4.2 Dental Assistant Duties: Traditional, Certified & Graduate Assistants (Den 404.01–404.02)

Dental Assistant Duties

New Hampshire does not license dental assistants. OPLC's licensing page notes that the Board's rules govern their scope of practice. The dentist decides whom to hire and what to delegate, but only within the Den 400 duty lists, and only to assistants trained to do the work correctly (Den 501.01(b)).

Assistant categories — Den 101

Duties of every dental assistant — Den 404.01

Under general supervision (Den 404.01(a))

1. Process and sterilize instruments and perform infection control
2. Organize and arrange instruments on bracket tables
3. Seat the patient and place protective materials or garments, including lubricating the patient's lips
4. Reorganize instruments and equipment after the patient leaves
5. Process dental radiographs
6. Function as a dental laboratory technician
7. Perform tests on saliva
8. Train or instruct groups or individual patients in oral hygiene and mouth care
9. Take and record vital signs

Under direct supervision (Den 404.01(b))

1. Retract the patient's cheek, tongue, or other oral tissues during a dental operation
2. Assist with placing or removing a rubber dam and its accessories, as directed by the operating dentist
3. Remove debris during treatment using vacuum devices, compressed air, mouthwashes, and water
4. Place cotton rolls and topical anesthesia before local anesthesia is delivered by a dentist or hygienist
5. Apply topical fluoride after a prophylaxis by a licensed professional
6. Apply non-prescription desensitizing agents to cementum and dentin
7. Select, seat, hold, and remove impression trays
8. Insert athletic mouthguards
9. Perform intraoral scanning with a digital device, or take photographs

Infection control prerequisite (Den 404.01(c))

Before a traditional assistant processes and sterilizes instruments or performs infection control, including in a public health setting, he or she must qualify in infection control in the dental office under Den 302.06(b). That means a course of at least 4 hours that follows current CDC recommendations and ends with a written exam. CDAs and graduate assistants are exempt from this prerequisite.

Assisting a CPHDH in public health settings (Den 404.01(d))

In a school, hospital, other institution, or homebound setting, an assistant may help a certified public health dental hygienist under public health supervision (Den 302.02(d)(2)). The eight permitted duties are:

• instrument processing, sterilization, and infection control;
• bracket-table setup;
• seating and draping the patient;
• reorganizing equipment;
• processing radiographs;
• oral hygiene instruction;
• retraction and debris removal during the hygienist's procedure;
• rubber dam assistance as directed by the operating CPHDH.

Additional duties of CDAs and graduate assistants — Den 404.02

Certified and graduate dental assistants may, in addition to all assistant duties, perform the following under direct supervision:

Reading the lists correctly

• The 400-hour clock counts clinical dental assisting experience. A CDA certificate does not replace it for the (l) duties.
• Rotary instruments are the recurring limit. Assistants may place and remove temporaries and cement orthodontic bands, but not with rotary instruments intraorally. Removing excess cement with a handpiece is outside the list.
• Placing amalgam is not condensing and carving it. The dentist condenses. Placing, contouring, and adjusting direct restorations is reserved for EFDAs under Den 302.07 (section 5.3).
• Traditional assistants cannot use Den 404.02 at all. They expand their duties through the qualification courses in Den 302.06 (section 4.3).

Worked scenario

Kelly, a traditional assistant with 3 years of experience, is asked to (1) take a patient's blood pressure while the dentist is at lunch, (2) place topical anesthetic before the dentist's injection, and (3) make a final impression for a crown.

1. Blood pressure with the dentist out is lawful: taking vital signs is a general-supervision duty for every assistant (404.01(a)(9)).
2. Topical anesthetic is lawful only with the dentist in the office: it is a direct-supervision duty (404.01(b)(4)).
3. A final impression is not permitted. Final impressions are a Den 404.02(l) duty for CDAs and graduate assistants with 400 or more hours, and Kelly is neither.