Hygienist news

Supervision and Scope of Practice of Dental Hygienists: Recent changes
to state law or administrative rules.
Updated: October 2001

First Letter of State: C F I K M N O R T U V W

California - Cal. Business & Professions Code § 1768 to 1770 allows
dental hygienists endorsed as registered dental hygienists in
alternative practice to provide services for patients who bring them a
prescription from a dentist of physician at the residences of
homebound people, schools, residential facilities, institutions, and
dental health professional shortage areas. The services permitted
under this law are those that require general supervision including
prophylaxis, root planing, pit and fissure sealants, charting and
examination of soft tissue.

Colorado - Colo. Rev. Stat. § 12-35-122.5 allows unsupervised practice
in all settings for all licensed dental hygienists for specified
services. The law also permits licensed dental hygienists to own a
dental hygiene practice.

Connecticut - CT 1999 20-1261 permits dental hygienists with two years
of experience practicing in a public health environment, in
institutions, group homes and schools to practice without supervision
of a dentist under certain circumstances.

Florida - the licensing board reports that certain services may be
provided without the physical presence of a dentist.

Indiana - 1992 Sec. 25-13-1-10 provides that a licensed dental
hygienist (licensed for two years) may provide dental hygiene
instruction and in-service training without restriction on location.
Dental hygienists may also provide dental prophylaxis for children up
to and including grade 12 without supervision if the hygienist is
employed by the state department of health, the state department of
education or an elementary or secondary school. Hygienists (licensed
for two years) in any public health setting may also do screenings and
referrals without direct supervision.

Iowa - the licensing board reports that certain services may be
provided without the physical presence of a dentist.

Illinois - the licensing board reports that certain services may be
provided in certain settings without the physical presence of a
dentist.

Kansas - Kan. Stat. Ann. § 65-1423, 74-1408 and 65-1466 amends the
existing Dental Practices Act. The amendments relate to the practice
of licensed dental hygienists and unlicensed people employed by a
dentist, to supervision by a dentist of licensed and unlicensed people
working under the direction of the dentist, to the practice of
licensed dentists in certain settings as employees or under contract,
and to the composition and selection of the Kansas Dental Board. The
act also amends a statute that concerns the liability of associations
that investigate alleged dental malpractice and creates a new statute
that concerns the education of dental hygienists.

Kansas - Kan. Stat. Ann. § 65-1423, 65-1444 and 65-1456 (1997)
authorizes, among other provisions, a dentist to utilize a dental
assistant for the administration of nitrous oxide or oxygen if the
dental assistant has completed board approved training (content
training is outlined). The law also increases the scope of practice
for licensed hygienists to include performing fluoride treatments as a
prophylactic measure, and the administration of local block and
infiltration anesthesia and nitrous oxide. The administration of local
anesthesia is to be performed only under the direct supervision of a
licensed dentist at his office and only after completion of board
approved instruction as outlined in the law.

Maine 2001 Chap.1 Sec. 4 provides for less restrictive public health
supervision of dental hygienists to encourage greater utilization of
services in institutional, public health and other settings outside a
dental office. A dental hygienist may practice in a public or private
school, hospital or other non-traditional practice under "public
health supervision status" granted by the dental board on a
case-by-case basis.

Michigan - Mich. Comp. Laws § 333.16625 (1991) provides that dental
hygienists may treat patients in an approved dentally underserved
program as long as a dentist is available in person, by radio,
telephone or telecommunication or a dentist is available on a
regularly scheduled basis for review and consultation.

Minnesota - MN Laws 1999, Chapter 245, Article 4, Section 78 increases
dental reimbursement rates by 3% over the rates in effect on December
31, 1999 for all services rendered on or after January 1, 2000 and
increases rates for sealants and fluoride treatments to the lesser of
the submitted charge or 80 percent of 1997 median charges, effective
October 1, 1999. In addition it authorizes the commissioner to award
grants to community clinics or other nonprofit community
organizations, political subdivisions, professional associations, or
other organizations that demonstrate the ability to provide dental
services effectively to public program recipients. The law outlines
acceptable uses of grant money and gives direction to the commissioner
in awarding and evaluating the grants. Section 113 requires the
Commissioner of Human Services to review the dental access problem,
evaluate the effects of the initiatives of the 1999 Legislature, and
make recommendations on how to improve access; and to submit a
progress report January 15, 2000, and a final report on January 15,
2001. Section 118 authorizes the Commissioner of Human Services to
develop dental access demonstration projects utilizing dental
hygienists. The projects would permit dental hygienists to provide
certain services to limited access patients without the patient being
first examined by a dentist. It requires the commissioner to report to
the Legislature by January 15, 2001, on the effectiveness of these
demonstration projects.

Minnesota - 2001 Section 150A.10, subd.1a provides that a dental
hygienist may be employed or retained by a health care facility to
perform dental hygiene services without the patient first being
examined by a licensed dentist if the hygienist meets certain
requirements.

Missouri - 2001 332.311.2 allows dental hygienists with 3 years
experience in a public health setting to provide prophylaxis, sealants
and fluorides without supervision to Medicaid eligible children and be
reimbursed y Medicaid.

Nevada 1998, Rule 631.210.5 allows a dental hygienist who has special
board authority to perform services in a health facility, school, or
place designated by the board without the supervision of a dentist.

New Hampshire - administrative rule 101.11(d) allows dental
hygienists, under public health supervision, to provide procedures
authorized by a dentist in a public or private school, hospital or
institution, provided the dentist reviews patient records once in a 12
month period.

New Mexico 1999 HB 265, Sec 61-5A-4D expands the scope of practice of
dental hygienists allowing them to practice without the oversight of a
dentist under certain circumstances. Creates a collaborative practice
agreement between the dental hygienist and one or more consulting
dentists.

Oregon - Oregon Sec. 680.200, rule 818-035-0065 allows dental
hygienists who have obtained a limited access permit to treat patients
in nursing home, adult foster homes, residential care facilities,
adult congregate care facilities and mental health residential
programs. The patients seen must be referred annually to a licensed
dentist available to treat the patient.

Rhode Island - R.I. Gen. Laws § 16-21-9 amends existing law by
allowing dental hygienists with at least three years of clinical
experience to perform dental screenings for children, except those in
kindergarten, third, and ninth grades. Dental hygienists performing
the dental screenings pursuant to the provisions of this section will
do so under the general supervision of the dentist liable and
responsible under the contract with the community. The law prohibits
dentists or dental hygienists who screen children to refer them to a
dental practice they own or practice in. The law requires all dentists
or dental hygienists performing dental screenings to meet with the
Oral Health Director of the department of health on a regular basis.

The law requires each community to provide to parents or custodians of
children who require professional or skilled treatment a list of both
dental practices in the community that accept patients insured by
Medical Assistance and or RIte Care and dental practices that provide
services on a sliding scale basis to uninsured individuals.

In addition, the law requires the Department of Human Services to
provide each community with a list containing the addresses and
telephone numbers of both dental practices that accept patients
insured by Medical Assistance and or RIte Care and dental practices
that provide services on a sliding scale basis to uninsured
individuals.

Texas - the licensing board reports that several services may be
provided without the physical presence of a dentist. In 2001 a pilot
program was established to allow dental hygienists in remote areas to
provide any dental hygiene service based on a teledentistry
consultation with a dentist. It also allows dental hygienists with two
years experience to provide services without prior authorization of a
dentist in school based health centers and certain nursing facilities
provided the hygienist refers the patient for dental services.

Utah - the licensing board reports that certain services may be
provided without the physical presence of a dentist.

Virginia - Va. Code § 54.1-2712.1 and 54.1-2726.1 authorizes the Board
of Dentistry to issue restricted volunteer licenses to dentists and
dental hygienists licensed to practice in other states to perform
dental services in the Commonwealth on patients in approved public
health or community free health clinics. No compensation can be
received and the practitioners must be in good standing in the state
in which licensed.

Washington - Wash. Rev. Code § 18.29.056 dental hygienists may
practice unsupervised in hospitals, nursing homes, home health
agencies, group homes, state institutions under department of health
and human services, jails, and public health facilities provided that
the hygienist refers to a dentist for dental treatment and planning
and they have two or more years of clinical experince in the past five
years. It also creates a program for the health department to endorse
any licensed hygienist to apply sealants in school programs without
the prior authorization of a dentist.

Wisconsin - the licensing board reports that many service do not
require the physical presence of a dentist. In certain settings, the
provision of prophylaxis requires no prior authorization by a dentist.

Source: NCSL and the American Dental Hygienists' Association

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--
Joel M. Eichen, .
Philadelphia PA

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