53 N.J.R. 614(a)

VOLUME 53, ISSUE 8, APRIL 19, 2021
RULE PROPOSALS

Reporter
53 N.J.R. 614(a)
NJ - New Jersey Register  >  2021  >  APRIL  >  APRIL 19, 2021  >  RULE PROPOSALS  >  LAW AND PUBLIC SAFETY -- DIVISION OF CONSUMER AFFAIRS

Interested Persons Statement 

INTERESTED PERSONS 
Interested persons may submit comments, information or arguments concerning any of the rule proposals in this issue until the date indicated in the proposal. Submissions and any inquiries about submissions should be addressed to the agency officer specified for a particular proposal. 
The required minimum period for comment concerning a proposal is 30 days. A proposing agency may extend the 30-day comment period to accommodate public hearings or to elicit greater public response to a proposed new rule or amendment. Most notices of proposal include a 60-day comment period, in order to qualify the notice for an exception to the rulemaking calendar requirements of  N.J.S.A. 52:14B-3. An extended comment deadline will be noted in the heading of a proposal or appear in a subsequent notice in the Register. 
At the close of the period for comments, the proposing agency may thereafter adopt a proposal, without change, or with changes not in violation of the rulemaking procedures at      N.J.A.C. 1:30-6.3. The adoption becomes effective upon publication in the Register of a notice of adoption, unless otherwise indicated in the adoption notice. Promulgation in the New Jersey Register establishes a new or amended rule as an official part of the New Jersey Administrative Code. 
Agency


LAW AND PUBLIC SAFETY > DIVISION OF CONSUMER AFFAIRS > STATE BOARD OF DENTISTRY


Administrative Code Citation


Notice of Proposed Substantial Changes Upon Adoption to Proposed Amendments  

Proposed Changes: N.J.A.C. 13:30-1A.4, 8.2, and 8.3


Text

  Dental Hygienist Scope of Practice in School Settings and Sedation Office Inspection Period
Proposed: November 18, 2019, at 51 N.J.R. 1648(a).
Authorized By: State Board of Dentistry, Elizabeth Clemente, DDS, President.
Authority: N.J.S.A. 45:1-15 and 45:6-19.4.
Submit written comments by June 18, 2021, to:

Joanne Magrath, Acting Executive Director
State Board of Dentistry
124 Halsey Street
PO Box 45005
Newark, New Jersey 07101

or electronically at:   www.NJConsumerAffairs.gov/proposal/comment

Take notice that the State Board of Dentistry (Board) proposed amendments at N.J.A.C. 13:30-1A.4, 8.2, and 8.3 on November 18, 2019, at 51 N.J.R. 1648(a), to expand the scope of practice of licensed dental hygienists in a school setting, and to standardize the inspection periods for mobile equipment, drugs, and supplies, and office inspections for both parenteral conscious sedation (PCS) (also known as moderate sedation) and general anesthesia. The public comment period closed on January 17, 2020.
The Board is proposing changes to the amendments in response to comments received. A summary of the comments that prompted changes, and the agency response to these comments, is provided below. Out of an abundance of caution, this notice of proposed substantial changes is published pursuant to N.J.S.A. 52:14B-4.10.  
Comments were received from:  
1. Kim Attanasi, PhD, MS, RDH;  
2. Jack Klepadlo, RDH, Immediate Past President of New Jersey Dental Hygienists' Association, Co-Chairman of Veterans Smile Day Foundation;  
3. Barbara Jacobs, RHD Med, Member of NJDHA;  
4. Dorrie Gagnon, RDH, Kinder Smile Foundation;  
5. Aleksandra Czaplinska, RDH, Member of NJ American Dental Hygienist Association;  
6. Collin McGee;  
7. Christine Lavelle, RDH;  
8. Gloria Galvis, RDH, MS;  
9. Paula R. Aneiros, BS, RDH;  
10. Michele Kenyon, RDH, BS;  
11. Janet Killeen, RDH, BA;  
12. Michael A. Carey DMD;  
13. Linda Hall;  
14. Eileen M. Armenio Prizzi, RDH;  
15. Erica D. Vincenti, RDH;  
16. Michael Carson;  
17. Erica D. Vincenti, RDH, ADHA;  
18. Michael Carson;  
19. Gianny Hernandez, RDH;  
20. Amanda Sargent, MSRDH;  
21. Rebecca Welch Pugh, Executive Director for the New Jersey Coalition on Oral Health for the Aging (NJCOHA);  
22. Krystine A Puccerella, RDH;  
23. Stacy L. Onofrietti, RDH, MS, CHP;  
24. Katarzyna Cybula-Tahmazian, RDH, Southern Component of NJDHA;  
25. Christina Moreia, RDH;  
26. Margaret Stone RDH;  
27. Kim Attanasi, President, New Jersey Dental Hygienists' Association (NJDHA);  
28. Benjamin Jacobs DMD, Diplomate, American Board of Oral & Maxillofacial Surgery;  
29. Dr. Ronen Gold;  
30. Lee C. Kojanis, DDS, Associate, Premier Oral Surgery Group PC, Assistant Clinical Professor, NYU/Bellevue Hospital Center, Attending, Englewood Hospital Medical Center;  
31. Michael DiPietro, DMD, Daniel Winston, DDS, and John Soliman, DMD, MD, Coastal Oral Surgery;  
32. Daniel P. Sullivan, DDS, Warren Oral Surgery;  
33. Ted Rosner, DMD;  
34. Manaf Saker, DMD, Ridgewood Oral Surgery & Implant Center;  
35. Joseph J. Sansevere, West Jersey Oral and Maxillofacial Surgeons, PC., DMD;  
36. Bradford J. Porter, DDS, Gene J. Martin, DDS, MD, and James B. Salman, DMD, Porter, Martin, Salman, P.A., Oral and Maxillofacial Surgery;  
37. Dr. Caprice, Vineland Oral Surgeons, PA;  
38. Dr. Leonard Infranco, DMD, Vineland Oral Surgeons, PA;  
39. Dr. Palma, Vineland Oral Surgeons, PA;  
40. Michael K. Goulston, DMD, MD, FACS, Oral and Maxillofacial Surgery and Implant Specialists of Middlesex;  
41. Torin W. Rutner, DMD, MD, Center For Oral & Facial Surgery;  
42. Gregg A. Jacob, DMD, FACS, Assistant Clinical Professor of Surgery, Department of Oral and Maxillofacial Surgery, New York Presbyterian Hospital, Weill-Cornell Medical College, Vice President, New Jersey Society of Oral and Maxillofacial Surgeons;  
43. Travis W. Reed, DMD, West Jersey Oral and Maxillofacial Surgeons, PC.;  
[page=615] 44. Shahid R. Aziz, DMD, MD, FACS, FRCSED, President, and Alan Hecht, DMD, Chairman, Anesthesia Committee, Past President, of the New Jersey Society of Oral and Maxillofacial Surgeons;  
45. John W. Vitale, DMD, Oral and Maxillofacial Surgery;  
46. Philip M. Echo, DMD;  
47. George W. Sandau, DMD, Westwood Oral Surgery Associates, P.A.; and  
48. Michael H. Kirsch, DDS, NJ Center for Oral Surgery;  
Dental Hygienists Scope of Practice  
1. COMMENT: Several commenters recommended that the Board amend N.J.A.C. 13:30-1A.4(c) to allow dental hygienists to provide child prophylaxis under general supervision in a school setting. The commenters believe that allowing for fluoride and sealants and not prophylaxis is advocating substandard care because the standard of care is to provide prophylaxis first.  
One of these commenters noted that without first removing biofilm with a prophylaxis, the effectiveness of fluoride and sealant applications is limited. This commenter also stated that dental hygienists are licensed, mid-level health care providers who can effectively serve this population with preventive treatments without direct supervision by a licensed dentist present.  
RESPONSE: The Board agrees with the commenters that providing prophylaxis is the standard of care and providing it in a school setting would expand access to care. The Board proposes to amend N.J.A.C. 13:30-1A.4(c)1 to allow a licensed dental hygienist practicing under the general supervision of a licensed dentist in a school setting to perform a complete prophylaxis, so long as the Federal Occupational Safety and Health Administration (OSHA) and Centers for Disease Control and Prevention (CDC) guidelines are followed, as is currently required at N.J.A.C. 13:30-1A.4(c)1i.  
Sedation  
2. COMMENT: Several commenters stated that office inspections for each level of anesthesia permit holder should be conducted every five years. One commenter stated that such a change is compliant with all of the other states requiring inspection. Another commenter noted that the national standard takes into consideration guidelines across the United States wherein the average inspection period is for every five years.  
RESPONSE: The Board agrees with the commenter that there would be a benefit in having the office inspection period for offices administering PCS and general anesthesia consistent with an existing standard. Accordingly, the Board proposes to amend the office inspection for PCS and general anesthesia from six to five years at N.J.A.C. 13:30-8.2(e) and 8.3(h). The Board notes that there is evidence-based science to conclude inspections of facilities every five years protects the health, safety, and welfare of the public. To the extent that the commenters are suggesting that even facilities administering enteral sedation should have office inspections, the Board disagrees. The Board does not believe that office inspections are warranted because these offices do not have the same level of facility requirements (for example, operating room and recovery area) as the offices that administer PCS and general anesthesia. The Board will maintain the requirement that mobile equipment, drugs, and supplies must be inspected every three years.  
Effect of Proposed Changes on Impact Statements Included in Original Proposal  
The change to allow a licensed dental hygienist practicing under the general supervision of a licensed dentist in a school setting to perform a complete prophylaxis, so long as the Federal OSHA and CDC guidelines are followed will have a positive social impact on the public by expanding access to care and ensuring that the standard of care can be met. The change will also have a positive social impact on dental hygienists by setting forth clear conditions under which a complete prophylaxis may be performed in a school setting. This change will not affect the Economic, Jobs, Agriculture Industry, or Racial and Ethnic Community Criminal Justice and Public Safety Impact statements; the Federal Standards Statement; the Regulatory Flexibility Statement; the Housing Affordability or Smart Growth Development Impact Analyses, as published in the original notice of proposal.  
The change to the inspection period from six to five years for offices that administer PCS and general anesthesia will have an economic impact for PCS and general anesthesia permit holders as the inspection fees will be incurred every five, instead of six years. The Board believes that any additional costs that may be borne by these permit holders are outweighed by the benefit to patient health, safety, and welfare in ensuring that sedation services are provided by qualified professionals in dental offices consistent with the professional practice and facility standards delineated in the rules. The changes to the proposed amendments will not affect the Social, Jobs, Agriculture Industry, or Racial and Ethnic Community Criminal Justice and Public Safety Impact statements; the Federal Standards Statement; the Regulatory Flexibility Statement; or the Housing Affordability or Smart Growth Development Impact Analyses, as published in the original notice of proposal.  
Full text of the proposed substantial changes to the proposed amendments follows (additions to proposal indicated in italicized boldface       thus; deletions from proposal indicated in italicized cursive brackets   [thus]):  
SUBCHAPTER 1A. DENTAL HYGIENISTS  
13:30-1A.4    Scope of practice of licensed dental hygienist under general supervision  
(a)-(b) (No change.)  
(c) School setting. A licensed dental hygienist practicing under the general supervision of a licensed dentist in a school setting:  
1. May administer to that school's students, with written parental or guardian consent, preventive measures such as the application of fluorides,       a complete prophylaxis,  pit and fissure sealants, as well as other recognized topical agents, including topical anesthetics, for the prevention of oral disease or associated discomfort and the detection of caries, and may use a curing light for the application of sealants, provided that:  
i.-ii. (No change.)  
2.-3. (No change.)  
(d)-(f) (No change.)  
SUBCHAPTER 8.    GENERAL PROVISIONS  
13:30-8.2    Parenteral conscious sedation  
(a)-(d) (No change.)  
(e)   All offices in which parenteral conscious sedation is conducted shall be inspected and approved once every  [six]    five years by the State Board of Dentistry, or its designee, and shall, at a minimum, have the equipment and supplies set forth at (i) below and at N.J.A.C. 13:30-8.26, which shall be readily accessible and maintained in good operating condition and shall meet the following standards:  
1. The operating room shall have space large enough to provide adequate accommodation of the patient on a table or in an operating chair, and allow an operating team consisting of at least three individuals to move about the patient without restriction or limitation;  
2. A recovery area that has available oxygen and monitoring equipment, adequate lighting, suction, and electrical outlets. The recovery area can be the operating theatre; and  
3. A lighting system adequate to permit visual evaluation of the patient's skin and mucosal color.  
(f)-(o) (No change.)  
13:30-8.3    Use of general anesthesia  
(a)-(g) (No change.)  
(h) The dental facility of any permit holder shall be inspected and approved by the State Board of Dentistry, or its designee, once every   [six]   five years.  
(i)-(r) (No change.)