What do you think about the supervision of dental assisting practice in Canada?

The dental assisting profession has a rich and vibrant history making an important and significant contribution to the dental profession for almost two centuries. Today’s dental assistant is a multi-skilled professional with a scope of practice that is expanding as the dental profession continues to evolve and change. 

The requirements for entry to practice for Level 2 dental assistants are very similar throughout Canada due to the collaborative efforts of Canadian dental assisting regulatory authorities and other stakeholders, and the signing of a Mutual Recognition Agreement (MRA). The recognition of the National Dental Assisting Examining Board Certification has been a tremendous step forward for the profession. There are however considerable differences in the number of intra-oral procedures permitted across jurisdictions, as well as the manner in which these services are supervised. 

From conversations with a number of stakeholders within the profession, there appears to be a general presumption that dental assisting standards of practice are uniform throughout Canada. Our research and understanding is that, with the exception of the entry-to-practice requirements, this is not the case. We believe that awareness of these differences, and consideration of a more uniform approach would result in greater efficiencies throughout all jurisdictions.

The Canadian Dental Assistants Association, in consultation with regulatory authorities and certifying bodies, has conducted an analysis to understand the variability of the methods of supervision of dental assisting practice required in each jurisdiction. A number of regulatory authorities require the direct supervision of a dentist for all intra-oral dental assisting procedures while others embrace a hybrid of both direct and general supervision. A third variation is the requirement for a mandatory employment relationship; however, supervision requirements are not regulated. 

A call for dialogue among stakeholders is presented to discuss the advantages as well as any challenges experienced by regulators relating to this aspect of dental assisting practice standards. This would be valuable and constructive in determining, if a more consistent approach would be both achievable and beneficial to the profession.

Supervision of dental assisting practice in Canada (PDF)

Report Key Messages

Recommendations for Further Research

1. Stakeholder feedback and perspective regarding existing models of supervision
   • Regulatory Authorities
   • Dental Assistants
   • Dentists
   • Other members of the dental team
   • The public
2. Evaluation of Quality of Care
   • Analysis of the existing methods of supervision in relation to whether there is any indication that treatment is compromised with general supervision or self-direction
3. Evaluation of Practice Productivity
   • Analysis of whether dental practice productivity is correlated to the varying supervisory models currently practiced in jurisdictions in Canada
4. Identification of best practices for delegation/assignment of dental assisting services in other countries
5. Analysis of opportunities for contribution to the disparities in access to care for vulnerable populations
   • Comparison of jurisdictions where general supervision and self-initiation are permitted to those where direct supervision is required for all intra-oral services to determine if there are opportunities for dental assistants to contribute to the oral healthcare delivery in vulnerable communities

Dialogue, collaboration and consideration of standardization within this critical aspect of dental assisting practice oversight are recommended. The development of a second research question would facilitate this call to action: “Is a consistent approach to harmonizing the definitions and practices of supervision an achievable or desirable goal for the dental assisting profession in Canada?”