New Regulations for Dental Hygienists Take Effect
On December 12, new regulations governing dentists’ supervision of
hygienists and their scope of practice took effect. These regulations
expand hygienists’ scope of practice and relax the supervision
requirements in private and public settings. Dental hygienists who meet
certain qualifications now have the ability to apply for two permits,
one to administer local anesthesia and the other to practice
independently in public settings. There also are changes to current
supervision requirements, depending on patients’ health and the
procedure that is performed.
Local anesthesia permits
Hygienists may now apply for a permit to administer local anesthesia
under dentists’ direct supervision. Direct supervision is defined
as the dentist being on premise when the hygienist is performing this
function. Local anesthesia is defined to include local infiltration
anesthesia and intraoral nerve block anesthesia limited to
the second (maxillary) and third (mandibular) divisions of the
trigeminal nerve. Please note that dentists are ultimately responsible
for deciding whether their hygienists administer local anesthesia, even
if they have the permit to do so.
In order to obtain this permit, a hygienist must:
- Have a current license in good standing.
- Hold current certification in Basic Life Support (BLS).
- Have graduated from a CODA-approved hygiene program that included a
course in local anesthesia within five years of applying for the
permit, or
- Have taken a course from a CODA-approved program that consists of at
least 30 hours of didactic and clinical instruction in local
anesthesia, or
- Have a current license or permit from another state to administer
local anesthesia (see regulations for more information.)
Hygienists who wish to maintain a permit to administer local
anesthesia must complete three hours of the required 20 hours of
continuing education in courses pertaining to local anesthesia,
including pharmacology or other related courses.
Hygienists may download the permit application online.
Public Health Dental Hygienists
Hygienists may now apply for a permit to practice as public health
dental hygienists (PHDH) after meeting the following conditions:
- Have a license in good standing.
- Have a statement from a licensed dentist(s) that he/she has at least
3,600 hours of clinical practice.
- Purchased malpractice insurance.
Public settings are defined as “public and private
educational institutions providing elementary and secondary instruction,
correctional facilities, health care facilities, domiciliary care
facilities, older adult daily living centers, continuing-care provider
facilities, federally qualified health centers, free and reduced-fee
nonprofit health clinics, and any public or private institution under
the jurisdiction of a federal, state or local agency.”
PHDHs are required to refer patients seen in public settings to a
dentist on an annual basis, though the patient’s failure to comply
with the referral does not preclude the PHDH from providing hygiene
services the following year. PHDHs are allowed to take radiographs
without any supervision from a dentist, and must provide the patient
with a copy of the radiograph, along with a referral to a dentist,
within one month of having taken the radiograph. Dentists reviewing
these radiographs should report any diagnosis to the patient and the
PHDH.
In order to maintain this permit, PHDHs must complete five hours of
the required 20 hours of continuing education in public health-related
courses. Those school hygienists who also have permits to practice
as PHDHs may complete education courses approved for certification by
the school district to meet the State Board of Dentistry’s 20-hour
continuing education requirement.
Hygienists may download the permit application online.
Supervision
The ASA Classifications used to determine a patient’s health and
treatment plan still remain but there are changes to how they apply to
supervision of dental hygienists. Most notably, the definition of
general supervision was changed so that hygienists may provide hygiene
services to patients within one year of a dentist having examined a
patient, rendered a diagnosis and treatment plan, and authorized the
hygiene services. Previously, hygienists had to provide these
services within 90 days of the dentist’s examination.
Direct supervision is
still defined as the dentist having examined the patient, authorized the
procedure to be preformed, is physically present in the dental facility
and available when the procedure occurs and takes full professional
responsibility for the completed procedure.
The following are the supervision requirements applying to these
hygiene services:
Placement of subgingival
agents: Hygienists may provide this service under direct
supervision, but general supervision would apply if the dentist has
review the patient’s records and medical history and has written a
prescription or given an order for the placement of subgingival
agents.
Periodontal probing, scaling, root
planning, polishing or another procedure required to remove calculus
deposits, accretions, excess or flash restorative materials and stains
from the exposed surfaces of the teeth and beneath the
gingiva: Hygienists may provide these services under
direct supervision when the patient is suffering from systemic disease
which is severe, incapacitating or life threatening. General supervision
would apply if the patient is free of systemic disease or suffers from
mild systemic disease (as determined by the dentist, with input from the
hygienist.)
Evaluation of that patient to collect
data to identity dental hygiene care needs:
Hygienists may provide this service under general supervision.
Application of fluorides and other
recognized topical agents for the prevention of oral
diseases: Hygienists may provide this service under
general supervision.
Conditioning of teeth for and
application of sealants: Hygienists may provide this
service under general supervision.
Taking impressions of teeth for
athletic appliances: Hygienists may provide this service
under general supervision.
Administration of local
anesthesia: Hygienists may provide this service only
under direct supervision.
Radiologic Procedures
Dental hygienists (who are not PHDHs) may take radiographs under
dentists’ general supervision in any setting. General supervision is defined as the
dentist having examined the patient, develops a treatment plan,
authorizes the performance of radiologic services to be performed within
one year of the exam and accepts full responsibility for the
hygienist’s performance.
Other auxiliary personnel who have passed the SBOD’s radiologic
procedure examination may perform such procedures only under
dentists’ direct supervision, which is defined as the dentist
having to be on the premises when a radiologic procedure is preformed
but not having to personally observe its performance.
Continuing Education
Hygienists may now take no more than three hours of the required 20
hours of continuing education credits in courses relating to
communication skills. See above for the new requirements for those
hygienists who obtain permits to administer local anesthesia or to
practice as PHDHs.
The SBOD will soon publish the new regulations on its website, but
for now a complete copy can be found in the Pennsylvania Bulletin.
Please contact Marisa
Swarney at (800) 223-0016, ext. 116, with any
questions or concerns about the new hygiene
regulations.
|
