650—23.7(153) Expanded function training.
	23.7(1) Approved expanded function training programs. Training programs for Level 1 and Level 2 expanded function procedures must be board-approved. Training programs for Level 2 expanded function procedures shall be eligible for board approval if the training is offered through the University of Iowa College of Dentistry or another accredited school.
	23.7(2) Certificates of completion. All board-approved training programs are authorized and required to issue certificates to dental hygienists and dental assistants who successfully complete expanded function training. A certificate shall be issued for one or more of the listed expanded function procedures completed. Dental hygienists and dental assistants shall prominently display the expanded functions certificate in each dental facility where services are provided.
	23.7(3) Training requirements. Training may be completed in one or more of the listed expanded function procedures. Clinical training in expanded function procedures must be completed under observational supervision. Level 1 expanded function training must consist of the following:
	a. 	An initial assessment to determine the base entry level of all participants in the program;
	b. 	Completion of a training program that meets the following minimum standards for each function:
	(1)	Taking occlusal registrations:
Goal: To reproduce the patient’s jaw relationship accurately.
Standard: Demonstrate an accurate occlusal registration confirmed by a supervising dentist.
Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(2)	Placement and removal of gingival retraction material:
Goal: To expose the margins of a crown by displacing tissue from the tooth.
Standard: Perform the procedural steps to place and remove retraction material and recognize oral conditions and techniques that may compromise tissue displacement or patient health.
Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of three experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(3)	Fabrication, temporary cementation, temporary recementation, and removal of provisional restorations:
Goal: To replicate the anatomy and function of the natural tooth, prior to the final restoration, and secure the provisional restoration to a previously prepared tooth after the provisional restoration has become loose or dislodged.
Standard: Use various methods to fabricate and temporarily cement single-unit and multiunit provisional restorations.
Minimum training requirement: Four hours of didactic training, the equivalent of four hours of laboratory training that includes a minimum of five experiences, and clinical training that includes a minimum of ten patient experiences under observational supervision.
	(4)	Applying cavity liners and bases and desensitizing agents:
Goal: To apply appropriate material that protects existing tooth structure and to apply appropriate medicaments to minimize sensitivity to existing tooth structure.
Standard: Manipulate and apply appropriate material and apply appropriate medicaments to meet clinical competency.
Minimum training requirement: One hour of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences in each one of the functions under observational supervision.
	(5)	Applying bonding systems, which may include the placement of the attachments used in clear aligner systems, following review of the fit and function by the supervising dentist:
Goal: To apply appropriate material and systems that adhere to the existing tooth structure.
Standard: Manipulate and apply appropriate material and systems to meet clinical competency.
Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(6)	Placement, bonding, and removal of orthodontic brackets and bands or provisional orthodontic appliances pursuant to subrules 23.4(5) and 23.5(7):
Goal: To place on and remove from the existing tooth structure orthodontic brackets and bands or provisional orthodontic appliances.
Standard: Manipulate and apply appropriate material and appliances to meet clinical competency.
Minimum training requirement: For each function, two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(7)	Monitoring of patients receiving nitrous oxide inhalation analgesia, pursuant to subrule 23.4(7):
Goal: Understand the equipment, recognize the signs of patient distress or adverse reaction, and know when to call for help.
Standard: Exercise the ability to maintain patient safety while nitrous oxide is used.
Minimum training requirement: Two hours of didactic training, one hour of laboratory training in the office where the dental hygienist or dental assistant is employed, and five patient experiences under observational supervision.
	(8)	Taking final impressions:
Goal: Reproduce soft and hard oral tissues, digitally or with impression materials.
Standard: Complete the procedural steps to obtain a clinically acceptable final impression.
Minimum training requirement: Three hours of didactic training, and the equivalent of clinical training that includes a minimum of six patient experiences under observational supervision.
	(9)	Removal of adhesives using nonmotorized hand instrumentation:
Goal: Remove excess adhesives and bonding materials to eliminate soft tissue irritation.
Standard: Identify how, when and where to remove excessive bonding or adhesive material.
Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(10)	Placement of temporary restorative materials following preparation of the tooth by the dentist:
Goal: Place temporary restorative materials following preparation of a tooth by a dentist.
Standard: Identify how, when and where to place temporary restorative materials.
Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(11)	Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth:
Goal: To make adjustments to dentures.
Standard: Identify how and where to make extraoral adjustments to dentures.
Minimum training requirement: One hour of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.
	(12)	Tissue conditioning (soft reline only):
Goal: To apply appropriate material to dentures.
Standard: Identify how and where to apply appropriate material to dentures.
Minimum training requirement: One hour of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.
	c. 	A postcourse written examination at the conclusion of the training program, with a minimum of ten questions per function, must be administered. Participants must obtain a score of 75 percent or higher on each examination administered.
	23.7(4) Grandfathering. Any dental hygienist or dental assistant who has completed expanded function training prior to January 1, 2020, can continue to perform expanded function procedures for which training has been completed. For any expanded function procedures that are new, in whole or in part, additional training to satisfy the standard and minimum training requirement is required of the dental hygienist or dental assistant prior to performing the new expanded function procedure.
[ARC 4676C, IAB 9/25/19, effective 10/30/19; ARC 6733C, IAB 12/14/22, effective 1/18/23]