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

The definitions section defines a dental assistant as anyone who assists the dentist in the clinical duties of a dental office, a certified dental assistant as one who holds current DANB certification, and a graduate dental assistant as one who has graduated from a CODA-accredited dental assisting school.

Den 302.07 separately defines the Expanded Function Dental Auxiliary (EFDA), open to a dental hygienist or a certified or graduate dental assistant who completes an EFDA course in direct dental restorations.

The rules describe no application, fee or registration process for a traditional, certified or graduate dental assistant.

An EFDA is different: the EFDA must register with the board and submit proof of the required EFDA training and experience along with a fee to obtain an EFDA permit, must renew that permit in odd-numbered years before May 1st if still employed as an EFDA, and must prominently display the permit where the EFDA works.

A dental practice may employ no more than 2 EFDAs regardless of the number of dentists, and dentists must inform the board of an EFDA's employment within 10 days.

Direct supervision requires the dentist to be in the office, authorize the procedure, remain in the office while it is performed, and evaluate the assistant's performance before the patient is dismissed.

Indirect supervision is the same except the dentist evaluates performance at a later appointment instead.

General supervision only requires the dentist to have authorized the procedures under a diagnosis and treatment plan and to personally evaluate and review them with the patient at least once every 12 months.

Public health supervision lets a dental assistant work in a school, hospital, other institution, or for a homebound person under a certified public health dental hygienist (CPHDH).

Under general supervision, any dental assistant may process and sterilize instruments, seat and reorganize equipment for patients, process dental radiographs, do lab technician work, run saliva tests, teach oral hygiene, and take vital signs.

Under direct supervision, an assistant may also retract oral tissue, place or remove a rubber dam, remove treatment debris, place cotton rolls and topical anesthesia, apply topical fluoride, seat impression trays, insert mouthguards, and do intraoral scanning or photographs.

Certified and graduate dental assistants get a wider direct-supervision list, including histories, matrices, pulpal vitality testing, and suture removal; after 400 hours of experience they may also take final impressions, place amalgam prior to condensing, cement bands, and make bite registrations, among other listed tasks.

Processing a radiograph (developing an already-exposed film) is a general-supervision duty open to any assistant.

Actually taking x-rays is a separate, gated skill: a traditional dental assistant needs 200 hours of clinical experience to qualify to take the radiology course, then must complete a course of at least 8 lecture hours and 8 lab hours covering asepsis and radiation safety, parallel and bisecting techniques, full-mouth and panoramic and extra-oral projections, dark-room procedures, and radiographic landmarks/interpretation/mounting, and must pass the DANB radiology written exam unless the assistant has been practicing since before December 9, 1998.

Once qualified, the duty of dental radiology may only be performed under a licensed dentist's direct supervision.

A traditional dental assistant needs 400 hours of clinical experience to take the nitrous oxide monitoring course, which must run at least 6 hours and cover pain and anxiety, respiratory anatomy and physiology, stages of CNS depression, nitrous oxide pharmacology, and proper administration including equipment, patient monitoring and management of complications.

A dental assistant who qualifies may monitor nitrous oxide only under a dentist's direct supervision, only after the dentist has initiated administration and brought the patient to the intended sedation level, and must be currently certified in BLS-HCP.

An assistant qualified to monitor nitrous oxide in another jurisdiction may seek endorsement by presenting equivalent training documentation and a supervising dentist's letter attesting to monitoring experience within the previous 2 years.

The rules extracted here do not describe a recurring continuing-education requirement for a traditional, certified or graduate dental assistant; instead, each expanded duty is unlocked once by completing that duty's specific course and any clinical-hour prerequisite, and a course provider must certify completion in writing.

An introduction to dental assisting course is the prerequisite every traditional assistant must pass, after 200 hours of clinical experience, before qualifying for any other expanded duty area, including infection control.

An EFDA permit does have its own biennial renewal in odd-numbered years, described above under registration.