Rhode Island Code of Regulations › Title 216 - Department of health › Chapter 40 - Professional licensing and facility regulation › Subchapter 05 - Professional Licensing › Part 2 - Dentists, Dental Hygienists, and Dental Assistants › Section 216-RICR-40-05-2.3 - Definitions

Current through June 14, 2024
A. Wherever used in this Part the following
				  terms shall be construed to mean:
1. "Act"
				  refers to R.I. Gen. Laws Chapter 5-31.1, entitled "Dentists and Dental
				  Hygienists". Also known as the Dental Practice Act.
2. "Adult" means a person thirteen (13) years
				  of age or older.
3. "Advisory
				  consultants" means those individuals appointed by the Board to serve as
				  advisory consultants to the Board in determining compliance with the statutory
				  and regulatory provisions of this Part, of applicants seeking a permit to
				  administer or to permit the administration of general anesthesia/deep sedation,
				  moderate sedation, minimal sedation or nitrous oxide sedation. Such consultants
				  may be Diplomates of the American Board of Oral and Maxillofacial Surgery,
				  Members or Fellows of the American Association of Oral and Maxillofacial
				  Surgeons, or Diplomates of the National Dental Board of Anesthesiology or the
				  American Dental Society of Anesthesiology, and may include a Board Certified
				  Anesthesiologist and a licensed dentist with experience in the administration
				  of general anesthesia/deep sedation, moderate sedation, minimal sedation or
				  nitrous oxide sedation.
4.
				  "Analgesia" means the diminution or elimination of pain.
5. "Biennial" means occurring every second
				  (2nd) year.
6. "Board" refers to
				  the Board of Examiners in Dentistry, or any committee or subcommittee thereof,
				  established in the Rhode Island Department of Health pursuant to the provisions
				  of the Act.
7. "Competency" means
				  displaying special skill or knowledge derived from training and
				  experience.
8. "Continuous" means
				  prolonged without any interruption at any time.
9. "DAANCE-certified maxillofacial surgery
				  assistant" means a person currently certified by the American Association of
				  Oral and Maxillofacial Surgeons to provide supportive anesthesia
				  care.
10. "DANB-certified
				  assistant" means a person currently certified by the Dental Assisting National
				  Board, Inc. (DANB), or its successor agency, holding the certified Dental
				  Assistant (CDA) certification in general dental assisting duties or another
				  DANB certification in a specific area of advanced or specialty practice, and
				  employed for the purpose of assisting a dentist in the performance of
				  procedures/duties related to dental care in accordance with the provisions of
				  this Part.
11. "Dental
				  administrator" means the Administrator of the Rhode Island Board of Examiners
				  in Dentistry.
12. "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.
13. "Dental assistant"
				  means a person not currently certified by the Dental Assisting National Board,
				  Inc. (DANB) holding the certified Dental Assistant (CDA) certification in
				  general dental assisting duties or another DANB certification in a specific
				  area of advanced or specialty practice, and employed for the purpose of
				  assisting a dentist in the performance of procedures/duties related to dental
				  care in accordance with the provisions of this Part.
14. "Dental auxiliary personnel" refers to a
				  dental hygienist, a public-health dental hygienist, a DANB-certified assistant,
				  a DAANCE-certified maxillofacial surgery assistant or a dental
				  assistant.
15. "Dental hygienist"
				  means an individual licensed under the provisions of the Act to practice dental
				  hygiene.
16. "Dental office or
				  facility" means a place, however named, where a dentist actively, regularly,
				  and personally practices dentistry, pursuant to the provisions of R.I. Gen.
				  Laws §
											5-31.1-1(16).
17. "Dentist" means an individual licensed
				  under the provisions of the Act to practice dentistry in Rhode
				  Island.
18. "Dentistry" means the
				  evaluation, diagnosis, prevention and/or treatment (non-surgical, surgical or
				  related procedures) of diseases, disorders and/or conditions of the oral
				  cavity, cranio-maxillofacial area and/or the adjacent and associated structures
				  and their impact on the human body, including any service or product that may
				  change the anatomy, appearance or arrangement of teeth provided by a dentist,
				  within the scope of his or her education, training and experience, in
				  accordance with the ethics of the profession and applicable law.
19. "Department" means the Rhode Island
				  Department of Health.
20. "Digital
				  scan" means a virtual computer generated replica of the hard and soft tissue of
				  the mouth using lasers or other optical scanning devices.
21. "Director" means the Director of the
				  Rhode Island Department of Health.
22. "Enteral" means any technique of
				  administration in which the agent is absorbed through the gastrointestinal
				  tract.
23. "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.
24. "Homebound" means an individual confined
				  to his or her home if the individual has a condition, due to illness or injury,
				  that restricts the ability of the individual to leave his or her home except
				  with the assistance of another individual or the aid of a supportive device or
				  if an individual has a condition such that leaving his or her home is medically
				  contraindicated. While an individual does not have to be bedridden to be
				  considered "confined to his home", the condition of the individual should be
				  such that there exists a normal inability to leave home and that leaving home
				  requires a considerable and taxing effort by the individual and/or
				  others.
25. "Immediately available"
				  means on site in the facility and available for immediate use.
26. "Impression" means an imprint or negative
				  likeness of teeth and/or other tissues of the oral cavity from which a positive
				  reproduction may be made.
27.
				  "Infection control" refers to policies and procedures used to minimize the risk
				  of spreading infections, within the dental healthcare setting. Compliance is
				  based on conformance with current recommendations developed by the Centers for
				  Disease Control and Prevention (CDC) and published in the document entitled
				  "Guidelines for Infection Control in Dental Health-Care Settings" and
				  incorporated in this Part.
28.
				  "Inhalation" means a technique of administration in which a gaseous or volatile
				  agent is introduced into the lungs and whose primary effect is due to the
				  absorption through the gas/blood interface.
29. "License", as used in this Part, is not
				  synonymous with "registration."
30.
				  "Local anesthesia" means the elimination of sensation, especially pain, in one
				  part of the body by the topical application or regional injection of a
				  drug.
31. "Minimal sedation" means
				  a state of sedation in which the patient is at a minimally depressed level of
				  consciousness. This state is produced through a pharmacological dosage less
				  than or equal to the U.S. FDA maximum recommended dose along with nitrous
				  oxide. Characteristics of minimal sedation include:
a. Patient retains the ability to
				  independently and continuously maintain an airway and respond normally to
				  tactile stimulation and verbal command;
b. Although cognitive function and
				  coordination may be modestly impaired, ventilatory and cardiovascular functions
				  are unaffected;
c. Patients whose
				  only response is reflex withdrawal from repeated painful stimuli would not be
				  considered to be in a state of minimal sedation;
d. If more than one enteral drug is
				  administered to achieve the desired effect, with or without the concomitant use
				  of nitrous oxide, the guidelines for moderate sedation must apply.
32. "Mobile dental facility" or
				  "MDF" means any self-contained facility where dentistry will be practiced which
				  may be driven, moved, towed, or transported from one location to another. See
				  definition of Portable Dental Operation in §
											2.3(A)(39)
				    of this Part.
33. "Mobile dental
				  facility (MDF) director" or "Portable dental operation (PDO) director" means a
				  dentist who is currently licensed to practice dentistry in the State of Rhode
				  Island or a public health dental hygienist practicing pursuant to R.I. Gen.
				  Laws §
											5-31.1-39 for the purposes of providing dental hygiene services in public health settings
				  who is responsible for dental services provided by the MDF or PDO.
34. "Mobile dental facility (MDF) permit
				  holder" or "portable dental operation (PDO) permit holder" means a dentist who
				  is currently licensed to practice dentistry in the State of Rhode Island or a
				  public health dental hygienist in whose name the MDF and/or PDO Facility Permit
				  is issued. Where the MDF or PDO is not wholly owned by a dentist(s) or public
				  health dental hygienist licensed to practice in the State of Rhode Island, the
				  owner(s) shall apply for a license to operate as a healthcare facility unless
				  the entity is exempt from such licensure.
35. "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.
36. "Nitrous oxide
				  sedation" means the administration of nitrous oxide to diminish or eliminate
				  the sensibility to pain in the conscious patient, designating in particular the
				  relief of pain without loss of consciousness. However, consciousness may be
				  moderately impaired.
37. "Operating
				  dentist" means the dentist with primary responsibility for providing dental
				  care.
38. "Parenteral" means a
				  technique of administration in which the drug bypasses the gastrointestinal
				  (GI) tract [i.e., intramuscular (IM), intravenous (IV), intranasal (IN),
				  submucosal (SC), intraosseous (IO)].
39. "Portable dental operation" or "PDO"
				  means any non-facility where dental equipment utilized in the practice of
				  dentistry is transported to and utilized on a temporary basis at an
				  out-of-office location. See related definitions under Mobile Dental Facility
				  (MDF).
40. "Public health dental
				  hygienist" or "PHDH" means a registered dental hygienist who holds a valid
				  license to practice in the State of Rhode Island and who has a minimum of three
				  (3) years of full-time or an equivalent four thousand five hundred (4500) hours
				  of clinical experience and who has the fulfilled the necessary training
				  requirements and who works in a public health setting pursuant to a written
				  collaborative agreement with a local or state government agency or institution
				  or a dentist who holds a valid license issued in the State of Rhode Island
				  pursuant to this Part.
41. "Public
				  health setting" includes, but is not limited to, residences of the homebound,
				  schools, Head Start programs, nursing homes and long-term care facilities,
				  licensed clinics, community health centers, hospitals, medical facilities,
				  prisons, residential treatment facilities, federal, state or local public
				  health programs, mobile dental facilities and portable dental
				  programs.
42. "Qualified dentist"
				  means a dentist providing sedation and anesthesia in compliance with this
				  Part.
43. "Qualified provider"
				  means a licensed healthcare provider providing sedation and anesthesia services
				  at a specific dental facility site holding the necessary Facility Host Permit
				  pursuant to § 2.11.4(E) of this Part, in compliance with applicable rules
				  and regulations for their profession.
44. "Supervision" includes four (4) types of
				  supervision for all dental auxiliary personnel as follows:
a. "Direct supervision" means the dentist is
				  in the dental office, personally diagnoses the condition to be treated,
				  personally authorizes the procedure(s)/duty(ies), remains in the dental office
				  while the procedure(s)/duty(ies) are being performed and examines the patient
				  before his/her dismissal.
b.
				  "General supervision" means the dentist has authorized the procedure/duty and
				  such is being carried out in accordance with his/her diagnosis and treatment
				  plan. The dentist does not have to be physically present in the dental office
				  when such treatment is being performed under general supervision.
c. "Indirect supervision" means the dentist
				  is in the dental office, personally diagnoses the condition to be treated,
				  personally authorizes the procedure(s)/duty(ies), and remains in the dental
				  office while the procedure(s)/duty(ies) is being performed by the dental
				  auxiliary.
d. "Direct visual
				  supervision" means supervision by an oral and maxillofacial surgeon (with a
				  permit to administer deep sedation and general anesthesia) by verbal command
				  and under direct line of sight.
45. "Time-oriented anesthesia record" means
				  documentation at appropriate time intervals of drugs, doses and physiologic
				  data obtained during patient monitoring.
46. "Titration" means administration of
				  incremental doses of an intravenous or inhalation drug until a desired effect
				  is reached.
47. "Transdermal" means
				  a route of administration whereby the active pharmacological ingredients are
				  transmitted across the skin.
48.
				  "Unprofessional conduct" shall include, but not be limited to, the provisions
				  of R.I. Gen. Laws §
											5-31.1-10,
				  and is further defined as failure to conform to the Category IC recommendations
				  of the Centers of Disease Control Guidelines for Infection Control in Dental
				  Health-Care Settings incorporated by reference at §
											2.2(A)   of
				  this Part, or its amendments.
49.
				  "Written collaborative agreement" or "WCA" means a written agreement that
				  complies with R.I. Gen. Laws §
											5   - 31.1-39(c). Written Collaborative
				  Agreement (WCA) with a Public Health Dental Hygienist is between a public
				  health dental hygienist and a local or state government agency or institution
				  or with a licensed dentist who holds a valid Rhode Island license and who
				  agrees to provide the appropriate level of communication and consultation with
				  the public health dental hygienist to ensure patient health and
				  safety.