Inside Dental Assisting
What Is Your Job Title
Depending on where you practice, the answer to this question can be very different.
Throughout the organizational world—from finance to healthcare to education—job titles are in a state of flux, as they reflect rapid changes in employment, influenced by social, technological, economic, and global issues. Whereas once a job title was a fairly accurate representation of the work performed, titles are becoming more individualized and disconnected from responsibilities, creating confusion and fragmentation within and between professions.
In the healthcare environment, patients expect that certain titles reflect qualifications that are overseen by professional boards. However, in many cases, dental assistants have titles and responsibilities that may be fully comprehended only by other dental assistants—and most likely only those working in the same state, as functions differ across state lines. Patients, colleagues, and even policy makers may not understand the nuances between these titles, which is a challenge for dental assistants as they work to effect change.
Are you a DA? CDA? RDA? EFDA? LDA? DAQEF? Depending on where you practice, the answer to this question can be very different, along with the accompanying responsibilities, educational requirements, and career path. However, regardless of which title applies, the foundation is constant—the skill and commitment to provide patient care.
No matter where they practice, dental assistants often act as oral healthcare ambassadors. The assistant is most likely the first and last person with whom patients typically communicate regarding their care. Dental assistants often determine the patient’s experience—and therefore have the opportunity to impact his or her inclination to continue treatment. They are involved in volunteer and community efforts, working with clinics, schools, and non-profit organizations. Finally, a dental assistant is a representative not only for oral healthcare or for the dental practice—but for the profession itself.
Today’s dental assistants have unparalleled opportunities to interact with colleagues, both local and national (if not global). Professional meetings, social networking, website forums, and online communities are venues where they can compare experiences, formulate strategies, and combine their voices. They are poised to move beyond the fragmentation in job titles and functions, to promote the profession as a whole and to influence the direction of oral healthcare.
A Profession Is Born
Like many professions, dental assisting started small, but it became quickly structured. Over 100 years ago, New Orleans dentist Dr. Edmund Kells brought his wife into his practice to assist him; later, as his practice became more successful, he hired the first recognized dental assistant, Malvina Cueria. In 1917, the first dental assistants’ association was formed in Nebraska, and in 1925 Juliette Southard of New York was elected the first president of the newly incorporated (in Illinois) American Dental Assistants Association (ADAA).1
In 1948, the ADAA developed its Certifying Board, which conceived the profession’s first credential: the Certified Dental Assistant (CDA). Today this credentialing agency, known as the Dental Assisting National Board (DANB), is the only national certification organization for dental assistants recognized by the American Dental Association (ADA). The CDA certification is currently recognized or required in 29 states.
In the mid-1970s Minnesota and California developed the first state credentials for dental assistants, under the Registered Dental Assistant (RDA) title. Both states required education, examination, and registration with their state board of dentistry and continuing education to maintain this credential.
The regulation of the profession continues to evolve, with an ever-increasing variety of responsibilities, education requirements, and state credentials added to its repertoire. However, the result is a patchwork quilt of State Dental Practice Acts and administrative rules, sometimes established with input from dental assistants themselves, sometimes not. Knowledge about these regulations, ensuing changes, and efforts by colleagues to impact policy is essential to guiding the future and identity of the profession.
Currently, there is no national set of guidelines that governs the practice of dental assisting in the United States. Each of the 50 states and the District of Columbia has a dental practice act governing the practice of dentistry, and the 51 dental practice acts define the allowable activities of dental assistants to varying degrees.2 Many of these states require registration, licensure, permits, or national certification before dental assistants can perform certain advanced or “expanded” functions, while other states permit dentists to delegate tasks to any assistant whom a dentist deems competent. The spectrum of variation among the 50 states and the District of Columbia is very broad, and the lack of consistency makes a state-by-state comparison of the dental assisting profession a time-consuming and labor-intensive proposition.3
The Heart of Dental Assisting
Wherever they practice, the essential responsibilities of dental assistants remain constant. They commonly prepare the patient for the procedure; discuss before and after treatment instructions; maintain materials, instruments, and equipment; identify and order supplies; assist in four-handed dentistry; perform infection control procedures; expose and process x-rays; take impressions; fabricate custom trays—including bleaching trays, athletic mouthguards, and impression trays; fabricate temporary crowns; and work closely with the dental laboratory.
This is where the commonality ends. The profession branches into more than 50+ different “road maps”—at least one for each state—to adequately document numerous additional duties, educational requirements, experience, documentation, levels of supervision, testing, and continuing education requirements. Since 2000, at least 15 states have passed new legislation or adopted new rules governing the practice of dental assisting.4 In each of these states, the new laws or rules permit more duties to be delegated to dental assistants—in some cases with additional education or credentialing requirements. Today, there are more than 35 different titles for dental assistants, and no two reflect the same career path. For example, Minnesota’s credential is now Licensed Dental Assistant (LDA). In 2006, California passed a law establishing four new job titles: Registered Orthodontic Assistant, Registered Restorative Assistant, Registered Oral and Maxillofacial Surgery Assistant, and Registered Restorative Assistant in Expanded Functions. The title in Montana is Dental Auxiliary, while North Dakota uses Qualified Dental Assistant.
Beyond DANB national certification and the CDA title, these various state titles can represent different credentials. For example, in some states, the dental assistant credential is a licensure, which is defined by the Institute for Credentialing Excellence as a “mandatory process in which a governmental agency grants time-limited permission to an individual to engage in a given occupation after verifying that he/she has met predetermined and standardized criteria.”5 The dental assistant’s titles include:
- California, Michigan, and New Jersey: licensed as a Registered Dental Assistant (RDA)
- New York: licensed as a New York State Licensed Certified Dental Assistant
- Minnesota: Licensed Dental Assistant (LDA)
The formal definition of registration varies from state to state, ranging from a process similar to licensure, to a simple government list of practitioners, to a professional designation.5 The following are examples of states that use the term to identify their credential:
- Arkansas, Iowa, and North Dakota: Registered Dental Assistant (RDA)
- Maryland: Dental Assistant Qualified in General Duties
- Massachusetts: Formally Trained Dental Assistant (FTA)
- Vermont: Expanded Function Dental Assistant (EFDA)
In other states, a state certification is required. Certification indicates a “voluntary process by which a non-governmental entity [ie, DANB] grants a time-limited recognition to an individual after verifying that he or she has met predetermined and standardized criteria. It is the vehicle that a profession or occupation uses to regulate itself.”5 Examples are:
- Maine and Pennsylvania: Expanded Function Dental Assistant (EFDA)
- New Mexico: Dental Assistant with state certification in expanded functions
- Tennessee: Registered Dental Assistant qualified to perform expanded functions
Dental assistants must remain knowledgeable about the differences between the types of credentials and, additionally, what type of credential their specific title represents. Dental assistants must also be aware of the different levels of supervision under which they may perform their various responsibilities. The American Dental Association (ADA) has identified four levels of supervision for dental auxiliaries: personal, direct, indirect, and general.6 While most states’ definitions are similar to the ADA’s, some may vary.
In October 2006, the ADA supported the development of two new workforce models for dental auxiliaries: the Oral Prevention Assistant (OPA) and the Community Dental Health Coordinator (CDHC). The last few years have seen a number of states evaluating their current delegation of functions and taking steps to move in the direction of benefiting access to care.
Presently, dental assistants are recognized in some fashion in dental practice acts or administrative rules in all 50 states and the District of Columbia; 41 states and the District of Columbia recognize more than one level of dental assistant in their practice acts. In addition, 38 states recognize or require education and/or credentialing to perform dental radiography procedures. Dental assistants are able to perform coronal polishing in 42 states, apply topical fluoride in 40 states, apply sealants in 32 states, and apply topical anesthetic in 41 states.7 Eleven states currently have provisions for dental assistants to place and carve amalgam and composite restorations.8 According to results from DANB’s 2010 Salary Survey, 70% of CDAs surveyed say that they perform infection control duties and work to ensure dental office compliance with Occupational Safety and Health Administration (OSHA) Standards and Centers for Disease Control and Prevention (CDC) Guidelines for Infection Control in Dental Health-Care Settings.9
The military adds yet another level of dental assistant titles. In the United States Army, Dental Specialists assist dentists in the examination and treatment of patients and help to manage dental offices. In August 2010, the Air Force adopted the job title Oral Preventive Assistant (OPA) for its preventive dentistry technicians. In addition to performing coronal polishing and applying topical fluoride, an OPA is trained to perform supragingival scaling and limited subgingival scaling, according to Thomas W. Davis, Jr, CMSgt, USAF, Career Field Manager, Dental Services Air Force Medical Operations Agency (oral communication, November 2010). However, these job descriptions are currently being revised. Per a federal government mandate, the Army, Air Force, and Navy are in the process of integrating their various dental assisting curricula into one standard, which will bring some consistency and continuity to these three branches of the armed services.
What’s In a Name?
According to human resource specialists, a job title can be crucial to one’s sense of purpose.10 In other words, you are your title, and it can influence the way you feel about your profession and perform your day-to-day responsibilities. It indicates level of accomplishment and authority. However, job titles that are applicable only to a limited group often create confusion for people attempting to assess a person’s role and level of responsibility. Multiplying, fragmented job titles can undermine identity within a profession—people are unable to compare their work experience and formulate collective goals.
What is your job title? What credential(s) are you required to have? What procedures can you perform and what do your responsibilities include? Dental assistants need to know and communicate what job titles their state dental practice acts define and allow. They also must know what duties are legally allowed to be delegated to them so that they can function fully in their role as part of the oral healthcare team.
Understanding that state dental practice act provisions are the purview of each state, if dental assistants who are qualified to perform certain duties in one state are recognized as competent in other states, recruitment, employment, and job satisfaction of qualified assistants will improve. This will also allow dentists to focus on dentistry while assistants perform delegated duties, thus increasing access to care.3
The profession of dental assisting is experiencing inevitable change. As more procedures are delegated, education requirements, levels of responsibility, and titles will continue to adjust. Many states are in the process of proposing or adopting rule changes for dental assistants. Presently, 17 states are anticipating legislation or rule-making in 2011.11 However, it is not enough to wait for states to adopt rules; dental assistants need to increasingly work to become a collaborative voice in directing these changes. Together, the profession has in its hands the ability, energy, and commitment to reach across state lines, and have a say in its future.
Although dental assistants wear different titles that may (or may not) signify different career paths and responsibilities, as a collective force, they have the potential to impact the industry. The profession is growing significantly. As of 2008, there were over 295,000 dental assistants employed, with projected numbers as high as over 400,000 in 2018.12 State-by-state, the number of dental assistants is expected to growth significantly (Figure 1). As these numbers increase and responsibilities expand, the role of the dental assistant will no longer be sidelined during the debate on healthcare.
Every job is a self-portrait of the person who does it (Unknown). The challenge for today’s dental assistant is to overcome the splintering of job titles and to communicate the commonality of experience, service, and professionalism to our patients, colleagues, and policy makers. The job requires extensive social and leadership skills (Table 1 and Table 2), capabilities that can readily be applied in a collective approach to professional development. As the importance of oral healthcare in the United States increases, dental assistants will undoubtedly have a central role to play. They will become more critical in the delivery of and access to oral healthcare. Not since the first dental assistant’s association began in 1917 has there been such an expansive opportunity to determine their own future and to effect real change for their profession and for their patients.
1. Watson S. The History of Dental Assistants and The American Dental Assistants Association: A Look Back in Dental History. http://dentistry.about.com/od/careersindentistry/a/dentalassistan.htm. Accessed December 13, 2010.
2. Dental Assisting National Board. State Career Ladder Templates for Dental Assistants. Chicago, IL: DANB; 2010:5.
3. ADAA/DANB Alliance. Executive Summary. Position Paper of the ADAA/DANB Alliance Addressing a Uniform National Model for the Dental Assisting Profession.Chicago, IL: Dental Assisting National Board; 2005.
4. Dental Assisting National Board. Understanding Dental Assisting Job Titles/Roles Assists in Career Options. Certified Press. 2007;26(4):1-3.
5. National Organization for Competency Assurance. The NOCA Guide to Understanding Credentialing Concepts. 2005. http://www.credentialingexcellence.org/portals/0/CredentialingConcepts.pdf. Accessed December 6, 2010.
6. American Dental Association. Current Policies: Adopted 1954–2009. Chicago, IL: American Dental Association; 2009:45.
7. Dental Assisting National Board. DANB Develops Certified Oral Preventive Assistant Exam. Certified Press. 2010;29(3):1-3.
8. Dental Assisting National Board. State Fact Booklet, Volume 7. Chicago, IL: DANB; 2010: 5-332.
9. Dental Assisting National Board. DANB 2010 CDA Salary Survey. In press.
10. Weiss T. Jacked-Up Job Titles. Forbes. http://www.forbes.com/2006/11/01/leadership-jobs-careers-lead-managing-cx_tw_1101titles.html. Accessed December 6, 2010.
11. Dental Assisting National Board. State of the States Update. Certified Press. 2010;29(4):3.
12. United States Department of Labor. Bureau of Labor Statistics. Occupational Outlook Handbook, 2010-11 Edition. http://www.bls.gov/oco/ocos163.htm. Accessed December 6, 2010.