THE SENATE	S.B. NO.	3085
TWENTY-EIGHTH LEGISLATURE, 2016		S.D. 1
STATE OF HAWAII

A BILL FOR AN ACT

 

 

RELATING TO HEALTH.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  The legislature finds that since the implementation of the dental anesthesia law in the 1990s, Hawaii's licensed dental hygienists have been held to the highest standards of patient safety and care, including a requirement that all new applicants for dental hygienist licensure be certified in local infiltration anesthesia and block anesthesia.  This stringent certification requirement was enforced until recently, when some dental hygienist applicants started to become licensed without a block anesthesia certification.  Clarification of the original intent behind these certification requirements is therefore needed, to specify that an applicant must be officially certified in the administration of intra-oral infiltration local anesthesia and officially certified in the administration of intra-oral block anesthesia prior to being licensed as a dental hygienist in Hawaii.

     The legislature further finds that existing law permits duly licensed and registered dentists to employ auxiliary personnel, known as dental assistants, to assist a dentist in the dentist's practice.  Like dental hygienists, dental assistants are a valuable part of a dental team.  However, dental assistants are not currently licensed or certified in Hawaii and are not required to meet the same stringent standards of training and care as licensed dental hygienists.  The legislature notes that some concerns have been raised over proposed expansion by rule of the duties of a dental assistant, and whether those duties would overlap with duties currently within the scope of practice for licensed dental hygienists.

     The legislature additionally finds that it is important for those in the field of dentistry to be aware of and adhere to legislatively determined parameters regarding duty and scope of practice for licensed dental hygienists.  It is also important that unlicensed persons do not infringe upon a particular licensed profession's scope of practice.  The legislature also finds that training and education for dental assistants are important.  However, it is not appropriate for unlicensed auxiliary personnel to be expected or required to perform duties, activities, or functions that, if performed by a dental hygienist, would require licensure.

     Accordingly, the purpose of this Act is to clarify the:

     (1)  Requirements for an individual to become a dental hygienist; and

     (2)  Allowable and prohibited practices and training requirements for dental assistants.

     SECTION 2.  Section 447-1, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  Any person:

     (1)  Eighteen years of age or over;

     (2)  Who has a diploma or proper certificate of graduation from a dental hygiene school accredited by the American Dental Association Commission on Dental Accreditation that requires at least a two year course and is recognized by the board of dental examiners;

     (3)  Who has been officially certified in the administration of intra-oral infiltration local anesthesia [and intra-oral block anesthesia] by an accredited dental hygiene school or by a certification program previously approved by the board; [and]

     (4)  Who has been officially certified in the administration of intra-oral block anesthesia by an accredited dental hygiene school or by a certification program previously approved by the board; and

    [(4)] (5)  Who has passed the National Board Dental Hygiene Examination;

upon written application made to and filed with the board may be examined for qualification as a dental hygienist.

     An application shall be accompanied by the applicant's certificate of graduation from an accredited dental hygiene school, documentary proof of the applicant's certification in the administration of intra-oral infiltration local anesthesia and intra-oral block anesthesia, and documentary proof of the applicant's passage of the National Board Dental Hygiene Examination.  At the time of filing the application, the applicant shall pay to the board an application fee, which together with all other fees or charges in this chapter, shall be as provided in rules adopted by the director of commerce and consumer affairs pursuant to chapter 91, and shall be deposited to the credit of the compliance resolution fund established pursuant to section 26-9(o)."

     SECTION 3.  Section 448-3, Hawaii Revised Statutes, is amended to read as follows:

     "§448-3  Practice by unlicensed employee prohibited; penalty.  (a)  Except as provided in section 447-3, no person who manages or conducts as manager, proprietor, conductor, or otherwise a place where dental operations are performed, shall employ any person as operator in dental surgery or as a practitioner, or cause to permit any person to so act, who is not duly licensed to practice dentistry; provided that nothing in this chapter shall prohibit any unlicensed person from performing merely mechanical work upon inert matter in a dental laboratory.

     (b)  A duly licensed and registered dentist may employ auxiliary personnel, other than registered dental hygienists, to assist the dentist in executing the dentist's practice of dentistry.  These employees shall be known as dental assistants and shall perform all duties assigned to them under the supervision, direction and responsibility of the dentist.  [Duties] Additional duties of the dental assistant and regulatory directives [shall] may be delineated under rules which the board of dental examiners may from time to time adopt[.]; provided that these rules shall not infringe upon or overlap or conflict with existing law, including the duties and scope of practice for licensed dental hygienists under chapter 447.

     (c)  A dental assistant may perform the following supportive dental procedures under the direct supervision, direction, evaluation, and responsibility of a licensed dentist:

     (1)  Assisting the licensed dentist who is actually performing a dental procedure on a patient, including:

         (A)  Preparing procedural trays or armamentaria set-ups;

         (B)  Retracting a patient's oral tissues to maintain the field of operation during the dental procedure;

         (C)  Removing debris, as is normally created and accumulated during or after operative procedures by the dentist;

         (D)  Placing and removing the rubber dam;

         (E)  Mixing dental materials; and

         (F)  Transferring dental instruments or any other concept of four-handed dentistry the dentist requires to perform the procedure;

     (2)  Assisting a licensed dental hygienist in the performance of the duties of the dental hygienist; provided that the assistance shall not include procedures, activities, or duties that dental assistants are prohibited from performing under this section; provided further that the assistance shall not include procedures, activities, or duties that are within the scope of a licensed dental hygienist pursuant to chapter 447;

     (3)  Collecting medical and dental histories, taking intra-oral and extra-oral photographs, and recording or charting clinical findings as dictated by a licensed dentist or licensed dental hygienist;

     (4)  Completing prescription and authorization forms for drug or restorative, prosthodontic, or orthodontic appliance for the supervising licensed dentist; provided that the licensed dentist shall sign the forms;

     (5)  Conducting mouth mirror supragingival inspections and reporting observations to the supervising licensed dentist; provided that the inspection and reporting observations shall not be interpreted as an oral cancer screening;

     (6)  Exposing, processing, mounting, and labeling radiographs;

     (7)  Making impressions for study casts; opposing models; occlusal appliances, such as splints and bite guards; mouth guards; orthodontic retainers; and medicament trays;

     (8)  Making intra-oral measurements for orthodontic procedures; performing the preliminary selection and sizing of bands; checking for loose bands and bonded brackets; placing and removing orthodontic separators, ligature ties, and inter-arch elastics, including chain elastics and rubber bands; fitting and removing head appliances; and removing arch wires;

     (9)  Measuring and recording vital signs;

    (10)  Monitoring the nitrous oxide/oxygen unit and reporting to the supervising dentist any adverse observations; provided that the licensed dentist shall evaluate, initiate, and administer the sedation;

    (11)  Placing matrix retainers;

    (12)  Placing non-aerosol topical anesthetics;

    (13)  Relating preoperative and postoperative instructions and patient education in oral hygiene, as instructed by the supervising licensed dentist or licensed dental hygienist;

    (14)  Removing dressing and sutures;

    (15)  Removing excess supragingival cement after a licensed dentist has placed a permanent or temporary prosthetic restoration, an appliance, or orthodontic bands with hand instruments; and

    (16)  Preforming a try-in with any removable prosthetic or orthodontic appliance; provided that the supervising licensed dentist shall make the adjustments.

     (d)  Dental assistants shall be appropriately trained in the following:

     (1)  Proper sterilization and disinfection procedures that meet the guidelines of:

         (A)  The United States Department of Labor Occupational Safety and Health Administration bloodborne pathogen standard; and

         (B)  The department of labor and industrial relations occupational health and safety bloodborne pathogen standard;

         (C)  The federal Centers for Disease Control and Prevention guidelines; and

         (D)  The American Dental Association clinical practice guidelines;

     (2)  Ethics;

     (3)  Proper recordkeeping and patient confidentiality; and

     (4)  Cardiopulmonary resuscitation.

     The training required pursuant to this section may be provided by programs that are approved or accredited by the board or by a licensed dentist; provided that a dentist who chooses to train the dentist's auxiliary personnel shall first complete a continuing education program on how to provide training to auxiliary personnel.

     (e)  Dental assistants shall not perform any activity that is deemed to be irreversible so as to cause change in the affected hard or soft tissues and is permanent, may require reconstructive or corrective procedures, or represents the practice of dentistry and dental hygiene or requires the knowledge, skill, and training of a licensed dentist or licensed dental hygienist, including the following intra-oral functions:

     (1)  Administering local anesthetic, sedation, or general anesthesia;

     (2)  Cementing, bonding, or adjusting any part of a prosthesis or appliance worn in the mouth;

     (3)  Cementing or re-cementing, finishing margins, performing a try-in, adjusting the occlusion of any temporary or permanent fixed prosthetic restoration, or placing cement bases;

     (4)  Cementing bands and brackets or activating any orthodontic appliance;

     (5)  Establishing occlusal vertical dimension, making bite registrations, or making face-bow transfers;

     (6)  Examining, diagnosing, or prescribing a treatment plan;

     (7)  Making final impressions, which would lead to the fabrication of any appliance or prosthesis that, when worn by the patient, would come in direct contact with hard or soft tissues; provided that this paragraph shall not apply to the making of impressions for study casts, opposing models, occlusal appliances, mouth guards, orthodontic retainers, or medicament trays;

     (8)  Performing any endodontic procedure to ream, file, irrigate, medicate, dry, try-in cores, or fill root canals, or to establish the length of the tooth;

     (9)  Performing any surgical or cutting procedures on hard or soft tissues, extracting teeth, or suturing;

    (10)  Placing, condensing, carving, finishing, or adjusting the occlusion of final restorations; or placing cavity liners, medicaments, or pulp cap materials;

    (11)  Placing subgingivally materials such as prescriptive medicaments, retraction cords, and other devices that are used for tissue displacement;

    (12)  Prescribing medications or authorizing the fabrication of any restorative, prosthodontic, or orthodontic appliances;

    (13)  Testing pulp vitality;

    (14)  Using ultrasonic instruments and polishing natural or restored surfaces of teeth;

    (15)  Removing hard and soft deposits and stains from the portion of the crown and root surfaces to the depth of the gingival sulcus; and

    (16)  Applying preventive chemical agents to the coronal surfaces of teeth.

     [(c)] (f)  Any person [violating] licensed pursuant to this chapter who violates this section shall be fined not less than $100 nor more than $1,000 for the first violation.  Any person [violating] licensed pursuant to this chapter who violates this section a second time shall be fined not less than $500 nor more than $2,000 and, in addition to the fine, the person's license shall be revoked."

     SECTION 4.  This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.

     SECTION 5.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 6.  This Act shall take effect on July 1, 2050.

 

 

 

Report Title:

Dental Hygienists; Dental Assistants; Licensing; Allowable and Prohibited Practices; Training Requirements; Board of Dental Examiners

 

Description:

Clarifies the requirements for an individual to become a dental hygienist.  Clarifies the allowable and prohibited practices and training requirements for dental assistants.  Effective 7/1/2050.  (SD1)

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.