Proposed Rule Changes
Department of Professional and Financial Regulation
Board of Dental Examiners
Chapter 1: Rules Relating to Dental Hygienists
Summary: This chapter sets forth rules for general and direct supervision of Dental Hygienists
Section 1. Definitions
A. General Supervision: “General supervision”
Shall mean that the dentist is not required to be in the dental office at the time the procedures are being performed on a patient of record.
B. Direct Supervision: “Direct supervision” shall
Mean that the dentist must be in the dental office at the time the duties under his/her supervision are being performed. In order to provide direct supervision of patient treatment, the dentist must at least diagnose the condition to be treated, authorize the treatment procedure prior to implementation, and examine the condition after treatment and prior to the patient’s discharge.
C. Public Health Supervision: “Public Health
Supervision” means that:
(1) The dentist provides general supervision to a dental hygienist who is practicing in a Public Health Supervision status that has been approved by the Board under Section 4 of this chapter, with the exception that the patient being treated shall not be deemed to be a patient of record of the dentist providing Public Health Supervision; and
(2) The dental hygienist has an active Maine license and practices in settings other than a traditional dental practice, provided that the service is rendered under the supervision of a dentist with an active Maine license. These settings may include but are not necessarily limited to public and private schools, medical facilities, nursing homes, residential care facilities, dental vans, and any other setting where adequate parameters of care, infection control, and public health guidelines can and will be followed.
Section 2. General Supervision of Dental Hygienists
Dental Hygienists may perform the following
duties under the general supervision of a
dentist:
A. Interview patients and record complete
Medical and dental histories;
B. Take and record the vital signs of blood
Pressure, pulse and temperature;
C. Perform oral inspections, recording all
Conditions that should be called to the attention of the dentist;
D. Perform complete periodontal and
Dental restorative charting;
E. Expose and process radiographs,
Permitted pursuant to Title 32 M.R.S.A. Section 1100-J (3)(A) (Supp.1985);
F. Perform pulp tests pursuant to the
Direction of a dentist;
G. Perform all procedures necessary for a complete prophylaxis, including root planing and curettage:
H. Apply fluoride to control caries:
I. Apply desensitizing agents to teeth;
J. Apply liquids, pastes or gel topical anesthetics;
K. Apply sealants, provided that a licensed dentist first makes the determination and diagnosis as to the surfaces on which the sealants shall be applied;
In Public Health or school sealant programs only, determination and diagnosis of the sealant site by a dentist need not occur.
L. Smooth and polish amalgam restorations:
M. Cement pontics and facings outside the mouth;
N. Take impressions for study casts, athletic mouth guards, custom trays, bleaching trays, fluoride trays, opposing models, retainers, and stents:
O. Take impressions for single arch athletic mouth guards and for custom trays; Recement temporary crowns with temporary cement;
P. Place and remove rubber dams;
Q. Remove sutures and periodontal dressings:
R. Perform post operative irrigation of surgical sites;
S. Place temporary restorations as an emergency procedure, provided that the patient is informed of the temporary nature of the filling;
T. Isolate operative fields;
U. Place and remove gingival retraction cord without vasoconstrictor for the purpose of sealant placement;
V. Obtain bacterial sampling when treatment planned by the dentist;
W. Place localized delivery of chemotherapeutic agents when treatment planned by the dentist; and
X. Perform any other duties that may be performed by a dental assistant under Chapter 2, sections 2 and 4 of these rules.
Section 3. Direct Supervision of Dental Hygienists.
A dental hygienist may perform the following
Duties only when under the direct
Supervision of a dentist:
A. Place periodontal dressings;
B. Remove socket dressings;
C. Place gingival retraction cords;
D. Apply identification microdisks;
E. C. Take cytological smears, as requested by dentist;
F. D. During nitrous oxide administration by the dentist, the dental hygienist may observe the gauges and advise the dentist of any changes in gauge indices or readings, but by no means shall this be intended or construed as permitting adjusting or controlling the machines or as permitting administration of nitrous oxide by the dental hygienist;
D. Administer nitrous oxide, utilizing induction via titration and not to exceed 50% concentration. A hygienist may apply for a permit to administer nitrous oxide after satisfactory completion of a nitrous oxide course in a CODA approved dental or dental hygiene program or other Maine Board of Dental Examiner approved course. The nitrous oxide course must minimally be 8 hours in length, include didactic and clinical components and an exit examination. The hygienist must receive both a minimum of 75% on the exit examination and course grade in order to meet satisfactory completion requirements. A hygienist may obtain a nitrous oxide permit via endorsement if the hygienist has taken a nitrous oxide course within a CODA approved dental or dental hygiene program, has been certified to administer nitrous oxide in another state, and has administered nitrous oxide within the last 2 years. Application fee and initial certification is $40. Renewal is $20 per biennium.
G.F. Administer local anesthesia for dental hygiene procedures only;
Special Endorsement: After satisfying the Board of his or her competence to administer local anesthesia, a licensed dental hygienist may qualify for a special endorsement to administer local anesthesia for dental hygiene procedures under the direct supervision of a licensed dentist, by performing the following:
(1) Competence to administer local anesthesia must be demonstrated to the Board by successfully completing with a passing grade a course of study of at least 60 hours of instruction in a formal program in administration of local anesthesia sponsored by an institutional program accredited by the Commission on Dental Accreditation of the American Dental Association. A certificate of course completion and a copy of the syllabus must be provided to the Board for approval. The course must include didactic studies and clinical experience in the administration of block and infiltration anesthesia. A minimum of 50 satisfactorily performed injections is required.
The curriculum for required study must include but is not necessarily limited to:
a. Medical history evaluation procedures;
b. Understanding pharmacology of local anesthesia and vasoconstrictors;
c. anatomy of head, neck, and oral cavity as it relates to administering local anesthetic agents;
d. indications and contraindications for administration of local anesthesia;
e. Selection and preparation of the armamentaria and record keeping for administering various local anesthetic agents;
f. Medical and legal management of complications;
g. Recognition and management of post-injection complications and management of reactions to injections;
h. Proper infection control techniques with regard to local anesthesia and proper disposal of sharps;
i. Methods of administering local anesthetic agents with emphasis on:
(i). Technique
a. aspiration
b. slow injection
( ii). Minimum effective dosage
(2) Upon satisfactory completion of the application process, including submission of a copy of a valid CPR certification, the applicant must pass a Board-administered, written examination in the administration of local anesthesia.
(3) A dental hygienist who has been licensed and trained to administer local anesthesia in another state may qualify, at the discretion of the Board, to take the examination by presenting written documentation of such licensure and training to the Board along with documentation of at least two years experience within the past five years and by gaining approval of the Board through the interview process.
(4) A dental hygienist can maintain local anesthesia privileges by administering at least 50 patient visits using local anesthetic injections during the previous five years, documented by a log book to include date of visit, patient name, supervising dentist, purpose of injection and ay adverse reaction or complication. He or she must satisfy the Board of competence (See number 7 below) to administer local anesthesia by successfully completing a course of 60 hours of studies that satisfies the curriculum requirements of Section 3(G)(1) of this chapter.
(54) A licensed dental hygienist who has demonstrated competence to the satisfaction of the Board may qualify for a special endorsement and may undertake the administration of local anesthesia by:
a. Successfully completing the written examination administered by the Board;
b. Substantiating the adequacy of training; and
c. Limiting administration of local anesthesia as provided by these rules.
(65) The endorsement shall be for a period of 5 years and renewable with documentation of experience as described in Section 5 of this rule.
G. Take impressions for nightguards and occlusal splints as long as the dentist takes all measurements and bite registrations;
H. Place tetracycline fibers, acticite or similar therapies; and
I. Perform any other duties that may be performed by a dental assistant under Chapter 2, Section 3 of these rules.
Section 4. Public Health Supervision Status
A. Public Health Supervision Status Allowed. The Board may grant “Public Health Supervision” status, as defined in Section 1(C), to a dental hygienist in situations the Board deems appropriate in its discretion, giving due consideration to the protection of the public.
B. Roles and Responsibilities. When working together in a Public Health Supervision relationship, dentists and dental hygienists shall enter into a Public Health Supervision
Agreement based on the following roles and responsibilities:
(1) The dentist providing Public Health Supervision must:
Be available to provide an appropriate level of contact, communication, collaboration, and consultation with the dental hygienist;
Have specific standing orders or policy guidelines for procedures which are to be carried out for each location or program, although the dentist need not be present when the procedures are being performed;
Help provide for the patient’s additional needed care in collaboration with the dental hygienist, although the dentist has no responsibility for providing treatment.
(2) A dental hygienist providing services under Public Health Supervision may perform only those duties within the accepted scope of practice of dental hygiene, as follows:
a. Interview patients and recoret zd complete medical and dental histories;
b. Take and record the vital signs of blood pressure, pulse and temperature;
c. Perform oral inspections, recording all conditions that should be called to the attention of the dentist;
d. Perform complete periodontal and dental restorative charting;
e. Expose and process radiographs if a dentist will be available to interpret all radiographs and agrees in writing to issue standing prescription orders for taking radiographs;
f. Perform pulp tests pursuant to the direction of a dentist;
g. Perform all procedures necessary for a complete prophylaxis, including root planing;
h. Apply fluoride to control caries;
i. Apply desensitizing agents to teeth;
j. Apply liquids, pastes or gel topical anesthetics;
k. Apply sealants;
l. Smooth and polish amalgam restorations, limited to slow speed application only;
m. Cement pontics and facings outside the mouth;
n. take impressions for study casts, single arch athletic mouth guards, custom trays, bleaching trays, fluoride trays, opposing models, retainers, and stents;
o. place and remove rubber dams;
p. remove sutures and periodontal dressings;
q. perform post operative irrigation of surgical sites;
r. isolate operative fields; and
s. perform any other duties that may be performed by a dental assistant under Chapter 2, Sections 2 and 4 of these rules.
(3) A dental hygienist providing services under Public Health Supervision must perform the following duties:
Provide to the patient, parent or guardian a written plan for referral or an agreement for follow-up recording all conditions that should be called to the attention of a dentist;
Have each patient sign a permission slip or consent form that informs them that the service to be received does not take the place of regular dental checkups at a dental office and is meant for people who otherwise would not have access to the services;
Inform each patient who may require further dental services of that need;
Inform the Board in writing of any changes in or termination of the Public Health Supervision Agreement; and
Maintain an appropriate level of contact and communication with the dentist providing Public Health Supervision .
C. Criteria. In deciding whether to grant Public Health Supervision status to a dental hygienist, the Board shall consider the following criteria:
(1) The proposal fills a need not currently being met;
(2) The particular proposed practice setting(s), including the proposed supervisor, will be adequate to accomplish the goal;
(3) Appropriate public health guidelines can be followed in the proposed setting(s);
(4) Adequate parameters of care can be maintained in the proposed practice setting(s);
(5) A dentist is available to provide Public Health Supervision to the dental hygienist and specific standing orders are submitted to and approved by the Board; and
(6) If criteria (1)-(4) are met, but a dentist is not readily available under (5), the Board shall assist the dental hygienist in finding a dentist to provide Public Health Supervision.
D. Application and Approval Process. A dental hygienist wishing to practice under Public Health Supervision must apply to the Board for approval, on an application form specified by the Board, providing such information as the Board may deem necessary. The dental hygienist shall list all known locations at which he or she expects to practice. Upon approval by the Board, the dental hygienist may practice under Public Health Supervision for a specified period determined by the board not to exceed three years. If, during the specified period, the dental hygienist finds that he or she will be providing services at additional locations than those described in the application form, he or she shall notify the Board about each of these locations, in the manner specified by the Board. Any application approved for a specified period may be amended, upon submission by the dental hygienist and approval by the Board. The Board may revoke its approval if a program does not continue to meet the criteria specified in 4(c).
E. Reporting requirements. Each dental hygienist who has rendered services under Public Health Supervision must complete a summary report at the completion of a program, or, in the case of an ongoing program, at least annually. The report must be completed in the manner specified by the Board, including information about each location where the dental hygienist has rendered these services. The dental hygienist must submit the form to the dentist providing Public Health Supervision for his or her signature, before sending it to the Board.
F. Reimbursement. Dental Hygienists providing services under Public Health Supervision may be compensated for their work by salary, honoraria, and other mechanisms by the employing or sponsoring entity. Nothing in this rule shall preclude the entity that employs or sponsors a dental hygienist from seeking payment, reimbursement, or other source of funding for the services provided.
Statutory Authority: 32 M.R.S.A. 1073 (2)
Effective Date:
September 18, 1978
Amended:
June 29, 1987
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