The value of education & certification in the dental office.

In September, 1999, Harvey Weener DDS, stated that he wanted all five of his dental assistants to be certified. My first response to this was, "At my age?" His immediate reply was, "It's never too late." We all were certified in dental radiology, two of the assistants, Sharon and Jen, were graduates from dental assistant programs and were certified, Felicia was a dental assistant program graduate, but had not taken her boards, and Laurianne and I were trained on the job with no schooling. Certain procedures can be taught chairside and a dental assistant can become proficient in these duties; but because each dental office uses a limited number of instruments and materials, their technical education is restricted. I felt that having been trained on the job, my education greatly lacked the necessary technical knowledge I needed to excel at my profession. So, at fifty-one years of age I decided not only to become certified, but to enroll in the spring semester of the dental program at N.H. Technical College, Concord, N.H. This came as a total surprise to Dr. Weener because he assumed that we would study the dental assistant book in our office and take the Chairside Challenge exam.

At the Tech I was pleased to find that our instructors were experts at coordinating the lecture material with the practical application. Mrs. Casey, Miss Scholl, Mrs. Carter, and Mrs. Wilson taught us how to identify and treat specific dental emergencies that might take place in a dental office. In office procedures they used a tutorial to teach us the Dentrix computer software program, and later, in the computer lab, they let us apply the concepts we had learned. In dental anatomy we learned the landmarks of the oral cavity, the exfoliation and eruption patterns for the primary and secondary teeth, the actual tooth structure, and technical terms and definitions. The instructor used various study aids, such as videos, models, and view graphs. The lectures on proper sterilization and disinfection were followed by demonstrations on proper suctioning techniques, rubber dam application and removal, the concepts of four-handed dentistry, and instrument usage and identification. We were lectured on the uses, and the mixing and setting times of various dental materials--cements, bases, and liners, elastomeric impression materials, alginates, amalgam, composite materials, acrylics, and waxes. Then we put this knowledge to use in the lab. Our instructors gave us the clinical and technical knowledge needed to perform our assistant duties well, and to pass the Chairside and Infection Control examinations

According to the N.H. Code of Administrative Rules, a dental assistant is qualified, only under the direct supervision of the dentist, to assist him with chairside procedures, sterilize instruments, seat and dismiss patients, process radiographs, assist with placement and removal of rubber dams and cotton rolls, perform oral evacuation and provide patient education. Other duties are not permitted without certification or qualification through specific eight-hour seminars. After successfully completing an eight-hour expanded course demonstrating how to correctly apply pit and fissure sealants a dental assistant may, under the direct supervision of the dentist, apply sealants on the chewing surfaces of newly erupted molars and premolars. The same rule applies after successfully completing an eight-hour expanded course for the fabrication of temporary crowns. The dental assistant, under the direct supervision of the dentist, is allowed to construct the temporary crown needed for a crown preparation procedure. An unqualified assistant trying to perform these tasks results in time wasted on failed attempts and repeated procedures, upset patients, frustrated dentists and dental assistants, and a decrease in overall productivity.

The N.H. Code of Administrative Rules states that a certified dental assistant may perform many extended duties without the direct supervision of the dentist. They may take dental and medical histories; take and record blood pressures; place and remove rubber dams and dental matrices; apply topical fluoride and topical anesthesia; apply desensitizing agents to cementum and dentin; insert nightguards and athletic mouth-guards; remove sutures and dressings; perform pulpal vitality tests; fabricate custom trays for dentures and partials; select impression trays; and take alginate impressions for study models, bleaching trays, night guards, and athletic mouth-guards. After successfully completing seminars on pit and fissure sealants and fabrication of provisional crowns, the certified dental assistant may, under the direct supervision of the dentist, perform these duties as well. This increases productivity by creating more spare time for the dentist, allowing him to check hygiene patients, return phone calls, write up records and treatment plans, and consult with other doctors, and begin or complete treatment on a patient in another treatment room.

The certified dental assistant must renew his or her certification each year by obtaining twelve continuing education credits. This can be accomplished by attending seminars, dental courses, reviewing ADA and ADAA magazines, tapes, and workbooks. The education courses keep the assistants current with the new dental materials and techniques, allowing them to better serve their patients. Dr. Weener not only encourages his staff to attend these continuing education classes, but reimburses them when they do so.

On February 15, 2000, I passed the Infection Control exam; and, on November 18, 2000, at age fifty-two, I finally passed the Chairside exam. My salary was increased and my assistant duties were extended, allowing me to perform labwork, make temporary crowns, remove sutures, and do a variety of tasks that I had previously not been able to accomplish. For me, education and certification have proven to be the positive experiences I needed to become more confident and assertive in my job. I am proud of my accomplishments, and my self-confidence has helped me to be a better assistant. Now I am better able explain the procedures to the patients because I better understand them myself. I proved to the doctor that I was committed to my job and willing to "go the distance."

Dr. Weener readily tells his patients that all of his assistants are either certified or working toward certification, and has been willing to rearrange his assistants' schedules to accommodate their school schedules. His flexibility has brought him closer to his goal--certification for all of his assistants. Felicia is currently studying for her infection control and chairside assisting exams. Laurianne will be attending the fall semester of the dental assisting program at the N.H. Technical Institute in Concord, N.H. Dr. Weener is fully aware of the increased value a well-educated, confident, certified assistant brings to his practice. Qualified, certified dental assistants are a plus in the dental practice. They help the dentist to:

* Provide patients with better and more expedient care

* Better utilize his time

* Help to gain and maintain patient confidence

* Increase overall productivity

References

N.H. Code of Administrative Rules
Comprised by--N.H. Dental
Association
Chapter--Den 400--Dental Assistant
Part--Den 401--Assistant
Den 401.01--Assistant duties
Den 401.02--CDA & Graduate DA
duties
Den 401.03--Qualified DA duties
Den 101.06--Direct supervision
Den 101.07--General supervision
Den 302.02--Degree supervision
Den 302.05--Qualified pursuant

Sources--

#287.2, eff 1/17/74; ss by #2981, eff
2/28/85
ss by #5110, eff 4/4/91; ss by #6186,
eff 2/17/96
ss by #6909, eff 12/9/98

Jeanne Schwartz is a member of both the American and the New Hampshire Dental Assistant Associations. After an eight and a half year absence from dental assisting she decided to attend the dental assisting program at New Hampshire Technical Institute in Concord, NH. Jeanne now works for Dr. Harvey Weener, DDS in Nashua, NH.