# Title 20 — State Board of Dental Examiners

## Article 20-03 — Dental Assistants

## Chapter 20-03-01 — Duties

### § 20-03-01-01. Duties.

Duties are delegated to dental assistants under prescribed levels of supervision as follows:
1. A dental assistant who is not registered with the board and who is employed by a dentist may:
a. Perform the following duties under direct supervision:
(1) Take and record pulse, blood pressure, and temperature.
(2) Take and record preliminary dental and medical history for the interpretation by the
dentist.
(3) Apply topical medications and drugs to oral tissues, including topical anesthetic,
topical fluoride, fluoride varnish, and desensitizing agents, but not including caustic
agents.
(4) Receive removable dental prosthesis for cleaning or repair.
(5) Take impressions for study casts.
(6) Hold impression trays in the mouth (e.g., reversible hydrocolloids, rubber base).
(7) Retract patient's cheek, tongue, or other tissue parts during a dental procedure.
(8) Remove such debris as is normally created in the course of treatment during or after
dental procedures by vacuum devices, compressed air, mouthwashes, and water.
(9) Isolate the operative field, not to include rubber dams.
(10) Hold a curing light for any dental procedure. Curing lights may not include a laser
capable of cutting, burning, or damaging hard or soft tissue or for electrosurgery for
tissue retraction.
(11) Produce on a patient of record, a final scan by digital capture for review and
inspection by the authorizing dentist for a prescriptive fixed or removable appliance.

(12) Monitor of a patient who has been induced into nitrous oxide analgesia if the dentist
has provided sufficient training to the dental assistant completed after January 1,
2024. The dentist shall maintain documentation of the training for the duration of the
delegation and shall provide documentation of the training to the board upon
request.
b. Perform the following duties under general supervision:
(1) Provide oral hygiene instructions and education.
(2) Remove periodontal dressings.
2. A qualified dental assistant may:
a. Perform the following duties under the direct supervision of a dentist:
(1) Duties set forth in subsection 1.
(2) Acid etch enamel surfaces as directed by the dentist.
(3) Dry root canal with paper points.
(4) Apply resin infiltration.
(5) Orally transmit a prescription that has been authorized by the supervising dentist.
(6) Remove band and bracket adhesives with a slow-speed handpiece.
(7) Place and remove matrix bands and wedges.
b. Perform the following duties under the general supervision of a dentist:
(1) Produce on a patient of record, a final scan by digital capture for review and
inspection by the authorizing dentist for a prescriptive fixed or removable appliance.
(2) Take and record pulse, blood pressure, and temperature.
(3) Take and record preliminary dental and medical history for the interpretation by the
dentist.
(4) Apply topical medications and drugs to oral tissues, including topical anesthetic and
anticariogenic agents, and desensitizing agents.
(5) Place and remove arch wires or appliances that have been activated by the dentist.
(6) Cut and remove arch wires or replace loose bands, loose brackets, or other
orthodontic appliances for palliative care.
(7) Remove sutures.
(8) Place, tie, and remove ligature wires and elastic ties, and select and place
orthodontic separators.
(9) Preselect and prefit orthodontic bands.
(10) Repack dry socket medication and packing for palliative care.
(11) Take dental radiographs.
c. Perform the following duties under the indirect supervision of a dentist:

(1) Polish coronal surfaces of teeth with a rubber cup or brush after the dentist provides
the dental assistant with sufficient training. The dentist shall maintain documentation
of the training completion for the duration of the delegation and provide it to the
board upon request.
(2) Place orthodontic brackets using an indirect bonding technique by seating the
transfer tray loaded with brackets previously positioned in the dental laboratory by a
licensed dentist.
3. A qualified dental assistant-limited radiology registrant may perform the duties listed in
subsection 1, and may take dental radiographs under the general supervision of a dentist.
4. A registered dental assistant may perform the duties set forth in subsection 2 and the following
duties under the direct supervision of a dentist:
a. Acid etch enamel surfaces prior to direct bonding of orthodontic brackets or composite
restorations.
b. Take face bow transfers.
c. Adjust permanent crowns outside of the mouth.
d. Administer emergency medications to a patient in order to assist the dentist in an
emergency.
e. Hold impression trays in the mouth (e.g., reversible hydrocolloids, rubber base).
5. A registered dental assistant may perform the following duties on a patient of record under the
indirect supervision of a dentist:
a. Place and remove rubber dams.
b. Place retraction cord in the gingival sulcus of a prepared tooth prior to the dentist taking
an impression of the tooth.
c. Remove excess cement from inlays, crowns, bridges, and orthodontic appliances with
hand instruments or a slow-speed handpiece.
d. Place and remove periodontal dressings.
e. Monitor a patient who has been inducted by a dentist into nitrous oxide inhalation
analgesia.
f. Apply bleaching solution, activate light source, and monitor and remove bleaching
materials.
g. Place orthodontic brackets using an indirect bonding technique by seating the transfer
tray loaded with brackets previously positioned in the dental laboratory by a licensed
dentist.
6. A registered dental assistant may perform the following duties under the general supervision
of a dentist:
a. Take and record pulse, blood pressure, and temperature.
b. Take and record preliminary dental and medical history for the interpretation by the
dentist.

c. Apply topical medications and drugs to oral tissues, including topical anesthetic, topical
fluoride, fluoride varnish, silver diamine fluoride, hemostatic agents, and desensitizing
agents.
d. Receive removable dental prosthesis for cleaning or repair.
e. Take impressions or occlusal bite registrations for study casts.
f. Fabricate, adjust, place, recement, or remove a temporary crown, bridge, or onlay or
temporary restorative material. This applies only to dentitions actively under treatment for
which a permanent restoration is being fabricated.
g. Remove sutures.
h. Cut and remove arch wires or replace loose bands, loose brackets, or other orthodontic
appliances for palliative treatment.
i. Place, tie, and remove ligature wires and elastic ties, and place orthodontic separators.
j. Provide oral hygiene education and instruction.
k. Provide an oral assessment for interpretation by the dentist.
l. Repack dry socket medication and packing for palliative treatment.
m. Apply pit and fissure sealants if the registered dental assistant has provided
documentation of a board-approved sealant course or training that includes hand skills,
and has received an endorsement from the board. Adjust sealants with slow-speed
handpiece.
n. Polish the coronal surfaces of the teeth with a rubber cup or brush.
o. Polish restorations with a slow-speed handpiece.
p. Take dental radiographs.
q. Take impressions for fixed or removable orthodontic appliances, athletic mouth guards,
bleaching trays, bite splints, flippers, and removable prosthetic repairs.
r. Preselect and prefit orthodontic bands.
s. Perform nonsurgical clinical and laboratory diagnosis tests, including pulp testing, for
interpretation by the dentist.
t. Place and remove arch wires or appliances that have been activated by a dentist.
u. Provide screenings as defined by subsection 44 of section 20-01-02-01.
v. Adjust a temporary denture or partial for dentitions actively under treatment for which
permanent dentures or partial dentures are being fabricated.
History: Effective September 1, 1980; amended effective February 1, 1992; October 1, 1993; May 1,
1996; August 1, 1998; April 1, 2000; June 1, 2002; July 1, 2004; April 1, 2006; January 1, 2011; April 1,
2015; July 1, 2017; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.1, 43-20-08, 43-20-10, 43-20-13

### § 20-03-01-01.1. Expanded duties of dental assistants.

A registered dental assistant shall apply for a permit to perform the following duties:
1. A registered dental assistant authorized by permit and under the direct supervision of a dentist
may perform the following restorative functions:
a. Place, carve, and adjust amalgam, glass ionomer, or composite restorations with hand
instruments or a slow-speed handpiece;
b. Adapt and cement stainless steel crowns; and
c. Place, contour, and adjust composite restorations where the margins are entirely within
the enamel with hand instruments or a slow-speed handpiece.
2. A dental anesthesia assistant authorized by a class I permit and under the contiguous
supervision of a dentist authorized by permit to provide moderate sedation, deep sedation, or
general anesthesia may:
a. Initiate and discontinue an intravenous line for a patient being prepared to receive
intravenous medications, sedation or general anesthesia;
b. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or
open;
c. Prepare anesthesia equipment and perform patient monitoring; and
d. Assist with emergency treatment and protocols.
3. A dental anesthesia assistant authorized by a class II permit and under the direct visual
supervision of a dentist authorized by permit to provide moderate sedation, deep sedation, or
general anesthesia may:
a. Draw up and prepare medications;
b. Follow instructions to deliver medication into an intravenous line upon verbal command
of the supervising dentist;
c. Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal
command of the supervising dentist; and
d. Adjust an electronic device to provide medications, such as an infusion pump upon
verbal command of the supervising dentist.
4. A registered dental assistant authorized by permit and under the indirect supervision of a
dentist may administer nitrous oxide analgesia to a patient who has not taken sedative
medications before treatment in accordance with subsection 2 of section 20-03-01-05.
History: Effective April 1, 2015; amended effective July 1, 2017; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.1, 43-20-08, 43-20-10, 43-20-13
### § 20-03-01-01.2. Requirements of permit for expanded duties.

The board may grant a permit to a registered dental assistant or any other individual who meets the
criteria listed below. Individuals authorized by other North Dakota licensing boards and whose scope of
practice encompasses the duties of a dental anesthesia assistant are not required to obtain the
respective anesthesia permit from the board to carry out the duties listed in this section.

1. The board may issue or renew a class I dental anesthesia assistant permit authorizing a
registered dental assistant or any other individual to provide anesthesia assistance under the
supervision of a dentist authorized by permit to provide general anesthesia, deep sedation, or
moderate sedation, upon successful completion of the following:
a. The applicant submits evidence of a board-approved dental anesthesia assistant
education and training course.
b. The applicant submits proof of current certification status from the American association
of oral and maxillofacial surgeon's dental anesthesia assistant national certification or a
board-approved competency examination.
c. The applicant holds current and valid certification for health care provider basic life
support, advanced cardiac life support, or pediatric advanced life support; and
d. The applicant provides a copy of a valid North Dakota general anesthesia, deep
sedation, or moderate sedation permit of the dentist where the registered dental assistant
will be performing anesthesia assistant services.
2. The board may issue or renew a class II dental anesthesia assistant permit authorizing a
registered dental assistant or any other individual to provide anesthesia assistance under the
supervision of a dentist authorized by permit to provide general anesthesia, deep sedation, or
moderate sedation, upon successful completion of the following:
a. The applicant submits evidence of a board-approved dental anesthesia assistant
education and training course.
b. The applicant submits proof of current dental anesthesia assistant national certification or
a board-approved competency examination;
c. The applicant has successfully completed hands-on training in intravenous access or
phlebotomy that includes live experience starting and maintaining intravenous lines;
d. The applicant holds current and valid certification for health care provider basic life
support, advanced cardiac life support, or pediatric advanced life support; and
e. The applicant provides a copy of a valid North Dakota general anesthesia, deep
sedation, or moderate sedation permit of the dentist where the registered or qualified
dental assistant will be performing anesthesia assistant services.
3. The board may issue or renew a permit on forms prescribed by the board authorizing a
registered dental assistant under the direct supervision of a dentist to provide restorative
functions under the following conditions:
a. The applicant meets any of the following requirements:
(1) The applicant has successfully completed a board-approved curriculum from a
program accredited by the commission on dental accreditation of the American
dental association or other board-approved course and successfully passed a
dental testing agency examination approved by the board, within the last five years.
The board may require successful completion of the restorative function component
of the dental assisting national board's certified restorative functions dental assistant
certification examination; or
(2) The applicant has successfully passed a board-approved dental testing agency
examination over five years from the date of application, and successfully
completed the restorative function component of the dental assisting national

board's certified restorative functions dental assistant certification examination or
other board-approved examination and provides evidence from another state or
jurisdiction where the applicant legally is or was authorized to perform restorative
functions and certification from the supervising dentist of successful completion of at
least twenty-five restorative procedures within the immediate five years from the
date of application.
b. A registered dental assistant may perform the placement and finishing of direct alloy or
direct composite restorations, under the direct supervision of a licensed dentist, after the
supervising dentist has prepared the dentition for restoration.
c. The restorative functions only may be performed after the patient has given informed
consent for the placement of the restoration by a restorative functions dental assistant.
d. Before the patient is released, the final restorations must be checked and documented by
the supervising dentist.
History: Effective July 1, 2022; amended effective October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-13.2
### § 20-03-01-02. Prohibited services.

A dental assistant, qualified dental assistant, or registered dental assistant may not perform the
following services:
1. Diagnosis and treatment planning.
2. Surgery on hard or soft tissue.
3. Administer local anesthetics, sedation or general anesthesia drugs or titrate local anesthetics,
sedation or general anesthesia drugs without a board authorized permit.
4. Any irreversible dental procedure or procedures which require the professional judgment and
skill of a licensed dentist.
5. Adjust a crown which has been cemented by a dentist.
6. Activate any type of orthodontic appliance or fabricate orthodontic impressions for an
individual who is not a patient of record.
7. Cement or bond orthodontic bands or brackets that have not been previously placed by a
dentist.
8. Place bases or cavity liners.
9. Scaling, root planing, or gingival curettage.
10. Measure the gingival sulcus with a periodontal probe.
11. Use a high-speed handpiece inside the mouth.
12. Unless authorized by permit in accordance with subsection 1 of section 20-02-01-05.1,
monitor a patient who has been induced to a level of moderate sedation, deep sedation, or
general anesthesia until the dentist authorized by permit to administer sedation or anesthesia
determines the patient may be discharged for recovery.

History: Effective February 1, 1992; amended effective October 1, 1993; April 1, 2000; June 1, 2002;
July 1, 2004; January 1, 2011; April 1, 2015; July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-01.1, 43-20-08, 43-20-10, 43-20-13
### § 20-03-01-03. Annual registration of dental assistants performing expanded duties.

Repealed effective January 1, 2011.
### § 20-03-01-04. Criteria for dental assistants placing sealants.

Repealed effective January 1, 2011.
### § 20-03-01-05. Registration of dental assistants.

An individual seeking registration as a dental assistant shall apply on forms prescribed by the
board. The application must be notarized and include the application fee.
1. The board may grant registration as a registered dental assistant to an applicant meeting all
the following requirements:
a. The applicant meets any of the following requirements:
(1) The applicant successfully completed a dental assisting program, accredited by the
commission on dental accreditation of the American dental association or approved
by the board, within one year of application.
(2) The applicant was certified by the dental assisting national board:
a. Within one year of application; or
b. More than one year prior to application, and within two years before
application, earned sixteen hours of continuing education in accordance with
section 20-03-01-06, and provides evidence the applicant was gainfully and
relevantly employed in the time prior to application. Proof of gainful and
relevant employment may include letters of recommendation, payroll
documentation, or other materials requested by the board.
(3) The applicant successfully completed a dental assisting program, accredited by the
commission on dental accreditation of the American dental association or approved
by the board, and completed, within two years before application, sixteen hours of
continuing education in accordance with section 20-03-01-06.
(4) The applicant is licensed in good standing under the laws of another jurisdiction and
possesses qualifications, education, or experience substantially similar to the
requirements for licensure set forth in this section. Applicants shall submit evidence
of at least one year of gainful and relevant employment in the practice prior to
application. Proof of gainful and relevant employment may include letters of
recommendation, payroll documentation, or other materials requested by the board.
Applicants shall submit evidence of earning sixteen hours of continuing education in
accordance with section 20-03-01-06 and meet other criteria as may be required by
the board.
(5) The applicant successfully completed the examination administered by the joint
commission on national dental examinations or the dental hygiene certification

board of Canada and completed within two years of application sixteen hours of
continuing education in accordance with section 20-03-01-06.
b. The applicant passed a written examination on the laws and rules governing the practice
of dentistry in North Dakota within one year of application.
c. The applicant successfully completed a cardiopulmonary resuscitation course within two
years of application.
d. Grounds for denial of the application under North Dakota Century Code section 43-20-05
do not exist.
2. The board may grant registration as a qualified dental assistant to an applicant meeting all the
following requirements:
a. The applicant meets any of the following requirements:
(1) The applicant passed the national entry level dental assistant certification
administered by the dental assisting national board and completed three hundred
hours of on-the-job clinical training within one year of application.
(2) The applicant passed the national entry level dental assistant certification
administered by the dental assisting national board, three hundred hours of
on-the-job clinical training, and completed, within two years before application,
sixteen hours of continuing education in accordance with section 20-03-01-06.
(3) The applicant successfully completed the national entry level dental assistant
certification administered by the dental assisting national board and successfully
completed the North Dakota department of career and technical education dental
assisting education program association.
(4) The applicant successfully completed a board-approved equivalent course within
one year of application.
(5) The applicant is licensed in good standing under the laws of another jurisdiction and
possesses qualifications, education, or experience substantially similar to the
requirements for licensure set forth in this section. Applicants shall submit evidence
of at least one year of gainful and relevant employment in the practice prior to
application. Proof of gainful and relevant employment may include letters of
recommendation, payroll documentation, or other materials requested by the board.
Applicants shall submit evidence of earning sixteen hours of continuing education in
accordance with section 20-03-01-06 and meet other criteria as may be required by
the board.
b. The applicant passed a written examination on the laws and rules governing the practice
of dentistry in North Dakota within one year of application.
c. The applicant successfully completed a cardiopulmonary resuscitation course within two
years of application.
d. Grounds for denial of the application under North Dakota Century Code section 43-20-05
do not exist.
3. The board may grant registration as a qualified dental assistant-limited radiology registrant to
an applicant meeting all the following requirements:

a. Within two years of application, the applicant obtained the dental assisting national
board's radiation health and safety certificate or completed a radiation health and safety
course approved by the board.
b. Within two years of application, the applicant completed a cardiopulmonary resuscitation
course.
c. Grounds for denial of the application under North Dakota Century Code section 43-20-05
do not exist.
History: Effective January 1, 2011; amended effective July 1, 2022; October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-13.2
### § 20-03-01-05.1. Additional expanded duties of registered dental assistants.

Repealed effective July 1, 2022.
### § 20-03-01-06. Continuing dental education for dental assistants.

Dental assistants shall provide evidence of attendance or participation in continuing clinical dental
education in accordance with the following conditions:
1. Continuing education activities include publications, seminars, symposiums, lectures, college
courses, and online education.
2. The continuing education hours accumulate on the basis of one hour of credit for each hour
spent in education. Subject matter directly related to clinical dentistry will be accepted by the
board without limit.
3. The minimum number of hours required within a two-year cycle is sixteen. Of these hours, a
qualified or registered dental assistant may earn no more than eight hours from self-study.
Self-study is an educational process designed to permit a participant to learn a given subject
without involvement of a proctor or without the opportunity to interact in real-time with the
proctor. A qualified professional may act as a proctor who oversees a clinical continuing
education course which may be used for classroom style continuing education credits.
Cardiopulmonary resuscitation courses must provide hands-on training. All other continuing
education requirements may be satisfied from webinars or classroom style learning that allows
for real-time interaction between attendees and the proctor. The continuing education must
include:
a. Two hours of ethics or jurisprudence. Passing the laws and rules examination is the
equivalent of two hours of ethics or jurisprudence.
b. Two hours of infection control.
c. A cardiopulmonary resuscitation course.
d. For registered dental assistants or qualified dental assistants that hold a dental
anesthesia assistant permit, at least two hours related to sedation or anesthesia.
e. For registered dental restorative assistant permitholders, two hours related to restorative
dentistry.
f. No more than one hour related to practice management or administration.

4. For qualified dental assistant-limited radiology registrants, the continuing education must
include:
a. At least two hours related to infection control.
b. A cardiopulmonary resuscitation course.
5. For individuals whose sole registration with the board is that of a dental anesthesia assistant,
the continuing education must include:
a. At least two hours related to sedation or anesthesia.
b. A cardiopulmonary resuscitation course.
6. Mere registration at a dental convention without specific attendance at continuing education
presentations will not be creditable toward the continuing dental education requirement.
Certificates awarded for continuing education must indicate the name of the continuing
education provider, date, and number of hours of continuing education. Certificates obtained
from webinar courses must indicate the course was a webinar. For continuing education
courses utilizing a proctor, the certificate of attendance must be signed by the proctor.
7. All qualified or registered dental assistants must hold a current cardiopulmonary resuscitation
certificate.
8. The board may audit continuing education credits of a registered dental assistant. Proof of
continuing education shall be maintained from the previous renewal cycle. Upon receiving
notice of an audit from the board, a registered dental assistant shall provide satisfactory
documentation of attendance at, or participation in, the continuing education activities. Failure
to comply with the audit is grounds for nonrenewal of or disciplinary action against the
registration.
History: Effective January 1, 2011; amended effective April 1, 2015; July 1, 2017; July 1, 2022;
October 1, 2024.
General Authority: NDCC 43-20-10
Law Implemented: NDCC 43-20-13.1
