ARC 2141C
DENTAL BOARD[650]
Adopted and Filed
Pursuant to the authority of Iowa Code sections 147.76 and 272C.2, the Dental Board hereby amends Chapter 10, “General Requirements,” Iowa Administrative Code.
The purposes of the amendments are as follows: to clarify that the removal of adhesives and the preliminary charting of existing dental restorations and teeth are permissible services a dental hygienist may perform under the supervision of a licensed dentist; to permit dental hygienists to perform expanded function procedures which may be delegated by a licensed dentist; to set the education and training requirements for those procedures; and to update the name of the Oral Health Bureau to the Bureau of Oral and Health Delivery Systems.
Current rules permit a dental hygienist to remove adhesives and to perform the preliminary charting of existing dental restorations and teeth. These amendments list these specific procedures.
Current rules do not allow a dentist to delegate expanded function procedures to a dental hygienist. These amendments allow a dentist to delegate expanded function procedures to a dental hygienist. The amendments list each expanded functions procedure, define the supervision requirements when each procedure is performed, and set the education and training requirements for the procedure.
These amendments update the change in name of the Oral Health Bureau to the Bureau of Oral and Health Delivery Systems.
Notice of Intended Action for these amendments was published in the June 24, 2015, Iowa Administrative Bulletin as ARC 2043C. A public hearing was held on July 21, 2015, at 2 p.m. at the offices of the Iowa Dental Board. There was one attendee, Tom Cope, representing the Iowa Dental Hygienists Association, who read previously submitted comments. There were two written comments received. All written comments supported the amendments.
The Board reviewed and discussed the public comments during their July 23, 2015, open session Board meeting and allowed additional comments from the public. One change has been made to the amendments since they were published under Notice of Intended Action. In Item 3, subparagraph 10.3(8)“c”(2), the word “procedure” was removed from the phrase “expanded function procedure training” to match usage throughout this rule making.
These amendments were adopted by the Board on August 13, 2015.
After analysis and review of this rule making, a positive impact on jobs has been found for dental hygienists, who will now be able to perform additional procedures.
These amendments are intended to implement Iowa Code section 153.15.
These amendments will become effective on October 21, 2015.
The following amendments are adopted.
	Item 1. Amend paragraph 10.3(1)“b” as follows:
	b. 	Therapeutic. Identifying and evaluating factors which indicate the need for and performing (1) oral prophylaxis, which includes supragingival and subgingival debridement of plaque, and detection and removal of calculus with instruments or any other devices; (2) periodontal scaling and root planing; (3) removing and polishing hardened excess restorative material; (4) administering local anesthesia with the proper permit; (5) administering nitrous oxide inhalation analgesia in accordance with 650—subrules 29.6(4) and 29.6(5); (6) applying or administering medicaments prescribed by a dentist, including chemotherapeutic agents and medicaments or therapies for the treatment of periodontal disease and caries; (7) removal of adhesives.
	Item 2. Amend paragraph 10.3(1)“d” as follows:
	d. 	Diagnostic. Reviewing medical and dental health histories; performing oral inspection; indexing dental and periodontal disease; preliminary charting of existing dental restorations and teeth; making occlusal registrations for mounting study casts; testing pulp vitality; analyzing dietary surveys.
	Item 3. Adopt the following new subrule 10.3(8):
	10.3(8) Expanded function requirements.
	a. 	Supervision requirements. A dental hygienist may only perform expanded function procedures which are delegated by and performed under the supervision of a dentist licensed pursuant to Iowa Code chapter 153. The taking of occlusal registrations for purposes other than mounting study casts may be performed under general supervision; all other expanded function procedures shall be performed under direct supervision.
	b. 	Expanded function training required. A dental hygienist shall not perform any expanded function procedures listed in this chapter unless the dental hygienist has successfully met the education and training requirements and is in compliance with the requirements of this chapter.
	c. 	Education and training requirements. All expanded function training must be prior-approved by the board. The supervising dentist and the dental hygienist shall be responsible for maintaining in each office of practice documentation of successful completion of the board-approved training.
	(1)	Expanded function training for Level 1 procedures shall be eligible for board approval if the training is offered through a program accredited by the Commission on Dental Accreditation of the American Dental Association (ADA) or another program, which may include on-the-job training offered by a dentist licensed in Iowa. Training must consist of the following:
	1.	An initial assessment to determine the base entry level of all participants in the program;
	2.	A didactic component;
	3.	A laboratory component, if necessary;
	4.	A clinical component, which may be obtained under the personal supervision of the participant’s supervising dentist while the participant is concurrently enrolled in the training program; and
	5.	A postcourse competency assessment at the conclusion of the training program.
	(2)	Expanded function training for Level 2 procedures shall be eligible for board approval if the training is offered through the University of Iowa College of Dentistry or a program accredited by the Commission on Dental Accreditation of the American Dental Association.
	Item 4. Adopt the following new subrule 10.3(9):
	10.3(9) Expanded function providers.
	a. 	Basic expanded function provider. Dental hygienists who do not wish to become certified as a Level 1 or Level 2 provider may perform select Level 1 expanded function procedures provided they have met the education and training requirements for those procedures and are in compliance with the requirements of this chapter. A dentist may delegate to a dental hygienist only those Level 1 procedures for which the dental hygienist has received the required expanded function training.
	b. 	Certified Level 1 provider. A dental hygienist must successfully complete training for all Level 1 expanded function procedures before becoming a certified Level 1 provider.
	(1)	A dentist may delegate any of the Level 1 expanded function procedures to a dental hygienist who is a certified Level 1 provider.
	(2)	Level 1 procedures include:
	1.	Taking occlusal registrations for purposes other than mounting study casts;
	2.	Placement and removal of gingival retraction;
	3.	Fabrication and removal of provisional restorations;
	4.	Applying cavity liners and bases and bonding systems for restorative purposes; and
	5.	Taking final impressions.
	c. 	Certified Level 2 provider. A dental hygienist must become a certified Level 1 provider and successfully pass a board-approved entrance examination with a score of at least 75 percent before beginning training to become a certified Level 2 provider. A dental hygienist must successfully complete training for all Level 2 expanded function procedures before becoming a certified Level 2 provider.
	(1)	A dentist may delegate any of the Level 1 or Level 2 expanded function procedures to a dental hygienist who is a certified Level 2 provider.
	(2)	Level 2 procedures include:
	1.	Placement and shaping of amalgam following preparation of a tooth by a dentist;
	2.	Placement and shaping of composite following preparation of a tooth by a dentist;
	3.	Forming and placement of stainless steel crowns;
	4.	Taking records for the fabrication of dentures and partial dentures; and
	5.	Tissue conditioning (soft reline only).
These procedures refer to both primary and permanent teeth.
	Item 5. Amend paragraph 10.5(3)“d” as follows:
	d. 	A copy of the written agreement for public health supervision shall be filed with the Oral Health Bureau of Oral and Health Delivery Systems, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, Iowa 50319.
	Item 6. Amend subrule 10.5(4) as follows:
	10.5(4) Reporting requirements. Each dental hygienist who has rendered services under public health supervision must complete a summary report at the completion of a program or, in the case of an ongoing program, at least annually. The report shall be filed with the oral health bureau of oral and health delivery systems of the Iowa department of public health on forms provided by the department and shall include information related to the number of patients seen and services provided to enable so that the department to may assess the impact of the program. The department will provide summary reports to the board on an annual basis.
[Filed 8/26/15, effective 10/21/15]
[Published 9/16/15]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 9/16/15.