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Oregon House passes bills removing dental assistant testing requirements

Backers of the bills say tests have become a stumbling block for attracting more needed dental assistants
A bill to streamline dental assistant certification is advancing in the Oregon Legislature, but opponents say patient safety could be impacted. | JAKE THOMAS/THE LUND REPORT
April 6, 2023

While providing free oral health services in Oregon’s underserved rural areas, Dr. Jared Thompson said he and other volunteers try to serve as many people as possible while traveling in a van loaded with dental equipment.

But Thompson, a dentist, recalled to The Lund Report how multiple times during these trips with Medical Teams International, he saw a dental chair sitting empty while people needing treatment stood nearby. The reason for this mismatch, he said, was a lack of dental assistants to take an X-ray. 

“People are not receiving the care simply because there is that barrier,” said Thompson, who owns a dental practice in Forest Grove that he said has also struggled to hire dental assistants. 

Dental assistants — who help with fillings and prepare patients for surgery — are in short supply in Oregon. In a job vacancy survey last fall, the Oregon Employment Department identified dental assistants as among the most challenging to fill health care positions. In 2021, dental assistant positions had the second-highest vacancy rate of health care positions at 9%, according to department figures

The situation has caught the attention of Oregon lawmakers who are advancing a pair of bills, House Bills 2996 and 3223, that are aimed at removing written tests that critics say have become unnecessary and costly barriers to people entering the profession.

Bolstering Oregon’s pandemic-drained work force has been a key issue this legislative session. The bipartisan dental assistant bills have passed the House and are awaiting hearings in the Senate. 

Opponents of the legislation hope to derail the bills, arguing they will lower standards for dental assistants and put patients in jeopardy.   

“It is a safety issue ... Training takes a lot of patience and a lot of time, and our patients should not be Guinea pigs.”

“It is a safety issue,” Bonnie Marshall, president of the Oregon Dental Assistants Association, told The Lund Report. “Training takes a lot of patience and a lot of time, and our patients should not be Guinea pigs.” 

She said the bills could mean people with little training or experience would have a fast track to working in patients’ mouths.

Related legislation, House Bill 2979, seeks $20 million to expand dental assistant and hygienist training programs in Oregon. The bill passed out of the House Behavioral Health and Health Care Committee and is currently under consideration in the Joint Ways and Means Committee along with other budgetary requests. 

‘My assistant just can’t pass this test’

Oregon does not license dental assistants. But state regulators require them to be certified in order to take X-rays, help install crowns and clean patients’ teeth along with other tasks common in dentist offices. Getting those certifications requires passing exams the Dental Assisting National Board administers that cost hundreds of dollars. 

“Dentists are coming to me and saying, ‘Hey, my assistant just can’t pass this test. They’ve taken it several times, and they’re asking questions that are irrelevant to their job.’”

“Dentists are coming to me and saying, ‘Hey, my assistant just can’t pass this test. They’ve taken it several times, and they’re asking questions that are irrelevant to their job,’” state Rep. Hai Pham, a Hillsboro Democrat and pediatric dentist, told The Lund Report about why he co-sponsored the legislation. 

Dental assistants seeking to become certified to operate an X-ray machine in Oregon have two paths to becoming certified: complete a radiography course or receive relevant training while working for a dentist for two years. The next step is taking the Dental Assisting National Board exam.  

H.B. 2996 prohibits the Oregon Board of Dentistry and the Oregon Health Authority from requiring dental assistants to pass a written exam in order to be certified to operate an X-ray machine. 

Proponents of the bill argue that modern X-ray machines have enough safeguards to prevent patients from being accidentally exposed to radiation and that dental assistants can be effectively trained to use them without passing the test.

State. Rep. Cyrus Javadi, R-Tillamook, told The Lund Report that passing the radiology test doesn’t necessarily translate into being a better dental assistant. 

“I’m sure if I took the test, I couldn’t pass it,” said Javadi, also a dentist, who co-sponsored the bills. 

Thirteen states don’t require a certificate to operate an X-ray machine, and many aspiring dental assistants don’t pass the test. The national pass rate for the required exam was 63% for the 2020-2021 fiscal year.  

Katherine Landsberg, director of government relations for the Dental Assisting National Board, told the Oregon House Behavioral Health and Health Care Committee in February that Oregon has a higher pass rate for the exam with 82% of candidates passing on the first or second attempt between 2019 and 2022. 

She said other states that have done away with the testing requirement are still facing dental assistant shortages. Idaho, for instance, does not require dental assistants to pass a test to operate an X-ray, and the state is still facing a shortage of dental assistants. 

But California lawmakers are also looking to streamline the process for certifying dental assistants in a similar way. They’re considering a bill that would remove the exam requirement to become an orthodontic assistant. 

The Oregon dental assistant bills, Landsberg said, will make it harder for Oregon regulators to protect and assure the public. 

 “High-quality, objective exams are the most common tool used by regulators to verify acquisition of knowledge in a way that’s legally defensible,” she said. “Dentists and dental hygienists have to take written exams.”

Proponents of the bill told the committee that there is no evidence that not requiring dental assistants to pass radiological exams has led to patients being harmed. 

“You get more radiation on a sunny day,” said Pham. 

Marshall agreed that radiation from X-ray machines is minimal. But she said the exam requirement should stay in place as a safeguard because people react differently to radiation and it builds up after multiple exposures. 

H.B. 3223 would enact a broader prohibition on the Oregon Board of Dentistry from requiring dental assistants to pass written exams as part of certification requirements. Those include certifications for polishing dental restorations, placing orthodontic wires, removing excess cement from crowns and others. 

Dental assistants seeking a certification would still have to complete a training course under the bill. It would also direct the Oregon Health Authority to develop an “alternative pathway” to getting these certifications that could include working in a dentist’s office while taking online training modules. 

Javadi said he’s had ads out for dental assistants at his Tillamook dental practice for the last two or three years. He said written tests have been a barrier to certifying dental assistants in rural areas because training programs are often hours away. 

But Marshall cautioned that weakening training requirements for dental assistants would be dangerous. She said dental assistants clean dental instruments and have other responsibilities that keep patients safe from infections.

“How is taking away standards going to make a difference with who becomes a dental assistant?” she said. 

You can reach Jake at [email protected] or via Twitter @jakethomas2009.


Submitted by Eliza Schmidkunz on Thu, 04/06/2023 - 13:31 Permalink

Dental assistants in Oregon make around $40 to $50k per year for full-time work. Not enough to support a family, but not shameful either. 

I imagine that if certification were eliminated, dental corporations would find a way to pay less and, eventually, that would make it even harder to attract employees.

So - rather than eliminate standards, how about underwriting the test and rewriting it to reflect the actual skills and judgment called for in the job?