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6. RDA Permits and Endorsements

RDA Permits and Endorsements

An RDA (registered dental assistant) may be authorized by permit to provide anesthesia duties under the direct or contiguous supervision of a dentist who is authorized by the Board to provide moderate sedation, and/or provide restorative procedures under the direct supervision of a dentist. A QDA (qualified dental assistant) is not eligible for the expanded functions permit. See Administrative Rule 20-03-01-01.1.  A qualified RDA may also apply for authorization to administer nitrous oxide inhalation analgesia.

How is an Endorsement Different Than a Permit?

In order to ensure patient safety, the law requires that in order to carry out certain duties, an Assistant must first obtain either an endorsement or a permit issued by the Board.

For endorsements, the applicant does not need to complete a formal application or pay a fee--but instead needs to submit proof of meeting the criteria for that duty's endorsement. The Board reviews the submissions and if they meet the requirements of law, it issues the endorsement.

Some of those 'extra' duties are more invasive and bring more risk to the public, so an RDA must recieve more training and or education. Examples are restorative care, local anesthetic, Class I and Class II anesthesia. For those duties, the Assistant must submit a formal application and undergo a more rigorous review by the Board. Those duties result in the Board's issuance of a Permit. Permits include appliation fees and must be renewed during the licensure renewal process at the end of even numbered years.   

Pit and Fissure Sealant - Endorsement

An RDA who successfully completes a CODA approved program or provides evidence of Board approved training on placing pit and fissure sealants. Once authorized by endorsement, a denist may delegate that duty to the RDA--under the designiated level of supervision. See NDAC 20-03-01-01(6)(l). The endorsement will appear on on the registration card. 

Nitrous Oxide Inhalation Analgesia Administration - Permit

Criteria

The holder of a 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 NDAC 20-02-01-05(2).

Download Application to Administer Nitrous  

Board-Approved Courses for Nitrous Oxide Administration Permit

Essentials of Nitrous Oxide for Dentistry Parts 1 & 2 (Online)

University of Minnesota School of Dentistry (umn.edu) (at this website, search “nitrous” for the most current course offering).

Nitrous Oxide/Oxygen Inhalation Analgesia Administration Course - Dakota College at Bottineau

Sedation Consult - Dr. Allan Schwatz

Standards and Protocols to be Met when Administering Nitrous Oxide

a. Inhalation equipment must have a fail-safe system that is appropriately checked and calibrated. The equipment also must have either a functioning device that prohibits the delivery of less than thirty percent oxygen or an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm. A scavenging system must be available if gases other than oxygen or air are used.

b. Patient dental records must include the concentration administered and duration of administration.

Restorative Care - Permit

The Board may issue or renew a restorative care permit on forms prescribed by the board authorizing a registered dental assistant or registered dental hygienist under the direct supervision of a dentist to provide restorative functions to an applicant who meets any of the following requirements:

a. 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 course must include a clinical and written examination. 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
b. 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.

The following courses have been approved by the Board for the restorative functions permit:

a. The University of Minnesota School of Dentistry’s Restorative Expanded Duties / 80-hour course

b. Metro State University’s Restorative Functions Theory and Lab

Restorative Functions Permit Application

Class I and Class II Anesthesia - Permits

Class I Permit

A dental hygienst, registered dental asssitant, or any other individual, may apply for a Class I anesthesia permit care permit as explained at NDAC 20-03-01-01.2(1). The scope of work of a Class I anesthesia permit holder is found at NDAC 20-03-01-01.1(2). Prohibitions related to anesthesia-related functions are found at NDAC 20-04-01-02. Dentists and dental hygienists are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 

The Board may issue a Class I permit once the applicant:

1. The applicant submits evidence of completing hands-on training in intravenous access or phlebotomy that includes live experience in starting and maintaining intravenous lines, and infection control. The evidence may be either a certificate of completion issued by a board-approved dental anesthesia assistant education and training course or an attestation by a supervising dentist who provided the training. A supervising dentist providing the training shall retain documentation of the training and provide it to the board upon request.
2. The applicant submits proof of current certification status from the American association of oral and maxillofacial surgeon's dental anesthesia assistant national certification evidence of completing a board-approved competency examinationdental anesthesia assistant education and training course that includes vital sign monitoring, training on emergency oxygen administration, suction, use of advanced automated external defibrillators, and crash cart equipment.
3. The applicant holds current and valid certification for health care provider basic life support, advanced cardiac life support, or pediatric advanced life support; and
4. 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 assistantindividual will be performing anesthesia assistant services.

An individual authorized by a Class I permit may provide the following duties under contiguous supervision of a dentist who is authorized to provide moderate sedation, deep sedation, or general anesthesia:

1. Initiate and discontinue an IV line for a patient being prepared to receive IV medication, sedation or general anesthesia; and
2. Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open
3. Prepare and monitor anesthesia equipment;
4. Perform patient monitoring including vital signs, adverse events, and patient positioning; and
5. Assist with emergency treatment and protocols, including the use of suction, automated defibrillators, and crash cart equipment.

 Class II Permit

A dental hygienst, registered dental asssitant, or any other individual, may apply for a Class II anesthesia permit care permit as explained at NDAC 20-03-01-01.2(2). The scope of work of a Class II anesthesia permit holder is found at NDAC 20-03-01-01.1(3). Prohibitions related to anesthesia-related functions are found at NDAC 20-04-01-02. Dentists and dental hygienists are strongly encouraged to have a full understanding of these laws. A summary, however, is proivded below for convenience. 

The Board may issue a Class II permit once:

1. The applicant submits evidence of completing the dental anesthesia assistant national course or an equivalent Board-approved dental anesthesia assistant education and training pharmacology course.
2. The applicant submits either proof of current dental anesthesia assistant national certification or an equivalent pharmacology certification, or proof of passage within the two years preceding application of a Board-approved competency examination;
3. The applicant submits evidence of successfully completing a Board-approved hands-on training in intravenous access or phlebotomy that includes live experience starting and maintaining intravenous lines, and infection control. The evidence may be either a certificate of completion issued by a Board-approved dental anesthesia assistant education and training course or an attestation by a supervising dentist who provided the training. A supervising dentist providing the training shall retain documentation of the training and provide it to the board upon request;
4. The applicant holds current and valid certification for health care provider basic life support, advanced cardiac life support, or pediatric advanced life support; and
5. 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 assistantindividual will be performing anesthesia assistant services.

An individual authorized by a Class II permit may provide the following duties under direct visual supervision of a dentist who is authorized to provide moderate sedation, deep sedation, or general anesthesia::

1. Draw up, label, prepare, and waste medications;
2. Follow instructions to deliver medication into an intravenous line upon verbal command of the supervising dentist;
3. Adjust the rate of intravenous fluids infusion beyond a keep-open rate upon verbal command of the supervising dentist; and
4. Adjust an electronic device to provide medications such as an infusion pump upon verbal command of the supervising dentist.

Anesthesia Assistant Permit Application

Board-approved Programs

Meeting requirement “A” for both the Class I and Class II permit. Complete one of the following:

1. The  two-part 36 hour continuing education program comprised of self-study material and a standardized computer based exam offered by the dental anesthesia assistant national certification examination (DAANCE)

2. The  two-day, 12 hour CE sedation course for auxiliaries featuring an in-depth approach designed especially for those who work in general anesthesia and moderate sedation practices that is provided by the American Dental Society of Anesthesiology, (ASDA)

3. Other courses may be submitted for approval

Meeting requirement “b” for both the Class I and Class II permit. Complete one of the following:

1. By submitting a certification from DAANCE. The DAANCE certification is valid for five years. To recertify, permit holders must retake the DAANCE examination every five years.

2. Other courses may be submitted for approval

NOTE: The ASDA CE course discussed above provides a certificate to those who complete its CE. That certificate demonstrating an applicant completed their program DOES NOT meet the anesthesia examination/certification requirements for the Board’s issuance of a Class I or Class II permit as listed in Requirement “b” further above.
 

Meeting requirement “c” for the Class II permit. Complete one the following:

1. The 3-day comprehensive IV sedation course provided by Sedation Consult, LLC: Allen Schwarz, DDS, CRNA (Sedation Consult). 

2. Certain courses that are offered by the Infusion Institute (Infusion Institute). Please submit documentation of the course before registering for it to ensure you have selected a course approved by the Board.

3. If you locate another course that you believe may meet this requirement, please submit documentation of it and request that the Board consider approving it.