Cal. Code Regs. Tit. 16, § 1109 - Approval of Curriculum Requirements for Radiographic Decision-Making and Interim Therapeutic Restoration Courses for the Registered Dental Hygienist (RDH), Registered Dental Hygienist in Alternative Practice (RDHAP), and Registered Dental Hygienist in Extended Functions (RDHEF)
(a) The Dental Hygiene Board of California
(Board) shall approve only those educational courses in Radiographic
Decision-Making (RDM) and Interim Therapeutic Restorations (ITR) for the
Registered Dental Hygienist (RDH), Registered Dental Hygienist in Alternative
Practice (RDHAP), and Registered Dental Hygienist in Extended Functions (RDHEF)
pursuant to Sections
1910.5,
1921,
and
1926.05
of the Business and Professions Code that continuously meet all course
requirements. Continuation of approval will be contingent upon compliance with
these requirements, in addition to the requirements set forth by sections
1104 through
1108 of Article 3 regarding
Educational Programs. Each approved course shall be subject to Board review at
any time for compliance with curriculum requirements. Course providers shall be
responsible for notifying the Board in writing of any changes to the course
content, physical facilities, and faculty within ten (10) days of such
changes.
(b) Approval of RDM or ITR
Educational Courses for the Student Enrolled in a Dental Hygiene Educational
Program (DHEP). To be approved, an educational program shall comply with the
following requirements:
(1) DHEP RDM Course
Requirements.
(A) A California DHEP shall
submit to the Board an "Application for Approval of a Course in Radiographic
Decision-Making for the Student in a Dental Hygiene Educational Program" DHBC
RDM-01 (New 07/21), hereby incorporated by reference;
(B) Submit a $300 application fee to the
Board; and
(C) The course shall be
sufficient in length for the students to develop competency in making decisions
regarding which radiographs to expose to facilitate diagnosis and treatment
planning by a dentist but shall be, at a minimum, four (4) hours in length and
include didactic, laboratory, and simulated clinical experiences.
(D) New or already approved DHEPs seeking to
incorporate or offer a stand-alone permit course in RDM shall submit to the
Board an "Application for Approval of a Course in Radiographic Decision-Making
for the Student in a Dental Hygiene Educational Program," DHBC RDM-01 (New
07/21) and a $300 application fee prior to instruction.
(2) DHEP ITR Course Requirements.
(A) A California DHEP shall submit to the
Board an "Application for Approval of a Course in Interim Therapeutic
Restorations for the Student in a Dental Hygiene Educational Program" DHBC
ITR-03 (New 07/21), hereby incorporated by reference; and
(B) Submit a $300 application fee to the
Board; and
(C) The course shall be
sufficient in length for the students to develop competency in placement of
protective restorations but shall be, at a minimum, sixteen (16) hours in
length, including four (4) hours of didactic training, four (4) hours of
laboratory training, and eight (8) hours of clinical training.
(D) New or already approved DHEPs seeking to
incorporate or offer a stand-alone permit course in ITR shall submit to the
Board an "Application for Approval of a Course in Interim Therapeutic
Restorations for the Student in a Dental Hygiene Educational Program" DHBC
ITR-03 (New 07/21) and a $300 application fee prior to
instruction.
(3) In
addition to the instructional components described in this subdivision, an RDM
or ITR DHEP educational course shall be established at the postsecondary
educational level.
(c)
Approval of RDM or ITR Continuing Educational (CE) Courses for the RDH, RDHAP,
and RDHEF. All courses must be approved by the Board before offered by the
provider. To be approved, an educational program shall comply with the
following requirements:
(1) RDM CE Course
Requirements.
(A) An applicant course
provider shall submit to the Board an "Application for Approval of a Continuing
Educational Course in Radiographic Decision-Making for the RDH, RDHAP, and
RDHEF" DHBC RDM-02 (New 07/21), hereby incorporated by reference; and
(B) Submit a $300 application fee to the
Board; and
(C) The course shall be
sufficient in length for the participants to develop competency in making
decisions regarding which radiographs to expose to facilitate diagnosis and
treatment planning by a dentist but shall be, at a minimum, four (4) hours in
length and include didactic, laboratory, and simulated clinical
experiences.
(2) ITR CE
Course Requirements.
(A) An applicant course
provider shall submit to the Board an "Application for Approval of a Continuing
Educational Course in Interim Therapeutic Restorations for the RDH, RDHAP, and
RDHEF" DHBC ITR-04 (New 07/21), hereby incorporated by reference; and
(B) Submit a $300 application fee to the
Board; and
(C) The course shall be
sufficient in length for the participants to develop competency in placement of
protective restorations but shall be, at a minimum, sixteen (16) hours in
length, including four (4) hours of didactic training, four (4) hours of
laboratory training, and eight (8) hours of clinical
training.
(3) In addition
to the instructional components described in subdivisions (c)(1) and (c)(2), a
program or course shall be established at a postgraduate educational
level.
(d) Requirements
for Approval of DHEP and CE RDM and ITR Courses.
(1) Administration.
To be approved, each course shall provide the resources necessary, including, but not limited to, equipment and facilities, to satisfy the educational requirements as specified in this section. Course providers shall be responsible for informing the Board of any changes in writing to the course content, physical facilities, and faculty within ten (10) days of such changes.
(2) Admission.
(A) To be eligible for admission to an RDM or
ITR Course for the Student in a DHEP, students shall:
(i) Be a student in good standing in a DHEP;
and
(ii) Possess current
certification in Basic Life Support (BLS) and Cardiopulmonary Resuscitation
(CPR) from the American Heart Association (AHA) or the American Red Cross
(ARC), or a provider approved by the American Dental Association's Continuing
Education Recognition Program (CERP) or the Academy of General Dentistry's
Program Approval for Continuing Education (PACE).
(B) To be eligible for admission to a CE
Course in RDM or ITR for the RDH, RDHAP, and RDHEF, participants shall:
(i) Possess a valid, active license as an
RDH, RDHAP, or RDHEF issued by the Board, and
(ii) Possess current certification in Basic
Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) from the American
Heart Association (AHA) or the American Red Cross (ARC), or a provider approved
by the American Dental Association's Continuing Education Recognition Program
(CERP) or the Academy of General Dentistry's Program Approval for Continuing
Education (PACE).
(3) Faculty. Didactic, laboratory,
preclinical, and clinical faculty, including the program or course director and
supervising dentist(s), shall:
(A) Possess a
valid, active California RDH, RDHAP, RDHEF license, or Doctor of Dental Surgery
(DDS) license, or Doctor of Dental Medicine (DMD) license with no disciplinary
actions in any jurisdiction to practice dental hygiene or dentistry;
(B) Possess current certification in Basic
Life Support (BLS) and Cardiopulmonary Resuscitation (CPR) from the American
Heart Association (AHA) or American Red Cross (ARC), or a provider approved by
the American Dental Association's Continuing Education Recognition Program
(CERP) or the Academy of General Dentistry's Program Approval for Continuing
Education (PACE);
(C) RDH, RDHAP,
and RDHEF faculty shall possess current licensure in RDM and ITR placement;
and
(D) Be calibrated in
instruction and grading of RDM and ITR as provided in
16 CCR
section
1105.1(c)(2).
(4) Facilities and Equipment.
(A) RDM and ITR Courses for the Student in a
DHEP.
Didactic instruction may take place in an in-person or an online environment. Each course shall have access to adequate equipment and facilities for lectures and testing.
Laboratory and clinical instruction shall be held at a physical facility. Physical facilities and equipment shall be maintained and replaced in a manner designed to provide students with a course that will meet the educational objectives set forth in this section. A physical facility shall have all the following:
(i) A patient
clinic area, laboratory, and a radiology area;
(ii) Access to equipment necessary to develop
dental hygiene skills in RDM and ITR duties; and
(iii) Infection control equipment shall be
provided as described in
16 CCR
section 1005.
(B) RDM CE Courses for the RDH, RDHAP, and
RDHEF.
Didactic instruction may take place in an in-person or an online environment. Each course shall have access to adequate equipment and facilities for lectures and testing and shall be maintained and replaced in a manner designed to provide participants with a course that will meet the educational objectives set forth in this section.
(C) ITR CE Courses for the RDH, RDHAP, and
RDHEF.
Didactic instruction may take place in an in-person or an online environment. Each course shall have access to adequate equipment and facilities for lectures and testing.
Laboratory and clinical instruction shall be held at a physical facility. Physical facilities and equipment shall be maintained and replaced in a manner designed to provide participants with a course designed to meet the educational objectives set forth in this section. A physical facility shall have all the following:
(i) A
patient clinic area, laboratory, and a radiology area;
(ii) Access to equipment necessary to develop
dental hygiene skills in ITR duties; and
(iii) Infection control equipment shall be
provided as described in
16 CCR
section 1005.
(5) Health and Safety. DHEP and CE course
providers shall comply with all local, state, and federal health and safety
laws and regulations.
(A) All students or
participants shall have access to the course's hazardous waste management plan
for the disposal of needles, cartridges, medical waste, and storage of oxygen
and nitrous oxide tanks.
(B) All
students or participants shall have access to the course's clinic and radiation
hazardous communication plan.
(C)
All students or participants shall receive a copy of the course's bloodborne
and infectious diseases exposure control plan, which shall include emergency
needlestick information.
(D)
Faculty shall review with each student or participant all requirements pursuant
to this section.
(6)
Curriculum and Learning Resources.
(A) RDM
didactic instruction shall include:
(i)
Caries Management by Risk Assessment (CAMBRA) concept;
(ii) Guidelines for RDM to include, but not
limited to, the following concepts of:
(a)
The American Dental Association's Guidelines on the Selection of
Patients for Dental Radiographic Examinations and
(b) The American Academy of Pediatric
Dentistry's Guidelines on Prescribing Dental
Radiographs.
(iii) The guidelines developed by Pacific
Center for Special Care at the University of the Pacific Arthur A. Dugoni
School of Dentistry (Pacific) for use in training for Health Workforce Pilot
Project (HWPP) #172. including:
(a)
Instruction on specific decision-making guidelines that incorporate information
about the patient's health, radiographic history, time span since previous
radiographs were taken, and availability of previous radiographs; and
(b) Instruction pertaining to the general
condition of the mouth, including extent of dental restorations present, and
visible signs of abnormalities, including broken teeth, dark stain within the
tooth, and visible holes in teeth.
(B) RDM laboratory instruction shall include
a review of clinical cases with instructor-led discussion about radiographic
decision-making in clinical situations.
(C) RDM simulated-clinical instruction shall
include case-based examination with various clinical situations where trainees
make decisions about which radiographs to expose and demonstrate competency to
faculty based on these case studies.
(D) Didactic instruction in ITR placement
shall include:
(i) Review of pulpal
anatomy.
(ii) Theory of adhesive
restorative materials used in the placement of adhesive protective
restorations, including mechanisms of bonding to tooth structure, handling
characteristics of the materials, preparation of the tooth prior to material
placement, and placement techniques.
(iii) Criteria used in clinical dentistry
pertaining to the use and placement of adhesive protective restorations, which
shall include, but not limited to:
(a) Patient
factors:
(1) According to the American
Society of Anesthesiologists Physical Status Classification, the patient is
Class III or less;
(2) The patient
is cooperative enough to have the interim restoration placed without the need
for special protocols, including sedation or physical support;
(3) The patient, or responsible party, has
provided consent for the ITR procedure; and
(4) The patient reports that the tooth is
asymptomatic, or if there is mild sensitivity which stops within a few seconds
of the removal of the offending stimulus.
(b) Tooth Factors:
(1) The lesion is accessible without the need
for creating access using a dental handpiece;
(2) The margins of the lesion are accessible
so that clean, non-involved margins can be obtained around the entire periphery
of the lesion with the use of hand instrumentation;
(3) The depth of the lesion is more than two
millimeters from the pulp on radiographic examination or is judged by the DDS
or DMD to be a shallow lesion such that the treatment does not endanger the
pulp or require the use of local anesthetic; and
(4) The tooth is restorable and does not have
other significant pathology.
(iv) Theory of protocols to deal with adverse
outcomes used in the placement of adhesive protective restorations, including
mechanisms of bonding to tooth structure, handling characteristics of the
materials, preparation of the tooth prior to material placement, and placement
techniques;
(v) Criteria for
evaluating successful completion of adhesive protective restorations,
including, but not limited to, restorative material not in hyper occlusion, no
marginal voids, and minimal excess material;
(vi) Protocols for adverse outcomes after ITR
placement, including, but not limited to; exposed pulp, tooth fracture,
gingival tissue injury, high occlusion, open margins, tooth sensitivity, rough
surface, complications, or unsuccessful completion of adhesive protective
restorations, including situations requiring immediate referral to a dentist;
and
(vii) Protocols for follow-up
of adhesive protective restorations, including, but not limited to, at least
two (2) follow-up examinations of the ITR within a twelve (12) month
period.
(E) Laboratory
instruction in ITR placement shall include placement of adhesive protective
restorations where students and participants demonstrate competency in this
technique on typodont teeth.
(F)
Clinical instruction in ITR shall include experiences where students and
participants demonstrate placement of ITRs under direct supervision of
faculty.
(G) Minimum ITR
Requirements.
(i) Laboratory instruction
shall include placement of ten (10) adhesive protective restorations where
students or participants demonstrate competency in this technique on typodont
teeth.
(ii) Clinical instruction
shall include experiences where students or participants demonstrate, at a
minimum, the placement of five (5) adhesive therapeutic restorations that shall
be evaluated by the program faculty to criteria-referenced
standards.
(H) Curriculum
shall require adherence to infection control standards as provided in
16 CCR
section 1005.
(I) Curriculum shall prepare the student or
participant to assess, plan, implement, and evaluate procedures as provided in
subdivision (c)(6) of this section to perform with competence and
judgment.
(J) Students or
participants shall be provided a course syllabus that contains:
(i) Course learning outcomes;
(ii) Titles of references used for course
materials;
(iii) Content
objectives; and
(iv) Grading
criteria which includes competency evaluations and laboratory, preclinical, and
clinical rubrics to include problem solving and critical thinking skills that
reflect course learning outcomes.
(K) Successful completion shall require
students or participants to achieve competency at a minimum of 75% in each of
the competencies.
(7)
Recordkeeping.
DHEP and CE course providers shall possess and maintain the following for a period of not less than five (5) years:
(A) Individual student or participant
records, including those necessary to establish satisfactory completion of the
course;
(B) Copies of lab and
clinical competency documents;
(C)
Copies of faculty calibration plans, faculty credentials, licenses, and
certifications, including documented background in educational methodology
within the previous two years;
(D)
Copies of student or participant course evaluations and a summation thereof;
and
(E) Copies of curriculum,
including course syllabi, exams, sample test questions, and clinic
rubrics.
(e)
Satisfactory completion of courses in RDM and ITR placement shall be determined
using criteria-referenced completion standards, where the instructor determines
when the student or participant has achieved RDM and ITR placement competency
based on these standards, including the duration of time needed to achieve
competency. Any student or participant who does not achieve competency in these
duties in the specified period of instruction may receive additional education
and evaluation, or, in the judgment of the faculty, may be discontinued from
the RDM or ITR courses.
(f)
Certificates of Completion. Pursuant to the regulatory requirements set forth
by 16 CCR
section 1016, subdivision (h)(1), only after
a student or participant has successfully completed the requirements of a
course in RDM, ITR, or RDM and ITR, may a DHEP or course provider provide the
student or participant with an original "Certification of Completion of a
Course in Interim Therapeutic Restoration for the RDH, RDHAP, and RDHEF,"
"Certification of Completion of a Course in Radiographic Decision-Making for
the RDH, RDHAP, and RDHEF," or "Certification of Completion of a Course in
Radiographic Decision-Making and Interim Therapeutic Restorations for the RDH,
RDHAP, and RDHEF," as applicable.
(g) Appeals.
(1) The Board may deny or withdraw its
approval of a course for non-compliance with this section. If the Board denies
or withdraws approval of a course, the reasons for withdrawal or denial will be
provided in writing within sixty (60) business days.
(2) Any course provider or applicant whose
approval is denied or withdrawn shall be granted an informal conference before
the Executive Officer or his or her designee prior to the effective date of
such action. The applicant or course provider shall be given at least ninety
(90) business days' notice of the time and place of such informal conference
and the specific grounds for the proposed action.
(3) The applicant or course provider may
contest the denial or withdrawal of approval by either:
(A) Appearing at the informal conference. The
Executive Officer shall notify the course provider of the final decision of the
Executive Officer within thirty (30) business days of the informal conference.
Based on the outcome of the informal conference, the course provider may then
request a hearing to contest the Executive Officer's final decision. A course
provider shall request a hearing by written notice to the Board within thirty
(30) business days of the postmark date of the letter of the Executive
Officer's final decision after informal conference. Hearings shall be held
pursuant to the provisions of Chapter 5 (commencing with Section 11500) of Part
1 of Division 3 of Title 2 of the Government Code; or
(B) Notifying the Board in writing the course
provider's election to forego the informal conference and to proceed with a
hearing pursuant to the provisions of Chapter 5 (commencing with Section 11500)
of Part 1 of Division 3 of Title 2 of the Government Code. Such notification
shall be made to the Board before the date of the informal
conference.
Notes
Note: Authority cited: Sections 1905, 1906, and 1910.5, Business and Professions Code. Reference: Section 1910.5, Business and Professions Code.
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