650—20.4 (153) Expanded function requirements.
	   20.4(1) Supervision requirements. Registered dental assistants may only perform expanded function procedures which are delegated by and performed under the direct supervision of a dentist licensed pursuant to Iowa Code chapter 153. Dental assistant trainees are not eligible to perform expanded function procedures.
	   20.4(2) Expanded function training required. A registered dental assistant shall not perform any expanded function procedures listed in this chapter unless the assistant has successfully met the education and training requirements and is in compliance with the requirements of this chapter.
	   20.4(3) Education and training requirements. All expanded function training must be prior-approved by the board. The supervising dentist and the registered dental assistant shall be responsible for maintaining in each office of practice documentation of successful completion of the board-approved training.
	      a.    	 Expanded function training for Level 1 procedures shall be eligible for board approval if the training is offered through a program accredited by the Commission on Dental Accreditation of the American Dental Association (ADA) or another program, which may include on-the-job training offered by a dentist licensed in Iowa. Training must consist of the following:
	       (1)  	 An initial assessment to determine the base entry level of all participants in the program. At a minimum, all participants must meet at least one of the following requirements before beginning expanded function training:
	      1. 	  Be a graduate of an ADA-accredited dental assistant program; or
	      2. 	  Be currently certified by the Dental Assisting National Board (DANB); or
	      3. 	  Have at least one year of clinical practice as a registered dental assistant; or
	      4. 	  Have at least one year of clinical practice as a dental assistant in a state that does not require registration;
	       (2)  	 A didactic component;
	       (3)  	 A laboratory component, if necessary;
	       (4)  	 A clinical component, which may be obtained under the personal supervision of the participant’s supervising dentist while the participant is concurrently enrolled in the training program; and
	       (5)  	 A postcourse competency assessment at the conclusion of the training program.
	      b.    	 Expanded function training for Level 2 procedures shall be eligible for board approval if the training is offered through the University of Iowa College of Dentistry or a program accredited by the Commission on Dental Accreditation of the American Dental Association.
	   20.4(4) Expanded function providers.
	      a.    	  Basic expanded function provider. Registered dental assistants who do not wish to become certified as a Level 1 or Level 2 provider may perform select Level 1 expanded function procedures provided they have met the education and training requirements for those procedures. A dentist may delegate to a registered dental assistant only those Level 1 procedures for which the assistant has received the required expanded function training.
	      b.    	  Certified Level 1 provider. Registered dental assistants must successfully complete training for all Level 1 expanded function procedures before becoming a certified Level 1 provider.
	       (1)  	 A dentist may delegate any of the Level 1 expanded function procedures to dental assistants who are certified Level 1 providers.
	       (2)  	 Level 1 procedures include:
	      1. 	  Taking occlusal registrations;
	      2. 	  Placement and removal of gingival retraction;
	      3. 	  Fabrication and removal of provisional restorations;
	      4. 	  Applying cavity liners and bases, desensitizing agents, and bonding systems;
	      5. 	  Placement and removal of dry socket medication;
	      6. 	  Placement of periodontal dressings;
	      7. 	  Testing pulp vitality;
	      8. 	  Monitoring of nitrous oxide inhalation analgesia;
	      9. 	  Taking final impressions;
	      10. 	  Removal of adhesives (hand instrumentation only); and
	      11. 	  Preliminary charting of existing dental restorations and teeth.
	      c.    	  Certified Level 2 provider. A registered dental assistant must become a certified Level 1 provider and successfully pass a board-approved entrance examination with a score of at least 75 percent before beginning training as a certified Level 2 provider. Registered dental assistants must successfully complete training for all Level 2 expanded function procedures before becoming certified Level 2 providers.
	       (1)  	 A dentist may delegate any of the Level 1 or Level 2 expanded function procedures to a registered dental assistant who is a certified Level 2 provider.
	       (2)  	 Level 2 procedures include:
	      1. 	  Placement and shaping of amalgam following preparation of a tooth by a dentist;
	      2. 	  Placement and shaping of composite following preparation of a tooth by a dentist;
	      3. 	  Forming and placement of stainless steel crowns;
	      4. 	  Taking records for the fabrication of dentures and partial dentures; and
	      5. 	  Tissue conditioning (soft reline only).
These procedures refer to both primary and permanent teeth.
	       (3)  	 Notwithstanding 650—paragraph 10.3(1)“e” and paragraph 20.3(2)“e,” for the purposes of this chapter, the removal of adhesives by hand instrumentation does not constitute the removal of “hard natural or synthetic material.”
[ARC 2028C, IAB 6/10/15, effective 7/15/15]