Chapter 30. Regulations Governing the Practice of Dental Assistants
Part I
General Provisions
18VAC60-30-10. Definitions.
A. The following words and terms when used in this chapter shall have the meanings ascribed to them in § 54.1-2700 of the Code of Virginia:
"Board"
"Dental hygiene"
"Dental hygienist"
"Dentist"
"Dentistry"
"License"
B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"CODA" means the Commission on Dental Accreditation of the American Dental Association.
"Code" means the Code of Virginia.
"Dental assistant I" means any unlicensed person under the direction of a dentist or a dental hygienist who renders assistance for services provided to the patient as authorized under this chapter but shall not include an individual serving in purely an administrative, secretarial, or clerical capacity.
"Dental assistant II" means a person under the direction and direct supervision of a dentist who is registered by the board to perform reversible, intraoral procedures as specified in 18VAC60-30-60 and 18VAC60-30-70.
"Direct supervision" means that the dentist examines the patient and records diagnostic findings prior to delegating restorative or prosthetic treatment and related services to a dental assistant II for completion the same day or at a later date. The dentist prepares the tooth or teeth to be restored and remains immediately available in the office to the dental assistant II for guidance or assistance during the delivery of treatment and related services. The dentist examines the patient to evaluate the treatment and services before the patient is dismissed.
"Direction" means the level of supervision (i.e., immediate, direct, indirect or general) that a dentist is required to exercise with a dental hygienist, a dental assistant I, or a dental assistant II or that a dental hygienist is required to exercise with a dental assistant to direct and oversee the delivery of treatment and related services.
"General supervision" means that a dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment that states the specific services to be provided by a dental hygienist during one or more subsequent appointments when the dentist may or may not be present. Issuance of the order authorizes the dental hygienist to supervise a dental assistant performing duties delegable to dental assistants I.
"Immediate supervision" means the dentist is in the operatory to supervise the administration of sedation or provision of treatment.
"Local anesthesia" means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.
"Monitoring" means to observe, interpret, assess, and record appropriate physiologic functions of the body during sedative procedures and general anesthesia appropriate to the level of sedation as provided in Part VII (18VAC60-21-260 et seq.) of Regulations Governing the Practice of Dentistry.
"Radiographs" means intraoral and extraoral radiographic images of hard and soft tissues used for purposes of diagnosis.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-20. Address of record; posting of registration.
A. Address of record. Each registered dental assistant II shall provide the board with a current address of record. All required notices and correspondence mailed by the board to any such registrant shall be validly given when mailed to the address of record on file with the board. Each registrant may also provide a different address to be used as the public address, but if a second address is not provided, the address of record shall be the public address. All changes of address shall be furnished to the board in writing within 30 days of such changes.
B. Posting of registration. A copy of the registration of a dental assistant II shall either be posted in an operatory in which the person is providing services to the public or in the patient reception area where it is clearly visible to patients and accessible for reading. If a dental assistant II is employed in more than one office, a duplicate registration obtained from the board may be displayed.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-30. Required fees.
| A. Initial registration fee. | $100 |
| B. Renewal fees. | |
| 1. Dental assistant II registration - active | $50 |
| 2. Dental assistant II registration - inactive | $25 |
| C. Late fees. |
|
| 1. Dental assistant II registration - active | $20 |
| 2. Dental assistant II registration - inactive | $10 |
| D. Reinstatement fees. |
|
| 1. Expired registration | $125 |
| 2. Suspended registration | $250 |
| 3. Revoked registration | $300 |
| E. Administrative fees. |
|
| 1. Duplicate wall certificate | $60 |
| 2. Duplicate registration | $20 |
| 3. Registration verification | $35 |
| 4. Handling fee for returned check or dishonored credit or debit card | $50 |
F. No fee will be refunded or applied for any purpose other than the purpose for which the fee is submitted.
G. For the renewal of an active dental assistant II registration in 2021, the fees for renewal of an active dental assistant II registration shall be prorated according to the registrant's birth month as follows:
| January birth month February birth month March birth month April birth month May birth month June birth month July birth month August birth month September birth month October birth month November birth month December birth month | $30 $33 $36 $39 $42 $45 $48 $51 $54 $57 $60 $63 |
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 34, Issue 11, eff. February 21, 2018; Volume 36, Issue 24, eff. August 19, 2020; Volume 37, Issue 1, eff. October 15, 2020.
Part II
Practice of Dental Assistants II
18VAC60-30-40. Practice of dental hygienists and dental assistants II under direction.
A. A dentist may utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction at one and the same time. In addition, a dentist may permit through issuance of written orders for services additional dental hygienists to practice under general supervision in a free clinic, a public health program, or a voluntary practice.
B. In all instances and on the basis of his diagnosis, a licensed dentist assumes ultimate responsibility for determining with the patient or his representative the specific treatment the patient will receive, which aspects of treatment will be delegated to qualified personnel, and the direction required for such treatment, in accordance with this chapter, Part IV (18VAC60-21-110 et seq.) of the Regulations Governing the Practice of Dentistry, and the Code.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-50. Nondelegable duties; dentists.
Only licensed dentists shall perform the following duties:
1. Final diagnosis and treatment planning;
2. Performing surgical or cutting procedures on hard or soft tissue except a dental hygienist performing gingival curettage as provided in 18VAC60-21-140;
3. Prescribing or parenterally administering drugs or medicaments, except a dental hygienist who meets the requirements of 18VAC60-25-100 may parenterally administer Schedule VI local anesthesia to patients 18 years of age or older;
4. Authorization of work orders for any appliance or prosthetic device or restoration that is to be inserted into a patient's mouth;
5. Operation of high speed rotary instruments in the mouth;
6. Administering and monitoring moderate sedation, deep sedation, or general anesthetics except as provided for in § 54.1-2701 of the Code and subsections J and K of 18VAC60-21-260;
7. Condensing, contouring, or adjusting any final, fixed, or removable prosthodontic appliance or restoration in the mouth with the exception of packing and carving amalgam and placing and shaping composite resins by dental assistants II with advanced training as specified in 18VAC60-30-120;
8. Final positioning and attachment of orthodontic bonds and bands; and
9. Final adjustment and fitting of crowns and bridges in preparation for final cementation.
Statutory Authority
§§ 54.1-2400 and 54.1-2709.5 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 35, Issue 5, eff. November 28, 2018.
18VAC60-30-60. Delegation to dental assistants II.
Duties may only be delegated under the direction and direct supervision of a dentist to a dental assistant II who has completed the coursework, corresponding module of laboratory training, corresponding module of clinical experience, and examinations specified in 18VAC60-30-120.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 37, Issue 14, eff. March 31, 2021.
18VAC60-30-70. Delegation to dental assistants I and II.
A. Duties appropriate to the training and experience of any dental assistant and the practice of the supervising dentist may be delegated to a dental assistant I or II under indirect supervision, with the exception of those listed as nondelegable in 18VAC60-30-50, those which may only be delegated to dental hygienists as listed in 18VAC60-21-140, and those which may only be delegated to a dental assistant II as listed in 18VAC60-30-60.
B. Duties delegated to any dental assistant under general supervision shall be under the direction of the dental hygienist who supervises the implementation of the dentist's orders by examining the patient, observing the services rendered by an assistant, and being available for consultation on patient care.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-80. Radiation certification.
A dental assistant I or II shall not place or expose dental x-ray film unless he has one of the following: (i) satisfactory completion of a radiation safety course and examination given by an institution that maintains a program in dental assisting, dental hygiene, or dentistry accredited by CODA; (ii) certification by the American Registry of Radiologic Technologists; or (iii) satisfactory completion of the Radiation Health and Safety Review Course provided by the Dental Assisting National Board or its affiliate and passage of the Radiation Health and Safety Exam given by the Dental Assisting National Board. Any certificate issued pursuant to satisfying the requirements of this section shall be posted in plain view of the patient.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-90. What does not constitute practice.
The following are not considered the practice of dental hygiene and dentistry:
1. General oral health education.
2. Recording a patient's pulse, blood pressure, temperature, presenting complaint, and medical history.
3. Conducting preliminary dental screenings in free clinics, public health programs, or a voluntary practice.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
Part III
Standards of Conduct
18VAC60-30-100. Patient records; confidentiality.
A. A dental assistant II shall be responsible for accurate and complete information in patient records for those services provided by the assistant under direction to include the following:
1. Patient's name on each page in the patient record;
2. Radiographs, digital images, and photographs clearly labeled with the patient name, date taken, and teeth identified; and
3. Notation of each treatment rendered, date of treatment and the identity of the dentist, the dental hygienist, or the dental assistant providing service.
B. A dental assistant shall comply with the provisions of § 32.1-127.1:03 of the Code related to the confidentiality and disclosure of patient records. A dental assistant shall not willfully or negligently breach the confidentiality between a practitioner and a patient. A breach of confidentiality that is required or permitted by applicable law or beyond the control of the assistant shall not be considered negligent or willful.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-110. Acts constituting unprofessional conduct.
The following practices shall constitute unprofessional conduct within the meaning of § 54.1-2706 of the Code:
1. Fraudulently obtaining, attempting to obtain, or cooperating with others in obtaining payment for services.
2. Performing services for a patient under terms or conditions that are unconscionable. The board shall not consider terms unconscionable where there has been a full and fair disclosure of all terms and where the patient entered the agreement without fraud or duress.
3. Misrepresenting to a patient and the public the materials or methods and techniques used or intended to be used.
4. Committing any act in violation of the Code reasonably related to dental practice.
5. Delegating any service or operation that requires the professional competence of a dentist, dental hygienist, or dental assistant II to any person who is not authorized by this chapter.
6. Certifying completion of a dental procedure that has not actually been completed.
7. Violating or cooperating with others in violating provisions of Chapter 1 (§ 54.1-100 et seq.) or 24 (§ 54.1-2400 et seq.) of Title 54.1 of the Code or the Drug Control Act (§ 54.1-3400 et seq. of the Code).
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
Part IV
Entry Requirements for Dental Assistants II
18VAC60-30-115. General application requirements.
All applications for registration as a dental assistant II shall include:
1. Evidence of a current credential as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board or another certification from a credentialing organization recognized by the American Dental Association and acceptable to the board that was granted following passage of an examination on general chairside assisting, radiation health and safety, and infection control;
2. Verification of completion of educational requirements set forth in 18VAC60-30-120; and
3. Attestation of having read and understood the laws and regulations governing the practice of dentistry and dental assisting in Virginia and of the applicant's intent to remain current with such laws and regulations.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-116. Requirements for educational programs.
In order to train persons for registration as a dental assistant II, an educational program shall meet the following requirements:
1. The program shall be provided by an educational institution that maintains a program accredited by the Commission on Dental Accreditation of the American Dental Association.
2. The program shall have a program coordinator who is registered in Virginia as a dental assistant II or is licensed in Virginia as a dental hygienist or dentist. The program coordinator shall have administrative responsibility and accountability for operation of the program.
3. The program shall have a clinical practice advisor who is a licensed dentist in Virginia and who may also serve as the program coordinator. The clinical practice advisor shall assist in the laboratory training component of the program and conduct the program's calibration exercise for dentists who supervise the student's clinical experience.
4. A dental assistant II, registered in Virginia, who assists in teaching the laboratory training component of the program shall have a minimum of two years of clinical experience in performing duties delegable to a dental assistant II.
5. The program shall enter into a participation agreement with any dentist who agrees to supervise clinical experience. The dentist shall successfully complete the program's calibration exercise on evaluating the clinical skills of a student. The dentist supervisor may be the employer of the student.
6. Each program shall enroll practice sites for clinical experience, which may be a dental office, a nonprofit dental clinic, or an educational institution clinic.
7. All treatment of patients shall be under the immediate supervision of a licensed dentist who is responsible for the performance of duties by the student. The dentist shall attest to the successful completion of the clinical competencies and restorative experiences.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 37, Issue 14, eff. March 31, 2021.
18VAC60-30-120. Educational requirements for dental assistants II.
A. A prerequisite for entry into an educational program preparing a person for registration as a dental assistant II shall be current certification as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board or active licensure as a dental hygienist.
B. To be registered as a dental assistant II, a person shall complete a competency-based program from an educational institution that meets the requirements of 18VAC60-30-116 and includes all of the following:
1. Didactic coursework in dental anatomy that includes basic histology, understanding of the periodontium and temporal mandibular joint, pulp tissue and nerve innervation, occlusion and function, muscles of mastication, and any other item related to the restorative dental process.
2. Didactic coursework in operative dentistry to include materials used in direct and indirect restorative techniques, economy of motion, fulcrum techniques, tooth preparations, etch and bonding techniques and systems, and luting agents.
3. Laboratory training to be completed in the following modules :
a. No less than 15 hours of placing, packing, carving, and polishing of amalgam restorations, placement of a non-epinephrine retraction cord, and pulp capping procedures and no less than six class I and six class II restorations completed on a manikin simulator to competency;
b. No less than 40 hours of placing and shaping composite resin restorations, placement of a non-epinephrine retraction cord, and pulp capping procedures, and no less than 12 class I, 12 class II, five class III, five class IV, and five class V restorations completed on a manikin simulator to competency; and
c. At least 10 hours of making final impressions , placement of a non-epinephrine retraction cord, final cementation of crowns and bridges after preparation, and adjustment and fitting by the dentist, and no less than four crown impressions, two placements of retraction cord, five crown cementations, and two bridge cementations on a manikin simulator to competency.
4. Clinical experience applying the techniques learned in the preclinical coursework and laboratory training in the following modules:
a. At least 30 hours of placing, packing, carving, and polishing of amalgam restorations, placement of a non-epinephrine retraction cord, and no less than six class I and six class II restorations completed on a live patient to competency;
b. At least 60 hours of placing and shaping composite resin restorations, placement of a non-epinephrine retraction cord, and no less than six class I, six class II, five class III, three class IV, and five class V restorations completed on a live patient to competency; and
c. At least 30 hours of making final impressions ; placement of non-epinephrine retraction cord; final cementation of crowns and bridges after preparation, adjustment, and fitting by the dentist; and no less than four crown impressions, two placements of retraction cord, five crown cementations, and two bridge cementations on a live patient to competency.
5. Successful completion of the following competency examinations given by the accredited educational programs:
a. A written examination at the conclusion of didactic coursework; and
b. A clinical competency exam.
C. An applicant may be registered as a dental assistant II with specified competencies set forth in subdivision a, b, or c of subdivisions B 3 and B 4 of this section.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 37, Issue 14, eff. March 31, 2021.
18VAC60-30-130. (Reserved).
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Reserved Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-140. Registration by endorsement as a dental assistant II.
A. An applicant for registration by endorsement as a dental assistant II shall provide evidence of the following:
1. Hold current certification as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association;
2. Be currently authorized to perform expanded duties as a dental assistant in each jurisdiction of the United States;
3. Hold a credential, registration, or certificate with qualifications substantially equivalent in hours of instruction and course content to those set forth in 18VAC60-30-120 or if the qualifications were not substantially equivalent the dental assistant can document experience in the restorative and prosthetic expanded duties set forth in 18VAC60-30-60 for at least 24 of the past 48 months preceding application for registration in Virginia.
B. An applicant shall also:
1. Be certified to be in good standing from each jurisdiction of the United States in which he is currently registered, certified, or credentialed or in which he has ever held a registration, certificate, or credential;
2. Not have committed any act that would constitute a violation of § 54.1-2706 of the Code; and
3. Attest to having read and understand and to remain current with the laws and the regulations governing dental practice in Virginia.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
Part V
Requirements for Renewal and Reinstatement
18VAC60-30-150. Registration renewal requirements.
A. Prior to 2022, every person holding an active or inactive registration shall annually, on or before March 31, renew his registration. Beginning in January of 2022, every person holding an active or inactive registration shall annually renew his registration in his birth month. Any person who does not return the completed form and fee by the deadline shall be required to pay an additional late fee.
B. The registration of any person who does not return the completed renewal form and fees by the deadline shall automatically expire and become invalid and his practice as a dental assistant II shall be illegal. Practicing in Virginia with an expired registration may subject the registrant to disciplinary action by the board.
C. In order to renew registration, a dental assistant II shall be required to maintain and attest to current certification from the Dental Assisting National Board or another national credentialing organization recognized by the American Dental Association.
D. A dental assistant II shall also be required to maintain evidence of successful completion of training in basic cardiopulmonary resuscitation.
E. Following the renewal period, the board may conduct an audit of registrants to verify compliance. Registrants selected for audit shall provide original documents certifying current certification.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015; amended, Virginia Register Volume 36, Issue 24, eff. August 19, 2020.
18VAC60-30-160. Inactive registration.
A. Any dental assistant II who holds a current, unrestricted registration in Virginia may upon a request on the renewal application and submission of the required fee be issued an inactive registration. The holder of an inactive registration shall not be entitled to perform any act requiring registration to practice as a dental assistant II in Virginia.
B. An inactive registration may be reactivated upon submission of evidence of current certification from the Dental Assisting National Board or a national credentialing organization recognized by the American Dental Association. An applicant for reactivation shall also provide evidence of continuing clinical competence, which may include (i) documentation of active practice in another state or in federal service or (ii) a refresher course offered by a CODA accredited educational program.
C. The board reserves the right to deny a request for reactivation to any registrant who has been determined to have committed an act in violation of § 54.1-2706 of the Code.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
18VAC60-30-170. Registration reinstatement requirements.
A. The board shall reinstate an expired registration if the renewal form, renewal fee, and late fee are received within one year of the deadline required in subsection A of 18VAC60-30-150, provided that no grounds exist to deny said reinstatement pursuant to § 54.1-2706 of the Code and 18VAC60-30-110.
B. A dental assistant II who has allowed his registration to lapse or who has had his registration suspended or revoked must submit evidence of current certification from the Dental Assisting National Board or a credentialing organization recognized by the American Dental Association to reinstate his registration.
C. The executive director may reinstate such expired registration provided that the applicant can demonstrate continuing competence, the applicant has paid the reinstatement fee and any fines or assessments, and no grounds exist to deny said reinstatement pursuant to § 54.1-2706 of the Code and 18VAC60-30-110.
D. An applicant for reinstatement shall provide evidence of continuing clinical competence, which may include (i) documentation of active practice in another state or in federal service or (ii) a refresher course offered by a CODA accredited educational program.
Statutory Authority
§ 54.1-2400 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 32, Issue 5, eff. December 2, 2015.
FORMS (18VAC60-30).
Instructions for Registration of Dental Assistant II (rev. 2/2022)
Instructions for Reactivation of Dental Assistant II Registration (rev. 7/2021)
Instructions for Reinstatement of Dental Assistant II Registration (rev. 7/2021)