HB 1514

Brief Description: Concerning advanced function dental auxiliaries.

Sponsors: Representatives Cody, Moeller, Green, Jinkins, Appleton and Pollet.

Hearing Date: 2/5/13

Staff: Jim Morishima (786-7191).

Background:

Dental Personnel in Washington.

Washington currently has a variety of credentialed providers who provide assistance to licensed dentists. For example:

• Dental hygienists remove deposits and stains from the surfaces of teeth, apply topical preventive or prophylactic agents, polish and smooth restorations, perform root planing and soft tissue curettage, and other operations and services delegated to them by a dentist. In order to be licensed, dental hygienists must complete an educational program, pass an examination, and fulfill continuing education requirements.

• Dental assistants are authorized to perform patient care and laboratory duties as authorized by the Dental Quality Assurance Commission (DQAC) in rule. Dental assistants must register with the DQAC.

• Expanded function dental auxiliaries may perform the duties of a dental assistant and may also perform coronal polishing, give fluoride treatments, apply sealants, place dental x-ray film and expose and develop the films, give the patient oral health instruction, place and carve direct restorations, and take final impressions. In order to be licensed, an expanded function dental auxiliary must complete a dental assistant education program and an expanded function dental auxiliary education program approved by the DQAC and pass an examination.

• Dental anesthesia assistants perform duties related to dental anesthesia under the supervision of an oral and maxillofacial surgeon or dental anesthesiologist. In order to be certified, a dental anesthesia assistant must complete a training course, complete a course in basic life support and cardiac pulmonary resuscitation, and provide the permit of the of the oral and maxillofacial surgeon or dental anesthesiologist where the dental anesthesia assistant will be performing his or her services.

The Dental Quality Assurance Commission.

The DQAC is the disciplining authority for dentists, dental assistants, expanded function dental auxiliaries, and dental anesthesia assistants. The DQAC consists of 16 members: 12 dentists, two public members, and two expanded function dental auxiliaries.

Mid-Level Dental Providers In Other States.

Other states have established mid-level dental providers who are authorized to provide a wide range of services. For example:

• Minnesota: In Minnesota, dental therapists and advanced dental therapists are authorized to perform a variety of tasks under the supervision of a dentist, including the administration of certain legend drugs and certain types of extractions. Dental therapists must possess a bachelor's or master's degree and pass an examination. Advanced dental therapists must possess a master's degree, complete additional training, and pass an additional examination. Dental therapists and advanced dental therapists are limited to practicing in settings that serve low-income, uninsured, and underserved populations.

• Alaska: In Alaska, dental health aide therapists are authorized provide a variety of services pursuant to an agreement with a supervising dentist, including fillings, preventive services, and uncomplicated extractions. A dental health aide therapist must have a high school education, complete a two-year educational/clinical program, and a perceptorship of at least 400 hours with a supervising dentist.

Summary of Bill:

A new profession is created: advanced function dental auxiliary. An advanced function dental auxiliary must meet the following requirements to be licensed by the DQAC:

• successful completion of either:

  • an expanded function dental auxiliary education program; or

  • a dental hygiene education program;

• successful completion of an advanced function dental auxiliary program (after completion of minimum work experience in a dental operatory);

• successful completion of a preceptorship of at least 400 hours under the close supervision and control of a dentist;

• successful completion of a written examination and a clinical examination;

• submission of proof of:

  • good moral character; and

  • the physical and mental capability to practice as an advanced function dental auxiliary with reasonable skill and safety; and

• other requirements to be determined by the DQAC, including continuing education.

The DQAC must adopt rules relating to the scope of advanced function dental auxiliary services. An advanced function dental auxiliary may perform the following services under the general supervisionof a dentist:

• oral health instruction and disease prevention education;

• preliminary charting of the oral cavity;

• making radiographs;

• mechanical polishing of restorations;

• application of topical preventive or prophylactic agents;

• pulp vitality testing

• application of temporary restorations;

• dressing changes;

• placement of temporary crowns;

• temporary recementing of crowns;

• suture removal;

• oral prophylaxis and removal of deposits and stains from the surfaces of the teeth;

• scaling; and

• gross debridement.

An advanced function dental auxiliary may perform the following services under the close supervisionof a dentist:

• tissue conditioning;

• administration of local anesthetic;

• administration of nitrous oxide;

• the placement and removal of space maintainers;

• cavity preparation;

• direct restoration of primary and permanent teeth;

• preparation and placement of pre-formed crowns;

• pulpotomies of primary teeth;

• indirect and direct pulp capping on permanent teeth;

• indirect pulp capping on primary teeth and direct pulp capping on primary teeth in cases of traumatic pulpal exposure or mechanical pulpal exposure;

• extractions of primary teeth with class III mobility;

• brush biopsies;

• permanent re-cementing of permanent crowns;

• non-surgical extractions of periodontally diseased permanent teeth with class III mobility if the teeth are erupted, are not impacted, are not fractured, and do not need to be sectioned for removal;

• taking final impressions; and

• dispensing and administering oral medications. The medications an advanced function dental auxiliary may dispense are limited by practice protocols established by the supervising dentist. The medications that may be administered are limited to non-narcotic analgesics, anti-inflammatories, preventive agents, and antibiotics, and may include sample drugs. Advanced function dental auxiliaries may not dispense narcotics.

Services provided by an advanced function dental auxiliary are subject to the direction and control of the supervising dentist, to applicable protocols established by the supervising dentist, and to rules established by the DQAC. The supervising dentist must examine the patient, make the diagnosis of the patient's dental condition, and determine the treatment to be provided. An advanced function dental auxiliary may not diagnose the dental condition of a patient or independently determine the treatment to be provided.

An advanced function dental auxiliary must work within the parameters of a written practice agreement with a dentist. If the supervisory relationship ends, the advanced function dental auxiliary must discontinue practice until a new agreement is established. Practice agreements must be submitted to the DQAC and made available upon request. The practice agreement must include the delegated functions the advanced function dental auxiliary may perform and practice protocols established by the supervising dentist. The protocols must, at a minimum, contain the following:

• protocols determining how the dentist delegates treatment after diagnosis;

• any limitations on the services or procedures that may be provided;

• a plan to manage medical emergencies and specific written protocols governing situations within the advanced function dental auxiliary's scope of practice; and

• protocols for allowing dental assistants and expanded function dental auxiliaries to assist advanced function dental auxiliaries.

An advanced function dental auxiliary must wear a badge identifying his or her profession whenever he or she is treating patients. An advanced function dental auxiliary may not be presented in a manner that would tend to mislead patients or the public as to his or her title. Patient consent must include specific disclosure of the services that will be provided by the advanced function dental auxiliary.

An advanced function dental auxiliary may only practice in federally qualified health centers approved by the DQAC. A dentist may supervise no more than two advanced function dental auxiliaries. By November 15, 2022, the DQAC must submit recommendations to the Legislature on maintaining, modifying, or removing these restrictions.

The membership of the DQAC is expanded by one dental auxiliary member (currently, two members must be expanded function dental auxiliaries). Of the three dental auxiliary members, one must be an expanded function dental auxiliary, one must be an advanced function dental auxiliary, and one may be either type of dental auxiliary.

The scope of practice of expanded function dental auxiliaries is expanded to include:

• dressing changes;

• suture removal;

• placement of temporary restorations;

• placement of temporary crowns;

• administration of local anesthesia;

• supragingival scaling;

• oral prophylaxis and removal of deposits and stains from the surfaces of the teeth; and

• gross debridement.

Appropriation: None.

Fiscal Note: Requested on January 30, 2013.

Effective Date: This bill takes effect 90 days after adjournment of the session in which the bill is passed, except for section 14 adding members to the DQAC, which takes effect on July 1, 2018, and sections 16 and 18 adding dental practitioners and dental hygiene practitioners to the Uniform Disciplinary Act and the definition of "practitioner" for purposes of sunrise reviews, which take effect on July 1, 2016.