Bill Text: CA AB1174 | 2013-2014 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Dental professionals.
Spectrum: Bipartisan Bill
Status: (Passed) 2014-09-27 - Chaptered by Secretary of State - Chapter 662, Statutes of 2014. [AB1174 Detail]
Download: California-2013-AB1174-Amended.html
Bill Title: Dental professionals.
Spectrum: Bipartisan Bill
Status: (Passed) 2014-09-27 - Chaptered by Secretary of State - Chapter 662, Statutes of 2014. [AB1174 Detail]
Download: California-2013-AB1174-Amended.html
BILL NUMBER: AB 1174 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 21, 2014
AMENDED IN ASSEMBLY JANUARY 6, 2014
AMENDED IN ASSEMBLY APRIL 9, 2013
AMENDED IN ASSEMBLY MARCH 21, 2013
INTRODUCED BY Assembly Members Bocanegra and Logue
FEBRUARY 22, 2013
An act to amend Sections 1752.4, 1910,
1684.5 and 1926 of, to amend, repeal, and add Section
1753.6 of, and to add, repeal, and add Sections 1753.55,
1910.5, and 1926.05 of, the Business and Professions Code, and
to add and repeal Section 128196 of the Health and Safety Code,
and to amend Section 14132.725 of the Welfare and Institutions
Code, relating to oral health.
LEGISLATIVE COUNSEL'S DIGEST
AB 1174, as amended, Bocanegra. Dental professionals:
teledentistry under Medi-Cal. professionals.
(1) Existing Under existing law, the
Dental Practice Act, establishes the Dental Board
of California licenses and regulates dentists . Existing
law creates, within the jurisdiction of the board, a Dental Assisting
Council that is responsible for the regulation of dental assistants,
registered dental assistants, and registered dental assistants in
extended functions and a Dental Hygiene Committee of California, that
is responsible for the regulation of registered dental hygienists,
registered dental hygienists in alternative practice, and registered
dental hygienists in extended functions. Existing law governs the
scope of practice for those professionals , and authorizes a
dentist to require or permit one of those professionals, referred to
as a dental auxiliary, to perform specified duties, including
exposing emergency radiographs upon the direction of the dentist,
prior to the dentist examining the patient .
This bill would authorize a registered dental assistant
who has completed a specified educational program to determine which
radiographs to perform. The bill would authorize a add
to those specified duties determining and performing radiographs, as
specified, make a dentist responsible to provide a
patient or the patient's representative written notice including
specified contact information and disclosing that the care was
provided at the direction of that authorizing dentist, and would
prohibit a dentist from concurrently supervising more than 5 dental
auxiliaries, as specified. The bill would authorize specified
registered dental assistant assistants
in extended functions licensed on or after January 1, 2010,
a functions, registered dental
hygienist, hygienists, and a
registered dental hygienist hygienists
in alternative practice to choose determine
which radiographs to perform and to place
protective restorations, as specified. The bill would require
the board to promulgate related regulations, and would also require
the committee to review proposed regulations and submit any
recommended changes to the board for review to establish a consensus.
(2) Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which qualified low-income individuals receive health care services,
including certain dental services, as specified. Existing law
provides that, to the extent that federal financial participation is
available, face-to-face contact between a health care provider and a
patient is not required under the Medi-Cal program for
"teleophthalmology and teledermatology by store and forward," as
defined to mean the asynchronous transmission of medical information
to be reviewed at a later time by a licensed physician or
optometrist, as specified, at a distant site.
This bill would additionally provide that face-to-face contact
between a health care provider and a patient is not required under
the Medi-Cal program for teledentistry by store and forward, as
defined.
(3) Existing law authorizes the Office of Statewide Health
Planning and Development to approve Health Workforce Pilot Projects
(HWPP), as defined. The office has approved operation HWPP 172,
relating to dental workforce, through December 15, 2014.
This bill would extend the operation of HWPP through January 1,
2016. The bill would also delete redundant provisions.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1752.4 of the Business and
Professions Code is amended to read:
1752.4. (a) A registered dental assistant may perform all of the
following duties:
(1) All duties that a dental assistant is allowed to perform.
(2) Mouth-mirror inspections of the oral cavity, to include
charting of obvious lesions, existing restorations, and missing
teeth.
(3) Apply and activate bleaching agents using a nonlaser
light-curing device.
(4) Use of automated caries detection devices and materials to
gather information for diagnosis by the dentist.
(5) Obtain intraoral images for computer-aided design (CAD),
milled restorations.
(6) Pulp vitality testing and recording of findings.
(7) Place bases, liners, and bonding agents.
(8) Chemically prepare teeth for bonding.
(9) Place, adjust, and finish direct provisional restorations.
(10) Fabricate, adjust, cement, and remove indirect provisional
restorations, including stainless steel crowns when used as a
provisional restoration.
(11) Place postextraction dressings after inspection of the
surgical site by the supervising licensed dentist.
(12) Place periodontal dressings.
(13) Dry endodontically treated canals using absorbent paper
points.
(14) Adjust dentures extra-orally.
(15) Remove excess cement from surfaces of teeth with a hand
instrument.
(16) Polish coronal surfaces of the teeth.
(17) Place ligature ties and archwires.
(18) Remove orthodontic bands.
(19) All duties that the board may prescribe by regulation.
(b) A registered dental assistant may only perform the following
additional duties if he or she has completed a board-approved
registered dental assistant educational program in those duties, or
if he or she has provided evidence, satisfactory to the board, of
having completed a board-approved course in those duties:
(1) Remove excess cement with an ultrasonic scaler from
supragingival surfaces of teeth undergoing orthodontic treatment.
(2) The allowable duties of an orthodontic assistant permitholder
as specified in Section 1750.3. A registered dental assistant shall
not be required to complete further instruction in the duties of
placing ligature ties and archwires, removing orthodontic bands, and
removing excess cement from tooth surfaces with a hand instrument.
(3) The allowable duties of a dental sedation assistant
permitholder as specified in Section 1750.5.
(4) The application of pit and fissure sealants.
(5) Determine which radiographs to perform.
(c) Except as provided in Section 1777, the supervising licensed
dentist shall be responsible for determining whether each authorized
procedure performed by a registered dental assistant should be
performed under general or direct supervision.
SECTION 1. Section 1684.5 of the
Business and Professions Code is amended to read:
1684.5. (a) In addition to other acts constituting unprofessional
conduct under this chapter, it is unprofessional conduct for any
dentist to perform or allow to be performed any treatment on a
patient who is not a patient of record of that dentist. A dentist
may, however, after conducting a preliminary oral examination,
require or permit any dental auxiliary to perform procedures
necessary for diagnostic purposes, provided that the procedures are
permitted under the auxiliary's authorized scope of practice.
Additionally, a dentist may require or permit a dental auxiliary to
perform all of the following duties prior to any examination of the
patient by the dentist, provided that the duties are authorized for
the particular classification of dental auxiliary pursuant to Article
7 (commencing with Section 1740):
(1) Expose Determine and perform
emergency radiographs upon direction of the dentist.
(2) Determine and perform radiographs for the specific purpose of
aiding a dentist in completing a comprehensive diagnosis and
treatment plan for a patient pursuant to Sections 1753.55, 1910.5,
and 1926.05.
(2)
(3) Perform extra-oral duties or functions specified by
the dentist.
(3)
(4) Perform mouth-mirror inspections of the oral
cavity, to include charting of obvious lesions, malocclusions,
existing restorations, and missing teeth.
(b) For purposes of this section, "patient of record" refers to a
patient who has been examined, has had a medical and dental history
completed and evaluated, and has had oral conditions diagnosed and a
written plan developed by the licensed dentist.
(c) For purposes of this section, if dental treatment is provided
to a patient by a dental auxiliary pursuant to the diagnosis and
treatment plan authorized by a supervising dentist, the supervising
dentist shall ensure that the patient or the patient's representative
is notified in writing of the supervising dentist's name, practice
location address, telephone number, and email address, and that the
care was provided at the direction of the dentist.
(d) A dentist shall not concurrently supervise more than five
dental auxiliaries providing services pursuant to Sections 1753.55,
1910.5, and 1926.05.
(c)
(e) This section shall not apply to dentists providing
examinations on a temporary basis outside of a dental office in
settings including, but not limited to, health fairs and school
screenings.
(d)
(f) This section shall not apply to fluoride mouth
rinse or supplement programs administered in a school or preschool
setting.
SEC. 2. Section 1753.55 is added to the Business and Professions
Code, to read:
1753.55. (a) For the purposes of this section, the following
definitions shall apply:
(1) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
(2) "Course" means a board-approved course preparing a registered
dental assistant in extended functions to perform the duties
described in subdivision (b).
(3) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
through electronic media, home study materials, or live lecture
methodology if the provider has submitted that content to the board
for approval.
(4) "Interim therapeutic restoration" means a direct provisional
restoration placed to stabilize the tooth until a licensed dentist
diagnoses the need for further definitive treatment.
(5) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods.
(6) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(7) "Program" means a board-approved registered dental assistant
in extended functions educational program.
(b)
1753.55. (a) In addition to the duties
specified in Section Sections 1753.5
and 1753.6 , a registered dental assistant in extended
functions licensed on or after January 1, 2010, or having
completed the educational requirements to perform the
duties authorized by Section 1753.5, is authorized to perform
both of the following additional duties pursuant to the order,
control, and full professional responsibility of a supervising
dentist:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(1) Determine which radiographs to perform on a patient who has
not received an initial examination by the supervising dentist for
the specific purpose of the dentist making a diagnosis and treatment
plan for the patient. In these circumstances, the dental assistant in
extended functions shall follow protocols established by the
supervising dentist. This paragraph only applies in the following
settings:
(A) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(B) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as
and defined by paragraph (4) of subdivision (a),
that compromise as a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment. An interim therapeutic
restoration consists of the removal of soft material from the
tooth using only hand instrumentation, without the use of rotary
instrumentation, and subsequent placement of an adhesive restorative
material. Local anesthesia shall not be necessary for interim
therapeutic restoration placement . The protective
restorations Interim therapeutic restorations
shall be placed only in accordance with both of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(ii) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c)
(b) The functions described in subdivision (b)
(a) may be performed by a registered dental
assistant in extended functions only after completion of a program
that includes training in performing those functions, or after
providing evidence, satisfactory to the board, of having completed a
board-approved course in those functions.
(1) No later than January 1, 2018, the board shall promulgate
regulations establishing requirements for courses of instruction for
the procedures authorized to be performed by a registered dental
assistant in extended functions pursuant to this section.
(2) Prior to January 1, 2018, the board shall use the
competency-based training protocols established by Health Workforce
Pilot Project (HWPP) No. 172 through the Office of Statewide Health
Planning and Development.
(1)
(3) A registered dental assistant in extended functions
who has completed the prescribed training in the Health Workforce
Pilot Project #172 No. 172 established
by the Office of Statewide Health Planning and Development pursuant
to Article 1 (commencing with Section 128125) of Chapter 3 of Part 3
of Division 107 of the Health and Safety Code shall be deemed to have
satisfied the requirement for completion of a course of instruction
approved by the board.
(2)
(4) In addition to the instructional components
described in subdivision (d) or (e), this
subdivision, a program shall contain both of the instructional
components described in this paragraph:
(A) The course shall be established at the postsecondary
educational level.
(B) All faculty responsible for clinical evaluation shall have
completed a one-hour methodology course in clinical evaluation or
have a faculty appointment at an accredited dental education program
prior to conducting evaluations of students.
(d) A program or course to perform the duties described in
paragraph (1) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency making decisions about which radiographs
to take to facilitate an evaluation by a dentist, but shall in no
event be less than six hours, including at least two hours of
didactic training, at least two hours of guided laboratory simulation
training, and at least two hours of examination using simulated
cases.
(2) Didactic instruction shall consist of instruction on both of
the following topics:
(A) Guidelines for radiographic decisionmaking prepared by the
American Dental Association and other professional dental
associations.
(B) Specific decisionmaking protocols that incorporate information
about the patient's health and radiographic history, the time span
since previous radiographs were taken, the availability of previous
radiographs, the general condition of the mouth including the extent
of dental restorations present, and visible signs of abnormalities,
including broken teeth, dark areas, and holes in teeth.
(3) Laboratory instruction shall consist of simulated
decisionmaking using case studies containing the elements described
in paragraph (2). There shall be at least one instructor for every 14
students who are simultaneously engaged in laboratory instruction.
(4) Examinations shall consist of decisionmaking where students
make decisions and demonstrate competency to faculty on case studies
containing the elements described in paragraph (2).
(e) A program or course to perform the duties described in
paragraph (2) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency in the application of protective
restorations, including interim therapeutic restorations, but shall
in no event be less than 16 clock hours, including at least four
hours of didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training.
(2) Didactic instruction shall consist of instruction on all of
the following topics:
(A) Pulpal anatomy.
(B) Theory of adhesive restorative materials used in the placement
of adhesive protective restorations related to mechanisms of bonding
to tooth structure, handling characteristics of the materials,
preparation of the tooth prior to material placement, and placement
techniques.
(C) Criteria that dentists use to make decisions about placement
of adhesive protective restorations including all of the following:
(i) Patient factors:
(I) The patient's American Society of Anesthesiologists Physical
Status Classification is Class III or less.
(II) The patient is cooperative enough to have the restoration
placed without the need for special protocols, including sedation or
physical support.
(III) The patient, or responsible party, has provided consent for
the procedure.
(IV) The patient reports that the tooth is asymptomatic, or if
there is mild sensitivity to sweet, hot, or cold that the sensation
stops within a few seconds of the stimulus being removed.
(ii) Tooth factors:
(I) The cavity is accessible without the need for creating access
using a dental handpiece.
(II) The margins of the cavity are accessible so that clean
noncarious margins can be obtained around the entire periphery of the
cavity with the use of hand instruments.
(III) The depth of the lesion is more than two millimeters from
the pulp on radiographic examination or is judged by the dentist to
be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic.
(IV) The tooth is restorable and does not have other significant
pathology.
(D) Criteria for evaluating successful completion of adhesive
protective restorations including all of the following:
(i) The restorative material is not in hyperocclusion.
(ii) There are no marginal voids.
(iii) There is minimal excess material.
(E) Protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations including
situations requiring immediate referral to a dentist.
(F) Protocols for followup of adhesive protective restorations.
(3) Laboratory instruction shall consist of placement of adhesive
protective restorations where students demonstrate competency in this
technique on typodont teeth.
(4) Clinical instruction shall consist of experiences where
students demonstrate placement of adhesive protective restorations
under direct supervision of faculty.
(f)
(c) This section shall remain in effect only until
January 1, 2018, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2018, deletes or
extends that date.
SEC. 3. Section 1753.55 is added to the Business and Professions
Code, to read:
1753.55. (a) For the purposes of this section, "interim
therapeutic restoration" means a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment.
(b)
1753.55. (a) In addition to the duties
specified in Section 1753.5, a registered dental assistant in
extended functions licensed on or after January 1, 2010, or
having completed the educational requireme nts to perform
the duties authorized by Section 1753.5, is authorized to
perform both of the following additional duties pursuant to the
order, control, and full professional responsibility of a supervising
dentist:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
(1) Determine which radiographs to perform on a patient who has
not received an initial examination by the supervising dentist for
the specific purpose of the dentist making a diagnosis and treatment
plan for the patient. In these circumstances, the dental assistant in
extended functions shall follow protocols established by the
supervising dentist. This paragraph only applies in the following
settings:
(A) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(B) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations through interim therapeutic
restorations that remove soft material from the tooth using only hand
instrumentation, without the use of rotary instrumentation, and
subsequent placement of an adhesive restorative material, without the
use of local anesthesia. The protective restorations shall only be
placed subject to both of the following:
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with both
of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the direct or general
supervision of a dentist as determined by the dentist.
(ii) In public health settings, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(b) The functions described in subdivision (a) may be performed by
a registered dental assistant in extended functions only after
completion of a program that includes training in performing those
functions, or after providing evidence, satisfactory to the board, of
having completed a board-approved course in those functions.
(c) The board shall promulgate regulations establishing criteria
for approval of courses of instruction for the procedures authorized
to be performed by a registered dental assistant in extended
functions pursuant to this section. The committee shall review
proposed regulations, and any subsequent proposed amendments to the
promulgated regulations, and shall submit any recommended changes to
the board for review to establish a consensus.
(c)
(d) This section shall become operative on January 1,
2018.
SEC. 4. Section 1753.6 of the Business and
Professions Code is amended to read:
1753.6. (a) Each person who holds a license as a registered
dental assistant in extended functions on the operative date of this
section may only perform those procedures that a registered dental
assistant is allowed to perform as specified in and limited by
Section 1752.4, and the procedures specified in paragraphs (1) to
(6), inclusive, until he or she provides evidence of having completed
a board-approved course in the additional procedures specified in
paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision
(b) of Section 1753.5, and an examination as specified in Section
1753.4:
(1) Cord retraction of gingiva for impression procedures.
(2) Take final impressions for permanent indirect restorations.
(3) Formulate indirect patterns for endodontic post and core
castings.
(4) Fit trial endodontic filling points.
(5) Apply pit and fissure sealants.
(6) Remove excess cement from subgingival tooth surfaces with a
hand instrument.
(b) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
SEC. 5. Section 1753.6 is added to the Business
and Professions Code, to read:
1753.6. (a) Each person who holds a license as a registered
dental assistant in extended functions on the operative date of this
section may only perform those procedures that a registered dental
assistant is allowed to perform as specified in and limited by
Section 1752.4, and the procedures specified in paragraphs (1) to
(6), inclusive, until he or she provides evidence of having completed
a board-approved course in the additional procedures specified in
paragraphs (1), (2), (5), and (7) to (11), inclusive, of subdivision
(b) of Section 1753.5, procedures specified in Section 1753.55, and
an examination as specified in Section 1753.4:
(1) Cord retraction of gingiva for impression procedures.
(2) Take final impressions for permanent indirect restorations.
(3) Formulate indirect patterns for endodontic post and core
castings.
(4) Fit trial endodontic filling points.
(5) Apply pit and fissure sealants.
(6) Remove excess cement from subgingival tooth surfaces with a
hand instrument.
(b) This section shall become operative on January 1, 2018.
SEC. 6. Section 1910 of the Business and
Professions Code is amended to read:
1910. A registered dental hygienist is authorized to perform the
following procedures under general supervision:
(a) Preventive and therapeutic interventions, including oral
prophylaxis, scaling, and root planing.
(b) Application of topical, therapeutic, and subgingival agents
used for the control of caries and periodontal disease.
(c) The taking of impressions for bleaching trays and application
and activation of agents with nonlaser, light-curing devices.
(d)
The taking of impressions for bleaching trays and placements of
in-office, tooth-whitening devices.
(e) After submitting to the committee evidence of satisfactory
completion of a course of instruction approved by the committee, the
following:
(1) Determine which radiographs to perform.
(2) Place interim therapeutic restorations, defined as the removal
of caries using hand instruments and placement of an adhesive
restorative material, upon the order of a licensed dentist.
SEC. 7. SEC. 4. Section 1910.5 is
added to the Business and Professions Code, to read:
1910.5. (a) For the purposes of this section, the following
definitions shall apply:
(1) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
(2) "Course" means a committee-approved course preparing
registered dental hygienist to perform the duties described in
subdivision (b).
(3) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
through electronic media, home study materials, or live lecture
methodology if the provider has submitted that content to the
committee for approval.
(4) "Interim therapeutic restoration" means a direct provisional
restoration placed to stabilize the tooth until a licensed dentist
diagnoses the need for further definitive treatment.
(5) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods.
(6) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(7) "Program" means a committee-approved registered dental
hygienist educational program.
(b) A registered dental hygienist may perform both of the
following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
1910.5. (a) In addition to the duties specified
in Section 1910, a registered dental hygienist is authorized to
perform the following additional duties, as specified:
(1) Determine which radiographs to perform on a patient who has
not received an initial examination by the supervising dentist for
the specific purpose of the dentist making a diagnosis and treatment
plan for the patient. In these circumstances, the dental hygienist
shall follow protocols established by the supervising dentist. This
paragraph shall only apply in the following settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
paragraph (4) of subdivision (a), that compromise the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary. The protective restorations shall be placed only in
accordance with both of the following:
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with both
of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c)
(b) The functions described in subdivision (b)
(a) may be performed by a registered dental
hygienist only after completion of a program that includes training
in performing those functions, or after providing evidence,
satisfactory to the committee, of having completed a
committee-approved course in those functions.
(1) No later than January 1, 2018, the dental board shall
promulgate regulations establishing criteria for approval of courses
of instruction for the procedures authorized to be performed by a
registered dental hygienist pursuant to this section. Proposed
regulations, and any subsequent proposed amendments to the
promulgated regulations, shall be reviewed by the committee. The
committee shall submit any recommended changes to the board for
review to establish a consensus.
(2) Prior to January 1, 2018, the dental board shall use the
competency-based training protocols established by Health Workforce
Pilot Project (HWPP) No. 172 through the Office of Statewide Health
Planning and Development.
(1)
(3) A registered dental hygienist who has completed the
prescribed training in the Health Workforce Pilot Project
#172 No. 172 established by the Office of
Statewide Health Planning and Development pursuant to Article 1
(commencing with Section 128125) of Chapter 3 of Part 3 of Division
107 of the Health and Safety Code shall be deemed to have satisfied
the requirement for completion of a course of instruction approved by
the committee.
(2)
(4) In addition to the instructional components
described in subdivision (d) or (e), a program shall contain both of
the instructional components described in this paragraph:
(A) The course shall be established at the postsecondary
educational level.
(B) All faculty responsible for clinical evaluation shall have
completed a one-hour methodology course in clinical evaluation or
have a faculty appointment at an accredited dental education program
prior to conducting evaluations of students.
(d) A program or course to perform the duties described in
paragraph (1) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency making decisions about which radiographs
to take to facilitate an evaluation by a dentist, but shall in no
event be less than six hours, including at least two hours of
didactic training, at least two hours of guided laboratory simulation
training, and at least two hours of examination using simulated
cases.
(2) Didactic instruction shall consist of instruction on both of
the following topics:
(A) Guidelines for radiographic decision making prepared by the
American Dental Association and other professional dental
associations.
(B) Specific decisionmaking protocols that incorporate information
about the patient's health and radiographic history, the time span
since previous radiographs were taken, the availability of previous
radiographs, the general condition of the mouth including the extent
of dental restorations present, and visible signs of abnormalities,
including broken teeth, dark areas, and holes in teeth.
(3) Laboratory instruction shall consist of simulated decision
making using case studies containing the elements described in
paragraph (2). There shall be at least one instructor for every 14
students who are simultaneously engaged in laboratory instruction.
(4) Examination shall consist of decisionmaking where students
make decisions and demonstrate competency to faculty on case studies
containing the elements described in paragraph (2).
(e) A program or course to perform the duties described in
paragraph (2) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency in the application of protective
restorations, including interim therapeutic restorations, but shall
in no event be less than 16 clock hours, including at least four
hours of didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training.
(2) Didactic instruction shall consist of instruction on all of
the following topics:
(A) Pulpal anatomy.
(B) Theory of adhesive restorative materials used in the placement
of adhesive protective restorations related to mechanisms of bonding
to tooth structure, handling characteristics of the materials,
preparation of the tooth prior to material placement, and placement
techniques.
(C) Criteria that dentists use to make decisions about placement
of adhesive protective restorations including all of the following:
(i) Patient factors:
(I) The patient's American Society of Anesthesiologists Physical
Status Classification is Class III or less.
(II) The patient is cooperative enough to have the restoration
placed without the need for special protocols, including sedation or
physical support.
(III) The patient, or responsible party, has provided consent for
the procedure.
(IV) The patient reports that the tooth is asymptomatic, or if
there is mild sensitivity to sweet, hot, or cold that the sensation
stops within a few seconds of the stimulus being removed.
(ii) Tooth factors:
(I) The cavity is accessible without the need for creating access
using a dental handpiece.
(II) The margins of the cavity are accessible so that clean
noncarious margins can be obtained around the entire periphery of the
cavity with the use of hand instruments.
(III) The depth of the lesion is more than two millimeters from
the pulp on radiographic examination or is judged by the dentist to
be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic.
(IV) The tooth is restorable and does not have other significant
pathology.
(D) Criteria for evaluating successful completion of adhesive
protective restorations including all of the following:
(i) The restorative material is not in hyperocclusion.
(ii) There are no marginal voids.
(iii) There is minimal excess material.
(E) Protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations including
situations requiring immediate referral to a dentist.
(F) Protocols for followup of adhesive protective restorations.
(3) Laboratory instruction shall consist of placement of adhesive
protective restorations where students demonstrate competency in this
technique on typodont teeth.
(4) Clinical instruction shall consist of experiences where
students demonstrate competency in placement of adhesive protective
restorations under direct supervision of faculty.
(f)
(c) This section shall remain in effect only until
January 1, 2018, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2018, deletes or
extends that date.
SEC. 8. SEC. 5. Section 1910.5 is
added to the Business and Professions Code, to read:
1910.5. (a) For the purposes of this section, "interim
therapeutic restoration" means a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment.
(b) A registered dental hygienist may perform both of the
following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
1910.5. (a) In addition to the duties specified
in Section 1910, a registered dental hygienist is authorized to
perform the following additional duties, as specified:
(1) Determine which radiographs to perform on a patient who has
not received an initial examination by the supervising dentist for
the specific purpose of the dentist making a diagnosis and treatment
plan for the patient. In these circumstances, the dental hygienist
shall follow protocols established by the supervising dentist. This
paragraph only applies in the following settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as
and defined by subdivision (a), that comprise
the removal of soft material from the tooth using only hand
instrumentation, without the use of rotary instrumentation, and
subsequent placement of an adhesive restorative material. Local
anesthesia shall not be necessary. The protective restorations
as a direct provisional restoration placed to
stabilize the tooth until a licensed dentist diagnoses the need for
further definitive treatment. An interim therapeutic restoration
consists of the removal of soft material from the tooth using only
hand instrumentation, without the use of rotary instrumentation, and
subsequent placement of an adhesive restorative material. Local
anesthesia shall not be necessary for interim therapeutic restoration
placement. Interim therapeutic restorations shall be placed
only in accordance with both of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c)
(b) The functions described in subdivision (b)
(a) may be performed by a registered dental
hygienist only after completion of a program that includes training
in performing those functions, or after providing evidence,
satisfactory to the committee, of having completed a
committee-approved course in those functions.
(c) The dental board shall promulgate regulations establishing
criteria for approval of courses of instruction for the procedures
authorized to be performed by a registered dental hygienist pursuant
to this section. The committee shall review proposed regulations, and
any subsequent proposed amendments to the promulgated regulations,
and shall submit any recommended changes to the board for review to
establish a consensus.
(d) This section shall become operative on January 1, 2018.
SEC. 9. SEC. 6. Section 1926 of the
Business and Professions Code is amended to read:
1926. A registered dental hygienist in alternative practice may
perform the duties authorized pursuant to subdivision (a) of Section
1907, subdivision (a) of Section 1908, subdivisions (a) and (b) of
Section 1910, and Section 1926.05 in the following settings:
(a) Residences of the homebound.
(b) Schools.
(c) Residential facilities and other institutions.
(d) Dental health professional shortage areas, as certified by the
Office of Statewide Health Planning and Development in accordance
with existing office guidelines.
SEC. 10. SEC. 7. Section 1926.05 is
added to the Business and Professions Code, to read:
1926.05. (a) For the purposes of this section, the following
definitions shall apply:
(1) "Clinical instruction" means instruction in which students
receive supervised experience in performing procedures in a clinical
setting on patients. Clinical instruction shall only be performed
upon successful demonstration and evaluation of preclinical skills.
There shall be at least one instructor for every six students who are
simultaneously engaged in clinical instruction.
(2) "Course" means a committee-approved course preparing
registered dental hygienist in alternative practice to perform the
duties described in subdivision (b).
(3) "Didactic instruction" means lectures, demonstrations, and
other instruction without active participation by students. The
approved provider or its designee may provide didactic instruction
through electronic media, home study materials, or live lecture
methodology if the provider has submitted that content to the
committee for approval.
(4) "Interim therapeutic restoration" means a direct provisional
restoration placed to stabilize the tooth until a licensed dentist
diagnoses the need for further definitive treatment.
(5) "Laboratory instruction" means instruction in which students
receive supervised experience performing procedures using study
models, mannequins, or other simulation methods.
(6) "Preclinical instruction" means instruction in which students
receive supervised experience performing procedures on students,
faculty, or staff members. There shall be at least one instructor for
every six students who are simultaneously engaged in preclinical
instruction.
(7) "Program" means a committee-approved registered dental
hygienist in alternative practice educational program.
(b) A registered dental hygienist in alternative practice may
perform both of the following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
1926.05. (a) In addition to the duties specified
in Section 1926, a registered dental hygienist in alternative
practice is authorized to perform the following additional duties, as
specified:
(1) Determine which radiographs to perform on a patient who has
not received an initial examination by the supervising dentist for
the specific purpose of the dentist making a diagnosis and treatment
plan for the patient. In these circumstances, the dental hygienist in
alternative practice shall follow protocols established by the
supervising dentist. This paragraph only applies in the following
settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
paragraph (4) of subdivision (a), that compromise the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary. The protective restorations shall be placed only in
accordance with both of the following:
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with both
of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c)
(b) The functions described in subdivision (b)
(a) may be performed by a registered dental
hygienist in alternative practice only after completion of a course
or program that includes training in performing those functions, or
after providing evidence, satisfactory to the committee, of having
completed a committee-approved course in those functions.
(1) No later than January 1, 2018, the dental board shall
promulgate regulations establishing criteria for the approval of
courses of instruction for the procedures authorized to be performed
by a registered dental hygienist in alternative practice pursuant to
this section. Proposed regulations, and any subsequent proposed
amendments to the promulgated regulations, shall be reviewed by the
committee. The committee shall submit any recommended changes to the
board for review to establish a consensus.
(2) Prior to January 1, 2018, the dental board shall use the
competency-based training protocols established by Health Workforce
Pilot Project (HWPP) No. 172 through the Office of Statewide Health
Planning and Development.
(1)
(3) A registered dental hygienist in alternative
practice who has completed the prescribed training in the Health
Workforce Pilot Project #172 No. 172
established by the Office of Statewide Health Planning and
Development pursuant to Article 1 (commencing with Section 128125) of
Chapter 3 of Part 3 of Division 107 of the Health and Safety Code
shall be deemed to have satisfied the requirement for completion of a
course of instruction approved by the committee.
(2)
(4) In addition to the instructional components
described in this subdivision (d) or (e)
, a program shall contain both of the instructional
components described in this paragraph:
(A) The course shall be established at the postsecondary
educational level.
(B) All faculty responsible for clinical evaluation shall have
completed a one-hour methodology course in clinical evaluation or
have a faculty appointment at an accredited dental education program
prior to conducting evaluations of students.
(d) A program or course to perform the duties described in
paragraph (1) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency making decisions about which radiographs
to take to facilitate an evaluation by a dentist, but shall in no
event be less than six hours, including at least two hours of
didactic training, at least two hours of guided laboratory simulation
training, and at least two hours of examination using simulated
cases.
(2) Didactic instruction shall consist of instruction on both of
the following topics:
(A) Guidelines for radiographic decision making
prepared by the American Dental Association and other professional
dental associations.
(B) Specific decisionmaking protocols that incorporate information
about the patient's health and radiographic history, the time span
since previous radiographs were taken, the availability of previous
radiographs, the general condition of the mouth including the extent
of dental restorations present, and visible signs of abnormalities,
including broken teeth, dark areas, and holes in teeth.
(3) Laboratory instruction shall consist of simulated decision
making using case studies containing the elements described in
paragraph (2). There shall be at least one instructor for every 14
students who are simultaneously engaged in laboratory instruction.
(4) Examination shall consist of decisionmaking where students
make decisions and demonstrate competency to faculty on case studies
containing the elements described in paragraph (2).
(e) A program or course to perform the duties described in
paragraph (2) of subdivision (b) shall contain all of the additional
instructional components described in this subdivision.
(1) The program shall be of sufficient duration for the student to
develop minimum competency in the application of protective
restorations, including interim therapeutic restorations, but shall
in no event be less than 16 clock hours, including at least four
hours of didactic training, at least four hours of laboratory
training, and at least eight hours of clinical training.
(2) Didactic instruction shall consist of instruction on all of
the following topics:
(A) Pulpal anatomy.
(B) Theory of adhesive restorative materials used in the placement
of adhesive protective restorations related to mechanisms of bonding
to tooth structure, handling characteristics of the materials,
preparation of the tooth prior to material placement, and placement
techniques.
(C) Criteria that dentists use to make decisions about placement
of adhesive protective restorations including all of the following:
(i) Patient factors:
(I) The patient's American Society of Anesthesiologists Physical
Status Classification is Class III or less.
(II) The patient is cooperative enough to have the restoration
placed without the need for special protocols, including sedation or
physical support.
(III) The patient, or responsible party, has provided consent for
the procedure.
(IV) The patient reports that the tooth is asymptomatic, or if
there is mild sensitivity to sweet, hot, or cold that the sensation
stops within a few seconds of the stimulus being removed.
(ii) Tooth factors:
(I) The cavity is accessible without the need for creating access
using a dental handpiece.
(II) The margins of the cavity are accessible so that clean
noncarious margins can be obtained around the entire periphery of the
cavity with the use of hand instruments.
(III) The depth of the lesion is more than two millimeters from
the pulp on radiographic examination or is judged by the dentist to
be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic.
(IV) The tooth is restorable and does not have other significant
pathology.
(D) Criteria for evaluating successful completion of adhesive
protective restorations including all of the following:
(i) The restorative material is not in hyperocclusion.
(ii) There are no marginal voids.
(iii) There is minimal excess material.
(E) Protocols for handling sensitivity, complications, or
unsuccessful completion of adhesive protective restorations including
situations requiring immediate referral to a dentist.
(F) Protocols for followup of adhesive protective restorations.
(3) Laboratory instruction shall consist of placement of adhesive
protective restorations where students demonstrate competency in this
technique on typodont teeth.
(4) Clinical instruction shall consist of experiences where
students demonstrate competency in placement of adhesive protective
restorations under direct supervision of faculty.
(f)
(c) This section shall remain in effect only until
January 1, 2018, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2018, deletes or
extends that date.
SEC. 11. SEC. 8. Section 1926.05 is
added to the Business and Professions Code, to read:
1926.05. (a) For the purposes of this section, "interim
therapeutic restoration" means a direct provisional restoration
placed to stabilize the tooth until a licensed dentist diagnoses the
need for further definitive treatment.
(b) A registered dental hygienist in alternative practice may
perform both of the following duties:
(1) Choose radiographs without the supervising dentist having
first examined the patient, following protocols established by the
supervising dentist and, consistent with the use of as low as
reasonably necessary radiation, for the purpose of diagnosis and
treatment planning by the dentist. The radiographs shall be taken
only in either of the following settings:
1926.05. (a) In addition to the duties specified
in Section 1926, a registered dental hygienist in alternative
practice is authorized to perform the following additional duties, as
specified:
(1) Determine which radiographs to perform on a patient who has
not received an initial examination by the supervising dentist for
the specific purpose of the dentist making a diagnosis and treatment
plan for the patient. In these circumstances, the dental hygienist in
alternative practice shall follow protocols established by the
supervising dentist. This paragraph only applies in the following
settings:
(A) In a dental office setting, under the general supervision of a
dentist.
(B) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, as defined by
subdivision (a), that compromise the removal of soft material from
the tooth using only hand instrumentation, without the use of rotary
instrumentation, and subsequent placement of an adhesive restorative
material. Local anesthesia shall not be necessary. The protective
restorations shall be placed only in accordance with both of the
following:
(2) Place protective restorations, which for this purpose are
identified as interim therapeutic restorations, and defined as a
direct provisional restoration placed to stabilize the tooth until a
licensed dentist diagnoses the need for further definitive treatment.
An interim therapeutic restoration consists of the removal of soft
material from the tooth using only hand instrumentation, without the
use of rotary instrumentation, and subsequent placement of an
adhesive restorative material. Local anesthesia shall not be
necessary for interim therapeutic restoration placement. Interim
therapeutic restorations shall be placed only in accordance with both
of the following:
(A) In either of the following settings:
(i) In a dental office setting, under the general supervision of a
dentist.
(ii) In a public health setting, including, but not limited to,
schools, head start and preschool programs, and residential
facilities and institutions, under the general supervision of a
dentist.
(B) After a diagnosis and treatment plan by a dentist.
(c)
(b) The functions described in subdivision (b)
this section may be performed by a registered
dental hygienist in alternative practice only after completion of a
course or program that includes training in performing those
functions, or after providing evidence, satisfactory to the
committee, of having completed a committee-approved course in those
functions.
(c) The dental board shall promulgate regulations establishing
criteria for approval of courses of instruction for the procedures
authorized to be performed by a registered dental hygienist in
alternative practice pursuant to this section. The committee shall
review proposed regulations, and any subsequent proposed amendments
to the promulgated regulations, and shall submit any recommended
changes to the board for review to establish a consensus.
(d) This section shall become operative on January 1, 2018.
SEC. 9. Section 128196 is added to the
Health and Safety Code , to read:
128196. (a) Notwithstanding Section 128180, the office shall
extend the duration of the health workforce project known as Health
Workforce Pilot Project No. 172 until January 1, 2016, in order to
maintain the competence of the clinicians trained during the course
of the project, and to authorize training of additional clinicians in
the duties specified in HWPP No. 172.
(b) This section shall remain in effect only until January 1,
2016, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2016, deletes or extends
that date.
SEC. 12. SEC. 10. Section 14132.725
of the Welfare and Institutions Code is amended to read:
14132.725. (a) To the extent that federal financial participation
is available, face-to-face contact between a health care provider
and a patient is not required under the Medi-Cal program for
teleophthalmology, teledermatology, and teledentistry by store and
forward. Services appropriately provided through the store and
forward process are subject to billing and reimbursement policies
developed by the department.
(b) For purposes of this section, "teleophthalmology,
teledermatology, and teledentistry by store and forward" means an
asynchronous transmission of medical or dental information to be
reviewed at a later time by a physician at a distant site who is
trained in ophthalmology or dermatology or, for teleophthalmology, by
an optometrist who is licensed pursuant to Chapter 7 (commencing
with Section 3000) of Division 2 of the Business and Professions
Code, or a dentist, where the physician, optometrist, or dentist at
the distant site reviews the medical or dental information without
the patient being present in real time. A patient receiving
teleophthalmology, teledermatology, or teledentistry by store and
forward shall be notified of the right to receive interactive
communication with the distant specialist physician, optometrist, or
dentist and shall receive an interactive communication with the
distant specialist physician, optometrist, or dentist, upon request.
If requested, communication with the distant specialist physician,
optometrist, or dentist may occur either at the time of the
consultation, or within 30 days of the patient's notification of the
results of the consultation. If the reviewing optometrist identifies
a disease or condition requiring consultation or referral pursuant to
Section 3041 of the Business and Professions Code, that consultation
or referral shall be with an ophthalmologist or other appropriate
physician and surgeon, as required.
(c) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement, interpret, and make specific this section
by means of all-county letters, provider bulletins, and similar
instructions.
(d) On or before January 1, 2008, the department shall report to
the Legislature the number and type of services provided, and the
payments made related to the application of store and forward
telehealth as provided, under this section as a Medi-Cal benefit.
