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Dental Assistant Levels: What is the Difference?

By: Alex Nikotina

Published On: June 29, 2017

Dentistry is an area of medicine that is very attractive for people who are looking into a career in healthcare. Becoming a Dental Assistant can be a great door opener into the dental career, and many professionals choose that path to acquire valuable industry knowledge and work experience.

Many industry experts have started their dentistry career as part of the dentist’s support team, later expanding into other areas in the dental industry. However, Dental Assistant profession itself also has different categories, or levels, within the profession.

We sat down with Dr. Pauline Imai, the Head of the Dental Department at Ashton College Abbotsford campus, to find out more about Dental Assistant career.

dental skull and teeth image

Level I VS Level II

According to the Canadian Dental Assistants Association, dental professionals can be divided into two main categories: level I assistants (also known as “chair side” assistants) and level II assistants (individuals who undergo specific education and/or training, usually Certified Dental Assistants). The tasks dental assistants can perform under those categories may vary depending on provincial regulations.

Level I Assistants

In BC, the College of Dental Surgeons of British Columbia (CDSBC) provides the following definition of a level I dental assistant: “A dental assistant is a person other than a certified dental assistant or a dental hygienist who assists a dentist in the provision of services while under the supervision of the dentist. Dental assistants are not a ‘class’ of CDA as they are neither certified nor regulated by the CDSBC.”

The main duties of Level I Dental Assistant may include:

  • Preparing the patient for the procedure(s);
  • Charting patient’s information;
  • Preparing and sterilizing the clinical area and/or the instruments for the procedure(s);
  • Pouring and making cast models;
  • Providing post-operative instructions and patient care;
  • Ordering and maintaining dental supplies.

Level II Assistants

dr. pauline imaiCDSBC defines Level II dental assistant as an individual who “…has been formally trained and has successfully completed all certification requirements.” Those individuals “…may perform all services as outlined in Part 8 of the CDSBC Bylaws, which may include expanded services in Orthodontics and Prosthodontics if they have the designation indicating successful completion of the specific module.”

“Most dental assistants aim to reach the certified level as soon as they can,” shares Dr. Imai. “This means more professional responsibilities, higher hiring chances and higher pay.”

On top of the duties performed by the chair side assistants, main duties of Level II Dental Assistant may include:

  • Exposing dental radiographs;
  • Obtaining impressions and occlusal records;
  • Applying desensitizing agents, anesthetics and whitening to the coronal portion of the teeth;
  • Applying pit and fissure sealants, and applying materials to prepare the teeth surface for pit and fissure sealants;
  • Mechanical polishing;
  • Oral hygiene instruction with an intra-oral component.

For the full list of services that CDAs may legally provide to their patients in BC, please visit the Guide to CDA Services.

Level II Assistants: What does it take?

In all provinces with the exception of Quebec, candidates who want to become Certified Dental Assistants need to obtain the National Dental Assisting Examining Board (NDAEB) certificate.

NDAEB certificate is given to the candidates that:

  • Have successfully completed formal education in key dental areas
    • The areas include basic dental assisting procedures, client care, oral hygiene instruction, dietary counselling, restorative dentistry, dental radiography, among others. Candidates should be able to perform mandatory dental skills in those areas.
  • Have taken the NDAEB Exam;
  • (if the candidates are graduates from non-CDAC accredited programs) Successfully passed the Clinical Practice Exam.


All graduates of dental assisting programs in Canada must successfully complete the NDAEB exam, a 200 multiple choice written exam, to obtain their certification. This exam is also required for foreign-trained dental health professionals in order to be able to practice in Canada (all provinces except Quebec).

“The exam is four hours long, and the fee in 2017 is $450,” shares Dr. Imai.

The following domains are covered on the exam:

  • 1. Conduct appropriate to a professional setting (5-10% of 200 item exam). Topic examples:
    • Provincial/National Code of Ethics
    • Jurisprudence and Provincial regulatory legislation
    • Time management, problem-solving and critical thinking techniques
    • Communication with patients, care givers, service providers and dental health team members
    • Medical and dental terminology
    • Signs of suspected physical, sexual and emotional abuse or neglect
    • Principles of obtaining informed consent
    • Privacy policies
  • 2. Dental sciences (7-12% of 200 item exam) Topic examples:
    • Oral anatomy
    • Anatomy of the head and neck
    • Tooth development and eruption
    • Oral pathology
    • Microbiology
    • Pharmacology
  • 3. Clinical support procedures (5-10% of 200 item exam). Topic examples:
    • Principles of asepsis
    • Equipment and supplies
    • Team ergonomics
  • 4. Patient records (5-10% of 200 item exam). Topic examples:
    • Legal requirements for maintaining and transferring patient records
    • Complete and update patient records/documents using paper-based and electronic systems, including personal history, health history, intra-oral/extra-oral examination, oral hygiene indices, diagnostic study models and bite registration, radiographs, photographs, vital signs, consent forms, care/treatment plan and progress notes, treatment records and/or medications administered
  • 5. Patient care procedures (40-50% of 200 item exam). Topic examples:
    • Obtain vital signs
    • Collect diagnostic information
    • Emergency care
    • Management of patients with special needs
    • Anaesthesia and pain management
    • Moisture control techniques
    • Operative dentistry procedures
    • Oral and maxillofacial surgical procedures
    • Endodontic procedures
    • Periodontic procedures
    • Prosthodontic procedures
    • Orthodontic procedures
  • 6. Practice management procedures (5-10% of 200 item exam). Topic examples:
    • Manage and maintain filing, recall and inventory systems in both paper-based and electronic systems
    • Manage patient appointments, referrals and consultations
    • Manage and maintain financial records in both paper-based and electronic systems
  • 7. Laboratory procedures (5-10% of 200 item exam). Topic examples:
    • Process impressions, trim and finish models
    • Fabricate appliances and trays
    • Maintain supplies and instruments, operate equipment and manipulate materials following protocols for safety and asepsis
  • 8. Preventive procedures (15-20% of 200 item exam). Topic examples:
    • Provide oral hygiene instruction
    • Provide nutritional counselling relative to oral health
    • Perform selective coronal polishing
    • Apply anti-cariogenic agents
    • Apply pit and fissure sealants
    • Apply desensitizing agents
    • Perform tooth whitening using trays

For further information on the NDAEB exam, please see the 2017 Candidate Handbook.

Clinical Practice Exam

Graduates from non-CDAC accredited programs must also successfully pass the Clinical Practice Exam. “This exam is 5-6.5 hours long, including a one-hour orientation, and the 2017 fee is $1,200,” says Dr. Imai.

There are nine clinical skills that must be passed on the exams:

  • Skill 1: Exposes dental radiographs
  • Skill 2: Obtains preliminary impressions for study casts
  • Skill 3: Applies and removes dental dam
  • Skill 4: Selective coronal polishing (Rubber Cup)
  • Skill 5: Applies treatment liner (No Pulpal Involvement)
  • Skill 6: Applies and removes matrix and wedge
  • Skill 7: Applies Anti-Cariogenic Agent (Tray Method)
  • Skill 8: Applies pit and fissure sealant (Cotton Roll Isolation)
  • Skill 9: Applies topical anesthetic

For further information on the Clinical Practice Exam, please see the 2017 CPE Candidate Handbook.


    View All Comments

  1. Dear Sir I have passed dental surgery assistant certificate 1992 ,I joined Dental assistant association of South Africa. Now I would like to study further or to be a Hygienist how long the course will take?

  2. Najia wahabi says:

    In most dental offices level 1 dental assistant take xray ?????

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