An Act To Amend the Dental Practice Act To Define "Supervision and Authorize Teledentistry
Maine Legislature, Session 130, LD 0076
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MATHIESON, BROOKS, MORALES
Amends: 32 MRSA §18302, 32 MRSA §18342, 32 MRSA §18371, 32 MRSA §18373, 32 MRSA §18374, 32 MRSA §18377, 32 MRSA §18394

Legislative Document
No. 76
H.P. 42
House of Representatives, January 13, 2021
An Act To Amend the Dental Practice Act To Define "Supervision" 
and Authorize Teledentistry
(EMERGENCY)
Submitted by the Department of Professional and Financial Regulation pursuant to Joint 
Rule 204.
Received by the Clerk of the House on January 11, 2021.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed pursuant to Joint Rule 401.
ROBERT B. HUNT
Clerk
Presented by Representative MATHIESON of Kittery.
Cosponsored by Representatives: BROOKS of Lewiston, MORALES of South Portland.
Emergency preamble.  Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and
Whereas, the sole purpose of the Board of Dental Practice is to protect the public 
health and welfare by ensuring that the public is served by competent and honest 
practitioners and by establishing minimum standards of proficiency; and
Whereas, pursuant to Public Law 2019, chapter 388, section 11, the Board of Dental 
Practice issued a legislative report dated January 31, 2020, making recommendations to 
further revise the Dental Practice Act by revising existing supervision and scopes of 
practice provisions, to consider technological advances such as the use of teledentistry to 
provide greater flexibility in the delivery of dental services and to improve access to dental 
care in Maine; and
Whereas, LD 2146, An Act To Implement the Recommendations of the Board of 
Dental Practice Related to the Definitions of "Supervision" and "Teledentistry," was 
introduced during the Second Regular Session of the 129th Legislature, but was not enacted 
due to the existing state of civil emergency due to the COVID-19 pandemic; and
Whereas, substantive policy decisions such as authorizing the use of teledentistry and 
refining scopes of practice, including levels of supervision, are appropriate for the 
legislative process, not an administrative rule-making process; and
Whereas, immediate enactment of this legislation is necessary to authorize dental 
professionals to fully exercise their scopes of practice and use available technologies to 
provide care; and
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore,
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  32 MRSA §18302, sub-§18, as enacted by PL 2015, c. 429, §21, is amended 
to read:
18.  Direct supervision.  "Direct supervision" means the supervision required by the 
board by rule of those tasks and procedures requiring the physical presence of the 
supervisor in the practice setting at the time such tasks or procedures are being performed. 
In order to provide direct supervision of patient treatment, the supervisor must at least 
identify or diagnose the condition to be treated, and authorize the treatment procedure prior 
to implementation and examine the condition after treatment and prior to the patient's 
discharge.
Sec. 2.  32 MRSA §18302, sub-§22, as enacted by PL 2015, c. 429, §21, is amended 
to read:
22.  General supervision.  "General supervision" means the supervision required by 
the board by rule of those tasks and procedures when that do not require the physical 
presence of the supervisor is not required in the practice setting while procedures are being 
performed but do require the tasks and procedures to be performed with the prior 
knowledge and consent of the supervisor.
Sec. 3.  32 MRSA §18302, sub-§35 is enacted to read:
35.  Supervision.  "Supervision" means either direct supervision or general supervision 
as determined by the tasks and procedures that are being performed in accordance with this 
chapter.
Sec. 4.  32 MRSA §18302, sub-§36 is enacted to read:
36.  Supervisor.  "Supervisor" means an individual licensed by the board and 
authorized to provide supervision under this chapter.
Sec. 5.  32 MRSA §18302, sub-§37 is enacted to read:
37.  Teledentistry.  "Teledentistry," as it pertains to the delivery of oral health care 
services, means the use of interactive, real-time visual and audio or other electronic media 
for the purposes of education, assessment, examination, diagnosis, treatment planning, 
consultation and directing the delivery of treatment by individuals licensed under this 
chapter and includes synchronous encounters, asynchronous encounters, remote patient 
monitoring and mobile oral health care in accordance with practice guidelines specified in 
rules adopted by the board.
Sec. 6.  32 MRSA §18342, sub-§6, ¶D, as enacted by PL 2015, c. 429, §21, is 
amended to read:
D.  A statement from the sponsoring supervising dentist that demonstrates that the level 
of supervision and control of the services to be performed by the applicant are adequate 
and that the performance of these services are within the applicant's dental knowledge 
and skill.
Sec. 7.  32 MRSA §18371, sub-§2, ¶E, as enacted by PL 2015, c. 429, §21, is 
amended to read:
E.  An individual with a resident dentist license may provide dental services only under 
the supervision of the sponsoring a dentist and in accordance with the level of 
supervision and control for which the license was issued by the board.
Sec. 8.  32 MRSA §18371, sub-§3, as amended by PL 2017, c. 388, §15, is repealed 
and the following enacted in its place:
3.  Delegation authorized.  A dentist may delegate to an unlicensed person or a 
licensed person activities related to dental care and treatment that are delegated by custom 
and usage as long as those activities are under the supervision or control of the dentist.  A 
dentist who delegates activities to an unlicensed person as described is legally liable for the 
activities of that unlicensed person and the unlicensed person in this relationship is 
considered the dentist's agent.
Sec. 9.  32 MRSA §18371, sub-§4, as amended by PL 2017, c. 288, Pt. A, §35, is 
further amended to read:
4.  Delegation not authorized.  A dentist may not delegate any dental activity not 
listed in subsection 3 or 6 to an unlicensed person activities related to dental care or 
treatment that require a license under this chapter.  A dentist may not delegate to a licensed 
person activities related to dental care or treatment that are outside the scope of practice of 
that licensed person.
Sec. 10.  32 MRSA §18373, sub-§1, as amended by PL 2017, c. 388, §17, is further 
amended to read:
1.  Scope of practice; direct supervision.  An expanded function dental assistant may 
perform under the direct general supervision of a dentist all of the activities that may be 
delegated by a dentist to an unlicensed person pursuant to section 18371, subsection 3, 
paragraph C.  An expanded function dental assistant may also perform the following 
activities authorized under the direct general supervision of a dentist:
A.  Apply cavity liners and bases as long as the dentist:
(1)  Has ordered the cavity liner or base; and
(2)  Has checked the cavity liner or base prior to the placement of the restoration; 
and
(3)  Has checked the final restoration prior to patient dismissal;
B.  Apply pit and fissure sealants after an evaluation of the teeth by the dentist at the 
time of sealant placement;
C.  Apply supragingival desensitizing agents to an exposed root surface or dentinal 
surface of teeth;
D.  Apply topical fluorides recognized for the prevention of dental caries;
E.  Cement provisional or temporary crowns and bridges and remove excess cement;
F.  Perform pulp vitality tests;
G.  Place and contour amalgam, composite and other restorative materials prior to the 
final setting or curing of the material;
I.  Place and remove gingival retraction cord;
K.  Size, place and cement or bond orthodontic bands and brackets with final inspection 
by the dentist;
L.  Supragingival polishing.  A dentist or a dental hygienist must first determine that 
the teeth to be polished are free of calculus or other extraneous material prior to 
polishing.  Dentists may permit an expanded function dental assistant to use only using 
a slow-speed rotary instrument and rubber cup.  Dentists may allow an expanded 
function dental assistant to use high-speed, power-driven handpieces or instruments to 
contour or finish newly placed composite materials; and
M.  Obtain impressions for athletic mouth guards, provisional or temporary crowns and 
bridges.
HH.  Contour or finish restorative materials using a high-speed, power-driven 
handpiece or instrument.
Sec. 11.  32 MRSA §18373, sub-§2, as amended by PL 2017, c. 388, §17, is 
repealed.
Sec. 12.  32 MRSA §18374, as amended by PL 2017, c. 388, §§18 and 19, is further 
amended to read:
§18374.  Dental hygienist
1.  Scope of practice; direct supervision.  A dental hygienist and faculty dental 
hygienist may perform the following procedures under the direct supervision of a dentist:
A.  Administer local anesthesia or nitrous oxide analgesia, as long as the dental 
hygienist or faculty dental hygienist has authority to administer the relevant medication 
pursuant to section 18345, subsection 2, paragraph D or E;.
B.  Irrigate and dry root canals;
C.  Record readings with a digital caries detector and report them to the dentist for 
interpretation and evaluation;
D.  Remove socket dressings;
E.  Take cytological smears as requested by the dentist; and
F.  Obtain impressions for nightguards and occlusal splints.
2.  Scope of practice; general supervision.  A dental hygienist and faculty dental 
hygienist may perform under the general supervision of a dentist all of the activities that 
may be delegated to an unlicensed person pursuant to section 18371, subsection 3, except 
the activities in section 18371, subsection 3, paragraph C, subparagraphs (6), (17) and (19).  
A dental hygienist and faculty dental hygienist may also perform the following procedures 
under the general supervision of a dentist:
A.  Prescribe, dispense or administer anticavity toothpastes or topical gels with 1.1% 
or less sodium fluoride and oral rinses with 0.05%, 0.2%, 0.44% or 0.5% sodium 
fluoride, as well as chlorhexidine gluconate oral rinse;
C.  Apply desensitizing agents to teeth;
D.  Apply fluoride to control caries;
F.  Apply sealants;
J.  Expose and process radiographs;
O.  Interview patients and record complete medical and dental histories;
R.  Obtain bacterial sampling when treatment is planned by the dentist;
S.  Perform all procedures necessary for a complete prophylaxis, including root 
planing;
U.  Perform complete periodontal and dental restorative charting;
X.  Perform oral inspections, recording all conditions that should be called to the 
attention of the dentist;
Y.  Perform postoperative irrigation of surgical sites;
CC.  Place and remove gingival retraction cord without vasoconstrictor;
GG.  Place localized delivery of chemotherapeutic agents when treatment is planned 
by the dentist;
JJ.  Place temporary restorations as an emergency procedure, as long as the patient is 
informed of the temporary nature of the restoration; and
LL.  Prepare tooth sites and surfaces with a rubber cup and pumice for banding or 
bonding of orthodontic brackets. This procedure may not be interpreted as a 
preparation for restorative material;
TT.  Smooth and polish amalgam restorations; and.
VV.  Obtain impressions for study casts, athletic mouth guards, custom trays, bleaching 
trays, fluoride trays, opposing models, retainers and stents.
3.  Limitation.  An individual with a faculty dental hygienist license may provide the 
services described in this section only as part of the education program for which the license 
was issued by the board.
Sec. 13.  32 MRSA §18377, sub-§1, as amended by PL 2019, c. 388, §10, is further 
amended to read:
1.  Scope of practice.  A dental therapist may perform the following procedures in 
limited practice settings, if authorized by a written practice agreement with a dentist 
licensed in this State pursuant to subsection 3.
A.  To the extent permitted in a written practice agreement, a dental therapist may 
provide the care and services listed in this paragraph only under the direct supervision 
of the supervising dentist:
(1)  Perform oral health assessments, pulpal disease assessments for primary and 
young teeth, simple cavity preparations and restorations and simple extractions;
(2)  Prepare and place stainless steel crowns and aesthetic anterior crowns for 
primary incisors and prepare, place and remove space maintainers;
(3)  Provide referrals;
(4)  Administer local anesthesia and nitrous oxide analgesia;
(5)  Perform preventive services;
(6)  Conduct urgent management of dental trauma, perform suturing, extract 
primary teeth and perform nonsurgical extractions of periodontally diseased 
permanent teeth if authorized in advance by the supervising dentist; and
(7)  Provide, dispense and administer anti-inflammatories, nonprescription 
analgesics, antimicrobials, antibiotics and anticaries materials;.
(8)  Administer radiographs; and
(9)  Perform other related services and functions authorized by the supervising 
dentist and for which the dental therapist is trained.
B.  To the extent permitted in a written practice agreement, a dental therapist may 
provide the care and services listed in identified in section 18371, subsection 3 and 
section 18374, subsections 1 and 2 under the general supervision of the supervising 
dentist.
Sec. 14.  32 MRSA §18394 is enacted to read:
§18394.  Teledentistry
An individual licensed under this chapter may provide oral health care services and 
procedures authorized under this chapter or by rule using teledentistry.  The board shall 
adopt by rule guidelines and practice standards for the use of teledentistry, including, but 
not limited to, practice requirements for protecting patient rights and protocols for referrals, 
quality and safety, informed consent, patient evaluation, treatment parameters, patient 
records, prescribing, supervision and compliance with data exchange standards for the 
security and confidentiality of patient information.  Rules adopted pursuant to this section 
are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Emergency clause.  In view of the emergency cited in the preamble, this legislation 
takes effect when approved.
SUMMARY
This bill implements the recommendations of the Board of Dental Practice that were 
included in the report required by Public Law 2019, chapter 388.  The bill makes the 
following changes:
1.  It makes changes to the definitions of "direct supervision" and "general supervision" 
and makes corresponding changes to the activities that may be performed under direct or 
general supervision by a person licensed by the Board of Dental Practice.
2.  It makes changes to provisions governing the delegation authority of dentists to 
unlicensed persons and to persons licensed by the Board of Dental Practice.
3.  It adds a definition of "teledentistry" and authorizes oral health care services and 
procedures to be provided through teledentistry in accordance with rules adopted by the 
Board of Dental Practice.