2024 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 2024

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 2024, 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 2024. 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 “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.

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 39 states, the District of Columbia, the U.S. Air Force and the Department of Veterans Affairs. DANB currently offers five national certifications.

national entry level dental assistant (nelda®)

Includes component exams in:

• Anatomy, Morphology and Physiology (AMP)*

• Radiation Health and Safety (RHS®)*

• Infection Control (ICE®)*

Certified dental assistant™ (Cda®)

Includes component exams in:

• Radiation Health and Safety (RHS)*

• Infection Control (ICE)*

• General Chairside Assisting (GC)

Certified orthodontic assistant (Coa®)

Includes component exams in:

• Orthodontic Assisting (OA)

• Infection Control (ICE)*

Certified preventive functions dental assistant (Cpfda®)

Includes component exams in:

• Coronal Polish (CP)*

• Sealants (SE)*

• Topical Fluoride (TF)*

Certified restorative functions dental assistant (Crfda®)

Includes component exams in:

• Impressions (IM)*

• Temporaries (TMP)*

• Sealants (SE)*

• Restorative Functions (RF)

Candidates who pass a component exam marked with an asterisk (*) will earn a certificate of knowledge-based competence.

DANB is a member of the Institute for Credentialing Excellence and maintains accreditation to the rigorous National Commission for Certifying Agencies (NCCA) Standards for the Accreditation of Certifying Bodies for its CDA and COA certification programs.

launched in 2022: ads-danb dental infection prevention and Control Certifications

DANB has collaborated with the Association for Dental Safety (ADS)** 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 as 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.

**Formerly known as OSAP

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 most 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 Minnesota North Dakota

California Missouri Ohio

Connecticut Montana Oregon

D.C. Nebraska Rhode Island

Georgia Nevada South Dakota

Illinois New Hsmpshire Vermont

Iowa New Jersey Virginia

Maine New Mexico Washington

Maryland New York Wisconsin

Massachusetts North Carolina

CDA certification meets state requirements** to perform radiography procedures in:

Arkansas Massachusetts Ohio

Colorado Minnesota South Carolina

D.C. Mississippi South Dakota

Delaware Nebraska Tennessee

Indiana New Jersey Texas

Maine North Carolina Vermont

Maryland North Dakota

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

Connecticut Massachusetts Oregon

Maryland New Jersey Rhode Island

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

Connecticut Massachusetts Rhode Island

D.C. Oregon

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

Connecticut Massachusetts Rhode Island

NELDA certifcication is required or recognized** to earn qualified status in:

North Dakota

DANB's RHS exam is recognized or required** to perform radiography procedures in:

Arizona Maryland Oregon

Colorado Massachusetts Pennyslvania

Connecticut Minnesota South Carolina

D.C. Montana South Dakota

Delaware New Hampshire Tennessee

Indiana New Jersey Utah

Iowa New Mexico Virginia

Maine North Dakota Wyoming

DANB exams are recognized or required in 39 states and D.C.

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

Connecticut New Hampshire North Dakota

Iowa New York Oregon

DANB’s CP exam is recognized** in:

Arizona New Mexico Oregon

New Jersey Ohio

DANB’s SE exam is recognized** in:

New Mexico Wyoming

DANB's TF exam is recognized** in:

New Jersey New Mexico

DANB's RF exam is recognized** in:

Arizona North Dakota

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

DANB's TMP exam is recognized** in:

Arizona

U.S. Military and Other Federal Agencies

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

**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 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 State Requirements > Publications and Services.

danb’s salary survey

Since 2001, DANB has conducted salary surveys of CDA® certificants every two years. The 2024 State Fact Booklet uses information from the 2024 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 State Requirements section provides state-specific dental assisting information in an easy-to-use, interactive state map, with shortcuts to essential information such as dental assisting levels, 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 section that provides information on CDE requirements by state, research reports, and scholarship information.

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

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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 205.

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.

danb’s 2024 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 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

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

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

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.

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

danb’s 2024 sTaTe Career ladder TemplaTes for denTal assisTanTs

new design snapshot, second page

MARYLAND

Functions NOT Permitted by Dental Assistants in Maryland, continued

• 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 (see Note on page 77)

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)

Duties (see requirements on p. 78), 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

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)

Under General Supervision*

• Assist in performing intraoral photography, other than conventional or digital x-ray; supervising dentist must review the photography and authorize the treatment plan (under new law effective 10/1/2022; see Note on page 77)

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

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

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 2024 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

2. Chart existing restorations or conditions

3. Phone in prescriptions at the direction of the dentist

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

5. Complete laboratory authorization forms

6. Place and remove retraction cord

7. Perform routine maintenance of dental equipment

8. Monitor and respond to post- surgical bleeding

9. Perform coronal polishing procedures

10. Apply effective communication techniques with a variety of patients

11. Transfer dental instruments

12. Place amalgam for condensation by the dentist

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

25. Perform sterilization and disinfection procedures

26. Provide pre- and post-operative instructions

27. Place and remove dental dam

28. Pour, trim and evaluate the quality of diagnostic casts

29. Size and place orthodontic bands and brackets

30. Using the concepts of four- handed 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

34. Place liners and bases

35. Place periodontal dressings

36. Demonstrate understanding of the OSHA Bloodborne Pathogens Standard

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.

49. Perform vitality tests

50. Place temporary fillings

51. Carve amalgams

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

59. Monitor nitrous oxide/oxygen analgesia

60. Maintain emergency kit

61. Remove permanent cement from supragingival surfaces

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.

a labama

State-approved 7/17/2024

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.

State Radiography Requirements

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.

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

Dental Assistant 1

State-approved 7/17/2024

Dental Assistant 1

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 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 examination and diagnosis must be made by a dentist before treatment can be instituted)

6. Place and remove gingival retraction materials

13. Remove intraoral sutures (excluding wire sutures)

18. Apply topical fluoride

22, 52. Make dental radiographs or digital images

24. Give oral hygiene instructions including plaque staining, flossing, brushing, and caries susceptibility tests

27. Place and remove rubber dam

29. Pre-fit and pre-contour orthodontic appliances either extraorally or intra-orally for final adaptation by the dentist

34. Place cavity liners and bases (excluding capping of exposed pulpal tissues)

35, 62. Place and remove periodontal dressings

37. Take and record case history, blood pressure, pulse and oral temperature

43. Contour stainless steel or chrome crowns but cannot cement them

44. Make impressions for diagnostic casts or opposing casts

45. Place, wedge, and remove matrices for operative dentistry

46. Make final impressions for removable and fixed prostheses, orthodontic appliances, retainers, devices to treat sleep apnea or anti-snoring devices, and medicament/whitening delivery trays; however, before said impressions may be used for the manufacture of prostheses and appliances, the dentist shall examine and approve such impressions for accuracy

47. Construct and place temporary crowns (excluding stainless steel crowns placed with intentions of reasonable permanency)

47, 50, 54, 55. Construct and remove with hand instruments only interim restorations (interim restorations being any restoration placed while a more permanent restoration is being completed)

56. Apply topical anesthetics

59. Assist in the administering of N2O and O2

61. Remove excess cement with hand instruments from around permanent dental restorations and orthodontic appliances

63, 69. Place and remove alveolar socket dressings

• Apply topical oxygenating agents (excluding endodontic therapy)

• Apply anti-inflammatory agents

• Apply astringents

• Apply desensitizing agents

• Apply light-cured medicinal bonding agents

• Apply etchant materials

• Insert into the mouth of the patient wax models of dentures, partial dentures, or any other structures and make adjustments outside the mouth of the patient to such wax models pursuant to written or verbal instructions or directions from the dentist; provided, however, (1) the dental hygienist or dental assistant shall not use these wax models of dentures, partial dentures or any other structure to register the jaw relationships or occlusal relationships of the patient, and (2) that before such wax models may be used for the manufacture of dentures, partial dentures or other structures the dentist shall personally consult with the patient, examine such wax models, and make such additional adjustments as may be required

• Insert into the mouth of the patient dentures, partial dentures, removable orthodontic appliances, prostheses or any other structures and make adjustments outside the mouth of the patient to the dentures, prostheses (fixed or removable), removable orthodontic appliances, prosthetic appliances, bridges, or other structures pursuant to written or verbal instructions or directions from the dentist; provided, however, (1) that before such prostheses (fixed or removable), removable orthodontic appliances, or other structures are delivered to the patient leaving the dental office with such prostheses (fixed or removable), removable orthodontic appliances, or other structures the dentist shall personally consult with the patient, examine such prostheses (fixed or removable), removable orthodontic appliances, or other structures, and make such additional adjustments as may be required; and (2) that final placement and cementation of all fixed appliances, fixed prostheses and other fixed structures shall be performed by the dentist

• Apply reversible liners and bases to prostheses, orthodontic appliances, or any other structures; however, the dentist shall personally consult with the patient and examine such liners and bases, and make such additional adjustments as may be necessary

• Use laser and/or narrow band (light) imaging technology for preliminary diagnostic purposes only with the dentist’s final examination and diagnosis

AK

State Career Ladder

a laska

State-approved 7/1/2024

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.

State Radiography Requirements

Dental Assistant qualified in coronal polishing procedures/ Dental Assistant qualified in restorative functions 2

Dental Assistant 1

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*.

*Note: A dental hygienist holding an advanced practice permit may also delegate to a dental assistant with a certificate in coronal polishing the exposure and development of radiographs under indirect supervision

Functions NOT Permitted by Dental Assistants in Alaska

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

• Other procedures considered prophylactic, such as scaling (per opinion issued at 8/25/2023 Board meeting)

State-approved 7/1/2024

Dental Assistant 1

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 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*

18. Apply topical preventive agents*

40. Apply pit and fissure sealants*

*Note: A dental hygienist holding an advanced practice permit may delegate to a dental assistant with a certificate in coronal polishing the application of topical preventive agents under either indirect or direct supervision and the placement of pit and fissure sealants under direct supervision

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

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 verifying the certificate and course taken to obtain that certification

In Alaska, all dental assistants may: 22, 52. Expose and develop dental radiographs*

• Perform infection control and occupational safety procedures

• Perform other duties not specified by this state’s dental practice act

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

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 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.

a rizona

State-approved 7/12/2024

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.

Dental Assistant Expanded Function Dental Assistant (EFDA) 2 1 3

Dental Assistant qualified in coronal polishing procedures

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.

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

46. Taking final impressions, other than digital 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 therapists, licensed dental hygienists, or certified denturists can perform

• Final jaw registrations

• Activating orthodontic appliances

• An irreversible procedure

* 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).

State-approved 7/12/2024

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 or licensed dental therapist.

There are no education or training requirements for this level of dental assisting.

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 analgesia as instructed by the dentist or licensed dental therapist

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 analgesia administration upon the direct instruction and presence of a dentist or licensed dental therapist

• Place dental material into a patient’s mouth in response to a licensed dentist’s or licensed dental therapist’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 final digital impressions for any activating orthodontic appliance, fixed, or removable prothesis

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

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 Polishing exam (administered by DANB)

AND

II. Submit to DANB the Arizona Coronal Polishing Certificate (AZCP) application, including an Arizona Coronal Polishing Clinical Skills Affidavit (completed by a licensed dentist or a coronal polishing educator/course instructor*

AND

III. Receive the Arizona Coronal Polishing Certificate, sent by DANB upon completion of all requirements

*Note: Beginning 6/1/2023, any educator or course instructor signing the Clinical Skills Affidavit must be a dentist or licensed hygienist or must hold the AZCP certificate.

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*

9. Perform coronal polishing procedures

a rizona

State-approved 7/12/2024

Expanded Function Dental Assistant (EFDA)

Education, Training and Credential 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

b. Hold the AZ Radiologic Proficiency certificate or pass the DANB RHS exam (see requirements on p.18) AND

c. 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

d. Pass DANB’s AMP, TMP and RF exams AND

e. 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

f. Apply to DANB for the Arizona Expanded Functions – Restorative Certificate by submitting a completed application, Licensed Dentist Endorsement form, required documentation and fee to DANB OR

II.

a. Hold the AZ Coronal Polishing certificate (see requirements on prior page), AND

b. Hold the AZ Radiologic Proficiency certificate or pass the DANB RHS exam (see requirements on p.18) AND

c. 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

d. Document clinical experience in the specified expanded functions on a Licensed Dentist Endorsement form AND

e. 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

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

*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.

a rkansas

State-approved 8/2/2024

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.

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

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

State-approved 8/2/2024

Dental Assistant 1

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

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 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

† 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 Career Ladder

There are three 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.

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 28 Dental Sedation Assistant See pages 29-30

State Radiography Requirements

Any person working in a dentist’s office who operates dental radiographic equipment must:

I. Pass a Board-approved course in radiation safety which includes theory, laboratory, 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.

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

• Surgery 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

• Administration of local or general anesthesia or sedation

• 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

• Starting the flow of nitrous oxide and oxygen gases

• 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

California

Unlicensed Dental Assistant

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, successfully complete a board-approved 8-hour course in infection control prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious materials, and that all unlicensed dental assistants in continuous or intermittent employment for one year have proof of completing all of the following within one year from date of employment:

I. A Board-approved 2-hour course in the California Dental Practice Act AND

II. Current BLS certification issued by ARC, ASHI, AHA, ADA-CERP, or AGD’s Program Approval for Continuing Education

To perform radiographic procedures, an unlicensed dental assistant must complete a board-approved course in radiation safety and a copy of the certificate of completion issued by the course provider must be displayed publicly in the treatment facility. (see “Radiography Requirements” on previous page)

To perform coronal polishing prior to licensure as an RDA, an unlicensed dental assistant must complete a board-approved coronal polishing course. Prior to taking the coronal polishing course, the dental assistant must complete a board-approved 8-hour course in infection control and a current, valid certification in basic life support. A copy of the certificate of completion issued by the coronal polishing course provider must be displayed publicly in the treatment facility.

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*

13. Remove sutures after inspection of the site by the dentist

18. 56. Apply non-aerosol and non-caustic topical agents, including all forms of 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

62. Remove periodontal dressings

69. Remove post-extraction dressings after inspection of the surgical site by the supervising licensed dentist

• Adjust the flow of nitrous oxide and oxygen gases if deemed necessary and directed by the supervising dentist who shall be present in the operatory directly supervising the adjustment

• Administer or assist in the administration of oxygen in response to a medical emergency

• Remove orthodontic separators

• Remove arch wires

• Remove ligature ties

• Cure dental materials with a light curing device

• Examine orthodontic appliances

• Take facebow transfers and bite registrations.

• Perform measurements for the purposes of orthodontic treatment.

• Place patient monitoring sensors

• Extraoral functions specified by the supervising dentist that meet the definition of basic supportive dental procedures spec-

ified in Dental Practice Act. Such duties may include patient monitoring, placing monitoring sensors, taking of vital signs, or other extraoral procedures related to the scope of their practice.

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 requirements above)

• Perform intraoral and extraoral photography

• Extraoral duties specified by the supervising licensee that meet the definition of a basic supportive dental procedures specified in the Dental Practice Act. These duties may include a procedure that requires the use of personal protective equipment, laboratory functions, and sterilization and disinfection procedures.

California

Updated by DANB 11/6/2024

Registered Dental Assistant (RDA)

Education, Training and Credential 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 ASHI, AHA or ARC-approved course in Basic Life Support or a course taught by a provider approved by the ADA’s Continuing Education Recognition Program (CERP) or the AGD’s Program Approval for Continuing Education (PACE) AND

V. Apply to the Dental Board of California for examination and licensure as an RDA AND

VI. Pass the state RDA Combined Written and Law and Ethics exam and obtain background clearance by the board

Note: With passage of Senate Bill 1453 in 2024 by the California State Legislature, the above requirements for dental assisting registration are effective only until July 1, 2025. Beginning July 1, 2025, new amended requirements and alternative pathways for RDA eligibility, such as DANB CDA certification and completion of a preceptorship in dental assisting, respectively, will go into effect. For more information on applying to become an RDA during this time, please contact the Dental Board of California directly.

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 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, etch and bonding agents for restorative procedures

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 (board-approved course required)

63. Place post-extraction dressings after inspection of the surgical site by the supervising licensed dentist

• Apply bleaching agents and activate with non-laser light-curing

device

• Use of automated caries detection devices and materials and recording of such findings before placement of pit and fissure sealants

• Obtain intraoral images for computer-aided design (CAD), milled restorations

• Chemically prepare teeth for bonding for restorative procedures

• Perform sore-spot adjustment only of dentures extraorally

• Perform tissue conditioning and soft reline of dentures

• 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 page 28 for requirements and duties)

• The allowable duties of a dental sedation assistant permit holder, if additional requirements have been met (see page 29 for requirements and duties)

Under Direct Supervision

29. Size, fit, secure, and remove orthodontic bands using appropriate dental materials

• Isolate, etch, bond, and attach composite buttons for orthodontic procedures

• Perform a duty specified in the RDA scope of practice using contemporary techniques and materials designed for the performance of that duty if the RDA has completed the appropriate education and training, and whose skill and knowledge in the use of such technique or material has been determined clinically competent by the supervising licensed dentist

Allowable functions for this level continued on next page

Allowable Functions (for Registered Dental Assistant), continued

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

Registered Dental Assistant in Extended Functions (RDAEF)

Education, Training and Credential 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. Hold a valid license as an RDA (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 RDAEF program AND

IV. Submit evidence of current BLS certification issued by ARC, ASHI, AHA, ADA-CEPRP, or AGD’s Program Approval for Continuing Education AND

V. Apply to the Dental Board of California for examination and licensure as a Registered Dental Assistant in Extended Functions AND

VI. Pass the California RDAEF written exam and obtain background clearance by the board

To qualify to perform additional functions of a Registered Dental Assistant in Extended Functions (RDAEF), one must:

I. Provide evidence, satisfactory to the Dental Board of California, of having completed a board-approved course in those functions

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. Perform oral health assessments, including intraoral and extraoral soft tissue evaluations to identify oral lesions, classifying occlusion, performing myofunctional evaluations, and oral cancer screenings as authorized by the supervising dentist.

6. Gingival retraction for impression and restorative procedures

12, 33, 51. Place, contour, finish, and adjust all direct restorations

46. Take final impression for permanent direct and indirect restorations

46. Take final impressions for tooth-borne removable prosthesis

• Perform post, core, and build-up procedures in conjunction with direct and indirect restorations

• Fit trial endodontic filling points

• Formulate indirect patterns for 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 adhere all permanent indirect restorations

• Perform a duty specified in the RDAEF scope of practice using contemporary techniques and materials designed for the performance of that duty if the RDAEF has been licensed on or since January 1, 2010 and has completed the appropriate education and training, and whose skill and knowledge in the use of such technique or material has been determined clinically competent by the supervising licensed dentist

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

Updated by DANB 11/6/2024

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

continued 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.

Requirements

California ( o r T hodon T i C )

Updated by DANB 11/6/2024

Orthodontic Assistant

Education, Training and Credential Requirements

To qualify for an Orthodontic Assistant permit by work experience in California, one must:

I. Successfully complete a 2-hour Board-approved course in the California Dental Practice Act and an 8-hour course in infection control within two years prior to application and successfully complete a Board-approved course in ultrasonic scaling within five years prior to application AND

II. Submit evidence of current BLS certification issued by ARC, ASHI, AHA, ADA-CERP, or AGD’s Program Approval for Continuing Education AND

III. Successfully complete a California Board-approved orthodontic assistant course AND

IV. Apply to the Dental Board of California for an Orthodontic Assistant examination and permit AND

V. Pass the California Orthodontic Assistant Written Exam and obtain background clearance by the board

A copy of the current, valid orthodontic assistant permit issued by the Board must be displayed publicly in the treatment facility where the permitholder performs dental services

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*

15. Place and ligate archwires

29. Prepare teeth for bonding, and select, preposition and cure orthodontic brackets after their position has been approved by the supervising licensed dentist

29. Size, fit and secure orthodontic bands using appropriate materials

61. Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment

• Isolate, condition, etch, and prepare teeth for provisional attachments, bonded attachments, aligner buttons, aligner connections, orthodontic brackets, and appliances.

• Remove orthodontic bands, brackets, and attachments and remove excess cement with a hand instrument, with the removal of any material by the supervising licensed dentist or registered dental assistant in extended functions licensed on or after January 1, 2010

• All duties that a dental assistant is allowed to perform under direct supervision

Under General Supervision

• All duties that a dental assistant is allowed to perform under general supervision

Registered Dental Assistant (RDA) with Orthodontic Assistant Permit

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 Functions

Under Direct Supervision*

• All allowable duties of an RDA (see page 25)

• All allowable duties of an Orthodontic Assistant permit holder (see above)

*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.

Requirements

CA

California ( d en Tal s edaT ion a ssis Tan T )

Updated by DANB 11/6/2024

Dental Sedation Assistant

Education, Training and Credential Requirements

To qualify for a Dental Sedation Assistant permit in California by work experience, one must:

I. Be an RDA, RDAEF, or 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 within two years prior to application AND

III. Submit evidence of current BLS certification issued by ARC, ASHI, AHA, ADA-CERP, or AGD’s Program Approval for Continuing Education

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 examination and permit AND

VI. Pass the California Dental Sedation Assistant Written Exam and obtain background clearance by the board

A copy of the current, valid dental sedation assistant permit issued by the Board must be displayed publicly in the treatment facility where the permitholder performs dental services

Allowable Functions

Under Direct Supervision*

• All duties that a dental assistant is allowed to perform under direct supervision

• Monitor patients undergoing moderate 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 supervising dentist or the licensed healthcare professional authorized to administer moderate sedation or general anesthesia, who shall be at the patient’s chairside while moderate 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, or the licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia

• 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 or the licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia)

• Removal of intravenous lines

The above duties may only be performed in a dental office or dental clinic.

Under General Supervision

• All duties that a dental assistant is allowed to perform under general supervision

Requirements

CA

California (den Tal sedaT ion assis Tan T )

Updated by DANB 11/6/2024

Registered Dental Assistant (RDA) with Dental Sedation Assistant Permit

Education, Training and Credential 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 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) Allowable

* 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

Updated by DANB 7/15/2024

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.

Dental Assistant 1

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.

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.

Updated by DANB 7/15/2024

Dental Assistant 1 C olorado

Education, Training and Credential Requirements

A dental assistant in 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.

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

• The use of tray, light, or light and tray whitening process systems (prescription strength) that are available only to dentists

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.

Conne CT i C u T

State-approved 8/7/2024

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.

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 or a radiation health and safety competency assessment administered by a dental education program in the state that is accredited by the ADA’s Commission on Dental Accreditation.

Note: Per state legislation passed during the 2023 session, “on or before January 1, 2025, The University of Connecticut School of Dental Medicine shall develop a radiation health and safety competency assessment for dental assistants that reflects current industry practices regarding the taking of dental x-rays. Such assessment shall be a suitable competency evaluation, the successful completion of which would allow a dental assistant to take dental x-rays under the direct supervision of a licensed dentist pursuant to the provisions of subdivision (1) of subsection (c) of section 20-112a of the general statutes, as amended by this act.”

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

C onne CT i C u T

State-approved 8/7/2024

Dental Assistant 1

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 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)

Education, Training and Credential Requirements

44. Taking of impressions for study models

• A licensed dentist may delegate to dental assistants such dental procedures as he/she may deem advisable

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

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

d ela W are

Reviewed by DANB 7/10/2024†

† 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 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.

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 waivedcontact the Delaware ORC for more information.)

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

Dental Assistant 1

Reviewed by DANB 7/10/2024

Dental

Assistant 1

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.

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

d is T ri CT of Columbia

Updated by DANB 7/18/2024†

† 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).

District of Columbia Career Ladder

There are three 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.

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 or Level III 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.

The following functions shall not be delegated to dental auxiliaries:

2. The charting of cavities during preliminary examination, prophylaxis, or polishing

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

35. Placing initial periodontal dressing

46. Taking final impressions

47, 50. Placement of temporary restorations

59. Administering or monitoring nitrous oxide

63, 69.Applying and removing a socket dressing

• The restoration of a tooth

• 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

• Adjusting occlusion of natural teeth, restorations, or appliances

• Registration of jaw relations

• Cementing permanent crowns or restorations

• Applying silver diamine fluoride

• Glucose monitoring

• Whitening or bleaching (internal, laser, or high-intensity light)

• Using a high speed handpiece intraorally

• Oral cancer screenings

• Oral cancer tissue biopsy

• Placement of subgingival medicaments

• Removing intracoronal temporary restorations

• Placement of liquid dam

dis T ri CT of C olumbia

by DANB 7/18/2024

Level 1 Dental Assistant 1

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. Pass the District of Columbia Dental Assistant Law Examination AND

III. Apply to the D.C. Board of Dentistry for 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.

Under Direct Supervision*

6. Placing retraction cord

13. Removing sutures

18. Applying fluoride (rinse, foam tray, and fluoride varnish)

27, 45, 48. Placing or removing materials for the isolation of the dentition, provided that the material is not retained by the dentition

35. Placing periodontal dressings

37. Take and record vital signs

44. Taking impression for study models or diagnostic casts

45. Placing matrices

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 and night guards on models

• Performing intraoral photography

• Curing by the use of halogen light

• Checking for loose bands

• Whitening or bleaching using trays

• Other functions as approved by the Board

Under Direct Supervision* of an Orthodontist

15. Placing and removing arch wires

29. Preparing and fitting orthodontic bands

• Removing excess cement from around orthodontic bands

• Cementing orthodontic bands, placing bonded attachments, or removing cemented or bonded orthodontic bands and attachments

• Placing elastics and ligatures

• Selecting headgear

dis T ri CT of C olumbia

Updated by DANB 7/18/2024

Level 2 Dental Assistant 2

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 a current and valid certification as a Certified Dental Assistant (CDA) in general duties from the DANB or another 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. Pass the District of Columbia Dental Assistant Law Examination AND

V. Apply for registration as a Level II Dental Assistant to the D.C. 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*

14. Drying a root canal

27. Placing or removing a rubber dam

35. 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. 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

• Applying desensitizing agents;

• Etching

• All functions permitted to Level I Dental Assistant

Under Direct Supervision* of an Orthodontist

15. Placing and removing arch wires

29. Preparing and fitting orthodontic bands

• Removing excess cement from around orthodontic bands

• Cementing orthodontic bands, placing bonded attachments, or removing cemented or bonded orthodontic bands and attachments

• Placing elastics and ligatures

• Selecting headgear

dis T ri CT of C olumbia

Updated by DANB 7/18/2024

Level 3 Dental Assistant

Education, Training and Credential Requirements

To be registered as a Level III Dental Assistant in the District of Columbia, one must:

I. Have graduated from high school or hold a general equivalency diploma AND

II. Successfully complete a dental assisting education program approved by the D.C. Board of Dentistry or accredited by the Commission on Dental Accreditation (CODA) 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. Hold a current and valid certification as a Certified Dental Assistant (CDA) in general duties from the DANB or another dental assisting certification approved by the Board AND

V. Obtain DANB Certified Preventive Functions Dental Assistant (CPFDA) Certification AND

VI. Pass a Board-approved, hands-on course in the functions and duties permitted to be performed by a Level III Dental Assistant AND

VII. Pass the District of Columbia Dental Assistant Law Examination AND

VIII.Apply for registration as a Level III Dental Assistant to the D.C. 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*

9. Coronal polishing to remove stain and biofilm

40. The application of pit and fissure sealants

• Glucose testing

• All functions permitted to Level I and Level II Dental Assistants

Under Direct Supervision* of an Orthodontist

15. Placing and removing arch wires

29. Preparing and fitting orthodontic bands

• Removing excess cement from around orthodontic bands

• Cementing orthodontic bands, placing bonded attachments, or removing cemented or bonded orthodontic bands and attachments

• Placing elastics and ligatures

• Selecting headgear

f lorida

State-approved 8/12/2024

State Career Ladder

There are three 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.

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.

46. Taking impressions for the purpose of fabricating any intraoral restorations or orthodontic appliance

• Gingival curettage and root planing

• 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

State-approved 8/12/2024

On-the-Job Trained Dental Assistant 1 florida

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 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*

56. Applying topical anesthetics and anti-inflammatory agents which are not applied by aerosol or jet spray

• Change bleach pellets in the internal bleaching process of non-vital, endodontically treated teeth after the placement of a rubber dam

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

Under General Supervision*

24. Instructing patients in oral hygiene care and supervising oral hygiene care

47. Fabricating temporary crowns or bridges in a laboratory

• Provide educational programs, faculty or staff programs, and other educational services, which do not involve diagnosis or treatment of dental conditions

florida

State-approved 8/12/2024

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.

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 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 existing restorations and missing teeth and a visual assessment of existing oral conditions

6. Packing and removing retraction cord, so long as it does not contain vasoactive chemicals and is used solely for restorative dental procedures

9. Polishing clinical crowns when not for the purpose of changing the existing contour of the tooth and only with burnishers, slow-speed handpieces, rubber cups, bristle brushes, and porte polishers, used with appropriate polishing materials

29. Selecting and pre-sizing orthodontic bands, including the selection of the proper size band for a tooth to be banded which does not include or involve any adapting, contouring, trimming, cementing, or otherwise modifying the band material such that it would constitute fitting the band

29. Removing and recementing properly contoured and fitting loose bands that are not permanently attached to any appliance

44. Making impressions for study casts which are being made for the purpose of fabricating orthodontic retainers

47. Fabricating temporary crowns or bridges intraorally which shall not include any adjustments of occlusion to the appliance or existing dentition

50. Cementing temporary crowns and bridges with temporary cement

50, 54, 55. Placing or removing temporary restoration with non-mechanical hand instruments only

54. Removing excess cement from dental restorations and appliances with non-mechanical hand instruments only

59. Monitor the administration of nitrous oxide oxygen making diminishing adjustments only during this administration and turning it off at the completion of the dental procedure (with completion of appropriate training and CPR certification; see requirements above)

63, 69. Inserting or removing dressings from alveolar sockets in post-operative osteitis

64. Taking of impressions for and delivery of at-home bleaching trays

• Polishing dental restorations of the teeth when not for the purpose of changing the existing contour of the tooth and only with burnishers, slow-speed handpieces, rubber cups, and bristle brushes, used with appropriate polishing materials

• Selecting and pre-sizing archwires prescribed by the patient’s dentist so long as the dentist makes all final adjustments to bend, arch form determination, and symmetry prior to final placement

• Selecting prescribed extraoral appliances by pre-selection or pre-measurement, not including final fit adjustment

• Preparing a tooth surface by applying conditioning agents for orthodontic appliances by conditioning or placing of sealant materials which does not include placing brackets

Allowable functions for this level continued on next page

*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 authorizes the procedures to be performed but need not be present when the authorized procedures are being performed. The authorized procedures may also be performed at a place other than the dentist’s usual place of practice.

florida

State-approved 8/12/2024

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

15. Securing or unsecuring an archwire by attaching or removing the fastening device

18. Applying topical fluorides which are approved by the ADA or the FDA

22. Positioning and exposing dental and carpal radiographic film and sensors

27. Placing or removing rubber dams

34. Applying cavity liners, varnishes, or bases

35. Placing periodontal dressings

Education, Training and Credential Requirements

40. Applying sealants

42. Placing or removing prescribed pre-treatment separators

44. Making impressions for study casts which are not being made for the purpose of fabricating any intraoral appliances, restorations or orthodontic appliances

45. Placing or removing matrices

46. Making impressions to be used for creating opposing models or the fabrication of bleaching stents and surgical stents to be used for the purpose of providing palatal coverage

62. Removing periodontal or surgical dressings

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 within 24 months of admittance to the mandatory restorative functions training course. AND

VI. Complete the 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

Note: All students must have a delegating dentist to enroll in the mandatory restorative functions training program.

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 composite restorations

43. Fitting and contouring (but not permanently cementing) stainless steel crowns

(The tasks shall only be performed using a slow speed handpiece and hand instruments.)

*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 authorizes the procedures to be performed but need not be present when the authorized procedures are being performed. The authorized procedures may also be performed at a place other than the dentist’s usual place of practice.

Dental Assistant formally trained in restorative functions 3

g eorgia

Reviewed by DANB 7/10/2024†

† 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 Career Ladder

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.

State Radiography Requirements

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.

Functions NOT Permitted by Dental Assistants in Georgia

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

• The administration of any medication or drugs given to a patient through phlebotomy and venipuncture procedures

Dental Assistant 1 georgia

Reviewed by DANB 7/10/2024

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.

During the administration of deep sedation/general anesthesia in the dental office or a site approved by the Board, all staff must be certified in cardiopulmonary resuscitation at the basic life support level given by a board-approved sponsor

There are no other 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.

Under Direct Supervision*

9. Use a rubber cup prophy on a patient with primary dentition** (see note below)

13. Remove sutures (other than wire sutures)

14. Dry canals with absorbent points and place soothing medicaments (not to include endodontic irrigation); and place and remove temporary stopping with non-mechanical hand instruments only

15. Select, pre-size and seat orthodontic arch wires with brackets which have been placed by the dentist

15. Cut and tuck ligatures, remove ligatures and arch wires, remove loose or broken bands

22. Place and expose radiographs with such training as may be required by law

27. Place and remove rubber dams

29. Select and pre-size orthodontic bands which initially must be seated by the dentist

42. Place and remove pre-treatment separators

44. Make impressions diagnostic models and opposing models

45. Place matrix bands and wedges

47. Fabricate extraorally temporary crowns and bridges

47, 50. Cement temporary crowns and bridges with intermediate cement

50. Place intracoronal temporary restorations using intermediate cement

54. Remove temporary crowns and bridges seated with intermediate cement

56. Apply topical anesthetic

61. Remove visible excess cement from supramarginal areas of dental restorations and appliances with non-mechanical hand instruments

62. Remove periodontal dressing

69. Remove dry socket medication

• Place drying and de-oiling agents prior to the cementation of permanent crowns and bridges

• Place and take off a removable prosthesis with a pressure sensitive paste after the appliance has been initially seated by the dentist

• Etch unprepared enamel

• Polish the enamel and restorations of the anatomical crown through the use of a slow speed handpiece (not to exceed 10,000 rpm), rubber cup and polishing agent; this procedure shall be used only for the purpose of enamel preparation for: 1) Bleaching, 2) Cementation of fixed restorations, 3) Bonding procedures including supramarginal enamel restorations after removal of orthodontic appliances

• Remove and re-cement loose bands that have previously been contoured and fitted by a dentist, but only after a dentist has examined the affected tooth and surrounded gingiva and found no evidence of pathology

• Perform phlebotomy and venipuncture procedures (after 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 is acquired)

**The Georgia Board of Dentistry has issued a policy addendum clarifying that “rubber cup prophy” refers to coronal polishing.

Direct Supervision:

georgia

Reviewed

by DANB 7/10/2024

Expanded Duty Dental Assistant (EDDA)

Education, Training and Credential 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

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

* 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.

State-approved 9/10/2024

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.

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.

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

Dental Assistant 1

9/10/2024

Dental Assistant 1

Education, Training and Credential 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).

A dental assistant may perform specified tasks under the general supervision of a licensed dentist or a licensed dental hygienist who is under the supervision of a licensed dentist to provide auxiliary support dental services in a public health setting (see Hawaii Revised Statutes Section 447-3 for definition of “public health setting”).

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 reporting observations to the supervising licensed dentist; provided that this is not interpreted as an oral cancer screening

2. Collecting medical and dental histories, taking intra-oral and extra-oral photographs, and recording or charting clinical findings as dictated by the licensed dentist or dental hygienist

13, 62, 69. Removing dressing and sutures

22, 52, 53. Exposing, processing, mounting, and labeling radiographs

24, 26. Relating pre-operative and post-operative instructions, and patient education in oral hygiene as instructed by the supervising licensed dentist or dental hygienist

29, 42. Making intra-oral measurements for orthodontic procedures, performing the preliminary selection and sizing of bands; checking for loose bands and bonded brackets; placing and removing orthodontic separators, ligature ties, and inter-arch elastics (i.e. chain elastics and rubber bands); fitting and removing head appliances; and removing arch wires

37. Measuring and recording vital signs

44. Making impressions for study casts, opposing models, occlusal appliances (e.g. splints, bite guards), mouth guards, orthodontic retainers, and medicament trays

45. Placing matrix retainers

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

Under General Supervision* in a Public Health Setting

2. Taking intra-oral and extra-oral photographs, and recording or charting clinical findings as directed by the licensed dental hygienist

22, 52, 53. Exposing, processing, mounting, and labeling radiographs

37. Measuring and recording vital signs

• Assisting the licensed dental hygienist who is performing a dental procedure on a patient, such as:

11. Transferring dental instruments or any other concept of four-handed dentistry the licensed dental hygienist requires to perform the procedure

41. Preparing procedural trays and armamentaria

* HAR 16-79-2 Definitions

56. Placing non-aerosol topical anesthetics

59. Monitoring the nitrous oxide/oxygen unit and reporting to the supervising dentist any adverse observations, provided the licensed dentist evaluates, initiates, and administers the sedation

• Completing prescription and authorization forms for drug or restorative, prosthodontic or orthodontic appliance for the supervising licensed dentist whereby the dentist signs the forms

• Performing a try-in with any removable prosthetic or orthodontic appliance, provided the supervising licensed dentist makes the adjustments

• Assisting the licensed dental hygienist in the performance of their duties

• Assisting the licensed dentist who is actually performing a dental procedure on the patient, including:

11. Transferring dental instruments

21. Mixing dental materials

27. Placing and removing the rubber dam

30, 58. Any other concept of four-handed dentistry the dentist requires to perform the procedure

41. Preparing procedural trays/armamentaria set-ups

48. Retracting a patient’s oral tissues to maintain the field of operation during the dental procedure

48. Removing debris, as is normally created and accumulated during or after operative procedures by the dentist

48. Retracting a patient’s oral tissues to maintain the field of operation during a dental procedure

48. Removing debris, as is normally created and accumulated during or after dental procedures by the licensed dental hygienist

• Assisting the licensed dental hygienist in the performance of the duties of the dental hygienist as requested; provided that the assistance does not include prohibited duties of dental assistants (HAR 16-79-69.5) or allowable duties of dental hygienists (HAR 16-79-69.10).

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 in any facility defined in section 447-3, HRS while the procedures are being performed, and shall be responsible for all delegated acts and procedures performed by dental assistants.

General Supervision: The supervising licensed dentist has examined and diagnosed the condition to be treated, and has authorized each procedure to be carried out in accordance with the dentist’s diagnosis and treatment plan. The presence of the supervising dentist is not required; provided the dentist shall be available for consultation and shall be responsible for all delegated acts and procedures performed by licensed dental hygienists. In the case of programs under the supervision and control by the department of health or in any facility specified in section 447-3, HRS, the foregoing shall not apply except that the supervising licensed dentist shall be available for consultation, shall be responsible for all delegated acts and procedures performed by licensed dental hygienists and the procedures pursuant to 447-3, HRS, shall have been prescribed by a licensed dentist or otherwise be authorized by law.

State-approved 8/27/2024

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

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.

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

• Final removal of any fixed appliance

Dental Assistant 1

State-approved 8/27/2024

Dental Assistant 1 idaho

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 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.

i llinois

State-approved 7/16/2024

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.

State Radiography Requirements

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.

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

State-approved 7/16/2024

Dental Assistant 1

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 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*

• Any authorized or prescribed services or procedures for which the dental assistant is considered competent by the supervising dentist as a result of on-the-job training

• After being authorized by a dentist, remove loose, broken, or irritating orthodontic appliances on a patient of record for the purpose of eliminating pain or discomfort

DANB’s Note on Allowable Dental Assisting Functions

In the state of Illinois, 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.

*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.

Dental Assistant qualified in expanded functions

Coronal Scaling and Intracoronal Temporization Restorative (Amalgams, Composites and Interim Restorations)

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:

I. Have at least 2,000 hours of direct clinical patient care experience

AND

II. Complete an approved coronal polishing course prior to taking coronal scaling course

AND

III. Complete a structured training program in coronal scaling and intracoronal temporization of a tooth provided by an educational institution (such as a dental school, dental hygiene or dental assisting program), an approved CE provider, or a statewide dental or dental hygienist association approved by the Department, that includes:

• minimum 32 hours of didactic and clinical manikin or human subject instruction in specified content

• an outcome assessment exam that demonstrates competency

• completion of 6 full-mouth scaling procedures, observed and approved by supervising dentist (if training not from a CODA-accredited dental assisting program)

• issuance of a certificate of completion (kept on file at the dental office)

Allowable Functions

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:

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

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

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

I. Be at least 18 years of age

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

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.

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”

20. Perform coronal scaling (using hand instruments) above the gum line, supragingivally, on the clinical crown of the tooth only on patients 17 years of age or younger who have an absence of periodontal disease and who are not medically compromised or individuals with special needs**

• Perform intracoronal temporization of a tooth (using hand instruments)

** 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 300% of the federal poverty level

Under Direct Supervision*

12, 51. Placing, carving, and finishing amalgam restorations

33. Place, pack, and finish composite restorations

50. Place interim restorations

Under Supervision”

9. Coronal polishing

40. Application of pit and fissure sealants

59. Monitor the patient while nitrous oxide is being administered

• Monitor a patient under minimal sedation, moderate sedation, deep sedation or general anesthesia

• All duties designated to Dental Assistants, under the same level of required supervision

*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

illinois

State-approved 7/16/2024

Expanded Function Dental Assistant 3

Education, Training and Credential 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

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**

20. Perform coronal scaling (using hand instruments)**

49. Perform pulp vitality test‡

59. Start the flow of oxygen and monitoring of nitrous oxide-oxygen analgesia‡

• Perform intracoronal temporization of a tooth (using hand instruments)

** 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

*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.

i ndiana

Reviewed by DANB 7/17/2024†

† 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 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 / Dental Assistant qualified in applying medicaments for the control and prevention of dental caries / Dental Assistant qualified in administering nitrous oxide

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 Department of Health/Division of Radiology and Weights & Measures.

To obtain this license, one must:

I. a. Successfully complete a CODA-accredited program in radiography OR b. Successfully complete an Indiana 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 Department of Health/ Division of Radiology and Weights & Measures AND

IV. Apply to the Indiana Department of Health/Division of Radiology and Weights & Measures for a limited dental radiographic license

The Indiana 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 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.

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

Dental Assistant 1 i ndiana

Reviewed by DANB 7/17/2024

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 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 applying medicaments for the control and prevention of dental caries

Education, Training and Credential 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

Dental Assistant qualified in nitrousadministering oxide

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

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.

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. Polish the coronal surface of teeth 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)

Dental Assistant qualified in coronal polishing

State-approved 7/15/2024

State Career Ladder

There are four 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.

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 has completed on-the-job training OR d. Be a dental assistant in another state within the previous five years with clinical experience taking dental radiographs AND

II. Provide proof of successful completion of education, clinical training and examination in dental radiography within the five years prior to application (The education and clinical training may be completed on the job as a dental assistant, as part of an accredited dental assisting program, or through DANB.)

AND

III. Provide proof that he or she successfully completed an exam in the area of dental radiography (The following exams meet this requirement: the board’s examination for dental assistants, which includes sections on infection control/hazardous materials, radiography, and jurisprudence; a board-approved examination in the area of dental radiography; DANB’s RHS exam; an examination in the area of dental radiography administered by accredited dental assisting programs; or a board-approved CE course in the area of dental radiography, which includes a posttest examination at completion.)

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

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

• Administration of local anesthesia

• Procedures that require the professional judgment and skill of a dentist

Dental Assistant Trainee

Education, Training and Credential Requirements

Dental assistant trainees are individuals who are engaging in on-the-job training to meet the requirements for registration and who are learning the necessary skills while employed in a dental office under the personal supervision of a licensee or registrant as delegated by a licensed dentist.

A Dental Assistant Trainee must successfully complete on-the-job training and examinations in the areas of infection control, hazardous materials, and jurisprudence to meet requirements for dental assisting registration.

If a trainee fails to become registered by the trainee status expiration date (12 months from the start of trainee employment), the trainee must stop work as a dental assistant trainee.

Allowable Functions

Under Personal Supervision*

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.

No allowable functions are specified in the state practice act, with the exception of on-the-job training in dental radiography for trainees 18 years of age or older (see “State Radiography Requirements” on previous page for additional requirements).

DANB’s Note on Allowable Dental Assisting Functions

In the state of Iowa, 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 dentist is present in the treatment facility, but it is not required that the dentist be physically present in the treatment room or the dentist is not present in the treatment facility but is able to appear using live video upon request with a response time similar to what would be expected if the dentist were present in the treatment facility

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. If a dentist will not be present, the following requirements shall be met: (1) patients or their legal guardians must be informed prior to the appointment that no dentist will be present and therefore no examination will be conducted at that appointment; (2) the dental assistant must consent to the arrangement; (3) basic emergency procedures must be established and in place, and the dental assistant must be capable of implementing these procedures; and (4) the treatment to be provided must be prior-prescribed by a licensed dentist and must be entered in writing in the patient record.

Personal Supervision: A licensee or registrant is physically present in the room to oversee and instruct all services of the dental assistant trainee as delegated by a licensed dentist.

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.

Registered Dental Assistant

Education, Training and Credential Requirements

To qualify as a Registered Dental Assistant (RDA) in Iowa, one must:

I. a. Work in a dental office as a dental assistant trainee (see requirements on previous page) until competency is achieved as determined by the supervising dentist OR b. Work as a dental assistant in another state, district or territory within five years prior to the date of application OR c. Graduate from an accredited dental assisting program AND

II. Pass required exams in infection control/hazardous materials and jurisprudence; exams approved for this purpose are: those exams or CE courses with posttest exams approved by the IDB; those administered by accredited dental assisting programs, 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

III. Hold current CPR certification that included a hands-on component AND

IV. 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 applicant must submit a completed application for registration and fee, verification form completed by the licensing authority that issued applicant’s license, 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

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 p. 58)

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

*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 or the dentist is not present in the treatment facility but is able to appear using live video upon request with a response time similar to what would be expected if the dentist were present in the treatment facility

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. If a dentist will not be present, the following requirements shall be met: (1) patients or their legal guardians must be informed prior to the appointment that no dentist will be present and therefore no examination will be conducted at that appointment; (2) the dental assistant must consent to the arrangement; (3) basic emergency procedures must be established and in place, and the dental assistant must be capable of implementing these procedures; and (4) the treatment to be provided must be prior-prescribed by a licensed dentist and must be entered in writing in the patient record.

Personal Supervision: A licensee or registrant is physically present in the room to oversee and instruct all services of the dental assistant trainee as delegated by a licensed dentist. 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.

Registered Dental Assistant trained in Level 1 expanded functions

Education, Training and Credential Requirements

To perform Level 1 expanded functions, a Registered Dental Assistant must complete a Board-approved training program and receive a certificate of completion in each Level 1 expanded function performed.

To qualify for Level 1 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 three months of clinical practice as a registered dental assistant OR

IV. Have a minimum of three months of clinical practice as a dental assistant in a state that does not require registration

A dentist may delegate to dental assistants only those expanded function procedures in which training has been successfully completed.

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.

Level 1 Expanded Functions

Under Direct Supervision*

6. Placement and removal of gingival retraction

29. Placement, bonding, and removal of provisional orthodontic restorations as follows: (a) Placement or bonding of orthodontic brackets and bands or provisional orthodontic appliances following review of the fit and function by the supervising dentist; and (b) Removal of adhesive, orthodontic brackets and bands, or provisional orthodontic appliances using nonmotorized hand instrumentation

34. Applying cavity liners and bases and desensitizing agents

46. Taking final impressions

47, 50. Fabrication, temporary cementation, and removal of provisional restorations following review of the fit and function by the supervising dentist, and temporary recementation of provisional restorations

50. Placement of temporary restorative materials following preparation of the tooth by a dentist;

• Applying bonding systems, which may include the placement of the attachments used in clear aligner systems, following review of the fit and function by the supervising dentist

• Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth

• Tissue conditioning (soft reline only)

Under General Supervision*

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

• Recementation of provisional restorations

*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 or the dentist is not present in the treatment facility but is able to appear using live video upon request with a response time similar to what would be expected if the dentist were present in the treatment facility

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. If a dentist will not be present, the following requirements shall be met: (1) patients or their legal guardians must be informed prior to the appointment that no dentist will be present and therefore no examination will be conducted at that appointment; (2) the dental assistant must consent to the arrangement; (3) basic emergency procedures must be established and in place, and the dental assistant must be capable of implementing these procedures; and (4) the treatment to be provided must be prior-prescribed by a licensed dentist and must be entered in writing in the patient record.

Personal Supervision: A licensee or registrant is physically present in the room to oversee and instruct all services of the dental assistant trainee as delegated by a licensed dentist.

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.

State-approved 7/15/2024

4

Registered Dental Assistant trained in Level 2 expanded functions

Education, Training and Credential Requirements

To perform Level 2 expanded functions, a Registered Dental Assistant must complete a Board-approved training program in each Level 2 expanded function procedure to be performed and receive a certificate of completion. To be eligible for approval, Level 2 expanded function training must be offered through the University of Iowa College of Dentistry or a program accredited by CODA.

Before beginning Level 2 training, dental assistants must complete all prerequisites established by the accredited school for the Level 2 training to be completed.

A dentist may delegate to dental assistants only those expanded function procedures in which training has been successfully completed.

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.

Level 2 Expanded Functions:

Under Direct Supervision*

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

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

*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 or the dentist is not present in the treatment facility but is able to appear using live video upon request with a response time similar to what would be expected if the dentist were present in the treatment facility

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. If a dentist will not be present, the following requirements shall be met: (1) patients or their legal guardians must be informed prior to the appointment that no dentist will be present and therefore no examination will be conducted at that appointment; (2) the dental assistant must consent to the arrangement; (3) basic emergency procedures must be established and in place, and the dental assistant must be capable of implementing these procedures; and (4) the treatment to be provided must be prior-prescribed by a licensed dentist and must be entered in writing in the patient record.

Personal Supervision: A licensee or registrant is physically present in the room to oversee and instruct all services of the dental assistant trainee as delegated by a licensed dentist.

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.

State-approved 7/16/2024

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.

State Radiography Requirements

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.

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)

State-approved 7/16/2024

Dental Assistant 1 kansas

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

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.

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.

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:

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 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

20. Coronal scaling (not including subgingival scaling)

59. Assisting in the administration and monitoring of nitrous oxide 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.

Dental Assistant with expanded duties training 2

State-approved 8/14/2024

State Career Ladder

There are two 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.

State Radiography Requirements

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures in Kentucky, a dental assistant must complete ten hours of training that includes a six-hour Kentucky Board-approved course in dental radiography safety* and one of the following:

I. Four hours of instruction in dental radiography technique under the employment and supervision of the dentist in the office OR

II. A four-hour course in radiography technique approved by the Kentucky Board of Dentistry

Functions NOT Permitted by Dental Assistants in Kentucky

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. 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, prescribing, or authorization for restorative, prosthodontic or orthodontic appliances

• Surgical procedures on tissues of the oral cavity or any other intraoral procedure that contributes to or results in an irreversible alteration of the oral anatomy

• 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

8/14/2024

Dental Auxiliary 1

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

Education, Training and Credential Requirements

Registered Dental Assistant (RDA) simply refers to an assistant who has been registered by their employer dentist and is not a recognition of any special training or achievement. The responsibility to register assistants and document CPR training belongs to the employer dentist. 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 Technique 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 Duties List

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

I. Successfully complete an eight-hour course at a CODA-accredited institution 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 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 a board-approved course in starting IV lines AND

II. Submit documentation of course completion to the supervising dentist, who shall retain such documentation 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 65.

Note: If the operating dentist authorizes a third-party qualified anesthesia provider to administer moderate sedation, deep sedation, or general anesthesia, the operating dentist shall confirm that at least two (2) members of the onsite care team, including RDAs, maintain current certifications in:

1. BLS for Healthcare Providers; and

2. ACLS if sedation is administered to an adult patient; or

3. PALS if sedation is administered to a pediatric patient.

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. Expose radiographs (see “Radiography Requirements” on p. 65)

• Establish and remove intravenous lines (see requirements above)

Allowable functions for this level continued on next page

ken T u C ky

State-approved 8/14/2024

Allowable Functions (for Registered 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 Direct Supervision* and Dentist’s Direct Orders

• Initiate nitrous oxide sedation if given specific instructions regarding the mode of administration and the titration, rate, and dosage of the anesthetic agent

Under Direct Supervision* of a Sedation Permit Holder

37. Record vital sign measurements in the sedation record

• Apply noninvasive monitors on the patient

• Perform continuous observation of patients and noninvasive monitors appropriate to the level of sedation, during the preoperative, intra-operative and post-operative (recovery) phases of treatment

• Report monitoring parameters at pre-determined intervals, and if changes in monitored parameters occur

• Assist in the management of a patient emergency

• Administer 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. The supervising dentist shall accept sole responsibility for the actions of the dental assistant.

l ouisiana

State-approved 7/15/2024

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.

State Radiography Requirements

Expanded Duty Dental Assistant (EDDA)

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.

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 nitrous oxide inhalation analgesia

• 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

State-approved 7/15/2024

Dental Assistant 1

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 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 make preliminary inspections of the mouth and teeth with a mouth mirror and floss only

13, 69. Remove sutures, post-extraction dressing and surgical ligature ties

15. Place or remove ligatures, cut and tuck ligatures, remove tension devices and any loose or broken bands or arch wires

18. Apply topical fluorides following prophylaxis by a dentist or dental hygienist

22, 52. Take and develop dental radiographs and intraoral photographs (See “Radiography Requirements” on previous page)

24. Give intraoral instructions and demonstrations on oral hygiene procedures

27. Apply and remove rubber dams

30. Serve as the dentist’s chair side assistant

37. Take and record pulse, blood pressure and temperature

39. Receive removable prostheses for cleaning or repair work

42. Place or remove temporary orthodontic separating devices

43. Place or remove preformed crowns or bands for determining size only when recommended by the dentist and only under his or her supervision

44. Make preliminary study model and opposing model impressions

47, 54. Fabricate and remove interim crowns or bridges (interim meaning temporary while permanent restoration is being fabricated)

54, 61. Remove cement from dental restorations and appliances, with hand instruments, limited to the clinical crown

56. Apply non-aerosol topical anesthetics

• Apply desensitizing agents

• Apply non-endodontic oxygenating agents

• Make dental plaque smears

• Place a removable retaining device in the mouth of a patient

• Remove final impressions

• Condition teeth prior to placement or orthodontics bands or brackets

*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.

State-approved 7/15/2024

Expanded Duty Dental Assistant 2

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).

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:

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.

State-approved 7/9/2024

State Career Ladder

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.

State Radiography Requirements

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 BLS 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.

Functions NOT Permitted by Dental Assistants in Maine

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

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 and as long as those activities do not require a license. 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 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 a Dentist’s Supervision and Control

• Activities related to dental care and treatment that are delegated by custom and usage

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.

State-approved 7/9/2024

Expanded Function Dental Assistant (EFDA) 2

Education, Training and Credential 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 BLS 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 BLS, 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.

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. 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

• 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.

m aryland

State-approved 7/1/2024

State Career Ladder

There are three 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.

Expanded Function Dental Assistant (see Note on page 76) 3

Dental Assistant 2 1

Dental Assistant Qualified in General Duties

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 77

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

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 (see Note on page 76)

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

40. Apply pit and fissure sealants (see Note on page 76)

59. Monitoring nitrous oxide (see Note on page 76)

• Examination, diagnosis and treatment planning

• Surgery on hard or soft tissues

• Administering injectable local anesthesia

Prohibited Functions list continued on next page.

maryland

State-approved 7/1/2024

Functions NOT Permitted by Dental Assistants

in Maryland, continued

• 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 (see Note on page 76)

• 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

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. 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

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)

Under General Supervision*

• Assist in performing intraoral photography, other than conventional or digital x-ray; supervising dentist must review the photography and authorize the treatment plan (under new law effective 10/1/2022; see Note on page 76)

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

maryland

State-approved 7/1/2024

Dental Assistant Qualified in General Duties (see Note on next page**)

Education, Training and Credential 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

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

State-approved 7/1/2024

Expanded Function Dental Assistant (see Note below**) 3

Education, Training and Credential Requirements

To perform specified intraoral procedures under the direct supervision of a licensed dentist, a dental assistant must obtain a state Expanded Function Dental Assistant certificate.

To qualify, one must:

I. Be at least 18 years old and of good moral character AND

II. Be a high school graduate or have attained a high school equivalency AND

III. Successfully complete a course of study approved by the Maryland State Board of Dental Examiners and meeting the requirements of Maryland law related to the intraoral procedure for which the applicant has applied for a certificate AND

IV. Hold the appropriate certification from DANB AND

V. Pass an examination provided by the Maryland State Board of Dental Examiners AND

VI. Submit to a criminal background check, apply to the Maryland State Board of Dental Examiners, and pay applicable fee

Allowable

Functions (see Note below**)

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 only to remove stain or biofilm in connection with a dental prophylaxis and before a dentist performs an estethic or cementation procedure

40. Placing dental sealants

59. Monitoring nitrous oxide by observing a patient

• Applying silver diamine fluoride

• Assisting in orthodontic procedures authorized by the Board

• Additional intraoral procedures authorized by the Board

**Note: The Maryland Legislature passed a law in 2022 (HB 968) authorizing the creation of a new expanded function dental assistant (EFDA) level who may perform specified expanded functions. The new EFDA categories will replace the Dental Assistant Qualified in General Duties or Orthodontics titles detailed in this document. Although the effective date of the law is 10/1/2022 and the Maryland State Board of Dental Examiners has drafted rules to implement this new law, the new rules are not yet finalized and effective. Until the effectiveness of the new rules, the current requirements for the Dental Assistant Qualified in General Duties or Orthodontics titles remain in effect.

Requirements

MD

m aryland ( o r T hodon T i C )

State-approved 7/1/2024

Dental Assistant Qualified in Orthodontics (see Note on previous page**)

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 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*

15. Placing and removing arch wires

15. Placing elastics and ligatures

29. Preparing and fitting orthodontic bands

44. Taking alginate impressions for intraoral appliances

54, 61. Removing excess cement from around orthodontic bands

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

• Cementing of orthodontic bands, placement of bonded attachments, or the removal of cemented or bonded orthodontic bands and attachments

• Selecting headgear

• Applying desensitizing agents

• All duties designated to Dental Assistants, under the same level of required supervision

• Any other duty approved by the Board (see the “Dental Auxiliaries Procedures Chart” on the Maryland 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.

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 (see Note on page 76)

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 (see Note on page 76)

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 (see Note on page 76)

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 (see Note on page 76)

• 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)

m assa C huse TT s

State-approved 7/3/2024

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.

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.

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

State-approved 7/3/2024

Dental Assistant Trained on the Job (OJT) 1

Education, Training and Credential 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 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*

12, 33. Place restorative materials in tooth for condensation and finishing by the dentist

34. Apply cavity varnish, liner(s) and bonding agents

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

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, 64. Take impressions for athletic mouth guards

45. Place and remove matrix bands

47. Fabricate provisional restorations intraorally

47, 54. Cement and remove temporary crowns and bridges

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

58. Removal of implant healing caps/cover screws for restorative procedures

59. Assist or monitor nitrous oxide analgesia

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

68. Perform minor emergency palliative orthodontic adjustments to eliminate pain and discomfort

• Place and remove wedges

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

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

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 Direct Supervision*

6. Place and remove gingival retraction materials

13. Remove sutures

15. Place and remove orthodontic arch wires

18. Apply anti-cariogenic agents, including fluoride varnish

24. Provide oral health instruction

27. Place and remove dental dams

29. Preliminary intraoral fit of bands

42. Place and remove orthodontic separators

44. Take impressions for orthodontic retainers

50. Place cotton pellets and temporary restorative materials into endodontic openings

56. Apply topical anesthetic agents

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

• Record dental screenings

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

• Preliminary oral fit of arch wire

• Apply desensitizing agents

• 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

See note on page 81 for information about delegation of administering COVID-19 tests to dental assistants.

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.

State-approved 7/3/2024

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

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 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*

12, 33. Place restorative materials in tooth for condensation and finishing by the dentist

34. Apply cavity varnish, liner(s) and bonding agents

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

50. Place temporary sedative restorations/fillings (CA only; FTDA is not allowed to perform this function)

54, 55. Remove temporary restorations with hand instruments

58. Removal of implant healing caps/cover screws for restorative procedures

59. Assist or monitor nitrous oxide analgesia

70. Place stainless steel crowns

• Place temporary soft liners in a removable prosthesis (FTDA; CA may perform under immediate supervision)

• Obtain endodontic cultures (FTDA; CA may perform under direct supervision)

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 Direct Supervision*

6. Place and remove gingival retraction materials

40. Apply and adjust dental sealants

45. Place and remove matrix bands

47. Fabricate provisional restorations intraorally

50. Place cotton pellets and temporary restorative materials into endodontic openings

61. Remove excess cement and bonding agents from bridges and appliances (including orthodontic appliances) with hand instruments

• Record dental screenings

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

• Apply desensitizing agents

• Place and remove wedges

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

• Preliminarily fit crowns to check contacts, adjust occlusion on crowns inside the mouth (CA only; FTDA is not allowed to perform this function)

• Place temporary soft liners in a removable prosthesis (CA; 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.

massa C huse TT s

State-approved 7/3/2024

Allowable Functions (for Certified Assistant and Formally Trained 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*

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

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.

*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.

2006-2024

State-approved 7/3/2024

Expanded Function Dental Assistant 3

Education, Training and Credential 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 2024, 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 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*

12, 33. Place restorative materials in tooth for condensation and finishing by the dentist

14 Dry root canals with paper points

34. Apply cavity varnish, liner(s) and bonding agents

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

58. Removal of implant healing caps/cover screws for restorative procedures

59. Assist or monitor nitrous oxide analgesia

• Assist in anesthesia administration, including patient monitoring (must be appropriately trained and hold current certification in BLS for the Healthcare Provider)

Under Direct Supervision*

6. Place and remove gingival retraction materials

12, 51 Place and condense amalgam restorations

33. Place and finish composite restorations

51. Carve, contour, adjust amalgam restorations

70. Place stainless steel crowns

• Record dental screenings

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

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

• Obtain endodontic cultures

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

• Place temporary soft liners in a removable prosthesis

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 page 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

40. Apply and adjust dental sealants

42. Place and remove orthodontic separators

44. 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

45. Place and remove matrix bands

47. Fabricate provisional restorations intraorally

47,54. Cement and remove temporary crowns and bridges

48. Irrigate and aspirate the oral cavity

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

50. Place cotton pellets and temporary restorative materials into endodontic openings

50. Place temporary sedative restorations/fillings

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.

State-approved 7/3/2024

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*

54, 55. Remove temporary restorations with hand instruments

56. Apply topical anesthetic agents

61. Remove excess cement and bonding agents from bridges and appliances (including orthodontic appliances)with hand instruments

68. Perform minor emergency palliative orthodontic adjustments to eliminate pain and discomfort

• 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

• Place elastics and ligature wires

• Remove fixed orthodontic appliances

• Take intra-oral photographs

• Review medical and dental history

• Perform dietary screening for dental disease prevention and control

• Adjust dentures on the tissue side to eliminate tissue irritation

*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.

State-approved 7/30/2024

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.

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

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

• A licensee shall not delegate an act, task, or function to a dental assistant if the act, task, or function, under standards of acceptable and prevailing practice, requires the level of education, skill, and judgment required of the licensee

State-approved 7/30/2024

Unregistered Dental Auxiliary (UDA)

Education, Training and Credential Requirements

A UDA in Michigan may perform basic supportive dental procedures (see below) specified by administrative rules under the direct or general supervision of a licensed dentist.

Before a dentist may delegate a function to a UDA, the UDA must:

I. Submit proof of current certification in BLS or ACLS for healthcare providers with a hands-on component from an agency or organization that grants certification in accordance to AHA standards earned within the previous two years, AND II. Submit proof of at least 1 hour of training in infection control, which must include sterilization of hand pieces, personal protective equipment, and the CDC’s infection control guidelines.

A licensee may delegate to an unlicensed dental auxiliary otherwise qualified by education, training, or experience the performance of selected acts, tasks, or functions where the acts, tasks, or functions fall within the scope of practice of the licensee’s profession and will be performed under the licensee’s supervision.

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 Assignment*

22. Operating dental radiographic equipment (see “Radiography Requirements” on previous page)

• Providing commonly accepted emergency procedures

Under Direct Supervision*

1, 2.Inspecting and charting the oral cavity using a mouth mirror and radiographs including the classifying of occlusion ‡

15. Placing, removing, and replacing orthodontic elastic or wire separators, arch wires, elastics, and ligatures

18. Applying anticariogenic agents including, but not limited to, sealants, fluoride varnish, and fluoride application. UDAs may not place sealants ‡

24. Providing nutritional counseling for oral health and maintenance ‡

29. Cementing orthodontic bands or initial placement of orthodontic brackets and attachments for aligners ‡

44. Taking impressions for intraoral appliances including bite registrations ‡

46. Taking digital scans for final restorations or intra-oral appliances

54. Temporarily cementing and removing temporary crowns and bands ‡

• Dispensing aligners

• Polishing assigned teeth with a slow-speed rotary hand piece immediately before an acid etch procedure ‡

• Etching and placing adhesives before placement of orthodontic brackets and attachment for aligners ‡

• Removing orthodontic bands, brackets, and adhesives with non-tissue cutting hand instruments only. Use of high-speed rotary instruments is not in the scope of practice of a UDA, RDA, or RDH.

Under General Supervision*

26. Instructing in the use and care of dental appliances

29. Trial sizing of orthodontic bands

44. Taking impressions or digital scans for study and opposing models and matrices for temporary crowns and bridges.

56. Applying nonprescription topical anesthetic solutions

‡ A dentist shall delegate these procedures to a UDA only if the UDA has successfully completed an in-person or virtual training with performance evaluations on 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.

State-approved 7/30/2024

Registered Dental Assistant (RDA)

Education, Training and Credential Requirements

To become licensed as a Registered Dental Assistant (RDA) in the state of Michigan, one must:

I. Be of good moral character, AND

II. Receive a degree or certificate from a CODA-accredited educational program (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

III. Pass a board-approved written and clinical exam, AND

IV. Submit proof of current certification in BLS or ACLS for healthcare providers with a hands-on component from an agency or organization that grants certification in accordance with AHA standards earned within the previous two years, AND

V. Complete two hours of implicit bias training within the five years prior to registration, AND

VI. Complete a one-time training in identifying victims of human trafficking, AND

VII. Complete the fingerprinting/criminal background check process, AND

VIII.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. See Section R.338.7002b of the Michigan Administrative Rules for further details.

Allowable Functions for Registered 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 Direct Supervision*

12, 51. Placing, condensing and carving amalgam restorations‡

13. Removing sutures

29. Cementing orthodontic bands or initial placement of orthodontic brackets and attachments for aligners

33. Placing Class I resin bonded restorations, occlusal adjustment, finishing and polishing with non-tissue cutting slow-speed rotary hand pieces‡

46. Taking final impressions for indirect restorations and prosthesis including bite registration, intra-oral imaging, and in-office fabrication of restorations‡

59. Assisting and monitoring the administration of nitrous oxide analgesia by a dentist or RDH**(The levels must be preset by the dentist or RDH and must not be adjusted by the RDA except in case of an emergency, in which case the RDA may turn off the nitrous oxide and administer 100% oxygen. As used in this subdivision, “assisting” means setting up equipment and placing the face mask. Assisting does not include titrating and turning the equipment on or off, except in the case of an emergency in which circumstances the RDA may turn off the nitrous oxide and administer 100% oxygen)

• Removing orthodontic bands, brackets, and adhesives with hand instruments only. Use of high-speed rotary instruments is not in the scope of practice of a UDA, RDA, or RDH

• Applying and dispensing in-office bleaching products

Under General Supervision*

6. Placing and removing nonepinephrine retraction cords or materials**

14. Drying endodontic canals with absorbent points**

34. Applying cavity liners and bases**

44. Taking impressions for intraoral appliances including bite registrations**

45. Placing and removing matrices and wedges**

46. Taking digital scans for final restorations or intra-oral appliances

49. Preliminary examination including performing pulp vitality testing**

• Before cementation by the dentist, adjusting and polishing contacts and occlusion of indirect restorations

• Applying desensitizing agents**

• Etching and placing adhesives before placement of orthodontic brackets and attachments for aligners**

Under Assignment*

1, 2. Inspecting and charting the oral cavity using a mouth mirror and radiographs including the classifying of occlusion

15. Placing, removing, and replacing orthodontic elastic or wire separators, arch wires, elastics, and ligatures

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 dental dam

29. Trial sizing of orthodontic bands

29, 47, 54.Temporarily cementing and removing temporary crowns and bands

44. Taking impressions or digital scans for study and opposing models and matrices for temporary crowns and bridges

47. Fabricating temporary restorations, temporary crowns, and temporary bridges

50, 54. Placing a nonmetallic temporary restoration with non-tissue cutting instruments

56. Applying nonprescription topical anesthetic solution

61. Removing excess temporary cement from supragingival surfaces of a tooth with hand instruments only

• Polishing assigned teeth with a slow-speed rotary handpiece immediately before an acid etch procedure

• Polishing and contouring of sealants with a slow-speed rotary hand piece immediately following a procedure for occlusal adjustment

• Providing nutritional counseling for oral health and maintenance

• Providing commonly accepted medical emergency procedures

• Dispensing orthodontic aligners

‡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.

m inneso Ta

Updated by DANB 11/12/2024†

† 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 Career Ladder

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.

State Radiography Requirements

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 with accompanying fee and current government-issued identification

Note: A limited radiology registrant must maintain compliance with the most current infection control practices for a dental setting.

Functions NOT Permitted by Dental Assistants in Minnesota

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.

m inneso Ta

by DANB 11/12/2024

Dental Assistant 1

Education, Training and Credential Requirements

An unlicensed 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 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*

48. Retract a patient’s cheek, tongue or other parts of tissue during a dental operation

48. Remove debris or water that is created during treatment rendered by a dentist or dental therapist using suction devices

48, 56. provide any assistance, including the placement of articles and topical medication in a patient’s oral cavity during dental treatment

• Assist with the placement or removal of devices or materials for isolation purposes as directed by the dentist or dental therapist during treatment

Under General Supervision*

18. An assistant without a license may apply fluoride varnish without the dentist or physician being present in the dental office or facility or on the premises if the licensed practitioner with prescribing authority has prior knowledge of and has consented to the procedure being performed and maintains appropriate patient records of the treatment.

Under Direct Supervision*

44, 46.take digital impressions

•. take photographs extraorally and intraorally

• aid dental hygienists and licensed dental assistants in the performance of their delegated procedures

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.

Ta

Education, Training and Credential 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 with accompanying fee and current government-issued identification

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.

To administer local anesthesia, a Licensed Dental Assistant must have completed the following:

1. at least one year of experience in general chairside dental assisting;

2. a board-approved didactic and clinical course at a CODA-accredited program that requires clinical competency in the administration of local anesthesia;

3. the CDCA-WREB-CITA local anesthesia exam or any other board-approved, nationally recognized local anesthetic exam; and

4. application for a local anesthesia certification through the 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.

Under Direct Supervision*

6. Place nonsurgical retraction material for gingival displacement

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

• administer local anesthesia limited to supraperiosteal and field block injections as prescribed by a dentist [Requires certification in local anesthesia. See requirements above]

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

• 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 if graduated from a dental assisting program prior to September 2, 2004]

• 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

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

*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.

m inneso Ta

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.

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 impression 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.

*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.

by DANB 11/12/2024

Licensed Dental Assistant with Collaborative Practice Authorization 3

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

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

*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.

m ississippi

State-approved 8/2/2024

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.

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures in Mississippi, a dental assistant must:

I. a. Hold a current national DANB Certified Dental Assistant (CDA) certification OR

b. Successfully complete a Mississippi board-approved radiology seminar and exam within 90 days prior to application OR

c. Graduate from a CODA-accredited dental assisting program within 12 months prior to application OR

d. 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 OR

e. Graduate from a CODA-accredited dental hygiene program AND

II. Apply to the Mississippi State Board of Dental Examiners for a radiology permit

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.

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

Dental Assistant 1

State-approved 8/2/2024

Dental Assistant 1

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 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 medicated cords

9. Coronal polishing

12. Placing amalgam restorations for condensation by the dentist

13. Removing sutures

18. Applying topical fluoride gels, rinses and varnishes

22. Exposing radiographs

27. Placing and removing rubber dams

35, 62. Placing and removing periodontal dressings

40. Apply pit and fissure sealants

44. Taking impressions for study models and opposing models

45. Place and remove matrix bands

47. Construction, adjustment and cementation of temporary crowns (temporary means crowns placed while permanent restoration is being fabricated)

47. Fabricating temporary/interim restorations

47,50. Placing temporary/interim restorations

54,55. Removing temporary/interim restorations

56. Apply topical anesthetic agents

59. Placement and monitoring of nitrous-oxide inhalation anxiolysis

61. Removing excess cement from coronal surfaces of teeth

64. Fabricating trays for in-office bleaching procedures

• Perform in-office bleaching procedures

• Adjust the gingival side of complete or partial dentures

• Detect possible caries using the KaVo DIAGNOdent

• Applying desensitizing agents

• Monitoring minimally sedated patients

• Monitoring moderately sedated patients

• Monitoring patients under deep sedation/general anesthesia

• 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.

State-approved 7/11/2024

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.

State Radiography Requirements

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.

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 if the dental assistant has not completed specific required training (see “Requirements” on the next page)

Dental Assistant 1

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.

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.

Under Direct Supervision*

59. Assist in the administration of and monitor nitrous oxide analgesia (see “Requirements” above)

DANB’s Note on Allowable Dental Assisting Functions

In Missouri, all dental assistants may perform:

9. Polishing the coronal surfaces of teeth (air polisher)

18. Application of topical fluoride

40. Placement of pit or fissure sealants

• 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.

Education, Training and Credential 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 Dental Assisting Skills (MDAS) 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.

*The Missouri Dental Assisting Skills (MDAS) exam was known as the Missouri Test of Basic Dental Assisting Skills (MBDA) before 11/15/2022.

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*

With Restorative I Permit:

12, 51. Placing, condensing, carving, and finishing amalgam for Class I, V, and VI restorations

33. Placing and finishing 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 orthodontic prosthesis/appliance

• Preliminary bending of archwire

• Removal of orthodontic bands and bonds

• Final cementation of any permanent orthodontic appliance or prosthesis

• Placement and cementation of orthodontic brackets and/or bands

Supervision

With Fixed Prosthodontics Permit:

6. Apply tissue retracting material prior to impression of a fixed prothesis

43, 70. Sizing and cementing of prefabricated crowns

46. Making impressions for the fabrication of any removable or fixed prosthesis/appliance

• Extra-oral adjustments of fixed prosthesis

• 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

m on Tana

State-approved 9/26/2024

State Career Ladder

There are two recognized (unlicensed) levels 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.

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 or another board-approved 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.

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.

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

• Metal based air polishing

• Prophylaxis

• Work authorizations

Dental Auxiliary 1

DANB Certified Dental Assistant (CDA) 2

State-approved 9/26/2024

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

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

9. Coronal polishing

13, 62. Removing sutures and dressings

18. Applying topical fluoride agents

22. Making radiographic exposures as prescribed by the supervising dentist (see “Radiography Requirements” on previous page)

24. Providing oral health instructions

27. Placing and removing rubber dams

40. Placing pit and fissure sealants

44. Taking impressions for study or working casts

45. Placing and removing matrices

47, 50, 54, 55. Placing and removing temporary restoration with hand instruments only

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

61. Removing excess cement from coronal surfaces

• Polishing amalgam restorations

• Digital capture of dental images

• Sodium bicarbonate air polishing

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 Functions

Under General Supervision*

22. Expose radiographs

40. Place pit and fissure sealants (following an in-person comprehensive oral examination or periodic examination within the preceding 30 days)

• Perform any duty that may be delegated to a dental auxiliary, excluding those duties prohibited under general supervision (see “Prohibited Duties” on previous page)

• Perform other intraoral procedures not requiring direct supervision

Under Direct Supervision*

12, 51. Polishing 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

• Applying silver diamine fluoride agents

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.

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.

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

State-approved 8/22/2024

Dental Assistant 1

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 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*

25, 57. Provide infection control practices which meet the national standards for dental facilities as outlined by the Centers for 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

Under General Supervision*

22. Take X-rays (see “Radiography Requirements” on previous page)

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

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*

9. Perform coronal polishing procedures

Dental Assistant qualified in coronal polishing 2

State-approved 8/22/2024

Licensed Dental Assistant 3

Education, Training and Credential 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. Submit proof of age and citizenship and apply to the Dept. of Health and Human Services for an LDA license

To qualify for licensure by reciprocity, see Nebraska rules 172 NAC 53 for more information.

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 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 completion of an approved course and permit in the function)

46. Take dental impressions and make minor adjustments for removable prostheses (with successful completion of an approved course and permit in the function)

59. Monitor and administer nitrous oxide analgesia (with successful completion of an approved course and permit in the function)

70. Cement prefabricated fixed prostheses on primary teeth (with

Education, Training and Credential Requirements

successful completion of an approved course and permit in the function)

• All procedures authorized for an unlicensed dental assistant

Note: At the September 23, 2022 meeting of the Nebraska Board of Dentistry, the board opined that an LDA may not switch a healing abutment with a scan body for the final scan.

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)

Note: At the September 23, 2022 meeting of the Nebraska Board of Dentistry, the board opined that with appropriate training, an expanded function dental assistant may take digital impressions for fixed prosthetics.

Expanded Function Dental Assistant

n evada

State-approved 9/10/2024

State Career Ladder

There are two recognized levels 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.

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

Dental Assistant 1

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

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 Direct Supervision by a Dental Hygienist with Public Health Dental Hygiene Endorsement

9. Perform coronal polishing

18. Administer a topical fluoride*

22. Take radiographs

24. Train and instruct persons in the techniques of oral hygiene and preventive procedures

24. Provide oral health education

40. Apply dental sealants

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.

Direct Supervision: This term is currently undefined in Nevada dental statutes and rules.

State-approved 9/10/2024

Expanded Function Dental Assistant (see Note below**) 2

Education, Training and Credential Requirements

To be eligible for licensure as an expanded function dental assistant, an applicant must:

I. Be at least 18 years of age AND

II. a. Graduate from an accredited program for dental assisting with expanded functions OR b. Successfully complete a course of training for EFDAs and either:

1. Graduate from an accredited program for dental assisting without expanded functions OR 2. Be employed as a dental assistant full-time for at least 2 years or part-time for at least 4 years and pass the DANB CDA exam AND

III. Hold a current certification in the techniques of administering cardiopulmonary resuscitation AND

IV. Pass a written clinical exam given by the Board upon subjects as the Board deems necessary for practice as an EFDA AND

V. Pass a written exam given by the Board on Nevada EFDA laws and regulations

For licensure by endorsement, an applicant must:

I. Provide proof of current licensure as an EFDA in another state or territory of the United States, or the District of Columbia AND

II. a. Graduate from an accredited program for dental assisting with expanded functions OR b. Be employed as a dental assistant or an EFDA full-time for at least 2 years or part-time for at least 4 years AND

III. Pass a written exam given by the Board on Nevada EFDA laws and regulations

The Board may require an applicant for licensure by endorsement to complete any training that the Board deems necessary for the applicant to be able to practice expanded function dental assisting with the same degree of competence as a person who possesses the qualifications described above.

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 Authorization of a Dentist*

12, 33.Placing, condensing, contouring, adjusting, curing and finishing restorations that are made of a direct restorative material, including, without limitation, amalgam, resin-based composite and glass ionomer.

18. Placing topical fluoride.

34. Placing desensitizers, liners and bases.

45. Placing and removing matrices and interproximal wedge devices.

46. Taking final impressions for indirect restorations, including, without limitation, crowns, bridges and veneers and removable prostheses, including, without limitation, dentures.

• Adjusting a removable prostheses extraorally.

• Cementation of permanent restorations, including, without limitation, crowns, bridges and veneers, if the authorizing dentist evaluates and approves each permanent restoration before the cementation is final and inspects each permanent restoration before the patient leaves the premises where the cementation occurred.

• Administering a hemostatic agent.

• Applying agents for bleaching teeth.

• Using an ultrasonic scaling unit only for the removal of bonding agents. This subsection does not authorize an expanded function dental assistant to use an ultrasonic scaling unit on any natural tooth

Under Direct Supervision by a Dental Hygienist with Public Health Dental Hygiene Endorsement

9. Perform coronal polishing

18. Apply topical fluoride

22. Take radiographs

24. Provide oral health education

40. Apply dental sealants

**Note: The Nevada Legislature passed a law in 2023 (SB 310) authorizing the creation of a new expanded function dental assistant (EFDA) level who may perform specified expanded functions. Although the effective date of the bill is 1/1/2024 and the Nevada State Board of Dental Examiners has drafted rules to implement this new law, the new rules are not yet finalized and effective. Please contact the Board directly for further information about applying for the EFDA level.

State-approved 7/10/2024

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.

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 109 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

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

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

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 109.

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*

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 the lubrication of such patient’s lips

24. Train or instruct groups or individual patients in techniques of oral hygiene and mouth care

25. Process and sterilize instruments and perform infection control

41. Organize and arrange instruments on bracket tables

48. Retract a patient’s cheek, tongue or other oral tissues during a dental hygiene and remove such debris as is normally created or accumulated during the course of treatment being rendered by a CPHDH by the use of vacuum devices, compressed air, mouthwashes and water

52. Process dental radiographs

• Reorganize instruments and equipment after the patient has departed the healthcare facility

• Assist with the placement or removal of a rubber dam and accessories used for its placement and retention, as directed by an operating CPHDH during the course of a dental hygiene operation

*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).

n e W h ampshire

State-approved 7/10/2024

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 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

12. Place amalgam prior to condensing by a dentist 13, 62, 69. Remove sutures and dressings

18. Apply topical fluoride after prophylaxis by a licensed professional

27. Place and remove rubber dams

28, 44, 46. Select impression trays; seat, hold, remove and pour impressions for study models, single arch athletic mouth guards, custom fluoride trays and whitening trays

29. Cement bands and bond brackets, not to include the use of rotary instruments to remove excess cement or bonding material

34. Place cavity liners and bases

35. Place periodontal dressings

37. Take and record blood pressure

45. Place and remove matrices

46. Make final impressions

49. Perform pulpal vitality testing procedures

50, 55. Place and remove temporary restorations, not to include temporary crowns and bridges, unless qualified (see requirements on page 109), and not to include the use of intraoral rotary instruments

56. Apply non-prescription topical anesthesia

• Take dental and medical histories

• Apply non-prescription desensitizing agents to the cementum and dentin

• Insert athletic mouth guards

• Make bite registrations when maximum intercuspation can be achieved

• Place and remove dry socket medications

• All duties designated to Dental Assistants, under the same levels of required supervision

Dental Assistant qualified to perform expanded duties

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 109 AND

III. Meet specific course, certification, or experience requirements for each function, as described on page 109

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

9. Coronal polishing (see DANB’s State Fact Booklet or NH Rule 302.06(u) for specific requirements related to coronal polishing)

22. Dental radiography

40. Dental sealants

47. Fabrication of provisional crown and bridge restorations

59. Monitor nitrous oxide administration

• In-office tooth whitening

Orthodontic duties:

15. Attachment or tying in and removal of orthodontic wires

29. Trial fitting of orthodontic bands

42. Placement and removal of orthodontic separators

*Direct Supervision: A dentist with an

44. Taking impressions for orthodontic appliances

61. Using hand instruments to remove excess cement from bands on the coronal surfaces of the teeth

68. Simple emergency adjustment of orthodontic appliances to relieve pain

• Preparation of teeth for bonding of brackets

• Removal of orthodontic bands or brackets

• Trial fitting of head gear

• Bending arch wires

Under Direct Supervision of a Licensed Dental Hygienist*

9. Coronal polishing (see page 109 for specific information)

State-approved 7/10/2024

Expanded Function Dental Auxiliary (EFDA)

Education, Training and Credential 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 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.)

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

*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.

State-approved 7/10/2024

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 107 for Graduate Dental Assistant requirements.

Summary of Expanded Functions

Requirements for Graduate Dental Assistants or for Holders of DANB CDA Certification

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

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

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

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).

• 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).

• Successfully complete a course and exam in infection control meeting requirements established by rule of the NHBDE

(Note: The DALE Foundation's DANB ICE Review course meets this requirement. Successful performance on DANB's Infection Control exam [ICE] also meets this requirement.)

function: Provisional crown and bridge

restorations

For more detailed information, see New Hampshire administrative rule Den 302.06(k)-(m).

• 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).

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

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

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

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

• Meet Introduction to Dental Assisting course requirements (see requirements above), AND

• Qualify in infection control (see requirements above), AND

• Successfully complete a course and exam in 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).

• 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).

• 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).

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

• Successfully complete a course and exam in nitrous oxide meeting requirements established by rule of the NHBDE, AND

• Be currently certified in BLS-HCP

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

• Meet Introduction to Dental Assisting course requirements (see requirements above), AND

• Qualify in infection control (see requirements above), AND

• Successfully complete a course and exam in 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).

• 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

n e W Jersey

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.

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 114

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures in New Jersey, a dental assistant must be licensed as a Dental Radiologic Technologist (DRT) by the New Jersey Radiologic Technology Board of Examiners. To obtain this license, one must:

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.

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

n e W J ersey

State-approved 7/31/2024

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

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 intra- oral 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

State-approved 7/31/2024

Registered Dental Assistant

Education, Training and Credential 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) 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

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.

n e W J ersey

State-approved 7/31/2024

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.

Requirements

n e W Jersey ( o r T hodon T i C )

State-approved 7/31/2024

Orthodontic Assistant

Education, Training and Credential 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 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 dental prosthesis provided that the prosthesis shall not require any intra-oral procedure and shall be thereafter inserted by a licensed dentist

15. Place and ligate arch wires; before an LRDA-O places the arch wire, the supervising licensed dentist shall verify the fit; only the supervising licensed dentist shall customize the arch wire for the patient

18. Apply topical fluoride

22. Make radiographic exposures as permitted by the Department of Environmental Protection, Bureau of X-Ray Compliance (see “Radiography Requirements” on page 110)

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 intra-orally or on diagnostic models

42. Place orthodontic separators. The supervising licensed dentist shall ensure proper placement

44. Take alginate impressions

45. Remove bands and brackets without the use of rotary instruments

46. Take impressions for orthodontic appliances; supervising licensed dentist shall review and evaluate the impression prior to its use for fabrication

48. Isolate the operative field, not to include rubber dams

54, 61. Remove excess cement from crowns or other restorations and orthodontic appliances; such removal shall not include any subgingival cement or debris

56. Apply topical anesthetic agents

64. Fabricate mouth guard appliances; this shall not include insertion of the appliance

• Take dental photographs including the use of intraoral cameras• Perform bite registration procedures

• 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

• Remove arch wires and ligature wires

• Perform bite registration procedures

• Etch teeth in preparation for bonding, sealants, or desensitizing agents

• 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

• 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

• Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket

• Apply hot and cold packets pursuant to the direction of a licensed dentist

• 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.

*Direct

Reviewed by DANB 6/27/2024†

† 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 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.

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.

Community Dental Health Coordinator (CDHC) See page 119

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures in New Mexico, a dental assistant 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

Reviewed by DANB 6/27/2024

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.

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

46. Final impressions, to include physical and digital impressions, for multiple-unit restorations or prosthetic appliances*

• Removal of, or addition to, the hard or soft tissue of oral cavity

• Diagnosis and treatment planning

• Final 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.

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.

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

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.

Reviewed by DANB 6/27/2024

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:

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 Polishing (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 2024 State Fact Booklet or contact the New Mexico Board of Dental Health Care for requirements.

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*

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.

Reviewed by DANB 6/27/2024

Expanded Function Dental Auxiliary

Education, Training and Credential 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

II. 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

* 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

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.)

Requirements

n e W m exi C o (Communi

Reviewed by DANB 6/27/2024

Community Dental Health Coordinator

Education, Training and Credential 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 117 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

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

State-approved 7/30/2024

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.

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.

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

• Performing bleaching services

• Removing calcareous deposits, accretions and stains, including scaling and planing of exposed root surfaces indicated for complete prophylaxis

• Applying fluoride varnish

• 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.

NY

n e W y ork

State-approved 7/30/2024

Dental Assistant with a Limited Permit 1

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 below, under the direct personal supervision of a licensed dentist. The permit expires after one year and may be renewed for an additional year.

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.

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, either separately or together through the New York Combination Exam: NYPDA, ICE, and RHS . AND

VI. Apply for licensure from the New York State Education Department after completing all of the above requirements

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 Personal Supervision*

13. Remove sutures placed by a licensed dentist

18. Apply topical anticariogenic agents to the teeth

22. Take x-rays

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

47,50, 54, 55. Place and remove temporary restorations

54. Remove temporary cement

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.

121 © 2006-2024 Dental Assisting National Board, Inc. All rights reserved.

State-approved 10/3/2024

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.

Dental Assistant II in Training (DA II in Training)

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. Successfully complete a course in dental radiology and the course’s final examination. The course shall include at least 7 hours of didactic, lecture-based instruction and at least 14 hours of laboratory instruction 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

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 the administration of topically-applied agents intended to anesthetize only cutaneous tissue

• 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

State-approved 10/3/2024

Dental Assistant I (DA I) 1

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 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 the dentist)

12. Place amalgam in prep w/carrier

18. Apply topical fluoride

22. Expose radiographs (see requirements on previous page)

24. Oral hygiene instruction

37. Take pulse, blood pressure and temperature

39. Polish dentures (extraorally, upon instruction by the dentist and re-insertion by the dentist)

56. Apply topical anesthetics/DentiPatch®

59. Monitor patients under nitrous oxide (see requirements above)

• Write prescriptions (drugs); exact words must be dictated by the dentist

• Perform extraoral adjustments of any temp. restoration or appliance (extraorally, upon instruction by the dentist and reinsertion by the dentist)

Dental Assistant II in Training (DA II in Training) 2

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. 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 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

13. Removing sutures

14. Flushing, drying and temporarily closing root canals or pulpotomies

15. Placing and tying in or untying and removing orthodontic arch wires, ligature wires or lock pins

22. Exposing radiographs and cone beam images

27. Placing and removing rubber dams

29. Fitting (sizing) orthodontic bands or brackets

34. Placing cavity bases and liners

38. Measuring pulse, blood pressure, and temperature

39. Polishing removable appliances extra-orally

40. Applying sealants to teeth that do not require mechanical alteration prior to the application of such sealants

42. Inserting interdental spacers

44. Taking impressions for study models and opposing casts that may be used for construction of temporary or permanent dental appliances, adjustable orthodontic appliances, nightguards and the repair of dentures or partials

45. Inserting matrix bands and wedges

47, 50, 54. Placing and removing temporary restorations

54, 61. Removing excess cement with hand scaler supragingivally

59. Monitoring patients under nitrous oxide (see requirements above)

62. Removing periodontal and surgical dressings

• Cementing temporary restorations using temporary cement

Allowable functions for this level continued on next page

State-approved 10/3/2024

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

• Applying bonding agents

• Applying dentin desensitizing solutions

• Performing extraoral adjustments which affect function, fit, or occlusion of any restoration or appliance

• Initially forming and sizing orthodontic arch wires and placing arch wires after final adjustment and approval by the dentist

• Preparing and loading amalgam in carrier

• Using micro-etcher extra-orally

• Placing a throat shield in oropharynx during administration of general anesthesia

• Delivering dentures to patient for insertion, provided the dentist approves the denture placement

• Removing or replacing healing abutments or cover screws for implants that may be accessed supragingivally

• A DA II may perform all duties designated to a DA I under the same level of supervision

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

and Supervision:

State-approved 10/3/2024

Dental Assistant II (DA II)

Education, Training and Credential 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

b. Complete one school year or longer in a CODA-accredited dental hygiene program OR

c. Complete a dental assistant program offered through a branch of the U.S. armed forces at the Medical Education & Training Campus that includes a clinical rotation providing dental assisting for live patients OR

d. Pass the national DANB Certified Dental Assistant (CDA) exam OR

e. 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 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

9. Polishing the clinical crown (Using a hand-held brush and appropriate polishing agents or a combination of a slow-speed handpiece [not to exceed 10,000 rpm] with an attached rubber cup or bristle brush and appropriate polishing agents) (see requirements above)

13. Removing sutures

14. Flushing, drying and temporarily closing root canals or pulpotomies

15. Placing and tying in or untying and removing orthodontic arch wires, ligature wires or lock pins

22. Exposing radiographs and cone beam images

27. Placing and removing rubber dams

29. Fitting (sizing) orthodontic bands or brackets

34. Placing cavity bases and liners

38. Measuring pulse, blood pressure, and temperature

39. Polishing removable appliances extra-orally

40. Applying sealants to teeth that do not require mechanical alteration prior to the application of such sealants

42. Inserting interdental spacers

44. Taking impressions for study models and opposing casts that may be used for construction of temporary or permanent dental appliances, adjustable orthodontic appliances, nightguards and the repair of dentures or partials

45. Inserting matrix bands and wedges

47, 50, 54. Placing and removing temporary restorations

54, 61. Removing excess cement with hand scaler supragingivally

59. Monitoring patients under nitrous oxide (see requirements on previous page)

62. Removing periodontal and surgical dressings

• Cementing temporary restorations using temporary cement

• Applying acid etch materials and rinses

• Applying bonding agents

• Applying dentin desensitizing solutions

• Performing extraoral adjustments which affect function, fit, or occlusion of any restoration or appliance

• Initially forming and sizing orthodontic arch wires and placing arch wires after final adjustment and approval by the dentist

• Preparing and loading amalgam in carrier

• Using micro-etcher extra-orally

• Placing a throat shield in oropharynx during administration of general anesthesia

• Delivering dentures to patient for insertion, provided the dentist approves the denture placement

• Removing or replacing healing abutments or cover screws for implants that may be accessed supragingivally

• A DA II may perform all duties designated to a DA I under the 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 sealants

• Assist in applying topical fluorides

• Assist in applying fluoride varnishes

• Assist while the Limited Supervision Hygienist is performing 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

State Job Titles

n or T h d ako Ta

Updated by DANB 9/25/2024†

† 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 Career Ladder

There are four 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.

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.

Anesthesia Assisting See page 131

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures under general supervision in North Dakota, a dental assistant must:

I. Be a Qualified Dental Assistant (QDA) (see requirements) OR

II. Hold a Qualified Dental Assistant (QDA) - limited radiology registration. To register, an applicant must provide evidence of having completed, within two years of application, the following:

a. A board-approved course on radiation health and safety or the DANB Radiation Health and Safety (RHS) exam AND

b. A course in CPR OR

III. Be a Registered Dental Assistant (RDA) (see requirements)

Every QDA - limited radiology registrant in North Dakota must maintain a current certificate of proficiency in cardiopulmonary resuscitation.

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.

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 or fabricate orthodontic impressions for an individual who is not a patient of record

• 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

• Unless authorized by permit in accordance with North Dakota code, monitor a patient who has been induced to a level of moderate sedation, deep sedation, or general anesthesia until the dentist authorized by permit to administer sedation or anesthesia determines the patient may be discharged for recovery

• Produce on a patient of record, a final scan by digital capture for review by the authorizing dentist for a prescriptive fixed or removable appliance

Updated by DANB 9/25/2024

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.

Note: A Qualified Dental Assistant (QDA) - limited radiology registrant may also perform any of the below functions as well.

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

48. Retract patient’s cheek, tongue, or other tissue parts during a dental procedure

48. Isolate the operative field, not to include rubber dams

56. Apply topical medications and drugs to oral tissues, including topical anesthetic, topical fluoride, fluoride varnish, and desensitizing agents, but not including caustic 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)

• Hold a curing light for any dental procedure. Curing lights may not include a laser capable of cutting, burning, or damaging hard or soft tissue or for electrosurgery for tissue retraction

• 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

• Produce on a patient of record, a final scan by digital capture for review and inspection by the authorizing dentist for a prescriptive fixed or removable appliance

• Monitor a patient that has been induced into nitrous oxide analgesia after the dentist has provided sufficient training to the dental assistant completed after January 1, 2024. The dentist must maintain documentation of the training for the duration of the delegation and must provide documentation of the training to the board upon request

Under General Supervision

24. Provide oral hygiene instructions and education

62. Remove periodontal dressings

by DANB 9/25/2024

Qualified Dental Assistant (QDA)

Education, Training and Credential Requirements

To earn status as a Qualified Dental Assistant (QDA) in North Dakota, one must:

I. a. Complete 300 hours of on-the-job clinical training and either have passed DANB’s National Entry Level Dental Assistant (NELDA) certification within one year prior to application or have passed DANB’s NELDA certification and completed, within two years prior to application, 16 hours of continuing education OR

b. Pass DANB’s NELDA certification and the North Dakota Department of Career and Technical Education dental assisting education program association OR

c. Successfully complete a North Dakota board-approved equivalent course within one year prior to application OR

d. Be licensed in good standing in another jurisdiction and possess qualifications, education, or experience substantially similar to the requirements for licensure in North Dakota. Applicants must submit evidence of at least one year of prior employment as a dental assistant, have completed 16 hours of continuing education, and meet any other requirement set by the Board AND

II. Pass a written examination of the laws and rules governing the practice of dentistry in North Dakota within one year of application AND

III. Maintain current CPR certification AND

IV. 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

V. Apply to the NDSBDE

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*

3. Orally transmit a prescription that has been authorized by the supervising dentist.

14. Dry root canal with paper points

45. Place and remove matrix bands and wedges

• Acid etch enamel surfaces as directed by the dentist

• Apply resin infiltration

• Remove band and bracket adhesives with a slow speed handpiece

Under General Supervision*

13. Remove sutures

15. Place and remove arch wires or appliances that have been activated by the dentist

15, 42.Place, tie, and remove ligature wires and elastic ties, and select and place orthodontic separators

18, 56.Apply topical medications and drugs to oral tissues, including topical anesthetic and anticariogenic agents, and desensitizing agents

22. Take dental radiographs (see “Radiography Requirements”)

29. Preselect and prefit orthodontic bands

37. Take and record pulse, blood pressure, and temperature

46. Produce on a patient of record, a final scan by digital capture for review and inspection by the authorizing dentist for a prescriptive fixed or removable appliance

• Take and record preliminary dental and medical history for the interpretation by the dentist

• Cut and remove arch wires or replace loose bands, loose brackets, or other orthodontic appliances for palliative care

• Repack dry socket medication and packing for palliative care

• All duties designated to Dental Assistants

Under Indirect Supervision*

9. Polish coronal surfaces of teeth with a rubber cup or brush after the dentist provides the dental assistant with sufficient training. The dentist must maintain documentation of the training completion for the duration of the delegation and provide it to the board upon request

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

*Direct Supervision:The dentist is physically present 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. A new patient who has not been examined by the authorizing dentist may be seen by a dental hygienist authorized to provide duties under general supervision.

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Updated by DANB 9/25/2024

Registered Dental Assistant (RDA) 3

Education, Training and Credential 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 and submit evidence of prior employment as a dental assistant or have completed a CODA-accredited or North Dakota board-approved dental assisting program (more than one year prior to application) AND

Have completed 16 hours of continuing education within two years prior to application OR

c. Be licensed in good standing in another jurisdiction and possess qualifications, education, or experience substantially similar to the requirements for licensure in North Dakota. Applicants must submit evidence of at least one year of prior employment as a dental assistant, have completed 16 hours of continuing education, and meet any other requirement set by the Board. OR

d Have passed an examination administered by the Joint Commission on National Dental Examinations (JCNDE) or the dental hygiene certification board of Canada (FDHRC) and 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

V. Apply for registration to the North Dakota State Board of Dental Examiners (NDSBDE)

To apply pit and fissure sealants under the general supervision of a licensed dentist, a registered dental assistant must provide documentation of successful completion of a North Dakota board-approved sealant course or training that includes hand-skills, and has received an endorsement from the 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.

Under General Supervision*

9. Polish the coronal surfaces of the teeth with a rubber cup or brush

13. Remove sutures

15. Place and remove arch wires or appliances that have been activated by a dentist

15, 42. Place, tie, and remove ligature wires and elastic ties, and place orthodontic separators

18, 56. Apply topical medications and drugs to oral tissues, including topical anesthetic and topical fluoride, fluoride varnish, silver diamine fluoride, hemostatic agents, and desensitizing agents

22. Take dental radiographs

24. Provide oral hygiene education and instruction

29 Preselect and prefit orthodontic bands

37. Take and record pulse, blood pressure, and temperature

40. Apply pit and fissure sealants and adjust sealants with a slowspeed handpiece (see requirements above)

44. Take impressions or occlusal bite registrations for study casts

44. Take impressions for fixed or removable orthodontic appliances, athletic mouth guards,bleaching trays, bite splints, flippers, and removable prosthetic repairs

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

49 Perform nonsurgical clinical and laboratory diagnosis tests, including pulp testing, for interpretation by the dentist

• 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

• Provide screenings for the early identification of individuals at potentially high risk for a specific condition or disorder (a screening is neither diagnostic nor a definitive indication of a specific condition and does not involve making diagnoses that lead to treatment plans)

• Adjust a temporary denture or partial for dentitions actively under treatment for which permanent dentures or partial dentures are being fabricated

Allowable functions for this level continued on next page

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Updated by DANB 9/25/2024

Allowable Functions for Registered Dental Assistant (RDA),

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*, on a patient of record

6. Place retraction cord in the gingival sulcus of a prepared tooth prior to the dentist taking an impression of the tooth

27. Place and remove rubber dams

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

Under Direct Supervision*

• 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

Indirect Supervision

59. Monitor a patient who has been inducted by a dentist into nitrous oxide inhalation analgesia

61. Remove excess cement from inlays, crowns, bridges and orthodontic appliances with hand instruments or a slow-speed handpiece

• Apply bleaching solution, activate light source, and monitor and remove bleaching materials

• Administer emergency medications to a patient in order to assist the dentist in an emergency

• Hold impression trays in the mouth (e.g., reversible hydrocolloids, rubber base)

• Terminate or reduce the amount of nitrous oxide previously administered by the authorized nitrous oxide inhalation analgesia provider

Registered Dental Assistant with Restorative Functions Permit

Education, Training and Credential 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

Requirements

b. Pass an examination from a dental testing agency 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 an examination from a dental testing agency 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

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 amalgam, glass ionomer, or composite restorations with hand instruments or a slow-speed hand**

33. Place, contour, and adjust 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.

*Direct Supervision:The dentist is physically present 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.

n or T h d ako Ta ( a nes T hesia a ssis T ing)

Updated by DANB 9/25/2024

Dental Anesthesia Assistant

Education, Training and Credential Requirements

To provide supportive anesthesia care, a dental anesthesia assistant must possess the expertise to do so in a safe and effective manner and receive education in the perioperative and emergent care management of patients undergoing dental office sedation and anesthesia.

Every dental anesthesia assistant in North Dakota must have a current certificate of proficiency in cardiopulmonary resuscitation.

Allowable Functions

• Provide supportive anesthesia care Allowable

Dental Anesthesia Assistant with Anesthesia Assisting Permit Requirements

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 moderate sedation, deep sedation or general anesthesia, a Dental Anesthesia Assistant may earn a Class I or a Class II anesthesia assistant permit.

To earn a Class I anesthesia assistant permit, a Dental Anesthesia 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, deep sedation, or moderate sedation permit of the dentist where the 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 Dental Anesthesia 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

Note: Individuals authorized by other North Dakota licensing boards and whose scope of practice encompasses the duties of a dental anesthesia assistant are not required to obtain the respective anesthesia permit from the board to carry out the duties listed below

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.

A registered dental assistant or dental anesthesia assistant authorized by permit and under the contiguous supervision* of a dentist authorized by permit to provide moderate sedation, deep sedation or general anesthesia may:

• 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

Allowable functions for this level continued on next page

*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 qualified dental staff member 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: The dentist is physically present to issue a verbal command and under direct line of sight.

n or T h d ako Ta ( a nes T hesia a ssis T ing)

Updated by DANB 9/25/2024

Allowable

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.

A registered dental assistant or dental anesthesia assistant authorized by permit and under the direct visual supervision* of a dentist authorized by permit to provide moderate sedation, deep sedation or general anesthesia may:

• 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

Registered Dental Assistant with Permit in Administering Nitrous Oxide Inhalation Analgesia

Education, Training and Credential Requirements

To earn a permit to administer nitrous oxide inhalation analgesia under the indirect supervision of a dentist, a Registered Dental Assistant must:

I. a. Complete a twelve-hour, board-approved course of training or course provided by a program accredited by an accrediting body recognized by the U.S. Department of Education within thirteen months prior to application OR

b. Complete a twelve-hour, board-approved course of training or course provided by a program accredited by an accrediting body recognized by the U.S. Department of Education more than thirteen months prior to application, have legally administered nitrous oxide inhalation analgesia for a period of time during the three years prior to application, and provide written documentation from an employing or supervising dentist attesting to current clinical proficiency to administer nitrous oxide inhalation analgesia. AND

II. Hold current and valid certification in basic life support by the American Heart Association for the health care provider, or an equivalent program approved by the board.

Note: Before authorizing a registered dental assistant to administer nitrous oxide inhalation analgesia, the dentist must have provided and documented training in the proper and safe operation of the nitrous oxide inhalation analgesia equipment.

Allowable Functions

Under Indirect Supervision

• Administer nitrous oxide inhalation analgesia to a patient who has not taken sedative medications before treatment

Updated by DANB 9/10/2024†

† 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 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.

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures in Ohio under the 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 135) OR b. Complete an Ohio Board-approved training course, including a clinical section* 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.

The board may issue a certificate to an applicant if the applicant holds a license or certificate in another state or if the applicant has satisfactory work experience, a government certification, or a private certification as a dental x-ray machine operator in a state that does not issue that license or certificate.

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 137.

Functions NOT Permitted by Dental Assistants in Ohio

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

• 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

by DANB 9/10/2024

Basic Qualified Personnel 1

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 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

4. Physical positioning of the patient

6. Retraction of the gingival tissue prior to the final impression which is performed by the licensed, supervising dentist

11. Intraoral instrument transfer

13. Suture removal

14. Irrigation and drying of canals during endodontic procedures

15. Placement and removal of orthodontic arch wires, auxiliary arch wires, and ligation of same to orthodontic bands and/or brackets

18. Fluoride application

24. Demonstration of oral hygiene procedures, including, but not limited to, use of toothbrushes and dental floss

24, 26. All patient education services, including, but not limited to, progress reports, consultations (oral or written), oral hygiene instructions, use of intraoral hygiene devices, normal nutrition information as it relates to dental health, behavioral modification, self adjustment of orthodontic appliances, and all other post-operative and post-insertion instructions, as deemed appropriate by the supervising dentist

25. All supportive services necessary to the maintenance of a hygienic practice environment, including, but not limited to, all sterilizing procedures

27. Placement of rubber dam over pre-placed clamp, and removal of clamp and rubber dam

29. Preliminary selection and sizing of orthodontic bands and arch wires

30, 48. Aspiration and retraction

35, 62. Application and removal of periodontal dressings

37. Measurement of blood pressure and body temperature

38. Monitoring of vital signs

42. Placement and removal of orthodontic separators and ties

43. Preliminary selection and sizing of stainless steel crowns

44. Taking impressions for the construction of custom athletic mouth protectors/mouthguards, and trays for application of medicaments

44. Elastomeric impressions for diagnostic models and models to be used for opposing models in the construction of appliances and restorations

47, 50, 54, 55. Impression, fabrication, cementation and removal of provisional restorations, not to include palliative or sedative restorations

49. Pulp testing

56. Application of topical anesthetics

59. Monitor nitrous oxide-oxygen analgesia (see requirements above)

63, 69. Placement and removal of surgical dressings

67. Assistance during administration of life-support activities

• Application of disclosing solutions

• Caries susceptibility testing

• Shade selection for fabrication of appliances or restorations

• Application of cavity varnish

• Taking photographs

• Placement of medication in the pulp chamber(s) of teeth with non-vital pulp or instrumented root canals

• Topical applications of desensitizing agents to teeth

• Intraoral bite registrations for diagnostic model articulation, restorations and appliances

• Polymerization of light-activated restorative/bonding materials

• Basic remediable intraoral and extraoral dental tasks and/or procedures (those which do not create irreparable changes within the oral cavity and/or the contiguous structures)

• Recording patient treatment

• Checking for and removal of loose orthodontic bands and loose brackets

• Repair, construction and finishing of metallic and plastic prosthetic devices

• Compilation of radiographic data for interpretation by the dentist, i.e., tracings, etc.

• The preparation of materials, drugs and medications for use in dental procedures, including, but not limited to, palliative, impression and restorative materials

• Any other non-invasive procedures deemed necessary by the supervising dentist to maintain the health and safety of the patient

• All non-invasive supportive services normally utilized in conjunction with the treatment by the dentist of fascia pain or TMJ syndrome

List of allowable functions for this level continued on next page

o hio

Updated by DANB 9/10/2024

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

Under Personal Supervision*

• 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

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

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 certification administered by the Ohio Commission on Dental Assistant Certification (CODA) OR

3. Registered Dental Assistant (RDA) certification administered by the American Medical Technologists (AMT))

Current holders of any of these certifications are considered Certified Assistants

Requirements

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 137.

**Please note: Holders of the Ohio coronal polishing certificate must maintain DANB CDA certification, certification through CODA, or RDA(AMT) certification.

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 (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 137)

18. Application of fluoride varnish

40. Application of pit and fissure sealants¥

47. Recementation of temporary crowns or recementation of crowns with temporary cement

• Application of disclosing solutions

• Application of desensitizing agents, excluding silver diamine fluoride

• Caries susceptibility testing

• Instruction on oral hygiene home care, including the use of toothbrushes 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 137 have been met.

*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.

135 © 2006-2024 Dental Assisting National Board, Inc. All

Certified Assistant

Expanded Function Dental Auxiliary 3

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:

I. a. Be an unlicensed dentist who has graduated from an accredited dental college and does not have a dental license under suspension or revocation by the OSDB OR

b. Be a dental student who is enrolled in an accredited dental college and is in good standing as a dental student OR

c. Be a graduate of an unaccredited dental college located outside the US OR

d. Be a current Certified Assistant (See page 135 for requirements) OR

e. Be a dental hygienist licensed by the OSDB in good standing OR

f. Be a dental hygienist who has graduated from an accredited dental hygiene program and does not have a dental hygiene license under suspension or revocation by the OSDB AND

II. Complete an EFDA training course that is accredited by either the Commission on Dental Accreditation (CODA) or the Higher Learning Commission AND

III. Pass the EFDA exam administered by the Commission on Dental Testing in Ohio (CODT) or the Commission on Dental Competency Assessments (CDCA) AND

IV. Complete a BLS training course certified by the American Red Cross, American Heart Association, or American Safety and Health Institute AND

V. Apply to the OSDB for registration

The board may issue a certificate to an applicant if the applicant holds a license or certificate in another state or if the applicant has satisfactory work experience, a government certification, or a private certification as an expanded function dental auxiliary in a state that does not issue that license or certificate.

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

12. 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.

‡ Note: An EFDA may not perform coronal polishing unless he or she has met the requirements described on page 135 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

18. Application of fluoride varnish

47. Recementation of temporary crowns or recementation of crowns with temporary cement

• Application of disclosing solutions

• Caries susceptibility testing

• Application of desensitizing agents, excluding silver diamine fluoride

• Instruction on oral hygiene home care, including the use of toothbrushes and dental floss

• Any additional procedures authorized by the state dental board

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

18. Application of fluoride varnish

22. Standard diagnostic radiologic procedures (EFDA must also hold the dental x-ray machine operator certificate; see requirements on page 133)

40. Application of pit and fissure sealants

47. Recementation of temporary crowns or recementation of crowns with temporary cement

• Place interim therapeutic restorations (when the EFDA has completed an OSDB-approved course)

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.

Teledentistry: The delivery of dental services through the use of synchronous, real-time communication and the delivery of services of a dental hygienist or expanded function dental auxiliary pursuant to a dentist’s authorization.

Updated by DANB 9/10/2024

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

• 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

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

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

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

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

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

(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

(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

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

o klahoma

Reviewed by DANB 6/11/2024†

† 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 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.

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.

Oral Maxillofacial Surgery Assistant See page 141

State Radiography Requirements

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 four hours, approved by the OBD AND

II. 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

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 with a high-speed handpiece

• Diagnosis

• Treatment planning

• Prescription of medications

• Surgery or the cutting or severance of hard and soft tissue

• Final cementation of fixed prosthesis or delivery of a removable prosthesis

• Administration of injectable local anesthesia or any other form of injectable including anesthesia including IV sedation

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

• Utilization of a laser, high-speed hand piece, power scaler, prophy jet or ultrasonic

• Adjustment of a prosthesis intraorally

• Administration of nitrous oxide

• Administration, evaluation or assessment of a level of anesthesia on a patient

• 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 or dentists

• Correcting or attempting to correct malposed teeth

• Administering anesthetics, general or local

• Treating deformities of the jaws and adjacent structures

• Using x-ray and interpreting dental x-ray film

Prohibited functions continued on next page

o klahoma

Reviewed by DANB 6/11/2024

Functions NOT Permitted by Dental Assistants

in

Oklahoma, continued

The following acts shall be regarded as practicing dentistry (continued):

• Offering, undertaking or assisting by any means or methods, to remove stains, discolorations, or concretions from the teeth (does not preclude or prohibit the sale of any teeth whitening kit designed for self-administration as approved by the United States Food and Drug Administration)

• Operating or prescribing for any disease, pain, injury, deficiency, deformity, or any physical condition connected with the human mouth

• Taking impressions of the teeth and jaws

• Furnishing, supplying, constructing, reproducing, or repairing, or offering to furnish, supply, construct, reproduce, or repair, prosthetic dentures, sometimes known as plates, bridges, or other substitutes for natural teeth for the user or prospective user thereof

• Adjusting or attempting to adjust any prosthetic denture, bridge, appliance, or any other structure to be worn in the human mouth

• Diagnosing, making, and adjusting appliances to artificial casts of malposed teeth for treatment of the malposed teeth in the human mouth, without instructions

• Writing a laboratory prescription to a dental laboratory or dental laboratory technician for the construction, reproduction or repair of any appliance or structure to be worn in the human mouth

• Any other procedure otherwise defined in the State Dental Act requiring a valid license or permit to perform while the person does not hold such valid license or permit issued by the Board

No dental assistant shall perform any duty not authorized by Title 195, Chapter 15, of the Oklahoma Administrative Code or the State Dental Act.

Dental Assistant

Education, Training and Credential 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

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

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 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.

o klahoma

Reviewed by DANB 6/11/2024

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 or oral maxillofacial surgery assistant must obtain a permit for each expanded duty he or she desires to perform.

Available permits are:

Radiation Safety See the “Radiography Requirements” on page 138.

Coronal polishing and topical fluoride. An applicant must successfully complete a Board-approved course in this function, including two hours of didactic education and six hours of a clinical training, including demonstration, in coronal polishing and the application of topical fluoride and desensitizing agents.

Sealants. An applicant must complete a Board-approved course of study in this function, consisting of a minimum of 6 hours to include 1 hour of didactic training and 5 clinical hours of training.

Monitoring and assisting in the administration of nitrous oxide. An applicant must successfully complete a Board-approved course of study in this function, consisting of a minimum of 12 hours. Applicants must have a current BLS certification prior to beginning this course.

Assisting a dentist who holds a parenteral or pediatric anesthesia permit: An applicant must meet the same requirements as those for an oral maxillofacial surgery assistant. (see next page.)

Vaccinations, venipuncture, and phlebotomy. An applicant must complete a Board-approved phlebotomy certification program or course, which must include a minimum of four hours of safe-needle and bloodborne pathogens procedures under the guidelines of the CDC

Elder care and public health. An applicant must have a minimum of two (2) years of active dental assisting practice.

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

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, polishing agent and the polishing is not prophylaxis (examination for calculus and scaling must be done by a dentist or dental hygienist)

18. Apply topical fluoride and desensitizing agents. A dental assistant may not use a prophy jet or any other instrument unless approved by the Board

22. Expose intraoral and extraoral radiographs

40. Place pit and fissure sealants

59. Monitor and assist in the administration of nitrous oxide; a dental assistant may turn on oxygen, but the level and adjustment of nitrous oxide can only be determined and administered by the dentist or hygienist; a dental assistant may adjust the level of nitrous oxide

at the verbal direction of a dentist under direct supervision; patients utilizing nitrous oxide must be visually monitored at all times

• Assist a dentist while the dentist administers anesthesia and assess the patient’s level of sedation; no dental assistant shall administer, evaluate or assess a level of anesthesia on a patient

• Administer vaccinations or draw blood for a platelet rich plasma procedure (PRP) or other testing under the direct supervision of a dentist

• All duties designated to Dental Assistants, under the same level of required supervision

Under General Supervision

• A dental assistant with a permit in elder care and public health may assist a dental hygienist while providing treatment in specified healthcare and long-term care facilities under the general supervision of the supervising dentist

*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.

General supervision: The supervisory dentist has diagnosed any conditions to be treated within the past thirteen (13) months, has personally authorized the procedures to be performed by a dental hygienist, and will evaluate the results of the dental treatment within a reasonable time as determined by the nature of the procedures performed, the needs of the patient, and the professional judgment of the supervisory dentist. General supervision may only be used to supervise a hygienist and may not be used to supervise an oral maxillofacial surgery assistant or dental assistant except as provided by law.

Requirements

o klahoma ( o ral m axillofa C ial s urgery a ssis Tan T )

Reviewed by DANB 6/11/2024

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:

I. 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 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*

• Initiate and discontinue an intravenous line for a patient being prepared to receive intravenous medications, sedation or general anesthesia

• Draw up and prepare medications

Under Direct Visual Supervision*

• Follow instructions of the oral surgeon while acting as an accessory hand on behalf of the oral surgeon that is administering** the medication and actively treating the patient.

• 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.

*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.

State-approved 11/6/2024

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.

Expanded Function Dental Assistant (EFDA) with Restorative Functions Certificate/ Expanded Function Dental Assistant (EFDA) with Local Anesthesia Functions Certificate

Expanded Function Dental Assistant (EFDA)

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

Anesthesia

See page 146 Preventive

See pages 148-149

State Radiography Requirements

See page 147

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 licensee 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 licensee 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, dental therapist, 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 licensee that the assistant is proficient to take radiographs.

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. 144

33, 51. Condense and carve permanent restorative material, except as permitted by an EFDA with a Restorative Functions Certificate - see p. 145

35. Place periodontal packs

• Diagnose or plan treatment

• Cut hard or soft tissue

• Start nitrous oxide

Prohibited Functions list continued on next page.

OR

oregon

State-approved 11/6/2024

Functions NOT Permitted by Dental Assistants

in Oregon, continued

• 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. 149

• 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. 145

• 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. 146

• Correct or attempt to correct the malposition or malocclusion of teeth, except those functions expressly permitted for EFODAssee p. 146

• 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. 146

• Apply denture relines, except those functions expressly permitted for EFDAs with additional training - see p. 144

• 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.

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

44. Take physical impressions and digital scans

• Place or remove healing caps or abutments

• Place implant impression copings

Under General Supervision*

22. Place films/sensors, adjust equipment preparatory to exposing films/ sensors, and expose the films and create the images(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. Place films/sensors, adjust equipment preparatory to exposing films/ sensors, and expose the films and create the images (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.

Note: A dental therapist may supervise a dental assistant if the dental therapist is authorized to perform the services provided by the dental assistant.

*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.

State-approved 11/6/2024

Expanded Function Dental Assistant

Education, Training and Credential 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. Hold an Oregon Certificate of Radiologic Proficiency (see requirements on p. 142) AND

b. Successfully complete a CODA-accredited dental assisting program AND

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

OR

II. a. Hold an Oregon Certificate of Radiologic Proficiency (see requirements on p. 142) AND

b. Pass the DANB Certified Dental Assistant (CDA) exam** AND

c. Pass the Oregon Expanded Functions—General Dental Assisting Exam** (administered by DANB) AND

d. Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements within six months of completion AND

e. Apply for the Oregon EFDA certificate (administered by DANB) OR

III. a. Hold an Oregon Certificate of Radiologic Proficiency (see requirements on p. 142) AND

b. Pass the DANB Infection Control (ICE) exam or the Oregon Basic Dental Assisting exam** (see note on p. 149) AND

c. Pass the Oregon Expanded Functions—General Dental Assisting Exam** (administered by DANB) AND

d. Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements within six months of completion AND

e. Apply for the Oregon EFDA certificate (administered by DANB) OR

I

V. 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 functions AND

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

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 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

Note: A dental therapist may supervise an EFDA if the dental therapist is authorized to perform the services provided by the EFDA

*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.

oregon

State-approved 11/6/2024

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 (effective 1/1/2025):

I. a. Complete a Oregon Board of Dentistry (OBD)-approved restorative functions curriculum from a CODA-accredited program AND

b. Pass the CDCA-WREB CITA’s Dental Hygiene Restorative Exam (or another OBD-approved exam) within five years of application AND

c. Apply for the Oregon Restorative Functions certificate (administered by DANB) OR

II. a. If an applicant passed the CDCA-WREB CITA’s Dental Hygiene 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 Functions

To perform the local anesthesia functions listed below in Oregon (effective 1/1/2025), an EFDA must hold a Local Anesthesia Functions certificate (LAFC).

To qualify, an EFDA must successfully complete a Board approved curriculum from a program accredited by the Commission on Dental Accreditation of the American Dental Association or other course of instruction approved by the Board.

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)

Under Indirect Supervision*

• Administer local anesthetic agents and local anesthetic reversal agents under the indirect supervision of a licensed dentist. Local anesthetic reversal agents shall not be used on children less than 6 years of age or weighing less than 33 pounds.

*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.

2006-2024 Dental

o regon (or T hodon T i C )

State-approved 11/6/2024

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).

To qualify, one must:

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

II. a. Pass DANB’s national Certified Dental Assistant (CDA) exam or Certified Orthodontic Assistant (COA) exam** 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

III. a. Pass the DANB Infection Control (ICE) exam or the Oregon Basic Dental Assisting exam** (see note on p. 149) 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 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*

15. Place and ligate archwires

29. Select or try for the fit of orthodontic bands

42. Place and remove orthodontic separators

• Remove orthodontic bands and brackets and attachments with removal of the bonding material and cement. An ultrasonic scaler, hand scaler or slow speed handpiece may be used. Use of a high speed handpiece is prohibited.

• 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

Under General Supervision*

• Remove any portion of an orthodontic appliance causing a patient discomfort and, in the process, replace ligatures and/ or separators if the dentist is not available, providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate

• Recement orthodontic bands if the dentist is not available and the patient is in discomfort, providing that the patient is rescheduled for follow-up care by a licensed dentist as soon as is reasonably appropriate

*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.

o regon ( p reven T ive)

State-approved 11/6/2024

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).

To qualify, one must:

I. a. Hold an Oregon Certificate of Radiologic Proficiency (see requirements on p. 142) AND b. Successfully complete a course of instruction in a program accredited by CODA AND c. Apply for the Oregon EFPDA certificate (administered by DANB) OR

II. a. Hold an Oregon Certificate of Radiologic Proficiency (see requirements on p. 142) AND b. Pass the DANB Infection Control (ICE) exam** AND

c. Pass one of the following exams:

Requirements

(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

d. Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements within six months of completion AND

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

OR

III. a. Hold an Oregon Certificate of Radiologic Proficiency (see requirements on p. 142) AND b. Pass the Oregon Basic Dental Assisting exam** (see note on p. 149), AND c. 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

d. Provide endorsement from an Oregon licensed dentist stating that the applicant has completed clinical requirements within six months of completion, AND

e. Apply for the Oregon EFPDA 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 the permitted expanded preventive functions AND b. Apply for the Oregon EFPDA certificate by credential (administered by DANB)

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 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

An EFPDA may perform the following procedure 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:

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

*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.

Requirements

Requirements

o regon ( a nes T hesia)

State-approved 11/6/2024

Expanded Function Dental Assistant (EFDA) with Local Anesthesia Functions Certificate

Education, Training and Credential Requirements

The Oregon Board of Dentistry has approved new rules allowing an EFDA to perform local anesthesia functions beginning January 1, 2025. For information about eligibility requirements, see p.145 .

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.

See p.145 for scope of practice information

Anesthesia Monitor

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 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*

59. Visually monitor a patient under nitrous oxide sedation and record the patient’s condition,

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

Requirements

Requirements

o regon ( a nes T hesia)

State-approved 11/6/2024

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. To qualify, one must:

I. Hold a current Health Care Provider BLS certification or equivalent AND

II. a. Successfully complete the Dental Anesthesia Assistant National Certification Exam (DAANCE) 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 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

• Perform phlebotomy for dental procedures

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. 143)

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

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 or to perform a phlebotomy blood draw 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

• Perform a phlebotomy blood draw. Products obtained through a phlebotomy blood draw may only be used by the dentist, to treat a condition that is within the scope of the practice of dentistry.

Note: The Oregon Board of Dentistry discontinued the administration of the Oregon Basic (ORB) exam in 2024. Since 1/5/2024, DANB no longer accepts applications for the ORB exam, and administration of the ORB exam ceased as of 6/1/2024. To meet the Pathway III eligibility requirements for the EFDA, EFODA, and EFPDA certificates, candidates are instead required to pass DANB’s Infection Control (ICE) exam. Candidates who passed the ORB prior to its discontinuation are still able to use their ORB result to qualify for an Oregon expanded function certificate.

*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.

p ennsylvania

State-approved 7/1/2024

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.

State Radiography Requirements

To legally operate dental x-ray equipment and perform dental radiographic procedures under the direct supervision of a dentist in Pennsylvania, auxiliary personnel, except dental hygienists and public health dental hygiene practitioners, must pass the national DANB Radiation Health and Safety (RHS) exam.

Evidence of having passed the required exam* should be retained by the dental assistant and the licensed dentist as evidence of the individual’s authority to perform radiologic procedures.

*Note: Prior to 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.

Functions NOT Permitted by Expanded Function 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 an expanded function 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.

The following functions may not be delegated or assigned:

• Treatment planning

• Writing prescriptions for drugs

• Writing authorizations for restorative, prosthetic or orthodontic appliances

• 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.

(Competent person)

Education, Training and Credential Requirements

The Pennsylvania State Board of Dentistry does not issue licenses for the practice of general dental assisting functions Pennsylvania has no statute, regulation, or rule recognizing or defining requirements or duties for dental assistants. Pennsylvania’s Dental Law contains the following provision:

Section 11.8. Additional Definition. “Assignment of Duties” shall mean the assignment by a dentist to another person of services and procedures which are performed in the office of a dentist. A dentist may assign to such competent person or persons as the dentist deems appropriate those services and procedures performed in the dental office in which the dentist is practicing but which do not require the professional competence and skill of a dentist or dental hygienist or expanded function dental assistant. Such assignment of services and procedures shall be under the direct supervision of a licensed dentist. This section shall not be construed as authorizing the delegation or assignment of diagnosing, treatment planning and writing prescriptions for drugs or writing authorizations for restorative, prosthetic or orthodontic appliances.

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*

• Services and procedures performed in the dental office that do not require the professional competence and skill of a dentist or dental hygienist or expanded function dental assistant

Expanded Function Dental Assistant

Education, Training and Credential 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) issued by the Pennsylvania State Board of Dentistry.

To obtain this state certification, one must:

I. a. Graduate from a Board-approved expanded function dental assisting program at a two-year college or institution accredited by an accrediting agency approved by the U.S. Dept. of Education Council on Postsecondary Accreditation 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 Board-approved EFDA program, which offers a certificate or diploma, consisting of at least 200 hours of clinical and didactic instruction from dental assisting program accredited either by CODA or an accrediting agency approved by the U.S. Dept. of Education Council on Postsecondary Accreditation whose expanded function educational standards are approved by the Board, 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

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

r hode i sland

State-approved 8/1/2024

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.

Other Levels

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.

DAANCE Certified Maxillofacial Surgery Assistant See page 154

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.

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

• 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

r hode island

8/1/2024

Dental Assistant

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 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

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.

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 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

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.

DANB-Certified Assistant

r hode i sland

( daan C e Cer T ified m axillofa C ial s urgery a ssis Tan T )

State-approved 8/1/2024

DAANCE Certified Maxillofacial Surgery Assistant

Education, Training and Credential 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 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.

State-approved 11/7/2024

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.

State Radiography Requirements

To legally place and expose radiographic films in a dental office, all personnel in a dental office who place and expose radiographic films must successfully complete a board-approved structured course of training in radiation safety.

DANB’s CDA certification and Radiation Health and Safety (RHS) exam are board-approved to meet this requirement.

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

State-approved 11/7/2024

Dental Assistant 1

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 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 appliances within the oral cavity

13. Remove sutures

15. Place and remove orthodontic ligatures

22. Expose radiographs (see “State Radiography Requirements” on previous page)

27. Place and remove rubber dam

30, 48. Assist in basic supportive chairside procedures

35, 62. Place and remove periodontal packs

37. Take and record vital signs (blood pressure, pulse, respiration, etc.)

45. Place and remove matrix

• Apply topical drugs as prescribed by the dentist (see note)

Note: At its July 9, 2021 meeting, the South Carolina Board of Dentistry clarified that silver diamine fluoride is considered a topical drug that all dental assistants are permitted to apply under direct supervision. Similarly, the Board clarified at their October 6, 2023 meeting that the general use of topical fluoride is permitted by dental assistants under direct supervision as well.

Under Direction of the Department of Health and Environmental Control Public Health Dental Program

• Perform oral screenings utilizing the Department of Health and Environmental Control approved screening system in school and public health settings

• Assist in the delivery of public health dental program services

• Perform other duties authorized by regulations of the State Board of Dentistry

State-approved 11/7/2024

Expanded Duty Dental Assistant (EDDA) 2

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 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

9. Polish restorations and supragingival tooth structure

40. Application of pit and fissure sealant

44. Take impressions for study models

47. Cement temporary crowns or bridges

50. Place temporary restorations

59. Monitor nitrous oxide conscious sedation/analgesia† (requires state certification – see requirements on previous page)

61. Remove excess cement from restorations and/or appliances

63, 69. Place and remove socket dressing

Under Direction of the Department of Health and Environmental Control Public Health Dental Program

• Perform oral screenings utilizing the Department of Health and Environmental Control approved screening system in school and public health settings

• Assist in the delivery of public health dental program services

• Perform other duties authorized by regulations of the State Board of Dentistry

† 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.

*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.

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.

Analgesia, Sedation and Anesthesia Assisting See pages 161-162 State

Other Levels

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.

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.

s ou T h d ako Ta

State-approved 7/9/2024

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

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

• Injecting medication, other than as permitted for dental assistants qualified in injection of medications (see page 162 for requirements)

• Administering nitrous oxide analgesia, other than as permitted for Registered Dental Assistants holding a permit to perform this function (see page 162 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 161 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

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.

Registered Dental Assistant

Education, Training and Credential 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 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

Requirements

Allowable

Requirements

State-approved 7/9/2024

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

Education, Training and Credential Requirements

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.

Allowable

Allowable Functions

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

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

State-approved 7/9/2024

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

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

Education, Training and Credential Requirements

A Registered Dental Assistant may apply for a permit to administer nitrous oxide sedation and analgesia under the indirect 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 for a permit, OR

b. Have completed a SDSBD-approved educational course more than 13 months prior to application for a permit 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 Indirect Supervision*

• Administer nitrous oxide sedation and analgesia

Tennessee

Updated by DANB 6/10/2024†

† 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 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.

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:

• 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)

Practical Dental Assistant 1 Tennessee

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 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, pulse, temperature, and medical history, and charting of oral conditions

3. Calling in prescriptions to the pharmacist as instructed by the employer/dentist

6. Packing and removing retraction cord, with or without vasoactive chemicals, for restorative dental procedures

12. The placement of amalgam in prepared cavities for condensation by the dentist

13. The removal of sutures and staples

14. Drying canals with absorbent paper points

15. Bending, selecting and pre-sizing arch wires and placing arch wires after final adjustment and approval by the dentist

15. Placement of chain elastics on brackets

15. Placement of exposure chains and attachments

18. The application of topical fluorides

24. The instruction of patients in dietary principles

24. Demonstration of oral hygiene procedures and oral health care regimen

25. The maintenance of instrument and operatory infection control

27. The placement and removal of rubber dam

29. The selection, prefitting, cementation, curing and removing of orthodontic bands or brackets

34. Placement of cavity bases and liners

35, 62. The placement and removal of periodontal dressings

41. The preparation of instrument trays

42. Placement and removal of pre-treatment separators

43. Selecting and pre-fitting of stainless steel crowns or other preformed crowns for insertion by the dentist

44, 46. The taking of alginate impressions or any purpose other than permanent restorations

45. The placement and removal of matrices for restoration

48. Irrigating extraction site

49. Performing pulp testing

50, 55. The fabrication, placement and removal of temporary restorations

52. The processing of radiographs, including digital, of the mouth, gums, jaws, teeth or any portion thereof for dental diagnosis

56. The application of topical anesthetics

61. Removal of cement excess from supragingival surface of teeth by hand instruments only

61. The removal of cement from restorations and bands

63, 69. The placement and removal of socket dressings

• The taking of dental plaque smears

• The removal of ligature and arch wires

• Wound care as directed

• Placement of springs on wires

• Placement of hooks on brackets

• Ligation of arch wires to brackets

• The taking of oral cytologic smears

• Removal of loose or broken bands or brackets

• The application of desensitizing agents

• Application of tooth conditioners for bonding

• Packing of pulpotomy paste

• Fitting, adjusting and cementation of correctional appliances

• Other duties specifically approved by the Board at a regularly scheduled meeting of the Board

Tennessee

Updated by DANB 6/10/2024

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*

• Apply teeth whitening formulations

• Those functions that may be delegated to a practical dental assistant under direct supervision (see previous page)

Unsupervised

• Participate in educational functions involving organized groups 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:

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 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

12, 33, 51. Restorative functions (insert, pack, carve and finish amalgam and intracoronal nonmetallic restorations)

22. Exposure of dental radiographs (see “Radiography Requirements” section on previous page)

40. Application of sealants

46. Prosthetic functions (take final impressions for fixed and removable prosthetic appliances)

59. Monitoring nitrous oxide

* 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

Texas

State-approved 7/24/2024

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.

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.

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

State-approved 7/24/2024

Dental Assistant 1

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 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*

• The provision of interim treatment of a minor emergency dental condition to an existing patient of the treating dentist; the treating dentist must delegate the procedure orally or in writing before the dental assistant performs the procedure, must retain responsibility for the procedure, and must schedule a follow-up appointment with the patient within 30 days

Under Direct Supervision*

18. Apply fluoride varnish

• Reversible acts and procedures

DANB’s Note on Allowable Dental Assisting Functions

In the state of Texas, 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 to perform expanded functions

Education, Training and Credential 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. a Graduate from a CODA-accredited dental assisting program that includes clinical and didactic education in coronal polishing OR

b Complete a minimum of eight hours clinical and didactic education in coronal polishing taken through a dental school, dental hygiene school or dental assisting program accredited by CODA. A dental assistant shall have at least one-year experience as a dental assistant prior to applying to a CODA program.

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 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.

2006-2024

State-approved 7/24/2024

Registered Dental Assistant

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 designation

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)

An RDA may provide teledentistry services to a patient in Texas.

*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.

State-approved 6/19/2024

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.

State Radiography Requirements

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 covers the topics found in Board rules.

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.

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 46, 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)

• Provide definitive treatment diagnosis

• Cut hard or soft tissue or extract teeth

• Provide injection 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 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)

• 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 that is worn in the mouth

• Perform sub-gingival instrumentation

• Provide decisions concerning the use of drugs, including their dosage or prescription

• Start an intravenous (IV) line or administer medication in an IV line

• Convert a denture into a fixed implant prosthesis, also known as performing a conversion

• Adjust a permanent or final prosthetic, removable or fixed, that is worn by a patient or will be worn by a patient

• Carry out any duties through teledentistry that require the in-person supervision of a licensed dentist

Dental Assistant 1

State-approved 6/19/2024

Dental Assistant 1

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 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. Initially introduce nitrous oxide and oxygen to a patient establishing and recording a safe plane of analgesia for the patient

Under Supervision*

9. Polish teeth coronally with a rubber cup

44. Take impressions for diagnostic or opposing models for the 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.

State-approved 6/17/2024

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.

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

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

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 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**

22. Take radiographs under a special endorsement (see “Radiography Requirements” on previous page)

40. Apply dental sealants**

• Perform extraoral duties assigned by the dentist

• Assist the dentist or clinical staff in intraoral procedures as assigned by the dentist

**To perform this function, a traditional dental assistant must be a graduate of a CODA-accredited dental assisting program or must have worked as a traditional dental assistant for at least six 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.

Education, Training and Credential Requirements

DANB’s Note on Allowable Dental Assisting Functions

In the state of Vermont, 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 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

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 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

v ermon T

State-approved 6/17/2024

Expanded Function Dental Assistant

Education, Training and Credential 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

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

VA

v irginia

Updated by DANB 11/7/2024†

† 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 Career Ladder

There are two 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.

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.

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

Dental Assistant II (DA II)

Dental Assistant I (DA I)

Updated by DANB 11/7/2024

Dental Assistant I (DA I) 1 v irginia

Education, Training and Credential 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

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.

virginia

Updated by DANB 11/7/2024

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.

*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.

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:

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 from another state 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. Apply to the Virginia Board of Dentistry for 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.

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 (per current Virginia Board of Dentistry guidance, only indirect pulp capping procedures may be delegated to a Dental Assistant II. See Guidance Document: 60-11)

• 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.

*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.

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.

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.

Dental Anesthesia Assistant See page 182

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.

WA

Functions

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State-approved 6/24/2024

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.

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)

Washing T on

State-approved 6/24/2024

Registered Dental Assistant (RDA)

Education, Training and Credential 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)

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.

Allowable

Functions (for

Under Close Supervision*

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State-approved 6/24/2024

Registered Dental Assistant),

• 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

continued

• 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) 2

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

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

*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.

Washing T on ( d en Tal a nes T hesia a ssis Tan T )

State-approved 6/24/2024 WA

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. An application, on a form provided by the department AND

II. An application fee AND

III. 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

IV. 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

V 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

VI. 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

VII. 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, as well as two hours of health equity training every three years.

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.

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 180.

*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.

Visual Supervision: Supervision by an oral and maxillofacial surgeon or dental anesthesiologist by verbal command and under direct line of sight.

Wes T v irginia

State-approved 6/25/2024

State Career Ladder

State Job Titles

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.

Other Levels

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.

Qualified Monitor See page 186

State Radiography Requirements

State Radiography Requirements

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

Functions NOT Permitted by Dental Assistants in West Virginia

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 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)

Wes T v irginia

State-approved 6/25/2024

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

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

Wes T v irginia

State-approved 6/25/2024

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.

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

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

Wes T v irginia (qualified moni T or)

State-approved 6/25/2024

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:

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 Functions

During Sedation Procedures

• Check closely and document the status of a patient undergoing anesthesia

• Observe utilized equipment

Wis C onsin

Updated by DANB 9/17/2024†

† 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 Career Ladder

There are two recognized levels 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.

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

State Radiography Requirements

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

Updated by DANB 9/17/2024

Unlicensed Person 1

Education, Training and Credential Requirements

An unlicensed person in Wisconsin may perform basic supportive dental procedures under the supervision of a licensed dentist or dental therapist.

Any dentist or dental therapist 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.

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 or dental therapist has verified the unlicensed person’s competency

DANB’s Note on Allowable Dental Assisting Functions

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.

Education, Training and Credential 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

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

Wyoming

State-approved 8/26/2024

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 1 2

Dental Assistant qualified in placement of pit and fissure sealants

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 within one (1) year immediately prior to application that meets either of the following:

1. a CODA-accredited radiography course;

2. the DANB RHS exam;

3. a radiography training course administered by a state dental association; OR

4. a course with a curriculum of at least 8 hours that includes a competency assessment or exam, covering specified subjects and clinical experience, 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.

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

State-approved 8/26/2024

Dental Assistant 1

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 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. Polish the coronal surfaces of the teeth, rubber cup only, but not for the purpose of prophylaxis

13. Remove sutures

27. Place and remove rubber dams

35, 62. Prepare and remove periodontal packs

44. Take impressions for orthodontic procedures, i.e. retainers and removable appliances

45. Place and remove matrices

48, 58. Assist the dentist in all operative and surgical procedures

61. Remove excess cement from the coronal surfaces of the teeth

• Perform whitening procedures not to include irreversible procedures such as etching and sandblasting

• Place and remove orthodontic wires and/or appliances that have been activated by the dentist

• Remove direct bond attachments and bands

• Treat diagnosed dry socket

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

Under General Supervision*

22. Place and expose x-ray image receptors (either film or digital) with a dentist’s order, either verbal or written (see “Radiography Requirements” on previous page)

24. Instruct patients in proper dental health care

37. Take vital statistics and health histories

42. Place and remove orthodontic separators

47. Fabricate and cement temporary crowns

52. Process radiographs

• Replace ligature wires and/or place elastic ties.

• Remove ligature wire and/or elastic ties.

• Remove broken bands, brackets, wires and appliances in emergency situations or as needed for operative or prophylactic purposes

In settings where nitrous oxide anxiolysis, sedation and/or anesthesia are administered

59. Patient monitoring

*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.

Wyoming State-approved 8/26/2024

Dental Assistant qualified in placement of pit and fissure sealants 2

Education, Training and Credential 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 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*

40. Place pit and fissure sealants (Board certificate required, see requirements above)

*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.

State Regulation of Dental Assistants’ Roles in Sedation and Anesthesia

State Regulation of Dental Assistants’ Roles in Sedation and Anesthesia

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 Anesthesia

Roles in Sedation and Anesthesia 1

Assistants’

State Regulation of Dental

2009-2024 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 Anesthesia

Induce Administer Prepare/ Assist in Administering Monitor Monitor Induce/ Administer Prepare/ Assist in Administering Monitor Initiate IV Lines Add Medication to IV 5Line In Operatory On-site

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." © 2009-2024 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 Requirements

Alabama

Arkansas

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 Boardapproved 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 adjust the flow of nitrous oxide and oxygen gases if deemed necessary and directed by the supervising dentist who shall be present in the operatory directly supervising the adjustment; unlicensed dental assistants must complete Dental Board of California-approved courses in the California Dental Practice Act and infection control and have current certification in basic life support offered by an instructor approved by the ARC, ASHI, AHA, ADA-CERP, or AGD’s Program Approval for Continuing Education.

California

Colorado

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 within two years of application, and submit evidence of current BLS certification issued by ARC, ASHI, AHA, ADA-CERP, or AGD’s Program Approval for Continuing Education; (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 12-35140(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.

Florida 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

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State 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.

Georgia, continued

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.

Idaho

Illinois

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 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 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.

Indiana

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State 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.

Iowa

Kansas

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.

Kentucky

Note: If the operating dentist authorizes a third-party qualified anesthesia provider to administer moderate sedation, deep sedation, or general anesthesia, the operating dentist shall confirm that at least two (2) members of the onsite care team, including registered dental assistants, maintain current certifications in:(1) BLS for Healthcare Providers; and (2) ACLS if sedation is administered to an adult patient; or (3) PALS if sedation is administered to a pediatric patient.

Louisiana 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.

Maine

Maryland

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 Maryland Legislature passed a law in 2022 (HB 968) authorizing the creation of a new expanded function dental assistant (EFDA) level who may perform specified expanded functions, which include nitrous oxide monitoring. To qualify for an EFDA certificate, one must: (1) be at least 18 years old and of good moral character,and (2)be a high school graduate or have attained a high school equivalency, and (3) successfully complete a course of study approved by the MSBDE and meeting the requirements of Maryland law related to the intraoral procedure for which the applicant has applied for a certificate, and (4) hold the appropriate certification from DANB, and (5) pass an examination provided by the MSBDE, and (6) submit to a criminal background check, apply to the MSBDE, and pay applicable fee.

Although the effective date of the law is 10/1/2022 and the MSBDE has drafted rules to implement this new law, the new rules are not yet finalized and effective.

Michigan 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.

Minnesota

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.

Continued on next page

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State Requirements

Minnesota, continued

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.

Mississippi 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).

Missouri

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.

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.

Both a dental auxiliary and a DANB certified dental assistant may, under direct supervision, initiate, adjust and monitor nitrous oxide flow for a patient who has been prescribed and administered nitrous oxide by a licensed dentist. To be a dental auxiliary, one must graduate from a CODA-accredited dental assisting program or receive instruction or training from a licensed dentist.

Montana

Nebraska

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.

To monitor and administer nitrous oxide analgesia, an LDA must complete a board-approved course and obtain a permit in that function.

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.

New Hampshire

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.

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State Requirements

New Jersey

North Carolina

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.

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 provide supportive anesthesia care, a Dental Anesthesia Assistant must possess the expertise to do so in a safe and effective manner and receive education in the perioperative and emergent care management of patients undergoing dental office sedation and anesthesia. Every dental anesthesia assistant in North Dakota must have a current certificate of proficiency in cardiopulmonary resuscitation.

To earn a permit to perform specified anesthesia assisting functions under the supervision of a dentist authorized by permit to administer moderate sedation, deep sedation, and general anesthesia, a Registered Dental Assistant or Dental Anesthesia Assistant may earn a Class I or a Class II anesthesia assistant permit.

To earn a Class I anesthesia assistant permit, a Registered Dental Assistant or Dental Anesthesia 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 or Dental Anesthesia Assistant must: (1) Complete all requirements for a Class I anesthesia assistant permit, and (2) Complete training in intravenous access or phlebotomy that includes live experience starting and maintaining intravenous lines, and (3) Apply to the North Dakota Board of Dental Examiners for a Class II anesthesia assisting permit.

To earn a permit to administer nitrous oxide inhalation analgesia under the indirect supervision of a dentist, an RDA must: (1a) complete a twelve-hour, board-approved course of training or course provided by a program accredited by an accrediting body recognized by the USDOE within thirteen months prior to application OR (1b) complete a twelve-hour, board-approved course of training or course provided by a program accredited by an accrediting body recognized by the USDOE more than thirteen months prior to application, have legally administered nitrous oxide inhalation analgesia for a period of time during the three years prior to application, and provide written documentation from an employing or supervising dentist attesting to current clinical proficiency to administer nitrous oxide inhalation analgesia, AND (2) hold current and valid certification in BLS by the American Heart Association for the health care provider, or an equivalent program approved by the board.

Note: Before authorizing an RDA to administer nitrous oxide inhalation analgesia, the dentist must have provided and documented training in the proper and safe operation of the nitrous oxide inhalation analgesia equipment.

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.

North Dakota

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State Requirements

Ohio

Oklahoma

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.

During moderate sedation, deep sedation, or general anesthesia, one of the required three individuals who must be physically present may be an individual currently certified in BLS-HCP who is experienced in patient monitoring and documentation and, if needed, able to assist the general anesthesia provider in an emergency.

To earn an expanded duty permit in monitoring and 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. Applicants must have a current BLS certification prior to beginning this course.

To earn an expanded duty permit in assisting a dentist who holds a parenteral or pediatric anesthesia permit. an applicant must meet the same requirements as those for an oral maxillofacial surgery assistant (see below).

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. 141 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.

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 Dental Anesthesia Assistant National Certification Exam (DAANCE) conducted by the American Association of Oral and Maxillofacial Surgeons; or (b) The “Oral and Maxillofacial Surgery Assistants Course” or successor course, conducted by the California Association of Oral 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; or (d) The Resuscitation Group – Anesthesia Dental Assistant course; or (e) Other course approved by the Board; and (2) Holding valid and current documentation showing successful completion of a Healthcare Provider BLS course, or its equivalent.

A Certified Anesthesia Dental Assistant may initiate IV lines for sedation and anesthesia and perform a phlebotomy blood draw 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.

Rhode Island

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.

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State Requirements

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.

South Carolina

South Dakota

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.

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.

Tennessee

Texas

Vermont

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 designation.

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.

Virginia

Washington

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)

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.

Continued on next page

Appendix: Education Requirements for Dental Assistants’ Roles in Sedation and Anesthesia

State Requirements

Washington, continued

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) 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 (5) 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.

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

Alaska Board of Dental Examiners: 907-465-2550 www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/ BoardofDentalExaminers.aspx

Arizona State Board of Dental Examiners: 602-242-1492 https://dentalboard.az.gov

Arkansas State Board of Dental Examiners: 501-682-2085 https://healthy.arkansas.gov/boards-commissions/boards/dental-examinersarkansas-state-board/

Dental Board of California: 916-263-2300 or 877-729-7789 (toll free) www.dbc.ca.gov

Colorado Dental Board: 303-894-7800 https://dpo.colorado.gov/Dental

Connecticut State Dental Commission: 860-509-7603, menu option 4 https://portal.ct.gov/dph/public-health-hearing-office/connecticut-state-dentalcommission/connecticut-state-dental-commission

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

District of Columbia Board of Dentistry: 877-672-2174 https://dchealth.dc.gov/service/dentistry-licensing

Florida Board of Dentistry: 850-245-4474 https://floridasdentistry.gov

Georgia Board of Dentistry: 404-651-8000 http://gbd.georgia.gov

Hawaii State Board of Dental Examiners: 808-586-2702 https://cca.hawaii.gov/pvl/boards/dentist

Idaho State Board of Dentistry: 208-577-2577 https://dopl.idaho.gov/bod/

Illinois Board of Dentistry: 888-473-4858 https://idfpr.illinois.gov/profs/boards/dentist.html

Indiana State Board of Dentistry: 317-234-2054 https://www.in.gov/pla/professions/dentistry-home/dentistry-board/ and Indiana Department of Health, Division of Radiology and Weights and Measures 317-233-7565

https://www.in.gov/health/cshcr/medical-radiology-services/

Iowa Dental Board: 515-281-5157 www.dentalboard.iowa.gov

Kansas Dental Board: 785-296-6400 www.dental.ks.gov

Kentucky Board of Dentistry: 502-429-7280 https://dentistry.ky.gov/Pages/index.aspx

Louisiana State Board of Dentistry: 225-219-7330 www.lsbd.org/

Maine Board of Dental Practice: 207-287-3333 www.maine.gov/dental

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

Michigan Board of Dentistry: 517-241-0199 https://www.michigan.gov/lara/bureau-list/bpl/health/hp-lic-health-prof/dental

Minnesota Board of Dentistry: 612-617-2250 or 888-240-4762 www.mn.gov/boards/dentistry/

Mississippi State Board of Dental Examiners: 601-944-9622 www.dentalboard.ms.gov

Missouri Dental Board: 573-751-0040 http://pr.mo.gov/dental.asp

Montana Board of Dentistry: 406-841-2359 www.dentistry.mt.gov

Nebraska Board of Dentistry: 402-471-2118 http://dhhs.ne.gov/licensure/Pages/Dental-Assistant.aspx

Nevada State Board of Dental Examiners: 702-486-7044 or 800-337-3926 https://dental.nv.gov

New Hampshire Board of Dental Examiners: 603-271-2152 www.oplc.nh.gov/board-dental-examiners

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

New Mexico Board of Dental Health Care: 505-476-4680 www.rld.state.nm.us/boards/Dental_Health_Care.aspx

New York State Board for Dentistry: 518-474-3817, ext. 550 https://www.op.nysed.gov/professions-index/dentistry

North Carolina State Board of Dental Examiners: 919-678-8223 www.ncdentalboard.org

North Dakota State Board of Dental Examiners: 701-258-8600 www.nddentalboard.org

Ohio State Dental Board: 614-466-2580 www.dental.ohio.gov

Oklahoma Board of Dentistry: 405-522-4844 www.ok.gov/dentistry

Oregon Board of Dentistry: 971-673-3200 www.oregon.gov/dentistry

Pennsylvania State Board of Dentistry: 717-783-7162 www.dos.pa.gov/dent

Rhode Island Board of Examiners in Dentistry: 401-222-1962 http://health.ri.gov/licenses/detail.php?id=251

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

Texas State Board of Dental Examiners: 512-463-6400 www.tsbde.texas.gov

Utah Dentist and Dental Hygenist Licensing Board: 801-530-6628 https://dopl.utah.gov/dental/index.html

Vermont Board of Dental Examiners: 802-828-2373 https://sos.vermont.gov/dental-examiners/

Virginia Board of Dentistry: 804-367-4538 www.dhp.virginia.gov/Boards/Dentistry/

Washington State Dental Quality Assurance Commission: 360-236-4700 https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renewor-update/dental-assistant

West Virginia Board of Dentistry: 877-914-8266 www.wvdentalboard.org

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/