ARC 1940C

ARC 1940C

DENTAL BOARD[650]

Notice of Intended Action

Twenty-five interested persons, a governmental subdivision, an agency or association of 25 or more persons may demand an oral presentation hereon as provided in Iowa Code section 17A.4(1)"b."

Notice is also given to the public that the Administrative Rules Review Committee may, on its own motion or on written request by any individual or group, review this proposed action under section 17A.8(6) at a regular or special meeting where the public or interested persons may be heard.

Pursuant to the authority of Iowa Code sections 147.76 and 272C.2, the Dental Board hereby gives Notice of Intended Action to amend Chapter 20, "Dental Assistants," Iowa Administrative Code.

The purposes of the proposed amendments are as follows: to clarify general supervision requirements for dental assistants, add to the list of permissible services a dental assistant may perform under general supervision, increase the number of expanded function procedures which may be delegated to a registered dental assistant and set the education and training requirements for those procedures, and permit registered dental assistants to work under public health supervision in certain settings.

Current rules regarding the general supervision of a dental assistant have consistently been interpreted to require that a dentist first examine the patient prior to delegating services to be provided by a dental assistant. These amendments clearly specify this requirement.

These amendments increase the number of services a dentist may delegate to a dental assistant under general supervision by adding the use of a curing light and intraoral camera.

Current rules authorize a licensed dentist to delegate 9 expanded function procedures to a properly trained registered dental assistant. These amendments would increase the number of procedures to 16 procedures, define the supervision requirements for the performing of all expanded functions, and set education and training requirements for all expanded functions.

Current rules authorize dental assistants to work under the personal, direct, or general supervision of a licensed dentist. These amendments would authorize an Iowa-licensed dentist to provide public health supervision to a registered dental assistant if the services are provided in a public or private school, public health agencies, hospitals, or the armed forces.

Any interested person may make written comments on the proposed amendments on or before April 21, 2015. Such written materials should be directed to Phil McCollum, Associate Director, Iowa Dental Board, 400 S.W. Eighth Street, Suite D, Des Moines, Iowa 50309, or sent by e-mail to phil.mccollum@iowa.gov.

There will be a public hearing on April 21, 2015, at 2 p.m. in the Board office, 400 S.W. Eighth Street, Suite D, Des Moines, Iowa, at which time persons may present their views orally or in writing.

The proposed amendments are subject to waiver or variance pursuant to 650—Chapter 7.

After analysis and review of this rule making, a positive impact on jobs has been found for dental assistants, who will now be able to perform more procedures and work in more settings.

These amendments are intended to implement Iowa Code sections 153.38 and 153.39.

The following amendments are proposed.

Item 1. Amend rule 650—20.2(153), definition of "General supervision," as follows:

"General supervision" means that a dentist has examined the patient and has delegated the services to be provided by a registered dental assistant, which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light and intraoral camera. The dentist need not be present in the facility while these services are being provided.

Item 2. Adopt the following new definition of "Public health supervision" in rule 650—20.2(153):

"Public health supervision" means all of the following:

1.The dentist authorizes and delegates the services provided by a registered dental assistant to a patient in a public health setting, with the exception that services may be rendered without the patient's first being examined by a licensed dentist;

2.The dentist is not required to provide future dental treatment to patients served under public health supervision;

3.The dentist and the registered dental assistant have entered into a written supervision agreement that details the responsibilities of each licensee/registrant, as specified in subrule 20.16(2); and

4.The registered dental assistant has an active Iowa registration and a minimum of three years of clinical practice experience.

Item 3. Rescind subrule 20.3(3).

Item 4. Renumber subrule 20.3(4) as 20.3(3).

Item 5. Renumber rules 650—20.4(153) to 650—20.14(153) as 650—20.5(153) to 650—20.15(153).

Item 6. Adopt the following new rule 650—20.4(153):

650—20.4(153) Expanded function requirements.

20.4(1) Supervision requirements. Registered dental assistants may only perform expanded function procedures which are delegated by and performed under the direct supervision of a dentist licensed pursuant to Iowa Code chapter 153. Dental assistant trainees are not eligible to perform expanded function procedures.

20.4(2) Expanded function training required. A registered dental assistant shall not perform any expanded function procedures listed in this chapter unless the assistant has successfully met the education and training requirements and is in compliance with the requirements of this chapter.

20.4(3) Education and training requirements. All expanded function training must be prior-approved by the board. The supervising dentist and the registered dental assistant shall be responsible for maintaining in each office of practice documentation of successful completion of the board-approved training.

a. Expanded function training for Level 1 procedures shall be eligible for board approval if the training is offered through a program accredited by the Commission on Dental Accreditation of the American Dental Association (ADA) or another program, which may include on-the-job training offered by a dentist licensed in Iowa. Training must consist of the following:

(1)An initial assessment to determine the base entry level of all participants in the program. At a minimum, all participants must meet at least one of the following requirements before beginning expanded function training:

1.Be a graduate of an ADA-accredited dental assistant program; or

2.Be currently certified by the Dental Assisting National Board (DANB); or

3.Have at least one year of clinical practice as a registered dental assistant; or

4.Have at least one year of clinical practice as a dental assistant in a state that does not require registration;

(2)A didactic component;

(3)A laboratory component, if necessary;

(4)A clinical component, which may be obtained under the personal supervision of the participant's supervising dentist while the participant is concurrently enrolled in the training program; and

(5)A postcourse competency assessment at the conclusion of the training program.

b. Expanded function training for Level 2 procedures shall be eligible for board approval if the training is offered through the University of Iowa College of Dentistry or a program accredited by the Commission on Dental Accreditation of the American Dental Association.

20.4(4) Expanded function providers.

a. Basic expanded function provider. Registered dental assistants who do not wish to become certified as a Level 1 or Level 2 provider may perform select Level 1 expanded function procedures provided they have met the education and training requirements for those procedures. A dentist may delegate to a registered dental assistant only those Level 1 procedures for which the assistant has received the required expanded function training.

b. Certified Level 1 provider. Registered dental assistants must successfully complete training for all Level 1 expanded function procedures before becoming a certified Level 1 provider.

(1)A dentist may delegate any of the Level 1 expanded function procedures to dental assistants who are certified Level 1 providers.

(2)Level 1 procedures include:

1.Taking occlusal registrations;

2.Placement and removal of gingival retraction;

3.Fabrication and removal of provisional restorations;

4.Applying cavity liners and bases, desensitizing agents, and bonding systems;

5.Placement and removal of dry socket medication;

6.Placement of periodontal dressings;

7.Testing pulp vitality;

8.Monitoring of nitrous oxide inhalation analgesia;

9.Taking final impressions;

10.Removal of adhesives (hand instrumentation only); and

11.Preliminary charting of existing dental restorations and teeth.

c. Certified Level 2 provider. A registered dental assistant must become a certified Level 1 provider and successfully pass a board-approved entrance examination with a score of at least 75 percent before beginning training as a certified Level 2 provider. Registered dental assistants must successfully complete training for all Level 2 expanded function procedures before becoming certified Level 2 providers.

(1)A dentist may delegate any of the Level 1 or Level 2 expanded function procedures to a registered dental assistant who is a certified Level 2 provider.

(2)Level 2 procedures include:

1.Placement and shaping of amalgam following preparation of a tooth by a dentist;

2.Placement and shaping of composite following preparation of a tooth by a dentist;

3.Forming and placement of stainless steel crowns;

4.Taking records for the fabrication of dentures and partial dentures; and

5.Tissue conditioning (soft reline only, where denture is not relieved or modified).

These procedures refer to both primary and permanent teeth.

(3)Notwithstanding 650—paragraph 10.3(1)"e" and paragraph 20.3(2)"e," for the purposes of this chapter, the removal of adhesives by hand instrumentation does not constitute the removal of "hard natural or synthetic material."

Item 7. Amend renumbered subparagraphs 20.5(1)"b"(1) and (2) as follows:

(1)Reapplying for trainee status. A trainee may "start over" as a dental assistant trainee provided the trainee submits an application in compliance with subrule 20.6(1) 20.7(1).

(2)Examination scores valid for three years. A "repeat" trainee is not required to retake an examination (jurisprudence, infection control/hazardous materials, radiography) if the trainee has successfully passed the examination within three years of the date of application. If a trainee has failed two or more examinations, the trainee must satisfy the remedial education requirements in subrule 20.10(1) 20.11(1). The trainee status application will not be approved until the trainee successfully completes any required remedial education.

Item 8. Amend renumbered subrule 20.5(2) as follows:

20.5(2) Registered dental assistant. A registered dental assistant may perform under general supervision dental radiography, intraoral suctioning, use of a curing light and intraoral camera, and all extraoral duties that are assigned by the dentist and are consistent with these rules. During intraoral procedures, the registered dental assistant may, under direct supervision, assist the dentist in performing duties assigned by the dentist that are consistent with these rules. The registered dental assistant may take radiographs if qualified pursuant to 650—Chapter 22.

Item 9. Amend renumbered subparagraph 20.7(2)"b"(2) as follows:

(2)Evidence of meeting the requirements specified in 20.6(2)"a." 20.7(2)"a."

Item 10. Amend renumbered paragraph 20.11(1)"b" as follows:

b. A dental assistant who fails the second examination will be required to complete the remedial education requirements set forth in subrule 20.10(2) 20.11(2).

Item 11. Rescind rule 650—20.15(153).

Item 12. Adopt the following new rule 650—20.16(153):

650—20.16(153) Public health supervision allowed. A dentist may provide public health supervision to a registered dental assistant if the dentist has an active Iowa license and the services are provided in a public or private school, public health agencies, hospitals, or the armed forces.

20.16(1) Public health agencies defined. For the purposes of this rule, public health agencies include programs operated by federal, state, or local public health departments.

20.16(2) Responsibilities. When working together in a public health supervision relationship, a dentist and registered dental assistant shall enter into a written agreement that specifies the following responsibilities.

a. The dentist providing public health supervision must:

(1)Be available to provide communication and consultation with the registered dental assistant;

(2)Have age- and procedure-specific standing orders for the performance of services. Those standing orders must include consideration for medically compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of services;

(3)Specify a period of time in which an examination by a dentist must occur prior to providing further services;

(4)Specify the location or locations where the services will be provided under public health supervision.

b. A registered dental assistant providing services under public health supervision may only provide services which are limited to all extraoral duties, dental radiography, intraoral suctioning, and use of a curing light and intraoral camera and must:

(1)Maintain contact and communication with the dentist providing public health supervision;

(2)Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient;

(3)Provide to the patient, parent, or guardian a written plan for referral to a dentist;

(4)Have each patient, parent, or guardian sign a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and

(5)Specify a procedure for creating and maintaining dental records for the patients who are treated, including where these records are to be located.

c. The written agreement for public health supervision must be maintained by the dentist and the registered dental assistant and a copy filed with the board office within 30 days of the date on which the dentist and the registered dental assistant entered into the agreement. The dentist and registered dental assistant must review the agreement at least biennially.

d. The registered dental assistant shall file annually with the supervising dentist a report detailing the number of patients seen, the services provided to patients and the infection control protocols followed at each practice location.

e. A copy of the written agreement for public health supervision shall be filed with the Oral Health Bureau, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, Iowa 50319.

20.16(3) Reporting requirements. Each registered dental assistant who has rendered services under public health supervision must complete a summary report at the completion of a program or, in the case of an ongoing program, at least annually. The report shall be filed with the oral health bureau of the Iowa department of public health on forms provided by the department and shall include information related to the number of patients seen and services provided so that the department may assess the impact of the program. The department will provide summary reports to the board on an annual basis.