Tenn. Comp. R. & Regs. 0460-05-.02 - SCHOOLS, PROGRAMS, AND COURSES FOR THE DENTAL HYGIENIST

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(1) Dental Hygiene Schools.

(a) Reserved.

(b) Reserved.

(2) Certification Course in Administration & Monitoring of Nitrous Oxide

(a) Application for Board Approval - The owner and/or director of a certification course in administration and monitoring of nitrous oxide shall make application for approval to operate that course of study on forms to be provided by the Board. The completed application must be received in the Board's Office at least thirty (30) days prior to the next regularly scheduled Board meeting in order for the Board to review the application. The owner and/or director of the certification course will be notified in writing of the Board's action(s). This section shall also apply to all dental hygiene schools.

(b) Retention of Approval.

1. The certification course, whether offered independently or as a part of the curriculum taught by a dental hygiene school, shall maintain strict compliance with all minimum standards for admissions, facilities, instructor(s), equipment, and curriculum as set forth in this rule, as amended/may be amended, in order to obtain and/or retain Board approval.

2. The certification course shall be subject to on-site inspections by representatives of the Board and/or required to complete such paper surveys, as requested.

3. The Board shall be notified immediately of any changes made in the operation of the certification course, such as change of location, directorship, and/ or instructors. A new certificate of approval will be issued in the event of change in either ownership or directorship of the course.

4. Certificates of approval shall be issued for one (1) year and shall expire on December 31^st of any given year.

1. The certification course shall admit only those dental hygienists who are currently licensed, pursuant to Rule 0460-03-.01, .02, or .03, or are currently enrolled in an ADA-accredited dental hygiene program which offers this course as a part of its curriculum.

2. The course shall be taught at an educational institution, defined as a school of dentistry, dental hygiene, or dental assisting, or a clinical facility approved by the Board which provides for proper patient care, including access to medication and equipment for the management of emergencies.

3. The certification course shall be taught by a Tennessee licensed dentist or a licensed dental hygienist with administration and monitoring certification and a minimum of three (3) years clinical experience in utilizing administration of nitrous oxide and education in comprehensive pain and anxiety control. The instructor/dentist may employ and/or utilize anesthesiologists, pharmacologists, internists, and/or cardiologists who are licensed in Tennessee as instructors to assist the instructor/dentist in the teaching of the course.

4. The clinical instructor-to-student ratio must be one (1) instructor to ten (10) students (1:10) with a class size no larger than fifty (50) students.

5. The certification course shall consist of fourteen (14) hours of study over a two (2) day period. The course syllabus must be approved by the Board and meet the following requirements:

(i) Didactic - The course shall be designed and conducted to provide the student with detailed knowledge of nitrous oxide - oxygen inhalation sedation, its use in dentistry, and the health hazards and abuse potential of nitrous oxide. The didactic portion of the course shall include instruction in all of the following subject matters:

(I) History, philosophy, psychology of nitrous oxide-oxygen inhalation sedation;

(II) Definitions and descriptions of the physiological and psychological aspects of pain and anxiety;

(III) Description of the stages of drug induced central nervous system depression, through all levels of consciousness and unconsciousness, with special emphasis on the difference between the conscious and unconscious state;

(IV) Anatomy and physiology of respiration;

(V) Pharmacological and physiological effects of nitrous oxide, including physical properties, action, side effects, absorption, excretion, and toxicity;

(VI) Advantages and disadvantages of inhalation sedation with nitrous oxide;

(VII) Discuss and review pediatric and adult respiration;

(VIII) Discuss and review circulatory physiology and related anatomy for pediatric and adult patients;

(IX) Management of reaction to, or complications with nitrous oxide;

(X) Taking and reviewing a thorough health history including:

I. Taking and reviewing vital signs;

II. Evaluating implications of the use of nitrous oxide based upon the patient's health history;

III. Reflexes related to consciousness;

IV. Possible reactions to nitrous oxide; and

V. Instruction for post-operative care;

(XI) Recognition, prevention and management of complications and life-threatening situations related to nitrous oxide;

(XII) Description and use of inhalation sedation equipment and appropriate physiologic monitoring and administration equipment;

(XIII) Legal considerations of nitrous oxide use;

(XIV) Discussion of sexual phenomena and hallucinatory effects reported with nitrous oxide;

(XV) Discussion of the potential for abuse of nitrous oxide;

(XVI) Recommended techniques for reducing occupational exposure to nitrous oxide; and

(XVII) An introduction of potential health hazards of trace anesthetics and proposed techniques for elimination thereof, including, but not limited to, recommendations and guidelines from the Centers for Disease Control (CDC) or the Occupational, Health, and Safety Administration (OSHA).

(ii) Clinical - The certification course shall afford participants with sufficient clinical experience to enable them to achieve competency. This experience must be provided under the supervision of qualified faculty, and the participants must be evaluated for competency. The clinical portion of the course shall be at least two (2) hours, including at least one (1) hour of demonstration by an instructor and hands on participation by students. The clinical experience shall include all significant portions of the didactic instruction including:

(I) Patient status assessment;

(II) Use of various equipment in the administration and monitoring of nitrous oxide;

(III) Introduction of sedation to a patient;

(IV) Monitoring of the patient; and

(V) Post-operative care of the patient and provision of instruction to the patient.

(d) The instructor shall provide a copy of the syllabus to the student before or at the beginning of each course, setting forth the materials to be presented in the course and the evaluation criteria to be utilized by the clinical instructor to determine successful completion of the certification course.

(e) Upon completion of the course, students shall be evaluated by written examination. The examination shall cover the didactic portion of the course. The passing grade is set at 75%. If the student initially fails the written examination, the exam may be taken no more than two (2) additional times before the course must be retaken and the exam retaken. The examination shall be developed and administered by the course director/instructor in such a manner as to determine competency for the administration and monitoring of nitrous oxide.

(f) The director/instructor of the certification course shall, within thirty (30) days after course completion or upon graduation from the dental hygiene school, complete a form, provided by the Board, for each student to attest to the student's successful completion of the course and the student's examination grade. The completed forms shall be submitted directly to the Board's Office by the Instructor/Director.

(g) The certification course, or dental hygiene school, will issue continuing education credit hours for the course.

(h) Failure to adhere to the rules governing the certification course or to provide access to inspection, pursuant to Rule 0460-05-.02 (2) (b), may subject the course provider and students to invalidation of the course results and withdrawal of course approval issued by the Board.

(3) Certification Course in Restorative Functions

(a) Application for Board Approval - The director of a certification course in restorative functions shall make application for approval to operate that course of study on forms to be provided by the Board. The completed application must be received in the Board's Office at least thirty (30) days prior to the next regularly scheduled Board meeting in order for the Board to review the application. The director of the certification course will be notified in writing of the Board's action(s).

(b) Retention of Approval.

1. The certification course must be taught at an educational institution as defined in part (3) (c) 2. of this rule and shall maintain strict compliance with all minimum standards for admissions, facilities, instructor(s), equipment, and curriculum as set forth in this rule, as amended/may be amended, in order to obtain and/or retain Board approval.

2. The certification course shall be subject to on-site inspections by representatives of the Board and/or required to complete such paper surveys, as requested.

3. The Board shall be notified immediately of any changes made in the operation of the certification course, such as change of location, directorship, and/or instructors. A new certificate of approval will be issued in the event of change in directorship of the course.

4. Certificates of approval shall be issued for two (2) years and shall expire on December 31st every two (2) years.

1. The certification course shall admit only those dental hygienists who are currently licensed, pursuant to Rule 0460-03-.01, .02, or .03, and who submit proof of a minimum of two (2) years continuous full-time employment within the past three (3) years in a dental practice as a dental hygienist.

2. The course shall be taught at an educational institution, defined as a school of dentistry or a school which offers a specialty program in a recognized specialty branch of dentistry.

3. The certification course shall be taught by one (1) or more Tennessee licensed dentists who are faculty members at an accredited school of dentistry.

4. The clinical instructor-to-student ratio must be one (1) instructor to eight (8) students (1:8).

5. The certification course shall consist of a minimum of ninety-six (96) hours of study over a three (3) week period.

6. The course syllabus shall be approved by the Board and the course shall be designed and conducted to provide the student with detailed knowledge of restorative functions. The clinical experience must be provided under the supervision of qualified faculty, and the students must be evaluated for competency. The didactic and clinical portions of the course shall include instruction in all of the following subject matters:

(i) First Week - The first (1st) week of the course must be a minimum of thirty-two (32) hours in length and a written and/or clinical competency examination is to be administered at the end of the week regarding:

(I) Dental morphology and occulusion;

(II) Dental materials, hazardous materials and product safety;

I. Amalgam;

II. Composite;

III. Glass Ionomer; and

IV. Mercury.

(III) Principles of cavity preparation on anterior and posterior class I, II, III, IV, and V teeth;

(IV) Instrumentation for all restorations;

(V) Liners and bases, types and placement;

(ii) Second Week - The second (2nd) week of the course must be a minimum of thirty-two (32) hours in length and a written and/or clinical competency examination regarding items (I) through (V) is to be administered at the end of the week. No high-speed handpiece is to be used in the course, only a slow-speed handpiece:

(I) Isolation and rubber dam placement;

(II) Caries;

(III) Selection and placement of matrix retainers;

(IV) Laboratory on insertion, packing and carving (finishing) of amalgam;

(V) Insertion, packing and carving (finishing) of amalgam;

(iii) Third Week - The third (3rd) week of the course must be a minimum of thirty-two (32) hours in length and a written and/or clinical competency examination regarding items (I) through (III) is to be administered at the end of the week. No high-speed handpiece is to be used in the course, only a slow-speed handpiece:

(I) Insertion, packing and carving (finishing) of amalgam;

(II) Laboratory on insertion, packing and carving (finishing) of composite and glass ionomers;

(III) Insertion, packing and carving (finishing) of composite and glass ionomers;

(iv) In addition to the weekly competency examinations required by subparts (i), (ii) and (iii), each student must pass a clinical examination regarding insertion, packing and carving (finishing) of amalgam prior to taking the comprehensive competency examination required by subpart (vi).

(v) Each student must pass the competency examination on the material covered each week before continuing to the material for the next week. Students who do not pass the competency examination may be offered remediation before the start of the next week.

(vi) Passage of a comprehensive competency examination on all material covered in the course is required at the end of the course. This examination shall be both written and clinical.

(e) The passing grade on each competency examination is set at seventy-five percent (75%). If the student initially fails any competency examination, the exam may be taken no more than one (1) additional time before the entire course must be retaken and the exam retaken. The examination shall be developed and administered by the course instructors in such a manner as to determine competency for the restorative functions.

(f) The director/instructor of the certification course shall, within thirty (30) days after course completion, complete a form, provided by the Board, for each student to attest to the student's successful completion of the course and the student's examination grade. The completed forms shall be submitted directly to the Board's Office by the director/instructor.

(g) The certification course will issue continuing education credit hours for the course.

(h) Failure to adhere to the rules governing the certification course or to provide access to inspection, pursuant to Rule 0460-05-.02 (3) (b), may subject the course provider and students to invalidation of the course results and withdrawal of course approval issued by the Board.

(4) Certification Course in Prosthetic Functions

(a) Application for Board Approval - The director of a certification course in prosthetic functions shall make application for approval to operate that course of study on forms to be provided by the Board. The completed application must be received in the Board's Office at least thirty (30) days prior to the next regularly scheduled Board meeting in order for the Board to review the application. The director of the certification course will be notified in writing of the Board's action(s).

(b) Retention of Approval.

1. The certification course must be taught at an educational institution as defined in part (4) (c) 2. of this rule and shall maintain strict compliance with all minimum standards for admissions, facilities, instructor(s), equipment, and curriculum as set forth in this rule, as amended/may be amended, in order to obtain and/or retain Board approval.

2. The certification course shall be subject to on-site inspections by representatives of the Board and/or required to complete such paper surveys, as requested.

3. The Board shall be notified immediately of any changes made in the operation of the certification course, such as change of location, directorship, and/or instructors. A new certificate of approval will be issued in the event of change in directorship of the course.

4. Certificates of approval shall be issued for two (2) years and shall expire on December 31st every two (2) years.

2. The course shall be taught at an educational institution, defined as a school of dentistry or a school which offers a specialty program in a recognized specialty branch of dentistry.

3. The certification course shall be taught by one (1) or more Tennessee licensed dentists who are faculty members at an accredited school of dentistry.

4. The clinical instructor-to-student ratio must be one (1) instructor to eight (8) students (1:8).

5. The certification course shall consist of a minimum of sixty-four (64) hours of study over a two (2) week period.

6. The course syllabus shall be approved by the Board and the course shall be designed and conducted to provide the student with detailed knowledge of prosthetic functions. The clinical experience must be provided under the supervision of qualified faculty, and the students must be evaluated for competency. The didactic and clinical portion of the course shall include instruction in all of the following subject matters:

(i) First Week - The first (1st) week of the course must be a minimum of thirty-two (32) hours in length and a competency examination is to be administered at the end of the week regarding:

(I) Anatomy and physiology;

(II) Dentulous soft tissue including the gingival sulcus and its management;

(III) Edentulous soft tissue;

(IV) Physiologic function of these tissues and the principles of soft tissue management;

(V) Occlusion for fixed and removable appliances;

(VI) Tray selection and impression materials of models;

(VII) Border molding and master impressions, including a live patient experience;

(VIII) Tray selection;

I. Custom;

II. Stock;

III. Triple tray; and

IV. Construction and fitting.

(IX) Fixed prosthodontic impressions;

I. Full mouth;

II. Quadrant; and

III. Individual.

(ii) Second Week - The second (2nd) week of the course must be a minimum of thirty-two (32) hours in length and a competency examination is to be administered at the end of the week regarding:

(I) Gingival retraction;

(II) Mechanisms of gingival retraction;

(III) Types and size of cord;

(IV) Pharmacology of medicaments used and the techniques for placement;

(V) Practice placement;

(VI) Techniques of making impressions;

(VII) Laboratory practice for fixed impressions including infection control;

(VIII) Temporary restorations and laboratory technique for each;

I. Aluminum;

II. Polycarbonate; and

III. Custom.

(IX) Fabrication, polishing and placement of temporary restorations;

I. Anterior; and

II. Posterior.

(iii) Each student must pass the competency examination on the material covered before continuing to the material for the next week. Students who do not pass the competency examination may be offered remediation; and

(iv) Passage of a comprehensive competency examination on all material covered in the course is required at the end of the course.

(g) The certification course will issue continuing education credit hours for the course.

(h) Failure to adhere to the rules governing the certification course or to provide access to inspection, pursuant to Rule 0460-05-.02 (4) (b), may subject the course provider and students to invalidation of the course results and withdrawal of course approval issued by the Board.

(5) Certification Course in Administration of Local Anesthesia

(a) Application for Board Approval - The director of a certification course in administration of local anesthesia shall make application for approval to operate that course of study on forms to be provided by the Board. The completed application must be received in the Board's Office at least thirty (30) days prior to the next regularly scheduled Board meeting in order for the Board to review the application. The director of the certification course will be notified in writing of the Board's action(s).

(b) Exemption from Board Approval - Dental hygiene programs accredited by the American Dental Association (ADA) Commission on Dental Accreditation which teach administration of local anesthesia to the level of clinical competency to the students enrolled in the associate, bachelor, or master degree program are exempt from obtaining Board approval.

1. Students who complete a course taught within their associate, bachelor, or master degree program shall have the program send an original letter on school letterhead signed by the program director attesting to successful completion of the course to the level of clinical competency.

2. Students shall submit the certification application and fee.

3. The certification will not be issued until the required information is received and the dental hygiene license has been issued.

1. The certification course must be taught at an educational institution and shall maintain strict compliance with all minimum standards for admissions, facilities, instructor(s), equipment, and curriculum as set forth in this rule, as amended/may be amended, in order to obtain and/or retain Board approval.

2. The certification course shall be subject to on-site inspections by representatives of the Board and/or required to complete such paper surveys, as requested.

3. The Board shall be notified immediately of any changes made in the operation of the certification course, such as change of location, directorship, and/or instructors. A new certificate of approval will be issued in the event of change in directorship of the course.

4. Certificates of approval shall be issued for two (2) years and shall expire on December 31st every two (2) years.

(d) Minimum Standards for Admissions, Facilities, Instructor(s), Equipment, and Curriculum.

1. The certification course shall admit only those dental hygienists who are currently licensed, pursuant to Rule 0460-03-.01, .02, or .03.

2. The certification course may only be taught by:

(i) Tennessee licensed dentists who are faculty members at an accredited school of dentistry or dental hygiene and who have experience teaching the administration of local anesthesia; or

(ii) Tennessee licensed dental hygienists with certification in the administration of local anesthesia who are faculty members at an accredited school of dentistry or dental hygiene and who have experience teaching the administration of local anesthesia. Such dental hygienist instructors may only teach the certification course while under the direct supervision of a qualified instructor-dentist.

3. The clinical instructor-to-student ratio must be one (1) instructor to six (6) students (1:6).

4. The certification course shall consist of a didactic section of twenty-four (24) hours and a clinical section of no less than eight (8) hours for a total of at least thirty-two (32) hours of study in administration of local anesthesia.

(i) Each student must pass a competency examination on the material covered in the didactic section before continuing to the clinical section of the course. Students who do not pass the competency examination may be offered remediation before the start of the clinical experience.

(ii) Passage of a clinical competency examination, including satisfactorily performing injections.

(iii) Upon successful completion of the course, the certification application and fee must be submitted by the student.

(iv) The director/instructor of the certification course shall, within ten (10) days after course completion submit a letter, on school letterhead, for each student which attests to the student's successful completion of the course and the student's examination grades. The completed forms shall be submitted directly to the Board's Administrative Office by the director/instructor.

(v) The student will be issued a temporary local anesthesia certification to complete a ninety (90) day extern in the office of the employer dentist(s). During the extern the following injections must be successfully completed:

(I) Minimum of fifteen (15) inferior alveolar blocks:

(II) Minimum of fifteen (15) posterior superior alveolar;

(III) Minimum of two (2) each of the following:

I. Middle superior alveolar;

II. Anterior superior alveolar;

III. Nasopalatine;

IV. Greater palatine;

V. Long buccal;

VI. Mental block; and

VII. Lingual block.

(vi) The employer/supervising dentist(s) must submit, on a form provided by the board, proof of successful completion of the injections required by subpart (5) (d) 4 (v) of this rule.

(vii) Upon receipt of proof of successful completion of the injections, the certification for administration of local anesthesia will be issued.

(viii) Extensions of the ninety (90) day temporary permit will be considered on a case-by-case basis upon receipt of written documentation stating the reason an extension is requested. The board consultant has the authority to grant or deny the request.

5. The course syllabus must be approved by the Board and meet the following requirements:

(i) Didactic Section - The didactic section shall be designed and conducted to provide the student with detailed knowledge of administration of local anesthesia, including didactic studies and clinical experience in the administration of posterior superior alveolar, middle superior alveolar, anterior superior alveolar, nasopalatine, greater palatine, long buccal, mental block, lingual block, inferior alveolar block and infiltration techniques, medical history and physical evaluation of the patient, and the prevention, diagnosis, and management of medical emergencies which can be encountered in the dental patient. The didactic section of the course shall include instruction in all of the following subject matters:

(I) Medical history evaluation procedures;

(II) Physical evaluation;

(III) Understanding pharmacology of local anesthesia and vasoconstrictors;

(IV) Anatomy of head, neck and oral cavity as it relates to administering local anesthetic agents;

(V) Indications and contraindications for administration of local anesthesia;

(VI) Selection and preparation of the armamentaria and record keeping for administering various local anesthetic agents;

(VII) Medical and legal management complications;

(VIII) Recognition and management of post-injection complications and management of reactions to injections;

(IX) Proper infection control techniques with regard to local anesthesia and proper disposal of sharps;

(X) Methods of administering local anesthetic agents with emphasis on:

I. Technique;

II. Aspiration;

III. Slow injection; and

IV. Minimum effective dosage;

(XI) Medical emergency, prevention, diagnosis, and management;

(XII) Instruction in the philosophy and psychology of the use of local anesthesia;

(XIII) A review of the physiology of nerve conduction;

(XIV) A review of regional anatomy;

(XV) A survey of local anesthetic agents on nerve conduction;

(XVI) A review of the metabolism and excretion of local anesthetics;

(XVII) Instruction on toxicity of local anesthetic drugs;

(XVIII) Instruction on the clinical manifestations of toxic reactions;

(XIX) Instruction on the treatment of toxic reactions;

(XX) Instruction on allergic reactions to local anesthetic drugs;

(XXI) Instruction on the clinical manifestations of allergic reactions;

(XXII) Instruction on the treatment of allergic reactions to local anesthetics;

(XXIII) Instruction regarding vasoconstrictor drugs used in local anesthetics;

(XXIV)Instruction on the clinical manifestations of toxic reactions to vasoconstrictor drugs used in local anesthesia;

(XXV) Instruction on the treatment of toxic reactions to vasoconstrictors used in local anesthesia;

(XXVI) Instruction on drug interactions related to local anesthesia;

(XXVII) Re-injecting when necessary; and

(XXVIII) Estimating the highest safe dosage of local anesthesia based upon the weight and/or age of the patient.

(ii) Clinical Section - The clinical section must be provided under the supervision of qualified faculty, and the students must be evaluated for competency. The clinical section of the course shall include instruction in all of the following subject matters:

(I) Evaluating the patient's health status;

(II) Taking the patient's vital signs;

(III) Administering local anesthetic infiltrations;

(IV) Administering local anesthetic nerve blocks; and

(V) Monitoring the patient's physical status while under the effects of local anesthetics.

(e) The instructor shall provide a copy of the syllabus to the student before or at the beginning of each course, setting forth the materials to be presented in the course and the evaluation criteria to be utilized by the clinical instructor to determine successful completion of the certification course.

(f) The passing grade on each competency examination is set at seventy per cent (70%). If the student initially fails any competency examination, the exam may be taken no more than one (1) additional time before the entire course must be retaken and the exam retaken. The examination shall be developed and administered by the course instructors in such a manner as to determine competency for the administration of local anesthesia.

(g) The certification course will issue continuing education credit hours for the course.

(h) Failure to adhere to the rules governing the certification course or to provide access to inspection, pursuant to subparagraph (5) (c) of this rule, may subject the course provider and students to invalidation of the course results and withdrawal of course approval issued by the Board.

Notes

Tenn. Comp. R. & Regs. 0460-05-.02

Original rule certified June 7, 1974. Amendment filed August 26, 1980; effective December 1, 1980. Repeal and new rule filed December 11, 1991; effective January 25, 1992. Repeal filed February 12, 1996; effective April 27, 1996. New rule filed September 17, 2003; effective December 1, 2003. Amendments filed August 3, 2005; effective October 17, 2005. Amendment filed October 12, 2007; effective December 26, 2007. Amendment filed September 25, 2008; effective December 9, 2008. Amendments filed September 30, 2014; effective 12/29/2014.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 63-5-105, 63-5-107, 63-5-108, 63-5-115, and 63-5-116.

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