Summary of Changes to DC Regulations on the Scope of Practice for Dental Assistants

V. 3/15/2024

On March 1, 2024, DC Health published regulations effectively immediately that make a number of changes to the scope of practice for dental assistants, including the creation of a new Level III Dental Assistant (Final RuleN135043).

DCDS successfully advocated for an expansion of the scope of practice for dental assistants in several areas, including the creation of the Level III Dental Assistant. A limited number of recommendations offered by DCDS were not included in the final rule, including our request to repeal the registration requirement for Level I Dental Assistants. We will continue to advocate on these other recommendations.

The text of the final rule is available on the website of the District of Columbia Municipal Regulations and District of Columbia Register (see N135043). As of 3/15/2024, the full text of the District Of Columbia Municipal Regulations for Dental Assistants is not yet available from DC Health. Notable changes as a result of the new rule are highlighted below. It is the responsibility of each dentist and dental assistant practicing in DC to be familiar with the latest regulations.

Expands scope of practice for Level I Dental Assistants- Subsection 9004.2, expands those functions a Level I Dental Assistant may perform under the direct supervision of a dentist to include the following:

(c) Applying fluoride (rinse, foam tray, and fluoride varnish);
(l)Constructing athletic mouth guards and night guards on models;
(p) Whitening or bleaching using trays;
(q) Take and record vital signs;

Changes scope of practice for Level II Dental Assistants- Subsection 9004.3, changes those functions a Level II Dental Assistant may perform under the direct supervision of a dentist to include the following:

  • DELETES: (d) Applying topical fluoride; (see Level III Dental Assistant)
  • ADDS: (m) Removing excess cement; and
  • ADDS: (n) Removing or placing a periodontal dressing (except placing the original periodontal dressing).

Creates a Level III Dental Assistant - Subsection 9004.4 authorizes a Level III Dental Assistant to perform the following functions under direct supervision of a dentist:

(a) All functions permitted to Level I Dental Assistant or Level II Dental Assistant, as enumerated in §§ 9004.2 and 9004.3;
(b) The application of pit and fissure sealants;
(c) Coronal polishing to remove stain and biofilm; and
(d) Glucose testing.

Requirements for a Level III Dental Assistant - Subsection 9003.3 specifies that an applicant for a Level III Dental Assistant registration shall submit proof satisfactory to the Board that the applicant has:
  1. A high school diploma or a general equivalency diploma;
  2. Successfully completed a course in dental radiography training meeting the requirements set forth in § 9005.1 of this chapter;
  3. Successfully completed and graduated from an educational program for dental assistants approved by the Board or the American Dental Association’s Commission on Dental Accreditation (CODA);
  4. A current and valid certification as a Certified Dental Assistant in general duties from the DANB or another dental assisting certification approved by the Board;
  5. Successfully completed and obtained the DANB Certified Preventive Functions Dental Assistant Certification; and
  6. Successfully passed a Board-approved, hands-on course in the functions and duties permitted to be performed by a Level III Dental Assistant.

The regulations expand the list of procedures that a dentists CANNOT DELEGATE to a dental assistant. Here is the latest list of procedures:

(a) Those procedures excluded by17 DCMR § 4215.1;
(b) A preliminary dental examination;
(c) A complete prophylaxis, including the removal of any deposits, diseased crevicular tissue, accretion, or stain from the surface of a tooth or a restoration;
(d) The restoration of a tooth;
(e) The charting of cavities during preliminary examination, prophylaxis, or polishing; however, a dentist may permit an assistant to record the charting of cavities as dictated by the dentist or dental hygienist during the course of a preliminary examination or dental procedure;
(f) The instruction of individuals or groups of individuals in oral health care, unless it is in the dental office and done as instructed by the dentist;
(g) [Repealed];
(h) Diagnostic screening to identify indications of oral abnormalities;
(i) Administration of local anesthesia;
(j) Administration of nitrous oxide;
(k) Placement of temporary restorations;
(l) Taking final impressions;
(m) Adjusting occlusion of natural teeth, restorations, or appliances;
(n) Registration of jaw relations;
(o) Cementing permanent crowns or restorations;
(p) Applying silver diamine fluoride;
(q) Glucose monitoring;
(r) Whitening or bleaching (internal, laser, or high-intensity light);
(s) Using a high speed handpiece intraorally;
(t) Oral cancer screenings;
(u) Oral cancer tissue biopsy;
(v) Placing initial periodontal dressing;
(w) Placement of liquid dam;
(x) Applying and removing a socket dressing;
(y) Placement of subgingival medicaments;
(z) Removing intracoronal temporary restorations; or
(aa) Placing sutures.

Jurisprudence exam requirement - Section 9008 establishes a requirement that a dental assistant of all levels passes a "written examination developed by the Board or a Board-approved entity on laws and rules pertaining to the practice of dental assistants (the District of Columbia Dental Assistants Law Examination)."