The Alberta Dental Association and College (ADA+C) recommendation for PEP (post exposure protocol) following a needlestick injury is to contact HealthLink (811) as soon as possible, preferably within an hour; tell them you have experienced an occupational exposure and ask for contact information for the Medical Officer of Health for your zone. Then contact your Medical Officer of Health for details about your next steps.

The nurses who man the HealthLink lines should have the appropriate contact information available for the area or region the incident occurs in. Please note that it is important for the contact to be made as soon as possible following the incident.

Incident reporting forms are available through the ADA+C website (members only) or by fax if requested by dental staff.

Mandatory Registration

Regulating the Profession
The College of Alberta Dental Assistants (the College) regulates the profession of dental assisting in a manner that protects and serves the public interest and sets standards for the practice of regulated members.¹ Therefore the College only authorizes regulated members to provide dental assisting services directly to the public including non-restricted activities (e.g. selective coronal polishing and application of anticariogenic agents), and basic chairside duties (e.g. maintaining operator's line of sight through retraction and suction).

Regulated members must provide verification of meeting the entry-to-practice education and training required to provide competent and safe care to patients. They must also hold the necessary malpractice insurance coverage should a professional negligence claim arise.² Regulated members must provide their employers with evidence of a practice permit in good standing, notify their employers of any conditions imposed on their practice permit or if the practice permit is suspended or cancelled, and inform their employers of any changes to their authorization to provide dental assisting services.³

When is registration mandatory?
Registration is mandatory when a person meets the requirements for registration and intends to provide dental assisting services directly to the public.⁴ Under the Health Professions Act (HPA) the College may use enforcement remedies when someone is practicing as a dental assistant in contravention of the HPA (i.e. the person qualifies for registration but is not registered by the College) or using any of the protected titles in contravention of the HPA (i.e. the person is using the protected titles but is not authorized by the College to do so). The titles "registered dental assistant/RDA" and "dental assistant/DA" are protected under the HPA and may only be used by regulated members of the College.

When can I start work as a dental assistant?
You may practice as a dental assistant when you are registered by the College and hold a valid practice permit.

Can I work as a dental assistant before I am registered and have a valid practice permit?
You must be registered and hold a valid practice permit to be authorized by the College to practice as dental assistant. If you choose to practice without registration and a valid practice permit you are putting yourself, the patient's well-being and your employer at risk. You are not covered by malpractice insurance and could be held personally liable for your actions or mistakes.

No one shall knowingly employ, for the purpose of providing professional services, a person who meets the requirements for registration unless that employed person is a regulated member, or authorized to provide the services pursuant to another enactment.⁵ Anyone who knowingly employs a person in contravention of the HPA is guilty of an offence.⁶

Jurisdiction
The College's jurisdiction is limited to those who meet the requirements for registration as a regulated member and who intend to provide professional dental assisting services directly to the public and/or who use the protected titles (registered dental assistant/RDA and dental assistant/DA). Dentists have the right to choose to employ support staff without registration provided the employees do not represent themselves as regulated members of the College. It is illegal for an unregistered individual to provide any restricted activities or use the protected titles.

1. Health Professions Act, RSA 2000, c H-7 [HPA], s 3(1)
2. Dental Assistants Profession Regulation [DAPR] s 9, 10
3. HPA s 47(2)
4. HPA s 46
5. HPA s 46, 47
6. HPA s 48
7. HPA s 46, s 128(1); DAPR s 30

You can find this information at Dental Assisting Schools.

Yes, if the dental assisting program they attended taught the skill to competency levels, or if they successfully completed an in-school continuing education course on probing.

Clarification Regarding Dental Probing
There has been some confusion recently regarding whether Registered Dental Assistants (RDAs) who have successfully completed training for Periodontal Screening and Recording (PSR)/probing can perform full mouth probings at their place of employment. The Dental Assistants Profession Regulation was reviewed, and input regarding safety and instrumentation was sought from the dental assisting programs in Alberta (all teach PSR/probing). The following motion was approved at the February 3, 2007, CADA Council meeting:

“I move that the CADA council supports the performance of full mouth probing by RDAs who have successfully completed training AND who feel competent and comfortable in periodontal screening and recording (PSR)/probing in accordance with the Dental Assistants Profession Regulation and input received by dental assisting programs in Alberta.”

Dental probing is a restricted activity under the legislation. Please remember that Section 13 of the Dental Assistants Profession Regulation states that RDAs must only perform restricted activities that they are competent to perform. If you do not feel comfortable, or confident transitioning to full mouth probing please inform your employer that you will not be able to perform that procedure. Please also note that refresher courses in all intra-oral skill areas are available at many of the dental assisting programs in Alberta.

Yes. With the appropriate training and registration, RDAs may perform intra-oral occlusal checks and material reduction using a slow-speed handpiece. High-speed hand-pieces may NOT be used intra-orally. Please note that the dentist is responsible for the final occlusal assessment and adjustment.

Yes. Bleaching techniques utilize skills that are currently taught such as: isolation techniques and application and curing. RDAs with dental dam, treatment liners, desensitizing, or pit and fissure sealants are fully qualified to apply bleaching agents. As with any procedure, be sure to follow the manufacturer’s directions pertaining to the product use and technique. RDAs are not authorized to provide tooth bleaching (tooth whitening) services independently (outside the dental office). CADA joins our colleagues in the dental community in protecting the public by supporting tooth bleaching procedures only within the dental office and following examination, medical/dental history review and prescription for treatment by a senior dental professional.  (See CADA Position Statement  on Independent Practice of Non-Restricted Activities)

RDAs who have advanced practice authorization for orthodontics may cement bands and appliances. The dentist must perform a final check prior to the patient being dismissed.

No, they may only adjust temporary restorations. (Note: The RDA is limited to using a slowspeed handpiece intra-orally, and the dentist is responsible for the final check of the occlusion.)

Yes, the placement of paper points and trial points are within the authorized practice of an RDA.

Yes, if they have successfully completed the temporary crowns/restorations course. Note: Temporary fillings are meant to be in place no longer than 90 days, and the filling material is at the discretion of the dentist.

Yes, restorations may be polished using slow-speed handpieces with rubber cups, rubber points and brushes. The use of finishing burs is not permitted.

No. Dental assistants may not use a high speed rotary handpiece intraorally under any circumstance.

Removal of supra-gingival cement may be delegated to any RDA, however successful completion of the temporary crowns/restorations course or orthodontic module is required for sub-gingival removal.

If the RDA is performing any of the skills directly related to orthodontic treatment, then she must have advanced practice authorization for orthodontics.

Clinical Orthodontic Procedures

1. A dental assistant authorized by the College to perform orthodontic procedures may under the direction and on-site supervision of a dentist perform the following clinical orthodontic procedures:

1. place and remove orthodontic separators
2. select, fit and cement orthodontic bands
3. preliminary fit of fixed orthodontic appliances
4. preliminary fit of removable orthodontic appliances
5. place and bond orthodontic brackets and bondable attachments
6. insert, ligate and remove orthodontic archwires which were formed by a dentist
7. insert and remove orthodontic accessories
8. remove orthodontic bands, brackets and bondable attachments

2. Prior to dismissal of the client, the dentist must:

1. Perform the final fitting and/or adjustment of any appliance where the dental assistant performed the preliminary fit;
2. Perform a final check of brackets and attachments where the dental assistant performed the bonding; and,
3. Perform a final check of bands and appliances where the dental assistant performed the cementing of bands and appliances.

RDAs may perform indirect and direct bonding of brackets and attachments under the direction of a dentist. The dentist must perform a final check prior to final dismissal of the patient.

No. At the present time RDAs can only remove orthodontic cement with hand instruments.

No. Registered Dental Assistants are not allowed to administer nitrous oxide. Note that administering includes the setting, starting, and adjusting of nitrous oxide flows and or ratios.

RDAs may assist with the administration of nitrous oxide by performing the following tasks:

• prepare and check nitrous oxide and oxygen sedation equipment
• select a mask of appropriate size and place it on the tubing
• have patient put on the mask and adjust the fit
• tighten the tubing once it is comfortable for the patient
• inform the patient about the effects of sedation
• assist with observing, documenting and reporting the patien'’s condition

Information about employment salary / wages is available on the Canadian Dental Assistants' Association website and the Alberta Government's ALIS website.