ADAA Education and Credentialing of Dental Assistants

ADAA is the voice of dental assistants to the public and to all professional communities of interest. ADAA in collaboration with other notable professional organizations is working to advance and promote initiatives for quality care and patient protection in meeting the current and changing needs of the dental community. Our ability to be flexible and open-minded in adapting to the evolving health care environment is critical to our future as allied dental professionals and to our ability to best serve the public.

The ADAA is focused on two major themes: standardized credentialing and education of dental assistants to assure competency and safeguard the welfare of the public; and the need for enhanced recognition of the critical role dental assistants play in the provision of quality care as vital members of the dental health team. From the first “Lady in Attendance” or female attendant in the dental office to the dental assistant of the present, the scope of practice and responsibilities delegated to dental assistants has changed drastically over the years. Depending upon the state in which one is employed, there are a variety of significant intraoral procedures performed by chairside dental assistants on patients on a daily basis.

In order to appropriately prepare to enter a highly demanding yet rewarding allied health career in dental assisting, interested individuals should be required to attend a formal dental assisting program as there are many critical areas in which individuals should achieve a sound knowledge base prior to employment in any dental practice setting. Mastery of pertinent information will allow dental assistants to translate background information into sound clinical practice protocols to assure high standards of quality patient care and public protection. In addition to finely honed business/front office, laboratory, radiology and chair side skills, the role of dental assistants also includes community outreach. Therefore, dental assistants also need to provide oral hygiene instruction, nutritional counseling and overall general health information to members of the community to enhance their well-being. The initiatives of the American Dental Assistants Association (ADAA) include but are not limited to: promoting formal education and credentialing of all dental assistants nationally and assuring adequate preparation and clinical competency of all dental assistants as part of best practices in dentistry for patient protection.
Multiple unfortunate cases have arisen in several areas across the country in which unqualified individuals performed tasks for which they were not adequately prepared. These cases serve as a reminder that all dental professionals must understand the guidelines and regulations related to infection control, radiology, health history information and intraoral functions and all other critical areas in dentistry for public protection. Every dental healthcare professional should periodically review infection control procedures and have those procedures in writing for reference.

Communication between team members is also essential to ensure team members understand their role in the infection control processes. At least an annual review of written protocols should be conducted which includes all team members. References should be made to scientific literature and other resources, such as the Center for Disease Control (CDC), Organization for Safety and Asepsis (OSAP) and the American Dental Association (ADA), so that all dental professionals may review available references for updates and any changes in recommendations.

On-the-job trained dental assistants are highly regarded, as they are the backbone of our profession. However, as our role has changed, so too must requirements for entry into the field of dental assisting. Therefore, it is important for dental assistants to not only complete an appropriate academic program in dental assisting but to also pursue continuing professional education after graduating from a formal dental assisting course of study. By doing so, dental assistants may continue to enhance both personal and professional development as highly valuable members of the dental health team. Whether as part of a requirement for credential renewal or as a part of enhancement as an allied dental professional, it is critical for dental assistants to continue to build upon the fundamental background they received as dental assisting students and as part of life-long learning.

Dental assistants must work with colleagues in encouraging legislators and state boards of dentistry to recognize the skills required of dental assistants in performing the wide variety of chairside, clinical and intraoral functions on patients, so that policies will be enacted in all states to require mandatory education and credentialing of all dental assistants nationally. In that dentistry and dental hygiene are both regulated professions, and considering the tremendous expansion of the scope of practice of dental assistants over recent years, it is appropriate that dental assistants also be required to meet certain benchmark standards prior to providing direct patient care services in order to protect the welfare of the public and the patients we serve.

According to the Raven Maria Blanco Foundation (RMBF) in 2013, a national survey was conducted to determine patient expectations and knowledge regarding medical emergency preparedness by their dentist. According to the Foundation, dental patients overwhelmingly expect their dentist to be prepared to manage a medical emergency occurring during dental treatment in all areas: ongoing training of the dentist; regular training of the dental staff; periodic mock emergency drills; written medical emergency plan; stocking routine emergency medications, and maintaining appropriate emergency equipment such as oxygen and an automated external defibrillator. The Foundation also believes that medical emergencies occurring during dental treatment are increasing in frequency and severity due to demographics, aging of dental patients, and patients with complex medical histories. As dental treatment is becoming more sophisticated and increasingly invasive (e.g. implants and grafts), public expectations of medical emergency preparedness are reasonable and appropriate and should be incorporated into training and emergency preparedness procedures.

There are many quality dental assistant training programs nationally. Unfortunately, there are no national or state requirements for dental assistants to complete formal dental assisting education prior to employment in various dental employment settings. The issue is one of social responsibility from within the profession for patient protection. Many states require no formal education or accountability requirements for dental assistants. Dental assistants can be on-the-job trained, so there is a lack of incentive to obtain formal dental assisting education.

The American Dental Association (ADA) Commission on Dental Accreditation (CODA) is recognized by the United States Department of Education (USDE). CODA has been recognized since 1952 and requires adherence to criteria and operational policies and procedures. ADA-CODA focuses on process fairness and consistency. Accreditation is a process involving self-review and peer assessment by which an agency uses experts in a particular field of interest or discipline to define standards of acceptable operation/performance of education programs and evaluates compliance with those standards for education programs. The roles and responsibilities of CODA are to establish standards that define quality of education, evaluate and monitor programs for compliance with standards and establish policies & procedures to guide evaluation and decision process.

The ADAA supports ADA-CODA accredited education to promote innovation in education, training and supervision. ADA-CODA also promotes a scope of practice that ensures the protection of the public. Through CODA, public perception of the profession increases as CODA establishes a high standard and level of respect for the dental assisting profession.

In this day and age, formal education is essential for preparing dental assistants to perform intraoral functions, infection control, radiography and a variety of additional critical procedures performed routinely by dental assistants. An appropriate education includes didactic, lab, preclinical and clinical practice components. The educational setting must provide adequate resources and qualified faculty.
Based on the best interests of the patient, public safety, education, training and credentialing, valid research should support intraoral functions based on the State Dental Practice Acts. Duties listed should specify education and training requirements to assure quality and public protection. Under the supervision of the dentist, the functions performed by dental assistants require background knowledge, manual dexterity, coordination and proficiency of multiple significant skills. Individuals interested in careers in dental assisting need to be adequately prepared to take their place in the profession with their peers. Although delegable functions outlined in state dental practice acts vary, the following is a partial listing of procedures dental assistants routinely perform on patients: preliminary impressions; placement and removal of rubber dams; placement and removal of matrices; placement and removal of arch wires and ligatures; placement of amalgam; removal of excess cement; cementation of temporary crowns; removal of sutures; placement of sealants; administration of topical fluoride; placement of topical anesthetics; patient education; and placement and removal of periodontal and surgical dressings. Some states also allow dental assistants to perform coronal polishing, radiographic exposures and placement of permanent restorations. However, there are a few states that require specific education and credentialing to legally perform the expanded functions referenced. These and other notable services provided by the dental assistant contribute directly to the oral health of the public.

As critical members of the dental workforce, we need to carefully examine the breadth of the role of the dental assistant in patient care and value the role of the dental assistant as part of the dental team. Most importantly, the contributions that dental assistants make to the health and welfare of the patients who come under their care must be noted and regarded by the dental community.

Professionalism is defined as: “The conduct, aims, or qualities that mark a profession or a professional person.” The essence of a profession or professionalism is a commitment to patient welfare, ethics, high ideals and desirable characteristics. An important aspect of being a professional is portraying behavior that is considered appropriate and ethical by colleagues and the public. In fulfilling daily responsibilities, dental assistants need to be mindful of the following, which assist in guiding appropriate ethical behavior. Prior to taking action, an assessment may be conducted to determine if pending actions will comply with rules, regulations and guidelines, and be compatible with organizational values.

As documented, a profession is distinguished by a body of knowledge that is constantly expanded, updated and documented in the literature; continual improvement in the quality of service to the public; specific academic preparation in specialized institutions; lifelong commitment to continuing education; self-regulation and a code of ethics developed by the profession. In carefully examining the characteristics of a profession, we can safely indicate that dental assisting meets several of those outlined. However, there are still multiple aspects of truly being recognized as a profession that dental assistants and ADAA must continue to address and toward which dental assistants and legislators must work.

The public in each state should have some assurance that those individuals providing care and assisting with care in the dental office have adequate education and understanding of their responsibilities. This includes all members of the dental team: dentist, hygienist and assistant. Dental assistants are a valuable member of the team and should be afforded the opportunity to be recognized for their level of knowledge through required credentialing. This can provide greater assurance to the public. Patients assume that the individuals assisting the dentist are highly educated and licensed or registered as required by the state. But for many dental assistants, this is not the case as some states view it as the dentist’s responsibility to ensure their staff is performing procedures correctly. Often the behind-the-scenes expertise is left to the uneducated clinical dental assistant.

The American Dental Assistants Association (ADAA) believes that dental assistants have a responsibility to monitor themselves and inform their patients about the importance of licensed or registered dental assistants as part of the dental team. Unfortunately, many trained-on-the-job assistants can be taught improper sterilization techniques by others who were also improperly trained. A means to address this issue is for strict guidelines and training to be implemented, which should be applied equally in ALL states and not just a few.

ADAA is working hard to develop collaborations with other notable national organizations to explore and outline initiatives to address the need for specific academic preparation in public protection and to assure quality care. The American Dental Assistants Association (ADAA) speaks for approximately 300,000 dental assistants in the United States and is America’s oldest and largest dental assisting association. ADAA is dedicated to the development and recognition of professionalism through education, membership services and public awareness programs. The ADAA is a strong advocate for legislation mandating required academic preparation and credentialing.

ADAA supports education and credentialing of dental assistants nationwide in order to assure that dental assistants have a comprehensive understanding of state dental practice acts containing legally delegated responsibilities for dental assistants, as well as a thorough knowledge of infection control and appropriate treatment protocols and knowledge of many other critical aspects of dental assisting responsibilities related to high standard quality care and patient protection.

State requirements:
CA: State course required after four months
MN: CPR certificate
MS: CPR certificate within 180 days
MT:OJT or CODA program grad
NC: No education or training unless involved with N/O
OH: Specific training by the dentist required
SD: High school diploma
UT: CPR Certificate
VT: Emergency procedures training within 180 days of hiring
WA: 7-hour AIDS course