VOLUME 47, ISSUE 24
December 21, 2015 Rule Proposals
Law and Public Safety
Division of Consumer Affairs New Jersey State Board of Dentistry
Proposed Amendments: N.J.A.C. 13:30-1.1, 1A.1, 1A.2, 2.1, 4.10, 8.17, and 8.20
Proposed New Rules: N.J.A.C. 13:30-1A.1, 1A.4, 1A.6, 8.25, and 8.26
Proposed Recodification: N.J.A.C. 13:30-1A.3 as 1A.5
Dental Hygienists Scope of Practice; Emergency Protocol
Authorized By: New Jersey State Board of Dentistry, Jonathan Eisenmenger, Executive Director.
Authority: N.J.S.A. 45:6-3 and 45:1-15.1.
Calendar Reference: See Summary below for explanation of exception to calendar requirement.
Proposal Number: PRN 2015-116.
Submit written comments by February 19, 2016, to:
Jonathan Eisenmenger, Executive Director
New Jersey State Board of Dentistry
124 Halsey Street
PO Box 45005
Newark, NJ 07101
The agency proposal follows:
Summary
The New Jersey State Board of Dentistry (Board) is proposing to amend its rules and promulgate new rules to harmonize its rules with, and implement, P.L. 2012, c. 29, which modifies the conditions under which a dental hygienist may engage in the practice of oral hygiene, expands the settings in which a dental hygienist may work under the general supervision of a licensed dentist, and prohibits certain activities by persons who are not licensed dentists.
In addition, the Board proposes to reorganize Subchapter 1A by adding a section for definitions to the beginning of the subchapter. As such, the definitions in N.J.A.C. 13:30-1A.2(a) are proposed to be relocated to proposed new N.J.A.C. 13:30-1A.1. N.J.A.C. 13:30-1A.1 and 1A.2 are proposed for recodification as N.J.A.C. 13:30-1A.2 and 1A.3, respectively, and N.J.A.C. 13:30-1A.3 is proposed for recodification, without change, as N.J.A.C. 13:30-1A.5.
Because of the recodification of Subchapter 1A, the Board also proposes to update the citations to that subchapter that are referenced in N.J.A.C. 13:30-4.10(f), 8.17(a) and (c), and 8.20(c), (e), and (i). Because dental hygienists are licensed, the Board is also proposing to delete the word "registered" when used in connection with the term "dental hygienist" in the section heading of recodified N.J.A.C. 13:30-1A.2 and in N.J.A.C. 13:30-1.1(b), recodified 1A.2(c), and recodified 1A.3(c).
The Board is also proposing to add new definitions and to amend several definitions at N.J.A.C. 13:30-1A.1 and 1A.3, to harmonize with the statutory modifications of P.L. 2012, c. 29. In accordance with P.L. 2012, c. 29, the definition of "institution" is proposed for amendment to replace "for the mentally disabled" with "for persons with developmental disabilities." At N.J.A.C. 13:30-1A.1, the Board proposes adding the following terms: "Commission on Dental Accreditation (CODA)," "dental clinic," and "school setting." The Board also proposes at N.J.A.C. 13:30-1A.1 and 1A.3, to amend the term "supervision" to "general supervision" to clearly distinguish between direct supervision which requires the physical presence of the licensed dentist and general supervision which does not. In addition, the Board proposes to amend the definition of "general supervision" to allow the licensed dentist to provide either a written order of protocol in order for the licensed dental hygienist to provide treatment, within his or her scope of practice without the dentist being physically present at the setting. At N.J.A.C. 13:30-2.1, the Board is proposing to add the definition of CODA. The Board is proposing to amend the heading of recodified N.J.A.C. 13:30-1A.3 to describe the scope of practice for dental hygienists to practice under the direct supervision of a licensed dentist. In addition, the Board is proposing to reorganize the order in which the functions appear in recodified N.J.A.C. 13:30-1A.3. The Board believes the reorganization will make it easy for licensees to compare the functions that may be performed solely under direct supervision with those that may be performed under general supervision in a dental office or dental clinic, as set forth in proposed N.J.A.C. 13:30-1A.4(a). The order of the itemized list of functions is: 1. the functions that may be performed either under direct or general supervision; then 2. the functions that are modified, as set forth in proposed N.J.A.C. 13:30-1A.4(a), for a licensed dental hygienist to perform them under general supervision in dental office or dental clinic; and finally 3. the functions that may be performed solely under the direct supervision of a licensed dentist.
The Board is proposing to amend recodified N.J.A.C. 13:30-1A.3(a)8 and 31 to better describe the activities of dental hygienists by, respectively, replacing "examine" with "assess" and "hold" with "use." The Board is also proposing new N.J.A.C. 13:30-1A.3(a)20, which replaces existing paragraphs (a)5 and 6, to better describe the function performed by the dental hygienist with respect to assessing whether there [page=3098] is carious activity by using detecting agents and carious detection instruments. In addition, the Board is proposing new N.J.A.C. 13:30-1A.3(a)35 to specify that dental hygienists may use an in-office light activated bleaching system only under the direct supervision of a licensed dentist. The Board is concerned about the damage this type of procedure can cause and believes it should be performed by a dental hygienist only when the supervising dentist is physically present. The Board notes that it does not assess the efficacy of any of the treatments listed in recodified N.J.A.C. 13:30-1A.3; the inclusion of a specific treatment reflects the Board's determination that the dental hygienist may perform it solely under the direct supervision of a licensed dentist.
The Board also proposes to amend recodified N.J.A.C. 13:30-1A.3(a)36 to clarify that a licensed dental hygienist who has the additional training specified in recodified subsection (b) and who is monitoring a patient who was administered nitrous oxide/oxygen inhalation analgesia may, while monitoring the patient, perform other functions within the dental hygienist's scope of practice as delegated by the supervising dentist.
The Board is also proposing to amend recodified N.J.A.C. 13:30-1A.3(b)5 to state the procedures a licensed dental hygienist must follow when a patient is having an untoward reaction to the nitrous oxide/oxygen inhalation analgesia by adding that the dental hygienist turns off the flow of nitrous oxide and maintains the established oxygen level.
The subject matter of existing N.J.A.C. 13:30-1A.2(f), (g), and (i) are relocated to N.J.A.C. 13:30-1A.4(b), 1A.6(c) and (d), and (e), respectively.
Proposed new N.J.A.C. 13:30-1A.4 specifies the scope of practice for dental hygienists to practice under the general supervision of a licensed dentist, that is, when the licensed dentist is not physically present. Because the scope of practice for dental hygienists practicing under the general supervision of a licensed dentist is different depending on the setting, the Board proposes to separately describe the scope of practice under general supervision for a dental office or dental clinic, an institution, and a school setting. The Board believes that the scope of practice for dental hygienists under the general supervision of a licensed dentist in a dental clinic should be the same as that of a dental office because the practice setting of both is similar with respect to equipment and personnel.
Proposed new N.J.A.C. 13:30-1A.4(a) specifies the scope of practice for dental hygienists practicing under the general supervision of a licensed dentist in a dental office or dental clinic. As discussed above, the itemized list of functions follows the order of functions set forth in N.J.A.C. 13:30-1A.3. Functions 1 through 20 are those that may be performed either under the direct or general supervision of a licensed dentist, and functions 21 through 24 have been modified for a licensed dental hygienist to perform them under general supervision in a dental office or dental clinic. Proposed N.J.A.C. 13:30-1A.3(a)21 allows licensed dental hygienists practicing under general supervision in a dental office or dental clinic to etch teeth in preparation for sealants and desensitizing agents; etching teeth for bonding may be performed solely under direct supervision. Proposed N.J.A.C. 13:30-1A.3(a)22 allows licensed dental hygienists to use a curing light for the application of sealants. Because dental hygienists practicing under the general supervision of a licensed dentist are now permitted to apply sealants, the Board believes dental hygienists should also be able, under general supervision in any setting, to use a curing light for the application of sealants. The Board notes that sealants can be applied only with a curing light and that the use of a curing light does not involve an irreversible procedure or pose a risk of harm to patients. Proposed N.J.A.C. 13:30-1A.4(a)23 allows the dental hygienist practicing under general supervision in a dental office or dental clinic to isolate the operative field for the placement of sealants, including the placement and removal of rubber dams. Proposed N.J.A.C. 13:30-1A.4(a)24 allows the dental hygienist practicing under supervision in a dental office or dental clinic to take alginate impressions for diagnostic casts, bleaching trays, and athletic mouth guards. In determining the functions that a licensed dental hygienist may perform in a dental office or dental clinic without the supervising dentist being physically present, the Board considered the health and safety of the patient, the risk of permanent alteration of the patient's dentition, and whether the activity occurs in contemplation of operative dentistry to be performed by the supervising dentist.
Notwithstanding N.J.A.C. 13:30-1A.4(a), proposed new N.J.A.C. 13:30-1A.4(d) provides that a supervising dentist may require the direct supervision of the dental hygienist in his or her dental office in his or her sole discretion.
As proposed, recodified N.J.A.C. 13:30-1A.4(b) sets forth the dental hygienist's scope of practice under the general supervision of a New Jersey licensed dentist in an institution. Consistent with the proposed amendment to recodified N.J.A.C. 13:30-1A.3(a)5, the Board is proposing to amend recodified N.J.A.C. 13:30-1A.4(b)4 to better describe the activity performed by a dental hygienist. As discussed above, the Board also proposes to specify that dental hygienists practicing under general supervision in an institution may use a curing light for the application of sealants. In addition, the Board also proposes to allow dental hygienists practicing under general supervision in an institution to etch teeth in preparation for sealants and desensitizing agents, isolate the operative field for the placement of sealants, including the placement and removal of rubber dams, and apply topical anesthetic agents.
Proposed new N.J.A.C. 13:30-1A.4(c) describes the scope of practice and requirements, including notification provisions, for dental hygienists to practice in a school setting under the general supervision of a licensed dentist. In a school setting, dental hygienists practicing under general supervision may administer only to students of the school and only preventive measures. The notification provisions reflect the Board's concern about the dental health and well-being of the children in the State and belief that it is important to encourage parents to have their children examined by a licensed dentist. Proposed new N.J.A.C. 13:30-1A.4(c) also includes additional requirements for the application of sealants in a school setting under general supervision. The supervising dentist must provide the dental hygienist with assessment guidelines for determining whether to apply sealants and the dental hygienist is required to conform to these guidelines. In addition, the Board proposes requiring the supervising dentist to maintain for at least seven years a copy of the parental/guardian consent and the written record of treatment by the dental hygienist.
In addition, proposed N.J.A.C. 13:30-1A.4(c) requires the supervising licensed dentist to review, within 30 days, the written record of treatment by the licensed dental hygienist in a school setting to ensure compliance with the dentist's assessment guidelines, treatment protocol standards, and the notification provisions set forth in the rule. If, upon review, the supervising dentist determines that the proper notification was not sent to the parent or guardian, the supervising dentist shall ensure that it is sent.
Proposed new N.J.A.C. 13:30-1A.4(e) sets forth additional requirements for the dental hygienist to be permitted to practice under general supervision. In accordance with P.L. 2012, c. 29, dental hygienists may treat only existing patients of record of the dental office, dental clinic, or institution. Proposed new N.J.A.C. 13:30-1A.4(e) defines patient of record as a dental patient examined by a licensed dentist of the dental office, dental clinic, or institution within the preceding 365 days. It also sets forth the standards and timeframes for the dental hygienist to notify the supervising dentist of a patient's dental or medical condition. In addition, in accordance with P.L. 2012, c. 29, the proposed new rule requires dental hygienists working under general supervision to hold a current certification in Basic or Advanced Cardiac Life Support by the American Heart Association, the American Red Cross, or an equivalent organization approved by the Board. The rule also provides that, in the dental office setting, the patient must be notified, as soon as it is known, that the dentist will not be present and the patient must be given the option to reschedule when the dentist is present. The Board anticipates that such notice will be provided in advance of the scheduled appointment to minimize any inconvenience to the patient.
Proposed new N.J.A.C. 13:30-1A.6 sets forth the scope of practice provisions that apply whether the dental hygienist is practicing under the direct or general supervision of a licensed dentist. Proposed new N.J.A.C. 13:30-1A.6(a) provides that a dental hygienist may practice only in a dental office, dental clinic, or institution having readily available emergency equipment as specified in proposed new N.J.A.C. 13:30-8.26, and only as long as a second employee who is trained to implement the emergency protocol is present when patient care is performed. As long as [page=3099] the second employee is trained to implement the emergency protocol, the Board does not believe that the second employee must be a licensed dentist or dental auxiliary. The Board notes that in a school setting, the dental hygienist must be aware of and follow the emergency protocol established by the school.
Proposed new N.J.A.C. 13:30-1A.6(b) prohibits a dental hygienist from establishing or engaging in independent practice, regardless of whether he or she is under the direct or general supervision of a licensed dentist.
In accordance with P.L. 2012, c. 29, the Board proposes, as discussed above, to relocate requirements from N.J.A.C. 13:30-1A.2(f) to N.J.A.C. 13:30-1A.6(c) to make clear that a licensed dentist may supervise a total of three licensed dental hygienists at one time in any setting.
The Board proposes amending the definitions at N.J.A.C. 13:30-2.1 to include the term "Commission on Dental Accreditation (CODA)." The Board also proposes to remove the terms "institution" and "supervision" because these terms are not referenced in Subchapter 2; dental assistants may practice only under the direct supervision of a supervising dentist and the scope of practice is the same for each setting.
In accordance with P.L. 2012, c. 29, proposed new N.J.A.C. 13:30-8.25 describes certain activities that may not be conducted by anyone other than a licensed dentist, with limited statutory exceptions.
Proposed new N.J.A.C. 13:30-8.26 establishes the emergency protocol including staff training requirements for each dental office, facility, dental clinic, or institution at which there is patient contact.
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 and new rules will have a positive impact upon dental hygienists and the patients they serve. The proposed amendments and new rules, which implement P.L. 2012, c. 29, set forth clear requirements for dental hygienists as to their scope of practice for particular settings and the conditions under which they may provide oral hygiene care. In addition, the proposed amendments and new rules detail the activities in each of the settings that dental hygienists may provide under direct and general supervision. The public will also benefit from the proposed amendments and new rules because they require that licensed dental hygienists provide oral hygiene care in an appropriate, supervised dental setting having a written protocol for managing medical or dental emergencies that staff is trained to implement. The proposed amendments also assure that supervising dentists are made aware of patients who require further care. Additionally, the public will benefit from the proposed amendments requiring licensed dental hygienists working under the general supervision of a licensed dentist to be currently certified in Basic or Advanced Cardiac Life Support by the American Heart Association, the American Red Cross, or an equivalent organization approved by the Board, because dental hygienists will be properly prepared to provide assistance in medical emergencies. Certification and requiring dental hygienists to practice dental hygiene only in facilities which have readily available emergency equipment are mandated under P.L. 2012, c. 29.
Economic Impact
The Board anticipates that the proposed amendment requiring that dental hygienists, as a condition of working under general supervision, be currently certified in Basic or Advanced Cardiac Life Support by the American Heart Association, the American Red Cross, or an equivalent organization approved by the Board, will have an economic impact on dental hygienists. They will likely have to pay tuition to complete a cardiac life support course in order to obtain certification or recertification. The Board, however, believes that any such costs are outweighed by the benefit to the public in protecting the public's health, safety, and welfare by ensuring that dental hygienists who are practicing under the general supervision of a licensed dentist are qualified to provide life-saving services in medical emergencies. In addition, certification is mandated by P.L. 2012, c. 29.
Also, the Board believes that the proposed new emergency protocol rule may have an economic impact. The Board believes that most dental facilities already have equipment to maintain adult and pediatric airways and an ambu bag (bag-valve-mask resuscitator) and, therefore, the proposed rule will not have a significant economic impact on dental facilities and dentists in the State. However, to the extent that the proposed new rules will have an economic impact on dental facilities and dentists who do not have the required equipment, the Board believes that any such impact is outweighed by the protection that the proposed new rule will provide to the patients of these dental facilities. In addition, P.L. 2012, c. 29 mandates that a dental hygienist practice dental hygiene only in a facility having readily available emergency equipment as designated by the Board.
Federal Standards Statement
A Federal standards analysis is not required because the proposed amendments to N.J.A.C. 13:30-1A.4(c) does not exceed, but rather references the requirements of the Occupational Safety and Health Administration (OSHA) and Centers for Disease Control and Prevention (CDC) as specified in N.J.A.C. 13:30-8.5.
Jobs Impact
The Board does not believe that the proposed amendments and new rules will result in the creation or loss of jobs in the State.
Agriculture Industry Impact
The proposed amendments and new rules will have no impact on the agriculture industry in the State because the proposed amendments and new rules concern the practice of dentistry and dental hygiene.
Regulatory Flexibility Analysis
Currently, the Board licenses approximately 8,800 dentists and 5,600 dental hygienists and registers approximately 3,200 dental assistants. Dental hygienists and dental assistants cannot be considered "small businesses" because they may not engage in independent practice. If dentists licensed by the Board are considered "small businesses" within the meaning of the Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq., then the following analysis applies.
The proposed amendments and new rules do not impose any new reporting requirements on licensees. However, the proposed amendments and new rules do impose recordkeeping and compliance requirements on licensees. These requirements are discussed in the Summary above.
No professional services will be needed to comply with the proposed amendments and new rules. The costs of compliance with the proposed amendments are discussed in the Economic Impact statement above. The Board believes that the proposed amendments and new rules should be uniformly applied to all licensees in order to ensure the health, safety, and welfare of the general public in the provision of dental and dental hygiene services. Therefore, no differing compliance requirements for licensees are provided based upon the size of the business.
Housing Affordability Impact Analysis
The proposed amendments and new rules will have an insignificant impact on the affordability of housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the proposed amendments and new rules concern the practice of dentistry and dental hygiene.
Smart Growth Development Impact Analysis
The proposed amendments and new rules will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2, or within designated centers, under the State Development and Redevelopment Plan in New Jersey because the proposed amendments and new rules concern the practice of dentistry and dental hygiene.
Full text of the proposal follows (additions indicated in boldface thus; deletions indicated in brackets [thus]):
SUBCHAPTER 1. LICENSURE TO PRACTICE DENTISTRY
13:30-1.1 Purpose and scope
(a) (No change.)
(b) The provisions of this chapter shall apply to all licensed dentists, licensed [registered] dental hygienists, registered dental assistants, limited registered dental assistants, and holders of dental clinic permits, and all applicants seeking licensure to engage in the practice of dentistry, dental [page=3100] hygiene, and dental assisting, and applicants seeking permits to operate dental clinics.
(c) (No change.)
SUBCHAPTER 1A. DENTAL HYGIENISTS
13:30-1A.1 Definitions
For purposes of this subchapter, the following words and terms shall have the following meanings, unless the context clearly indicates otherwise:
"Commission on Dental Accreditation" means the Commission on Dental Accreditation of the American Dental Association (CODA).
"Dental clinic" as defined in N.J.S.A. 45:6-15.1 means and includes any clinic, infirmary, hospital, institution, or other place of any kind whatsoever in which science of dentistry in any of its branches is practiced, demonstrated, or taught, upon or with respect to human beings, but shall not include the private office of a regularly licensed dentist of this State. A dental clinic located inside a school setting is also considered a dental clinic.
"Direct supervision" means that a licensed dentist is physically present in the office or facility at all times during the performance of any act and that such acts are performed pursuant to the licensed dentist's order, control, and full professional responsibility.
"General supervision" means that a licensed dentist shall provide a written order or protocol and shall maintain control and full professional responsibility for the performance of any act, whether or not the licensed dentist is physically present at the setting.
"Institution" means any nursing home, veterans' home, hospital, or prison, or any State or county facility providing inpatient care, supervision, and treatment for persons with developmental disabilities.
"School setting" means any public or private school, with any grade(s) pre-kindergarten (pre-k) through 12, in the State. School setting shall not include a dental clinic located inside a school setting.
13:30-[1A.1]1A.2 Application for licensure as [registered] dental hygienist
(a)-(b) (No change.)
(c) As part of its review of applicants for licensure as [registered] dental hygienists, the Board shall consider and evaluate any prior record of disciplinary action or pending disciplinary action against the applicant or investigation of the applicant in any other state or jurisdiction and the applicant's complete professional employment history.
(d)-(f) (No change.)
13:30-[1A.2]1A.3 Scope of practice of licensed dental hygienist under direct supervision
[(a) For purposes of this subchapter, the following words and terms shall have the following meanings, unless the context clearly indicates otherwise:
"Direct supervision" means that a licensed dentist is physically present in the office at all times during the performance of any act and that such acts are performed pursuant to the licensed dentist's order, control and full professional responsibility.
"Institution" means any nursing home, veterans' home, hospital or prison, or any State or county facility providing inpatient care, supervision and treatment for the mentally disabled.
"Supervision" means that a licensed dentist shall provide a written order and shall maintain control and full professional responsibility for the performance of any act, whether or not the licensed dentist is physically present.]
[(b)] (a) A licensed dental hygienist practicing under the direct supervision of a licensed dentist may:
1.-2. (No change.)
[3. Etch teeth in preparation for bonding, sealants and desensitizing agents;]
[4.] 3. (No change in text.)
[5. Place caries detecting agents;
6. Use instruments for caries detection. Such instruments shall not include lasers that are capable of altering, cutting, burning or damaging hard or soft tissue;]
[7.] 4. (No change in text.)
[8.] 5. [Examine] Assess soft and hard tissue of the head, neck and oral cavity and note deformities, defects, and abnormalities therein;
[9.] 6. (No change in text.)
[10. Isolate the operative field, including the placement and removal of rubber dams;
11. Place and remove matrices and wedges;
12. Place temporary restorations;
13. Perform hand removal of soft temporary restorations;]
Recodify existing 14.-15. as 7.-8. (No change in text.)
[16. Fabricate and cement temporary crowns and bridges after preparation of tooth (teeth) by a dentist. This shall not include intra-oral occlusal adjustment;
17. Perform hand removal of crowns and bridges that have been temporarily cemented;
18. Take alginate impressions;
19. Place amalgam, composite or gold foil in a tooth for condensation by the dentist;
20. Place and remove retraction cords and medicated pellets. This shall not include electrosurgery or the use of lasers for tissue retraction;
21. Perform bite registration procedures;]
Recodify existing 22.-23. as 9.-10. (No change in text.)
[24. Place and remove arch wires and ligature wires;]
Recodify 25.-30. as 11.-16. (No change in text.)
[31. Hold 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 electrosurgery for tissue extraction.]
Recodify existing 32.-33. as 17.-18. (No change in text.)
[34. Demonstrate home-use bleaching systems and apply bleaching agents;]
[35.] 19. (No change in text.)
20. Assess whether there is carious activity by the use of detecting agents and carious detection instruments. Such instruments shall not include lasers that are capable of altering, cutting, burning, or damaging hard or soft tissue;
21. Etch teeth in preparation for bonding, sealants, and desensitizing agents;
22. 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 electrosurgery for tissue retraction;
23. Isolate the operative field, including the placement and removal of rubber dams;
24. Take alginate impressions;
25. Place and remove matrices and wedges;
26. Place temporary restorations;
27. Perform hand removal of soft temporary restorations;
28. Fabricate and cement temporary crowns and bridges after preparation of tooth (teeth) by a dentist. This shall not include intra-oral occlusal adjustment;
29. Perform hand removal of crowns and bridges that have been temporarily cemented;
30. Place amalgam, composite or gold foil in a tooth for condensation by the dentist;
31. Place and remove retraction cords and medicated pellets. This shall not include electrosurgery or the use of lasers for tissue retraction;
32. Perform bite registration procedures;
33. Place and remove arch wires and ligature wires;
34. Demonstrate home-use bleaching systems and apply bleaching agents;
35. Use an in-office light activated bleaching system;
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[; and].
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
[page=3101] 37. Administer local anesthesia provided he or she satisfies the requirements set forth in N.J.A.C. 13:30-[1A.3]1A.5.
[(c)] (b) In addition to the activities set forth in [(b)] (a) above, a licensed dental hygienist 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 that:
1. The licensed dental hygienist has successfully completed a Board-approved course offered in a Commission on Dental Accreditation [of the American Dental Association (CODA)] accredited college or university or in a hospital licensed by the Department of Health [and Senior Services], which emphasizes the administration of nitrous oxide [simultaneous] simultaneously with the administration of oxygen and safe and effective patient monitoring;
i.-iii. (No change.)
2.-4. (No change.)
5. Upon any untoward reaction of the patient, the licensed dental hygienist immediately turns off the flow of nitrous [oxide/oxygen inhalation analgesia] oxide, maintains the established oxygen level, and immediately summons the dentist.
[(d)] (c) The monitoring of nitrous oxide/oxygen inhalation analgesia by a [registered] licensed dental hygienist without first having met the minimum standards of training and procedures [as contained in this section] pursuant to (b) above, shall constitute a deviation from normal standards of practice required of a licensee.
[(e) A licensed dental hygienist practicing under the supervision of a New Jersey licensed dentist in an institution may:
1. Perform a complete prophylaxis including the removal of all hard and soft deposits from all surfaces of human natural and restored teeth to the epithelial attachments and the polishing of natural and restored teeth;
2. Perform root planning;
3. 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.
4. Examine soft and hard tissue of the head, neck and oral cavity and note deformities, defects and abnormalities therein;
5. Make radiographic exposures as permitted by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq.;
6. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health;
7. Take and record vital signs; and
8. Take dental photographs including the use of intra-oral cameras.
(f) Each licensed dentist may supervise no more than three licensed dental hygienists at one time in a dental office. In an institutional setting, a licensed dentist shall review all chart entries within 30 days of treatment of the patient by a licensed dental hygienist.]
[(g)] (d) A licensed dental hygienist who engages in the activities outlined in (a) and (b) [and (c)] above without direct supervision, except as provided in [(e) above] N.J.A.C. 13:30-1A.4, shall be deemed to be engaging in the unauthorized practice of dental hygiene and shall be subject to the penalties set forth in N.J.S.A. 45:6-58 and 45:1-25.
[(h)] (e) A licensed dentist who permits a licensed dental hygienist to engage in the activities outlined in (a) and (b) [and (c)] above without direct supervision, except as provided in [(e) above] N.J.A.C. 13:30-1A.4, shall be subject to the penalties set forth in N.J.S.A. 45:1-21 and 45:1-25.
[(i) A licensed dental hygienist may provide a written work authorization for emergency repair of a dental prosthesis provided that the prosthesis shall not require any intra-oral procedure and shall be thereafter inserted by a licensed dentist.]
13:30-1A.4 [(Reserved)] 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. Perform a complete prophylaxis including the removal of all hard and soft deposits from all surfaces of human natural and restored teeth to the epithelial attachments and the polishing of natural and restored teeth;
2. Perform root planing;
3. 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;
4. Place intrasulcular therapeutic medications approved by the Food and Drug Administration, as directed by a dentist;
5. Assess soft and hard tissue of the head, neck, and oral cavity and note deformities, defects, and abnormalities therein;
6. Fabricate mouth guard appliances;
7. Remove excess cement from crowns or other restorations and orthodontic appliances;
8. Remove sutures;
9. Place and remove periodontal dressings and other surgical dressings;
10. Trial size (pre-select) orthodontic bands, wires, stainless steel crowns, and temporary crowns intra-orally or on diagnostic models;
11. Make radiographic exposures as permitted by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq.;
12. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health;
13. Apply topical anesthetic agents;
14. Take and record vital signs;
15. Retract patient's cheek, tongue, or other tissue parts during a dental procedure;
16. 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;
17. Take dental photographs including the use of intraoral cameras;
18. Select shades of prosthetic appliances;
19. Apply hot or cold packs pursuant to the direction of a licensed dentist;
20. Assess whether there is carious activity by the use of detecting agents and carious detection instruments. Such instruments shall not include lasers that are capable of altering, cutting, burning, or damaging hard or soft tissue;
21. Etch teeth in preparation for sealants and desensitizing agents;
22. Use a curing light for the application of sealants;
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.
(b) Institution. A licensed dental hygienist practicing under the general supervision of a New Jersey licensed dentist in an institution may:
1. Perform a complete prophylaxis including the removal of all hard and soft deposits from all surfaces of human natural and restored teeth to the epithelial attachments and the polishing of natural and restored teeth;
2. Perform root planing;
3. 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;
4. Assess soft and hard tissue of the head, neck, and oral cavity and note deformities, defects, and abnormalities therein;
5. Make radiographic exposures as permitted by the Department of Environmental Protection pursuant to N.J.S.A. 26:2D-24 et seq.;
6. Provide oral health education including dietary analysis and clinical instruction in order to promote dental health;
7. Take and record vital signs;
8. Take dental photographs including the use of intra-oral cameras;
9. Use a curing light for the application of sealants;
10. Etch teeth in preparation for sealants and desensitizing agents;
11. Isolate the operative field for the placement of sealants, including the placement and removal of rubber dams; and
12. Apply topical anesthetic agents.
[page=3102] (c) School setting. A licensed dental hygienist practicing under the general supervision of a licensed dentist in a school setting may:
1. Administer to that school's students, with written parental or guardian consent, preventive measures such as the application of fluorides, 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. The licensed dental hygienist complies with the Occupational Safety and Health Administration (OSHA) and Centers for Disease Control and Prevention (CDC) requirements of N.J.A.C. 13:30-8.5; and
ii. When applying sealants, the licensed dental hygienist conforms to the assessment guidelines set forth by the supervising dentist and adheres to acceptable treatment protocol standards, including maintaining a dry field.
2. The licensed dental hygienist must comply with the notification requirements of (e)3 below and provide written notice of the administered treatment to the supervising dentist, school, and parent/guardian.
i. The notification to the parent/guardian shall include a statement that the assessment performed by the licensed dental hygienist is not a comprehensive dental examination and a list of sources for dental referrals in the community.
ii. If, after performing an assessment, a licensed dental hygienist reasonably believes that a student has either dental caries or some other medical or dental condition requiring diagnosis, treatment, or medical referral by a licensed dentist, the notification to the parent/guardian shall also include a statement that the student should be seen by a licensed dentist for a definitive diagnosis and possible treatment or medical referral.
3. The supervising dentist shall maintain for at least seven years:
i. A copy of the parental/guardian consent; and
ii. The written record of treatment by the licensed dental hygienist.
4. The supervising dentist shall review, within 30 days of treatment by the licensed dental hygienist, the written record of treatment to ensure compliance with the assessment guidelines, treatment protocol standards, and notification requirements set forth in (c)1 and 2 above.
i. If, upon review, the supervising dentist determines that the proper notification was not sent to the parent/guardian, the supervising dentist shall ensure that it is sent to the parent/guardian.
(d) Notwithstanding the provisions of (a) above, a New Jersey licensed dentist, in his or her sole discretion, may require direct supervision in his or her dental office.
(e) A licensed dental hygienist may practice dental hygiene under general supervision provided that:
1. The licensed dental hygienist treats only existing patients of record, except for school settings, as provided in (c) above. For purposes of this subchapter, an existing patient of record is a dental patient examined by a licensed dentist of the dental office, dental clinic, or institution, within the immediately preceding 365-day period and who has a dental treatment plan that is prescribed by the dentist.
2. In dental offices, the patient is notified, as soon as it is known, that the dentist will not be present, and is given the option to reschedule to a time when the dentist will be present.
3. After performing an assessment, a licensed dental hygienist who reasonably believes that a person has either dental caries or some other medical or dental condition requiring diagnosis, treatment, or medical referral by a dentist shall so inform the supervising dentist in writing, within seven days. If it appears that emergent care is indicated, the licensed dental hygienist shall immediately, but no later than 24 hours, notify the supervising dentist.
4. The licensed dental hygienist holds a current certification in Basic or Advanced Cardiac Life Support by the American Heart Association, the American Red Cross, or an equivalent organization approved by the Board.
13:30-[1A.3]1A.5 (No change in text.)
13:30-1A.6 Scope of practice of licensed dental hygienists; general provisions
(a) A licensed dental hygienist may practice dental hygiene in a dental office, dental clinic, or institution under the general supervision or direct supervision of a licensed dentist provided that:
1. The facility has readily available emergency equipment as specified in N.J.A.C. 13:30-8.26; and
2. A second employee, who is also trained to implement the emergency protocol as required in N.J.A.C. 13:30-8.26, is present in the treatment facility at all times when patient care is rendered.
(b) A licensed dental hygienist may not establish an independent office or engage in independent practice in connection with the performance of traditional hygienist services under either the general supervision or direct supervision of a licensed dentist.
(c) Each licensed dentist may supervise, whether they are under general supervision or direct supervision, no more than a total of three licensed dental hygienists at one time in any setting.
(d) For patient care rendered by a licensed dental hygienist practicing under general supervision in an institution, a licensed dentist shall review all chart entries within 30 days of treatment of the patient by a licensed dental hygienist.
(e) A licensed dental hygienist may provide a written work authorization for emergency repair of a dental prosthesis provided that the prosthesis shall not require any intra-oral procedure and shall be thereafter inserted by a licensed dentist.
SUBCHAPTER 2. DENTAL ASSISTANTS
13:30-2.1 Definitions
For purposes of this subchapter, the following words and terms, shall have the following meanings, unless the context clearly indicates otherwise:
"Commission on Dental Accreditation" means the Commission on Dental Accreditation of the American Dental Association (CODA).
. . .
["Institution" means any nursing home, veterans home, hospital or prison, or any State or county facility providing inpatient care, supervision and treatment for the mentally disabled.
"Supervision" means that a licensed dentist shall provide a written order and shall maintain control and full professional responsibility for the performance of any act, whether or not the licensed dentist is physically present.]
SUBCHAPTER 4. INDUSTRIAL OR CORPORATE CLINICS
13:30-4.10 Inspection; requirements of director
(a)-(e) (No change.)
(f) Dental hygienists employed by the dental clinic shall provide only those services permitted pursuant to N.J.A.C. 13:30-[1A.2]1A.3 and 1A.4.
(g) (No change.)
SUBCHAPTER 8. GENERAL PROVISIONS
13:30-8.17 Delegation of physical modalities
(a) A dentist may delegate the administration of certain physical modalities to licensed dental hygienists, registered dental assistants, limited registered dental assistants, and unregistered dental assistants consistent with their particular scopes of practice as set forth in N.J.A.C. 13:30-[1A.2]1A.3, 1A.4, 2.4, 2.5, and 2.6 and as set forth in this section.
(b) (No change.)
(c) A dentist may delegate the administration of the physical modalities set forth in (b) above to licensed dental hygienists, registered dental assistants, and limited registered dental assistants consistent with their particular scopes of practice as set forth in N.J.A.C. 13:30-[1A.2]1A.3, 1A.4, 2.4, and 2.5, provided all of the following conditions are satisfied:
1.-4. (No change.)
(d)-(e) (No change.)
[page=3103] 13:30-8.20 Nitrous oxide/oxygen inhalation analgesia; duties of a licensed dentist, delegation to licensed dental hygienist and registered dental assistant
(a)-(b) (No change.)
(c) A supervising dentist may delegate the monitoring of the nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist during the performance of dental hygiene procedures provided that the patient is stabilized and that the licensed dental hygienist satisfies the requirements set forth in N.J.A.C. 13:30-[1A.2]1A.3.
(d) (No change.)
(e) If a supervising dentist delegates the monitoring of the nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist pursuant to N.J.A.C. 13:30-[1A.2]1A.3, or to a registered dental assistant pursuant to N.J.A.C. 13:30-2.4, the supervising dentist shall ensure that:
1.-2. (No change.)
(f)-(h) (No change.)
(i) The delegation of the monitoring of nitrous oxide/oxygen inhalation analgesia to a licensed dental hygienist pursuant to N.J.A.C. 13:30-[1A.2]1A.3 or registered dental assistant pursuant to N.J.A.C. 13:30-2.4 who has not yet met the minimum standards of training and procedures as stated therein shall constitute a deviation from normal standards of practice required of a licensee.
13:30-8.25 Prohibited acts
(a) Except as otherwise provided in N.J.S.A. 45:6-16.1 et seq., 45:6-19, and 45:6-20, no person other than a person duly licensed to practice dentistry in this State shall:
1. Make any diagnosis or develop any treatment plan with respect to the dental condition or treatment of any living person in this State;
2. Perform any surgical or irreversible procedure, including but not limited to, the cutting of hard or soft tissue or the extraction of any tooth on any living person in this State;
3. Either bill or submit a claim for any service rendered involving the practice of dentistry or dental hygiene in this State; or
4. Receive payment for the performance of dental or dental hygienist services from any source other than an employer authorized by law to practice dentistry in this State or any dental clinic, institution, or employment agency, as defined pursuant to N.J.S.A. 34:8-43, that employs licensed dental hygienists to provide temporary dental hygiene services.
13:30-8.26 Emergency protocol
(a) Each dental office, facility, dental clinic, or institution at which there is patient contact, at a minimum, shall:
1. Have a written protocol for managing medical or dental emergencies;
2. Have equipment to maintain adult and pediatric airways;
3. Have an ambu bag (bag-valve-mask resuscitator); and
4. Ensure that all staff are trained upon hire, and at least annually thereafter, to implement the emergency protocol. |
