216-RICR-40-05-2
216-RICR-40-05-2. Dentists, Dental Hygienists, and Dental Assistants (version Periodic Refile, 01/02/2002 to 11/21/2004)
RULES AND REGULATIONS PERTAINING TO
DENTISTS - DENTAL HYGIENISTS -
AND
DENTAL ASSISTANTS
(R5-31.1-DHA)
STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF HEALTH
BOARD OF EXAMINERS IN DENTISTRY
July 1959
As Amended:
January 1964
January 1986
August 1988
October 1989
February 1991(E)
June 1991(E)
September 1991 (E)
January 1992 (E)
April 1992
February 1993
April 1996
July 1999
November 2001
January 2002 (re-filing in accordance with the
provisions of section 42-35-4.1 of the Rhode
Island General Laws, as amended)
i
INTRODUCTION
These rules and regulations are promulgated pursuant to the authority conferred under Chapter 5-31.1
of the General Laws of Rhode Island, as amended, and are established for the purpose of adopting standards
governing the licensure of dentists and dental hygienists; the practice of dentistry as it pertains to dentists,
dental hygienists and dental assistants; continuing education for dentists and dental hygienists; the administration
of general anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious sedation, and/or
nitrous oxide analgesia; and to establish administrative procedures for the implementation of the statutory and
regulatory provisions.
Pursuant to the provisions of section 42-35-3(c) of the General Laws of Rhode Island, as amended,
consideration was given in arriving at the regulations as to: (1) alternative approaches to the regulations; (2)
duplication or overlap with other state regulations; (3) significant economic impact on small business as defined
in Chapter 42-35 of the General Laws, which would result from the regulations. No known overlap,
duplication, alternative approach or significant economic impact was identified. Consequently, these amended
rules and regulations are adopted in the best interest of the public health, safety and welfare.
These amended rules and regulations shall supersede all previous rules and regulations pertaining to
dentists and dental hygienists promulgated by the Rhode Island Department of Health and the Board of
Examiners in Dentistry and filed with the Secretary of State.
ii
TABLE OF CONTENTS
Page
PART I
DEFINITIONS
1
1.0 Definitions
1
PART II
DENTISTS/LICENSING REQUIREMENTS
4
2.0
License Requirements
4
3.0
Qualifications
4
4.0
Application/Fee
4
5.0
Examinations
5
5.2
Continuing Education
6
6.0
Issuance and Renewal of License
7
PART III
DENTAL HYGIENISTS/LICENSING REQUIREMENTS
8
7.0
License Requirements
8
8.0
Qualifications
8
9.0
Application/Fee
8
10.0
Examinations
9
10.2
Continuing Education
10
11.0
Issuance and Renewal of License
11
PART IV
DELEGABLE/NON-DELEGABLE PROCEDURES/
DUTIES - SUPERVISION
12
12.0
General Requirements
12
12.1
Dental Hygienists
12
12.2
Certified Dental Assistants & Dental Assistants
12
13.0
Delegable Procedures/Duties
13
14.0
Non-Delegable (Exclusionary) Procedures/Duties
14
PART V ADMINISTRATION OF ANESTHESIA IN DENTAL OFFICES
16
15.0
General Requirements
16
16.0
Qualifications for Permit
16
17.0
Application for Permit
18
18.0
Issuance and Renewal of Permit
19
19.0
Inspections
19
20.0
Inactive Status
19
21.0
General Anesthesia/Deep Sedation, Inhalation Conscious Sedation, Parenteral
Conscious Sedation or Nitrous Oxide Analgesia Services
20
22.0
Physical Facility, Equipment & Safety
21
23.0
Violations & Sanctions
23
PART VI
RECORD KEEPING & DISCLOSURE
24
24.0
Dental Records
24
25.0
Controlled Substances - Records
25
PART VII
VIOLATIONS, SANCTIONS, SEVERABILITY
26
26.0
Denial, Suspension or Revocation of License, Violations & Sanctions
26
27.0
Rules Governing Practices & Procedures
28
28.0
Severability
28
REFERENCES
29
1
PART I
DEFINITIONS
Section 1.0 Definitions
Whenever used in these rules and regulations the following terms shall be construed as follows:
1.1
"Act" refers to Chapter 5-31.1 entitled "Dentists and Dental Hygienists" of the General Laws of
Rhode Island, 1956 (reenactment of 1987).
1.2
"Advisory consultants" means those individuals appointed by the Board to serve as advisory
consultants to the Board in determining compliance with the statutory and regulatory provisions herein,
of applicants seeking a permit to administer or to permit the administration of general anesthesia/deep
sedation, conscious sedation, or nitrous oxide analgesia. Such consultants may be Diplomates of the
American Board of Oral and Maxillofacial Surgery, Members or Fellows of the American Association
of Oral and Maxillofacial Surgeons, or Fellows of the American Dental Society of Anesthesiology, and
may include a Board Certified Anesthesiologist and a licensed dentist with experience in the
administration of general anesthesia/deep sedation, conscious sedation, or nitrous oxide analgesia.
1.3
"Board" refers to the Board of Examiners in Dentistry, or any committee or subcommittee thereof,
established in the Rhode Island Department of Health pursuant to the provisions of the Act.
1.4
"Certified dental assistant" means a person currently certified by the Dental Assisting National
Board, Inc., or its successor agency as a certified dental assistant in general dentistry or in one of the
appropriate specialties, and employed for the purpose of assisting a dentist in the performance of
procedures/duties related to dental care in accordance with the provisions herein.
1.5
"Conscious sedation" means a minimally depressed level of consciousness that retains the patient's
ability to independently and continuously maintain an airway and respond appropriately to physical
stimulation or verbal command; conscious sedation may be produced by a pharmacological or non-
pharmacological method, or by a combination thereof. The term “inhalation conscious sedation” is not
intended to include nitrous oxide/oxygen, when used alone and/or with local anesthetics.
1.6
“Dental administrator” means the Administrator of the Rhode Island Board of Examiners in
Dentistry.
1.7
“Deep sedation” means an induced 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 physical stimulation or verbal command; deep sedation may be produced by a
pharmacological or non-pharmacological method, or by a combination thereof.
1.8
"Dental assistant" means a person not currently certified by the Dental Assisting National Board,
Inc., or its successor agency as a certified dental assistant in general dentistry or in one of the
appropriate specialties, and employed for the purpose of assisting a dentist in the performance of
procedures/duties related to dental care in accordance with the provisions herein.
2
1.9
"Dental auxiliary personnel" refers to a dental hygienist, a certified dental assistant or a dental
assistant.
1.10
"Dental hygienist" means an individual licensed under the provisions of Chapter 5-31.1 of the
General Laws of Rhode Island, as amended to practice dental hygiene.
1.11
"Dental office" means a place, however named, where a dentist actively, regularly, and personally
practices dentistry, pursuant to the provisions of 5-31.1-1 (g) of the General Laws.
1.12
"Dentist" means an individual licensed under the provisions of Chapter 5-31.1 of the General Laws
of Rhode Island, as amended, 1956 (reenactment of 1987) to practice dentistry in this state.
1.13
"Dentistry" refers to the practice of dentistry as defined in section 5-31.1-1 of the Act.
1.14
"General anesthesia" means an induced state of unconsciousness accompanied by partial or
complete loss of protective reflexes, including the inability to continually maintain an airway
independently and respond purposefully to physical stimulation or verbal command; general anesthesia
may be produced by a pharmacological or non-pharmacological method, or by a combination thereof.
1.15
“Inhalation” means a technique of administration in which a gaseous or volatile agent is introduced
into the pulmonary tree and whose primary effect is due to the absorption through the pulmonary bed.
1.16
"License", as used herein, is synonymous with "registration.”
1.17
"Nitrous oxide analgesia" means the administration of nitrous oxide to diminish or eliminate the
sensibility to pain in the conscious patient, designating in particular the relief of pain without loss of
consciousness.
1.18
"Parenteral" means a technique in which the drug bypasses the gastrointestinal (GI) tract [i.e.,
intramuscular (IM), intravenous (IV), intranasal (IN), submucosal (SM), subcutaneous (SC),
intraocular (IO)].
1.19
"Supervision" includes four (4) types of supervision as follows:
a)
"Direct supervision" means the dentist is in the dental office, personally diagnoses the
condition to be treated, personally authorizes the procedure(s)/duty(ies), remains in the dental
office while the procedure(s)/duty(ies) are being performed and examines the patient before
his/her dismissal.
b)
"General supervision" means the dentist has authorized the procedure/duty and such is
being carried out in accordance with his/her diagnosis and treatment plan. The dentist does
not have to be physically present in the dental office when such treatment is being performed
under general supervision.
3
c)
"Indirect supervision" means the dentist is in the dental office, personally diagnoses the
condition to be treated, personally authorizes the procedure(s)/duty(ies), and remains in the
dental office while the procedure(s)/duty(ies) is being performed by the dental auxiliary.
d)
"Personal supervision" means the dentist is personally operating on a patient and authorizes
the dental auxiliary to aid his/her treatment by concurrently performing a supportive procedure.
1.20
"Triennial" shall mean occurring every third (3) year.
1.21
"Unprofessional conduct" shall include, but not be limited to, the provisions of section 5-31.1-10 of
the General Laws, and is further defined as failure to conform to the current guidelines regarding
Universal Precautions and Infection Control of the Centers for Disease Control.
4
PART II
DENTISTS/LICENSING REQUIREMENTS
Section 2.0 License Requirements
2.1
No person shall perform any act which constitutes the practice of dentistry in this state unless such
person is duly licensed in accordance with the regulatory and statutory provisions of the Act as a
dentist or a dental hygienist. Furthermore, dental hygienists, certified dental assistants and dental
assistants shall perform only those auxiliary dental services, procedures and duties, and under the
specified type of supervision, as set forth in section 13.0, Part IV of these Rules and Regulations.
Exempt from these requirements are those persons listed in section 5-31.1-37 of the Act.
Section 3.0 Qualifications for Licensure
3.1
An applicant seeking licensure to practice dentistry in the state of Rhode Island must:
a)
be of good moral character;
b)
be eighteen (18) years of age or over;
c)
be a graduate of a school of dentistry accredited by the American Dental Association
Commission on Dental Accreditation or its designated agency and approved by the Board;
d)
have passed to the satisfaction of the Board the required examinations in accordance with
section 5.0 herein; and
e)
be in good standing in each state in which he/she holds a license.
Section 4.0 Application for License and Fee
4.1
Application for license shall be made on forms provided by the Board, which shall be completed,
notarized and submitted to the Board thirty (30) days prior to the scheduled date of the Board meeting
at which the application is scheduled to be reviewed. Such application shall be accompanied by the
following documents (non-returnable):
a)
three (3) affidavits from responsible persons (preferably Rhode Island residents) attesting to
the applicant's good moral character;
b)
one (1) unmounted recent photograph of the applicant, head and shoulder front view,
approximately 2 x 3 inches in size.
c)
a certified copy of birth certificate;
For foreign nationals: if a certified copy of birth certificate cannot be obtained, immigration
papers or resident alien card or such other birth-verifying papers acceptable to the Director;
5
d)
supporting official transcript of grades and/or verification of graduation signed by the dean or
registrar of the dental school;
e)
national board results in accordance with section 5.1.1(b) submitted either with application or
submitted by the National Dental Examination Commission to the Board;
f)
the results of the Northeast Regional Board of Dental Examiners, Inc., examination (as
required herein) submitted directly by the Board of the Northeast Regional Board of Dental
Examiners, Inc.;
g)
verification that the licensee is in good standing in state(s) where licensed [if licensed in another
state(s)];
h)
the application fee of four hundred thirty-seven dollars and fifty cents ($437.50) (non-
refundable) made payable by check to the General Treasurer, state of Rhode Island, in
accordance with section 5-31.1-6 of the Act.
Section 5.0 Examination for Licensure
5.1
By Examination:
Applicants shall be required to pass such examination(s) as the Board deems most practical and
expeditious to test the applicant's knowledge and skills to practice dentistry in this state pursuant to
section 5-31.1-6 of the Act; and:
5.1.1 The Board requires each applicant to:
a)
have graduated from a school of dentistry in accordance with section 3.1(c) herein;
b)
have successfully passed the national examination of the Joint Commission on National Dental
Examination (Parts I and II); and
c)
have successfully passed the Northeast Regional Board of Dental Examiners, Inc.,
Examination within five (5) years from the date of application for licensure in this state;
or
i.
hold a current license to practice dentistry in another state; and
ii.
have been actively engaged in the practice of dentistry in good standing for the past
five (5) years from the date of application for licensure.
5.1.2 Applicants must submit to the Board, the application accompanied with the appropriate
documentation as set forth in section 4.0 herein.
6
5.1.3 Sites and schedules of examinations may be obtained directly from the examination service(s)
referred to above or from the Board.
5.2
Continuing Dental Education
5.2.1 Pursuant to the provisions of section 5-31.1-7 of the Act, every dentist licensed to practice in
this state under the provisions of the Act and the regulations herein, on or before the first day
of June of every third year after the 2001 registration shall maintain evidence that in the
preceding three (3) years he or she has satisfactorily completed at least sixty (60) hours of
continuing dental education courses, according to the criteria established by the Rhode Island
Dental Association and approved by the Board. Continuing education requirements cited
herein shall be prorated for a licensee whose license is in effect for a period of less than three
(3) years (i.e., an average of twenty (20) hours of continuing education shall be required each
year the license is in effect).
a)
It shall be the sole responsibility of the individual dentist to obtain documentation from
the approved sponsoring or co-sponsoring organization, agency or other, of his or her
participation in a learning experience, including the date, and number of hours earned.
b)
At the time of license renewal, each licensee shall be required to attest to the fact that
he/she has complied with the continuing education requirements stated herein. Course
descriptions, proof of attendance, or other documentation of completion shall be
retained by the licensee for a minimum of five (5) years and is subject to random audit
by the Board. Failure to produce satisfactory documentation of completion of
requirements upon request of the Board may constitute grounds for disciplinary action.
5.2.2 All dentists and dental auxiliary personnel practicing in a dental setting shall receive annual
training on and shall comply with the Occupational Safety and Health Administration’s
(OSHA) Bloodborne Pathogen Standards (reference 1) in order to protect themselves against
occupational exposure to bloodborne pathogens.
5.2.3 If the applicant submits evidence satisfactory to the Board of completion of the prescribed
course(s) of continuing dental education established by the Rhode Island Dental Association,
as approved by the Board, and is in compliance with the provisions of section 5-31.1-7 of the
Act, the Board shall issue the applicant a license registration for a one (1) year period in
accordance with the requirements of section 6.0 herein.
5.2.4 Licensure renewal shall be denied to any applicant who fails to provide satisfactory evidence
of continuing dental education as required herein.
a)
Notwithstanding the provisions of section 5.2.3 above, no license to practice dentistry
in this state shall be refused, nor shall any license be suspended or revoked except as:
(1) provided in the Act; and (2) for failure to provide satisfactory evidence of
continuing dental education as required herein.
7
5.2.5 The Board may, however, extend for only one (1) six (6) month period such educational
requirements, if the Board is satisfied that the applicant has suffered hardship which prevented
him/her from meeting the requirements herein.
Section 6.0 Issuance and Renewal of License
6.1
A license shall be issued by the Board to an applicant found to have satisfactorily met all requirements
herein. Said license unless sooner suspended or revoked shall expire annually on the 30th of June.
6.2
Every person so licensed who desires to renew his or her license shall file with the Board before the
first (1st) of May a renewal application duly executed together with evidence of completion of
continuing education requirement and the renewal fee as determined annually by the Director of Health
in consultation with the Board, made payable by check to the General Treasurer, state of Rhode
Island. Upon receipt of such application and payment of such fee, a license renewal shall be granted
effective for the calendar year unless sooner suspended or revoked.
i.
for those licensees who shall have attained the age of not less than seventy (70) years
("emeritus active") as of June 30th of the year of licensure, the renewal fee (non-refundable)
shall be sixty-two dollars and fifty cents ($62.50) made payable by check to the General
Treasurer, state of Rhode Island.
6.3
Pursuant to the provisions of section 5-31.1-21 of the Act, the registration certificate of all dentists
whose renewals accompanied by the prescribed fee are not filed on or before the first day of June shall
be automatically revoked. The Board may in its discretion and upon the payment by the dentist of the
current licensure (registration) fee plus an additional fee of sixty-two dollars and fifty cents ($62.50)
reinstate any license (certificate) revoked under the provisions of the Act and the regulations herein.
Inactive Status
6.4
Dentists not intending to practice in this state may request on an annual basis to be placed on inactive
status. Such requests must be made in writing to the dental administrator and must be accompanied by
a fee of sixty-two dollars and fifty cents ($62.50). Persons on inactive status may be reinstated by
paying the current annual registration fee and must meet such requirements established by the Act and
as prescribed herein.
8
PART III
DENTAL HYGIENISTS LICENSING REQUIREMENTS
Section 7.0 License Requirements
7.1
No person shall perform any act which constitutes the practice of dental hygiene in this state unless
such person is duly licensed in accordance with the regulatory and statutory provisions of the Act as a
dentist or dental hygienist.
7.1.1 Furthermore, dental hygienists, certified dental assistants and dental assistants, shall perform
only those auxiliary dental services, procedures/duties, and under the specified type of
supervision, as set forth in Part IV of these Rules and Regulations. Exempt from these
requirements, are those persons listed in section 5-31.1-37 of the Act.
Section 8.0 Qualifications for Licensure
8.1
An applicant seeking licensure to practice dental hygiene in this state must:
a)
be of good moral character;
b)
be eighteen (18) years of age or over;
c)
have graduated from a program for dental hygienists accredited by the Commission on Dental
Accreditation or its designated agency and approved by the Board;
d)
have passed to the satisfaction of the Board the required examinations in accordance with
section 10.0 herein; and
e)
be in good standing in each state in which he/she holds a license.
Section 9.0 Application for Licensure and Fee
9.1
Application for licensure shall be made on forms provided by the Board which shall be completed,
notarized and submitted to the Board thirty (30) days prior to the scheduled date of the Board meeting
at which the application is scheduled to be reviewed. Such application shall be accompanied by the
following documents (non-returnable):
a)
three (3) affidavits from responsible persons (preferably Rhode Island residents) attesting to
applicant's good moral character;
b)
a certified copy of birth record;
For foreign nationals: if a certified copy of birth certificate cannot be obtained, immigration
papers or resident alien card or such other birth-verifying papers acceptable to the Director;
9
c)
one (1) unmounted photograph of the applicant, head and shoulder front view, approximately
2 x 3 inches in size;
d)
supporting official transcript of education credentials signed by the dean or registrar of the
program of dental hygiene;
e)
national board results in accordance with section 10.1.1(a) herein, (submitted either with the
application or submitted by the National Board Dental Hygiene Examination to the Board);
f)
the results of the Northeast Regional Board of Dental Examiners, Inc., examination (as
required herein) submitted directly by the Board of Northeast Regional Board of Dental
Examiners, Inc.;
g)
verification that the licensee is in good standing in state(s) where licensed [if licensed in another
state(s)]; and
h)
the application fee of ninety-three dollars and seventy-five cents ($93.75) (non-refundable)
made payable by check to the General Treasurer, state of Rhode Island in accordance with
section 5-31.1-6 of the Act.
Section 10.0 Examination for Licensure
10.1
By Examination:
Applicants shall be required to pass such examination(s) as the Board deems most practical and
expeditious to test the applicant's knowledge and skills to practice dental hygiene in this state pursuant
to section 5-31-12 of the Act, and:
10.1.1
The Board requires each applicant to:
a)
have graduated from a program for dental hygienists in accordance with section 8.1(c)
herein;
b)
have successfully passed the National Board Dental Hygiene Examination; and
c)
have successfully passed the Northeast Regional Board Examination in Dental
Hygiene within five (5) years from the date of application for licensure in this state;
or
i.
hold a current license to practice dental hygiene in another state; and
ii.
have been actively engaged in the practice of dental hygiene in good standing
for the past five (5) years from the date of application for licensure.
10
10.1.2
Applicants must submit to the Board, the application accompanied with the appropriate
documentation as set forth in section 9.0 herein.
10.1.3
Sites and schedules of examinations may be obtained directly from the examination
service(s) referred to above or from the Board.
10.2
Continuing Education--Dental Hygienists
10.2.1 Pursuant to the provisions of section 5-31.1-7 of the Act, every dental hygienist licensed to
practice in this state under the provisions of the Act and the regulations herein, shall, on or
before the first day of June of every third year after the 2001 registration maintain evidence
that in the preceding three (3) years he or she has satisfactorily completed at least thirty (30)
hours of continuing education courses relevant to the practice of dental hygiene, according to
the criteria established by the Rhode Island Dental Hygienists Association and approved by
the Board. Continuing education requirements cited herein shall be prorated for a licensee
whose license is in effect for a period of less than three (3) years (i.e., an average of ten (10)
hours of continuing education shall be required each year the license is in effect).
10.2.2 All dentists and dental auxiliary personnel practicing in a dental setting shall receive annual
training on and shall comply with the Occupational Safety and Health Administration’s
(OSHA) Bloodborne Pathogen Standards (reference 1) in order to protect themselves against
occupational exposure to bloodborne pathogens.
10.2.3 If the applicant maintains evidence satisfactory to the Board of completion of prescribed
course(s) of continuing education and is in compliance with the provisions of section 5-31.1-6
of the Act, the Board shall issue the applicant a license registration for one (1) year period in
accordance with the requirements of section 6.0 herein.
10.2.4 It shall be the sole responsibility of the individual dental hygienist to obtain documentation from
the approved sponsoring or co-sponsoring organization, agency or other, of his or her
participation in the learning experience, including the date and number of hours earned.
a)
These documents must be safeguarded by the dental hygienist for a minimum of five
(5) years for random audit by the Board, if requested. At the time of license renewal,
each licensee shall be required to attest that he/she has complied with the continuing
education requirements stated herein. Failure to produce satisfactory documentation
of completion of continuing education requirements upon request by the Board may
constitute grounds for disciplinary action.
10.2.5 Licensure renewal shall be denied to any applicant who fails to provide satisfactory evidence
of continuing education courses relevant to the practice of dental hygiene as required herein.
a)
Notwithstanding the provisions of section 10.2.4 above, no license to practice
dentistry or dental hygiene in this state shall be refused, nor shall any license be
11
suspended or revoked, except as: (1) provided for in the Act; and (2) failure to
provide satisfactory evidence of continuing education as provided herein.
10.2.6 The Board may, however, extend for only one (1) six (6) month period such educational
requirements, if the Board is satisfied that the applicant has suffered hardship which prevented
the applicant from meeting the requirements herein.
Section 11.0 Issuance and Renewal of License
11.1
A license shall be issued by the Board to an applicant found to have satisfactorily met all the
requirements herein. Said license unless sooner suspended or revoked shall expire annually on the 30th
of June.
11.2
Every person so licensed who desires to renew his or her license shall file with the Board by the 1st of
May a renewal application duly executed together with evidence of completion of continuing education
requirements and the renewal fee as determined annually by the Director of Health in consultation with
the Board, made payable by check to the General Treasurer, state of Rhode Island. Upon receipt of
such application and payment of said fee, a license renewal shall be granted effective for the calendar
year unless sooner suspended or revoked.
i.
for those licensees who shall have attained the age of not less than seventy (70) years
("emeritus active") as of June 30th of the year of licensure, the renewal fee (non-refundable)
shall be thirty-one dollars and twenty-five cents ($31.25), made payable by check to the
General Treasurer, state of Rhode Island.
11.3
Pursuant to the provisions of section 5-31.1-21 of the Act, the registration certificate of all dental
hygienists whose renewals accompanied by the prescribed fee are not filed on or before the first day of
June, shall be automatically revoked. The Board may in its discretion and upon the payment by the
dental hygienist of the current licensure (registration) fee plus an additional fee of sixty-two dollars and
fifty cents ($62.50) reinstate any license (certificate) revoked under the provisions of the Act and the
regulations herein.
Inactive Status
11.4
Dental hygienists not intending to practice in this state may request on an annual basis to be placed on
inactive status. Such requests must be made in writing to the dental administrator and must be
accompanied by a fee of thirty-one dollars and twenty-five cents ($31.25). Persons on inactive status
may be reinstated by paying the current annual registration fee and must meet such requirements
established by the Act and as prescribed herein.
12
PART IV
DELEGABLE
PROCEDURES/DUTIES
TO
DENTAL
HYGIENISTS,
CERTIFIED DENTAL ASSISTANTS AND DENTAL ASSISTANTS WITH
SPECIFIC TYPE OF SUPERVISION
Section 12.0 General Requirements
12.1
Dental Hygienists
Pursuant to section 5-31.1-33 of the Act, any licensed dentist, public institution or school authority
may employ any licensed dental hygienist whose activities shall be confined to those dental services,
procedures/duties that licensed dental hygienist he/she has been educated to perform and which are
authorized by the Board, and under the specific type of supervision as set forth in section 13.0 herein.
Such dental procedures/duties may be delegated by the dentist and performed under the direction of
the dentist, in accordance with the statutory and regulatory provisions herein.
12.1.1 Nothing in this section shall be construed to authorize a licensed dental hygienist to perform
any of the non-delegable (exclusionary) procedures/ duties as set forth in section 14.0 herein.
12.2
Certified Dental Assistants and Dental Assistants
A dentist may delegate to a certified dental assistant or a dental assistant, based on the individual's
competency and/or training, reversible intraoral dental services, procedures or duties which are to be
performed under the supervision of the dentist as approved by the Board and set forth in section 13.0
herein. Provided, however, oral prophylaxis shall be performed only by a licensed dentist or a licensed
dental hygienist.
12.2.1 Nothing in this section shall authorize a certified dental assistant or a dental assistant to
perform any of the non-delegable (exclusionary) procedures/duties as set forth in section 14.0
herein.
12.3
All procedures/duties performed by dental auxiliaries shall be performed under the direct supervision of
a dentist, unless otherwise specified in section 13.0 herein.
12.4
Any reversible intraoral procedure not specifically enumerated as delegable or non-delegable
(exclusionary) pursuant to sections 13.0 and 14.0 herein, may be delegated to any category of dental
auxiliary, (dental hygienist, certified dental assistant, and dental assistant) based on the discretion of the
delegating dentist, the education and training and competency of the dental auxiliary.
12.5
The supervising dentist shall be accountable and fully responsible for all dental services, procedures
and duties performed by any dental auxiliary under his or her supervision. However, a dental auxiliary
is responsible for his/her own professional behavior and shall be guided by existing professional
standards.
12.6
All dentists and dental auxiliary personnel practicing in a dental setting shall receive annual training on
and shall comply with the Occupational Safety and Health Administration’s (OSHA) Bloodborne
13
Pathogen Standards (reference 1) in order to protect themselves against occupational exposure to
bloodborne pathogens.
Section 13.0 Delegation of Duties
13.1
A dentist may delegate to auxiliary personnel those procedures which the dentist may deem advisable,
except for those procedures excluded in Section 14. Any delegated procedures shall be both the
responsibility of and under the specified supervision of the dentist.
13.1.1 Dental Hygienist
A dental hygienist may remove calculus, accretions and stains from both supragingival and
subgingival tooth surfaces by scaling and root planing, as well as any duties performed by a
certified dental assistant or a dental assistant. These procedures may be accomplished under
general supervision, in a dental office, and under general supervision of the dentist.
13.1.2 Certified Dental Assistant
a)
A certified dental assistant may perform reversible intraoral procedures under the
direct supervision of the dentist.
b)
Such procedures may include the application of pit and fissure sealants and fluoride
treatments, provided:
i.
such procedures were incorporated into the academic training from which the
certified dental assistant graduated; OR
ii.
provided he/she has completed academic clinical training to clinical
competence.
c)
The certified dental assistant may not perform any of the procedures specifically listed
for a dental hygienist, nor any irreversible intraoral procedures.
13.1.3 Dental Assistant
A dental assistant may perform reversible intraoral procedures under the personal supervision
of the dentist. He/she may not perform any of the procedures listed specifically for a licensed
dental hygienist nor any irreversible intraoral procedures.
Section 14.0 Non-Delegable (Exclusionary) Procedures/Duties
14
14.1
Notwithstanding the provisions of sections 12.0 and 13.0 herein, nothing in these rules and regulations
shall authorize a dental hygienist, certified dental assistant or dental assistant, to perform any of the
following procedures or duties:
1)
Diagnosis and treatment planning;
2)
Surgical procedures on hard or soft tissue;
3)
Prescribing medications;
4)
Administering injectable local anesthetics;
5)
Administering parenteral conscious sedation, and/or general anesthesia/ deep sedation;
6)
Administering inhalants or inhalation conscious sedation agents;
7)
Taking impressions for models upon which full or partial dentures, or permanent crowns,
bridges, inlays, onlays, posts and cores will be fabricated;
8)
Adjusting occlusion of fixed and removable prosthodontic appliances;
9)
Final cementation of permanent crowns, bridges, inlays, onlays and posts and cores; and
insertion of final prosthesis.
10)
Condensing and carving restorative materials in teeth, except temporary restoratives;
11)
Placement or removal of bonded orthodontic attachments and/or cementation or removal of
orthodontic bands;
12)
Placement of sutures;
13)
Exposure of radiographs without successful completion of a course in dental radiography
which is offered by an education institution with a program accredited by the Commission on
Dental Accreditation and which fulfills institutional requirements as set forth in section F.2.3 of
the Rules and Regulations for the Control of Radiation (R23-1.3-RAD), Rhode Island
Department of Health Office of Occupational and Radiological Health;
14)
Perform direct pulp capping procedures;
15)
Orthodontic arch wire activation with the exception of minor adjustments to eliminate pain or
discomfort;
16)
Flush root canal;
15
17)
Temporary wire ligation; and
18)
Use of a rotary instrument in the oral cavity unless licensed or certified under the provisions of
the Act and the regulations herein. (See also section 13.1.2 (b) herein).
16
PART V
ADMINISTRATION OF ANESTHESIA IN DENTAL OFFICES
Section 15.0 General Requirements
15.1
Any dentist licensed in this state who is administering, permitting the administration of, or intending to
administer general anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious
sedation, or nitrous oxide analgesia in his or her dental office, must meet the statutory and regulatory
requirements herein, and must hold a permit granted by the Board to administer or to permit the
administration of general anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious
sedation, or nitrous oxide analgesia in his or her dental office.
15.2
Any licensed dentist permitted to administer general anesthesia/deep sedation, inhalation conscious
sedation, parenteral conscious sedation, or nitrous oxide analgesia who intends to do so in a dental
office in this state that does not have a facility permit allowing the administration of these anesthesia
services on the premises, as required by section 22.3 below, shall be allowed to do so only with prior
approval of the Board.
15.2.1 As a condition for this approval, the Board, or its designee, shall inspect all equipment utilized
for the purpose of administering general anesthesia/deep sedation, inhalation conscious
sedation, parenteral conscious sedation, or nitrous oxide analgesia. Said equipment shall meet
all applicable requirements of sections 22.1 and 22.2 herein.
15.2.2 The Board’s written approval shall be obtained by the licensed dentist prior to commencing
the anesthesia services described in this section.
15.2.3 Those licensed dentists approved by the Board to engage in the practice of administering
general anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious sedation,
or nitrous oxide analgesia in those dental offices that do not possess a facility permit allowing
the administration of these anesthesia services on the premises shall submit a written schedule
at intervals required by the Board describing the frequency and location(s) of anesthesia
services rendered.
Section 16.0 Qualifications for Permit
16.1
An applicant seeking a permit to administer or to permit the administration of general anesthesia/deep
sedation, inhalation conscious sedation, parenteral conscious sedation, or nitrous oxide analgesia must:
16.1.1 For General Anesthesia/Deep Sedation:
a)
be licensed as a dentist in this state; and
b)
have completed an advanced training program in anesthesia and related subjects
beyond the undergraduate dental curriculum that satisfies the requirements described
in Part II of the American Dental Association Guidelines for Teaching the
17
Comprehensive Control of Pain and Anxiety in Dentistry at the time training was
commenced;
or
c)
have completed an American Dental Association accredited post-doctoral training
program (e.g., oral and maxillofacial surgery) which affords comprehensive and
appropriate training necessary to administer and manage deep sedation/general
anesthesia, commensurate with the American Dental Association Guidelines for
Teaching the Comprehensive Control of Pain and Anxiety in Dentistry;
or
d)
be employed or practice in conjunction with a Board certified or Board eligible
anesthesiologist.
16.1.2 For Parenteral Conscious Sedation:
a)
be licensed as a dentist in this state; and
b)
satisfy one of the following education and training requirements:
i)
completion of a comprehensive training program in parenteral conscious sedation that
satisfies the requirements described in Part III of the ADA Guidelines for Teaching
the Comprehensive Control of Pain and Anxiety in Dentistry at the time training
was commenced;
ii)
Completion of an ADA accredited post-doctoral training program (e.g., general
practice residency) which affords comprehensive and appropriate training necessary
to administer and manage parenteral conscious sedation; or,
iii)
meet one of the requirements as set forth in section 16.1.1 (b) through (d) above.
16.1.3 For Inhalation Conscious Sedation:
a)
be licensed as a dentist in this state; and
b)
satisfy one of the following education and training requirements:
i)
completion of a training consistent with that described in Part I or Part III of the ADA
Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in
Dentistry;
18
ii)
Completion of an ADA accredited post-doctoral training program which affords
comprehensive and appropriate training necessary to administer and manage inhalation
conscious sedation; or,
iii)
meet one of the requirements as set forth in section 16.1.1(b) through 16.1.1(d) or
section 16.1.2 (b) above.
16.1.4 For Nitrous Oxide Analgesia:
a)
be licensed as a dentist in this state; and
b)
meet one of the requirements as set forth in section 16.1.3 (b)(iii) above;
or
c)
have satisfactorily completed a nitrous oxide analgesia training program from a school
accredited by the American Dental Association, and whose training program is
consistent with the provisions of the "GUIDELINES FOR TEACHING THE
COMPREHENSIVE CONTROL OF PAIN AND ANXIETY IN DENTISTRY,
PART ONE (1), or PART III", of the American Dental Association, Council on
Dental Education and which includes clinical experience in the administration of nitrous
oxide analgesia.
Section 17.0 Application
17.1
Application for a permit shall be made on forms provided by the Board which shall be completed,
notarized and submitted to the Board thirty (30) days prior to the scheduled date of the Board meeting.
Such application shall be accompanied by the following documents (non-returnable and non-
refundable):
a)
supporting official transcripts of verification of the qualification requirements as set forth in
section 16.1.1 or 16.1.2 or 16.1.3 or 16.1.4 above;
b)
a statement attesting that he or she has or has not been involved in any morbidity or mortality
secondary to the administration of general anesthesia/deep sedation, inhalation conscious
sedation, parenteral conscious sedation, or nitrous oxide analgesia; and
c)
the permit fee, where applicable, as determined annually by the Director of Health in
consultation with the Board, made payable by check to the General Treasurer, state of Rhode
Island; and
d)
such other information as may be deemed necessary and as may be requested by the Board.
19
Section 18.0 Issuance and Renewal of Permit
18.1
Upon receipt of an application for a permit to administer or to permit the administration of general
anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious sedation, or nitrous oxide
analgesia, the Board with the advice of the advisory consultant(s), may issue a permit to an applicant
found to meet all the prescribed requirements herein. Said permit unless sooner suspended or revoked
shall expire every five (5) years from the date of issuance.
18.2
Every person issued a permit who desires to renew his or her permit shall file with the Board one
month before the date of expiration of permit, a renewal application duly executed together with the
renewal fee, where applicable, as determined annually by the Director of Health in consultation with the
Board, made payable by check to the General Treasurer, state of Rhode Island. Upon receipt of such
renewal application and payment of any fee, a renewal shall be issued effective for five (5) years from
the date of renewal, unless sooner suspended or revoked.
18.3
Any person who allows his or her permit to lapse through accident, mistake or unforseen cause by
failing to renew the permit on or before the expiration date, may be reinstated upon filing an application
with payment of the current renewal fee, where applicable, in accordance with section 18.2 above.
Section 19.0 Inspections
19.1
The Board may, through appointed advisory consultants, conduct such inspections and investigations
as deemed necessary by the Board to ensure compliance with the requirements herein.
19.2
Refusal to permit inspection shall constitute a valid ground for permit denial, suspension or revocation.
19.3
Every applicant shall be given notice by the Board of all deficiencies reported as a result of an
inspection or investigation.
Section 20.0 Inactive Status
20.1
A dentist who holds a permit for the administration of or to permit the administration of general
anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious sedation, or nitrous oxide
analgesia in his or her dental office and who desires to withdraw from the practice of dental anesthesia
in his or her office, may request from the Board that his or her permit be withdrawn and placed on an
inactive status.
20.2
A dentist whose permit has been inactive for more than one (1) year may be reactivated upon
application to the Board and submission of any current application fee, made payable by check to the
General Treasurer, state of Rhode Island. The Board shall determine, at its discretion, whether or not
to reactivate the permit or require renewed proof of competency or need for additional educational
requirements.
20
Section 21.0
General Anesthesia/Deep Sedation, Inhalation Conscious Sedation, Parenteral
Conscious Sedation, or Nitrous Oxide Analgesia Services
21.1
Personnel:
21.1.1 A dentist administering or permitting the administration of general anesthesia/deep sedation,
inhalation conscious sedation, parenteral conscious sedation, or nitrous oxide analgesia must
ensure that there is a sufficient number of members on the "team of auxiliary personnel" to
assist in handling procedures and emergencies.
21.1.2 a)
The dentist administering or permitting the administration of general anesthesia/deep
sedation shall hold a current certificate in Advanced Cardiac Life Support, as
described in the most current version of the American Dental Association,
“Guidelines for the Use of Conscious Sedation, Deep Sedation and General
Anesthesia for Dentists.”
b)
The dentist administering or permitting the administration of inhalation conscious
sedation shall hold a current certificate in Basic Life Support, as described in the
most current version of the American Dental Association, “Guidelines for the Use of
Conscious Sedation, Deep Sedation and General Anesthesia for Dentists.”
c)
The dentist administering or permitting the administration of parenteral conscious
sedation shall hold a current certificate in Basic Life Support, as described in the
most current version of the American Dental Association, “Guidelines for the Use of
Conscious Sedation, Deep Sedation and General Anesthesia for Dentists.”
d)
The dentist administering or permitting the administration of nitrous oxide analgesia
shall hold a current certificate in Basic Life Support.
e)
Each member of the "team of auxiliary personnel" shall hold a current certificate in
Basic Life Support.
21.2
Management of Services:
21.2.1
Written policies and procedures shall be established regarding: (1) the administration of
general anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious sedation,
or nitrous oxide analgesia; (2) maintenance of safety controls; (3) qualifications and supervision
of the "team of auxiliary personnel" involved in the general anesthesia/deep sedation, inhalation
conscious sedation, parenteral conscious sedation, or nitrous oxide analgesia service. In
addition, the policies shall include provisions for no less than the following:
a)
pre-anesthesia evaluation;
b)
safety of the patient during the anesthesia period;
21
c)
review of patient's condition prior to induction of general anesthesia/deep sedation,
inhalation conscious sedation, parenteral conscious sedation, or nitrous oxide
analgesia, and post-anesthetic evaluation;
d)
signed informed consent obtained prior to the administration of general
anesthesia/deep sedation, inhalation conscious sedation, parenteral conscious
sedation, or nitrous oxide analgesia. In the case of a minor, consent from a parent or
legal guardian must be obtained; in case of emergency, an oral permit will be
acceptable;
e)
recording of all events related to the administration of general anesthesia/deep
sedation, inhalation conscious sedation, parenteral conscious sedation, or nitrous oxide
analgesia;
f)
written report(s) of any morbidity requiring hospitalization or mortality occurring in the
dental office as a result of general anesthesia/deep sedation, inhalation conscious
sedation, parenteral conscious sedation, or nitrous oxide analgesia. Report of such
mortality must be made within twenty-four (24) hours to the Board, and report of such
morbidity must be made to the Board within thirty (30) days from the date of
occurrence;
g)
dentists holding permits to administer general anesthesia/deep sedation, inhalation
conscious sedation, parenteral conscious sedation, or nitrous oxide analgesia, and/or
Board certified or Board eligible anesthesiologists, employed by or practicing in
conjunction with a dentist must remain on the premises of the dental office until the
patient has been discharged from the dentist’s (or anesthesiologist’s) care.
Section 22.0 Physical Facility, Equipment and Safety
22.1
In order to ensure the protection and safety of patients receiving general anesthesia/deep sedation,
inhalation conscious sedation, or parenteral conscious sedation in a dental office, the following
standards shall be applied in determining the adequacy and safety of the physical facility and
equipment.
a)
the current standards of the American Dental Association, “Guidelines for the Use of
Conscious Sedation, Deep Sedation and General Anesthesia for Dentists,” including but not
limited to the following equipment requirements:
i)
equipment must have a fail-safe system that is appropriately checked and calibrated;
ii)
equipment must have an appropriate scavenging system; and,
22
iii)
if nitrous oxide and oxygen delivery equipment capable of delivering less than 25%
oxygen is used, an in-line oxygen analyzer must be used;
b)
the standards for "Occupational Exposure to Waste Anesthetic Gases and Vapors" of the
National Institute for Occupational Safety and Health (NIOSH); and
c)
the Rhode Island Fire Safety Code where flammable anesthetics are present.
22.2
In order to ensure the protection and safety of patients receiving nitrous oxide analgesia in a dental
office, the following requirements shall be applied in determining the adequacy and safety of the
physical facility and equipment:
a)
equipment must have a fail-safe system that is appropriately checked and calibrated;
b)
equipment must have an appropriate scavenging system;
c)
if nitrous oxide and oxygen delivery equipment capable of delivering less than 25% oxygen is
used, an in-line oxygen analyzer must be used;
d)
facilities and equipment must conform to the standards for "Occupational Exposure to Waste
Anesthetic Gases and Vapors" of the National Institute for Occupational Safety and Health
(NIOSH); and
e)
where flammable anesthetics are present, facilities and equipment must conform to the Rhode
Island Fire Safety Code.
Facility Permit
22.3
Prior to the administration of general anesthesia/deep sedation, inhalation conscious sedation,
parenteral conscious sedation, or nitrous oxide analgesia in a dental office by a qualified dentist as
described in section 16.0 above and/or a Board certified or Board eligible anesthesiologist employed
by or practicing in conjunction with a dentist, each office site must obtain a facility permit to allow the
administration of these anesthesia services on the premises.
22.3.1 A facility permit is issued for one office site, and is non-transferable.
22.3.1 (a)
Those dental office sites in which all anesthesia services are administered by a licensed
dentist approved by the Board to administer anesthesia services as described in
section 15.2 (above) shall be exempt from the requirements of section 22.3 herein.
22.3.2 Application for a permit shall be made on forms provided by the Board. These forms shall be
completed, notarized and submitted to the Board thirty (30) days prior to the scheduled date
of the Board meeting. Such application shall be accompanied by:
23
a)
the permit fee (non-refundable and non-returnable) as determined annually by the
Director of Health in consultation with the Board, made payable by check to the
General Treasurer, state of Rhode Island; and,
b)
such other information as may be deemed necessary and as may be requested by the
Board.
22.3.3 Upon receipt of an application for a facility permit as described above, the Board, with the
advice of the advisory consultant(s), may issue a permit to an applicant found to meet all the
prescribed requirements herein. Said permit unless sooner suspended or revoked shall expire
five (5) years from the date of issuance.
a)
To renew such permit, the applicant shall file with the Board a renewal application at
least one (1) month before the date of expiration of the permit, duly executed together
with the renewal fee as determined annually by the Director of Health in consultation
with the Board, made payable by check to the General Treasurer, state of Rhode
Island. Upon receipt of such renewal application and payment of any fee, a renewal
shall be issued effective for five (5) years from the date of renewal, unless sooner
suspended or revoked.
b)
Any applicant allowing this permit to lapse through accident, mistake or unforseen
cause by failing to renew the permit on or before the expiration date, may be
reinstated upon filing an application with payment of the current renewal fee in
accordance with section 22.3.3(a) above.
22.3.4 Those dental offices holding facility permits as described above may be subject to inspections
as described in section 19.0 above.
Section 23.0 Violations & Sanctions
23.1
Failure to comply with any of the provisions of Part V herein shall be cause for denial, revocation or
suspension of permit for the administration of general anesthesia/deep sedation, inhalation conscious
sedation, parenteral conscious sedation, or nitrous oxide analgesia, and of disciplinary action in
accordance with section 26.0 herein.
23.2
Furthermore, all hearings and reviews pertaining to the requirements as set forth herein, shall be subject
to the provisions of section 27.0 of these rules and regulations.
24
PART VI
RECORD KEEPING & DISCLOSURE
Section 24.0 Availability of Dental Records
24.1
A licensed dentist and/or other licensee shall maintain a dental record for each patient which is
adequate to enable the licensee and/or another licensee to provide proper diagnosis and treatment. The
dentist must maintain a patient's written dental record and radiographs (x-rays) for a minimum of five
(5) years from the date of the last dental visit, in accordance with Section 23-3-26 of the General
Laws, entitled "Vital Records." Records of minors shall be kept for at least five (5) years after such
minor shall have reached the age of 18 years. Records must be maintained in a manner which permits
the patient and/or successor dentist access to these records.
24.1.1 At a minimum, said records must include:
a)
the name, address and date of birth of the patient and, if a minor, the name of the
parent or guardian;
b)
the patient’s medical history;
c)
a record of results of a clinical examination, where appropriate, or an indication of the
patient’s chief complaint;
d)
a treatment plan, where appropriate;
e)
the dates of each patient visit and a description of the treatment or services rendered
at each visit;
f)
a description of all radiographs taken and diagnostic models made, properly identified
with the patient’s name and date;
g)
the date, dosage and amount of any medication or drug prescribed, dispensed or
administered to the patient; and,
h)
a record of any recommendations or referrals for treatment or consultation by a
specialist, including those which were refused by the patient.
24.1.2 Upon a patient's written request, a dentist shall provide a patient or another specifically
authorized person with a complete copy of and a detailed summary of the patient's dental
record, which includes all relevant data.
24.1.3 A dentist may charge a reasonable fee for the expense of providing a patient's dental record,
not to exceed cost. The dentist shall not require prior payment of charges for dental services
as a condition for providing a copy of the dental record.
25
24.1.4 Dentists shall maintain patient confidentiality in the storage and transfer of records pursuant to
the provisions Chapter 5-37.3 of the General Laws, entitled "Confidentiality of Health Care
Information Act."
24.1.5 A dentist or other licensee treating the patient shall sign or initial the patient’s dental record
after each procedure or visit.
Section 25.0 Scheduled Controlled Substances: Inventory Record Requirements
25.1
All actions related to the storage, dispensing or administering of controlled substances must be in
conformity with the provisions of Chapter 21-28 of the General Laws.
When a controlled substance is stocked in a dental office for dispensing or administering to a patient,
an accurate inventory of the drug shall be maintained and include all of the following information:
a)
the date and quantity of the drug purchased;
b)
the amount, dosage and date dispensed or administered;
c)
the name of the patient to whom it was dispensed or administered.
25.2
The inventory record shall be available for inspection for no less than two (2) years.
25.3
The inventory record shall be in addition to the dental treatment records.
26
PART VII VIOLATIONS, SANCTIONS, SEVERABILITY
Section 26.0 Denial, Revocation or Suspension of License/Violations & Sanctions
26.1
Any dentist or dental hygienist may have his or her license revoked or suspended by the Board: if said
person has been found guilty of unprofessional conduct, which shall include, but not be limited to those
items listed in section 5-31.1-10 of the General Laws and as stated below:
a)
Fraudulent or deceptive procuring or use of a license or limited registration;
b)
All advertising of dental or dental hygiene business which is intended or has a tendency to
deceive the public or a dentist advertising as a specialty in an area of dentistry unless the
dentist:
(i)
Is a diplomate of or a fellow in a specialty board accredited or recognized by the
American Dental Association; or
(ii)
Has completed a post graduate program approved by the Commission on Dental
Accreditation of the American Dental Association;
c)
Conviction of a crime involving moral turpitude; conviction of a felony; conviction of a crime
arising out of the practice of dentistry or of dental hygiene;
d)
Abandonment of patient;
e)
Dependence upon controlled substances, habitual drunkenness or rendering professional
services to a patient while the dentist or dental hygienist, or limited registrant is intoxicated or
incapacitated by the use of drugs;
f)
Promotion by a dentist, dental hygienist, or limited registrant of the sale of drugs, devices,
appliances, or goods or services provided for a patient in a manner as to exploit the patient for
the financial gain of the dentist, dental hygienist, or limited registrant;
g)
Immoral conduct of a dentist, dental hygienist, or limited registrant in the practice of dentistry
or dental hygiene;
h)
Willfully making and filing false reports or records in the practice of dentistry or dental hygiene;
i)
Willful omission to file or record, or willfully impeding or obstructing a filing or recording, or
inducing another person to omit to file or record dental or other reports as required by law;
j)
Failure to furnish details of a patient's dental record to succeeding dentists, or dental care
facility upon proper request pursuant to the Act;
27
k)
Solicitation of professional patronage by agents or persons or profiting from acts of those
representing themselves to be agents of the licensed dentist, dental hygienist, or limited
registrant;
l)
Division of fees or agreeing to split or divide the fees received for professional services for any
person for bringing to or referring a patient;
m)
Agreeing with clinical or bioanalytical laboratories to accept payments from those laboratories
for individual tests or test series for patients, or agreeing with dental laboratories to accept
payment from those laboratories for work referred;
n)
Willful misrepresentation in treatments;
o)
Practicing dentistry with an unlicensed dentist or practicing dental hygiene with an unlicensed
dental hygienist except in an accredited training program, or with a dental assistant in
accordance with the rules and regulations of the Board or aiding or abetting those unlicensed
persons in the practice of dentistry or dental hygiene;
p)
Gross and willful overcharging for professional services; including filing of false statements for
collection of fees for which services are not rendered or willfully making or assisting in making
a false claim or deceptive claim or misrepresenting a material fact for use in determining rights
to dental care or other benefits;
q)
Offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure,
treatment, or medicine;
r)
Professional or mental incompetence;
s)
Incompetent, negligent, or willful misconduct in the practice of dentistry or dental hygiene,
which includes the rendering of unnecessary dental services and any departure from or the
failure to conform to the minimal standards of acceptable and prevailing dental or dental
hygiene practice in his or her area of expertise as is determined by the Board. The Board need
not establish actual injury to the patient in order to adjudge a dentist, dental hygienist or limited
registrant guilty of the previously named misconduct;
t)
Failure to comply with the provisions of Chapter 4.7 of Title 23;
u)
Revocation, suspension, surrender, or limitation of privilege based on quality of care provided
or any other disciplinary action against a license to practice dentistry or dental hygiene in
another state or jurisdiction, or revocation, suspension, surrender, or other disciplinary action
as to membership on any dental staff or in any dental or professional association or society for
conduct similar to acts or conduct which would constitute grounds for action as prescribed in
the Act;
28
v)
Any adverse judgment, settlement, or award arising from a dental liability claim related to acts
or conduct similar to acts or conduct which would constitute grounds for action as defined in
the Act or regulations adopted herein;
w)
Failure to furnish the Board, its dental administrator, investigator, or representatives,
information legally requested by the Board;
x)
Violation of any provision(s) of the Act or the rules and regulations of the Board or any rules
and regulations promulgated by the Director or of an action, stipulation or agreement of the
Board;
y)
Cheating on or attempting to subvert the licensing examination;
z)
Violating any state or federal law or regulation relating to controlled substances;
aa)
Failure to maintain standards established by peer review boards, including, but not limited to,
standards related to proper utilization of services, and use of nonaccepted procedure and/or
quality of care;
bb)
Malpractice as defined in § 5-37-1(8) of the Rhode Island General Laws, as amended.
cc)
No person licensed to practice dentistry in the state of Rhode Island may permit a non-dentist
who operates a dental facility in the form of a licensed out patient health care center or
management service organization to interfere with the professional judgment of the dentist in
the practice.
26.2
Furthermore, any violation pursuant to any provisions of the Act and the rules and regulations herein,
may be cause for denial, revocation or suspension of license or for imposing such other penalties as
prescribed in the Act.
26.3
Any hearings or reviews required under statutory or regulatory provisions herein shall be held in
accordance with the provisions of the Act and of the Administrative Procedures Act, Chapter 42-35 of
the General Laws of Rhode Island, as amended.
Section 27.0 Rules Governing Practices & Procedures
27.1
All hearings and reviews required under the provisions of Chapter 5-31.1 of the General Laws of
Rhode Island, as amended, shall be held in accordance with the provisions of the Rules and
Regulations of the Rhode Island Department of Health Regarding Practices and Procedures
Before the Department of Health and Access to Public Records of the Department of Health
(R42-35-PP).
Section 28.0 Severability
28.1
If any provisions of these rules and regulations or the application thereof to any person or circumstance
shall be held invalid such invalidity shall not affect the provisions or application of the rules and
29
regulations which can be given effect, and to this end the provisions of the rules and regulations are
declared to be severable.
REFERENCES
1.
Blood borne Pathogens, Occupational Safety and Health Administration (OSHA), 29 Code of
Federal Regulations, Part 1910--1000 to end, section 1910.1030, pp.316-326, July 1, 1994.
2.
Rules and Regulations of the Rhode Island Department of Health Regarding Practices and
Procedures Before the Department of Health and Access to Public Records of the Department
of Health (R42-35-PP), Rhode Island Department of Health, October 2000.
October 15, 2001
dentists regs-refiling-jan02.doc