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Legal Implications

Objectives:

  • Define the South Dakota Dental Practice Act.
  • Define Expanded functions and Advanced Dental Assistant
  • Identify legal expanded functions for an ADA in South Dakota

Dental Practice Act
In each state statues are enacted by legislature to make rules and regulations. The state board of dentistry is an administrative agency in each state that enforces these statues and rules. Each state has a Dental Practice Act that describes the legal restrictions on the dentist, hygienists, and dental assistants. The Dental Practice Act describes team members as licensed or nonlicensed and lists what is allowed or disallowed duties for each, including expanded functions for dental assistants. The Dental Practice Act for each state gives guidelines for licensing and identifies grounds by which the license can be suspended or repealed. The content in this module addresses the South Dakota Dental Practice Act. As a dental assistants you are advised to access the current State Dental Practice Act for that state when moving to another state to determine that state’s guidelines for delegable expanded functions.

Dental Assistant and Dental Radiographer
The South Dakota Dental Practice Act requires a dental assistant to be at minimum a high school graduate or its equivalent and be at least 18 years of age. In order to expose radiographs the dental assistant must have successfully completed a minimum of a 16 hour board approved course in dental radiograph, pay a fee and obtain a license in dental radiography. Most of you have probably already completed a qualifying course and have this license.

Advanced Dental Assistant
South Dakota’s State Dental Practice Act assigns the duties of expanded functions to the “Advanced Dental Assistant” (ADA) The minimum educational requirement for an ADA is one of the following:

  • Completion of a Dental Assisting program approved by the board
  • Dental Assisting National Board certified
  • Certificate of Competency from the state board

Completion of this course in it’s entirety will give you the educational requirement for making application to the South Dakota Board of Dentistry for a license as an ADA. Performing any expanded duty without this license is performing dentistry without a license and is considered an illegal act. In addition to completing this course you must have proof of CPR and pay a fee. Go to www.sdboardofdentistry.com for the application forms.

Expanded Functions
Expanded Functions are specific advanced tasks delegated to a dental assistant that requires increased skill and responsibility. These functions are delegated to the dental assistant by the dentist in accordance to the Dental Practice Act. Like all functions the dental assistant performs, the expanded functions fall under the doctrine of respondeat superior. Translated this means “let the master answer.” So, if wrong doing takes place under the guidelines of employment, the dentist is liable for the negligent act. However, this does not mean that the dental assistant is not held responsible and therefore cannot be sued. It merely means that a suit can be filed against either the employee or the dentist or both.

Dental Assistants who perform expanded duties are generally covered under their dentists liability malpractice insurance however is it advised the dental assistants performing expend functions carry their own liability insurance. Current members in the American Dental Assistant Association (ADAA) have a $50,000 professional liability coverage. Other organizations and professional groups offer malpractice/professional liability insurance and risk management information. Be sure to discuss this issue with your dentist/employer to decide your best option.

The expanded functions are further specified according to how they are to be delegated. In South Dakota expanded functions can only be performed by an advanced dental assistant under the direct supervision of a dentist.

Procedures that may not be delegated
South Dakota’s Dental Practice act lists specific procedures that may not be delegated to an advanced dental assistant. Those procedures include:

  • The cutting of hard or soft tissue
  • Intraoral procedures that will be used directly in the fabrication of a dental prosthesis
  • Irreversible procedures
  • The injection of medication
  • The administration of nitrous oxide analgesia
  • The placing, finishing, and adjusting of final restorations; and
  • Those procedures specifically delegated to dental hygienists with the exception of sealants and coronal polishing following a prophylaxis by a dentist or dental hygienist.

Procedures that may be delegated
The South Dakota Board of Dentistry does not specifically list those functions that can be delegated. The following is a list of duties the members of the South Dakota State Board compiled a number of years ago to give some guidance to educational programs in preparing their curriculums for expanded functions.

Board approved CODA accredited DA program curriculum allowable functions not listed for an RDA are as follows:

  • Take impressions for casts and appropriate bite registrations. Advanced dental assistants shall not take impressions and bite registrations for final construction of fixed and removable prostheses.
  • Apply topical medications and fluoride, cavity liners and bases.
  • Place and remove periodontal dressings.
  • Preliminary charting Of the oral cavity.
  • Etch enamel and place sealants.
  • Place and remove rubber dam.
  • Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with hand instruments only.
  • Construct custom trays.
  • Place and remove retraction cord.
  • Prepare, place, and remove temporary crowns.
  • Polish coronal surfaces of the teeth.
  • Remove sutures.
  • Place and remove wedge matrix bands.
  • Place and remove elastic orthodontic separators.
  • Pre select and cement orthodontic bands and brackets.
  • Remove excess cement from coronal surfaces of teeth.
  • Remove and replace ligature ties on orthodontic appliances.
  • Place and remove preformed arch wires.
  • Administer nitrous oxide analgesia with a separate certificate.