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AB-2242 Dentistry: dental assistants.(2023-2024)

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AB2242:v99#DOCUMENT

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 2242

Introduced by Assembly Member Wendy Carrillo

February 08, 2024

An act to amend Sections 1740, 1741, 1747, 1750.1, 1750.3, 1750.5, and 1752.4 of, to add Sections 1747.5, 1748, 1748.6, 1749.2, 1749.3, 1749.4, 1750.35, 1753.1, 1753.2, 1753.3, 1754, 1754.5, and 1755 to, to repeal Sections 1749.1, 1750, 1751, 1752.1, 1752.6, 1753, 1753.5, 1753.55, 1753.6, and 1753.7 of, and to repeal and add Sections 1750.2 and 1750.4 of, the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL'S DIGEST

AB 2242, as introduced, Wendy Carrillo. Dentistry: dental assistants.

(1) Existing law, the Dental Practice Act, establishes the Dental Board of California for the licensure and regulation of dentists and dental assistants.

Existing law sets forth requirements for licensure as a registered dental assistant and as a registered dental assistant in extended functions, and sets forth duties and functions that a registered dental assistant or a registered dental assistant in extended function is authorized to perform.

This bill would revise and recast those provisions.

(2) Existing law specifies a dental assistant is an individual who, without a license, may perform basic supportive dental procedures, as specified, and sets forth the responsibilities of a supervising licensed dentist, including ensuring that a dental assistant has completed specified courses. Existing law sets forth the duties and functions a dental assistant is authorized to perform.

This bill would revise the responsibilities of a supervising dentist relating to an unlicensed dental assistant, and the functions and duties that an unlicensed dental assistant is authorized to perform. The bill would revise the course requirements for an unlicensed dental assistant, including by requiring verification that the dental assistant has completed specified preceptorship and work experience requirements by an affidavit signed under penalty of perjury by the preceptor or the supervising dentist, as provided. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would require an unlicensed dental assistant to obtain a certificate of completion of radiation safety to perform radiographic procedures.

(3) Existing law establishes requirements for obtaining an orthodontic assistant permit or a dental sedation assistant permit from the board, including licensure as a registered dental assistant, and sets forth the duties and functions that a person holding an orthodontic assistant permit or a dental sedation assistant permit may perform.

This bill would revise the requirements to obtain an orthodontic assistant permit and would revise the duties and functions that a person holding an orthodontic assistant permit is authorized to perform.

This bill would revise and recast the requirements to obtain a dental sedation assistant permit, including requiring licensure as a dental assistant, registered dental assistant, or registered dental assistant in extended functions and would revise the duties and functions that a person holding a dental sedation assistant permit is authorized to perform.

(4) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES

The people of the State of California do enact as follows:

SECTION 1.

Section 1740 of the Business and Professions Code is amended to read:

1740.

It is the intention of the Legislature by enactment of this article to permit the full utilization of dental assistants in order to meet the dental care needs of all the state’s citizens. The Legislature further intends that the classifications of dental assistants established ~~pursuant to~~ by this article permit the continual advancement of persons to successively higher levels of licensure with additional education and training. The Legislature further intends that the Dental Board of California, in implementing this article, ~~give specific consideration to~~ consider the recommendations of the Dental Assisting Council, established pursuant to Section 1742.

SEC. 2.

Section 1741 of the Business and Professions Code is amended to read:

1741.

As used in this article:

(a) “Alternative dental assisting program” means a program offered by an institution of secondary or postsecondary education which has a current accreditation from the Commission on Dental Accreditation or is accredited or approved by an agency recognized by the United States Department of Education or State Department of Education including career health and technical education programs, regional occupation centers or programs, or apprenticeship programs registered by the State Department of Education or Division of Apprenticeship Standards of the Department of Industrial Relations in allied dental programs, and whereby a certificate of completion from the program shall serve as a pathway component for licensure as a registered dental assistant.
(b) “Basic supportive dental procedures” means procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated, including extraoral tasks involving sterilization procedures and infection control and disease prevention tasks.
~~(a)~~

(c) “Board” means the Dental Board of California.

(d) “Certified dental assistant” means an individual who has successfully passed the general chairside assisting, radiation health and safety, and infection control examinations administered by the Dental Assisting National Board and has an active certification satisfactory to terms and conditions of the Dental Assisting National Board at the time of application for a dental assisting license. A current and valid certified dental assistant certificate is not required for subsequent licensure renewals.
(e) “Certificate of completion” means a certificate which shall include, at minimum, the participant’s name, the name of the program or course completed, the name of the program or course provider, the date or date range of completion, the number of completed hours of the course or program, and the signature of the course or program provider, director, administrator, or their designee, and that verifies the participant has successfully completed any of the following:
(1) A board-approved educational course or program in dental assisting.
(2) A board-approved continuing education course provided by a board-approved continuing education provider.
(3) An alternative dental assisting program.
(f) “Continuing education” means a course of study specific to the performance of dental-related procedures, where a license or permit issued pursuant to this article is impacted, and where the education is directly related to the clinical and supplemental duties and functions of dental assistants, registered dental assistants, registered dental assistants in extended functions, and dental assisting permitholders, as defined in this article. Continuing education units obtained for licensure or permit renewal shall be limited to no more than eight units per day. The following shall apply to the continuing education units:
(1) Live interactive coursework units obtained for licensure or permit renewal shall total no more than eight units per day.
(2) Nonlive or self-paced online coursework units shall be no more than eight units per day within a range of dates during a seminar, workshop, or educational series where more than one day is required to complete the coursework.
(g) “Coronal polishing” means a procedure limited to the removal of plaque and stain from exposed tooth surfaces, utilizing an appropriate mechanical instrument or device and may include the use of a polishing agent.
(h) “Council” means the Dental Assisting Council of the board.
(i) “Course” means an educational offering, class, presentation, meeting, or other similar event.
(j) “Dental assistant” means an individual who, without a license, may perform only basic supportive dental procedures described in Section 1750.1.

(k) “Direct supervision” means supervision of dental procedures based on instructions given by a licensed dentist, who ~~must~~ shall be physically present in the treatment facility during the performance of those procedures.

~~(c)~~

(l) “General supervision” means supervision of dental procedures based on instructions given by a licensed dentist but not requiring the physical presence of the supervising dentist during the performance of those procedures.

(m) “Good standing” means the licensee has not been disciplined, is not the subject of an unresolved complaint or review procedure, and is not the subject of any unresolved disciplinary proceeding.
(n) “Interim therapeutic restoration” means a direct provisional restoration placed to stabilize the tooth until a licensed dentist diagnoses the need for further definitive treatment. An interim therapeutic restoration consists of the removal of soft material from the tooth using only hand instrumentation, without the use of rotary instrumentation, and subsequent placement of an adhesive restorative material. An interim therapeutic restoration may also be applied to a tooth with caries that has been confirmed by the treating dentist to be arrested through the use of a caries arresting agent with or without further removal of tooth structure. Local anesthesia shall not be necessary for interim therapeutic restoration placement.
(o) “Preceptee” means an unlicensed dental assistant who is supervised by a California-licensed dentist or dentists in good standing and is participating in a preceptorship in dental assisting to learn the clinical skills and acquire procedural knowledge through work experience and supplemental dental assisting coursework.
(p) “Preceptor” means a California-licensed dentist in good standing who directly supervises and provides on-the-job training to a preceptee in a preceptorship in dental assisting by evaluating clinical competence, documenting completion of clinical chairside work experience, learning, and clinical progress, teaching and promoting clinical reasoning, and ensuring the preceptee has completed course requirements before performing dental assisting duties pursuant to Section 1750.1. A preceptee may have more than one California licensed dentist serve as a preceptor.
(q) “Preceptorship in dental assisting” means supervised on-the-job training of a preceptee by a preceptor in the performance of duties specified in Section 1750.1 in a competent manner as determined by the preceptor.
(r) “Registered dental assistant” means a person licensed by the board to perform all procedures authorized under Section 1752.4.
(s) “Registered dental assistant in extended functions” means a person licensed by the board to perform all procedures authorized under Section 1753.5.
(t) “Work experience” means performance of the duties of a dental assistant as described in Section 1750.1 in a competent manner as determined by the supervising dentist.

SEC. 3.

Section 1747 of the Business and Professions Code is amended to read:

1747.

The procedure on all matters relating to the denial, suspension, or revocation of ~~licenses~~ a permit or license granted under this article shall be governed by the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code.

SEC. 4.

Section 1747.5 is added to the Business and Professions Code, to read:

1747.5.

(a) Prior to applying for licensure as a registered dental assistant under Section 1748, the applicant shall complete one of the following pathways for licensure:

(1) A board-approved program in registered dental assisting including the coursework defined in board regulations.

(2) An alternative dental assisting program as defined in subdivision (a) of Section 1741 that includes all of the following:

(A) At least 500 hours of didactic and laboratory coursework in dental assisting-related topics that shall encompass all aspects of clinical chairside assisting, including, but not limited to, medical and dental emergencies, first aid and safety precautions, protocols and armamentaria associated with a variety of dental assisting chairside procedures, dental materials, and skill development courses associated with operative and specialty dentistry and that include education as defined in subdivision (a) of Section 1749.3 and Section 1749.4.

(B) At least 300 hours of clinical chairside work experience, involving the allowable duties described in Section 1750.1, directly supervised, evaluated, and documented by a supervising licensed dentist.

(3) A preceptorship in dental assisting that includes all of the following:

(A) At least 500 hours of clinical chairside work experience on a form furnished by the board, involving allowable duties described in Section 1750.1, directly supervised, evaluated, and documented by a preceptor, who certifies under penalty of perjury under the laws of the State of California to the applicant’s completion of the clinical chairside work experience. Clinical work experience that meets the eligibility requirements of this term performed as a dental assistant within the two years immediately preceding the effective date of this section may be used to satisfy this requirement.

(B) At least 300 hours documented on a form furnished by the board of coursework in dental assisting-related topics, inclusive of the education required in subdivision (a) of Section 1749.3 and Section 1749.4, which may be obtained concurrent to the work experience and satisfies all of the following:

(i) The coursework shall include education defined in subdivision (a) of Section 1749.3 and Section 1749.4, and encompass all aspects of clinical chairside assisting, including, but not limited to, medical and dental emergencies, first aid and safety precautions, protocols and armamentaria associated with a variety of dental assisting chairside procedures, dental materials, and skill development courses associated with operative and specialty dentistry.

(ii) Courses shall be obtained through a board-approved dental assisting educational program or course provider, a board-registered provider of continuing education courses, the American Dental Association’s Continuing Education Recognition Program, or a provider approved by the Academy of General Dentistry Program Approval for Continuing Education.

(iii) For purposes of paragraph (5) of subdivision (a) of Section 1748 and subdivision (d) of Section 1750.1, the preceptee’s completion of the coursework shall be verified by the preceptor, who shall certify under penalty of perjury under the laws of the State of California verification of the preceptee’s completion of the required coursework.

(4) Possession of a current, valid certification as a certified dental assistant, as issued by the Dental Assisting National Board, and completion of all education defined in subdivision (a) of Section 1749.3 and Section 1749.4.

(5) (A) Completion of satisfactory work experience performing duties of a dental assistant as defined under Section 1750.1 totaling at least 1,280 hours completed within at least 15 months prior to submission of the application under Section 1748 and all education as defined in subdivision (a) of Section 1749.3 and Section 1749.4.

(B) “Satisfactory work experience” under subparagraph (A) means performance of the duties specified in Section 1750.1 in a competent manner as determined by the supervising dentist or dentists, who shall certify under penalty of perjury under the laws of the State of California the applicant’s completion of the work experience.

(b) Evidence of completion of eligibility requirements under this section shall be dated no more than five years immediately preceding application for licensure under Section 1748.

(c) Preparation or execution of false documentation of satisfaction of any requirement under this section shall be considered unprofessional conduct and grounds for license denial, revocation, or suspension.

SEC. 5.

Section 1748 is added to the Business and Professions Code, to read:

1748.

(a) To obtain a registered dental assistant license to perform the duties specified under Section 1752.4, an individual shall submit to the board all of the following:

(1) A board-prescribed application.

(2) The applicable application fee.

(3) Evidence of successful completion within five years prior to application of board-approved courses in all of the following:

(A) All courses described in paragraphs (1) through (4) of subdivision (a) of Section 1749.3.

(B) A board-approved course in radiation safety.

(4) A full set of fingerprints for purposes of conducting a criminal history record check.

(5) Evidence of successful completion of one of the licensure pathways under Section 1747.5.

(6) Successful completion of the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board.

(b) The applicant shall submit documentation of completion of the requirements in paragraphs (1) through (5) of subdivision (a) to receive board authorization to take the examination under paragraph (6) of subdivision (a).

(c) The licensee shall be responsible for complying with all applicable licensure renewal requirements, including continuing education pursuant to Section 1645.

(d) The Registered Dental Assistant Combined Written and Law and Ethics Examination required by this section shall comply with Section 139.

SEC. 6.

Section 1748.6 is added to the Business and Professions Code, to read:

1748.6.

(a) To obtain a registered dental assistant in extended functions license to perform the duties under Section 1753.1, an individual shall submit to the board all of the following:

(1) A board-prescribed application and applicable fees.

(2) A full set of fingerprints for purposes of conducting a criminal history record check.

(3) A valid, active, and current registered dental assistant license issued by the board.

(4) Evidence of successful completion of a board-approved registered dental assistant in extended functions program. For enrollment in a board-approved registered dental program, the board-approved program provider shall ensure that the student has complied with the requirements of paragraphs (3), (5), and (6).

(5) Evidence of completion within two years of the date of application of a course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent.

(6) Evidence of successful completion of a board-approved pit and fissure sealant course.

(7) (A) Successful completion of the Registered Dental Assistant in Extended Functions Written Exam administered by the board that shall encompass the knowledge, skills, and abilities necessary to competently perform the duties the license allows.

(B) The applicant shall submit documentation as evidence of completion of paragraphs (1) to (6), inclusive, of subdivision (a) to receive board authorization to take the examination.

(b) The licensee shall be responsible for complying with all applicable licensure renewal requirements, including continuing education pursuant to Section 1645.

SEC. 7.

Section 1749.1 of the Business and Professions Code is repealed.

1749.1.
In addition to any other examination required by this article, the board may require applicants for licensure under this article to successfully complete the Registered Dental Assistant Combined Written and Law and Ethics Examination.

SEC. 8.

Section 1749.2 is added to the Business and Professions Code, to read:

1749.2.

The supervising dentist shall be directly responsible for the following, as it relates to the initial and ongoing employment of an unlicensed dental assistant:

(a) Adequately informing a dental assistant of the educational requirements described in paragraphs (1) to (4), inclusive, of subdivision (a) of Section 1749.3 to maintain employment as an unlicensed dental assistant.

(b) Determining the competency of the dental assistant to perform only the duties authorized by Section 1750.1.

(c) Maintaining evidence for the length of the individual’s employment as a dental assistant at the supervising dentist’s treatment facility to verify the dental assistant has met and maintained all certification requirements as dictated by statute and regulation.

SEC. 9.

Section 1749.3 is added to the Business and Professions Code, to read:

1749.3.

(a) Except as stated otherwise in this section, within one year of initial employment, an individual performing the duties of an unlicensed dental assistant, as defined in Section 1750.1, shall obtain and provide evidence to the dentist-employer of having completed the following courses:

(1) A board-approved eight-hour infection control course which shall meet the requirements of Section 1755. This course must be completed prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious materials.

(2) A board-approved two-hour course in the Dental Practice Act.

(3) A course satisfying the requirements of the Division of Occupational Safety and Health’s bloodborne pathogens training consisting of at least two hours of didactic training.

(4) (A) A course in basic life support shall be met by completion of any of the following:

(i) An American Heart Association (AHA) or American Red Cross (ARC) course in Basic Life Support (BLS).

(ii) A BLS course taught by a provider approved by the American Dental Association’s Continuing Education Recognition Program (CERP) or the Academy of General Dentistry’s Program Approval for Continuing Education (PACE).

(iii) A BLS course taught by a provider approved by the American Safety and Health Institute (ASHI).

(B) The dental assistant shall be responsible for obtaining recertification in basic life support to perform duties involving patients.

(b) The dental assistant shall be the responsible for providing evidence of having met the requirements of this section to a dentist-employer.

SEC. 10.

Section 1749.4 is added to the Business and Professions Code, to read:

1749.4.

(a) To perform radiographic procedures, a dental assistant shall obtain a radiation safety certificate of completion from a board-approved radiation safety course provider, whose course shall meet the requirements of Section 1754.5 and board regulations.

(b) To enroll in a board-approved radiation safety course, a dental assistant shall provide evidence to the radiation safety course provider of having completed a board-approved eight-hour course in infection control and a current, valid certification in basic life support.

(c) The original or a copy of the current, valid certificate issued by the board shall be publicly displayed at the treatment facility where the dental assistant performs dental services.

SEC. 11.

Section 1750 of the Business and Professions Code is repealed.

1750.
(a)A dental assistant is an individual who, without a license, may perform basic supportive dental procedures, as authorized by 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.
~~(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 by Section 1750.1.~~
(c)The employer of a dental assistant shall be responsible for ensuring that the dental assistant who has been in continuous employment for 120 days or more, has already successfully completed, or successfully completes, all of the following within a year of the date of employment:
~~(1)A board-approved two-hour course in the Dental Practice Act.~~
~~(2)A board-approved eight-hour course in infection control.~~
(3)A course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent and that provides the student the opportunity to engage in hands-on simulated clinical scenarios.
~~(d)The employer of a dental assistant shall be responsible for ensuring that the dental assistant maintains certification in basic life support.~~
~~(e)This section shall become operative on January 1, 2010.~~

SEC. 12.

Section 1750.1 of the Business and Professions Code is amended to read:

1750.1.

(a) A dental assistant may perform the following duties under the general supervision ~~of a supervising~~ and pursuant to the order, control, and full professional responsibility of a licensed dentist:

(1) ~~Extra-oral duties or procedures~~ Extraoral duties specified by the supervising ~~licensed dentist, provided that these duties or procedures~~ dentist that meet the definition of a basic supportive ~~procedure specified in Section 1750.~~ dental procedures specified in subdivision (c) of Section 1741. Such duties may include a procedure that requires the use of personal protective equipment, laboratory functions, sterilization and disinfection procedures described in Section 1005 of Title 16 of the California Code of Regulations, and OSHA-related procedures as defined in the Cal-DOSH Bloodborne Pathogens Standard.

(2) Operate dental radiography equipment for the purpose of oral radiography if the dental assistant has ~~complied with~~ completed the requirements of Section ~~1656.~~ 1749.4.

(3) Perform intraoral and extraoral photography.

(b) A dental assistant may perform the following duties under the direct supervision ~~of a supervising~~ and pursuant to the order, control, and full professional responsibility of a licensed dentist:

(1) Apply ~~nonaerosol and noncaustic topical agents.~~ topical agents, including all forms of topical fluoride.

~~(2)Apply topical fluoride.~~
~~(3)Take intraoral impressions for all nonprosthodontic appliances.~~
~~(4)Take facebow transfers and bite registrations.~~
(2) Perform intraoral measurements for the purposes of orthodontic treatment.
~~(5)~~

(3) Place and remove rubber dams or other isolation devices.

~~(6)~~

(4) Place, wedge, and remove matrices for restorative procedures.

(5) Remove orthodontic ligature ties and archwires.
(6) Remove periodontal dressings.

(7) Remove postextraction 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.~~
(8) Remove sutures after inspection of the site by the supervising licensed dentist.
(9) Take facebow transfers and bite registrations.
(10) Take intraoral impressions for all nonprosthodontic appliances.
(11) Cure dental materials used for procedures with a light-curing device.
~~(13)~~

(12) After adjustment by the dentist, examine and seat removable orthodontic appliances and deliver ~~care instructions to the patient.~~ patient education instructions for use and care.

~~(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 at 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)Notwithstanding subdivision (b), when operating in a school-based setting or a public health program created or administered by a federal, state, county, or local governmental entity pursuant to Sections 104762 and 104830 of the Health and Safety Code, a dental assistant may apply topical fluoride under the general direction of a licensed dentist or physician.
~~(d)Under the supervision of a registered dental hygienist in alternative practice, a dental assistant may perform intraoral retraction and suctioning.~~
~~(e)The board may specify additional allowable duties by regulation.~~
(f)The duties of a 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:
(13) Place and remove orthodontic separators.
(14) Extraoral functions specified by the supervising dentist that meet the definition of basic supportive dental procedures specified in subdivision (c) of Section 1741. Such duties may include patient monitoring, placing monitoring sensors, taking of vital signs, or other extraoral procedures related to the scope of their practice.
(c) In response to a medical emergency and under the direct supervision, order, control, and full professional responsibility of the licensed dentist, a dental assistant may administer or assist in the administration of oxygen.
(d) (1) A dental assistant who has completed one of the following requirements shall be allowed to perform coronal polishing prior to licensure as a registered dental assistant:
(A) Completion of the requirements defined in paragraphs (1) and (2) of subdivision (a) of Section 1747.5 and a certificate of completion in coronal polishing as part of the curriculum.
(B) A certificate of completion of a board-approved coronal polishing course. Completion of the requirements in paragraphs (2), (3), and (4) of subdivision (a) of Section 1747.5 shall satisfy the eligibility requirements for enrollment on a board-approved course in coronal polishing. The coronal polishing course student shall provide evidence of completion of the requirements of paragraph (2), (3), or (4) of subdivision (a) of Section 1747.5 to the course provider.
(2) The dental assistant shall provide evidence of completion of a board-approved coronal polishing course to the supervising dentist prior to performing coronal polishing on a patient as prescribed by the dentist.
(3) Coronal polishing performed pursuant to this subdivision shall be performed under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist who shall, at a minimum, evaluate each patient after coronal polishing procedures are performed by the dental assistant.
(4) The original or a copy of the certificate of completion issued by a program defined in paragraph (1) or (2) of subdivision (a) of Section 1747.5 that is inclusive of board-approved coronal polishing curriculum or a board-approved coronal polish course provider shall be publicly displayed at the treatment facility where the dental assistant performs dental services.
(e) A dental assistant shall not perform any of the following procedures unless specifically allowed by law:

(1) Diagnosis and comprehensive treatment planning.

(2) Placing, finishing, or removing ~~permanent~~ restorations.

(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.~~ or issuing any medications.

(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 by law.
(g)The duties of a dental assistant are defined in subdivision (a) of Section 1750 and do not include any duty or procedure that only an orthodontic assistant permitholder, dental sedation assistant permitholder, registered dental assistant, registered dental assistant in extended functions, registered dental hygienist, or registered dental hygienist in alternative practice is allowed to perform.
~~(h)This section shall become operative on January 1, 2010.~~
(5) Starting the flow of nitrous oxide gas, unless the adjustment of the flow of nitrous oxide gas is deemed necessary and is directed by the supervising dentist who shall be present in the operatory directly supervising the adjustment.
(6) Administration of local or general anesthesia or sedation.
(f) Unless otherwise permitted in this section, the duties of a dental assistant do not include any duty or procedure that only a registered dental assistant, registered dental assistant in extended functions, registered dental hygienist, or registered dental hygienist in alternative practice is allowed to perform.
(g) The placement of pit and fissure sealants may only be performed by a registered dental assistant, registered dental assistant in extended functions, registered dental hygienist, or registered dental hygienist in alternative practice.

SEC. 13.

Section 1750.2 of the Business and Professions Code is repealed.

1750.2.
(a)The board may 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)Current, active, and valid licensure as a registered dental assistant or completion of at least 12 months of verifiable work experience as a dental assistant.~~
~~(2)Successful completion of a two-hour board-approved course in the Dental Practice Act and an eight-hour board-approved course in infection control.~~
(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, or any other course approved by the board as equivalent.
~~(4)Successful completion of a board-approved orthodontic assistant course, which may commence after the completion of six months of work experience as a dental assistant.~~
(5)Passage of a written examination administered by the board 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 the same continuing education requirements for registered dental assistants as established by the board pursuant to Section 1645 and the renewal requirements of Article 6 (commencing with Section 1715).

SEC. 14.

Section 1750.2 is added to the Business and Professions Code, to read:

1750.2.

(a) To obtain an orthodontic assistant permit, a dental assistant shall submit to the board an application, with an applicable fee, and all of the following documentation:

(1) A full set of fingerprints for purposes of conducting a criminal history record check.

(2) Evidence of successful completion of the educational requirements defined in Section 1749.3.

(3) Evidence of completion of a board-approved orthodontic assistant permit course totaling at least 84 hours.

(4) Successful completion of a state board-administered written examination that shall encompass the knowledge, skills, and abilities necessary to competently perform the duties the permit allows.

(5) Successful passage of a written examination administered by the board after completion of paragraphs (1) to (3), inclusive, of this subdivision. The written examination shall encompass the knowledge, skills, and abilities necessary to completely perform the duties specified in Section 1750.35.

(b) To obtain an orthodontic assistant permit, a registered dental assistant or registered dental assistant in extended functions shall submit to the board an application, with an applicable fee, and satisfy all of the following eligibility requirements:

(1) Current, active, and valid licensure as a registered dental assistant or registered dental assistant in extended functions.

(2) Evidence of successful completion of a board-approved orthodontic assistant permit course totaling 55 hours.

(3) Successful completion of a board-administered written examination that shall encompass the knowledge, skills, and abilities necessary to competently perform the duties specified in Section 1750.3.

(c) The permitholder shall be responsible for complying with all applicable renewal requirements, including continuing education pursuant to Section 1645.

SEC. 15.

Section 1750.3 of the Business and Professions Code is amended to read:

1750.3.

(a) A person holding an orthodontic assistant permit ~~pursuant to Section 1750.2 may perform~~ issued before June 30, 2025, may perform under the general supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist all duties that a dental assistant is allowed to perform and the following duties under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:

~~(a)All duties that a 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.~~
(1) Isolate, condition, etch, and prepare teeth for bonded attachments, aligner buttons, orthodontic brackets, and appliances only after their position has been approved by the supervising licensed dentist and before curing.
~~(c)~~

(2) Remove only orthodontic brackets and attachments with removal of the bonding material by the supervising licensed dentist.

~~(d)~~

(3) Size, fit, and ~~cement orthodontic bands.~~ secure orthodontic bands and brackets using appropriate materials only after their position has been approved by the supervising licensed dentist and before curing.

~~(e)Remove orthodontic bands and remove excess cement from supragingival surfaces of teeth with a hand instrument.~~
(4) Remove orthodontic brackets and attachments and remove excess cement from supragingival surfaces of teeth with a hand instrument, with the removal of any remaining material by the supervising licensed dentist or registered dental assistant in extended functions licensed on or after January 1, 2010.
~~(f)~~

(5) Place and ligate archwires.

~~(g)~~

(6) Remove excess cement with an ultrasonic scaler from supragingival surfaces of teeth undergoing orthodontic treatment.

~~(h)~~

(7) Any additional duties that the board may prescribe by regulation.

(b ) The original or a copy of the current, valid permit issued by the board shall be publicly displayed at the treatment facility where the permitholder performs dental services.

SEC. 16.

Section 1750.35 is added to the Business and Professions Code, to read:

1750.35.

(a) A person who holds an orthodontic assistant permit issued on or after June 30, 2025, may perform under the general supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist all duties that a dental assistant is allowed to perform and the placement of indirect bonded or cemented provisional attachments and brackets when delivered by transfer tray, composite buttons, or aligner connections when placement is confirmed by the supervising dentist and under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist.

(b) A registered dental assistant or registered dental assistant in extended functions who holds an orthodontic assistant permit may perform a placement of direct bonded or cemented lab-fabricated permanent, semipermanent or provisional attachments, composite buttons, or aligner connections under the direct supervision, when placement is confirmed by the supervising dentist, and pursuant to the order, control, and full professional responsibility of a licensed dentist.

(c) The original or a copy of the current, valid permit issued by the board shall be publicly displayed at the treatment facility where the permitholder performs dental services.

(d) This section shall become operative on June 30, 2025.

SEC. 17.

Section 1750.4 of the Business and Professions Code is repealed.

1750.4.
(a)The board may 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)Current, active, and valid licensure as a registered dental assistant or completion of at least 12 months of verifiable work experience as a dental assistant.~~
~~(2)Successful completion of a two-hour board-approved course in the Dental Practice Act and an eight-hour board-approved course in infection control.~~
(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, or any other course approved by the board as equivalent.
~~(4)Successful completion of a board-approved dental sedation assistant course, which may commence after the completion of six months of work experience as a dental assistant.~~
(5)Passage of a written examination administered by the board 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. 18.

Section 1750.4 is added to the Business and Professions Code, to read:

1750.4.

(a) The board may 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) Current, active, and valid licensure as a registered dental assistant or completion of at least 12 months of verifiable work experience as a dental assistant.

(2) A full set of fingerprints for purposes of conducting a criminal history record check.

(3) Evidence of completion of a board-approved dental sedation assistant permit course totaling 110 hours of education. For course enrollment, the course provider shall ensure the student’s prior completion of course requirements under paragraphs (1) to (4), inclusive, of subdivision (a) of Section 1749.3.

(4) Successful passage of a written examination administered by the board after completion of paragraphs (1) to (3), inclusive, of this subdivision. The written examination shall encompass the knowledge, skills, and abilities necessary to completely perform the duties specified in Section 1750.5.

(b) To obtain a dental sedation assistant permit to perform the duties specified under Section 1750.5, a registered dental assistant or registered dental assistant in extended functions shall satisfy all of the following eligibility requirements:

(1) A board-prescribed application and applicable fees.

(2) Current, active, and valid licensure as a registered dental assistant or registered dental assistant in extended functions.

(3) Evidence of completion of a board-approved dental sedation assistant permit course.

(4) Evidence of completion within two years of the date of application of a course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent.

(5) Successful passage of a written examination administered by the board after completion of paragraphs (1) to (4), inclusive, of this subdivision. The written examination shall encompass the knowledge, skills, and abilities necessary to competently perform the duties specified in Section 1750.5.

(c) A person who holds a permit pursuant to this section shall be responsible for obtaining recertification in basic life support as part of permit renewal and completing the same continuing education requirements for registered dental assistants as established by the board pursuant to Section 1645 and the renewal requirements of Article 6 (commencing with Section 1715).

(d) The original or a copy of the current, valid permit issued by the board shall be publicly displayed at the treatment facility where the permitholder performs dental services.

SEC. 19.

Section 1750.5 of the Business and Professions Code is amended to read:

1750.5.

(a) A ~~person holding~~ dental assistant, registered dental assistant, or registered dental assistant in extended functions who holds a dental sedation assistant permit ~~pursuant to Section 1750.4~~ may perform all of the following duties under the direct supervision ~~of a~~ and pursuant to the order, control, and full professional responsibility of a current, valid licensed dentist or other licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia in the ~~dental office:~~ treatment facility:

(1) All duties that a dental assistant is allowed to perform.

(2) Monitor patients undergoing moderate sedation, deep sedation, or general anesthesia utilizing data from noninvasive instrumentation such as pulse oximeters, electrocardiograms, capnography, blood pressure, pulse, and respiration rate monitoring devices. Evaluation of the condition of a sedated patient shall remain the responsibility of the supervising dentist or ~~other~~ the licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia, who shall be at the patient’s chairside while moderate sedation, deep sedation, or general anesthesia is being administered.

(3) 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.~~ dentist or the licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia.

(4) 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. The exception to this duty is that the initial dose of a drug or medication shall be administered by the supervising licensed ~~dentist.~~ dentist or the licensed health care professional authorized to administer moderate sedation, deep sedation, or general anesthesia.

(5) Removal of intravenous lines.

(6) Any additional duties that the board may prescribe by regulation.

(7) The duties listed in paragraphs (2) to (5), inclusive, ~~may~~ shall not be performed in any setting other than a dental office or dental clinic.

~~(b)This section shall become operative on January 1, 2022.~~

SEC. 20.

Section 1751 of the Business and Professions Code is repealed.

1751.
At least once every seven years, the board shall review the allowable duties for dental assistants, registered dental assistants, registered dental assistants in extended functions, dental sedation assistant permitholders, and orthodontic assistant permitholders, the supervision level for these categories, and the settings under which these duties may be performed, and shall update the regulations as necessary to keep them current with the state of the dental practice.

SEC. 21.

Section 1752.1 of the Business and Professions Code is repealed.

1752.1.
~~(a)The board may license as a registered dental assistant a person who files an application and submits written evidence, satisfactory to the board, of one of the following eligibility requirements:~~
(1)Graduation from an educational program in registered dental assisting approved by the board, and satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board.
(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 the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board.
(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 the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board.
(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 work experience referred to in this 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. 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.
(d)In addition to the requirements specified in subdivision (a), each applicant for registered dental assistant licensure 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.
(e)In addition to the requirements specified in subdivisions (a) and (d), individuals applying for registered dental assistant licensure on or after January 1, 2010, shall demonstrate satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board 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 course in infection control.~~
~~(3)A course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent.~~
~~(f)A registered dental assistant may apply for an orthodontic assistant permit or a dental sedation assistant permit, or both, by submitting written evidence of the following:~~
~~(1)Successful completion of a board-approved orthodontic assistant or dental sedation assistant course, as applicable.~~
(2)Passage of the Registered Dental Assistant Combined Written and Law and Ethics Examination administered by the board 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. These terms shall be used for reference purposes only and do not create additional categories of licensure.
(h)Completion of the continuing education requirements established by the board pursuant to Section 1645 by a registered dental assistant who also holds a permit as an orthodontic assistant or dental sedation assistant shall fulfill the continuing education requirements for the permit or permits.
(i)The board shall, in consultation with the Office of Professional Examination Services, conduct a review to determine whether a practical examination is necessary to demonstrate competency of registered dental assistants, and if so, how this examination should be developed and administered. The board shall submit its review and determination to the appropriate policy committees of the Legislature on or before July 1, 2017.
(j)Notwithstanding any other law, if the review conducted by the Office of Professional Examination Services pursuant to subdivision (i) concludes that the practical examination is unnecessary or does not accurately measure the competency of registered dental assistants, the board may vote to suspend the practical examination. The suspension of the practical examination shall commence on the date the board votes to suspend the practical examination.
~~(k)The Registered Dental Assistant Combined Written and Law and Ethics Examination required by this section shall comply with Section 139.~~

SEC. 22.

Section 1752.4 of the Business and Professions Code is amended to read:

1752.4.

(a) A registered dental assistant ~~may perform all of the following duties:~~ is authorized to perform all duties and procedures of a dental assistant as specified in subdivisions (a), (b), and (c) of Section 1750.1 and may perform all of the following duties under the direction and pursuant to the order, control, and full professional responsibility of a licensed dentist:

~~(1)All duties that a dental assistant is allowed to perform.~~
~~(2)~~

(1) Mouth-mirror inspections of the oral cavity, to include charting of obvious lesions, existing restorations, and missing teeth.

~~(3)~~

(2) Apply and activate bleaching agents using a nonlaser light-curing device.

~~(4)~~

(3) Use of automated caries detection devices and materials ~~to gather information for diagnosis by the dentist.~~ and recording of findings before placement of pit and fissure sealants.

~~(5)~~

(4) Obtain intraoral images for computer-aided design ~~(CAD),~~ (CAD) milled restorations.

~~(6)~~

(5) Pulp vitality testing and recording of findings.

~~(7)~~

(6) Place bases, liners, etch, and bonding ~~agents.~~ agents for all restorative procedures.

~~(8)~~

(7) Chemically prepare teeth for ~~bonding.~~ bonding for restorative procedures.

~~(9)~~

(8) Place, adjust, and finish direct provisional restorations.

~~(10)~~

(9) Fabricate, adjust, cement, and remove indirect provisional ~~restorations, including stainless steel crowns when used as a provisional restoration.~~ restorations.

~~(11)~~

(10) Place ~~post-extraction~~ postextraction dressings after inspection of the surgical site by the supervising licensed dentist.

~~(12)~~

(11) Place periodontal dressings.

~~(13)~~

(12) Dry endodontically treated canals using absorbent paper points.

~~(14)Adjust dentures extra-orally.~~
(13) Perform sore-spot adjustment only of dentures extraorally.
(14) Tissue conditioning and soft reline of dentures.

(15) Remove excess cement from surfaces of teeth with a hand instrument.

(16) Polish coronal surfaces of the ~~teeth.~~ teeth upon completion of a board-approved course in the subject area or graduation from a board-approved registered dental assistant program.

~~(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 board, 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.~~
(17) Securely ligate archwires.
(18) Apply pit and fissure sealants upon completion of a board-approved course in the subject area or graduation from a board-approved registered dental assistant program.
~~(c)Except as provided in Section 1777, the supervising licensed~~

(b) The supervising dentist shall be responsible for determining whether each authorized procedure in subdivision (a) performed by a registered dental assistant should be performed under general or direct supervision.

~~(d)This section shall become operative on January 1, 2010.~~
(c) A registered dental assistant may perform the following duties under direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:
(1) Etch, bond, and attach composite buttons or attachments for orthodontic procedures.
(2) Size, fit, secure, and remove orthodontic bands using appropriate dental materials.
(d) Notwithstanding subdivision (b), a registered dental assistant may perform a duty specified in this section using contemporary techniques and materials designed for use in the performance of that duty under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist if the registered dental assistant has completed the appropriate education and training, and whose skill, knowledge, and education in the use of such contemporary technique or material has been determined clinically competent by the supervising licensed dentist.

SEC. 23.

Section 1752.6 of the Business and Professions Code is repealed.

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. 24.

Section 1753 of the Business and Professions Code is repealed.

1753.
(a)On and after January 1, 2010, the board may 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 administered by the board. The board shall designate whether the written examination shall be administered by the board or by the board-approved extended functions program.
(b)A registered dental assistant in extended functions may apply for an orthodontic assistant permit or a dental sedation assistant permit, or both, by providing written evidence of the following:
~~(1)Successful completion of a board-approved orthodontic assistant or dental sedation assistant course, as applicable.~~
~~(2)Passage of a written examination administered by the board 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. These terms shall be used for reference purposes only and do not create additional categories of licensure.
(d)Completion of the continuing education requirements established by the board pursuant to Section 1645 by a registered dental assistant in extended functions who also holds a permit as an orthodontic assistant or dental sedation assistant shall fulfill the continuing education requirement for such permit or permits.

SEC. 25.

Section 1753.1 is added to the Business and Professions Code, to read:

1753.1.

(a) A registered dental assistant in extended functions 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.

(b) A registered dental assistant in extended functions licensed after January 1, 2010, may also perform all the following duties under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:

(1) Perform oral health assessments, including intraoral evaluations to identify oral lesions, intraoral and extraoral evaluations of soft tissue, classifying occlusion, performing myofunctional evaluations, and oral cancer screenings as authorized by the supervising dentist. The intraoral soft tissue evaluation shall not include periodontal probing.

(2) Tissue retraction of gingivae for impression and restorative procedures.

(3) Perform post, core, and buildup procedures in conjunction with direct and indirect restorations.

(4) Perform final impression procedures for permanent direct and indirect restorations including implants.

(5) Perform final impressions for removable prosthesis.

(6) Place, contour, finish, and adjust all direct restorations.

(7) Adjust and adhere all permanent indirect restorations.

(8) Size and fit endodontic master points and accessory points.

(9) Cement endodontic master points and accessory points.

(c) A registered dental assistant in extended functions licensed on or after June 1, 2025, may also perform all of the following duties under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:

(1) Mechanical removal of residual bonded or cemented dental materials following the removal of direct-bonded or laboratory-fabricated permanent, semipermanent, or provisional attachments, composite buttons, or aligner connections requiring direct bond or cementation procedures.

(2) Place and remove healing caps and transfer abutments or impression coping.

(3) Place sutures in surgical sites as directed by the supervising dentist.

(4) Fit, seat, and cement active and inactive orthodontic appliances after inspection by the supervising dentist.

(5) Excluding placement of a surgical implant and torquing of the abutment coping or final restoration, the registered dental assistant in extended functions may complete all restorative procedures associated with implant-supported restorations.

(d) A registered dental assistant in extended functions licensed on or after January 1, 2010, may perform the duties specified in subdivision (c) following completion of continuing education by a board-approved provider or board-approved registered dental assistant in extended functions education program in those duties and procedures before performing the duty.

(e) A registered dental assistant in extended functions licensed on or after January 1, 2010, may perform a duty specified in this section using contemporary techniques and materials designed for use in the performance of that duty under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist if the registered dental assistant in extended functions has completed the appropriate education and training, and whose skill, knowledge, and education in the use of such contemporary technique or material has been determined clinically competent by the supervising licensed dentist.

SEC. 26.

Section 1753.2 is added to the Business and Professions Code, to read:

1753.2.

(a) A registered dental assistant in extended functions licensed before January 1, 2010, may perform all duties that a registered dental assistant may perform and shall perform only the following additional duties under the 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) Final impressions procedures for permanent direct and indirect restorations.

(3) Fit trial endodontic filling points.

SEC. 27.

Section 1753.3 is added to the Business and Professions Code, to read:

1753.3.

(a) Unless otherwise specified in this section, a registered dental assistant in extended functions licensed on or after January 1, 2010, who successfully completes a board-approved course in interim therapeutic restoration and radiographic decisionmaking, is authorized to perform the following enhanced duties pursuant to the order, control, and full professional responsibility of the supervising licensed dentist:

(1) Under general supervision, determine which radiographs to perform on a patient who has not received an initial examination by the supervising dentist for the specific purpose of the dentist making a diagnosis and treatment plan for the patient. The registered dental assistant in extended functions shall follow protocols established by the supervising dentist.

(2) Under direct supervision, place interim therapeutic restorations to stabilize the tooth until a licensed dentist diagnoses the need for further definitive treatment.

(b) Place interim therapeutic restorations after the supervising dentist confirms a diagnosis and provides instruction to perform the procedure in the following settings:

(1) In a dental office setting, under the direct or general supervision of a dentist.

(2) In public health settings, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, Head Start and preschool programs, and community clinics, under the general supervision of a dentist.

(c) The board shall identify, on the statewide license verification website, the enhanced duty of interim therapeutic restoration for a registered dental assistant in extended functions who files a completed verification form issued by the board including the applicable fee.

SEC. 28.

Section 1753.5 of the Business and Professions Code is repealed.

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.
(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)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 gingiva 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.~~
~~(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. 29.

Section 1753.55 of the Business and Professions Code is repealed.

1753.55.
(a)A registered dental assistant in extended functions is authorized to perform the additional duties as set forth in subdivision (b) pursuant to the order, control, and full professional responsibility of a supervising dentist, if the licensee meets one of the following requirements:
~~(1)Is licensed on or after January 1, 2010.~~
(2)Is licensed before January 1, 2010, and has successfully completed a board-approved course in the additional procedures specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision (b) of Section 1753.5.
(b)(1)Determine which radiographs to perform on a patient who has not received an initial examination by the supervising dentist for the specific purpose of the dentist making a diagnosis and treatment plan for the patient. In these circumstances, the dental assistant in extended functions shall follow protocols established by the supervising dentist. This paragraph only applies in the following settings:
~~(A)In a dental office setting.~~
(B)In public health settings, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, head start and preschool programs, and community clinics, under the general supervision of a dentist.
(2)Place protective restorations, which for this purpose are identified as interim therapeutic restorations, and defined as a direct provisional restoration placed to stabilize the tooth until a licensed dentist diagnoses the need for further definitive treatment. An interim therapeutic restoration consists of the removal of soft material from the tooth using only hand instrumentation, without the use of rotary instrumentation, and subsequent placement of an adhesive restorative material. Local anesthesia shall not be necessary for interim therapeutic restoration placement. Interim therapeutic restorations shall be placed only in accordance with both of the following:
~~(A)In either of the following settings:~~
~~(i)In a dental office setting, under the direct or general supervision of a dentist as determined by the dentist.~~
(ii)In public health settings, using telehealth, as defined by Section 2290.5, for the purpose of communication with the supervising dentist, including, but not limited to, schools, head start and preschool programs, and community clinics, under the general supervision of a dentist.
~~(B)After the diagnosis, treatment plan, and instruction to perform the procedure provided by a dentist.~~
(c)The functions described in subdivision (b) may be performed by a registered dental assistant in extended functions only after completion of a program that includes training in performing those functions, or after providing evidence, satisfactory to the board, of having completed a board-approved course in those functions.
(d)No later than January 1, 2018, the board shall adopt regulations to establish requirements for courses of instruction for the procedures authorized to be performed by a registered dental assistant in extended functions pursuant to this section using the competency-based training protocols established by the Health Workforce Pilot Project (HWPP) No. 172 through the Department of Health Care Access and Information. The board shall submit to the committee proposed regulatory language for the curriculum for the Interim Therapeutic Restoration to the committee for the purpose of promulgating regulations for registered dental hygienists and registered dental hygienists in alternative practice as described in Section 1910.5. The language submitted by the board shall mirror the instructional curriculum for the registered dental assistant in extended functions. Any subsequent amendments to the regulations that are promulgated by the board for the Interim Therapeutic Restoration curriculum shall be submitted to the committee.
(e)The board may issue a permit to a registered dental assistant in extended functions who files a completed application, including the fee, to provide the duties specified in this section after the board has determined the registered dental assistant in extended functions has completed the coursework required in subdivision (c).
~~(f)This section shall become operative on January 1, 2018.~~

SEC. 30.

Section 1753.6 of the Business and Professions Code is repealed.

1753.6.
(a)Each person who holds a license as a registered dental assistant in extended functions on the 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 Section 1752.4, and the procedures specified in paragraphs (1) to (6), inclusive, until the person provides evidence of having completed a board-approved course in the additional procedures specified in paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision (b) of Section 1753.5:
~~(1)Cord retraction of gingiva 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. 31.

Section 1753.7 of the Business and Professions Code is repealed.

1753.7.
A licensed dentist may simultaneously utilize in his or her practice no more than three registered dental assistants in extended functions or registered dental hygienists in extended functions licensed pursuant to Section 1753 or 1918.

SEC. 32.

Section 1754 is added to the Business and Professions Code, to read:

1754.

(a) On or after January 1, 2026, a provider of a course for instruction in interim therapeutic restorations (ITR) and radiographic decisionmaking (RDM) for a registered dental assistant in extended functions shall apply for board approval to offer the course and submit all of the following to the board:

(1) An application prescribed by the board that shall specify the name of the course or educational program administrator or director, the name of the course provider, the name of the course, and the location where the course will be offered.

(2) The application fee prescribed in Section 1724.

(3) A detailed course curriculum evidencing that the course is sufficient in length for the students to develop competency in placement of protective restorations, but shall be, at a minimum, 16 hours in length and include all of the following:

(A) Four hours of didactic training, which may take place in an in-person or online environment, and shall include:

(i) Review of pulpal anatomy.

(ii) Theory of adhesive restorative materials used in the placement of adhesive protective restorations, including mechanisms of bonding to tooth structure, handling characteristics of the materials, preparation of the tooth prior to material placement, and placement techniques.

(iii) Criteria used in clinical dentistry pertaining to the use and placement of adhesive protective restorations, which shall include:

(I) Patient factors, as follows:

(ia) According to the American Society of Anesthesiologists Physical Status Classification, the patient is Class III or less.

(ib) The patient is cooperative enough to have the ITR placed without the need for special protocols, including sedation or physical support.

(ic) The patient, or responsible party, has provided consent for the ITR procedure.

(id) The patient reports that the tooth is asymptomatic, or if there is mild sensitivity which stops within a few seconds of the removal of the offending stimulus.

(II) Tooth factors, as follows:

(ia) The lesion is accessible without the need for creating access using a dental handpiece.

(ib) The margins of the lesion are accessible so that clean, noninvolved margins can be obtained around the entire periphery of the lesion with the use of hand instrumentation.

(ic) The depth of the lesion is more than two millimeters from the pulp on radiographic examination or is judged by the supervising licensed dentist to be a shallow lesion such that the treatment does not endanger the pulp or require the use of local anesthetic.

(id) The tooth is restorable and does not have other significant pathology.

(iv) The protocols to deal with adverse outcomes used in the placement of adhesive protective restorations, including mechanisms of bonding to tooth structure, handling characteristics of the materials, preparation of the tooth prior to material placement, and placement techniques.

(v) Criteria for evaluating successful completion of adhesive protective restorations, including, but not limited to, restorative material not in hyper occlusion, no marginal voids, and minimal excess material.

(vi) Protocols for adverse outcomes after ITR placement, including, but not limited to, exposed pulp, tooth fracture, gingival tissue injury, high occlusion, open margins, tooth sensitivity, rough surface, complications, or unsuccessful completion of adhesive protective restorations, including situations requiring immediate referral to a dentist.

(vii) Protocols for followup of adhesive protective restorations, including, but not limited to, at least two followup examinations of the ITR within a 12-month period.

(B) Four hours of laboratory training, which shall be held at a physical facility, and include placement of 10 adhesive protective restorations where students demonstrate competency in this technique on typodont teeth.

(C) Eight hours of clinical training, which shall be held at a physical facility, and include experiences where students demonstrate, at minimum, place of five ITRs under direct supervision of faculty.

(4) A detailed course curriculum evidencing that the course is sufficient in length for the students to develop competency in making decisions about which radiographs to expose to facilitate diagnosis and treatment planning by a dentist, but shall be, at a minimum, four hours in length and include all of the following:

(A) Didactic instruction, including all of the following:

(i) The concept of managing caries and individualizing treatment based on a caries risk assessment.

(ii) Guidelines for RDM, including, but not limited to, both of the following concepts:

(I) The American Dental Association’s Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation (Revised 2012).

(II) The American Academy of Pediatric Dentistry’s Guidelines on Prescribing Dental Radiographs.

(iii) The guidelines developed by Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry (Pacific) for use in training for Health and Workforce Pilot Project No. 172, including both of the following:

(I) Instruction on specific decisionmaking guidelines that incorporate information about the patient’s health, radiographic history, time span since previous radiographs were taken, and availability of previous radiographs.

(II) Instruction pertaining to the general condition of the mouth, including the extent of dental restorations present and visible signs of abnormalities, including broken teeth, dark areas, holes in teeth, demineralization, visible carious lesions, and remineralization.

(B) Laboratory training that includes case-based examination with various clinical situations where trainees make decisions about which radiographs to expose and demonstrate competency to faculty based on these case studies.

(C) Simulated clinical experiences consisting of a review of various clinical cases with instructor-led discussion about RDM in these clinical situations.

(5) Evidence of student access to adequate equipment and facilities to satisfy the educational requirements as specified in this section.

(6) Evidence that the physical facilities required under this section have all of the following:

(A) A patient clinic area, laboratory, and radiology area.

(B) Access to equipment necessary to develop dental assisting skills in RDM.

(7) Evidence that the physical facilities and equipment are maintained and replaced in a manner designed to provide students with a course that will meet the educational objectives set forth in this section.

(8) Evidence that all students have access to all of the following:

(A) A hazardous waste management plan for the disposal of needles, cartridges, medical waste, and storage of oxygen and nitrous oxide tanks.

(B) A clinic hazardous communication plan.

(C) A copy of the course’s bloodborne and infectious diseases exposure control plan, which shall include emergency needlestick information.

(9) Written clinical and laboratory protocols to ensure adequate asepsis, infection and hazard control, and disposal of hazardous wastes, which shall comply with the board’s regulations and other federal, state, and local requirements. The course provider shall provide such protocols to all students, faculty, and appropriate staff to assure compliance with such protocols. Adequate space shall be provided for preparing and sterilizing all armamentaria.

(10) Evidence that the course is established at the postsecondary educational level.

(b) The course content may be incorporated into a current registered dental assistant in extended functions program.

(c) For course enrollment, the course provider shall ensure submission by the student of satisfactory evidence of both of the following requirements:

(1) A current, active license as a registered dental assistant in extended functions issued on or after January 1, 2010.

(2) A current certification in basic life support from the American Heart Association or the American Red Cross or a course deemed equivalent by the board.

(d) The program or course director shall do both of the following:

(1) Ensure all faculty involved in clinical evaluation of students maintain currency in evaluation protocols for ITR placement and RDM.

(2) Ensure that all faculty responsible for clinical evaluation have completed a one-hour methodology course in clinical evaluation for ITR placement and RDM before instruction.

(e) Satisfactory completion of a course in ITR and RDM is determined using criteria-referenced completion standards, where the instructor determines when the trainee has achieved competency based on these standards, but trainees take varying amounts of time to achieve competency. Any student who does not achieve competency in this duty in the specified period of instruction may receive additional training and evaluation. In cases where, in the judgment of the faculty, students are not making adequate progress, they shall be discontinued from the program.

(f) Each student shall pass a written examination which reflects the entire curriculum content.

(g) Each student shall pass a simulated clinical examination in which the student successfully completes the application of three of the five ITR placements required for clinical instruction under faculty supervision.

(h) Each approved course shall be subject to board review at any time for compliance with the requirements under this section.

(i) The program or course director shall be responsible for notifying the board in writing of any changes to the course content, physical facilities, and faculty within 10 days of such changes.

SEC. 33.

Section 1754.5 is added to the Business and Professions Code, to read:

1754.5.

(a) A radiation safety course shall have the primary purpose of providing theory, laboratory, and clinical application in radiographic techniques. The board shall approve only those courses which adhere to the minimum requirements of this section.

(b) A course provider applying for initial board approval shall submit a completed application for course approval, on a form provided by the board, accompanied by the applicable fee. The board may approve or deny approval after it evaluates all components of the course.

(c) Continuation of approval will be contingent upon continued compliance with Sections 1070 and 1070.1 of Title 16 of the California Code of Regulations and all requirements set forth in this section.

(d) Providers shall make adequate provisions for appropriate supervision, operation, and facilities when used for laboratory and preclinical instruction.

(e) A course in radiation safety shall be of sufficient duration for the student to achieve minimum competence, but in no event less than 32 hours, including at least 8 hours of didactic instruction, at least 12 hours of laboratory instruction, and at least 12 hours of supervised clinical instruction.

(f) A course shall establish specific instructional objectives. The theoretical aspects of the course shall provide the content necessary for students to make safe and ethical judgments regarding radiation safety.

(g) Objective evaluation criteria shall be used for measuring student progress. Students shall be provided with specific performance objectives and the evaluation criteria that will be used for all evaluation and testing procedures.

(h) Areas of didactic instruction shall include, at a minimum, all of the following:

(1) Radiation physics and biology.

(2) Radiation protection and safety.

(3) Recognition of normal intraoral and extraoral anatomical landmarks.

(4) Radiograph exposure and processing techniques.

(5) Radiograph mounting or sequencing, and viewing, including anatomical landmarks of the oral cavity.

(6) Intraoral techniques including holding devices and image receptors.

(7) Proper use of patient protection devices and personal protective equipment for operator use.

(8) Identification and correction of faulty radiographs.

(9) Introduction to contemporary equipment and devices including the use of computerized digital radiography and extraoral imaging that may include panographs or cone-beam imaging.

(10) Techniques and exposure guidelines for a variety of patients including, but not limited to, adult, pediatric, edentulous, partially edentulous, endodontic, and patients with special needs.

(11) Radiographic record management.

(i) For the student to achieve minimum competence in the application of dental radiographic techniques and radiation safety, all of the following shall be met by a board-approved course:

(1) Successful completion of laboratory experiences consisting of at least two bitewing radiographic series and two full mouth intraoral radiographic series using an x-ray training mannequin designed for radiographic exposures utilizing any dental radiographic image receptor or device deemed appropriate by the course director.

(2) Successful completion of clinical experiences consisting of at least three full-mouth intraoral radiographic series using any dental radiographic image receptor or device deemed appropriate by the course director or supervising dentist.

(j) All clinical radiographs shall be made using diagnostic criteria established by the course of instruction and shall in no event exceed three reexposures per series.

(k) Completion of student and instructor written evaluations of each radiographic series identifying errors, causes of error, correction of errors, and, if applicable, the number of reexposures necessary for successful completion of a series to clinical competency.

(l) The student shall successfully complete a comprehensive written exam prior to the completion of the course. The exam shall include questions specific to items addressed in Article 4 (commencing with Section 30305) of Group 3 of Subchapter 4 of Chapter 5 of Division 1 of Title 17 of California Code of Regulations relative to the special requirements for the use of x-ray in the healing arts.

(m) Extramural dental facilities may be utilized by a course for the purposes of clinical experiences. Clinical oversight shall be performed under the general supervision of a licensed dentist who shall authorize the student to perform, at minimum, three radiographic series. Didactic and laboratory instruction shall be provided only by course faculty or instructional staff prior to clinical performances.

(n) Programs and courses using extramural dental faculties for dental radiographic clinical experiences shall provide to the board, upon request or renewal of provider status, copies of all contracts of affiliation and documentation demonstrating compliance with board regulations.

(o) Upon successful completion of the course, students shall receive a certificate of completion.

(p) The board shall provide a 90-day notice of compliance for radiation safety course providers subject to this section.

SEC. 34.

Section 1755 is added to the Business and Professions Code, to read:

1755.

(a) A course in infection control is one that has as its primary purpose providing theory and clinical application in infection control practices and principles where the protection of the public is its primary focus.

(b) An unlicensed dental assistant not enrolled in a board-approved program for registered dental assisting or an alternative dental assisting program as defined in Section 1741, shall complete one of the following infection control certification courses:

(1) A board-approved eight-hour course, with six hours being didactic instruction and two hours being laboratory instruction.

(2) A board-approved eight-hour course, with six hours of didactic instruction and at least two hours of laboratory instruction using video or a series of video training tools, all of which may be delivered using live, interactive, or online learning mechanisms or a combination thereof.

(c) A course shall establish specific instructional objectives. Instruction shall provide the content necessary for students to make safe and ethical judgments regarding infection control and asepsis.

(d) Objective evaluation criteria shall be used for measuring student progress. Students shall be provided with specific performance objectives and the evaluation criteria that will be used for didactic testing.

(e) To maintain approval, course providers approved prior to the effective date of this section, shall submit to the board a completed “Notice of Compliance with New Requirements for 8-Hour Infection Control Courses” by April 1, 2025.

(f) Didactic instruction shall include, at a minimum, all of the following as they relate to Cal/OSHA regulations, as set forth in Section 5193 of Title 8 of the California Code of Regulations, and the Board’s Minimum Standards for Infection Control, as set forth in Section 1005 of Title 16 of the California Code of Regulations:

(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 Section 1005 of Title 16 of the California Code of Regulations 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, exposure control, postexposure requirements, and monitoring systems for radiation safety and sterilization systems.

(g) Upon successful completion of the course, students shall receive a certificate of completion.

SEC. 35.

No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.

Bill Text

Bill Information

AB-2242 Dentistry: dental assistants.(2023-2024)

Bill Start

LEGISLATIVE COUNSEL'S DIGEST

Digest Key

Bill Text

The people of the State of California do enact as follows:

SECTION 1.

1740.

SEC. 2.

1741.

SEC. 3.

1747.

SEC. 4.

1747.5.

SEC. 5.

1748.

SEC. 6.

1748.6.

SEC. 7.

SEC. 8.

1749.2.

SEC. 9.

1749.3.

SEC. 10.

1749.4.

SEC. 11.

SEC. 12.

1750.1.

SEC. 13.

SEC. 14.

1750.2.

SEC. 15.

1750.3.

SEC. 16.

1750.35.

SEC. 17.

SEC. 18.

1750.4.

SEC. 19.

1750.5.

SEC. 20.

SEC. 21.

SEC. 22.

1752.4.

SEC. 23.

SEC. 24.

SEC. 25.

1753.1.

SEC. 26.

1753.2.

SEC. 27.

1753.3.

SEC. 28.

SEC. 29.

SEC. 30.

SEC. 31.

SEC. 32.

1754.

SEC. 33.

1754.5.

SEC. 34.

1755.

SEC. 35.