Part 1 General Information
Section 1.1 Appeal
Introduction These rules are divided into general information
for all professions regulated herein and individual sections for each of the
professions governed: dentists, dental hygienists, and dental assistants These
rules also contain rules governing the practice areas of sedation, analgesia,
anesthesia, and general supervision of dental hygienists in public or private
schools or public or private institutions.
Section 1.2 Appeal
Duty to Inform It is the responsibility of each supervising
dentist to inform each person hired to work in an office subject to these rules
of the responsibilities and licensing and registration requirements imposed by
these rules and to ensure that all employees are properly licensed or
registered and trained A copy of these rules shall be readily available to all
persons subject to these rules All persons subject to these rules are reminded
that 3 Vermont Statutes Annotated (VSA) § 129a(6) includes within the
definition of "unprofessional conduct" " Delegating professional
responsibilities to a person whom the licensed professional knows, or has
reason to know, is not qualified by training, experience, education or
licensing credentials to perform them".
Section 1.3 Appeal
The Board's Purpose The State Board of Dental Examiners ("the
Board") has been created and given powers by Vermont law The Board's purpose is
to protect the public health, safety, and welfare The Board does this by
setting standards for issuing licenses and registrations, by licensing and
registering only qualified applicants, and regulating license and registration
holders and their practices.
Section
1.4 Appeal
Business Address The Board's mailing address is the Office of
the Secretary of State, Office of Professional Regulation, Board of Dental
Examiners, National Life Bldg, North, FL2, Montpelier, VT 056203402 ("the
Office") Copies of these rules and more information about the Board and its
requirements and procedures can be obtained by contacting the Office at
18028282363 This information may also be obtained from the Board's Web site at
http://vtprofessionalsorg/.
Section
1.5 Appeal
Board Members and Officers The Board is composed of five
dentists, two dental hygienists, and two public members all of whom reside in
Vermont The dentists are in active practice and have practiced in Vermont for
at least five years The dental hygienists are in active practice and have
practiced in Vermont for at least three years All members may serve two
consecutive five year terms Members are appointed by the
Governor.
Section 1.6 Appeal
Terms of Office A chair, vice chair, and secretary are elected
annually, usually in September or the Board's first meeting after September
Their duties are:
(a) The Chair calls
Board meetings, presides at meetings and signs all certificates, vouchers and
other official Board papers.
(b)
The Vice Chair is authorized to act when the chair is not present or is unable
to attend to the duties of office.
(c) The Secretary may, unless delegated to
the OPR administrative staff, handle the Board's correspondence, take the
minutes of meetings, certify transcripts of proceedings, sign all certificates,
and inform the public and all members of Board meetings.
Section 1.7 Appeal
Contacting the Board Names of the Board members and officers
may be obtained from the Office or the Board's Web site at
http://vtprofessionalsorg/ Members may be contacted through the
Office.
Section 1.8 Regular,
Special, and Emergency Meetings
(a) The Board
holds at least one regular meeting a year, but usually meets monthly. The chair
or two other Board members may call a special or emergency meeting when it is
necessary.
(b) A majority of the
Board constitutes a quorum for all meetings. No formal action at any meeting
may be taken unless a majority of the quorum votes in favor of the action. The
Office can provide meeting dates and locations. Notice of meetings may usually
be found online at http://vtprofessionals.org/.
Section 1.9 Laws Governing the Board
(a) The Board is created by law, Title 26,
V.S.A., Chapter 13, which establishes its responsibilities for setting
standards, issuing licenses and regulating the profession. The statutes are
online at http://www.leg.state.vt.us/statutes/statutes2.htm. In addition, the
Board is subject to several other state laws such as the Administrative
Procedure Act (Title 3, V.S.A., Chapter 25), the "Law of Professional
Regulation" (Title 3, V.S.A., Sections 121-131), the "Right to Know Law"
(Title 1, V.S.A., Sections 311-314), and the "Access to Public Records Law"
(Title 1, V.S.A., Sections 315-320). These laws spell out the rights of
applicants, license holders or members of the public.
(b) The Vermont Statutes Annotated contain
the complete text of these laws. They can usually be found in any Town Clerk's
office or public library. "Vermont Statutes Online" are also available at
http://www.leg.state.vt.us. The Board's statutes and rules may be accessed
through the Board's website at http://vtprofessionals.org/.
Section 1.10 Effect of Rules
(a) The Board is authorized to make these
rules under Title 26, V.S.A., Sections 767 and 804. These rules are approved by
the Vermont Legislative Committee on Administrative Rules and have the effect
of law and govern the Board's proceedings. Rules are made following the
Administrative Procedure Act ("APA"). The Office of Professional Regulation
("Office") helps the Board to comply with the Act. Rules are reviewed and
revised periodically. Rules regulating supervised practice of dental hygienists
in public or private schools or public or private institutions will become
effective only upon passage of an authorizing amendment to 26 V.S.A. §
854.
(b) Legislative changes from
time to time may create inconsistencies between statutes and administrative
rules. When rules and statutes conflict, the statutes govern.
Section 1.11 Permitted Practices
(a) Dentists: The following tasks may be
performed by licensed dentists only:
(1)
Practices permitted by Chapter 13 of Title 26 including diagnosis, treatment
planning and prescription, including prescription for drugs and medicaments or
authorization for restorative, prosthodontic or orthodontic appliances;
or
(2) Surgical procedures on hard
and soft tissues within or ancillary to them related to the treatment of the
maxillofacial complex and any other intraoral procedure that contributes to and
results in an irreversible alteration to the oral anatomy.
(3) Dentists are responsible for general
supervision of dental hygienists and "direct supervision" of dental hygienists
where specifically required elsewhere in these rules.
(4) Dentists are responsible for the direct
supervision of dental assistants.
(b) Clarifications, Limitations on Scope of
Practice, Dentists or Dental Hygienists: Oral prophylaxis, oral debridement,
periodontal descriptions and charting, including periodontal probing and
placement of subgingival chemotherapeutic agents shall be performed only by a
licensed dentist or dental hygienist.
Part 2 Definitions
Section 2.1 Definitions
As used in these rules:
(a) "Active practice" -
1. "active practice" for dentists: means
maintaining a valid license in good standing in this or another U.S. or
Canadian jurisdiction and providing dental services to patients for at least
800 hours, or accumulating 100 continuing education credits (1 hour = 1 credit)
approved by the Board in patient care related subjects during the previous five
years. A combination of practice hours and continuing education hours in that
ratio may be accepted in the discretion of the Board.
2. "active practice" for dental hygienists
means practicing under a valid license in this or another U.S. or Canadian
jurisdiction for no fewer than 50 hours in five years.
(A) Active practice for dental hygienists
includes activities which the Board determines to be reasonably related to the
retention of competency skills. These may include, but are not limited to
traditional clinical practice or volunteer work at dental clinics, public
health practice, teaching undergraduate or graduate education, teaching patient
education or dental health education at schools, fairs, or meetings of dental
professionals.
3. for
dental assistants: there is no active practice requirement.
(b) "ACLS"- means Advanced Cardiac
Life Support.
(c) "ADA" - means
American Dental Association.
(d)
"Board" - means State of Vermont Board of Dental Examiners.
(e) "CODA" - means Commission on Dental
Accreditation of the American Dental Association.
(f) "CITA" means Council of Interstate
Testing Agencies.
(g) "CPR" - means
Cardio-Pulmonary Resuscitation.
(h)
"CRDTS" - means Central Regional Dental Testing Service.
(I) "CSE" - means Conscious Sedation
Endorsement.
(j) "DANB" - means
Dental Assisting National Board.
(k) "Direct Supervision" - means a dentist
agreeing to procedures or treatment performed by appropriate personnel by being
readily available at the dental facility for consultation or
intervention.
(l) "Director" -
means the Director of the Office of Professional Regulation.
(m) "Emergency Office Procedures" - means
courses in external cardiopulmonary resuscitation which are approved by the
Vermont Heart Association or the American Red Cross, or courses which include a
review of health conditions and factors which might produce emergencies.
Acceptable courses will be consistent with current educational curricula in
schools of dentistry and dental hygiene accredited by the Commission on
Accreditation of the American Dental Association.
(n) "General Supervision" - (1) in the office
of a licensed dentist means a dentist with the responsibility to periodically
examine patients, agreeing to procedures or treatment performed by appropriate
personnel. The dentist must be available for consultation, but does not
necessarily have to be physically present at the dental facility when providing
general supervision.
"General supervision" (2) in a public or private school or
public or private institution means supervision by a dentist with no less than
three years experience in accordance with a general supervision agreement as
set forth in Part 10 of these rules. When providing general supervision the
dentist must be available for consultation but does not have to be physically
present at the site where dental hygiene services are provided.
(o) "GAE" -means General
Anesthesia Endorsement.
(p) "Good
standing" means that the professional holds a current, unrestricted license and
has not been subject to disciplinary action resulting in a finding of
unprofessional conduct within the previous five years.
(q) "OPR" - means the Office of Professional
Regulation.
(r) "Office" - means the
Office of Professional Regulation.
(s) "PALS" - means Pediatric Advanced Life
Support.
(t) "PGY1" -means Post
Graduate Year.
(u) "NERB - means
Northeast Regional Board of Dental Examiners.
(v) "SRTA" - means Southern Regional Testing
Agency.
(w) "Supervising dentist" -
means that dentist in a practice who is designated to ensure compliance with
the licensing and registration requirements of these rules. The designation
need not be formal and is not required to be reported to the Board. Each
dentist in a practice is charged with ensuring that there is a designated
supervising dentist. If no dentist has been designated as the supervising
dentist, every dentist in the practice is responsible for ensuring compliance
with the licensing and registration requirements of these rules.
(x) "Unrestricted license" - means that the
licensed or registered professional is not subject to a sanction following a
completed disciplinary action which resulted in a finding of unprofessional
conduct.
(y) "V.S.A." - means
Vermont Statutes Annotated.
(z)
"WREB" - means Western Regional Examining Board.
Part 4 Information for Dentists
Section 4.1 How to Obtain a License as a
Dentist
(a) Qualifications for licensure as a
dentist are set forth by 26 V.S.A. Chapter 13 §§ 801 through 805. 26
V.S.A. § 804 gives the Board authority to promulgate rules relating to 1)
the qualifications of applicants; 2) conducting the examinations; and 3)
granting licenses.
(b) Applications
for a dental license may be obtained from the Office or online at
http://vtprofessionals.org/. An applicant shall submit a fully completed
application form with all supporting documentation and the fee to the
Office.
(c) An applicant may obtain
a license as a dentist through one of the following three paths: examination,
credentials (also referred to as "endorsement"), or licensed practice
experience.
(d) Regardless of route
to licensure, each applicant shall:
1) have
graduated from a school of dentistry or dental college accredited by the
Commission on Dental Accreditation of the American Dental Association (CODA)
or, if the applicant has completed a program of dental education in an
unregistered and unaccredited foreign dental school, evidence of successful
completion of a minimum of one year of study in a school of dentistry
accredited by the Commission on Dental Accreditation of the American Dental
Association, resulting in the awarding of a dental degree (D.D.S. or D.M.D.) by
that institution;
2) be at least 18
years of age and not in violation of these rules or statutes governing the
profession;
Section
4.2 How to Obtain a License as a Dentist
Licensure by Examination The application and accompanying
documents must show that the applicant:
(a) Is at least 18 years of age and not in
violation of these rules or statutes governing the profession.
(b) Has graduated from a school of dentistry
or dental college accredited by the Commission on Dental Accreditation of the
American Dental Association or, if the applicant has completed a program of
dental education in an unregistered and unaccredited foreign dental school,
evidence of successful completion of a minimum of one year of study in a school
of dentistry accredited by the Commission on Dental Accreditation of the
American Dental Association, resulting in the awarding of a dental degree
(D.D.S. or D.M.D.) by that institution;
(c) Presents a certificate of the National
Board of Dental Examiners; and
(d)
Has passed every part of one of the following examinations:
(1) the American Dental Licensing Exam
(ADLEX) administered by the Northeast Regional Board (NERB);
(2) the Central Regional Dental Testing
Service Examination (CRDTS);
(3)
the Council of Interstate Testing Agencies (CITA);
(4) the Southern Regional Testing Agency
Examination (SRTA);
(5) the Western
Regional Examining Board Examination (WREB);
(6) another regional or national clinical
examination approved by the Board before the examination is taken,
or;
(7) has passed the board
certifying examinations of the American Dental Association's recognized
specialty boards.
(e)
Has completed training in emergency office procedures required in Rule 2. 1(m),
and;
(f) Has successfully completed
the Vermont dental statutes and rules examination. The examination questions
are available from the Office or online at
http://vtprofessionals.org/.
Section
4.3 Testing Information
(a)
Information on the NERB may be obtained by writing to:
Office of the Secretary
Northeast Regional Board of
Dental Examiners
8484 Georgia Avenue, Suite 900
Silver Spring, MD 20910
(b) Information on the CRDTS may be obtained
by writing to:
Central Regional Dental Testing Service
5200 Huntoon Street
Topeka, Kansas 66604
(c) Information on the SRTA may be obtained
by writing to:
Southern Regional Testing Agency
1072 Laskin Road
Suite 203
Virginia Beach, Virginia 23451
(d) Information on the WREB may be obtained
by writing to:
Western Regional Examining Board
10040 North 25th Avenue
No. 116
Phoenix, Arizona 85021
(e) Should changes occur after adoption of
these rules, the Office should be able to provide up-dated contact
information.
(f) If other regional
board or national testing organizations are formed, the Board, at its
discretion, may accept passage of their examinations as fulfilling the
requirements of this rule.
(g) The
Board will compare additional regional or national examinations and examination
services to the ones listed before deciding whether other examinations should
be approved.
(h) Applicants should
check with the Board before taking an examination other than one specifically
named herein to verify whether the examination has been approved by the
Board.
Section 4.4
Testing Information
Previously Licensed, but Who Do Not Meet Active Practice
Requirements If the applicant meets all the requirements for licensure but has
not actively practiced dentistry for five years or more, the applicant
must:
a) successfully complete a
clinical course approved by the Board which will assure competence to reenter
dental practice. A course taken to satisfy this rule must be one offered by a
CODA accredited dental school, or;
b) successfully complete the NERB, or the
written portion of NERB and CRDTS, SRTA, WREB, or other examination as in Rule
4.3 immediately preceding the
filing of the application.
c)
successfully complete the Vermont dental statutes and rules examination. The
examination questions are available from the Office or online at
http://vtprofessionals.org/.
Section
4.5 Licensure by Endorsement
(a)
The Board may issue a license to an applicant who meets the requirements of
Rule 4.1(d) and:
(1) is currently licensed to
practice dentistry in any jurisdiction of the United States or Canada whose
licensing requirements are deemed by the Board to be substantially equivalent
to those of this state and;
(2) is
in good standing as verified to the Board by the licensing authority of that
jurisdiction, and;
(3) has been in
active practice and;
(4) has passed
an examination administered by the Board testing the applicant's knowledge of
Vermont laws and rules of the profession; and
(5) has completed the emergency office
procedure training as described in Rule 2.1(m).
(b) For purposes of determining active
practice the Board may include periods of
(1)
dental practice within the military service,
(2) teaching in an accredited dental
school,
(3) accredited dental
residency programs, and
(4)
residency programs in American Dental Association recognized board specialties
may be considered.
Section
4.6 PGY Licensed Experience: Endorsement, 5 Year Rule
The Board may grant a license to a person licensed in a
jurisdiction of the United States or Canada who obtained licensure through a
CODA approved PGY1 residency program, rather than passing the examination
required in Rule 4. 3, if the Board in its discretion, determines:
(a) that the applicant has been in practice
full time of at least 1,200 hours per year for a minimum of five years, and is
in good standing in all jurisdictions in which licensed;
(b) that the applicant's practice experience
or education overcomes any lesser licensing requirement of that other
jurisdiction; and
(c) that the
applicant has successfully completed the Vermont dental statutes and rules
examination. The examination questions are available from the Office or online
at http://vtprofessionals.org/, and;
(d) met the requirements of 4.1(d).
Section 4.7 Licensure by Licensed
Experience, 5 Year Rule
(a) The Board may
issue a license to an applicant who is currently licensed to practice dentistry
in any jurisdiction of the United States or Canada whose licensing requirements
are deemed by the Board to be not substantially equivalent to those of this
state if:
(1) the applicant meets the
requirements of Rule 4. 1(d);
(2)
the applicant is in good standing as verified to the Board by the licensing
authorities of all jurisdictions in which licensed;
(3) the applicant has been in practice full
time of at least 1,200 hours per year for a minimum of five years before the
application, and;
(4) the Board in
its discretion determines that the applicant's practice experience or education
overcomes any lesser licensing requirement(s) of that other jurisdiction,
and;
(5) the applicant has
successfully completed the Vermont dental statutes and rules examination. The
examination questions are available from the Office or online at
http://vtprofessionals.org.
(b) For purposes of determining active
practice the Board may include periods of:
(1)
dental practice within the military service,
(2) teaching in an accredited dental
school,
(3) accredited dental
residency programs, and
(4)
residency programs in American Dental Association recognized board specialties
may be considered.
Section
4.8 Licensure by Licensed Experience, 5 Year Rule
Transient Practice Permit A person who is not licensed in
Vermont may obtain, without payment of a licensing fee, a transient practice
permit from the Board to perform acts constituting the practice of dentistry,
provided that:
(a) The practice in
Vermont does not exceed 10 days in any calendar year;
(b) The person is licensed as a dentist in
another jurisdiction of the United States or Canada which, in the opinion of
the Board, has regulatory standards substantially equivalent to those currently
in effect in Vermont; and
(c) The
practice is for educational or volunteer purposes only.
Section 4.9 Licensure by Licensed Experience,
5 Year Rule
Display of Dentist License The dental license or certificate,
or a photo copy if the licensee practices at more than one location, must be
conspicuously displayed in the licensee's place(s) of practice Licensees may
black out or cover their residence address if it appears on the
license.
Section 4.10
Licensure by Licensed Experience, 5 Year Rule
Maintaining a Dentist License The Board will renew a license
when the dentist shows the active practice, / continuing education, and
emergency office procedures requirements set forth below have been
met.
Section 4.11 Licensure
by Licensed Experience, 5 Year Rule
Active Practice Requirement In order to renew a license each
dentist must maintain a license in good standing and engage in active practice,
for at least 800 hours, or accumulate 100 continuing education credits approved
by the Board in practice related subjects during the previous five years A
combination of practice hours and continuing education hours in that ratio may
be accepted in the discretion of the Board.
Section 4.12 Licensure by Licensed
Experience, 5 Year Rule
Continuing Education Requirement In addition to meeting the
active practice requirement in subsection (a) above, a dentist must also
document completion of 30 hours professional education which shall include
emergency office procedures courses during the two year licensing period
preceding renewal Except for emergency office procedures, this provision shall
apply only to renewals after an applicant's initial two years of practice in
Vermont.
Section 4.13
Approval of Continuing Education Programs
(a)
Standards - A program meets Board qualifications if it is a formal course of
learning which contributes to the growth of professional knowledge and
competence in providing patient care.
(b) The board will consider a continuing
education course to be a "formal course of learning" if it meets the following
criteria: The course is conducted by a qualified instructor who will be able to
instruct and interact in any of the following formats:
(1) Classroom Instruction - Traditional
in-classroom, with instructor and student interaction and written
materials;
(2) Interactive
Television which permits continuous mutual communication between the instructor
and all students, continuous observation of the instructor by all students, and
continuous observation of all students by the instructor;
(3) Distance Courses /Online Delivery
Distance education courses are defined as programs whereby instruction does not
take place in a traditional classroom setting but rather through other media
where teacher and student are apart but exchange between instructor and student
by electronic means.
(4) Self-study
courses which conclude with an examination may be accepted.
(c) Case-by-case approval -
Individual courses may be approved upon submitting to the Board a course
outline, instructor qualifications, sponsoring organization, and dates of
presentation. Advance approval is not required. The Board will not approve a
course or program for continuing education credit if, in its discretion, the
Board determines that the program does not contain sufficient educational
content.
(d) Approved sponsors may
include the ADA, ADHA, ADAA, and their constituent and component dental
societies and associations, CODA accredited schools or programs, and home study
programs sponsored by any of the above groups. Approved sponsors will also
include any sponsor that has ADA, CERP, or AGD, PACE certification.
(e) Courses in practice management and
financial management will be accepted if they contribute to the growth of
professional knowledge and competence in providing patient care. Examples
include, but are not limited to the following:
(1) courses that promote communication among
members of the dental team and between members of the dental team and
patients;
(2) ethics;
(3) insurance billing and coding;
and
(4) proper patient record
keeping.
(f) The Board
considers that the following are among the subjects that do not contribute to
the growth of professional knowledge and competence in providing patient care,
and will not be approved by the Board for continuing education credit:
(1) accounting and similar topics;
(2) business administration or
management;
(3) cultural
matters;
(4) general office and
computer skills:
(5) memory
training;
(6) personal business and
financial planning matters;
(7)
personal development;
(8) personal
health and recreation;
(9) personal
money management;
(10)
politics;
(11) software for office
use;
(12) speed reading;
(13) success training;
(14) time management; and
(15) web site development.
Section 4.14 Approval
of Continuing Education Programs
Verification Audits The Board may conduct random audits to
verify completion of continuing education up to seven years after a license is
renewed Upon request by the Board, the licensee shall submit certificates of
completion for all programs listed in the licensee's renewal
application.
Section 4.15
Approval of Continuing Education Programs
Failure to Meet Active Practice/Continuing Education
Requirement A dentist who fails to meet the active practice/continuing
education requirement will be refused renewal and must file an application and
must successfully complete the examinations required by Rule 44.
Section 4.16 Approval of
Continuing Education Programs
Emergency Office Procedures Completion of a course in emergency
office procedures as defined in Rule 21(m) is required for license
renewal.
Part 5
Sedation, Analgesia, Anesthesia: Special Endorsements, Incident Reports
Section 5.1 Approval of Continuing Education
Programs
Preamble The Board seeks to protect the public health, safety
and welfare by adopting specific rules in the area of anesthesia and pain
reduction The Board recognizes the value of making comfortable dental services
available to those who might otherwise postpone or avoid necessary dental care
It recognizes that there can be some risk in the use of certain medications By
these rules the Board seeks to ensure that practitioners are adequately
prepared to use such medications in their practice.
Section 5.2 Incident Reports
(a) Each dentist, whether or not holding a
special endorsement provided under these rules, must submit a complete report
to the Board within 30 days of any incident which occurs in the dentist's
office or outpatient facility during, or as a direct result of the
administration of any anesthetic, local or general, anxiolysis, parenteral deep
sedation, or parenteral conscious sedation, or sedation regardless of the route
of administration, which results in a patient being transported to a hospital,
hospitalization, or death.
(b) The
incident report shall be submitted whether or not the patient is admitted, and
whether or not the incident has the potential for life-threatening
consequences. A report of an incident shall include a statement setting forth
the names and credentials of those present or participating during the
anesthesia, anxiolysis or sedation. Failure to comply with this reporting
requirement may result in disciplinary action including loss of a special
endorsement.
Section 5.3
Anesthesia Definitions and Guidelines
(a)
"Administering nitrous oxide analgesia" means: the dispensing, applying, or
offering of nitrous oxide analgesia to a dental patient.
(b) "Anxiolysis" means: the reduction of
anxiety through the administration of pharmacological agent or agents. The
administered dose should be within the guidelines for dosage on the
manufacturer's package insert, or using techniques taught by CODA approved
programs. When anxiolysis is achieved, the patient
(1) is conscious;
(2) can and does respond to conversation
appropriately without extra stimulation; and
(3) is fully able to independently and
continuously maintain an unimpeded airway.
(c) "Conscious Sedation" means a depressed
level of consciousness achieved through the administration of a
pharmaceutical/pharmacological agent or agents in which:
(1) the patient retains the ability to
independently and continuously maintain an airway;
(2) the patient's ability to comprehend
questions and conversation and react appropriately is suppressed;
(3) protective reflexes remain active;
and
(4) the patient is easily
aroused.
(d) Techniques
and pharmaceutical or pharmacological agents used to achieve conscious sedation
must render unintended consequences unlikely. Doses shall be within the
guidelines on the manufacture's package insert or used according to techniques
taught by CODA approved programs. Intravenous pharmaceutical or pharmacological
agents used to achieve conscious sedation are limited to those for which there
is a reversal agent.
(e) Dentists
who administer a pharmaceutical/pharmacological agent or agents with the intent
to achieve conscious sedation in a patient and who do not possess a General
Anesthesia Endorsement must obtain a Conscious Sedation Endorsement from the
Board.
(f) " Deep Sedation " - Deep
sedation is a controlled state of depressed consciousness accompanied by
partial loss of protective reflexes, including the inability to continually
maintain an airway independently and/or to respond purposefully to verbal
command, and is produced by a pharmacologic or non-pharmacologic method or
combination thereof. Deep sedation may not be employed without a General
Anesthesia Endorsement issued by the board.
(g) "General Anesthesia" - General anesthesia
is a controlled state of unconsciousness accompanied by a partial or complete
loss of protective reflexes, including inability to independently maintain an
airway and respond purposefully to physical stimulation or verbal command, and
is produced by a pharmacologic or non-pharmacologic method or combination
thereof.
(h) "Monitoring" - For
purposes of these rules, monitoring patients who have received analgesic or
anesthetizing drugs or otherwise mind altering drugs means observing the
patient and evaluating through clinical evaluation, electronic and mechanical
means, recognizing adverse reactions or complications, and reporting any
adverse reaction or complication to the supervising dentist, where applicable,
immediately. The degree of monitoring necessary depends on the level of
sedation or anesthesia achieved.
Section 5.4 Anesthesia Definitions and
Guidelines
Subsection Regarding: Authorization to Administer Anesthesia or
Certain Pharmaceuticals or Pharmacological Agents.
Section 5.5 Anesthesia Definitions and
Guidelines
When No Endorsement Required A dentist needs no special
endorsement to employ the following:
(a) Nitrous Oxide: Use of nitrous oxide in a
dental office does not require a special license or endorsement.
(1) Under direct supervision of a licensed
dentist, registered dental assistants and licensed dental hygienists instructed
and trained by the dentist may monitor nitrous oxide analgesia during a dental
procedure. Administration of nitrous oxide analgesia, as well as prescription,
initiation, and determination of nitrous oxide analgesia levels and release and
discharge of the patient after administration of nitrous oxide analgesia, shall
be performed by and shall be the responsibility of the supervising
dentist.
(2) All individuals
administering and monitoring nitrous oxide analgesia must, in addition to
required emergency office procedures, have annual CPR training.
(b) Local Anesthesia:
Administration of local anesthesia by dentists does not require a special
endorsement from the Board.
(c)
Anxiolysis: Dentists who administer a pharmaceutical/pharmacological agent or
agents with intent to achieve a state of "anxiolysis" as defined in these rules
do not require a specific Board endorsement of authority. This includes the
prescription of orally-administered, rectally-administered, or
nasally-administered sedatives by dentists for anxiolysis before treatment
which may be supplemented by nitrous oxide.
Section 5.6 Anesthesia Definitions and
Guidelines
Duty for Use of Pharmaceuticals As licensed professionals,
dentists employing the above, or any pharmaceuticals, are responsible to assure
that they possess sufficient knowledge of the proper use of medications to
achieve analgesia, anxiolysis, sedation, or anesthesia They must be able to
respond if pharmaceuticals intended to achieve anxiolysis have unintended
effects If patients given anxiolysis medications go to the next level beyond
anxiolysis, dentists must have the knowledge and resources to manage the
effects of the medication.
Section
5.7 Anesthesia Definitions and Guidelines
Endorsements Required A Special Endorsement from the Board is
required before use of Conscious Sedation or General
Anesthesia.
Section 5.8
Conscious Sedation: Special Endorsement Required
Dentists Who Do Not Have a General Anesthesia Endorsement and
Who Wish to Employ Conscious Sedation as Defined by These Rules must Obtain a
Conscious Sedation Privilege Endorsement from the Board.
Section 5.9 Conscious Sedation: Special
Endorsement Required
Introduction To Conscious Sedation The administration of
conscious sedation carries with it inherent risks and added responsibility for
care of the patient Titration of oral medication for the purposes of sedation
is unpredictable Improper or repeated dosing of orally administered sedative
agents can result in an alteration in the state of consciousness beyond the
intent of the practitioner The administration of conscious sedation on an
outpatient basis by dentists is, with appropriate safeguards, an accepted
patient care modality.
Section
5.10 Need for Conscious Sedation Endorsement
(a) Dentists who do not possess a general
anesthesia endorsement under rules 5.24 - 5.26 herein and who wish to use
pharmaceutical/pharmacological agents to achieve conscious sedation may do so
only in compliance with the requirements of these rules.
(b) No Dentist may employ a pharmacological
agent or agents with the intent of achieving conscious sedation without first
obtaining from the Board an endorsement of authority to employ conscious
sedation. The endorsement shall be maintained with the dentist's
license.
Section 5.11
Need for Conscious Sedation Endorsement
Application for Conscious Sedation Endorsement A licensed
dentist seeking conscious sedation administration privileges shall file an
application with the Board, on the form provided by the Office Applicants must
submit:
(a) Documentation of
satisfactory completion of a conscious sedation training program provided under
the auspices of a dental school or program accredited by the Commission on
Dental Accreditation of the ADA. The program must:
(1) include a minimum of 60 hours of didactic
and clinical study including training in conscious sedation, physical
evaluation, venipuncture, technical administration;
(2) include training in recognition and
management of complications and emergencies;
(3) include documented clinical experience in
managing compromised airways and certification of competency in airway
management from the program director;
(4) include training in monitoring patient
vital signs to assure expertise in interpretation of those signs and
appropriate reaction to them;
(5)
contain additionally supervised experience in providing conscious sedation
including successful management of parenteral conscious sedation for no fewer
than 20 patients;
(6) be given in
an organized sequence of study administered by one entity; and
(7) be completed in less than two calendar
years or as part of a CODA accredited dental specialty training program;
or
(b) Certification by
an CODA accredited school showing that the applicant has completed a course of
training in conscious sedation while a student in an accredited school of
dentistry or through postgraduate training which meets the requirements of the
ADA Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in
Dentistry; or
(c) Conscious
Sedation Endorsement Based on Endorsement from Another Jurisdiction:
documentation showing that he or she is a licensed dentist in good standing in
a jurisdiction of the United States or Canada having conscious sedation
standards substantially equivalent to those of this state; or
(d) for those treating children under 12
years of age, documentation of appropriate training, in pediatric sedation
techniques according to the guidelines of the American Academy of Pediatric
Dentistry and in pediatric resuscitation including the recognition and
management of pediatric airway and respiratory problems; and
(e) A signed affidavit certifying that the
dentist:
1) understands the requirements of
these rules; and
2) will use a
properly staffed and equipped facility as defined in rule
5.13 of this Section for the
administration of conscious sedation.
Section 5.12 Issuance of Endorsement
(a) When the applicant has shown compliance
with the rules, the Board will issue a conscious sedation endorsement. The
endorsement, unless renewed with the biennial renewal, will expire at the end
of the licensing period.
(b) The
Board, in its discretion, may waive some or all of the Rule 5.11(a) training
requirement upon the applicant's showing adequate initial training in conscious
sedation in a CODA approved program, and treatment of a minimum of 10 patients
in the preceding two years before the application (Rule 5. 19(a)(2)), which
assures the Board that the applicant has the current ability to employ
conscious sedation with safety.
Section 5.13 Facility and Personnel
Requirements
(a) Facility Requirements: A
dentist employing conscious sedation may do so only in a properly equipped
facility which shall include at a minimum:
1)
Sphygmomanometer, stethoscope, and pulse oximeter,
2) A positive pressure oxygen delivery system
with full face masks and connectors capable of delivering to the sedated
patient oxygen under positive pressure, plus a back up system;
3) emergency drugs and equipment appropriate
to the medications administered including drugs appropriate to address
emergencies and drugs appropriate for ACLS or PALS;
4) suction equipment;
5) an emergency back up light source system
that will permit safe termination of any procedure under way; and
6) a defibrillator.
(b) Staffing Requirements:
(1) In addition to the dentist or other
professional permitted under these rules to administer pharmaceuticals to
achieve conscious sedation, there must be a minimum of one assistant licensed
or registered under Chapter 13 of Title 26 who possesses a current
certification in cardio pulmonary resuscitation and is capable of assisting
with procedures, problems and emergencies incident to the administration of
such sedation.
(2) A licensed or
registered dental assistant or dental hygienist trained in airway management
must remain with the patient until the patient's escort arrives, and the
patient is able to maintain a patent airway unassisted.
Section 5.14 Patient Risk Criteria
(a) Conscious sedation may be provided in a
dental office for patients who are Class I and II as classified by the American
Society of Anesthesiologists (ASA).
(b) Conscious sedation shall not be provided
in a dental office for patients in ASA risk category V.
(c) Patients in ASA risk categories Class III
and Class IV shall only be provided conscious sedation:
(1) by an oral and maxillofacial surgeon
after performing an evaluation and documenting the ASA risk assessment category
and any special monitoring requirements that may be necessary; or
(2) by a dentist with a conscious sedation
endorsement after consultation with the patient's primary care physician or
other medical specialist regarding potential risk and special monitoring
requirements that may be necessary.
Section 5.15 Monitoring Requirements
To minimize risks to patients, a dentist who uses conscious
sedation shall:
(a) Ensure that
monitoring of a patient under conscious sedation begins prior to the
administration of sedation, and takes place continuously during the procedure
and recovery from sedation. The person who administers the sedation or another
licensed practitioner qualified to administer conscious sedation shall remain
on the premises until the patient is responsive and discharged;
(b) Ensure that monitoring includes:
(1) continuous direct clinical observation of
the patient;
(2) interval recording
of blood pressure and pulse;
(3)
continuous evaluation of oxygen saturation; and
(4) additional devices such as EKG for
monitoring when dictated by the medical needs of the patient;
(c) Ensure that alarms on devices
used for monitoring are enabled.
Section 5.16 Conscious Sedation Protocols
The dental office shall develop written protocols for sedation
of dental patients addressing the following:
(a) preoperative patient evaluation and
selection prior to conscious sedation,
(b) informed consent,
(c) sedation monitoring procedures,
(d) sedation record keeping procedures,
and
(e) patient discharge
assessment.
Section 5.17
Emergency Protocols
(a) The dental office
shall develop written protocols for sedation-related emergencies addressing the
following:
(1) Laryngospasm,
(2) Bronchospasm,
(3) Aspiration of emesis,
(4) Angina Pectoris,
(5) Myocardial infarction,
(6) Hypotension,
(7) Hypertension,
(8) Cardiac arrest,
(9) Hyperventilation,
(10) Hypoventilation,
(11) Convulsions,
(12) Allergic and toxic reaction,
and
(13) Airway occlusion by
foreign body.
(b)
Training to educate assistants with respect to these protocols must be provided
to all sedation team assistants and updated periodically.
Section 5.18 Emergency Protocols
Records of Conscious Sedation Administration The following
records shall be made for each administration of conscious sedation:
(a) relevant medical history of the
patient;
(b) consent for
administration of conscious sedation prior to the performance of any procedure
and administration of any drugs;
(c) preoperative, intra operative and
pre-discharge monitoring of blood pressure, pulse, respiration and oxygen
saturation where the level of patient cooperation and/or medical/physical
limitations of the patient allows; and
(d) drugs and dosages of drugs used during
the operative procedure, and times of their administration over the course of
the procedure.
Section
5.19 Emergency Protocols
Renewal of Conscious Sedation Endorsement: Continued Competence
At the time of license renewal, a dentist who wishes to renew the conscious
sedation endorsement shall:
(a)
provide documentation of:
(1) 6 hours of
continuing education in conscious sedation during the licensing period;
and
(2) treatment of a minimum of
ten patients in the preceding two years. In cases where the renewal occurs less
than two years after the conscious sedation endorsement was initially issued,
the Board may waive all or part of this requirement.
(b) provide documentation of current,
successful completion of an Advanced Cardiac Life Support (ACLS) or Pediatric
Advanced Life Support (PALS) training as appropriate. This training may be
applied toward the continuing education requirement in this rule.
Section 5.20 Emergency Protocols
Others Permitted to Administer Conscious Sedation: Certified
Registered Nurse Anesthetists.
(a) A
dentist who holds a valid conscious sedation endorsement from the board may
permit a Certified Registered Nurse Anesthetist (CRNA) to administer conscious
sedation. Use of a Certified Registered Nurse Anesthetist does not relieve the
dentist of responsibility for the patient.
(b) A dentist who does not hold a conscious
sedation endorsement may not have a CRNA administer conscious
sedation.
Section 5.21
Emergency Protocols
Exemptions from Conscious Sedation Endorsement Requirement A
dentist does not need to hold a conscious sedation endorsement when conscious
sedation is administered by:
(a)
another assisting dentist, who possesses one; or
(b) a physician anesthesiologist.
(c) "Physician" for purposes of this section
means a physician who is licensed to practice medicine and all of its branches
under the laws of Vermont and is authorized to provide anesthesia services in a
licensed hospital or licensed ambulatory surgical treatment center, or is an
anesthesiologist.
(d)
Administration of conscious sedation under the exemption sections above is
permitted only in facilities which meet the equipment and staffing requirements
of these rules.
Section
5.22 Incident Reports
(a) Each
dentist, whether or not holding a special endorsement provided under these
rules, must submit a complete report to the Board within 30 days of any
mortality, or other incident which occurs in the dentist's office or outpatient
facility during, or as a direct result of, the administration of any
anesthesia, local or general, anxiolysis, parenteral deep sedation, or
parenteral conscious sedation or sedation regardless of the route of
administration, and which results in a patient being transported to a hospital,
hospitalization, or death.
(b) The
incident report shall be submitted whether or not the patient is admitted, and
whether or not the incident has the potential for life-threatening
consequences. A report of an incident shall include a statement setting forth
the names and credentials of those present or participating during the
anesthesia, anxiolysis or sedation. Failure to comply with this reporting
requirement may result in disciplinary action including loss of a special
endorsement.
Section
5.23 Incident Reports
Conscious Sedation Provisions: Effective Date Effective January
1, 2007 no dentist shall administer a pharmaceutical agent or agents to induce
conscious sedation without first obtaining a conscious sedation endorsement or
general anesthesia endorsement from the Board.
Section 5.24 Incident Reports
General Anesthesia: Endorsement Required Dentists who employ
general anesthesia must obtain a Special Endorsement from the
Board.
Section 5.25 Incident
Reports
Obtaining a General Anesthesia Endorsement The Board will issue
a General Anesthesia Endorsement to authorize qualified dentists to administer
general anesthesia, parenteral deep sedation, and parenteral sedation, and
parenteral conscious sedation in dental offices.
Section 5.26 Incident Reports
Prerequisites to Approval An applicant must demonstrate that he
or she:
(a) has a properly staffed and
equipped facility, as set forth in the current edition of the Office Anesthesia
Evaluation Manual of the American Association of Oral and Maxillofacial
Surgeons; and
(b) has either
completed a minimum of 12 months of advanced clinical training in
anesthesiology and related academic subjects (or the equivalent) beyond the
undergraduate dental school level in a training program, as set forth in Part
II of the current edition of the Guidelines for Teaching the Comprehensive
Control of Pain and Anxiety in Dentistry of the American Dental Association;
or
(c) is a diplomate of the
American Board of Oral and Maxillofacial Surgery, is a fellow or member of the
American Association of Oral and Maxillofacial Surgeons, or is a fellow of the
American Dental Society of Anesthesiology or has successfully completed a CODA
accredited oral and maxillofacial surgery residency program.
Section 5.27 Incident Reports
(a) Each dentist, whether or not holding a
special endorsement provided under these rules, must submit a complete report
to the Board within 30 days of any mortality, or other incident which occurs in
the dentist's office or outpatient facility during, or as a direct result of
the administration of any anesthesia, local or general, anxiolysis, parenteral
deep sedation, or parenteral conscious sedation, or sedation regardless of the
route of administration, which results in a patient being transported to a
hospital, hospitalization, or death.
(b) The incident report shall be submitted
whether or not the patient is admitted, and whether or not the incident has the
potential for life-threatening consequences. A report of an incident shall
include a statement setting forth the names and credentials of those present or
participating during the anesthesia, anxiolysis, or sedation. Failure to comply
with this reporting requirement may result in disciplinary action including
loss of a special endorsement.
Section 5.28 Incident Reports
Exemption from General Anesthesia Endorsement Requirement The
General Anesthesia Endorsement requirement does not apply to dentists
administering general anesthesia, parenteral deep sedation, or parenteral
conscious sedation in a hospital setting with supervision by an physician or
dentist credentialed by the hospital to provide anesthesia
services.
Section 5.29
Incident Reports
Renewal of Special Endorsements A special endorsement must be
renewed every two years at the same time as license renewal A special
endorsement which is not renewed lapses on the expiration date In cases where
the renewal occurs less than two years after the general anesthesia endorsement
was initially issued, the Board may waive all or part of the renewal
requirement.
Section 5.30
Incident Reports
Inspection of Dentist Offices The Board may as it deems
appropriate inspect a licensee's facility, equipment, and staff Such inspection
shall be conducted by a person or team appointed by the Board or
office.
Part 6
Information for Dental Hygienists
Section 6.1
Incident Reports
Dental Hygienist License This license allows a person to
practice dental hygiene in Vermont It includes the dental hygienist who is
practicing expanded function dental assisting duties or administering local
anesthesia by endorsement.
Section
6.2 Incident Reports
How to Become Licensed as a Dental Hygienist There are two ways
to qualify for a license as a dental hygienist, licensure by examination,
licensure by endorsement.
Section
6.3 Incident Reports
Licensure by Examination To qualify by examination, the
applicant must file a written application (obtained from the Office or online),
showing that the applicant:
(a) Is at
least 18 years old; and
(b) Has
graduated from a school of dental hygiene accredited by the Commission on
Dental Accreditation of the American Dental Association;
(c) Presents a certificate of the National
Board of Dental Examiners;
(d) Has
completed the emergency office procedure training required in Rule 6. 21;
and
(e) Has passed the Northeast
Regional Board Examination ("NERB") or the Central Regional Dental Testing
Service Examination ("CRDTS") or a successor regional or national examination
approved by the board before the examination is taken.
Section 6.4 Testing Information
(a) Information on the NERB may be obtained
by writing:
Office of the Secretary
Northeast Regional Board of Dental Examiners
8484 Georgia Avenue, Suite 900
Silver Spring, MD 20910
(b) Information of the CRDTS may be obtained
by writing:
Central Regional Dental Testing Service, Inc.
1725 SW Gage Blvd.
Topeka, KS 66604-3333
(c) Should changes occur after adoption of
these rules, the Office should be able to provide up-dated contact
information.
Section 6.5
Testing Information
Vermont Rules and Statutes Examination The applicant must
successfully complete the Vermont dental statutes and rules examination which
is available from the office or on line and submit it with the
application.
Section 6.6
Testing Information
Licensure by Endorsement To qualify by endorsement, the
applicant must file an application (obtained from the Office or online),
showing that the applicant:
(a) Is
currently licensed in a jurisdiction of the United States or Canada with
requirements of education and examination which are substantially equivalent to
those currently in effect in Vermont;
(b) Is currently in good standing and has not
been disciplined in any jurisdiction where the applicant has been licensed, or
has been fully reinstated after having been disciplined;
(c) Has completed the emergency office
procedure training required in Rule 6.21.
(d) The applicant must successfully complete
the Vermont dental statutes and rules examination which is available from the
office or on line and submit it with the application.
Section 6.7 Reserved
Section 6.8 Reserved
Transient Practice Permit A person who is not licensed in
Vermont may obtain a transient practice permit from the Board to perform acts
constituting the practice of dental hygiene, provided that:
(a) The practice in Vermont does not exceed
10 days in any calendar year;
(b)
The person is licensed as a dental hygienist in a jurisdiction of the United
States or Canada which, in the opinion of the Board, has regulatory standards
substantially equivalent to those currently in effect in Vermont; and
(c) The practice is for educational or
volunteer purposes only.
Section
6.9 Reserved
Local Anesthesia Privileges for Dental Hygienists A licensed
dental hygienist may qualify for a special endorsement and may undertake the
administration of local anesthesia upon:
(a) satisfactorily completing a course of
study of at least 24 hours of instruction or three eight-hour days of
instruction in a formal program in expanded function dental hygiene sponsored
by an institution accredited by the Commission on Dental Accreditation of the
American Dental Association. The course must include didactic and clinical
studies in the administration of block and infiltration anesthesia. The
curriculum must include:
(1) Medical history
evaluation procedures,
(2)
Understanding pharmacology of local anesthesia and vasoconstrictors,
(3) Anatomy of head, neck, and oral cavity as
it relates to administering local anesthetic agents,
(4) Indications and contraindications for
administration of local anesthesia,
(5) Selection and preparation of the
armamentaria and record keeping for administering various local anesthetic
agents,
(6) Medical and legal
management of complication,
(7)
Recognition and management of post-injection complications and management of
reactions to injections,
(8) Proper
infection control techniques with regard to local anesthesia and proper
disposal of sharps,
(9) Methods of
administering local anesthetic agents, with emphasis on:
(A) Technique,
(B) Minimal effective dosage,
(10) A certificate of course
completion and a copy of the syllabus must be provided to the Board.
(b) Successfully completing the
written examination in the administration of local anesthesia authorized by the
Board.
(c) Administration of local
anesthesia may occur as provided by statutes and these rules.
Section 6.10 Reserved
Anesthesia Endorsement A dental hygienist in good standing and
who has been licensed and trained to administer local anesthesia in any
jurisdiction of the US or Canada having substantially equivalent standards may
qualify for a special endorsement to perform that function by presenting
written documentation of such licensure and training to the
Board.
Section 6.11 Reserved
Maintaining Anesthesia Privileges A dental hygienist may
maintain local anesthesia privileges by administering at least 50 local
anesthetic injections during the previous five years Otherwise, a dental
hygienist must satisfy the Board of competence to administer local anesthesia
by successfully completing a course of three or more eighthour days of
instruction The course must include didactic and clinical studies in the
administration of block and infiltration anesthesia and must meet the
curriculum requirements of Rule 69(a) above.
Section 6.12 Dental Hygienists, Expanded
Function Duties
(a) A licensed dental
hygienist may qualify for registration as an expanded function dental assistant
and may perform the expanded function dental assisting duties for which the
dental hygienist has been trained in a formal program in expanded function
dental assisting accredited by the Commission on Dental Accreditation of the
American Dental Association.
(b) A
dental hygienist trained as an expanded function dental assistant may be
registered by substantiating the adequacy of training.
Section 6.13 Dental Hygienists, Expanded
Function Duties
Dental Hygienists, Expanded Functions Duties, Scope of Practice
Dental hygienists performing expanded function duties must limit the expanded
duties to those for which the dental hygienist is trained within the limits of
Vermont rules.
Section 6.14
Dental Hygienists, Expanded Function Duties
Maintaining a Dental Hygienist License To maintain a license as
a dental hygienist, the licensee must meet the active practice, continuing
education (Rule 616), and emergency office procedures
requirements.
Section 6.15
Dental Hygienists, Expanded Function Duties
Active Practice If the applicant has not met the dental hygiene
active practice requirement immediately preceding application or renewal, the
applicant must successfully complete the NERB or CRDTS or other examination
approved by the Board.
Section
6.16 Mandatory Continuing Education for Dental Hygienists
(a) During each full licensing period,
licensed dental hygienists must satisfactorily complete 12 hours continuing
education as prescribed below. Effective after the 2009 renewal: dental
hygienists must satisfactorily complete 18 hours of continuing education as
provided below.
(b) Exception: New
licensees will not be required to submit evidence of continuing education,
except emergency office procedures required by Rule 6. 21, until the first full
two-year renewal period following initial licensure.
(c) Documentation of continuing education
shall be presented to the Board upon request.
(d) Types of Education: Nine credits or hours
must be taken in clinical or didactic dental or dental hygiene subject areas.
Effective after the 2009 renewal: 15 credits or hours must be taken in clinical
or didactic dental or dental hygiene subject areas. The remaining three credits
or hours may be taken in non-scientific areas appropriate to the practice of
dental hygiene.
(e) One hour of
continuing education credit shall be given for each hour of attendance at
lectures, seminars, or other similar programs. Home study course credit will be
determined by the course sponsor based upon the reasonable amount of time
necessary to cover course material.
(f) Credit hours obtained during a renewal
period shall not be applied to any succeeding renewal period.
(g) Approved course sponsors shall include:
(1) American Dental Hygienist's Association
(ADHA),
(2) American Dental
Association (ADA),
(3) Constituent
and component state dental hygiene associations and constituent and component
state dental societies,
(4) Academy
of General Dentistry,
(5) Dental or
dental hygiene teaching institutions accredited by the Commission on Dental
Accreditation (CODA) of the ADA,
(6) Home study courses sponsored by any of
the organizations or institutions listed in subparagraphs 1 through 5
above.
Section
6.17 Mandatory Continuing Education for Dental Hygienists
Documentation Licensees must obtain an authenticated document
of attendance from the course sponsor The document of attendance shall
include:
(a) Participant's
name,
(b) Title or subject area of
course,
(c) Course
sponsor,
(d) Date and location of
course,
(e) Number of lecture and
clinical or laboratory participation hours.
Section 6.18 Mandatory Continuing Education
for Dental Hygienists
Retention of Continuing Education Records Documents pertaining
to continuing education programs attended shall be retained by the licensee for
seven years.
Section 6.19
Mandatory Continuing Education for Dental Hygienists
Verification of Compliance Compliance with continuing education
requirement shall be verified by the licensee's signature on the license
renewal form.
Section 6.20
Mandatory Continuing Education for Dental Hygienists
Audits The Board may audit licensees for compliance with the
continuing education requirement The auditing procedure shall be as
follows:
(a) A letter will be sent by
the Board requesting the licensee to provide within 30 days photocopies of
authenticated documents of attendance obtained from course sponsors.
(b) Documentation submitted will be examined
by the Board.
(c) If the
documentation submitted fulfills all of the requirements of this section, the
Board will send a letter confirming compliance to the licensee.
(d) If the documentation submitted does not
fulfill all of the requirements of this section, the discrepancy must be
justified or corrected within 90 days.
Section 6.21 Emergency Office Procedures
(a) All dental hygienists licensed or
registered in the State of Vermont shall as a condition of every biennial
license or registration renewal show evidence of having completed a course in
emergency office procedures defined in Rule 2.1(m).
(b) Only one emergency office procedure
course may count toward continuing education requirements for any licensing
period.
Section 6.22
Emergency Office Procedures
Dental Hygienist Licenses: Display Once licensed or registered,
the dental hygienist license or a photo copy if the licensee practices at more
than one location, must be conspicuously displayed in the licensee's place(s)
of practice Licensees may black out or cover their residence address if it
appears on the license.
Part
7 Information for Dental Assistants
Section
7.1 Emergency Office Procedures
Dental Assistant Registration This registration allows a person
to practice as a dental assistant in Vermont A dental assistant assists the
dentist in providing care directly to the patient.
Section 7.2 Emergency Office Procedures
Limitation on Practice A dental assistant may perform duties in
the office of any licensed dentist consistent with these rules, and in public
or private schools or public or private institutions under the supervision of a
licensed dentist The performance of any intraoral tasks by a dental assistant
shall be under the direct supervision of a dentist.
Section 7.3 Emergency Office Procedures
Duties of Dental Assistants The specific duties dental
assistants may perform are based upon:
(a) Their education;
(b) Their experience; and
(c) An agreement with the employing dentist
whose goal as a team is to promote the efficiency and reduce the cost of dental
services in the state consistent with the highest possible standards of dental
care.
Section 7.4
Emergency Office Procedures
Three categories of dental assistants There are three
categories of dental assistants:
(a)
Traditional Dental Assistants
(b)
Certified Dental Assistants
(c)
Expanded Function Dental Assistants
Section 7.5 Emergency Office Procedures
How to Become Registered as a Traditional Dental Assistant All
persons employed as traditional dental assistants in a dental office must
register with the Board A person who has not previously registered with the
Board and who is hired to be a dental assistant must register within 30 days of
the first day of employment Any person employed as a traditional dental
assistant in a dental office in this state is subject to these rules
immediately upon commencing such employment.
Section 7.6 Emergency Office Procedures
Traditional Dental Assistants, Scope of Practice A traditional
dental assistant who is not a graduate of a CODA accredited program may perform
all extraoral duties in the dental office or dental clinic which are assigned
by the dentist During intraoral procedures, the traditional dental assistant
may assist the dentist or clinical staff as assigned by the dentist The
traditional dental assistant may take radiographs under a special endorsement
of the registration.
Section
7.7 Emergency Office Procedures
Traditional Dental Assistants, Limitations A traditional dental
assistant not a graduate of a CODA accredited dental assisting program may not
perform coronal polishing or apply dental sealants until the traditional dental
assistant has worked as a traditional dental assistant for at least six
consecutive months
Section
7.8 How to Become Registered as a Certified Dental Assistant
(a) A person may become registered as a
certified dental assistant if the person is certified by the Dental Assisting
National Board. A traditional dental assistant who has already obtained
radiology privileges may register as a certified dental assistant upon
successfully completing the Dental Assisting National Board (DANB)
examination.
(b) Certification must
be renewed in accordance with DANB requirements. Certified Dental Assistants
whose certification status has changed, for any reason, must notify the Board
of the change in status within 30 days of the change.
Section 7.9 How to Become Registered as a
Certified Dental Assistant
Certified Dental Assistants, Scope of Practice Except as
limited by statute, for example 26 VSA § 864, a certified dental assistant
may perform all the duties for which the certified dental assistant has
received training.
Section
7.10 How to Become Registered as a Certified Dental Assistant
How to Become Registered as an Expanded Function Dental
Assistant A certified dental assistant or a licensed dental hygienist who has
successfully completed a formal program in expanded function duties at a
program accredited by the Commission on Dental Accreditation of the American
Dental Association may be registered as an expanded function dental
assistant.
Section 7.11 How
to Become Registered as a Certified Dental Assistant
Expanded Function Dental Assistants, Training The training
program shall have the minimal requirements of 50 hours of didactic training
and five weeks of clinical training, followed by six weeks of field training in
dental offices, all under supervision of the faculty of the accredited school
or its designates.
Section
7.12 Expanded Function Dental Assistants, Scope of Practice
(a) An expanded function dental assistant may
perform those functions for which the certified dental assistant or licensed
dental hygienist has been trained upon becoming employed by a licensed
dentist.
(b) As permitted by
statute and these rules an expanded function dental assistant may perform the
dental duties for which he or she is trained.
Section 7.13 Expanded Function Dental
Assistants, Scope of Practice
Dental Assistants, Radiographic Endorsement The Board will
issue a radiographic endorsement to an applicant who:
(a) is at least 18 years of age;
and
(b) has within the previous ten
years, successfully completed a didactic and clinical or practical radiology
course provided by a school accredited by the Commission on Dental
Accreditation of the American Dental Association. A student enrolled in a
radiology course may take radiographs necessary to course completion, in the
office of the employing or supervising dentist, but in no event more than 100
radiographs; and
(c) has documented
six months lawful employment as a dental assistant, or,
(d) has a radiography endorsement from
another U.S. or Canadian jurisdiction having substantially equivalent standards
to those of this state.
Section
7.14 Expanded Function Dental Assistants, Scope of Practice
Radiology Courses, Advisory Potential applicants, especially
those new to Vermont, should be aware that acceptable radiology courses are not
frequently offered in Vermont Finding and taking an acceptable radiology course
in another jurisdiction may shorten or eliminate any delay before a radiologic
endorsement can be issued.
Section
7.15 Expanded Function Dental Assistants, Scope of Practice
Dental Assistants, Certificate Display Dental assistant
registration certificates or a photo copy if the dental assistant practices at
more than one location, must be conspicuously displayed in the registrant's
place(s) of practice Dental Assistants may black out or cover their residence
address if it appears on the certificate.
Section 7.16 Expanded Function Dental
Assistants, Scope of Practice
Emergency Office Procedures All dental assistants, shall
complete emergency office procedures training required in Rule 717 within six
months of their date of hire.
Section
7.17 Expanded Function Dental Assistants, Scope of Practice
Renewal of Dental Assistant Registration All dental assistants
shall as a condition of every registration renewal complete a course in
emergency office procedures The Board will accept the following types of
courses as satisfying this requirement:
(a) courses in external cardiopulmonary
resuscitation which are approved by the Vermont Heart Association or the
American Red Cross; or
(b) courses
which include a review of health conditions and factors which might produce
emergencies. Acceptable courses will be consistent with current educational
curricula in schools of dentistry and dental hygiene accredited by the
Commission on Accreditation of the American Dental Association.
Section 7.18 Expanded Function
Dental Assistants, Scope of Practice
Dental Assistant Transient Practice Permit A person who is not
registered in Vermont may obtain a transient practice permit from the Board to
perform acts constituting the practice of dental assisting, provided
that:
(a) The practice in Vermont does
not exceed 10 days in any calendar year;
(b) The person is registered or certified as
a dental assistant in another state which, in the opinion of the Board, has
regulatory standards substantially equivalent to those currently in effect in
Vermont; and
(c) The practice is
for educational or volunteer purposes only.
Part 9 Professional Standards,
Unprofessional Conduct
Section 9.1 Renewing a
License or Registration
Change of Name, Address Licensees and registrants must notify
the Office promptly of any changes in name or address Failure to comply with
this provision can result in unlicensed practice, late fees, and unprofessional
conduct charges.
Section 9.2
Making and Resolving Complaints
(a) The Board
follows the complaint procedure of the Office of Professional Regulation.
Copies of the procedure and more information about the complaint process may be
obtained from the Office or online at http://vtprofessionals.org/.
(b) Under
3 V.S.A. §
127(c), a person may be
imprisoned for up to one year or fined up to $ 5,000.00, or both for practicing
without a valid license or registration.
Section 9.3 Grounds for Discipline
(a)
3 V.S.A. §
129a defines unprofessional conduct for all
professions including those governed by these rules. Whenever its provisions
are in conflict or overlap with the statutes specifically governing these
professions, or these rules, the provisions which provide greater safety to the
public shall apply. Chapter 13 of Title 26 of the Vermont Statutes contains
specific definitions of unprofessional conduct for the professions subject to
these rules.
(b)
3 V.S.A. §
129a and 26 V.S.A. § 809 specify certain
acts which constitute unprofessional conduct. Those statutes are not the only
basis of discipline. Failing to comply with provisions of federal or state
statutes or rules governing the practice of the profession,
3 V.S.A. §
129a(3), also constitutes
unprofessional conduct.
(c)
Unprofessional conduct includes failure to practice competently. 3 V.S.A.
§ 120a(b). Failure to practice competently includes performing treatments
or providing services which one is not qualified to perform, or which are
beyond the scope of one's education, training, capabilities, experience, or
scope of practice. This means that persons subject to these rules, when
presented with an unfamiliar or complicated treatment challenge, have a duty to
acquire necessary skill or knowledge to treat a patient. This may mean
consulting with another professional before treating the patient. If acquiring
sufficient skill and knowledge to competently treat the patient is not
possible, the professional has a duty to refer the patient to another
professional qualified to treat the patient.
Section 9.4 Grounds for Discipline
Ethics Codes The Ethics Codes of the American Dental
Association and the American Dental Hygienists' Association can provide
guidance to the Board of Dental Examiners as it is called upon to determine the
meaning of the statutes and rules governing the profession, as well as
unprofessional conduct The Board may refer to the Codes for guidance when
possible.
Section 9.5
Grounds for Discipline
Unauthorized Practice The Board also has authority to decide
complaints of unauthorized practice as indicated in
3 VSA §
127.
Section 9.6 Grounds for Discipline
Sanctions for Unprofessional Conduct Among the possible
disciplinary actions the Board may impose against the license of a dentist,
dental hygienist, or dental assistant after a finding of unprofessional conduct
are:
(a) denial of licensure or
registration or renewal;
(b)
warnings or reprimands;
(c)
suspension for a period of time to be determined by the Board;
(d) revocation;
(e) limitations on practice;
(f) setting conditions for practice or
resumption of practice;
(g) denial
of reinstatement; or,
(h)
imposition of a civil penalty of up to $ 1,000 for each instance of
unauthorized practice, unprofessional conduct, or violation not related to
patient care.
Section
9.7 Supervising Dentist: Duty to Inform
(a) It is the responsibility of each
supervising dentist to inform each person hired to work of the responsibilities
and licensing and registration requirements imposed by these rules and to
ensure that all employees are properly licensed or registered.
(b) A copy of these rules shall be readily
available to all persons subject to these rules. All persons subject to these
rules are reminded that
3 V.S.A. §
129a(6) includes within the
definition of "unprofessional conduct" " D elegating professional
responsibilities to a person whom the licensed professional knows, or has
reason to know, is not qualified by training, experience, education or
licensing credentials to perform them."
Section 9.8 Supervising Dentist: Duty to
Inform
Public Records All Board decisions on disciplinary complaints
are public records Unprofessional Conduct decisions are available online or
from the office.
Part
10 Rules for Dental Hygienists Practicing Under General
Supervision in Public or Private Schools or Public or Private Institutions
Section 10.1 Supervising Dentist: Duty to
Inform
Eligibility Dental hygienists who have a minimum of three years
licensed clinical practice experience and have been in good standing for three
years before entering the agreement are permitted to provide services as
authorized in a General Supervision Agreement between the dental hygienist and
dentist licensed and in good standing in Vermont.
Section 10.2 General Supervision Agreement
(a) A general supervision agreement
(agreement) is a written document signed by the dental hygienist being
supervised and the dentist providing general supervision. Both must be in good
standing with the Board of Dental Examiners.
(b) The agreement authorizes the dental
hygienist who is providing dental hygiene services in a public or private
school or institution under the general supervision of a dentist to provide
specific hygiene services agreed to between the dentist and dental hygienist.
The agreement sets forth the responsibilities of the dentist and dental
hygienist.
(c) The dental hygienist
shall practice according to the parameters of the agreement.
(d) The variable terms of the agreement can
be modified at any time in writing. Modifications must then be signed by both
parties.
(e) A supervision
agreement template is available on line at
http://vtprofessionals.org.
Section
10.3 General Supervision Agreement
Contents of the Agreement The agreement shall contain the
following provisions:
Responsibilities of Supervising Dentist and Dental
Hygienist:
"The parties agree that:
(1) The dental hygienist will practice
according to the parameters set forth in this agreement.
(2) The dentist providing general supervision
must be available for consultation but is not required to be physically present
at the site where dental hygiene services are provided.
(3) The dental hygienist working under this
agreement and supervising dentist agree to maintain communication and
consultation with each other.
(4)
The dental hygienist will provide the dentist opportunities to review patient
records as requested.
(5) The
dentist will review the records of patients treated by the dental hygienist
from the beginning of general supervision. Reviews will include records of all
patients seen. Reviews must occur no less than once every 6 (six) months at a
minimum. The dentist may determine the need for and conduct more frequent
reviews. Subsequent reviews of records need only encompass patients seen since
the last review.
(6) Limitation on
treatment:
(A) When the patient's dental
condition requires services beyond what the dental hygienist can provide, the
dental hygienist will advise or refer the patient to obtain dental or other
care.
(B) For patients who have
been treated by a dental hygienist under general supervision and who since
treatment began have not been seen or examined by a dentist in 24 months, the
hygienist should inform the patient or guardian that an examination by a
dentist is strongly recommended.
(7) The dental hygienist will ensure that
patient records are properly maintained and comply with applicable state or
federal laws.
(8) Authorized
services. The agreement must contain a listing of the dental hygiene services
that are authorized. The dental hygienist may provide only the services
authorized by the agreement. A list of approved dental hygiene services which
may be included in the supervision agreement is contained in Rule 10.6.
(9) Consent Form
(a) The dental hygienist will, as
appropriate, obtain written consent from the patient, parent or guardian on a
form that may include:
"I understand that the records for services provided by the
dental hygienist will be reviewed by a Vermont licensed dentist providing the
dental hygienist general supervision.
I understand that treatment I receive from the dental hygienist
is limited in scope. It does not take the place of a regular dental examination
or treatment by a licensed dentist.
I understand that the dental hygienist will refer __________
(me, my child name of patient) for treatment by a dentist or other medical
professional when a dental condition requires treatment beyond what the dental
hygienist can provide."
(b)
If a school or institution uses its own consent form for medical or dental
hygiene services provided at its facilities, the dental hygienist shall then
document reasonable efforts to ensure that the consent form used by the school
or institution provides an equivalent notice, and that patients, parents or
guardians are aware of the information in the consent form above.
Section 10.4 General
Supervision Agreement
Duration of Agreement Unless modified before, this agreement
shall expire on _______ (not more than one year after effective
date.)
Section 10.5
Agreement Filing and Retention
(a) A copy of
the agreement shall be sent to:
The Board of Dental Examiners
Vermont Secretary of State
Office of Professional Regulation
National Life Bldg., North, FL2
Montpelier, VT 05620-3402
(b) The dentist and dental hygienist shall
retain copies of supervision agreements for seven years.
Section 10.6 Approved Services
The following hygiene services are approved by the Board of
Dental Examiners for use in public and private schools and institutions and
approved for use in the agreement:
The dental hygienist under this agreement is authorized
to:
(a) interview patients and record
complete medical and dental histories;
(b) take and record the vital signs of blood
pressure, pulse and respiration;
(c) perform oral inspection and record all
conditions identified;
(d) perform
complete periodontal charting and charting of existing dental
restorations;
(e) provide the
patient information so that the patient may be referred for or seek necessary
follow up dental care;
(f) provide
dental health education and oral hygiene instructions;
(g) assess the patient's treatment needs and
provide the assessment to the patient;
(h) after determining their necessity;
(1) expose and process radiographs;
(2) apply fluoride varnish and/or fluoride to
control caries;
(3) apply
desensitizing agents to teeth;
(4)
apply sealants;
(i)
regardless of periodontal case type classification, provide in appropriate
circumstances when there are no medical contra-indications:
(1) prophylaxis adult;
(2) prophylaxis child;
(3) full mouth debridement to enable
comprehensive evaluation and diagnosis;
(j) Provide, for patients with mild
periodontitis; (Defined as: gingival edema, bleeding upon probing, and/or
suppuration, up to 1/4 loss of supporting periodontal tissues and no more than
class 1 (incipient) furcation involvement. Pocket depths of 6 mm. or less.)
(1) periodontal maintenance;
(2) periodontal scaling and root
planing.
Section
10.7 Approved Services
Additional Information Practitioners are reminded that the
Board's web site http://vtprofessionalsorg may have additional information
regarding general supervision in public and private schools and
institutions
