Unlicensed Dental Assistants

What new duties will I be allowed to do if I’m an unlicensed dental assistant?

Starting on January 1, 2010, you will be able to do the following duties and procedures. The new duties, which you are currently not allowed to perform, are in bold:

A dental assistant may do the following under the general supervision of a supervising licensed dentist:

1. Extra-oral duties or procedures specified by the supervising licensed dentist, provided that those 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

A dental assistant may do the following under the direct supervision of a supervising dentist:

1. Apply non-aerosol and non-caustic 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 post-extraction 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 arch wires


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.

Under the supervision of a registered dental hygienist in alternative practice, a dental assistant may perform intraoral retraction and suctioning.

What courses will I have to take as an unlicensed dental assistant starting January 1, 2010?

Starting January 1, 2010, an unlicensed dental assistant who is in a dentist’s continuous employment 120 days or more must complete all of the following within a year of the date of employment. For example, if you are employed by a dentist for one year, you must complete these courses within one year after you have been hired. If you are employed by a dentist for two months, and then become employed by a different dentist, you then have up to one year after you become employed by the second dentist to complete the following courses.

1. A course in basic life support. In addition, the dental assistant’s employer must make sure that the dental assistant continues to maintain certification of basic life support.
2. A course in the California Dental Practice Act approved by the Dental Board.
3. A course in infection control.

Is the Infection Control course that I have to take the same one that my dentist must take every 2 years?

No, the Infection Control Course must be at least 8 hours long, include lecture, laboratory and clinical instruction, and must be given by a provider who is approved by the Dental Board.

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Registered Dental Assistants (RDAs)

What will I have to do to become a licensed RDA after January 1, 2010?

Much like the current requirements, a person who wants to get a license as an RDA will have to complete an approved RDA program, or complete certain work experience requirements, and pass both a written and practical examination.

How many months of experience will I need to apply for an RDA license?

If you apply after January 1, 2010, you must have 15 months of qualifying work experience, instead of the current 12 months of experience that are required. If you graduate from an approved RDA program, you do not need to meet any experience requirements.

What courses will I have to take before I can get an RDA license?

A person who applies for an RDA license on or after January 1, 2010, must have completed the following within the five years prior to the date of application:

1. A course in basic life support
2. An infection control course. The course must be at least 8 hours long, and must be given by a provider who is approved by the Dental Board.
3. A course in the California Dental Practice Act approved by the Dental Board

You must also have successfully completed Board-approved courses in Radiation Safety and Coronal Polishing.

Do I have to take a course in Pit and Fissure Sealants?

You do not have to complete a Pit and Fissure Sealant Course before you get your RDA license, but RDAs who receive a license on or after January 1, 2010, must complete a Pit and Fissure Sealant Course as a condition of the first renewal that requires CE.

Will the RDA examinations change after January 1, 2010?

The practical exam will have 3 procedures instead of two (2). The possible tested procedures will be: (1) Place a base or liner; (2) Place, adjust, and finish a direct provisional restoration; (3) Fabricate and adjust an indirect provisional restoration; and (4) Cement an indirect provisional restoration.

The written exam will most likely change as well to reflect the new duties that RDAs will be allowed to perform.

In addition, RDAs applying on or after January 1, 2010, must also pass a written examination in Law and Ethics.

What new duties will I be allowed to do if I’m a licensed RDA?

Starting January 1, 2010, RDAs will be able to do the following duties and procedures. The new duties are in bold text.

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 (broader definition of current duty)


10. Fabricate, adjust, cement and remove indirect provisional restorations, including stainless steel crowns when used as a provisional restoration (broader definition of current duty)


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 (broader definition of current duty)


16. Polish coronal surfaces of the teeth


17. Place ligature ties and arch wires.


18. Remove orthodontic bands

As a licensed RDA, will I have to take any courses before doing the new RDA duties?

A person licensed as an RDA on January 1, 2010, will not have to take any additional courses in order to perform the new duties listed above.

However, an RDA may only do the following duties if he or she has provided evidence to the Dental Board of having completed a board-approved course in such duty or duties. In addition, an RDA who receives a license on or after January 1, 2010, must complete a Pit and Fissure Sealant Course as a condition of the first renewal that requires CE.

1. The application of pit and fissure sealants.
2. Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment
3. The allowable duties of an orthodontic assistant, except that a licensed RDA may continue to do the following RDA orthodontic duties: placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument).
4. The allowable duties of a dental sedation assistant.
   

What level of supervision will the RDA duties have to be performed under?

Starting January 1, 2010, the supervising licensed dentist will be responsible for deciding whether each procedure should be performed under general or direct supervision.

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Registered Dental Assistants in Extended Functions (EFs)

What will I have to do to become a licensed RDAEF after January 1, 2010?

To become licensed as an RDAEF on or after January 1, 2010, you must complete the following requirements:

1. Hold a current license as an RDA or complete the requirements for licensure as an RDA.
2. Successfully complete a board-approved course in the application of pit and fissure sealants.
   
3. Successfully complete the following:
1. A board-approved RDAEF course or courses in all of the existing and new procedures. A course approved by the Dental Board must be at least 380 hours long.
2. Pass a written examination given by the Dental Board.
3. Pass a clinical or practical examination given by the Dental Board.
   

What new duties will RDAEFs be allowed to perform starting January 1, 2010?

RDAEFs issued a license on or after January 1, 2010, will be able to perform the following duties and procedures. The new duties (that existing RDAEFs are not allowed to perform until they meet certain requirements) are in bold text.

1. All duties and procedures that a RDA is allowed to perform.


2. 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.


3. 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.


4. Cord retraction of gingiva for impression procedures.


5. Size and fit endodontic master points and accessory points.


6. Cement endodontic master points and accessory points.


7. Take final impressions for permanent indirect restorations.


8. Take final impressions for tooth-borne removable prosthesis.


9. Polish and contour existing amalgam restorations.


10. Place, contour, finish, and adjust all direct restorations.


11. Adjust and cement permanent indirect restorations.

If I'm a licensed as an RDAEF before January 1, 2010, what will I have to do to do the new duties starting January 1, 2010?

Existing RDAEFs will have to complete the following in order to do the new duties on or after January 1, 2010:

1. Successfully complete a course in the new duties that is approved by the Dental Board. A course approved by the Dental Board must be at least 288 hours long.
2. Pass a written examination given by the Dental Board.
3. Pass a clinical or practical examination given by the Dental Board.

What if I'm an RDAEF now, and don't want to perform any of the new duties?

A person who has a valid and current RDAEF license may choose to continue to just perform the existing allowable duties. There is no requirement that you take another EF program or otherwise qualify to perform the new duties. You will be allowed to continue to perform the following duties:

1. All duties and procedures that a RDA is allowed to perform.
2. Cord retraction of gingiva for impression procedures.
3. Take final impressions for permanent indirect restorations.
4. Formulate indirect patterns for endodontic post and core castings.
5. Fit trial endodontic filling points.
6. Apply pit and fissure sealants.
7. Remove excess cement from subgingival tooth surfaces with a hand instrument.

What if I’ve already completed a current RDAEF program, but have not taken or passed the RDAEF exam by January 1, 2010?

You will have to meet the following requirements if you are not licensed as an RDAEF by January 1, 2010:

1. Hold a current license as an RDA or complete the requirements for licensure as an RDA.
2. Successfully complete a board-approved course in the application of pit and fissure sealants.
3. Successfully complete the following:
1. A board-approved RDAEF course in the new duties. A course approved by the Dental Board must be at least 288 hours long.
2. Pass a written examination given by the Dental Board.
3. Pass a clinical or practical examination given by the Dental Board
   

What level of supervision will the RDAEF duties have to be performed under starting January 1, 2010?

They must be performed under direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist. All procedures performed under direct supervision must be checked and approved by the supervising licensed dentist prior to the patient's dismissal from the office.

Is there a limit to the number of EFs that can be used in one office?

Currently, a licensed dentist may simultaneously use in his or her practice no more than two dental assistants in extended functions or registered dental hygienists in extended functions. Starting January 1, 2010, that limit will be increased to three (3).

Orthodontic Assistant Permit

If I’m an unlicensed dental assistant, how will I be able to get a permit as an Orthodontic Assistant?

1. Complete 12 months of work experience as a DA.
2. Successfully complete an Orthodontic Assistant course that is approved by the Dental Board. You may begin taking this course once you have at least 6 months of work experience as a DA, but you cannot apply for a permit until you have finished the 12 months of work experience.

How long will the Orthodontic Assistant Course be?

Orthodontic Assistant courses approved by the Dental Board must be at least 84 hours long.

What else must I do to get an Orthodontic Assistant Permit?

1. Pass a written examination given by the Dental Board.
2. Complete a course in basic life support.
3. Complete a course in infection control. The course must be at least 8 hours long, and must be given by a provider that is approved by the Dental Board.
4. Complete a course in the California Dental Practice Act approved by the Dental Board.

If I’m a licensed RDA or RDAEF, how will I be able to get a permit as an Orthodontic Assistant?

To apply for a permit to become an Orthodontic Assistant, an RDA or RDAEF holding a valid and current license will have to meet the following requirements:

1. Successfully complete an Orthodontic Assistant course that is approved by the Dental Board. Orthodontic Assistant courses approved by the Dental Board must be at least 84 hours long.
   
   RDAs and RDAEFs applying for an OA permit will not be required to complete further training during the course in the following duties, since they will be legally allowed to perform them as an RDA or RDAEF: placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument
   
2. Pass a written exam given by the Dental Board.

What duties will I be allowed to do if I get an Orthodontic Assistant permit?

An Orthodontic Assistant holding a current and valid permit will be allowed to perform the following duties:

1. All duties that a dental assistant is allowed to perform.
2. Prepare teeth for bonding, and select, preposition, and cure orthodontic brackets after their position has been approved by the licensed dentist.
3. Remove only orthodontic brackets and attachments with removal of the bonding material by the supervising licensed dentist.
4. Size, fit, and cement orthodontic bands.
5. Remove orthodontic bands and remove excess cement from supragingival surfaces of teeth with a hand instrument.
6. Place and ligate archwires.
7. Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment.

As an RDA or RDAEF, will I be able to do some of the Orthodontic Assistant duties without getting an Orthodontic Assistant permit?

RDAs and RDAEFs will be able to continue to do some of the Orthodontic Assistant duties without seeking an Orthodontic Assistant permit, since they will be legally allowed to perform them as an RDA or RDAEF. Those duties are: placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument.

If I get a permit as an Orthodontic Assistant, will I need to renew the permit?

Each permit must be renewed, just like a license, by paying a renewal fee. Also, if the holder of the permit is an unlicensed dental assistant, he or she must complete the required number of continuing education units specified by the Dental Board.

If the holder of the permit is a licensed RDA or RDAEF, completion of the CE units for the RDA or RDAEF license will fulfill the CE requirements for the permit without taking additional CE units.

An RDA or RDAEF holding an Orthodontic Assistant permit will be referred to as an "RDA with orthodontic assistant permit" or "RDAEF with orthodontic assistant permit", or "RDAEF with dental sedation assistant permit," as applicable.

Dental Sedation Permit

If I’m an unlicensed dental assistant, how will I be able to get a permit as a Dental Sedation Assistant?

To apply for a permit to become a Dental Sedation Assistant, an unlicensed dental assistant has to meet the following requirements:

1. Complete 12 months of work experience as a DA.
2. Successfully complete a Dental Sedation Assistant course that is approved by the Dental Board. You may begin taking this course once you have at least 6 months of work experience as a DA, but you cannot apply for a permit until you have finished the 12 months of work experience.

How long will the Dental Sedation Assistant Course be?

Dental Sedation Assistant courses approved by the Dental Board must be at least 110 hours long.

What else must I do to get a Dental Sedation Assistant Permit?

1. Pass a written examination given by the Dental Board.
2. Complete a course in basic life support.
3. Complete a course in infection control. The course must be at least 8 hours long, and must be given by a provider that is approved by the Dental Board.
4. Complete a course in the California Dental Practice Act approved by the Dental Board.

If I’m a licensed RDA or RDAEF, how will I be able to get a permit as a Dental Sedation Assistant?

To apply for a permit to become a Dental Sedation Assistant, an RDA or RDAEF holding a valid and current license will have to meet the following requirements:

1. Successful complete a Dental Sedation Assistant course that is approved by the Dental Board. Dental Sedation Assistant courses approved by the Dental Board must be at least 110 hours long. The Dental Board cannot approve these courses until sometime after January 1, 2009.
2. Pass a written exam given by the Dental Board.

What duties will I be allowed to do if I get a Dental Assistant permit?

A Dental Sedation Assistant holding a current and valid permit will be allowed to perform the following duties:

1. All duties that a dental assistant is allowed to perform.
2. 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.
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.
   

What level of supervision must the Dental Sedation Assistant duties be performed under?

The allowable duties must be performed under the direct supervision of a licensed dentist or other licensed health care professional authorized to administer conscious sedation or general anesthesia in the dental office.

In what offices can the allowable Dental Sedation Assistant duties be performed?

The allowable duties may not be performed in any setting other than a dental office or dental clinic.

If I get a permit as a Dental Sedation Assistant, will I need to renew the permit?

Each permit must be renewed, just like a license, by paying a renewal fee. Also, if the holder of the permit is an unlicensed dental assistant, he or she must complete the required number of continuing education units specified by the Dental Board.

If the holder of the permit is a licensed RDA or RDAEF, completion of the CE units for the RDA or RDAEF license will fulfill the CE requirements for the permit without taking additional CE units.

An RDA or RDAEF holding a Dental Sedation Assistant permit will be referred to as an "RDA with dental sedation assistant permit" or "RDAEF with dental sedation assistant permit," as applicable.

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