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

Maryland's dental assistant chapter recognizes a level one dental assistant who performs a set list of intraoral duties under a dentist's direct supervision without Board certification, a general duties EFDA certified to perform additional intraoral procedures such as placing sealants and coronal polishing, and an orthodontic EFDA certified to perform orthodontic procedures such as banding and placing arch wires.

A companion chapter, COMAR 10.44.19, defines a fourth credential, the dental radiation technologist, the only assistant permitted to place or expose dental radiographs.

An individual may hold more than one of these certifications at the same time.

A level one dental assistant must be at least 18 years old and works under a licensed dentist's direct supervision performing the procedures the chapter lists, without obtaining Board certification.

General duties and orthodontic EFDAs must apply for and hold a Board certification, each with its own eligibility requirements, course hours, and exam.

A dental radiation technologist must be currently certified by the Board before practicing dental radiation technology on a patient in Maryland.

Direct supervision means the supervising dentist is in the dental office and personally diagnoses the condition to be treated, authorizes the procedure, and evaluates the dental assistant's performance before the patient is dismissed.

General supervision means a dentist supervises a dental assistant but the dentist may or may not be present in the dental office while the assistant performs the procedures.

Most level one duties require direct supervision; the chapter allows general supervision only for a narrow dental sealant program tied to a dental-hygienist supervision waiver under a separate chapter.

Under a dentist's direct supervision, without certification, a level one dental assistant may perform a 34-item list of intraoral procedures, including rinsing and aspirating the oral cavity, retracting the cheeks and tongue, taking impressions for study models, applying topical anesthetic and desensitizing agents, placing and removing rubber dams and matrix bands, placing temporary restorations and crowns, removing sutures, and taking and recording vital signs.

General duties and orthodontic EFDAs may also perform this same level one list, once certified, in addition to the procedures reserved to their own certification.

Maryland regulations bar a dentist from letting a dental assistant place or expose radiographs unless the assistant is certified as a dental radiation technologist under COMAR 10.44.19.

That certification requires the applicant to be at least 18, of good moral character, a high school graduate or equivalent, complete Board-approved educational requirements and a Board-approved course of at least 24 hours in dental radiology, and pass a Board-administered or Board-approved exam qualifying the applicant to place and expose radiographs.

Neither the level one dental assistant list nor the EFDA duty lists include radiographs.

Without the matching certification, an individual may not perform the general duties EFDA procedures reserved to that certification, including placing sealants, coronal polishing, applying silver diamine fluoride, monitoring nitrous oxide, acid etching, and applying bonding agents, or the orthodontic EFDA procedures reserved to that certification, such as preparing and fitting orthodontic bands, placing arch wires, cementing orthodontic bands and attachments, placing elastics and ligatures, and selecting headgear.

A general duties EFDA who is monitoring a patient on nitrous oxide may not increase the nitrous oxide level, monitor more than one patient at a time, treat another patient during the monitoring, or leave the operatory except in an emergency.

Placing or exposing radiographs without dental radiation technologist certification is separately barred.

A general duties EFDA may monitor a patient on nitrous oxide by observing the patient from the start of the flow through full recovery, but may not increase nitrous oxide levels, monitor more than one patient, treat another patient during the monitoring, or leave the operatory except in an emergency.

The dentist who orders that monitoring must have a written emergency plan, remain in the dental office and in close proximity to be summoned, and personally discharge the patient.

The Board-approved general duties EFDA course must include 6 hours of instruction on nitrous oxide monitoring and 4 hours of didactic training in listed sedation topics; the chapter lists nitrous oxide monitoring only as a general duties EFDA procedure, not on the level one or orthodontic EFDA duty lists.

An EFDA, general duties or orthodontic, renewing a 2-year certification must complete at least 15 hours of Board-approved continuing education, including a 3-hour Board-approved infection control course that counts toward that total, in the 2-year period before the certificate expires.

A dental radiation technologist renewing generally must show at least 600 hours of active practice in the preceding 6 years, or, failing that, complete 8 classroom hours of continuing education, 4 of them on radiation safety, in the year before renewal, plus a 2-hour Board-approved infection control course for certificates renewing in 2011 or later.

The chapter names no continuing education requirement for a level one dental assistant.