1. Chapter 7 Society and the State Dental Practice Act

2. Objectives Relate the role of the state in the governing of health care professions. Identify the provisions that are likely to be included in state statutory law for the practice of dental hygiene. List the reasons that a dental hygiene license may be suspended, restricted, or revoked. Define and describe direct supervision, indirect supervision, and general supervision. Recognize the responsibility of the dental hygienist for understanding the state statutory and regulatory provisions.

3. Statutory Law The legislative branch of government is generally responsible for the enactment of the state dental practice act. The state dental practice act may be a single law or a compilation of laws that regulate the practice of dentistry. DH must be familiar with the laws that deal specifically with dental hygiene, as well as the general laws that protect the well-being of the state’s citizens. EX: most states have enacted laws that require health care professionals to report suspected child abuse. This law may be found in acts that focus on child protection, rather than the practice of dental hygiene.

4. Issues regulated by state laws but may not be incorporated into a state’s dental practice act. Abuse reporting requirements Biomedical wastes and hazards management Consent to treatment and informed consent Criminal activity Disability accommodation False health claims Patient confidentiality Public health reporting requirements(contagious or infectious diseases)

5. Statutory Law State statutory law that regulates the practice of dental hygiene is likely to include provisions regarding the following: Licensure requirements Licensure examination requirements Licensure eligibility requirements Licensure by endorsement Approval of educational programs Examination and disciplinary authority Scope of practice Supervision requirements Continuing education requirements

6. Rules and Regulations The executive branch of government is responsible for implementing the statutory law and providing more specific guidance and regulation regarding dental hygiene practice. The executive branch includes the departments and agencies of state government (Dept. of Health, Dept. of Professional Regulation, etc.). The regulation of the practice of dental hygiene may be facilitated by an appointed board or an elected regulatory body. The regulatory body may be referred to as Board of Dental Examiners, Board of Dentistry, State Dental Board, etc. In some states a regulatory board may be advised by a 2ndary body, which has greater dental hygiene representation, such as a council or dental hygiene committee.

7. Enactment of the state dental practice act. Laws specifically with dental hygiene General laws that protect the well- being of the state’s citizens Ex: Abuse reporting, consent to tx, informed consent, criminal activity, disability accommodations, confidentiality Implementing statutory law Provide more specific guidance and regulation regarding dental hygiene practice. Includes Dept of Health, Dept of Professional Regulation Regulation body: Board of Dental examiners, Board of Dentistry, State Dental Board

8. The Practice of Dental Hygiene In the US the practice of DH is not nationally regulated and is different in every state A hygienist on an annual basis should obtain and review the applicable state dental practice act A good time to do this might be at your license renewal, birth date, or other annual occurrence of significance Our State Dental Practice Act can be found at www.tsbde.state.tx.us

9. Types of DH Licenses Full license: granted on basis of examination or endorsement of credentials. Temporary license: granted on the basis of licensure in another jurisdiction, permits practice for a limited period of time while the DH pursues full licensure status. Volunteer license: granted on the basis of licensure in another jurisdiction, permits practice for the purpose of public service. Faculty license: granted on prior licensure in another jurisdiction, permits faculty member to practice within the scope of his/her educational responsibilities.

10. Licensure Provisions In order to practice DH legally, you must have a license in the state you are to practice. A condition of DH licensure is to graduate from a DH school that is accredited by the CODA (Commission on Dental Accreditation), as well as successful completion of a national, regional, and/or state licensure exam. An exception to these general conditions exist in Alabama (refer to book pg 105).

11. Licensure Provisions A DH license may be issued on the basis of a review of credentials (aka licensure by endorsement or reciprocity). If you have graduated from an accredited school, are licensed in good standing in a state with similar or higher requirements for licensure, have practiced DH for a minimum prescribed period may have exam requirements waived on basis of credentials.

12. Licensure Provisions Some states provide for temporary licensure of DH who are licensed in other jurisdictions, are relocating to that state, and do not have the option of licensure by credentials. A temporary license is valid for a prescribed period of time or until the next scheduled licensure exam. A volunteer license may be available to DH who hold a DH license in good standing in another jurisdiction, have a minimum specified years of clinical experience, and seek to provide volunteer services. A limited number of states provide for a faculty license for a DH whose practice will be limited to DH education only.

13. Licensure Provisions DH are generally required to display a copy of their license at their place (s) of practice. DH licenses expire and require renewal on a schedule (annually, bi-annually) prescribed by state law. When a DH experiences a limited lapse of licensure, the state may reinstate without exam upon proof of continued professional competence and payment of renewal and penalty fees.

14. Licensure Provisions The practice of DH without a valid license is a criminal offense. The penalty for noncompliance with licensure requirements may include a monetary fine and/or imprisonment. A DH license may be suspended or revoked on the basis of unprofessional conduct, violations of laws and regulations, and clinical incompetence or delivery of substandard care. EX of unprofessional conduct- acts of fraud, conviction of felony, sexual conduct with a patient, violation of state or federal laws.

15. Dental Hygienists breaking the law!! Practicing without a valid DH license Unprofessional conduct, violations of laws and regulations Clinical incompetence, delivery of substandard care. Fraud, conviction of a felony, sexual conduct with a patient, violation of state or federal laws

16. Licensure Provisions DH may also have their practice restricted or suspended if they become impaired by reason of mental illness, physical illness, or habitual or excessive use or abuse of alcohol or controlled substance. Many states have CE requirements for maintaining licensure. Documentation or certification of compliance is generally necessary when renewing the license. License renewal requires payment of a licensing fee. If you are not currently practicing DH some states have the option to make your license inactive, but still maintain professional status and reactivate when ready. Some states like Arkansas requires a DH to be practicing in order to maintain active license status.

17. License Restriction or Suspension Impaired for mental illness Physical illness Habitual or excessive use of alcohol and drugs

18. Scope of Practice Varies among the states. Includes educational, assessment, preventive, clinical, and other therapeutic services. Each specific function is defined by state law. Some routine functions that are allowed are removal of deposits and stains from supra and subgingival surfaces by SRP, polishing, applying pit and fissure sealants, fluoride, charting of oral conditions and exposing, developing and referring to oral radiographs. Some states allow for DHs to administer local anesthesia and perform restorative procedures (Expanded Functions).

19. Scope of Practice In some states (Arkansas) you are required to have a separate certification from your hygiene license to administer local anesthetics. DH can also perform, if competent, any procedure that can legally be delegated to a non-licensed provider, such as a dental assistant. General preclusions of practice include diagnosis for dental treatments, cutting or removing of hard or soft tissues, and prescribing of drugs or medications. It is the DH legal responsibility to stay within the scope of practice for that state; if asked to do something outside your scope, you are obligated to decline that request.

21. Supervision Requirements Level of supervision varies by state, scope of practice, and location of practice. Direct supervision generally requires prior diagnosis of the patient’s condition and authorization of a procedure by a dentist, presence of dentist on premises, and dentist approval of work prior to patient dismissal. Indirect supervision requires prior diagnosis of the patient’s condition and authorization of a procedure by a dentist, and the presence of the dentist on the premises. General supervision requires that the services to be delivered are authorized by the dentist, however, the presence of the dentist in the treatment facility is not required.

22. Other Selected Statutory Provisions Not all laws governing the practice of DH are encompassed in the state dental practice act. This does not negate the DHs obligation to comply with such laws like: Abuse Reporting Most states have enacted laws that mandate the reporting of child abuse. In addition, several states have enacted legislation that mandates or encourages the reporting of abuse of vulnerable, dependent, and disabled adults.

23. Other Selected Statutory Provisions Patient Records Although maintenance of a patient record is professionally prudent, it may also be mandated statutorily. Some states have incorporated patient record requirements within the state dental practice act. Health care records are generally recognized to be confidential and protected against disclosure to unauthorized third parties.

24. Other Selected Statutory Provisions Professional Liability Insurance DH in some states are mandated to maintain professional liability insurance or other indemnity against liability for professional malpractice. When mandated, the law may prescribe the level of insurance that must be maintained per incident as well as in the aggregate (collection of particulars into a whole mass or sum; a total or gross amount).

25. Other Selected Statutory Provisions CPR Certification It is professionally prudent to maintain current cardiopulmonary resuscitation (CPR) certification. Some states have enacted legislation that mandates that dental professionals be currently certified in CPR.

26. Other Selected Statutory Provisions Self-Referral and Kickbacks State and local self-referral statutes have been enacted to avoid the conflict of interest that may be inherent in the referral of a patient by a health care provider to a provider that the referring provider has an investment in. Prohibitions on kickbacks, or remuneration or payment back as an incentive or inducement to refer or solicit patients, have also been enacted at the federal and state levels.

28. Due Process In the event of threatened adverse reactions against licensure status, DH should become familiar with the available administrative procedures. General due process provisions include notice and an opportunity to be heard. Notice generally includes a statement of the proposed action to be taken, the available evidence supporting the proposed action, and the opportunity for a hearing.

29. Due Process The proposed action can be taken within the time and manner specified in the notice. If a hearing is requested the DH will be notified of the time and place and who is conducting the hearing.

30. Summary Dental hygiene is a state regulated health profession because of society’s concern for its citizens. It is the DH responsibility to be intimately familiar with the statutory and regulatory provisions of the practice of dental hygiene. Noncompliance with these provisions is not an excuse for failure or to understand the hygienist’s responsibilities.

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