TITLE IV
AUXILIARY PERSONNEL
CHAPTER 20
DENTAL ASSISTANTS
[Prior to 5/18/88, Dental Examiners, Board of[320]]
650—20.1(153) Registration required. A person shall not practice dental assisting without a certificate of registration issued by the board pursuant to rule 650—11.8(153), unless practicing as a dental assistant trainee.
[ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.2(153) Definitions. As used in this chapter:
“Dental assistant” means any person who, under the supervision of a dentist, performs any extraoral services including infection control or the use of hazardous materials or performs any intraoral services on patients. The term “dental assistant” does not include persons otherwise actively licensed in Iowa to practice dental hygiene or nursing who are engaged in the practice of said profession.
“Dental assistant trainee” means any person who is engaging in on-the-job training to meet the requirements for registration in accordance with Iowa Code section 153.39 and who is learning the necessary skills under the personal supervision of a licensee or registrant. Trainees who are 18 years of age or older may also engage in on-the-job training in dental radiography pursuant to rule 650—22.3(136C,153).
“Public health supervision” means all of the following:
	1.	The dentist authorizes and delegates the services provided by a registered dental assistant to a patient in a public health setting, with the exception that services may be rendered without the patient’s first being examined by a licensed dentist;
	2.	The dentist is not required to provide future dental treatment to patients served under public health supervision;
	3.	The dentist and the registered dental assistant have entered into a written supervision agreement that details the responsibilities of each licensee/registrant, as specified in subrule 20.9(2); and
	4.	The registered dental assistant has an active Iowa registration and a minimum of one year of clinical practice experience.
“Registered dental assistant” means any person who has met the requirements for registration and has been issued a certificate of registration.
“Trainee status expiration date” means 12 months from the date of employment as a dental assistant trainee.
[ARC 8369B, IAB 12/16/09, effective 1/20/10; ARC 0465C, IAB 11/28/12, effective 1/2/13; ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 3489C, IAB 12/6/17, effective 1/10/18; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.3(153) Dental assistants.
	20.3(1) Dental assistant trainee.
	a. 	Dental assistant trainees are individuals who are engaging in on-the-job training to meet the requirements for registration and who are learning the necessary skills under the personal supervision of a licensee or registrant. Trainees who are 18 years of age or older may also engage in on-the-job training in dental radiography pursuant to rule 650—22.3(136C,153).
	b. 	The dental assistant trainee shall:
	(1)	Successfully complete on-the-job training and examinations in the areas of infection control, hazardous materials, and jurisprudence.
	(2)	If the trainee fails to become registered by the trainee status expiration date, stop work as a dental assistant trainee.
	20.3(2) Registered dental assistant. Registered dental assistants are individuals who have met the requirements for registration and have been issued a certificate of registration. A registered dental assistant may, under direct supervision, assist a dentist in performing duties assigned by the dentist that are consistent with these rules. The registered dental assistant may take radiographs if qualified pursuant to 650—Chapter 22.
[ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.4(153) Scope of practice.
	20.4(1) In all instances, a dentist assumes responsibility for determining, on the basis of diagnosis, the specific treatment patients will receive and which aspects of treatment may be delegated to qualified personnel as authorized in these rules.
	20.4(2) A licensed dentist may delegate to a dental assistant those procedures for which the dental assistant has received training. This delegation shall be based on the best interests of the patient. Such services shall be delegated by and performed under the supervision of a licensed dentist and may include:
	a. 	Placement and removal of dry socket medication;
	b. 	Placement of periodontal dressings;
	c. 	Testing pulp vitality;
	d. 	Preliminary charting of existing dental restorations and teeth;
	e. 	Glucose testing;
	f. 	Phlebotomy; and
	g. 	Expanded function procedures in accordance with 650—Chapter 23.
	20.4(3) The dentist shall exercise supervision and shall be fully responsible for all acts performed by a dental assistant. A dentist may not delegate to a dental assistant any of the following, unless allowed pursuant to 650—Chapter 23:
	a. 	Diagnosis, examination, treatment planning, or prescription, including prescription for drugs and medicaments or authorization for restorative, prosthodontic or orthodontic appliances.
	b. 	Surgical procedures on hard and soft tissues within the oral cavity and any other intraoral procedure that contributes to or results in an irreversible alteration to the oral anatomy.
	c. 	Administration of local anesthesia.
	d. 	Placement of sealants.
	e. 	Removal of any plaque, stain, or hard natural or synthetic material except by toothbrush, floss, or rubber cup coronal polish, or removal of any calculus.
	f. 	Dental radiography, unless the assistant is qualified pursuant to 650—Chapter 22.
	g. 	Those procedures that require the professional judgment and skill of a dentist.
	20.4(4) A dental assistant may perform duties consistent with these rules under the supervision of a licensed dentist. The specific duties dental assistants may perform are based upon:
	a. 	The education of the dental assistant.
	b. 	The experience of the dental assistant.
[ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 3489C, IAB 12/6/17, effective 1/10/18; ARC 4676C, IAB 9/25/19, effective 10/30/19]
650—20.5(153) Continuing education. Each person registered as a dental assistant shall complete continuing education requirements as specified in 650—Chapter 25.
[ARC 0265C, IAB 8/8/12, effective 9/12/12; ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 3489C, IAB 12/6/17, effective 1/10/18; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.6(252J) Receipt of certificate of noncompliance. The board shall consider the receipt of a certificate of noncompliance of a support order from the child support recovery unit pursuant to Iowa Code chapter 252J and 650—Chapter 33. Registration denial or denial of renewal of registration shall follow the procedures in the statutes and board rules as set forth in this rule.
This rule is intended to implement Iowa Code chapter 252J.
[ARC 0265C, IAB 8/8/12, effective 9/12/12; ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 4747C, IAB 11/6/19, effective 12/11/19; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.7(153) Unlawful practice. A dental assistant who assists a dentist in practicing dentistry in any capacity other than as a person supervised by a dentist in a dental office, or who directly or indirectly procures a licensed dentist to act as nominal owner, proprietor or director of a dental office as a guise or subterfuge to enable such dental assistant to engage directly or indirectly in the practice of dentistry, or who performs dental service directly or indirectly on or for members of the public other than as a person working for a dentist shall be deemed to be practicing dentistry without a license.
[ARC 0265C, IAB 8/8/12, effective 9/12/12; ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.8(153) Advertising and soliciting of dental services prohibited. Dental assistants shall not advertise, solicit, represent or hold themselves out in any manner to the general public that they will furnish, construct, repair or alter prosthetic, orthodontic or other appliances, with or without consideration, to be used as substitutes for or as part of natural teeth or associated structures or for the correction of malocclusions or deformities, or that they will perform any other dental service.
[ARC 0265C, IAB 8/8/12, effective 9/12/12; ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.9(153) Public health supervision allowed. A dentist may provide public health supervision to a registered dental assistant if the dentist has an active Iowa license and the services are provided in a public or private school, public health agencies, hospitals, or the armed forces.
	20.9(1) Public health agencies defined. For the purposes of this rule, public health agencies include programs operated by federal, state, or local public health departments.
	20.9(2) Responsibilities. When working together in a public health supervision relationship, a dentist and registered dental assistant shall enter into a written agreement that specifies the following responsibilities.
	a. 	The dentist providing public health supervision must:
	(1)	Be available to provide communication and consultation with the registered dental assistant;
	(2)	Have age- and procedure-specific standing orders for the performance of services. Those standing orders must include consideration for medically compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of services;
	(3)	Specify a period of time in which an examination by a dentist must occur prior to providing further services;
	(4)	Specify the location or locations where the services will be provided under public health supervision.
	b. 	A registered dental assistant providing services under public health supervision may only provide services which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light and intraoral camera and must:
	(1)	Maintain contact and communication with the dentist providing public health supervision;
	(2)	Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient;
	(3)	Ensure that the patient, parent, or guardian receives a written plan for referral to a dentist;
	(4)	Ensure that each patient, parent, or guardian signs a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and
	(5)	Ensure that a procedure is in place for creating and maintaining dental records for the patients who are treated, including where these records are to be located.
	c. 	The written agreement for public health supervision must be maintained by the dentist and the registered dental assistant and a copy filed with the board office within 30 days of the date on which the dentist and the registered dental assistant entered into the agreement. The dentist and registered dental assistant must review the agreement at least biennially.
	d. 	The registered dental assistant shall file annually with the supervising dentist and the bureau of oral and health delivery systems a report detailing the number of patients seen, the services provided to patients and the infection control protocols followed at each practice location.
	e. 	A copy of the written agreement for public health supervision shall be filed with the Bureau of Oral and Health Delivery Systems, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, Iowa 50319.
	20.9(3) Reporting requirements. Each registered dental assistant who has rendered services under public health supervision must complete a summary report at the completion of a program or, in the case of an ongoing program, at least annually. The report shall be filed with the bureau of oral and health delivery systems of the Iowa department of public health on forms provided by the department and shall include information related to the number of patients seen and services provided so that the department may assess the impact of the program. The department will provide summary reports to the board on an annual basis.
[ARC 2028C, IAB 6/10/15, effective 7/15/15; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
650—20.10(153) Students enrolled in dental assisting programs. Students enrolled in an accredited dental assisting program are not considered to be engaged in the unlawful practice of dental assisting provided that such practice is in connection with their regular course of instruction and meets the following:
	1.	The practice of clinical skills on peers enrolled in the same program must be under the direct supervision of a program instructor with an active Iowa dental assistant registration, Iowa dental hygiene license, Iowa faculty permit, or Iowa dental license;
	2.	The practice of clinical skills on members of the public must be under the direct supervision of a dentist with an active Iowa dental license.
[ARC 2593C, IAB 6/22/16, effective 7/27/16; ARC 4948C, IAB 2/26/20, effective 4/1/20; ARC 6673C, IAB 11/16/22, effective 12/21/22]
These rules are intended to implement Iowa Code chapter 153.
[Filed 4/9/79, Notice 10/4/78—published 5/2/79, effective 6/6/79]1
[Filed 8/3/79, Notice 6/27/79—published 8/22/79, effective 9/26/79]
[Filed 3/20/86, Notice 9/11/85—published 4/9/86, effective 5/14/86]
[Filed 4/28/88, Notice 3/23/88—published 5/18/88, effective 6/22/88]
[Filed 11/19/93, Notices 6/9/93, 8/18/93—published 12/8/93, effective 1/12/94]
[Filed 11/2/95, Notice 8/16/95—published 11/22/95, effective 12/27/95]
[Filed 10/23/00, Notice 8/9/00—published 11/15/00, effective 1/1/01]
[Filed 7/27/01, Notice 5/30/01—published 8/22/01, effective 9/26/01]
[Filed emergency 6/21/02—published 7/10/02, effective 7/1/02]
[Filed 1/30/03, Notice 11/13/02—published 2/19/03, effective 3/26/03]
[Filed 8/29/03, Notice 5/14/03—published 9/17/03, effective 10/22/03]
[Filed 7/1/04, Notice 5/12/04—published 7/21/04, effective 8/25/04]
[Filed 4/22/05, Notice 2/2/05—published 5/11/05, effective 6/15/05]
[Filed emergency 6/30/05—published 7/20/05, effective 7/1/05]
[Filed 2/5/07, Notice 11/22/06—published 2/28/07, effective 4/4/07]
[Filed 1/10/08, Notice 11/7/07—published 1/30/08, effective 3/5/08]
[Filed ARC 7789B (Notice ARC 7575B, IAB 2/11/09), IAB 5/20/09, effective 6/24/09]
[Filed ARC 8369B (Notice ARC 8044B, IAB 8/12/09), IAB 12/16/09, effective 1/20/10]
[Filed ARC 0265C (Notice ARC 0128C, IAB 5/16/12), IAB 8/8/12, effective 9/12/12]
[Filed ARC 0465C (Notice ARC 0170C, IAB 6/13/12), IAB 11/28/12, effective 1/2/13]
[Filed ARC 0985C (Notice ARC 0723C, IAB 5/1/13), IAB 9/4/13, effective 10/9/13]
[Filed ARC 2028C (Notice ARC 1940C, IAB 4/1/15), IAB 6/10/15, effective 7/15/15]
[Filed ARC 2593C (Notice ARC 2431C, IAB 3/2/16), IAB 6/22/16, effective 7/27/16]
[Filed ARC 3489C (Notice ARC 3157C, IAB 7/5/17), IAB 12/6/17, effective 1/10/18]
[Filed ARC 4187C (Notice ARC 4005C, IAB 9/26/18), IAB 12/19/18, effective 1/23/19]
[Filed ARC 4676C (Notice ARC 4424C, IAB 5/8/19), IAB 9/25/19, effective 10/30/19]
[Filed ARC 4747C (Notice ARC 4526C, IAB 7/3/19), IAB 11/6/19, effective 12/11/19]
[Filed ARC 4948C (Notice ARC 4741C, IAB 11/6/19), IAB 2/26/20, effective 4/1/20]
[Filed ARC 5747C (Notice ARC 5371C, IAB 12/30/20), IAB 7/14/21, effective 8/18/21]
[Filed ARC 6673C (Notice ARC 6514C, IAB 9/7/22), IAB 11/16/22, effective 12/21/22]
1	The Administrative Rules Review Committee at their May 21, 1979, meeting delayed the effective date of Chapters 20 and 21 70 days.