4.4 Dental Assistants: Delegable Tasks, Training & Remediable Restorative Functions

Dental Assistants

The statutory frame — s. 466.024, F.S.

A dentist may not delegate irremediable tasks except as provided by law, may delegate remediable tasks when they pose no risk to the patient, and may only delegate remediable tasks so defined by law or rule of the Board. Section 466.024(1) then lists twelve tasks that are found by law to be remediable and delegable, before any Board rule:

(a) taking impressions for study casts but not for fabricating any intraoral restoration or orthodontic appliance; (b) placing periodontal dressings; (c) removing periodontal or surgical dressings; (d) removing sutures; (e) placing or removing rubber dams; (f) placing or removing matrices; (g) placing or removing temporary restorations; (h) applying cavity liners, varnishes, or bases; (i) polishing amalgam restorations; (j) polishing clinical crowns to remove stains but not changing existing contour; (k) obtaining bacteriological or cytological specimens not involving cutting of tissue; and (l) administering local anesthesia pursuant to s. 466.017(5).

The list closes with "This subsection does not limit delegable tasks to those specified herein" — the Board may designate more.

Section 466.024(10): "A dental assistant may not perform an intraoral procedure except after such formal or on-the-job training as the board by rule shall prescribe." Training is a precondition, not a courtesy.

Rule 64B5-16.005 — the assistant task matrix

Formal training + DIRECT supervision — 64B5-16.005(1): placing or removing temporary restorations with non-mechanical hand instruments only; polishing dental restorations (burnishers, slow-speed handpieces, rubber cups, bristle brushes) and polishing clinical crowns (adding porte polishers), in each case not to change contour; removing excess cement from restorations and appliances with non-mechanical hand instruments only; cementing temporary crowns and bridges with temporary cement; monitoring the administration of nitrous-oxide oxygen, making adjustments only during administration and turning it off at the completion of the procedure; selecting and pre-sizing orthodontic bands and archwires; selecting prescribed extra-oral appliances by pre-selection or pre-measurement; applying conditioning agents or placing sealant materials, not including placing brackets; preliminary charting of existing restorations and missing teeth and visual assessment; fabricating temporary crowns or bridges intra-orally without occlusal adjustment; packing and removing retraction cord with no vasoactive chemicals; removing and re-cementing properly contoured loose bands; inserting or removing alveolar socket dressings in post-operative osteitis; making impressions for study casts for orthodontic retainers; taking impressions for and delivering at-home bleaching trays; and taking impressions for passive appliances, occlusal guards, space maintainers and protective mouth guards.

Formal training + INDIRECT supervision — 64B5-16.005(2): making impressions for study casts not used to fabricate intra-oral appliances, restorations or orthodontic appliances; impressions for opposing models, bleaching stents, palatal-coverage surgical stents, and home fluoride trays; placing periodontal dressings; removing periodontal or surgical dressings; placing or removing rubber dams; placing or removing matrices; applying cavity liners, varnishes or bases; applying topical fluorides approved by the ADA or FDA, including varnishes; positioning and exposing dental and carpal radiographic film and sensors; applying sealants; placing or removing prescribed pre-treatment separators; securing or unsecuring an archwire; and removing sutures.

On-the-job training + DIRECT supervision — 64B5-16.005(3): applying topical anesthetics and anti-inflammatory agents that are not applied by aerosol or jet spray; and changing bleach pellets in internal bleaching of non-vital endodontically treated teeth after rubber dam placement — the assistant may not make the initial access preparation.

On-the-job training + INDIRECT supervision — 64B5-16.005(4): retraction of lips, cheeks and tongue; irrigation and evacuation of debris not including endodontic irrigation; placement and removal of cotton rolls; taking and recording blood pressure, pulse rate, respiration rate, case history and oral temperature; and removing excess cement from orthodontic appliances with non-mechanical hand instruments only.

On-the-job training + GENERAL supervision — 64B5-16.005(5): instructing patients in oral hygiene care and supervising oral hygiene care; providing educational programs and other educational services not involving diagnosis or treatment; and fabricating temporary crowns or bridges in a laboratory.

The pairs that catch candidates out

Remediable restorative functions — Rule 64B5-16.0051

This rule creates Florida's expanded restorative role for assistants. All functions delegated under it are performed under direct supervision.

What may be delegated. After a dentist has prepared the tooth, the dentist may delegate to a trained dental assistant the tasks of placing, packing and contouring amalgam and composite restorations and the fitting and contouring of stainless-steel crowns. Critically: "a dental assistant shall not permanently cement stainless steel crowns." Tasks may be performed only using a slow-speed handpiece and hand instruments.

Practice controls.

• The delegating dentist may not supervise more than four (4) dental hygienists or dental assistants in combination simultaneously performing these tasks.
• The patient's chart must be annotated with the initials of the dental assistant who performed the tasks.
• The chart must reflect that the final restoration was verified by the delegating dentist, and the result of the verification must also be documented.
• A copy of the Restorative Function Course training certificate must be immediately available at the location where tasks are delegated, and produced on request by the Board office or any authorised inspector.
• The delegating and supervising dentist remains fully responsible for all delegated tasks and for ensuring the assistant meets the training requirements.

Candidate prerequisites. At least 18 years of age; a high school graduate or holder of a High School Equivalency Certificate; a current Basic Life Support for Healthcare Provider certificate; a graduate of a dental assisting program accredited by a USDE-recognised dental accrediting entity or formal expanded-duties training under Rule 64B5-16.002(1)(b); never having had a dental assisting licence suspended or revoked in any jurisdiction; documented proof of 2,400 hours of clinical work experience in a dental office or as a dental assisting educator within the 24 months prior to admission; and an enrolled delegating dentist, who must attend a two-hour online interactive video conference on the laws and rules of remediable restorative functions and clinical calibration.

The course. Offered by a USDE-recognised accredited dental or dental hygiene school or program, comprising 105 clock hours: a minimum of 10 hours preclinical didactic (which may be online), a minimum of 70 hours simulated lab, and a minimum of 25 hours on live patients — split into 12 clinical hours with the delegating dentist and 13 clinical hours at the provider institution. An initial written examination must be passed at 75% before the clinical portion. Exit examinations include a written section covering the laws and rules of dentistry in Florida plus a live-patient clinical examination, each requiring 75% or above, and the two may not be weighted to reach an overall 75%. Examination hours do not count toward the 105.

Emergency remediable tasks — Rule 64B5-16.008

Where the dentist of record cannot be physically present to pre-examine the patient and the patient will be seen by a dentist within 3 days, both assistants and hygienists who hold current CPR certification (AHA, Red Cross or equivalent) and are trained under Rule 64B5-16.002 may, without pre-examination by a dentist, remove and re-cement properly contoured loose bands not permanently attached to an appliance; secure or unsecure an archwire by attaching or removing the fastening device; insert or remove alveolar socket dressings in diagnosed post-operative osteitis; and place or remove periodontal dressings where the patient is uncomfortable due to loss of a periodontal pack during the prescribed treatment period.