The Dental Assisting National Board, Inc (DANB) frequently receives requests for information from dental assistants, educators, and state legislators. These queries cover many topics, including: How many states require dental assistants to complete education, training, or exams before performing expanded functions? Can dental assistants in certain states perform radiological procedures without meeting any prerequisites? Do variations in state dental practice acts affect assistants who move from one state to another?

To help provide insight into these matters, this article provides an overview of dental assisting in the United States, updated from information contained in the Position Paper of the ADAA/DANB Alliance: Addressing a Uniform National Model for the Dental Assisting Profession (September 2005).

State Regulations
Currently, there is no nationally accepted set of guidelines that govern the practice of dental assisting in the United States. Each of the 50 states has a dental practice act governing the practice of dentistry and defining the allowable activities of dental assistants. Almost every state (49) recognizes dental assistants in its dental practice act or administrative rules. Only Alaska and Washington, DC, do not address the practice of dental assisting in their dental practice acts. Since 2000, at least 11 states have enacted new legislation or adopted new administrative rules addressing the practice of dental assisting.

The Certified Dental Assistant (CDA) credential is currently the only measure of dental assisting competency that draws nationwide recognition and participation. Thirty-five states recognize or require successful performance on a DANB dental assisting exam (CDA, Certified Orthodontic Assistant [COA], or one or more component exams) for dental assistants to meet state regulations or as a prerequisite to performing expanded functions.

Career Levels
A majority of states (38) recognize more than 1 level of dental assistant in their practice acts. Twelve states recognize only 1 level of dental assistant. Thirty-five states require education, registration, national certification, licensing, or some type of credentialing to perform advanced or expanded functions (excluding radiography). A separate count reveals that 37 states require education, registration, national certification, licensing, or some type of credentialing to perform dental radiography procedures. Twenty-nine of these recognize or require that dental assistants pass DANB’s Radiation Health and Safety (RHS) examination or CDA examination to expose dental radiographs.

Workforce
There are approximately 266,000 dental assistants currently practicing nationwide.

Approximately 46% of these receive most or all of their education through on-the-job training. The remaining 54% have completed some type of formal dental assisting education, provided either by dental assisting programs accredited by the American Dental Association’s (ADA) Commission on Dental Accreditation or in vocational/technical programs located in institutions accredited by another US Dept of Education recognized accrediting agency (that is, these dental assisting programs are not accredited, but the postsecondary institutions are).

Approximately 32,000 of all dental assistants are DANB Certified, and more than 90,600 non-Certified dental assistants have passed 1 or 2 of the 3 CDA component exams (RHS, Infection Control, or General Chairside) since 1997. Please remember that even if a dental assistant passes the CDA examination, he or she is not considered a DANB Certificant unless the assistant maintains the credential by meeting DANB Recertification Requirements. (Visit www.danb.org for more information.)

Approximately 7200 dental assistants may move each year from one US state to another, and as many as 29,000 of the 266,000 active dental assistants might be in positions to accept offers of employment in neighboring states.

DANB’s 2006 “Show Me the Money” Salary Survey revealed that CDAs earn an average of $1.76 more per hour than their non-Certified counterparts. DANB Certificants stay in the dental assisting field for an average of 15.9 years, and stay with the same dentist/employer for an average of 9.3 years. According to the ADA’s 2004 Survey of Dental Practice: Employment of Dental Practice Personnel, dental assistants stay in the profession for an average of 12.1 years and stay with the same practice for an average of 6.8 years. Therefore, DANB-Certified assistants’ career longevity is about one third longer than that of the pool of all dental assistants, both Certified and non-Certified. (Complete results from the 2006 Salary Survey are available from the Winter 2007 issue of Certified Press [www.danb.org].)

According to the ADA’s 2005 Workforce Needs Assessment Survey (Chairside Assistants), responding dentists employed an average of 2.2 full-time and 1 part-time chairside assistants. About 59% of first chairside assistants employed at the time of the survey had been with their dentist employers for less than 5 years. (The percentages for second and third chairside assistants were approximately 82% and 93%, respectively.) About 46% of dentists reported that the supply of chairside assistants was inadequate, and about 51% of these felt that a shortage of chairside assistants in their practice led to difficulty in providing quality care to patients.

Learning More
State dental boards and other state regulatory agencies are responsible for determining which duties can be delegated to dental assistants in their states as well as what is required to perform these duties. DANB, the American Dental Assistants Association (ADAA), and the ADA can only make recommendations for these state bodies and their legislatures to consider.

The ADAA/DANB Alliance supports the adoption of a uniform national career ladder for the dental assisting profession. More information about the proposed career ladder is available in the Position Paper of the ADAA/DANB Alliance. To download a free Executive Summary or to order the paper in its entirety, visit www.danb.org

For more information on DANB Certification, visit the DANB Web site at www.danb.org or call 800.FOR.DANB and ask to speak to a service representative.