Current through Register Vol. 48, No. 38, September 20, 2024
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 a 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 DANB may perform the
following services and procedures, but only under the following terms and
conditions:
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 the
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 preapproved 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.
2) 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 anethesia 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 pre-approved by the
Division, the dental assistant need not complete 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.
3)
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 Division 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 Division 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 is limited to polishing
the clinical crown of the tooth and existing restoration,
supragingivally;
C) Coronal
polishing is 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 4 dental assistants at any one time for the
task of coronal polishing.
4) 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 placing 6 pit
and fissure sealants;
C) The
supervising dentist documents 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.
5) 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 hands-on 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.
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 of 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.
