The dental assisting profession in the United States is not a one-size-fits-all profession. Depending on a state’s Dental Practice Act, the duties, requirements, and responsibilities of dental assistants may vary significantly.
Although the American Association of Dental Assistants (AADA) has, for some time, been focused on establishing standardized credentialing and education for dental assistants in the United States as a way to ensure the competency of these dental professionals and to safeguard the welfare of the public, to date this has not come to fruition.
State Regulation of Dental Assistants
The Dental Assisting National Board (DANB) recognizes 70 dental assisting functions that dental assistants may be allowed to perform under a dentist’s supervision. Although many of these clinical and administrative duties are standard responsibilities across the board, a number of them are considered expanded functions by many states. It is up to the state’s Board of Dental Examiners, through their Dental Practice Act, to outline which of the 70 responsibilities require additional registration, training, or certification, and which responsibilities are prohibited.
While the majority of states require dental assistants to be certified, licensed, or registered, many still do not. Those that do require some type of regulation for dental assistants may register or license just one type of dental assistant or they may have various levels of registration, depending on the responsibilities and duties dental assistants in the state are authorized to perform. The bottom line is that it is up to a state’s Board of Dental Examiners to determine which expanded duty functions dental assistants in the state can perform and the training, registration, and/or certification required to do so.
Just a few of the possible job duties of dental assistants that may be regulated in the state in which they work include:
- Applying pit and fissure sealants
- Applying topical anesthetics and anti-inflammatory agents
- Applying topical fluoride
- Making impressions and restorations
- Monitoring nitrous oxide or oxygen analgesia
- Preparing materials to make impressions
- Processing dental x-ray films
- Removing excess filling cement
- Removing periodontal dressings
- Removing sutures
State Requirements Specific to General and Expanded Functions
There are currently 15 states that require some form of training for dental assistants, while just a few states, including Minnesota, California, and Michigan, have set specific educational standards and examinations in order to become a registered dental assistant. Many states still have no training, credentialing, or continued education standards for dental assistants.
Entry-Level Requirements for Dental Assistants
The majority of states allow entry-level training for dental assistants, with many states using specific titles for these dental assistants. In California, the title is “unlicensed dental assistant,” while Iowa refers to them as “dental assistant trainees.”
For states that recognize entry-level dental assistants, there are typically probationary time periods that must be completed before these entry-level dental professionals can apply for a license/registration or begin performing expanded functions.
Still other states, such as North Carolina, have no requirements, thereby allowing dental assistants to perform basic supportive dental procedures without completing specific training requirements.
The AADA stresses the importance for all dental professionals to understand the guidelines and regulations related to:
- Infection control procedures
- Health history information
- Intraoral functions
Basic requirements for beginning dental assistants often include:
- Washington: An AIDS course
- Vermont: Emergency procedures training within 180 days of being hired
- South Dakota: High school diploma
- Mississippi: CPR certification within 180 days
- Minnesota: CPR certification
- California: The completion of a state course after four months of training
Dental Assistant Job Requirements and Titles
Many states recognize dental assistants of various levels, thereby allowing dental assistants to achieve the required training to advance to the next level. For example, in Texas, a dental assistant, who is allowed to perform basic supportive dental procedures under the direct supervision of a licensed dentist, need not possess any specific education or training requirements. However, to become a Registered Dental Assistant (RDA) in Texas, dental assistants must complete a course in basic life support and one of the following:
- A mandatory course of training approved by the Texas State Board of Dental Examiners (TSBDE) that includes procedures for infection control, positioning exposing dental x-rays, or jurisprudence
- Earn DANB’s Certified Dental Assistant (CDA) credential and complete the Texas jurisprudence examination
Texas also outlines specific requirements for dental assistants who want to perform specific, expanded function procedures. For example, to receive a pit and fissure sealant certification in Texas, dental assistants must: have at least two years of experience as a dental assistant; complete a course in basic life support; complete at least 8 hours of Board-approved clinical and didactic education in pit and fissure sealants; and register with the TSBDE.
Another example is New York State, which recognizes three dental assistant levels:
- Unlicensed dental assistant: No education or training requirements
- Dental assistant with a limited permit: Dental assistants may apply for a one-year permit before taking and passing the examinations required to become a licensed and certified dental assistant. These dental assistants must have complete a Board-approved program in dental assisting or an alternate course of study in dental assisting that includes at least 1,000 hours of relevant work experience.
- New York State Licensed Certified Dental Assistant: A dental assistant in New York State must be licensed as to perform supportive services under the direction of a licensed dentist. The above educational requirements must be met, and the dental assistant must successfully complete one of two examination pathways:
- Pathway 1: All three components of the DANB Certified Dental Assistant (CDA) exam
- Pathway 2: Pass the DANB RHS and ICE component examinations, as well as the New York Professional Dental Assisting (NYPDA) exam
Some states, such as New York State and Alaska, have no radiography requirements for dental assistants, while still others, such as Florida, have specific requirements for dental assistants who operate dental x-ray equipment and perform dental radiographic procedures.
In Florida, dental assistants who perform radiographic functions must be graduates of Florida Board of Dentistry-approved dental assisting programs or be state-certified as dental radiographers through the Florida Department of Health (FDOH). To hold certification from the FDOH, dental assistants must have completed at least three months of on-the-job training under the direct supervision of a Florida licensed dentist and must have completed a Florida Board-approved radiology course.
Dental assistants in Washington D.C., on the other hand, may be allowed to perform radiography if they have taken and passed the DANB’s Radiation Health and Safety (RHS) exam or CDA exam, or if they have successfully completed a dental radiography training program approved by the D.C. Board of Dentistry.
More Information on Dental Assistant State Requirements for State Licensure
More information on dental assistant state requirements may be obtained through:
- The DALE Foundation, a recognized provider of the American Dental Association, maintains information on state requirements that has been compiled by the DANB and state dental boards.
- The Dental Assisting National Board (DANB) also maintains current state information on its website and provides links to the appropriate state Boards of Dental Examiners.