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CALIFORNIA DENTAL LEGISLATION
History of Change in Dental Assisting
As far back as 1999, California began to re-evaluate the scope of practice for dental assisting.
The Dental Board requested that COMDA begin reviewing the duties that RDA’s were allowed to perform, to assist the Board in meeting the mandate of Business and Professions Code Section 1754 that it review such duties every seven years.
COMDA began that review, as well as a review of the regulations defining the duties of DAs and EFs, and the entire regulatory scheme. It appointed a Task Force of 14 members that met for the first time in December 1999. The Task Force held four lengthy, often day-long, meetings throughout California in 2000, and in May 2001, voted to disband after having made preliminary recommendations.
Task Force members testified at the December 2000, Joint Legislative Sunset Review Committee hearings about the disagreements that occurred during their meetings. Their testimony, and the inability of the Task Force to reach agreement, were strong indications that it would be difficult to devise a regulatory scheme with which all groups representing dental assisting, dentistry and dental hygiene could agree.
COMDA continued its review by evaluating all reports and findings to date. During this process, two very different modes of thought emerged regarding the regulation of dental assistants who perform intra-oral procedures on patients. Dentists felt that they were the most appropriate educators and did not believe government should be involved in how that was provided. Dental assisting believed that the public was most protected by independent education with related regulatory oversight.
When this process began, a collaborative group of professional organizations representing the dental assistant, RDA, permited licentiates and EFs called the Dental Assisting Alliance emerged as a primary voice of dental assisting. Part of this Alliance was represented by RDAEFs in California, as their scope of practice would be affected by all of these legislative activities.
During the past ten years, the California Legislature passed several legislative bills to address the dental assistant scope of practice.
In 2008, the culmination of those efforts resulted in the passage of AB2637 that will significantly impact dental assisting in California in the future.
This document summarizes how the new laws will affect old and new categories of dental assistants:
- Unlicensed dental assistants
- Permitted Orthodontic Assistants (OA)
- Permitted Dental Sedation Assistants (DSA)
- Registered Dental Assistants (RDA)
- Registered Dental Assistant in Extended Functions (RDAEF)
The Dental Assisting Alliance has been actively involved in assuring that the new statutes are clear and consistent, and that regulations needed to implement the new statutes are appropriate.
EFDAAs Role in the Future
The Expanded Functions Dental Assistants Association (EFDAA), a professional organization for RDAEFs will continue to be a part of the Dental Assisting Alliance. They will continue to:
- Provide meaningful input regarding legislation, regulations and policies.
- Strive to promote an educated, knowledgeable and clinically competent direct patient care provider.
AB2637 (Chapter 499, Statutes of 2008)
AB2637 was signed by the Governor on September 28, 2008, and became effective January 1, 2009, although many of its provisions are not operative until January 1, 2010. Generally, the bill retains the DA, RDA, and EF licensure categories, establishes Orthodontic Assistant and Dental Sedation and Assistant permit categories. Note the italized duties are new duties that have been added to the category. Please note that the following information is quoted by the actual statute.
1. Unlicensed Dental Assistants
a. Duties. Beginning January 1, 2010, B&P Section 1750.1 places into statute the duties that regulations currently allow DAs to perform, with the addition of certain duties. Following are all of the duties, with new duties noted in italics:
(a) A dental assistant may perform the following duties 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
(b) A dental assistant may perform the following duties under the direct supervision of a supervising dentist:
(1) Apply non-aerosol and non-caustic topical agents
(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.
(c) Under the supervision of a registered dental hygienist in alternative practice, a dental assistant may perform intraoral retraction and suctioning.
(d) The board may specify additional allowable duties by regulation.
(e) The duties of a dental assistant or a dental assistant holding a permit in orthodontic assisting or in dental sedation do not include any of the following procedures unless specifically allowed by law:
(1) Diagnosis and comprehensive treatment planning.
(2) Placing, finishing, or removing permanent restorations.
(3) Surgery or cutting on hard and soft tissue including, but not limited to, the removal of teeth and the cutting and suturing of soft tissue.
(4) Prescribing medication.
(5) Starting or adjusting local or general anesthesia or oral or parenteral conscious sedation, except for the administration of nitrous oxide and oxygen, whether administered alone or in combination with each other and except as otherwise provided by law.
(f) The duties of a dental assistant are defined in subdivision (a) of Section 1750 and do not include any duty or procedure that only an orthodontic assistant permitholder, dental sedation assistant permitholder, registered dental assistant, registered dental assistant in extended functions, registered dental hygienist, or registered dental hygienist in alternative practice is allowed to perform.
b. Required Courses. Beginning January 1, 2010, B&P Section 1750 requires that unlicensed DAs who are in a dentist’s continuous employment 120 days or more must complete, within a year of the date of employment, a course in basic life support, a board-approved 8 hour course in infection control, and a board-approved course in the California Dental Practice Act.
B&P Section 1750 also provides that the employer of a dental assistant shall be responsible for ensuring that the dental assistant maintains certification in basic life support.
B&P Section 1756 provides that the board-approved infection control course must be at least 8 hours in length.
2. Orthodontic Assistants (OAs) and Dental Sedation Assistants (DSAs)
a. Permit Requirements. Beginning January 1, 2010, B&P Sections 1750.2 and 1750.4 establish Orthodontic Assistant (OA) and Dental Sedation Assistant (DSA) permit categories, which require completion of 12 months of work experience as a DA, completion of a board-approved OA or DSA course which may commence after 6 months of work experience, a written examination, and completion of board-approved courses in the California Dental Practice Act, 8 hour infection control, and basic life support. These permits must be maintained in the same manner as other licenses, including renewal and required CE.
b. Course Requirements. B&P Sections 1756.1 and 1756.2 specifies that the OA course must be a minimum of 84 hours, and the DSA course a minimum of 110 hours, and that both must be board-approved. B&P Sections 1754.5, 1755, 1756.1 and 1756.2 specify the requirements that courses must meet to obtain Board approval.
c. RDAs and RDAEFs Seeking OA or DSA Permits. An RDA or RDAEF may apply for an OA permit or a DSA permit, or both, by completing the applicable board-approved course, and passing a written examination.
An RDA or RDAEF holding an Orthodontic Assistant permits or Dental Sedation Assistant permit shall be referred to as an "RDA with orthodontic assistant permit", "RDA with dental sedation assistant permit", "RDAEF with orthodontic assistant permit", or "RDAEF with dental sedation assistant permit," as applicable. Completion of the CE requirements by an RDA or RDAEF who also holds a permit will fulfill the CE for the permit or permits.
d. OA Duties. B&P Section 1750.3 specifies the duties of an OA as:
1750.3. A person holding an orthodontic assistant permit pursuant to Section 1750.2 may perform the following duties under the direct supervision of a supervising licensed dentist:
(a) All duties that a dental assistant is allowed to perform.
(b) Prepare teeth for bonding, and select, preposition, and cure orthodontic brackets after their position has been approved by the licensed dentist.
(c) Remove only orthodontic brackets and attachments with removal of the bonding material by the supervising licensed dentist.
(d) Size, fit, and cement orthodontic bands.
(e) Remove orthodontic bands and remove excess cement from supragingival surfaces of teeth with a hand instrument.
(f) Place and ligate archwires.
(g) Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment.
(h) Any additional duties that the board may prescribe by regulation.
e. DSA Duties. B&P Section 1750.5 specifies the duties of a DSA as:
1750.5. A person holding a dental sedation assistant permit pursuant to Section 1750.4 may perform the following duties 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:
(a) All duties that a dental assistant is allowed to perform.
(b) 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.
(c) 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.
(d) 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.
(e) Removal of intravenous lines.
(f) Any additional duties that the board may prescribe by regulation.
(g) The duties listed in subdivisions (b) to (e), inclusive, may not be performed in any setting other than a dental office or dental clinic.
f. Overlapping RDA and OA Duties. RDAs will be allowed to continue to perform the overlapping OA duties that they are currently allowed to perform without seeking an OA permit (placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument), and RDAs applying for an OA permit will not be required to complete further training in such duties.
3. Registered Dental Assistants (RDAs)
a. Duties. Beginning January 1, 2010, B&P Section 1752.4 places into statute most of the duties that regulations currently allow RDAs to perform, with the addition of certain duties, and with some duties moved to the DA category. Following are all of the duties, with new duties noted in italics. RDAs licensed prior to January 1, 2010, will be allowed to perform all listed duties without further instruction, except as specifically noted.
(a) A registered dental assistant may perform all of the following duties:
(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
(19) All duties that the board may prescribe by regulation.
(b) A registered dental assistant may only perform the following additional duties if he or she has completed a board-approved registered dental assistant educational program in those duties, or if he or she has provided evidence, satisfactory to the board , of having completed a board-approved course in those duties.
(1) Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment.
(2) The allowable duties of an orthodontic assistant permitholder as specified in Section 1750.3. A registered dental assistant shall not be required to complete further instruction in the duties of placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument.
(3) The allowable duties of a dental sedation assistant permitholder as specified in Section 1750.5.
(4) The application of pit and fissure sealants.
(c) Except as provided in Section 1777, the supervising licensed dentist shall be responsible for determining whether each authorized procedure performed by a registered dental assistant should be performed under general or direct supervision.
b. Optional RDA Duties. B&P Section 1752.4 (see section above) allows an RDA to optionally perform the following additional duties if he or she has completed a board-approved RDA educational program approved to instruct in such duty or duties, or if he or she has provided evidence to the Board of having completed a board-approved course in such duty or duties: (1) Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment. (2) The permitted duties of an orthodontic assistant (except that a licensed RDA shall not be required to complete further instruction in the duties of placing ligature ties and archwires, removing orthodontic bands, and removing excess cement from tooth surfaces with a hand instrument). (3) The permitted duties of a dental sedation assistant. (4) The application of pit and fissure sealants.
c. Pit and Fissure Sealants. B&P Section 1752.6 requires that RDAs who are licensed on and after January 1, 2010, complete a board-approved course in the application of pit and fissure sealants as a condition of the first renewal that requires CE.
d. Work Experience. B&P Section 1752.1 requires that individuals applying via the work experience pathway on or after January 1, 2010, must have 15 months of work experience rather than 12 months. B&P Section 1752.1 allows credit toward the 15-month work experience requirement for graduation from non-board dental assisting programs on a week-for-week basis, eliminating the current 16-week maximum credit.
e. RDA Licensure Requirements. Beginning January 1, 2010, B&P Section 1752.1 requires that all applicants for RDA licensure must have completed a board-approved course in the California Dental Practice Act, an 8-hour board-approved course in infection control, and a course in basic life support within five years prior to application.
f. Law and Ethics Examinations. B&P Section 1752.1 requires that individuals applying after January 1, 2010 must pass a written examination in Law and Ethics.
g. Examination Requirements. Beginning January 1, 2010, B&P Section 1752.3 places the RDA examination requirements into statute. Also, 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.
5. Registered Dental Assistants in Extended Functions (EFs)
a. Duties. Beginning January 1, 2010, B&P Section 1753.3 places into statute most of the duties that regulations currently allow EFs to perform, with the addition of certain duties, and certain duties moved to other categories. Following are all of the duties that EFs licensed after January 1, 2010, will be allowed to perform, with new duties noted in italics:
1753.5. (a) A registered dental assistant in extended functions licensed on or after January 1, 2010, is authorized to perform all duties and procedures that a registered dental assistant is authorized to perform as specified in and limited by Section 1752.4, and those duties that the board may prescribe by regulation.
(b) A registered dental assistant in extended functions licensed on or after January 1, 2010, is authorized to perform the following additional procedures under direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:
(1) 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.
(2) 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.
(3) Cord retraction of gingiva for impression procedures.
(4) Size and fit endodontic master points and accessory points.
(5) Cement endodontic master points and accessory points.
(6) Take final impressions for permanent indirect restorations.
(7) Take final impressions for tooth-borne removable prosthesis.
(8) Polish and contour existing amalgam restorations.
(9) Place, contour, finish, and adjust all direct restorations.
(10) Adjust and cement permanent indirect restorations.
(11) Other procedures authorized by regulations adopted by the board.
(c) All procedures required to be performed under direct supervision shall be checked and approved by the supervising licensed dentist prior to the patient's dismissal from the office.
b. Existing EFs. B&P Section 1753.4 requires EFs who are licensed prior to January 1, 2010, and who wish to perform the new duties, to complete a board-approved course in all of the new duties, and complete specified examinations.
c. EF Examinations. Beginning January 1, 2010, B&P Section 1753.4 places the EF examination requirements in statute. This examination will consist of the following specified under 1753.4:
- Successful completion of two of the following procedures on a simulated patient head mounted in appropriate position and accommodation an articulated typodont in an enclosed intra-oral environment, or mounted on a dental chair in a dental operatory
- Place, condense and carve an amalgam restoration
- Place and contour a nonmetallic direction restoration
- Polish and contour an existing amalgam restoration
- Successful complete of the following two procedures on a patient provided by the applicant.
- Cord retraction of gingiva for impression procedures
- Take a final impression for a permanent indirect restoration
In addition to the above requirements, a candidate must complete a written examination with 75% pass rate. The Dental Board will be deciding on the format for this written examination.
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