DEPARTMENT OF HEALTH
(Dental Quality Assurance Commission)
[Filed June 18, 2019, 3:53 p.m.]
Supplemental Notice to WSR 19-03-072.
Preproposal statement of inquiry was filed as WSR 18-04-078.
Title of Rule and Other Identifying Information: WAC 246-817-550 Acts that may be performed by licensed dental hygienists under general supervision, supplemental notice to WSR 19-03-072. The dental quality assurance commission (commission) is proposing rule amendments add identified tasks from WAC 246-817-520, acts that may be performed by dental assistants under close supervision, to the list of allowable tasks that a dentist can delegate to dental hygienists under general supervision. This supplemental proposal removes orthodontic tasks.
Hearing Location(s): On July 26, 2019, at 9:35 a.m., at the Department of Health, Point Plaza East, Room 152/153, 310 Israel Road S.E., Tumwater, WA 98501.
Date of Intended Adoption: July 26, 2019.
Submit Written Comments to: Jennifer Santiago, P.O. Box 47852, Olympia, WA 98504, email https://fortress.wa.gov/doh/policyreview, fax 360-236-2901, by July 22, 2019.
Assistance for Persons with Disabilities: Contact Jennifer Santiago, phone 360-236-4893, fax 360-236-2901, TTY 360-833-6388 or 711, email email@example.com, by July 22, 2019.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rule amendments update the listing of allowable duties a dentist may delegate to a licensed dental hygienist under general supervision with the exception of orthodontic tasks that were previously proposed. A licensed dental hygienist has appropriate education and training to competently perform the tasks in the proposed rule amendments after a dentist has examined and diagnosed the patient and provided subsequent instructions to be performed without the dentist physically present in the office. Additionally, several tasks in the proposed rule amendments may provide more opportunities for teledentistry when a dentist is not required to be on site. This would allow a dentist and dental hygienist to provide dental care to patients unable to be physically in the dental office.
Reasons Supporting Proposal: The commission considered a rule request in July 2017 to allow dental hygienists to perform certain tasks under general supervision that are typically completed by dental assistants under close 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. Identifying a list of acceptable tasks that may be delegated by a licensed dentist to a licensed dental hygienist in rule establishes enforceable practice standards while ensuring patient safety. Because a general supervision list of tasks already exists in current rule, rule making is necessary to amend the rule to include proposed tasks which are currently allowed under close supervision. Stakeholder comments received during the March 1, 2019, hearing expressed concerns that several of the orthodontic tasks were inappropriate to delegate under general supervision. The commission determined four of the six orthodontic tasks require[d] examination, diagnosis, and treatment planning each time the task was performed.
The commission changed the original proposal to delete the following: Prepare teeth for the bonding of orthodontic appliances; bond attachments for clear removable orthodontic aligners; remove and replace archwires and orthodontic wires; and remove fixed orthodontic appliances, orthodontic cement, and orthodontic bonded resin material.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: 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.
A school district fiscal impact statement is not required under RCW 28A.305.135
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 98504-7852, phone 360-236-4893, fax 360-236-2901, TTY 360-833-6388 or 711, email firstname.lastname@example.org
The proposed rule does not impose more-than-minor costs on businesses. Following is a summary of the agency's analysis showing how costs were calculated. The proposed rule does not impose costs on businesses.
June 18, 2019
Julia Richman, DDS, Chairperson
Dental Quality Assurance Commission
AMENDATORY SECTION(Amending WSR 17-01-045, filed 12/13/16, effective 1/13/17)
WAC 246-817-550Acts that may be performed by licensed dental hygienists under general supervision.
A dentist may allow a dental hygienist licensed under 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.
(3) Record health histories.
(4) Take and record blood pressure and vital signs.
(5) Take intraoral and extraoral radiographs.
(6) Take intraoral and extraoral photographs.
(7) Patient education in oral hygiene.
(((4) Take intra-oral and extra-oral radiographs.
(5)))(8) Give preoperative and postoperative instructions.
(9) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth.
(10) Give fluoride treatments.
(11) Apply topical anesthetic agents.
(12) Deliver oral antibiotic prophylaxis as prescribed by a dentist.
(13) Place and remove the rubber dam.
(14) Apply topical preventive or prophylactic agents.
(((6)))(15) 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)))(16) Perform subgingival and supragingival scaling.
(17) Perform root planing.
(18) Apply sealants.
(19) Polish and smooth restorations.
(((8) Oral prophylaxis and removal of deposits and stains from the surfaces of the teeth.
(9) Record health histories.
(10) Take and record blood pressure and vital signs.
(11) Perform sub-gingival and supra-gingival scaling.
(12) Perform root planing.
(13) Apply sealants.
(14) Apply topical anesthetic agents.
(15) Deliver oral antibiotic prophylaxis as prescribed by a dentist.
(16)))(20) Sterilize equipment and disinfect operatories.
(21) Place retraction cord.
(22) 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.
(23) Take a facebow transfer for mounting study casts.
(24) Fabricate and deliver bleaching and fluoride trays.
(25) Fabricate, cement, and remove temporary crowns or temporary bridges.
(26) Place a temporary filling such as zinc oxide-eugenol or ZOE after diagnosis and examination by the dentist.
(27) Remove excess cement after the dentist has placed a permanent or temporary inlay, crown, bridge or appliance, or around orthodontic bands.
(28) Pack and medicate extraction areas.
(29) Place periodontal packs.
(30) Remove periodontal packs or sutures.
(31) Select denture shade and mold.
(32) Place and remove orthodontic separators.
(33) Select and fit orthodontic bands, try in fixed or removable orthodontic appliances prior to the dentist cementing or checking the appliance.