Iowa Dental Board Rule Changes

Regulatory Update

Expanded Functions

On August 2, 2019, the Iowa Dental Board adopted amendments to the expanded function rules.  The amendments include the addition of new expanded functions, establish minimum training requirements for Level 1 expanded functions, and make minor updates to the scope of practice for both dental hygienists and dental assistants.  The new rules go into effect on October 30, 2019. 

All expanded function rules have been moved into a single chapter, IAC 650 – Chapter 23.  The rules regarding scope of practice for dental hygienists and dental assistants continue to be addressed in IAC 650 – Chapters 10 and 20 respectively.  You may review the complete expanded function rules for further details, including the minimum training requirements, here.

Please note: The new rules require expanded function training providers to issue certificates of completion for the corresponding function(s) in which dental assistants and dental hygienists successfully completed Board-approved training.  The certificate(s) of completion will serve as evidence of having met the requirements to perform these services.

The following is a quick breakdown of the different levels of expanded function categories:

• Basic Level 1: If a dental hygienist or dental assistant trains in some, but not all, Level 1 expanded functions, they will be deemed to be basic expanded function dental hygienists or dental assistants. A dentist may only delegate to a dental hygienist or dental assistant those Level 1 procedures for which training has been successfully completed.  
• Certified Level 1: Expanded function dental hygienists or dental assistants who have successfully completed training for all Level 1 expanded function procedures are deemed to be Certified Level 1 dental hygienists or dental assistants.   
• Certified Level 2: Expanded function dental hygienists or dental assistants who have successfully completed training for all Level 1 and Level 2 expanded function procedures are deemed to be Certified Level 2 dental hygienists or dental assistants.
  • Prior to training in Level 2 expanded functions, expanded function dental hygienists or dental assistants must have a minimum of one year of clinical practice as a certified Level 1 dental hygienist or dental assistant and successfully pass an entrance examination with a score of at least 75 percent.
  • A dental hygienist or dental assistant must successfully complete training for all Level 2 expanded function procedures before becoming certified in Level 2.

The rule amendments include a grandfathering clause that allows dental hygienists and dental assistants who successfully completed Board-approved training in expanded functions prior to January 1, 2020 to continue to perform those services.  Documentation of having successfully completed Board-approved training prior to January 1, 2020 must be provided upon request.  For any new expanded function(s), additional training will be required prior to performing those services.

The updated list of Level 1 expanded functions is as follows:

1. Taking occlusal registrations;
2. Placement and removal of gingival retraction material;
3. Fabrication, temporary cementation, and removal of provisional restorations;
4. Applying cavity liners and bases; desensitizing agents; and bonding systems, to include the placement of orthodontic brackets, following the determination of location by the supervising dentist;
5. Monitoring of patients receiving nitrous oxide inhalation analgesia, which may include increasing oxygen levels as needed, pursuant to the following;
   1. A dentist shall induce a patient and establish the maintenance level;
   2. A dental assistant may make adjustments that decrease the nitrous oxide concentration during the administration of nitrous oxide;
   3. A dental assistant may turn off the oxygen delivery at the completion of the dental procedure;
6. Taking final impressions;
7. Removal of adhesives using nonmotorized hand instrumentation;
8. Placement of Class 1 temporary filling materials; and
9. Recementation of provisional restorations.

The updated list of Level 2* expanded functions is as follows:

1. Placement and shaping of amalgam following preparation of a tooth by a dentist;
2. Placement and shaping of adhesive restorative materials following preparation of a tooth by a dentist;
3. Polishing of adhesive restorative material using a slow-speed handpiece;
4. Fitting of stainless steel crowns on primary posterior teeth, and cementation after fit verification by the dentist;
5. Tissue conditioning (soft reline only);
6. Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth; and
7. Placement of intracoronal temporary fillings following preparation of a tooth by a dentist.

*These Level 2 expanded function procedures refer to both primary and permanent teeth except as otherwise noted.
Training in functions that have been added to the scope of practice for dental assistants and dental hygienists will be left up to the discretion of dentists who choose to delegate those procedures.
You may email Board staff at steven.garrison@iowa.gov with any questions about the regulatory changes.

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