Dental assistant requirements: California, Colorado, Connecticut, and Delaware

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. This series explores the requirements to become a dental assistant in each of the states, comparing and contrasting prerequisites and providing 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).

California – 4+ levels of dental assistants

California is one of the states that has the most varied levels of dental assistants in the nation with some of the most progressive expanded functions. Although there are four distinct levels, there are two additional permits that dental assistants can attain – orthodontic and sedation permits. Requirements for each category follow each section describing the level of dental assisting. To legally operate dental x-ray equipment and perform dental radiographic procedures in California, a dental assistant must meet specific requirements.

California Radiography Requirements

A dental assistant in California must be state certified in radiography to legally operate dental x-ray equipment and perform dental radiographic procedures. To apply for state certification in the state of California, a dental assistant must:

  • Successfully complete a California Board-approved radiation safety course which includes theory and clinical application in radiographic technique, OR
  • Have passed a radiation exam conducted by the California Board prior to Jan. 1, 1985, AND
  • Submit a copy of the certificate of completion to the Dental Board of California.

Requirements for radiation safety courses to meet CA Board requirements

Information on approval of radiation safety courses

Request for Radiation Safety Certification to expose dental radiographic images

Unlicensed Dental Assistant (Dental Assistant, UDA)

A “dental assistant” means an unlicensed person who may perform basic supportive dental procedures specified by these regulations under the supervision of a licensed dentist. An Unlicensed Dental Assistant (UDA) may perform basic supportive dental procedures under the supervision of a licensed dentist. “Basic supportive dental procedures” means fundamental duties or functions which may be performed by an UDA 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.

The employer is responsible for ensuring dental assistants maintain Basic Life Support (BLS) certification, and that all 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:

  • A California Board-approved 2-hour course in the California Dental Practice Act, AND
  • A California Board-approved 8-hour course in infection control, AND
  • An American Heart Association or American Red Cross-approved course in Basic Life Support (BLS) which includes hands-on simulated clinical scenarios.

§ 1070.6. Approval of Infection Control Courses

According to the California Dental Board (Board), UDAs are not licensed by the Board, but they are subject to certain laws governing their conduct. Section 1085 is the regulation governing the duties that unlicensed dental assistants are allowed to perform. Unless a specific duty is listed in that regulations, the dental assistant is NOT allowed to perform that duty. A dental assistant may only expose radiographs after successful completion of a board-approved radiation safety course. Dental assistants with certain experience or educational backgrounds may qualify to apply for Registered Dental Assistant (RDA) licensure. “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.

Registered Dental Assistant (RDA)

To be licensed as a Registered Dental Assistant (RDA) in California, the dental professional must:

Registered Dental Assistant in Extended Functions (RDAEF)

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). Direct supervision is defined as the supervision of dental procedures based on instructions given by a licensed dentist who must be physically present in the treatment facility during performance of those procedures. To register as an RDAEF in California, one must:

  • Hold a valid CA license as an RDA, OR

RDAEF with additional training

To perform additional functions in California, 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:

“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.

§ 1070.5. Approval of Ultrasonic Scaling Courses

§ 1070.4. Approval of Coronal Polishing Courses

Information for RDAEF educational programs

Orthodontic Assistant (OA) Permit Holder

To hold an Orthodontic Assistant permit in California, one must:

  • Be an RDAEF (see requirements above), OR
  • Be an RDA (see requirements above), OR

Board Approved Ultrasonic Scaling courses

Allowable duties for Orthodontic Assistant Permit

Dental Sedation Dental Assistant Permit Holder

To hold a Dental Sedation Assistant permit in California, one must:

  • Be an RDAEF (see requirements above), OR
  • Be an RDA (see requirements above), OR

§ 1070.8. Approval of Dental Sedation Assistant Permit Courses

Allowable duties for Dental Sedation Assistant permit

Information on examinations through the CA Dental Board

Information on fees for CA dental team members

Access the CA Dental Board for additional information or phone numbers for assistance.

Colorado – one level of dental assistant

The Colorado Dental Board regulates and licenses dentists and dental hygienists and does not regulate or require the registration of dental assistants or expanded duty dental assistants.

Colorado Radiography Requirements

Pursuant to Board Rule regarding Minimum Standards for Qualifications, Training and Education for Unlicensed Personnel Exposing Patients to Ionizing Radiation, all unlicensed dental personnel who expose patients to ionizing radiation must successfully complete minimum safety education and training for operating machine sources of ionizing radiation and administering such radiation to patients.

The Colorado State Board has approved an educational video that is jointly sponsored by the Colorado Dental Association (CDA) and the University of Colorado School of Dentistry and is available on DVD or VHS format. For purchasing information, please contact the CDA at 303-740-6900, 1-800-343-3010 ext. 100, or at info@cdaonline.org

According to the Dental Assisting National Board (DANB) in order to expose dental radiographic images, a dental assistant must:

  • Be at least 18 years of age, AND
  • Successfully complete minimum safety, education and training for operating machine sources of ionizing radiation and administering such radiation to patients. Approved education or training includes:
    • Completion of five hours of practical or clinical experience and 3.5 hours of lecture for a total of 8.5 hours from a program accredited by the Commission on Dental Accreditation (CODA), Colorado Commission on Higher Education (CCHE), the State Board of Community Colleges and Occupational Education (SBCCOE), the Private Occupational School Division (POSD) (or the equivalent in any other state), OR
  • Education and training may be provided on the job by a Colorado licensed dentist or dental hygienist, provided that the educational module used is approved by the Colorado Dental Board, OR

Dental Assistant

A dental assistant in Colorado may perform basic supportive dental procedures specified by the state dental practice act under the supervision of a licensed dentist. There are no educational requirements for this level of dental assisting. 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. Dental assistants who administer and/or monitor nitrous oxide/oxygen inhalation must successfully complete current Basic Life Support (BLS) training.

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).

Expanded Duties Dental Assistant (EDDA)

Some dental assistants in the state of 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. Access the Colorado Board of Dentistry or the Colorado Dental Associationfor more information.

Connecticut – two levels of dental assistants

To legally operate dental x-ray equipment and perform dental radiographic procedures in Connecticut, a dental assistant must meet the requirements shown below.

A dental assistant must pass the national DANB Radiation Health and Safety (RHS) exam.

Dental Assistant

A dental assistant in Connecticut may perform basic supportive dental procedures specified by the state dental practice act under the supervision of a licensed dentist.

Effective July 1, 2018, all dental assistants and Expanded Function Dental Assistants must provide records demonstrating successful performance on DANB’s Infection Control (ICE) exam or an infection control competency assessment administered by a CODA-accredited dental education program in Connecticut.

*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.

Please note that DANB’s Infection Control (ICE) exam became a component of the Certified Dental Assistant (CDA) certification on June 1, 1993. The ICE exam became a component of the Certified Orthodontic Assistant (COA) certification on June 1, 1994. Dental assistants who earned CDA certification before June 1, 1993 or who earned COA certification before June 1, 1994 and who have not subsequently taken the CDA, COA or ICE exam after these dates will be required to take the ICE exam prior to April 1, 2019.

Expanded Function Dental Assistant (EFDA)

To perform expanded functions under the direct or indirect supervision of a licensed dentist in the state of Connecticut, a dental assistant must earn Expanded Function Dental Assistant (EFDA) status. To qualify as an EFDA, one must:

Note: The EFDA 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. Contact the CT State Dental Commission for additional information.

Effective July 1, 2018, any 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.

  • Connecticut dental assistants hired after July 1, 2018 have nine 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.

Please note that DANB’s Infection Control (ICE) exam became a component of the Certified Dental Assistant (CDA) certification on June 1, 1993. The ICE exam became a component of the Certified Orthodontic Assistant (COA) certification on June 1, 1994. Dental assistants who earned CDA certification before June 1, 1993 or who earned COA certification before June 1, 1994 and who have not subsequently taken the CDA, COA or ICE exam after these dates will be required to take the ICE exam prior to April 1, 2019.

Additional information on the process to become and EFDA in CT

CT State Dental Commission

Delaware – one level of dental assistant

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 meet the following requirements:

  • 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:
  • 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.

The Delaware ORC has discontinued the Delaware Dental Radiologic Technology (DDRT) exam, which was a state-specific exam equivalent to DANB’s 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 exam prior to December 31, 2015 may still use their DDRT exam passing result to qualify for the Dental Radiation Technician certificate.

Dental Assistant

In the state of 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.

What this means is the Delaware Board of Dentistry and Dental Hygiene places full responsibility for the work done by dental assistants directly upon the dentist.

As you can see with the first eight 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!

Note on photo: “Welcome to Colorful Colorado” by bk1bennett is licensed with CC BY-ND 2.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-nd/2.0/

Next read: A look at dental assistant requirements in Alabama, Alaska, Arizona, and Arkansas