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Request to Provide Level 1 Expanded Functions Training

The following information must be included with the request for review. Incomplete requests may be returned for additional information. Documentation may be attached prior to submitting this form.

  • Detailed course outline for each function demonstrating  compliance with the minimum training standards
  • Initial assessment exam (pre-test)*
  • Post-course competency assessment (post-test)*
  • List of resources and other information as appropriate

*Assessment questions should focus on the clinical application of the expanded function(s) being taught.

Name of Licensee Submitting Request

Address

Do you wish to have your information posted to the Board's website if approved to offer training?

Level 1 Expanded Functions

Please mark the expanded function(s) for which you are requesting approval to provide training.

Note:  Dental assistant trainees are not eligible to train in expanded functions.  Training must be completed under observational supervision.  See Iowa Administrative Code 481—Chapter 577 for more information expanded function training requirements.

Certificates of Completion

Approved expanded function training providers must issue a certificate of completion at the conclusion of training.  The certificate will serve as evidence of Board-approved training to provide those services in which training was completed.

Select the Level 1 Expanded Functions Included in This Request

Minimum Training Requirements

1. Taking Occlusal Registrations

  • Didactic: 1 hour
  • Clinical Training: 5 patient experiences

2. Placement and Removal of Gingival Retraction Material

  • Didactic: 2 hours
  • Lab Training: 1 hour, 3 experiences
  • Clinical Training: 5 patient experiences

3. Fabrication, Temporary Cementation, and Removal of Provisional Restorations following Review of the Fit and Function by the Supervising Dentist, and Temporary Recementation of Provisional Restorations

  • Didactic: 4 hours
  • Lab Training: 4 hours, 5 experiences
  • Clinical Training: 10 patient experiences

4. Applying Cavity Liners and Bases and Desensitizing Agents

  • Didactic: 1 hour
  • Lab Training: 1 hour, 2 experiences
  • Clinical Training: 5 patient experiences

5. Applying Bonding Systems, which May Include the Placement of the Attachments Used in Clear Aligner Systems, following Review of the Fit and Function by the Supervising Dentist

  • Didactic: 2 hours
  • Lab Training: 1 hour, 2 experiences
  • Clinical Training: 5 experiences

6. Placement, Bonding, and Removal of Provisional Orthodontic Restorations as Follows:

  1. Placement or bonding of orthodontic brackets and bands or provisional orthodontic appliances following review of the fit and function by the supervising dentist; &
  2. Removal of adhesive, orthodontic brackets and bands, or provisional orthodontic appliances using nonmotorized hand instrumentation.

Per function:

  • Didactic: 2 hours
  • Lab Training: 1 hour, 2 experiences
  • Clinical Training: 5 patient experiences

7. Monitoring of Patients Receiving Nitrous Oxide Inhalation Analgesia**

  • Didactic: 2 hours
  • Lab Training: 1 hour
  • Clinical Training: 5 patient experiences

**Expanded functions for registered dental assistants.  Scope of practice for licensed dental hygienists.

8. Taking Final Impressions

  • Didactic: 3 hours
  • Clinical Training: 6 patient experiences

9. Removal of Adhesives Using Nonmotorized Hand Instrumentation

  • Didactic: 1 hour
  • Clinical Training: 5 patient experiences

**Expanded functions for registered dental assistants.  Scope of practice for licensed dental hygienists.

10. Placement of Temporary Restorative Materials following Preparation of the Tooth by a Dentist

  • Didactic: 2 hours
  • Lab Training: 1 hour, 2 experiences
  • Clinical Training: 5 patient experiences

11. Extraoral Adjustment to Acrylic Dentures without Making any Adjustments to the Prosthetic Teeth

  • Didactic: 1 hour
  • Lab Training: 1 hour, 2 experiences
  • Clinical Training: 5 patient experiences

12. Tissue Conditioning (Soft Reline Only)

  • Didactic: 1 hour
  • Lab Training: 1 hour, 2 experiences
  • Clinical Training: 5 patient experiences

13. Placement, Management, and Removal of an IV Infusion Line

  • Didactic: 12 hours or DAANCE Certification
  • Lab and Clinical Training: 8 hours that includes a minimum of six venipunctures, two of which are completed on human subjects.

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