WSR 16-19-079 PROPOSED RULES DEPARTMENT OF HEALTH (Dental Quality Assurance Commission) [Filed September 20, 2016, 10:31 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 15-23-005.
Title of Rule and Other Identifying Information: WAC 246-817-550 Acts that may be performed by licensed dental hygienists under general supervision and 246-817-560 Acts that may be performed by licensed dental hygienists under close supervision, the proposed rules add three new tasks under general supervision, and clarifies when close or general supervision is appropriate for administering local anesthetic.
Hearing Location(s): Department of Health, Point Plaza East, Room 152/153, 310 Israel Road S.E., Tumwater, WA 98501, on October 28, 2016, at 8:05 a.m.
Date of Intended Adoption: October 28, 2016.
Submit Written Comments to: Jennifer Santiago, P.O. Box 47852, Olympia, WA 98504-7852, e-mail https://fortress.wa.gov/doh/policyreview, fax (360) 236-2901, by October 21, 2016.
Assistance for Persons with Disabilities: Contact Jennifer Santiago by October 21, 2016, TTY (800) 833-6388 or 711.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rules update the listing of allowable duties a dentist may delegate to a licensed dental hygienist under general and close supervision. The proposed rules add three new tasks to general supervision and duplicate one task from close supervision in general supervision. Close supervision requires the dentist to be physically present in the treatment facility during the performance of a delegated task while general supervision does not.
Reasons Supporting Proposal: Dental hygienists routinely treat patients under general supervision. The commission evaluated and researched dental hygienist education and training related to administering local anesthetic and medical emergencies. The commission determined dental hygienists are properly trained. Adding administering local anesthetic under general supervision will better serve dental patients with consistent treatment and appointment availability. RCW 18.29.050 allows the commission to adopt rules to identify specific allowable impressions that may be performed by dental hygienists.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Washington state dental quality assurance commission, governmental.
Name of Agency Personnel Responsible for Drafting, Implementation, and Enforcement: Jennifer Santiago, 111 Israel Road S.E., Tumwater, WA 98501, (360) 236-4893.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed rule would not impose more than minor costs on businesses in an industry.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Jennifer Santiago, P.O. Box 47852, Olympia, WA 98501, phone (360) 236-4893, fax (360) 236-2901, e-mail jennifer.santiago@doh.wa.gov.
September 20, 2016
C. Madden, Chair
Dental Quality Assurance Commission
AMENDATORY SECTION (Amending WSR 14-12-057, filed 5/30/14, effective 6/30/14)
WAC 246-817-550 Acts that may be performed by licensed dental hygienists under general supervision.
A dentist may allow a dental hygienist licensed under ((the provisions of)) chapter 18.29 RCW to perform the following acts under the dentist's general supervision:
(1) Head and neck examination.
(2) Oral inspection and measuring of periodontal pockets, with no diagnosis.
(((2))) (3) Patient education in oral hygiene.
(((3))) (4) Take intra-oral and extra-oral radiographs.
(((4))) (5) Apply topical preventive or prophylactic agents.
(((5))) (6) Administer local anesthetic agents and adjunctive procedures if all conditions in (a) through (d) of this subsection are met. Adjunctive procedures include local anesthetic reversal agents and buffered anesthetic.
(a) The patient is at least eighteen years of age;
(b) The patient has been examined by the delegating dentist within the previous twelve months;
(c) There has been no change in the patient's medical history since the last examination. If there has been a change in the patient's medical history within that time, the dental hygienist must consult with the dentist before administering local anesthetics;
(d) The delegating dentist who performed the examination has approved the patient for the administration of local anesthetics by a dental hygienist under general supervision and documented this approval in the patient's record;
(e) If any of the conditions in (a) through (d) of this subsection are not met, then close supervision is required.
(7) Polish and smooth restorations.
(((6))) (8) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth.
(((7))) (9) Record health histories.
(((8))) (10) Take and record blood pressure and vital signs.
(((9))) (11) Perform sub-gingival and supra-gingival scaling.
(((10))) (12) Perform root planing.
(((11))) (13) Apply sealants.
(((12))) (14) Apply topical anesthetic agents.
(15) Deliver oral antibiotic prophylaxis as prescribed by a dentist.
(16) Take impressions, bite registration, or digital scans of the teeth and jaws for:
(a) Diagnostic and opposing models;
(b) Fixed and removable orthodontic appliances, occlusal guards, bleaching trays, and fluoride trays; and
(c) Temporary indirect restorations such as temporary crowns.
AMENDATORY SECTION (Amending WSR 06-14-018, filed 6/23/06, effective 7/24/06)
WAC 246-817-560 Acts that may be performed by licensed dental hygienists under close supervision.
In addition to the acts ((performed under)) allowed in WAC 246-817-520 and 246-817-550, a dentist may allow a dental hygienist licensed under ((the provisions of)) chapter 18.29 RCW to perform the following acts under the dentist's close supervision:
(1) Perform soft-tissue curettage.
(2) ((Give injections of a local anesthetic.)) Administer local anesthetic agents and adjunctive procedures.
(a) General supervision is allowed if all conditions in WAC 246-817-550 (6)(a) through (d) are met.
(b) Adjunctive procedures include local anesthetic reversal agents and buffered anesthetic.
(3) Place restorations into the cavity prepared by the dentist, and thereafter could carve, contour, and adjust contacts and occlusion of the restoration.
(4) Administer nitrous oxide analgesia.
(5) Place antimicrobials.
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