2020 State Fact Booklet by Dental Assisting National Board

DENTAL ASSISTING NATIONAL BOARD, INC.

2020

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

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

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

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

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

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

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

2 2 3 4 5 5

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

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

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

579 580 583

Canada International

586 587 1

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

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

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

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

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

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

Certified Orthodontic Assistant (COA ) ®

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

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

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

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

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

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

Oregon Pennsylvania South Carolina South Dakota Tennessee Utah Virginia Wyoming

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

New Hampshire New York

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

DANB’s CP exam is recognized** in:

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

DANB’s SE exam is recognized** in:

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

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

North Dakota Ohio Oregon Rhode Island South Dakota Vermont Virginia Washington

Massachusetts Minnesota Mississippi Nebraska New Jersey North Carolina North Dakota

Ohio South Carolina South Dakota Tennessee Texas Vermont

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

Massachusetts New Jersey

Oregon Rhode Island

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

New Mexico

New Mexico Ohio

Oregon Texas

Wyoming

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

New Mexico

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

North Dakota

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

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

Arizona New Jersey

North Dakota Oregon

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

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

Oregon Rhode Island

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

Massachusetts

Rhode Island

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

Additional DANB Services and Resources Support for the Entire Dental Community

State Career Ladder Templates

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

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

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

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

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

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

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

Credential Verification and Protection

DANB's Website

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

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

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

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

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

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

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

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

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

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

196.

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

826

Infection Control (ICE)

895

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

DANB CDA Certificant State of Alabama+

$17.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

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

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

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

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

Alabama State Dental Practice Act and Administrative Rules for Dental Assistants

(2)

(3) (4)

(5) (6) (7)

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

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

p 12

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

157

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

445

Infection Control (ICE)

450

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

DANB CDA Certificant State of Alaska+

$25.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

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

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

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

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

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

p 19

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

Certified Dental Assistant (CDA) certificants

324

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

Radiation Health and Safety (RHS)

State Board of Dentistry Contact

15,127

Infection Control (ICE)

1,474

Coronal Polishing (CP)

2,486

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

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

110

Impressions (IM)

Temporaries (TMP)

124

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Phoenix College Pima Community College

DANB CDA Certificant State of Arizona+

$19.25 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

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

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

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

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

p 25

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

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

354

Infection Control (ICE)

408

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

DANB CDA Certificant State of Arkansas+

$18.25 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants

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

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

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

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

Arkansas State Dental Practice Act and Administrative Rules for Dental Assistants

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

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

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

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

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

p 38

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

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

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

2,985

Infection Control (ICE)

2,785

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

627

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

DANB CDA Certificant State of California+

$22.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

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

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

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

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(b)

(e) (f)

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

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

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

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

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

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

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

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

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

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

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

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

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

Lab Areas:

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

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

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

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

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

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

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(b)

(e) (f)

(g)

(h)

(i) 60

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(j)

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

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

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

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

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

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

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

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

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

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

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

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(d) (e)

(f)

(g)

(h) (i)

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(h)

(i)

(j) (k) (l)

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

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(h) (i)

(j)

(k)

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(l)

(m)

(n)

(o) (p)

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(e)

(f)

(g)

(h)

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

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

California State Dental Practice Act and Administrative Rules for Dental Assistants

(n)

(o)

(p) (q)

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

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

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

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

p 83

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

261

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

1,128

Infection Control (ICE)

1,041

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

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

Impressions (IM)

Temporaries (TMP)

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

DANB CDA Certificant State of Colorado+

$19.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

Article 220 Dentists and Dental Hygienists

Colorado Revised Statutes Title 12 Professions and Occupations

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

Colorado State Dental Practice Act and Administrative Rules for Dental Assistants

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

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

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

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

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

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

Privileges included in Colorado Dental Licensure

Minimal Sedation

Minimal Sedation Permit

Moderate Sedation

Moderate Sedation Permit

Deep Sedation

General Anesthesia

Deep Sedation/General Anesthesia Permit

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

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

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

p 91

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

Certified Dental Assistant (CDA) certificants

694

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

7,474

Infection Control (ICE)

4,907

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

DANB CDA Certificant State of Connecticut+

$21.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

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

Connecticut State Dental Practice Act and Administrative Rules for Dental Assistants

(d)

(e)

(f)

(g)

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

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

p 96

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

Certified Dental Assistant (CDA) certificants

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

Radiation Health and Safety (RHS)

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

1,768

Infection Control (ICE)

117

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

Median Salary of DANB CDA Certificants

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

DANB CDA Certificant State of Delaware+

$26.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

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

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

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

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

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

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

100

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

101

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

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

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

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

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

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

102

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

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

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

Radiation Health and Safety (RHS)

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

242

Infection Control (ICE)

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

DANB Certified Assistant District of Columbia+

$22.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

103

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

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

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

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

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

105

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

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

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

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

107

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

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

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

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

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

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

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

109

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

110

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

111

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

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

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

7,404

Infection Control (ICE)

7,684

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

2,079

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

DANB CDA Certificant State of Florida+

$17.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

112

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

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

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

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

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

113

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

114

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

115

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

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

117

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

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

119

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

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

121

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

122

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

Certified Dental Assistant (CDA) certificants

530

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

State Board of Dentistry Contact

1,944

Infection Control (ICE)

2,021

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

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

Anatomy, Morphology and Physiology (AMP)

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

Radiation Health and Safety (RHS)

Impressions (IM)

Temporaries (TMP)

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

$20.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

123

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

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

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

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

125

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

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

127

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

• •

128

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

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

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

362

Infection Control (ICE)

341

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs Kapi'olani Community College

DANB CDA Certificant State of Hawaii+

$21.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

129

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

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

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

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

131

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

132

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

Certified Dental Assistant (CDA) certificants

160

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

State Board of Dentistry Contact

Radiation Health and Safety (RHS)

896

Infection Control (ICE)

867

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

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

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs College of Western Idaho

DANB CDA Certificant State of Idaho+

$16.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

133

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

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

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

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

135

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

136

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

Certified Dental Assistant (CDA) certificants

586

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

3,091

Infection Control (ICE)

3,163

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

DANB CDA Certificant State of Illinois+

$18.00 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

137

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

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

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

139

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

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

140

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants

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

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

(b)

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

141

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

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

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

143

Illinois State Dental Practice Act and Administrative Rules for Dental Assistants

144

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

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

145

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

146

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

Certified Dental Assistant (CDA) certificants

1,298

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

Radiation Health and Safety (RHS)

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

11,241

Infection Control (ICE)

4,087

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

Median Salary of DANB CDA Certificants

CODA-Accredited Dental Assisting Programs

DANB CDA Certificant State of Indiana+

$18.75 per hour

DANB CDA Certificant

$20.76

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

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

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

147

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

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

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

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

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

149

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

150

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

151

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

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

153

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

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

155

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

721

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

2,125

Infection Control (ICE)

2,133

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

DANB CDA Certificant State of Iowa+

$18.50 per hour

DANB CDA Certificant National+

$20.73 per hour

All Dental Assistants National++

$18.59 per hour

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

156

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

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

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

157

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

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

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

159

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

4. 5.

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

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

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

161

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

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

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

163

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

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

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

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

165

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

166

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

167

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

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

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

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

169

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

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

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

171

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

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

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

172

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

173

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

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

175

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

176

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

177

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

178

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

179

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

180

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

244

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

990

Infection Control (ICE)

982

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

DANB CDA Certificant State of Kansas+

$17.06 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

181

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

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

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

182

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

183

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

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

185

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

186

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

214

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

Radiation Health and Safety (RHS)

874

Infection Control (ICE)

708

Coronal Polishing (CP)

Sealants (SE)

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

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

DANB CDA Certificant State of Kentucky+

$17.13 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

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

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

187

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

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

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

188

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

189

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

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

191

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

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

193

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

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

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

195

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

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

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

Radiation Health and Safety (RHS)

232

Infection Control (ICE)

284

Coronal Polishing (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

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

DANB CDA Certificant State of Louisiana+

$20.76 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

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

196

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

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

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

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

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

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

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

197

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

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

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

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

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

198

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

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

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

Minimum Maximum $100.00 $200.00

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

199

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

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

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

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

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

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

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

201

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

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

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

202

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

281

Certified Orthodontic Assistant (COA) certificants

Certified Preventive Functions Dental Assistant (CPFDA) certificants

Certified Restorative Functions Dental Assistant (CRFDA) certificants

DANB Contact

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

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

Radiation Health and Safety (RHS)

2,399

Infection Control (ICE)

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

600

Coronal Polish (CP)

Sealants (SE)

Topical Fluoride (TF)

Anatomy, Morphology and Physiology (AMP)

Impressions (IM)

Temporaries (TMP)

Median Salary of DANB CDA Certificants

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

DANB CDA Certificant State of Maine+

$23.50 per hour

DANB CDA Certificant National+

$20.76 per hour

All Dental Assistants National++

$18.59 per hour

DANB certificant an