DEPARTMENT OF HEALTH

[Filed April 29, 2026, 8:40 a.m., effective May 30, 2026]

Effective Date of Rule: Thirty-one days after filing.

Purpose: Dental hygienist and dental assistant usage of silver diamine fluoride in school-based and school-linked programs and the requirement of participation in regional health coalition meetings.

The department of health (department), in consultation with the dental quality assurance commission and dental hygiene examining committee, is adopting amendments to WAC 246-814-020 Practices authorized, by adding clarifying language around the use of silver diamine fluoride in school settings and school-linked programs.

The department is also adopting amendments to WAC 246-814-030 Application process and documentation to training required for endorsement, to remove the requirement that dental assistants and their supervising dentists, as well as dental hygienists, participate in oral health coalition meetings.

Citation of Rules Affected by this Order: Amending WAC 246-814-020 and 246-814-030.

Statutory Authority for Adoption: RCW 18.29.210, 18.29.220, and 43.70.650.

Adopted under notice filed as WSR 26-02-062 on January 6, 2026.

Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 2, Repealed 0.

Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.

Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 2, Repealed 0.

Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 2, Repealed 0.

Date Adopted: April 27, 2026.

Kristin Peterson, JD

for Dennis E. Worsham

AMENDATORY SECTION(Amending WSR 18-21-048, filed 10/8/18, effective 11/8/18)

WAC 246-814-020Practices authorized.

(1) Dental hygienists. Solely for purposes of providing services under this chapter, dental hygienists holding endorsements under this chapter may assess by determining the need for (i.e., the absence of gross carious lesions and sealants) and acceptability of dental sealant or fluoride varnish treatment for children in school-based and school-linked programs. Dental hygienists may apply dental sealants and fluoride varnish treatments, including silver diamine fluoride, and may remove deposits and stains from the surfaces of teeth, without the supervision of a licensed dentist. This determination does not include or involve diagnosing conditions or constitute a dental examination.

(2) Dental assistants. A dental assistant is currently defined in RCW 18.260.010 as a person who is registered by the dental quality assurance commission to provide supportive services to a licensed dentist to the extent provided in chapter 18.260 RCW and under the close supervision of a dentist. Solely for purposes of this chapter, authorized dental assistants may apply dental sealants and fluoride varnish treatments, including silver diamine fluoride, to children in school-based and school-linked programs under the general supervision of a Washington state licensed dentist, as described in this chapter.

(a) Close supervision requires the supervising dentist to first determine the need for and acceptability of dental sealant and fluoride varnish treatments, refer the treatment and the dentist is continuously on-site and physically present in the treatment facility when the treatment is provided.

(b) General supervision requires the supervising dentist to first determine the need for and acceptability of dental sealant and fluoride varnish treatments, refer the treatment and the dentist does not have to be in the treatment facility when the treatment is provided.

(3) Dental assistants and their supervising dentists, as well as dental hygienists shall coordinate with local public health jurisdictions and local oral health coalitions prior to providing services under this chapter, consistent with RCW 18.29.220 and 18.32.226.

AMENDATORY SECTION(Amending WSR 18-21-048, filed 10/8/18, effective 11/8/18)

WAC 246-814-030Application process and documentation of training required to qualify for endorsement.

(1) The department has issued endorsements to all dental hygienists holding valid licenses on or before April 19, 2001, the effective date of RCW 18.29.220.

(2) Dental hygienists licensed after April 19, 2001, must obtain an endorsement to provide services under this chapter. Applicants must meet the additional requirements in RCW 18.29.220 and must submit the following to the department:

(a) Application for endorsement;

(b) Fee;

(d) Proof of the completion of training that has incorporated the Washington state department of health sealant/fluoride varnish program guidelines as described in WAC 246-814-040(3).

(3) Dental assistants employed by a Washington state licensed dentist on or before April 19, 2001, are not required to obtain an endorsement but may voluntarily do so without having to meet the additional requirements in RCW 18.32.226.

(4) Dental assistants employed by a Washington state licensed dentist for two hundred hours after April 19, 2001, must obtain an endorsement to provide services under this chapter. Applicants must meet the additional requirements in RCW 18.32.226 and must submit the following to the department:

(a) Application for endorsement;

(b) Fee;

(c) Proof of two hundred hours of employment as a dental assistant by a Washington state licensed dentist that has included theoretical and clinical training in the application of dental sealants and fluoride varnish treatments, verified by a declaration provided by the licensed dentist who provided the training; and

(d) Proof of completion of training that has incorporated the Washington state department of health sealant/fluoride varnish program guidelines as described in WAC 246-814-040(3).

(5) Dental assistants and their supervising dentists, as well as dental hygienists should use the Washington state department of health sealant/fluoride varnish guidelines described in WAC 246-814-040 and other protocols that may be in place for the geographic region when coordinating with local public health jurisdictions.

(((6) Dental assistants and their supervising dentists, as well as dental hygienists shall coordinate with established local oral health coalitions by participating in oral health coalition meetings that may be held in the geographical region.))