NDAEB Dental Assisting Course Work Report

NDAEB Dental Assisting Course Work Report – Checklist Revised October 2024 CREDENTIAL ASSESSMENT SUBMISSION CHECKLIST To determine exam eligibility, all applicants trained at a non-registered program are required to follow the NDAEB Candidate Eligibility Assessment process. Documents required for credential assessment must be received by the NDAEB office at least 2 weeks prior to an exam application deadline. Documents received after this deadline will not be guaranteed assessment for exam eligibility for the applied sitting.  Checklist:  $320.00 credential assessment fee, payable to the NDAEB in Canadian dollars by money order or bank draft only. NDAEB does not accept credit or debit cards, electronic fund transfers, personal cheques or cash. ***Please ensure accuracy when filling in the [Payable to] field of the money order/bank draft.  Original report from one of the following credentials assessment agencies in Canada: • (ICES) International Credentials Evaluation Service [Type of report required: Comprehensive Report] • (IQAS) International Qualifications Assessment Service [Type of report required: Basic report with the Dental Assisting Course Work Report (DACWR) submitted directly to IQAS for review. IQAS will send your DACWR and agency report to NDAEB with your permission]. • (WES) World Education Services (WES - Canada) (Type of report required: Course-by-Course Report - ICAP). WES reports completed in the United States will not be accepted by the NDAEB. o When applying for WES, please grant NDAEB access to the online report through AccessWES*. *Please contact WES for information on granting access to NDAEB OR  (NDEB) National Dental Examining Board of Canada. Applicants who have applied to the NDEB and have been deemed eligible for exams may submit proof of NDEB exam eligibility in lieu of an agency report. • Refer to Method 2 on our website. Please note documents submitted without the NDEB online profile header will not be accepted.  Certified true copies of academic transcripts and diploma. – Copies of academic transcripts and diploma issued outside of Canada must be certified/notarized as true copies of the original by a commissioner of oaths, notary public or lawyer in Canada. If the original documents are not in English or French, translated copies must also be submitted and must be certified/notarized as true copies in Canada by a notary public, lawyer or commissioner of oaths. True copies of documents certified at a Canadian provincial government office are also acceptable. Documents notarized in another country are not acceptable except those that were certified/notarized by Canadian staff at a Canadian embassy or consulate abroad. o Please DO NOT SEND original documents. National Dental Assisting Examining Board

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Checklist Revised October 2024  A completed and signed Dental Assisting Course Work Report (DACWR). – Applicants using either ICES or WES as their assessment agency or who submit NDEB proof of registration must submit the DACWR to NDAEB directly along with the other required documents. Applicants using IQAS for credentials assessment must submit the DACWR directly to IQAS for review. IQAS will forward directly to NDAEB the DACWR along with their assessment report.  Program Survey Requirements Form must be completed by applicants of Dental Assisting, Hygiene or other allied dental health care programs.  A Signed Consent for Personal Information Form included at the end of the Dental Assisting Course Work Report (DACWR).  Proof of name change is required if the name appearing on the academic records or other documents submitted to the NDAEB is different from the name used in your application, a copy of a marriage or divorce certificate, affidavit or proof of legal name change is required for the NDAEB to verify and reconcile the name on the application with the name appearing on the documents submitted. Documents issued outside of Canada must be certified/notarized by the commissioner of oaths, notary public, or lawyer in Canada. If the original documents are not in English or French, translated copies must also be submitted and must be certified/notarized as true copies in Canada by a notary public, lawyer or commissioner of oaths.

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 1 - DENTAL ASSISTING COURSE WORK REPORT INSTRUCTIONS • Please TYPE OR PRINT your responses. The report must be legible. Altered formats will not be accepted. • Please confirm that all required signatures and dates on the declaration page and personal consent form have been entered. • In the tables below, check () the topic areas covered by your course work in dental assisting (or other formal dental training) and list the title of your courses. • Note that all topic areas that you report being covered by your program must be supported by official documentation from a recognized academic institution and verified by ICES, IQAS or WES in their report. • By completing this document, you are attesting to the fact that you have successfully completed all education and training necessary to be granted eligibility to write the NDAEB Exam and Clinical Practice Evaluation (CPE) (See theory and clinical requirements for each of the mandatory skills in this report). ***The Dental Assisting Course Work Report (DACWR) must be completed and submitted to the NDAEB for assessment along with your academic records. Refer to the ‘Applicant Credentials Assessment Submission Checklist’ above for application requirements. DENTAL ASSISTING COURSE WORK REPORT Personal Information The NDAEB certificate is an official document used in the registration/licensure of dental assistants in Canada. Your name will appear on your NDAEB certificate EXACTLY as typed below. Use only your official given name(s) and surname as they appear on your valid photo identification that you will present on the day of the exam. Do not use nicknames. If the name appearing on your academic records is different from your name as stated below, you will be asked to provide proof of name change (ex. marriage certificate, legal name change affidavit). First Name Middle Name Last Name Note: If you do not have a legal last name/surname, please enter a period (.) as a placeholder in the last name field. □ My name entered above MATCHES the name on my academic records from my dental health program. □ My name entered above DOES NOT MATCH the name on my academic records from my dental health program. **Proof of Name Change required if “DOES NOT MATCH” o Please refer to the checklist above for specific requirements. Alternate / Previous / Maiden Name (if applicable) Date of Birth (Please enter by: Year / Month / Day)

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 2 - Personal Information (continued) Mailing / Home Address Canadian addresses must be entered accurately and verifiable by Canada Post https://www.canadapost-postescanada.ca/ac/ Suite / Apt. Street Address PO Box (If applicable) City State / Province / Region Postal Code / ZIP Code Country Note, if you are applying with an out-of-country address, please format your mailing address according to your home country's standards, including all essential components such as street address, city, postal code, and country name. Contact Information Email Address Alternate Email Address Cellular Telephone Alternate Telephone International Credential Agency Used: ICES () IQAS () WES () OR (NDEB) () Applications will remain as “pending” until an agency report has been received. Refer to the ‘Applicant Credentials Assessment Submission Checklist’ above for credential assessment details.

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 3 - Academic / Educational Information A. Please list the educational credential(s) you are presenting for assessment below: Name of Certificate/Diploma/Degree Country Issuing Institution Dates Issued Length of Program Entrance Requirements Office Use only B. Check () the topic areas covered in your program and list the courses completed in each topic area. Note: there are nine (9) mandatory intra-oral competencies required for exam eligibility. All are evaluated on the Clinical Practice Evaluation (CPE). 1. Conduct Appropriate to a Professional Setting – Check () those topic areas covered in your course work ()  Apply the principles of the ethics including self-reflection as to personal competence to perform assigned, legal duties  Practice according to the principles of dental jurisprudence and legal scope of practice  Apply time management, problem solving and critical thinking techniques  Apply effective communication techniques with patients, care givers, service providers and dental health team members including written and electronic formats  Use professionally acceptable medical and dental terminology and abbreviations  Recognize signs of suspected physical, sexual and emotional abuse or neglect and report suspected cases to the appropriate authority  Explain treatment to patients and/or caregivers and respond to questions to help resolve concerns in accordance with the principles of obtaining informed consent  Apply privacy policies to all communications List the title of course(s) taken in the Conduct Appropriate to a Professional Setting below. Course Title(s) Name of document where course is listed Year course completed For office use only 2. Dental Sciences – Check () those topic areas covered in your course work () Oral Anatomy  Describe, locate and identify structures of the oral cavity  Describe, locate and identify soft tissue landmarks of the oral cavity  Describe, locate and identify tooth anatomical landmarks  Describe, locate and identify the tissues and supporting structures of the teeth  State the functions of teeth and their supporting structures

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 4 - Anatomy of the Head and Neck  Identify and locate the bones of the head and describe their structure and function  Identify anatomical landmarks of the head  Identify and describe the parts of the temporomandibular joint (TMJ), it’s movements and disorders  Identify the muscles of the face and oral cavity and describe their function  Identify and locate the salivary glands and ducts and describe their function  Identify and locate the sinuses  Identify and describe the innervations of the teeth and surrounding tissue of mandibular and maxillary arches  Identify and locate the lymph nodes of the head and neck and describe their functions Tooth Development and Eruption  Describe oral facial development including the teeth  Describe tooth eruption and exfoliation patterns Oral Pathology  Describe genetic, developmental and acquired anomalies/pathologies of the hard and soft tissues of the oral cavity  Describe the etiology and progression of hard and soft tissue lesions Microbiology  Describe and identify diseases related to micro-organisms including bacteria, spores, viruses, fungi, protozoa and prions  Describe the routes of disease transmission Pharmacology  Describe the effects and interactions of non-prescription, prescription and controlled drugs on patient care and safety issues  Explain the purpose and process of recording medications including dosages and frequency taken  Explain the indications for pre-medication prior to dental treatment  Interpret information regarding medications taken for medical conditions  Explain the clinical indications for antibiotic prophylaxis prior to invasive procedures List the title of course(s) taken in the Dental Sciences below. Course Title(s) Name of document where course is listed Year course completed For office use only 3. Clinical Support Procedures – Check () those topic areas covered in your course work () Principles of Asepsis  Explain the rationale for infection prevention procedures in the dental office  Explain approved methods for the prevention of disease transmission for patients and dental healthcare providers including:  standard infection control procedures  sanitation, disinfection, sterilization and storage  quality assurance protocols for instrument processing equipment and procedures in accordance with manufactures’ instructions  personal protection equipment  immunization

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 5 -  Discuss the ethical and legal considerations of treating patients with infectious diseases  Employ accepted safety standards for infection prevention and handling of hazardous materials and substances in the workplace  Employ ethical protocols for injury prevention, exposure control, post-exposure first-aid and maintenance of employee health records  Explain protocols used to reduce biofilm within dental unit waterlines and evacuation systems Equipment and Supplies  Identify, operate and maintain dental instruments and equipment  Select and prepare supplies Team Ergonomics  Apply principles of ergonomics in positioning the patient/operator/dental assistant throughout all procedures  Apply the principles of instrument and material transfer to support procedural efficiency and patient safety  Use appropriate instrumentation techniques to ensure procedural efficiency and patient safety List the title of course(s) taken in the Clinical Support Procedures below. Course Title(s) Name of document where course is listed Year course completed For office use only 4. Patients Records – Check ( ) those topic areas covered in your course work ()  Apply protocols to comply with legal requirements for maintaining and transferring patient records/documents in both paperbased and electronic systems  Complete and update patient records/documents using paper-based and electronic systems to include:  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/medications administered  Relate patient health history information to treatment  Use professionally acceptable terminology, charting symbols, abbreviations and tooth numbering systems

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 6 - List the title of course(s) taken in Patient Records below. Course Title(s) Name of document where course is listed Year course completed For office use only 5. Patient Care Procedures - Check (  ) those topic areas covered in your course work () Obtain Vital Signs  Explain the rationale for obtaining vital signs  Describe procedures for measuring pulse, temperature, blood pressure and respiration with reference to “normal” ranges  Describe factors that affect vital signs  Obtain vital signs including blood pressure, pulse, respirations and temperature Collect Diagnostic Information  Assist with diagnostic procedures:  State the types of and provide the rationale for performing diagnostic procedures  Prepare and transfer equipment and supplies for diagnostic procedures  Obtains preliminary impressions for study models:  State the rationale for obtaining preliminary impressions and bite registrations for the fabrication of study models  Select and prepare equipment and supplies specific to the patient’s dentition and anatomy  Manipulate preliminary impression material  Obtain mandibular and maxillary preliminary impressions following procedural steps *  Evaluate impressions  Disinfect impressions  Prepare impressions for storage and pouring  Obtain, evaluate and disinfect simple bite registrations  Provide pre-operative, operative and post-operative information/instructions *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE))  Produce digital and conventional film based radiographic images:  Describe components of x-ray machines and their functions  Describe factors that affect the quantity and quality of the x-ray beam  Describe composition of dental film and types of digital imaging receptors  Describe components of the dental film packet and their purposes  Describe care, storage and handling of dental films and digital imaging receptors  Describe the biological effects of radiation exposure  Describe personal radiation monitoring devices and procedures  Describe the types of radiographic images and the rationale for their use  Provide pre-exposure information and instructions to the patient  Apply principles of extra-oral and intra-oral radiographic techniques  Select and prepare equipment and supplies  Expose prescribed radiographic images in accordance to A.L.A.R.A. principles when using conventional film based or digital radiography *  Apply quality assurance standards  Process exposed conventional films  Explain causes and corrective measures for radiographic image exposure, processing and handling errors

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 7 -  Describe radiographic image duplicating procedures  Evaluate radiographic images for technical quality, accuracy and diagnostic acceptability  Describe the difference between radiolucent and radiopaque  Identify and describe anatomical landmarks and dental anomalies on radiographic images  Mount, label and store/save radiographic images  Differentiate between direct and indirect digital imaging *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE)) Emergency Care  Assist with the assembly and maintenance of emergency supplies, drugs and equipment  Assist in the prevention and management of dental office emergencies  Identify and interpret signs and symptoms of medical conditions which may require emergency care  Assist in the management and treatment of dental emergencies Management of Patients with Special Needs  Schedule appointments to accommodate patients with special needs  Adapt procedures according to patients’ physical needs and mobility limitations  Provide information and instructions to patients and care givers with consideration of their cognitive level and communication ability Anaesthesia and Pain Management  Assist with the administration of topical and local anaesthetic:  Identify precautions during application of topical and administration of local anaesthetic  Describe injection techniques and locate injection sites  Describe signs and symptoms of adverse reactions to anaesthetic  Describe procedure for application of topical and administration of local anaesthetic  Prepare equipment and supplies for topical and local anaesthetic administration  Monitor patient for signs of anxiety and adverse reactions to anaesthetic  Apply techniques for the safe handling of needles  Manage needlestick injuries according to protocols  Provide pre-operative, operative and post-operative information/instructions for administration of topical and local anaesthetic  Apply topical anaesthetic agents as prescribed: *  Select and prepare equipment and supplies for treatment  Prepare injection site and apply the topical anaesthetic according to manufacturer’s instructions  Assess tissue for adverse reactions and apply corrective measures *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE))  Assist with sedation and general anaesthesia:  Differentiate between levels of sedation and general anaesthesia  Identify contra-indications for the administration of sedation and anaesthesia and monitor patient for adverse reactions to each  Describe signs and symptoms of adverse reactions to anaesthesia and sedation  Prepare equipment and supplies and monitor patient for signs of adverse reactions related to sedation and anaesthesia  Record and monitor vital signs before, during and after sedation and anaesthesia  Provide verbal/written, pre-operative, operative and post-operative and home care information/instructions Moisture Control Techniques  State indications and contra-indications for various moisture control techniques  Select equipment and supplies, prepare for and assist with moisture control  Place and remove moisture control equipment and supplies  Apply and removes dental dam: *  Select and prepare equipment and supplies considering the patient’s dentition and prescribed procedure  Assist with the application and removal of dental dam

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 8 -  Apply and remove dental dam following procedural steps  Evaluate dental dam placement and isolation effectiveness  Identify and correct dental dam positioning and isolation errors  Provide pre-operative, operative and post-operative information/instructions *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE))  Position oral evacuation to maintain a dry operating field and patient comfort Operative Dentistry Procedures  Identify cavity/restoration classifications  Use terminology associated with cavity preparation and restorations  Assist with the application of treatment liners:  Describe the functions and benefits of liners, bases, varnishes, cements and bonding materials and the indications and contra-indications for their use  Describe the components of bonding systems, their uses, effects and precautions  List the order of placement and location for treatment liners  Prepare, manipulate and transfer treatment liner, acid etchant and bonding materials according to manufacturer’s instructions  Apply treatment liners (no pulpal involvement), acid etch and bonding materials: *  Select and prepare equipment and supplies  Apply treatment liners, acid etchant and bonding materials following procedural steps  Evaluate placement according to criteria and make modifications as necessary *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE))  Assist with the application and removal of matrix systems and wedges:  State the rationale for using matrix systems and wedges  Select and assemble matrix system and wedge(s) for prescribed restorative procedures  Assist with placement and removal of matrix system and wedge(s)  Apply and remove matrix system and wedge(s): *  Select and prepare equipment and supplies  Apply matrix system and wedge(s) following procedural steps  Evaluate placement according to criteria  Correct application errors  Remove matrix system and wedge(s) following procedural steps  Evaluate removal according to criteria *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE))  Assist with preparation and placement of permanent restorative materials:  Describe the properties and explain the rationale for the use of amalgam and tooth-coloured restorative materials  Prepare equipment and supplies and assist with amalgam placement and finishing procedures, observing mercury hygiene practice  Describe tooth-coloured restorative materials and their polymerization  Prepare equipment and supplies and assist with placement and finishing of tooth-coloured restorative materials  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions  Dispense and/or mix temporary restorative materials:  Explain the rationale for using various types of temporary restorative materials  Prepare equipment and supplies and assist with placement of temporary restorative materials  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions  Assist with tooth whitening techniques:  State indications and contra-indications for whitening of vital and non-vital teeth  Describe tooth whitening materials and techniques  Describe the complications which may result from tooth whitening  Prepare equipment and supplies and assist with tooth whitening  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions  Assist with placement of dental implants  State indications and contra-indications for the placement of the various types of dental implants

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 9 -  Describe the diagnostic tests and information necessary to prepare for dental implant placement  Prepare equipment and supplies and assist with the placement of dental implants  Describe complications that may arise from the placement of dental implants  Provide verbal/written, pre-operative, operative, postoperative and home care instructions Oral and Maxillofacial Surgical Procedures  State indications and contra-indications for surgical procedures  Prepare equipment and supplies and assist with surgical procedures  Monitor patient’s condition prior to, during and after surgical procedures  Describe complications which may arise from surgical procedures and their treatment  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions  Perform suture removal *  Identify various suture materials and techniques  Assess soft tissue for signs of healing, infection or post-operative complications and record/report to dentist  Evaluate site to determine where to cut suture  Cut and remove suture  Provide patient with post-operative care instructions following suture removal  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions *Mandatory intra-oral skills Endodontic Procedures  State indications and contra-indications for endodontic procedures  Describe diagnostic tests to determine tooth vitality  Prepare equipment and supplies and assist with endodontic procedures in both primary and permanent dentitions  Describe complications which may arise from endodontic procedures and their treatment  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions Periodontic procedures  State indications and contra-indications for periodontic procedures  Describe periodontal screening and recording  Prepare equipment and supplies and assist with periodontic procedures  Describe complications which may arise from periodontic procedures and their treatment  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions Prosthodontic Procedures  Differentiate between fixed and removable prostheses  State indications and contra-indications for fixed and removable prostheses  Prepare equipment and supplies and assist with prosthodontic procedures  Describe the dental assistant’s role in coordinating the preparation, packaging, delivery and reception of lab cases  Describe complications which may arise from prosthodontic procedures and their treatment  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions Orthodontic Procedures  Describe and classify occlusion and malocclusion according to Angle’s Classification  Use terminology associated with malaligned teeth and arches  Identify and describe factors affecting occlusion  Differentiate between fixed and removable orthodontic appliances  State indications and contra-indications for orthodontic treatment  Prepare equipment and supplies and assist with orthodontic procedures  Describe the dental assistant’s role in written and verbal communication with the dental lab  Coordinate the preparation, packaging, delivery and reception of lab cases  Describe complications which may arise from orthodontic procedures and their treatment  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 10 - List the title of course(s) taken in Patient Care Procedures below. Course Title(s) Name of document where course is listed Year course completed For office use only 6. Practice Management Procedures – Check (  ) those topic areas covered in your course work ()  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 List the title of course(s) taken in Practice Management Procedures below. Course Title(s) Name of document where course is listed Year course completed For office use only 7. Laboratory Procedures - Check (  ) those topic areas covered in your course work ()  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 List the title of course(s) taken in Laboratory Procedures below. Course Title(s) Name of document where course is listed Year course completed For office use only

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 11 - 8. Preventive Procedures –Check (  ) those topic areas covered in your course work () Provide Oral Hygiene Instruction  Describe the periodontal disease process and the factors affecting its development and progress  Describe the caries process and the factors affecting its development and progress  Describe the indications, contra-indications, types, purposes and methods of applying disclosing agents  List and describe oral hygiene indices  Apply the principles of instruction and learning to individuals and groups  Collect data to assess patient needs using methods such as: plaque/biofilm indices, disclosing agents in addition to observation of tissue condition  Develop oral hygiene goals using patient centered approach  Select and demonstrate oral care aids specific to oral conditions to achieve goals  Apply disclosing agents  Evaluate outcomes of oral hygiene instruction, provide feedback and make necessary modifications Provide Nutritional Counseling Relative to Oral Health  List nutrients, their sources, functions and effects  Collect data to assess patient’s nutritional needs  Develop dietary goals using patient centered approach  Make dietary recommendations specific to oral health conditions  Evaluate nutritional counseling outcomes, provide feedback and make recommendations and/or modifications Performs Selective Coronal Polishing *  State the rationale, indications and contra-indications for selective coronal polishing  Differentiate between intrinsic and extrinsic stain  Describe the etiology of stain  Select and prepare equipment and supplies specific to the patient’s needs  Remove stain according to procedural steps  Evaluate selective coronal polishing outcomes and make any necessary modifications  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE)) Apply Anti-Cariogenic Agents *  State the rationale, indications and contra-indications for application  Describe the effects of anti-cariogenic agents on tooth structure  Describe methods for topical application of anti-cariogenic agents  Assess patient needs for appropriate anti-cariogenic agents selection  Select and prepare equipment and supplies for various types of anti-cariogenic agents specific to the patient’s needs  Apply anti-cariogenic agents according to manufacturer’s instructions  Evaluate anti-cariogenic agent outcomes, provide feedback and make necessary recommendations and/or modifications  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE)) Apply Pit and Fissure Sealants *  State the rationale, indications and contra-indications for application  Describe sealant materials and their polymerization  Select and prepare equipment and supplies for prescribed treatment  Evaluate the effectiveness of various moisture control techniques  Prepare prescribed surfaces and apply sealant material according to manufacturer’s instructions  Evaluate sealant placement according to criteria and make modifications if required  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions *Mandatory intra-oral skills (also evaluated on Clinical Practice Evaluation (CPE))

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 12 - Applies desensitizing agents*  State the rationale, indications and contra-indications for application  Describe desensitizing agents and their mode of action  Select and prepare equipment and supplies for prescribed treatment  Prepare prescribed surfaces and apply material according to manufacturer’s instructions  Evaluate the application of the desensitizing agent according to criteria and make modifications if required  Provide verbal/written, pre-operative, operative, and post-operative and home care information/instructions *Mandatory intra-oral skills Performs tooth whitening using trays *  State the rationale, indications and contra-indications for patient use  Select and prepare equipment and supplies  Determine existing tooth shade prior to whitening  Demonstrate and deliver the product to the patient according to manufacturer’s instructions  Identify and explain effects of improper use of whitening products  Provide verbal/written, pre-operative, operative, post-operative and home care information/instructions *Mandatory intra-oral skills List the titles of course(s) taken in Preventive Procedures below. Course Title(s) Name of document where course is listed Year course completed For office use only 9. In-Office Practicum/Externship Experience Please describe the in-office practicum or externship (if applicable) that you completed prior to graduation from your program of study:

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 13 - Non-Registered Program Graduate – Candidate Declaration: I declare that the information I have provided is factual with respect to the education and training I have completed. I understand that to be eligible for the NDAEB certificate, I must be trained to perform the mandatory core skills (intra- oral duties) as the operator and that I will be required to have my clinical skills evaluated by the NDAEB confirming my clinical competence. I understand that if I have not received the required education and training to meet the NDAEB standard, the NDAEB will direct me to attend an educational upgrade program at a Canadian educational institute before being granted exam eligibility. I acknowledge the mandatory intra-oral skills evaluated on the Clinical Practice Evaluation are: Skill 1 – Exposes Digital Radiographic Images Skill 2 – Obtains Impressions for Study Casts Skill 3 – Applies and Removes Dental Dam Skill 4 – Selective Coronal Polishing Skill 5 – Applies Treatment Liners Skill 6 – Applies and Removes Matrix Band and Wedge Skill 7 – Applies Anti-Cariogenic Topical Fluoride Gel Skill 8 – Applies Pit and Fissure Sealants Skill 9 – Applies Topical Anesthetic I further acknowledge that if I am applying from outside Canada, the NDAEB written examination and CPE are available only in Canada and that the granting of exam eligibility by the NDAEB in no way assures or implies acceptance for immigration or entry to Canada, nor does it guarantee the likelihood or possibility of attaining employment, registration or licensure as a dental assistant in a Canadian province. (See notes below). Candidate Signature Date **NDAEB will NOT accept the Candidate Declaration Form signed electronically. If signature and /or date is not included on the Candidate Declaration Form, a new signed and dated form will need to be mailed to head office before the application can be reviewed.

National Dental Assisting Examining Board NDAEB Dental Assisting Course Work Report – Revised October 2024 - 14 - PROGRAM SURVEY REQUIREMENTS (For Dental Assisting and Hygiene Programs or other allied dental health care programs) ***Note: Dentists with a bachelor’s degree or higher do not need to submit the program survey requirements. Please proceed to the “Consent for Personal Information Form” In order to assess the eligibility of graduates of non-registered Dental Assisting / Hygiene programs (or other allied dental health care programs), the NDAEB requires program information provided by the educational institute clearly indicating the mandatory core skills required for NDAEB exam eligibility were included in that program. Please provide NDAEB with the following institutional contact information. NOTE: If the program does not submit to the NDAEB office the required program survey, the NDAEB may not grant exam eligibility. Institutional Contact Information Name of University/College/Institute: Name of Director/Program Head: University/College/Institute Street Address City State / Province / Region Postal Code / ZIP Code Country Email Address Telephone: Graduation Date (Please enter by: Year / Month / Day)

I understand that for the purpose of assessing my application to register for and participate in the Written Examination and/or Clinical Practice Evaluation (CPE), the NDAEB collects personal information including: my name, photograph (for identification purposes at the examination facility), mailing address, educational transcripts/diplomas or letter(s) from my school confirming my enrollment in or graduation from an eligible dental assisting educational program. I understand that if I received my dental assisting (or allied) education outside Canada, the required documents will also include, but may not be limited to, report(s) from third parties such as translators and international credentials evaluation agencies confirming my academic records. I understand that if I request special exam accommodations for medical or other reasons, I may be required to provide the NDAEB with reports or other documents from third parties such as, educational counselors, psychologists or physicians to support my request. I understand that if I request a special exam sitting date for religious reasons, I may be required to provide written confirmation from a religious leader before the NDAEB considers my request. I have read the NDAEB Privacy Policy regarding the collection, use, disclosure and protection of my personal information and I have been provided with contact information and a telephone number should I have questions or concerns. The NDAEB Privacy Policy, which governs the NDAEB’s practices with respect to the collection, use and disclosure of personal information, is readily available at https://ndaeb.ca/privacy-policy/. As indicated in the NDAEB Privacy Policy, I understand that I may request access to my personal information and request that corrections be made. I may also refuse to provide some personal information or request to withdraw my consent; however, some personal information is necessary to fulfill the NDAEB’s mandate. As such, the NDAEB may be unable to provide its services if necessary personal information is not provided. I understand that, as part of the mandate and in the interest of public safety, the NDAEB may disclose personal information, which may include my name, my pass/fail result(s) of the NDAEB Written Examination and/or Clinical Practice Evaluation (CPE), my NDAEB Certificate Number, the date of my examination sitting, the date of my taking the CPE, and the date of the completion of my Transfer of Credentials (ToC)to the Canadian Dental Assisting Regulatory Authority (CDARA) in the province in which my address is listed, the province in which I wrote the exam and/or took the CPE, to any other CDARA requesting information about me, and to any other CDARA to which the NDAEB considers, in its sole discretion, that such disclosure is appropriate. I understand that the NDAEB may retain my personal information as long as is necessary to meet the requirements of the NDAEB mandate. I hereby give my consent to the NDAEB to collect, use, disclose and protect my personal information as set out above. I consent (): _______ I do not consent (): _______ I hereby give my consent to the NDAEB to contact me by email as necessary to provide me with information regarding the NDAEB examination and/or Clinical Practice Evaluation (CPE). **NDAEB will NOT accept the Consent for Personal Information Form signed electronically. If the signature, date and/or name are not included on the Consent for personal Information Form, a new completed form will need to be mailed to head office before the application can be reviewed. Signature: _____________________________________________ Date: _________________________ Printed Name: ________________________________________________________ Contact Us: Information Officer (Responsible for privacy compliance) NDAEB Stephen Grundy, CAO/Registrar 204-2283 St. Laurent Blvd. Ottawa, Ontario K1G 5A2 Ph: 613-526-3424 • Fax: 613-526-5560 • E-mail: office@ndaeb.ca Consent for Personal Information Form • 2024 ! Consent for the processing of personal information by the NDAEB for purposes related to the assessment of my application and administration of examinations.

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