Know the law: Dental assistant regulation and education

When I became a dental assistant over 33 years ago, I never imagined that one day I would love teaching as much as I do.

My love of dentistry and my love of teaching allow me to talk to dental assistants all over the country. When you get a room full of assistants together, engaging and talking, you learn so much. One of the subjects that comes up often is laws regarding dental assistants. I find that there is a tremendous lack of knowledge of the law.

What is legal for a dental assistant to do? Do assistants have to be licensed? What is a “registered” dental assistant? Do you have to be a Certified Dental Assistant (CDA) to do expanded functions and if not, why should I become one?

I find it somewhat frustrating that when this subject is brought up, the information passing through the room is usually wrong. And many times, when someone asks, “how do you know that” or “where did you get that information” a simple, “well that’s what so-and-so said” is the explanation. Patient care, infection control and protecting your patients and yourself should always be your number one priority every single day. So, not knowing the laws, not completely understanding right from wrong and not educating yourself is not only lazy, it’s downright dangerous.

Did you know that there are approximately 300,000 dental assistants in the U.S.? There are approximately 200,000 dentists, and 175,000 dental hygienists. Dental assistants make up the greatest number of the oral healthcare team, yet for the most part we are unregulated and undereducated. It’s for this reason that I believe that there is a lack of knowledge of the law. Assistants, for the most part, just haven’t been taught what it is they are allowed to do. Or, if they have been formally trained, they don’t always keep up with continuing education and changes. Over the years, I have seen some incredible changes in our industry with technology and materials, including OSHA and CDC guidelines. As the laws change from year to year, keeping up with education is more important than ever before.

Many of you have heard of the Tulsa dentist who lost his license due to some unsavory practices; rusty instruments, an autoclave that was never spore tested and proved to be malfunctioning, questionable infection control procedures and assistants who were administering IV’s when it wasn’t allowed by the Oklahoma Board of Dentistry. But did you know his assistants were brought up on felony charges as well? They were arrested, jailed and they are waiting for their fate to be decided. Even if they serve no prison time, the devastation this has caused has severely impacted their lives. They may serve prison time or possibly fined a pretty hefty amount. They had been sent to a course on IV sedation and assumed it was legal for assistants to do. They failed to keep accurate spore test records and their infection control procedures were extremely out of date. Their lack of understanding of the law and current guidelines for infection control has cost them greatly. In this case, their employer may or may not have known the law either.

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Ignorance of the law is no excuse. You can still be held accountable for your actions or lack thereof. No longer can you use the excuse of “well, that’s the way we’ve always done it,” or “that’s the way to they told me to do it when I got here.” It’s your responsibility to know right from wrong and you should never simply take someone’s word for it. The statement that “it’s ok, we’ve always done it that way, no big deal,” is just laziness!

Does your state require dental assistants to have a radiology permit? Some states allow for dental assistants to preform expanded functions. What functions does your state allow and how do you go about becoming certified for these functions? If I am certified in one state, but am moving to another, will that permit/license be valid in my new state? I would love to take all the credit and say that I have done all the research for this but the truth is that the Dental Assisting National Board (DANB) has already done it for us. Listed on their website is a state-specific tab where you can search your state and its laws governing dental assistants. Go to the experts who have done the research for you and get the correct information. Never assume that just because it’s always been done that way that is the right way to do it. Do your research and educate yourself.  

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According to DANB.org, there are approximately 36,000 Certified Dental Assistants in the U.S. So out of approximately 300,000, only 12% are certified with a national standard requiring them to achieve 12 hours of CE a year to keep that certification. Many states that require their assistants to be registered dental assistants (RDA) also require licensure or radiology permits. RDAs also have to complete a number of hours each year to keep their certification current.

Not all states have those requirements; some require no continuing education whatsoever. We hear new studies all the time that link our oral health to our overall health yet, the most oral healthcare workers have no minimal standards for education and for the most part are not required to continue their education to keep up with a growing profession. Does that blow anyone else’s mind but mine?

If continuing education isn’t mandatory for your state, YOU should take it upon yourself to get educated. Whether you were formally trained or trained on the job doesn’t really matter. As assistants, we play a vital role in our patient’s care and infection control. What should matter is that you are up-to-date, knowledgeable and completely confident that you are holding yourself and team members to the highest standards for patient care. Doing it the way you’ve always done it doesn’t really cut it anymore. Times, infection control procedures and materials all change. Educate yourself on what the latest and greatest in infection control is and make sure your office is performing to the highest standards.

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I often hear; “it’s not legal but our doctor allows us to do it” or “it’s no big deal, they tell us to do it,” or “yeah, you’re supposed to, but we don’t,” – words that make me cringe. I can only imagine that if you were to talk to those Tulsa dental assistants just one week before the Board of Dentistry questioned them, they might have said the same things. And they aren’t the only assistants serving time in jail: In many cases, depending on the infraction, the state board deems some procedures “practicing dentistry without a license,” which is a felony. When you know you are doing something wrong, then you are and you can be held accountable for your actions. You can also be held accountable for knowing something is wrong and not doing anything about it, i.e. improper infection control procedures, not spore testing your autoclave, knowing team members are doing more than they are allowed by your state, etc.

Are you prepared to go to jail, have felony charges against you or have your mug shot on the evening news or morning paper? If you are told to do something that you know you aren’t supposed to be doing, then don’t do it! If you aren’t sure, then find out. DANB.org will have those answers for you and if you need better clarification, call your state dental board. The greatest asset you have is yourself, so protect yourself and the investment you have made to this profession by educating yourself and knowing what your state laws are.

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I had been a dental assistant for 29 years when I took my Dental Assistant National Board test to become a Certified Dental Assistant (CDA). Before that, I had always heard things like; “you don’t have to be a CDA to get a job” or “it’s not going to make you any more money, so why do it?” And the one I now hate the most; “oh, you’re just a dental assistant, you don’t need continuing education.” I think back to all those years before I became a CDA and see how much growth I missed out on. I feel like I was held back and not given the chance to better myself. I can only blame myself; I chose to listen to bad advice.

As I stated earlier, approximately only 12% of dental assistants nationwide currently hold a CDA. Those assistants who maintain their CDA are dedicated, educated and passionate about their careers. In most cases you don’t have to be a CDA, but any employer knows the CDA is a national standard for excellence in dental assisting. Having a CDA behind your name sets you apart. And don’t think that just because you took and passed the CDA exam that you don’t have to keep that certification up to date. Each year you must maintain that excellence by obtaining the 12 continuing education credits necessary for renewing your CDA. If you don’t, then you’re not a CDA.

It is my opinion that one day, dental assistants will be held to minimal standards and I believe that the DANB CDA certification will be the gold standard that states will look to. Many states right now that require infection control or radiology permits already use DANB as their go-to resource and I believe that more states will do the same.

And of course, not one of my articles would be complete without me mentioning another amazing tool for growth in yourself and your profession. The American Dental Assistant’s Association is your own professional organization that speaks for you in terms of legislation, education and professionalism. As a member, you are entitled to countless hours of CE, articles that help you and give you ideas for growth, the opportunity to network with an amazing group of individuals just like yourself who face all the same issues and are there to help you be the best you can be, and so much more. Their Fellowship/Mastership program is nothing short of learning excellence. I can say without hesitation that my career took a major turn for the better by becoming a CDA and a member of the phenomenal organization called the ADAA. These two organizations will give you the tools you need to excel, know the law and be educated. When you take your career more seriously, the people around you and your employer will too.

Do your job and know the law, become involved, get educated and hold yourself to a high standard of patient care. Your patients depend on you; they trust you to be educated and take excellent care of them. Never forget that you are responsible for that care.