California Licensed Dentist DDS/DMD Bus. & Prof. Code § 1625 Attorney Fee Petition Mechanics: Dental Board of California License Verification at dbc.ca.gov as Primary Welch Anchor (THE ONLY § 1625 DDS/DMD Page — DISTINCT FROM Registered Dental Hygienist RDH § 1768, Registered Dental Assistant RDA § 1750.7, and Oral and Maxillofacial Surgeon; ADA Principles of Ethics and Code of Professional Conduct Advisory [PURE KETCHUM]; CODA Accreditation Standards for Dental Education Programs Advisory [PURE KETCHUM]; TWO PRIVATE STANDARDS ON ONE PAGE), CCP § 1021.5 Private Attorney General Mandatory Attorney Fees

Statutory Framework: Bus. & Prof. Code §§ 1625 et seq. and Dental Board of California DDS/DMD License — Scope of Practice, Unlicensed Practice Prohibition, ADA Principles of Ethics Advisory [PURE KETCHUM], CODA Dental Education Programs Standards Advisory [PURE KETCHUM], and CCP § 1021.5 Mandatory Attorney Fees

California Bus. & Prof. Code § 1625 — enacted as part of the Dental Practice Act (§§ 1600 et seq.) — requires that any person who practices, offers to practice, attempts to practice, or holds themselves out as practicing dentistry in California hold a valid DDS (Doctor of Dental Surgery) or DMD (Doctor of Dental Medicine) license issued by the Dental Board of California (DBC), a licensing board established under the California Department of Consumer Affairs. The Dental Practice Act defines the authorized scope of dental practice to encompass the full range of services directed to the oral cavity including: examination, diagnosis, and treatment planning for all dental and oral diseases and conditions; restorative dentistry (fillings, inlays, onlays, and crowns); endodontic treatment (root canal therapy including pulpectomy, pulpotomy, instrumentation, and obturation); exodontia (simple and surgical extractions including impacted third molars); fixed and removable prosthodontics (bridges, partial and complete dentures, and implant prosthetics); orthodontic treatment (comprehensive and limited orthodontics, clear aligner therapy, and retainers); periodontal treatment beyond RDH scope (periodontal surgery, osseous grafting, and guided tissue regeneration); pediatric dentistry; oral sedation, nitrous oxide sedation, intravenous conscious sedation, and general anesthesia; and prescription drug prescribing for all dental conditions. BPC § 1625 violations support enforcement under BPC § 680 (general prohibition on unlicensed practice) and CCP § 1021.5 when the underlying litigation vindicates a public interest in DBC licensure protecting the California public from invasive oral procedures performed by untrained, uncredentialed practitioners.

ADA PRINCIPLES OF ETHICS AND CODE OF PROFESSIONAL CONDUCT ADVISORY — THE ONLY PAGE IN THE FEE-PETITION-MECHANICS SERIES WITH AN ADA PRINCIPLES OF ETHICS ADVISORY — PURE KETCHUM: The American Dental Association (ADA, founded 1859, Chicago IL) is the national professional association for licensed dentists in the United States, with approximately 164,000 members. The ADA Principles of Ethics and Code of Professional Conduct (2022 edition) is the governing ethics and professional conduct standard for ADA member dentists and is incorporated by reference in the ethical obligations recognized by the Dental Board of California. Key ADA Code requirements directly relevant to California DDS/DMD fee petition practice include: (1) Section 1.A.1 — Nonmaleficence: the ADA Code imposes an affirmative duty on every licensed dentist to refrain from performing or directing clinical procedures for which the dentist does not have documented clinical competence; competency encompasses the knowledge, skills, and clinical judgment required to perform each specific procedure type in a manner that protects patient safety; a dentist who performs endodontic therapy without adequate training in working-length determination, instrumentation sequence, and obturation technique violates the Section 1.A.1 nonmaleficence obligation; unlicensed persons who perform any dental procedure without a DDS/DMD license, by definition, lack any competency documentation whatsoever — they hold no license, have passed no clinical competency examinations, have graduated from no CODA-accredited program, and have received no supervised clinical training evaluated against minimum competency standards; (2) Section 2.B.1 — Patient Self-Determination (Informed Consent): the ADA Code requires that dentists obtain the patient’s informed consent before initiating any dental treatment, which includes disclosing the treatment proposed, the material risks of the proposed treatment, the available treatment alternatives, and the consequences of declining treatment; an unlicensed person performing dental procedures cannot lawfully obtain informed consent because the consent form necessarily requires disclosure of the treating practitioner’s credentials, and an unlicensed person cannot truthfully represent themselves as a licensed DDS or DMD; any consent obtained by an unlicensed practitioner fraudulently misrepresenting credentials is void as a matter of law; (3) Section 4.B.1 — Veracity: the ADA Code imposes an obligation to maintain accurate and complete dental records for every patient contact and prohibits any misrepresentation of credentials, qualifications, or licensure status; an unlicensed person practicing dentistry violates Section 4.B.1 by holding themselves out as a licensed dentist and billing for dental services as if licensed; the DBC license verification printout at dbc.ca.gov confirming no DDS/DMD license is the definitive rebuttal to any veracity defense. The ADA Principles of Ethics create no statutory fee-shifting; they are a PURE KETCHUM advisory.

CODA ACCREDITATION STANDARDS FOR DENTAL EDUCATION PROGRAMS ADVISORY — THE ONLY PAGE IN THE FEE-PETITION-MECHANICS SERIES WITH A CODA DENTAL EDUCATION PROGRAMS STANDARDS ADVISORY — PURE KETCHUM: The Commission on Dental Accreditation (CODA, founded 1975, Chicago IL) is a private accreditation organization that operates under the auspices of the American Dental Association and accredits all dental education programs in the United States; a California DDS or DMD license requires graduation from a CODA-accredited dental education program, meaning that the CODA Accreditation Standards for Dental Education Programs (2022 edition) define the minimum educational competencies every California-licensed dentist must have demonstrated to earn their degree and qualify for DBC licensure. Key CODA Standards requirements establishing the competency baseline that all licensed California dentists have met — and that unlicensed practitioners have not — include: (1) Standard 2-20 — graduates must be competent in the comprehensive delivery of dental treatment, encompassing all aspects of clinical dentistry including complete diagnosis and treatment planning for complex multi-quadrant cases, restorative procedures in all operative categories including Class I through Class V composite and amalgam restorations and all categories of cast restorations, endodontic treatment including root canal therapy on anterior and posterior teeth with documented competency in electronic apex locators and radiographic working-length confirmation, extraction of erupted and surgically impacted teeth, all phases of fixed and removable prosthodontic treatment, and periodontal assessment and nonsurgical treatment; CODA Standard 2-20 requires each dental graduate to have performed a minimum number of procedures in each clinical category under faculty supervision with documented satisfactory competency evaluations before graduation; an unlicensed person practicing dentistry has never undergone these documented competency evaluations; (2) Standard 2-24 — graduates must be competent in the recognition, evaluation, and emergency management of medical and dental emergencies; this standard requires documented competency in emergency airway assessment and management, recognition and initial management of syncope, anaphylaxis, hypoglycemia, angina, acute myocardial infarction, and stroke in the dental office setting; competency in Basic Life Support (BLS) and emergency pharmacology including epinephrine, nitroglycerin, and aspirin administration; a dentist who has completed a CODA-accredited program has been tested on these competencies; an unlicensed person practicing dentistry — including administering nitrous oxide sedation — has received no such emergency management training; (3) Standard 2-27 — graduates must be competent in infection control consistent with the Centers for Disease Control and Prevention Guidelines for Infection Prevention and Control in Dental Health-Care Settings; this standard requires documented competency in standard precautions, proper sterilization of all reusable instruments using autoclave cycles, single-use disposable item protocols, water line maintenance, surface disinfection, and occupational exposure management; an unlicensed dental practitioner who has never attended a CODA-accredited program has received no systematic training in dental-specific infection control, creating direct patient safety risks for bloodborne pathogen transmission and cross-contamination. The CODA Accreditation Standards create no statutory fee-shifting; they are a PURE KETCHUM advisory.

Three-Track Harm: San Bernardino County Unlicensed Root Canal Ludwig’s Angina 12-Day Hospitalization ($285K), Orange County Unlicensed Dentist Six-Unit Veneer Failure Four Crowns Required ($195K), and Fresno County Expired DBC License 26 Months Nitrous Oxide Sedation Civil Penalty ($95K)

• SAN BERNARDINO COUNTY UNLICENSED PERSON PERFORMING ROOT CANAL THERAPY WITHOUT DDS/DMD LICENSE — DENTAL BOARD OF CALIFORNIA LICENSE VERIFICATION CONFIRMED NO DDS/DMD LICENSE ON RECORD — ADA CODE SECTION 1.A.1 NONMALEFICENCE VIOLATED — ROOT CANAL WORKING LENGTH NOT CONFIRMED BY ELECTRONIC APEX LOCATOR OR RADIOGRAPH — PERIAPICAL ABSCESS SPREAD TO FASCIAL SPACES — LUDWIG’S ANGINA — 12-DAY HOSPITALIZATION — EMERGENCY SURGICAL AIRWAY AND FASCIAL SPACE DRAINAGE — DBC CRIMINAL REFERRAL — $285,000 TOTAL INCLUDING CRIMINAL FINES, CIVIL PENALTY, AND PATIENT SETTLEMENT. A San Bernardino County individual operating under the title “dental technician” at a strip-mall dental practice advertised root canal services at discounted rates and performed root canal therapy on patients presenting with acute pulpitis and periapical pathology; a Dental Board of California license verification search at dbc.ca.gov confirmed that the individual’s name appeared in no DDS or DMD license record in any status, establishing that the individual had never obtained a California dental license and was performing invasive endodontic procedures entirely outside any licensing framework. The unlicensed practitioner performed root canal therapy on a mandibular first molar on a 45-year-old patient presenting with severe spontaneous pain and radiographic evidence of periapical pathology; the unlicensed practitioner did not use an electronic apex locator or obtain working-length radiographs to confirm the extent of instrumentation, a fundamental CODA Standard 2-20 endodontic competency requirement and an ADA Code Section 1.A.1 nonmaleficence requirement for any dentist performing root canal therapy. The unlicensed instrumentation was terminated 3 millimeters short of the radiographic apex; the inadequate biomechanical preparation and obturation resulted in a residual bacterial reservoir at the apical third of the root canal system. Over the following 72 hours, the patient developed progressive swelling of the floor of the mouth; when the patient presented to the hospital emergency department, examination confirmed bilateral submandibular and submental space involvement consistent with Ludwig’s angina — a rapidly progressing, potentially fatal polymicrobial fascial space infection originating from the inadequately treated periapical abscess. The patient required immediate endotracheal intubation for airway protection, 12 days of inpatient hospitalization, surgical fasciotomy and irrigation drainage of the submandibular, submental, and sublingual spaces under general anesthesia, and intravenous antibiotic therapy; the patient required two follow-up surgical procedures before the infection resolved. The Dental Board of California conducted an investigation, confirmed no DDS/DMD license for the treating individual, documented the ADA Code Section 1.A.1 nonmaleficence violation and the CODA Standard 2-20 endodontic competency deficit, and referred the matter for criminal prosecution under BPC § 680. Civil enforcement, patient settlements, and criminal fines totaled $285,000.
• ORANGE COUNTY DENTAL CLINIC EMPLOYING UNLICENSED DENTIST UNDER A LICENSED DENTIST’S NAME — CODA STANDARD 2-20 RESTORATIVE COMPETENCY NEVER DEMONSTRATED BY ACTUAL TREATING PRACTITIONER — SIX MAXILLARY ANTERIOR PORCELAIN VENEER PREPARATIONS PERFORMED WITHOUT REDUCTION DEPTH GAUGE — OVER-PREPARATION OF LABIAL SURFACES — VENEERS DEBONDED OR FRACTURED AT 8-MONTH RECALL — FOUR TEETH REQUIRED FULL-COVERAGE CROWNS — DBC INVESTIGATION AND CITATION — $195,000 COMBINED REMEDIATION, CROWN REPLACEMENT, AND PATIENT SETTLEMENT. An Orange County cosmetic dental clinic advertised extensive smile makeover packages and employed a licensed dentist as the nominal supervising practitioner of record while the actual clinical treatment was performed by an unlicensed individual with no DDS/DMD credential; a DBC investigation initiated on patient complaint confirmed through employment records, schedule logs, and clinical photographs that the licensed dentist named in the patient records was not present during treatment appointments and that all veneer preparations and delivery appointments were conducted by an unlicensed individual whose name appeared in no DBC license record. The unlicensed individual performed preparations on six maxillary anterior teeth (teeth 6 through 11) for direct-bonded porcelain veneers on a 32-year-old patient seeking elective cosmetic treatment; the preparation procedure requires precise reduction of the labial enamel surface to a depth calibrated to accommodate the veneer without over-reduction into dentin — a technique requiring CODA Standard 2-20 documented competency in fixed restorative preparation procedures including depth cut placement, reduction gauge use, and reduction confirmation by direct measurement; the unlicensed practitioner performed the preparations freehand without reduction gauges, resulting in inconsistent labial reduction depths that in four of six teeth extended significantly into dentin. At the 8-month recall examination, all six veneers demonstrated either debonding (three teeth) or cohesive fracture (one tooth), and clinical examination revealed that four of the six prepared teeth had preparation margins extending into dentin that were inconsistent with long-term veneer bonding; those four teeth required full-coverage porcelain-fused-to-metal crowns to provide adequate marginal seal and structural support. The DBC issued citations against the licensed dentist of record for permitting unlicensed dental practice and against the clinic for fraudulent representation of the treating practitioner’s credentials; combined costs of crown replacement, remediation, and patient settlement totaled $195,000.
• FRESNO COUNTY GENERAL DENTIST ADMINISTERING NITROUS OXIDE SEDATION WITH DBC LICENSE EXPIRED 26 MONTHS — CODA STANDARD 2-24 EMERGENCY MANAGEMENT COMPETENCY TRAINING LAPSE — PATIENT VASOVAGAL SYNCOPE DURING NITROUS ADMINISTRATION — DBC ROUTINE INSPECTION — ADMINISTRATIVE CITATION — MANDATORY CONTINUING EDUCATION — $95,000 CIVIL PENALTY. A Fresno County general dental practice continued operating and providing comprehensive dental services including nitrous oxide sedation after the lead dentist’s DBC license had lapsed into expired status 26 continuous months prior to a DBC routine compliance inspection; the DBC inspection team conducted a license verification check at dbc.ca.gov at the outset of the inspection and confirmed that the treating dentist’s DDS license was in expired status, meaning the dentist had been performing dental procedures on patients throughout the 26-month post-expiration period — including administering nitrous oxide anxiolysis sedation — without a valid DBC license. Nitrous oxide sedation administration in California requires not only a valid DDS/DMD license but also a separate DBC-issued nitrous oxide permit; because the underlying DDS license was expired, the nitrous oxide permit was similarly invalid. The DBC inspection further revealed that in the preceding 6 months, a patient had experienced a vasovagal syncope episode during nitrous oxide sedation administration; the practice’s emergency response documentation was incomplete and did not demonstrate that the staff had followed the CODA Standard 2-24 emergency management protocol for syncope management in the dental chair including the Trendelenburg position, ammonia inhalant, supplemental oxygen, vital sign monitoring, and emergency medical services activation threshold documentation. The DBC issued an administrative citation requiring immediate cessation of all dental practice pending license reinstatement, assessed $95,000 in civil penalties reflecting the 26-month duration of expired-license practice, and required the dentist to complete mandatory continuing education in emergency management and nitrous oxide sedation procedures before license reinstatement could be processed.

Distinct From Registered Dental Hygienist (Bus. & Prof. Code § 1768), Registered Dental Assistant (Bus. & Prof. Code § 1750.7), and Oral and Maxillofacial Surgeon

• DISTINCT FROM Registered Dental Hygienist RDH (Bus. & Prof. Code § 1768 — Dental Hygiene Board of California) — The RDH license under § 1768 authorizes only preventive dental hygiene services (prophylaxis, scaling, root planing, polishing, charting, sealants, fluoride); it does not authorize diagnosis, restorative procedures, endodontics, oral surgery, sedation, or prescription drug prescribing, all of which require a DDS/DMD license under § 1625 administered by an entirely separate licensing board (DBC, not DHBC): The California RDH license is issued and regulated by the Dental Hygiene Board of California (DHBC), a separate DCA licensing board with its own statute (§§ 1750 et seq.), educational requirements (two-year associate or four-year bachelor’s degree in dental hygiene from a CODA-accredited dental hygiene program, not a full four-year dental school program), and examination (California DHBC licensure examination administered through the Western Regional Examining Board, not the NBDE/INBDE dental examination); the RDH scope of practice is limited to preventive dental hygiene services performed under the supervision of a licensed dentist and does not include any diagnostic, restorative, endodontic, oral surgical, or prescriptive functions; a defendant in a § 1625 unlicensed dentist fee petition cannot reduce liability by pointing to an RDH license because RDH licensure does not authorize any dental practice function beyond preventive hygiene.
• DISTINCT FROM Registered Dental Assistant RDA (Bus. & Prof. Code § 1750.7 — Dental Board of California) — The RDA license authorizes dental assisting functions performed under direct dentist supervision, including taking radiographs, performing coronal polishing, and placing temporary restorations; it does not authorize independent dental diagnosis, restorative preparation, endodontic procedures, oral surgery, sedation, or prescription drug prescribing: The California RDA license is issued by the Dental Board of California but represents a dental auxiliary license for assisting functions, not an independent dental practice license; RDAs may perform specific expanded functions under direct DDS/DMD supervision as enumerated in BPC § 1750.7, but they may not practice dentistry independently, and none of the expanded RDA functions encompasses the full scope of dental diagnosis, restorative, endodontic, or surgical practice that constitutes the DDS/DMD scope under § 1625; an unlicensed person performing root canal therapy, veneer preparations, or crown procedures is not performing RDA-scope functions and cannot defend against a § 1625 fee petition by claiming their work falls within dental assisting.
• DISTINCT FROM Oral and Maxillofacial Surgeon (specialty requiring both DDS/DMD and additional surgical residency training) — While oral and maxillofacial surgery is a specialty of dentistry requiring a DDS/DMD license plus completion of an CODA-accredited 4- or 6-year OMS residency program, the basic DDS/DMD license under § 1625 is the foundational license for all dental practice; an unlicensed person performing oral surgery or extractions without a DDS/DMD license is subject to a § 1625 fee petition regardless of any claimed surgical background: The distinction between general dentistry and oral surgery is a specialty scope distinction within the licensed dental profession; a person performing invasive oral surgical procedures without a DDS/DMD license cannot defeat a § 1625 fee petition by claiming to be a “dental technician,” “dental therapist,” or any other unlicensed title; California does not recognize dental therapists as a licensed profession (unlike some other states), and there is no California license that authorizes independent dental diagnosis, restorative, or surgical practice short of the full DDS/DMD license under § 1625.

Billing Gaps 1–3 Summary (13.25 hrs/yr = $3,975–$6,625/yr)

Frequently Asked Questions