The Scope of Practice for Dental Assistants

Dental assistants handle a wide range of responsibilities that contribute to the efficiency and success of a dental practice. Their duties include preparing treatment rooms, sterilizing instruments, assisting dentists during procedures, and providing patient education.

Learn more: What are the differences between dental hygienists and assistants?

They may also take impressions, fabricate temporary restorations, and maintain patient records. In some states, with additional certification, they can apply sealants, perform coronal polishing, or even take X-rays under supervision.

Despite their integral role, dental assistants are not licensed to diagnose, develop treatment plans, or perform irreversible procedures. While they support dentists in many aspects of patient treatment, their primary function remains assistive rather than independent.

What Dental Assistants Cannot Do

1. Administering Anesthetics or Sedation

Anesthesia is a delicate process that requires precision. Even a slight miscalculation can lead to complications like respiratory distress or allergic reactions. For this reason, only licensed dentists or, in some cases, hygienists with special certification can administer local anesthesia.

A dental assistant may hand the dentist syringes or topical anesthetics, but they cannot inject a patient or determine dosage. Imagine an assistant attempting to numb a patient before a filling. If the dose is too low, the patient might feel pain mid-procedure. Too high, and there could be a serious reaction. That level of responsibility belongs to trained professionals.

2. Adjusting, Cementing, or Placing Prosthetics

Bridges, crowns, and dentures must fit precisely. Even a slight misalignment can cause discomfort, speech issues, or long-term damage to a patient’s bite. Adjusting or cementing these restorations is a job for dentists, not assistants.

However, a dental assistant might be allowed to assist by preparing materials or passing instruments. If a patient complains that their crown feels high, the assistant can relay the message to the dentist but cannot take a handpiece and adjust the bite themselves.

3. Placing or Adjusting Orthodontic Appliances

Orthodontics is highly technical. Even a minor tweak to braces can shift teeth incorrectly, leading to months of setbacks. In most states, dental assistants cannot place brackets, adjust wires, or determine the force applied during treatment.

A dentist or orthodontist has the training to predict how a patient's teeth will move over time. Dental assistants support the process by prepping instruments or handing the doctor the necessary tools, but the final adjustments are always up to a licensed provider.

4. Performing Surgical Procedures or Suturing

Oral surgery is not just about precision—it’s about risk management. Any procedure that involves cutting into tissue carries a risk of infection, excessive bleeding, or nerve damage. Even something that seems minor, like placing sutures, requires training in wound healing and tissue response.

A dental assistant can help by setting up a sterile field, suctioning blood, or passing instruments. But if a wisdom tooth extraction requires stitching, only a dentist or oral surgeon should place those sutures. Even removing sutures later is often restricted to licensed professionals in many states.

5. Making Diagnoses or Treatment Plans

Only a dentist can diagnose conditions like cavities, gum disease, or oral cancer. A dental assistant may spot something unusual on an X-ray, but they cannot interpret the image or inform the patient of a suspected issue.

Misdiagnosis can lead to unnecessary treatments or missed serious conditions. If an assistant incorrectly tells a patient that their tooth looks fine, they might delay needed care. Likewise, suggesting treatment plans, such as recommending a crown over a filling, crosses a legal boundary.

6. Performing Root Canal Therapy

Endodontics is a specialized field requiring a deep understanding of tooth anatomy and infection control. Cleaning and shaping a root canal involves precision that dental assistants are not trained for. Even placing medication inside the canal is typically beyond their scope.

However, they can assist by preparing instruments, mixing materials, or passing tools to the dentist. Their role is to support, not perform, the procedure itself.

7. Placing, Adjusting, or Finishing Restorations

Filling a cavity seems simple, but achieving the right shape and bite alignment takes skill. If a filling is too high, it can cause discomfort or even lead to bite problems over time. That’s why only a dentist should carve, adjust, or finish restorations.

Dental assistants might handle preliminary tasks, like preparing composite material or passing curing lights, but placing the actual filling or shaping it is off-limits.

8. Prescribing Medications or Approving Lab Work

Prescription authority is tightly controlled in dentistry. Only dentists can prescribe antibiotics, pain relievers, or other medications. A dental assistant might be responsible for calling in a prescription dictated by the dentist, but they cannot decide on medication or dosage.

Similarly, while an assistant can communicate with dental labs about cases, they cannot approve final restorations or authorize lab work independently.

Regulations Vary by State

The rules about what dental assistants can and cannot do are not universal. Some states allow expanded functions with additional training, while others have stricter limitations.

For example, in some states, an assistant with the proper certification can place temporary restorations, apply sealants, or perform coronal polishing. In others, even those tasks are restricted. 

The best way to stay compliant is to check your state’s dental board regulations regularly.

What Happens When an Assistant Oversteps?

Crossing legal boundaries doesn’t just put a practice at risk—it can lead to serious consequences. If a dental assistant performs a restricted task and something goes wrong, both the assistant and the supervising dentist could face consequences.

Beyond legal concerns, patient trust and practice reputation are on the line. If a patient finds out that someone unqualified performed their treatment, they might leave negative reviews or discourage others from coming to your practice.

The risks aren’t just theoretical. Regulatory bodies, such as state dental boards, regularly investigate cases where assistants have exceeded their legal scope. A common example is an assistant who attempts to adjust a patient’s bite after a crown placement, leading to discomfort or an improper fit. If the patient experiences ongoing issues and files a complaint, the board will investigate, resulting in disciplinary action.

Supervising dentists and practice managers have significant HR responsibilities to ensure staff understand their roles and legal limitations. Supervising dentists also have a legal duty to oversee their staff appropriately. If a dentist knowingly allows an assistant to perform restricted tasks or fails to provide proper supervision, they may be held accountable. In extreme cases, dental licenses have been suspended or revoked due to repeated violations.

Financial penalties can add another layer of stress. Fines for non-compliance vary by state but can range from hundreds to thousands of dollars per infraction. These fines can escalate quickly if multiple violations occur over time. Additionally, malpractice insurance may not cover incidents involving unlicensed individuals performing restricted tasks, leaving the practice financially exposed.

Even unintentional overstepping can have repercussions. An assistant might believe they are helping by performing a procedure that seems minor, such as removing sutures or adjusting an orthodontic appliance. But if the patient suffers an adverse effect, such as infection or misalignment, the practice could still face legal action. Ignorance of the law is not a defense, which is why continuous education is necessary.

To prevent assistants from overstepping, practices should implement clear protocols and continuous training. Regular meetings can reinforce the importance of scope-of-practice laws, and role-playing exercises can help assistants understand their limitations. Dentists should also create an open-door policy where assistants feel comfortable asking for clarification about their duties rather than making assumptions.

How to Keep Your Practice on the Right Side of the Law

A dental office thrives when every team member knows their role and respects professional boundaries. Clear communication, ongoing education, and proactive leadership help prevent legal missteps. Here are some strategies to keep your practice compliant and efficient:

• Stay informed about state regulations and scope-of-practice rules. Laws change, and what’s allowed in one state may be restricted in another. Regularly reviewing updates from your state dental board and keeping an eye on industry trends ensures that your practice remains compliant.

• Provide ongoing training so assistants understand their limits. Compliance involves knowing and reinforcing rules. Hold regular training sessions to review legal restrictions, discuss real-world scenarios, and answer questions. Online courses, workshops, and in-office training can help reinforce these guidelines.

• Establish clear office policies outlining who can do what. A written scope-of-practice policy or standard operating procedures helps eliminate gray areas. Make sure each assistant receives an employee handbook that clearly defines their responsibilities and limitations. This also protects the practice if legal questions arise.

• Encourage open communication so assistants feel comfortable asking if a task is within their scope. Mistakes often happen when staff members assume rather than ask. Create a culture where assistants can speak up without fear of reprimand. Supervision should be supportive, and any uncertainty about tasks should be addressed immediately.

• Perform regular audits to catch potential issues before they escalate. Periodically reviewing procedures and patient records can help identify instances where an assistant may have overstepped. If any red flags appear, use them as training opportunities rather than just disciplinary actions.

• Use technology to streamline compliance. Digital systems and the automation of administrative tasks can help track licensing, training completions, and policy acknowledgments.

Build a Stronger Team with Teero

When dental assistants stick to their role, the entire practice runs more smoothly. Patients get high-quality care, dentists avoid legal trouble, and the team works more efficiently.

Need help keeping your practice fully staffed? Teero connects dental offices with top-tier hygienists, so you’re never scrambling to fill a gap in your team. Whether you need short-term coverage or long-term support, Teero makes staffing easy.

Find out how Teero can support your practice today.