VOLUME 49, ISSUE 13
ISSUE DATE:
JULY 3, 2017
RULE PROPOSALS
LAW AND PUBLIC SAFETY
DIVISION OF
CONSUMER AFFAIRS
STATE BOARD OF DENTISTRY
Proposed Amendments: N.J.A.C. 13:30-1A.3,
1A.4,
1A.5, and
2.3 through
2.6
Click here to view Interested Persons Statement
Scope of Practice: Dental Hygienist, Registered Dental Assistant, Limited Registered Dental Assistant in Orthodontics, and Unregistered Dental Assistant; Application for Registration as Limited Registered Dental Assistant in Orthodontics
Authorized By: State Board of Dentistry, Jonathan Eisenmenger, Executive Director.
Authority:
N.J.S.A. 45:1-15 and
45:6-19.4.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2017-109.
Submit comments by September 1, 2017, to:
Jonathan Eisenmenger, Executive Director
State Board of Dentistry
124 Halsey Street
PO Box 45005
[page=1822] Newark, NJ 07101
or electronically at:
http://www.njconsumeraffairs.gov/Proposals/Pages/default.aspx.
The agency proposal follows:
Summary
In response to a petition for rulemaking, the State Board of Dentistry (Board) is proposing amendments to N.J.A.C. 13:30 to expand the scope of practice for a licensed dental hygienist, registered dental assistant, and limited registered dental assistant in orthodontics (LRDA-O), and to modify the registration requirements for a limited registered dental assistant in orthodontics.
On January 24, 2014, the Board received a petition for rulemaking from Dr. Rene Johe, President, on behalf of the New Jersey Association of Orthodontists, requesting that the Board amend the rules governing the scope of practice of dental auxiliaries in an orthodontic office. (46 N.J.R. 647(a)).
The petitioner proposed expanding the functions that an LRDA-O may perform to include: holding and applying a curing light; applying topical anesthetic; applying topical fluoride; placing and ligating arch wires; and preparing teeth for bonding, that is, polish, etch, and seal. The petitioner noted that these functions are currently performed by licensed dental hygienists and registered dental assistants and maintained that the orthodontic-specific training of an LRDA-O is more intensive and extensive than that of a licensed dental hygienist or a registered dental assistant. The petitioner also noted that the testing for an LRDA-O is exclusively in the field of orthodontics and an LRDA-O is required to spend a minimum of two years in an orthodontic office. The petitioner further noted that despite this orthodontic-specific testing and experience, an LRDA-O is not permitted to perform orthodontic functions performed by licensed dental hygienists and registered dental assistants.
In addition, the petitioner recommended expanding the functions of a licensed dental hygienist, registered dental assistant, and an LRDA-O to include: taking impressions for orthodontic appliances; placing orthodontic separators; removing bands and brackets without the use of rotary instruments; removing primary adhesive after debanding or debonding without the use of rotary instruments; performing intra-oral scanning for the purpose of obtaining digital study models or orthodontic appliances; and under direct supervision, performing emergency treatment to provide immediate relief from an offending appliance, for example, clipping a protruding arch wire or removing a loose bracket. The petitioner believes that the performance of these procedures, which are reversible in nature, involve skills for which these dental auxiliaries are trained.
The petitioner also requested that the Board institute a new mechanism for attaining LRDA-O status because the requisite examinations specified in N.J.A.C. 13:30-2.3 are no longer administered by the Dental Assisting National Board (DANB).
On March 19, 2014, the Board referred this matter to its Rules and Regulations Committee for further deliberation in order to develop a better understanding of the implications this request would have for licensees, registrants, and patients, and to obtain additional information from the petitioner about a proposed new mechanism for attaining LRDA-O status. On May 19, 2014, a notice acknowledging the Board's action was filed with the Office of Administrative Law and was published in the New Jersey Register on April 21, 2014, at
46 N.J.R. 716(a).
The Board and the petitioner subsequently agreed to three extensions of the period for Board deliberation. The notices acknowledging these extensions were published in the New Jersey Register on July 7, 2014, at
46 N.J.R. 1655(b), on January 5, 2015, at
47 N.J.R. 234(a), and on April 6, 2015, at
47 N.J.R. 745(b). The Board considered the petition for rulemaking at the open public session of its June 3, 2015 meeting and determined to grant, in part, the petition and to initiate a rulemaking proceeding. Notice of the final action taken by the Board was published in the New Jersey Register on July 20, 2015, at
47 N.J.R. 1882(b).
The Board agreed with the petitioner that it is necessary to create a new mechanism for attaining LRDA-O status because the current requisite examinations (New Jersey Orthodontics Certification Examination and New Jersey Expanded Functions in Orthodontics Examination) specified in N.J.A.C. 13:30-2.3 are no longer administered by the Dental Assisting National Board.
In addition, the Board agreed with the petitioner that the functions that an LRDA-O may perform should be expanded to include: using a curing light; applying topical anesthetic; applying topical fluoride; placing and ligating arch wires; and etching teeth in preparation for bonding, sealants, and desensitizing agents. The Board also agreed, in part, with the petitioner's suggestion that the functions that a licensed dental hygienist, registered dental assistant, and an LRDA-O are permitted to perform should also be expanded.
The Board determined to allow licensed dental hygienists under direct supervision and under the general supervision of a licensed dentist in a dental office or dental clinic to: take impressions for orthodontic appliances; remove bands and brackets without the use of rotary instruments; place orthodontic separators, but the supervising licensed dentist must review the placement; remove primary adhesive, without the use of rotary instruments, after debanding or debonding; and perform emergency treatment to provide immediate relief from an offending appliance, for example, clipping a protruding arch wire or removing a loose bracket. Except for the placement of orthodontic separators, a licensed dental hygienist may also perform these functions under the general supervision of a licensed dentist in an institution.
The Board also determined to allow registered dental assistants and LRDA-Os, under the direct supervision of a licensed dentist, to: take impressions for orthodontic appliances; place orthodontic separators; remove bands and brackets without the use of rotary instruments; and perform emergency treatment to provide immediate relief from an offending appliance, for example, clipping a protruding arch wire or removing a loose bracket.
The Board determined to deny the petitioner's request to include intra-oral scanning for the purpose of obtaining digital study models or orthodontic appliances as one of the functions performed by a licensed dental hygienist, registered dental assistant, or an LRDA-O. The Board believes including this function is unnecessary as it is encompassed in taking impressions for orthodontic appliances. The Board also denied the petitioner's request to expand the functions of registered dental assistants and LRDA-Os to include removing primary adhesive after debanding or debonding without the use of rotary instruments. The Board is concerned about the risk to the tooth enamel under the bonding, especially when there is decalcification, and believes that registered dental assistants and LRDA-Os do not have the necessary training in tooth histology, or training and experience in the removal of all types of foreign accumulations on enamel surfaces to protect against inadvertent tooth damage.
The Board is proposing to amend N.J.A.C. 13:30-1A.3(a) and
1A.4(a) and (b) to specify the functions that a licensed dental hygienist may respectively perform under the direct supervision or general supervision of a New Jersey licensed dentist in a dental office, dental clinic, or institution. With respect to the placement of orthodontic separators, the Board proposes to require that the supervising licensed dentist ensures the proper placement of the orthodontic separators placed by a licensed dental hygienist. The Board recognizes that in a dental office or dental clinic setting, a licensed supervising dentist may briefly leave the office/clinic and still be able to ensure the proper placement of the orthodontic separators. The Board, therefore, proposes to allow a licensed dental hygienist under general supervision in a dental office or dental clinic to place orthodontic separators; this function may be performed under direct supervision in an institution.
The Board also proposes to amend N.J.A.C. 13:30-1A.3(d) to add that, if a licensed dental hygienist engages in certain activities without direct supervision, it is deemed professional misconduct and subject to the penalties set forth in the Uniform Enforcement Act at N.J.S.A. 45:1-22. Similarly, the Board proposes to amend N.J.A.C. 13:30-1A.5(g) to add that, if a licensed dental hygienist administers local anesthesia without a permit and without direct supervision, it is deemed professional misconduct and subject to the penalties set forth in the Uniform Enforcement Act at N.J.S.A. 45:1-22.
The Board proposes to amend N.J.A.C. 13:30-2.3, which sets forth the education, examination, and experiential requirements to obtain [page=1823] registration as an LRDA-O. Because, as noted above, the New Jersey Orthodontics Certification Examination and New Jersey Expanded Functions in Orthodontics Examination are no longer offered by the DANB, the Board proposes to remove the requirement for applicants to successfully complete these examinations. Instead, the Board proposes to amend N.J.A.C. 13:30-2.3(a) to require applicants for registration as a limited registered dental assistant in orthodontics to successfully complete the Certified Orthodontic Assistant (COA) Examination, or its successor, the Topical Fluoride Examination, or its successor, and the Coronal Polish Examination, or its successor, which are administered by the DANB. The Board believes that these new examination requirements will ensure that an applicant for registration as a limited registered dental assistant in orthodontics has the necessary knowledge to perform the functions set forth in his or her scope of practice, including the proposed additional functions. In addition to passing these three examinations, the applicant must satisfy the Board's training and/or experiential requirements.
Consistent with
N.J.S.A. 45:6-55, the Board is proposing to amend N.J.A.C. 13:30-2.3 to specify two distinct pathways to become a limited registered dental assistant in orthodontics. Paragraph (a)1 sets forth that an applicant must, within the past 10 years, complete and graduate from a Board-approved and Commission on Dental Accreditation (CODA)-accredited training program for dental assistants. Paragraph (a)2 provides, alternatively, that an applicant successfully complete high school (or its equivalent) and obtain at least two years' work experience, during the five-year period prior to the date of application, as a dental assistant under the supervision of a licensed dentist holding a specialty permit in orthodontics. The Board proposes new N.J.A.C. 13:30-2.3(a)2i, which states that to satisfy the work experience requirement, the applicant must satisfy the same work experience required to sit for the COA examination. In addition, the Board proposes new N.J.A.C. 13:30-2.3(a)2ii to clarify for the regulated community, consistent with existing N.J.A.C. 13:30-2.5 and
2.6, that while an applicant is obtaining the required work experience, the applicant shall not perform the duties of a registered dental assistant or a limited registered dental assistant.
Consistent with the proposed amendments to N.J.A.C. 13:30-2.3(a), the Board proposes to amend subsection (b), which concerns the information that must be submitted to the Board with the application. The Board proposes to delete existing subparagraphs (b)2ii and iv, which reference the requirement for the New Jersey Orthodontics Certification Examination and New Jersey Expanded Functions in Orthodontics Examination, and to add new paragraph (b)3 to reference the proposed new required examinations. The Board proposes to amend recodified subparagraph (b)2ii to update cross-references. The Board also proposes new subparagraph (b)2iii to require a certification of work experience from the supervising dentist with a specialty permit in orthodontics. The Board proposes to recodify existing paragraphs (b)3 and (b)4 as (b)4 and (b)5.
The Board is also proposing to amend N.J.A.C. 13:30-2.4(a) and
2.5(a) to allow a registered dental assistant and LRDA-O, under the direct supervision of a licensed dentist, to: take impressions for orthodontic appliances, place orthodontic separators, remove bands and brackets without the use of rotary instruments, and perform emergency treatment to provide immediate relief from an offending appliance, for example, clipping a protruding arch wire or removing a loose bracket. When a registered dental assistant or an LRDA-O take an impression for orthodontic appliances, the Board is requiring the supervising licensed dentist to review and evaluate the impression prior to its use for fabrication. In addition, the supervising licensed dentist is required to ensure the proper placement of the orthodontic separators placed by a registered dental assistant or LRDA-O.
The Board also proposes to amend N.J.A.C. 13:30-2.5(a) to expand the scope of functions that may be performed by an LRDA-O, under the direct supervision of a licensed dentist, to include using a curing light, applying topical anesthetic, applying topical fluoride, placing and ligating arch wires, and etching teeth in preparation for bonding, sealants, and desensitizing agents. For the safety and welfare of the patient, the Board is requiring the supervising licensed dentist to verify the fit, before the LRDA-O may place the arch wire, and specifying that only the supervised licensed dentist is permitted to customize the arch wire for the patient.
The Board is also proposing to amend N.J.A.C. 13:30-2.4(a)4 and 2.5(a)8 to prevent a registered dental assistant or an LRDA-O from removing subgingival cement or debris. The Board is concerned about the potential harm to the patient and believes that a limited registered dental assistant and LRDA-O do not have the requisite education and training to safely remove cement and debris from below the gums.
The Board is proposing to amend N.J.A.C. 13:30-2.4(a)27 and 2.6(a)9 to better describe the function performed respectively by a registered dental assistant and unregistered dental assistant ("use" rather than "hold" a curing light). The Board is also proposing to amend N.J.A.C. 13:30-2.4(b) to clarify the procedures a registered dental assistant must follow when a patient is having an untoward reaction to nitrous oxide/oxygen inhalation analgesia.
In addition, the Board proposes to amend N.J.A.C. 13:30-2.4(d) and proposes new N.J.A.C. 13:30-2.5(c) to provide, respectively, that, if a registered dental assistant or an LRDA-O engages, without direct supervision, in the activities specified in their scope of practice, it will be deemed professional misconduct and subject the registered dental assistant or LRDA-O to the penalties set forth in the Uniform Enforcement Act.
The Board has provided a 60-day comment period for this notice of proposal. Therefore, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.
Social Impact
The Board has determined that the proposed amendments will have a positive impact on licensees, registrants, and the patients they serve. The proposed amendments to the examination, experiential, and training requirements at N.J.A.C. 13:30-2.3 provide LRDA-O applicants with a mechanism for achieving this status. The new examination requirements will also benefit the public by ensuring that applicants for registration as an LRDA-O have the necessary knowledge to perform the functions set forth in their scope of practice.
Economic Impact
The Board believes that the proposed amendments, which expand the scope of functions that a licensed dental hygienist, registered dental assistant, and an LRDA-O may perform, may have a positive economic impact on licensed dentists and the patients they serve. Licensed dentists will be able to delegate additional functions and, when services are performed by dental auxiliaries, there may be a cost savings to the dentists and patients.
The proposed amendments will have an economic impact on those applying to become a limited registered dental assistant in orthodontics. LRDA-O applicants will have to pay, to DANB, the fees associated with the Certified Orthodontic Assistant (COA) Examination, the Topical Fluoride Examination, and the Coronal Polish Examination. The Board, however, believes that these costs are outweighed by the benefits to the public in protecting the public's health, safety, and welfare by ensuring that LRDA-Os are competent to perform the functions within their scope of practice.
Federal Standards Statement
A Federal standards analysis is not required because the proposed amendments are governed by N.J.S.A. 45:6, and are not subject to any Federal requirements or standards.
Jobs Impact
The Board does not believe that the proposed amendments will result in the creation or loss of jobs in the State.
Agriculture Industry Impact
The proposed amendments will have no impact on the agriculture industry in the State.
Regulatory Flexibility Analysis
Currently, the Board licenses approximately 8,840 dentists and 5,890 dental hygienists and registers approximately 3,460 dental assistants and five limited registered dental assistants in orthodontics. Dental hygienists, dental assistants, and limited registered dental assistants in orthodontics cannot be considered "small businesses" because they may [page=1824] not engage in independent practice. If dentists licensed by the Board are considered "small businesses" within the meaning of the New Jersey Regulatory Flexibility Act,
N.J.S.A. 52:14B-16 et seq., then the following analysis applies.
The proposed amendments do not impose any new reporting or recordkeeping requirements on licensed dentists. However, the proposed amendments do impose compliance requirements on licensed dentists. These requirements are discussed in the Summary above.
No professional services will be needed to comply with the proposed amendments. There are no costs associated with the compliance requirements for the supervising licensed dentists. The Board believes that the proposed amendments should be uniformly applied to all licensees and registrants in order to ensure the health, safety, and welfare of the general public in the provision of dental, dental hygiene services, and dental assisting services. Therefore, no differing compliance requirements for licensees are provided based upon the size of the business.
Housing Affordability Impact Analysis
The proposed amendments will have an insignificant impact on the affordability of housing in New Jersey and there is an extreme unlikelihood that the proposed amendments would evoke a change in the average costs associated with housing, because the proposed amendments concern the practice of dental hygiene, dental assisting, and dental assisting in orthodontics.
Smart Growth Development Impact Analysis
The proposed amendments will have an insignificant impact on smart growth and there is an extreme unlikelihood that the proposed amendments would evoke a change in housing production in Planning Areas 1 or 2, or within designated centers, under the State Development and Redevelopment Plan because the proposed amendments concern the practice of dental hygiene, dental assisting, and dental assisting in orthodontics.
Full text of the proposal follows (additions indicated in boldface
thus; deletions indicated in brackets [thus]):
SUBCHAPTER 1A. DENTAL HYGIENISTS
13:30-1A.3 Scope of practice of licensed dental hygienist under direct supervision
(a) A licensed dental hygienist practicing under the direct supervision of a licensed dentist may:
1.-35. (No change.)
36. Assist a licensed dentist in the administration of nitrous oxide, provided the licensed dentist is physically present in the operatory at all times during the procedure.
i. In accordance with this subsection, a licensed dental hygienist who is monitoring a patient to whom the supervising dentist has administered nitrous oxide/oxygen inhalation analgesia may, while monitoring the patient, perform other functions within the dental hygienist scope of practice as delegated by the supervising dentist even if the dentist is not physically present in the operatory; [and]
37. Administer local anesthesia provided he or she satisfies the requirements set forth in N.J.A.C. 13:30-1A.5[.];
38. Take impressions for orthodontic appliances;
39. Place orthodontic separators. The supervising licensed dentist shall review the placement to ensure proper placement of the orthodontic separators;
40. Remove bands and brackets without the use of rotary instruments;
41. Remove primary adhesive, without the use of rotary instruments, after debanding and/or debonding; and
42. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket.
(b)-(c) (No change.)
(d) A licensed dental hygienist who engages in the activities outlined in (a) and (b) above without direct supervision, except as provided in N.J.A.C. 13:30-1A.4, shall be deemed to be engaging in the unauthorized practice of dental hygiene and
professional misconduct and shall be subject to the penalties set forth in
N.J.S.A. 45:6-58,
45:1-22, and 45:1-25.
(e) (No change.)
13:30-1A.4 Scope of practice of licensed dental hygienist under general supervision
(a) Dental office or dental clinic. A licensed dental hygienist practicing under the general supervision of a licensed dentist in a dental office or a dental clinic may:
1.-22. (No change.)
23. Isolate the operative field for the placement of sealants, including the placement and removal of rubber dams; [and]
24. Take alginate impressions for diagnostic casts, bleaching trays, and athletic mouth guards[.];
25. Take impressions for orthodontic appliances;
26. Place orthodontic separators. The supervising licensed dentist shall review the placement to ensure proper placement of the orthodontic separators;
27. Remove bands and brackets without the use of rotary instruments;
28. Remove primary adhesive, without the use of rotary instruments, after debanding and/or debonding; and
29. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket.
(b) Institution. A licensed dental hygienist practicing under the general supervision of a New Jersey licensed dentist in an institution may:
1.-10. (No change.)
11. Isolate the operative field for the placement of sealants, including the placement and removal of rubber dams; [and]
12. Apply topical anesthetic agents[.];
13. Take impressions for orthodontic appliances;
14. Remove bands and brackets without the use of rotary instruments;
15. Remove primary adhesive, without the use of rotary instruments, after debanding and/or debonding;
and
16. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket.
(c)-(e) (No change.)
13:30-1A.5 Administration of local anesthesia by licensed dental hygienists
(a)-(f) (No change.)
(g) A licensed dental hygienist who administers local anesthesia without a permit and without direct supervision shall be deemed to be engaging in the unauthorized practice of dental hygiene and
professional misconduct and shall be subject to the penalties set forth in
N.J.S.A. 45:6-58,
45:1-22, and 45:1-25.
(h) (No change.)
SUBCHAPTER 2. DENTAL ASSISTANTS
13:30-2.3 Application for registration as limited registered dental assistant in orthodontics
(a) An applicant desiring to secure registration as a limited registered dental assistant in orthodontics shall have:
1.
Satisfactorily completed and graduated, within the past 10 years, from a training program for dental assistants approved by the Board and accredited by the Commission on Dental Accreditation (CODA), and within 10 years prior to the date of application passed the Certified Orthodontic Assistant (COA) Examination, or successor examination, the Topical Fluoride Examination, or successor examination, and the Coronal Polish Examination, or successor examination, which are administered by the Dental Assisting National Board (DANB); or
[1.] 2. Successfully completed high school (or its equivalent) and shall have obtained at least two years work experience as a dental assistant
under the supervision of a licensed dentist holding a specialty permit in orthodontics during the five-year period prior to [page=1825] making application for [Registration]
registration, passed the [New Jersey Orthodontics Certification Examination]
Certified Orthodontic Assistant (COA) Examination, or successor examination, the Topical Fluoride Examination, or successor examination, and the Coronal Polish Examination, or successor examination, which are administered by the Dental Assisting National Board (DANB) within 10 years prior to the date of application[, successfully completed a Board-approved program in expanded functions in orthodontics, and passed the New Jersey Expanded Functions in Orthodontics Examination administered by DANB].
i.
To satisfy the work experience required pursuant to this section, the applicant shall satisfy the work experience requirements to sit for the COA examination as set forth in DANB's COA examination application packet, and which is available at
www.danb.org.
ii. An applicant obtaining work experience pursuant to this section shall not perform the duties of a registered dental assistant or a limited registered dental assistant. An applicant may perform the duties of an unregistered dental assistant as set forth in N.J.A.C. 13:30-2.6. Nothing in this subparagraph shall be construed to preclude an applicant from observing any tasks or duties performed in a dental office.
(b) An applicant for registration as a limited registered dental assistant in orthodontics shall submit a completed application to the Board, which contains the following information and materials:
1. (No change.)
2. Proof of the following, if applicable, pursuant to (a) above:
i. (No change.)
[ii. A certificate of successful completion of an examination for clinical competency in expanded functions in orthodontics administered by DANB;]
[iii.]
ii. A certificate of successful completion of an approved program in expanded functions in orthodontics. The Board shall recognize the following as providers of approved programs in expanded functions:
(1)-(2) (No change.)
(3) In-service training programs conducted at the graduate level by agencies of the Federal, State, or local government, which are substantially similar to programs described in [(b)2iii(1)]
(b)2ii(1) and (2) above; [and]
or
[iv. A certificate of successful completion of the limited registered dental assistant certification examination administered by DANB;]
iii.
A certification of work experience from the licensee(s) who possess(es) the specialty permit in orthodontics under whose supervision the applicant obtained the required work experience. The certification shall be on a form provided by the Board;
3. A certificate of successful completion of the Certified Orthodontic Assistant (COA) Examination, or successor examination, administered by DANB, the Topical Fluoride Examination, or successor examination, administered by DANB, and the Coronal Polish Examination, or successor examination, administered by DANB;
Recodify existing 3.-4. as
4.-5. (No change in text.)
13:30-2.4 Scope of practice of registered dental assistant
(a) A registered dental assistant may perform the following duties under the direct supervision of a licensed dentist:
1.-3. (No change.)
4. Remove excess cement from crowns or other restorations and orthodontic appliances[;]. Such removal shall not include any subgingival cement or debris;
5.-26. (No change.)
27. [Hold]
Use a curing light for any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning, or damaging hard or soft tissue or for electrosurgery for tissue retraction;
28.-32. (No change.)
33. Assist a licensed dentist in the administration of nitrous oxide, provided the licensed dentist is physically present in the operatory at all times during the procedure; [and]
34. Provide prophylactic and preventive measures, such as the application of fluorides and pit and fissure sealants and other recognized topical agents for the prevention of oral disease or discomfort. This shall not include prophylaxis[.];
35. Take impressions for orthodontic appliances. The supervising licensed dentist shall review and evaluate the impression prior to its use for fabrication;
36. Place orthodontic separators. The supervising licensed dentist shall ensure proper placement;
37. Remove bands and brackets without the use of rotary instruments; and
38. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket.
(b) A registered dental assistant practicing under the direct supervision of a licensed dentist pursuant to N.J.A.C. 13:30-8.20 may monitor a patient to whom the supervising dentist has administered nitrous oxide/oxygen inhalation analgesia provided the registered dental assistant does not perform any other function while monitoring the patient, and provided that:
1.-4. (No change.)
5. Upon any untoward reaction of the patient, the registered dental assistant immediately turns off the
flow of nitrous [oxide/oxygen inhalation analgesia]
oxide, maintains the established oxygen level, and
immediately summons the dentist.
(c) (No change.)
(d) A registered dental assistant who engages in the activities outlined in
(a), (b), and (c) above without direct supervision shall be deemed to be engaging in the unauthorized practice of dental assisting and
professional misconduct, and shall be subject to the penalties set forth in
N.J.S.A.
45:1-22 and 45:1-25.
(e) (No change.)
13:30-2.5 Scope of practice of limited registered dental assistant in orthodontics
(a) A limited registered dental assistant in orthodontics may perform the following duties under the direct supervision of a New Jersey licensed dentist who has obtained a Board permit number to announce a specialty in orthodontics pursuant to N.J.A.C. 13:30-6.1:
1.-7. (No change.)
8. Remove excess cement from crowns and other restorations and orthodontic appliances[;]. Such removal shall not include any subgingival cement or debris;
9.-10. (No change.)
11. Remove such debris as is normally created in the course of treatment during or after dental procedures by vacuum devices, compressed air, mouthwashes, and water; [and]
12.
Use a curing light for any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning, or damaging hard or soft tissue or for electrosurgery for tissue retraction;
13. Apply topical anesthetic agents;
14. Apply topical fluoride;
15. Etch teeth in preparation for bonding, sealants, and desensitizing agents;
16. Place and ligate arch wires. Before a limited registered dental assistant in orthodontics places the arch wire, the supervising licensed dentist shall verify the fit. Only the supervising licensed dentist shall customize the arch wire for the patient;
17. Take impressions for orthodontic appliances. The supervising licensed dentist shall review and evaluate the impression prior to its use for fabrication;
18. Place orthodontic separators. The supervising licensed dentist shall ensure proper placement;
19. Remove bands and brackets without the use of rotary instruments;
20. Perform emergency treatment to provide immediate relief from an offending appliance, such as clip a protruding arch wire or remove a loose bracket; and
[12.] 21. (No change in text.)
(b) (No change.)
[page=1826]
(c)
A limited registered dental assistant in orthodontics who engages in the activities outlined in (a) above without direct supervision shall be deemed to be engaging in the unauthorized practice of limited registered dental assisting in orthodontics and professional misconduct, and shall be subject to the penalties set forth in
N.J.S.A. 45:1-22 and 45:1-25.
13:30-2.6 Scope of practice of unregistered dental assistant
(a) A dental assistant who has not obtained a registration from the Board may perform the following duties under the direct supervision of a licensed dentist:
1.-8. (No change.)
9. [Hold]
Use a curing light in any dental procedure. Such curing light shall not include a laser capable of altering, cutting, burning, or damaging hard or soft tissue or for electrosurgery for tissue retraction;
10.-13. (No change.)
(b) (No change.)
