An Act To Improve Access to Oral Health Care
Maine Legislature, Session 126, LD 1230
Committee: Labor, Commerce, Research and Economic Development
Sponsors: EVES, SIROCKI, BURNS, BEAVERS, BOLAND, CAMPBELL, CASSIDY, CHIPMAN, CROCKETT, DAVIS, DUNPHY, EVANGELOS, FARNSWORTH, GATTINE, GIFFORD, GOODE, HAMANN, HARVELL, JORGENSEN, KESCHL, KINNEY, KNIGHT, KORNFIELD, LIBBY, MASTRACCIO, MORIARTY, ROTUNDO, SCHNECK, SHAW, SOCTOMAH, STUCKEY, THERIAULT, TURNER, WALLACE, CRAVEN, HASKELL, HILL, JACKSON, MAZUREK, PATRICK, PLUMMER, TUTTLE, WOODBURY

Legislative Document 
No. 1230 
H.P. 870 
House of Representatives, March 26, 2013 
An Act To Improve Access to Oral Health Care 
Reference to the Committee on Labor, Commerce, Research and Economic Development 
suggested and ordered printed. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Speaker EVES of North Berwick. 
Cosponsored by Representative SIROCKI of Scarborough, Senator BURNS of Washington 
and Representatives: BEAVERS of South Berwick, BOLAND of Sanford, CAMPBELL of 
Newfield, CASSIDY of Lubec, CHIPMAN of Portland, CROCKETT of Bethel, DAVIS of 
Sangerville, DUNPHY of Embden, EVANGELOS of Friendship, FARNSWORTH of 
Portland, GATTINE of Westbrook, GIFFORD of Lincoln, GOODE of Bangor, HAMANN of 
South Portland, HARVELL of Farmington, JORGENSEN of Portland, KESCHL of Belgrade, 
KINNEY of Limington, KNIGHT of Livermore Falls, KORNFIELD of Bangor, LIBBY of 
Waterboro, MASTRACCIO of Sanford, MORIARTY of Cumberland, ROTUNDO of 
Lewiston, SCHNECK of Bangor, SHAW of Standish, SOCTOMAH of the Passamaquoddy 
Tribe, STUCKEY of Portland, THERIAULT of Madawaska, TURNER of Burlington, 
WALLACE of Dexter, Senators: CRAVEN of Androscoggin, HASKELL of Cumberland, 
HILL of York, JACKSON of Aroostook, MAZUREK of Knox, PATRICK of Oxford, 
PLUMMER of Cumberland, TUTTLE of York, WOODBURY of Cumberland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  32 MRSA c. 16, sub-c. 3-C is enacted to read: 
SUBCHAPTER 3-C 
DENTAL HYGIENE THERAPIST 
§1094-AA.  Dental hygiene therapist 
A dental hygienist or independent practice dental hygienist licensed by the board 
pursuant to this chapter may practice as a licensed dental hygiene therapist to the extent 
permitted by this subchapter.  To qualify for licensure under this subchapter as a dental 
hygiene therapist, a person shall apply to the board on forms provided by the board, pay 
the application fee under section 1094-DD and demonstrate to the board that the 
applicant: 
1.  Licensure.  Possesses a valid license to practice dental hygiene or independent 
practice dental hygiene pursuant to this chapter or qualifies for licensure to practice by 
endorsement pursuant to section 1094-L; 
2.  Education and experience.  Has graduated from a dental hygiene therapy 
education program that: 
A.  Meets the standards adopted in this State for the certification of a degree-granting 
program in dental hygiene therapy at an accredited postsecondary institution; 
B.  Is consistent with the model curriculum for educating dental hygiene therapists 
adopted by the American Association of Public Health Dentistry, or a successor 
organization, is consistent with existing dental hygiene therapy programs in other 
states and is approved by the Commissioner of Health and Human Services and the 
Commissioner of Professional and Financial Regulation; and 
C.  Meets the requirements for dental hygiene therapy education programs adopted by 
the board; 
3.  Examination.  Has passed a comprehensive, competency-based clinical 
examination approved by the board and administered independently of an institution 
providing dental hygiene therapy education and has passed an examination of the 
applicant's knowledge of Maine laws and rules relating to the practice of dentistry; and 
4.  Supervised clinical practice.  Has completed 500 hours of supervised clinical 
practice under the supervision of a dentist licensed under this chapter and in conformity 
with rules adopted by the board, during which supervised clinical practice the applicant 
holds a provisional dental hygiene therapy license pursuant to section 1094-BB. 
§1094-BB.  Provisional dental hygiene therapy license 
The board shall issue a provisional dental hygiene therapy license to an applicant for 
licensure under this subchapter who has met the requirements of section 1094-AA, 
subsections 1 to 3 and rules adopted by the board and who has paid a fee established by 
the board of not more than $175.  During the period of provisional licensure the applicant 
shall maintain in good standing the applicant's license to practice as a dental hygienist or 
an independent practice dental hygienist.  During the period of provisional licensure the 
applicant may be compensated for services performed as a dental hygiene therapist. 
§1094-CC.  Dental coverage and reimbursement 
Any service performed by a dentist, dental assistant or dental hygienist licensed in 
this State that is reimbursed by private insurance, a dental service corporation, the 
MaineCare program under Title 22 or the Cub Care program under Title 22, section 
3174-T must also be covered and reimbursed when performed by a dental hygiene 
therapist authorized to practice under this subchapter. 
§1094-DD.  License; fees; discontinuation of license 
The board shall issue a license to practice as a dental hygiene therapist to an applicant 
for licensure under this subchapter who has met the requirements of this subchapter and 
rules adopted pursuant to the subchapter for licensure and has paid the application fee of 
not more than $175.  A dental hygiene therapist shall publicly exhibit the license at the 
therapist's place of business or employment.  The initial date of expiration of the license 
must be the original expiration date of the dental hygiene therapist's dental hygienist 
license issued by the board pursuant to subchapter 4 or, for an independent practice dental 
hygienist licensed by endorsement, January 1st of the first odd-numbered year following 
initial licensure.  On or before January 1st of each odd-numbered year, a dental hygiene 
therapist shall pay to the board a license renewal fee.  The board may renew the license of 
a dental hygiene therapist who meets the requirements for continued licensure and pays a 
renewal fee and a late fee by February 1st in the year in which renewal is due. The board 
shall suspend the license of a dental hygiene therapist who does not renew a license by 
February 1st in the year that renewal is due.  The board may renew the license of a dental 
hygiene therapist who pays a renewal fee and a reinstatement fee as required by the 
board.  
§1094-EE.  Continuing education 
As a condition of renewal of a license to practice under this subchapter, a dental 
hygiene therapist shall submit evidence of successful completion of 35 hours of 
continuing education in the 2 years prior to renewal.  Continuing education under this 
section must be in conformity with the provisions of section 1084-A and must include 
board-approved courses, including but not limited to a course in cardiopulmonary 
resuscitation.  The board may refuse renewal to an applicant who has not satisfied the 
requirements of this section or may renew a license on terms and conditions set by the 
board. 
§1094-FF.  Limitation of practice 
Upon completion of 500 hours of supervised clinical practice under section 1094-AA, 
subsection 4 a dental hygiene therapist may provide services within the scope of practice 
provided in section 1094-HH and under the general supervision of a dentist in the 
following health settings: a hospital; a clinic; a health center reimbursed as a federally 
qualified health center as defined in 42 United States Code, Section 1395x(aa)(4) (1993) 
or that has been determined by the federal Department of Health and Human Services, 
Centers for Medicare and Medicaid Services to meet the requirements for funding under 
Section 330 of the Public Health Service Act, 42 United States Code, Section 254(b); a 
federally qualified health center licensed in this State; a public health setting that serves 
underserved populations as recognized by the federal Department of Health and Human 
Services; a setting in a county designated as a dental shortage area by the federal 
Department of Health and Human Services; or a private dental practice that serves a 
population that is at least 25% patients covered by the MaineCare program under Title 22 
or underserved adults. 
§1094-GG.  Written practice agreement; standing orders 
A dental hygiene therapist may practice only under the supervision of a dentist who is 
licensed in this State and through a written practice agreement signed by both parties.  
For the purposes of this section, a written practice agreement is a signed document that, 
in conformity with the legal scope of practice provided in section 1094-HH, outlines the 
functions that the dental hygiene therapist is authorized to perform.  A dental hygiene 
therapist may practice only under the standing order of a dentist, may provide only care 
that follows written protocols and may provide only services that the dental hygiene 
therapist is authorized to provide by that dentist. 
1.  Limitation.  A dental hygiene therapist may provide services to a patient who has 
not first seen a dentist for an examination if the supervising dentist has given the dental 
hygiene therapist written authorization and standing protocols for the services and 
reviews the patient records at least once in a 12-month period, as provided in the written 
practice agreement.  The standing protocols may require the supervising dentist to 
personally examine patients either face-to-face or by the use of electronic means. 
2.  Minimum written practice agreement requirements.  A written practice 
agreement between a supervising dentist and a dental hygiene therapist must include the 
following elements: 
A.  The services and procedures and the practice settings for those services and 
procedures that the dental hygiene therapist may provide, together with any 
limitations on those services and procedures; 
B.  Any age-specific and procedure-specific practice protocols, including case 
selection criteria, assessment guidelines and imaging frequency; 
C.  Procedures to be used with patients treated by the dental hygiene therapist for 
obtaining informed consent and for creating and maintaining dental records; 
D.  A plan for review of patient records by the supervising dentist and the dental 
hygiene therapist; 
E.  A plan for managing medical emergencies in each practice setting in which the 
dental hygiene therapist provides care; 
F.  A quality assurance plan for monitoring care, including patient care review, 
referral follow-up and a quality assurance chart review; 
G.  Protocols for administering and dispensing medications, including the specific 
circumstances under which medications may be administered and dispensed; 
H.  Criteria for providing care to patients with specific medical conditions or complex 
medical histories, including requirements for consultation prior to initiating care; and 
I.  Specific written protocols, including a plan for providing clinical resources and 
referrals, governing situations in which the patient requires treatment that exceeds the 
scope of practice or capabilities of the dental hygiene therapist. 
3.  Responsibility.  The supervising dentist shall accept responsibility for all 
authorized services and procedures performed by the dental hygiene therapist pursuant to 
the written agreement.  A dental hygiene therapist who provides services or procedures 
beyond those authorized in the written agreement engages in unprofessional conduct for 
the purposes of this chapter. 
4.  Revision.  Revisions to the written practice agreement must be documented in a 
new written practice agreement signed by the supervising dentist and the dental hygiene 
therapist. 
5.  Requirements.  A supervising dentist and a dental hygiene therapist who sign a 
written practice agreement shall each file a copy of the agreement with the board, keep a 
copy for the dentist's or dental hygiene therapist's own records and make a copy available 
to patients of the dental hygiene therapist upon request.  The copy of the written practice 
agreement in the records of the board must be made available to the public upon request. 
§1094-HH.  Scope of practice 
A dental hygiene therapist may provide the care and services listed in this section and 
may provide them only under the general supervision of a dentist.  A dental hygiene 
therapist practicing under general supervision of a dentist may perform all duties of a 
dental hygiene therapist listed in rules adopted by the board.  A dental hygiene therapist 
who is licensed as a dental hygienist may perform all of the duties of a dental hygienist 
under this chapter.  A dental hygiene therapist who is licensed as an independent practice 
dental hygienist may perform all of the duties of an independent practice dental hygienist.  
A dental hygiene therapist may: 
1.  Assessments and treatments; preparations; restorations.  Perform oral health 
assessments, pulpal disease assessments for primary and young teeth, simple cavity 
preparations and restorations and simple extractions; 
2.  Crowns; space maintainers.  Prepare and place stainless steel crowns and 
aesthetic anterior crowns for primary incisors and prepare, place and remove space 
maintainers; 
3.  Referrals.  Provide referrals; 
4.  Anesthesia.  Administer local anesthesia and nitrous oxide analgesia; 
5.  Preventive services.  Perform preventive services; 
6.  Management of dental trauma, minor surgical care and suturing; extractions.  
Conduct urgent management of dental trauma, perform minor surgical care and suturing 
and extract primary and permanent teeth; 
7.  Prescribe.  Prescribe anti-inflammatories, analgesics, antimicrobials, antibiotics 
and anticaries materials in consultation with the supervising dentist or through standing 
orders from the supervising dentist; 
8.  Radiographs.  Administer radiographs; and 
9.  Other related services and functions.  Perform other related services and 
functions authorized by the supervising dentist and for which the dental hygiene therapist 
is trained. 
§1094-II.  Supervision of dental hygienists and dental assistants 
A dental hygiene therapist may supervise dental assistants and dental hygienists to 
the extent permitted in the written practice agreement entered into under section 
1094-GG.  A dental hygiene therapist may not supervise more than 3 dental assistants and 
dental hygienists in any one practice setting. 
§1094-JJ.  Referrals 
A supervising dentist shall arrange for another dentist or specialist to provide any 
services needed by a patient of a dental hygiene therapist supervised by that dentist that 
are beyond the scope of practice of the dental hygiene therapist and that the supervising 
dentist is unable to provide.  A dental hygiene therapist, in accordance with a written 
practice agreement entered into under section 1094-GG, shall refer patients to another 
qualified dental or health care professional to receive needed services that exceed the 
scope of practice of the dental hygiene therapist. 
§1094-KK.  Rulemaking 
The board shall adopt rules to implement this chapter.  Rules adopted pursuant to this 
section are major substantive rules as defined in Title 5, chapter 375, subchapter 2-A. 
Sec. 2.  Board of Dental Examiners.  By January 1, 2014, the Department of 
Professional and Financial Regulation, Board of Dental Examiners shall adopt rules 
setting requirements for dental hygiene therapy education programs.  Rules adopted 
pursuant to this section are routine technical rules as defined in Title 5, chapter 375, 
subchapter 2-A. 
SUMMARY 
This bill establishes a licensure process and scope of practice for dental hygiene 
therapists.  It requires the dental hygiene therapist to be supervised by a dentist licensed 
in this State.  It requires a written practice agreement between the supervising dentist and 
the dental hygiene therapist.  It provides rulemaking authority for the Board of Dental 
Examiners.