The Compliance Divas Podcast
Our podcast covers current topics such as infection prevention and control, OSHA and HIPAA compliance for dentistry. We discuss the latest regulatory information, answer frequently asked questions and give suggestions for dental practices to make compliance easy and sustainable. The Compliance Divas are a trusted source for consistent, accurate information based upon current guidelines, standards, science, and recommendations.
The Compliance Divas Podcast
#180 Special Edition - New CA Dental Assisting Rules - What You Need to Know
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The California Dental Board has implemented new rules affecting unlicensed and Registered Dental Assistants in CA. These rules have a 1-1-2025 deadline for compliance and our resident expert, Leslie Canham, will explain all of the upcoming changes.
Resources:
- CA Dental Board Statutes and Regulations https://bit.ly/4hgYsO5
- CA Allowable Duties of Registered Dental Assistant https://bit.ly/4f0ATYi
- CDA - Licensure and scope changes will affect CA dental practices in 2025 https://bit.ly/48nuzY6
Welcome!
SPEAKER_00I'm Leslie Cannon. I'm Mary Gavoni. I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas podcast. I'm Mary Gavoni and I will be the moderator for this episode. We have a very special episode today. We're going to interview Leslie Cannum, who is a compliance expert from California, and we're going to discuss what is happening with the rules and regulations for dental assistants in California. The Compliance Divas bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. You can subscribe to the Compliance Divas podcast through your favorite podcast channel or on the compliance divas website. You also can ask or submit questions to the ComplianceDivas at support at compliancedevas.com. All the resources we mentioned during our podcast can be found in the show notes in your podcast app. And we ask that as you complete listening to the podcast, that you scroll down and leave us some feedback or leave us a review. The California Dental Board has been very busy with updates that go into effect on January 1, 2025. It means big changes for dental assistants on infection control training, allowable duties, and pathways to licensure. Every dental practice needs to take note of what is in store. So, Leslie, as our California resident expert, tell us about the changes to the infection control training requirements for dental assistants in California.
SPEAKER_01Well, Mary, it's actually very exciting because when we have changes to infection control, it means that there's more attention brought to the topic. And in many cases, we have team members who are hired in dental offices who don't have any kind of formal training or education in dentistry. And many times dentists will train people on the job, but sometimes there's a gap in understanding the true meaning of how infection control works. So according to Senate Bill 1453, which actually goes into effect on January 1st of 2025, there are stricter requirements for completing infection control courses for unlicensed dental assistants. And there has been since 2010 a requirement to take an eight-hour infection control course for all dental assistants who were not licensed as RDAs. And it had a little cutoff or a time frame where if you were hired by a dental practice before 2010, you dodged the bullet. You didn't need to take that if you were an unlicensed dental assistant. This new regulation that goes into effect requires that all unlicensed dental assistants complete an eight-hour infection control course actually prior to performing any basic supportative procedures in dentistry. And anytime someone is exposed to blood or other potentially infectious materials, they are considered a dental assistant. So let's say that someone only works in sterilization, so they're required to have that kind of training too. And I'll talk a little bit more about that in just a few minutes. And the other part of this that's interesting is that there's no exceptions. If you were hired before 2010, it doesn't matter if you're unlicensed as a dental assistant working in a dental practice on January 1 of 2025, you don't get to work in the clinical area anywhere, and there's no exceptions.
SPEAKER_00Wow, Leslie, that has some pretty broad effects on dental practices. I imagine there are folks that were grandfathered in in 2010 who maybe have not taken this infection control eight-hour course. And again, a pretty broad definition of who is a dental assistant. So let's go back and talk about the sterilization text. And as you mentioned, who all is required to take this course?
SPEAKER_01Well, you know, Mary, a lot of times with the workforce shortage, the first place where we think to hire someone to help us out so that the clinical team can be at chair side and be with patients and be productive is to bring somebody into the sterilization room and train them. Because you think, well, how hard is it to show someone how to process instruments? Well, you know, and I know, as former dental assistants, it can be pretty overwhelming if you don't know your tray setups, if you don't understand, you know, the concept of handling sharp items, of packaging. I remember, Mary, if you could just refresh our viewers' memory of this one instance where you had somebody who wasn't trained in dental assisting who made a mistake when it came to the color change on sterilization pouches.
SPEAKER_00Oh, Leslie, that's my signature infection control nightmare story. And it happened a number of years ago in a practice that was utilizing nylon tubing, typically called Nyclave, to package their instruments. And so you cut it to length for your instruments that you're processing, and you can either heat seal or you can put autoclave tape on each end of the package to seal it. So who knows how much training or the quality of the training that was done for this person? She had previously worked at McDonald's, and she remembered that she wasn't supposed to put instruments away in storage or in the treatment rooms until they had these black lines on the autoclave tape on the pouches. So when she attempted to operate the sterilizer, she couldn't remember. She was in a hurry. Um, people needed instruments, so she got out a ruler and a Sharpie and drew, traced the lines on the ends of the package on the autoclave tape. So we don't know exactly how long that was going on, but it was a few days that they were doing this, and so they had unsterile instruments cleaned, but unsterile instruments going into treatment rooms.
SPEAKER_01You know, and that's pretty scary because you would think someone who's put on the spot in a position where they want to shine as an employee, don't want to admit that they don't have the knowledge, and people sometimes are a little reluctant to say, you know, help me. I don't understand what is the process, or remind me. I know you've told me before or you've shown me before, you know, I made notes, but I still don't get it. And and people sometimes are reluctant to show that they're worried that that maybe they might be fired for not being competent in the job. So sterilization texts really do need the attention, this the training and the information. And of course, our very favorite place to send people for that is the Association for Dental Safety, formerly known as OSAP. So with this in mind, sterilization techs can might be somebody who hops in from the front office area to run those instruments in. Or you may have someone who comes on a day where one of receptors who's called back on a day where they're shorthanded and asked to turn over a treatment room. Well, now they're in the category of needing to have the eight-hour infection control course. So it's before anyone's exposed to anything that OSHA would consider you to be exposed to, blood or other potentially infectious materials.
SPEAKER_00And Leslie, I think I heard you say before that any unlicensed dental assistant who has not taken this eight-hour course is not able to work in dentistry when this rule takes effect January 1st. Is that true?
SPEAKER_01That is absolutely true. And that just astounds me because so many people are working in dentistry in California who are not licensed as either RDAs or have one of the special permits where they've already taken this course. So it means that they must take it if they haven't already taken it. And I think it's going to really rock dentistry in California because dentists will be operating illegally if their dental assistant doesn't have this certificate. But one of the things that did come out of this new um, I guess you could say, legislation that you know is great for infection control, not so great for the workforce shortage and for the distribution of how we're going to manage this and implement this all in dental offices coming up in January, is that now it's easier to get the eight-hour infection control certificate. It's an eight-hour course, but starting January 1, they've eliminated the lab portion, which means that there's a didactic portion, and it's still going to be eight hours, six hours is really going to be devoted to the didactic or education part, but the part that's really more on I could say hands-on can be videos instead of actual hands-on. Now, it doesn't mean that the eight-hour courses have to change to that. The ones that are teaching the hands-on portion now and the didactic, currently it's it's a minimum of four hours hands-on. And in my opinion, that's really very little time to teach infection control to someone that hasn't had experience with it or doesn't understand the fundamentals or have a formal background in dental assisting training. So it's really, it's going to make the information very concise, very clip, very short, very minimum need to know, not nice to know. It's a lot of nice to know stuff when it comes to infection control. And that's where I'm going to circle back to Association for Dental Safety with the information that they have, the abundance of information on their website, the webinars that can be taken to supplement someone's information. There's also the CDC Division of Oral Health. They have a fantastic three-hour program that is a self-paced program. And I'm going to hope to make that something that be even mandatory as part of my training that they get or get extra credit or bonus points or something for taking that, besides the coming out at the other end, having a very good foundation. And it's really, you know, called foundations. It's called foundations for the safest dental visit. So I'm going to see how I can make that part of my program that's going to be a recorded program, but something that dental assistants can access very, very quickly so that there's not an interruption in the delivery of dental services in California. We're already suffering from the workforce shortage.
SPEAKER_00You're so right, Leslie. And so this is the double-edged sword. This legislation is good for patient safety, making sure everybody is trained and understands how to help with providing that safest dental visit for patients. But on the other side, when you're dealing with shortages and putting extra requirements on, wow, there's a juggling act to try to balance that. But in addition to the infection control training, my understanding is that there are new duties for a dental assistant that are in this legislation.
SPEAKER_01That's right, Mary. And for dental assistants, I think it's rather exciting. I'm thinking that it may cause a little bit of trepidation for others that aren't certain that this should be a dental assistant duty. It's actually the duty of coronal polishing. And coronapolishing is currently an RDA duty. And when I got my RDA license, it was an elective. You could get it or not get it. It was up to you. If you wanted to do it, you'd have to go to the course and get the certificate, and then you could do it. And I remember taking the course and the instructor telling me that Leslie, you're you're you're pushing too hard on the Profi Cup. You know, you're creating a lot of heat there. And I had no idea. I thought, you know, well, you know, the harder you polish and the more you push, the better job you're gonna do, and the happier your boss is gonna be. And she said, no, you could cause some serious, you know, root damage if you're if you're pushing and creating heat. So I had to be educated on how to do it, and then I had to practice it. Well, today coronal polishing is actually a prerequisite for becoming an RDA. And there was a period of time where you had to get your coronal polishing license to renew your RDA. So now coronal polishing being a DA duty, you don't need to be an RDA, and all you need to do is to take the coronal polishing course. And the prerequisite to that, the only thing is the eight-hour infection control course and a CBR certificate. There's no other work experience or education required in order to get into that coronal polishing course. So that's something that is a little bit scary in that uh we hope that the coronal polishing course is going to do a good job of training on all the things that you can go wrong when you're coronal polishing. And then we hope that it will be something that is embraced and used properly. It used to be coronal polishing was only to remove from surfaces of teeth prior to cementing of anything that ortho or bonding any brackets or or anything prior to certain cementation. But today, coronal polishing doesn't have that restriction. So it could be used as part of a prof. No, hopefully, we're not talking about a profile all by itself. We still want to make sure that the teeth are deemed plaque-free by the dentist or hygienist. And the other new duty that is something that is kind of exciting for the orthodontists who are utilizing dental assistants, there is an orthodontic assistant permit that you can acquire. And previously it had all sorts of prerequisites for becoming an orthodontic assistant permit holder. And they removed all of the educational or training requirements prior to starting an orthodontic assistant permit course or even applying for the orthodontic assistant examination. And that permit is something that allows a dental assistant to actually not only do coronal polishing but ultrasonic scaling, again, prior to cementation of brackets or bands for orthodontic, to size and cement orthobands as long as their position has been approved by the supervising dentist or orthodontist. So there's some new things that are coming for unlicensed dental assistants. And then later this year, I want to talk about what's happening for RDAs. There's a few new things that are coming up our pipeline for RDAs and RDA apps. But that's it, that's a later discussion to have.
SPEAKER_00Well, thank you for that summary and that news. I imagine there will be some trepidation, as you said, from some hygienists about the corona polishing issue. But as you said, there's a lot of issues or a lot of damage that could be done if people aren't knowledgeable about how to correctly polish, what kind of pressure, and even what kind of polishing agents to use, since we have so many different restorative materials out there, and it makes a difference what you do or do not use. So thank you for that. Then I think I understand as well, Leslie, that there are some new pathways to RDA licensure. Can you fill us in on that?
SPEAKER_01Yes. And you know, Mary, I know you're going to be thrilled to hear this that finally in California, CDAs, certified dental assistants are recognized. And in the past, we were not. We were considered to be, well, you know, it's nice that you're a CDA and you've got that national recognition. But in California, that doesn't help you with being able to do anything or apply for RDA here. It doesn't really count. And you know, that's kind of a slap in the face because really we worked hard to become certified dental assistants and have maintained that designation over and over again, just like dental licensure with continuing education and other requirements. So today, certified dental assistants actually qualify to apply for RDA designation, which will help us with the workforce shortage, because as we have people moving to California instead of hopefully moving away but moving into the state, a certified dental assistant only needs to acquire the prerequisite courses in order to apply for the RDA exam. They don't have to take the exam. So it's the eight-hour infection control course, which will be able to be done online, the California Dental Practice Act course, which is another requirement for unlicensed people, but a different situation with how soon they have to have that, a CPR certificate, which likely they already have, a California radiation safety certificate, a coronal polishing certificate, and a fit and fish resealment certificate. And all of these certificates that we're talking about are California board-approved providers. So if you had an X-ray certificate or license in another state, that wouldn't qualify here. But it is nice that they can bypass, CDAs can bypass all the other requirements. So for everyone else in California, you either have to graduate from a board-approved registered dental assistant program, or there's the on-the-job training pathway, which is either it's 15 months or 1,280 hours of OJT, completion of an alternative dental assisting program, or completion of something called a preceptorship. And a preceptorship is something that is new that the California Dental Association has helped dentists come up with a curriculum where they can be the dental assisting school, so to speak. And it includes a certain number of hours that they have as supervision. It's 500 hours of clinical chair side experience directly supervised, approved, and documented by a preceptor who would be the dentist. And then the accumulation of work experience. And then they have uh 300 didactic uh coursework hours, and California Dental Association has helped to incorporate some of those uh training mechanisms for dentists so that they have, so to speak, a curriculum or syllabus to work off of. And that'll include the eight-hour infection control certificate and the dental practice act, the things that they have to have, so those other required items. And so that's all pretty exciting for helping us develop some new dental assistance and into maybe climbing the career ladder of becoming RDAs. But one of the biggest things that I want California dental professionals to know, there is a time clock on the current eight-hour infection control course for unlicensed dental assistants. And there's also another part of that, the Dental Practice Act is a requirement for unlicensed dental assistants as well as CPR. But the infection control eight-hour course and the dental practice act course that have been taken by people in California today who are unlicensed, there's a new time clock. Starting January 1, they're only good for two years if you are going to advance the career ladder to RDA or to get one of the specialty permits, like the orthodontic assistant permit or the other dental sedation assistant permit. Now, previously, assistants would have five years from the time that they took that course or those courses. And it's a funny thing, I had one dental assistant who had taken this training for me, and she was five years and one day past the deadline to apply for her RDA exam, and the dental board turned her down flat. She had to retake the course again in order to apply for her RDA, even though she had taken it, even though it was only 24 hours, they were very strict. The law is the law. It's black and white. So the big shout out and the big message if you are applying for RDA or orthodontic assistant or dental sedation assistant permit, do it now. And and the information I have for my most recent meeting with the California Dental Assistant Teachers is that uh the deadline to do this, to submit your application is probably by December 31st of this year. And when you're postmarked by then, that they should be able to go by the old regulations. But if you wait until January 1, then if you're over that two-year period, you're gonna have to take those courses again. Oh, one more thing to add to the information is that uh starting January 1, the eight-hour infection control course is also prerequisite for anyone who wants to get a radiation safety certificate. And you cannot expose images, you can't uh operate radiographic equipment without it in California today.
SPEAKER_00Great information and very important for our listeners in California to make sure that you are paying attention to those deadlines. There's not a grace period, it's very hard line. It is interesting to me that California finally has, and I think there are other states as well, recognizing certified dental assistance as something other than an unlike. Licensed assistant, so that you are given credit, as you said, for all that hard work completing that examination. The only thing in the criteria list that concerns me a little bit is the completion of an alternative DA program. So I'm guessing maybe that means something maybe that would fall into the preceptorship category or something that's not accredited. And I know I just put you on the spot, Leslie, of trying to find an answer to that, but that's kind of a vague alternative. You know, do I have to prove that I graduated from another dental assisting program? Could it be something in another state? Leslie has an answer for us on what qualifies as an alternate dental assisting program.
SPEAKER_01Oh, great question, Mary. And the dental board did give us the definition of that. Alternative dental assisting program means a program that's offered from institution of secondary or post-secondary education that has a current accreditation from the Commission on Dental Accreditation, or is accredited or approved by an agency recognized by the United States Department of Education or the State Department of Education. And that would include career health and technical education programs, regional occupational centers or programs, or apprenticeship programs registered by the State Department of Education or Division of Apprentices Standards of the Department of Industrial Relations and Allied Dental Programs. And whereby a certificate of completion from the program shall serve as a pathway component for a licensure as a registered dental assistant.
SPEAKER_00Fabulous. So that then allows dental assistants in California a wealth of pathways in order to become an RDA. That is absolutely amazing. Thank you for that, Leslie. Leslie, any closing thoughts on all these changes happening for dental assistants in California?
SPEAKER_01Well, you know, the main thing is for dental assistants to know that the career ladder is available to you and there are pathways to become more able-bodied to provide and produce in dentistry, and there's a career ladder that can lead you to even an RDAEF, which is expanded functions. In California, EFs can place amalgam and composite restorations, they can cement crowns, they can starting in July, they'll be able to do oral cancer screening, which is be a huge, huge benefit to the patients out there that may not be getting that on a regular basis. And so it's really exciting. And for the dentists who are uh over seeing dental assistants, who supervise dental assistants, please do this. Do yourself a favor and subscribe to the dental board's newsletter so that you can be informed of these changes before they actually catch you by surprise.
SPEAKER_00Oh, wise words, Leslie, wise words. Well, thank you for joining us for this special episode on changes to the dental board rules for dental assistance in California. The compliance divas bring clarity and simplicity to compliance by navigating the regulatory world to keep you on course. You can submit questions to support at the compliancedivas.com. We will include resources, including a copy of the legislation about these new functions and link to the California Dental Board newsletter so that you can stay up to date in the show notes on your favorite podcast app. When you finish listening, please scroll down to the end of the app and leave us a review or send us some feedback. We thank you for joining us and we'll see you next time.