ARC 6515C

ARC 6515C

DENTAL BOARD[650]

Notice of Intended Action

Proposing rule making related to expanded functions

and providing an opportunity for public comment

The Dental Board hereby proposes to amend Chapter 23, "Expanded Functions," Iowa Administrative Code.

Legal Authority for Rule Making

This rule making is proposed under the authority provided in Iowa Code section 147.76 and chapter 153.

State or Federal Law Implemented

This rule making implements, in whole or in part, Iowa Code chapter 153.

Purpose and Summary

These proposed amendments update the rules related to expanded functions. The proposed amendments lower the clinical practice requirement following registration for dental assistants to train in expanded functions and provide greater flexibility to train in the functions. Additionally, the rule making moves some of the Level 2 expanded functions to Level 1 designation for the purposes of training.

Fiscal Impact

This rule making has no fiscal impact to the State of Iowa.

Jobs Impact

After analysis and review of this rule making, there will be a positive impact on jobs in Iowa as the rule making allows licensees and registrants greater flexibility to grow within the profession.

Waivers

Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Board for a waiver of the discretionary provisions, if any, pursuant to rule 650—7.4(17A,147,153).

Public Comment

Any interested person may submit written comments concerning this proposed rule making. Written comments in response to this rule making must be received by the Board no later than 4:30 p.m.on September 30, 2022. Comments should be directed to:

Public Hearing

No public hearing is scheduled at this time. As provided in Iowa Code section 17A.4(1)"b," an oral presentation regarding this rule making may be demanded by 25 interested persons, a governmental subdivision, the Administrative Rules Review Committee, an agency, or an association having 25 or more members.

Review by Administrative Rules Review Committee

The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee's meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).

The following rule-making actions are proposed:

Item 1. Rescind the definitions of "Direct supervision," "General supervision of a dental assistant," "General supervision of a dental hygienist" and "Provisional restoration" in rule 650—23.1(153).

Item 2. Amend subrules 23.2(2) and 23.2(3) as follows:

23.2(2) To be eligible to train in Level 1 expanded function procedures, dental hygienists or dental assistants must comply with one of the following:

a. Hold an active dental hygiene license in Iowa; or

b. Hold an active dental assistant registration, and comply with at least one of the following:

(1)Be a graduate of an accredited school; or

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

(3)Have at least one year three months of clinical practice as a registered dental assistant; or

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

23.2(3) A dentist who delegates Level 1 or Level 2 expanded function procedures to dental hygienists or dental assistants under direct supervision must examine the patient to review the quality of work prior to the conclusion of the dental appointment. The following expanded function procedures are exempt from this requirement and may be performed under general supervision:

a. Recementation of a provisional restoration.

b. Taking occlusal registrations for purposes other than mounting study casts by Level 1 or Level 2 dental hygienists only.

Item 3. Amend rule 650—23.3(153) as follows:

650—23.3(153) Expanded function categories. Dental hygienists and dental assistants must be issued a certificate of completion for the corresponding function in which training has been completed by a board-approved training program before performing a specific expanded function procedure. A dentist may delegate to dental hygienists or dental assistants only those expanded function procedures in which training has been successfully completed.

23.3(1) Basic Level 1. Dental hygienists or dental assistants who train in some, but not all, Level 1 expanded function procedures are deemed to be basic expanded function dental hygienists or dental assistants. Dental hygienists and dental assistants must be issued a certificate of completion for the corresponding function by a board-approved training program before performing a specific expanded function procedure. A dentist may delegate to dental hygienists or dental assistants only those Level 1 expanded function procedures for which training has been successfully completed. Level 1 expanded functions may be taught by board-approved training providers using curriculum prior-approved by the board.

23.3(2) Certified Level 1. Expanded function dental hygienists or dental assistants who have successfully completed training for all Level 1 expanded function procedures and have been issued a certificate of completion by a board-approved training program are deemed to be certified Level 1 dental hygienists or dental assistants.

23.3(3) 23.3(2) Certified Level 2. Before beginning Level 2 training to become certified in Level 2, expanded function dental hygienists or dental assistants must have a minimum of one year of clinical practice as a certified Level 1 dental hygienist or dental assistant and pass an entrance examination administered by the Level 2 training program. Training in Level 2 expanded functions must be completed at the University of Iowa College of Dentistry or another accredited school using curriculum approved by the board. Before beginning Level 2 training, dental assistants and dental hygienists must complete all prerequisites established by the accredited school for the Level 2 training to be completed.

a. Dental hygienists or dental assistants who have successfully completed training in Level 2 expanded function procedures and have been issued a certificate of completion by a board-approved training program are deemed to be certified Level 2 dental hygienists or dental assistants.

b. A dentist may delegate any Level 1 or Level 2 expanded function procedures to dental hygienists or dental assistants who are certified Level 2.

Item 4. Amend rule 650—23.4(153) as follows:

650—23.4(153) Level 1 expanded function procedures for dental assistants. Level 1 expanded function procedures for dental assistants include:

23.4(1) Taking occlusal registrations;

23.4(2) Placement and removal of gingival retraction material;

23.4(3) Fabrication, temporary cementation, and removal of provisional restorations following review of the fit and function by the supervising dentist, and temporary recementation of provisional restorations;

23.4(4) Applying cavity liners and bases; desensitizing agents; and bonding systems, to include the placement of orthodontic brackets, following the determination of location by the supervising dentist;

23.4(5) Applying desensitizing agents;

23.4(6) Applying bonding systems, which may include the placement of orthodontic brackets and bands, following review of the fit and function by the supervising dentist;

23.4(5) 23.4(7) Monitoring of patients receiving nitrous oxide inhalation analgesia, which may include increasing oxygen levels as needed, pursuant to the following:

a. A dentist shall induce a patient and establish the maintenance level;

b. A dental assistant may make adjustments that decrease the nitrous oxide concentration during the administration of nitrous oxide;

c. A dental assistant may turn off the oxygen delivery at the completion of the dental procedure;

23.4(6) 23.4(8) Taking final impressions;

23.4(7) 23.4(9) Removal of adhesives or orthodontic brackets or bands using nonmotorized hand instrumentation;

23.4(8) 23.4(10) Placement of Class 1 temporary filling restorative materials; and

23.4(9) Recementation of provisional restorations.

23.4(11) Placement of intracoronal temporary restorative materials following preparation of a tooth by a dentist;

23.4(12) Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth; and

23.4(13) Tissue conditioning (soft reline only).

Item 5. Amend rule 650—23.5(153) as follows:

650—23.5(153) Level 1 expanded function procedures for dental hygienists. Level 1 expanded function procedures for dental hygienists include:

23.5(1) Taking occlusal registrations;

23.5(2) Placement and removal of gingival retraction material;

23.5(3) Fabrication, temporary cementation, and removal of provisional restorations following review of the fit and function by the supervising dentist, and temporary recementation of provisional restorations;

23.5(4) Applying cavity liners and bases and applying bonding systems for restorative purposes, including the placement of orthodontic brackets, following the determination of location by the supervising dentist;

23.5(5) Applying bonding systems, which may include the placement of orthodontic brackets and bands, following review of the fit and function by the supervising dentist;

23.5(5) 23.5(6) Taking final impressions;

23.5(7) Removal of orthodontic brackets or bands;

23.5(6) 23.5(8) Placement of Class 1 temporary filling restorative materials; and

23.5(7) Recementation of provisional restorations.

23.5(9) Placement of intracoronal temporary restorative material following preparation of a tooth by a dentist;

23.5(10) Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth; and

23.5(11) Tissue conditioning (soft reline only).

Item 6. Amend rule 650—23.6(153) as follows:

650—23.6(153) Level 2 expanded function procedures for dental hygienists and dental assistants.

23.6(1) Level 2 expanded function procedures for dental hygienists and dental assistants include:

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

b. Placement and shaping of adhesive restorative materials following preparation of a tooth by a dentist;

c. Polishing of adhesive restorative material using a slow-speed handpiece; and

d. Fitting of stainless steel crowns on primary posterior teeth, and cementation after fit verification by a dentist;.

e. Tissue conditioning (soft reline only);

f. Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth; and

g. Placement of intracoronal temporary fillings following preparation of a tooth by a dentist.

23.6(2) Level 2 expanded function procedures for dental assistants include the placement of sealants. The placement of sealants is included in the scope of practice for dental hygienists and is not considered an expanded function for dental hygienists.

23.6(3) These Level 2 expanded function procedures refer to both primary and permanent teeth except as otherwise noted. Training in Level 2 expanded functions may be separated between application of the services on primary or permanent teeth as determined by the accredited training provider.

Item 7. Amend rule 650—23.7(153) as follows:

650—23.7(153) Expanded function training.

23.7(1) Approved expanded function training programs. Training programs for Level 1 and Level 2 expanded function procedures must be board-approved. Training programs for Level 2 expanded function procedures shall be eligible for board approval if the training is offered through the University of Iowa College of Dentistry or another accredited school.

23.7(2) Certificates of completion. All board-approved training programs are authorized and required to issue certificates to dental hygienists and dental assistants who successfully complete expanded function training. A certificate shall be issued for one or more of the listed expanded function procedures completed as Basic Level 1, or a certificate shall be issued for Certified Level 1 or Certified Level 2. Dental hygienists and dental assistants shall prominently display the expanded functions certificate in each dental facility where services are provided.

23.7(3) Training requirements. Training may be completed in one or more of the listed expanded function procedures. Clinical training in expanded function procedures must be completed under observational supervision. Beginning January 1, 2020, Level 1 expanded function training must consist of the following:

a. An initial assessment to determine the base entry level of all participants in the program;

b. Completion of a training program that meets the following minimum standards for each function:

(1)Taking occlusal registrations:

Goal: To reproduce the patient's jaw relationship accurately.

Standard: Demonstrate an accurate occlusal registration confirmed by a supervising dentist.

Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision.

(2)Placement and removal of gingival retraction material:

Goal: To expose the margins of a crown by displacing tissue from the tooth.

Standard: Perform the procedural steps to place and remove retraction material and recognize oral conditions and techniques that may compromise tissue displacement or patient health.

Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of three experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.

(3)Fabrication, temporary cementation, temporary recementation, and removal of provisional restorations:

Goal: To replicate the anatomy and function of the natural tooth, prior to the final restoration, and secure the provisional restoration to a previously prepared tooth after the provisional restoration has become loose or dislodged.

Standard: Use various methods to fabricate and temporarily cement single-unit and multiunit provisional restorations.

Minimum training requirement: Four hours of didactic training, the equivalent of four hours of laboratory training that includes a minimum of five experiences, and clinical training that includes a minimum of ten patient experiences under observational supervision.

(4)Applying cavity liners and bases; desensitizing agents; and bonding systems, to include the placement of orthodontic brackets, following the determination of location by the supervising dentist:

Goal: To apply appropriate material that protects existing tooth structure and adheres existing tooth structure to restorative materials.

Standard: Manipulate and apply appropriate material to meet clinical competency.

Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of 5 five patient experiences in each one of these areas (for a total of 15 patient experiences under observational supervision).

(5)Applying desensitizing agents:

Goal: To apply appropriate medicaments to minimize sensitivity to existing tooth structure.

Standard: Apply appropriate medicaments to meet clinical competency.

Minimum training requirement: One hour of didactic training and clinical training that includes a minimum of five patient experiences under observational supervision.

(6)Applying bonding systems, which may include the placement of orthodontic brackets and bands, following review of the fit and function by the supervising dentist:

Goal: To apply appropriate material and systems that adhere to the existing tooth structure.

Standard: Manipulate and apply appropriate material and systems to meet clinical competency.

Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.

(5) (7)Monitoring of patients receiving nitrous oxide inhalation analgesia, pursuant to subrule 23.4(5) 23.4(7):

Goal: Understand the equipment, recognize the signs of patient distress or adverse reaction, and know when to call for help.

Standard: Exercise the ability to maintain patient safety while nitrous oxide is used.

Minimum training requirement: Two hours of didactic training, one hour of laboratory training in the office where the dental hygienist or dental assistant is employed, and five patient experiences under observational supervision.

(6) (8)Taking final impressions:

Goal: Reproduce soft and hard oral tissues, digitally or with impression materials.

Standard: Complete the procedural steps to obtain a clinically acceptable final impression.

Minimum training requirement: Three hours of didactic training, and the equivalent of clinical training that includes a minimum of six patient experiences under observational supervision.

(7) (9)Removal of adhesives or orthodontic brackets and bands using nonmotorized hand instrumentation:

Goal: Remove excess adhesives and bonding materials to eliminate soft tissue irritation, and remove brackets and bands used in orthodontic treatment.

Standard: Identify how, when and where to remove excessive bonding or adhesive material or orthodontic brackets and bands.

Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision.

(8) (10)Placement of Class 1 temporary filling restorative materials:

Goal: Place Class 1 temporary filling restorative materials following preparation of a tooth by a dentist.

Standard: Identify how, when and where to place Class 1 temporary filling restorative materials.

Minimum training requirement: One hour of didactic training, and clinical training that includes a minimum of five patient experiences under observational supervision.

(9)Recementation of provisional restorations:

Goal: Secure the provisional restoration to a previously prepared tooth after the provisional restoration has become loose or dislodged.

Standard: Use various methods to fabricate and temporarily cement single-unit and multiunit provisional restorations.

Minimum training requirement: If this training is completed in conjunction with training in fabrication, temporary cementation and removal of provisional crown and bridge restorations, the training requirements may be combined since the procedures are related. If this training is being completed separately, the same training requirements for fabrication, temporary cementation and removal of provisional restorations applies.

(11)Placement of intracoronal temporary restorative materials following preparation of a tooth by a dentist:

Goal: To place intracoronal temporary restorative materials following preparation of a tooth by a dentist.

Standard: Identify how, when and where to place intracoronal restorative materials.

Minimum training requirement: Two hours of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.

(12)Extraoral adjustment to acrylic dentures without making any adjustments to the prosthetic teeth:

Goal: To make adjustments to dentures.

Standard: Identify how and where to make extraoral adjustments to dentures.

Minimum training requirement: One hour of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.

(13)Tissue conditioning (soft reline only):

Goal: To apply appropriate material to dentures.

Standard: Identify how and where to apply appropriate material to dentures.

Minimum training requirement: One hour of didactic training, the equivalent of one hour of laboratory training that includes a minimum of two experiences, and clinical training that includes a minimum of five patient experiences under observational supervision.

c. A postcourse written examination at the conclusion of the training program, with a minimum of ten questions per function, must be administered. Participants must obtain a score of 75 percent or higher on each examination administered.

23.7(4) Grandfathering. Any dental hygienist or dental assistant who has completed expanded function training prior to January 1, 2020, can continue to perform expanded function procedures for which training has been completed. For any expanded function procedures that are new, in whole or in part, additional training to satisfy the standard and minimum training requirement is required of the dental hygienist or dental assistant prior to performing the new expanded function procedure.