Chapter D2 – Article 30. Skillsets
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Chapter D2 – Article 30. Skillsets

Sec. D2.30.100. Village Based Dental Practice.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed certification requirements for one or more of the following:
    1. 20.200 [PDHA II];
    2. 20.400 [EFDHA I]; or
    3. 20.500 [EFDHA II].
  2. Education. Requirements include (1) below:
    1. complete a Board approved DHA village-based dental practice course that meets all of the following requirements:
      1. Subject Matter. A Village-Based Dental Practice course must address the following topics:
        1. use of telemedicine technology, including use of intra- and extra-oral photographs;
        2. problem specific dental history taking;
        3. reviewing and recognition of medical and dental conditions;
        4. identification and basic management of dental emergencies including:
          1. chipped tooth;
          2. avulsed tooth;
          3. acute abscess;
          4. broken jaw;
          5. soft tissue/oral trauma;
        5. recognition and basic management of medical emergencies including:
          1. syncope;
          2. allergic reactions;
          3. angina;
          4. hypoglycemia;
          5. asthma attack;
          6. seizures;
          7. myocardial infarction;
          8. stroke; and
          9. opioid overdose.
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 7 hours.
  3. Scope of Practice. Includes (1) and (2) below:
    1. Knowledge/Skills. A DHA certified in Village Based Dental Practice must maintain an understanding of:
      1. use of telemedicine technology;
      2. problem specific dental history taking;
      3. reviewing and recognition of medical and dental conditions;
      4. identification and basic management of dental emergencies;
      5. recognition and basic management of medical emergencies; and
    2. A DHA certified in Village Based Dental Practice must maintain and demonstrate competency in the following:
      1. Intraoral and Extraoral Photographs.

Sec. D2.30.200. Sealants.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed certification requirements for one or more of the following:
    1. 20.200 [PDHA II];
    2. 20.300 [DHAH]; or
    3. 20.400 [EFDHA I].
  2. Education. Must meet the requirements of (1), (2) or (3) below:
    1. A board approved course in sealants that satisfies the requirements below:
      1. Subject Matter. A course in sealants must address the following topics:
        1. dental treatment plans;
        2. identifying contraindications for sealant treatment;
        3. explaining sealant procedure and responding to questions from patient regarding sealants;
        4. proper patient and provider safety procedures;
        5. sealant material(s) and instructions for use;
        6. isolating teeth to be sealed;
        7. identifying and correcting occlusal discrepancies caused by excess sealant;
        8. sealant retention;
        9. sealant placement; and
      2. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (a) of this section; hands-on practice must include a minimum of 25 sealants.
    2. a sealant course offered by an accredited school of higher education; or
    3. a sealant course offered by IHS.
  3. Preceptorship. A DHA must, after completion of the requirements in subsection (b) of this section, under the direct supervision of a dentist, DHAT, or DHATP, complete a preceptorship. The DHA must satisfactorily perform a minimum of 25 sealant procedures including:
    1. a minimum of 10 on molars; 
    2. a minimum of 5 on children under 7 years of age; and
    3. a minimum of 10 on second molars.
  4. Supervision.
    1. A DHA certified in sealants may provide services under the scope of practice listed in this skillset provided that the sealant was ordered by a dentist, DHAT, or DHATP prior to the sealant procedure and following the requirements of (A), (B), or (C) below:
      1. under the direct supervision of a dentist, DHAT, DHATP;
      2. under the indirect supervision of a dentist, DHAT or DHATP if they have the following:
        1. a signed set of standing orders; or
      3. under the general supervision of a dentist if they have both of the following:
        1. a signed set of standing orders; and
        2. D2.30.100 [village based dental practice] skillset.
  5. Scope of Practice. Includes (1) and (2) below:
    1. Knowledge/Skills. A DHA certified in sealants must maintain an understanding of:
      1. Dental treatment plans;
      2. identifying contraindications for sealant treatment;
      3. explaining sealant procedure and responding to questions from patient regarding sealants;
      4. proper patient and provider safety procedures;
      5. sealant material(s) and instructions for use;
      6. isolating teeth to be sealed;
      7. identifying and correcting occlusal discrepancies caused by excess sealant; and
      8. sealant retention.
    2. A DHA certified in sealants must maintain and demonstrate competency in the following:
      1. sealant placement.

Sec. D2.30.300. Dental Prophylaxis.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed certification requirements for one or more of the following:
    1. 20.200 [PDHA II]; or
    2. 20.400 [EFDHA I].
  2. Education. Must satisfactorily complete (1), (2), or (3) below:
    1. a Board approved course in dental prophylaxis that satisfies the requirements below:
      1. Subject Matter. A course in dental prophylaxis must address the following topics:
        1. understanding and following dental orders;
        2. reviewing medical history and identify contraindications for performing prophylaxis;
        3. understanding when the patient should be referred to a dentist prior to carrying out prophylaxis;
        4. explaining prophylaxis procedure and respond to questions from patient regarding prophylaxis;
        5. proper patient and provider safety procedures, including:
          1. proper use of dental instruments for safety of patient and provider; and
          2. proper use of ultrasonic scalers;
        6. scaling and polishing to remove plaque, calculus, and stains from the coronal or exposed surface of the tooth; and
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 16 hours, of which, 8 hours must be clinical encounters:
        1. a course in dental prophylaxis offered by an accredited school of higher education; or
        2. a course in dental prophylaxis offered or approved by IHS.
  3. Preceptorship. A DHA must, after completion of the requirements in subsection (b) of this section, under the direct supervision of a dentist, DHAT, or DHATP complete a preceptorship. The DHA must satisfactorily perform a minimum of 40 dental prophylaxis of which:
    1. a minimum of 10 must be performed on children under 8 years of age; and
    2. a minimum of 10 must be performed on adults with supra-gingival calculus.
  4. Supervision.
    1. A DHA certified in dental prophylaxis may provide services under the scope of practice listed in this skillset provided that the dental prophylaxis was ordered by a dentist, DHAT, or DHATP prior to the dental prophylaxis procedure and following the requirements of (A), (B), or (C) below:
      1.  under the direct supervision of a dentist, DHAT, DHATP;
      2. under the indirect supervision of a dentist, DHAT or DHATP if they have the following:
        1. a signed set of standing orders; or
      3.  under the general supervision of a dentist if they have both of the following:
        1. a signed set of standing orders; and
        2. D2.30.100 [village based dental practice] skillset.
  5. Scope of Practice. Includes (1) and (2) below:
    1. Knowledge/Skills. A DHA certified in dental prophylaxis must maintain an understanding of:
      1. understanding and following dental orders;
      2. Reviewing medical history and identifying contraindications for performing prophylaxis;
      3. understanding when the patient should be referred to a dentist prior to carrying out prophylaxis;
      4. explaining prophylaxis procedure and respond to questions from patient regarding prophylaxis;
      5. proper patient and provider safety procedures;
      6. proper use of dental instruments for safety of patient and provider;
      7. proper use of ultrasonic scalers; and
      8. scaling and polishing to remove plaque, calculus, and stains from the coronal or exposed surface of the tooth; and
    2. A DHA certified in dental prophylaxis must maintain and demonstrate competency in the following:
      1. child dental prophylaxis; and
      2. Adult dental prophylaxis with coronal or clinically visible calculus.

Sec. D2.30.400. Dental Radiology.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed the certification requirements for one or more of the following:
    1. 20.200 [PDHA II]; or
    2. 20.400 [EFDHA I].
  2. Education. Must satisfactorily complete (1), (2) or (3) below:
    1. a Board approved course in dental radiology that satisfies the requirements below:
      1. Subject Matter. A course in dental radiology must address the following topics:
        1. components of an x-ray machine;
        2. kilovoltage (kVp);
        3. density and contrast;
        4. milliamperage (mA);
        5. exposure time;
        6. sensor type;
        7. radiological protection;
        8. radiographic quality;
        9. radiographic technique;
        10. presentation of radiographs;
        11. radiographic infection control;
        12. special radiograph techniques;
        13. mounting and labeling of radiographs;
        14. radiological protection of operator and patient;
        15. use and storage of the lead apron and thyroid collar;
        16. review medical history and identify contraindications for performing x-rays;
        17. recognition and correction of:
          1. distortion;
          2. overlap; and
          3. cone-cutting;
        18. use of sensor holding device;
        19. positioning and exposing intra-oral radiographs;
        20. troubleshooting technique errors;
        21. image labeling;
        22. use of landmarks to display images;
        23. basic knowledge of film radiography; and
        24. variety of digital radiography systems.
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 10 anterior PAs, 10 posterior Pas, and 10 sets of bitewings.
    2. a course in dental radiology offered by an accredited school of higher education; or
    3. a course in dental radiology offered or approved by IHS;
  3. Preceptorship. A DHA must, after completion of the requirements in subsection (b) of this section, under the direct supervision of a dentist, DHAT, or DHATP complete a preceptorship. The DHA must satisfactorily perform:
    1. a minimum of 10 anterior periapical radiographs;
    2. a minimum of 10 posterior periapical radiographs; and
    3. a minimum of 5 sets of bitewings.
  4.  Supervision.
    1. A DHA certified in dental radiology may provide services under the scope of practice listed in this skillset provided that the radiograph was ordered by a dentist, DHAT, or DHATP prior to the radiograph procedure and following the requirements of (A), (B), or (C) below:
      1. under the direct supervision of a dentist, DHAT, or DHATP;
      2. under the indirect supervision of a dentist, DHAT, or DHATP if they have the following:
        1. a signed set of standing orders; and
      3. under the general supervision of a dentist, if they have the following:
        1. a signed set of standing orders.
  5. Scope of Practice. Includes (1) and (2) below:
    1. Knowledge/Skills. A DHA certified in radiology must maintain an understanding of:
      1. radiological protection of operator and patient;
      2. radiographic quality;
      3. radiographic technique;
      4. presentation of radiographs;
      5. radiographic infection control;
      6. special radiograph techniques;
      7. mounting and labeling of radiographs;
      8. use and storage of the lead apron and thyroid collar;
      9. review medical history and identify contraindications for performing x-rays;
      10. troubleshooting technique errors, including recognition and correction of:
        1. distortion;
        2. overlap; and
        3. cone-cutting;
      11. use of sensor holding devices;
      12. positioning and exposing intra-oral radiographs; and
      13. use of landmarks to display images.
    2. Competencies. A DHA certified in radiology must maintain and demonstrate competency in the following:
      1. bitewing radiographs;
      2. anterior periapical radiographs; and
      3. posterior periapical radiographs.

Sec. D2.30.500. Atraumatic Restorative Treatment (ART).

  1. Prerequisites. To qualify for this skillset, a DHA must have completed the certification requirements for one or more of the following:
    1. 20.200 [PDHA II];
    2. 20.300 [DHAH]; or
    3. 20.400 [EFDHA I].
  2. Education. Must satisfactorily complete (1), (2), or (3) below:
    1. A Board approved course in ART that satisfies the requirements below:
      1. (A) Subject Matter. A course in atraumatic restorative treatment must address the following topics:
        1. understanding and following dental orders;
        2. reviewing medical history and identifying contraindications for performing ART;
        3. identify cases appropriate for ART;
        4. understanding when the patient should be referred to a dentist, DHAT, or DHATP;
        5. explaining ART procedure and responding to questions from patient regarding ART;
        6. proper patient and provider safety procedures, including proper use of dental instruments;
        7. isolating the tooth/teeth;
        8. removing gross caries with hand instruments;
        9. mixing, placing and contouring appropriate restorative material;
        10. recognizing potential and actual procedural complications and consulting appropriately with the dentist, DHAT, or DHATP; and
        11. Evaluating occlusion.
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 21 hours;
    2. a course in ART offered by an accredited school of higher education; or
    3. a course in ART offered or approved by IHS.
  3. Preceptorship. A DHA must, after completion of the requirements in subsection (b) of this section, under the direct supervision of a dentist, DHAT, or DHATP complete a preceptorship during which the DHA satisfactorily performs ART on:
    1. a minimum of 10 patients of whom a minimum of 5 must be children under 4 years of age; and
    2. a minimum of 50 teeth.
  4. Supervision.
    1. A certified PDHA II, EFDHA I, or DHAH may provide services under the scope of practice listed in this skillset provided that a consult is done with a dentist, DHAT, or DHATP prior to the ART procedure and following the requirements of (A), (B), or (C) below:
      1. under the direct supervision of a dentist, DHAT, or DHATP;
      2. under the indirect supervision of a dentist, DHAT, or DHATP if they have the following:
        1. a signed set of standing orders; or
      3. Under the general supervision of a dentist if they have both of the following:
        1. a signed set of standing orders; and
        2. D2.30.100 [village based dental practice] skillset.
  5. Scope of Practice. Includes (1) and (2) below:
    1. Knowledge/Skills. A DHA certified in ART must maintain an understanding of:
      1. identifying contraindications for performing ART;
      2. identify cases appropriate for ART;
      3. understanding when the patient should be referred to a dentist;
      4. explaining ART procedure and responding to questions from patient regarding ART;
      5. proper patient and provider safety procedures, including proper use dental instruments; and
      6. recognizing potential and actual procedural complications and consulting appropriately with the dentist; and
    2. A DHA certified in ART must maintain and demonstrate competency in the following:
      1. Performing ART, which includes:
        1. isolating the tooth/teeth;
        2. removing gross caries with hand instruments;
        3. mixing, placing and contouring appropriate restorative material; and
        4. evaluating occlusion.

Sec. D2.30.600. Basic Restorative.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed the certification requirements for one or more of the following:
    1. 20.400 [EFDHA I]; or
    2. 20.500 [EFDHA II].
  2. Education. Must satisfactorily complete (1), (2), or (3) below:
    1. A Board approved course in basic restorative functions that satisfies the requirements below:
      1. Subject Matter. A course in basic restorative functions must address the following topics:
        1. advanced tooth morphology, structure and function;
        2. occlusion;
        3. restorative materials and instructions for use;
        4. discrimination between acceptable and unacceptable restoration;
        5. placement and finishing of Class I, II, III and V restorations after preparation by the dentist, DHAT, or DHATP; and
        6. appropriate post-procedure instructions; and
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 21 hours;
    2. a course in basic restorative functions offered by an accredited school of higher education; or
    3. a course in basic restorative functions offered or approved by IHS.
  3. Preceptorship. Must, after completion of the requirements in section (b) of this section, under the direct supervision of a dentist, DHAT, or DHATP complete a preceptorship for a minimum of six months or 400 hours, whichever is longer. The preceptorship should encompass all the requirements of the scope of practice in this skillset, include at least 50 satisfactory restorations, and show that the DHA has demonstrated competency at least five times in all the procedures listed under the competencies.
  4. Supervision. This skillset may not be performed under general supervision.
    1. A DHA certified in basic restorative may provide services under the scope of practice listed in this skillset following the requirements of (A) or (B) below:
      1. under the direct supervision of a dentist, DHAT, or DHATP; or
      2. under the indirect supervision of a dentist, DHAT, or DHATP if they have the following:
        1. a signed set of standing orders.
  5. Scope of Practice. Includes (1) and (2):
    1. Knowledge/Skills. A DHA certified in basic restorative must maintain an understanding of:
      1. advanced tooth morphology, structure and function;
      2. the difference between acceptable and unacceptable restorations;
      3. restorative materials;
      4.  the basics of occlusion as they apply to restorative dentistry; and
      5. appropriate post-procedure instructions; and
    2. A DHA certified in basic restorative must maintain and demonstrate competency in the following simple restorations:
      1. Class I restorations;
      2. Class II restorations;
      3. Class III restorations; and
      4. Class V restorations.

Sec. D2.30.700. Stainless Steel Crown Placement on Primary Teeth.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed the certification requirements for one or more of the following:
    1. 20.300 [DHAH]; or
    2. 20.400 [EFDHA I].
  2. Education. Must complete (1), (2), or (3):
    1. a Board approved course in stainless steel crown placement that satisfies the requirements below:
      1. (A) Subject Matter. A course in stainless steel crowns must address the following topics:
        1. selecting the appropriate stainless steel crown and cementation materials;
        2. Space requirement for stainless steel crown placement, including using spacers to create space;
        3. preventing and managing aspiration risk;
        4. modifying the crown, as necessary;
        5. checking and correcting occlusion, contact and margins of stainless steel crown;
        6. cementing and removing excess cement;
        7. reverifying the occlusion; and
        8. providing appropriate post-procedure instructions; and
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 14 hours;
    2. a course in stainless steel crown placement offered by an accredited school of higher education; or
    3. a course in stainless steel crown placement offered or approved by IHS.
  3. Preceptorship. A DHA must, after completion of the requirements in subsection (b) of this section, satisfactorily complete a preceptorship, which must meet (1) and (2) below:
    1. be under the direct supervision of a dentist, DHAT, or DHATP; and
    2. include satisfactory performance, in the DHA’s clinical setting, of placing a minimum of 20 stainless steel crowns.
  4. Supervision. This skillset may not be performed under general supervision.
    1. A certified EFDHA I or DHAH may provide services under the scope of practice listed in this skillset following the requirements of (A) or (B) below:
      1. under the direct supervision of a dentist, DHAT or DHATP; or
      2. under the indirect supervision of a dentist, DHAT or DHATP if they have the following:
        1. a signed set of standing orders.
  5. Scope of Practice. Includes (1) and (2) below:
    1. Knowledge/Skills. A DHA certified in stainless steel crown placement on primary teeth must maintain an understanding of:
      1. space requirement for stainless steel crown placement, including using spacers to create space;
      2. selecting the appropriate stainless steel crown and cementation material;
      3. preventing and managing aspiration risk;
      4. modifying the crown, as necessary;
      5. checking and correcting occlusion, contact and margins of stainless steel crown;
      6. cementing and removing excess cement;
      7. re-verifying the occlusion; and
      8. providing appropriate post-procedure instructions; and
    2. A DHA certified in stainless steel crown placement on primary teeth must maintain and demonstrate competency in the following:
      1. placement of a stainless steel crown.

Sec. D2.30.800. Advanced Restorative.

  1. Prerequisites. To qualify for this skillset, a DHA must have completed the certification requirements for one or more of the following:
    1. 20.500 [EFDHA II].
  2. Education. Must complete (1), (2) or (3) below:
    1. A Board approved course in advanced restorative functions that satisfies the requirements below:
      1. (A) Subject Matter. A course in advanced restorative functions must address the following topics:
        1. the basics of occlusion as they apply to restorative dentistry;
        2. current state-of-the-art dentinal bonding agents;
        3. placement and finishing of cusp protected amalgam and complex Class II amalgams (complex fillings) after preparation by the dentist, DHAT, or DHATP;
        4. placement and finishing of dental composite Class II and IV (complex fillings) after preparation by the dentist, DHAT, or DHATP; and
        5. appropriate post-procedure instructions; and
      2. Training. The training will include instruction and hands-on practice in a lab or clinic setting sufficient to demonstrate competency of the subject matter in subsection (A) of this section; hands-on practice must include a minimum of 21 hours.
    2. a course in advanced restorative functions offered by an accredited school of higher education; or
    3. a course in advanced restorative functions offered or approved by IHS, and
  3. Preceptorship. An EFDHA II must after completion of the requirements in subsection (b) of this section, satisfactorily complete a preceptorship, which will meet all of the following:
    1. be under the direct supervision of a dentist;
    2. be a minimum of six months or 400 hours whichever is longer; and
    3. include satisfactory performance in the DHA’s clinical setting under direct supervision of a dentist, DHAT, or DHATP a minimum of 50 complex restorations.
  4. Supervision. This skillset may not be performed under general supervision.
    1. A DHA certified in advanced restorative may provide services under the scope of practice listed in this skillset following the requirements of (A) or (B) below:
      1. under the direct supervision of a dentist, DHAT, or DHATP; or
      2. under the indirect supervision of a dentist, DHAT, or DHATP if they have the following:
        1. a signed set of standing orders.
  5. Scope of Practice. Includes (1) below:
    1. A DHA certified in advanced restorative must maintain and demonstrate competency in the following complex restorations:
      1. Cuspal coverage Class II restorations; and
      2. Class IV restorations.

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