Existing law, the Dental Practice Act, establishes the Dental Board of California to license and regulate the practice of dentistry, including the licensure and regulation of dental auxiliaries, including, among others, dental assistants, as defined, and sets forth duties and functions that those dental auxiliaries are authorized to perform. Existing law authorizes requires the board to review and evaluate all applications for licensure in all dental assisting categories to ascertain whether a candidate meets the appropriate licensing requirements specified by statute and board regulation. Existing law establishes the Dental Assisting Council within the Dental Board of California and requires the council to consider all matters relating to dental assistants in the state, as specified, and to make appropriate recommendations to the board and the standing committees of the board in specified areas, including standards and criteria for approval of dental assisting educational programs, courses, and continuing education. Existing law requires the board to approve, modify, or reject recommendations by the council within 120 days of submission to the board during full board business.

Existing law requires that fees relating to the licensing and permitting of dental assistants be established by regulation, subject to certain limitations prescribed by statute. Existing regulations set the fee for an application for board approval of various courses for dental auxiliaries, including infection control courses and radiation safety courses, at $300.

This bill would require that the fee for review of each approval application or reevaluation for a course for instruction in interim therapeutic restoration and radiographic decisionmaking, radiation safety, or infection control that is not accredited by a board-approved agency or the Chancellors office of the California Community Colleges not exceed $300, and would make conforming changes.

Existing law provides that makes the employer of a dental assistant is responsible for ensuring that the dental assistant has successfully completed a board-approved 8-hour course in infection control prior to before performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious material. Existing regulations require an employer of employees who, through performance of their duties, could reasonably anticipate skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials to ensure that those employees participate in a bloodborne pathogen training program that provides, among other things, explanations related to bloodborne diseases and pathogens.

This bill would, instead, provide that make the employer is responsible for ensuring that the dental assistant has successfully completed the course within 90 in infection control on or before 60 days from the date of first employment with the employer. at the dental office. The bill would also expand the courses that authorize a dental assistant may take to comply with this requirement to include a by taking a board-approved course provided by a board-approved registered dental assisting education program, and a stand-alone course approved by the board, as specified, or a course with 6 hours of didactic instruction and at least 2 hours of laboratory instruction using video or a series of video training tools, as specified. The bill would also require the employer to provide the above-described bloodborne pathogen training program prior to the dental assistants potential exposure to blood, saliva, or other potentially infectious materials and annually thereafter.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law, the Dental Practice Act, establishes the Dental Board of California to license and regulate the practice of dentistry, including the licensure and regulation of dental auxiliaries, including, among others, dental assistants, as defined, and sets forth duties and functions that those dental auxiliaries are authorized to perform. Existing law authorizes the board to review and evaluate all applications for licensure in all dental assisting categories to ascertain whether a candidate meets the appropriate licensing requirements specified by statute and board regulation. Existing law establishes the Dental Assisting Council within the Dental Board of California and requires the council to consider all matters relating to dental assistants in the state, as specified, and to make appropriate recommendations to the board and the standing committees of the board in specified areas, including standards and criteria for approval of dental assisting educational programs, courses, and continuing education. Existing law requires the board to approve, modify, or reject recommendations by the council within 120 days of submission to the board during full board business.

Existing law establishes various requirements for courses in infection control for certain unlicensed dental assistants and requires an unregistered dental assistant not enrolled in a board-approved program for registered dental assisting or an alternative dental assisting program, as specified, to complete a certification course, as specified. provides that the employer of a dental assistant is responsible for ensuring that the dental assistant has successfully completed a board-approved 8-hour course in infection control prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious material.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law, the Dental Practice Act, establishes the Dental Board of California to license and regulate the practice of dentistry, including the licensure and regulation of dental auxiliaries, including, among others, dental assistants, as defined, and sets forth duties and functions that those dental auxiliaries are authorized to perform.

Existing law establishes various requirements for courses in infection control for certain unlicensed dental assistants and requires an unregistered dental assistant not enrolled in a board-approved program for registered dental assisting or an alternative dental assisting program, as specified, to complete a certification course, as specified.

This bill would repeal those requirements for courses in infection control for certain unlicensed dental assistants.

Existing law provides the employer of a dental assistant is responsible for ensuring that the dental assistant has successfully completed the above course prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious material.

This bill would, instead, provide that the employer of a dental assistant is responsible for ensuring that a dental assistant who has been in continuous employment for 90 days or more has already completed, or successfully completes, the above course within a year of the date of employment.

This bill would declare that it is to take effect immediately as an urgency statute.

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Angelique Ashby, Chair

2025 - 2026 Regular

Bill No: Hearing Date: July 14, 2025

Subject:

SUMMARY:

An urgency bill that updates requirements for an unlicensed dental assistant (DA) to complete an infection control course, as specified; requires DA employers to provide a bloodborne pathogen training program prior to the DA’s potential exposure to blood, saliva, or other potentially infectious materials, and annually thereafter; updates various provisions related to radiation safety course requirements and; makes numerous conforming changes to the Dental Practice Act (Act).

Existing law:

1. Regulates the practice of dentistry under the Act and establishes the Dental Board of California (DBC) to administer and enforce the Act. (Business and Professions Code (BPC) §§ 1600-1976)
2. Establishes a Dental Assisting Council within the DBC to consider all matters relating to DAs and make appropriate recommendations to the DBC and the standing committees of the DBC. (BPC § 1742)
3. Provides regulation of registered dental assistants (RDAs) and registered dental assistants in extended functions (RDAEFs), sets the duties and functions of unlicensed DAs, and issues permits to other specified assistants. (BPC §§ 1740 – 1777)
4. Defines a DA as an individual without a license who may perform basic supportive dental procedures under the supervision of a licensed dentist that have technically elementary characteristics, are completely reversible and are unlikely to cause potentially hazardous conditions for the patient being treated. (BPC § 1750 (a))
5. Requires the supervising licensed dentist to be directly responsible for determining the competency of the DA to perform the basic supportive dental procedures, and responsible for ensuring the DA has successfully completed a board-approved eight-hour course in infection control prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious materials, a board approved two-hour course in the Act, and a basic life support course. Requires the employer to maintain evidence for the length of the employment for the DA at the supervising dentist’s treatment facility to verify the DA has met and maintained all certification requirements as dictated by statute and regulation (BPC § 1750 (b-d))
6. Defines “alternative dental assisting program” to mean a program offered by an institution of secondary or postsecondary education that has a current accreditation from the Commission on Dental Accreditation or is accredited or approved by an agency recognized by the United States Department of Education or State Department of Education, including career health and technical education programs, regional occupation centers or programs, or apprenticeship programs registered by the State Department of Education or Division of Apprenticeship Standards of the Department of Industrial Relations in allied dental programs, and whereby a certificate of completion from the program shall serve as a pathway component for licensure as a registered dental assistant. (BPC § 1741 (a))
7. Defines “direct supervision” to mean the supervision of dental procedures based on instructions given by a licensed dentist who shall be physically present in the treatment facility during the performance of those procedures. (BPC § 1741 (k))
8. Defines “general supervision” to mean supervision of dental procedures based on instructions given by a licensed dentist, but not requiring the physical presence of the supervising dentist during the performance of those procedures. (BPC § 1741 (l))
9. Defines the duties a DA may perform under the general supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:
10. Extraoral duties specified by the supervising licensee that meet the definition of a basic supportive dental procedure. These duties may include a procedure that requires the use of personal protective equipment, laboratory functions, and sterilization and disinfection procedures.
11. Operate dental radiography equipment for the purpose of oral radiography if the dental assistant has taken a board-approved radiation safety course.
12. Perform intraoral and extraoral photography. (BPC § 1750.1 (a) (1-3))
13. Authorizes a DA to perform the following duties under the direct supervision and pursuant to the order, control, and full professional responsibility of a licensed dentist:
14. Apply nonaerosol and noncaustic topical agents, including all forms of topical fluoride.
15. Take intraoral impressions for all nonprosthodontic appliances.
16. Take facebow transfers and bite registrations.
17. Place and remove rubber dams or other isolation devices.
18. Place, wedge, and remove matrices for restorative procedures.
19. Remove postextraction dressings after inspection of the surgical site by the supervising licensed dentist.
20. Perform measurements for the purposes of orthodontic treatment.
21. Cure dental materials with a light curing device.
22. Examine orthodontic appliances.
23. Place and remove orthodontic separators.
24. Remove ligature ties and archwires.
25. After adjustment by the dentist, examine and seat removable orthodontic appliances and deliver care instructions to the patient.
26. Remove periodontal dressings.
27. Remove sutures after inspection of the site by the dentist.
28. Place patient monitoring sensors.
29. Adjust the flow of nitrous oxide and oxygen gases if deemed necessary and directed by the supervising dentist who shall be present in the operatory directly supervising the adjustment.
30. Extraoral functions specified by the supervising dentist that meet the definition of basic supportive dental procedures. Such duties may include patient monitoring, placing monitoring sensors, taking of vital signs, or other extraoral procedures related to the scope of their practice.
31. In response to a medical emergency and under the direct supervision, order, control, and full professional responsibility of the licensed dentist, a dental assistant may administer or assist in the administration of oxygen. (BPC § 1750.1 (b) (1-18))
32. Defines an infection control course as providing theory and clinical application in infection control practices and principles where the protection of the public is its primary focus. An unlicensed DA not enrolled in a board-approved program for registered dental assisting or an alternative dental assisting program shall complete either a board-approved eight-hour course, with six hours being didactic instruction and two hours being laboratory instruction or a board-approved eight-hour course, with six hours of didactic instruction and at least two hours of laboratory instruction using video or a series of video training tools, all of which may be delivered using asynchronous, synchronous, or online learning mechanisms. (BPC § 1755)

This bill:

1. Requires an employer to ensure that an unlicensed DA successfully complete a DBC-approved 8-hour infection control course on or before 60 days of the first day of employment at the dental office.
2. Authorizes a DA to take either a DBC-approved course provided by a DBC-approved registered DA education program, a stand-alone course approved by the DBC as specified, or a course with 6 hours of didactic instruction and at least 2 hours of laboratory instruction using video or a series of video training tools, as specified.
3. Requires an employer to provide a bloodborne pathogen training program prior to the DA’s potential exposure to blood, saliva, or other potentially infectious materials, and annually thereafter.
4. Establishes a fee not to exceed $300 for DBC course approval of DA infection control, interim therapeutic restorations, radiographic decision making, and radiation safety courses for dental auxiliaries.
5. Authorizes a RDAEF to polish and contour existing amalgam restorations.
6. Establishes parameters for safety course providers.
7. Enhances DBC oversight and approval and establishes course requirements of infection control courses.
8. Makes various technical, conforming and clarifying changes to the Act.
9. States that the bill is urgent and necessary to take effect immediately because unlicensed DAs are currently required to take an eight-hour course prior to performing any basic supportive dental procedures that would have potential exposure to infectious materials. However, there have been delays in establishing a virtual format for this course, and it is not readily available in many regions of the state, particularly in remote and rural areas that already face significant access and workforce challenges. Immediate action is necessary to expand access to infection control training and ensure appropriate safeguards are in place. In addition, this bill includes essential updates to licensing pathways, continuing education requirements, and permit processes for dental licenses, which are needed to remove outdated or unclear provisions, address inconsistencies, and modernize the Act to reflect current practice standards and evolving technologies. Prompt enactment of these provisions will enhance public protection, improve regulatory clarity, and ensure the DBC has the authority to implement necessary oversight and course approval processes without delay.

FISCAL EFFECT:

This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations, DBC estimates it would receive 173 new applications for approval of infection control courses annually. DBC will need to review each course for compliance with the Act and related regulations, minimum standards for infection control such as those set forth by the federal Centers for Disease Control and Prevention, Occupational Safety and Health Administration (OSHA), and California OSHA. Assuming the maximum fee, DBC estimates costs of $184,000 in 2026-27 and $176,000 in 2027-28 and ongoing. The Department of Consumer Affairs Office of Information Services anticipates absorbable costs to post the new course approval form in compliance with existing standards.

COMMENTS:

1. Purpose. The California Dental Association is the sponsor of this bill. According to the Author, “AB 873 aims to address critical issues faced by dental assistants and the dental workforce shortage across California. Our bill proposes to repeal the strict timing requirement for unlicensed dental assistants to complete the 8-hour infection control course and replace it with a 90-day window. This window will provide dental assistants more flexibility when trying to begin work in the dental industry. Looking out for those in underserved and rural areas is crucial, and this bill not only allows dental assistants to begin working earlier, but also helps patients’ access necessary and timely care.”
2. Background. The DBC licenses an estimated 112,000 dental professionals, of which 43,000 are fully licensed dentists; 46,000 are registered dental assistants; and 2,300 are registered dental assistants in extended functions. The DBC is also responsible for setting the duties and functions of an estimated 50,000 unlicensed dental assistants. Dental hygienists are licensed and regulated by a separate and distinct regulatory body, the Dental Hygiene Board of California.

The Dental Assisting Council within the DBC makes recommendations regarding the DBC’s regulation of DAs. Three categories of DAs are distinguished by what duties they may perform based on their training. This includes unlicensed DAs, authorized to perform “basic supportive dental procedures”; registered dental assistants (RDA), authorized to perform more complex duties; and registered dental assistants in extended functions (RDAEF), authorized to perform additional restorative procedures following diagnosis and intervention by a dentist. DAs are unlicensed, thus not registered with the DBC or directly regulated by the DBC.

Last year, DBC was subject to the Legislature’s sunset review oversight process which culminated in the passage of SB 1453 (Ashby, Chapter 483, Statutes of 2024), the DBC sunset bill. Among a voluminous amount of provisions, including the extension of DBC and DBC operations for 4 years, SB 1453 made significant changes to unlicensed DA practice. In response to concerns about dental workforce shortages, AB 481 (Carrillo) was introduced in 2023 to create new licensure pathways and expand the duties of DAs. Proponents cited data from DBC showing that half of the state’s 58 counties are experiencing a shortage of dental assistants and noted a 2021 survey that found 44% of providers indicated that trouble filling vacant staff positions had limited their practice’s ability to treat more patients. The bill made a number of changes intended to decrease barriers to licensure and expanding safe opportunities for the dental workforce. SB 1453 was amended to incorporate provisions of AB 481 pursuant to ongoing stakeholder discussions and in order to reflect changes that DBC can effectively implement. SB 1453 included various changes to the education, scope of practice, and regulation of dental auxiliaries, including DAs, orthodontic assistants, and RDAs.

SB 1453 established the requirement that all unlicensed DAs who are not enrolled in a DBC-approved or alternative dental assisting program must complete an eight-hour infection control course prior to the unlicensed DA performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious materials. The bill specified that the course must be comprised of six hours of didactic instruction and two hours of laboratory instruction and authorized the course to be offered either in-person or using a video or a series of video training tools, all of which may be delivered using asynchronous, synchronous, or online learning mechanisms. SB 1453 took effect on January 1, 2025.

DBC Implementation Issues with SB 1453. In the months before SB 1453 took effect, despite being involved in every single aspect of the bill and having opportunities to weigh in about barriers to effective implementation of the measure, including language surrounding the infection-control course, DBC began to publicly discuss issues that DBC staff said prevented key provisions of SB 1453 from taking effect. While the statute clearly and intentionally outlined a separate set of standards for the unlicensed DA infection control course, DBC staff expressed concerns at DBC meetings that this course would not meet the same standards as other courses required for DBC licensees and registrants. It should be noted, unlicensed DAs only perform basic supportive dental procedures, defined as those procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated. Despite this fact, DBC cited additional concerns.

DBC staff said that the hours in the infection control course could not be met by existing DBC-approved course providers, despite the likely ability for course providers to update content to comply with the statutory requirements and receive updated approval to offer this specific course.

DBC also took umbrage with the fact that DBC was not provided authority to approve, deny, or withdraw approval for the SB 1453-created course, authority DBC has in regulations for oversight of RDA and RDAEF programs. Rather than explore alternatives to ensure program integrity for this one specific, statutorily prescribed course, DBC said it could not be implemented because DBC didn’t have a process the same as its process for other courses.

DBC also continued to cite existing regulations for its role related to different courses as a barrier to even attempting to implement this new, unique course. DBC said that approving the course could not happen because regulations requiring specified actions and equipment for RDA educational programs were not specified for this course for unlicensed DAs, and also cited concerns that requirements outlined in regulations for RDA educational programs related to equipment were not the same for the SB 1453-established course. SB 1453 authorized two hours of instruction to be delivered using asynchronous, synchronous, or online learning mechanisms or a combination thereof, but DBC said that is not enough and said it needed to meet requirements for the existing infection control course that requires hands-on laboratory activities like hand washing and glove use, despite the statute clearly establishing a different course and different course pathway for unlicensed DAs.

DBC also noted that there are no examination requirements, despite the intended course participants being unlicensed DAs who are not required to demonstrate competency through formal examination prior to performing their duties, as their competency is determined at the discretion of the supervising dentist.

This bill is intended to respond to DBC’s determination that provisions of SB 1453 are not implementable, and among other changes, codify DBC regulations related to course approval, instruction, oversight, examinations, and more. The bill also updates current law to specify that a DA must complete the infection control course on or before 60 days from the first day of employment and specifies that, prior to the DAs exposure to any potentially infectious materials, a bloodborne pathogen training is required to be provided by the employer.

1. Arguments in Support. California Dental Association, sponsors, write in support, “Both unlicensed medical and dental assistants must complete basic infection control training as required by Cal/OSHA. However, unlike medical assistants, who can begin working after completing their required training, unlicensed dental assistants must now also take a separate, state-mandated eight-hour infection control course before starting their roles. This is despite also receiving general onboarding and supervision from their dentist, who is ultimately responsible for ensuring the office complies with state-mandated infection control protocols. While there is no question about the value of this training, allowing a 90-day window to complete the course would provide new dental assistants with valuable on-the-job experience, enabling them to better understand and retain the intensive training.”

California Association of Orthodontists states, “As part of the 2023 Dental Board Sunset Review process, new regulations mandated that dental assistants complete an 8-hour infection control (IC) course before performing any basic supportive dental procedures. While well-intended, this requirement has created significant workforce challenges due to a lack of available courses, particularly in rural and underserved areas. The shortage of in-person course options has left new hires unable to start work, delaying patient care and worsening staffing shortages across dental and orthodontic practices.” AB 873 provides a practical solution by restoring a reasonable 90-day window for completion of the IC course, allowing new dental assistants to begin working while completing this required training. This bill will alleviate the bottleneck preventing new hires from entering the dental workforce; Ensure that orthodontic and dental practices can continue providing timely care to patients; and maintain infection control standards while addressing real-world workforce barriers. The proposed change strikes a balance between maintaining patient safety and ensuring dental offices have the staff needed to operate efficiently.”

California Society of Pediatric Dentistry notes, “By reinstating a reasonable timeframe for course completion and authorizing virtual course options, AB 873 provides a practical solution to ongoing hiring challenges. This change will help dental offices recruit and train new assistants more efficiently while ensuring infection control standards remain a priority.”

CPCA Advocates write in support, “AB 873 aims to alleviate the statewide shortage of dental professionals by providing dental assistants with greater flexibility to complete the required coursework while maintaining their employment, allowing them to begin serving patients earlier.”

SUPPORT AND OPPOSITION:

Support:

California Association of Orthodontists

California Dental Association

California Society of Pediatric Dentistry

CPCA Advocates

Opposition:

None received for the current version of the bill

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 873

Author:(Alanis)

As Amended Ver:April 9, 2025

2/3 vote. Urgency

SUMMARY

Modifies various requirements regarding unlicensed dental assistant (DA) infection control courses.

Major Provisions

1. Establish a fee for Dental Board of California (DBC) approval of DA infection control, interim therapeutic restorations, radiographic decision making, and radiation safety courses.
2. Replace the requirement that a DA must complete the infection control course prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious materials, with the requirement that a DA completes the course within 90 days.
3. Delete the limitation that the infection control course requirement only applies to DAs in continuous employment for 90 days.
4. Establish new and modify existing procedures and requirements around DBC approval of infection control courses.
5. Declare the urgency of the bill.

COMMENTS

Background. DAs are one of three types of dental practitioners that assist licensed dentists, the other two being registered dental assistants (RDAs) and registered dental assistants in extended functions (RDAEFs). RDAs and RDAEFs are licensed by the DBC and can perform relatively complex services. DAs are unlicensed and may perform "basic supportive dental procedures," which are procedures that are elementary from a technical standpoint, are completely reversible, and are unlikely to result in hazardous conditions for the patient.

DAs are not licensed, so they are indirectly regulated by the DBC through requirements on their dentist employers. Dentist employers are responsible for the services provided by their DA employees, so they must provide proper training and oversight. They must also document compliance with all relevant requirements. When there is an adverse event, the employing or supervising dentist's license may be subject to discipline by the DBC.

DA Training. In addition to any training needed to successfully incorporate a DA into a dental practice, employers of DAs also have statutorily and regulatorily required training requirements. The Dental Practice Act specifies that DA employers are responsible for DAs completing a DBC-approved two-hour course on the Dental Practice Act and maintaining certification in basic life support issued by the American Red Cross, the American Heart Association, the American Safety and Health Institute, the American Dental Association's Continuing Education Recognition Program, or the Academy of General Dentistry's Program Approval for Continuing Education.

The act also requires DA employers to ensure DA employees complete a DBC-approved eight-hour course in infection control that meets various statutory requirements prior to performing any service that involves potential exposure to blood, saliva, or other potentially infectious materials. This bill, for purposes of the Dental Practice Act, would instead allow DAs to begin providing those services prior to completing the infection course, except that those employed for 90 days or more must take the infection control course within a year of the date of employment. This bill would not modify other requirements related to infection control training, such as those required by the Division of Occupational Safety and Health.

According to the Author

"[This bill] aims to address critical issues faced by dental assistants and the dental workforce shortage across California. Our bill proposes to repeal the strict timing requirement for unlicensed dental assistants to complete the 8-hour infection control course and replace it with a 90-day window. This window will provide dental assistants more flexibility when trying to begin work in the dental industry. Looking out for those in underserved and rural areas is crucial, and this bill not only allows dental assistants to begin working earlier but also helps patients access necessary and timely care."

Arguments in Support

The California Dental Association (sponsor) writes in support:

Dental practices across California are struggling to hire unlicensed dental assistants due to new statutory barriers. Currently, newly hired unlicensed dental assistants must complete an in-person, eight-hour infection control course before they can begin working in a dental office—a requirement that replaced the previous one-year completion window following the 2024 dental board sunset review.

Both unlicensed medical and dental assistants must complete basic infection control training as required by Cal/OSHA. However, Unlike medical assistants, who can begin working after completing their required training, unlicensed dental assistants must now also take a separate, state-mandated eight-hour infection control course before starting their roles. This is despite also receiving general onboarding and supervision from their dentist, who is ultimately responsible for ensuring the office complies with state-mandated infection control protocols. While there is no question about the value of this training, allowing a 90-day window to complete the course would provide new dental assistants with valuable on-the-job experience, enabling them to better understand and retain the intensive training.

Additionally, some dentists may prefer to have their dental staff complete the in-person course format. The limited availability of in-person courses—especially in rural and underserved areas already struggling with workforce shortages—creates significant hiring delays. As a result, some candidates pursue jobs in other industries, further reducing the dental workforce. This challenge not only worsens staffing shortages in dental practices but also limits patient access to care.

Arguments in Opposition

The Dental Assisting Alliance is opposed to this bill unless it is amended, writing:

Current law requires that an unlicensed dental assistant take an 8-hour infection control course prior to "potential exposure to blood and other potentially infectious materials." This aligns with OSHA regulations that require appropriate training "At the time of initial assignment to tasks where occupational exposure may take place". [This bill] would allow an unlicensed dental assistant up to 90 days to take a Dental Board approved infection control course. That is unacceptable.

The impetus to the sponsor's proposal allowing 3 months in which to work as a dental assistant without the necessary training in infection control is due to the perceived lack of courses within a reasonable distance to those who live in remote areas of California. This erroneous assumption is negated by three facts:

1. Courses are available within a 40–50-mile radius of any county in California,
2. Several course providers will travel to the dental office to complete the hands-on lab and evaluation portion of the course (while the didactic portion of the course is available virtually),
3. [AB 1453 (Ashby), Chapter 483, Statutes of 2024], which passed last year, provides for a virtual only option for this 8-hour infection control course.

For the reasons stated above, there is no potential obstacle for compliance or delay in taking the course "prior to potential exposure to blood and OPIM" as current law requires, and we respectfully oppose unless amended [to this bill].

FISCAL COMMENTS

According to the Appropriations Committee:

The Board estimates it would receive 173 new applications for approval of infection control courses annually. The Board will need to review each course for compliance with the state's Dental Practice Act and related regulations, minimum standards for infection control such as those set forth by the federal Centers for Disease Control and Prevention, Occupational Safety and Health Administration (OSHA), and California OSHA. The Board estimates it will need one program analyst and an increase in subject matter expert workload of four hours per application, at a rate of $100 per hour in 2026-27 and ongoing. If the Board charged the maximum fee of $300 to review an application, the Board would experience a revenue increase of $52,000 per year, which will not cover the total yearly cost associated with the workload. Assuming the maximum fee, the Board estimates costs of $184,000 in 2026-27 and $176,000 in 2027-28 and ongoing (State Dentistry Fund).

The Department of Consumer Affairs Office of Information Services anticipates absorbable costs to post the new course approval form in compliance with existing standards.

VOTES

ASM BUSINESS AND PROFESSIONS: 17-0-1

YES: Berman, Flora, Ahrens, Alanis, Bains, Caloza, Chen, Elhawary, Hadwick, Haney, Irwin, Jackson, Krell, Lowenthal, Macedo, Nguyen, Pellerin

ABS, ABST OR NV: Bauer-Kahan

ASM APPROPRIATIONS: 14-0-1

YES: Wicks, Arambula, Calderon, Caloza, Dixon, Elhawary, Fong, Mark González, Hart, Pacheco, Pellerin, Solache, Ta, Tangipa

ABS, ABST OR NV: Sanchez

UPDATED

VERSION: April 9, 2025

CONSULTANT: Vincent Chee / B. & P. / (916) 319-3301 FN: 0000526

Date of Hearing: April 23, 2025

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 873

Author:(Alanis) – As Amended Ver:April 9, 2025

Urgency: Yes State Mandated Local Program: No Reimbursable: No

SUMMARY:

The bill revises requirements for infection control training for dental assistants (DAs). This bill also requires the fee the Dental Board of California (Board) charges for reviewing approval or reevaluation for certain non-accredited courses for DAs not exceed $300, and would take effect immediately as an urgency statute.

Specifically, this bill:

1. Provides that the employer of a DA (a licensed dentist) is responsible for ensuring the DA has successfully completed an approved infection control course within 90 days of first employment with the employer.
2. Authorizes the Board or its designees to approve, provisionally approve, or deny approval of, a course in infection control, as specified. Requires the Board or its designees reevaluate a Board-approved course every seven years, and authorizes the Board to withdraw approval if it determines the course does not meet specified requirements.
3. Prohibits the Board from requiring a fee of over $300 for review of an approval application or reevaluation for an infection control course.
4. Imposes requirements on infection control courses, including content areas, and that the provider of the course obtain approval from the Board to offer the course, as specified.
5. Expands the courses that may meet the requirements for Board approval, and prohibits certain courses from satisfying the infection control course requirement for licensure as a registered DA or obtaining an orthodontic assistant permit or a dental sedation assistant permit.
6. Requires the certificate of completion of an infection control course to state the statutory authority used to approve the course.
7. Declares this act an urgency statute necessary because unlicensed DAs are currently required to take an eight-hour course prior to performing procedures with potential exposure to infectious materials, and access to such courses is not readily available in many parts of the state, especially remote and rural areas already experiencing access problems and workforce shortages.

FISCAL EFFECT:

The Board estimates it would receive 173 new applications for approval of infection control courses annually. The Board will need to review each course for compliance with the state’s Dental Practice Act and related regulations, minimum standards for infection control such as those set forth by the federal Centers for Disease Control and Prevention, Occupational Safety and Health Administration (OSHA), and California OSHA. The Board estimates it will need

one program analyst and an increase in subject matter expert workload of four hours per application, at a rate of $100 per hour in 2026-27 and ongoing. If the Board charged the maximum fee of $300 to review an application, the Board would experience a revenue increase of $52,000 per year, which will not cover the total yearly cost associated with the workload. Assuming the maximum fee, the Board estimates costs of $184,000 in 2026-27 and $176,000 in 2027-28 and ongoing (State Dentistry Fund).

The Department of Consumer Affairs Office of Information Services anticipates absorbable costs to post the new course approval form in compliance with existing standards.

COMMENTS:

1. Purpose. This bill is sponsored by the California Dental Association. According to the author:

[This bill] aims to address critical issues faced by dental assistants and the dental workforce shortage across California. Our bill proposes to repeal the strict timing requirement for unlicensed dental assistants to complete the 8-hour infection control course and replace it with a 90-day window. This window will provide dental assistants more flexibility when trying to begin work in the dental industry. Looking out for those in underserved and rural areas is crucial, and this bill not only allows dental assistants to begin working earlier but also helps patients access necessary and timely care.

1. Background. DAs are one of three types of dental practitioners that assist licensed dentists, the other two being registered dental assistants (RDAs) and registered dental assistants in extended functions (RDAEFs). RDAs and RDAEFs are licensed by the DBC and can perform relatively complex services. DAs are unlicensed and may perform “basic supportive dental procedures,” which are procedures that are elementary from a technical standpoint, are completely reversible, and are unlikely to result in hazardous conditions for the patient. DAs are indirectly regulated by the Board through requirements on their dentist employers. Dentist employers are responsible for the services provided by their DA employees, so they must provide proper training and oversight. They must also document compliance with all relevant requirements. When there is an adverse event, the employing or supervising dentist’s license may be subject to discipline by the Board.
   

DA Training. In addition to any training needed to successfully incorporate a DA into a dental practice, statutes and regulations require employers of DAs to meet training requirements. The Dental Practice Act (Act) specifies that DA employers are responsible for DAs completing a Board-approved two-hour course on the Act and maintaining certification in basic life support. The Act also requires DA employers to ensure DA employees complete a Board-approved eight-hour course in infection control that meets various statutory requirements prior to performing any service that involves potential exposure to blood, saliva, or other potentially infectious materials. This bill instead allows DAs to begin providing services prior to completing the infection course.

1. Prior Legislation.
   
   AB 2242 (Carrillo) and AB 481 (Carrillo), of the 2023-24 Legislative Session, would have made numerous changes to the education, scope of practice, and regulation of dental auxiliaries, including DAs, orthodontic assistants, and RDAs. AB 2242 died pending a hearing in the Assembly Business and Professions Committee. AB 481 was held on the Senate Appropriations Committee suspense file.

SB 1453 (Ashby), Chapter 483, Statutes of 2024, was the DBC’s sunset review bill and contained, among other things, provisions substantially similar to those in AB 2242 and the infection control requirements being amended under this bill.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Marc Berman, Chair

ABPCA Bill Id:AB 873

Author:(Alanis) – As Introduced Ver:February 19, 2025

SUBJECT: Dentistry: dental assistants: infection control course.

SUMMARY: Removes the requirement that an unlicensed dental assistant (DA) complete an 8-hour infection control course approved by the Dental Board of California (DBC) prior to providing specified services, instead allowing DAs to provide the services but requiring those who have been in continuous employment for 90 days or more to take the infection control course within a year of the date of employment, and deletes other provisions related to the infection control course.

EXISTING LAW:

1. Regulates the practice of dentistry under the Dental Practice Act and establishes the DBC within the Department of Consumer Affairs to administer and enforce the act. (Business and Professions Code (BPC) §§ 1600-1976)
2. Defines “dentistry” as the diagnosis or treatment, by surgery or other method, of diseases and lesions and the correction of malpositions of the human teeth, alveolar process, gums, jaws, or associated structures; and such diagnosis or treatment may include all necessary related procedures as well as the use of drugs, anesthetic agents, and physical evaluation. (BPC § 1625)
3. Establishes a Dental Assisting Council within the DBC to consider all matters relating to DAs, registered dental assistants (RDAs), and registered dental assistants in extended functions (RDAEFs), and make appropriate recommendations to the DBC and its standing committees. (BPC § 1742)
4. Defines “alternative dental assisting program” as a program offered by an institution of secondary or postsecondary education that has a current accreditation from the Commission on Dental Accreditation or is accredited or approved by an agency recognized by the United States Department of Education or State Department of Education, including career health and technical education programs, regional occupation centers or programs, or apprenticeship programs registered by the State Department of Education or Division of Apprenticeship Standards of the Department of Industrial Relations in allied dental programs, and through which a certificate of completion from the program serves as a pathway component for licensure as a registered dental assistant. (BPC § 1741(a)
5. Defines “basic supportive dental procedures” as procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated. (BPC §§ 1741(b), 1750(a))
6. Defines “dental assistant” as an individual who may perform, without a license, basic supportive dental procedures. (BPC § 1750(j))
7. Defines “direct supervision” to mean the supervision of dental procedures based on instructions given by a licensed dentist, who must be physically present in the treatment facility during the performance of those procedures. (BPC § 1741(k))
8. Defines “general supervision” as supervision of dental procedures based on instructions given by a licensed dentist but not requiring the physical presence of the supervising dentist during the performance of those procedures. (BPC § 1741(l))
9. Authorizes DAs to perform the following basic supportive dental procedures and specifies the level of supervision required:
10. Under the general supervision and according to the order, control, and full professional responsibility of a licensed dentist:
11. Extraoral duties specified by the supervising licensee that meet the definition of a basic supportive dental procedure, including a procedure that requires the use of personal protective equipment, laboratory functions, and sterilization and disinfection procedures. (BPC § 1750.1(a)(1))
12. Operate dental radiography equipment for oral radiography if the DA has completed a DBC-approved course in radiation safety, although an erroneous cross-reference points to the requirements for coronal polishing. (BPC § 1750.1(a)(2))
13. Perform intraoral and extraoral photography. (BPC § 1750.1(a)(3))
14. Under the direct supervision and according to the order, control, and full professional responsibility of a licensed dentist:
15. Apply nonaerosol and noncaustic topical agents, including all forms of topical fluoride. (BPC § 1750.1(b)(1))
16. Take intraoral impressions for all nonprosthodontic appliances. (BPC § 1750.1(b)(2))
17. Take facebow transfers and bite registrations. (BPC § 1750.1(b)(3))
18. Place and remove rubber dams or other isolation devices. (BPC § 1750.1(b)(4))
19. Place, wedge, and remove matrices for restorative procedures. (BPC § 1750.1(b)(5))
20. Remove postextraction dressings after inspection of the surgical site by the supervising licensed dentist. (BPC § 1750.1(b)(6))
21. Perform measurements for the purposes of orthodontic treatment. (BPC § 1750.1(b)(7))
22. Cure dental materials with a light curing device. (BPC § 1750.1(b)(8))
23. Examine orthodontic appliances. (BPC § 1750.1(b)(9))
24. Place and remove orthodontic separators. (BPC § 1750.1(b)(10))
25. Remove ligature ties and archwires. (BPC § 1750.1(b)(11))
26. After adjustment by the dentist, examine and seat removable orthodontic appliances and deliver care instructions to the patient. (BPC § 1750.1(b)(12))
27. Remove periodontal dressings. ((BPC § 1750.1(b)(13))
28. Remove sutures after inspection of the site by the dentist. (BPC § 1750.1(b)(14))
29. Place patient monitoring sensors. (BPC § 1750.1(b)(15))
30. Adjust the flow of nitrous oxide and oxygen gases if deemed necessary and directed by the supervising dentist who shall be present in the operatory directly supervising the adjustment. (BPC § 1750.1(b)(16))
31. Extraoral functions specified by the supervising dentist that meet the definition of basic supportive dental procedures, including patient monitoring, placing monitoring sensors, taking of vital signs, or other extraoral procedures related to the scope of their practice. (BPC § 1750.1(b)(17))
32. Administer or assist in the administration of oxygen in response to a medical emergency. (BPC § 1750.1(b)(18))
33. Specifies that the supervising licensed dentist is responsible for determining the competency of a DA to perform any basic supportive dental procedures. (BPC § 1750(b))
34. Specifies that the employer of a DA is responsible for ensuring that the DA has passed a DBC-approved eight-hour course in infection control prior to performing any basic supportive dental procedures involving potential exposure to blood, saliva, or other potentially infectious materials. (BPC § 1750(c))
35. Establishes the following regarding DA infection control courses:
36. Defines “a course in infection control” as one that has as its main purpose providing theory and clinical application in infection control practices and principles where the protection of the public is its primary focus. (BPC § 1755(a))
37. Requires an unlicensed DA who is not enrolled in a DBC-approved program for registered dental assisting or an alternative dental assisting program to complete one of the following infection control certification courses:
38. A DBC-approved eight-hour course, with six hours being didactic instruction and two hours being laboratory instruction. (BPC § 1755(b)(1))
39. A DBC-approved eight-hour course, with six hours of didactic instruction and at least two hours of laboratory instruction using video or a series of video training tools, all of which may be delivered using asynchronous, synchronous, or online learning mechanisms or a combination thereof. (BPC § 1755(b)(2))
40. Requires a course to establish specific instructional objectives. Instruction must provide the content necessary for students to make safe and ethical judgments regarding infection control and asepsis. (BPC § 1755(c))
41. Requires objective evaluation criteria to be used for measuring student progress. Students must be provided with specific performance objectives and the evaluation criteria that will be used for didactic testing. (BPC § 1755(d))
42. Requires didactic instruction to include, at a minimum, all of the following as they relate to Division of Occupational Safety and Health, known as Cal/OSHA, regulations and the DBC’s Minimum Standards for Infection Control:
43. Basic dental science and microbiology as they relate to infection control in dentistry. (BPC § 1755(e)(1))
44. Legal and ethical aspects of infection control procedures. (BPC § 1755(e)(2))
45. Terms and protocols specified in Section 1005 of Title 16 of the California Code of Regulations regarding the minimum standards for infection control. (BPC § 1755(e)(3))
46. Principles of modes of disease transmission and prevention. (BPC § 1755(e)(4))
47. Principles, techniques, and protocols of hand hygiene, personal protective equipment, surface barriers and disinfection, sterilization, sanitation, and hazardous chemicals associated with infection control. ((BPC § 1755(e)(5))
48. Principles and protocols of sterilizer monitoring and the proper loading, unloading, storage, and transportation of instruments to the work area. (BPC § 1755(e)(6))
49. Principles and protocols associated with sharps management. (BPC § 1755(e)(7))
50. Principles and protocols of infection control for laboratory areas. (BPC § 1755(e)(8))
51. Principles and protocols of waterline maintenance. 1755(e)(9))
52. Principles and protocols of regulated and nonregulated waste management. 1755(e)(10))
53. Principles and protocols related to injury and illness prevention, hazard communication, general office safety, exposure control, postexposure requirements, and monitoring systems for radiation safety and sterilization systems. 1755(e)(11))
54. Requires the issuance of a certificate of completion to students who pass the course.

THIS BILL:

1. Amends the requirement on the employer of an unlicensed DA to ensure that the DA completes a DBC-approved, eight-hour course in infection control from “prior to performing” services to “within a year of the date of employment.”
2. Limits the requirement to the employer of a DA who has been in continuous employment for 90 days or more.
3. Deletes the provisions specifying the DA infection control course requirements.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the California Dental Association. According to the author, “[This bill] aims to address critical issues faced by dental assistants and the dental workforce shortage across California. Our bill proposes to repeal the strict timing requirement for unlicensed dental assistants to complete the 8-hour infection control course and replace it with a 90-day window. This window will provide dental assistants more flexibility when trying to begin work in the dental industry. Looking out for those in underserved and rural areas is crucial, and this bill not only allows dental assistants to begin working earlier but also helps patients access necessary and timely care.”

Background. DAs are one of three types of dental practitioners that assist licensed dentists, the other two being RDAs and RDAEFs. RDAs and RDAEFs are licensed by the DBC and can perform relatively complex services. DAs are unlicensed and may perform “basic supportive dental procedures,” which are procedures that are elementary from a technical standpoint, are completely reversible, and are unlikely to result in hazardous conditions for the patient.

DAs are not licensed, so they are indirectly regulated by the DBC through requirements on their dentist employers. Dentist employers are responsible for the services provided by their DA employees, so they must provide proper training and oversight. They must also document compliance with all relevant requirements. When there is an adverse event, the employing or supervising dentist’s license may be subject to discipline by the DBC.

DA Training. In addition to any training needed to successfully incorporate a DA into a dental practice, employers of DAs also have statutorily and regulatorily required training requirements. The Dental Practice Act specifies that DA employers are responsible for DAs completing a DBC-approved two-hour course on the Dental Practice Act and maintaining certification in basic life support issued by the American Red Cross, the American Heart Association, the American Safety and Health Institute, the American Dental Association’s Continuing Education Recognition Program, or the Academy of General Dentistry’s Program Approval for Continuing Education.

The act also requires DA employers to ensure DA employees complete a DBC-approved eight-hour course in infection control that meets various statutory requirements prior to performing any service that involves potential exposure to blood, saliva, or other potentially infectious materials. This bill, for purposes of the Dental Practice Act, would instead allow DAs to begin providing those services prior to completing the infection course, except that those employed for 90 days or more must take the infection control course within a year of the date of employment. This bill would not modify other requirements related to infection control training, such as those required by the Division of Occupational Safety and Health.

Prior Related Legislation. AB 2242 (Carrillo) of 2024 would have made numerous changes to the education, scope of practice, and regulation of dental auxiliaries, including dental assistants, orthodontic assistants, and registered dental assistants. AB 2242 died pending a hearing in the Assembly Business and Professions Committee.

SB 1453 (Ashby), Chapter 483, Statutes of 2024, which was the DBC’s sunset review bill,^[1] contained, among other things, provisions substantially similar to those in AB 2242 (Carrillo) of 2024 and the infection control requirements being amended under this bill.

AB 481 (Carrillo) of 2023 was substantially similar to AB 2242 (Carrillo) of 2024. AB 481 was held on the Senate Appropriations Committee suspense file.

AB 2276 (Carrillo) of 2022 would have authorized unlicensed dental assistants to polish teeth and apply dental sealants. AB 2276 was held on the Assembly Appropriations Committee suspense file.

ARGUMENTS IN SUPPORT:

The California Dental Association (sponsor) writes in support:

Dental practices across California are struggling to hire unlicensed dental assistants due to new statutory barriers. Currently, newly hired unlicensed dental assistants must complete an in-person, eight-hour infection control course before they can begin working in a dental office—a requirement that replaced the previous one-year completion window following the 2024 dental board sunset review.

Both unlicensed medical and dental assistants must complete basic infection control training as required by Cal/OSHA. However, Unlike medical assistants, who can begin working after completing their required training, unlicensed dental assistants must now also take a separate, state-mandated eight-hour infection control course before starting their roles. This is despite also receiving general onboarding and supervision from their dentist, who is ultimately responsible for ensuring the office complies with state-mandated infection control protocols. While there is no question about the value of this training, allowing a 90-day window to complete the course would provide new dental assistants with valuable on-the-job experience, enabling them to better understand and retain the intensive training.

Additionally, some dentists may prefer to have their dental staff complete the in-person course format. The limited availability of in-person courses—especially in rural and underserved areas already struggling with workforce shortages—creates significant hiring delays. As a result, some candidates pursue jobs in other industries, further reducing the dental workforce. This challenge not only worsens staffing shortages in dental practices but also limits patient access to care.

ARGUMENTS IN OPPOSITION:

The Dental Assisting Alliance is opposed to this bill unless it is amended, writing:

Current law requires that an unlicensed dental assistant take an 8-hour infection control course prior to “potential exposure to blood and other potentially infectious materials.” This aligns with OSHA regulations that require appropriate training “At the time of initial assignment to tasks where occupational exposure may take place”. [This bill] would allow an unlicensed dental assistant up to 90 days to take a Dental Board approved infection control course. That is unacceptable.

The impetus to the sponsor’s proposal allowing 3 months in which to work as a dental assistant without the necessary training in infection control is due to the perceived lack of courses within a reasonable distance to those who live in remote areas of California. This erroneous assumption is negated by three facts:

• Courses are available within a 40–50-mile radius of any county in California,
• Several course providers will travel to the dental office to complete the hands-on lab and evaluation portion of the course (while the didactic portion of the course is available virtually),
• [AB 1453 (Ashby), Chapter 483, Statutes of 2024], which passed last year, provides for a virtual only option for this 8-hour infection control course.

For the reasons stated above, there is no potential obstacle for compliance or delay in taking the course “prior to potential exposure to blood and OPIM” as current law requires, and we respectfully oppose unless amended [to this bill].

POLICY ISSUES FOR CONSIDERATION:

Timing of 8-hour Infection Control Course. Prior to the passage of the DBC’s prior sunset review bill, SB 1453 (Ashby), Chapter 483, Statutes of 2024, the Dental Practice Act required long-term employees to complete the infection control course and other specified courses within one year of employment:

(c) The employer of a dental assistant shall be responsible for ensuring that the dental assistant who has been in continuous employment for 120 days or more, has already successfully completed, or successfully completes, all of the following within a year of the date of employment:

(1) A board-approved two-hour course in the Dental Practice Act.

(2) A board-approved eight-hour course in infection control.

(3) A course in basic life support offered by an instructor approved by the American Red Cross or the American Heart Association, or any other course approved by the board as equivalent and that provides the student the opportunity to engage in hands-on simulated clinical scenarios.

(d) The employer of a dental assistant shall be responsible for ensuring that the dental assistant maintains certification in basic life support.

That sunset bill, which took effect this year on January 1, 2025, removed the infection control requirement from that section, instead requiring any employee, regardless of the time they have been employed, to take the 8-hour course prior to performing any supportive dental procedures that involve risk of exposure to infectious materials.

Opponents of this bill argue that the 8-hour course being taken prior to performing services is extremely important for public safety. However, the DBC has not reported a large number of issues related to the timing of the training. Even if the timing of the training requirement was reverted to some period of time after a DA is employed, employers would still have to comply with the training requirements related to bloodborne pathogens promulgated by the Division of Occupational Safety and Health, known as Cal/OSHA (Californa Code of Regulations, Title 8, §§ 5193).

The bloodborne pathogens requirements apply to all places of work where there is occupational exposure to blood or other potentially infectious materials (OPIM). Occupational exposure is defined as "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties."

The requirements specify that the training be provided “at the time of initial assignment to tasks where occupational exposure may take place” and at least annually after that. The training must include, at a minimum, all of the following:

1. Copy and Explanation of Standard. An accessible copy of the regulatory text of the bloodborn pathogens standard and an explanation of its contents.
2. Epidemiology and Symptoms. A general explanation of the epidemiology and symptoms of bloodborne diseases.
3. Modes of Transmission. An explanation of the modes of transmission of bloodborne pathogens.
4. Employer's Exposure Control Plan. An explanation of the employer's exposure control plan and the means by which the employee can obtain a copy of the written plan.
5. Risk Identification. An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and OPIM.
6. Methods of Compliance. An explanation of the use and limitations of methods that will prevent or reduce exposure including appropriate engineering controls, administrative or work practice controls and personal protective equipment.
7. Decontamination and Disposal. Information on the types, proper use, location, removal, handling, decontamination and disposal of personal protective equipment.
8. Personal Protective Equipment. An explanation of the basis for selection of personal protective equipment.
9. Hepatitis B Vaccination. Information on the hepatitis B vaccine, including information on its efficacy, safety, method of administration, the benefits of being vaccinated, and that the vaccine and vaccination will be offered free of charge.
10. Emergency. Information on the appropriate actions to take and persons to contact in an emergency involving blood or OPIM.
11. Exposure Incident. An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident, the medical follow-up that will be made available and the procedure for recording the incident on the Sharps Injury Log.
12. Post-Exposure Evaluation and Follow-Up. Information on the post-exposure evaluation and follow-up that the employer is required to provide for the employee following an exposure incident.
13. Signs and Labels. An explanation of the signs and labels and/or color coding.
14. Interactive Questions and Answers. An opportunity for interactive questions and answers with the person conducting the training session.

The requirements also specify that the person conducting the training must be knowledgeable in the subject matter covered by the elements contained in the training program as it relates to the workplace that the training will address.

IMPLEMENTATION ISSUES:

Dental Board Approval of New Infection Control Courses. The DBC, which would support this bill if amended, writes that this bill would repeal the infection control provisions establishing a new dental assistant infection control course that could be completed electronically. Specifically:

As described in the Board’s November 2024 meeting materials (Agenda Item 27.e.), Board staff identified numerous concerns when preparing to implement Board approval of the new infection control course created in BPC section 1755. Following the Board’s November 2024 meeting, the Board’s Dental Assisting Council Infection Control Working Group met with various stakeholders, including CDA and the Dental Assisting Alliance, to determine the best pathway to implement this new course that maintains consumer protection through appropriate course instruction while improving course access to unlicensed dental assistants in rural areas.

The Board recommends the following amendments to resolve the urgent implementation issues with the infection control and radiation safety courses:

• Amend BPC section 1725 to add new subdivision (l) to establish preexisting application fees
• Amend BPC section 1755 (infection control course), subdivision (b), to allow an unlicensed dental assistant, who previously took or wants to take a Board-approved education program’s infection control course currently authorized in regulation or an eight-hour infection control course currently authorized in regulation, to use any of those infection control courses to satisfy the infection control course requirement, in effect providing legacy compliance for those individuals who have already completed the infection control course prior to January 1, 2025, when BPC section 1755 went into effect.
• Add new BPC section 1755, new subdivisions (c) and (d), to establish course application, laboratory instruction, and Board approval process requirements, based on existing course application regulations.
• Add new BPC section 1755, subdivision (g), to limit the use of the electronic infection control courses solely to unlicensed dental assistants, so that all registered dental assistant (RDA) license, orthodontic assistant, and dental sedation permit applicants would continue to take the eight-hour infection control course offered by an education program or infection control course provider under regulation. Currently, BPC section 1755 creates a disparity in the infection control course requirement for RDA applicants – subdivision (a) provides that an unlicensed dental assistant not enrolled in a Board approved program or alternative dental assisting program (two of the five pathways for RDA licensure) have to take the new infection control course with six hours of didactic instruction and two hours of laboratory instruction (no in-person supervised clinical instruction). The Board has received comment from dental assisting stakeholders that clinical instruction on infection control is extremely important for public safety; such instruction on the use of personal protective equipment (PPE) and instrument cleaning, disinfection, and sterilization cannot be effectively taught through electronic means. The Board has not received any information on why some RDA applicant pathways should be required to receive clinical instruction and other pathways should not. Since RDAs perform many more dental procedures involving infectious materials, many of which are not directly supervised, than unlicensed dental assistants, the Board believes RDAS and other dental assisting permitholders should receive effective clinical instruction on Infection control. The issue communicated to the Board was the need to improve access by unlicensed dental assistants to infection control courses: the proposed amendments would accomplish this by allowing three different infection control courses, including the new electronic course, while maintaining consumer protection by requiring RDA license and dental assisting permit applicants to receive clinical instruction.

Dental Board Implementation of Other Sunset Review Recommendations. The DBC also requested additional amendments, writing:

During the Board’s February 2025 meeting, the Board approved a legislative proposal to resolve the implementation concerns with BPC section 1755, along with various other provisions to clarify the dental assisting statutes amended by SB 1453. The Board also approved several other legislative proposals at its November 2024 and February 2025 meetings to better clarify other SB 1453 implementation issues. Board staff have been in continued discussions with stakeholders on these issues, and CDA has expressed willingness to incorporate additional amendments to the bill.

If this bill passes this committee, the author may wish to continue working with the DBC on its additional proposals.

AMENDMENTS:

1. To reduce the timeframe that a DA must complete the infection control course and apply the requirement to all DAs regardless of length of employment, amend the bill as follows:

On page 2 of the bill, lines 15-23:

(c) The employer of a dental assistant shall be responsible for ensuring that a dental assistant who has been in continuous employment for 90 days or more, has already completed, or successfully completes, has successfully completed a board-approved eight-hour course in infection control within a year of the date of employment. within 90 days from the date of first employment at the dental office.

1. To incorporate the DBC’s implementation language allowing for the approval of additional infection control courses, amend the bill as follows:

On page 4, beginning with line 8:

Section 1755 of the Business and Professions Code is amended to read:

1755. (a) A course in infection control is one that has as its main purpose providing theory and clinical application in infection control practices and principles where the protection of the public is its primary focus. The board shall approve only those courses that adhere to the minimum requirements of this section and applicable regulations adopted by the board.

(b) An unlicensed dental assistant not enrolled in a board-approved program for registered dental assisting or an alternative dental assisting program as defined in subdivision (a) of Section 1741, shall complete one of the following infection control certification courses: An eight-hour infection control course taken for compliance with the requirements of paragraph (c) of Section 1750 shall be one of the following:

(1) A board-approved eight-hour course, with six hours being didactic instruction and two hours being laboratory instruction.

(1) A board-approved eight-hour infection control course provided by a board-approved registered dental assisting education program.

(2) An eight-hour infection control course approved by the board pursuant to Section 1070.6 of Title 16 of the California Code of Regulations.

(32) A board-approved eight-hour course, with six hours of didactic instruction and at least two hours of laboratory instruction using video or a series of video training tools, all of which may be delivered using asynchronous, synchronous, or online learning mechanisms or a combination thereof.

(c) A provider of an infection control course offered to students for compliance with paragraph (3) of subdivision (b) shall submit an application on a form furnished by the board for board approval to offer the course, the applicable fee specified in Section 1725, and all of the following:

(1) The course name, course provider name, course director name, business address, telephone number, and email address shall be identified in the application for board approval.

(2) Proof that the course director possesses a valid, active, and current license issued by the board or the Dental Hygiene Board of California.

(3c) A detailed course outline, in writing, that clearly states the curriculum subject matter, hours of didactic and laboratory instruction, and specific instructional objectives. Instruction shall provide the content necessary for students to make safe and ethical judgments regarding infection control and asepsis.

(4d) Objective evaluation criteria shall be used for measuring student progress. Students shall be provided with specific performance objectives and the evaluation criteria that will be used for didactic testingcourse examination.

(5) Proof that course instructors have experience in the instruction of California Division of Occupational Safety and Health (Cal/OSHA) regulations (Cal. Code Regs., Title 8, Sections 330-344.85) and the board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005).

(6e) Documentation of didactic instruction shallthat includes, at a minimum, all of the following as they relate to Cal/OSHA regulations, as set forth in Sections 300 to 344.85, inclusive, of Title 8 of the California Code of Regulations, and the board’s Minimum Standards for Infection Control, as set forth in Section 1005 of Title 16 of the California Code of Regulations:

(A1) Basic dental science and microbiology as they relate to infection control in dentistry.

(B2) Legal and ethical aspects of infection control procedures.

(C3) Terms and protocols specified in Section 1005 of Title 16 of the California Code of Regulations regarding the minimum standards for infection control.

(D4) Principles of modes of disease transmission and prevention.

(E5) Principles, techniques, and protocols of hand hygiene, personal protective equipment, surface barriers and disinfection, instruments and devices, sterilization, sanitation, and hazardous chemicals associated with infection control.

(F6) Principles, and protocols, and procedures of sterilizer monitoring and the proper loading, unloading, storage, and transportation of instruments to work area.

(G7) Principles, and protocols, and procedures associated with sharps management.

(H8) Principles, and protocols, and procedures of infection control for laboratory areas.

(I9) Principles, and protocols, and procedures of waterline maintenance.

(J10) Principles, and protocols, and procedures of regulated and nonregulated contaminated medical waste management occurring in the dental healthcare setting.

(K11) Principles, and protocols, and procedures related to injury and illness prevention, hazard communication, general office safety, exposure control, postexposure requirements, and monitoring systems for radiation safety and sterilization systems.

(7) Documentation of laboratory instruction that includes, at a minimum, demonstrations in the following areas, as they relate to Cal/OSHA regulations, as set forth in Sections 300 to 344.85, inclusive, of Title 8 of the California Code of Regulations, and the board’s Minimum Standards for Infection Control, as set forth in Section 1005 of Title 16 of the California Code of Regulations:

(A) Apply hand cleansing products and perform hand cleansing techniques, protocols, and procedures.

(B) Apply, remove, and dispose of patient treatment gloves, utility gloves, overgloves, protective eyewear, masks, and clinical attire.

(C) Utilize instruments, surfaces, and situations where contamination is simulated, without actual contamination, from bloodborne and other pathogens being present.

(D) Apply the appropriate techniques, protocols, and procedures for the preparation, sterilization, and storage of instruments including, at a minimum, application of personal protective equipment, precleaning, ultrasonic cleaning, rinsing, sterilization wrapping, internal or external process indicators, labeling, sterilization, drying, storage, and delivery to work area.

(E) Preclean and disinfect contaminated operatory surfaces and devices, and properly use, place, and remove surface barriers.

(F) Maintain sterilizer including, at a minimum, proper instrument loading and unloading, operation cycle, spore testing, and handling and disposal of sterilization chemicals.

(G) Apply work practice controls as they relate to the following classification of sharps: anesthetic needles or syringes, orthodontic wires, and broken glass.

(H) Apply infection control protocol and procedures for the following laboratory devices: impressions, bite registrations, and prosthetic appliances.

(I) Perform waterline maintenance, including use of water tests and purging of waterlines.

(J) Perform techniques for safe handling and disposal of contaminated regulated medical waste.

(8) Written laboratory protocols that comply with the board's Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005) and other federal, state, and local requirements governing infection control. The course shall provide these protocols to all students and course instructors to ensure compliance.

(9) A written examination that reflects the curriculum content, which may be administered at intervals throughout the course as determined by the course director and shall be successfully completed by each student prior to issuing the certificate of completion described in subdivision (e).

(d) For infection control courses offered to students for compliance with paragraph (3) of subdivision (b), all of the following applies:

(1) The board or its designee may approve, provisionally approve, or deny approval of the course after it evaluates all components of the course. Provisional approval shall expire one year from the date of provisional approval or upon subsequent board approval or denial, whichever occurs first. Provisional approval shall be limited to those courses that substantially comply with all existing standards for full approval. A course given provisional approval shall immediately notify each student of such status. If the board provisionally approves or denies approval of a course, the specific reasons therefore shall be provided by the board to the course director in writing within 90 days after such action.

(2) A board-approved course shall be re-evaluated approximately every seven years, but may be subject to re-evaluation and inspection by the board at any time to ensure compliance with this section.

(3) The board may withdraw approval at any time that it determines the course does not meet the requirements of this section.

(4) The course director shall actively participate in and be responsible for the administration of the course and each of the following requirements:

(A) Maintaining for a period of not less than five years copies of curricula, program outlines, objectives, and grading criteria, and copies of course instructor credentials, licenses, and certifications, and individual student records, including those necessary to establish satisfactory completion of the course.

(B) Informing the board of any major change to the course (including closure), course provider name, course director, business contact information, or course content within 10 days of the change.

(C) Ensuring that all course instructors meet the requirements set forth in this section.

(5) Prior to enrolling a student, the course shall provide notification to the prospective student of the computer or communications technology necessary to participate in didactic and laboratory instruction.

(6) The course shall provide technological assistance to students, as needed, to participate in didactic and laboratory instruction.

(7) The course shall ensure completion of didactic instruction by the student prior to the student’s participation in laboratory instruction.

(ef) Upon successful completion of the course, students shall receive a certificate of completion as defined in subdivision (e) of Section 1741. The certificate of completion shall state the statutory authority under paragraph (1), (2), or (3) of subdivision (b) for which the course has been approved.

(f) Course records shall be subject to inspection by the board at any time.

(g) A course taken pursuant to paragraph (3) of subdivision (b) shall not satisfy completion of an infection control course required for licensure as a registered dental assistant or permit as an orthodontic assistant or dental sedation assistant.

(hg) The board may adopt regulations to implement this section.

1. To incorporate the DBC’s sunset review implementation language codifying existing fees (CCR, tit. 16, § 1022(p)-(v)) relating to DA courses, amend the bill as follows:

On page 2, before line 1, insert:

Section 1725 of the Business and Professions Code is amended to read:

1725. The amount of the fees prescribed by this chapter that relate to the licensing and permitting of dental assistants shall be established by regulation and subject to the following limitations:

(a) The application fee for an original license shall not exceed two hundred dollars ($200).

(b) The fee for examination for licensure as a registered dental assistant shall not exceed the actual cost of the examination.

[…]

(l) The fee for review of each approval application or reevaluation for a course provided pursuant to Sections 1753.52, 1754.5, and 1755 that is not accredited by a board-approved agency or the Chancellor’s office of the California Community Colleges shall be three hundred dollars ($300).

REGISTERED SUPPORT:

California Dental Association (sponsor)

California Association of Orthodontists

California Society of Pediatric Dentistry

CPCA Advocates, Subsidiary of the California Primary Care Association

REGISTERED OPPOSITION:

The California Dental Assisting Alliance (unless amended)

Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301

1. The sunset review process provides an opportunity for the DCA, the Legislature, the boards, and interested parties and stakeholders to discuss the performance of the boards, and make recommendations for improvements. Each year, the Assembly Business and Professions Committee and the Senate Business, Professions, and Economic Development Committee hold joint sunset review oversight hearings to review the boards and bureaus. For more information, see the background paper on the DBC’s 2024 Sunset Review, accessible at: https://abp.assembly.ca.gov/jointsunsethearings. ↑