Recent Rule Changes Related to Expanded Functions
On November 21, 2022, the Iowa Dental Board adopted rulemaking related to expanded functions. The notification of adoption was published as ARC 6733C in the Iowa Administrative Bulletin on December 12, 2022. The rule changes will be effective January 18, 2023. You can view the complete rules in IAC 650--Chapter 23
Below is a summary of some of the changes enacted by the Board.
- Updated the clinical practice requirement following issuance of a dental assistant registration prior to training in expanded functions.
- Updated Level 1 and Level 2 expanded functions and minimum training requirements.
- Eliminated the requirement to train in all Level 1 expanded functions prior to training in Level 2 expanded functions.
- Updated prerequisites to training in Level 2 expanded functions.
- Level 1 expanded function training may be provided by any Board-approved training program.
- Level 2 expanded function training may be completed at CODA-accredited schools.
Dental hygienists and dental assistants must be issued a certificate of completion for the corresponding function(s) in which training has been completed by a Board-approved training program before performing a specific expanded function procedure. Board-approved expanded function training providers are required to issue certificates of completion when training is successfully concluded.
Level 1 Expanded Functions
A dentist may delegate to dental hygienists or dental assistants those Level 1 expanded function procedures for which training has been successfully completed. Dental hygienists or dental assistants may train in any of the Level 1 expanded function procedures and are not required to train in all of the procedures.
Level 1 Expanded Functions
Taking occlusal registrations.
Placement and removal of gingival retraction material.
Fabrication, temporary cementation, and removal of provisional restorations following review of the fit and function by the supervising dentist, and temporary recementation of provisional restorations.
Applying cavity liners and bases.
Applying bonding systems, which may include the placement of the attachments used in clear aligner systems, following review of the fit and function by the supervising dentist.
Placement, bonding, and removal of provisional orthodontic restorations as follows:
a. Placement or bonding of orthodontic brackets and bands or provisional orthodontic appliances following review of the fit and function by the supervising dentist; and
b. Removal of adhesive, orthodontic brackets and bands, or provisional orthodontic appliances using nonmotorized hand instrumentation.
Monitoring of patients receiving nitrous oxide inhalation analgesia, which may include increasing oxygen levels as needed, pursuant to the following:*
a. A dentist shall induce a patient and establish the maintenance level;
b. A dental assistant may make adjustments that decrease the nitrous oxide concentration during the administration of nitrous oxide;
c. A dental assistant may turn off the oxygen delivery at the completion of the dental procedure.
Taking final impressions;
Removal of adhesives using nonmotorized hand instrumentation.*
Placement of temporary restorative materials following preparation of the tooth by a dentist; and
Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth; and
Tissue conditioning (soft reline only).
*Expanded functions for registered dental assistants.
Level 2 Expanded Functions
A dentist may delegate to dental hygienists or dental assistants those Level 2 expanded function procedures for which training has been successfully completed. Dental hygienists or dental assistants are not required to train in all of the Level 2 procedures.
: Before beginning Level 2 training, expanded function dental hygienists or dental assistants must have successfully completed the prerequisites, for which training will be completed, as established by the Board-approved Level 2 expanded function training provider.
Level 2 Expanded Functions
- Placement and shaping of amalgam following preparation of a tooth by a dentist.
- Placement and shaping of adhesive restorative materials following preparation of a tooth by a dentist.
- Polishing of adhesive restorative material using a slow-speed handpiece.
- Fitting of stainless steel crowns on primary posterior teeth, and cementation after fit verification by a dentist.
- Placement of sealants.*
*Level 2 expanded function for registered dental assistants.
Level 2 expanded function procedures refer to both primary and permanent teeth except as otherwise noted. Training in Level 2 expanded functions may be separated between application of the services on primary or permanent teeth as determined by the accredited training provider.
Expanded Functions Training Approval
Pursuant to IAC 650--Chapter 23, expanded function training shall be eligible if the training has been prior-approved by the Board. You may find a list of Board-approved expanded function training providers here.
1. An initial assessment to determine the base entry level of all participants in the program.
2. A didactic component in accordance with IAC 650--23.7(3);
3. A laboratory component, if necessary, in accordance with IAC 650--23.7(3);
4. A clinical component, which may be obtained under the personal supervision of the participant’s supervising dentist while the participant is concurrently enrolled in the training program in accordance with IAC 650--23.7(3); and
5. A post-course competency assessment at the conclusion of the training program.
Review of Out-of-State Expanded Functions Training
Individuals who completed training in expanded functions in another state may submit information related to the training to the Board for review. Forms to request the review are available here.
Certificate of Completion
Upon the successful conclusion of Board-approved training, training programs are required to issue a certificate of completion for the expanded function(s) in which training was completed. The certificate shall be prominently displayed at the facility where the services will be provided.