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
Pursuant to IAC 650--Chapter 23, dentists may delegate expanded function duties to registered dental assistants if the assistant has completed Board-approved training in the specific expanded function that will be delegated. Certain restrictions and limitations apply. Please refer to IAC 650--Chapter 23 for specific requirements.
A list of Board-approved expanded function training providers is available here.
Certificate of Completion
Beginning in October 2020, 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 or other evidence of Board-approved expanded function training shall be prominently displayed at the facility where the services will be provided.
As a reminder, like all intraoral duties performed by registered dental assistants, expanded function duties must be performed under the direct supervision of a licensed dentist.
In order to be eligible to complete training in expanded functions, a dental assistant must qualify based on one of the following:
1. Be a graduate of an ADA-accredited dental assistant program; or
2. Be currently certified by the Dental Assisting National Board (DANB); or
3. Have at least three months of clinical practice as a registered dental assistant; or
4. Have at least three months of clinical practice as a dental assistant in a state that does not require registration.
Level 1 Expanded Functions
A dentist may delegate to dental assistants those Level 1 expanded function procedures for which training has been successfully completed. Dental assistants may train in any of the Level 1 expanded function procedures and are not required to train in all of the procedures.
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).
Level 2 Expanded Functions
A dentist may delegate to dental assistants those Level 2 expanded function procedures for which training has been successfully completed. Dental assistants are not required to train in all of the Level 2 procedures.
: Before beginning Level 2 training, expanded function 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.
- 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.