20 CSR 2110-2.120 - Dental Assistants
(1)
Definitions.
(A) Accredited dental assisting
program-A dental assisting educational program accredited by the Commission on
Dental Accreditation of the American Dental Association.
(B) Certified dental assistant-A dental
assistant who is currently certified by the Dental Assisting National Board,
Inc.
(C) Dental assistant-An
employee of a duly registered and currently licensed dentist in Missouri, other
than either a dental hygienist or a certified dental assistant.
(D) Dental auxiliary-Either a dental
assistant or certified dental assistant as defined in subsections (1)(B) and
(C).
(E) Direct supervision-The
following conditions must be satisfied for direct supervision to apply:
1. The dentist is in the dental office or
treatment facility;
2. The dentist
has personally diagnosed the condition to be treated;
3. The dentist has personally authorized the
procedures;
4. The dentist remains
in the dental office or treatment facility while the procedures are being
performed by the dental auxiliary; and
5. The dentist evaluates the performance of
the dental auxiliary before the dismissal of the patient.
(F) Expanded functions approved course
provider-A provider of expanded functions curriculum and competency testing
approved by the Missouri Dental Board.
(G) Expanded functions permit-A permit issued
by the Missouri Dental Board authorizing a dental assistant, certified dental
assistant, or Missouri licensed dental hygienist to perform expanded functions
duties upon delegation from a Missouri licensed dentist. Expanded functions
permits will be issued in the following categories: restorative I, restorative
II, removable prosthodontics, fixed prosthodontics, and orthodontics.
(H) Missouri Test of Basic Dental Assisting
Skills-A test of basic knowledge of dental assisting approved by the board
including terminology, principles of asepsis, disinfection and sterilization,
and other concepts of dental assisting deemed necessary to master courses in
more advanced assisting functions.
(I) Proof of competence-Documentation, such
as a diploma, a certificate of mastery, or a letter from an approved course
provider or competency testing agent stating that the dental auxiliary has
successfully completed a board-approved course of training and competency
testing of that training.
(2) Prohibited Acts.
(A) A registered and currently licensed
dentist may not delegate to a dental assistant or certified dental assistant,
as defined in subsections (1)(B) and (C) respectively, the performance of the
following procedures:
1. Diagnosis, including
interpretation of dental radiographs and treatment planning;
2. Cutting of tooth structure;
3. Surgical procedures on hard and soft
tissues including, but not limited to, the removal of teeth and the cutting and
suturing of soft tissues;
4. The
prescription, injection, and parenteral administration of drugs;
5. The final bending of archwire prior to
ligation;
6. The scaling of teeth;
and
7. Administration of nitrous
oxide-oxygen analgesia except that a dental assistant or certified dental
assistant may assist in the administration of and monitor nitrous oxide-oxygen
analgesia with specific training as provided in section (3) of this
rule.
(3)
Permitted Acts.
(A) A dental assistant or
certified dental assistant may assist in the administration of and monitor
nitrous oxide analgesia under direct supervision if s/he-
1. Has successfully completed formal
certified training in a course approved by the Missouri Dental Board;
and
2. Has successfully passed an
approved competency test regarding the clinical and didactic training;
or
3. Has been certified in another
state to assist in the administration of and monitor nitrous oxide subsequent
to equivalent training and testing. The dental assistant may qualify to perform
these functions by presenting proof of competence of this equivalent training
and testing to the Missouri Dental Board.
(4) Expanded Functions Permits.
(A) Effective December 1, 2012, a currently
licensed dentist may delegate, under direct supervision, functions listed in
section (5) of this rule to a dental assistant possessing a board-issued permit
authorizing the dental assistant to perform expanded functions duties. To
qualify for a board-issued permit to perform expanded functions duties, the
dental assistant must provide the board with the following:
1. Proof of certification as a certified
dental assistant from the Dental Assisting National Board and proof of
competence as defined in subsection (1)(I) showing graduation from an
accredited dental assisting program in which competency testing in the
appropriate expanded functions category was completed; or
2. Proof of certification as a certified
dental assistant from the Dental Assisting National Board and proof of
competence as defined in subsection (1)(I) showing the dental assistant has
completed a board-approved expanded functions training course; or
3. Proof of competence as defined in
subsection (1)(I) showing that the dental assistant has passed the board's
Missouri Test of Basic Dental Assisting Skills and that the dental assistant
has completed a board-approved expanded functions training course;
and
4. Evidence of current
certification in the American Heart Association's Basic Life Support for the
Healthcare Provider (BLS), or an equivalent certification approved by the
Missouri Dental Board. Board-approved courses shall meet the American Heart
Association guidelines for cardiopulmonary resuscitation (CPR) and emergency
cardiovascular care (ECC) and provide written and manikin testing on the course
material by an instructor who is physically present with the students. Online
only courses will not be accepted to satisfy the BLS
requirement.
(B) The board
shall issue the appropriate expanded functions permit upon receipt of a
completed application form, payment of the appropriate fee specified in
20 CSR
2110-2.170, and proof of competence as defined in
subsection (1)(I) that the dental assistant has complied with the requirements
of subsection (4)(A) of this rule. The requirements of this section must be
completed within one (1) year of the date of submission of the application
form. The board-issued expanded functions permit must be displayed in plain
view in any facility where the dental assistant will be providing expanded
functions prior to delegation of expanded functions to that dental
assistant.
(C) Any dental assistant
or certified dental assistant to whom a dentist could legally delegate expanded
functions duties prior to December 1, 2012, or any dental assistant or
certified dental assistant who meets the qualifications for a board-issued
expanded functions permit prior to December 1, 2012, may submit their proof of
competence to the Missouri Dental Board and be issued an expanded functions
permit prior to December 1, 2012.
(D) Beginning March 1, 2013, every expanded
functions permit issued by the board shall be renewed every five (5) years. In
order to renew an expanded functions permit, the dental assistant shall submit
to the board-
1. A completed renewal
application form provided by the board for each permit the permit holder wishes
to renew;
2. The renewal fee
specified in 20 CSR 2110-2.170 payable to the
Missouri Dental Board for each permit the permit holder wishes to
renew;
3. Satisfactory evidence of
completion of sixteen (16) hours of continuing education from board-approved
sponsors as specified in
20 CSR
2110-2.240(1)(C) during the five-
(5-) year period immediately preceding the expiration date. All sixteen (16)
hours of continuing education for renewal must be directly related to the
updating and maintaining of knowledge and skills in the treatment, health, and
safety of the individual dental patient. Permit holders shall only be required
to complete sixteen (16) hours of continuing education regardless of the number
of permits the permit holder wishes to renew. For any permits that are issued
twelve (12) months or less from the expiration date of that permit, the permit
holder shall only be required to obtain four (4) hours of board-approved
continuing education to renew those permits. Each permit holder shall maintain
documentation of completion of the required continuing education hours for five
(5) years after the completion of the permit period in which the continuing
education was earned; and
4.
Evidence of current certification in the American Heart Association's Basic
Life Support for the Healthcare Provider (BLS), or an equivalent certification
approved by the Missouri Dental Board. Board-approved courses shall meet the
American Heart Association guidelines for cardiopulmonary resuscitation (CPR)
and emergency cardiovascular care (ECC) and provide written and manikin testing
on the course material by an instructor who is physically present with the
students. Online only courses will not be accepted to satisfy the BLS
requirement.
(E) An
expanded functions permit shall expire if not renewed on or before the permit
expiration date. An expired permit can be renewed at any time within one (1)
year of the permit expiration date. Any expired expanded functions permit that
is not renewed within one (1) year of the expiration date shall be
void.
(5) Categories.
(A) Functions delegable to a dental assistant
possessing a board-issued permit to perform expanded functions are divided into
five (5) categories; restorative I, restorative II, removable prosthodontics,
fixed prosthodontics, and orthodontics and are listed below by category.
1. Restorative I-
A. Sizing and cementing of prefabricated
crowns;
B. Placing, condensing,
carving, and finishing amalgam for Class I, V, and VI restorations;
C. Placing and finishing composite for Class
I, V, and VI restorations; and
D.
Minor palliative care of dental emergencies (place sedative
filling).
2. Restorative
II-
A. Sizing and cementing of prefabricated
crowns;
B. Placing, condensing,
carving, and finishing amalgam for Class I, II, III, IV, V, and VI
restorations;
C. Placing and
finishing composite for Class I, II, III, IV, V, and VI restorations;
and
D. Minor palliative care of
dental emergencies (place sedative filling).
3. Orthodontics-
A. Preliminary bending of archwire;
B. Removal of orthodontic bands and
bonds;
C. Final cementation of any
permanent orthodontic appliance or prosthesis;
D. Making impressions for the fabrication of
any orthodontic prosthesis/appliance; and
E. Placement and cementation of orthodontic
brackets and/or bands.
4.
Prosthodontics-Fixed-
A. Apply tissue
retracting material prior to impression of a fixed prosthesis;
B. Extra-oral adjustments of fixed
prosthesis;
C. Final cementation of
any permanent appliance or prosthesis;
D. Making impressions for the fabrication of
any removable or fixed prosthesis/appliance; and
E. Sizing and cementing of prefabricated
crowns.
5.
Prosthodontics-Removable-
A. Placement of
temporary soft liners in a removable prosthesis;
B. Extra-oral adjustments of removable
prosthesis during and after insertion; and
C. Making impressions for the fabrication of
any removable or fixed
prosthesis/appliance.
(6) Expanded Functions Course Providers.
(A) The board may approve expanded functions
course providers that satisfy the following minimum criteria:
1. Uses course curriculum approved by the
board;
2. Demonstrates that faculty
at each course include at least one (1) dentist and that the student to faculty
ratios do not exceed one (1) faculty member per ten (10) students;
3. Demonstrates that adequate faculty
calibration occurs to insure that educational standards are
maintained;
4. Demonstrates that
adequate testing, monitoring, and evaluation is in place to assure that
graduates can be certified as having attained mastery of the component skills
and concepts in a laboratory setting; and
5. Demonstrates that mechanisms are in place
to provide the board with data on the outcomes of expanded functions duty
dental assisting training by reporting on follow-up blind surveys of
certificated assistants, supervising dentists, and
patients.
(7)
Delegated Acts.
(A) A currently licensed
dentist may delegate under direct supervision to a dental assistant or
certified dental assistant any functions not specifically referenced in section
(5) of this rule and not considered either the practice of dentistry or the
practice of dental hygiene as defined in sections
332.071 and
332.091, RSMo, and
20 CSR
2110-2.130.
(B) The licensed dentist is responsible for
determining the appropriateness of delegation of any specific functions based
upon knowledge of the skills of the auxiliary, the needs of the patient, the
requirements of the task, and whether proof of the competence is
required.
(C) Pursuant to section
332.031.2., RSMo, the licensed dentist is ultimately responsible for patient
care. Nothing contained in the authority given the licensed dentist by this
rule to delegate the performance of certain procedures shall in any way relieve
the supervising licensed dentist from liability to the patient for negligent
performance by a dental assistant or certified dental assistant. Expanded
functions permits shall be subject to discipline as provided in section
332.321,
RSMo.
Notes
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