Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Prepared by the Dental Assisting National Board, Inc. September 5, 2008

The following table contains information about delegation of expanded functions to dental assistants (analogous, we believe, to Virginia’s DA II level), including delegable duties, educational requirements for delegation of expanded duties, and duties that are restricted from delegation to dental assistants in 10 states. These 10 states were selected for comparison because they each explicitly recognize two levels of dental assistant and each state’s dental board has promulgated regulations for the second or expanded functions level that, in DANB’s judgment, are in accord with the dental board’s public protection mission. In addition, information about a new proposal for dental assisting regulations in Nebraska is presented at the end of the table. Please note: This table contains no information about the entry level duties allows in these states (analogous, we believe, to Virginia’s DA I level).

State DA II-Level Duties DA II-Level Requirements Restricted Duties Florida • Charting • Graduate from a CODA-accredited dental • Gingival curettage and root planning • Retraction cord assisting program, provided that it included • Taking impressions for the purpose of • Polish clinical crowns appropriate training in the function fabricating any intraoral restorations or ortho • Suture removal OR appliances • • Initial access preparation Sealants • Successfully complete a Board-approved • Impressions for study casts and bleaching EFDA training program OR trays • Fabrication and cementation of temporary • Hold a current DANB CDA crowns

• Placing or removing temporary restorations • Removing excess cement from restorations with hand instruments • Monitoring nitrous • Inserting or removing dressings from alveolar sockets • Apply topical fluoride • Dental • Place and remove rubber dams • Apply cavity liners, varnishes, or bases • Place periodontal dressings • Place and remove matrices • Remove periodontal or surgical dressings

Appendix B Page 1 Appendix B State DA II-Level Duties DA II-Level Requirements Rest ricted Duties Iowa* • Place and remove gingival retraction cord • Hold CDA or complete a minimum of two • Removal of any plaque, stain, or hard natural or • Apply cavity liners and bases years of work experience as an RDA synthetic material except by toothbrush, floss, • Apply desensitizing agents (RDAs must have worked as a dental or rubber cup coronal polish, or removal of any • Apply bonding systems assistant for at least 6 months or have calculus • Place periodontal dressings graduated from a CODA-accredited dental • Place sealants • Take final impressions assisting program, and then must take • Diagnosis, examination, treatment planning or • Fabricate and remove temporary control course, pass DANB ICE prescription, including prescription for drugs and restorations exam, take jurisprudence course) medicaments or authorization for restorative, • Test pulp vitality AND prosthodontic, or orthodontic appliances • Surgical procedures on hard and soft tissues • Monitor nitrous oxide • Complete Board-approved education in within the oral cavity and any other intraoral • Place and remove dry socket medication each RDAEF function • Take occlusal registrations procedure that contributes to or results in an irreversible alteration to the oral anatomy • Administration of local anesthesia • Procedures that require the professional judgment and skill of a

Maryland • Place and remove retraction cord • Complete a training program (minimum of • Oral prophylactic procedures, including scaling, • Remove sutures 35 hours) approved by the Board AND pass root planing, and polishing teeth • Dry a root canal the Maryland General Dental Assisting • Condensing, carving, or finishing any • Apply topical fluoride Expanded Functions exam developed and restoration • Place or remove a rubber dam administered by DANB • Placing an initial surgical dressing • Remove or place periodontal dressing OR • Applying pit and fissure sealants • • Prepare and fit stainless steel crowns • Pass the CDA exam Examination, diagnosis, and treatment planning • Take alginate impressions for intraoral • Surgery on hard or soft tissues appliances • Administering injectable local anesthesia • Place and remove matrices • Initiating treatment at any time for the correction • Prepare temporary crowns of malocclusions and malformations of the teeth • Cement temporary crowns or restorations and jaws • Perform vitality tests • Adjusting occlusion of natural teeth, • Remove temporary crowns restorations, or appliances • Remove excess cement • Registration of jaw relations • Etching • Adjusting prosthetic appliances • Fabricate indirect restorations • Cementing permanent crowns or restorations • Apply desensitizing agents

* The State of Iowa actually has a three-tiered dental assistant career ladder, but the first rung is a Dental Assistant Trainee level; a Dental Assistant Trainee can only remain at this level for up to 12 months, during which time he or she must pass DANB’s Infection Control (ICE) and Radiation Health and Safety (RHS) Exams, and then apply for a Registered Dental Assistant (RDA) certificate.

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 2 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties Massachusetts • Place and remove retraction cord • Successfully complete a CODA-accredited • Place permanent or bonded restorations in or on • Place amalgam in tooth for condensation dental assisting program that has included natural teeth by the dentist a course in radiological techniques and • Apply cavity liner or base • Irrigate and dry root canals safeguards • Take impressions for fabrication of restorations, • Apply cavity varnish OR appliances, or prostheses • • Condense or carve amalgam or composite Place surgical dressings • Hold a current DANB CDA certification • Apply dental sealants restorations • Select and try stainless steel or other • Diagnose oral conditions preformed crowns for insertion by dentist • Develop treatment plans for dental services • Place and remove matrices and wedges • Surgically cut or remove hard or soft tissue (not to • Perform vitality testing include gingival curettage) • Remove temporary restorations with hand • Prescribe medications or drugs instrument • Administer general anesthesia, parenteral • Assist in administration of nitrous oxide sedation, or conscious sedation • Chart • Administer local anesthesia • Polish teeth after dentist determination that • Perform extractions they are free of calculus • Place sutures • Remove sutures • Perform endodontic therapy • Apply anti-cariogenic agents • Intraorally finish margins or adjust the occlusion of • Give oral health instruction restorations • Place and remove rubber dam • Fabricate or adjust dentures • Place and remove periodontal dressing • Permanently cement or recement cast crowns or • Take and record vital signs stainless steel crowns • Take impressions for study casts, athletic • Perform orthodontic therapy mouthguards, custom trays • Apply finish composite or bonding materials for • Place temporary restorations restorative or cosmetic procedures • Cement and remove temporary crowns and • Perform any other procedure prohibited by the bridges Board • Irrigate and aspirate the oral cavity • Retract lips, cheek, tongue, and other oral tissue parts • Isolate the operative field • Apply topical anesthetic agents • Remove surgical dressings • Perform dietary analysis for dental disease control • Take intraoral photos • Take wax bite registrations for identification purposes • Take oral cytologic smears • Insert and/or perform minor adjustment of athletic mouthguards and custom fluoride trays

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 3 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties Missouri • Place retraction cord • Pass the Missouri Basic Dental Assisting • Scaling of teeth • Polish the coronal surfaces of teeth Skills exam administered by DANB • Diagnosis, including interpretation of dental • Place and condense amalgam for Class I, AND radiographs and treatment planning V, and VI restorations Complete the appropriate Board-approved • Cutting of tooth structure • Place periodontal dressings expanded functions course(s) • Surgical procedures on hard and soft tissues • Size stainless steel crowns OR including, but not limited to, the removal of teeth • Make impressions for the fabrication of • and the cutting and suturing of soft tissues Graduate from a CODA-accredited dental • removable and fixed prostheses assisting program and hold a current DANB Prescription, injection, and parenteral • Carve amalgam CDA certification administration of drugs • Monitor nitrous oxide • Administration of nitrous oxide/oxygen analgesia • Place post-extraction and sedative dressing • CDAs who were Certified prior to 6/1/1995 • Final bending of archwire prior to ligations • Place composite for Class I, V, and VI or who have graduated from programs restorations (what type of programs?) outside of • Place sedative filling for palliative care in Missouri may perform expanded functions if dental emergencies they complete a Board-approved expanded • Extraoral adjustment of removable functions course and pass and can provide prosthesis during and after insertion proof of competence • Extraoral adjustment of fixed prosthesis • To monitor nitrous oxide, EFDA must • Final cementation of any permanent complete a formal training course approved appliance or prosthesis by the Board and pass an approved • Placement of temporary soft liners in a competency exam in both clinical and removable prosthesis didactic areas OR hold certification in another state to assist in the administration and monitoring of nitrous

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 4 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties New Jersey • Place and remove retraction cords and • Graduate from high school or equivalent • None specified medicated pellets AND • Place amalgam, composite, and gold foil in • a tooth for condensation by a dentist Pass DANB’s CDA or COA exam within 10 years of applying for RDA • Remove sutures AND • Isolate the operative field, including placement and removal of rubber dam • Graduate from a CODA-accredited dental • Place and remove periodontal and other assisting program within 10 years of surgical dressings applying for RDA • Take alginate impressions OR • Place and remove matrices and wedges Obtain at least two years’ work experience • Fabricate and cement temporary crowns as a dental assistant (within 5 years prior to and bridges after preparation of tooth application) AND pass the New Jersey (teeth) by a dentist. This does not include Expanded Duties –General exam intra-oral occlusal adjustment administered by DANB • Perform hand removal of crowns and bridges that have been temporarily cemented • Remove excess cement from crowns or other restorations • Perform hand removal of soft temporary restorations • Monitor nitrous oxide (no other functions are allowed to be performed simultaneously and patient cannot be taking any other medication, and assistant must hold current Cardiac Life Support CPR certification) • Take impressions for and perform laboratory fabrication of athletic mouthguard • Perform bite registrations • Place temporary sedative restorations • Place caries detecting agents and use instruments for caries detection (not including laser)

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 5 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties New York • Remove sutures • At least 17 years of age • Diagnosing • Apply topical anticariogenic agents • Performing surgical procedures • High school graduate or equivalent • Provide patient education • Performing irreversible procedures • Place and remove rubber dams • Education • Performing procedures that would alter the hard or • Take preliminary medical histories and vital soft tissue of the oral and maxillofacial area signs Complete a Board-approved one year • Removing calcareous deposits, accretions, and • Place and remove temporary separating dental assisting course in a degree- stains, including scaling and planning of exposed devices granting institution or a board of root surfaces indicated for complete dental cooperative educational services • Take impressions for study or diagnostic prophylaxis program that includes at least 200 casts • Applying topical agents indicated for a complete hours of clinical experience (CODA- • Place and remove matrices dental prophylaxis accredited programs meet this • • Removing excess cement from tooth surfaces Select and pre-fit temporary crowns requirement) • • Providing patient education Remove temporary cement OR • • Remove periodontal dressing Complete an alternate course of study Polishing teeth, including existing restorations • • Apply desensitizing agents in dental assisting acceptable to the Charting caries and periodontal conditions as an • Perform other dental supportive services New York State Education department aid to the dentist • authorized by the licensed dentist while that includes at least 1,000 hours of Applying pit and fissure sealants under direct personal supervision of the relevant work experience in • Applying desensitizing agents to the teeth licensed dentist, providing that such other accordance with the Commissioner’s • Applying a topical medication not related to a dental supportive services are not excluded regulations complete dental prophylaxis • Placing periodontal dressings • Examination • Such dental supportive services that a New York Pass all three components of DANB’s State licensed “certified dental assistant” would CDA exam (RHS, ICE, and GC) not reasonably be qualified to perform based upon OR meeting the requirements for licensure as a New Pass the New York Professional York State licensed “certified dental assistant” Dental Assistant exam plus DANB’s and/or obtaining additional legally authorized RHS and ICE exams (NYPDA is the experience in the practice of licensed dental GC exam without any eligibility assisting requirements) • A person who has met the age, high school and advanced education requirements can apply for a Limited (one-year) Permit in order to take one year to pass the examination requirement; Limited Permit holders may perform all expanded duties under the direct personal supervision of a licensed dentist; Limited Permits expire after one year and may be renewed for one additional year.

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 6 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties North Carolina • Place retraction cord • Hold a current CPR certification AND • Taking impressions for final fixed or removable • restorations or prostheses Polish coronal surfaces of teeth by hand or • with a slowspeed handpiece Successfully complete a CODA-accredited • Prophylaxis dental assisting program or one academic • Remove sutures • Periodontal screening year or longer in a CODA-accredited dental • Flush, dry, and temporarily close root • Periodontal probing hygiene program canals • Subgingival exploration for or removal of hard or • OR Place and remove rubber dams Complete two years (3,000 hours) of full soft deposits • • Place cavity bases and liners time employment and experience as a Sulcular irrigation • • Apply sealants after dentist has examined chairside dental assistant, radiography Comprehensive examination, diagnosis, and patient and prescribed procedure training as required by law AND a 3-hour treatment planning • Insert interdental spacers course in dental office emergencies AND a • Surgical cutting procedures on hard or soft • Take impressions for study models or 3-hour course in sterilization and infection tissues, including laser, air abrasion, or micro- opposing casts control abrasion procedures • Insert matrices and wedges OR • Placement or removal of sulcular nonresorbable • Place and remove temporary restorations Pass DANB’s CDA examination agents • Remove excess cement • The issuance of prescription drugs, medications, • • Monitor nitrous oxide To perform coronal polishing, a DA II must or work authorizations also successfully complete a 7 hour Board- • Remove periodontal dressings • Final placement or intraoral adjustment of a fixed approved coronal polishing course (3 hours • Cement temporary restorations with or removable appliance didactic, 4 hours clinical) temporary cement • Intraoral occlusal adjustments which affect • Apply acid etch materials/rinses • To monitor patients under nitrous oxide, a function, fit, or occlusion of any temporary or • Apply bonding agents DA II must successfully complete a 7 hour permanent appliance • • Apply desensitizing agents Board –approved course in nitrous oxide- Performance of direct pulp capping or pulpotomy • oxygen conscious sedation (DA I’s are also Placement of sutures allowed to monitor patients under nitrous if • Final placement or cementation of orthodontic they complete this course.) bands or brackets • Placement or cementation of final restorations • Administration of any anesthetic except the administration of topically applied agents intended to anesthetize only cutaneous tissue • Intraoral use of a highspeed handpiece

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 7 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties Oregon • Polish coronal surfaces of teeth that a • Hold an Oregon Certificate of Radiological • Place any type of cord subgingivally dentist or hygienist has determined to be Proficiency (requires taking Board- • Condense and carve permanent restorative free of calculus approved course, passing DANB’s RHS material (except as provided in OAR 818- • Apply pit and fissure sealants exam, and passing DANB’s Clinical 04200095) • Place and remove matrices Radiological Proficiency exam) AND • Place periodontal packs • Fabricate and cement temporary crowns • Take jaw registrations or oral impressions except • Complete a CODA-accredited dental with temporary cement for diagnostic or opposing models to fabricate assisting program • temporary restorations or appliances Place temporary restorative material OR • • Remove temporary crowns for final Pass the Oregon Basic Dental Assisting Diagnose or plan treatment • cementation and clean teeth for final exam administered by DANB or the CDA Cut hard or soft tissue • cementation exam AND the Oregon EFDA exam Adjust or attempt to adjust any ortho wire, fixed or • Remove excess supragingival cement from administered by DANB removable appliance while it is in the patient’s crowns, bridges with hand instruments AND mouth • Preliminarily fit crowns to check contacts or • Administer or dispense any drug except fluoride, adjust occlusion outside of the mouth • Provide certification from a licensed dentist topical anesthetic, or desensitizing agent • Polish amalgams with a slowspeed that the assistant has completed clinical • Prescribe any drug handpiece requirements • Start nitrous oxide • • Apply temporary soft relines to full dentures • EFDAs may also earn State Certification by Use high speed handpiece or any device • For palliative relief, EFDA may recement Credentials if they are certified in another intraorally that is operated by a highspeed temporary crown or permanent crown with state that has training and certification handpiece • temporary cement requirements substantially similar to Use lasers, except for laser-curing lights • Dental assistants who have completed Oregon’s OR be certified by an employer • Use air abrasion or air polishing specific OBD-training and exam can dentist that the assistant has been • Remove teeth or parts of tooth structure apply to receive a Restorative employed as a dental assistant for at least • Apply denture relines Endorsement and are allowed to place 1,000 hours in the past two years in a State • Use Hand Over Mouth or Hand Over Mouth and finish direct alloy or direct anterior other than Oregon, and is competent to Airway Restriction technique for behavior composite restoration under direct dentist perform all of the Oregon expanded management supervision, after dentist has prepared the functions. • Use ultrasonic equipment intraorally tooth (teeth) • Correct or attempt to correct the malposition or • Note that in order for an EFDA to be malocclusion of teeth or to take any action related qualified to apply pit and fissure sealants to the movement of teeth (excluding those and temporary soft relines to full dentures, Expanded Orthodontic Functions expressly he/she must complete a specific course of permitted) instruction in a CODA-accredited program • Cement or bond any fixed appliance, including or such course approved by the Board. bands, brackets, retainers, tooth moving devices, or orthopedic appliances (excluding those Expanded Orthodontic Functions expressly permitted) • Apply denture relines, excluding those functions expressly permitted • Remove stains or deposits

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 8 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties Washington • Coronal polishing • Complete an EFDA course approved by the • Scaling procedures • Apply topical fluoride Washington Dental Quality Assurance • Removal of or addition to the hard or soft natural • Apply sealants Commission tissue of the oral cavity • Place and expose dental radiographic film AND • Diagnosis of or prescription for treatment of • disease, pain, deformity, deficiency, injury, or Provide oral health instruction • Pass the Washington State Restorative • physical condition of the human teeth or jaws, or Place and carve direct restorations Exam developed by DANB • adjacent structure Take final impressions AND • Administration of general or injected local • Pass the Western Regional Examining anesthetic Board’s clinical restorative exam • Oral prophylaxis (except coronal polishing) AND • Intraorally adjust occlusion of inlays, crowns, and bridges • Make application to DQAC for a license • Intraorally finish margins of inlays, crowns, and bridges • Cement or recement, permanently, any cast restoration or stainless steel crown • Incise gingiva or other soft tissue • Elevate soft tissue flap • Luxate teeth • Curette to sever epithelial attachment • Suture • Establish occlusal vertical dimension for dentures • Try-in of dentures set in wax • Insertion and post-insertion adjustment of dentures • Endodontic treatment (open, extirpate pulp, ream and file canals, establish length of tooth, fill root canal)

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 9 Appendix B State DA II-Level Duties DA II-Level Requirements Restricted Duties Nebraska Proposed LDAEF Duties (* see current NE Proposed LDAEF Requirements: Current Nebraska Restrictions (Proposed) restrictions, in last column): (duties marked with an asterisk [*] are listed as • At least 18 years of age proposed LDA or LDAEF duties): • Place and remove retraction cord* • • Place, cure and finish composite or glass CPR certification • Placing and packing retraction cords * • ionomer restorations* • Successfully complete an LDAEF course Placing and condensing amalgam restorations * • • Place, condense, and carve amalgams* taught at a CODA-accredited dental Performing supragingival scaling • Polish and contour restorations for assisting program; minimum course • Placing and finishing composite resin restorations* preventive purposes requirements proposed include 64 hours of • Applying cavity liners or bases* • Take final impressions for restorations and laboratory and didactic curriculum, plus an • Applying pit and fissure sealants* removable prostheses externship in which the dentist will evaluate • Taking final impressions for dentures* • Remove temporary fillings with hand the LDAEF candidate to clinic competency; • Taking final impressions for crown and bridge instruments externship may extend up to one year after • Carving amalgams* • Remove excess cement from coronal LDAEF coursework completion. • Remove excess cement from coronal surfaces of surfaces of the teeth with ultrasonic scaler teeth with an instrument * • Pass a written LDAEF exam developed by • Remove excess cement from supragingival • Polish amalgams* DANB. surfaces with hand instruments or floss • Place tetracycline periodontal fibers (other than for temporary restorations) • Complete 30 hours of continuing dental • Place dentinal bonding agents • Make minor adjustments to removable education every 2 years, with 6 hours in • Apply enamel/dentin etching agents dentures, partial dentures, after dentist infection control and 4 hours in • Cement permanent restorations examination of patient jurisprudence • Atraumatic restorative therapy (ART) • Take bite registrations for final prosthetic • Adjustments to dentures and/or partials devices • Apply bleaching products

Appendix B Dental Assisting Expanded Functions, Requirements, and Restrictions in Selected States Page 10