Each applicant for an expanded function dental assistant certificate must submit to the board or its agent the required fees and following documentation.

1. A. Completed application and the completed jurisprudence take home exam. Applications are valid for one year from the date of receipt.

2. B. Dental radiography:

   1. (1) proof of passing the board or DANB written examination on radiation health and safety;

   2. (2) an affidavit from a supervising dentist, dental hygienist, or dental assistant certified in radiography verifying the applicant has:

      1. (a) assisted with and observed five cases of full-mouth intra oral radiographic series or five panoramic films if applying for a limited certification; and
      2. (b) that upon reaching competency, the applicant independently exposed the radiographs submitted for technique examination;
   3. (3) the completed full mouth intra oral radiographic series or a panoramic film as required for the technique exam described in 16.5.33.9 NMAC.

3. C. Rubber cup coronal polishing and application of topical fluoride:

   1. (1) proof of passing the board or DANB written examination for rubber cup coronal polishing and application of topical fluoride;

   2. (2) an affidavit from a supervising dentist, dental hygienist, or dental assistant certified in rubber cup coronal polishing and topical fluoride application that the applicant has:

      1. (a) assisted with and observed five cases of rubber cup coronal polishing on adults and children and five applications of topical fluoride on children; and
      2. (b) while being personally observed by a dentist, dental hygienist, or dental assistant certified in rubber cup coronal polishing, application of topical fluoride provided rubber cup coronal polishing on five adults and five children; and, provide applications of topical fluoride on five children.

4. D. Pit and fissure sealants:

   1. (1) proof of passing the board approved examination on application of pit and fissure sealants;

   2. (2) an affidavit from a supervising dentist or dental hygienist verifying that the applicant has:

      1. (a) assisted with and observed placement of 12 pit and fissure sealants; and
      2. (b) while being personally observed by a dentist or dental hygienist, the applicant successfully place pit and fissure sealants on six patients.
   3. (3) proof of 2080 hours of chair side dental assisting experience within two years immediately prior to application for certification;
   4. (4) the completed jurisprudence exam.

[16.5.33.12 NMAC - Rp, 16.5.33.12 NMAC, 5/31/2023]