BILL NUMBER: AB 2637 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 1, 2008
INTRODUCED BY Assembly Member Eng
FEBRUARY 22, 2008
An act to amend Section 1752.1 of the Business and
Professions Code, relating to dentistry. An act to
amend Sections 1725, 1750, 1750.1, and 1752.1 of, to amend and
renumber Sections 1753.1, 1754, and 1770 of, to amend, renumber and
add Sections 1756 and 1757 of, to add Sections 1750.5, 1752.3,
1752.4, 1753.4, 1754 .5, 1755, 1756.1, 1756.2, 1757.1, and
1758 to, to repeal Sections 1751, 1751.1, 1752, 1752.2, 1752.5, and
1753.5 of, and to repeal and add Sections 1750.2, 1750.3, 1750.4,
1752.6, and 1753 of, the Business and Professions Code, relating to
dentistry.
LEGISLATIVE COUNSEL'S DIGEST
AB 2637, as amended, Eng. Dental auxiliaries.
Existing law, the Dental Practice Act, provides for the licensure
and regulation of dentists by the Dental Board of California and
dental auxiliaries by the Committee on Dental Auxiliaries.
Existing law, on and after, January 1, 2010, authorizes an unlicensed
dental assistant to perform basic supportive dental procedures, as
defined, subject to a determination by the supervising
licensed dentist that the dental assistant is competent to perform
those procedures. Existing law, until January 1, 2011, requires
the board to license as a registered dental assistant a person who
files an application prior to September 1, 2009, and submits
specified written evidence of either graduation from a specified
educational program or specified work experience that is satisfactory
to the board. Existing law, on and after January 1, 2010,
requires the board to license as a registered dental assistant in
extended functions a person who submits specified evidence of current
licensure as a registered dental assistant or completion of the
requirements for licensure, successful completion of a specified
extended functions postsecondary program, and board-approved courses
in radiation safety, infection control, California dental law, and
basic life support, and satisfactory performance on a specified
written examination and a clinical or practical e
xamination. Existing law, on and after January 1, 2010, also requires
the board to license a person who meets specified requirements as a
registered orthodontic assistant, registered surgery assistant,
registered restorative assistant, or registered restorative assistant
in extended functions.
This bill would instead extend these licensure requirements, until
January 1, 2012, with respect to a person who files an application
prior to September 1, 2010. The bill would make related changes to
that provision.
This bill would repeal those provisions governing registered
orthodontic assistants, registered surgery assistants, registered
restorative assistants, and registered restorative assistants in
extended functions.
The bill would, on and after January 1, 2010, specify the duties
that a dental assistant is authorized to perform under the general
and direct supervision of a supervising licensed dentist.
The bill would revise and recast the registered dental assistant
provisions and would require the board to license a person as a
registered dental assistant if he or she files an application and
submits written evidence that is satisfactory to the board, of either
(1) graduation from a board-approved educational program in
registered dental assisting, or (2) for individuals applying prior to
January 1, 2010, satisfactory work experience, as defined, of at
least 12 months or, for individuals applying on and after January 1,
2010, satisfactory work experience of at least 15 months and
satisfactory performance on a written and practical examination
administered by the committee. The bill would also require that those
individuals applying on or after January 1, 2010, to pass a written
examination in law and ethics and complete board-approved courses in
the act, infection control, and basic life support. The bill would,
on and after January 1, 2010, impose specific content requirements
for the written and practical examinations and would require the
committee to appoint a registered dental assistant examination
subcommittee to assign specific procedures for the practical
examination. The bill would, commencing January 1, 2010, specify the
duties a registered dental assistant is authorized to perform. The
bill would specify that the fee for the written examination in law
and ethics shall not exceed the actual cost of the examination.
The bill would, on and after January 1, 2010, modify the
requirements for a license as a registered dental assistant in
extended functions to include, among other things, completion of a
board-approved course in the application of pit and fissure sealants
and passage of a written examination and a clinical or practical
examination. The bill would specify the duties and procedures a
registered dental assistant in extended functions, licensed on or
after January 1, 2010, is authorized to perform, as well as those
additional procedures that may be performed under the direct
supervision of a licensed dentist. The bill would, commencing January
1, 2010, also require applicants for a registered dental assistant
in extended functions license to complete a specified examination
regarding certain procedures.
The bill would, commencing January 1, 2010, require the board to
issue an orthodontic assistant permit or a dental sedation assistant
permit to a person who files a completed application, including a
fee, and provides proof of certain eligibility requirements. The bill
would authorize a dental assistant, a registered dental assistant,
or a registered dental assistant in extended functions to apply for
and maintain an orthodontic assistant permit or a dental sedation
assistant permit. The bill would also, commencing January 1, 2010,
specify the duties that may be performed by an orthodontic assistant
permitholder or a dental sedation assistant permitholder under the
direct supervision of a licensed dentist. The bill would subject
these permitholders to board established continuing education and
renewal requirements. The bill would specify that the fee for these
permits shall not exceed $50 and that the fee for the written
examination for these permits shall not exceed the actual cost of the
examination.
The bill would require a dental assisting program or course, a
permit program or course, a registered dental assistant program, a
registered dental assistant in extended function program, an
orthodontic assistant permit course, a dental sedation assistant
permit course, an infection control course, and an instructional
methodology course to meet various requirements, relating to, among
other things, administration, facilities, supervision, curriculum,
instruction, equipment, and examinations in order to secure and
maintain approval by the board.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1725 of the Business
and Professions Code is amended to read:
1725. The amount of the fees prescribed by this chapter that
relate to the licensing of dental auxiliaries shall be established by
board resolution and subject to the following limitations:
(a) The application fee for an original license shall not exceed
twenty dollars ($20). On and after January 1, 2010, the application
fee for an original license shall not exceed fifty dollars ($50).
(b) (1) The fee for examination for licensure
as a registered dental assistant shall not exceed fifty dollars ($50)
for the written examination and shall not exceed sixty dollars ($60)
for the practical examination.
(2)
(c) On and after January 1, 2008
2010 , the following fees are established for
registered orthodontic assistants, registered surgery assistants,
registered restorative assistants, and registered dental assistants:
fee for application and for the issuance of an
orthodontic assistant permit or a dental sedation assistant permit
shall not exceed fifty dollars ($50).
(A) The fee for application and for the issuance of a license
shall not exceed fifty dollars ($50).
(B) The fee for the practical examination shall not exceed the
actual cost of the examination.
(C) The fee for a written examination shall not exceed the actual
cost of the examination.
(d) The fee for the written examination for an orthodontic
assistant permit or a dental sedation assistant permit shall not
exceed the actual cost of the examination.
(e) The fee for the written examination in law and ethics for a
registered dental assistant shall not exceed the actual cost of the
examination.
(c)
(f) The fee for examination for licensure as a
registered dental assistant in extended functions or a
registered restorative assistant in extended functions
shall not exceed the actual cost of the examination.
(d)
(g) The fee for examination for licensure as a
registered dental hygienist shall not exceed the actual cost of the
examination.
(e)
(h) For third- and fourth-year dental students, the fee
for examination for licensure as a registered dental hygienist shall
not exceed the actual cost of the examination.
(f)
(i) The fee for examination for licensure as a
registered dental hygienist in extended functions shall not exceed
the actual cost of the examination.
(g)
(j) The board shall establish the fee at an amount not
to exceed the actual cost for licensure as a registered dental
hygienist in alternative practice.
(h)
(k) The biennial renewal fee for a dental auxiliary
whose license expires on or after January 1, 1991, shall not exceed
sixty dollars ($60). On or after January 1, 1992, the board may set
the renewal fee in an amount not to exceed eighty dollars ($80).
(i)
(l) The delinquency fee shall not exceed twenty-five
dollars ($25) or one-half of the renewal fee, whichever is greater.
Any delinquent license may be restored only upon payment of all fees,
including the delinquency fee.
(j)
(m) The fee for issuance of a duplicate registration,
license, permit, or certificate to replace one that is
lost or destroyed, or in the event of a name change, shall not exceed
twenty-five dollars ($25).
(k)
(n) The fee for each curriculum review and site
evaluation for educational programs for registered dental assistants
that are not accredited by a board-approved agency, the
Council for Private Postsecondary and Vocational Education,
or the Chancellor's office of the California Community Colleges
shall not exceed one thousand four hundred dollars ($1,400).
(l)
(o) The fee for review of each approval application for
a course that is not accredited by a board-approved agency,
the Council for Private Postsecondary and Vocational Education,
or the Chancellor's office of the California Community
Colleges shall not exceed three hundred dollars ($300).
(m)
(p) No fees or charges other than those listed in
subdivisions (a) through (k) to (n),
inclusive, above shall be levied by the board in connection
with the licensure of dental auxiliaries, registered dental
assistants educational program site evaluations and radiation safety
course evaluations pursuant to this chapter.
(n)
(q) Fees fixed by the board pursuant to this section
shall not be subject to the approval of the Office of Administrative
Law.
(o)
(r) Fees collected pursuant to this section shall be
deposited in the State Dental Auxiliary Fund.
SEC. 2. Section 1750 of the Business
and Professions Code , as amended by Section 6 of Chapter
588 of the Statutes of 2007, is amended to read:
1750. (a) A dental assistant is a person who may perform basic
supportive dental procedures as authorized by this article under the
supervision of a licensed dentist and who may perform basic
supportive procedures as authorized pursuant to subdivision (b) of
Section 1751 under the supervision of a registered dental hygienist
in alternative practice.
(b) The supervising licensed dentist shall be responsible for
determining the competency of the dental assistant to perform
allowable functions.
(b)
(c) This section shall remain in effect only until
January 1, 2010, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2010, deletes or
extends that date.
SEC. 3. Section 1750 of the Business
and Professions Code , as amended by Section 7 of Chapter
588 of the Statutes of 2007, is amended to read:
1750. (a) A dental assistant is an individual who, without a
license, may perform basic supportive dental procedures, as
authorized by this article Section 1750.1
and by regulations adopted by the board, under the supervision
of a licensed dentist. "Basic supportive dental procedures" are those
procedures that have technically elementary characteristics, are
completely reversible, and are unlikely to precipitate potentially
hazardous conditions for the patient being treated. These
basic supportive dental procedures may be performed under general
supervision. These basic supportive dental procedures do not include
those procedures authorized in Section 1750.3 or Section 1753.1, or
by the board pursuant to Section 1751 for registered assistants.
(b) The supervising licensed dentist shall be responsible for
determining the competency of the dental assistant to perform the
basic supportive dental procedures , as authorized
pursuant to subdivision (a) by Section 1750.1
.
(c) The supervising licensed dentist shall be responsible for
assuring ensuring that each dental
assistant , registered orthodontic assistant, registered
surgery assistant, registered restorative assistant, registered
restorative assistant in extended functions, registered dental
assistant, and registered dental assistant in extended functions,
who is in his or her continuous employ for 120 days or
more, has successfully completed both
all of the following within a year of the date of
employment:
(1) Board-approved courses in infection control and California
law.
(2) A course in basic life support offered by the American Red
Cross, the American Heart Association, or any other course approved
by the board as equivalent.
(d) Prior to operating radiographic equipment or applying for
licensure as a registered dental assistant under Section 1752.5, an
auxiliary described in subdivision (c) shall successfully complete a
radiation safety course approved by the board.
(1) A board-approved course in the Dental Practice Act.
(2) A board-approved eight-hour course in infection control that
meets the requirements of Section 1756.
(3) A course in basic life support offered by an instructor
approved by the American Red Cross or the American Heart Association.
(d) The supervising licensed dentist shall ensure that the dental
assistant maintains certification in basic life support.
(e) This section shall become operative on January 1, 2010.
SEC. 4. Section 1750.1 of the Business
and Professions Code is amended to read:
1750.1. The practice of dental assisting does not include any of
the following procedures:
1750.1. (a) A dental assistant may perform the
following duties under the general supervision of a supervising
licensed dentist:
(1) Extra-oral duties or procedures specified by the supervising
licensed dentist, provided that these duties or procedures meet the
definition of a basic supportive procedure specified in Section 1750.
(2) Operate dental radiography equipment for the purpose of oral
radiography if the dental assistant has complied with the
requirements of Section 1656.
(3) Perform intraoral and extraoral photography.
(b) A dental assistant may perform the following duties under the
direct supervision of a supervising licensed dentist:
(1) Apply nonaerosol and noncaustic topical agents.
(2) Apply topical fluoride.
(3) Take intraoral impressions for all nonprosthodontic
appliances.
(4) Take facebow transfers and bite registrations.
(5) Place and remove rubber dams or other isolation devices.
(6) Place, wedge, and remove matrices for restorative procedures.
(7) Remove post-extraction dressings after inspection of the
surgical site by the supervising licensed dentist.
(8) Perform measurements for the purposes of orthodontic
treatment.
(9) Cure restorative or orthodontic materials in operative site
with a light-curing device.
(10) Examine orthodontic appliances.
(11) Place and remove orthodontic separators.
(12) Remove ligature ties and archwires.
(13) After adjustment by the dentist, examine and seat removable
orthodontic appliances and deliver care instructions to the patient.
(14) Remove periodontal dressings.
(15) Remove sutures after inspection of the site by the dentist.
(16) Place patient monitoring sensors.
(17) Monitor patient sedation, limited to reading and transmitting
information from the monitor display during the intraoperative phase
of surgery for electrocardiogram waveform, carbon dioxide and end
tidal carbon dioxide concentrations, respiratory cycle data,
continuous noninvasive blood pressure data, or pulse arterial oxygen
saturation measurements, for the purpose of interpretation and
evaluation by a supervising licensed dentist who shall be at the
patient's chairside during this procedure.
(18) Assist in the administration of nitrous oxide when used for
analgesia or sedation. A dental assistant shall not start the
administration of the gases and shall not adjust the flow of the
gases unless instructed to do so by the supervising licensed dentist
who shall be present during the patient's chairside during the
implementation of these instructions. This paragraph shall not be
construed to prevent any person from taking appropriate action in the
event of a medical emergency.
(c) Under the supervision of a registered dental hygienist in
alternative practice, a dental assistant may perform intraoral
retraction and suctioning.
(d) The board may specify additional allowable duties by
regulation.
(e) The duties of an unlicensed dental assistant or a dental
assistant holding a permit in orthodontic assisting or in dental
sedation do not include any of the following procedures unless
specifically allowed by law:
(1) Diagnosis and comprehensive treatment planning.
(2) Placing, finishing, or removing permanent restorations
, except as provided in Section 1753.1 .
(3) Surgery or cutting on hard and soft tissue including, but not
limited to, the removal of teeth and the cutting and suturing of soft
tissue.
(4) Prescribing medication.
(5) Starting or adjusting local or general anesthesia or oral or
parenteral conscious sedation, except for the administration of
nitrous oxide and oxygen, whether administered alone or in
combination with each other and except as otherwise provided
in this article by law .
(f) The duties of an unlicensed dental assistant do not include
any duty or procedure that an orthodontic assistant permitholder, a
dental sedation assistant permitholder, registered dental assistant,
registered dental assistant in extended functions, registered dental
hygienist, or a registered dental hygienist in alternative practice
is allowed to perform.
(b)
(g) This section shall become operative on January 1,
2010.
SEC. 5. Section 1750.2 of the Business
and Professions Code is repealed.
1750.2. (a) On and after January 1, 2010, the board shall license
as a "registered orthodontic assistant," "registered surgery
assistant," or "registered restorative assistant" any person who does
either of the following:
(1) Submits written evidence of satisfactory completion of a
course or courses approved by the board pursuant to subdivision (b)
that qualifies him or her in one of these specialty areas of practice
and obtains a passing score on both of the following:
(A) A written examination approved by the board and administered
by the Committee on Dental Auxiliaries (COMDA) or by an entity
recommended by COMDA. COMDA may enter into a written agreement with a
public or private organization for the administration of the
examination. All aspects of the examination shall comply with Section
139.
(B) A practical examination for the specialty category for which
the person is seeking licensure that is approved by the board and
administered by the Committee on Dental Auxiliaries (COMDA) or by an
entity recommended by COMDA. COMDA may enter into a written agreement
with a public or private organization for the administration of the
examination. All aspects of the examination shall comply with Section
139.
(2) Completes a work experience pathway to licensure that meets
the requirements set forth in Section 1750.4. This section permits
the work experience pathway to licensure only for those assistants
described in this subdivision and does not apply to dentists or
dental hygienists.
(b) The board shall adopt regulations for the approval of
specialty registration courses in the specialty areas specified in
this section. The board shall also adopt regulations for the approval
and recognition of core courses that teach basic dental science.
The regulations shall define the minimum education and training
requirements necessary to achieve proficiency in the procedures
authorized for each specialty registration, taking into account the
combinations of classroom and practical instruction, clinical
training, and supervised work experience that are most likely to
provide the greatest number of opportunities for improving dental
assisting skills efficiently.
(c) The board may approve specialty registration courses referred
to in this section prior to January 1, 2010, and the board shall
recognize the completion of these approved courses prior to January
1, 2010, but no specialty registrations shall be issued prior to
January 1, 2010.
(d) The board may approve a course for the specialty registration
listed in subdivision (b) that does not include instruction in
coronal polishing.
(e) The board may approve a course that only includes instruction
in coronal polishing as specified in paragraph (8) of subdivision (b)
of Section 1750.3.
(f) A person who holds a specialty registration pursuant to this
section shall be subject to the continuing education requirements
established by the board pursuant to Section 1645 and the renewal
requirements of Article 6 (commencing with Section 1715).
SEC. 6. Section 1750.2 is added to the
Business and Professions Code , to read:
1750.2. (a) On and after January 1, 2010, the board shall issue
an orthodontic assistant permit to a person who files a completed
application including a fee and provides evidence, satisfactory to
the board, of all of the following eligibility requirements:
(1) Completion of at least 12 months of work experience as a
dental assistant.
(2) Successful completion of a board-approved course in the Dental
Practice Act and a board-approved, eight-hour course in infection
control that meets the requirements of Section 1756.
(3) Successful completion of a course in basic life support
offered by an instructor approved by the American Red Cross or the
American Heart Association.
(4) Successful completion of a board-approved course in all of the
duties specified in Section 1750.3, which may commence after the
completion of six months of work experience as a dental assistant.
The course shall be a minimum of 84 hours in length.
(5) Passage of a written examination administered by the committee
after completion of all of the other requirements of this
subdivision. The written examination shall encompass the knowledge,
skills, and abilities necessary to competently perform the duties
specified in Section 1750.3.
(b) A person who holds an orthodontic assistant permit pursuant to
this section shall be subject to all continuing education
requirements established by the board pursuant to Section 1645 and
the renewal requirements of Article 6 (commencing with Section 1715).
SEC. 7. Section 1750.3 of the Business
and Professions Code is repealed.
1750.3. (a) A registered orthodontic assistant may perform all of
the following dental procedures, as well as those authorized by
board regulations adopted pursuant to Section 1751:
(1) Any duties that a dental assistant may perform.
(2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
(3) Placing metal orthodontic separators.
(4) Placing ligatures and arch wires.
(5) Taking orthodontic impressions.
(6) Sizing, fitting, cementing, and removal of orthodontic bands.
(7) Selecting, prepositioning, curing in a position approved by
the supervising dentist, and removal of orthodontic brackets.
(8) Coronal polishing.
(9) Preparing teeth for bonding.
(10) Applying bleaching agents and activating bleaching agents
with nonlaser, light-curing devices.
(11) Removal of excess cement from coronal surfaces of teeth under
orthodontic treatment by means of a hand instrument or an ultrasonic
scaler.
(12) Taking facebow transfers and bite registrations for
diagnostic models for case study only.
(b) A registered surgery assistant may perform the following
dental procedures, as well as those authorized by board regulations
adopted pursuant to Section 1751:
(1) Any duties that a dental assistant may perform.
(2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
(3) Monitoring of patients during the preoperative,
intraoperative, and postoperative phases.
(A) For purposes of this paragraph, patient monitoring includes
the following:
(i) Selection and validation of monitoring sensors, selecting
menus and default settings and analysis for electrocardiogram, pulse
oximeter and capnograph, continuous blood pressure, pulse, and
respiration rates.
(ii) Interpretation of data from noninvasive patient monitors
including readings from continuous blood pressure and information
from the monitor display for electrocardiogram waveform, carbon
dioxide and end tidal carbon dioxide concentration, respiratory cycle
data, continuous noninvasive blood pressure data, and pulse arterial
oxygen saturation measurements, for the purpose of evaluating the
condition of the patient during preoperative, intraoperative, and
postoperative treatment.
(B) For purposes of this paragraph, patient monitoring does not
include the following:
(i) Reading and transmitting information from the monitor display
during the intraoperative phase of surgery for electrocardiogram
waveform, carbon dioxide and end tidal carbon dioxide concentrations,
respiratory cycle data, continuous noninvasive blood pressure data,
or pulse arterial oxygen saturation measurements, for the purpose of
interpretation and evaluation by a licensed dentist who shall be at
chairside during this procedure.
(ii) Placing of sensors.
(4) Taking impressions for surgical splints and occlusal guards.
(5) Placement of surgical dressings.
(6) Adding drugs, medications, and fluids to intravenous lines
using a syringe, provided that a licensed dentist is present at the
patient's chairside.
(7) Removal of intravenous lines.
(8) Coronal polishing, provided that evidence of satisfactory
completion of a board-approved course in this function has been
submitted to the board prior to the performance thereof.
(c) A registered restorative assistant may perform all of the
following dental procedures, as well as those authorized by board
regulations adopted pursuant to Section 1751:
(1) Any duties that a dental assistant may perform.
(2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
(3) Sizing, fitting, adjusting, intraorally fabricating,
temporarily cementing, and removing temporary crowns and other
temporary restorations.
(4) Placing bases and liners on sound dentin.
(5) Removing excess cement from supragingival surfaces of teeth
with a hand instrument or an ultrasonic scaler.
(6) Taking facebow transfers and bite registrations for diagnostic
models for case study only.
(7) Taking impressions for space-maintaining appliances and
occlusal guards.
(8) Coronal polishing.
(9) Applying pit and fissure sealants.
(10) Applying bleaching agents and activating bleaching agents
with nonlaser, light-curing devices.
(11) Placement of surgical dressings.
(d) The supervising dentist shall be responsible for determining
the level of supervision required for assistants registered pursuant
to this section.
(e) This section shall become operative on January 1, 2010.
SEC. 8. Section 1750.3 is added to the
Business and Professions Code , to read:
1750.3. A person holding an orthodontic assistant permit pursuant
to Section 1750.2 may perform the following duties under the direct
supervision of a supervising licensed dentist:
(a) All duties that an unlicensed dental assistant is allowed to
perform.
(b) Prepare teeth for bonding, and select, preposition, and cure
orthodontic brackets after their position has been approved by the
supervising licensed dentist.
(c) Remove only orthodontic brackets and attachments with removal
of the bonding material by the supervising licensed dentist.
(d) Size, fit, and cement orthodontic bands.
(e) Remove orthodontic bands and remove excess cement from
supragingival surfaces of teeth with a hand instrument.
(f) Place and ligate archwires.
(g) Remove excess cement with an ultrasonic scaler from
supragingival surfaces of teeth undergoing orthodontic treatment.
SEC. 9. Section 1750.4 of the Business
and Professions Code is repealed.
1750.4. (a) A dentist who holds an active, current, and
unrestricted license to practice dentistry under this chapter may
train and educate his or her employees, or employees of the dental
office, primary care clinic, or hospital where the dentist is
practicing and directly supervises the employees, without charge or
cost to the employees, in all of the allowable duties for the purpose
of licensure in one of the specialty licensure categories set forth
in Section 1750.2. A dentist may not begin the work experience
training and education of an employee until his or her application
for that particular employee is approved by the Committee on Dental
Auxiliaries. For purposes of this subdivision, an unrestricted
license means a license that is not suspended, placed on probation,
or restricted pursuant to subparagraph (B) or (C) of paragraph (3) of
subdivision (a) of Section 1635.5.
(1) In order to train or educate pursuant to this subdivision,
the dentist shall be subject to the following terms and conditions,
which are applicable prior to commencing training for each employee:
(A) On a completed and signed application form approved by the
committee, the dentist shall provide the specialty dental assistant
category in which the dentist will be training the employee and the
name of the employee. When the committee provides a requested
application to an employer, the committee shall also provide a copy
of the regulations governing the education and training of the
specialty assistants or provide access to the regulations on the
committee's Internet Web site.
(B) The education and training the dentist provides shall be in
compliance with the regulations adopted by the board pursuant to
subdivision (b) of Section 1750.2. Employees trained pursuant to this
section shall be considered bona fide students, as described in
Section 1626.5, as added by Section 6 of Chapter 655 of the Statutes
of 1999. The dentist shall not allow the employee to begin the
clinical training on patients until the employee has completed the
didactic and preclinical training, which includes nonpatient training
on typodonts and other laboratory models and as prescribed in
regulations, and a minimum of 120 days as a dental assistant in
California or another state, which may include graduation from a
regional occupational center or regional occupation program pursuant
to paragraph (1) of subdivision (b).
(C) The dentist shall pay a fee to the committee to cover
administrative costs not to exceed two hundred fifty dollars ($250)
for each employee he or she is training and educating. If a dentist
is training and educating an employee in more than one of the
specialty licensure categories at the same time, the dentist shall
pay the fee for each category in which the employee is being trained
and educated.
(D) Prior to beginning employee training, the dentist shall
complete a teaching methodology course approved by the board that is
six hours in length and covers educational objectives, content,
instructional methods, and evaluation procedures. The dentist shall
be exempt from this requirement if he or she holds any one of the
following degrees, credentials, or positions:
(i) A postgraduate degree in education.
(ii) A Ryan Designated Subjects Vocational Education Teaching
Credential.
(iii) A Standard Designated Subjects Teaching Credential.
(iv) A Community College Teaching Credential.
(v) Is a faculty member of a dental school approved by the
Commission on Dental Accreditation.
The dentist shall provide to the board proof of one of these
designations or shall submit a certificate of course completion in
teaching methodology.
(2) All duties performed by an employee pursuant to this section
shall be done in the dentist's presence. The dentist shall ensure
that any patient treated by a bona fide student is verbally informed
of the student's status.
(3) The work experience pathway for the employee shall not exceed
a term of 18 months, starting on the date that the Committee on
Dental Auxiliaries approves the application submitted by the dentist
for that employee.
(4) Upon successful completion of the work experience pathway
period, the dentist shall certify in writing that the employee has
successfully completed the educational program covering all
procedures authorized for the specialty category for which the
employee is seeking licensure.
(5) With respect to this subdivision, the committee:
(A) Shall approve the application form described in subparagraph
(A) of paragraph (1). The application form shall not be required to
comply with the provisions of Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code.
(B) Shall have a maximum of 60 days from the date a completed
application is received in which to approve or deny an application
under this subdivision. Nothing in this section shall prohibit a
dentist from appealing the denial of an application to the executive
officer of the committee.
(C) May inspect the dentist's facilities and practice at any time
to ensure compliance with regulations adopted by the board pursuant
to Section 1750.2.
(D) May revoke an approval for a dentist to provide training or
education pursuant to this section if the dentist is disciplined by
the board, fails to provide the training or education in accordance
with the law and regulations governing the specialty licensure
category, or fails to allow an inspection by the committee, or other
good cause. A dentist whose approval is revoked may appeal the
revocation to the committee's executive officer.
(E) May limit by regulations, approved by the board, the number of
times a dentist may train or educate an individual employee in one
or more of the specialty licensure categories.
(F) May limit by regulations, approved by the board, the number of
employees a dentist may train during the same time period.
(G) May by regulations, approved by the board, require an
applicant for licensure who has repeatedly failed to pass either the
written or practical examination for the specialty licensure category
to complete additional training and education before he or she is
allowed to retake the examination.
(b) As a condition for licensure for specialty registration under
Section 1750.2, an applicant who completes a work experience pathway
pursuant to this section shall do the following:
(1) Certify to the board that he or she has a minimum of 1600
hours of prior work experience as a dental assistant. The 1600 hours
of required work experience may be obtained by working for multiple
employers, if the applicant provides written evidence of work
experience from each dentist employer. The employee may begin the
work experience pathway before he or she completes 1600 hours of work
experience, but may not apply for licensure until that work
experience is completed. The board shall give credit toward the 1600
hours of work experience to persons who have graduated from a dental
assisting program in a postsecondary institution, secondary
institution, regional occupational center, or regional occupation
program that is not approved by the board. The credit shall equal the
hours spent in classroom training and internship on an hour-for-hour
basis not to exceed 400 hours.
(2) Certify to the board that he or she has completed the
educational program covering all procedures authorized for the
specialty category for which the applicant is seeking licensure.
(3) Obtain a passing score on a written examination that is
approved by the board and administered by the Committee on Dental
Auxiliaries (COMDA) or by an entity that is recommended by COMDA.
COMDA may enter into a written agreement with a public or private
organization for the administration of the examination. All aspects
of the examination shall comply with Section 139.
(4) Obtain a passing score on the practical examination for the
specialty category for which the employee is seeking licensure that
is approved by the board and administered by the Committee on Dental
Auxiliaries (COMDA) or by an entity recommended by COMDA. COMDA may
enter into a written agreement with a public or private organization
for the administration of the examination. All aspects of the
examination shall comply with Section 139.
SEC. 10. Section 1750.4 is added to the
Business and Professions Code , to read:
1750.4. (a) On and after January 1, 2010, the board shall issue a
dental sedation assistant permit to a person who files a completed
application including a fee and provides evidence, satisfactory to
the board, of all of the following eligibility requirements:
(1) Completion of at least 12 months of work experience as a
dental assistant.
(2) Successful completion of a board-approved course in the Dental
Practice Act and a board-approved, eight-hour course in infection
control that meets the requirements of Section 1756.
(3) Successful completion of a course in basic life support
offered by an instructor approved by the American Red Cross or the
American Heart Association.
(4) Successful completion of a board-approved course in all of the
duties specified in Section 1750.5, which may commence after the
completion of six months of work experience as a dental assistant.
The course shall be a minimum of 110 hours in length.
(5) Passage of a written examination administered by the committee
after completion of all of the other requirements of this
subdivision. The written examination shall encompass the knowledge,
skills, and abilities necessary to competently perform the duties
specified in Section 1750.5.
(b) A person who holds a permit pursuant to this section shall be
subject to the continuing education requirements established by the
board pursuant to Section 1645 and the renewal requirements of
Article 6 (commencing with Section 1715).
SEC. 11. Section 1750.5 is added to the
Business and Professions Code , to read:
1750.5. A person holding a dental sedation assistant permit
pursuant to Section 1750.4 may perform the following duties under the
direct supervision of a supervising licensed dentist:
(a) All duties that an unlicensed dental assistant is allowed to
perform.
(b) Monitor patients during the preoperative, intraoperative, and
postoperative phases, using noninvasive instrumentation such as pulse
oximeters, electrocardiograms, and capnography, limited to selection
and validation of monitoring sensors, selecting menus and default
settings and analysis for electrocardiogram, pulse oximeter and
capnograph, continuous blood pressure, pulse, and respiration rates;
interpretation of data from noninvasive patient monitors, including
readings from continuous blood pressure and information from the
monitor display for electrocardiogram waveform, carbon dioxide and
end tidal carbon dioxide concentration, respiratory cycle data,
continuous noninvasive blood pressure data, and pulse arterial oxygen
saturation measurements, for the purpose of evaluating the condition
of the patient during preoperative, intraoperative, and
postoperative treatment.
(c) Drug identification and draw, limited to identification of
appropriate medications, ampule and vial preparation, and withdrawing
drugs of correct amount as verified by the supervising licensed
dentist.
(d) Add drugs, medications, and fluids to intravenous lines using
a syringe, provided that a supervising licensed dentist is present at
the patient's chairside, limited to determining patency of
intravenous line, selection of injection port, syringe insertion into
injection port, occlusion of intravenous line and blood aspiration,
line release and injection of drugs for appropriate time interval.
(e) Removal of intravenous lines.
SEC. 12. Section 1751 of the Business
and Professions Code , as amended by Section 13 of Chapter
588 of the Statutes of 2007, is repealed.
1751. (a) The board, upon recommendation of the committee, shall
adopt regulations governing the procedures that dental assistants,
registered orthodontic assistants, registered surgery assistants,
registered restorative assistants, registered dental assistants,
registered restorative assistants in extended functions, and
registered dental assistants in extended functions are authorized to
perform consistent with and necessary to implement the provisions of
this article, and the settings within which each may practice.
(b) The board shall conduct an initial review of the procedures,
supervision level, settings under which they may be performed, and
utilization of extended functions dental auxiliaries by January 1,
2012. The board shall submit the results of its review to the Joint
Committee on Boards, Commissions, and Consumer Protection. After the
initial review, a review shall be conducted at least once every five
to seven years thereafter and the board shall update regulations as
necessary to keep them current with the state of dental practice.
(c) This section shall become operative on January 1, 2010.
SEC. 13. Section 1751.1 of the Business
and Professions Code is repealed.
1751.1. Notwithstanding any other provision of law, in order to
expedite the implementation of the provisions in Chapter 667 of the
Statutes of 2004 and Senate Bill 1111 of the 2005-06 Regular Session
relating to educational programs and courses for registered
orthodontic assistants, registered surgery assistants, registered
restorative assistants, registered dental assistants, registered
restorative assistants in extended functions, and registered dental
assistants in extended functions and to ensure consistency between
these provisions, in initially adopting regulations pursuant to
Sections 1750.2, 1752.2, 1752.5, 1752.6, 1753 and 1757, the board
shall publish a notice of proposed regulatory action for each of the
above regulations on the same date in the same year.
SEC. 14. Section 1752 of the Business
and Professions Code , as amended by Section 14 of Chapter
588 of the Statutes of 2007, is repealed.
1752. (a) The supervising licensed dentist shall be responsible
for determining the competency of the dental assistant to perform
allowable functions.
(b) This section shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2010, deletes or extends
that date.
SEC. 15. Section 1752 of the Business
and Professions Code , as amended by Section 15 of Chapter
58 8 of the Statutes of 2007, is repealed.
1752. (a) A "registered dental assistant in extended functions"
is an individual licensed pursuant to this article who may perform
basic restorative services and direct patient care, as authorized by
Sections 1750, 1750.3, and 1753.1, and by the board regulations
adopted pursuant to Section 1751 under the supervision of a licensed
dentist.
(b) A "registered restorative assistant in extended functions" is
an individual licensed pursuant to this article who may perform basic
restorative services and direct patient care, as authorized by
Section 1750, subdivision (c) of Section 1750.3, and Section 1753.1,
and by board regulations adopted pursuant to Section 1751 under the
supervision of a licensed dentist.
(c) This section shall become operative on January 1, 2010.
SECTION 1. SEC. 16. Section 1752.1
of the Business and Professions Code is amended to read:
1752.1. (a) The board shall license as a registered dental
assistant a person who files an application prior to
September 1, 2010, and submits written evidence,
satisfactory to the board, of either one of the
following eligibility requirements:
(1) Graduation from an educational program in registered
dental assisting approved by the board, and satisfactory
performance on a written and practical
examinations required by the board examination
administered by the committee .
(2) Satisfactory work experience of more than 12 months as a
(2) For individuals applying prior to
January 1, 2010, evidence of completion of satisfactory work
experience of at least 12 months as a dental assistant in
California or another state and satisfactory performance on a written
and practical examination required by the board.
administered by the committee.
(3) For individuals applying on or after January 1, 2010, evidence
of completion of satisfactory work experience of at least 15 months
as a dental assistant in California or another state and satisfactory
performance on a written and practical examination administered by
the committee.
(b) For purposes of this section, "satisfactory work experience"
means performance of the duties specified in Section 1750.1 in a
competent manner as determined by the employing dentist, who shall
certify to such satisfactory work experience in the application.
(c) The board shall give credit toward the
12 months work experience referred to in this
subdivision section to persons who have
graduated from a dental assisting program in a postsecondary
institution approved by the Department of Education or in a secondary
institution, regional occupational center, or regional occupational
program, that are not, however, approved by the board pursuant to
subdivision (a). The credit shall equal the total weeks spent in
classroom training and internship on a week-for-week basis
not to exceed 16 weeks . The board, in cooperation with the
Superintendent of Public Instruction, shall establish the minimum
criteria for the curriculum of nonboard-approved programs.
Additionally, the board shall notify those programs only if the
program's curriculum does not meet established minimum criteria, as
established for board-approved registered dental assistant programs,
except any requirement that the program be given in a postsecondary
institution. Graduates of programs not meeting established minimum
criteria shall not qualify for satisfactory work experience as
defined by this section.
(b)
(d) In addition to the requirements specified in
subdivision (a), each applicant for registered dental assistant
licensure on or after July 1, 2002, shall provide evidence of having
successfully completed board-approved courses in radiation safety and
coronal polishing as a condition of licensure. The length and
content of the courses shall be governed by applicable board
regulations.
(c) An applicant who fails to pass the written and practical
examinations required by this section on or before June 30, 2011,
shall not be eligible for further reexamination and must apply for
and meet the requirements for registered dental assistant licensure
specified in Section 1752.5. Between September 1, 2010, and June 30,
2011, an applicant shall only be allowed to apply to take the written
examination two times, and shall only be allowed to apply to take
the practical examination two times.
(d) This section shall remain in effect only until January 1,
2012, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2012, deletes or extends
that date.
(e) In addition to the requirement specified in subdivisions (a)
and (d), individuals applying for registered dental assistant
licensure on or after January 1, 2010, shall demonstrate satisfactory
performance on a written examination in law and ethics administered
by the committee and shall provide written evidence of successful
completion within five years prior to application of all of the
following:
(1) A board-approved course in the Dental Practice Act.
(2) A board-approved eight-hour course in infection control that
meets the requirements of Section 1756.
(3) A course in basic life support offered by an instructor
approved by the American Red Cross or the American Heart Association.
(f) A registered dental assistant may apply for and maintain an
orthodontic assistant permit or a dental sedation assistant permit,
or both, by adhering to the following:
(1) Successful completion of a board-approved course pursuant to
Section 1756.1 or 1756.2, as applicable.
(2) Passage of a written examination administered by the committee
that shall encompass the knowledge, skills, and abilities necessary
to competently perform the duties of the particular permit.
(g) A registered dental assistant with permits in either
orthodontic assisting or dental sedation assisting shall be referred
to as an "RDA with orthodontic assistant permit," or "RDA with dental
sedation assistant permit," as applicable.
(h) The continuing education requirements for a registered dental
assistant shall be deemed to satisfy the continuing education
requirements for renewal of a permit in orthodontic assisting or
dental sedation assisting, or both.
SEC. 17. Section 1752.2 of the Business
and Professions Code is repealed.
1752.2. (a) A board-approved educational program in registered
dental assisting, as provided in subdivisions (a) and (b) of Section
1752.5, is a program that has met the requirements for approval
pursuant to board regulations.
(b) An educational program in registered dental assisting that has
been approved by the board prior to January 1, 2010, to teach the
duties that a registered dental assistant was allowed to perform
pursuant to board regulations prior to January 1, 2010, shall
continue to be so approved on and after January 1, 2010, if it has
certified no later than November 30, 2009, on a form specified by the
board, that it shall provide instruction in all duties that
registered dental assistants shall be allowed to perform on and after
January 1, 2010, with the exception of adding drugs, medications,
and fluids to intravenous lines using a syringe and the monitoring of
patients during the preoperative, intraoperative, and postoperative
phases.
(c) The board may at any time conduct a thorough evaluation of an
approved educational program's curriculum and facilities to determine
whether the program meets the requirements for approval as specified
in board regulations.
SEC. 18. Section 1752.3 is added to the
Business and Professions Code , to read:
1752.3. (a) On and after January 1, 2010, the written examination
for registered dental assistant licensure required by Section 1752.1
shall comply with Section 139.
(b) On and after January 1, 2010, the practical examination for
registered dental assistant licensure required by Section 1752.1
shall consist of any of the three procedures described in paragraphs
(1) to (5), inclusive. The specific procedures shall be assigned by a
registered dental assistant examination subcommittee appointed by
the committee and shall be graded by examiners appointed by the
committee. The procedures shall be performed on a fully articulated
maxillary and mandibular typodont secured with a bench clamp. Each
applicant shall furnish the required materials necessary to complete
the examination.
(1) Place a base.
(2) Place a liner.
(3) Place, adjust, and finish a direct provisional restoration.
(4) Fabricate and adjust an indirect provisional restoration.
(5) Cement an indirect provisional restoration.
SEC. 19. Section 1752.4 is added to the
Business and Professions Code , to read:
1752.4. (a) A registered dental assistant may perform all of the
following duties:
(1) All duties that an unlicensed dental assistant is allowed to
perform.
(2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
(3) Apply and activate bleaching agents using a nonlaser
light-curing device.
(4) Use of automated caries detection devices and materials to
gather information for diagnosis by the dentist.
(5) Obtain intraoral images for computer-aided design (CAD),
milled restorations.
(6) Pulp vitality testing and recording of findings.
(7) Place bases, liners, and bonding agents.
(8) Chemically prepare teeth for bonding.
(9) Place, adjust, and finish direct provisional restorations.
(10) Fabricate, adjust, cement, and remove indirect provisional
restorations, including stainless steel crowns when used as a
provisional restoration.
(11) Place postextraction dressings after inspection of the
surgical site by the supervising licensed dentist.
(12) Place
periodontal dressings.
(13) Dry endodontically treated canals using absorbent paper
points.
(14) Adjust dentures extra-orally.
(15) Remove excess cement from surfaces of teeth with a hand
instrument.
(16) Polish coronal surfaces of the teeth.
(17) Place ligature ties and archwires.
(18) Remove orthodontic bands.
(19) All duties that the board may prescribe by regulation.
(b) A registered dental assistant may only perform the following
additional duties if he or she has completed a board-approved
registered dental assistant educational program in those duties, or
if he or she has provided evidence, satisfactory to the committee, of
having completed a board-approved course in those duties.
(1) Remove excess cement with an ultrasonic scaler from
supragingival surfaces of teeth undergoing orthodontic treatment.
(2) The allowable duties of an orthodontic assistant permitholder
as specified in Section 1750.3. A registered dental assistant shall
not be required to complete further instruction in the duties of
placing ligature ties and archwires, removing orthodontic bands, and
removing excess cement from tooth surfaces with a hand instrument.
(3) The allowable duties of a dental sedation assistant
permitholder as specified in Section 1750.5.
(4) The application of pit and fissure sealants.
(c) Except as provided in Section 1777, the supervising licensed
dentist shall be responsible for determining whether each authorized
procedure performed by a registered dental assistant should be
performed under general or direct supervision.
(d) This section shall become operative on January 1, 2010.
SEC. 20. Section 1752.5 of the Business
and Professions Code is repealed.
1752.5. On and after September 1, 2009, a person may apply for
and be issued a license as a registered dental assistant upon
obtaining a passing score on a written and practical examination
required by the board and providing evidence to the board of one of
the following:
(a) Successful completion of an educational program in registered
dental assisting approved by the board on or after January 1, 2008,
to teach all of the functions specified in Section 1750.3, with the
exception of the duties of adding drugs, medications, and fluids to
intravenous lines using a syringe and the monitoring of patients
during the preoperative, intraoperative, and postoperative phases.
(b) Successful completion of:
(1) An educational program in registered dental assisting approved
by the board to teach the duties that registered dental assistants
were allowed to perform pursuant to board regulations prior to
January 1, 2010.
(2) A board-approved course or courses in the following duties:
(A) Selecting, prepositioning, curing in a position approved by
the supervising dentist, and removal of orthodontic brackets.
(B) Applying pit and fissure sealants.
(c) Successful completion of:
(1) Twelve months of satisfactory work experience as a dental
assistant in California or another state. The board shall give credit
toward the 12 months of work experience to persons who have
graduated from a dental assisting program in a postsecondary
institution, secondary institution, regional occupational center, or
regional occupation program that are not approved by the board. The
credit shall equal the total weeks spent in classroom training and
internship on a week-for-week basis not to exceed 16 weeks.
(2) The three board-approved specialty registration courses, as
defined in Section 1750.2, for registration as a registered
orthodontic assistant, registered surgery assistant, and registered
restorative assistant. Any specialty license issued pursuant to
subparagraph (B) of paragraph (3) of subdivision (a) of Section
1750.2 shall be deemed to have met the requirements of this
subdivision for that specialty.
(3) A board-approved radiation safety program.
SEC. 21. Section 1752.6 of the Business
and Professions Code is repealed.
1752.6. A registered dental assistant may perform all duties and
procedures that a dental assistant, registered orthodontic assistant,
registered surgery assistant, and a registered restorative assistant
are allowed to perform, as well as those procedures authorized by
regulations adopted pursuant to Section 1751, except for the
following:
(a) A registered dental assistant who qualifies for licensure
under subdivision (a) of Section 1752.5 may only perform the
registered surgery assistant duties of adding drugs, medications, and
fluids to intravenous lines and the monitoring of patients during
the preoperative, intraoperative, and postoperative phases after
providing evidence of completion of a board-approved course or
courses in these duties.
(b) A registered dental assistant licensed on or before July 1,
2010, who qualified for licensure prior to September 1, 2009, may
only perform the following duties after the completion of a
board-approved course or courses in the following duties:
(1) Selecting, prepositioning, curing in a position approved by
the supervising dentist, and removal of orthodontic brackets.
(2) Monitoring of patients during the preoperative,
intraoperative, and postoperative phases, using noninvasive
instrumentation such as pulse oximeters, electrocardiograms, and
capnography.
(3) Adding drugs, medications, and fluids to intravenous lines.
(4) Applying pit and fissure sealants.
(c) The supervising dentist shall be responsible for determining
the level of supervision required for authorized procedures performed
by registered dental assistants.
(d) This section shall become operative on January 1, 2010.
SEC. 22. Section 1752.6 is added to the
Business and Professions Code , to read:
1752.6. A registered dental assistant licensed on and after
January 1, 2010, shall provide evidence of successful completion of a
board-approved course in the application of pit and fissure sealants
prior to the first expiration of his or her license that requires
the completion of continuing education as a condition of renewal. The
license of a registered dental assistant who does not provide
evidence of successful completion of that course shall not be renewed
until evidence of course completion is provided.
SEC. 23. Section 1753 of the Business
and Professions Code is repealed.
1753. (a) On and after January 1, 2010, the board shall license
as a registered dental assistant in extended functions a person who
submits written evidence, satisfactory to the board, of all of the
following:
(1) Current licensure as a registered dental assistant, or
completion of the requirements for licensure as a registered dental
assistant, as provided in Section 1752.5.
(2) Successful completion of either of the following:
(A) An extended functions postsecondary program approved by the
board in all of the procedures specified in Section 1753.1.
(B) An extended functions postsecondary program approved by the
board on or before July 1, 2009, to teach the duties that registered
dental assistants in extended functions were allowed to perform
pursuant to board regulations prior to January 1, 2010, and a course
approved by the board in the procedures specified in paragraphs (8)
through (13) of subdivision (b) of Section 1753.1.
(3) Successful completion of board-approved courses in radiation
safety and, within the last two years, courses in infection control,
California dental law, and basic life support.
(4) Satisfactory performance on a written examination and a
clinical or practical examination specified by the board. The board
shall designate whether the written examination shall be administered
by the committee or by the board-approved extended functions
program.
(b) On and after January 1, 2010, the board shall license as a
registered restorative assistant in extended functions a person who
submits written evidence, satisfactory to the board, of all of the
following:
(1) Completion of 12 months of satisfactory work experience as a
dental assistant in California or another state. The board shall give
credit toward the 12 months of work experience to persons who have
graduated from a dental assisting program in a postsecondary
institution, secondary institution, regional occupational center, or
regional occupation program that are not approved by the board. The
credit shall equal the total weeks spent in classroom training and
internship on a week-for-week basis, not to exceed 16 weeks.
(2) Successful completion of a board-approved course in radiation
safety, and, within the last two years, courses in infection control,
California dental law, and basic life support.
(3) Successful completion of a postsecondary program approved by
the board for restorative dental assisting specialty registration
specified in subdivision (c) of Section 1750.3.
(4) Successful completion of an extended functions postsecondary
program approved by the board in all of the procedures specified in
Section 1753.1.
(5) Satisfactory performance on a written examination and a
clinical or practical examination specified by the board. The board
shall designate whether the written examination shall be administered
by the committee or by the board-approved extended functions
program.
(c) In approving extended functions postsecondary programs
required to be completed for licensure pursuant to this section, the
board shall require that the programs be taught by persons having
prior experience teaching the applicable procedures specified in
Section 1753.1, or procedures otherwise authorized by the board
pursuant to Section 1751, in a dental school approved either by the
Commission on Dental Accreditation or a comparable organization
approved by the board. Approved programs shall include didactic,
laboratory, and clinical modalities.
(d) The board may approve extended functions postsecondary
programs referred to in this section prior to January 1, 2010, and
the board shall recognize the completion of these approved programs
prior to January 1, 2010.
SEC. 24. Section 1753 is added to the
Business and Professions Code , to read:
1753. (a) On and after January 1, 2010, the board shall license
as a registered dental assistant in extended functions a person who
submits written evidence, satisfactory to the board, of all of the
following eligibility requirements:
(1) Current licensure as a registered dental assistant or
completion of the requirements for licensure as a registered dental
assistant.
(2) Successful completion of a board-approved course in the
application of pit and fissure sealants.
(3) Successful completion of either of the following:
(A) An extended functions postsecondary program approved by the
board in all of the procedures specified in Section 1753.5.
(B) An extended functions postsecondary program approved by the
board to teach the duties that registered dental assistants in
extended functions were allowed to perform pursuant to board
regulations prior to January 1, 2010, and a course approved by the
board in the procedures specified in paragraphs (1), (2), (5), and
(7) to (11), inclusive, of subdivision (b) of Section 1753.5.
(4) Passage of a written examination and a clinical or practical
examination administered by the committee. The board shall designate
whether the written examination shall be administered by the
committee or by the board-approved extended functions program.
(b) A registered dental assistant in extended functions may apply
for and maintain an orthodontic assistant permit or a dental sedation
assistant permit, or both, by meeting all of the following
requirements:
(1) Successful completion of a board-approved course pursuant to
Section 1756.1 or 1756.2, as applicable.
(2) Passage of a written examination administered by the committee
that shall encompass the knowledge, skills, and abilities necessary
to competently perform the duties of the particular permit.
(c) A registered dental assistant in extended functions with
permits in either orthodontic assisting or dental sedation assisting
shall be referred to as an "RDAEF with orthodontic assistant permit,"
or "RDAEF with dental sedation assistant permit," as applicable.
(d) The continuing education requirements for a registered dental
assistant in extended functions shall be deemed to satisfy the
continuing education requirements for renewal of a permit in
orthodontic assisting or dental sedation assisting, or both.
SEC. 25. Section 1753.1 of the Business
and Professions Code is amended and renumbered to read:
1753.1. 1753.5. (a) A registered
dental assistant in extended functions licensed on or after January
1, 2010, is authorized to perform all duties and procedures that a
registered dental assistant is authorized to perform as
specified in and limited by Section 1752.4 , and those duties
that the board may prescribe by regulation pursuant to
Section 1751 .
(b) A registered dental assistant in extended functions licensed
on or after January 1, 2010, is authorized to perform the following
additional procedures under direct supervision and pursuant to the
order, control, and full professional responsibility of a licensed
dentist:
(1) Cord retraction of gingivae for impression procedures.
(2) Taking impressions for cast restorations.
(3) Formulating indirect patterns for endodontic post and core
castings.
(4) Fitting trial endodontic filling points.
(5) Drying canals previously opened by the supervising dentist,
with absorbent points.
(6) Testing pulp vitality.
(7) Removing excess cement from subgingival tooth surfaces with a
hand instrument.
(8) Fitting and cementing stainless steel crowns.
(9) Placing, condensing, and carving amalgam restorations.
(10) Placing class I, III, and V nonmetallic restorations.
(11) Taking facebow transfers and bite registrations for fixed
prostheses.
(12) Taking final impressions for tooth-borne, removable
prostheses.
(13) Placing and adjusting permanent crowns for cementation by the
dentist.
(14) Applying etchants for bonding restorative materials.
(15) Other procedures authorized by regulations adopted by the
board pursuant to Section 1751.
(c) A registered restorative assistant in extended functions
licensed on or after January 1, 2010, is authorized to perform all
duties and procedures that a registered restorative assistant is
authorized to perform, those duties that the board may prescribe by
regulation pursuant to Section 1751, and the duties specified in
subdivision (b) of this section.
(1) Conduct preliminary evaluation of the patient's oral health,
including, but not limited to, charting, intraoral and extra-oral
evaluation of soft tissue, classifying occlusion, and myofunctional
evaluation.
(2) Perform oral health assessments in school-based, community
health project settings under the direction of a dentist, registered
dental hygienist, or registered dental hygienist in alternative
practice.
(3) Cord retraction of gingivae for impression procedures.
(4) Size and fit endodontic master points and accessory points.
(5) Cement endodontic master points and accessory points.
(6) Take final impressions for permanent indirect restorations.
(7) Take final impressions for tooth-borne removable prosthesis.
(8) Polish and contour existing amalgam restorations.
(9) Place, contour, finish, and adjust all direct restorations.
(10) Adjust and cement permanent indirect restorations.
(11) Other procedures authorized by regulations adopted by the
board.
(d)
(c) All procedures required to be performed under
direct supervision shall be checked and approved by the supervising
licensed dentist prior to the patient's dismissal from the
office.
SEC. 26. Section 1753.4 is added to the
Business and Professions Code , to read:
1753.4. On and after January 1, 2010, each applicant for
licensure as a registered dental assistant in extended functions
shall successfully complete a practical examination consisting of the
procedures described in subdivisions (a) and (b). On and after
January 1, 2010, each person who holds a current and active
registered dental assistant in extended functions license issued
prior to January 1, 2010, who wishes to perform the duties specified
in paragraphs (1), (2), (5), and (7) to (11), inclusive, of
subdivision (b) of Section 1753.5, shall successfully complete a
practical examination consisting of the procedures described in
subdivision (b). The specific procedures shall be assigned by a
registered dental assistant in extended functions examination
subcommittee appointed by the committee and shall be graded by
examiners appointed by the committee. Each applicant shall furnish
the required materials necessary to complete the examination.
(a) Successful completion of the following two procedures on a
patient provided by the applicant. The prepared tooth, prior to
preparation, shall have had mesial and distal contact. The
preparation performed shall have margins at or below the free
gingival crest and shall be one of the following: 7/8 crown, 3/4
crown, or full crown, including porcelain fused to metal. Alginate
impression materials alone shall not be acceptable:
(1) Cord retraction of gingivae for impression procedures.
(2) Take a final impression for a permanent indirect restoration.
(b) Successful completion of two of the following procedures on a
simulated patient head mounted in appropriate position and
accommodating an articulated typodont in an enclosed intraoral
environment, or mounted on a dental chair in a dental operatory:
(1) Place, condense, and carve an amalgam restoration.
(2) Place and contour a nonmetallic direct restoration.
(3) Polish and contour an existing amalgam restoration.
SEC. 27. Section 1753.5 of the Business
and Professions Code is repealed.
1753.5. A registered dental assistant may apply pit and fissure
sealants under the general supervision of a licensed dentist, after
providing evidence to the board of having completed a board-approved
course in that procedure.
SEC. 28. Section 1754 of the Business
and Professions Code is amended and renumbered to read:
1754. 1752.4. (a) By September 15,
1993, the board, upon recommendation of the committee and consistent
with this article, standards of good dental practice, and the health
and welfare of patients, shall adopt regulations relating to the
functions that may be performed by registered dental assistants under
direct or general supervision, and the settings within which
registered dental assistants may work. At least once every seven
years thereafter, the board shall review the list of functions
performable by registered dental assistants, the supervision level,
and settings under which they may be performed, and shall update the
regulations as needed to keep them current with the state of the
practice.
(b) A registered dental assistant may apply pit and fissure
sealants under the general supervision of a licensed dentist, after
providing evidence to the board of having completed a board-approved
course in that procedure.
(b)
(c) This section shall remain in effect only until
January 1, 2010, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2010, deletes or
extends that date.
SEC. 29. Section 1754.5 is added to the
Business and Professions Code , to read:
1754.5. As used in this article, the following definitions shall
apply:
(a) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
via electronic media, home study materials, or live lecture
methodology if the provider has submitted that content for approval.
(b) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods. There shall be at
least one instructor for every 14 students who are simultaneously
engaged in laboratory instruction.
(c) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(d) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
SEC. 30. Section 1755 is added to the
Business and Professions Code , to read:
1755. (a) (1) The criteria in subdivisions (b) to (h), inclusive,
shall be met by a dental assisting program or course and all
orthodontic assisting and dental sedation assisting permit programs
or courses to secure and maintain approval by the board as provided
in this article.
(2) The board may approve, provisionally approve, or deny approval
of any program or course.
(3) Program and course records shall be subject to inspection by
the board at any time.
(4) The board may withdraw approval at any time that it determines
that a program or course does not meet the requirements established
in this section or any other requirements of law.
(5) All programs and courses shall be established at the
postsecondary educational level or deemed equivalent thereto by the
board.
(b) The program or course director and each faculty member shall
possess a valid, active, and current license issued by the board.
Each faculty member shall have been licensed for a minimum of two
years and possess experience in the subject matter he or she is
teaching. No faculty member shall instruct in any procedure that he
or she is not licensed to perform. The program or course director
shall actively participate in and be responsible for the day-to-day
administration of the program or course, including both of the
following:
(1) Maintaining for a period of not less than five years copies of
curricula, program outlines, objectives, and grading criteria, and
copies of faculty credentials, licenses, and certifications, and
individual student records, including those necessary to establish
satisfactory completion of the program or course.
(2) Informing the committee of any major change to the program or
course content, physical facilities, or faculty, within 10 days of
the change.
(c) A certificate or other evidence of completion shall be issued
to each student who successfully completes the program or course and
shall include the student's name, name of the program or course, the
total number of program or course hours, the date of completion, and
the signature of the program or course director or his or her
designee.
(d) Facilities and class scheduling shall provide each student
with sufficient opportunity, with instructor supervision, to develop
minimum competency in all duties for which the program or course is
approved to instruct.
(1) The location and number of general use equipment and
armamentaria shall ensure that each student has the access necessary
to develop minimum competency in all
of the duties for which the program or course is approved
to instruct. The program or course provider may either provide the
specified equipment and supplies or require that the student provide
them. Nothing in this section shall preclude a dental office that
contains the equipment required by this section from serving as a
location for laboratory instruction.
(2) The minimum requirement for armamentaria includes infection
control materials specified by the Division of Occupational Safety
and Health and the regulations of the board, protective eyewear,
mask, and gloves for each student and faculty member, and appropriate
eye protection for each piece of equipment.
(3) Clinical instruction shall be of sufficient duration to allow
the procedures to be performed to clinical proficiency. Operatories
shall be sufficient in number to allow a ratio of at least one
operatory for every five students who are simultaneously engaged in
clinical instruction.
(A) Each operatory shall contain functional equipment, including a
power-operated chair for treating patients in a supine position,
operator and assistant stools, air-water syringe, adjustable light,
oral evacuation equipment, work surface, and adjacent hand-washing
sink.
(B) Each operatory shall be of sufficient size to simultaneously
accommodate one student, one instructor, and one patient.
(e) The program or course shall establish written clinical and
laboratory protocols to ensure adequate asepsis, infection, and
hazard control and disposal of hazardous wastes, that comply with the
board's regulations and other federal, state, and local
requirements. The program or course shall provide these protocols to
all students, faculty, and appropriate staff to ensure compliance
with these protocols. Adequate space shall be provided for preparing
and sterilizing all armamentarium. All reusable armamentarium shall
be sterilized and nonreusable items properly disposed.
(f) A written policy on managing emergency situations shall be
made available to all students, faculty, and staff. All faculty and
staff involved in the direct provision of patient care shall be
certified in basic life support procedures, including cardiopulmonary
resuscitation. Recertification intervals may not exceed two years.
The program or course director shall ensure and document compliance
by faculty and staff. A program or course shall not be required to
ensure that students complete instruction in basic life support prior
to performing procedures on patients.
(g) A detailed program or course outline shall clearly state
curriculum subject matter and specific instruction hours in the
individual areas of didactic, laboratory, and clinical instruction.
General program or course objectives and specific instructional unit
objectives shall be stated in writing, and shall include theoretical
aspects of each subject as well as practical application. Objective
evaluation criteria shall be used for measuring student progress
toward attainment of specific program or course objectives. Students
shall be provided with all of the following:
(1) Specific unit objectives and the evaluation criteria that will
be used for all aspects of the curriculum including written,
practical, and clinical examinations.
(2) Standards of performance that state the minimum number of
satisfactory performances that are required for each procedure.
(3) Standards of performance for laboratory, preclinical, and
clinical functions, those steps that constitute a critical error and
would cause the student to fail the procedure, and a description of
each of the grades that may be assessed for each procedure.
(h) (1) If an extramural clinical facility is utilized, students
shall, as part of an extramural organized program of instruction, be
provided with planned, supervised clinical instruction. Laboratory
and preclinical instruction shall be performed under the direct
supervision of program or course faculty and shall not be provided in
extramural facilities.
(2) The program or course director, or a designated faculty
member, shall be responsible for selecting extramural clinical sites
and evaluating student competence in performing procedures both
before and after the clinical assignment.
(3) The program or course director, or a designated faculty
member, shall orient dentists who intend to provide extramural
clinical facilities prior to the student assignment. Orientation
shall include the objectives of the program or course, the student's
preparation for the clinical assignment, and a review of procedures
and criteria to be used by the dentist in evaluating the student
during the assignment. The program or course faculty and extramural
clinic personnel shall use the same objective evaluation criteria.
(4) There shall be a written contract of affiliation with each
extramural clinical facility, which shall describe the settings in
which the clinical training will be received, and affirm that the
dentist and clinic personnel acknowledge the legal scope of duties
and infection control requirements, that the clinical facility has
the necessary equipment and armamentaria appropriate for the
procedures to be performed, and that the equipment and armamentaria
are in safe operating condition.
SEC. 31. Section 1756 of the Business
and Professions Code is amended and renumbered to read:
1756. 1753.1. (a) The board shall
license as a registered dental assistant in extended functions a
person who satisfies all of the following eligibility
requirements:
(1) Status as a registered dental assistant.
(2) Completion of clinical training approved by the board in a
facility affiliated with a dental school under the direct supervision
of the dental school faculty.
(3) Satisfactory performance on an examination required by the
board.
(b) This section shall remain in effect only until January 1,
2010, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2010, deletes or extends
that date.
SEC. 32. Section 1756 is added to the
Business and Professions Code , to read:
1756. In addition to the requirements of Section 1755, the
following criteria shall be met by a course in infection control, to
secure and maintain approval by the board:
(a) Adequate provisions for the supervision and operation of the
course in infection control shall be made. Notwithstanding Section
1755, faculty shall not be required to be licensed by the board, but
faculty shall have experience in the instruction of the infection
control regulations and guidelines issued by the board and the
Division of Occupational Safety and Health (Cal-DOSH). In addition to
the requirements of Section 1755, all faculty responsible for
clinical evaluation shall have completed a two-hour methodology
course in clinical evaluation.
(b) A course in infection control shall be of sufficient duration
for the student to develop minimum competency in all aspects of
infection control regulations and guidelines issued by the board and
Cal-DOSH, but in no event less than eight hours, including at least
four hours of didactic instruction, at least two hours of laboratory
or preclinical instruction, and at least two hours of clinical
instruction. Preclinical instruction shall utilize instruments,
surfaces, and situations where contamination is simulated, without
actual contamination, from bloodborne and other pathogens being
present.
(c) The minimum requirements for equipment and armamentaria shall
include personal protective equipment, FDA-approved sterilizer,
ultrasonic unit or instrument processing device, sharps container,
selection of instruments, equipment, and armamentaria that are
necessary to instruct or demonstrate proper hazardous waste disposal,
consistent with Cal-DOSH regulations, local, state, and federal
mandates, and all other armamentaria required to instruct or properly
demonstrate the subjects described in the course content.
(d) Areas of instruction shall include, at a minimum, the
instruction specified in subdivisions (e) and (f).
(e) Didactic instruction shall include, at a minimum, the
following as they relate to the infection control regulations of the
board and of Cal-DOSH:
(1) Basic dental science and microbiology as they relate to
infection control in dentistry.
(2) Legal and ethical aspects of infection control procedures.
(3) Terms and protocols specified in the regulations of the board
regarding the minimum standards for infection control.
(4) Principles of modes of disease transmission and prevention.
(5) Principles, techniques, and protocols of hand hygiene,
personal protective equipment, surface barriers and disinfection,
sterilization, sanitation, and hazardous chemicals associated with
infection control.
(6) Principles and protocols of sterilizer monitoring and the
proper loading, unloading, storage, and transportation of instruments
to work area.
(7) Principles and protocols associated with sharps management.
(8) Principles and protocols of infection control for laboratory
areas.
(9) Principles and protocols of waterline maintenance.
(10) Principles and protocols of regulated and nonregulated waste
management.
(11) Principles and protocols related to injury and illness
prevention, hazard communication, general office safety, and
monitoring systems for radiation safety and sterilization systems.
(f) Preclinical instruction shall include three experiences in the
following areas, with one used for a practical examination. Clinical
instruction shall include two experiences in the following areas,
with one used for a clinical examination:
(1) Apply hand cleansing products and perform hand cleansing
techniques and protocols.
(2) Apply, remove, and dispose of patient treatment gloves,
utility gloves, overgloves, protective eyewear, masks, and clinical
attire.
(3) Apply the appropriate techniques and protocols for the
preparation, sterilization, and storage of instruments including, at
a minimum, application of personal protective equipment, precleaning,
ultrasonic cleaning, rinsing, sterilization wrapping, internal or
external process indicators, labeling, sterilization, drying,
storage, and delivery to work area.
(4) Preclean and disinfect contaminated surfaces and devices.
(5) Maintain sterilizer including, at a minimum, proper instrument
loading and unloading, operation cycle, spore testing, and handling
and disposal of sterilization chemicals.
(6) Apply work practice controls as they relate to the following
classification of sharps: anesthetic needles or syringes, orthodontic
wires, and broken glass.
(7) Apply infection control protocol for the following laboratory
devices: impressions, bite registrations, and prosthetic appliances.
(8) Perform waterline maintenance, including use of water tests
and purging of waterlines.
(g) Each student shall pass a written examination that reflects
the curriculum content, which may be administered at intervals
throughout the course as determined by the course director.
SEC. 33. Section 1756.1 is added to the
Business and Professions Code , to read:
1756.1. In addition to the requirements of Section 1755, the
following criteria shall be met by a orthodontic assistant permit
course to secure and maintain approval by the board. The board may
approve orthodontic assistant permit courses prior to January 1,
2010, and recognize the completion of orthodontic assistant permit
courses by students prior to January 1, 2010, but the board may not
issue an orthodontic assistant permit to students graduating from
orthodontic assistant permit courses until on or after January 1,
2010.
(a) The course shall be of sufficient duration for the student to
develop minimum competence in all of the duties that orthodontic
assistant permitholders are authorized to perform, but in no event
less than 84 hours, including at least 24 hours of didactic
instruction, at least 28 hours of laboratory instruction, and at
least 32 hours of clinical instruction.
(b) The minimum requirements for equipment and armamentaria shall
include banded or bonded orthodontic typodonts, bench mount or dental
chair mounted mannequin head, curing light, regular typodont with
full dentition or soft gingiva in the ratio of at least one for every
three students, and a selection of orthodontic instruments and
adjunct material for all of the procedures that orthodontic assistant
permitholders are authorized to perform.
(c) All faculty responsible for clinical evaluation shall have
completed a two-hour methodology course in clinical evaluation.
(d) Areas of instruction shall include, at a minimum, the
instruction specified in subdivisions (e) to (j), inclusive. In
addition to the requirements of those subdivisions, instruction shall
include basic background information on orthodontic practice,
including orthodontic treatment review, charting, patient education,
and legal and infection control requirements as they apply to
orthodontic practice.
(e) The following requirements shall be met for sizing, fitting,
cementing, and removing orthodontic bands:
(1) Didactic instruction shall include the following:
(A) Theory of band positioning and tooth movement.
(B) Characteristics of band material including malleability,
stiffness, ductility, and work hardening.
(C) Techniques for orthodontic banding and removal, including all
of the following:
(i) Armamentaria.
(ii) General principles of fitting and removing bands.
(iii) Normal placement requirements of brackets, tubes, lingual
sheaths, lingual cleats, and buttons onto bands.
(iv) Orthodontic cements and adhesive materials: classifications,
armamentaria, and mixing technique.
(v) Cementing bands: armamentaria, mixing technique, and band
cementation procedures.
(vi) Procedure for removal of bands after cementation.
(2) Laboratory instruction shall include typodont experience in
the sizing, fitting, cementing, and removal of four posterior first
molar bands a minimum of two times, with the cementing and removal of
two first molar bands used as a practical examination.
(3) Clinical instruction shall include the sizing, fitting,
cementing, and removal of four posterior first molar bands on at
least two patients.
(f) The following requirements shall be met for preparing teeth
for bonding:
(1) Didactic instruction shall include the following: chemistry of
etching materials and tooth surface preparation, application and
time factors, armamentaria, and techniques for tooth etching.
(2) Laboratory instruction shall include typodont experience with
etchant application in preparation for subsequent bracket bonding on
four anterior and four posterior teeth a minimum of four times each,
with one of each of the four times used for a practical examination.
(3) Clinical instruction shall include etchant application in
preparation for bracket bonding on anterior and posterior teeth on at
least two patients.
(g) The following requirements shall be met for bracket
positioning, bond curing, and removal of orthodontic brackets.
(1) Didactic instruction shall include the following:
(A) Characteristics and methods of orthodontic bonding.
(B) Armamentaria.
(C) Types of bracket bonding surfaces.
(D) Bonding material characteristics, application techniques, and
curing time factors.
(E) Procedure for direct and indirect bracket bonding.
(F) Procedures for bracket or tube removal.
(2) Laboratory instruction shall include typodont experience with
selecting, prepositioning, tooth etching, positioning, curing and
removing of four anterior and four posterior brackets a minimum of
four times each, with one each of the four times used for a practical
examination.
(3) Clinical instruction shall include selecting, adjusting,
prepositioning, etching, curing and removal of anterior and posterior
brackets on at least two patients.
(h) The following requirements shall be met for archwire placement
and ligation:
(1) Didactic instruction shall include the following:
(A) Archwire characteristics.
(B) Armamentaria.
(C) Procedures for placement of archwire previously adjusted by
the dentist.
(D) Ligature systems, purpose and types, including elastic, wire,
and self-ligating.
(2) Laboratory instruction shall include typodont experience on
the following:
(A) The insertion of a preformed maxillary and mandibular archwire
a minimum of four times per arch, with one of each of the four times
used for a practical examination.
(B) Ligation of maxillary and mandibular archwire using elastic or
metal ligatures or self-ligating brackets a minimum of four times
per arch, with one of each of the four times used for a practical
examination.
(3) Clinical instruction shall include the following:
(A) Insertion of a preformed maxillary and mandibular archwire on
at least two patients.
(B) Ligating both preformed maxillary and mandibular archwires
using a combination of elastic and metal ligatures or self-ligating
brackets on at least two patients for each.
(i) The following requirements shall be met for cement removal
with a hand instrument:
(1) Didactic instruction shall include, armamentaria and
techniques of cement removal using hand instruments and related
materials.
(2) Laboratory instruction shall include typodont experience on
the removal of excess cement supragingivally from an orthodontically
banded typodont using a hand instrument four times, with one of the
four times used for a practical examination.
(3) Clinical instruction shall include removal of excess cement
supragingivally from orthodontic bands with a hand instrument on at
least two patients.
(j) Instruction for cement removal with an ultrasonic scaler shall
be in accordance with the regulations of the board governing courses
in the removal of excess cement from teeth under orthodontic
treatment with an ultrasonic scaler.
(k) Each student shall pass a written examination that reflects
the curriculum content, which may be administered at intervals
throughout the course as determined by the course director.
SEC. 34. Section 1756.2 is added to the
Business and Professions Code , to read:
1756.2. In addition to the requirements of Section 1755, the
following criteria shall be met by a dental sedation assistant permit
course to secure and maintain approval by the board. The board may
approve a dental sedation assistant permit course prior to January 1,
2010, and recognize the completion of these courses by students
prior to January 1, 2010, but the board may not issue a dental
sedation assistant permit to students graduating from dental sedation
assistant permit courses until on or after January 1, 2010. As used
in this section, "IV" means "intravenous."
(a) (1) The course director or faculty may, in lieu of a license
issued by the board, possess a valid, active, and current license
issued in California as a registered nurse or a physician and
surgeon.
(2) All faculty responsible for clinical evaluation shall have
completed a two-hour methodology course in clinical evaluation.
(b) The course shall be of a sufficient duration for the student
to develop minimum competence in all of the duties that dental
sedation assistant permitholders are authorized to perform, but in no
event less than 110 hours, including at least 40 hours of didactic
instruction, at least 32 hours of laboratory instruction, and at
least 38 hours of clinical instruction.
(c) (1) The following are minimum requirements for equipment and
armamentaria: one pulse oximeter for each six students; one automatic
electronic defibrillator or defibrillator trainer; one capnograph or
teaching device for monitoring of end tidal CO2; blood pressure cuff
and stethoscope for each six students; one pretracheal stethoscope
for each six students; one electrocardiogram machine, one automatic
blood pressure/pulse measuring system/machine, and one oxygen
delivery system including oxygen tank; one IV start kit for each
student, one venous access device kit for each student; IV equipment
and supplies for IV infusions including hanging device infusion
containers and tubing for each six students; one sharps container for
each six students; packaged syringes, needles, needleless devices,
practice fluid ampules and vials for each student, stop watch or
timer with second hand for each six students; one heart/lung sounds
mannequin or teaching device; tonsillar or pharyngeal suction tip,
endotrachial tube forceps, endotracheal tube and appropriate
connectors, suction equipment for aspiration of oral and pharyngeal
cavities, and laryngoscope in the ratio of at least one for each six
students; any other monitoring or emergency equipment that the
regulations of the board require for the administration of general
anesthesia or conscious sedation; and a selection of instruments and
supplemental armamentaria for all of the procedures that dental
sedation assistant permitholders are authorized to perform.
(2) Each operatory shall contain either a surgery table or a
power-operated chair for treating patients in a supine position, an
irrigation system or sterile water delivery system as they pertain to
the specific practice, and all other equipment and armamentarium
required to instruct in the duties that dental sedation assistant
permitholders are authorized to perform.
(3) All students, faculty, and staff involved in the direct
provision of patient care shall be certified in basic life support
procedures, including the use of an automatic electronic
defibrillator.
(d) Areas of instruction shall include, at a minimum, the
instruction specified in subdivisions (e) to (n), inclusive, as they
relate to the duties that dental sedation assistant permitholders are
authorized to perform.
(e) General didactic instruction shall include:
(1) Characteristics of general body anatomy and systems including
the vascular system and nervous system and the physiology of the
cardiovascular and respiratory systems.
(2) Characteristics of anxiety management related to the surgical
patient, relatives, and escorts, and characteristics of anxiety and
pain reduction techniques.
(3) Overview of the classification of drugs used by patients for
cardiac disease, respiratory disease, hypertension, diabetes,
neurological disorders, and infectious diseases.
(4) Overview of specific drug groups utilized for sedation and
general anesthesia.
(5) Overview of specific drug groups utilized for medical
emergencies.
(f) (1) Didactic instruction shall also include an overview of
medical emergencies, including, but not limited to, airway
obstruction, bronchospasm or asthma, laryngospasm, allergic
reactions, syncope, cardiac arrest, cardiac dysrhythmia, seizure
disorders, hyperglycemia and hypoglycemia, drug overdose,
hyperventilation, acute coronary syndrome including angina and
myocardial infarction, and congestive heart failure.
(2) Laboratory instruction shall include the simulation and
response to at least the following medical emergencies: airway
obstruction, bronchospasm, emesis and aspiration of foreign material
under anesthesia, angina pectoris, myocardial infarction,
hypotension, hypertension, cardiac arrest, allergic reaction,
convulsions, hypoglycemia, syncope, and respiratory depression. Both
training mannequins and other students or staff may be used for
simulation. Instruction shall include at least
two experiences each, one of each of which
shall be used for a practical examination.
(g) Didactic instruction shall include the following with respect
to oral sedation and the pediatric patient:
(1) Psychological considerations.
(2) Patient evaluation and selection factors through review of
medical history, physical assessment, and medical consultation.
(3) Definitions and characteristics of levels of sedation achieved
with general anesthesia and sedative agents, with special emphasis
on the distinctions between conscious sedation, deep sedation, and
general anesthesia.
(4) Review of respiratory and circulatory physiology and related
anatomy, with special emphasis on establishing and maintaining a
patent airway.
(5) Overview of pharmacology agents used in contemporary sedation
and general anesthesia.
(6) Patient monitoring.
(7) Obtaining informed consent.
(8) Prevention, recognition, and management of complications,
including principles of basic life support.
(h) With respect to physically, mentally, and neurologically
compromised patients, didactic instruction shall include the
following: characteristics of medical conditions including Alzheimer'
s disease, autism, cerebral palsy, Down syndrome, mental retardation,
multiple sclerosis, muscular dystrophy, Parkinson's disease,
schizophrenia, and stroke.
(i) With respect to health history and patient assessment,
didactic instruction shall include, but not be limited to, the
recording of the following:
(1) Age, sex, weight, physical status (American Society of
Anesthesiologists Classification), medication use, general health,
any known or suspected medically compromising conditions, rationale
for anesthesia or sedation of the patient, visual examination of the
airway, and auscultation of the heart and lungs as medically
required.
(2) General anesthesia or conscious sedation records including a
time-oriented record with preoperative, multiple interoperative, and
postoperative pulse oximetry and blood pressure and pulse readings,
amounts of time of drug administration, length of procedure,
complications of anesthesia or sedation, and a statement of the
patient's condition at time of discharge.
(j) (1) With respect to monitoring heart sounds with
pretracheal/precordial stethoscope and ECG/EKG and use of
defibrillator, didactic instruction shall include the following:
(A) Characteristics of pretracheal/precordial stethoscope.
(B) Review of anatomy and physiology of circulatory system: heart,
blood vessels, and cardiac cycle as it relates to EKG.
(C) Characteristics of rhythm interpretation and waveform analysis
basics.
(D) Characteristics of manual intermittent and automatic blood
pressure and pulse assessment.
(E) Characteristics and use of a defibrillator.
(F) Procedure for using a pretracheal/precordial stethoscope for
monitoring of heart sounds.
(G) Procedure for use and monitoring of the heart with an ECG/EKG
machine, including electrode placement, the calibration of such
equipment.
(H) Procedure for using manual and automatic blood
pressure/pulse/respiration measuring system.
(2) Preclinical and clinical instruction shall include at least
three experiences on another student or staff person for each of the
following, one of each of which shall be used for a clinical
examination:
(A) Assessment of blood pressure and pulse both manually and
utilizing an automatic system. Instruction shall include the
calibration of such equipment.
(B) Placement and assessment of an electrocardiogram (ECG/EKG).
Instruction shall include the calibration of such equipment.
(C) Monitoring and assessment of heart sounds with a
pretracheal/precordial stethoscope.
(D) Use of a defibrillator or defibrillator trainer.
(k) (1) With respect to monitoring lung/respiratory sounds with
pretracheal/precordial stethoscope and monitoring oxygen saturation
end tidal CO2 with pulse oximeter and capnograph, didactic
instruction shall include the following:
(A) Characteristics of pretracheal/precordial stethoscope, pulse
oximeter and capnograph for respiration monitoring.
(B) Review of anatomy and physiology of respiratory system to
include the nose, mouth, pharynx, epiglottis, larynx, trachea,
bronchi, bronchioles, and alveolus.
(C) Characteristics of respiratory monitoring/lung sounds:
mechanism of respiration, composition of respiratory gases, oxygen
saturation.
(D) Characteristics of manual and automatic respiration
assessment.
(E) Procedure for using a pretracheal/precordial stethoscope for
respiration monitoring.
(F) Procedure for using and caring for pulse oximeter for
monitoring oxygen saturation.
(G) Procedure for use, care, and maintenance for capnograph for
monitoring end tidal CO2 levels.
(H) Characteristics for monitoring blood and skin color and other
related factors.
(I) Procedures and use of an oxygen delivery system.
(J) Characteristics of airway management to include armamentaria
and use.
(2) Clinical and preclinical instruction shall include at least
three experiences on a student or staff person for each of the
following, one of each of which shall be used for a clinical
examination:
(A) Assessment of respiration rates both visually and utilizing an
automatic system. Instruction shall include the calibration of such
equipment.
(B) Monitoring and assessment of lung sounds and ventilation with
a pretracheal/precordial stethoscope.
(C) Monitoring oxygen saturation with a pulse oximeter.
(D) Use of an oxygen delivery system.
(l) (1) With respect to drug identification and draw, didactic
instruction shall include:
(A) Characteristics of syringes and needles including use, types,
gauges, lengths, and components.
(B) Characteristics of drug, medication, and fluid storage units,
use, type, components, identification of label including generic and
brand names, strength, potential adverse reactions, expiration date,
and contraindications.
(C) Characteristics of drug draw including armamentaria, label
verification, ampule and vial preparation, and drug withdrawal
techniques.
(2) Laboratory instruction shall include at least three
experiences in the withdrawal of fluids from a vial or ampule in the
amount specified by faculty, one of which shall be for a practical
examination.
(3) Clinical instruction shall include at least three experiences
in the evaluation of vial or container labels for identification of
content, dosage, and strength and in the withdrawal of fluids from a
vial or ampule in the amount specified by faculty or the extramural
facility dentist.
(m) (1) With respect to adding drugs, medications, and fluids to
IV lines, didactic instruction shall include:
(A) Characteristics of adding drugs, medications, and fluids to IV
lines in the presence of a licensed dentist.
(B) Armamentaria.
(C) Procedures for adding drugs, medications, and fluids,
including amount and time intervals.
(D) Procedures for adding drugs, medications, and fluids by IV
bolus.
(E) Characteristics of patient observation for signs and symptoms
of drug response.
(2) Laboratory instruction shall include at least three
experiences of adding fluids to an existing IV line on a venipuncture
training arm or in a simulated environment, one of which shall be
used for a practical examination.
(3) Clinical instruction shall include at least three experiences
adding fluids to existing IV lines on at least three patients in the
presence of a licensed dentist.
(n) (1) With respect to the removal of IV lines, didactic
instruction shall include overview and procedures for the removal of
an IV line.
(2) Laboratory instruction shall include at least three
experiences on a venipuncture training arm or in a simulated
environment for IV removal, one of which shall be used for a
practical examination.
(3) Clinical instruction shall include at least three experiences
removing IV lines on at least three patients in the presence of a
licensed dentist.
(o) Each student shall pass a written examination that reflects
the curriculum content, which may be administered at intervals
throughout the course as determined by the course director.
SEC. 35. Section 1757 of the Business
and Professions Code is amended and renumbered to read:
1757. 1753.6. (a) Each person who
holds a license as a registered dental assistant in extended
functions on the effective operative
date of this section may only perform those procedures that a
registered dental assistant is allowed to perform as specified in and
limited by subdivision (b) of Section
1752.6 1752.4 , and the procedures
listed in paragraphs (1), (2), (3), (4), (5), (6), (7), and (14) of
subdivision (b) of Section 1753.1 specified in
paragraphs (1) to (6), inclusive , until he or she provides
evidence of having completed a board-approved course or
courses in the additional procedures specified in
paragraphs (8) to (13) (1), (2), (5), and (7)
to (11), inclusive, of subdivision (b) of Section
1753.1 1753.5 , and an examination in
those additional procedures as specified by the board.
as specified in Section 1753.4:
(1) Cord retraction of gingivae for impression procedures.
(2) Take final impressions for permanent indirect restorations.
(3) Formulate indirect patterns for endodontic post and core
castings.
(4) Fit trial endodontic filling points.
(5) Apply pit and fissure sealants.
(6) Remove excess cement from subgingival tooth surfaces with a
hand instrument.
(b) This section shall become operative on January 1, 2010.
SEC. 36. Section 1757 is added to the
Business and Professions Code , to read:
1757. (a) A registered dental assistant program shall receive
board approval prior to operation.
(1) In order for a registered dental assistant program to secure
and maintain approval by the board, it shall meet the requirements of
Section 1755 and the following requirements:
(A) Programs approved on or after January 1, 2009, shall meet all
of the requirements of this section.
(B) Programs approved prior to January 1, 2009, shall meet all of
the requirements of this section except as otherwise specified.
(2) A program shall notify the board in writing if it wishes to
increase the maximum student enrollment for which it is approved and
shall provide whatever additional documentation the board requires to
reapprove the program for the increased enrollment prior to
accepting additional students.
(3) The board may at any time conduct a thorough evaluation of an
approved educational program's curriculum and facilities to determine
whether the program meets the requirements for continued approval.
(4) The board may, in lieu of conducting its own investigation,
accept the findings of any commission or accreditation agency
approved by the board and adopt those findings as its own.
(b) Programs shall have an advisory committee consisting of an
equal number of registered dental assistants and dentists, including
at least two registered dental assistants and two dentists, all
currently licensed by the board. The advisory committee shall meet at
least once each academic year with the program director, faculty,
and appropriate institutional personnel to monitor the ongoing
quality and performance of the program. Programs that admit students
at different phases shall meet at least twice each year.
(c) Adequate provision for the supervision and operation of the
program shall be made. In addition to the requirements of Section
1755, the following requirements shall be met:
(1) Each program faculty member shall have successfully completed
a board-approved course in the application of pit and fissure
sealants.
(2) By January 1, 2010, each faculty member shall have completed a
board-approved course in instructional methodology of at least 30
hours, unless he or she holds any one of the following: a
postgraduate degree in education, a Ryan Designated Subjects
Vocational Education Teaching Credential, a Standard Designated
Subjects Teaching Credential, or, a Community College Teaching
Credential. Each faculty member employed on or after January 1, 2010,
shall complete a course in instructional methodology within six
months of employment.
(3) The program director shall have teaching responsibilities that
are less than those of a full-time faculty member. He or she shall
actively participate in and be responsible for the day-to-day
administration of the program including the following:
(A) Participating in budget preparation and fiscal administration,
curriculum development and coordination, determination of teaching
assignments, supervision and evaluation of faculty, establishment of
mission criteria and procedures, design and operation of program
facilities, and selection of extramural facilities and coordination
of instruction in those facilities.
(B) Holding periodic faculty meetings to provide for subject
matter correlation and curriculum evaluation, and coordinating
activities of full-time, part-time, and volunteer faculty.
(C) Maintaining for not less than five years copies of minutes of
all advisory committee meetings.
(4) The owner or school administrator shall be responsible for the
compliance of the program director with the provisions of this
section and Section 1755.
(d) The program shall have sufficient financial resources
available to support the program and to comply with this section. If
the program or school requires approval by any other governmental
agency, that approval shall be obtained prior to application to the
board for approval and shall be maintained at all times. The failure
to maintain that approval shall result in the automatic withdrawal of
board approval of the program.
(e) The program shall be of sufficient duration for the student to
develop minimum competence in performing dental assistant and
registered dental assistant duties, but in no event less than 800
hours, including at least 275 hours of didactic instruction, at least
260 hours of laboratory instruction, and at least 85 hours of
preclinical and clinical instruction conducted in the program's
facilities under the direct supervision of program faculty. No more
than 180 hours of clinical instruction may be conducted at an
externship site or extramural facility. A program approved prior to
January 1, 2009, shall comply with board regulations with regard to
required program hours until the earlier of July 1, 2010, or the date
on which the program certifies to the board that it will begin
teaching the duties that registered dental assistants will be
authorized to perform on and after January 1, 2010.
(f) Facilities and class scheduling shall provide each student
with sufficient opportunity, with instructor supervision, to develop
minimum competency in all duties that registered dental assistants
are authorized to perform. The following requirements are in addition
to those contained in Section 1755:
(1) The following are minimum requirements for equipment and
armamentaria: an X-ray unit and X-ray mannequin for every five
students, an amalgamator, model trimmers in the ratio of at least one
for every seven students, dental rotary equipment and vibrators in
the ratio of at least one for every three students, one light curing
device for every five students, one functional typodont and bench
mount for every two students, one functional orthodontically banded
or bonded typodont for every four students, two facebows, one
automated blood pressure and respiration device for every seven
students, one EKG machine, three pulse oximeters, one capnograph or
simulated device, one set of hand instruments for each procedure for
every two students, and all other equipment and armamentaria required
to teach dental assistant and registered dental assistant duties.
(2) One permanently preassembled tray for each procedure shall be
provided for reference purposes.
(3) Provision shall be made for reasonable access to current and
diverse dental and medical reference texts, current journals,
audiovisual materials, and other necessary resources. Library
holdings, which may include access through the Internet, shall
include materials on the following subjects: nutrition, oral health
education, preventive dentistry, dental materials, anesthesia and
pain control, oral anatomy, oral histology, oral physiology, oral
pathology, morphology, pharmacology, microbiology, chairside
assisting, legal and ethical aspects of dentistry, radiology and
radiation safety, sterilization and infection control, laboratory
procedures, office emergency procedures, general dentistry, and
specialty dentistry including, but not limited to, endodontics, oral
and maxillofacial surgery, orthodontics, pediatric dentistry,
periodontics, and prosthodontics.
(4) Emergency materials shall include, but not be limited to, an
oxygen tank that is readily available and functional. Medical
materials for treating patients with life-threatening conditions
shall be available for instruction and accessible to the operatories.
Facilities that do not treat patients shall maintain a working model
of a kit of such emergency materials for instructional purposes.
(g) The organization of the curriculum shall be balanced and
flexible, creating opportunities for adjustments to changes in the
practice of dentistry and registered dental assisting. Programs that
admit students at different phases shall provide students with an
orientation that shall be successfully completed prior to
participation in any other phase of the program and that shall
include tooth anatomy, tooth numbering, and universal precautions,
including instrument sterilization and infection control protocols
associated with patient treatment.
(h) In addition to the requirements of Section 1755 with regard to
extramural instruction, no more than 180 hours of the required
clinical instruction shall take place in extramural clinical
facilities, and no more than 25 percent of extramural clinical
instruction shall take place in a specialty dental practice.
(i) (1) A program approved prior to January 1, 2009, shall comply
with board regulations with regard to program content until the date
that it certifies to the board that it will begin teaching all of the
duties that registered dental assistants will be allowed to perform
beginning January 1, 2010, after which time the program content shall
meet the requirements of paragraph (2).
(2) Programs receiving initial approval on or after January 1,
2009, shall meet all the requirements of Section 1755, and
subdivisions (j) and (k) of this section, and shall include the
following additional content:
(A) A radiation safety course that meets all of the requirements
of the regulations of the board.
(B) A coronal polishing course that meets all of the requirements
of the regulations of the board.
(C) A pit and fissure sealant course that meets all of the
requirements of the regulations of the board.
(D) A course in basic life support provided by an instructor
approved by the American Red Cross or the American Heart Association.
(3) On and after January 1, 2009, a program that desires to
provide instruction in the following areas shall apply separately for
approval to provide the following courses:
(A) A course in the removal of excess cement with an ultrasonic
scaler, which course shall meet the requirements of the regulations
of the board.
(B) A orthodontic assistant permitholder course that shall meet
the requirements of Section 1756.1, except that a program shall not
be required to obtain separate approval to teach the duties of
placing ligature ties and archwires, removing orthodontic bands, and
removing excess cement from surfaces of teeth with a hand instrument.
(C) A dental sedation assistant permitholder course that shall
meet the requirements of Section 1756.2.
(j) General didactic instruction shall include, at a minimum, the
following:
(1) Principles of general anatomy, physiology, oral embryology,
tooth histology, and head-neck anatomy.
(2) Principles of abnormal conditions related to and including
oral pathology, orthodontics, periodontics, endodontics, pedodontics,
oral surgery, prosthodontics, and esthetic dentistry.
(3) Legal requirements and ethics related to scope of practice,
unprofessional conduct, and, patient records and confidentiality.
(4) Principles of infection control and hazardous communication
requirements in compliance with the board's regulations and other
federal, state, and local requirements.
(5) Principles and federal, state, and local requirements related
to pharmacology.
(6) Principles of medical-dental emergencies and first aid
management, including symptoms and treatment.
(7) Principles of the treatment planning process including medical
health history data collection, patient and staff confidentiality,
and charting.
(8) Principles of record classifications including management,
storage, and retention protocol for all dental records.
(9) Principles and protocols of special needs patient management.
(10) Principles, protocols, and armamentaria associated with all
dental assisting chairside procedures.
(11) Principles, protocols, manipulation, use, and armamentaria
for dental materials.
(12) Principles and protocols for oral hygiene preventative
methods including, plaque identification, toothbrushing and flossing
techniques, and nutrition.
(13) Principles, protocols, armamentaria, and procedures
associated with operative and specialty dentistry.
(14) Principles, protocols, armamentaria, and procedures for each
duty that unlicensed dental assistants and registered dental
assistants are allowed to perform.
(k) Laboratory and clinical instruction shall be of sufficient
duration and content for each student to achieve minimum competence
in the performance of each procedure that an unlicensed dental
assistant and registered dental assistant is authorized to perform.
(l) Each student shall pass a written examination that reflects
the curriculum content, which may be administered at intervals
throughout the course as determined by the course director.
SEC. 37. Section 1757.1 is added to the
Business and Professions Code , to read:
1757.1. Notwithstanding Section 1755, the following criteria
shall be met for a course in instructional methodology, as specified
in subdivision (c) of Section 1757, to secure and maintain approval
by the board.
(a) The course shall be established at the postsecondary
educational level.
(b) (1) The course director and each faculty member shall have the
education or teaching experience necessary to teach instructional
methodology. Possession of a teaching credential shall satisfy this
requirement.
(2) The course director shall have the education, background, and
occupational experience necessary to understand and fulfill the
course goals. The course director shall actively participate in and
be responsible for the day-to-day administration of the course
including the following:
(A) Conducting student assessments.
(B) Maintaining for a period of not less than five years all of
the following:
(1) Copies of curricula, course outlines, objectives, and grading
criteria.
(2) Copies of faculty credentials, licenses, and certifications
where applicable.
(3) Individual student records, including those
necessary to establish satisfactory completion of the course.
(C) Informing the committee of any major change to the course
content or faculty within 10 days of the change.
(c) The course shall be of sufficient duration for the student to
develop minimum competence in teaching methodology, but in no event
less than 30 h