Myth busters for dental assistants: Know the laws for dental assisting in your state

The misinformation about the laws governing dental assisting is amazing. Where do people come up with the wild and crazy versions of what they think is true?

I recently read a Facebook post where someone talked about “phantom billing.” Phantom billing refers to billing a service before the practice performs the service. Wow, how creative! So let’s use the proper name for that—insurance fraud!

You must either have already performed the service or be in the process of it, like the start of root canal treatment (RCT), where the patient will need to come back later to have a permanent seal done. Another example is a crown prep, when a patient will need to come back for the final cementation. However, many insurance companies are working from a “crown seat” date.

Dental assistants and the laws governing them are very different. As a matter of fact, each state has its own set of laws. What dental assistants can do in one state often cannot be done in another. It’s so confusing.

I was told by an attendee at one of my courses that California is called the brat state. I hadn’t heard that before, so I asked her what it meant. She explained, “If you are licensed to do something in California, then you can do it anywhere in the country. You know, because California has the toughest laws and it’s the brat state.” This little tidbit of information is . . . wrong!

You might also want to read: Dental office infection control myth busters: handpieces

What's required in your state?

Every state has a different set of laws. Some states require a license, but many do not. Some states require assistants be RDAs and some do not. But an RDA license will differ greatly from state to state. Some states require DAs to carry a permit to perform expanded functions, while others do not.

Expanded functions are something that are all over the board as well. Some states don’t offer expanded functions and, if they do, they vary in responsibilities and duties. Some states offer an EFDA—Expanded Functions Dental Assistant—while others offer an EDDA—Expanded Duties Dental Assistant.

Earning Certified Dental Assistant (CDA) certification through the Dental Assisting National Board (DANB) is not required for entry-level employment in any state. However, some states do require DANB’s CDA certification if an assistant wants to move up in his or her career. For instance, Massachusetts requires holding DANB certification or a certification from another board-approved certifying body, along with specific education, to register as an expanded function dental assistant.

Missouri requires assistants either to hold DANB CDA certification or to pass the DANB-administered Missouri Basic Skills Exam and to complete approved coursework in order to earn an expanded functions permit. The Missouri Basic Skills state exam does not carry over to other states. However, DANB’s national exams and certifications are recognized or required by 39 states, the District of Columbia, the U.S. Air Force, and the Department of Veterans Affairs.

Is there a doctor, no wait, a lawyer in the house?

I was recently speaking to a packed room about dental assisting laws and I was fortunate enough to have a doctor in attendance who was not only a dentist but also a lawyer. During the break, I had several people come up and ask questions. Several of them wanted to talk about IV sedation and the regulations governing it. Since I wasn’t in my state and I was not familiar with the law, I waited until everyone was seated and asked for the help of the dentist/lawyer. When I asked him the question regarding IV sedation in that state, his response was, “There is no question. It is illegal for a dental assistant to perform IV sedation in this state.” With that, you could have heard a pin drop. At least 15 people shared with me that they are sedating patients, yet none of them knew it was illegal. They were all “doing what their doctors told them to do.”

I was instructing a class about nitrous oxide and two assistants shared that they had just attended a course about “venipuncture.” I asked them what that is, and they explained that they were now certified to draw blood from patients to use for bone grafts and implants. I asked them who presented the course they took. The course was from a dentist who is now retired and teaches this class.

With them in earshot, I called the dental board for that state and asked the person who answered if she was qualified to speak about the laws governing dental assistants. She assured me she was and asked what I needed to know. “Is it legal for a dental assistant in this state to draw blood on a patient?” Her answer was a resounding no! Although a phlebotomist does not necessarily need a license to draw blood in a medical setting (depending on the state), when it is done in a dental setting, the Dental Practice Act kicks in. Dental assistants are not licensed to perform this task.

So, how do we stop the craziness that is misinformation out there? Go to the source! If you want to know what is legal in your state, you can do one of two things. You can visit DANB's website at danb.org and look under the “meet state requirements” tab to search laws in any state. DANB updates this information regularly, so it’s a great resource. Or you can call your state dental board. If you don’t know how to contact the board, Google them, or you can go to DANB’s website to access a list of state dental board website links on the Dental Community Links page. In most cases, you can just call teh state dental board and ask for information without sharing your name or practice name. These are the people who are experts in the law, so tap into their knowledge!

Whatever you do, do not rely on social media to guide you through the twists and turns of dental assisting rules and regulations. Again, the misinformation monster will tell you all sorts of crazy things, and we all know you can’t believe everything you read on the internet.

The other thing is, if you feel uneasy about something you’ve been asked to do, you do not need to do it just because you were told. Check with your state. Ask the people who make the laws. Don’t do something just because it’s always been done that way!