Coronal Polishing Registration

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Date you plan to attend course:

Course Description:

The course is a 7 hour course intended to prepare dental assistants to perform coronal polishing while under the supervision of a licensed dentist.
Instruction includes practice in:

• Aseptic technique
• Differentiation between stains
• Clinical appearance of plaque and calculus
• Abrasive agents
• Fluoride application
• Coronal polishing procedure
• Course Outcomes

At the end of the course, students take a final written exam and clinical competency exam. In order to pass the course, the student must achieve a 75 percent or higher grade on both exams. Upon successful completion of the course and exams, you will be awarded a Coronal Polishing certificate

The cost of the course is $300.00 with lunch provided.

You will need to pay a deposit of $150.00 to hold your place in the course.

Cancellation, refund, and requirements policy:

A full refund of all monies will be made to any applicant who cancels the enrollment agreement within THREE business days of the first class. All applicants must be classified as DA2 and or CDA.

PAGE EDUCATION AND CONSULTING LLC

Verification of Dental Assistant II Status

The North Carolina State Board of Dental Examiners has ruled that coronal polishing is a legal function for trained Dental Assistant IIs. To be accepted in The Dental Assistant Academy’s Coronal Polishing course, the participant must submit documentation of status as a Dental Assistant II.

Please indicate which training you completed to be classified as a Dental Assistant II. Verify successful completion by attaching documentation or having your employer sign below.

Approved Education and Training Programs

To be classified as a Dental Assistant II, an assistant must meet one of the following criteria:

Successful completion of:

1. An ADA-accredited dental assisting program and current certification in CPR; or
2. One academic year or longer in an ADA-accredited dental hygiene program, and current certification in CPR; or

Successful completion of:

1. Full-time employment and experience as a chair side assistant for two years (3,000 hours) of the preceding five, during which period the assistant may be trained in any dental delivery setting and allowed to perform the functions of a Dental Assistant II under the direct control and supervision of a licensed dentist;
2. A 3-hour course in sterilization and infection control;
3. A 3-hour course in dental office emergencies;
4. Radiology training consistent with G.S 90-29(c)(12) bi-laws of the North Carolina State Board of Dental Examiners; and
5. Current certification in CPR; or Successful completion of the certification examination administered by the Dental Assisting National Board (DANB), and a current certification in CPR. (We can provide a CPR certification if needed)

PARTICIPANT SIGNATURE: I have attached documentation supporting the above classification as a Dental Assistant II.

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Participant’s printed name

AND/OR

Employer Signature: I verify that my employee has completed the above requirements and is classified as a Dental Assistant II.