Why a career ladder matters for dental assistants

July 28, 2026

You’ve probably heard the saying that real estate is all about location. In many respects, so is dental assisting.

In fact, where dental assistants live and work can make all the difference in their career journey.

Dental assisting requirements vary significantly across the country, as each state dental board sets its own regulations and qualifications. Many states, though not all, have ample opportunities for advancement by providing dental assisting levels or career ladders.

“Having that clear advancement — that’s what keeps people interested in the profession,” says Ginny Jorgensen, CDA, CDIPC, president of the Oregon Dental Assistants Association (ODAA).

“Having that clear advancement — that’s what keeps people interested in the profession.”

— Ginny Jorgensen

Oregon is one of 28 states that issue a license or registration for dental assistants to perform expanded functions. In fact, Oregon has five different expanded function levels, making it one of the most robust states in the country for dental assistants’ career growth. It’s also one of the 39 states, plus the District of Columbia, where DANB exams are recognized or required, which helps to support a qualified dental assisting workforce.

When Jorgensen started as a dental assistant in 1972, Oregon did not have a strong career ladder in place. Throughout her five decades in the profession, Jorgensen has seen the state introduce more and more opportunities for dental assistants, allowing her and others to reach new heights in their careers.

Jorgensen has also worked as an educator at Portland Community College, an orthodontic assistant, a training specialist at Kaiser Permanente, and an infection control specialist, in addition to serving as president of the ODAA.

Paired with Jorgensen’s drive to continually learn and grow, Oregon’s career ladder has helped make her success possible — and ultimately kept her in the dental assisting profession.

“If I walked into an office in 1972, I would be sucking spit, cleaning rooms, passing instruments, and talking to a patient and seating them,” explains Jorgensen. “Today, I walk in and I could provide local anesthetic. Or the dentist cuts a prep, and I fill and finish. I really do almost everything. And that just makes a huge, huge difference.”

Why do career ladders matter?

Advancement opportunities are essential for supporting and growing the dental assisting profession. States with well-defined career ladders can set dental assistants up for long, successful futures, while also building a workforce pipeline that can alleviate ongoing staffing shortages.

Career ladders allow dental assistants to learn more about dentistry, expand their skill set, work toward goals, take on more responsibilities, earn more pay, and plan for their future in the profession. In other words, it keeps them motivated, says Guinevere Juckett, CDA, CPFDA, CRFDA, EFDA, who has worked her way up the career ladder in Ohio over her 36 years in the profession.

“Nobody wants to do the same thing day in and day out,” says Juckett. “When you advance your duties, you elevate a person’s self-esteem. It drives their income up. It allows them to feel more cohesive with the team. A career ladder — it gives you goals. I’m going to start here, and I’m going to work hard, and I know where I want to end up. It just gives you something to strive for.”

“A career ladder — it gives you goals. I’m going to start here, and I’m going to work hard, and I know where I want to end up. It just gives you something to strive for.”

— Guinevere Juckett

These factors can draw more people into a profession that has experienced staffing shortages for years.

“You talk to high school students and they want to see what they can do 10 years down the road,” shares Jorgensen. “Sure, they want to know what they’re going to do on day one, but they want to see how they can grow and what the opportunities are.”

With clear goals to strive for, dental assistants are also more likely to stay in the profession, helping practices retain qualified, talented staff.

“If there hadn’t been all those other opportunities out there, I probably wouldn’t have [stayed in the profession],” admits Jorgensen.

For DANB Board member Stephanie Bustos, CDA, CDIPC, RDA, seeing those advancement opportunities in her state of New Jersey prompted her to enter the profession.

Bustos started her professional career working at a post office. Inspired by a friend, she looked into dental assisting and the growth opportunities available to her.

“If I’m going to do a career change, I want to see all the paths that I could take to get the highest pay,” she shares.

Bustos enrolled in a CODA-accredited dental assisting program, ultimately becoming a Registered Dental Assistant (RDA) in New Jersey and earning her Certified Dental Assistant (CDA) certification. Bustos eventually found a practice that valued her worth and has held a variety of roles, including lead assistant, lab technician, office trainer, OSHA coordinator, and clinical manager.

How do career ladders affect pay?

As Bustos found, these advancement opportunities can lead to higher wages — which is the top factor in dental assistant job satisfaction and retention, according to DANB’s Dental Assistants Salary and Satisfaction Survey. The top nine states in median hourly pay for dental assistants, as reported by the Bureau of Labor Statistics, have an expanded functions level that requires registration with the state dental board. Of the 28 states (including the District of Columbia) in that category, 21 have an hourly wage above the national median for dental assistants. These positions may be referred to as an expanded functions dental assistant (EFDA) or another name, such as Registered Dental Assistant (RDA).

In Minnesota — the state with the highest median hourly wage in the country ($31.38) — dental assistants can pursue a Licensed Dental Assistant (LDA) credential, allowing them to perform a range of advanced functions as well as earn certificates in restorative functions and administering nitrous oxide.

“If I’m going to do a career change, I want to see all the paths that I could take to get the highest pay.”

— Stephanie Bustos

Jorgensen’s state of Oregon has the fifth-highest median hourly wage ($28.60) in the country, and Bustos’ state of New Jersey ranks 15th in median hourly wages for dental assistants ($23.74).

“If I didn’t have those credentials, I don’t think I would be making what I’m making now,” says Bustos.

With clear growth opportunities in place, states can build and maintain a strong dental assistant pipeline, which improves access to care, patient safety, and practice productivity. That’s why Bustos believes dentists should support and encourage their dental assistants in pursuing expanded functions.

“Once a dentist realizes that this is going to save them time and they start getting in the flow of doing it, they’re going to be so used to it that they’re not going to know how to function when they are overbooked and they don’t have that assistant helping them,” believes Bustos.

Areas for improvement

Several states have created new EFDA levels in recent years. It often takes time for new levels to be fully available to dental assistants and widely embraced by dentists; however, it’s a positive development that many states are moving in this direction.

But this is not the case everywhere. Each state’s dental assisting requirements are different, meaning there is no national consensus. The lack of uniformity limits career growth for dental assistants in some states, and it creates confusion around job titles and duties. Addressing this inconsistency would greatly improve the profession, Juckett believes.

“I’d like to see consistency from state to state, basic to advanced training for all dental assistants, and have it be a licensed profession,” she says.

While states such as Oregon, Ohio, and New Jersey offer multiple dental assisting levels that require more advanced training and education, others only have a basic “dental assistant” title. There are also differences in allowable and prohibited duties between states. Even “expanded functions” can mean something different in the states with such a level. If a dental assistant moves to another state, they may need to start over if their existing credentials are not recognized.

All these factors contribute to the ongoing dental assistant shortage.

“Those who want to do more may leave the field because there isn’t a clear pathway of what they can do,” says Jorgensen. “And that has to be attached to income as well. Because we are the lowest-paid professionals in the dental office, it’s difficult if you don’t know: Where am I going to go? And how am I ever going to make any more money? So, if you have this ladder that shows if I get my expanded functions, I’m going to get another dollar per hour … I think that’s what really helps.”

Looking ahead

A clear career ladder is a key pillar of the Dental Assisting Professional Model, a framework that outlines proposed dental assisting levels, functions, pathways for education and training, and considerations for implementation to create consistency nationally.

Jorgensen says she was “jazzed” when the professional model was introduced in 2025, seeing it as an opportunity for Oregon to become an example other states can look toward.

“Now that we've got all these levels [in Oregon], it’s a great time for us to have a model, to have a standard,” she explains. “And I would love for Oregon to be that state that shows how it works.”

The model, which was developed by 20 professionals from leading dental organizations, includes recommendations for a three-level career path for dental assistants, with additional function-specific certificates for crucial duties like exposing dental radiographs and monitoring nitrous oxide. Each level offers multiple pathways to provide dental assistants, as well as states and employers, with flexibility.

With a shared understanding of what dental assistants do and how they can advance, the profession will become more viable for many, helping states recruit and retain qualified personnel more easily.

“Bridging the gaps is what DANB is trying to do,” says Bustos. “I’m proud to be a part of it.”