PURPOSE: This rule expands the functions a dental assistant may perform under the dentist’s direct supervision.

1. (1) Definitions. FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

   1. (A) Certified dental assistant—a dental assistant who is currently certified by the Dental Assisting National Board, Inc.
   2. (B) Dental assistant—an employee of a duly registered and currently licensed dentist in Missouri, other than either a dental hygienist or a certified dental assistant.
   3. (C) Dental auxiliary—either a dental assistant or certified dental assistant as defined in subsections (1)(B) and (C).

   4. (D) Direct supervision—the following conditions must be satisfied for direct supervision to apply:

      1. 1. The dentist is in the dental office or

treatment facility;

1. 2. The dentist has personally diagnosed

the condition to be treated;

1. 3. The dentist has personally authorized

the procedures;

1. 4. The dentist remains in the dental

office or treatment facility while the procedures are being performed by the dental auxiliary; and

1. 5. The dentist evaluates the performance

of the dental auxiliary before the dismissal of the patient.

1. (E) Proof of competence—any written document, such as a diploma, a certificate of mastery, or a letter from an approved competency testing agent stating that the dental auxiliary has successfully passed the competency testing for specific functions after having—

   1. 1. Completed an approved course—a

course of study offered by an accredited school of dentistry, dental hygiene, or dental assisting or any course approved by the Missouri Dental Board; and

1. 2. Passed an approved competency

examination—an examination testing essential knowledge of specifically itemized functions constructed, administered and evaluated by an accredited school of dentistry, dental hygiene, or dental assisting, the Dental Assisting National Board, or any other competency testing agent approved by the Missouri Dental Board.

1. (2) A registered and currently licensed dentist may not delegate to a dental assistant or certified dental assistant, as defined in subsections (1)(B) and (C) respectively, the performance of the following procedures:

   1. (A) Diagnosis, including interpretation of dental radiographs and treatment planning;
   2. (B) Cutting of tooth structure;
   3. (C) Surgical procedures on hard and soft tissues including, but not limited to, the removal of teeth and the cutting and suturing of soft tissues;
   4. (D) The prescription, injection and parenteral administration of drugs;
   5. (E) The final bending of archwire prior to ligation;
   6. (F) The scaling of teeth; and
   7. (G) Administration of nitrous oxide-oxygen analgesia except that a dental assistant or certified dental assistant may assist in the administration of and monitor nitrous oxide-oxygen analgesia with specific training as provided in section (3) of this rule.

2. (3) A dental assistant or certified dental assistant may assist the administration of and monitor nitrous oxide analgesia under direct supervision if s/he—

   1. (A) Has successfully completed formal certified training in a course approved by the Missouri Dental Board; and
   2. (B) Has successfully passed an approved competency test regarding the clinical and didactic training; or
   3. (C) Has been certified in another state to assist the administration and monitor nitrous oxide subsequent to equivalent training and testing. The dental assistant may qualify to perform this function by presenting proof of competence of this equivalent training and testing to the Missouri Dental Board;
   4. (D) The responsibility of the dental assistant or certified dental assistant shall be to provide the Missouri Dental Board proof of competence; and
   5. (E) Upon presentation to the dental board of proof of competency that the dental assistant or certified dental assistant has complied with the requirements imposed by subsections (3)(A), (B) or (C) of this rule, and remitted the appropriate fee as specified in 4 CSR 110-2.170, the Missouri Dental Board will issue the appropriate certification to the dental assistant or certified dental assistant.

3. (4) A currently licensed dentist may delegate, under direct supervision, functions listed in subsection (4)(D) of this rule to a certified dental assistant or a dental assistant subsequent to submission to the Missouri Dental Board of the following satisfactory proof of competence:

   1. (A) After June 1, 1995, all certified dental assistants graduating from accredited dental assisting programs in Missouri will have competency testing for all functions listed in subsection (4)(D) of this rule and may be delegated those functions by a currently licensed dentist;
   2. (B) Certified dental assistants graduating prior to June 1, 1995, or from programs outside Missouri, may be delegated the functions in subsection (4)(D) of this rule with proof of competence issued by their educational institutions and may be delegated other specific functions if they have completed an approved course, passed an approved competency examination, and can provide proof of competency as defined in subsection (1)(D);
   3. (C) Dental assistants, as defined in subsection (1)(B), may be delegated any specific function listed in subsection (4)(D) of this rule if they have successfully completed a basic dental assisting skills mastery examination approved by the board, completed an approved course, passed an approved competency examination, and can provide proof of competence as defined in subsection (1)(D);

   4. (D) Functions delegable upon successful completion of competency testing are—

      1. 1. Placement of post-extraction and

sedative dressings;

1. 2. Placing periodontal dressings;
2. 3. Size stainless steel crowns;
3. 4. Placing and condensing amalgam for

Class I, V, and VI restorations;

1. 5. Carving amalgam;
2. 6. Placing composite for Class I, V, and

VI restorations;

1. 7. Polishing the coronal surfaces of teeth

(air polisher);

1. 8. Minor palliative care of dental emer-

gencies (place sedative filling);

1. 9. Preliminary bending of archwire;
2. 10. Removal of orthodontic bands and

bonds;

1. 11. Final cementation of any permanent

appliance or prosthesis;

1. 12. Minor palliative care of orthodontic

emergencies (that is, bend/clip wire, remove broken appliance);

1. 13. Making impressions for the fabrica-

tion of removable prosthesis;

1. 14. Placement of temporary soft liners

in a removable prosthesis;

1. 15. Place retraction cord in preparation

for fixed prosthodontic impressions;

1. 16. Making impressions for the fabrica-

tion of fixed prosthesis;

1. 17. Extra-oral adjustment of fixed pros-

thesis;

1. 18. Extra-oral adjustment of removable

prosthesis during and after insertion; and

1. 19. Placement and cementation of

orthodontic brackets and/or bands; and

1. (E) Upon request by the Missouri Dental Board, the licensed and supervising dentist must provide copies of proof of competence of dental auxiliaries.

1. (5) A currently licensed dentist may delegate under direct supervision to a dental assistant or certified dental assistant any functions not specifically referenced in sections (2)–(4) of this rule and not considered either the practice of dentistry or the practice of dental hygiene as defined in sections 332.071 and 332.091, RSMo, and 4 CSR 110-2.130.
2. (6) The licensed dentist is responsible for determining the appropriateness of delegation of any specific function based upon knowledge of the skills of the auxiliary, the needs of the patient, the requirements of the task and whether proof of the competence is required.
3. (7) Pursuant to section 332.031.2., RSMo, the dentist is ultimately responsible for patient care. Nothing contained in the authority given the dentist by this rule to delegate the performance of certain procedures shall in any way relieve the supervising dentist from liability to the patient for negligent performance by a dental assistant or certified dental assistant.

AUTHORITY: section 332.031.2, RSMo 1994.* This rule originally filed as 4 CSR 110-2.120. Original rule filed Dec. 12, 1975, effective Jan. 12, 1976. Rescinded and readopted: Filed April 14, 1982, effective Oct. 11, 1982. Rescinded and readopted: Filed Oct. 13, 1983, effective Jan. 13, 1984. Amended: Filed May 2, 1988, effective July 28, 1988. Rescinded and readopted: Filed Feb. 16, 1994, effective Sept. 30, 1994. Emergency amendment filed Feb. 21, 1995, effective March 3, 1995, expired June 30, 1995. Amended: Filed March 14, 1995, effective Oct. 30, 1995. Moved to 20 CSR 2110-2.120, effective Aug. 28, 2006.

*Original authority: 332.031, RSMo 1969, amended 1981, 1993.