RDA Expanded Functions - Permit

Restorative Functions | Anesthesia Assistant | administration of nitrous oxide inhalation analgesia

An RDA (registered dental assistant) may be authorized by permit to provide anesthesia assistant 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.

New RDA Duty Effective 7/1/2022 - Administration of Nitrous Oxide Inhalation Analgesia

1. The following standards apply to the administration of nitrous oxide inhalation analgesia:

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.

c. A dentist may not delegate monitoring of nitrous oxide inhalation analgesia once the patient has ingested an enteral drug for the purpose of minimal sedation.

d. Before authorizing a dental hygienist or registered dental assistant to administer nitrous oxide inhalation analgesia, the dentist must have provided and documented training in the proper and safe operation of the nitrous oxide inhalation analgesia equipment.

e. A patient receiving nitrous oxide inhalation analgesia must be continually monitored by authorized dental staff. A dental hygienist or a registered dental assistant may terminate or reduce the amount of nitrous oxide previously administered by the authorized nitrous oxide inhalation analgesia provider.

f. The board may issue a permit authorizing the administration of nitrous oxide inhalation to a dentist or dental hygienist or registered dental assistant if the following requirements are met:

(1) Evidence of successful completion of a twelve-hour, board-approved course of training or course provided by a program accredited by an accrediting body recognized by the United States department of education, and either:

(a) Completed the course within thirteen months before application; or

(b) Completed the course more than thirteen months before application, has legally administered nitrous oxide inhalation analgesia for a period of time during the three years preceding application, and provides written documentation from a dentist that has employed or supervised the applicant, attesting to the current clinical proficiency of the applicant to administer nitrous oxide inhalation analgesia.

(2) Evidence of current certification in basic life support by the American heart association for the health care provider, or an equivalent program approved by the board.

Application for Administration of Nitrous Oxide Inhalation Analgesia

Board-approved Courses:

Nitrous Oxide Course

UMN Nitrous Oxide Administration Course

Restorative Functions

The Board may issue a permit authorizing a registered dental assistant under the direct supervision to provide restorative duties if the applicant successfully completes the following:

Completes a board approved course;
Passes the Western Regional Examining Board’s restorative examination or other equivalent examination approved by the Board;
Completes the restorative function component of the Dental Assisting National Board’s certified restorative functions dental assistant examination.

Restorative procedures allowed under direct supervision of a dentist are as follows:

Place, carve, and adjust Class I, II and Class V supragingival amalgam or glass ionomer restorations with hand instruments or a slow-speed handpiece;
Adapt and cement stainless steel crowns;
Place, contour, and adjust Class I, II and Class V supragingival composite restorations where the margins are entirely within the enamel with hand instruments or a slow-speed handpiece.

The University of Minnesota offers a restorative expanded duties 80 course, approved by the NDBDE.

Restorative Functions Permit Application

Anesthesia Assistant

A registered dental assistant may provide anesthesia assistance under the direct supervision of a dentist authorized to provide moderate sedation, once the applicant successfully completes the following:

Board-approved dental anesthesia assistant education and training course;
Board-approved competency examination;
Completion of a training in intravenous access or phlebotomy;
Has proof of current BLS or ACLS or PALS;
Provides proof of a general anesthesia permit issued to the OMFS who will be supervising the anesthesia assistant’s services.

A registered dental assistant or a registered dental hygienist authorized by permit, may provide the following duties under contiguous supervision of a dentist authorized to provide moderate sedation:

Initiate and discontinue an IV line for a patient being prepared to receive IV medication, sedation or general anesthesia; and
Adjust the rate of intravenous fluids infusion only to maintain or keep the line patent or open.
Prepare anesthesia equipment and perform patient monitoring; and
Assist with emergency treatment and protocols.

A registered dental assistant or a registered dental hygienist authorized by permit, may provide the following duties under direct visual supervision of an OMFS:

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

Anesthesia Assistant Permit Application

Anesthesia Assistant Courses Accepted by the NDBDE

The Dental Anesthesia Assistant National Certification Examination (DAANCE) is a two-part 36 hour continuing education program comprised of self-study material and a standardized computer based exam. The course is designed for auxiliary who assist a dentist or OMFS with a valid ND sedation or anesthesia permit. DAANCE certification is valid for five years. To recertify, assistants must retake the DAANCE examination every five years and maintain current BLS and/or ACLS certifications. Note: Online CPR certifications are not accepted.The course meets the requirements for a ND Class I Dental Anesthesia Assistant Permit.
Sedation Consult, LLC: Allan Schwartz, DDS, CRNA provides a 3 day course, Monitoring Sedation/General Anesthesia & I.V. Certification meets the requirements for requirements of ND Class II Dental Anesthesia Assistant Permit.
The American Dental Society of Anesthesiology is a two-day, 12 hour CE sedation course for auxillaries featuring an indepth approach designed especially for those who work in general anesthesia and moderate sedation practices. The course provides a certificate for the completion of the CE but does not provide certification or testing therefore to achieve Permit I, the DAANCE exam would also be required.

Expanded Duties - New Rules

Administrative rules regarding delivery of duties and procedures have been significantly expanded for dentists, hygienists and registered dental assistants. Administrative Code Title 20 prescribes law, procedures, practice requirements and defines the specific duties for all dental practitioners. New rules are in effect as of April 1, 2015 for dentists, dental hygienists and registered dental assistants.

North Dakota laws governing dentists, dental hygienists and registered dental assistants may be found at:

State Statute - North Dakota Century Code 43-28-01-43-28-27 - Dentist

State Statute - North Dakota Century Code 43-28.1 - Dentist

State Statute - North Dakota Century Code 43-20-01-43-20-12 - Hygienist and Dental Assistant

Contact the Board office if you have questions about the regulations governing the practice of dental hygiene in North Dakota.