DAR File No. 32655

Commerce, Occupational and Professional Licensing

R156-69

Dentist and Dental Hygienist Practice Act Rule

NOTICE OF PROPOSED RULE

DAR File No.: 32655
Filed: 05/07/2009, 09:47
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division and the Dentist and Dental Hygienist Licensing Board reviewed this rule and determined that changes needed to be made.

Summary of the rule or change:

In Section R156-69-102, added a definition for "PALS" (Pediatric Advanced Life Support) and added Subsection R156-69-102(15) which defines the scope of each anesthesia classification within the scope of the practice of dentistry. The anesthesia classifications are now parallel to the American Dental Association (ADA) guidelines. In Section R156-69-202, updated the American Dental Association Guidelines document to the October 2007 edition. In Sections R156-69-204 and R156-69-303, made minor subsection numbering and rule citation amendments. In Section R156-69-304a, amendments are made in this section with respect to continuing education to clarify the expectations and requirements while obtaining continuing education. The Division of Occupational and Professional Licensing is also added as an approved provider for continuing education. In Section R156-69-502, added two new behaviors that would be categorized as unprofessional conduct: failing to provide records to patients and failing to report an anesthetic or sedative drug incident to the Division. In Section R156-69-602, added that laser periodontal debridement is within the scope of practice of a dental hygienist as it is a function they currently perform. In Section R156-69-603, added the requirement of cardiopulmonary resuscitation (CPR) or Basic Cardiac Life Support (BCLS) certification for a dental assistant which is consistent with other practitioners in the profession.

State statutory or constitutional authorization for this rule:

Section 58-69-101 and Subsections 58-1-106(1)(a) and 58-1-202(1)(a)

This rule or change incorporates by reference the following material:

Deletes the Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, Parts I, II, or III of the American Dental Association, July 1993 edition; and adds the Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, published by the American Dental Association, October 2007 edition

Anticipated cost or savings to:

the state budget:

The Division will incur minimal costs of approximately $50 to print the rule once the proposed amendments are made effective. Any costs incurred will be absorbed in the Division's current budget.

local governments:

The proposed amendments only apply to licensed dentists and dental hygienists and applicants for licensure as either a dentist or dental hygienist and dental assistants. As a result, the proposed amendments do not apply to local governments.

small businesses and persons other than businesses:

The proposed amendments only apply to licensed dentists and dental hygienists and applicants for licensure in these classifications and dental assistants which are not licensed by the Division. Licensees and applicants for licensure may work in a small business; however, the proposed amendments would not directly affect the business. As a result of the proposed amendments, licensees will now have an additional option with respect to obtaining required continuing education hours as a result of the Division being added as an approved continuing education provider. Licensees may see minimal savings in continuing education costs as a result of the Division now providing continuing education training for the profession. However, any exact amount of savings is unable to be determined. There may be unknown costs if a licensee engages in either of the new behaviors which are being added as unprofessional conduct and if an administrative proceeding is initiated as a result of those behaviors against the licensee. However, if a licensee does not engage in the unprofessional conduct behaviors, no costs will be incurred. Dental assistants who are not licensed/regulated by the Division will need to maintain regular CPR or BCLS certification in order to work in a dental office. The Division anticipates minimal costs of less than $100 every 2 years to the dental assistant to complete a course necessary to maintain that certification. This cost may be incurred by the dental assistant or a dental office if the office chooses to pay the certification course fee for a dental assistant employee.

Compliance costs for affected persons:

The proposed amendments only apply to licensed dentists and dental hygienists and applicants for licensure in these classifications and dental assistants which are not licensed by the Division. As a result of the proposed amendments, licensees will now have an additional option with respect to obtaining required continuing education hours as a result of the Division being added as an approved continuing education provider. Licensees may see minimal savings in continuing education costs as a result of the Division now providing continuing education training for the profession. However, any exact amount of savings is unable to be determined. There may be unknown costs if a licensee engages in either of the new behaviors which are being added as unprofessional conduct and if an administrative proceeding is initiated as a result of those behaviors against the licensee. However, if a licensee does not engage in the unprofessional conduct behaviors, no costs will be incurred. Dental assistants who are not licensed/regulated by the Division will need to maintain regular CPR or BCLS certification in order to work in a dental office. The Division anticipates minimal costs of less than $100 every 2 years to the dental assistant to complete a course necessary to maintain that certification. This cost may be incurred by the dental assistant or a dental office if the office chooses to pay the certification course fee for a dental assistant employee.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule filing further defines the practice of dentistry with respect to the administration of anesthesia, further defines unprofessional conduct, clarifies continuing education requirements, updates references to the ADA guidelines and makes other technical changes. No fiscal impact to businesses is anticipated from the adoption of these standards and the clarifications. Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY UT 84111-2316

Direct questions regarding this rule to:

Noel Taxin at the above address, by phone at 801-530-6621, by FAX at 801-530-6511, or by Internet E-mail at ntaxin@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/01/2009

Interested persons may attend a public hearing regarding this rule:

6/18/2009 at 1:30 PM, Heber Wells Bldg, 160 E 300 S, Conference Room 474, Salt Lake City, UT

This rule may become effective on:

07/08/2009

Authorized by:

Thad LeVar, Deputy Director

R156. Commerce, Occupational and Professional Licensing.

R156-69. Dentist and Dental Hygienist Practice Act Rule.

R156-69-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 69, as used in Title 58, Chapters 1 and 69 or this rule:

(1) "ACLS" means Advanced Cardiac Life Support.

(2) "ADA" means the American Dental Association.

(3) "ADA CERP" means American Dental Association Continuing Education Recognition Program.

(4) "BCLS" means Basic Cardiac Life Support.

(5) "ADHA" means the American Dental Hygienists' Association.

(6) "CPR" means cardiopulmonary resuscitation.

(7) "CRDTS" means the Central Regional Dental Testing Service, Inc.

(8) "Competency" means displaying special skill or knowledge derived from training and experience.

(9) "Conscious sedation" means a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command, produced by a pharmacologic or non-pharmacologic method, or a combination thereof.

(10) "DANB" means the Dental Assisting National Board, Inc.

(11) "Deep sedation" means a controlled state of depressed consciousness, accompanied by partial loss of protective reflexes, including inability to respond purposefully to verbal command, produced by a pharmacologic or non-pharmacologic method, or combination thereof.

(12) "General anesthesia" means a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including inability to independently maintain an airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method or a combination thereof.

(13) "NERB" means Northeast Regional Board of Dental Examiners, Inc.

(14) "PALS" means Pediatric Advanced Life Support.

(15) "Practice of dentistry" in regard to administering anesthesia is further defined as follows:

(a) a Class I permit allows for local anesthesia which is the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug;

(b) a Class II permit allows for minimal sedation which is a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient's ability to independently and consciously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected;

(c) a Class III permit allows for moderate sedation in which a drug induced depression of consciousness occurs during which a patient responds purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patient's airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained; and

(d) a Class IV permit allows for deep sedation in which a drug induced depression of consciousness occurs from which a patient cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. A patient may require assistance in maintaining an airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

([14]16) "SRTA" means Southern Regional Testing Agency, Inc.

([15]17) "Unprofessional conduct," as defined in Title 58 Chapters 1 and 69, is further defined, in accordance with Subsection 58-1-203(5), in Section R156-69-502.

([16]18) "UDA" means Utah Dental Association.

([17]19) "UDHA" means Utah Dental Hygienists' Association.

([18]20) "WREB" means the Western Regional Examining Board.

 

R156-69-202. Qualifications for Anesthesia and Analgesia Permits - Dentist.

In accordance with Subsection 58-69-301(4)(b), the qualifications for anesthesia and analgesia permits are:

(1) for a class I permit:

(a) current licensure as a dentist in Utah; and

(b) documentation of current CPR or BCLS certification;

(2) for a class II permit:

(a) current licensure as a dentist in Utah;

(b) documentation of current BCLS certification;

(c) evidence of having successfully completed training in the administration of nitrous oxide conscious sedation which conforms to the [Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, Parts I, II, or III, of the American Dental Association, July 1993]Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, published by the American Dental Association, October 2007, which is incorporated by reference; and

(d) certification that the applicant will comply with the scope of practice as set forth in Subsection R156-69-601(2);

(3) for a class III permit:

(a) compliance with Subsections (1)(a) and (2) above;

(b) evidence of current Advanced Cardiac Life Support (ACLS) certification;

(c) evidence of holding a current Utah controlled substance license in good standing and a current Drug Enforcement Administration (DEA) Registration in good standing;

(d) evidence of having successfully completed comprehensive predoctoral or post doctoral training in the administration of parenteral conscious sedation which conforms to the [Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, Part III, of the American Dental Association, July 1993]Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, published by the American Dental Association, October 2007, and a letter from the course director documenting competency in performing parenteral conscious sedation; and 60 hours of didactic education in sedation and successful completion of 20 cases; and

(e) certification that the applicant will comply the scope of practice as set forth in Subsection R156-69-601(3); and

(4) for a class IV permit:

(a) compliance with Subsections (1), (2), and (3) above;

(b) evidence of current ACLS certification;

(c) evidence of having successfully completed advanced training in the administration of general anesthesia and deep sedation consisting of not less than one year in a program which conforms to the [Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry, Part II, of the American Dental Association, July 1993]Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, published by the American Dental Association, October 2007, and a letter from the course director documenting competency in performing general anesthesia and deep sedation;

(d) documentation of successful completion of advanced training in obtaining a health history, performing a physical examination and diagnosis of a patient consistent with the administration of general anesthesia or deep sedation; and

(e) certification that the applicant will comply with the scope of practice as set forth in Subsection R156-69-601(4).

 

R156-69-204. Qualifications for Anesthesia and Analgesia Permits - Dental Hygienist.

In accordance with Subsection 58-69-301(4)(b), the qualifications for a local anesthesia permit are the following:

(1) current Utah licensure as a dental hygienist or documentation of meeting all requirements for licensure as a dental hygienist;

(2) successful completion of a program of training in the administration of local anesthetics accredited by the Commission on Dental Accreditation of the ADA; and

(3)(a) a passing score on the WREB examination in anesthesiology; or

([4]b) documentation of having a current, active license to administer local anesthesia in another state in the United States.

 

R156-69-303. Renewal Cycle - Procedures.

(1) In accordance with Subsection 58-1-308(1), the renewal date for the two-year renewal cycle applicable to licensees under Title 58, Chapter 69, is established by rule in Section R156-1-308a.

(2) Renewal procedures shall be in accordance with Section R156-1-308c.

 

R156-69-304a. Continuing Education - Dentist and Dental Hygienist.

In accordance with Section 58-69-304, qualified continuing professional education requirements are established as the following:

(1) All licensed dentists and dental hygienists shall complete 30 hours of qualified continuing professional education during each two year period of licensure.

(2) Qualified continuing professional education hours for licensees who have not been licensed for the entire two year period will be prorated from the date of licensure.

(3) Continuing education under this section shall:

(a) be relevant to the licensee's professional practice;

(b) be prepared and presented by individuals who are qualified by education, training and experience to provide dental and dental hygiene continuing education; and

(c) have a method of verification of attendance and completion.

(4) Credit for continuing education shall be recognized in accordance with the following:

(a) unlimited hours shall be recognized for continuing education completed in blocks of time of not less than 50 minutes in formally established classroom courses, seminars, lectures, conferences, or training sessions which meet the criteria listed in Subsection (3) above, and which are approved by, conducted by or under sponsorship of:

(i) the Division of Occupational and Professional Licensing;

(ii) recognized universities and colleges;

(iii) professional associations, societies and organizations representing a licensed profession whose program objectives relate to the practice of dentistry and dental hygiene; or

(iv) ADA or any subgroup thereof, the ADHA or any subgroup thereof, an accredited dental, dental hygiene or dental postgraduate program, a government agency, a recognized health care professional association or a peer study club;

(b) a maximum of ten hours per two year period may be recognized for teaching continuing education relevant to dentistry and dental hygiene;

(c) a maximum of 15 hours per two year period may be recognized for continuing education that is provided via Internet or through home study which provides an examination and a completion certificate;

(d) a maximum of six hours per two year period may be recognized for continuing education provided by the Division of Occupational and Professional Licensing; and

(e) qualified continuing professional education may include up to three hours in practice and office management.

(5) If properly documented that a licensee is engaged in full time activities or is subjected to circumstances which prevent that licensee from meeting the continuing education requirements established under this section, the licensee may be excused from the requirement for a period of up to three years. However, it is the responsibility of the licensee to document the reasons and justify why the requirement could not be met.

[(4) Qualified continuing professional education shall consist of clinically oriented institutes, seminars, lectures, conferences, workshops, various forms of mediated instruction, and programmed learning.

(5)

(a) Qualified continuing professional education shall be approved by the Academy of General Dentistry or ADA CERP; or

(b) sponsored or presented by the ADA or any subgroup thereof, the ADHA or any subgroup thereof, an accredited dental, dental hygiene, or dental postgraduate program, a government agency, a recognized dental or health care professional association, or a peer study club.

(6) Qualified continuing professional education does not include courses in practice management.

]([7]6) [Any licensee with a class III or IV anesthesia permit must complete at least 15 hours of continuing education related to parenteral anesthesia every two years. These 15 hours may be part of the 30 hours required in Subsection (1).]Hours for recertification in BCLS, ACLS and PALS do not count as continuing education.

([3]7) A licensee shall be responsible for maintaining competent records of completed qualified continuing professional education for a period of four years after close of the two year period to which the records pertain. It is the responsibility of the licensee to maintain such information with respect to qualified continuing professional education to demonstrate it meets the requirements under this section.

 

R156-69-502. Unprofessional Conduct.

"Unprofessional Conduct" includes the following:

(1) failing to provide continuous in-operatory observation by a trained dental patient care staff member for any patient under nitrous oxide administration;

(2) advertising or being listed under a specialty heading when having not completed an ADA accredited educational program beyond the dental degree in one or more recognized areas: dental public health, endodontics, oral pathology, oral and maxillofacial surgery, orthodontics, pediatric dentistry, periodontics and prosthodontics;

(3) engaging in practice as a dentist or dental hygienist without prominently displaying a copy of the current Utah license;

(4) failing to personally maintain current CPR or BCLS certification, or employing patient care staff who fail to maintain current CPR or BCLS certification;

(5) providing consulting or other dental services under anonymity;

(6) engaging in unethical or illegal billing practices or fraud, including:

(a) reporting an incorrect treatment date for the purpose of obtaining payment;

(b) reporting charges for services not rendered;

(c) incorrectly reporting services rendered for the purpose of obtaining payment;

(d) generally representing a charge to a third party that is different from that charged to the patient;[ and]

(7) failing to establish and maintain appropriate records of treatment rendered to all patients for a period of seven years;

(8) failing to provide copies of x-rays, reports or records to a patient or the patient's designee upon written request and payment of a nominal fee for copies regardless of the payment status of the services reflected in the record; and

(9) failing to submit a complete report to the Division within 30 calendar days concerning an incident, in which any anesthetic or sedative drug was administered to any patient, which resulted in, either directly or indirectly, the death or adverse event resulting in patient admission to a hospital.

 

R156-69-602. Practice of Dental Hygiene.

In accordance with Subsection 58-69-102(7)(a)(ix), other practices of dental hygiene include performing laser bleaching and laser periodontal debridement.

 

R156-69-603. Use of Unlicensed Individuals as Dental Assistants.

In accordance with Section 58-69-803, the standards regulating the use of unlicensed individuals as dental assistants are that an unlicensed individual shall not, under any circumstance:

(1) render definitive treatment diagnosis;

(2) place, condense, carve, finish or polish restorative materials, or perform final cementation;

(3) cut hard or soft tissue or extract teeth;

(4) remove stains, deposits, or accretions, except as is incidental to polishing teeth coronally with a rubber cup;

(5) initially introduce nitrous oxide and oxygen to a patient for the purpose of establishing and recording a safe plane of analgesia for the patient, except under the direct supervision of a licensed dentist;

(6) remove bonded materials from the teeth with a rotary dental instrument or use any rotary dental instrument within the oral cavity except to polish teeth coronally with a rubber cup;

(7) take jaw registrations or oral impressions for supplying artificial teeth as substitutes for natural teeth, except for diagnostic or opposing models for the fabrication of temporary or provisional restorations or appliances;

(8) correct or attempt to correct the malposition or malocclusion of teeth, or make an adjustment that will result in the movement of teeth upon an appliance which is worn in the mouth;

(9) perform sub-gingival instrumentation;

(10) render decisions concerning the use of drugs, their dosage or prescription;[ or]

(11) expose radiographs without meeting the following criteria:

(a) completing a dental assisting course accredited by the ADA Commission on Dental Accreditation; or

(b) passing one of the following examinations:

(i) the DANB Radiation Health and Safety Examination (RHS); or

(ii) a radiology exam approved by the board that meets the criteria established in Section R156-69-604; or

(12) work without a current CPR or BCLS certification.

 

KEY: licensing, dentists, dental hygienists

Date of Enactment or Last Substantive Amendment: [June 9, 2008]2009

Notice of Continuation: June 19, 2006

Authorizing, and Implemented or Interpreted Law: 58-69-101; 58-1-106(1)(a); 58-1-202(1)(a)