Tip Sheets

Are dental assistants in your state expanding their scope of practice?

By Mary Otto

Brandi Tweeter worked for more than a decade as a dental assistant in Minnesota. Then she made a career move that put her in the spotlight. She enrolled in a 28-month dental therapy program at the University of Minnesota. 

Now she is back with her former boss, dentist John Powers, with a new set of responsibilities, including preparing and restoring decayed teeth and performing extractions.   

In a newly published report, "Expanding the Dental Team," the Pew Charitable Trust analyzes Tweeter’s contributions to Powers’ practice, Main Street Dental Care in Montevideo, Minn., working as one of the state’s first dental therapists. 

While dental therapists are still rare in the United States, Tweeter is not the only dental assistant to figure out a way to build on her experience and expand her scope of practice. This year, March 2-8 marks Dental Assistants Recognition Week. It might be an opportunity to take a look at this changing profession, and to learn more about what dental assistants are doing in your state.  

There are more than 300,000 dental assistants at work across America and their ranks are expected to  increase 25 percent in the next decade, according to the Bureau of Labor Statistics (BLS). The growth is being driven by a recognition of the link between oral health and overall health. 

They staff private dental offices as well as public health and military clinics. Their work often includes helping dentists with procedures, taking and developing x-rays, preparing and sterilizing  instruments, making appointments, keeping records, and giving patients post-operative instructions.

But from state to state, duties, credentialing, and training standards vary widely.

In some states, for example, dental assistants are allowed to place restorations on teeth that have been prepared by dentists. In other states, they are prohibited from placing restorations. Some states require dental assistants to graduate from accredited programs and pass state exams, while other states have no formal educational requirements.

The American Dental Assistants Association (ADAA), a professional organization for dental assistants, advocates for standardized credentialing and education. 

In Oklahoma last year, Gov. Mary Fallin signed a bill into law that created the first oral surgery dental assistant permit in the country. The measure, which requires all dental assistants in the state to have permits, came in the wake of a scandal centering on Tulsa oral surgeon W. Scott Harrington, D.D.S., who was found to be using unsanitary equipment and poor infection-control procedures that could have exposed more than 7,000 patients to HIV, hepatitis B and hepatitis C.

According to a complaint from the state board of dentistry, Harrington said his dental assistants were in charge of sterilization procedures at his practice. The assistants were also performing IV sedation, which is forbidden by the new law.  

Expanded-duty permits continue to be available for assistants wishing to perform extra duties such as polishing teeth or administering nitrous oxide, Shannon Muchmore reported in The Tulsa World.

The Chicago-based Dental Assisting National Board (DANB), which is the national certification board for dental assistants, has produced an interactive map that provides state-by-state information on dental assisting job titles, scope of practice, and requirements.

The Academy of General Dentistry has also created a state-by-state chart outlining the levels at which dental assistants are allowed to work, the requirements they must fulfill to reach each level, and the duties they are allowed and not allowed to perform.

Efforts by assistants to expand the range of tasks they are allowed to do have often been marked by controversy similar to the debate over dental therapists. Supporters of such efforts have typically portrayed them as ways of delivering care more efficiently and extending services to wider populations. But detractors, including organized dental groups, have often opposed them, saying dental auxiliaries lack the training to perform advanced and irreversible procedures.     

In California, it took more than two decades of struggle with organized dental groups to establish a new category of dental assistant, the Registered Dental Assistant Extended Function 2.

RDA-EF2s now enjoy a scope of practice that includes the placing of all types of restorations.  

But in Virginia, a proposal that would have allowed a new class of dental assistants to work in patients’ mouths with high-speed rotary instruments was turned down in 2012 by the state board of dentistry.

The measure was proposed by Denice Burnette, a dental assistant who had received training in the use of such instruments while working as an Expanded Functions Dental Assistant in Pennsylvania.

What’s up with your local dental assistants? Maybe this is the week to find out.