Thursday Troubleshooter: Dental assistants should not be performing some functions

This registered dental assistant has expressed her concerns that the other dental assistants perform duties they're not trained to do. The doctor ignores her. She doesn't want the practice to be liable. What should she do?

Jun 18th, 2019
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Do you have a tough issue in your dental office that you would like addressed? Each week the experts on Team Troubleshooter will tackle those issues and provide you with answers. Send questions to megk@pennwell.com.

QUESTION: The dentist I work for allows dental assistants (DAs) to perform registered dental assistant (RDA) functions on a regular basis. I am the only RDA in the office and the others think nothing of letting the DAs do things they should not be allowed to do. Many of us have been with this practice for over 20 years. This issue has always irritated me. Recently, a DA with very little experience was hired and almost immediately started doing coronal polishing. Among other things, the DAs perform coronal polishing, fabricate, cement, and clean provisional crowns, and clean cement from permanent crowns. A dentist that used to work here even had the DAs packing retraction cord. I have a good working relationship with the other women in the office. They are not bad at what they do, but it’s wrong for the dentist to allow them to do these functions without a license. I have voiced my concern but he totally disregards my comments. Is this common practice in other offices? How do I handle this?

ANSWER FROM THE DENTAL ASSISTING NATIONAL BOARD INC. (DANB):
This is a great question! As you may know, each state has different requirements for dental assistants. In most states, a dental assistant must meet specific requirements set forth by the state dental board or another state regulatory agency to be eligible to perform certain duties. It sounds like your employer may not be aware of your state’s requirements as specified in the state’s dental practice act and the state dental board’s administrative rules.

Since DANB is not a regulatory agency, we can’t say whether your situation is common practice, but we certainly hope not! It’s unfortunate that you are in this position and we understand your dilemma. There are a few ways to handle this situation.

Option one would be to do nothing. However, if you believe that patients may be harmed by the practice, that approach is problematic. In this connection, you may want to review DANB’s Code of Professional Conduct, which calls upon dental assistants who hold DANB certification or who have taken a DANB exam to act within the law and to report those who fail to do so.

Option two would be to take action. It sounds like you have already voiced your concerns, but your dentist has not been receptive. We suggest calling to the dentist’s attention the specific state law or regulation that you believe to be implicated. We recognize that you may not want to be seen as a thorn in the side of the dentist who employs you, so you should consider the potential consequences.

You may wish to have a conversation in person or send the information via email. The benefit to an in-person conversation is that you can gauge the dentist’s reaction. However, sending the information via email has the benefit of documenting your concerns and creating a “paper trail.” Only you know what is best for your specific situation.

DANB is not a regulatory agency, but we do try to keep on top of the regulations and administrative rules governing dental assisting in each state. You can access your state’s dental assisting regulations on DANB’s website through the Search-By-State Map, which outlines all the dental assisting requirements in each state. Each state page also includes a downloadable PDF that lists the dental assisting duties that are allowed or prohibited, and any requirements that dental assistants must meet in that state.

You can also access links to the full dental practice acts and administrative rules for all members of the dental team, a collaborative resource developed and maintained by DANB and the American Association of Dental Boards (AADB), accessible from a link on both websites. DANB and AADB developed this resource to help all dental team members keep current and help them to comply with the state law. Learn more by visiting the Search Dental Practice Acts tool.

If the dentist has questions about what is or is not allowed, you can suggest that he may want to raise the issue with the state dental board. Learn more or find contact information by visiting the state dental board link at the bottom of your state’s page on DANB’s Search-By-State Map.

If the dentist continues to delegate duties to staff who are not qualified to perform those duties, you will have to decide if you want to continue working with that dentist. Switching jobs may be difficult or stressful, so you will have a lot to think about.

We wish you all the best as you address this situation with your employer. For more information, visit danb.org.

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