louisiana State Board of Dentistry for confirmation of EDDA certification. The Louisiana State Board of Dentistry only recognizes the Expanded Duty Dental Assistant (EDDA) Certificate earned through the EDDA course taught at the Louisiana State University (LSU) School of Dentistry, the University of Louisiana at Monroe (ULM), and Southern University at Shreveport. 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:

Allowable

6. Place and remove retraction cords 34. Apply cavity liners, excluding capping of exposed pulpal tissue 35, 62. Place and remove periodontal dressings 45. Place, wedge or remove matrices for restoration by the dentist

Allowable Functions Under Direct Supervision* • Any chairside dental act that a licensed dentist deems reasonable, using sound professional judgment. Such act must be performed properly and safely on the patient and must be reversible in nature.

MAINE: OVERVIEW State-approved 5/18/2022

State Career Ladder

Expanded Function Dental Assistant (EFDA)

Unlicensed Person

State Radiography Requirements

Prohibited Duties

State Job Titles

There are two recognized levels of dental assistants in Maine. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Functions NOT Permitted by Dental Assistants in Maine

To practice dental radiography in Maine under the general supervision of a licensed dentist or independent practice dental hygienist, an individual must be licensed as a Dental Radiographer by the Maine Board of Dental Practice. To qualify, an individual must: I. Be at least 18 years of age AND II. Hold a high school diploma or its equivalent AND III. Hold current CPR certification AND IV. a. Complete a course in dental radiologic technique and safety, which included a dental radiography exam, approved by the Maine Board of Dental Practice, OR b. Successfully complete an examination in dental radiologic technique and safety approved by the Board* AND V. Successfully complete (grade of 90 percent) the Maine Board of Dental Practice’s jurisprudence exam AND VI. Submit an application and pay applicable fee to the Maine Board of Dental Practice *Note: DANB’s Radiation Health and Safety (RHS) exam meets this requirement.

The following functions are not permitted by an Expanded Function Dental Assistant (EFDA): • • • • • •

Complete or limited examination, diagnosis or treatment planning Surgical or cutting procedures of hard or soft tissue Prescribing drugs, medicaments or work authorizations Pulp capping, pulpotomy or other endodontic procedures Placement and intraoral adjustments of fixed or removable prosthetic appliances Administration of local anesthesia, parenteral or inhalation sedation or general anesthesia

Requirements

Unlicensed Person

Education, Training and Credential Requirements A dentist in Maine may delegate to an unlicensed person activities related to dental care and treatment that are delegated by custom and usage as long as those activities are under the supervision and control of the dentist. Dentists must ensure that all dental personnel 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. Licensees must provide training, if responsible for hiring and/or supervising staff, to ensure that staff are trained upon employment/supervision, and at least annually thereafter, to implement emergency protocols.

Allowable

Note: A licensee may delegate the use of lasers and digital equipment when both the supervising licensee and the individual subject to the supervision obtain proper training on the use of the device.

MAINE

State-approved 5/18/2022

Expanded Function Dental Assistant (EFDA)

Education, Training and Credential Requirements

Requirements

To practice expanded function dental assisting under the direct supervision of a licensed dentist in Maine, an individual must be licensed as an Expanded Function Dental Assistant (EFDA). To qualify, one must: I. a. Be at least 18 years of age AND b. Hold current CPR certification AND c. Pass the jurisprudence exam administered by the Maine Board of Dental Practice with a grade of 90 percent AND d. Hold a high school diploma or its equivalent AND e. Hold current DANB CDA certification or hold an active dental hygiene license in good standing under the laws of Maine or another jurisdiction, AND f. Successfully complete training in a school or program in expanded function dental assisting approved by the Maine Board of Dental Practice, AND g. Submit an application and pay applicable fee to the Maine Board of Dental Practice for EFDA licensure OR To qualify for licensure by endorsement, one must: II. a. Be at least 18 years of age AND b. Provide verification of current certification in CPR, AND c. 1. Provide evidence of holding a substantially equivalent license in another jurisdiction, 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 preceding application, OR 2. Provide evidence of substantially similar qualifications, including all application materials required for initial licensure as an EFDA (see EFDA licensure requirements above), AND d. Submit an application, along with all required materials, and pay applicable fee to the Maine Board of Dental Practice

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Please note: The following list of allowable functions for EFDAs is reproduced as closely as possible from Title 32, Chapter 143, Section 18373 of the Maine Revised Statutes. Any differences in language between the lists reproduced here and those found in statute are inadvertent. Please consult the State’s official copy of the statute at http://legislature.maine.gov/legis/statutes/32/title32ch143sec0.html to verify the accuracy of any information presented here.

Under General Supervision* (As listed in 32 MRS §18373(1)) 6. Place and remove gingival retraction cord. 9, 33. Supragingival polishing using a slow-speed rotary instrument and rubber cup 12, 33. Place and contour amalgam, composite and other restorative materials prior to the final setting or curing of the material 18. Apply topical fluorides recognized for the prevention of dental caries 29. Perform preliminary selection and fitting of orthodontic bands, with final placement and cementing in the patient’s mouth by the dentist 29. Size, place and cement or bond orthodontic bands and brackets with final inspection by the dentist

33. Contour or finish restorative materials using a high-speed, power-driven handpiece or instrument 34. Apply cavity liners and bases as long as: 1) the dentist has ordered the cavity liner or base; and 2) the dentist has checked the cavity liner or base prior to the placement of the restoration 40. Apply pit and fissure sealants after an evaluation of the teeth by the dentist at the time of sealant placement 44. Obtain impressions for athletic mouth guards, provisional or temporary crowns and bridges • Apply supragingival desensitizing agents to an exposed root surface and/or dentinal surface of teeth

*Direct Supervision: The supervision required 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 identify or diagnose the condition to be treated and authorize the treatment procedure prior to implementation. General Supervision: The supervision of those tasks and procedures that do not require the physical presence of the supervisor in the practice setting while procedures are being performed but do require the tasks and procedures to be performed with the prior knowledge and consent of the supervisor.

MARYLAND: OVERVIEW State-approved 4/27/2022

State Job Titles

Dental Assistant Qualified in General Duties

Other Levels

1 Dental Assistant

Orthodontic

See page 77

State Radiography Requirements

State Radiography Requirements A dental assistant in Maryland must be state certified as a Dental Radiation Technologist in order to operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist. To obtain this state certification, one must: I. Be at least 18 years of age AND II. Be of good moral character AND III. Hold a high school diploma or its equivalent AND IV. Successfully complete a Board-approved course of at least 24 hours related to Maryland dental radiology AND V. Pass the national DANB Radiation Health and Safety (RHS) exam or Certified Dental Assistant (CDA) exam AND VI. 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 Dental Radiation Technologist Certification by Waiver of Examination 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.

Functions NOT Permitted by Dental Assistants in Maryland Prohibited

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted* by a Dental Assistant and a Dental Assistant Qualified in General Duties: 9, 20. Oral prophylactic procedures, including scaling, root planing and polishing teeth 15. Placing or removing an arch wire 15. Placing elastics or ligatures 29. Preparing or fitting orthodontic bands 33, 51. Condensing, carving or finishing any restoration 35. Placing an initial surgical dressing

MARYLAND

State-approved 4/27/2022

Functions NOT Permitted by Dental Assistants in Maryland, continued

Prohibited Duties

• • • • • • • • • • • •

Dental Assistant

Requirements

Maintain American Heart Association Basic Life Support for Healthcare Providers (BLS) or American Red Cross CPR for Professional Rescuers Have at least 400 hours of dental assisting clinical practice in dental patient care Successfully complete a Board-approved course of at least two hours in infection control with OSHA protocol, or be Qualified in General Duties (see requirements above) or Orthodontic Duties (see requirements on p. 77), or hold current DANB CDA or COA certification Enter into a written agreement with the supervising dentist setting forth the terms and conditions of practice under general supervision

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 12. Delivering restorative material with dentist at chairside 18. Applying topical fluoride rinse or foam tray; apply fluoride varnish 24. Instructing on oral hygiene 27, 25, 48. Placement and removal of materials for the isolation of the dentition, provided that the material is not retained by the dentition 37. Take and record vital signs 44. Taking impressions for study models or diagnostic casts 48 Rinsing and aspiration of the oral cavity 48. Retraction of the lips, cheek, tongue and flaps 48. Place and remove cotton rolls 56. Applying topical anesthesia 64. Constructing athletic mouth guards on models • Performing intraoral photography • Curing by the use of halogen light • Checking for loose bands • Any other duty approved by the Maryland State Board of Dental Examiners (see the “Dental Auxiliaries Procedures Chart” on the Maryland Board of Dental Examiners’ website at https://health.maryland.gov/dental for additional duties)

MD 2

MARYLAND State-approved 4/27/2022

Dental Assistant Qualified in General Duties

Education, Training and Credential Requirements

Requirements

To perform expanded functions in Maryland (see listing below), a dental assistant must register as a Dental Assistant Qualified in General Duties. To qualify, one must: I. Complete a Board-approved course of at least 35 hours related to Maryland general duties dental assisting AND II. a. Pass the Maryland General Dental Assisting Expanded Functions (MDG) exam administered by DANB OR b. Hold the national DANB Certified Dental Assistant (CDA) certification AND III. 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 on the first page of this section).

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Placing or removing retraction cord 13. Removing sutures 14. Drying a root canal 18. Applying topical fluoride; applying fluoride varnish 27. Placing or removing a rubber dam 35, 62. Removing or placing a periodontal dressing (except placing the original periodontal dressing) 43. Preparing and fitting stainless steel crowns 44. Taking alginate impressions for intraoral appliances 45. Placing or removing a matrix band 47. Preparing temporary crowns 47. Cementing temporary crowns or restorations 49. Performing vitality tests 50. Placement of temporary restorations 54. Removing temporary crowns 54. Removing excess cement 64. Fabricating athletic mouthguards, bleaching trays, fluoride trays, impression trays, nightguards on models • Performing bite registration • Bleaching (using bleaching tray)

• • • • • • •

Applying bonding agents Etching teeth Fabricating indirect restorations in a dental office Applying desensitizing agents Placing and removing wedges All duties designated to Dental Assistants, under the same level of required supervision Any other duty approved by the Maryland State Board of Dental Examiners (see the “Dental Auxiliaries Procedures Chart” on the Maryland Board of Dental Examiners’ website at https://health.maryland.gov/dental for additional duties)

Note: This state allows dental assistants qualified in orthodontics to perform a separate set of orthodontic functions. Please see the separate chart for Maryland orthodontic functions on the pages that follow.

MARYLAND (ORTHODONTIC) State-approved 4/27/2022

Dental Assistant Qualified in Orthodontics

Requirements

Education, Training and Credential Requirements To perform orthodontic functions in Maryland, a dental assistant must register as a Dental Assistant Qualified in Orthodontics. To qualify, one must: I. Complete a Board-approved course of at least 35 hours related to Maryland orthodontic dental assisting AND II. a. Pass the Maryland Orthodontic Assisting Expanded Functions (MDO) exam administered by DANB OR b. Hold the national DANB Certified Orthodontic Assistant (COA) certification AND III. Apply to the Maryland State Board of Dental Examiners for state recognition as a Maryland Dental Assistant Qualified in Orthodontics

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* • Etching teeth 15. Placing and removing arch wires • Cementing of orthodontic bands, placement of bonded attach15. Placing elastics and ligatures ments, or the removal of cemented or bonded orthodontic bands 29. Preparing and fitting orthodontic bands and attachments 44. Taking alginate impressions for intraoral appliances • Selecting headgear 54, 61. Removing excess cement from around orthodontic bands • Applying desensitizing agents 64. Fabricating athletic mouthguards, bleaching trays, fluoride trays, • All duties designated to Dental Assistants, under the same level impression trays, nightguards on models of required supervision • Performing bite registration • Any other duty approved by the Board • Bleaching (using bleaching tray) (see the “Dental Auxiliaries Procedures Chart” on the Maryland • Applying bonding agents Board of Dental Examiners’ website at https://health.maryland. gov/dental for additional duties)

Functions NOT Permitted by a Dental Assistant Qualified in Orthodontics in Maryland Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted* by a Dental Assistant Qualified in Orthodontics: 6. Placing or removing retraction cord 9, 20. Oral prophylactic procedures, including scaling, root planing and polishing teeth 13. Removing sutures 14. Drying a root canal 27. Placing or removing a rubber dam 33, 51. Condensing, carving or finishing any restoration 35, 62. Removing or placing a periodontal dressing 40. Applying pit and fissure sealants 43. Preparing and fitting stainless steel crowns 45. Placing or removing a matrix band 47. Preparing temporary crowns 47. Cementing temporary crowns or restorations 49. Performing vitality tests 50. Placement of temporary restorations 54. Removing temporary crowns 59. Monitoring nitrous oxide 63. Placing an initial surgical dressing • Examination, diagnosis and treatment planning • Surgery on hard or soft tissues • Initiation of treatment at any time for the correction of malocclusions and malformations of the teeth or jaws • Administering injectable local anesthesia

• • • • • • • • • • • • • • • • • • • •

Adjusting occlusion of natural teeth, restorations or appliances Adjusting prosthetic appliances Cementing permanent crowns or restorations Administering nitrous oxide Applying silver diamine fluoride Glucose monitoring Arch wire adjustment Bleaching (internal, laser or high-intensity light) Use a high speed handpiece intraorally Oral cancer screenings Oral cancer tissue biopsy Placement of liquid dam Applying and removing socket dressing Placement of subgingival medicaments Remove intracoronal temporary restoration Polish restorations Place sutures Place and remove wedges Perform manual curettage Any other duty prohibited by the Maryland State Board of Dental Examiners (for additional prohibited duties, see the “Dental Auxiliaries Procedures Chart” on the Maryland Board of Dental Examiners’ website at https://health.maryland.gov/dental)

MASSACHUSETTS: OVERVIEW State-approved 5/17/2022

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Massachusetts. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3 Expanded Function Dental Assistant (EFDA) 2 Certified Assistant (CA) or Formally Trained Dental Assistant (FTDA)

State Radiography Requirements

1 Dental Assistant Trained on the Job (OJT)

State Radiography Requirements To take dental radiographs under the supervision of a dentist, a dental assistant must I. a. Be an on-the-job trained Dental Assistant (OJT), AND b. Complete a course in radiological techniques and safeguard, AND c. 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 II. a. Be a Massachusetts Expanded Function Dental Assistant (EFDA), Certified Assistant (CA), or Formally Trained Dental Assistant (FTDA), AND b. Successfully complete a course with a curriculum that complies with Commission on Dental Accreditation (CODA) standards for radiological techniques and safeguards in dentistry

Functions NOT Permitted by Dental Assistants in Massachusetts Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 2. Perform and record charting of the oral cavity and surrounding structures, including but not limited to existing dental restorations, lesions, and periodontal probing depths 20. Perform sub-gingival and supra-gingival scaling 29. Perform final positioning and attachment of orthodontic bonds and bands 46. Take final impressions for fixed and removable prosthetic restoration of teeth or oral structures 49. Perform pulp testing • Perform final diagnoses and treatment planning • Perform surgical or cutting procedures on hard or soft tissue • Prescribe or parenterally administer drugs or medicaments • Prescribe dental lab work orders for any appliance or prosthetic device or restoration to be inserted into a patient’s mouth • Operate high speed rotary instruments in the mouth • Perform pulp-capping procedures • Perform final cementation of crowns and bridges • Perform preliminary evaluation to determine needed dental hygiene services

• • • • • • • • • • • • • •

Make referrals to dentist, physicians and other practitioners in consultation with a dentist Conduct dental screenings Evaluate radiographs for provision of dental hygiene services Perform minor emergency denture adjustments in nursing homes or other residential or long-term care facilities Perform minor emergency dental adjustments Administer local anesthesia Perform gross debridement and/or scaling and root planing Perform root planing and curettage Prepare and perform oral cytological smears or studies Use diagnostic and periodontic non-cutting lasers Perform polishing of amalgam restorations Perform micro disk identification applications Perform periodontal charting Irrigate root canals

MA 1

MASSACHUSETTS State-approved 5/17/2022

Dental Assistant Trained on the Job (OJT)

Education, Training and Credential Requirements

Requirements

To qualify as a Dental Assistant Trained on the Job (OJT), one must: I. Be 18 years of age or older, of good moral character, and not licensed as a dentist or dental hygienist AND II. Complete a course in CDC Guidelines AND III. Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or BLS from the American Heart Association AND IV. Apply to the Massachusetts Board of Registration in Dentistry for registration AND V. Take and pass the Massachusetts Board’s ethics and jurisprudence exam Note: A person who is at least 18 years of age and who has not previously been licensed as a dental assistant, dental hygienist, or dentist may undergo unlicensed on-the-job training for a one-time period of up to six consecutive months. Prior to commencing training, the prospective dental assistant must complete a course in CDC Guidelines and must submit a notice of intent to the MA Board of Registration in Dentistry containing information required by the Board.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Immediate Supervision* Under Direct Supervision* 12, 33. Place restorative materials in tooth for condensation and 6. Place and remove gingival retraction materials finishing by the dentist 13. Remove sutures 34. Apply cavity varnish, liner(s) and bonding agents 15. Place and remove orthodontic arch wires 43. Select and adapt stainless steel crowns or other pre-formed 18. Apply anti-cariogenic agents, including fluoride varnish crown for insertion by dentist 24. Provide oral health instruction 44, 64. Take impressions for study casts and bite registrations, 27. Place and remove dental dams including for identification purposes, night guards and custom 29. Preliminary intraoral fit of bands fluoride and bleaching trays pursuant to a dentist’s prescription 42. Place and remove orthodontic separators or order 44. Take impressions for orthodontic retainers 44, 64. Take impressions for athletic mouth guards 50. Place cotton pellets and temporary restorative materials into 45. Place and remove matrix bands endodontic openings 47. Fabricate provisional restorations intraorally 56. Apply topical anesthetic agents 47, 54. Cement and remove temporary crowns and bridges 61. Remove excess cement and bonding agents from orthodontic 50. Place temporary restorations (not including temporization of inappliances with hand instruments lays, on-lays, crowns and bridges) to provide palliative treatment • Record dental screenings 58. Removal of implant healing caps/cover screws for restorative • Record charting of the oral cavity and surrounding structures, procedures including but not limited to dental restorations, lesions and peri59. Assist or monitor nitrous oxide analgesia odontal probing depths 61. Remove excess cement and bonding agents from bridges and • Preliminary oral fit of arch wire appliances with hand instruments • Apply desensitizing agents 68. Perform minor emergency palliative orthodontic adjustments to • Select size of headgear eliminate pain and discomfort • Etch appropriate enamel surfaces before bonding of orthodontic • Place and remove wedges appliances by a dentist • Insert and/or perform minor adjustment of night mouth guards, • Place elastics and ligature wires athletic mouth guards and custom fluoride trays • Remove fixed orthodontic appliances • Apply bleaching agents and activate with a non-laser non-curing See note on page 81 for information about delegation of adminisdevice tering COVID-19 tests to dental assistants. Under supervision of a dentist holding a deep sedation/general anesthesia permit* • Assist in anesthesia administration, including patient monitoring (must be appropriately trained and hold current certification in BLS for the Healthcare Provider)

Under General Supervision* 22. Expose radiographs (see “Radiography Requirements” on prior page) 37. Take and record vital signs 48. Retract lips, cheek, tongue and other oral tissue parts 48. Irrigate and aspirate the oral cavity • Review medical and dental history and consult when necessary with medical practitioner • Take intraoral photographs

*Immediate Supervision: 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. Direct Supervision: Supervision of dental procedures based on instructions given by a licensed dentist who remains in the dental facility while procedures are being performed by the auxiliary. 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.

MA 2

MASSACHUSETTS State-approved 5/17/2022

Certified Assistant (CA) or Formally Trained Dental Assistant (FTDA)

Requirements

Education, Training and Credential Requirements To qualify as a Certified Assistant (CA), one must: I. Be at least 18 years of age and of good moral character AND II. Hold any of the following national DANB certifications: CDA, COA, CPFDA or CRFDA; or certification from another Board-approved certifying body at the time of registration AND III. Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or BLS from the American Heart Association AND IV. Apply to the Massachusetts Board of Registration in Dentistry for registration AND VI. Take and pass the Massachusetts Board’s ethics and jurisprudence exam

To qualify as a Formally Trained Dental Assistant (FTDA), one must: I. Be 18 years of age or older and of good moral character AND II. 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 III. Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or BLS from the American Heart Association AND IV. Apply to the Massachusetts Board of Registration in Dentistry for registration. AND V. Take and pass the Massachusetts Board’s ethics and jurisprudence exam

Allowable

Allowable Functions (for Certified Assistant and Formally Trained Assistant) Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Immediate Supervision* Under Direct Supervision* 12, 33. Place restorative materials in tooth for condensation and 6. Place and remove gingival retraction materials finishing by the dentist 40. Apply and adjust dental sealants 34. Apply cavity varnish, liner(s) and bonding agents 45. Place and remove matrix bands 43. Select and adapt stainless steel crowns or other pre-formed 47. Fabricate provisional restorations intraorally crown for insertion by dentist 50. Place cotton pellets and temporary restorative materials into 50. Place temporary sedative restorations/fillings (CA only; FTDA is endodontic openings not allowed to perform this function) 61. Remove excess cement and bonding agents from bridges 54, 55. Remove temporary restorations with hand instruments and appliances (including orthodontic appliances) with hand 58. Removal of implant healing caps/cover screws for restorative instruments procedures • Record dental screenings 59. Assist or monitor nitrous oxide analgesia • Record charting of the oral cavity and surrounding structures, 70. Place stainless steel crowns including but not limited to dental restorations, lesions and • Place temporary soft liners in a removable prosthesis (FTDA; periodontal probing depths CA may perform under immediate supervision) • Apply desensitizing agents • Obtain endodontic cultures (FTDA; CA may perform under • Place and remove wedges direct supervision) • Apply bleaching agents and activate with non-laser non-curing device Under supervision of a dentist holding a deep sedation/gener• Preliminarily fit crowns to check contacts, adjust occlusion al anesthesia permit on crowns inside the mouth (CA only; FTDA is not allowed to • Assist in anesthesia administration, including patient monitoring perform this function) (must be appropriately trained and hold current certification in • Place temporary soft liners in a removable prosthesis (CA; BLS for the Healthcare Provider) FTDA may perform under immediate supervision) • Obtain endodontic cultures (CA; FTDA may perform under immediate supervision) See note on next page for information about delegation of administering COVID-19 tests to dental assistants. Allowable functions for this level continued on next page *Immediate Supervision: 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. Direct Supervision: Supervision of dental procedures based on instructions given by a licensed dentist who remains in the dental facility while procedures are being performed by the auxiliary. 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.

MASSACHUSETTS State-approved 5/17/2022

Allowable Functions (for Certified Assistant and Formally Trained Assistant), continued

Note

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 9. Polish teeth, after dentist or dental hygienist has determined that teeth are free of calculus, with slow-speed hand piece 13. Remove sutures 15. Place and remove orthodontic arch wires 18. Apply anti-cariogenic agents, including fluoride varnish 22. Expose radiographs (See “Radiography Requirements” on p. 78) 24. Provide oral health instruction 27. Place and remove dental dams 29. Preliminary intraoral fit of bands 35, 62. Place and remove periodontal dressings 37. Take and record vital signs 48. Irrigate and aspirate the oral cavity 42. Place and remove orthodontic separators 44, 64. Take impressions for study casts and bite registrations, including for identification purposes, night guards, and custom fluoride and bleaching trays pursuant to a dentist’s prescription or order 44. Take impressions for orthodontic retainers 44, 64. Take impressions for athletic mouth guards 47, 54. Cement and remove temporary crowns and bridges

48. Retract lips, cheek, tongue and other oral tissue parts 50. Place temporary restorations (not including temporization of inlays, on-lays, crowns and bridges) to provide palliative treatment 56. Apply topical anesthetic agents 68. Perform minor emergency palliative orthodontic adjustments to eliminate pain and discomfort • Insert and/or perform minor adjustment of night mouth guards, athletic mouth guards and custom fluoride trays • Preliminary oral fit of archwire • Select size of headgear • Etch appropriate enamel surfaces before bonding of orthodontic appliances by a dentist • Place elastics and ligature wires • Remove fixed orthodontic appliances • Remove excess cement and bonding agents from orthodontic appliances with hand instruments • Re-cement and adjust intact temporary restorations intraorally • Review medical and dental history and consult when necessary with medical practitioner • Take intraoral photographs • Perform dietary screening for dental disease prevention and control

Note: At its September 16, 2020 meeting, the Massachusetts Board of Registration in Dentistry voted to permit licensed dental assistants to administer COVID-19 tests under the direct supervision of a licensed dentist and that such actions falls within their permissible scope of practice.

MA 3

MASSACHUSETTS State-approved 5/17/2022

Expanded Function Dental Assistant

Education, Training and Credential Requirements

Requirements

To qualify as an Expanded Function Dental Assistant (EFDA), one must: I. Be 18 years of age or older and of good moral character AND II. Hold any of the following national DANB certifications: CDA, COA, CPFDA or CRFDA; or certification from another Board-approved certifying body at the time of registration AND III. Complete a formal program in the Massachusetts delegable expanded functions at a CODA-accredited program AND IV. Hold current certification in CPR/AED for the Professional Rescuer from the American Red Cross or BLS from the American Heart Association AND V. Apply to the Massachusetts Board of Registration in Dentistry for registration AND VI. Take and pass the Massachusetts Board’s ethics and jurisprudence exam Note: As of spring 2022, the Massachusetts Board of Registration in Dentistry has temporarily stopped issuing EFDA licenses; the Board has formed a workgroup to revisit the requirements for licensure as an EFDA

Allowable

Allowable Functions (for Expanded Function Dental Assistant) Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Immediate Supervision* Under General Supervision* 12, 33. Place restorative materials in tooth for condensation and 9. Polish teeth, after dentist or dental hygienist has determined finishing by the dentist that teeth are free of calculus, with slow-speed hand piece 14 Dry root canals with paper points 13. Remove sutures 34. Apply cavity varnish, liner(s) and bonding agents 15. Place and remove orthodontic arch wires 43. Select and adapt stainless steel crowns or other pre-formed 18. Apply anti-cariogenic agents, including fluoride varnish crown for insertion by dentist 22. Expose radiographs (see “Radiography Requirements” on 58. Removal of implant healing caps/cover screws for restorative page 78) procedures 24. Provide oral health instruction 59. Assist or monitor nitrous oxide analgesia 27. Place and remove dental dams • Assist in anesthesia administration, including patient monitoring 29. Preliminary intraoral fit of bands (must be appropriately trained and hold current certification in 35, 62. Place and remove periodontal dressings BLS for the Healthcare Provider) 37. Take and record vital signs 40. Apply and adjust dental sealants Under Direct Supervision* 42. Place and remove orthodontic separators 6. Place and remove gingival retraction materials 44. Take impressions for study casts and bite registrations, includ12, 51 Place and condense amalgam restorations ing for identification purposes, night guards and custom fluoride 33. Place and finish composite restorations and bleaching trays pursuant to a dentist’s prescription or order 51. Carve, contour, adjust amalgam restorations 44. Take impressions for orthodontic retainers 70. Place stainless steel crowns 44,64. Take impressions for athletic mouth guards • Record dental screenings 45. Place and remove matrix bands • Record charting of the oral cavity and surrounding structures, 47. Fabricate provisional restorations intraorally including but not limited to dental restorations, lesions and 47,54. Cement and remove temporary crowns and bridges periodontal probing depths 48. Irrigate and aspirate the oral cavity • Apply bleaching agents and activate with non-laser non-curing 48. Retract lips, cheek, tongue and other oral tissue parts device 50. Place temporary restorations (not including temporization of • Obtain endodontic cultures inlays, on-lays, crowns and bridges) to provide palliative treat• Preliminarily fit crowns to check contacts, adjust occlusion on ment crowns inside the mouth 50. Place cotton pellets and temporary restorative materials into • Place temporary soft liners in a removable prosthesis endodontic openings 50. Place temporary sedative restorations/fillings Allowable functions for this level continued on next page

MASSACHUSETTS State-approved 5/17/2022

Allowable

Allowable Functions (for Expanded Function Dental Assistant), continued Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* • Place elastics and ligature wires 54, 55. Remove temporary restorations with hand instruments • Remove fixed orthodontic appliances 56. Apply topical anesthetic agents 61. Remove excess cement • Take intra-oral photographs and bonding agents from bridges and appliances (including • Review medical and dental history orthodontic appliances)with hand instruments • Perform dietary screening for dental disease prevention and 68. Perform minor emergency palliative orthodontic adjustments to control eliminate pain and discomfort • Adjust dentures on the tissue side to eliminate tissue irritation • Re-cement and adjust intact temporary restorations intraorally • Apply desensitizing agents • Place and remove wedges • Insert and/or perform minor adjustment of night mouth guards, athletic mouth guards and custom fluoride trays • Preliminary oral fit of arch wire • Select size of headgear • Etch appropriate enamel surfaces before bonding of orthodontic appliances by a dentist

MICHIGAN: OVERVIEW

State-approved 5/11/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Michigan. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Registered Dental Assistant (RDA)

Dental Assistant

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.

Functions NOT Permitted by Dental Assistants in Michigan Prohibited Duties

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted to be delegated or assigned to any level of dental assistant unless authorized by rules or code: 46. Taking impressions for any purpose other than study or opposing models • Diagnosing, or prescribing for, any of the following: disease, pain, deformity, deficiency, injury, or physical condition • Cutting of hard and soft tissue • Removal of any of the following: accretions, stains, or calculus deposits • Deep scaling • Root planing • Any intra-oral restorative procedures • Administration of any of the following: local anesthesia, nitrous oxide analgesia, or acupuncture • Irrigation and medication of root canals, try-in of cones or points, filing, or filling of root canals • Permanent cementation of any restoration or appliance

MICHIGAN

State-approved 5/11/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements An unlicensed dental assistant in Michigan may perform basic supportive dental procedures (see below) specified by the state dental practice act and administrative rules under the direct or general supervision of a licensed dentist. There are no other education or training requirements for this level of dental assisting, except for the training required to operate x-ray equipment (see previous page).

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 22. Operating dental radiographic equipment (see “Radiography Requirements” on previous page) 26. Instructing in the use and care of dental appliances 29. Trial sizing of orthodontic bands 44. Taking impressions for study and opposing models 56. Applying nonprescription topical anesthetic solutions • Holding the matrix for anterior resin restorations

Under Assignment* • Applying commonly accepted emergency procedures Under Direct Supervision* 15. Placement and removal of orthodontic separators 15. Placement and removal of orthodontic elastics, ligatures and arch wires 46. Taking digital scans for final restorations or intra-oral appliances • Dispensing aligners

Registered Dental Assistant (RDA)

Education, Training and Credential Requirements

Requirements

To become licensed as a Registered Dental Assistant (RDA) in the state of Michigan, one must: I. 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 (Note: Individuals who earned the RDA credential prior to March 22, 2004 must complete additional expanded functions training courses before performing the functions marked with ** or ‡ below.), AND II. Pass the Michigan board comprehensive and clinical exam or pass an equivalent exam in another state (proof of out-of-state licensure required), AND III. Complete two hours of implicit bias training within the five years prior to registration, AND IV. Complete a one-time training in identifying victims of human trafficking, AND V. Complete the fingerprinting/criminal background check process, AND VI. Apply for a license to the Michigan Board of Dentistry Additionally, to receive an RDA license, an applicant must demonstrate a working knowledge of the English language under the minimum standards established by the Michigan Department of Licensing & Regulatory Affairs. See Section R.338.7002b of the Michigan Administrative Rules for further details.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 12, 51. Placing, condensing and carving amalgam restorations‡ 46. Taking final impressions for direct and indirect restorations and 13. Removing sutures prosthesis including bite registrations‡ 29. Cementing orthodontic bands or initial placement of orthodontic 59. Assisting and monitoring of the administration of nitrous oxide brackets analgesia by the dentist or dental hygienist** 33. Placing Class I resin bonded restorations, occlusal adjustment, • Removing orthodontic adhesive from teeth, supragingivally, after finishing and polishing with non-tissue cutting rotary hand removing brackets with non-tissue cutting instruments pieces‡ • Applying in-office bleaching Allowable functions for this level continued on next page

MICHIGAN State-approved 5/11/2022

Allowable Functions for Registered Dental Assistant, continued

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 6. Placing and removing nonepinephrine retraction cords** 6. Placing and removing of retraction materials 14. Drying endodontic canals with absorbent points** 34. Applying cavity liners and bases** 44. Taking an impression for orthodontic appliances, mouth guards, bite splints and bleaching trays** 45. Placing and removing matrices and wedges** 46. Taking digital scans for final restorations or intra-oral appliances 49. Performing pulp vitality testing** 61. After cementation, removing excess cement from around restorations • Prior to cementation by the dentist, adjusting and polishing contacts and occlusion of indirect restorations • Applying desensitizing agents** • Etching and placing adhesives prior to placement of orthodontic brackets** • All duties that may be performed by Dental Assistants under General Supervision, except making impressions for study and opposing models.

Under Assignment* 1, 2. Inspecting and charting the oral cavity using a mouth mirror and radiographs 18, 40. Applying anticariogenic agents including, but not limited to, sealants, fluoride varnish, and fluoride applications 22. Operating of dental radiographic equipment (see “Radiography Requirements” on page 84) 24. Instructing in the use and care of dental appliances 27. Placing and removing a rubber dam 29. Sizing of temporary crowns and bands 29, 47, 54. Temporarily cementing and removing temporary crowns and bands 35, 62. Placing and removing periodontal dressings 44. Making impressions for study and opposing models 47. Fabricating temporary restorations and existing temporary crowns and temporary bridges 50, 54. Placing and removing a nonmetallic temporary restoration with non-tissue cutting instruments 56. Applying nonprescription topical anesthetic solution 61. Removing excess cement from supragingival surfaces of a tooth with non-tissue cutting instruments • Polishing specific teeth with a slow-speed rotary handpiece immediately before procedures that require acid etching, for placement of sealants,placement of resin-bonded orthodontic appliances, and placement of direct restorations by the dentist • Polishing and contouring of sealants with a slow-speed rotary hand piece immediately following the procedure for the purpose of occlusal adjustment • Removing orthodontic elastics, ligatures and elastic or wire separators • Replacing elastic or wire separators • Classifying occlusion • Providing nutritional counseling for oral health and maintenance

‡RDAs must first complete an approved course followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a criterion-based assessment instrument before performing these functions **RDAs must first complete an approved course before performing these functions

*Assignment: A dentist has designated a patient of record upon whom services are to be performed and describes the procedures to be performed. The dentist need not be physically present in the office at the time the procedures are being performed Direct Supervision: A dentist complies with all of the following: designates a patient of record upon whom the procedures are to be performed and describes the procedures to be performed; examines the patient before prescribing the procedures to be performed and upon completion of the procedures; and is physically present in the office at the time the procedures are being performed. General Supervision: A dentist complies with both of the following: designates a patient of record upon whom services are to be performed; and is physically present in the office at the time the procedures are being performed.

MINNESOTA: OVERVIEW State-approved 5/19/2022

There are three recognized levels of dental assistants in Minnesota. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Licensed Dental Assistant with Collaborative Practice Authorization

Licensed Dental Assistant (LDA)

Dental Assistant

State Radiography Requirements

Prohibited Duties

State Job Titles

State Career Ladder

Functions NOT Permitted by Dental Assistants in Minnesota

To legally operate dental x-ray equipment and perform dental radiographic procedures in Minnesota, a dental assistant must: I. Be a Licensed Dental Assistant (see requirements on the next page) OR II. Hold a limited radiology registration. To register, an applicant must: a. Provide evidence of having completed a board-approved course on dental radiology offered through a CODA accredited school, AND b. Pass the DANB Radiation Health and Safety (RHS) exam or other board-approved nationally recognized radiation exam within the last 5 years, AND c. Pass the MN jurisprudence exam within the last 5 years, AND d. Provide proof of current CPR certification, AND e. Submit to a criminal background check, AND f. Submit an application to the MN Board of Dentistry and pay the accompanying fee.

According to the Minnesota Board of Dentistry, “The State of Minnesota only recognizes permissive (allowable) expanded functions and not non-permissive (prohibited) expanded functions.” A dental assistant must not administer general anesthesia, deep sedation, moderate sedation or minimal sedation.

MINNESOTA

State-approved 5/19/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Minnesota may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist or dental therapist. The dentist is responsible for ensuring that the assistant: • Completes and maintains consecutive and current CPR certification • Complies with the most current infection control practices for a dental setting

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Personal Supervision* In a community setting, under the authorization and direction 48. Retract a patient’s cheek, tongue or other parts of tissue during of a licensed practitioner with prescribing authority, such as a a dental operation dentist or physician 48. Remove debris or water that is created during treatment ren18. Apply fluoride varnish, as long as the licensed practitioner audered by a dentist or dental therapist using suction devices thorizing the service or the facility at which the fluoride varnish 48, 56. provide any assistance, including the placement of articles is administered maintains appropriate patient records of the and topical medication in a patient’s oral cavity during dental treatment treatment under the personal supervision of a dentist or dental therapist • Aid dental hygienists and licensed dental assistants in the performance of their delegated procedures • Assist with the placement or removal of devices or materials for isolation purposes as directed by the dentist or dental therapist during treatment Note: A licensed dental therapist may supervise dental assistants to the extent permitted in the collaborative management agreement, but may not supervise more than four Licensed Dental Assistants in any practice setting.

*General Supervision: 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. Indirect Supervision: 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. Direct Supervision: 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. Personal Supervision: The dentist is personally operating on a patient and authorizes the allied dental personnel to aid in treatment by concurrently performing supportive procedures.

MN 2

MINNESOTA State-approved 5/19/2022

Licensed Dental Assistant

Education, Training and Credential Requirements

Requirements

To earn status as a Licensed Dental Assistant in Minnesota, dental assistants must: I. Pass the national DANB Certified Dental Assistant (CDA) exam within the past five years, AND II. a. Graduate from a Minnesota CODA-accredited dental assisting program OR b. Graduate from a CODA-accredited program in a state other than Minnesota and, upon Minnesota Board review of curriculum, complete additional coursework AND III. Pass the Minnesota Dental Assistant State Licensing Exam within the past five years*, AND IV. Pass the Minnesota Jurisprudence Exam within the past five years, AND V. Provide proof of current CPR certification, AND VI. Submit to a criminal background check; AND VII. Apply for licensure to the MN Board of Dentistry 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 listed under “Allowable Functions” below, 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.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Place nonsurgical retraction material for gingival displacement [Requires a course in the function presented by a CODA-accredited program] 45. Place and remove matrix systems and wedges 47. Fabricate, place, replace cement and adjust temporary crowns or restorations 54. Remove temporary restorations with hand instruments only • Remove excess bond material from orthodontic appliances • Etch appropriate enamel surfaces before bonding of orthodontic appliances by dentist • Attach prefit and preadjusted orthodontic appliances Under Indirect Supervision* 9. Perform mechanical polishing to clinical crowns, not including the removal of calculus by instrumentation; 12, 33, 51, 70. 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 [Requires a board-approved course in the function] 13. Remove sutures 14. Dry root canals with paper points

•

Remove fixed orthodontic bands and brackets• Remove bond material from teeth with rotary instruments after removal of orthodontic appliances [Requires a course in the function presented by a CODA-accredited program if graduated from a dental assisting program prior to September 2, 2004] Administer nitrous oxide inhalation analgesia (only after a maximum dosage has been prescribed by a dentist for a specific patient) [Requires a course in the function presented by a CODA-accredited program] Initiate and place intravenous line in preparation for intravenous medications and sedation [Requires a board-approved course in the function and certification by the board]

15. Place initial arch wires on orthodontic appliances; a dentist must select and, if necessary, adjust arch wires prior to placement 27. Place and remove devices or materials for isolation purposes 29. Preselect orthodontic bands 35, 62. Place and remove periodontal dressings 40, 49. Etch appropriate enamel surfaces and apply and adjust pit and fissure sealants [Requires a course in the function presented by a CODA-accredited program] 59. Monitor a patient who has been induced by a dentist into nitrous oxide inhalation analgesia Allowable functions for this level continued on next page

MINNESOTA State-approved 5/19/2022

Allowable Functions for Licensed Dental Assistant (continued) Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Indirect Supervision* (continued) 61. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments only • Apply topical medications including bleaching agents, desensitizing agents, and cavity varnishes as prescribed by a dentist • Place cotton pellets and temporary restorative materials into endodontic access openings

Under General Supervision* 2. Complete preliminary charting of the oral cavity and surrounding structures with the exception of periodontal probing and assessment of the periodontal structures 15. Remove and place ligature ties and remove and replace existing arch wires on orthodontic appliances 18. Apply topical fluoride, including foam, gel, or varnish 22. Take radiographs 37. Take vital signs such as pulse rate and blood pressure as directed by a dentist 42. Place and remove elastic orthodontic separators

• •

Maintain and remove intravenous lines [Requires a board-approved course in the function and certification by the board] 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 [Requires a board-approved course in the function and certification by the board]

44, 46.Take impressions and bite registration 50. Place temporary fillings, not including temporization of inlays, onlays, crowns, and bridges • Cut arch wires on orthodontic appliances • Remove loose bands on orthodontic appliances • Remove loose brackets on orthodontic appliances • Recement intact temporary crowns or restorations • Fabricate and deliver custom fitted trays. • Take photographs extraorally or intraorally

Under Personal Supervision* of a General Anesthesia or Moderate Sedation Certificate Holder • Concurrently perform supportive services if the dentist 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 [Requires board-approved course in the function and certification by the board] **Note: At its November 18, 2020 meeting, the Policy Committee of the Minnesota Board of Dentistry determined that the taking of a digital scan is to be considered a digital impressions and is therefore allowed under the scope of practice for Licensed Dental Assistants. The Committee additionally clarified that silver diamine fluoride is considered an application of topical fluoride and that Licensed Dental Assistants are permitted to perform this function under general supervision.

MN 3

MINNESOTA State-approved 5/19/2022

Licensed Dental Assistant with Collaborative Practice Authorization

Requirements

Education, Training and Credential Requirements A Licensed Dental Assistant may be employed or retained by a health care facility, program, or nonprofit organization to perform specified dental assisting services 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 the Licensed Dental Assistant has: I. 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, that designates authorization for the services being provided by the dental assistant AND II. Documented completion of a course on medical emergencies within each continuing education cycle

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* of a Collaborating Dentist 2. Complete preliminary charting of the oral cavity and surrounding structures, except periodontal probing and assessment of the periodontal structure 9. Perform mechanical polishing to clinical crowns not including instrumentation 18, 40. Apply topical preventative agents, including fluoride varnishes and pit and fissure sealants 22. Take radiographs

24. Provide oral health promotion and disease prevention education 37. Take vital signs such as pulse rate and blood pressure • Obtain informed consent for treatments authorized by the collaborating dentist within the licensed dental assistant’s scope of practice • Take photographs extraorally or intraorally

MISSISSIPPI: OVERVIEW State-approved 4/7/2022

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Mississippi. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Mississippi, a dental assistant must: Hold a current national DANB Certified Dental Assistant (CDA) certification OR Successfully complete a Mississippi board-approved radiology seminar and exam within 90 days prior to application OR Graduate from a CODA-accredited dental assisting program within 12 months prior to application OR 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 II. Apply to the Mississippi State Board of Dental Examiners for a radiology permit I. a. b. c. d.

Functions NOT Permitted by Dental Assistants in Mississippi Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 1,2. Inspecting the oral cavity (including charting carious lesions, existing restorations and missing teeth) 6. Placement of any subgingival medicated cords 20. Performing supragingival and coronal scaling 33. Placing and finishing composite resin restorations 34. Applying cavity liners and bases 46. 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 49. Performing pulp vitality testing 51. Carve and pack amalgams • Periodontal screening and probing, or subgingival explorations for hard or soft deposits and sulcular irrigations • Use of ultrasonic and/or sonic instruments • Placement, cementation or final torquing of inlays, permanent crowns, fixed bridges, removable bridges, partial dentures, full dentures or implant abutments • Equilibration or adjustment of occlusion on natural or artificial dentition, restoration or sealants

• • • • • • • • • • • • • •

Activation or adjustments of orthodontic appliances Injections of drugs, medication or anesthetics Performing pulp capping, pulpotomy, and other endodontic therapy Intraoral restorative procedures Removal of calcareous deposits with an instrument Brush biopsies Remove facial hair with lasers Administer Oraqix Perform sulcular debridement of periodontal pockets using a Diode dental laser Condensing amalgam restorations Polishing amalgam restorations Bending archwires Placing local antimicrobial agents Procedures that require the professional judgment and skill of a licensed dentist such as diagnosis, treatment planning, surgical procedures involving hard or soft tissue, or any intra-oral procedure of an irreversible nature that could result in injury to the patient

MISSISSIPPI

State-approved 4/7/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements A dental assistant in Mississippi may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. All dental assistants involved in direct patient care must be certified in CPR (within 180 days of employment). There are no other education or training requirements for this level of dental assisting. Auxiliary personnel who are present during sedation procedures must be currently certified in Basic Life Support at the Health Care Provider Level endorsed by or equivalent to the American Heart Association (BLS-HCP). Auxiliary staff who have the primary responsibility of monitoring patients under deep sedation/general anesthesia must have current certification in a board-approved training program for such a role and have current certification in Advanced Cardiac Life Support (ACLS) for patients 8 years of age or older, or alternatively in Pediatric Advanced Life Support (PALS) for pediatric patients 7 years of age or younger.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Place and pack retraction cords, excluding subgingival medicat47. Fabricating temporary/interim restorations ed cords 47,50. Placing temporary/interim restorations 9. Coronal polishing 54,55. Removing temporary/interim restorations 12. Placing amalgam restorations for condensation by the dentist 56. Apply topical anesthetic agents 13. Removing sutures 59. Placement and monitoring of nitrous-oxide inhalation anxiolysis 18. Applying topical fluoride gels, rinses and varnishes 61. Removing excess cement from coronal surfaces of teeth 22. Exposing radiographs 64. Fabricating trays for in-office bleaching procedures 27. Placing and removing rubber dams • Perform in-office bleaching procedures 35, 62. Placing and removing periodontal dressings • Adjust the gingival side of complete or partial dentures 40. Apply pit and fissure sealants • Detect possible caries using the KaVo DIAGNOdent 44. Taking impressions for study models and opposing models • Applying desensitizing agents 45. Place and remove matrix bands • Monitoring minimally sedated patients 47. Construction, adjustment and cementation of temporary crowns • Monitoring moderately sedated patients (temporary means crowns placed while permanent restoration • Monitoring patients under deep sedation/general anesthesia is being fabricated) • Make the Essix vacuum permanent retainer • Perform face bow procedures Note: Some functions listed above as allowed and some functions listed on the previous page as prohibited do not appear in Mississippi statutes or regulations; rather, the Mississippi State Board of Dental Examiners has made a determination at a meeting as to whether these functions may be delegated to dental assistants and reported the determination on its website. DANB’s Note on Allowable Dental Assisting Functions In the state of Mississippi, all dental assistants may: • Perform infection control and occupational safety procedures • Perform other duties not specified by this state’s dental practice act At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

* Direct Supervision: 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 auxiliary, and will evaluate the performance of the dental auxiliary.

MISSOURI: OVERVIEW

State-approved 2/23/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Missouri. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded-Functions Dental Assistant

Dental Assistant

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.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Missouri Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 20. Scaling of teeth • Diagnosis, including interpretation of dental radiographs and treatment planning • Cutting of tooth structure • Surgical procedures on hard and soft tissues including, but not limited to, the removal of teeth and the cutting and suturing of soft tissues • Prescription, injection and parenteral administration of drugs • Final bending of archwire prior to ligation • Administration of nitrous oxide/oxygen analgesia

MISSOURI

Dental Assistant

State-approved 2/23/2022

Education, Training and Credential Requirements A dental assistant in Missouri may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist.

Requirements

There are no education or training requirements for this level of dental assisting. Dental assistants may assist in the administration of and monitor nitrous oxide analgesia under direct supervision if they meet the following requirements: I. Successfully complete formal certified training in a course approved by the Missouri Dental Board AND II. a. Pass an approved competency test regarding clinical and didactic training OR b. Submit proof to the Missouri Dental Board of having been certified in these functions in another state subsequent to equivalent training and testing AND III. Obtain a permit from the Missouri Dental Board

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. DANB’s Note on Allowable Dental Assisting Functions

Allowable

In the state of Missouri, all dental assistants may: 9. Polishing the coronal surfaces of teeth (air polisher) 18. Application of topical fluoride 40. Placement of pit or fissure sealants 59. Assist in the administration of and monitor nitrous oxide analgesia (see requirements above) • Expose, process and evaluate dental radiographs • Perform infection control and occupational safety procedures • Perform other duties not specified by this state’s dental practice act At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

*Direct Supervision: The dentist is in the dental office or treatment facility; has personally diagnosed the condition to be treated; has personally authorized the procedures; remains in the dental office or treatment facility while the procedures are being performed by the dental auxiliary; and evaluates the performance of the dental auxiliary before the dismissal of the patient.

MO 2

MISSOURI State-approved 2/23/2022

Expanded-Functions Dental Assistant

Education, Training and Credential Requirements

Requirements

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. To earn this permit, one must: I. a. 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 b. Hold DANB CDA certification and complete a Missouri Dental Board-approved expanded functions training course OR c. 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 Board-approved expanded functions training course AND II. 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 III. 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.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision*

Allowable

With Restorative I Permit: 12, 51. Placing, condensing, and carving amalgam for Class I, V, and VI restorations 33. Placing composite for Class I, V, and VI restorations 43, 70. Sizing and cementing of prefabricated crowns • Minor palliative care of dental emergencies (place sedative filling) With Restorative II Permit: 12, 51. Placing, condensing, carving, and finishing amalgam for Class I, II, III, IV, V, and VI restorations 33. Placing and finishing composite for Class I, II, III, IV, V, and VI restorations 43, 70. Sizing and cementing of prefabricated crowns • Minor palliative care of dental emergencies (place sedative filling) With Orthodontic Permit: 46. Making impressions for the fabrication of any removable or fixed prosthesis/appliance • Preliminary bending of archwire • Removal of orthodontic bands and bonds • Final cementation of any permanent appliance or prosthesis • Placement and cementation of orthodontic brackets and/or bands

With Fixed Prosthodontics Permit: 6. Place retraction cord in preparation for fixed prosthodontic impressions 46. Making impressions for the fabrication of any removable or fixed prosthesis/appliance • Extra-oral adjustments of fixed prosthesis • Extra-oral adjustments of removable prosthesis during and after insertion • Final cementation of any permanent appliance or prosthesis With Removable Prosthodontics Permit: 46. Making impressions for the fabrication of any removable or fixed prosthesis/appliance • Placement of temporary soft liners in a removable prosthesis • Extra-oral adjustments of removable prosthesis during and after insertion • Minor palliative care of dental emergencies (place sedative filling)

MONTANA: OVERVIEW

State-approved 3/23/2022

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Montana. See the following pages for details about requirements and allowed functions for this level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

DANB Certified Dental Assistant (CDA)

Dental Auxiliary

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: I. Successfully complete the national DANB Radiation Health and Safety (RHS) exam. After successfully completing the DANB RHS exam, DANB will issue the dental 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 II. Graduate from a CODA-accredited dental assisting program OR III. Be certified in dental radiography as a result of military experience To expose radiographs under the general supervision of a licensed dentist, a dental auxiliary must hold DANB’s CDA certification. 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.

Functions NOT Permitted by Dental Assistants in Montana Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant under any level of supervision*: 12, 33, 51. Placing, carving or condensing any permanent restorations 46. Taking final impressions of the involved arch for crowns, bridges, implant prosthesis, partial or complete dentures • Diagnosis and treatment planning • Cutting hard or soft tissue or extracting teeth • Prescribing any drugs • Administering or dispensing any drug, without the prior authorization of the supervising dentist • Administering intravenous and intramuscular injections or local anesthetic

• • • • • • • •

Restorative, prosthetic, orthodontic, and other procedures that require the knowledge and skill of a dentist Bonding or cementing any fixed prosthesis, including veneers, except for provisionals Bonding or cementing orthodontic brackets or orthodontic appliances that would provide activation upon cementation Placing sulcular medicinal or therapeutic materials Periodontal probing Air polishing Prophylaxis Work authorizations

The following functions may not be performed by a dental auxiliary holding DANB CDA certification and working under the general supervision* of a dentist: 12, 51. Amalgam restorations 27. Placing and removing rubber dams 45. Placing and removing matrices 56. Applying topical anesthetic agents

59. Initiating, adjusting, and monitoring nitrous oxide flow for a patient who has been prescribed and administered nitrous oxide by a licensed dentist • Applying silver diamine fluoride agents

*Direct Supervision: The provision of allowable functions by dental auxiliaries with the intent and knowledge of the dentist and while the supervising dentist is on the premises. General supervision: 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 Montana. The supervising dentist need not be on the premises.

MONTANA

State-approved 3/23/2022

Dental Auxiliary

Requirements

Education, Training and Credential Requirements A dental auxiliary in Montana may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. To qualify, one must: I. Graduate from a CODA-accredited dental assisting program OR II. Receive instruction and training by a licensed dentist OR III. Receive instruction and training in a board-approved continuing education course

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 2. Collecting patient data 44. Taking impressions for study or working casts 9. Coronal polishing 45. Placing and removing matrices 13, 62. Removing sutures and dressings 47, 50, 54, 55. Placing and removing temporary restoration with 18. Applying topical fluoride agents hand instruments only 22. Making radiographic exposures as prescribed by the super56. Applying topical anesthetic agents vising dentist (see “Radiography Requirements” on previous 59. Initiating, adjusting and monitoring nitrous oxide flow for a page) patient who has been prescribed and administered nitrous 24. Providing oral health instructions oxide by a licensed dentist 27. Placing and removing rubber dams 61. Removing excess cement from coronal surfaces 40. Placing pit and fissure sealants • Polishing amalgam restorations

Requirements

DANB Certified Dental Assistant (CDA)

Education, Training and Credential Requirements To perform duties under the general supervision of a licensed dentist, a dental auxiliary must: Hold DANB Certified Dental Assistant (CDA) certification

Allowable

Allowable Functions Under General Supervision* • Perform any duty that may be delegated to a dental auxiliary, excluding those duties prohibited under general supervision (see “Prohibited Duties” on previous page) 40. Place pit and fissure sealants (following an in-person comprehensive oral examination or periodic examination within the preceding 30 days)

NEBRASKA: OVERVIEW State-approved 5/12/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are four recognized levels of dental assistants in Nebraska. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 4

Expanded Function Dental Assistant (EFDA)

Licensed Dental Assistant (LDA)

Dental Assistant qualified in coronal polishing

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Nebraska, a dental assistant must: I. 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 II. Pass the national DANB Certified Dental Assistant (CDA) exam OR III. Successfully complete a dental assisting course from a CODA-approved technical program or community college which provides training in dental radiography as part of its curriculum

Functions NOT Permitted by Dental Assistants in Nebraska Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: • • • • • •

Cutting of hard and soft tissue Irreversible procedures Restorative dentistry Making a dental diagnosis Fabricating a treatment plan Any task or procedure that requires the professional skill or judgment of a licensed dentist or licensed hygienist

NEBRASKA

State-approved 5/12/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements A dental assistant in Nebraska may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting. Dental assistants who assist in the administration of general anesthesia, deep sedation, moderate sedation or minimal sedation must be currently certified in basic life support skills (BLS) or the equivalent. To monitor nitrous oxide, a dental assistant must hold current certification in healthcare cardiopulmonary resuscitation (CPR) from a course accredited by the American Heart Association, American Red Cross, or an equivalent certification approved by the Board of Dentistry.

Allowable

Allowable Scope Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* Under General Supervision* 25, 57. Provide infection control practices which meet the national 22. Take X-rays (see “Radiography Requirements” on previous standards for dental facilities as outlined by the Centers for page) Disease Control Summary of Infection Prevention Practices In Dental Settings as published October of 2016 56. Place topical local anesthesia 59. Monitor nitrous oxide (see requirements above) • Complete any task or procedure that does not require the professional skill or judgment of a licensed dentist or licensed hygienist, excluding prohibited tasks

Allowable

Requirements

Dental Assistant qualified in coronal polishing

Education, Training and Credential Requirements To perform coronal polishing procedures under the indirect supervision of a licensed dentist in Nebraska, a dental assistant must: I. Graduate from a CODA-accredited dental assisting program which includes a coronal polishing course OR II. Complete one year (1,500 hours minimum) of clinical work experience as a dental assistant and a Nebraska Board-approved course in polishing procedures

*Indirect Supervision: The licensed dentist authorizes the procedure to be performed by a dental auxiliary and is physically present on the premises when such procedure is being performed. General Supervision: The directing of activities of a dental auxiliary by a licensed dentist, not construed to require the physical presence of the supervisor when directing such activities

100

NE 3

NEBRASKA State-approved 5/12/2022

Licensed Dental Assistant

Education, Training and Credential Requirements

Requirements

To qualify as a Licensed Dental Assistant in Nebraska, one must: I. Hold a high school diploma or equivalent AND II. a. Graduate from a CODA-accredited dental assisting program OR b. Complete one year (1,500 hours minimum) of dental assisting experience in the five years preceding application AND III. Pass DANB’s CDA Certification or an equivalent exam approved by the Nebraska Board of Dentistry AND IV. Pass a jurisprudence exam approved by the Board AND V. Apply to the Dept. of Health and Human Services for an LDA license To perform selected functions, an LDA must complete education and testing approved by the Nebraska Board of Dentistry and earn a permit in each function (see “Allowable Functions” below). Note: Under the Nebraska Uniform Credentialing Act, an applicant must be of good character and at least 19 years of age to be issued an LDA license.

Allowable

Allowable Scope Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* 46. Take dental impressions for fixed prostheses (with successful 59. Monitor and administer nitrous oxide analgesia (with successful completion of an approved course and permit in the function) completion of an approved course and permit in the function) 46. Take dental impressions and make minor adjustments for 70. Cement prefabricated fixed prostheses on primary teeth (with removable prostheses (with successful completion of an apsuccessful completion of an approved course and permit in the proved course and permit in the function) function) • All procedures authorized for an unlicensed dental assistant

Expanded Function Dental Assistant

Allowable

Requirements

Education, Training and Credential Requirements To qualify as an Expanded Function Dental Assistant in Nebraska, one must: I. Hold a valid, current license as an LDA AND II. Complete a minimum of 1,500 hours of work experience as an LDA AND III. Complete board approved courses and acceptable clinical exams in expanded function dental assisting as approved by the Board AND IV. Pass a jurisprudence exam approved by the Board AND V. Apply to the Dept. of Health and Human Services for the applicable EFDA permit

Allowable Scope Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* 12, 33, 51. Place restorative level one simple restorations (one surface) 12, 33, 51. Place restorative level two complex restorations (multiple surfaces)

101

NEVADA: OVERVIEW

State-approved 3/24/2022

Prohibited Duties

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Nevada. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant

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: I. Adequate instruction in radiographic procedures AND II. Training in CPR at least every two years while employed AND III. A minimum of four hours of continuing education in infection control every two years while employed AND IV. Before commencing performance of radiographic procedures, a copy of the Nevada statutes and regulations governing dentistry

Functions NOT Permitted by Dental Assistants in Nevada The following functions are not permitted by any level of dental assistant: • • • •

The diagnosis, treatment planning, or prescribing of drugs or medicaments, or authorizing the use of restorative, prosthodontic or orthodontic appliances 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 The administration of general anesthesia, conscious sedation, or deep sedation except as otherwise authorized by regulations adopted by the Nevada State Board of Dental Examiners The performance of a task outside the authorized scope of practice of the employee who is being assigned the task

102

NEVADA

State-approved 3/24/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Nevada may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist or dental hygienist. 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.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Supervision by a Dentist* 6. Retract gingival tissue if the retraction cord contains no medicaments that have potential systemic side effects 9. 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 13. Remove sutures 15. Place and secure an orthodontic ligature 18. Administer a topical fluoride* 24. Train and instruct persons in the techniques of oral hygiene and preventive procedures 27. Place or remove a rubber dam and accessories used for its placement 29. 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 35, 62. Place and remove a periodontal pack 40. 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. 44. Take the following types of impressions: those used for the preparation of counter or opposing models; those used for the fabrication of temporary crowns or bridges; and those used for the fabrication of temporary removable appliances, provided no missing teeth are replaced by those appliances 47. 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 48. Retract a patient’s cheek, tongue or other tissue during a dental operation 48. Remove the debris which normally accumulates during or after a cleaning or operation by the dentist by using mouthwash, water, compressed air or suction 56. Administer a topical anesthetic in any form except aerosol 61. 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

Under Supervision by a Dentist*, before the patient is examined by the dentist 22. Expose radiographs (see “Radiography Requirements” on previous page) 44. Take impressions for the preparation of diagnostic models Under Supervision by a Dental Hygienist with Public Health Dental Hygiene Endorsement 18. Administer a topical fluoride* 24. Train and instruct persons in the techniques of oral hygiene and preventive procedures 48. Retract a patient’s cheek, tongue or other tissue during a dental operation 48. 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

Note: A dental assistant may assist a dental hygienist performing these tasks if the hygienist has received Nevada Board approval to perform services without supervision or authorization of a licensed dentist in schools and certain health facilities. *At its October 8, 2020 meeting, the Nevada State Board of Dental Examiners issued an advisory opinion that a dental assistant may administer silver diamine fluoride and that such administration is considered a topical fluoride permitted under their scope of practice.

*Supervision by a Dentist: A dentist is physically present in the office where the procedures to be supervised are being performed, while these procedures are being performed, and is capable of responding immediately if any emergency should arise.

103

NEW HAMPSHIRE: OVERVIEW State-approved 4/14/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are four recognized levels of dental assistants in New Hampshire. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 4

Expanded Function Dental Auxiliary (EFDA)

Dental Assistant qualified to perform expanded duties

DANB Certified Dental Assistant (CDA) and Graduate Dental Assistant (GDA)

Traditional Dental Assistant

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: I. Be 18 years of age or older AND II. a. Be a Graduate Dental Assistant or hold DANB Certified Dental Assistant (CDA) certification OR b. Complete 200 hours of experience in clinical dental assisting prior to course enrollment AND pass an introduction to dental assisting course and qualify in infection control, as described on page 108 AND III. Successfully complete an expanded duty course in dental radiology meeting the requirements established by rule of the New Hampshire Board of Dental Examiners (NHBDE) AND IV. Pass the national DANB Radiation Health and Safety (RHS) exam

Prohibited Duties

Functions NOT Permitted by Dental Assistants in New Hampshire Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: • • •

Diagnosis, treatment planning and prescriptions (including prescriptions for drugs and medicaments or authorization for restorative, prosthodontic, or orthodontic appliances) 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 Apply silver diamine fluoride

104

NEW HAMPSHIRE

State-approved 4/14/2022

Requirements

Traditional Dental Assistant

Education, Training and Credential Requirements A traditional dental assistant in New Hampshire may perform basic supportive dental procedures specified by the state dental practice act under the direct or general supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting. A traditional dental assistant is a dental assistant who is neither a Certified Dental Assistant nor a Graduate Dental Assistant. To perform specified duties under public health supervision to assist a Certified Public Health Dental Hygienist (CPHDH), a dental assistant must qualify in infection control in the dental office as described on page 108.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct Supervision* 27. Assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating dentist or during the course of a dental operation 48. Retract a patient’s cheek, tongue or other oral tissues during a dental operation 48. Place cotton rolls prior to delivery of local anesthesia by dentist or dental hygienist Under General Supervision* 4. Seat patient, place protective materials or garments including the lubrication of such patient’s lips 24. Train or instruct groups or individual patients in techniques of oral hygiene and mouth care 25. Sterilize instruments 25. Reorganize instruments and equipment after the patient has departed

48. 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, mouthwashes and water 56. Place topical anesthesia prior to delivery of local anesthesia by dentist

37. Take the blood pressure of a patient 41. Organize and arrange instruments on bracket tables 52. Process dental radiographs • Function as a dental laboratory technician • Perform tests on saliva

Under Public Health Supervision* to assist a Certified Public Health Dental Hygienist (CPHDH) 4. Seat patient, place protective materials or garments including 52. Process dental radiographs the lubrication of such patient’s lips • Reorganize instruments and equipment after the patient has 24. Train or instruct groups or individual patients in techniques of departed the healthcare facility oral hygiene and mouth care • Assist with the placement or removal of a rubber dam and 25. Process and sterilize instruments and perform infection control accessories used for its placement and retention, as directed 41. Organize and arrange instruments on bracket tables by an operating CPHDH during the course of a dental hygiene 48. Retract a patient’s cheek, tongue or other oral tissues during a operation 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

*Direct Supervision: A dentist with an active license is in the dental office, authorizes the procedures, remains in the dental office while the procedures are being performed and, before dismissal of the patient, evaluates the performance of the dental assistant. General Supervision: A dentist with an active license has authorized the procedures; 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 Public Health Supervision: 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 reviews 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).

105

Requirements

NEW HAMPSHIRE State-approved 4/14/2022

DANB Certified Assistant (CDA) and Graduate Dental Assistant (GDA)

Education, Training and Credential Requirements New Hampshire allows dental assistants who hold the national DANB Certified Dental Assistant (CDA) certification or are Graduate Dental Assistants* to perform specified duties (see below). *Dental assistants in New Hampshire can earn status as a Graduate Dental Assistant by graduating from a CODA-accredited program of dental assisting.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Place and remove gingival retraction cord 49. Perform pulpal vitality testing procedures 12. Place amalgam prior to condensing by a dentist 50, 55. Place and remove temporary restorations, not to include 13, 62, 69. Remove sutures and dressings temporary crowns and bridges, unless qualified (see require18. Apply topical fluoride after prophylaxis by a licensed professional ments on page 108), and not to include the use of intraoral 27. Place and remove rubber dams rotary instruments 28, 44, 46. Select impression trays; seat, hold, remove and pour 56. Apply non-prescription topical anesthesia impressions for study models, single arch athletic mouth guards, • Take dental and medical histories custom fluoride trays and whitening trays • Apply non-prescription desensitizing agents to the cementum 29. Cement bands and bond brackets, not to include the use of and dentin rotary instruments to remove excess cement or bonding material • Insert athletic mouth guards 34. Place cavity liners and bases • Make bite registrations when maximum intercuspation can be 35. Place periodontal dressings achieved 37. Take and record blood pressure • Place and remove dry socket medications 45. Place and remove matrices • All duties designated to Dental Assistants, under the same levels 46. Make final impressions of required supervision

Dental Assistant qualified to perform expanded duties

Requirements

Education, Training and Credential Requirements To perform any expanded duty in New Hampshire, with the exception of restorative duties restricted to EFDAs, a dental assistant must I. Be at least 18 years of age AND II. a. Be a Graduate Dental Assistant* or DANB Certified Dental Assistant OR b. Pass an introduction to dental assisting course and qualify in infection control in the dental office as described on page 108 AND III. Meet specific course, certification, or experience requirements for each function, as described on page 108

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 1. Preliminary inspections of the oral cavity 44. Taking impressions for orthodontic appliances 9. Coronal polishing (see DANB’s State Fact Booklet or NH Rule 61. Using hand instruments to remove excess cement from bands 302.06(u) for specific requirements related to coronal polishing) on the coronal surfaces of the teeth 22. Dental radiography 68. Simple emergency adjustment of orthodontic appliances to 40. Dental sealants relieve pain 47. Fabrication of provisional crown and bridge restorations • Preparation of teeth for bonding of brackets 59. Monitor nitrous oxide administration • Removal of orthodontic bands or brackets • In-office tooth whitening • Trial fitting of head gear Orthodontic duties: • Bending arch wires 15. Attachment or tying in and removal of orthodontic wires 29. Trial fitting of orthodontic bands Under Direct Supervision of a Licensed Dental Hygienist* 42. Placement and removal of orthodontic separators 9. Coronal polishing (see page 108 for specific information)

106

NH 4

NEW HAMPSHIRE State-approved 4/14/2022

Expanded Function Dental Auxiliary (EFDA)

Education, Training and Credential Requirements

Requirements

To qualify to place, contour and adjust direct restorative materials within the oral cavity, one must register as an Expanded Function Dental Auxiliary (EFDA) with the New Hampshire Board of Dental Examiners (NHBDE). To register, one must: I. Be at least 18 years of age AND II. a. Be a registered dental hygienist OR b. Hold current DANB CDA certification (and be qualified to perform preliminary inspection of the oral cavity) OR c. Be a graduate of a CODA-accredited dental assisting program AND III. Have a minimum of 4,500 hours of dental clinical experience AND IV. Obtain a recommendation for the EFDA course from a NH-licensed dentist AND V. Complete an EFDA course in dental restorations meeting requirements established by rule of the NHBDE

Allowable

AND VI. Be currently certified in BLS-HCP AND VII. 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.)

107

NEW HAMPSHIRE State-approved 4/14/2022

Additional Requirements for Dental Assistants to Qualify in Expanded Functions Permitted in New Hampshire The following table summarizes requirements for Graduate Dental Assistants, for holders of DANB Certified Dental Assistant (CDA) certification and for Traditional Dental Assistants to qualify to perform the expanded dental assistant functions permitted under New Hampshire regulations. See page 106 for Graduate Dental Assistant requirements. Summary of Expanded Functions Requirements for Graduate Dental Assistants or for Holders of DANB CDA Certification

Summary of Expanded Functions Requirements for Traditional Dental Assistants Introduction to Dental Assisting For more detailed information, see New Hampshire administrative rule Den 302.06(e)-(f).

•

No further requirements beyond those • to earn status as a Graduate Dental • Assistant or to hold DANB's CDA certification

Have at least 200 hours of clinical dental assisting experience prior to course, AND Successfully complete an introduction to dental assisting course and exam 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).

•

No further requirements beyond those • Successfully complete a course and exam in infection control meeting requirements established by rule of the NHBDE to earn status as a Graduate Dental (Note: The DALE Foundation's DANB ICE Review course meets this requirement. Successful performance on DANB's Infection Control exam Assistant or to hold DANB's CDA [ICE] also meets this requirement.) certification

Function: Provisional crown and bridge restorations For more detailed information, see New Hampshire administrative rule Den 302.06(k)-(m).

•

Successfully complete a course or exam in provisional crown and bridge restorations meeting requirements established by rule of the NHBDE

•

Have at least 200 hours of clinical dental assisting experience prior to course, AND

•

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).

•

Successfully complete a course and exam in orthodontic duties meeting requirements established by rule of the NHBDE

•

Have at least 200 hours of clinical dental assisting experience prior to course, AND

•

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

Function: Dental sealants For more detailed information, see New Hampshire administrative rule Den 302.06(q)-(s).

•

Successfully complete a course and exam in dental sealants meeting requirements established by rule of the NHBDE

• • • •

Have at least 400 hours of clinical dental assisting experience prior to course, AND 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 dental sealants meeting requirements established by rule of the NHBDE

Function: Coronal polishing For more detailed information, see New Hampshire administrative rule Den 302.06(t)-(v).

•

Successfully complete a course and exam in coronal polishing meeting requirements established by rule of the NHBDE

• • • •

Have at least 400 hours of clinical dental assisting experience, AND 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 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).

•

Successfully complete a course and exam in nitrous oxide meeting requirements established by rule of the NHBDE, AND Be currently certified in BLS-HCP

•

Have at least 400 hours of clinical dental assisting experience prior to course, AND

•

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 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).

•

Successfully complete a course and exam in in-office tooth whitening meeting requirements established by rule of the NHBDE

• • • •

Have at least 400 hours of clinical dental assisting experience prior to course, AND 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 in-office tooth whitening meeting requirements established by rule of the NHBDE

108

NEW JERSEY: OVERVIEW State-approved 5/13/2022

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in New Jersey. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Registered Dental Assistant (RDA)

Other Levels

1 Unregistered Dental Assistant

Orthodontic

See page 113

State Radiography Requirements (State-approved 2/19/2020) 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:

State Radiography Requirements

I. Successfully complete high school or its equivalent AND II. Be at least 18 years of age AND III. Be of good moral character AND IV. a. Successfully complete a NJ state-approved dental radiography course or its equivalent within the 5 years prior to application AND b. Pass the national DANB RHS exam within the 5 years prior to application OR V. a. Successfully complete a NJ state-approved dental radiography course or its equivalent more than 5 years prior to application AND b. Pass the national DANB RHS exam within the 5 years prior to application AND c. 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 VI. a. Successfully complete a NJ state-approved dental radiography course or its equivalent AND b. Hold current DANB CDA certification AND VII. 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.

109

NEW JERSEY State-approved 5/13/2022

Prohibited

Functions NOT Permitted by Dental Assistants in New Jersey The following functions are not permitted by any level of dental assistant: • Make any diagnosis or develop any treatment plan with respect to the dental condition or treatment of any living person • Perform any surgical or irreversible procedure, including, but not limited to, the cutting of hard or soft tissue or the extraction of any tooth • Either bill or submit a claim for any service rendered involving the practice of dentistry or dental hygiene • 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, that employs licensed dental hygienists to provide temporary dental hygiene services

Requirements

Unregistered Dental Assistant

Education, Training and Credential Requirements An unregistered dental assistant in New Jersey may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 5. Provide a written work authorization for emergency repair of a dental prosthesis, provided that the prosthesis shall not require any intraoral procedure and shall be thereafter inserted by a licensed dentist 22. Make radiographic exposures as permitted by the Department of Environmental Protection, Bureau of X-Ray Compliance (see “Radiography Requirements” on previous page) 24. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health 29, 43. Trial size (pre-select) orthodontic bands, wires, stainless steel crowns and temporary crowns on a diagnostic model only 37. Take and record vital signs 48. Retract patient’s cheek, tongue or other tissue parts during a dental procedure 48. 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

48. Isolate the operative field, not to include rubber dams 56. Apply topical anesthetic agents • 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 • Take dental photographs including the use of intraoral cameras • Select shades of prosthetic appliances • 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 • Apply hot or cold packs pursuant to the direction of a licensed dentist

110

NEW JERSEY State-approved 5/13/2022

Registered Dental Assistant

Education, Training and Credential Requirements

Requirements

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: I. Successfully complete high school or its equivalent AND II. Obtain a certificate of completion of the online New Jersey Jurisprudence orientation (within six months prior to application) AND III. Pass DANB’s national Certified Dental Assistant (CDA) or Certified Orthodontic Assistant (COA) exam (within 10 years prior to application) AND IV. a. Graduate from a New Jersey Board-approved CODA-accredited dental assisting program (within 10 years prior to application) OR b. Obtain at least two years’ work experience as a dental assistant (within five years prior to application), successfully complete a Board-approved program in expanded functions, and pass the New Jersey Expanded Duties - General Exam (NJXDG) administered by DANB OR c. 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 Exam (NJXDG) administered by DANB) AND V. Apply for licensure as a Registered Dental Assistant to the New Jersey State Board of Dentistry

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Place and remove retraction cords and medicated pellets; this shall not include electrosurgery or the use of lasers for tissue retraction 12. Place amalgam, composite and gold foil in a tooth for condensation by the dentist 13. Remove sutures 18, 40. 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 27, 48. Isolate the operative field, including the placement and removal of rubber dams 29, 43. Trial size (pre-select) orthodontic bands, wires, stainless steel crowns and temporary crowns intra-orally or on diagnostic models 35, 62, 63, 69. Place and remove periodontal dressings and other surgical dressings 42. Place orthodontic separators; supervising licensed dentist shall ensure proper placement 44. Take alginate impressions 46. Take impressions for orthodontic appliances; supervising licensed dentist shall review and evaluate the impression prior to its use for fabrication 45. Place and remove matrices and wedges 47. Fabricate and cement temporary crowns and bridges after preparation of tooth (teeth) by a dentist. This does not include intraoral occlusal adjustment

50. Place temporary restorations 54. Perform hand removal of crowns and bridges that have been temporarily cemented 54, 61. Remove excess cement from crowns or other restorations and orthodontic appliances; such removal shall not include any subgingival cement or debris 55. Perform hand removal of soft temporary restorations 59. Monitor a patient to whom the supervising dentist has administered nitrous oxide/oxygen inhalation analgesia, provided the RDA does not perform any other function while monitoring the patient (upon completion of a Board-approved course and with current Cardiac Life Support certification) and provided the patient is not taking any medication, whether prescribed by the dentist or by another licensed practitioner 64. Take impressions for and perform laboratory fabrication of mouth guards. This shall not include insertion of the appliance. • Place and remove arch wires and ligature wires • Perform bite registration procedures • Etch teeth in preparation for bonding, sealants, or desensitizing agents • Place caries detecting agents • Use instruments for caries detection. Such instrument shall not include a laser capable of altering, cutting, burning, or damaging hard or soft tissue

Allowable functions for this level continued on the next page Note: This state allows dental assistants qualified in orthodontics to perform a separate set of orthodontic functions. Please see the separate chart for New Jersey orthodontic functions on the pages that follow.

111

NEW JERSEY State-approved 5/13/2022

Allowable

Allowable Functions (for Registered Dental Assistant), continued Under Direct Supervision* • Prepare coronal surfaces for bonding and restoration with pumice and water only, not to include a prophylaxis • Demonstrate home-use bleaching systems and apply bleaching agents • Administer a topical treatment on a patient after a licensed dentist or licensed dental hygienist has performed a prophylaxis • Remove bands and brackets without the use of rotary instruments • Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket

• •

•

Access the Prescription Monitoring Program (PMP) database, in accordance with PMP regulations**, on behalf of a dentist prescriber, if designated as a delegate Administer physical modalities, including hot and cold packs, ultrasound, electrogalvanic stimulation, transcutaneous electrical nerve stimulation (“T.E.N.S.”) and phonophoresis, consistent with scope of practice, in accordance with conditions outlined in regulation‡ All duties designated to Unregistered Dental Assistants, under the same level of required supervision

‡ For complete information about regulations governing delegation of these physical modalities to registered dental assistants, see the New Jersey section of DANB’s State Fact Booklet for regulation 13:30-8.17. Note: This state allows dental assistants qualified in orthodontics to perform a separate set of orthodontic functions. Please see the separate chart for New Jersey orthodontic functions on the page that follows.

112

NEW JERSEY (ORTHODONTIC) State-approved 5/13/2022

Orthodontic Assistant Education, Training and Credential Requirements

Requirements

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: (Option 1) I. a. 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 b. Obtain a certificate of completion of the online New Jersey Jurisprudence orientation (within six months prior to application) AND c. Have passed, within the past 10 years, DANB’s Certified Orthodontic Assistant (COA) Exam, Topical Fluoride (TF) Exam, and the Coronal Polish (CP) Exam AND d. Apply to the New Jersey State Board of Dentistry for registration as an LRDA-O. OR (Option 2) II. a. Be a high school graduate (or its equivalent) AND b. Obtain a certificate of completion of the online New Jersey Jurisprudence orientation (within six months prior to application) AND c. 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 d. Have passed, within the past 10 years, DANB’s Certified Orthodontic Assistant (COA) Exam, Topical Fluoride (TF) Exam, and the Coronal Polish (CP) Exam AND e. 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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 5. Provide a written work authorization for emergency repair of a • Perform bite registration procedures dental prosthesis provided that the prosthesis shall not require • Remove such debris as is normally created in the course of any intra-oral procedure and shall be thereafter inserted by a treatment during or after dental procedures by vacuum devices, licensed dentist compressed air, mouthwashes, and water 15. Place and ligate arch wires; before an LRDA-O places the arch • Remove arch wires and ligature wires wire, the supervising licensed dentist shall verify the fit; only the • Perform bite registration procedures supervising licensed dentist shall customize the arch wire for the • Etch teeth in preparation for bonding, sealants, or desensitizing patient agents 18. Apply topical fluoride • Take impressions for orthodontic appliances; supervising li22. Make radiographic exposures as permitted by the Department censed dentist shall review and evaluate the impression prior to of Environmental Protection, Bureau of X-Ray Compliance (see its use for fabrication “Radiography Requirements” on page 109) • Assist a licensed dentist in the administration of nitrous oxide, 24. Provide oral health education including dietary analysis and provided the licensed dentist is physically present in the operaclinical instruction in order to promote dental health tory at all times during the procedure 29, 43. Trial size (pre-select) orthodontic bands, wires, stainless • Use a curing light for any dental procedure; such curing light steel crowns and temporary crowns intra-orally or on diagnostic shall not include a laser capable of altering, cutting, burning, models or damaging hard or soft tissue or for electrosurgery for tissue 42. Place orthodontic separators. The supervising licensed dentist retraction shall ensure proper placement • Perform emergency treatment to provide immediate relief from 44. Take alginate impressions an offending appliance, such as clip a protruding arch wire or 45. Remove bands and brackets without the use of rotary remove a loose bracket instruments • Apply hot and cold packets pursuant to the direction of a 48. Isolate the operative field, not to include rubber dams licensed dentist 54, 61. Remove excess cement from crowns or other restorations • Administer physical modalities, including hot and cold packs, and orthodontic appliances; such removal shall not include any ultrasound, electrogalvanic stimulation, transcutaneous electrical subgingival cement or debris nerve stimulation (“T.E.N.S.”) and phonophoresis, consistent 56. Apply topical anesthetic agents with scope of practice, in accordance with conditions outlined in 64. Fabricate mouth guard appliances; this shall not include inserregulation‡ tion of the appliance • All duties designated to Unregistered Dental Assistants, under • Take dental photographs including the use of intraoral cameras the same level of required supervision ‡ For complete information about regulations governing delegation of these physical modalities to registered dental assistants, see the New Jersey section of DANB’s State Fact Booklet for regulation 13:30-8.17.

113

NEW MEXICO: OVERVIEW State-approved 5/10/2022

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in New Mexico. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3 Expanded Function Dental Auxiliary 2

Dental Assistant with state certificate in expanded functions

Other Levels

1 Dental Assistant

Community Dental Health Coordinator (CDHC)

See page 118

State Radiography Requirements

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in New Mexico, a Community Dental Health Coordinator must be certified. To obtain this certification, one must: I. Study by independent preparation or in a training course on radiation health and safety within the past 36 months AND II. Have assisted with or observed five cases of full mouth series intraoral radiographs (or five extraoral radiographs, if applying for limited certificate) AND III. Pass the national DANB Radiation Health and Safety (RHS) exam AND IV. Apply to the NM Board of Dental Health Care for a training permit, valid for six months AND V. Pass a state radiography clinical exam, within six months of passing the DANB RHS exam AND VI. Pass the New Mexico jurisprudence exam (take-home) AND VII. Apply to the NM Board of Dental Health Care for certification to perform radiography

114

NEW MEXICO State-approved 5/10/2022

Functions NOT Permitted by Dental Assistants in New Mexico Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited

The following functions are not permitted by any level of dental assistant: 46. Final impressions, to include physical and digital impressions, for restorations or prosthetic appliances* • Removal of, or addition to, the hard or soft tissue of oral cavity • Diagnosis and treatment planning • Initial fitting and adaptation of prostheses • 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

• • • •

Irrigation and medication of canals, cone try-in, reaming, filing or filling of root canals Other services defined as the practice of dentistry or dental hygiene Bleaching or whitening teeth without the direct or indirect supervision of a dentist Laser-assisted non-surgical periodontal treatment

*This task is prohibited for dental assistants and dental assistants with state certification in expanded functions. EFDAs are permitted, under direct supervision, to take impressions, including digital impressions, for permanent fixed or removable prosthetics involving single teeth; EFDAs are prohibited from taking final impressions for multiple units of crowns, bridges, cast framework, partial dentures, or full dentures final impressions.

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in New Mexico is an individual who may perform basic supportive dental procedures under the supervision of a licensed dentist (see notes below). There are no education or training requirements for this level of dental assistant.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Indirect Supervision* 9. Rubber cup coronal polishing 18. Application of topical fluoride 40. Pit and fissure sealant application 59. Administer nitrous oxide with the dentist’s authorization • Any basic supportive dental procedure, not excluded elsewhere in rule or in statute Note: Rubber cup coronal polishing, application of topical fluoride and pit and fissure sealants must be approved by the dentist or dental hygienist upon completion.

DANB’s Note on Allowable Dental Assisting Functions In the state of New Mexico, all dental assistants may: • •

Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act

Indirect Supervision*: 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 assistant

115

NM 2

NEW MEXICO State-approved 5/10/2022

Dental Assistant with state certification in expanded functions

Education, Training and Credential Requirements Note: Holders of state-certification in dental assisting expanded functions and EFDAs must have formal training in infection control from a course approved in accordance with New Mexico Board of Dental Health Care rules and regulations. To perform expanded functions under the general supervision of a licensed dentist in New Mexico, a dental assistant must earn state certification. To qualify, one must: Rubber cup coronal polishing and application of topical fluoride:

Requirements

I. 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 II. Pass DANB’s national Coronal Polish (CP) exam and DANB’s Topical Fluoride (TF) exam AND III. Apply to the NM Board of Dental Health Care for advanced certification in coronal polishing and application of topical fluoride AND IV. Pass the state jurisprudence exam (take-home) AND V. Perform rubber cup coronal polishing on five adults and children and application of topical fluoride on five children while being personally observed by a dentist, dental hygienist, or a dental assistant certified in rubber cup coronal polishing and topical fluoride. Pit and Fissure Sealants: I. Have 2,080 hours of dental assisting chairside experience in the two years prior to application AND II. Study by independent preparation or in a training course in the function AND III. Assist with/observe 12 pit and fissure sealant applications AND IV. Pass DANB’s national Sealants (SE) exam AND V. Apply for advanced certification in pit and fissure sealants to the NM Board of Dental Health Care AND VI. Pass the NM jurisprudence exam (take-home) AND VII. Apply pit and fissure sealants on five patients while being personally observed by a licensed dentist or dental hygienist Holding a current 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 one or more expanded functions in another state with requirements not less stringent than those in New Mexico may apply for state certification based on credentials. See DANB’s 2020 State Fact Booklet or contact the New Mexico Board of Dental Health Care for requirements.

Allowable Functions Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 9. Rubber cup coronal polishing 18. Application of topical fluoride 22. Place and expose dental radiographs 40. Pit and fissure sealants Note: New Mexico rules indicate that collaborative practice dental hygienists may work with and supervise dental assistants, including dental assistants certified to perform these expanded functions.

116

NM 3

NEW MEXICO State-approved 5/10/2022

Expanded Function Dental Auxiliary

Education, Training and Credential Requirements

Requirements

To earn NM certification as an expanded function dental auxiliary (EFDA), one must: I. a. Complete an accepted EFDA course in a program approved by the board or accredited by CODA OR b. Have a minimum of five years, 1000 hours per year, continuous employment as a dental assistant or dental hygienist, AND complete a course of study in subject areas prescribed by the board, including a post-test approved by the board, AND obtain a recommendation for EFDA certification from a supervising dentist AND Earn state certification in radiography, rubber cup coronal polishing and application of topical fluoride and pit and fissure sealant expanded functions* (see previous page for requirements) AND III. Pass a clinical exam accepted by the board for EFDA certification AND IV. Earn a 75% score on the NM jurisprudence exam AND V. Apply for an apprenticeship permit from the NM Board of Dental Health Care AND VI. Complete an apprenticeship within 180 days AND VII. Return permit and signed affidavit to NM Board of Dental Health Care, which will then issue EFDA certificate II.

* 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.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 12, 51. Place and shape direct restorative materials into cavity preparations completed by a dentist, using instrumentation as necessary and proper for this purpose 43. Perform preliminary fitting and shaping of stainless steel crowns which shall undergo final evaluation and cementation by a dentist 46. Take impressions for permanent fixed or removable prosthetics involving single teeth, to include digital impressions; these include single crowns or single tooth replacement prosthetics; EFDAs shall not take final impressions for multiple units of single crowns, bridges, cast framework partial dentures or full dentures final impressions 47, 50. 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 50. 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. 50. 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. 61. Remove residual orthodontic bracket or band cement or resin from teeth after the brackets or bands have been removed by the dentist, or to prepare the tooth or teeth for re-cementation of a debonded bracket or band, using instrumentation as necessary and proper for this purpose Under General Supervision* 40. Place pit and fissure sealants (under supervision as certification or licensure allows) 47. In emergency situation, recement temporary or permanent crowns or bridges using provisional cement when instructed to do so by the dentist, provided the permanent cementation will be completed or monitored by the dentist within six months

Note: EFDA duties are allowed under direct supervision of a NM licensed dentist provided the dentist has prepared the cavity or tooth for the restorative procedure; instructed the EFDA on the particular elements of the individual case; 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; the dentist is ultimately responsible for the quality of the final restorative procedure carried out by the EFDA; and not more than two EFDAs, performing expanded functions, per licensed dentist are present in office.)

General Supervision*: Authorization by a dentist of the procedures to be used by a dental assistant or expanded functions dental auxiliary 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 Direct Supervision*: 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

117

NEW MEXICO

(COMMUNITY DENTAL HEALTH COORDINATOR) State-approved 5/10/2022

Community Dental Health Coordinator Education, Training and Credential Requirements

Requirements

To work as a Community Dental Health Coordinator (CDHC) in New Mexico, one must obtain certification from the New Mexico Board of Dental Health Care. To qualify, an applicant must: I. Have a high school diploma or equivalent, or a college-level degree AND II. Have New Mexico certification in radiography, rubber cup coronal polishing, and application of topical fluoride and pit and fissure sealant expanded functions (see page 116 of this publication for requirements) AND III. Complete the New Mexico jurisprudence exam with a score of at least 75% AND IV. Successfully complete a CDHC program approved by the NM Board of Dental Health Care CDHCs must have formal training in infection control from a course approved in accordance with New Mexico Board of Dental Health Care rules and regulations.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 9. Rubber cup coronal polishing (not to be represented as a prophylaxis)** 18. Topical application of fluorides** 22, 52. Expose and develop necessary radiographs as ordered by the supervising dentist or as established in protocol by a supervising dentist 40. Application of pit and fissure sealants** 50. Place temporary and sedative restorative materials in unexcavated carious lesions and unprepared tooth fractures • Take a complete health and dental history • Observe and transmit patient data through teledentistry means to a dentist • Transmit prescription or medication orders on the direct order of a dentist • Act as an advocate for patients and the community in accessing dental care

•

Provide the following limited palliative procedures: 24. Instruct the patient on brushing, flossing, gingival massage or cleaning for gingival inflammation or infection ◦ Application of hot/cold compresses to the face and mouth ◦ Instruct patient in the use of various rinses containing salt, sodium bicarbonate, chlorhexidine, etc. as ordered by the dentist ◦ Place avulsed teeth in the proper preservation solution for transport to a dentist ◦ Apply pressure compresses to intraoral wounds ◦ Perform any other palliative procedures as directly instructed by the supervising dentist, and within the scope of practice of the CDHC

** when previously authorized by the supervising dentist or dental hygienist and cavitation of the enamel is not present

118

NEW YORK: OVERVIEW State-approved 4/19/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized categories of dental assistants in New York. See the following pages for details about requirements and allowed functions for each category. Numbers for each category are provided for internal reference and do not correspond to specific state designations.

Registered Dental Assistant

Dental Assistant with a Limited Permit

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 radiographic 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.

Functions NOT Permitted by Dental Assistants in New York Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any category of dental assistant: 2. Charting caries and periodontal conditions as an aid to diagnosis by the dentist 9. Polishing teeth, including existing restorations 35. Placing periodontal dressings 40. Applying pit and fissure sealants 61. Removing excess cement from surfaces of the teeth • Diagnosing • Performing surgical procedures • Performing irreversible procedures • Performing procedures that would alter the hard or soft tissue of the oral and maxillofacial area • Removing calcareous deposits, accretions and stains, including scaling and planing of exposed root surfaces indicated for complete prophylaxis • Applying topical agents indicated for a complete dental prophylaxis • Applying a topical medication not related to a complete dental prophylaxis • Such dental supportive services that a Registered Dental Assistant would not reasonably be qualified to perform based upon meeting the New York requirements for licensure as a Registered Dental Assistant and/or obtaining additional legally authorized experience in practicing as a Registered Dental Assistant.

119

Allowable Requirements

NEW YORK State-approved 4/19/2022

Dental Assistant with a Limited Permit

Education, Training and Credential Requirements A person who has completed a dental assisting program or an alternative course of study in dental assisting acceptable to the New York State Education Department (see details under “Registered Dental Assistant: Education, Training and Credentialing Requirements” below) may apply for a limited (one-year) permit prior to taking and passing the required exams. A limited permittee may perform all tasks designated to Registered Dental Assistants, under the direct personal supervision of a licensed dentist. The permit expires after one year and may be renewed for an additional year.

Allowable Functions Dental assistants with a limited permit may perform all tasks designated to Registered Dental Assistants listed on the next page, under the direct personal supervision of a licensed dentist. The permit expires after one year and may be renewed for an additional year.

Registered Dental Assistant

Education, Training and Credential Requirements 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.

Requirements

To be licensed as a Registered Dental Assistant in the state of New York, one must: I. Be at least 18 years of age AND II. Be a high school graduate or its equivalent AND III. Be of good moral character as determined by the New York State Education Department. AND IV. Successfully complete one of the two education options listed below: a. an approved one-year course of study in dental assisting in a degree-granting institution or a board of cooperative educational services program that includes 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 that includes at least 1,000 hours of relevant work experience in accordance with the Commissioner’s regulations. AND V. Successfully complete one of the two exam pathways listed below: 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 PATHWAY II: Pass the New York Professional Dental Assisting (NYPDA) exam along with DANB’s RHS and ICE component exams. AND VI. Apply for licensure from the New York State Education Department after completing all of the above requirements

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Personal Supervision* 13. Remove sutures placed by a licensed dentist 18. Apply topical anticariogenic agents to the teeth 24. Provide patient education 27. Place and remove rubber dams 29. Select and prefit orthodontic bands 37. Take preliminary medical histories and vital signs to be reviewed by the dentist 42. Place and remove temporary separating devices 44. Take impressions for study casts or diagnostic casts 44. Take impressions for space maintainers, orthodontic appliances and occlusal guards

45. Place and remove matrix bands 47. Select and prefit provisional crowns 54. Remove temporary cement (not including temporary fillings) 62. Remove periodontal dressings • Apply desensitizing agents to the teeth • Place orthodontic ligatures • Remove orthodontic arch wires and ligature ties • Other dental supportive services authorized by the licensed dentist while the Registered Dental Assistant is under the direct personal supervision of the licensed dentist, provided that such other dental supportive services are not excluded

*Direct Personal Supervision: Instructions are 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.

120

NORTH CAROLINA: OVERVIEW State-approved 5/2/2022

Radiography Requirements

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in North Carolina. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3 Dental Assistant II (DA II) 2

Dental Assistant II in Training (DA II in Training)

Dental Assistant I (DA I)

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in North Carolina, a dental assistant must: I. a. Pass the national DANB Certified Dental Assistant (CDA) exam OR b. 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 c. Successfully complete a CODA-accredited dental assisting program OR d. Qualify as a DA II (see requirements on following pages)

Functions NOT Permitted by Dental Assistants in North Carolina

Prohibited Duties

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 12, 33. Performing the placement or cementation of final restorations • 35, 63. Placing periodontal or surgical dressing • 49. Performing pulp vitality testing • 70. Placing stainless steel crown on permanent or primary teeth • • Performing prophylaxis • • Performing periodontal screening • • Performing periodontal probing • • Performing subgingival exploration for or removal of hard or soft deposits • • Performing sulcular irrigation • Performing comprehensive examination, diagnosis and treatment planning • • Performing surgical or cutting procedures on hard or soft tissues, • including laser air abrasion or micro-abrasion procedures • • Placing or removing therapeutic sulcular nonresorbable agents • • Issuing prescription drugs, medications or work authorizations • • Performing the final placement or intraoral adjustment of a fixed • or removable appliance • • Performing intraoral occlusal adjustments that affect function, • fit or occlusion of any temporary or permanent restoration or • appliance • • Performing direct pulp capping or pulpotomy • • Placing sutures • Performing final placement or cementation of orthodontic bands • or brackets • Using a high speed handpiece intraorally • Administering any anesthetic by any route except administering topically applied agents intended to anesthetize only cutaneous tissue

121

Inducing conscious sedation Using ultrasonic scalers for prophylaxis Applying antibiotic-coated materials Applying resorbable antimicrobial agents Performing root planing Applying oral cancer screening products Using laser fluorescence detectors in preparation for dentist’s examination and diagnosis of cavities Applying resin infiltration treatment for incipient smooth surface lesions, following the dentist’s diagnosis that the lesion is non-penetrable Performing cementation of endodontic posts Condensing amalgam Using a transcutaneous electrical nerve stimulation (TENS) unit Applying formocresol Performing curettage Performing oral brush biopsy Taking bite registration or Elastometrics Placing eugenol wick in dry socket Fabricating or delivering sleep apnea appliance Applying silver diamine fluoride Removing, replacing, or torquing either impression or prosthetic implant abutments Administering any sedation or general anesthesia pharmacological agents, including drawing a dosage into a syringe

NORTH CAROLINA State-approved 5/2/2022

Requirements

Dental Assistant I (DA I)

Education, Training and Credential Requirements A Dental Assistant I (DA I) 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

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Control and Supervision* 5. Write laboratory work orders (Exact words must be dictated by 56. Apply topical anesthetics/DentiPatch® the dentist) 59. Monitor patients under nitrous oxide (see requirements above) 12. Place amalgam in prep w/carrier • Write prescriptions (drugs); exact words must be dictated by 18. Apply topical fluoride the dentist 22. Expose radiographs (see requirements on previous page) • Perform extraoral adjustments of any temp. restoration or 24. Oral hygiene instruction appliance (extraorally, upon instruction by the dentist and rein37. Take pulse, blood pressure and temperature sertion by the dentist) 39. Polish dentures (extraorally, upon instruction by the dentist and re-insertion by the dentist)

Dental Assistant II in Training (DA II in Training)

Requirements

Education, Training and Credential Requirements A Dental Assistant II in Training (DA II in Training) is an individual who is participating in on-the-job training to become a DA II. Training consists of at least two years (3,000 hours) of chairside assisting, during which period the assistant may be trained and allowed to perform the functions of a DA II under the direct control and supervision of a NC licensed dentist. To begin receiving on-the-job training in DAII duties, a dental assistant must 1. Complete a 3-hour course in dental office emergencies AND 2. Complete a 3-hour course in sterilization and infection control Note: The “DA II in training” functions are the same functions as allowed and listed on the next page for a DA II, with the exception of coronal polishing. A DA II in Training may not monitor patients under nitrous oxide, take radiographs, or coronal polish until he or she successfully completes the required courses in these topics.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Control and Supervision* (provided that the dentist first examined the patient and prescribed the procedure) 6. Placing and removing gingival retraction cord 42. Inserting interdental spacers 13. Removing sutures 44. Taking impressions for study models and opposing casts that 14. Flushing, drying and temporarily closing root canals or may be used for construction of temporary or permanent dental pulpotomies appliances, adjustable orthodontic appliances, nightguards and 15. Placing and tying in or untying and removing orthodontic arch the repair of dentures or partials wires, ligature wires or lock pins 45. Inserting matrix bands and wedges 22. Exposing radiographs and cone beam images 47, 50, 54. Placing and removing temporary restorations 27. Placing and removing rubber dams 54, 61. Removing excess cement with hand scaler supragingivally 29. Fitting (sizing) orthodontic bands or brackets 59. Monitoring patients under nitrous oxide (see requirements 34. Placing cavity bases and liners above) 38. Measuring pulse, blood pressure, and temperature 62. Removing periodontal and surgical dressings 39. Polishing removable appliances extra-orally • Cementing temporary restorations using temporary cement 40. Applying sealants to teeth that do not require mechanical alteration prior to the application of such sealants Allowable functions for this level continued on next page

* Direct Control and Supervision:

A dentist must be present in office when the act or function is being performed and must directly and personally supervise, examine, and evaluate the results.

122

NORTH CAROLINA State-approved 5/2/2022

Allowable

Allowable Functions (for Dental Assistant II in Training), continued Under Direct Control and Supervision* (provided that the dentist first examined the patient and prescribed the procedure) • Applying acid etch materials and rinses • Placing a throat shield in oropharynx during administration of • Applying bonding agents general anesthesia • Applying dentin desensitizing solutions • Delivering dentures to patient for insertion, provided the dentist • Performing extraoral adjustments which affect function, fit, or approves the denture placement occlusion of any restoration or appliance • Removing or replacing healing abutments or cover screws for • Initially forming and sizing orthodontic arch wires and placing implants that may be accessed supragingivally arch wires after final adjustment and approval by the dentist • A DA II may perform all duties designated to a DA I under the • Preparing and loading amalgam in carrier same level of supervision • Using micro-etcher extra-orally Under Supervision of a Public Health Hygienist (working in a dental access shortage area) • Assist in the performance of clinical hygiene procedures performed under the direction of a dentist in accordance with conditions outlined in rule

* Direct Control and Supervision:

A dentist must be present in office when the act or function is being performed and must directly and personally supervise, examine, and evaluate the results.

123

NORTH CAROLINA

State-approved 5/2/2022

Dental Assistant II (DA II)

Education, Training and Credential Requirements

Requirements

To perform expanded functions under the direct supervision of a licensed dentist in North Carolina, one must be classified as a Dental Assistant II (DA II). To qualify, one must: I. Hold a current Cardiopulmonary Resuscitation (CPR) certification AND II. a. Complete a CODA-accredited dental assisting program or complete one academic year or longer in a CODA-accredited dental hygiene program OR b. Pass the national DANB Certified Dental Assistant (CDA) exam OR c. Complete full-time employment as a DA I for 2 years of the preceding 5, consisting of at least 3,000 total and complete a 3-hour course in dental office emergencies and complete a 3-hour course in sterilization and infection control and, after completing these courses and CPR certification, receive training in any dental delivery setting and perform the functions of a DA 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 NC hygienist or dentist of least 7 hours and meeting content requirements established by the North Carolina Board To qualify to monitor patients under nitrous oxide, a DA II must: Successfully complete a North Carolina Board-approved 7-hour course in nitrous oxide-oxygen conscious sedation Note: At its April 8, 2021 meeting, the North Carolina Board of Dental Examiners opined that a foreign trained dentist may serve as a Dental Assistant II, provided that their credentials are verified by the supervising dentist.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Control and Supervision* (provided that the dentist first examined the patient and prescribed the procedure) 6. Placing and removing gingival retraction cord 45. Inserting matrix bands and wedges 9. Polishing the clinical crown (Using a hand-held brush and 47, 50, 54. Placing and removing temporary restorations appropriate polishing agents or a combination of a slow-speed 54, 61. Removing excess cement with hand scaler supragingivally handpiece [not to exceed 10,000 rpm] with an attached rubber 59. Monitoring patients under nitrous oxide (see requirements on cup or bristle brush and appropriate polishing agents) (see previous page) requirements above) 62. Removing periodontal and surgical dressings 13. Removing sutures • Cementing temporary restorations using temporary cement 14. Flushing, drying and temporarily closing root canals or pulpoto• Applying acid etch materials and rinses mies • Applying bonding agents 15. Placing and tying in or untying and removing orthodontic arch • Applying dentin desensitizing solutions wires, ligature wires or lock pins • Performing extraoral adjustments which affect function, fit, or 22. Exposing radiographs and cone beam images occlusion of any restoration or appliance 27. Placing and removing rubber dams • Initially forming and sizing orthodontic arch wires and placing 29. Fitting (sizing) orthodontic bands or brackets arch wires after final adjustment and approval by the dentist 34. Placing cavity bases and liners • Preparing and loading amalgam in carrier 38. Measuring pulse, blood pressure, and temperature • Using micro-etcher extra-orally 39. Polishing removable appliances extra-orally • Placing a throat shield in oropharynx during administration of 40. Applying sealants to teeth that do not require mechanical altergeneral anesthesia ation prior to the application of such sealants • Delivering dentures to patient for insertion, provided the dentist 42. Inserting interdental spacers approves the denture placement 44. Taking impressions for study models and opposing casts that • Removing or replacing healing abutments or cover screws for may be used for construction of temporary or permanent dental implants that may be accessed supragingivally appliances, adjustable orthodontic appliances, nightguards and • A DA II may perform all duties designated to a DA I under the the repair of dentures or partials same level of supervision Under Supervision of a Limited Supervision Hygienist (when treatment is provided to children in an authorized school-based program and ordered by a licensed dentist, subject to conditions outlined in rule) • Assist in providing oral hygiene instruction • Assist in applying fluoride varnishes • Assist in applying sealants • Assist while the Limited Supervision Hygienist is performing • Assist in applying topical fluorides prophylaxis Under Supervision of a Public Health Hygienist (working in a dental access shortage area) • Assist in the performance of clinical hygiene procedures performed under the direction of a dentist in accordance with conditions outlined in rule * Direct Control and Supervision:

A dentist must be present in office when the act or function is being performed and must directly and personally supervise, examine, and evaluate the results.

124

NORTH DAKOTA: OVERVIEW State-approved 3/31/2022

State Career Ladder

Other Levels

State Job Titles

There are five recognized levels of dental assistants in North Dakota. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 5

Registered Dental Assistant (RDA) with Restorative Functions Permit

Registered Dental Assistant (RDA) qualified to apply pit and fissure sealants

Registered Dental Assistant (RDA)

Qualified Dental Assistant (QDA)

Dental Assistant

Registered Dental Assistant with Anesthesia Assisting Permit

See page 130

State Radiography Requirements

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in North Dakota, one must be a Registered Dental Assistant or Qualified Dental Assistant (see requirements on the following pages).

Functions NOT Permitted by Dental Assistants in North Dakota Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited

The following functions are not permitted by any level of dental assistant: 20. Scaling, root planing or gingival curettage 34. Place bases or cavity liners 40. Apply pit and fissure sealants (unless requirements have been met) • Diagnosis and treatment planning • Surgery on hard or soft tissue • Administer local anesthetics, sedation or general anesthesia drugs or titrate local anesthetics, sedation or general anesthesia drugs without board authorized permit. • Initiate the administration of nitrous oxide to a patient • Any irreversible dental procedure or procedures which require the professional judgment and skill of a licensed dentist • Adjust a crown which has been cemented by a dentist • Activate any type of orthodontic appliance • Cement or bond orthodontic bands or brackets that have not been previously placed by a dentist • Measure the gingival sulcus with a periodontal probe • Use a high-speed handpiece inside the mouth

125

NORTH DAKOTA State-approved 3/31/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in North Dakota may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. Every dental assistant in North Dakota must have a current certificate of proficiency in cardiopulmonary resuscitation.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 37. Take and record pulse, blood pressure, and temperature 39. Receive removable dental prosthesis for cleaning or repair 44. Take impressions for study casts 56. Apply topical medications and drugs to oral tissues, including topical anesthetic, but not including desensitizing or caustic agents or anticariogenic agents

• •

Take and record preliminary dental medical history for the interpretation by the dentist Hold impression trays in the mouth (e.g., reversible hydrocolloids, rubber base)

Qualified Dental Assistant (QDA)

Education, Training and Credential Requirements

Requirements

To earn status as a Qualified Dental Assistant (QDA) in North Dakota, one must: I. Have passed DANB’s RHS and ICE exams within one year prior to application or have passed DANB’s RHS and ICE exams and completed, within two years prior to application, 16 hours of continuing education AND II. Complete 650 hours of dental assisting instruction including on-the-job training AND III. Pass a written examination of the laws and rules governing the practice of dentistry in North Dakota within one year of application AND IV. Maintain current CPR certification AND V. 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 VI. Apply to the NDSBDE

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 22. Take dental radiographs (see “Radiography Requirements” on previous page) • All duties designated to Dental Assistants

*Direct Supervision: 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 assistant, and, before dismissal of the patient, evaluates the performance of the dental assistant.

126

ND 3

NORTH DAKOTA State-approved 3/31/2022

Registered Dental Assistant (RDA)

Education, Training and Credential Requirements

Requirements

To earn status as a Registered Dental Assistant (RDA) in North Dakota, one must: I. a. 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 b. Have passed DANB’s national CDA exam or have completed a CODA-accredited or North Dakota board-approved dental assisting program (more than one year prior to application) AND II. Have completed 16 hours of continuing education within two years prior to application AND III. Pass a written examination of the laws and rules governing the practice of dentistry in North Dakota within one year of application AND IV. Maintain current CPR certification AND V. 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 VI. Apply for registration to the North Dakota State Board of Dental Examiners (NDSBDE)

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct, Indirect or General Supervision* 9. Polish the coronal surfaces of the teeth with a rubber cup or brush 13. Remove sutures 24. Provide oral hygiene education and instruction. 37. Take and record pulse, blood pressure, and temperature 44. Take impressions or occlusal bite registrations for study casts 47, 54. 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

Under Direct or Indirect Supervision* 6. Place retraction cord in the gingival sulcus of a prepared tooth prior to the dentist taking an impression of the tooth 14. Dry root canal with paper points 15, 42. Place, tie and remove ligature wires and elastic ties and place orthodontic separators 18. Apply anticariogenic agents topically 22. Take dental radiographs 27. Place and remove rubber dams 29. Preselect and prefit orthodontic bands 35, 62, 63. Place and remove periodontal dressings, dry socket medications, and packing

56. Apply topical medications and drugs to oral tissues, including topical anesthetic, but not including desensitizing or caustic agents or anticariogenic agents • Cut and remove arch wires or replace loose bands, loose brackets or other orthodontic appliances for palliative treatment • Polish restorations with a slow-speed handpiece • Take and record preliminary dental and medical history for the interpretation by the dentist • Receive removable dental prosthesis for cleaning or repair • Provide an oral assessment for interpretation by the dentist. • Repack dry socket medication and packing for palliative treatment.

44. Take impressions for fixed or removable orthodontic appliances, athletic mouth guards, bleaching trays, bite splints, flippers and removable prosthetic repairs 49. Perform nonsurgical clinical and laboratory oral diagnosis tests, including pulp testing, for interpretation by the dentist 59. Monitor a patient who has been inducted by a dentist into nitrous oxide relative analgesia 61. Remove excess cement from inlays, crowns, bridges and orthodontic appliances with hand instruments only • Apply desensitizing solutions to the external surfaces of the teeth • Take occlusal bite registration study casts Allowable functions for this level continued on next page

Direct Supervision: 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 assistant, and, before dismissal of the patient, evaluates the performance of the dental assistant. Indirect Supervision: The 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 assistant. General Supervision: The dentist has authorized the procedures and they are carried out in accordance with the dentist’s diagnosis and treatment plan. The dentist is not required to be in the treatment facility.

127

NORTH DAKOTA State-approved 3/31/2022

Allowable Functions for Registered Dental Assistant (RDA), continued

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 3. Orally transmit a prescription that has been authorized by the supervising dentist 15. Place and remove arch wires or appliances that have been activated by a dentist 29. 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

45. Place and remove matrix bands and wedges• Take face bow transfers • Acid-etch enamel surfaces prior to direct bonding of orthodontic brackets or composite restorations • Adjust permanent crowns outside of the mouth • Administer emergency medications to a patient in order to assist the dentist in an emergency • All duties designated to Qualified Dental Assistants, below

Under Indirect Supervision* • Terminate or reduce the amount of nitrous oxide previously administered by the dentist

Requirements

Registered Dental Assistant (RDA) qualified to apply pit and fissure sealants

Education, Training and Credential Requirements To apply pit and fissure sealants in North Dakota under the direct supervision of a licensed dentist, a dental assistant must: I. Be a Registered Dental Assistant AND II. Provide documentation of a successful completion of a North Dakota board-approved sealant course

Allowable

128

ND 5

NORTH DAKOTA State-approved 3/31/2022

Registered Dental Assistant with Restorative Functions Permit

Education, Training and Credential Requirements

Requirements

To earn a permit to perform specified restorative functions under the direct supervision of a dentist, a Registered Dental Assistant must: I. a. Complete a board-approved curriculum from a program accredited by the Commission on Dental Accreditation or other board-approved course AND b. Pass the Western Regional Examining Board (WREB) Restorative Examination or other equivalent examinations approved by the board within the five years preceding application The Board may require completion of the Restorative Function (RF) component of DANB’s Certified Restorative Functions Dental Assistant (CRFDA) certification exam OR II. a. Pass the WREB Restorative Examination or other board-approved examination more than five years from the date of application AND b. Complete the RF component of DANB’s CRFDA certification examination AND c. 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: Restorative functions may be performed only after the patient has given informed consent for placement of the restoration by a restorative functions dental assistant; before the patient is released, the final restoration shall be checked and documented by the supervising dentist.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 12, 51. Place, carve, and adjust class I, II and class V supragingival amalgam or glass ionomer restorations with hand instruments or a slow-speed hand** 33. Place, contour, and adjust class I, II and class V supragingival composite restorations where the margins are entirely within the enamel with hand instruments or a slow-speed handpiece. 70. Adapt and cement stainless steel crowns **An RDA with a restorative functions permit may perform the placement and finishing of direct alloy or direct composite restorations after the supervising dentist has prepared the dentition for restoration.

129

NORTH DAKOTA (ANESTHESIA ASSISTING) State-approved 3/31/2022

Registered Dental Assistant with Anesthesia Assisting Permit Education, Training and Credential Requirements To be authorized to perform specified anesthesia assisting functions under the supervision of a dentist authorized by permit to provide parenteral sedation, a Registered Dental Assistant may earn a Class I or a Class II anesthesia assistant permit.

Requirements

To earn a Class I anesthesia assistant permit, a Registered Dental Assistant must: I. Complete a board-approved dental anesthesia assistant education and training course AND II. 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 III. Hold current and valid certification for health care provider basic life support, or advanced cardiac life support or pediatric advanced life support AND IV. 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 V. 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: I. Complete all requirements for a Class I anesthesia assistant permit (see requirements above) AND II. Complete training in intravenous access or phlebotomy that includes live experience starting and maintaining intravenous lines AND III. Apply to the North Dakota Board of Dental Examiners for a Class II anesthesia assisting permit

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. 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 registered dental assistant 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:

•

• •

• • •

Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medication, sedation or general anesthesia Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open Prepare anesthesia equipment and perform patient monitoring Assist with emergency treatment and protocols

• •

Draw up and prepare medications Follow instructions to deliver medication into an intravenous line upon verbal command of the supervising dentist Adjust the rate of intravenous fluids infusion beyond a keepopen rate upon verbal command of the supervising dentist Adjust an electronic device to provide medications, such as an infusion pump upon verbal command of the supervising dentist

*Contiguous Supervision: The dentist whose patient is being treated has personally authorized the 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. Direct visual supervision: Supervision by an oral and maxillofacial surgeon by verbal command and under direct line of sight.

130

OHIO: OVERVIEW State-approved 5/19/2022

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Ohio. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Expanded Function Dental Auxiliary (EFDA)

Certified Assistant

Basic Qualified Personnel (BQP)

State Radiography Requirements

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: I. a. Be a Certified Assistant (See “Certified Assistant” requirements on page 133) OR b. Complete an Ohio Board-approved training course, including a clinical section* OR c. Hold a license, certificate or other credential issued by another state that the OSDB deems equivalent to Ohio’s standards for Dental X-Ray Machine Operator certification AND II. Apply to the OSDB 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. A Dental X-Ray Machine Operator who is also an EFDA may perform radiologic procedures when the supervising dentist is not physically present by authorization of a dentist working under a teledentistry permit, subject to conditions listed on page 135.

Functions NOT Permitted by Dental Assistants in Ohio

Prohibited Duties

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 46. Final impressions of any tissue-bearing area upon which a • prosthetic restoration is to be placed (not including the taking of impressions for athletic mouthguards or similar appliances) • 70. Final placement of pre-fabricated or cast restorations or • crowns • • Definitive diagnosis and treatment planning • • Final placement of any fixed or removable appliances • Final removal of any fixed appliance • Therapeutic intraoral adjustment of any fixed or removable • appliance • Cutting procedures utilized in the preparation of the coronal or root portion of the tooth

131

Cutting procedures involving the supportive structures of the tooth Placement of the final root canal filling Occlusal registration procedures for any prosthetic restoration Diagnosis Treatment planning and prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic or orthodontic appliances Parenteral injection for the administration of drugs, including local anesthetic agents

OHIO

State-approved 5/19/2022

Basic Qualified Personnel

Requirements

Education, Training and Credential Requirements Basic Qualified Personnel must be trained directly via an employer/dentist, via a planned sequence of instruction in an educational institution or via in-office training. 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. To monitor nitrous oxide-oxygen minimal sedation, Basic Qualified Personnel must: I. Be at least 18 years of age AND II. Have completed an accepted basic life-support training course and remain current at all times when monitoring nitrous oxide/oxygen AND III. Have successfully completed a six-hour course in N2O-O2 monitoring (unless exempt due to prior education or existing credential) AND IV. Have at least two years of active practice and at least 3,000 hours of experience in the practice of dental assisting

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 2. Preliminary charting of missing and filled teeth 47, 50, 54, 55. Impression, fabrication, cementation and removal 4. Physical positioning of the patient of provisional restorations, not to include palliative or sedative 6. Retraction of the gingival tissue prior to the final impression restorations which is performed by the licensed, supervising dentist 49. Pulp testing 11. Intraoral instrument transfer 56. Application of topical anesthetics 13. Suture removal 59. Monitor nitrous oxide-oxygen analgesia (see requirements 14. Irrigation and drying of canals during endodontic procedures above) 15. Placement and removal of orthodontic arch wires, auxiliary arch 63, 69. Placement and removal of surgical dressings wires, and ligation of same to orthodontic bands and/or brackets 67. Assistance during administration of life-support activities 18. Fluoride application • Application of disclosing solutions 24. Demonstration of oral hygiene procedures, including, but not • Caries susceptibility testing limited to, use of toothbrushes and dental floss • Shade selection for fabrication of appliances or restorations 24, 26. All patient education services, including, but not limited to, • Application of cavity varnish progress reports, consultations (oral or written), oral hygiene • Taking photographs instructions, use of intraoral hygiene devices, normal nutrition • Placement of medication in the pulp chamber(s) of teeth with information as it relates to dental health, behavioral modification, non-vital pulp or instrumented root canals self adjustment of orthodontic appliances, and all other post-op• Topical applications of desensitizing agents to teeth erative and post-insertion instructions, as deemed appropriate • Intraoral bite registrations for diagnostic model articulation, by the supervising dentist restorations and appliances 25. All supportive services necessary to the maintenance of a • Polymerization of light-activated restorative/bonding materials hygienic practice environment, including, but not limited to, all • Basic remediable intraoral and extraoral dental tasks and/or prosterilizing procedures cedures (those which do not create irreparable changes within 27. Placement of rubber dam over pre-placed clamp, and removal of the oral cavity and/or the contiguous structures) clamp and rubber dam • Recording patient treatment 29. Preliminary selection and sizing of orthodontic bands and arch • Checking for and removal of loose orthodontic bands and loose wires brackets 30, 48. Aspiration and retraction • Repair, construction and finishing of metallic and plastic pros35, 62. Application and removal of periodontal dressings thetic devices 37. Measurement of blood pressure and body temperature • Compilation of radiographic data for interpretation by the dentist, 38. Monitoring of vital signs i.e., tracings, etc. 42. Placement and removal of orthodontic separators and ties • The preparation of materials, drugs and medications for use 43. Preliminary selection and sizing of stainless steel crowns in dental procedures, including, but not limited to, palliative, 44. Taking impressions for the construction of custom athletic impression and restorative materials mouth protectors/mouthguards, and trays for application of • Any other non-invasive procedures deemed necessary by the medicaments supervising dentist to maintain the health and safety of the 44. Elastomeric impressions for diagnostic models and models to be patient used for opposing models in the construction of appliances and • All non-invasive supportive services normally utilized in conrestorations junction with the treatment by the dentist of fascia pain or TMJ syndrome List of allowable functions for this level continued on next page

*Direct Supervision: Acts must be 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. Personal Supervision: A dentist is personally operating on a patient and authorizes an auxiliary to aid treatment by concurrently performing supportive procedures.

132

OHIO

State-approved 5/19/2022

Allowable

Allowable Functions for Basic Qualified Personnel, continued Under Direct Supervision* • 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 • Impressions for removable or fixed orthodontic appliances

• •

All non-invasive supportive services and procedures necessary to the gathering and maintaining of accurate and complete medical and dental history of the patient All supportive services or procedures necessary to protect the physical well-being of the patient during routine treatment procedures and during periods of emergencies

Under Personal Supervision* • Assist in the concurrent performance of supportive procedures, and with the administration of drugs, medications and inhalation anesthetic agents, including nitrous oxide

Certified Assistant

Education, Training and Credential Requirements The Ohio State Dental Board (OSDB) recognizes the following three dental assisting certifications: 1. DANB CDA certification OR 2. Certified Ohio Dental Assistant (CODA) certification administered by the Ohio Commission on Dental Assistant Certification (OCDAC) OR 3. Registered Dental Assistant certification administered by the American Medical Technologists (RDA [AMT])

Requirements

Current holders of any of these certifications are considered Certified Assistants. (Holders of DANB’s NELDA certification temporarily qualify as Certified Assistants; See NOTE below.) NOTE: The OSDB voted to recognize DANB’s NELDA certification to qualify for Certified Assistant status through the end of 2021. At its meeting on March 9, 2022, the OSDB voted to extend its temporary acceptance of DANB’s NELDA certification through June 30, 2023, and to r eview and consider permanent inclusion of this exam via its rulemaking process. Current Certified Assistants may qualify to perform placement of pit and fissure sealants and to earn a state certificate in coronal polishing by meeting the following additional requirements: Coronal Polishing: I. Successfully complete an OSDB-approved training program AND II. a. Successfully pass standardized testing immediately following successful completion of a skills assessment component of an approved training program OR b. Pass DANB’s Coronal Polishing (CP) exam AND III. Apply to the OSDB for certification to perform coronal polishing.

Pit and Fissure Sealants: I. Successfully complete a course containing a minimum of 2 hours of didactic instruction and 6 hours of clinical instruction AND II. The supervising dentist must observe the assistant successfully apply at least 6 sealants.

NOTE: 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 on page 135. **Please note: Holders of the Ohio coronal polishing certificate must maintain DANB CDA certification, CODA certification through OCDAC, or RDA(AMT) certification (or DANB’s NELDA certification, while recognized) to perform coronal polishing.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Under Direct Supervision* 9. Coronal polishing (rubber cup and slow-speed rotary dental hand piece only); assistant must be Ohio Board-certified in polishing (see requirements above) 40. Pit and fissure sealants (see requirements above)

• •

Basic remediable intraoral dental tasks All duties designated to Basic Qualified Personnel, under the same levels of required supervision

When the supervising dentist is not physically present at the location where the services are provided, subject to certain conditions (See list of conditions on page 135) 18. Application of fluoride varnish • Application of desensitizing agents, excluding silver diamine 40. Application of pit and fissure sealants¥ fluoride 47. Recementation of temporary crowns or recementation of crowns • Caries susceptibility testing with temporary cement • Instruction on oral hygiene home care, including the use of tooth• Application of disclosing solutions brushes and dental floss ¥ A Certified Assistant who has met the prescribed education and training requirements may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis if all of the other conditions listed on page 135 have been met.

133

OHIO

State-approved 5/19/2022

Expanded Function Dental Auxiliary

Requirements

Education, Training and Credential Requirements To perform expanded functions under the direct supervision of a licensed dentist in Ohio, a dental assistant must qualify as an Expanded Function Dental Auxiliary (EFDA). To qualify as an EFDA, one must: II. Complete an EFDA training course that is accredited by either I. a. Be an unlicensed dentist who has graduated from an accredthe Commission on Dental Accreditation (CODA) or the Higher ited dental college and does not have a dental license under Learning Commission suspension or revocation by the OSDB OR b. Be a dental student who is enrolled in an accredited dental AND college and is in good standing as a dental student OR III. Pass the EFDA exam administered by the Commission on c. Be a graduate of an unaccredited dental college located Dental Testing in Ohio (CODT) or the Commission on Dental outside the US OR Competency Assessments (CDCA) d. Be a current Certified Assistant (See page 133 for requireAND ments) OR IV. Complete a BLS training course certified by the American Red e. Be a dental hygienist licensed by the OSBD in good standing Cross, American Heart Association, or American Safety and OR Health Institute f. Be a dental hygienist who has graduated from an accredited dental hygiene program and does not have a dental hygiene AND license under suspension or revocation by the OSBD V. Apply to the OSDB for registration AND Note: An EFDA may perform specified functions when the supervising dentist is not physically present (for not more than 15 consecutive business days) or by authorization of a dentist working under a teledentistry permit subject to the conditions listed on the next page. To qualify to perform placement of interim therapeutic restorations or application of silver diamine fluoride, an EFDA must complete an OSDB-approved course in the function.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision 2. Place amalgam restorative materials 18. Application of topical fluoride 18. Application of fluoride varnish 33. Place nonmetallic restorative materials, including direct-bonded restorative materials 40. Application of pit and fissure sealants • Application of disclosing solutions

• • • • •

Application of desensitizing agents Caries susceptibility testing Instruction on oral hygiene home care, including the use of toothbrushes and dental floss Any additional procedures authorized by the state dental board All duties designated to Certified Assistants‡ and Basic Qualified Personnel, under the same levels of required supervision.

Allowable

‡ Note: An EFDA may not perform coronal polishing unless he or she has met the requirements described on page 133 and received a state certificate in coronal polishing from the Ohio State Dental Board. When the supervising dentist is not physically present at the location where the services are provided, subject to certain conditions (See list of conditions on the next page.) 40. Application of pit and fissure sealants (An EFDA may apply pit and fissure sealants prior to a dentist examining the patient and rendering a diagnosis, if all of the conditions listed on the next page have been met.) 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 dentist meets the conditions of item 7 on the next page) 18. Application of topical fluoride • Application of desensitizing agents, excluding silver diamine 18. Application of fluoride varnish fluoride 47. Recementation of temporary crowns or recementation of crowns • Instruction on oral hygiene home care, including the use of with temporary cement toothbrushes and dental floss • Application of disclosing solutions • Any additional procedures authorized by the state dental board • Caries susceptibility testing By authorization of a dentist working under a teledentistry* permit, when the supervising dentist is not physically present at the location where the services are provided, subject to certain conditions (See list of conditions on the next page.) 18. Application of topical fluoride 40. Application of pit and fissure sealants 18. Application of fluoride varnish 47. Recementation of temporary crowns or recementation of crowns 22. Standard diagnostic radiologic procedures (EFDA must with temporary cement also hold the dental x-ray machine operator certificate; see • Place interim therapeutic restorations (when the EFDA has requirements on page 131) completed an OSDB-approved course) List of allowable functions for this level continued on next page

134

OHIO

State-approved 5/19/2022

Allowable

Allowable Functions for Expanded Function Dental Auxiliaries, continued By authorization of a dentist working under a teledentistry permit, when the supervising dentist is not physically present at the location where the services are provided, subject to certain conditions (See list of conditions below) •

•

Application of silver diamine fluoride (when the EFDA’s supervising dentist has examined the patient and diagnosed the need for such treatment and the EFDA has completed an OSDB-approved course) Application of disclosing solutions

• • • •

Conditions for Performing Functions When Supervising Dentist is Not Physically Present Conditions under which a Certified Assistant or an Expanded Function Dental Auxiliary (EFDA), may perform specified functions when the supervising dentist is not physically present, for not more than 15 consecutive business days: 1. The Certified Assistant or EFDA has at least 1 year/1,500 hours experience as a dental assistant or EFDA 2. The Certified Assistant or EFDA successfully completes a board-approved course in identification and prevention of potential medical emergencies 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

7. The Certified Assistant or EFDA is employed by, or under contract with, the supervising dentist, 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, or a dentist licensed under this chapter who is one of the following: (a) The employer of the supervising dentist (b) A shareholder in a professional association formed under Chapter 1785. of the Revised Code of which the supervising dentist is a shareholder

4. 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

(c) 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

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 Certified Assistant or EFDA provides services to the patient, and the supervising dentist determines that the patient is in a medically stable condition

(d) 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 (e) 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

6. 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

Conditions under which a Certified Assistant or an Expanded Function Dental Auxiliary (EFDA), may perform application of pit and fissure sealants prior to the dentist examining the patient and rendering a diagnosis: 8. All of the conditions listed above, with the exception of item 5 9. 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 10. The supervising dentist for the program is employed by or a volunteer for, and the patients are referred by, the entity through

which the program is operated and is available for consultation by telephone, videoconferencing, or other means of electronic communication 11. The application of sealants is limited to erupted permanent posterior teeth without suspicion of dentinal cavitation 12. For minor patients, a parent or other person responsible for the patient is 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

Conditions under which an Expanded Function Dental Auxiliary (EFDA), may perform specified functions when the supervising dentist is not physically present, by authorization of a dentist working under a teledentistry permit: 13. Conditions described in items 1-4 and 7 above 14. The authorizing dentist must prepare a written authorization that includes all of the information required by law 15. 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 16. The patient consents to the provision of services through teledentistry and the consent is documented in the patient’s record

17. 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 by the OSDB have been met 18. The authorizing dentist establishes the patient’s identity and physical location through synchronous, real-time communication 19. The authorizing dentist provides dental services through teledentistry only as is appropriate for the patient and in accordance with appropriate standards of care 20. The authorizing dentist establishes a diagnosis and treatment plan and documents it in the patient’s record 21. The authorizing dentist specifies the services the expanded function dental auxiliary is authorized to provide to the patient

135

OKLAHOMA: OVERVIEW Reviewed by DANB 3/22/2022 †

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Oklahoma. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant with expanded function permit

Other Levels

Other Specialized Dental Assistant Categories

Radiography Requirements

1 Dental Assistant

State Radiography Requirements

This state allows dental assistants meeting requirements in the following specialized categories to perform sets of functions specific to those categories. See requirements and functions for these categories on the indicated pages.

Oral Maxillofacial Surgery Assistant

See page 139

To legally operate dental x-ray equipment and perform dental radiographic procedures in Oklahoma, a dental assistant must obtain a permit from the Oklahoma Board of Dentistry. To qualify, one must: I. Complete a course of study in radiation safety and protection, consisting of a minimum of seven hours, approved by the OBD AND II. Submit written verification to the OBD from the applicant’s current employing dentist attesting to competent clinical experience AND III. Apply for a Radiation Safety permit from the Oklahoma Board of Dentistry and pass a background check with criteria established by the OBD.

Functions NOT Permitted by Dental Assistants in Oklahoma

Prohibited

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 12, 33. Placement or removal of restorative materials in a human • oral cavity • 61. Removal of fully hardened cement • • Diagnosis • • Treatment planning • Prescription of medications • • Final placement or removal of orthodontic brackets and bands • Surgery or the cutting or severance of hard and soft tissue • Placement or adjustment of any removable or fixed prosthesis • The following acts shall be regarded as practicing dentistry: • Representing oneself as treating or professing to treat by professional instructions or by advertising use of professional equipment or products • Removing human teeth • Repairing or filling cavities in human teeth

• • •

Administration of injectable local anesthesia Utilization of a laser Administration of nitrous oxide Any procedure that may contribute to or result in an irreversible alteration of the human oral anatomy An expanded duty (see list on the next page) when the dental assistant does not hold a current permit issued by the Oklahoma Board of Dentistry for the expanded duty Those procedures allocated exclusively to dental hygienists Correcting or attempting to correct malposed teeth Administering anesthetics, general or local Treating deformities of the jaws and adjacent structures

Prohibited functions continued on next page

136

OKLAHOMA

Reviewed by DANB 3/22/2022

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Oklahoma, continued The following acts shall be regarded as practicing dentistry (continued): • Using x-ray and interpreting dental x-ray film • Diagnosing, making, and adjusting appliances to artificial casts • Offering, undertaking or assisting by any means or methods, to of malposed teeth for treatment of the malposed teeth in the remove stains, discolorations, or concretions from the teeth human mouth, without instructions • Operating or prescribing for any disease, pain, injury, deficien• Writing a laboratory prescription to a dental laboratory or dental cy, deformity, or any physical condition connected with the laboratory technician for the construction, reproduction or repair human mouth of any appliance or structure to be worn in the human mouth • Taking impressions of the teeth and jaws • Any other procedure otherwise defined in the State Dental Act • Furnishing, supplying, constructing, reproducing, or repairing, requiring a valid license or permit to perform while the person or offering to furnish, supply, construct, reproduce, or repair, does not hold such valid license or permit issued by the Board prosthetic dentures, sometimes known as plates, bridges, or other substitutes for natural teeth for the user or prospective No dental assistant shall perform any duty not authorized by Title user thereof 195, Chapter 15, of the Oklahoma Administrative Code or the • Adjusting or attempting to adjust any prosthetic denture, bridge, State Dental Act. appliance, or any other structure to be worn in the human mouth

Dental Assistant

Education, Training and Credential Requirements

Requirements

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 I. Submit a completed application form and the required fee to the Oklahoma Board of Dentistry AND II. 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. A dental assistant in Oklahoma may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. A dental assistant must receive adequate office-based training by the supervisory dentist to ensure that the dental assistant is aware of all requirements and responsibilities of each duty to be performed. Beginning January 1, 2020, every dental assistant receiving a permit shall complete an infection control course approved by the OBD within one year of the date of receipt of permit. Dental assistants holding permits prior to January 1, 2020 must complete an infection control course approved by the OBD before December 31, 2020.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* • 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 DANB’s Note on Allowable Dental Assisting Functions In the state of Oklahoma, all dental assistants may: • •

Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act

*Direct Supervision: A 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 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. Direct visual supervision: 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.

137

OKLAHOMA Reviewed by DANB 3/22/2022

Dental Assistant with expanded function permit

Education, Training and Credential Requirements 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 CODA-accredited dental assisting program or in a course approved by the Oklahoma Board of Dentistry (OBD). Available permits are: Radiation Safety. See the “Radiography Requirements” on page 136. Coronal polishing/Topical fluoride. A dental assistant must successfully complete a Board-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 a Board-approved course of study, consisting of a minimum of 12 hours.

Requirements

Assisting in the administration of nitrous oxide. A dental assistant must successfully complete a Board-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: I. Held a valid dental assistant permit in another state for a minimum of two years and is in good standing AND II Held a valid expanded duty in another state for a minimum of one year AND III. 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: I. Proof of military service in excess of two years with any certifications or training in the expanded function areas AND II. 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.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Polish coronal surface of teeth, or prepare teeth for band cementation or bonding of brackets utilizing a slow speed rotary handpiece and prophy/polishing cup or brush (examination for calculus and scaling must be done by a dentist or dental hygienist) 18. Apply topical fluoride and desensitizing agents 22. Expose intra-oral and extra-oral radiographs 40. Place pit and fissure sealants 59. Assist in the administration of nitrous oxide • All duties designated to Dental Assistants, under the same level of required supervision

138

OKLAHOMA

(ORAL MAXILLOFACIAL SURGERY ASSISTANT) Reviewed by DANB 3/22/2022

Oral Maxillofacial Surgery Assistant Education, Training and Credential Requirements To perform specified oral maxillofacial surgical assisting functions in Oklahoma, one must hold an Oral Maxillofacial Surgery Assistant permit. To qualify, one must:

Requirements

Pass a background check with criteria established by the Oklahoma Board of Dentistry AND II. Be supervised by an oral maxillofacial surgeon with a current Oklahoma license, AND III. 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 IV. Complete the Dental Anesthesia Assistant National Certification Examination (DAANCE) program provided by the American Association of Oral Maxillofacial Surgeons (AAOMS) AND V. Hold valid BLS certification, AND VI. Complete a standardized course approved by the OBD including a minimum of four hours of didactic training that includes the required content, AND VII. Complete an infection control course approved by the Board, AND VIII. Meet any other requirements established by the OBD AND IX. Apply to the OBD for an Oral Maxillofacial Surgery Assistant permit An oral maxillofacial surgery assistant permit shall be considered a temporary training permit until all of the training requirements have been completed and approved by the OBD. A temporary training permit shall not be extended beyond two years. 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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under Direct Visual Supervision* • Initiate and discontinue an intravenous line for a patient being • Follow instructions of the oral surgeon while acting as an prepared to receive intravenous medications, sedation or accessory hand on behalf of the oral surgeon that is administergeneral anesthesia ing** the medication and actively treating the patient. • Draw up and prepare medications • 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 • 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 **Note: “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.

139

OREGON: OVERVIEW

State-approved 2/7/2022

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Oregon. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3 Expanded Function Dental Assistant (EFDA) with Restorative Functions Certificate 2

Expanded Function Dental Assistant (EFDA)

1 Dental Assistant

Other Levels

Other Specialized Dental Assistant Categories Oregon allows dental assistants meeting requirements in the following specialized categories to perform sets of functions specific to those categories. See requirements and functions for these categories on the indicated pages.

Orthodontic

See page 144

Preventive

Anesthesia

See pages 146-147

See page 145

State Radiography Requirements

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under general supervision in Oregon, a dental assistant must: I.

Complete all of the following requirements and apply to DANB for a state certificate of radiologic proficiency: a. Complete a course approved by the OBD*, or submit evidence of equivalent training recognized by the Oregon Health Authority, Center for Health Protection, Radiation Protection Services AND b. Pass the national DANB Radiation Health and Safety (RHS) exam‡ AND c. Submit verification** from an Oregon licensed dentist or Oregon licensed dental hygienist that the assistant is proficient to take radiographs.

OR II. Complete one of the following requirements and apply to DANB for a state certificate of radiologic proficiency by credential: a. Be certified in another state that has training and certification requirements substantially similar to Oregon’s OR b. 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 *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. **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 6 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.

Prohibited

Functions NOT Permitted by Dental Assistants in Oregon Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant in Oregon: 6. Place any type of retraction material subgingivally, except as permitted for EFDAs with additional training - see p. 142 33, 51. Condense and carve permanent restorative material, except as permitted by an EFDA with a Restorative Functions Certificate - see p. 143

35. Place periodontal packs • Diagnose or plan treatment • Cut hard or soft tissue • Start nitrous oxide Prohibited Functions list continued on next page.

‡ 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.

140

OREGON

State-approved 2/7/2022

Functions NOT Permitted by Dental Assistants in Oregon, continued •

Prohibited

•

• •

• • • • •

Adjust or attempt to adjust any orthodontic wire, fixed or removable appliance or other structure while it is in the patient’s mouth Administer any drug except fluoride, topical anesthetic, desensitizing agents, over the counter medications per package instructions, drugs administered as allowed under anesthesia permit rules and drugs administered as expressly permitted for Certified Anesthesia Dental Assistants - see p. 146 Prescribe any drug Use a high speed handpiece or any device operated by a high-speed handpiece intra-orally, except as permitted for an EFDA with a Restorative Functions Certificate, for the purpose of adjusting occlusion, contouring, and polishing restorations on the tooth or teeth that are being restored - see p. 143 Use lasers, except laser curing lights Use air abrasion or air polishing Remove teeth or parts of tooth structure Use the behavior management techniques known as Hand Over Mouth (HOM) or Hand Over Mouth Airway Restriction (HOMAR) on any patient Use ultrasonic equipment intraorally, except those functions expressly permitted for EFODAs - see p. 144

Requirements

• •

• • • • • •

Correct or attempt to correct the malposition or malocclusion of teeth, except those functions expressly permitted for EFODAs see p. 144 Cement or bond any fixed prosthesis or orthodontic appliance, including bands, brackets, retainers, tooth moving devices, or orthopedic appliances, except those functions expressly permitted for EFODAs - see p. 144 Apply denture relines, except those functions expressly permitted for EFDAs with additional training - see p. 142 Remove stains or deposits, excluding EFDA functions expressly permitted Perform periodontal assessment Place or remove healing caps or abutments, except under direct supervision Place implant impression copings, except under direct supervision Perform any Expanded Function duty, Expanded Orthodontic Function duty, Restorative Function duty, Expanded Preventive duty or Expanded Function Anesthesia duty without holding the appropriate certificate

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Oregon may perform basic supportive dental procedures specified by the state dental practice act (see next page) under the indirect supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Allowable

Under Direct Supervision* • Place or remove healing caps or abutments • Place implant impression copings Under Indirect Supervision* 8, 56. Administer or dispense fluoride, topical anesthetic, desensitizing agents, and over the counter medications per package instructions 44. Take impressions for diagnostic or opposing models or for fabrication of temporary or provisional restorations or appliances Under General Supervision* 22. Exposing of radiographs: place films, adjust equipment preparatory to exposing films, and expose the films (see “Radiography Requirements” on previous page) • Dental assistants who are in compliance with written training and screening protocols adopted by the state may perform oral health screening

Under Indirect Supervision* of a Dentist, Dental Hygienist, or Dental Assistant Who Holds an Oregon Radiologic Proficiency Certificate 22. Exposing of radiographs: place films, adjust equipment preparatory to exposing films, and expose the films (see note under “Radiography Requirements” on previous page) Under Direct Supervision* of a Dentist Holding (at a minimum) a Moderate Sedation Permit • Dispense oral medications that have been prepared by a dentist permit holder for oral administration to a patient, after adequate training Under Direct Supervision* and at the Direction of a Dentist Holding (at a minimum) a Minimal Sedation Permit • Administer oral sedative agents or anxiolysis agents calculated and dispensed by a dentist, after training At the Direction of a Dental Hygienist 62. Remove periodontal dressings

Note: A dental assistant may be supervised by a dental hygienist who works under general supervision in the dental office if the assistant is rendering assistance to the 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 a dental assistant who will render assistance to the dental hygienist in providing dental hygiene services. *Direct Supervision: A dentist must diagnose the condition to be treated, authorize the procedure to be performed, and remain in the dental treatment room while the procedures are performed. Indirect Supervision: A dentist must authorize the procedures and be on the premises while the procedures are being performed. Unless otherwise specified, dental assistants work under indirect supervision in the dental office. General Supervision: A dentist must authorize the procedures, but need not be present when the authorized procedures are being performed. The authorized procedures may be performed at a place other than the usual place of practice of the dentist.

141

OR 2

OREGON State-approved 2/7/2022

Expanded Function Dental Assistant

Education, Training and Credential Requirements

Requirements

To perform expanded functions in Oregon under the supervision of a licensed dentist, a dental assistant must earn an Oregon Expanded Function Dental Assistant (EFDA) certificate. To qualify, one must: I. a. b. c. OR II. a. b. c. d. e. OR III. a. b. c. d. e. OR IV. a.

Hold an Oregon Certificate of Radiologic Proficiency (see requirements on page 1) AND Successfully complete a CODA-accredited dental assisting program AND Apply for the Oregon EFDA certificate (administered by DANB) Hold an Oregon Certificate of Radiologic Proficiency (see requirements to the right) AND Pass the DANB Certified Dental Assistant (CDA) exam** AND Pass the Oregon Expanded Functions—General Dental Assisting Exam** (administered by DANB) AND Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements AND Apply for the Oregon EFDA certificate (administered by DANB) Hold an Oregon Certificate of Radiologic Proficiency (see requirements to the right) AND Pass the DANB Infection Control (ICE) exam or the Oregon Basic Dental Assisting exam** (administered by DANB) AND Pass the Oregon Expanded Functions—General Dental Assisting Exam** (administered by DANB) AND Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements AND Apply for the Oregon EFDA certificate (administered by DANB)

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 b. Apply for the Oregon EFDA certificate by credential (administered by DANB)

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* 9. 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 45. Place and remove matrix retainers for alloy and composite restorations 47. Fabricate temporary crowns, and temporarily cement the temporary crown. Cemented crown must be examined and approved by the dentist prior to the patient being released 50. Place temporary restorative material (i.e. zinc oxide eugenol based material) in teeth providing that the patient is checked by a dentist before and after the procedure is performed 54. Remove temporary crowns for final cementation and clean teeth for final cementation 61. 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 • Preliminarily fit crowns to check contacts or to adjust occlusion outside the mouth • Polish amalgam restorations with a slow-speed handpiece • Perform all aspects of teeth whitening procedures

Under General Supervision* 47. 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 An EFDA may perform the following procedures under the indirect supervision* of a dentist or dental hygienist after successful completion of a CODA-accredited program or other course approved by the Oregon Board, provided the procedure is checked by a dentist or dental hygienist prior to dismissal of the patient: 6. Place retraction material subgingivally 40. Apply pit and fissure sealants provided the patient is examined before the sealants are placed. Sealants must be placed within 45 days of the procedure being authorized by a dentist or dental hygienist • Apply temporary soft relines to complete dentures for the purpose of tissue conditioning

*Direct Supervision: A dentist must diagnose the condition to be treated, authorize the procedure to be performed, and remain in the dental treatment room while the procedures are performed. Indirect Supervision: A dentist must authorize the procedures and be on the premises while the procedures are being performed. Unless otherwise specified, dental assistants work under indirect supervision in the dental office. General Supervision: A dentist must authorize the procedures, but need not be present when the authorized procedures are being performed. The authorized procedures may be performed at a place other than the usual place of practice of the dentist. **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.

142

OR 3

OREGON State-approved 2/7/2022

Expanded Function Dental Assistant (EFDA) with Restorative Functions Certificate

Requirements

Education, Training and Credential Requirements To perform the restorative functions listed below in Oregon, an EFDA must hold a Restorative Functions certificate. To qualify, an EFDA must: I. a. b. c. OR II. a.

Complete a Oregon Board of Dentistry (OBD)-approved restorative functions curriculum from a CODA-accredited program AND Pass the WREB Restorative Exam (or another OBD-approved exam) within five years of application AND Apply for the Oregon Restorative Functions certificate (administered by DANB)

If applicant passed the WREB Restorative Exam more than five years prior to application, 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 prior five years AND b. Apply for the Oregon Restorative Functions certificate (administered by DANB)

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* 12, 33, 51. Perform the placement and finishing of restorations, except gold foil, after the supervising dentist has prepared the tooth (teeth) for restoration(s).

143

OREGON (ORTHODONTIC) State-approved 2/7/2022

Expanded Function Orthodontic Dental Assistant (EFODA) Education, Training and Credential Requirements To perform expanded orthodontic functions in Oregon under the supervision of a licensed dentist, a dental assistant must earn status as an Expanded Function Orthodontic Dental Assistant (EFODA).

Requirements

To qualify, one must: I. a. b. OR II. a. b. c.

Complete a course of instruction in a CODA-accredited dental assisting program AND Apply for Oregon EFODA certification (administered by DANB)

Pass DANB’s national Certified Dental Assistant (CDA) exam or Certified Orthodontic Assistant (COA) exam** AND Pass the Oregon Expanded Functions—Orthodontic Assisting (ORXO) exam** (administered by DANB) AND Provide endorsement from an Oregon licensed dentist stating that the applicant has successfully completed the clinical requirements AND d. Apply for the Oregon EFODA certificate (administered by DANB)

OR III. a. Pass the DANB Infection Control (ICE) exam or the Oregon Basic Dental Assisting exam** (administered by DANB) AND b. Pass the Oregon Expanded Functions—Orthodontic Assisting (ORXO) exam** (administered by DANB) AND c. Provide endorsement from an Oregon licensed dentist stating that the applicant has successfully completed the clinical requirements AND d. Apply for the Oregon EFODA certificate (administered by DANB) OR IV. a. 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 b. Apply for the Oregon EFODA certificate by credential (administered by DANB)

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* Under General Supervision* 15. Place and ligate archwires • Remove any portion of an orthodontic appliance causing a 29. Select or try for the fit of orthodontic bands patient discomfort and, in the process, replace ligatures and/ 42. Place and remove orthodontic separators or separators if the dentist is not available, providing that the 44. Take impressions for study models or temporary oral devices patient is rescheduled for follow-up care by a licensed dentist such as, but not limited to, space maintainers, orthodontic as soon as is reasonably appropriate retainers and occlusal guards • Recement orthodontic bands if the dentist is not available • Remove orthodontic bands and brackets and attachments with and the patient is in discomfort, providing that the patient is removal of the bonding material and cement. An ultrasonic scalrescheduled for follow-up care by a licensed dentist as soon as er, hand scaler or slow speed handpiece may be used. Use of a is reasonably appropriate high speed handpiece is prohibited. • Recement loose orthodontic bands • 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 • Fit and adjust headgear • Remove fixed orthodontic appliances • Remove and replace orthodontic wires • Place elastic ligatures or chains as directed • Cut arch wires

144

OREGON (PREVENTIVE) State-approved 2/7/2022

Expanded Function Preventive Dental Assistant (EFPDA) Education, Training and Credential Requirements To perform expanded preventive functions in Oregon under the supervision of a licensed dentist, a dental assistant who does not hold the Oregon EFDA certificate must earn status as an Expanded Function Preventive Dental Assistant (EFPDA).

Requirements

To qualify, one must: I. a. b. c. OR II. a. b. c. d. e. OR III. a. b. c. d. e. OR IV. a.

Hold an Oregon Certificate of Radiologic Proficiency (see requirements to the right) AND Successfully complete a course of instruction in a program accredited by CODA AND Apply for the Oregon EFPDA certificate (administered by DANB) Hold an Oregon Certificate of Radiologic Proficiency (see requirements to the right) AND Pass the DANB Infection Control (ICE) exam** AND 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 Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements AND Apply for the Oregon EFPDA certificate (administered by DANB) Hold an Oregon Certificate of Radiologic Proficiency (see requirements on previous page) AND Pass the Oregon Basic Dental Assisting exam** (administered by DANB), AND 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 Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements, AND Apply for the Oregon EFPDA certificate (administered by DANB)

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 b. Apply for the Oregon EFPDA certificate by credential (administered by DANB)

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision* 9. Polish the coronal surfaces of teeth with a brush or rubber An EFPDA may perform the following procedure under the cup as part of oral prophylaxis to remove stains providing the indirect supervision* of a dentist or dental hygienist after sucpatient is checked by a dentist or dental hygienist after the cessful completion of a CODA-accredited program or other course procedure is performed, prior to discharge approved by the Oregon Board, provided the procedure is checked by a dentist or dental hygienist prior to dismissal of the patient: 40. Apply pit and fissure sealants provided the patient is examined before the sealants are placed. Sealants must be placed within 45 days of the procedure being authorized by a dentist or dental hygienist

145

OREGON (ANESTHESIA) State-approved 2/7/2022

Anesthesia Monitor Requirements

Education, Training and Credential Requirements To perform the duties of an Anesthesia Monitor, a dental assistant must : I. 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 II. Maintain current certification in BLS for Healthcare Providers Basic Life Support (BLS)/Cardio Pulmonary Resuscitation (CPR) training or equivalent AND III. Receive training in monitoring vital signs AND IV. Be competent in the use of monitoring and emergency equipment appropriate for the level of sedation utilized

Allowable

•

Visually monitor and record condition of patients being treated under minimal sedation, moderate sedation, deep sedation or general anesthesia

Anesthesia Dental Assistant Education, Training and Credential Requirements A dental assistant in Oregon must hold state certification as an Anesthesia Dental Assistant in order to perform the functions listed below.

Requirements

To qualify, one must: I. Hold a current Health Care Provider BLS/CPR certification or equivalent AND II. a. Successfully complete the Oral and Maxillofacial Surgery Anesthesia Assistants Program** conducted by the American Association of Oral and Maxillofacial Surgeons OR b. Successfully complete the Oral and Maxillofacial Surgery Assistants Course** conducted by the California Association of Oral and Maxillofacial Surgeons OR c. Have passed the national DANB Certified Oral and Maxillofacial Surgery Assistant (COMSA) exam** (prior to discontinuation of the COMSA exam in 2000) OR d. Successfully complete the Resuscitation Group – Anesthesia Dental Assistant course OR e. Successfully complete another course approved by the Oregon Board of Dentistry AND III. Apply for the Oregon Anesthesia Dental Assistant certificate (administered by DANB)

Allowable

Allowable Functions Under Direct Visual Supervision* • Administer medications into an existing intravenous (IV) line of a patient under sedation or anesthesia • Administer emergency medications to a patient in order to assist the licensee in an emergent situation Under Indirect Supervision* • Dispense oral medications that have been prepared by the dentist and given to the surgery assistant by the supervising dentist for oral administration to a patient • All duties designated to Dental Assistants, under the same required levels of supervision (see p. 141)

Under Direct Visual Supervision of a Dentist Holding a Deep Sedation or General Anesthesia Permit* • Administer oral sedative agents calculated by a dentist permit holder Under Direct Visual Supervision of a Dentist Holding a General Anesthesia Permit* • Introduce additional anesthetic agents to an infusion line Under Direct Supervision of a Dentist Holding a Moderate Sedation Permit* • Introduce additional anesthetic agents to an infusion line

146

OREGON (ANESTHESIA) State-approved 2/7/2022

Allowable

Requirements

Anesthesia Assistant with IV Therapy Certificate Education, Training and Credential Requirements 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: I. Complete a course in intravenous access or phlebotomy approved by the OBD AND II. Apply for the Anesthesia Dental Assistant with IV Therapy certificate (administered by DANB)

Allowable Functions Under Indirect Supervision* • Initiate an IV infusion line for a patient being prepared for IV medications, sedation or general anesthesia

147

PENNSYLVANIA: OVERVIEW State-approved 4/18/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Pennsylvania. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Function Dental Assistant (EFDA)

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a dentist in Pennsylvania, a dental assistant must: I. Pass the national DANB Radiation Health and Safety (RHS) exam, AND II. Complete 3 hours of training in child abuse recognition and reporting requirements as approved by the Pennsylvania Department of Human Services. 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 Dec. 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.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Pennsylvania Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 46. Take impressions other than for study models, diagnostic casts or athletic appliances • Complete or limited examination, diagnosis and treatment planning. • Surgical or cutting procedures of hard or soft tissue. • Prescribing drugs, medicaments or work authorizations. • Final inspection and approval of restorative and other treatment which affects occlusion and any necessary occlusal adjustments.

148

• • •

Pulp capping, pulpotomy and other endodontic procedures. Placement and intraoral adjustments of fixed and removable prosthetic appliances. Administration of local anesthesia, parenteral or inhalational sedation, nitrous oxide analgesia or general anesthesia.

PENNSYLVANIA State-approved 4/18/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Pennsylvania may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assistant.

Allowable

Allowable Functions Under Direct Supervision* • Any task, as deemed appropriate by the dentist, excluding prohibited tasks and tasks for which state certification as an EFDA is required

DANB’s Note on Allowable Dental Assisting Functions In the state of Pennsylvania, all dental assistants may • •

Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act

Expanded Function Dental Assistant

Education, Training and Credential Requirements

Requirements

To perform expanded functions in 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: I. a. Graduate from an expanded function dental assisting program at a two-year college or other state board-approved program which offers an associate degree OR b. 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 c. 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 state board-approved dental assisting program, AND II. Apply for state certification in expanded functions to the Pennsylvania State Board of Dentistry, AND III. Pass a Pennsylvania board-acceptable written exam, AND IV. Complete 3 hours of training in child abuse recognition and reporting requirements as approved by the Pennsylvania Department of Human Services.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Perform coronal polishing 12. Placing and condensing amalgam restoration and other restorative materials 18. Perform fluoride treatments, including fluoride varnish 27. Placing and removing rubber dams 33, 40. Placing and finishing composite resin restorations and/or sealant material or both 34. Applying cavity liners and bases

45. Placing and removing matrices 51. Carving and contouring amalgam restorations • Placing and removing wedges • Taking impressions of teeth for study models, diagnostic casts or athletic appliances • All duties designated to Dental Assistants, under the same levels of required supervision

*Direct Supervision: 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, evaluates the work performed by the expanded function dental assistant.

149

RHODE ISLAND: OVERVIEW State-approved 5/11/2022

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Rhode Island. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

DANB-Certified Assistant

Radiography Requirements

Other Levels

1 Dental Assistant

DAANCE Certified Maxillofacial Surgery Assistant

See page 152

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Rhode Island, a dental assistant must: I. Complete a course in dental radiography from an educational institution with a CODA-accredited program

Functions NOT Permitted by Dental Assistants in Rhode Island Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited

The following functions are not permitted by any level of dental assistant: 22. Exposure of radiographs without successful completion of required course in dental radiography (see “Radiography Requirement” above for requirements) 33, 51. Condensing and carving restorative materials in teeth, except temporary restoratives 46. Taking conventional/physical impressions for models upon which full or partial dentures, or permanent crowns, bridges, inlays, onlays, posts and cores will be fabricated • Diagnosis and treatment planning • Surgical procedures on hard or soft tissue • Prescribing medications • Administering injectable anesthetics • Administering general anesthesia/deep sedation, moderate sedation and/or minimal sedation, or nitrous oxide plus medication • Administering inhalants or inhalation conscious sedation agents • Adjusting occlusion of fixed and removable prosthodontic appliances • Final cementation of permanent crowns, bridges, inlays, onlays, and posts and cores; and insertion of final prosthesis

150

• • • • • •

• • •

Placement of sutures Perform direct pulp capping procedures Orthodontic arch wire detailing with the exception of minor adjustments to eliminate pain or discomfort Flush root canal Temporary wire ligation Use of a rotary instrument in the oral cavity unless licensed or certified under the provisions of the Rhode Island Dental Practice Act and the Rules and Regulations Pertaining to Dentists, Dental Hygienists and Dental Assistants (See also §2.10.2(A) (2)(b) of the Regulations in DANB’s 2019 State Fact Booklet.) Oral prophylaxis Any irreversible intraoral procedure Any procedure listed specifically for dental hygienists: • Remove calculus, accretions and stains from both supragingival and subgingival tooth surfaces by scaling and root planing

RHODE ISLAND State-approved 5/11/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements A dental assistant in Rhode Island may perform dental procedures under the supervision of a licensed dentist, as specified by the state dental practice act (see below). All dental assistants practicing in a dental setting shall hold a current certificate of completion of an approved course in 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. Every dental assistant in Rhode Island must receive a minimum of one (1) hour per year of training in the CDC Infection Control Guidelines.

Allowable

Allowable Functions Under Direct Supervision* • Perform a final digital scan (with final inspection and approval of dentist) • Reversible intraoral procedures as delegated by the dentist

DANB’s Note on Allowable Dental Assisting Functions In the state of Rhode Island, all dental assistants may: • •

Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act

DANB-Certified Assistant

Requirements

Education, Training and Credential Requirements To perform expanded functions in 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). Note: Individuals who have passed a DANB certification exam but have not renewed certification are no longer DANB-Certified assistants. In Rhode Island, DANB-Certified assistants may perform the expanded functions listed below 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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Placing and/or removing retraction cord 9. Coronal polishing 18. Fluoride treatments 29. Placing and removing bonded orthodontic attachments and/or cementation or removal of orthodontic bands

40. Application of pit and fissure sealants • Reversible intraoral procedures as delegated by the dentist • All duties designated to dental assistants, under the same levels of required supervision

151

RHODE ISLAND

(DAANCE CERTIFIED MAXILLOFACIAL SURGERY ASSISTANT) State-approved 5/11/2022

DAANCE Certified Maxillofacial Surgery Assistant Education, Training and Credential Requirements

Requirements

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: I. Be of good moral character AND II. Be eighteen (18) years or older AND III. Successfully complete 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 IV. Be certified as a dental anesthesia assistant by the American Association of Oral and Maxillofacial Surgeons AND V. Complete a Board of Examiners in Dentistry-approved advanced cardiac life support (ACLS) course and hold current certification AND VI. Be in good standing in each state in which he/she holds a license AND VII. Apply to the Rhode Island Board of Examiners in Dentistry for licensure Note: The Rhode Island DAANCE-Certified Maxillofacial Surgery Assistant application form (created December 1, 2017) is now available on the Rhode Island Department of Health Website (http://health.ri.gov/licenses/detail.php?id=251) under the heading “Applications.”

Allowable

Allowable Functions Under Direct Visual Supervision* • Follow instructions to prepare and assist in the administration of medications • Adjust the rate of intravenous fluids infusion beyond a keep open rate • Adjust an electronic device to provide medications, such as an infusion pump • Assist with preparation/delivery/infusion/administration of emergency medications to a patient in order to assist the oral and maxillofacial surgeon in an emergency

Under Direct Supervision* by an oral and maxillofacial surgeon holding a valid general anesthesia/deep sedation permit • Discontinue an intravenous line for a patient who has received intravenous medications, sedation, or general anesthesia • Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open • Make medications readily available for review, inspection and use by the oral and maxillofacial surgeon.

*Direct Supervision: 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. Direct visual supervision: 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.

152

SOUTH CAROLINA: OVERVIEW State-approved 3/14/2022

Prohibited Duties

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in South Carolina. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Duty Dental Assistant (EDDA)

Dental Assistant

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: I. Diploma from a CODA-accredited dental assisting program OR II. DANB CDA certification or the DANB RHS certificate of competency OR III. Certificate in radiation safety from the South Carolina Dental Association (SCDA) OR IV. 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.

Functions NOT Permitted by Dental Assistants in South Carolina The following functions are not permitted by any level of dental assistant: • • • • • •

Establish an IV line Draw sedative drugs into a syringe Deliver drugs in to an established IV line Use lasers in performing bleaching procedures Employ a laser capable of the removal of hard and/or soft tissue in the treatment of a dental patient Use an air abrasion system at settings that could remove a tooth structure or cause irreversible harm to the tooth structure

153

SOUTH CAROLINA State-approved 3/14/2022

Dental Assistant

Requirements

Education, Training and Credential Requirements A dental assistant in South Carolina may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no initial education or training requirements for this level of dental assisting. 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. In settings where sedation is administered, all dental staff who provide direct, hands-on patient care must be certified in CPR at the basic life support level by a board-approved training course, received within the last two years. The operating dentist must 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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 2. Chart existing restorations, clinically missing teeth and appli37. Take and record vital signs (blood pressure, pulse, respiration, ances within the oral cavity etc.) 13. Remove sutures 45. Place and remove matrix 15. Place and remove orthodontic ligatures • Apply topical drugs as prescribed by the dentist* 22. Expose radiographs (see “State Radiography Requirements” on previous page) * At its July 9, 2021 meeting, the South Carolina Board of Dentistry 27. Place and remove rubber dam clarified that silver diamine fluoride is considered a topical drug that 30, 48. Assist in basic supportive chairside procedures all dental assistants are permitted to apply under direct supervision. 35, 62. Place and remove periodontal packs Under Direction of the Department of Health and Environmental Control Public Health Dental Program • Perform oral screenings utilizing the Department of Health and • Perform other duties authorized by regulations of the State Environmental Control approved screening system in school Board of Dentistry and public health settings • Assist in the delivery of public health dental program services

*Direct Supervision: 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.

154

SC 2

SOUTH CAROLINA State-approved 3/14/2022

Expanded Duty Dental Assistant (EDDA)

Requirements

Education, Training and Credential Requirements To perform expanded functions under the direct supervision of a licensed dentist in South Carolina, a dental assistant must earn status as an Expanded Duty Dental Assistant (EDDA). To qualify, one must: I. Graduate from a CODA-accredited dental assisting program OR II. Complete two years of continuous full-time employment as a chairside dental assistant Note: In order to monitor nitrous oxide conscious sedation (analgesia), EDDAs must complete a course approved by the South Carolina Board of Dentistry, successfully complete the state board examination, submit proof of Board-approved CPR certification within the three years preceding application, and apply for state certification from the South Carolina Board of Dentistry.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Place gingival retraction cord 59. Monitor nitrous oxide conscious sedation/analgesia† (requires 9. Polish restorations and supragingival tooth structure state certification – see requirements on previous page) 40. Application of pit and fissure sealant 61. Remove excess cement from restorations and/or appliances 44. Take impressions for study models 63, 69. Place and remove socket dressing 47. Cement temporary crowns or bridges 50. Place temporary restorations Under Direction of the Department of Health and Environmental Control Public Health Dental Program • Perform oral screenings utilizing the Department of Health and • Perform other duties authorized by regulations of the State Environmental Control approved screening system in school Board of Dentistry and public health settings • Assist in the delivery of public health dental program services † 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.

155

SOUTH DAKOTA: OVERVIEW State-approved 5/9/2022

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in South Dakota. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Registered Dental Assistant (RDA)

Other Levels

1 Unlicensed Dental Assistant

Analgesia, Sedation and Anesthesia Assisting

See pages 159-160

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures in South Dakota, an individual must be registered as a Dental Radiographer. To qualify, one must: To qualify for registration as a dental radiographer, one must I. Meet one of the following requirements within 13 months prior to application a. Complete a dental radiography course taken through a dental assisting, dental hygiene or dental program accredited by the Commission on Dental Accreditation, OR b. Pass DANB’s Radiation Health and Safety (RHS) exam, OR c. Complete a South Dakota State Board of Dentistry-approved radiography training program, OR d. Hold DANB Certified Dental Assistant (CDA) certification AND II. 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 I. Have been legally practicing dental radiography in another state within the three years prior to application AND II. Provide verification of completing a course including at least 16 hours of training in areas outlined in South Dakota rules AND III. a. 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 b. If not currently registered as a dental radiographer, verification of having legally practiced 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 IV. Submit application for registration, required documentation, and fee to the South Dakota State Board of Dentistry.

156

SOUTH DAKOTA State-approved 5/9/2022

Functions NOT Permitted by Dental Assistants in South Dakota, continued Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. NOTE: South Dakota regulations contain two separate lists of prohibited functions—one for Registered Dental Assistants and one for Dental Assistants.

Prohibited

The following functions are not permitted for Registered Dental Assistants: 12, 33. Intraoral placing, finishing and adjusting of final restorations 20. Supra and subgingival scaling and periodontal probing as it pertains to dental hygiene and those procedures dental hygienists may perform with the exception of placing sealants and coronal polishing 22. Applying X-radiation to human teeth and supporting structures other than as permitted for a dental assistant qualified as a Dental Radiographer (see requirements on previous page) • Cutting of hard or soft tissue • Establishing a final diagnosis or treatment plan • Irreversible procedures • Using lasers that are capable of altering, cutting, burning or damaging hard or soft tissue The following functions are not permitted for Dental Assistants: 6. Placing nonsurgical retraction materials for gingival displacement 40. Placing sealants 47. Fabricating provisional restorations • Using electronic instruments for caries detection • Adjusting dentures or partials • Intraoral use of rotary hand instruments or ultrasonic instruments

Requirements

• • •

• • • • •

Injecting medication, other than as permitted for dental assistants qualified in injection of medications (see page 160 for requirements) Administering nitrous oxide analgesia, other than as permitted for Registered Dental Assistants holding a permit to perform this function (see page 160 for requirements) Monitoring patients under general anesthesia, deep sedation, or moderate sedation other than for Registered Dental Assistants holding a permit to perform this function (see page 159 for requirements) Any procedure that falls outside of the relevant education, training, and experience of the registered dental assistant Other procedures prohibited by the board Any duty or procedure that falls outside of the relevant education, training, and experience of the dental assistant Any procedure that cannot be performed by a registered dental assistant Other duties or procedures prohibited by the board

Dental Assistant

Education, Training and Credential Requirements A dental assistant in South Dakota may perform basic supportive dental procedures under the direct or indirect supervision of a licensed dentist or under the personal supervision of a licensed dental hygienist. There are no training requirements for this level of dental assisting.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct or Indirect Supervision By the Dentist OR Personal Supervision of a Licensed Dental Hygienist** • Perform duties or procedures incidental to patient care, including intraoral services or assisting in the performance of clinical or clinical-related duties If the supervising dentist is not present in the dental clinic, but has prior knowledge of and has authorized the performance (subject to the supervising dentist exercising full responsibility) 25. Duties or procedures that involve infection control 37. Taking vital signs and updating health history 44. Making impressions or obtaining digital records for casts and appliances • Creating or delivering vacuum-formed orthodontic retainers • Taking photographs extraorally or intraorally • Removing loose bands, clasps, or brackets on orthodontic appliances or retainers

• • • • •

Cutting long or broken wires Removing and replacing existing ligature ties and arch wires on orthodontic appliances Removing existing and replacing lost or missing elastic orthodontic separators Recementing existing provisional restorations Manipulating dental software for designing restorations

*Direct supervision: A dentist diagnoses the condition to be treated, authorizes the procedure to be performed, remains in the dental clinic while the procedure is performed, and before dismissal of the patient, approves the work performed by the dental hygienist or registered dental assistant. Indirect supervision: A dentist authorizes the procedures and is in the dental clinic while the procedures are performed by the registered dental assistant. Personal supervision: A dentist or dental hygienist is personally treating a patient and authorizes the dental assistant to aid the treatment by concurrently performing a supportive procedure.

157

SOUTH DAKOTA

Registered Dental Assistant

State-approved 5/9/2022

Education, Training and Credential Requirements

Requirements

To perform expanded functions under the direct supervision of a licensed dentist in South Dakota, a dental assistant must be registered as a Registered Dental Assistant. To qualify, one must: I. Be at least 18 years of age AND II. Hold a current American Heart Association Healthcare Provider, American Red Cross Professional Rescuer or board-approved equivalent CPR certification AND III. a. Graduate from a CODA-accredited dental assisting program, OR b. Hold current national DANB Certified Dental Assistant (CDA) certification, OR c. Complete a dental assisting education approved program approved by the South Dakota State Board of Dentistry (SDSBD) resulting in a registered dental assistant certificate of competency AND IV. If applicant holds or has held registration to perform expanded functions in other states, submit a certified letter verifying registration number and status from the board of dentistry in each state where the applicant has been registered AND V. Apply to the SDSBD for registration as a Registered Dental Assistant, pay a fee, and submit required proof of meeting the above requirements 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.

Allowable

Allowable Functions Under Direct Supervision* • Perform expanded functions (list not available; see list of prohibited functions on page 2 for functions that may not be performed) • All duties designated to Dental Assistants, under the same level of supervision required to perform those tasks

158

SOUTH DAKOTA

(ANALGESIA, SEDATION AND ANESTHESIA) State-approved 5/9/2022

Requirements

Education, Training and Credential Requirements

Allowable

Registered Dental Assistant or Dental Assistant with training in starting intravenous lines

Allowable Functions

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.

Under Direct Supervision* • Start an intravenous line

Registered Dental Assistant or Dental Assistant with a permit to monitor patients under general anesthesia, deep sedation or moderate sedation

Allowable

Requirements

Education, Training and Credential Requirements 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: I. 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 II. a. Have completed a SDSBD-approved educational course in anesthetic assisting of at least eight hours within 13 months of application, OR b. Have complete a SDSBD-approved educational course in anesthetic assisting (min. 8 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 2 years preceding application and provide written documentation from an employing/supervising dentist attesting to clinical proficiency

Allowable Functions Under Direct Supervision* of a dentist who holds a permit to administer general anesthesia and deep sedation or moderate sedation* • Monitor patients under general anesthesia, deep sedation, or moderate sedation

159

SOUTH DAKOTA

(ANALGESIA, SEDATION AND ANESTHESIA) State-approved 5/9/2022

Registered Dental Assistant or Dental Assistant qualified in injection of medication

Requirements

Education, Training and Credential Requirements 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: I. The assistant holds a permit to monitor patients under general anesthesia, deep sedation or moderate sedation AND II. The assistant has passed the Dental Anesthesia Assistant National Certification Examination (DAANCE) administered by the American Association of Oral and Maxillofacial Surgeons (AAOMS) and is currently DAANCE-certified AND III. The supervising dentist holds a permit to administer general anesthesia and deep sedation or moderate sedation

Allowable Functions Allowable

Under Personal* and Direct Visual Supervision • Inject medication through an intravenous site** **Note: In addition to the training and credentialing requirements above, the following requirements must be met: (1) The supervising dentist draws up the medications that will be utilized during the procedure (2) The 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 (3) 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.

Registered Dental Assistant with a permit to administer nitrous oxide sedation and analgesia

Allowable

Requirements

Education, Training and Credential Requirements A Registered Dental Assistant may apply for a permit to administer nitrous oxide sedation and analgesia under the direct supervision of a dentist. To qualify, a Registered Dental Assistant must: I. 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 II. a. Have completed a SDSBD-approved educational course meeting specified requirements within 13 months of application, OR b. Have completed a SDSBD-approved educational course more than 13 months prior to application and have legally administered nitrous oxide sedation and analgesia for a period of time during the 3 years preceding application and provide written documentation from an employing/supervising dentist attesting to clinical proficiency

Allowable Functions Under Direct Supervision* • Administer nitrous oxide sedation and analgesia

160

TENNESSEE: OVERVIEW State-approved 4/6/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Tennessee. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Registered Dental Assistant (RDA) qualified to perform expanded functions

Registered Dental Assistant (RDA)

Practical Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a licensed dentist in Tennessee, a dental assistant must hold a certificate in dental radiology from the Tennessee Board of Dentistry. To qualify, one must: I. Be a Registered Dental Assistant (see requirements on the pages that follow) AND II. a. Successfully complete a Tennessee Board-approved radiology certification course (to qualify, one must be a current Tennessee RDA) OR b. Successfully complete a comparable training program in dental radiology in another state OR c. Be enrolled in a CODA-accredited or Board-approved dental assisting program that offers a dental radiology course as part of its curriculum OR d. Hold current DANB Certified Dental Assistant (CDA) certification OR e. Pass the Radiation Health and Safety (RHS) component of the DANB CDA exam AND III. Apply to the Tennessee Board of Dentistry for state certification in dental radiology

Functions NOT Permitted by Dental Assistants in Tennessee The following functions are not permitted by any level of dental assistant: • •

Prohibited Duties

• • • • • • • • • • • • • • • • • • • •

Examination, diagnosis and treatment planning Surgical or cutting procedures on hard or soft tissue, including laser, air abrasion or micro-abrasion procedures, including curettage or root planing Fitting, adjusting and placement of prosthodontic appliances Issuance of prescription medications, medications not authorized by Tennessee law or Board of Dentistry rules, or work authorizations Performance of direct pulp capping, pulpotomy and other endodontic procedures not authorized by Tennessee law or Board of Dentistry rules Approve the final occlusion Placement of sutures Administration of local anesthesia, nitrous oxide, conscious sedation, or general anesthesia Use of a high-speed handpiece intraorally Utilization of laser equipment and technology Diagnosing of the need for restorations Preparation/cutting of the tooth or soft tissue Modifying existing structure Removal of caries, bases and liners Diagnosing need for any prosthetic appliance Establishing vertical dimension of occlusion and interocclusal records Delivering and/or adjusting appliance Expose radiographs without state certification (as indicated above) Expanded restorative or prosthetic functions without certification (as indicated on the pages that follow) Perform coronal polishing without state certification (as indicated on the pages that follow) Apply sealants without state certification (as indicated on the pages that follow) Monitoring nitrous oxide without state certification (as indicated on the pages that follow)

161

Requirements

TENNESSEE State-approved 4/6/2022

Practical Dental Assistant

Education, Training and Credential Requirements 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 program accredited by the Commission on Dental Accreditation (CODA).

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 2, 37. The taking and recording of a patient’s blood pressure, 44, 46. The taking of alginate impressions or any purpose other pulse, temperature, and medical history, and charting of oral than permanent restorations conditions 45. The placement and removal of matrices for restoration 3. Calling in prescriptions to the pharmacist as instructed by the 48. Irrigating extraction site employer/dentist 49. Performing pulp testing 6. Packing and removing retraction cord, with or without vasoac50, 55. The fabrication, placement and removal of temporary tive chemicals, for restorative dental procedures restorations 12. The placement of amalgam in prepared cavities for condensa52. The processing of radiographs, including digital, of the mouth, tion by the dentist gums, jaws, teeth or any portion thereof for dental diagnosis 13. The removal of sutures and staples 56. The application of topical anesthetics 14. Drying canals with absorbent paper points 61. Removal of cement excess from supragingival surface of teeth 15. Bending, selecting and pre-sizing arch wires and placing arch by hand instruments only wires after final adjustment and approval by the dentist 61. The removal of cement from restorations and bands 15. Placement of chain elastics on brackets 63, 69. The placement and removal of socket dressings 15. Placement of exposure chains and attachments • The taking of dental plaque smears 18. The application of topical fluorides • The removal of ligature and arch wires 24. The instruction of patients in dietary principles • Wound care as directed 24. Demonstration of oral hygiene procedures and oral health care • Placement of springs on wires regimen • Placement of hooks on brackets 25. The maintenance of instrument and operatory infection control • Ligation of arch wires to brackets 27. The placement and removal of rubber dam • The taking of oral cytologic smears 29. The selection, prefitting, cementation, curing and removing of • Removal of loose or broken bands or brackets orthodontic bands or brackets • The application of desensitizing agents 34. Placement of cavity bases and liners • Application of tooth conditioners for bonding 35, 62. The placement and removal of periodontal dressings • Packing of pulpotomy paste 41. The preparation of instrument trays • Fitting, adjusting and cementation of correctional appliances 42. Placement and removal of pre-treatment separators • Other duties specifically approved by the Board at a regularly 43. Selecting and pre-fitting of stainless steel crowns or other prescheduled meeting of the Board formed crowns for insertion by the dentist

* 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

162

Allowable

Requirements

TENNESSEE State-approved 4/6/2022

Registered Dental Assistant (RDA)

Education, Training and Credential Requirements Registered Dental Assistants in Tennessee may perform the procedures listed for this level below. To register as an RDA, one must: I. Be at least 18 years old AND II. Have a high school diploma or GED certificate AND III. Successfully complete BLS for Healthcare Providers, CPR/AED for Professional Rescuers, or equivalent course AND IV. Successfully complete the Tennessee Board of Dentistry Ethics and Jurisprudence exam AND V. Apply for registration to the Tennessee Board of Dentistry

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Unsupervised • Those functions that may be delegated to a practical dental • Participate in educational functions involving organized groups assistant under direct supervision (see previous page) or healthcare institutions regarding preventive oral health care

Registered Dental Assistant (RDA) qualified to perform expanded functions

Education, Training and Credential Requirements To perform expanded functions in Tennessee, Registered Dental Assistants (RDAs) must earn state certification by completing the requirements for each of the desired expanded functions listed below:

Requirements

Perform coronal polishing procedures: I. Successfully complete a Board-approved coronal polishing course, including both a written and a clinical exam (to qualify, an individual must be an RDA in Tennessee) OR complete a CODA-accredited dental assisting program that included coronal polishing in the curriculum AND II. Receive a certificate in coronal polishing from the Tennessee Board of Dentistry Apply sealants: I. Successfully complete a Board-approved course in sealant application (to qualify, one must be a current RDA) OR be enrolled in a CODA-accredited or TN Board-approved program which offers such a course AND II. Receive a certificate in sealant application from the Board Monitor nitrous oxide: I. Successfully complete a Board-approved nitrous oxide monitoring course (to qualify, one must be a current RDA) OR be enrolled in a CODA-accredited or TN Board-approved program which offers such a course AND II. Receive a certificate in monitoring nitrous oxide from the Board Perform restorative and/or prosthetic functions: I. Have a minimum of two years of continuous, full-time registered dental assisting employment in the three years prior to enrolling in course AND II. Complete a Board-approved certification course AND III. Receive a certificate in restorative and/or prosthetic functions from the Board 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. For details see DANB’s State Fact Booklet or contact the Tennessee Board of Dentistry.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Coronal polishing 40. Application of sealants 12, 33, 51. Restorative functions (insert, pack, carve and finish 46. Prosthetic functions (take final impressions for fixed and removamalgam and intracoronal nonmetallic restorations) able prosthetic appliances) 22. Exposure of dental radiographs (see “Radiography Require59. Monitoring nitrous oxide ments” section on previous page)

163

TEXAS: OVERVIEW

State-approved 4/12/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Texas. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Registered Dental Assistant (RDA)

Dental Assistant qualified to perform expanded functions

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Texas, one must be a Registered Dental Assistant (see requirements on the following pages). 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.

Functions NOT Permitted by Dental Assistants in Texas Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 20. The removal of calculus, deposits or accretions from the natural and restored surfaces of exposed human teeth and restorations in the human mouth 33. The placement of any final restoration 46. The taking of an impression for a final restoration, appliance or prosthesis • Root planing or the smoothing and polishing of roughened root surfaces or exposed human teeth • Comprehensive examination or diagnosis and treatment planning • Surgical or cutting procedure on hard or soft tissue • The prescription of a drug, medication or work authorization • The making of an intraoral occlusal adjustment • Direct pulp capping, pulpotomy or any other endodontic procedure • The final placement and intraoral adjustment of a fixed or removable appliance • The authority to an individual to administer a local anesthetic agent, inhalation sedative agent, parenteral sedative agent or general anesthetic agent • Diagnosis, treatment planning, prescription of therapeutic measures and reevaluation • Placement of site-specific subgingival medicaments • Any other act the delegation of which is prohibited by board rule

164

Requirements

TEXAS

State-approved 4/12/2022

Dental Assistant

Education, Training and Credential Requirements A dental assistant in Texas may perform basic supportive dental procedures specified by the state dental practice act under the direct supervision of a licensed dentist (see below). There are no education or training requirements for this level of dental assisting.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* DANB’s Note on Allowable Dental Assisting Functions • The provision of interim treatment of a minor emergency dental In the state of Texas, all dental assistants may: condition to an existing patient of the treating dentist; the • Perform infection control and occupational safety procedures treating dentist must delegate the procedure orally or in writing • Perform other duties not specified by this state’s dental practice before the dental assistant performs the procedure, must retain act responsibility for the procedure, and must schedule a follow-up appointment with the patient within 30 days At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts Under Direct Supervision* outline very specific allowable functions, while others outline only 18. Apply fluoride varnish prohibited functions and some contain minimal or no regulation of • Reversible acts and procedures dental assisting duties.

Dental Assistant qualified to perform expanded functions

Education, Training and Credential Requirements

Requirements

To qualify to perform selected expanded functions under the direct supervision of a licensed dentist in Texas, a dental assistant must complete the following: Perform pit and fissure sealant procedures: I. Work at least 2 years as a dental assistant AND II. Complete a current course in Basic Life Support AND III. 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 Texas State Board of Dental Examiners

Perform coronal polishing procedures: I. Work at least 2 years as a dental assistant AND II. a. Complete a minimum of 8 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 Texas State Board of Dental Examiners OR b. Earn DANB’s Coronal Polishing (CP) certificate of knowledge-based competence OR c. Graduate from a CODA-accredited dental assisting program approved by the Texas State Board of Dental Examiners that includes clinical and didactic education in coronal polishing

Note: Effective September 1, 2017, the pit and fissure sealants certificate and coronal polishing certificate, formerly required for dental assistants to qualify to perform these functions in Texas, have been discontinued. Effective March 18, 2018, the Texas Board has passed new requirements for dental assistants to be eligible to perform these functions.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Coronal polishing (see requirements above) 40. Apply pit and fissure sealants, to include the use of 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 (see requirements above)

*Direct Supervision: The dentist who employs the dental assistant or is in charge of the dental assistant must be physically present in the dental office when the dental assistant performs a delegated dental act. General Supervision: The dentist who employs or is in charge of the dental assistant 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.

165

TX 3

TEXAS

State-approved 4/12/2022

Registered Dental Assistant

Requirements

Education, Training and Credential Requirements To earn status as a Registered Dental Assistant (RDA) in Texas, one must: I. Graduate from an accredited high school or hold a GED AND II. Complete a current hands-on course in Basic Life Support AND III. a. Complete a mandatory course of training specified by the Texas State Board of Dental Examiners that includes procedures for positioning and exposing dental x-rays, jurisprudence and infection control OR b. Earn the national DANB CDA certification and successfully complete the Texas State Board of Dental Examiners jurisprudence assessment AND IV. Complete a course in human trafficking prevention approved by the executive commissioner of the Texas Health and Human Services Commission AND V. Apply to the Texas State Board of Dental Examiners for registration AND VI. Submit fingerprints for the retrieval of criminal history record information To qualify to monitor the administration of nitrous oxide, an RDA must: I. Complete 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 Texas State Board of Dental Examiners AND II. Complete a current course in Basic Life Support AND III. Apply to the Texas State Board of Dental Examiners for a nitrous oxide monitoring certificate

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under General Supervision* 22. Expose radiographs (see RDA requirements above) Under Direct Supervision* 59. Monitor nitrous oxide (see requirements above)

166

UTAH: OVERVIEW State-approved 5/2/2022

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Utah. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in the state of Utah, a dental assistant must: I. Complete a dental assisting course from a CODA-accredited program OR II. Pass the national DANB Radiation Health and Safety (RHS) exam OR III. Complete a radiology course and exam approved by the Utah Dentist and Dental Hygienist Licensing Board that meet the criteria established by rule of the Board

Functions NOT Permitted by Dental Assistants in Utah Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 12, 47, 50, 51. Place, condense,carve, finish or polish restorative materials, or perform final cementation • Render definitive treatment diagnosis • Cut hard or soft tissue or extract teeth • Provide injections of any substance • Remove stains, deposits or accretions (except as is incidental to polishing teeth coronally with a rubber cup) • 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 after a baseline percentage and flow rate suitable for the patient is established and documented by a licensed dentist holding the appropriate permit) • 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) • Take jaw registrations or oral impressions for supplying artificial teeth as substitutes for natural teeth, including electronic imaging (except for diagnostic or opposing models for the fabrication of temporary or provisional restorations or appliances) • 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 • Perform sub-gingival instrumentation • Render decisions concerning the use of drugs, their dosage, or prescription

167

Requirements

UTAH

State-approved 5/2/2022

Dental Assistant

Education, Training and Credential Requirements A dental assistant in the state of Utah may perform basic supportive dental procedures under the supervision of a licensed dentist. All dental assistants must have current Cardiopulmonary Resuscitation (CPR) or Basic Cardiac Life Support (BCLS) certification.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under Supervision* 59. Initially introduce nitrous oxide and oxygen to a patient for the 9. Polish teeth coronally with a rubber cup purpose of establishing and recording a safe plane of analgesia 44. Take impressions for diagnostic or opposing models for the for the patient fabrication of temporary or provisional restorations or appliances • Supervised** acts and duties as defined by division rule made in collaboration with the Utah Dentist and Dental Hygienist Licensing Board **Level of supervision not defined DANB’s Note on Allowable Dental Assisting Functions In Utah, all dental assistants may: • Perform infection control and occupational safety procedures • Perform other duties not specified by this state’s dental practice act At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

*Direct supervision: 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.

168

VERMONT: OVERVIEW

State-approved 3/17/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are three recognized levels of dental assistants in Vermont. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations. 3

Expanded Function Dental Assistant

DANB Certified Dental Assistant (CDA) with state certification

Traditional Dental Assistant

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 on following pages). Traditional Dental Assistants can earn a special endorsement to perform dental radiographic procedures by completing the following requirements: I. a. Be at least 18 years of age, AND b. Successfully complete a CODA-accredited radiology course within 10 years of application for endorsement AND c. Work for at least six months as a dental assistant OR II. Hold a radiography endorsement equivalent to that required in Vermont AND ALL MUST THEN III. Apply to the Vermont Board of Dental Examiners for endorsement

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Vermont The following functions are not permitted by any level of dental assistant: • • • • • •

Diagnosis, treatment planning and prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic, or orthodontic appliances Surgical procedures on hard and soft tissues within the oral cavity or any other intraoral procedure that contributes to or results in an irremediable alteration of the oral anatomy Oral prophylaxis Oral debridement Periodontal descriptions and charting, including periodontal probing Placement of subgingival chemotherapeutic agents

169

Requirements

VERMONT State-approved 3/17/2022

Traditional Dental Assistant

Education, Training and Credential Requirements 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 registering with the Vermont Board of Dental Examiners within 30 days of being hired. All dental assistants shall complete emergency office procedures training within six months of their date of hire.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 9. Perform coronal polishing** DANB’s Note on Allowable Dental Assisting Functions 22. Take radiographs under a special endorsement (see “RadiogIn the state of Vermont, all dental assistants may: raphy Requirements” on previous page) 40. Apply dental sealants** • Perform infection control and occupational safety procedures • Perform extraoral duties assigned by the dentist • Perform other duties not specified by this state’s dental prac• Assist the dentist or clinical staff in intraoral procedures as tice act assigned by the dentist At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts **To perform this function, a traditional dental assistant must be outline very specific allowable functions, while others outline only a graduate of a CODA-accredited dental assisting program or prohibited functions and some contain minimal or no regulation of must have worked as a traditional dental assistant for at least six dental assisting duties. consecutive months. Note: A dental therapist may supervise dental assistants directly to the extent permitted in the collaborative agreement between the dental therapist and the dentist; a dental therapist may have under his or her direct supervision no more than a total of two auxiliaries (any combination of assistants and hygienists) in any one practice setting.

DANB Certified Dental Assistant (CDA) with state certification

Requirements

Education, Training and Credential Requirements Dental assistants who hold the national DANB Certified Dental Assistant (CDA) certification can also earn Vermont state certification. To qualify, one must: I. Hold a current national DANB Certified Dental Assistant (CDA) certification AND II. Be employed by a Vermont licensed dentist AND III. Apply to the Vermont Board of Dental Examiners for registration All dental assistants shall complete emergency office procedures training within six months of their date of hire.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 59. Monitor nitrous oxide analgesia • All duties for which the assistant has received formal training in a CODA-accredited dental assisting program and for which the assistant has been DANB certified

*Direct Supervision: A licensed dentist agrees to the procedure or treatment and is readily available at the dental facility for consultation or intervention.

170

VT 3

VERMONT State-approved 3/17/2022

Expanded Function Dental Assistant

Education, Training and Credential Requirements

Requirements

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: I. a. Be a current DANB Certified Dental Assistant (CDA) certificant with Vermont state certification AND b. Be employed by a Vermont licensed dentist OR II. Be a licensed dental hygienist AND III. Successfully complete a formal program in each of the desired expanded functions at a CODA-accredited program of dental assisting AND IV. Apply to the Vermont Board of Dental Examiners for registration

Allowable

All dental assistants shall complete emergency office procedures training within six months of their date of hire.

Allowable Functions Under Direct Supervision* • Any expanded duty for which the Expanded Function Dental Assistant has been trained, within the limits of Vermont rules

*Direct Supervision: A licensed dentist agrees to the procedure or treatment and is readily available at the dental facility for consultation or intervention.

171

VIRGINIA: OVERVIEW

State-approved 4/28/2022

State Job Titles

Other Specialized Dental Assistant Categories

Radiography Requirements

There are three recognized levels of dental assistants in Virginia. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Other Levels

State Career Ladder

Dental Assistant II (DA II)

Dental Assistant I (DA I)

Digital Scan Technician

See page 176

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Virginia, a dental assistant must: I. Satisfactorily complete a radiation safety course and exam in radiology given by an institution that maintains a CODA-accredited dental assisting, dental hygiene, or dentistry program OR II. Earn certification from the American Registry of Radiologic Technologists OR III. 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.)

Functions NOT Permitted by Dental Assistants in Virginia Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited Duties

The following functions are not permitted by any level of dental assistant: 1, 2. Performing an initial/clinical 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 or for further evaluation by the dentist 20. 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 33, 51. Condensing, contouring or adjusting any final, fixed or removable prosthodontic appliance or restoration in the mouth, with the exception of placing, packing and carving amalgam and composite resins by DA IIs with advanced training 59. Administer nitrous oxide; turn nitrous oxide machines on or off • Final diagnosis and treatment planning • Performing surgical or cutting procedures on hard or soft tissue • Prescribing or parenterally administering drugs or medicaments • Authorization of work orders for any appliance or prosthetic device or restoration to be inserted into a patient’s mouth • Operation of high speed rotary instruments in the mouth • Administering nitrous oxide or oxygen inhalation analgesia • Final positioning and attachment of orthodontic bonds and bands • Final adjustment and fitting of crowns and bridges in preparation for final cementation • Polishing of natural and restored teeth using air polishers • Subgingival irrigation or subgingival application of topical Schedule VI medicinal agents • Administering and monitoring moderate sedation, deep sedation, or general anesthetics, except monitoring in accordance with anesthesia and sedation rules (see requirements on the pages that follow and 18VAC60-21-260 for more information) • Non-delegable duties of a dentist and duties only delegable to a dental hygienist

172

VA 1

VIRGINIA

State-approved 4/28/2022

Dental Assistant I (DA I)

Education, Training and Credential Requirements

Requirements

A dental assistant I (DA I) in Virginia may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direction and supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting. To qualify to assist in the administration of or monitor inhalation analgesia, minimal sedation, moderate sedation, deep sedation or general anesthesia, a DA I or DA II must meet one of the following requirements: I. 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 II. Current certification as a certified anesthesia assistant by the American Association of Oral and Maxillofacial Surgeons or the American Dental Society of Anesthesiology

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Indirect Supervision of a Dentist* 1. Perform mouth mirror inspection of the oral cavity 2. Chart existing restorations and conditions as instructed by the dentist 4. Prepare patients for treatment/seating/positioning chair/placing napkin 5. Prep lab forms for signature by the dentist 7. Maintenance of dental equipment 8, 63, 69. Place and remove post-extraction dressings/monitor bleeding 9. Polish coronal portion of teeth with rotary hand piece and rubber prophy cup or brush 11. Transfer dental instruments 12. Amalgam: Place only 13. Remove sutures 14. Dry canals with paper points 18. Apply fluoride varnish, gels, foams and agents 19. Select and manipulate gypsums and waxes 21. Mix dental materials 22. Place x-ray film and expose radiographs (see Radiography Requirements) 24. Preventive education and oral hygiene instruction 24. Address risks of tobacco use 24. Give oral hygiene instruction 24. General oral health education 25. Sterilization and disinfection procedures 26. Provide pre- and post-operative instructions 27. Place and remove dental dam 27. Rubber dams: Place and remove 28. Make impressions and pour and trim study/diagnostic models and opposing models 29. Select and fit bands and brackets for cementation by dentist

32, 36, 57. Compliance with OSHA Regulations and Centers for Disease Control Guidelines 34. Apply and cure primer and bonding agents 35, 62. Place and remove periodontal dressings 37. Take blood pressure, oxygen saturation, pulse and temperature 37. Recording a patient’s pulse, blood pressure, temperature, presenting complaint, and medical history 37, 38. Take, record and monitor vital signs 39. Clean and polish removable appliances and prostheses 40. Apply pit and fissure sealants 41. Prepare procedural trays/ armamentaria set-ups 42. Place and remove elastic separators 44. Take impressions and make study models for orthodontic treatment and retainers 45. Matrices - place and remove 47, 54. Fabricate, cement and remove temporary crowns/restorations 48. Maintain field of operation through use of retraction, suction, irrigation, drying 53. Mount and label images 56. Apply Schedule VI topical oral anesthetic 59. Monitor patient under nitrous oxide (see Anesthesia Requirements) 60. Maintain emergency kit 61. Remove excess cement from coronal surfaces of teeth, using a non-cutting instrument 64. Make impressions for athletic/night/ occlusal/snore mouthguards and fluoride/bleaching trays 64. Take impressions and fabricate bleaching trays

Allowable functions for this level continued on next page

*Direct Supervision: The dentist examines the patient and records diagnostic findings prior to delegating restorative or prosthetic treatment and related services to DA 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 DA 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: 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 a certified registered nurse anesthetist or the level of supervision 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: A dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment which 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. Indirect Supervision: 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, a dental assistant, or a certified registered nurse anesthetist who is delivering hygiene treatment, or who is preparing the patient for examination or treatment by the dentist, or who is preparing the patient for dismissal following treatment or administering topical local anesthetic, sedation, or anesthesia as authorized by law or regulation.

173

VIRGINIA

State-approved 4/28/2022

Allowable

Allowable Functions (for Dental Assistant I), continued Under Indirect Supervision of a Dentist* • Perform health assessment • Conducting preliminary dental screenings in free clinics, public health programs, or a voluntary practice • Use intraoral camera or scanner to take images for tooth preparation and CAD CAM restorations • Acid Etch - Apply/wash/dry remove only when reversible • Amalgam: Polish only with slow-speed handpiece and prophy cup • Measure instrument length • Apply dentin desensitizing solutions • Check for loose bands and brackets • Remove arch wires and ligature ties • Place ligatures to tie in archwire • Instruct patients in placement and removal of retainers and appliances after dentist has fitted and made adjustments in the mouth • Apply bleach/whitener • Bleach with light but not laser • Instruct patient on bleaching procedures • Take bite and occlusal registrations • Monitor patient under minimal sedation/anxiolysis (see requirements for administration and monitoring of sedation on the previous page) • Monitor patient under moderate sedation (see requirements for administration and monitoring of sedation on the previous page) • Monitor patient under deep sedation/general anesthesia (see requirements for administration and monitoring of sedation on the previous page) • Duties appropriate to the training and experience of the dental assistant and the practice of the supervising dentist

Under Indirect Supervision of a Dental Hygienist† 4. Prepare patients for treatment/seating/ positioning chair/placing napkin 7. Maintenance of dental equipment 9. Polish coronal portion of teeth with rotary hand piece and rubber prophy cup or brush 11. Transfer dental instruments 22. Place x-ray film and expose radiographs (see Radiography Requirements) 24. Preventive education and oral hygiene instruction 25. Sterilization and disinfection procedures 32, 36, 57. Compliance with OSHA Regulations and Centers for Disease Control Guidelines 35, 62. Place and remove periodontal dressings 39. Clean and polish removable appliances and prostheses 41. Prepare procedural trays/armamentaria set-ups 53. Mount and label images 60. Maintain emergency kit • Perform health assessment † Duties delegated to a dental assistant under general supervision shall be 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.

174

VA 2

VIRGINIA

State-approved 4/28/2022

Dental Assistant II (DA II)

Education, Training and Credential Requirements To perform expanded functions in Virginia under the direct supervision of a licensed dentist, one must be registered as Dental Assistant II (DA II). To qualify for registration as a DA II by education, one must:

Requirements

I. Hold current DANB Certified Dental Assistant (CDA) certification or active licensure as a dental hygienist. AND II. Successfully complete board-approved expanded functions requirements from a CODA-accredited program. AND III. Apply to the Virginia Board of Dentistry for registration To qualify for registration as a DA II by endorsement, one must: I. Hold current DANB CDA certification AND II. Be currently authorized to perform expanded duties in a jurisdiction of the United States AND III. Hold a credential, registration, or certificate 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 IV. Be certified to be in good standing in each U.S. jurisdiction where currently or formerly credentialed AND V. Not have committed any prohibited act AND VI. 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.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Use of a non-epinephrine retraction cord 33. Placing and shaping composite resin restorations only with slow-speed handpiece 46. Taking final impressions 51. Packing and carving amalgam restorations • Performing pulp capping procedures • Final cementation of crowns and bridges after adjustment and fitting by the dentist

Under Indirect Supervision of a Dentist* DA II’s can perform all duties a DA I is allowed to perform under the Indirect Supervision of a dentist. Under Indirect Supervision of a Dental Hygienist* DA II’s can perform all duties a DA I is allowed to perform under the Indirect Supervision of a dental hygienist.

175

VIRGINIA (DIGITAL SCAN TECHNICIAN) State-approved 4/28/2022

Digital Scan Technician

Allowable

Requirements

Education, Training and Credential Requirements Digital Scan Technician is a designation for an individual who performs digital scans outside of a dental office, in a teledentistry setting. A digital scan technician does not work in a dental office To qualify to perform digital scans of intraoral and extraoral hard and soft tissues for use in teledentistry, a Digital Scan Technician must complete a training program approved by the Virginia Board of Dentistry. Note: In March 2020, the Virginia legislature passed a law related to teledentistry authorizing performance of digital scanning by Digital Scan Technicians. The Virginia Board of Dentistry is in the process of developing rules to implement this law.

176

WASHINGTON: OVERVIEW State-approved 5/10/2022

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Washington. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Function Dental Auxiliary (EFDA)

Other Levels

1 Registered Dental Assistant (RDA)

Dental Anesthesia Assistant

See page 181

State Radiography Requirements

All dental assistants (registered dental assistants or EFDAs) operating x-ray equipment in the state of Washington shall be adequately instructed in safe operating procedures and shall be able to demonstrate competency, upon request from the Washington State Dental Quality Assurance Commission, in the correct use of the equipment. The following are areas in which the department considers it important that an individual have expertise for the competent operation of x-ray equipment: (1) Familiarization with equipment (a) Identification of controls (b) Function of each control (c) The use of a technique chart (2) Radiation protection (a) Collimation (b) Filtration (c) Gonad shielding and other patient protection devices (d) Restriction of X-ray tube radiation to the image receptor (e) Personnel protection (f) Grids (3) Film processing (a) Film speed as relates to patient exposure (b) Film processing parameters (c) Quality assurance and quality control A registered dental assistant requires close supervision and an EFDA requires general supervision by a licensed dentist to perform dental radiography procedures.

177

WASHINGTON State-approved 5/10/2022

Functions NOT Permitted by Dental Assistants in Washington Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information.

Prohibited

The following functions are not permitted by any level of dental assistant: 20. Scaling procedures 70. Cement or recement any permanent restoration or stainless steel crown • Removal of or addition to the hard or soft natural tissue of the oral cavity (except for placing and carving direct restorations by an EFDA) • Diagnosis of or prescription for treatment of disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure • Administration of general or local anesthetic, including intravenous sedation • Oral prophylaxis [except coronal polishing as part of oral prophylaxis as defined in WAC 246-817- 510 and 246-817-520(4)(e)] • Intraorally adjust and finish permanent restorations • Incise gingiva or other soft tissue • Elevate soft tissue flap • Luxate teeth • Curette to sever epithelial attachment • Suture • Establish occlusal vertical dimension for dentures • Try-in of dentures set in wax • Insertion and post-insertion adjustments of dentures • Endodontic treatment (open, extirpate pulp, ream and file canals, establish length of tooth, fill root canal) • Use of any light or electronic device for invasive procedures • Intraoral air abrasion or mechanical etching devices • Place direct pulp caps. • Fit and adjust occlusal guards In addition to the functions listed above, the following functions are not permitted by a registered dental assistant: 12, 33. Placing of permanent or semi-permanent restorations in natural teeth 46. Taking of any impressions of the teeth or jaws for the purpose of fabricating any intraoral restoration, appliances, or prosthesis, other than impressions allowed as a delegated task for registered dental assistants pursuant to rules adopted by DQAC (see Allowable Functions on the next page)

178

WA 1

WASHINGTON State-approved 5/10/2022

Registered Dental Assistant (RDA)

Education, Training and Credential Requirements

Requirements

Every dental assistant in the state of Washington must be registered. To be eligible for registration as a dental assistant, one must: I. Provide a completed application on forms provided by the Washington State Dental Quality Assurance Commission (DQAC) AND II. Pay applicable fees AND III. Provide any other information determined by the DQAC The dental assistant registration must be renewed annually on or before the dental assistant’s birthday. A registered dental assistant must hold a current and valid health care provider basic life support (BLS) certification. An RDA must complete one hour of current infection prevention standards education annually provided by a qualified individual or organization. A registered 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. To earn the endorsement, a dental assistant must provide proof of 200 hours of employment by a WA licensed dentist, which included theoretical and clinical training in sealants and fluoride varnish, and provide proof of completion of a training program meeting WA state requirements, and submit an application and fee. A volunteer dental assistant is an individual who, without compensation, provides supportive services in a charitable dental clinic. For information about requirements visit www.doh.wa.gov. Note: Dental assistants who monitor 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.

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Supervision • Administer screening tests for novel coronavirus disease 2019 (provided the RDA has demonstrated skills necessary to perform the task competently)

Allowable

Under General Supervision*, with endorsement in sealant/fluoride varnish 40. Apply sealant/fluoride varnish solely for the purpose of treating children in school-based and school-linked programs Under Close Supervision* 1. Oral inspection, with no diagnosis 6. Place retraction cord 9. Perform coronal polish (a licensed dentist shall determine the teeth are free of calculus or other extraneous material prior to dismissing the patient) 13, 62. Remove periodontal packs or sutures 15. Remove and replace archwires and orthodontic wires 18. Give fluoride treatments 22. Place, expose, and process radiographs 24. Give patient education in oral hygiene 25. Sterilize equipment and disinfect operatories 26. Give preoperative and postoperative instructions 27. Place and remove the rubber dam 29. Select and fit orthodontic bands, try in fixed or removable orthodontic appliances prior to the dentist cementing or checking the appliance 34. Place cavity liners and bases 35. Place periodontal packs 37. Take and record blood pressure and vital signs 40. Apply sealants 42. Place and remove orthodontic separators

44. 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 45. Place a matrix and wedge for a direct restorative material after the dentist has prepared the cavity 47, 54. Fabricate, cement, and remove temporary crowns or temporary bridges 50. Place a temporary filling (as zinc oxide-eugenol (ZOE)) after diagnosis and examination by the dentist 54, 61. Remove the excess cement after the dentist has placed a permanent or temporary inlay, crown, bridge or appliance, or around orthodontic bands 56. Place topical anesthetics 59. Assist in the administration of inhalation minimal sedation (nitrous oxide) analgesia or sedation, including starting and stopping the flow as directed by the supervising dentist 63. Pack and medicate extraction areas 64. Fabricate and deliver bleaching and fluoride trays. Allowable functions for this level continued on next page

*Close Supervision: 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 dentist to be physically present in the operatory. General Supervision: 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.

179

WASHINGTON State-approved 5/10/2022

Allowable

Allowable Functions (for Registered Dental Assistant), continued Under Close Supervision* • Hold in place and remove impression materials after the dentist has placed them • Apply tooth separators as for placement for Class III gold foil • Deliver an oral sedative drug to patient • Polish restorations but may not intraorally adjust or finish permanent restorations • Select denture shade and mold • Perform acid etch and apply bonding agents • Take intraoral and extraoral photographs • Take health histories • Prepare teeth for the bonding of orthodontic appliances • Fit and adjust headgear

• • • • •

Remove fixed orthodontic appliances, orthodontic cement, and orthodontic bonded resin materials Take a facebow transfer for mounting study casts Bond attachments for clear removable orthodontic aligners Take digital scans of prepared teeth for fabrication of permanent indirect restorations Monitor patients receiving deep sedation or general anesthesia (see requirements above)

Note: An unlicensed person may select the shade for crowns or fixed prostheses with the use of a technique which does not contact the oral cavity (outside treatment facility, pursuant to written instructions and order of a licensed dentist)

Expanded Function Dental Auxiliary (EFDA)

Education, Training and Credential Requirements To become an Expanded Function Dental Auxiliary (EFDA) in Washington, a dental assistant must: I. a. Graduate from a CODA-accredited dental assisting program OR b. Be DANB CDA certified through CDA/GC Pathway II; in addition to DANB’s requirements, the candidate must take an additional dental assisting review course AND II. Complete an EFDA course approved by the Dental Quality Assurance Commission (DQAC) AND III. Pass the Washington State Restorative Exam (WARE)* administered by DANB AND IV. Pass the clinical exam* administered by the Western Regional Examining Board (WREB) or Central Regional Dental Testing Services (CRDTS) AND V. Provide any other information determined by DQAC AND VI. Apply to DQAC for an EFDA license. To be eligible for a license as an EFDA without examination, one must: I. a. Hold a current license in another state with substantially equivalent licensing standards as determined by DQAC OR b. Hold a Washington full dental hygiene license and complete a course in taking final impressions affiliated with or provided by a CODA accredited dental assisting program, dental hygiene school or dental school, AND II. Provide any other information determined by the state, AND III. Apply to DQAC for an EFDA license

Allowable Requirements

An EFDA must hold a current and valid health care provider basic life support (BLS) certification. An EFDA must complete one hour of current infection prevention standards education annually provided by a qualified individual or organization.

Allowable Functions

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Supervision • Administer screening tests for novel coronavirus disease 2019 (provided the EFDA has demonstrated skills necessary to perform the task competently) Under General Supervision* 9. Perform coronal polishing 18. Give fluoride treatments 22. Place, expose, and process radiographs 40. Apply sealants • Give patient oral health instructions

Under Close Supervision* 12, 33, 51. Place, carve, finish, and polish direct restorations 44, 46. Take preliminary and final impressions and bite registrations, to include computer assisted design and computer assisted manufacture applications • All other functions allowed to be performed by RDAs

180

WASHINGTON (DENTAL ANESTHESIA ASSISTANT) State-approved 5/10/2022

Dental Anesthesia Assistant Education, Training and Credential Requirements Each applicant for certification as a dental anesthesia assistant must submit to the Washington State Dental Quality Assurance Commission (DQAC): I. II.

Requirements

III.

IV.

VI.

VII.

An application, on a form provided by the department AND An application fee AND Evidence of completion of one of the following: a. The “Dental Anesthesia Assistant National Certification Examination (DAANCE)” or predecessor program, provided by the American Association of Oral and Maxillofacial Surgeons (AAOMS) OR b. The “Oral and Maxillofacial Surgery Assistants Course” course provided by the California Association of Oral and Maxillofacial Surgeons (CALAOMS) OR c. Substantially equivalent education and training approved by DQAC AND a. 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 b. Evidence of completion of substantially equivalent education and training approved by DQAC AND 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 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 Any other information determined by DQAC

A Dental Anesthesia Assistant must complete one hour of current infection prevention standards education annually provided by a qualified individual or organization. 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.

Prohibited

Allowable

Allowable Functions Under Close Supervision* • Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia • Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open

Under Direct Visual Supervision* • Draw up and prepare medications • Follow instructions to deliver medications into an intravenous line upon verbal command • Adjust the rate of intravenous fluids infusion beyond a keep open rate • Adjust an electronic device to provide medications, such as an infusion pump • Administer emergency medications to a patient in order to assist the oral and maxillofacial surgeon or dental anesthesiologist in an emergency

Functions NOT Permitted by Dental Anesthesia Assistants in Washington A certified dental anesthesia assistant may not practice or represent himself or herself as a registered dental assistant without being registered by the Washington Dental Quality Assurance Commission (DQAC) as having met the standards for registration. See requirements for registration as a dental assistant on page 179.

*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. Close Supervision: 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 dentist to be physically present in the operatory. Direct Visual Supervision: Supervision by an oral and maxillofacial surgeon or dental anesthesiologist by verbal command and under direct line of sight.

181

WEST VIRGINIA: OVERVIEW State-approved 2/28/2022

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in West Virginia. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant qualified in expanded duties

Other Levels

Other Specialized Dental Assistant Categories

State Radiography Requirements

1 Dental Assistant

State Radiography Requirements

Qualified Monitor

See page 185

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.

Functions NOT Permitted by Dental Assistants in West Virginia Prohibited

Diagnosis, treatment planning and prescription (including prescriptions for drugs and medicaments or authorizations for restorative, prosthodontic or orthodontic appliances) 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 Use a power-driven instrument of any type intra-orally except as specifically set forth in West Virginia rules (see “Allowable Functions” on the pages that follow for a list of expanded duties that may be delegated to qualified dental assistants)

182

WEST VIRGINIA State-approved 2/28/2022

Requirements

Dental Assistant

Education, Training and Credential Requirements A dental assistant in West Virginia may perform basic supportive dental procedures specified by the state dental practice act (see below) under the direct supervision of a licensed dentist. There are no education or training requirements for this level of dental assisting. Note: A chairside assistant assisting a dentist holding a permit to administer conscious/moderate sedation or general anesthesia/deep sedation must maintain BLS/CPR certification.

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 1. Viewing the oral cavity and reporting the symptoms/problems to the supervising dentist 2. Charting existing restorations and missing teeth 13. Holding and removing materials, trays, strips and sutures previously placed in the patient’s mouth by the dentist 22, 52, 53. Placing, exposing, developing and mounting dental radiographs 26. Providing pre- and post-treatment instructions 27. Placing and removing rubber dams 29. Fitting bands and brackets prior to final cementation and/or bonding by the supervising dentist 34. Applying cavity liners and bases with a final evaluation by the supervising dentist 40. Applying pit and fissure sealants with a final evaluation by the supervising dentist 44. Taking impressions for study cast and pouring models 45. Placing and removing matrices after a final evaluation by the supervising dentist 46. Taking final impressions for fixed or removable prosthesis and/ or appliance with a final evaluation by the supervising dentist 47. Fabricating and cementing temporary crowns and bridges with a final evaluation by the supervising dentist 49. Performing pulp vitality testing (thermal or electrical) with a final evaluation by the supervising dentist

50, 55. Placing and removing temporary restorations by a non power-driven method with a final evaluation by the supervising dentist 54, 61. Removing excess cement from coronal surfaces of teeth without the use of rotating, power-driven or scaling instruments 56. Applying topical anesthetic agents with prior approval by the supervising dentist 62. Removing periodontal dressings with a final evaluation by the supervising dentist • Recording medical and dental histories for interpretation by the supervising dentist • Inserting and adjusting athletic mouth guards and bleaching trays with a final evaluation by the supervising dentist • Removing soft tissue dressings with a final evaluation by the supervising dentist • Taking intra oral and extra oral photographs • Checking for loose orthodontic appliances with a final evaluation by the supervising dentist • Taking orthodontic measurements with a final evaluation by the supervising dentist • Bending archwires with a final evaluation by the supervising dentist at the time of placement • Removing loose or broken bands, brackets or archwires when directed by the supervising dentist

*Direct Supervision: 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.

183

WV 2

WEST VIRGINIA State-approved 2/28/2022

Dental Assistant qualified in expanded duties

Education, Training and Credential Requirements To qualify to perform the expanded duties listed under “Allowable Functions” below in West Virginia, a dental assistant must complete these requirements.

Requirements

For visual monitoring of nitrous oxide analgesia units: I. Complete a West Virginia Board of Dentistry-approved course and exam in monitoring nitrous oxide AND II. Be currently certified in health care provider CPR through the American Red Cross or the American Heart Association AND III. Apply to the West Virginia Board of Dentistry for a certificate For coronal polishing on children under age 21: I. Complete two years, at least 3,000 hours, of clinical experience in a dental office, as attested to by the supervising dentist AND II. Hold the expanded duties certificate issued by the West Virginia Board of Dentistry (see requirements below) AND III. Complete a West Virginia Board of Dentistry-approved coronal polishing course AND IV. Complete required clinical experiences under the observation of the supervising dentist, who attests to the dental assistant’s competent performance of the function AND V. Apply to the West Virginia Board of Dentistry for a certificate For all other expanded duties (as listed below): I. Complete a West Virginia Board of Dentistry-approved course and exam in each of the desired expanded duties AND II. Complete required clinical experiences under the observation of the supervising dentist, who attests to the dental assistant’s competent performance of the function AND III. Apply to the West Virginia Board of Dentistry for a certificate

Allowable Functions

Allowable

Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* 6. Placing retraction cords for crown impressions with prior approval of the supervising dentist 9. 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 9. Perform supragingival and coronal polishing on children under 21 years of age using a slow speed hand piece with a rubber cup 18 Applying topical anticariogenic agents, with prior approval of the supervising dentist

29, 42. 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 40. Applying pit and fissure sealants, with a final evaluation by the supervising dentist 59. Visually monitoring a nitrous oxide analgesia unit • Chemical conditioning of the tooth to accept a restoration and/ or bracket by topical application

*Direct Supervision: 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.

184

WEST VIRGINIA (QUALIFIED MONITOR) State-approved 2/28/2022

Qualified Monitor Education, Training and Credential Requirements 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:

Requirements

For relative analgesia/minimal sedation: I. Possess a current health care provider BLS/CPR certification (qualified monitor certificate is not required) For anxiolysis/minimal sedation: I. Possess a current health care provider BLS/CPR certification AND II. 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: I. Possess a current health care provider BLS/CPR certification AND II. 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 III. 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 on the previous page. A dentist holding an anesthesia permit must report the names and qualifications of each Qualified Monitor providing services to that permitholder to the West Virginia Board of Dentistry.

Allowable

Allowable Functions During Sedation Procedures • Check closely and document the status of a patient undergoing anesthesia • Observe utilized equipment

185

WISCONSIN: OVERVIEW Updated by DANB 5/25/2022†

State Radiography Requirements

State Job Titles

State Career Ladder There is one recognized level of dental assistant in Wisconsin. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Expanded Function Dental Auxiliary

Unlicensed Person

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.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Wisconsin The following functions are not permitted by any level of dental assistant: • • • • • •

Any procedure of a character which may cause damage to the patient’s teeth or oral cavity which cannot be remedied without professional intervention Any procedure of a character which may cause adverse or unintended general systemic reaction Any procedures which are intended, interpreted or represented to be preliminary assessments, dental hygiene treatment planning, oral screenings, supragingival or subgingival calculus removal Cutting of hard or soft tissue Diagnosis Treatment planning

186

WISCONSIN

Updated by DANB 5/25/2022

Requirements

Unlicensed Person

Education, Training and Credential Requirements An unlicensed person in Wisconsin may perform basic supportive dental procedures under the supervision of a licensed dentist. Any dentist who delegates any remediable dental procedure or function to an unlicensed person must first provide training to or verify competence of the person in the performance of the procedure or function. Auxiliary personnel in settings where sedation or general anesthesia are administered must be certified in Basic Life Support for the Healthcare Provider. DANB’s Note on Allowable Dental Assisting Functions

Allowable

Allowable Functions Under Supervision* • Any remediable dental procedure or function for which the unlicensed person has received training or in the performance of which the delegating dentist has verified the unlicensed person’s competency

In Wisconsin, all dental assistants may: • • •

Expose, process and evaluate dental radiographs Perform infection control and occupational safety procedures Perform other duties not specified by this state’s dental practice act. At this time, DANB cannot list all allowable dental assisting functions for each state because some states’ dental practice acts outline very specific allowable functions, while others outline only prohibited functions and some contain minimal or no regulation of dental assisting duties.

Expanded Function Dental Auxiliary

Education, Training and Credential Requirements

Requirements

To perform specified expanded functions in Wisconsin, one must obtain state certification as an Expanded Function Dental Auxiliary: To qualify, one must: I. a. Complete at least 1,000 hours practicing as a dental assistant and hold current DANB Certified Dental Assistant (CDA) certification OR b. Complete at least 2,000 hours practicing as a dental assistant, as verified by the supervising licensed dentist AND II. Successfully complete at least 70 hours of classroom instruction from an accredited program that provides training in practice as an auxiliary AND III. Maintain current proficiency in CPR, including the use of an automated external defibrillator, achieved through instruction provided by an approved individual, organization, or institution of higher education AND IV. Submit fee and application to the Board for EFDA certification Note: The Wisconsin Legislature passed a new law during the 2022 legislative session authorizing the creation of an Expanded Function Dental Auxiliary who may perform the functions below. The Wisconsin Dentistry Examining Board has not yet promulgated rules to implement this new law.

Allowable

Allowable Functions Under Supervision** 6. Packing cord 9. Coronal polishing 12, 33, 51. Placement and finishing of restoration material after the dentist prepares a tooth for restoration 13, 62, 69. Removal of sutures and dressings 18. Application of topical fluoride, fluoride varnish, or similiar dental topical agent

40. Application of sealants 44, 46. Impressions 61. Removal of cement from crowns • Adjustment of dentures and other removable oral appliances • Temporizations

* 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 any practice or 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; and (c) the unlicensed individual’s performance of the remediable procedures is subject to inspection by the dentist. The dentist is responsible for that individual’s performance of that delegated practice or procedure. **A dentist who delegates a procedure to an Expanded Function Dental Auxiliary must remain on the premises where the auxiliary is performing the procedure until the procedure is complete and the dentist has verified that the procedure has been performed successfully.

187

WYOMING: OVERVIEW

State-approved 3/29/2022

State Radiography Requirements

State Job Titles

State Career Ladder There are two recognized levels of dental assistants in Wyoming. See the following pages for details about requirements and allowed functions for each level. Numbers for each level are provided for internal reference and do not correspond to specific state designations.

Dental Assistant qualified in placement of pit and fissure sealants

Dental Assistant

State Radiography Requirements To legally operate dental x-ray equipment and perform dental radiographic procedures in Wyoming, a dental assistant must have: I. a. Completed a course or examination** in dental radiography approved by the Wyoming Board of Dental Examiners (WBDE) within one (1) year immediately prior to application OR b. Been authorized to expose dental radiographs in another jurisdiction within the last five (5) years AND II. Apply to the WBDE for a dental radiography permit. **DANB’s Radiation Health and Safety (RHS) exam meets the examination requirement.

Prohibited Duties

Functions NOT Permitted by Dental Assistants in Wyoming Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. The following functions are not permitted by any level of dental assistant: 46. Take final impressions either digital or conventional or deliver a permanent prosthesis of any type • Remove tooth structure • Diagnose for treatment • Remove chemically bonded attachments • Any procedure billed as a dental prophylaxis • Perform whitening by irreversible procedures such as etching and sandblasting • Use high speed handpiece intraorally • Use low speed handpiece intraorally, except for coronal polishing

188

Requirements

WYOMING

Dental Assistant

State-approved 3/29/2022

Education, Training and Credential Requirements A dental assistant in Wyoming may perform basic supportive dental procedures specified by the state dental practice act (see below) under the supervision of a licensed dentist. Dental assistants may be trained by their employer or by an accredited or WBDE-approved program for dental assistants. 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.

Allowable

Allowable Functions Functions with numbers correspond to functions included in a 2002-2005 study of dental assisting core competencies. See page 11 for more information. Under Direct Supervision* Under General Supervision* 9. Polish the coronal surfaces of the teeth, rubber cup only, but 22. Place and expose x-ray image receptors (either film or digital) not for the purpose of prophylaxis with a dentist’s order, either verbal or written (see “Radiography 13. Remove sutures Requirements” on previous page) 27. Place and remove rubber dams 24. Instruct patients in proper dental health care 35, 62. Prepare and remove periodontal packs 37. Take vital statistics and health histories 44. Take impressions for orthodontic procedures, i.e. retainers and 42. Place and remove orthodontic separators removable appliances 47. Fabricate and cement temporary crowns 45. Place and remove matrices 52. Process radiographs 48, 58. Assist the dentist in all operative and surgical procedures • Replace ligature wires and/or place elastic ties. 61. Remove excess cement from the coronal surfaces of the teeth • Remove ligature wire and/or elastic ties. • Perform whitening procedures not to include irreversible proce• Remove broken bands, brackets, wires and appliances in dures such as etching and sandblasting emergency situations or as needed for operative or prophylac• Place and remove orthodontic wires and/or appliances that tic purposes have been activated by the dentist • Remove direct bond attachments and bands In settings where nitrous oxide anxiolysis, sedation and/or • Treat diagnosed dry socket anesthesia are administered 59. Patient monitoring Under Indirect Supervision* 15. Insert arch wires that have been adjusted by the dentist into the brackets or attachments and secured in place 18, 56. Apply topical medications, excluding pit and fissure sealants and silver diamine fluoride 21. Mix dental materials to be used by the dentist 44. Take impressions, other than final or master impressions and/or digital scan impressions

*Direct Supervision: A dentist is physically present in the dental office, has diagnosed the condition to be treated, has authorized the procedure to be performed, and, before dismissal of the patient, has approved the work performed by the auxiliary. Indirect Supervision: A dentist is physically present in the dental office, has diagnosed the condition to be treated, and has authorized the procedure to be performed. General Supervision: 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.

189

WY 2

WYOMING State-approved 3/29/2022

Dental Assistant qualified in placement of pit and fissure sealants

Education, Training and Credential Requirements Requirements

To perform placement of pit and fissure sealants under the direct supervision of a licensed dentist in Wyoming, a dental assistant must: I. a. Complete a Wyoming Board of Dental Examiners (WBDE)-approved pit and fissure sealants course meeting specified didactic and clinical requirements* within one (1) year immediately prior to the date of application OR b. Complete a CODA-accredited dental hygiene or dental assisting program AND II. Submit an application for a Pit and Fissure Sealant Certificate and completed checklist demonstrating competency and completion of course to the WBDE. *The WBDE also accepts successful performance on DANB’s Sealants (SE) exam to meet requirements to earn the Wyoming Pit and Fissure Sealants certificate.

Allowable

190

191

(Dental sedation assistant permitholder)

Y Y

Minimal and moderate sedation

Parenteral sedation; oral sedation

Conscious sedation

Minimal and moderate

Education Requirements3 (See Appendix)

CPR

CPR/Training

Direct

Initiate IV Lines

CPR Healthcare Provider level; Course/Training/ Exam CPR Healthcare Provider level BLS/Course BLS/ Work Experience/ Course/Exam

Level of Supervision4

Indirect

Add Medication to IV Line5

Ancillary Staff Required2

Monitor

Prepare/ Assist in Administering

Induce/ Administer

Monitor Y

Minimal sedation (patient under 13); moderate sedation Oral conscious sedation; parenteral sedation

AZ CA CA

Intravenous (IV) Sedation

On-site

Deep Sedation/ General Anesthesia

In Operatory

Prepare/ Assist in Administering

Administer

State

Monitor

Other Sedation

Nitrous Oxide

Induce

State Regulation of Dental Assistants’ Roles in Sedation and Anesthesia1

(Personal or operative)

Y Y Y

CT D.C. DE

N N

Conscious sedation N

N N

Y N

BLS/Training

N Y

GA HI

(Direct, continuous and visual when medication is being administered)

Y N

Moderate sedation and pediatric moderate sedation

Moderate enteral or parenteral conscious sedation

Y N

Perform venipuncture procedures after Boardapproved training

CPR/BLS course with AED/Defibrillator

BLS; Board-approved training

CPR

© 2009-2022 Dental Assisting National Board, Inc. All rights reserved. These data are presented for informational purposes only and are not intended as a legal opinion about dental practice in any state. DANB makes no warranties about the correctness of the information presented herein. For authoritative information regarding requirements for dental assistants in each state or district, please contact the relevant dental board.

State Regulation of Dental Assistants’ Roles in Sedation and Anesthesia1

Minimal/moderate sedation

192

BLS; DAANCE or ACLS/PALS; Course/Training

BLS/Training

Light parental conscious sedation

Enteral, inhalation/ enteral, and parenteral conscious sedation Minimal sedation, moderate sedation Parenteral moderate sedation Moderate or minimal sedation Moderate enteral and parenteral sedation

N Y N N

BLS/Course/Training

Course/ Demonstration of clinical competence; BLS

BLS/CPR/Course

BLS/Training/Course

EDDA Course CPR/BLS BLS/CPR with AED/ Training

Indirect

Minimal sedation, moderate sedation

Direct

On-site

Level of Supervision4

Add Medication to IV Line5

Education Requirements3 (See Appendix)

In Operatory

Ancillary Staff Required2

Initiate IV Lines

Moderate sedation

Intravenous (IV) Sedation

Monitor

Induce/ Administer

Monitor

Prepare/ Assist in Administering

Administer

Induce

State

Deep Sedation/ General Anesthesia Prepare/ Assist in Administering

Other Sedation

Nitrous Oxide

Y (Immediate)

BLS Y

Minimal/moderate sedation

Moderate sedation

MN MO

BLS; Training Course

Y Y

(Direct, continuous and visual when medication is being administered)

Y Y

CPR/Course

(and Personal)

BLS/Course/Exam

193

Minimal and moderate sedation Minimal or moderate sedation Minimal conscious sedation; moderate parenteral and enteral conscious sedation; moderate pediatric conscious sedation

Y Y

Minimal and moderate sedation

NM NV NY

Y N

Parenteral conscious sedation; enteral sedation Minimal sedation

Y Y

Y Y N

N N

Minimal and moderate sedation

CPR/Training; BLS/ACLS/PALS Course CPR, BLS or equivalent BLS-HCP/ Expanded Duties Course with Exam

BLS or ACLS/Course

Y Y Y

BLS CPR BLS

Indirect

Level of Supervision4

Direct BLS/Course/ Continuing Education

Y Y

(Direct control and supervision)

(and Direct visual; Contiguous)

Y Y

Y Y Y Y Y

BLS/Course

(and Personal)

CPR/BLS/Course

BLS/Training/ Courses and Exam

(or Direct visual)

BLS/CPR/Training

(Oral Maxillofacial Surgery Assistant)

BLS/ACLS/PALS; Training Program; Continuing Education BLS/Instruction/ Training

N Conscious sedation

Education Requirements3 (See Appendix)

On-site

In Operatory

Ancillary Staff Required2

Y Y

Add Medication to IV Line5

Intravenous (IV) Sedation Initiate IV Lines

Monitor

Prepare/ Assist in Administering

Deep Sedation/ General Anesthesia Induce/ Administer

Monitor

Prepare/ Assist in Administering

Administer

State

Monitor

Other Sedation

Nitrous Oxide

Induce

State Regulation of Dental Assistants’ Roles in Sedation and Anesthesia1

Conscious sedation

Minimal sedation Moderate sedation Pediatric anesthesia

Minimal or moderate sedation

Moderate sedation

Conscious sedation

Recovery from minimal or moderate sedation

UT VA VT WA

N N

Y Y

Minimal or moderate sedation Minimal sedation/ anxiolysis; moderate sedation Conscious sedation Minimal sedation; moderate sedation; moderate sedation with parenteral agents

BLS/CPR/Course

(Direct visual)

BLS

Y Y

BLS/ACLS/PALS

(and Personal)

Course/ACLS

(Direct and direct visual)

(DAANCE Certified Maxillofacial Surgery Assistant

Indirect

Level of Supervision4

Direct

Education Requirements3 (See Appendix)

On-site

(with certificate)

In Operatory

Ancillary Staff Required2

Add Medication to IV Line5

Intravenous (IV) Sedation Initiate IV Lines

Monitor

Induce/ Administer

Monitor

Prepare/ Assist in Administering

Administer

PA RI

Deep Sedation/ General Anesthesia Prepare/ Assist in Administering

(Anesthesia Dental Assistant)

Induce

State

Monitor

Other Sedation

Nitrous Oxide

CPR/BLS Course/Exam/ Training

BLS/Course/ Training/Exam

BLS/CPR/Course

BLS/Course

Y Y

(and Personal and Direct visual)

Y Y

CPR/BLS

BLS/Course

N N

(Continuous direct and continuous personal)

Y Y

CPR/Training

BLS/Course

(Close)

Moderate sedation Relative analgesia/ anxiolysis/minimal sedation; conscious/ moderate sedation Minimal and moderate sedation

BLS/ACLS/PALS Course/Training Y

Indirect

Level of Supervision4

Direct

Education Requirements3 (See Appendix)

On-site

Ancillary Staff Required2 In Operatory

Add Medication to IV Line5

Monitor

Prepare/ Assist in Administering Y

Intravenous (IV) Sedation Initiate IV Lines

(dental anesthesia assistant)

Deep Sedation/ General Anesthesia Induce/ Administer

Monitor

Prepare/ Assist in Administering

Administer

State

Monitor

Other Sedation

Nitrous Oxide

Induce

State Regulation of Dental Assistants’ Roles in Sedation and Anesthesia1

(Close; direct visual)

BLS

BLS/CPR Training/Course/ Exam

BLS

195 1. Please note the language of the regulations and of the requirements to perform these functions varies significantly from state to state. “N” is marked only in states where regulations expressly prohibit a function, “Y” is marked only in states where regulations expressly allow a function, and the item is left blank if the regulation does not expressly prohibit or expressly allow a function. 2. Ancillary staff: In order for a dentist to administer sedation, he or she must maintain a properly equipped facility staffed with a supervised team of allied dental personnel who will be appropriately trained and capable of reasonably assisting the dentist with CPR and/or emergencies. Some regulations call for trained staff being present during administration of sedation; others call for trained staff being available on-site. 3. The requirements for cardiopulmonary resuscitation (CPR), basic life support (BLS), and/or coursework may pertain to one or more of the sedation categories. Education requirements listed here and described in more detail in the accompanying appendix pertain specifically to sedation-related duties; this chart does not indicate whether a dental assistant must meet requirements for and obtain registration, licensure or advanced status before performing some or all of the sedation-related duties addressed in the chart. 4. The level of supervision may pertain to one or more sedation functions. Definitions of supervisory levels vary by state, as not all states use the American Dental Association’s (ADA) definitions. See p. 12 for ADA definitions. 5. If some level of dental assistant or anesthesia/surgery assistant is permitted to add medications to an intravenous line at the direction of the supervising dentist during the administration of sedation or anesthesia, "Y" is marked in the column for "Add Medication to IV Line." © 2009-2022 Dental Assisting National Board, Inc. All rights reserved. These data are presented for informational purposes only and are not intended as a legal opinion about dental practice in any state. DANB makes no warranties about the correctness of the information presented herein. For authoritative information regarding requirements for dental assistants in each state or district, please contact the relevant dental board.

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State Alabama

Arkansas

Requirements All allied personnel who are 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 clinical emergencies. Any dentist using general anesthesia, and his or her auxiliary personnel shall be currently certified in cardiopulmonary resuscitation. 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. A dental assistant monitoring a patient under deep sedation or general anesthesia must hold a current Sedation Assistant permit from the Board. To qualify, a dental assistant must: (1) Hold current DANB CDA certification (or be a registered dental assistant, registered nurse, or licensed practical nurse); (2) Hold current Healthcare Provider level CPR; (3) Hold current nitrous oxide analgesia expanded duty permit from the Board; (4) Successfully complete the American Association of Oral and Maxillofacial Surgeons Anesthesia Assistant’s Training program or a Board-approved equivalent course within the two-year period prior to application; (5) Successfully complete the Arkansas jurisprudence exam; and (6) Apply to the Arkansas State Board of Dental Examiners for a 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 the regulation, can be submitted to fulfill this requirement. An unlicensed dental assistant may assist in the administration of nitrous oxide and monitor patient sedation; unlicensed dental assistants must complete Dental Board of California-approved courses in the California Dental Practice Act and infection control and 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.

California

Colorado

Florida

To hold a Dental Sedation Assistant permit, one must: (1a) Be a Registered Dental Assistant in Extended Functions (RDAEF) or (1b) Be a Registered Dental Assistant (RDA) or (1c) Complete at least 12 months of work experience as a dental assistant, and successfully complete a two-hour Board-approved course in the California Practice Act and an eight-hour course in infection control, and successfully complete an American Heart Association or American Red Crossapproved course in BLS or another course approved as equivalent by the California Board; (2) Successfully complete a California Board-approved dental sedation assistant course (which may commence after six months of work experience as a dental assistant); (3) Apply for a dental sedation assistant permit to the Dental Board of California; and (4) Pass the California Dental Sedation Assistant Written Exam. A dentist may delegate under direct supervision the monitoring and administration of nitrous oxide/oxygen inhalation to appropriately trained dental personnel, pursuant to section 12-35-113(1)(p) and (q), 12-35-128(3)(c), and 12-35-140(4), C.R.S.. 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. All dentists and dental personnel utilizing, administering or monitoring local anesthesia, analgesia, minimal sedation, moderate sedation, deep sedation or general anesthesia shall have successfully completed and maintain continuous certification of Basic Life Support (BLS) training for healthcare providers that is recognized by the American Heart Association, American Safety and Health Institute or the American Red Cross. To monitor nitrous oxide inhalation analgesia, a dental assistant must (1) have satisfactorily completed no less than a two-day course of training as described in the American Dental Association's “Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students” or its equivalent, and (2) maintain 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 person CPR, two person CPR, infant resuscitation and obstructed airway, with a periodic update not to exceed two years. Dental assistants working with dentists holding permits to administer general anesthesia, moderate sedation, and pediatric moderate sedation or who utilize nitrous oxide inhalation analgesia must meet the CPR course requirements above and must also be trained in the use of either an Automated External Defibrillator or a defibrillator and electrocardiograph as part of a cardiopulmonary course at the basic life support level.

Georgia

To meet the requirements of an expanded duty dental assistant (EDDA), 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. An EDDA may 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. Continued on next page

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Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State

Georgia, continued

Idaho

Illinois

Indiana

Requirements All support personnel who provide direct hands-on care to patients under conscious sedation or deep sedation/general anesthesia must be certified in CPR at the basic life support level given by a Board-approved provider with an update not to exceed two years. A dental assistant performing phlebotomy and venipuncture procedures must complete Board-approved training in phlebotomy, intravenous access, infection control, the handling of any medical or dental emergencies associated with such procedures, and any other safety related topics required by the Board. A dental assistant assisting a licensed dentist during the lawful administration of conscious sedation or general anesthesia must complete Board-approved training on the applicable procedures, protocols, patient monitoring techniques, equipment, and any other safety related topics required by the Board. A dental assistant may be considered qualified to initiate, regulate, and monitor the administration of nitrous oxide/oxygen to a patient after completion of Board-approved training and verification of training to be provided to the Board upon request and successful completion of a Board-approved competency examination. 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 Commission on Dental Accreditation, or currently holds DANB CDA certification, may qualify to monitor nitrous oxide or to monitor patients under sedation by maintaining Basic Life Support for Healthcare Providers certification, which includes evaluation of hands-on skills and a written exam, and by meeting the following additional requirements: • To qualify to monitor nitrous oxide, a dental assistant must complete an approved course of 12 hours (between Jan. 1, 1998 and Jun. 1, 2014) or six hours or more relative to nitrous oxide analgesia and submit certification of valid completion of such course to the dentist; 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 association program or by an approved CE sponsor and include areas of anatomy, physiology, monitoring, pharmacology and emergency procedures with an emphasis on airway management. • To qualify to monitor patients under minimal sedation, moderate sedation, deep sedation or general anesthesia, a dental assistant must obtain proof of certification validating completion of a course totaling 12 hours or more, including six hours of didactic education and six hours of clinical training. The didactic coursework shall include the areas of anatomy, physiology, pharmacology, monitoring, including nitrous oxide monitoring, and emergency procedures with an emphasis on airway management. The clinical components may be conducted by an approved CE sponsor, an approved dental hygiene program, or a licensed dentist having a permit A or B who employs the dental assistant (subject to specific documentation requirements). 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. If the dental assistant has completed a monitoring course or courses totaling 12 hours or more provided by the American Association of Oral and Maxillofacial Surgeons (AAOMS) or a similar course or courses preapproved by the Division no earlier than Dec. 31, 2002, the dental assistant need not complete the courses described above. Proof shall be made available to the Division upon request. An Expanded Function Dental Assistant (EFDA) in Illinois may start the flow of oxygen and perform monitoring of nitrous oxide. To qualify as an Expanded Function Dental Assistant in Illinois, a dental assistant must complete required training in each of the allowed expanded functions, as follows: (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. A dental assistant 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 year or has graduated from a program accredited by the Commission on Dental Accreditation of the American Dental Association; (2) satisfactorily completed a three-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 patients under the direct supervision of a licensed Indiana dentist whose license is in good standing. The licensed Indiana dentist supervising the clinical competency shall provide to the dental hygienist or dental assistant a signed affidavit certifying the competency. Upon receipt of the affidavit, the provider of an educational program or curriculum shall issue a certificate of completion to the dental assistant. The certificate of completion must be publicly displayed in the dental office of the dental assistant.

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Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State

Iowa

Kansas

Kentucky Louisiana

Maine

Michigan

Minnesota

Requirements 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 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. 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. 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 CPR and has satisfactorily completed a course of instruction that has been approved by the Kansas Dental Board. 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 employee’s personnel file. The Louisiana Administrative Code contains guidelines for curriculum development for an Expanded Duty Dental Assistant course; these guidelines include instruction in monitoring nitrous oxide/oxygen sedation. 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: Laryngospasm; Bronchospasm; Emesis and aspiration; Airway blockage by foreign body; Angina pectoris; Myocardial infarction; Hypertension/Hypotension; Allergic and toxicity reactions; Seizures; Syncope; Intra-arterial injection; Hyperventilation/Hypoventilation; Cardiac arrest; 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. The registered dental assistant must successfully complete a course in the assisting and monitoring of the administration of nitrous oxide analgesia offered by a Commission on Dental Accreditation (CODA)-accredited program. A dentist, dental therapist, dental hygienist, or licensed dental assistant must complete CPR training and maintain current CPR certification thereafter. “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. The CPR course and certificate must be for healthcare professionals through the American Heart Association or the American Red Cross. A licensed dental assistant who administers nitrous oxide inhalation analgesia must be under the supervision of a licensed dentist. A licensed dental assistant who graduated from a dental assisting program in Minnesota after September 2, 2004, may administer nitrous oxide inhalation analgesia without completing any further requirements. A licensed dental assistant who graduated from a dental assisting program in Minnesota prior to September 2, 2004, or graduated from another United States jurisdiction or Canadian province, may administer nitrous oxide inhalation analgesia after providing the board: (1) a completed application; (2) evidence of having completed a course in administering nitrous oxide inhalation analgesia from an institution accredited by the Commission on Dental Accreditation. The course must be at least 12 hours total and contain didactic instruction, personal administration and management of at least three individual supervised cases of analgesia, and supervised clinical experience using fail-safe anesthesia equipment capable of positive pressure respiration; and (3) documentation of current CPR certification. A licensed dental assistant may 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 be certified by the Board. The same course is required before a licensed dental assistant may manage and remove intravenous lines and monitor patients under general anesthesia or moderate sedation under the indirect supervision of a dentist who holds a valid general anesthesia or moderate sedation certificate. Auxiliary personnel who are present during sedation procedures must be currently certified in Basic Life Support at the Health Care Provider Level endorsed by or equivalent to the American Heart Association (BLS-HCP).

Mississippi

For patients eight (8) years of age and older undergoing deep sedation/general anesthesia, a minimum of three (3) persons must be present with the patient during the critical portion of the procedure. A qualified auxiliary staff whose primary responsibility is to monitor the patient during the procedure must have current certification in a board-approved training program for such a role and have current certification in ACLS. For pediatric patients seven (7) years of age and younger, a qualified auxiliary staff whose primary responsibility is to monitor the patient during the procedure must have current certification in a board-approved training program for such a role and have current certification in PALS. The oral and maxillofacial surgeon auxiliary staff whose primary responsibility is to monitor the patient must complete a board approved CE course every two years.

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Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State

Missouri

Montana

Nebraska

New Hampshire

New Jersey

North Carolina

Requirements A dental assistant or holder of DANB's CDA certification may assist the administration of and monitor nitrous oxide analgesia under direct supervision 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 competence test regarding clinical and didactic training; or (1b) Submit proof to the Missouri Dental Board of having been certified in another state to assist in the administration of an monitoring of nitrous oxide subsequent to equivalent training and testing; and (2) Obtain a permit from the Missouri Dental Board. To qualify for a site certificate, all moderate sedation team members and deep sedation/general anesthesia sedation team members must have completed a board-approved course in monitoring sedated patients during the past (5) years. For the purpose of supervising and monitoring a moderately sedated patient, members of the sedation team shall be qualified as follows: (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 AHA 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 students; (3) Certified in monitoring moderate sedation from a board-approved course provider; 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. Minimum standards for monitoring minimal sedation patients shall include the following: When the dentist who administers 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. To monitor nitrous oxide, a dental assistant must hold current certification in healthcare cardiopulmonary resuscitation (CPR) from a course accredited by the American Heart Association, American Red Cross, or an equivalent certification approved by the Board of Dentistry. 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. To qualify to monitor nitrous oxide, a dental assistant must be currently certified in BLS-HCP and successfully complete a course and exam in monitoring the administration of nitrous oxide meeting requirements established by rule of the New Hampshire Board of Dental Examiners, after meeting specified prerequisites. To qualify for the expanded duty course, a dental assistant must either (1) be a graduate of a CODA-accredited dental assisting program, or (2) Hold DANB's CDA certification or have at least 400 hours of clinical dental assisting experience prior to course, and meet Introduction to Dental Assisting course requirements, and qualify in infection control. A registered dental assistant must successfully complete a New Jersey State Board of Dentistry-approved course offered in a CODA-accredited program that emphasizes the administration of nitrous oxide simultaneously with the administration of oxygen and safe and effective patient monitoring. A dental assistant must also complete a three-hour didactic or clinical course in nitrous oxide/oxygen inhalation analgesia in every other RDA registration renewal period. 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 North Carolina State Board of Dental Examiners 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. All auxiliaries involved in sedation procedures must have completed BLS certification and three hours of continuing education annually in any of the following areas: sedation; medical emergencies; monitoring IV sedation and the use of monitoring equipment; pharmacology of drugs and agents used in IV sedation; physical evaluation, risk assessment, or behavioral management; or airway management.

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Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State

Requirements For registered dental assistants monitoring nitrous oxide, the dentist must provide and document training in the proper and safe operation of the analgesia machine being used, including emergency procedures to be employed if required. To earn a permit 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.

North Dakota

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.

Ohio

Oklahoma

For a registered dental assistant holding an anesthesia assisting permit, two of the 16 continuing education hours required in a two-year renewal cycle must be related to sedation or anesthesia. Basic qualified personnel (BQP) may monitor nitrous oxide-oxygen (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. To earn an expanded duty permit in assisting in the administration of nitrous oxide, a dental assistant must satisfactorily complete a course of study in nitrous oxide administration, consisting of a minimum of 12 hours, approved by the Oklahoma Board of Dentistry. To earn an Oral Maxillofacial Surgery Assistant permit in Oklahoma, one must: (1) Be of good moral character, 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 or another program or examination approved by the Oklahoma Board, and (4) Complete the Dental Anesthesia Assistant National Certification Examination (DAANCE) program provided by the American Association of Oral Maxillofacial Surgeons (AAOMS) or another program or examination approved by the Oklahoma Board, 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. See p. 139 for functions that may be performed by a holder of an Oral Maxillofacial Surgery Assistant permit. 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. The Oklahoma Board of Dentistry is in the process of developing rules to define requirements for a permit to assist a dentist who holds a parenteral or pediatric anesthesia permit. Persons serving as anesthesia monitors in a dental office shall maintain current certification in Healthcare Provider Basic Life Support (BLS)/Cardiopulmonary Resuscitation (CPR) training or its equivalent and 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" means displaying special skill or knowledge derived from training and experience.

Oregon

The Oregon Board of Dentistry 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 Assistants 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 Oregon Association of Oral and 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 (prior to discontinuation of the COMSA exam in 2000) or other Oregon Board of Dentistry-approved examination; (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. A Certified Anesthesia Dental Assistant may initiate IV lines for sedation and anesthesia upon successful completion of a board-approved course in intravenous access or phlebotomy and receipt of a certificate in IV therapy from the Oregon Board of Dentistry (administered by DANB). A Certified Anesthesia Dental Assistant may administer medications into an existing IV line of a patient under sedation or anesthesia under the direct visual supervision of the dentist.

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Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State

Rhode Island

South Carolina

Requirements 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. Expanded Duty Dental Assistants are authorized to monitor nitrous oxide conscious sedation (analgesia) upon: 1) Successful completion of a Board-approved course; 2) Application to the Board 3) Successful completion of the State Board Examination 4) Certification by the Board. All dental staff who provide direct, hands-on patient care must be certified in cardiopulmonary resuscitation at the basic life support level by a board-approved training course. The certification must have been received in the immediately preceding two years. 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. A registered dental assistant may earn a permit to administer nitrous oxide sedation and analgesia after becoming certified in BLS, completing a South Dakota Board of Dentistry-approved course+ and obtaining a permit from the Board. A registered dental assistant may earn a permit to monitor patients under general anesthesia, deep sedation or moderate sedation under the direct supervision of a dentist after becoming certified in BLS, completing at least an eight-hour course+ in anesthetic assisting and obtaining a permit from the Board. Course must have been completed within 13 months of permit application unless applicant legally performed the function during a specified number of years preceding application and provides required documentation attesting to proficiency. +

A dental assistant or registered dental assistant may start intravenous (IV) lines after taking a Board-approved course in anesthesia assisting and receiving intravenous training. South Dakota

Tennessee

Texas

Vermont

Virginia

A dentist may authorize a 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. To be eligible for certification in nitrous oxide monitoring, 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. To qualify to monitor the administration of nitrous oxide in Texas, a dental assistant must (1) Be registered as a Registered Dental Assistant (RDA); (2) Complete 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 Texas State Board of Dental Examiners (TSBDE); (3) Complete a current course in Basic Life Support; and (4) Apply to the TSBDE for a nitrous oxide monitoring certificate. All individuals administering and monitoring nitrous oxide analgesia must, in addition to required emergency office procedures, have annual CPR training. For dentists with conscious sedation endorsement, training to educate assistants with respect to emergency protocols must be provided to all sedation team assistants and updated periodically. 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).

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Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia State

Washington

Requirements The dentist cannot employ an individual to monitor patients receiving deep sedation or general anesthesia unless that individual has received a minimum of 14 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 specified monitoring equipment and instruction in other topics specified in rules. A certified dental anesthesia assistant may, under close supervision, initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation, or general anesthesia and adjust the rate of IV fluids infusion only to maintain or keep line patent or open, and may perform additional functions under direct visual supervision. Applicants for state certification as a dental anesthesia assistant must: (1a) Complete the “Dental Anesthesia Assistant National Certification Examination (DAANCE)” or predecessor program, provided by the American Association of Oral and Maxillofacial Surgeons (AAOMS), or (1b) Complete the “Oral and Maxillofacial Surgery Assistants Course” course provided by the California Association of Oral and Maxillofacial Surgeons (CALAOMS), or (1c) Complete substantially equivalent education and training approved by the Washington Dental Quality Assurance Commission (DQAC); AND (2a) Complete 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 (2b) Complete substantially equivalent education and training approved by DQAC; AND (3) Hold 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 (4) Complete of seven clock hours of AIDS education and training; AND (5) Submit 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 (6) Submit application form, fee, and evidence of completing all requirements to DQAC. 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.

West Virginia

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. To qualify to perform visual monitoring of nitrous oxide analgesia units in West Virginia, a dental assistant must: (1) Successfully complete a West Virginia Board of Dentistry-approved course of at least two hours of didactic instruction and pass an examination, 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.

See DANB’s State Fact Booklet for anesthesia and sedation requirements from each state’s dental practice act and/or administrative rules pertaining to dental assistants. These data are presented by DANB for informational purposes only and do not constitute a legal opinion about dental practice in any state. DANB makes no warranties about the correctness of the information presented herein. For authoritative information regarding requirements for dental assistants in each state or district, please contact the relevant dental board.

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STATE DENTAL BOARD CONTACT INFORMATION For the most up-to-date and authoritative information on a state’s requirements, please contact the state dental board at the phone number or Internet address provided below. Specific questions about state fees, forms, exam and course approval, and the licensure/registration process (including continuing education) should be directed to the state dental board. Questions about the national DANB certifications or exams, or any state exams administered by DANB, may be directed to DANB. Board of Dental Examiners of Alabama: 205-985-7267 www.dentalboard.org

Missouri Dental Board: 573-751-0040 http://pr.mo.gov/dental.asp

Alaska Board of Dental Examiners: 907-465-2542 www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/ BoardofDentalExaminers.aspx

Montana Board of Dentistry: 406-841-2390 www.dentistry.mt.gov Nebraska Board of Dentistry: 402-471-2118 http://dhhs.ne.gov/licensure/Pages/Dental-Assistant.aspx

Arizona State Board of Dental Examiners: 602-242-1492 https://dentalboard.az.gov

Nevada State Board of Dental Examiners: 702-486-7044 or 800-337-3926 https://dental.nv.gov

Arkansas State Board of Dental Examiners: 501-682-2085 www.asbde.org

New Hampshire Board of Dental Examiners: 603-271-2152 www.oplc.nh.gov/board-dental-examiners

Dental Board of California: 916-263-2300 or 877-729-7789 (toll free) www.dbc.ca.gov

New Jersey State Board of Dentistry: 973-504-6405 www.njconsumeraffairs.gov/den and New Jersey Department of Environmental Protection, Bureau of X-Ray Compliance: 609-984-5890 www.xray.nj.gov

Colorado Dental Board: 303-894-7800 https://dpo.colorado.gov/Dental Connecticut State Dental Commission: 860-509-7603, menu option 4 www.ct.gov/dph/cwp/view.asp?=3143&q=388884 Delaware Board of Dentistry and Dental Hygiene: 302-744-4500 www.dpr.delaware.gov/boards/dental and Delaware Division of Public Health, Office of Radiation Control: 302-744-4546 http://dhss.delaware.gov/DPH/hsp/orc.html

New Mexico Board of Dental Health Care: 505-476-4622 www.rld.state.nm.us/boards/Dental_Health_Care.aspx

District of Columbia Board of Dentistry: 877-672-2174 https://dchealth.dc.gov/service/dentistry-licensing

North Carolina State Board of Dental Examiners: 919-678-8223 www.ncdentalboard.org

Florida Board of Dentistry: 850-245-4474 https://floridasdentistry.gov

North Dakota State Board of Dental Examiners: 701-258-8600 www.nddentalboard.org

Georgia Board of Dentistry: 404-651-8000 http://gbd.georgia.gov

Ohio State Dental Board: 614-466-2580 www.dental.ohio.gov

Hawaii State Board of Dental Examiners: 808-586-2702 https://cca.hawaii.gov/pvl/boards/dentist

Oklahoma Board of Dentistry: 405-522-4844 www.ok.gov/dentistry

Idaho State Board of Dentistry: 208-334-2369 http://isbd.idaho.gov/

Oregon Board of Dentistry: 971-673-3200 www.oregon.gov/dentistry

Illinois Board of Dentistry: 855-445-7763 www.idfpr.com/profs/dentist.asp

Pennsylvania State Board of Dentistry: 717-783-7162 www.dos.pa.gov/dent

Indiana State Board of Dentistry: 317-234-2054 www.in.gov/pla/dental.htm and Indiana State Department of Health, Division of Radiology and Weights and Measures 317-233-7565 https://www.in.gov/health/cshcr/medical-radiology-services/

Rhode Island Board of Examiners in Dentistry: 401-222-1962 http://health.ri.gov/licenses/detail.php?id=251

Iowa Dental Board: 515-281-5157 www.dentalboard.iowa.gov

New York State Board for Dentistry: 518-474-3817, ext. 550 http://www.op.nysed.gov/prof/dent/

South Carolina Board of Dentistry: 803-896-4599 https://llr.sc.gov/bod/ South Dakota State Board of Dentistry: 605-224-1282 www.sdboardofdentistry.com Tennessee Board of Dentistry: 615-532-5073 https://www.tn.gov/health/health-program-areas/health-professional-boards/ dentistry-board.html

Kansas Dental Board: 785-296-6400 www.dental.ks.gov

Texas State Board of Dental Examiners: 512-463-6400 www.tsbde.texas.gov

Kentucky Board of Dentistry: 502-429-7280 www.dentistry.ky.gov

Utah Dentist and Dental Hygenist Licensing Board: 801-530-6628 https://dopl.utah.gov/dental/index.html

Louisiana State Board of Dentistry: 225-219-7330 www.lsbd.org/

Vermont Board of Dental Examiners: 802-828-2373 https://sos.vermont.gov/dental-examiners/

Maine Board of Dental Practice: 207-287-3333 www.maine.gov/dental

Virginia Board of Dentistry: 804-367-4538 www.dhp.virginia.gov/dentistry

Maryland State Board of Dental Examiners: 410-402-8501 https://health.maryland.gov/dental/ Massachusetts Board of Registration in Dentistry: 617-973-0971 http://www.mass.gov/dph/dentalboard

Washington State Dental Quality Assurance Commission: 360-236-4700 https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renewor-update/dental-assistant

Michigan Board of Dentistry: 517-241-0199 www.michigan.gov/healthlicense

West Virginia Board of Dentistry: 877-914-8266 www.wvdentalboard.org

Minnesota Board of Dentistry: 612-617-2250 or 888-240-4762 www.mn.gov/boards/dentistry/

Wisconsin Dentistry Examining Board: 608-266-2112 https://dsps.wi.gov/Pages/BoardsCouncils/Dentistry/Default.aspx

Wyoming Board of Dental Examiners: 307-777-7387 http://dental.wyo.gov/

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