Have credential, will travel? Not as easy for a dental assistant

By Natalie Kaweckyj, LDA, RF, CDA, CDPMA, COA, COMSA, CPFDA, CRFDA, MADAA, BA

One of the greatest challenges for current dental assistants is the portability of their profession across state lines. With more than 50 designations of dental assistants nationwide, no two designations are alike, nor are the requirements for becoming a dental assistant. Allowable duties, education and continuing education requirements as well as state specific credentials are all over the spectrum.

Over the next several articles, I will explore the requirements to become a dental assistant in each of the states, comparing and contrasting prerequisites and provide some useful sources for additional information. Information was obtained from each individual state dental practice act, individual state boards of dentistry or boards of dental examiners, and the Dental Assisting National Board (DANB).

In this article, we will look at Alabama, Alaska, Arizona, and Arkansas requirements.

Alabama – one level of dental assistants

According to DANB, there are no radiography requirements for dental assistants in the state of Alabama and all dental assistants may legally operate dental x-ray equipment and perform radiographic procedures. A dental assistant in Alabama may perform basic supportive dental procedures specified by the state dental practice act under the direct supervision of a licensed dentist. Direct supervision is defined as the type of supervision in which a dentist is in the dental office or treatment facility, personally diagnoses and treatment plans the condition to be treated, personally authorizes the procedures and remains in the dental office or treatment facility while the procedures are being performed by the dental assistant, and evaluates their performance before dismissal of the patient. There are no educational or training requirements for this level of dental assisting in Alabama. It is unknown the number of dental assistants practicing in Alabama as they are not regulated or tracked.

Alaska – two levels of dental assistants

According to DANB, there are no radiography requirements for dental assistants in the state of Alaska and all dental assistants may legally operate dental x-ray equipment and perform radiographic procedures. There are two levels of dental assistants, the dental assistant and those additionally qualified in coronal polishing procedures and or restorative functions.

Dental Assistant

A dental assistant in Alaska may perform basic supportive dental procedures specified by the state dental practice act under indirect supervision of a licensed dentist. Indirect supervision is the type of supervision in which a dentist is in the dental office or treatment facility, has personally diagnosed and treatment planned the condition to be treated, authorizes the procedures and remains in the dental office or treatment facility while the procedures are being performed by the dental assistant, and will evaluate the performance of the dental assistant. Additional specific allowable duties under indirect supervision include application of topical preventive agents and application of pit and fissure sealants. There are no educational or training requirements for this level of dental assisting and therefore not regulated or tracked by the Alaska Board of Dental Examiners (AKBDE).

Dental Assistant Qualified in Coronal Polishing Procedures

To perform coronal polishing procedures in Alaska under the direct supervision of a licensed dentist, the dental assistant must hold a valid certificate in coronal polishing. Direct supervision is defined as a dentist licensed in Alaska 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.

  • There are two pathways to becoming a DA qualified in coronal polishing procedures with the first being licensed or certified to perform the expanded function in another state and be able to provide documentation to the AKBDE. There are several states that allow this expanded function for dental assistants.
  • The second pathway is to submit a completed notarized application and applicable fees to the AKBDE and successfully complete a program of instruction approved by the AKBDE.

The initial application form to be qualified in coronal polishing procedures can be found at https://www.commerce.alaska.gov/web/portals/5/pub/den4561.pdf

The course approval application can be found at https://www.commerce.alaska.gov/web/Portals/5/pub/den4762.pdf

The renewal form for being qualified in coronal polishing procedures can be found at https://www.commerce.alaska.gov/web/portals/5/pub/den4610.pdf

Dental Assistant Qualified in Restorative Functions

To perform specified restorative functions in Alaska under the direct supervision of a licensed dentist, the dental assistant must hold a valid certificate in restorative functions. Direct supervision is defined as a dentist licensed in Alaska 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.

  • There are two pathways to becoming a DA qualified in restorative functions with the first having legal authorization from another state or jurisdiction to perform restorative functions and submitting a completed notarized application and applicable fees to the AKBDE. There are a number of states that currently allow dental assistants to perform restorative functions.
  • The second pathway includes successfully completing a course offered by or under the auspices of a program accredited by the Commission on Dental Accreditation (CODA) or another equivalent course or program approved by the AKBDE AND
  • Passing the Western Regional Examining Board’s (WREB) restorative examination or other equivalent examination approved by the AKBDE within the five years preceding the dental assistant’s certificate application.

The initial application form to be qualified in restorative functions can be found at https://www.commerce.alaska.gov/web/portals/5/pub/den4577.pdf

The renewal form for being qualified in restorative functions can be found at https://www.commerce.alaska.gov/web/portals/5/pub/den4784.pdf

The AKBDE does maintain a registry of dental assistants who hold certificates in coronal polishing and/or restorative functions.

  • The Alaska Board of Dental Examiners can be accessed at

https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofDentalExaminers.aspx

Arizona – three levels of dental assistants

According to DANB, in order for a dental assistant to take radiographs in Arizona, one must hold a current board-approved certificate in dental radiology. To obtain such certificate, the dental assistant must either successfully pass the national DANB Radiation Health and Safety (RHS) exam, OR currently be certified in another state or jurisdiction that requires successful completion of a written dental radiography exam. In both instances, the dental assistant would also need to apply to the Arizona State Board of Dental Examiners (ASBDE) for Dental Assistant Radiography Certification by Credential and receive the Arizona Radiologic Proficiency Certificate, which is issued by the ASBDE. Information on the RHS exam can be accessed at https://www.danb.org/en/Become-Certified/Exams-and-Certifications/RHS-Exam.aspx

https://azadoagov.na1.echosign.com/public/esignWidget?wid=CBFCIBAA3AAABLblqZhD5XweFFkRo3mrU_P7HljKDi_kZ7a3m3DGK96tSLrQRTGPo2TusZ6fqLKDVUL-FIow*

Information of radiology certification by credential: https://dentalboard.az.gov/sites/default/files/DA%20_Application%20for%20Web%201-2018_0.pdf

There are three levels of dental assistants, the dental assistant, the dental assistant qualified in coronal polishing and the Expanded Function Dental Assistant (EFDA).

Dental Assistant

A dental assistant in the state of Arizona may perform basic supportive dental procedures specified by the state dental practice act under the direct supervision of a licensed dentist. Direct supervision is defined as a dentist licensed in Arizona 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. There are no educational or training requirements for this level of dental assisting.

Dental Assistant Qualified in Coronal Polishing

To perform coronal polishing procedures in the state of Arizona under the general supervision of a licensed dentist, a dental assistant must hold an Arizona Coronal Polishing Certificate. General Supervision is defined 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.

To qualify for an AZ Coronal Polishing Certificate, the dental assistant must:

Successfully pass DANB’s Coronal Polish (CP) exam found in the “Coronal Polish Exam for AZ Residents” application packet AND submit an AZ Coronal Polishing Clinical Skills Affidavit that is completed by a licensed dentist or a coronal polishing educator/course instructor, to DANB; AND receive the AZ Coronal Polishing Certificate, sent upon successful completion of the DANB CP exam and submission of the Arizona Coronal Polishing Clinical Skills Affidavit to DANB.

An application for the coronal polishing exam can be found at under the Arizona heading: https://www.danb.org/en/Meet-State-Requirements/State-Exam-Applications.aspx

Additional information on AZBDE: https://dentalboard.az.gov/sites/default/files/da_coronal.pdf

Expanded Function Dental Assistant (EFDA)

A dental assistant who wants to specified restorative functions in Arizona under the supervision of a licensed dentist, must hold an Arizona Expanded Function – Restorative Certificate. There are two pathways to obtaining the restorative certification.

To qualify, the dental assistant must:

  • Hold the Arizona Coronal Polishing certificate and the Arizona Radiologic Proficiency certificate AND successfully complete an ASBDE-approved EFDA training course approved by the AZSBDE at a Commission on Dental Accreditation (CODA)-accredited program, AND successfully pass the following DANB examinations:
    • Anatomy, Morphology and Physiology (AMP)
    • Temporaries (TMP)
    • Restorative Functions (RF) AND

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 then applying to DANB for the Arizona Expanded Function – Restorative Functions Certificate.

  • Pathway two includes providing evidence of currently holding or having held within the previous ten (10) years a license, registration, permit or certificate in expanded functions in restorative procedures issued by another state or jurisdiction; AND documenting clinical experience in the specified expanded functions on a Licensed Dentist Endorsement form, AND applying to DANB for the Arizona Expanded Function – Restorative Functions Certificate.

All forms for applications through DANB in restorative functions can be accessed at https://www.danb.org/~/media/Files/2015-State-Applications/AZCP-Certificate-Application.ashx?la=en

Information on EFDA at AZBDE: https://dentalboard.az.gov/sites/default/files/EFDA_Info_for_Web%202017.pdf

The Arizona Board of Dental Examiners can be accessed at https://dentalboard.az.gov/

Arkansas – two levels of dental assistants

According to DANB, a dental assistant must be a Registered Dental Assistant (RDA) who holds a permit in radiography from the Arkansas State Board of Dental Examiners (ARSBDE) in order to expose dental radiographs. To obtain this permit, the dental assistant must:

  • Hold a current national DANB Certified Dental Assistant (CDA) certification, or be a graduate from a CODA-accredited dental assisting program, or successfully complete and submit a certificate of completion of a radiography course approved by the ARSBDE, AND hold a current Healthcare Provider-level CPR certification, AND apply for registration to the ARSBDE, AND successfully complete the Arkansas jurisprudence exam.

Please note that 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.

Training in standard precautions and other infection control protocols required by OSHA and as recommended by the CDC and set forth in Arkansas rule shall be provided to all dental healthcare personnel by the employer upon initial employment prior to direct patient care, whenever new tasks are assigned which effects the level of occupational exposure, and at least annually.

To learn more about DANB’s CDA exam, please access: https://www.danb.org/en/Become-Certified/Exams-and-Certifications/CDA.aspx

For a list of CODA accredited dental assisting programs, please access: https://www.danb.org/en/The-Dental-Community/Dental-Assistants/Dental-Assisting-Programs/CODA-Accredited-Dental-Assisting-Programs.aspx

Dental Assistant

Dental assistants in Arkansas may perform basic supportive dental procedures specified by the state dental practice act under the personal supervision of a licensed dentist. Personal supervision is defined as the dentist is in the office or treatment facility, has personally diagnosed the condition to be treated, has personally authorized the procedures, remains in the office or treatment facility while the procedures are being performed, and evaluates the performance of the dental assistant before the dismissal of the patient. Any reversible dental task or procedure assigned by the supervising dentist that does not require a permit or the professional skills of a licensed dentist or licensed dental hygienist is allowable to this level of dental assistant. There are no educational or training requirements for this level of dental assisting other than the required OSHA, CDC and Arkansas rule in infection control and prevention and occupational exposure.

Registered Dental Assistant (RDA)

A Registered Dental Assistant in Arkansas is an individual who holds a permit from the Arkansas State Board of Dental Examiners (ASBDE) to perform one or more of the allowed expanded functions, which include coronal polishing, operating dental radiographic equipment inducing and monitoring nitrous oxide/oxygen analgesia, and monitoring patients under deep sedation or general anesthesia in offices where the dentist is permitted to provide these services. A separate permit is required for each of the expanded functions. To be issued a permit for any of the expanded functions (except Sedation Monitoring, which has additional requirements), the RDA must:

  • Hold a current national DANB Certified Dental Assistant (CDA) certification OR
  • Graduate from a CODA-accredited dental assisting program OR
  • Complete an ASBDE-approved course in the desired expanded function(s) OR
  • Receive on-the-job training from an Arkansas licensed dentist;

AND

  • Hold current Basic Life Support-level CPR certificate;

AND

  • Provide proof of competency in the desired expanded function(s) and apply for registration to the ASBDE;

AND

  • Successfully complete the Arkansas jurisprudence exam.

For those interested in sedation monitoring, the requirements are as follows:

  1. Hold a current permit for nitrous oxide administration,
  2. hold current CPR certification,
  3. hold current DANB CDA certification (or be a Registered Dental Assistant, RN or LPN),
  1. 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,
  1. apply to the ASBDE for registration,
  1. and successfully complete the Arkansas jurisprudence exam.

To renew permits to perform expanded functions, RDAs must provide the ASBDE proof of completing two (2) hours of continuing education in infection control every two years.

To access the application for being a Registered Dental Assistant in Arkansas, please access  https://www.healthy.arkansas.gov/images/uploads/pdf/New_2014_RDA_Application_fillable.pdf

To access the application for expanded functions permits, please access https://www.healthy.arkansas.gov/programs-services/topics/asbde-applications

To access the Arkansas Board of Dental Examiners, please access https://www.healthy.arkansas.gov/programs-services/topics/arkansas-state-board-of-dental-examiners/

As you can see with the first four states explored, requirements do vary greatly from one state to the next. Being credentialed in one state or being DANB certified as a CDA does assist in some cases. Tune in next time for further exploration into more state requirements for dental assistants!

NEXT ARTICLE: 3 reasons why the dental hiring crisis may soon subside

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