Dental Assistant Requirements in California: Registration, X-Ray Rules & Allowed Duties

The statute defines an unlicensed dental assistant tier for basic supportive procedures, two permits built on top of that tier (orthodontic assistant and dental sedation assistant), and two licensed tiers, registered dental assistant and registered dental assistant in extended functions.

The Legislature states its intent that these classifications let a dental assistant advance to successively higher levels of licensure with more education and training.

The orthodontic assistant permit and the registered dental assistant in extended functions license each have their own eligibility and duty sections below.

A person may qualify for an RDA license by graduating from a board-approved RDA program, completing at least 15 months and 1,280 hours of satisfactory work experience performing a dental assistant's duties, holding a current Dental Assisting National Board certified dental assistant certification, completing an alternative dental assisting program, or completing a preceptorship.

Every applicant must also complete Dental Practice Act, infection control, pit-and-fissure-sealant, coronal polishing and radiation safety coursework, hold current basic life support certification, pass the board's Registered Dental Assistant Combined Written and Law and Ethics Examination, and submit fingerprints for a criminal history check.

Regardless of tier, an employer must ensure a dental assistant completes a board-approved eight-hour infection control course before performing any procedure with potential exposure to blood, saliva or other infectious material, and, within one year of first employment, a two-hour Dental Practice Act course and current basic life support certification.

To perform radiographic procedures the assistant must also complete the board-approved radiation safety course, and to perform coronal polishing before RDA licensure, a separate coronal polishing course.

Current certificates for these courses must be publicly displayed at the treatment facility.

Direct supervision means the licensed dentist gives the instructions and is physically present in the treatment facility while the procedure is performed.

General supervision means the dentist gives the instructions but does not have to be physically present while the assistant performs the procedure.

The statute assigns each dental assistant duty to one of these two supervision levels.

Under general supervision, a dental assistant may perform assigned extraoral duties, operate dental radiography equipment once the radiation safety course is complete, and take intraoral and extraoral photographs.

Under direct supervision, the list includes applying topical fluoride, taking impressions for nonprosthodontic appliances, placing and removing rubber dams and matrices, several orthodontic-adjacent tasks like removing ligature ties and examining appliances, removing sutures and dressings after the dentist inspects the site, and adjusting nitrous oxide and oxygen flow only while the dentist is present in the operatory directing it.

A registered dental assistant is authorized to perform additional duties under Section 1752.4, including mouth-mirror inspections, applying pit and fissure sealants, and placing and finishing direct provisional restorations.

The board may issue an orthodontic assistant permit to an applicant who, within the statute's time windows, completes a two-hour Dental Practice Act course, an eight-hour infection control course and a course in ultrasonic scaling, holds current basic life support certification, completes a board-approved orthodontic assistant course, submits fingerprints for a criminal history check, and passes a written exam covering the permit's duties.

Under a dentist's general supervision a permitholder may perform every duty a dental assistant may perform, and under direct supervision may also isolate and prepare teeth for orthodontic attachments and appliances, size and secure bands, prepare and cure brackets after the dentist approves their position, remove bands, brackets and excess cement, and place and ligate archwires.

The board may license as an RDAEF a current registered dental assistant who submits fingerprints, completes a board-approved extended-functions program, holds current basic life support certification, completes a pit-and-fissure-sealant course, and passes a written exam.

An RDAEF licensed on or after January 1, 2010 is authorized to perform everything a registered dental assistant may perform, plus, under a dentist's direct supervision, oral health assessments and cancer screenings, gingival retraction, sizing and cementing endodontic points, post-and-core procedures, taking final impressions for permanent or tooth-borne restorations, and placing, contouring, finishing and adjusting direct restorations and adjusting permanent indirect restorations.

A dental assistant may operate dental radiography equipment under general supervision once they've completed the board-approved radiation safety course the statute requires before performing radiographic procedures.

That course must run at least 32 hours: a minimum of 8 hours of didactic instruction, 12 hours of laboratory instruction, and 12 hours of supervised clinical instruction, and the current certificate must be publicly displayed at the treatment facility.

Registered dental assistant applicants must also show completion of a radiation safety course within the 10 years before their application.

A dental assistant, including one holding an orthodontic or dental sedation permit, may not diagnose or plan comprehensive treatment, place, finish or remove permanent restorations, perform surgery or cut hard or soft tissue including extractions and suturing, prescribe medication, start the flow of nitrous oxide and oxygen gases, or administer local or general anesthesia or sedation, unless another law specifically allows it.

Unless the statute otherwise permits it, a dental assistant also may not perform any duty reserved to a registered dental assistant, registered dental assistant in extended functions, orthodontic assistant, dental sedation assistant, or dental hygienist.

A dental assistant may adjust the flow of nitrous oxide and oxygen only if the supervising dentist is present in the operatory directing the adjustment; starting that flow is on the prohibited list.

A separate dental sedation assistant permit authorizes monitoring a patient under moderate sedation, deep sedation or general anesthesia using pulse oximetry, ECG, capnography, blood pressure, pulse and respiration monitoring, plus drug identification and draw, adding drugs to an intravenous line, and removing intravenous lines, all under the direct chairside supervision of the dentist or another licensed provider authorized to administer the sedation, and confined to a dental office or clinic setting.

The statute defines continuing education as coursework tied to the clinical and supplemental duties of dental assistants, registered dental assistants, registered dental assistants in extended functions, and permitholders, capped at eight units per day whether the coursework is live or self-paced.

Registered dental assistant, registered dental assistant in extended functions, orthodontic assistant permit and dental sedation assistant permit holders must each complete the continuing education requirements the board sets under Section 1645 as part of renewing that license or permit; this article does not restate what those requirements are.