Source: http://register.dls.virginia.gov/details.aspx?id=5246
Timestamp: 2019-07-22 01:33:15
Document Index: 609562005

Matched Legal Cases: ['§ 54', '§ 54', '§ 54', '§ 54', '§ 54', '§ 54', '§ 54', '§ 54', '§ 54', '§ 54']

Vol. 32 Iss. 5 (Final Regulation) 18VAC60-30, Regulations Governing The Practice Of Dental Assistants November 02, 2015
18VAC60-30. Regulations Governing the Practice of Dental Assistants (adding 18VAC60-30-10 through 18VAC60-30-170).
Pursuant to a periodic review, the Board of Dentistry repeals its regulatory chapter governing all dental practices (18VAC60-20) and replaces it with four regulatory chapters derived from 18VAC60-20. Regulations Governing the Disciplinary Process (18VAC60-15) sets out provisions for recovery of disciplinary costs in a case in which there is a finding of a violation and for establishment of criteria for delegation of information fact-finding to an agency subordinate. Regulations Governing the Practice of Dentistry (18VAC60-21) includes provisions that are applicable to the licensure and practice of dentists and oral and maxillofacial surgeons. Regulations Governing the Practice of Dental Hygiene (18VAC60-25) include provisions that are applicable to the licensure and practice of dental hygienists. Regulations Governing the Practice of Dental Assistants (18VAC60-30) include provisions on dental practice that are applicable to the registration and practice of dental assistants. This action includes a reduction in fees for the renewal of licenses, registrations, certifications, and permits in 2016 adopted in a separate action.
A. Decision to delegate. In accordance with subdivision 10 of § 54.1-2400 of the Code [ of Virginia ], the board may delegate an informal fact-finding proceeding to an agency subordinate at the time a determination is made that probable cause exists that a practitioner may be subject to a disciplinary action. If delegation to a subordinate is not recommended at the time of the probable cause determination, delegation may be approved by the president of the board or his designee.
[ "AAOMS" means the American Association of Oral and Maxillofacial Surgeons. ]
[ "Analgesia" means the diminution or elimination of pain in the conscious patient. ]
[ "Conscious/moderate sedation" means a drug-induced depression of consciousness, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
"Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained. ]
[ "Mobile dental facility" means a self-contained unit in which dentistry is practiced that is not confined to a single building and can be transported from one location to another.
C. The following words and terms relating to supervision as used in this chapter shall have the following meanings unless the context clearly indicates otherwise: ]
[ "Enteral" means any technique of administration in which the agent is absorbed through the gastrointestinal tract or oral mucosa (i.e., oral, rectal, or sublingual).
"General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. ]
[ D. The following words and terms relating to sedation or anesthesia as used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"General anesthesia" means a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilator function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired. ]
"Minimal sedation" means a [ minimally depressed level of consciousness, produced by a pharmacological method, which retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilator and cardiovascular functions are unaffected. Minimal sedation includes "anxiolysis" (the diminution or elimination of anxiety through the use of pharmacological agents in a dosage that does not cause depression of consciousness) and includes "inhalation analgesia" (the inhalation of nitrous oxide and oxygen to produce a state of reduced sensibility to pain without the loss of consciousness) ].
[ "Mobile dental facility" means a self-contained unit in which dentistry is practiced that is not confined to a single building and can be transported from one location to another. ]
[ "Portable dental operation" means a nonfacility in which dental equipment used in the practice of dentistry is transported to and utilized on a temporary basis at an out-of-office location, including patients' homes, schools, nursing homes, or other institutions.
"Titration" means the incremental increase in drug dosage to a level that provides the optimal therapeutic effect of sedation. ]
B. In accordance with § 54.1-2721 of the Code a dentist shall display [ a his dental ] license where it is conspicuous and readable by patients in each dental practice setting. If a licensee practices in more than one office, a duplicate license obtained from the board may be displayed.
D. A dentist who administers conscious/moderate sedation, deep sedation, or general anesthesia in a dental office shall display his sedation or anesthesia permit issued by the board [ or certificate issued by AAOMS ].
[ 4. Dental teacher's license
5. 4. ] Dental [ full-time ] faculty license
[ $285 $400
6. 5. ] Dental temporary resident's license
[ 7. 6. ] Restricted volunteer license
[ 8. 7. ] Volunteer exemption registration
[ 9. 8. ] Oral maxillofacial surgeon registration
[ 10. 9. ] Cosmetic procedures certification
[ 11. 10. ] Mobile clinic/portable operation
[ 12. 11. ] Conscious/moderate sedation permit
[ 13. 12. ] Deep sedation/general anesthesia permit
[ H. For the renewal of licenses, registrations, certifications, and permits in 2016, the following fees shall be in effect:
8. Conscious/moderate sedation certification
$110 ]
A. A dentist shall not commit any act that violates provisions of the Code that reasonably relate to the practice of dentistry [ and dental hygiene ] including but not limited to:
1. Delegating any [ dental ] service or operation that requires the professional competence or judgment of a dentist [ or dental hygienist ] to any person who is not a licensed dentist or dental hygienist [ or a registered dental assistant II ].
C. Discounts and free offers. Discount and free offers for a dental service are permissible for advertising only when the nondiscounted or full fee [ , if any, ] and the final discounted fee are also disclosed in the advertisement. In addition, the time period for obtaining the discount or free offer must be stated in the advertisement. The dentist shall maintain documented evidence to substantiate the discounted fee or free offer.
D. Retention of [ broadcast ] advertising. A prerecorded [ or archived ] copy of all advertisements [ on radio or television ] shall be retained for a [ 12-month two-year ] period following the final appearance of the advertisement. The advertising dentist is responsible for making prerecorded [ or archived ] copies of the advertisement available to the board within five days following a request by the board.
2. Publishing an advertisement that fails to include the information and disclaimers required by this section; [ or ]
3. Publishing an advertisement that contains a false claim of professional superiority, contains a claim to be a specialist, or uses any terms to designate a dental specialty unless he is entitled to such specialty designation under the guidelines or requirements for specialties approved by the American Dental Association (Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists, [ October 2009 November 2013 ] ), or such guidelines or requirements as subsequently amended [ .; or ]
2. Records that have previously been transferred to another practitioner or health care provider or provided to the patient or his personal representative [ pursuant to § 54.1-2405 of the Code ]; or
3. Diagnosis and options discussed, including the risks and benefits of treatment or [ non-treatment nontreatment ] and the estimated cost of treatment options;
6. Radiographs, digital images, and photographs clearly labeled with patient name [ and, ] date taken [ , and teeth identified ];
7. Notation of each [ treatment rendered, the ] date of treatment and of the dentist, dental hygienist, and dental assistant II providing service;
11. The information required for the administration of [ moderate conscious/moderate ] sedation, deep sedation, and general anesthesia required in 18VAC60-21-260 D.
G. Records shall not be abandoned or otherwise left in the care of someone who is not licensed by the board except that, upon the death of a licensee, a trustee or executor of the estate may safeguard the records until they are transferred to a [ licensee licensed dentist ], are sent to the patients of record, or are destroyed.
The treating dentist shall submit a written report to the board within 15 calendar days following an unexpected patient event that occurred intra-operatively or during the first 24 hours immediately following the patient's departure from his facility, resulting in either a physical injury or a respiratory, cardiovascular, or neurological complication that [ was related to the dental treatment or service provided and that ] necessitated admission of the patient to a hospital or in a patient death. [ Any emergency treatment of a patient by a hospital that is related to sedation anesthesia shall also be reported. ]
A dentist may utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction at one and the same time. In addition, a dentist may permit through issuance of written orders for services [ , ] additional dental hygienists to practice under general supervision in a free clinic or a public health program, or on a voluntary basis.
18VAC60-21-140. [ Dental Delegation to dental ] hygienists.
1. Scaling, root planing, or gingival curettage of natural and restored teeth using hand instruments, slow-speed rotary instruments, ultrasonic devices, and [ athermal nonsurgical ] lasers, with any sedation or anesthesia administered [ by the dentist ].
1. Scaling, root planing, or gingival curettage of natural and restored teeth using hand instruments, slow-speed rotary instruments, ultrasonic devices, and [ athermal nonsurgical ] lasers with or without topical oral anesthetics.
A. Duties appropriate to the training and experience of the dental assistant and the practice of the supervising dentist may be delegated to a dental assistant I or II under [ the ] indirect [ or under general ] supervision [ required in 18VAC60-21-120 ], with the exception of those listed as nondelegable in 18VAC60-21-130, those which may only be delegated to dental hygienists as listed in 18VAC60-21-140, and those which may only be delegated to a dental assistant II as listed in 18VAC60-21-150.
B. Duties delegated to a dental assistant under general supervision shall be [ performed ] under the direction [ and indirect supervision ] of the dental hygienist who supervises the implementation of the dentist's orders by examining the patient, observing the services rendered by an assistant, and being available for consultation on patient care.
1. A final certified transcript of the grades from the college from which the applicant received the dental degree, dental hygiene degree or certificate, or post-doctoral degree or certificate [ as specified in 18VAC60-21-200 ];
3. A current report from the [ Healthcare Integrity and Protection Data Bank (HIPDB) and a current report from the National Practitioner U.S. Department of Health and Human Services National Practitioner ] Data Bank (NPDB).
An applicant for [ any type of unrestricted ] dental licensure shall be a graduate of and a holder of a diploma or a certificate from a dental program accredited by the Commission on Dental Accreditation of the American Dental Association, which consists of either a pre-doctoral dental education program or at least a 12-month post-doctoral advanced general dentistry program or a post-doctoral dental program of at least 24 months in any other specialty that includes a clinical component.
[ B. Teacher's license. A teacher's license shall be issued to any dentist certified to be on the faculty of an accredited dental program who meets the entry requirements of § 54.1-2713 of the Code.
C. Full-time faculty B. Faculty ] license. A faculty license shall be issued for the purpose of allowing dental practice as a [ full-time ] faculty member of an accredited dental program when the applicant meets the entry requirements of § 54.1-2713 of the Code.
3. A faculty license shall remain valid only while the holder is serving [ full time ] on the faculty of an accredited dental program in the Commonwealth. When any such license holder ceases to continue serving [ full time ] on the faculty of the dental school for which the license was issued, the licensee shall surrender the license, which shall be null and void upon termination of [ full-time ] employment.
4. The dean of the dental school shall notify the board within five working days of such termination of [ full-time ] employment.
[ D. C. ] Temporary licenses to persons enrolled in advanced dental education programs. A dental intern, resident, or post-doctoral certificate or degree candidate shall obtain a temporary license to practice in Virginia.
1. The applicant shall have successfully completed a D.D.S. or D.M.D. degree program required for admission to a clinical competency examination accepted by the board. Submission of a letter of confirmation from the registrar of the school or college conferring the professional degree, or official transcripts confirming the professional degree and date the degree was received [ , ] is required.
[ E. D. ] Restricted volunteer license.
a. Held an unrestricted license in Virginia or another [ state U.S. jurisdiction ] as a licensee in good standing at the time the license expired or became inactive;
[ F. E. ] Registration for voluntary practice by out-of-state licensees. Any dentist who does not hold a license to practice in Virginia and who seeks registration to practice on a voluntary basis under the auspices of a publicly supported, all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people shall:
B. Every person holding an active or inactive license [ ; and those holding ] a permit to administer conscious/moderate sedation, deep sedation, or general anesthesia [ ; or a full-time faculty license ] shall annually, on or before March 31, renew his license or permit. Every person holding a [ teacher's faculty ] license, temporary resident's license, a restricted volunteer license, or a temporary permit shall, on or before June 30, request renewal of his license.
1. All renewal applicants shall attest that they have read and understand and will remain current with the laws and regulations governing the practice of dentistry and dental hygiene in Virginia. [ Continuing education credit may be earned for passage of the online Virginia Dental Law Exam. ]
2. A dentist shall maintain current training certification in basic cardiopulmonary resuscitation [ with hands-on airway training for health care providers ] or basic life support unless he is required by 18VAC60-21-290 or 18VAC60-21-300 to hold current certification in advanced life support with hands-on simulated airway and megacode training for health care providers.
1. The American Dental Association and the National Dental Association, their constituent and component/branch associations, and approved [ continuing education ] providers;
6. The Academy of General Dentistry, its constituent and component/branch associations, and approved [ continuing education ] providers;
14. The Dental Assisting National Board [ and its affiliate, the Dental Auxiliary Learning and Education Foundation ]; or
15. A regional testing agency (i.e., Central Regional Dental Testing Service, Northeast Regional Board of Dental Examiners, Southern Regional Testing Agency, [ Council of Interstate Testing Agencies, ] or Western Regional Examining Board) when serving as an examiner.
F. All licensees are required to maintain original documents verifying the date and subject of the program or activity, the sponsor, and the amount of time earned. Documentation [ must shall ] be maintained for a period of four years following renewal.
G. A licensee who has allowed his license to lapse, or who has had his license suspended or revoked, [ must shall ] submit evidence of completion of continuing education equal to the requirements for the number of years in which his license has not been active, not to exceed a total of 45 hours. Of the required hours, at least 15 must be earned in the most recent 12 months and the remainder within the 36 months preceding an application for reinstatement.
4. [ Pre-operative Preoperative ] vital signs;
E. Pediatric patients. No sedating medication shall be prescribed for or administered to a [ child patient ] 12 years of age or younger prior to his arrival at the dentist office or treatment facility.
H. Emergency management.
[ 1. ] If a patient enters a deeper level of sedation than the dentist is qualified and prepared to provide, the dentist shall stop the dental procedure until the patient returns to and is stable at the intended level of sedation.
[ 2. A dentist in whose office sedation or anesthesia is administered shall have written basic emergency procedures established and staff trained to carry out such procedures. ]
1. Training and hold current certification in basic resuscitation techniques with hands-on airway training for health care providers, such as Basic Cardiac Life Support for Health Professionals or [ an approved, a ] clinically oriented course devoted primarily to responding to clinical emergencies offered by an approved provider of continuing education as set forth in 18VAC60-21-250 C; or
[ L. A dentist who allows the administration of general anesthesia, deep sedation, or conscious/moderate sedation in his dental office is responsible for assuring that:
1. The equipment for administration and monitoring, as required in subsection B of 18VAC60-21-291 or subsection C of 18VAC60-21-301, is readily available and in good working order prior to performing dental treatment with anesthesia or sedation. The equipment shall either be maintained by the dentist in his office or provided by the anesthesia or sedation provider; and
2. The person administering the anesthesia or sedation is appropriately licensed and the staff monitoring the patient is qualified. ]
18VAC60-21-280. Administration of minimal sedation [ (anxiolysis or inhalation analgesia) ].
B. No sedating medication shall be prescribed for or administered to a [ child patient ] 12 years of age or younger prior to his arrival at the dental office or treatment facility.
a. A dental hygienist with the training required by 18VAC60-25-90 C to [ parenterally ] administer Schedule VI local anesthesia to persons 18 years of age or older; or
2. Blood pressure, oxygen saturation, respiratory rate, [ and ] pulse [ , and heart rate ] shall be monitored intraoperatively.
[ 5. If any other pharmacological agent is used in addition to nitrous oxide/oxygen and a local anesthetic, requirements for the induced level of sedation must be met. ]
2. Enteral administration only. A dentist may be issued a conscious/moderate sedation permit to administer only by an enteral method if he has completed a continuing education program that meets the requirements of 18VAC60-21-250 and consists of not less than 18 hours of didactic instruction plus 20 [ clinically-oriented clinically oriented ] experiences in enteral or a combination of enteral and nitrous oxide/oxygen conscious/moderate sedation techniques. The course content shall be consistent with the ADA's Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry in effect at the time the training occurred. The certificate of completion and a detailed description of the course content must be maintained.
3. A dentist who self-certified his qualifications in anesthesia and moderate sedation prior to January 1989 may [ continue to administer only conscious/moderate sedation until September 14, 2012. After September 14, 2012, be issued a temporary conscious/moderate sedation permit to continue to administer only conscious/moderate sedation until [ one year from the effective date of regulations for sedation permits May 7, 2015. After May 7, 2015, ] a dentist shall meet the requirements for and obtain a conscious/moderate sedation permit to administer by any method or by enteral administration only.
18VAC60-21-291. Requirements for administration of [ conscious/moderation conscious/moderate ] sedation.
1. A dentist [ not qualified who does not hold a permit ] to administer conscious/moderate sedation shall only use the services of a qualified dentist or an anesthesiologist to administer such sedation in a dental office. In a licensed outpatient surgery center, a dentist [ not qualified who does not hold a permit ] to administer conscious/moderate sedation shall use either a qualified dentist, an anesthesiologist, or a certified registered nurse anesthetist to administer such sedation.
2. A [ qualified ] dentist [ who holds a permit ] may administer or use the services of the following personnel to administer conscious/moderate sedation:
3. If minimal sedation is self-administered by or to a patient 13 years of age or older before arrival at the dental office, the dentist may only use the personnel listed in subdivision 2 of this subsection to administer local anesthesia. No sedating medication shall be prescribed for or administered to a [ child patient ] 12 years of age or younger prior to his arrival at the dentist office or treatment facility.
4. Preceding the administration of conscious/moderate sedation, a [ qualified permitted ] dentist may use the services of the following personnel under indirect supervision to administer local anesthesia to [ numb anesthetize ] the injection or treatment site:
[ 5. A dentist who delegates administration of conscious/moderate sedation shall ensure that:
a. All equipment required in subsection B of this section is present, in good working order, and immediately available to the areas where patients will be sedated and treated and will recover; and
b. Qualified staff is on site to monitor patients in accordance with requirements of subsection D of this section. ]
B. Equipment requirements. A dentist who administers conscious/moderate sedation shall [ maintain have available ] the following equipment [ in sizes for adults or children as appropriate for the patient being treated and shall maintain it ] in working order and immediately available to the areas where patients will be sedated and treated and will recover:
1. Full face mask [ for children or adults, as appropriate for the patient being treated or masks ];
3. Endotracheal tubes [ for children or adults, or both, ] with appropriate connectors or other appropriate airway management adjunct such as a laryngeal mask airway;
11. Electrocardiographic monitor [ if a patient is receiving parenteral administration of sedation or if the dentist is using titration ];
2. Blood pressure, oxygen saturation, [ and ] pulse [ , and heart rate ] shall be monitored continually during the administration and recorded every five minutes.
3. [ Patients The patient ] shall be discharged with a responsible individual who has been instructed with regard to the patient's care.
A. After March 31, 2013, no dentist may employ or use deep sedation or general anesthesia in a dental office unless he has been issued a permit by the board. The requirement for a permit shall not apply to an oral and maxillofacial surgeon who maintains membership in [ the American Association of Oral and Maxillofacial Surgeons (AAOMS) AAOMS ] and who provides the board with reports that result from the periodic office examinations required by AAOMS. Such an oral and maxillofacial surgeon shall be required to post a certificate issued by AAOMS.
4. A copy of current certification in [ Advanced Cardiac Life Support for Health Professionals ( ] ACLS [ ) ] or [ Pediatric Advanced Life Support for Health Professionals ( ] PALS [ ) ] as required in subsection C of this section.
3. Current certification in advanced resuscitative techniques with hands-on simulated airway and megacode training for health care providers, [ including basic electrocardiographic interpretations, ] such as courses in ACLS or PALS; and
3. Be given [ pre-operative preoperative ] verbal and written instructions including any dietary or medication restrictions.
1. A dentist [ not qualified to administer deep sedation or general anesthesia who does not meet the requirements of 18VAC60-21-300 ] shall only use the services of a [ qualified ] dentist [ who does meet those requirements ] or an anesthesiologist to administer deep sedation or general anesthesia in a dental office. In a licensed outpatient surgery center, a dentist [ not qualified to administer deep sedation or general anesthesia ] shall use either a [ qualified ] dentist [ who meets the requirements of 18VAC60-20-300 ], an anesthesiologist, or a certified registered nurse anesthetist to administer deep sedation or general anesthesia.
2. A [ qualified ] dentist [ who meets the requirements of 18VAC60-20-300 ] may administer or use the services of the following personnel to administer deep sedation or general anesthesia:
3. Preceding the administration of deep sedation or general anesthesia, a [ qualified ] dentist [ who meets the requirements of 18VAC60-20-300 ] may use the services of the following personnel under indirect supervision to administer local anesthesia to [ numb anesthetize ] the injection or treatment site:
C. Equipment requirements. A dentist who administers deep sedation or general anesthesia shall [ maintain have available ] the following equipment [ in sizes appropriate for the patient being treated and shall maintain it ] in working order and immediately available to the areas where patients will be sedated and treated and will recover:
1. Baseline vital signs shall be taken and recorded prior to administration of any controlled drug at the facility to include: temperature, blood pressure, pulse, [ pulse oximeter, ] oxygen saturation, [ and ] respiration [ , and heart rate ].
2. The patient's vital signs [ and EKG readings ] shall be monitored, recorded every five minutes, and reported to the treating dentist throughout the administration of controlled drugs and recovery. When depolarizing medications are administered, temperature shall be monitored constantly.
3. Monitoring of the patient [ under undergoing ] deep sedation or general anesthesia is to begin prior to the administration of any drugs and shall take place continuously during administration, the dental procedure, and recovery from anesthesia. The person who administers the anesthesia or another licensed practitioner qualified to administer the same level of anesthesia must remain on the premises of the dental facility until the patient has regained consciousness and is discharged.
2. Post-operative instructions shall be given verbally and in writing. The written instructions shall include a 24-hour emergency telephone number [ for the dental practice ].
A. The failure to provide the information required in [ subsection A of 18VAC60-20-260 18VAC60-21-320 A ] may constitute unprofessional conduct and may subject the licensee to disciplinary action by the board.
(4) The American Medical Association approved for category 1, continuing medical education [ .; and ]
Mobile Dental Clinics ]
[ DOCUMENTS INCORPORATED BY REFERENCE (18VAC60-21)
Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists, November 2013, American Dental Association ]
[ "Nonsurgical laser" means a laser that is not capable of cutting or removing hard tissue, soft tissue, or tooth structure. ]
B. Posting of license. In accordance with § 54.1-2727 of the Code, a dental hygienist shall display a [ dental hygiene ] license where it is conspicuous and readable by patients. If a licensee is employed in more than one office, a duplicate license obtained from the board may be displayed.
[ G. For the renewal of licenses in 2016, the following fees shall be in effect:
$10 ]
7. Condensing, contouring, or adjusting any final, fixed, or removable prosthodontic appliance or restoration in the mouth with the exception of packing and carving amalgam and placing and shaping composite resins by dental assistants II with advanced training as specified in [ Part IV (18VAC60-25-130 et seq.) of this chapter 18VAC60-30-120 ];
1. Scaling, root planing, or gingival curettage of natural and restored teeth using hand instruments, slow-speed rotary instruments, ultrasonic devices, and [ athermal nonsurgical ] lasers with any sedation or anesthesia administered [ by the dentist ].
1. Scaling, root planning, or gingival curettage of natural and restored teeth using hand instruments, slow-speed rotary instruments, ultrasonic devices, and [ athermal nonsurgical ] lasers with or without topical oral anesthestics.
[ F. A dental hygienist employed by the Virginia Department of Health may provide educational and preventative dental care under remote supervision, as defined in § 54.1-2722 D of the Code, of a dentist employed by the Virginia Department of Health and in accordance with the protocol adopted by the Commissioner of Health for Dental Hygienists to Practice in an Expanded Capacity under Remote Supervision by Public Health Dentists, September 2012, which is hereby incorporated by reference. ]
A. Duties appropriate to the training and experience of the dental assistant and the practice of the supervising dentist may be delegated to [ a any ] dental assistant under the direction of [ a dentist or ] a dental hygienist practicing under general supervision as permitted in subsection B of this section, with the exception of those listed as nondelegable and those [ which that ] may only be delegated to dental hygienists as listed in 18VAC60-25-40 [ and those that may only be delegated to a dental assistant II as listed in 18VAC60-21-150 ].
1. Administer topical oral fluoride varnish to children aged six months to three years [ of age ] under an oral or written order or a standing protocol issued by a dentist or a doctor of medicine or osteopathic medicine pursuant to subsection V of § 54.1-3408 of the Code;
3. If qualified in accordance with subsection B or C of this section, administer Schedule VI nitrous oxide/inhalation analgesia and, to persons 18 years of age or older, Schedule VI [ parenterally ] local anesthesia [ parenterally ] under the indirect supervision of a dentist.
C. To administer [ both nitrous oxide/inhalation analgesia and, local anesthesia parenterally ] to patients 18 years of age or older, [ parenterally local anesthesia, ] a dental hygienist shall:
1. Successfully complete a didactic and clinical course leading to certification in administration of local anesthesia [ and nitrous oxide/inhalation analgesia ] that is offered by a CODA accredited dental or dental hygiene program, which includes a minimum of [ 36 28 ] didactic and clinical hours in the following topics:
i. Management of medical emergencies; [ and ]
[ j. Clinical experiences in maxillary and mandibular infiltration and block injections;
m. j. ] Clinical experiences in administering [ nitrous oxide and ] local anesthesia injections on patients.
2. Successfully complete an examination with a minimum score of 75% in the [ parenteral ] administration of [ nitrous oxide/inhalation analgesia and ] local anesthesia given by the accredited program.
5. Radiographs, digital images, and photographs clearly labeled with the patient's name [ and, ] date taken [ , and teeth identified ];
7. Notation of each [ treatment rendered, ] date of treatment [ , ] and the identity of the dentist and the dental hygienist providing service.
A. All applications for licensure by examination or credentials, temporary permits, or [ teacher's faculty ] licenses shall include:
3. A current report from the [ Healthcare Integrity and Protection Data Bank (HIPDB) and a current report from the National Practitioner U.S. Department of Health and Human Services National Practitioner ] Data Bank (NPDB); and
18VAC60-25-160. Temporary permit; [ teacher's faculty ] license.
B. The board may issue a [ teacher's faculty ] license pursuant to the provisions of § 54.1-2725 of the Code.
C. A dental hygienist holding a temporary permit or a [ teacher's faculty ] license issued pursuant to this section is subject to the provisions of this chapter and the disciplinary regulations that apply to all licensees practicing in Virginia.
A. An active dental hygiene license shall be renewed on or before March 31 each year. A [ teacher's faculty ] license, a restricted volunteer license, or a temporary permit shall be renewed on or before June 30 each year.
2. A dental hygienist who monitors patients under general anesthesia, deep sedation, or [ conscious conscious/moderate ] sedation [ or who administers nitrous oxide or nontopical local anesthesia ] shall complete four hours every two years of approved continuing education directly related to [ administration or ] monitoring of such anesthesia or sedation as part of the hours required for licensure renewal.
14. The Dental Assisting National Board [ and its affiliate, the Dental Auxiliary Learning and Education Foundation ]; [ or
15. 16. ] A regional testing agency (i.e., Central Regional Dental Testing Service, Northeast Regional Board of Dental Examiners, Southern Regional Testing Agency, [ Council of Interstate Testing Agencies, ] or Western Regional Examining Board) when serving as an examiner.
3. Licensees selected for audit [ must shall ] provide original documents certifying that they have fulfilled their continuing education requirements by the deadline date as specified by the board.
4. Licensees are required to maintain original documents verifying the date and the subject of the program or activity, the sponsor, and the amount of time earned. Documentation [ must shall ] be maintained for a period of four years following renewal.
[ DOCUMENTS INCORPORATED BY REFERENCE (18VAC60-25)
Protocol adopted by Virginia Department of Health for Dental Hygienists to Practice in an Expanded Capacity under Remote Supervision by Public Health Dentists, September 2012 ]
REGULATIONS GOVERNING THE PRACTICE OF DENTAL ASSISTANTS [ II ]
"Direction" means the level of supervision (i.e., [ immediate, ] direct, indirect or general) that a dentist is required to exercise with a dental hygienist, a dental assistant I, or a dental assistant II or that a dental hygienist is required to exercise with a dental assistant to direct and oversee the delivery of treatment and related services.
B. Posting of registration. A copy of the registration of a dental assistant II shall either be posted in an operatory in which the person is providing services to the public or in the patient reception area where it is clearly visible to patients and accessible for reading. [ If a dental assistant II is employed in more than one office, a duplicate registration obtained from the board may be displayed. ]
[ G. For the renewal of a dental assistant II registration in 2016, the fees shall be $35. ]
A. Duties appropriate to the training and experience of [ the any ] dental assistant and the practice of the supervising dentist may be delegated to a dental assistant I or II under [ the ] indirect [ or under general ] supervision [ required in 18VAC60-21-120 ], with the exception of those listed as nondelegable in 18VAC60-30-50, those which may only be delegated to dental hygienists as listed in 18VAC60-21-140, and those which may only be delegated to a dental assistant II as listed in 18VAC60-30-60.
B. Duties delegated to [ a any ] dental assistant under general supervision shall be under the direction of the dental hygienist who supervises the implementation of the dentist's orders by examining the patient, observing the services rendered by an assistant, and being available for consultation on patient care.
[ No dentist or dental hygienist shall permit a person not otherwise licensed by this board to A dental assistant I or II shall not ] place or expose dental x-ray film unless he has one of the following: (i) satisfactory completion of a radiation safety course and examination given by an institution that maintains a program in dental assisting, dental hygiene, or dentistry accredited by CODA; (ii) certification by the American Registry of Radiologic Technologists; or (iii) satisfactory completion of the Radiation Health and Safety Review Course provided by the Dental Assisting National Board or its affiliate and passage of the Radiation Health and Safety Exam given by the Dental Assisting National Board. Any certificate issued pursuant to satisfying the requirements of this section shall be posted in plain view of the patient.
[ 3. Conducting preliminary dental screenings in free clinics, public health programs, or a voluntary practice. ]
2. Radiographs, digital images, and photographs clearly labeled with the patient name [ and, ] date taken [ , and teeth identified ]; and
3. Notation of each [ treatment rendered, ] date of treatment and the identity of the dentist, the dental hygienist, or the dental assistant providing service.
[ 18VAC60-30-115. General application requirements.
A. All applications for registration as a dental assistant II shall include:
3. Attestation of having read and understood the laws and regulations governing the practice of dentistry and dental assisting in Virginia and of the applicant's intent to remain current with such laws and regulations. ]
B. To be registered as a dental assistant II, a person shall complete the following requirements from an educational [ institution that maintains a ] program [ in dental assisting, dental hygiene, or dentistry ] accredited by CODA:
[ 18VAC60-30-130. Registration certification. (Reserved.)
C. All applicants for registration as a dental assistant II shall be required to attest that they have read and understand and will remain current with the applicable Virginia dental and dental hygiene laws and the regulations of this board. ]
E. Following the renewal period, the board may conduct an audit of registrants to verify compliance. Registrants selected for audit [ must shall ] provide original documents certifying current certification.
[ F. Continuing education hours required by board order shall not be used to satisfy the requirement for registration renewal or reinstatement. ]
[ A. ] Any dental assistant II who holds a current, unrestricted registration in Virginia may upon a request on the renewal application and submission of the required fee be issued an inactive registration. The holder of an inactive registration shall not be entitled to perform any act requiring registration to practice as a dental assistant II in Virginia.
[ B. ] An inactive registration may be reactivated upon submission of evidence of current certification from the [ Dental Assisting National Board or a ] national credentialing organization recognized by the American Dental Association. [ An applicant for reactivation shall also provide evidence of continuing clinical competence, which may include (i) documentation of active practice in another state or in federal service or (ii) a refresher course offered by a CODA accredited educational program.
C. ] The board reserves the right to deny a request for reactivation to any registrant who has been determined to have committed an act in violation of § 54.1-2706 of the Code.
B. A dental assistant II who has allowed his registration to lapse or who has had his registration suspended or revoked must submit evidence of current certification from [ the Dental Assisting National Board or ] a credentialing organization recognized by the American Dental Association to reinstate his registration.
[ D. An applicant for reinstatement shall provide evidence of continuing clinical competence, which may include (i) documentation of active practice in another state or in federal service or (ii) a refresher course offered by a CODA accredited educational program. ]
VA.R. Doc. No. R10-2362; Filed October 2, 2015, 11:43 a.m.