TITLE III
LICENSING
CHAPTER 10
GENERAL REQUIREMENTS
[Prior to 5/18/88, Dental Examiners, Board of[320]]
650—10.1(153) Licensed or registered personnel. Persons engaged in the practice of dentistry in Iowa must be licensed by the board as a dentist, and persons performing services under Iowa Code section 153.15 must be licensed by the board as a dental hygienist. Persons engaged in the practice of dental assisting must be registered by the board pursuant to 650—Chapter 20.
This rule is intended to implement Iowa Code sections 147.2 and 153.17.
650—10.2(147,153) Display of license, registration, permit, and renewal. The license to practice dentistry or dental hygiene or the registration as a dental assistant and the current renewal must be prominently displayed by the licensee or registrant at each permanent practice location. A dentist who holds a permit to administer deep sedation/general anesthesia or conscious sedation, or a dental hygienist who holds a permit to administer local anesthesia, shall also prominently display the permit and the current renewal at each permanent practice location.
	10.2(1) Additional certificates shall be obtained from the board whenever a licensee or registrant practices at more than one address.
	10.2(2) Duplicate licenses, certificates of registration, or permits shall be issued by the board upon satisfactory proof of loss or destruction of the original license, certificate of registration, or permit.
This rule is intended to implement Iowa Code sections 147.7, 147.10 and 147.80(17).
650—10.3(153) Authorized practice of a dental hygienist.
	10.3(1) “Practice of dental hygiene” as defined in Iowa Code section 153.15 means the performance of the following educational, therapeutic, preventive and diagnostic dental hygiene procedures which are delegated by and under the supervision of a dentist licensed pursuant to Iowa Code chapter 153.
	a. 	Educational. Assessing the need for, planning, implementing, and evaluating oral health education programs for individual patients and community groups; conducting workshops and in-service training sessions on dental health for nurses, school personnel, institutional staff, community groups and other agencies providing consultation and technical assistance for promotional, preventive and educational services.
	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.
	c. 	Preventive. Applying pit and fissure sealants and other medications or methods for caries and periodontal disease control; organizing and administering fluoride rinse or sealant programs.
	d. 	Diagnostic. Reviewing medical and dental health histories; performing oral inspection; indexing dental and periodontal disease; making occlusal registrations for mounting study casts; testing pulp vitality; analyzing dietary surveys.
	e. 	The following services may only be delegated by a dentist to a dental hygienist: administration of local anesthesia, placement of sealants, and the removal of any plaque, stain, calculus, or hard natural or synthetic material except by toothbrush, floss, or rubber cup coronal polish.
	10.3(2) All authorized services provided by a dental hygienist shall be performed under the general, direct, or public health supervision of a dentist currently licensed in the state of Iowa in accordance with 650—1.1(153) and 650—10.5(153).
	10.3(3) Under the general or public health supervision of a dentist, a dental hygienist may provide educational services, assessment, screening, or data collection for the preparation of preliminary written records for evaluation by a licensed dentist. A dentist is not required to examine a patient prior to the provision of these dental hygiene services.
	10.3(4) The administration of local anesthesia or nitrous oxide inhalation analgesia shall only be provided under the direct supervision of a dentist.
	10.3(5) All other authorized services provided by a dental hygienist to a new patient shall be provided under the direct or public health supervision of a dentist. An examination by the dentist must take place during an initial visit by a new patient, except when hygiene services are provided under public health supervision.
	10.3(6) Subsequent examination and monitoring of the patient, including definitive diagnosis and treatment planning, is the responsibility of the dentist and shall be carried out in a reasonable period of time in accordance with the professional judgment of the dentist based upon the individual needs of the patient.
	10.3(7) General supervision shall not preclude the use of direct supervision when in the professional judgment of the dentist such supervision is necessary to meet the individual needs of the patient.
This rule is intended to implement Iowa Code section 153.15.
650—10.4(153) Unauthorized practice of a dental hygienist. A dental hygienist who assists a dentist in practicing dentistry in any capacity other than as an employee or independent contractor supervised by a licensed dentist or who directly or indirectly procures a licensed dentist to act as nominal owner, proprietor, director, or supervisor of a practice as a guise or subterfuge to enable such dental hygienist to engage in the practice of dentistry or dental hygiene or who renders dental service(s) directly or indirectly on or for members of the public other than as an employee or independent contractor supervised by a licensed dentist shall be deemed to be practicing illegally.
	10.4(1) The unauthorized practice of dental hygiene means allowing a person not licensed in dentistry or dental hygiene to perform dental hygiene services authorized in Iowa Code section 153.15 and rule 650—10.3(153).
	10.4(2) The unauthorized practice of dental hygiene also means the performance of services by a dental hygienist that exceeds the scope of practice granted in Iowa Code section 153.15.
	10.4(3) A dental hygienist shall not practice independent from the supervision of a dentist nor shall a dental hygienist establish or maintain an office or other workplace separate or independent from the office or other workplace in which the supervision of a dentist is provided.
This rule is intended to implement Iowa Code sections 147.10, 147.57 and 153.15.
650—10.5(153) Public health supervision allowed. A dentist who meets the requirements of this rule may provide public health supervision to a dental hygienist if the dentist has an active Iowa license and the services are provided in public health settings.
	10.5(1) Public health settings defined. For the purposes of this rule, public health settings are limited to schools; Head Start programs; programs affiliated with the early childhood Iowa (ECI) initiative authorized by Iowa Code chapter 256I; child care centers (excluding home-based child care centers); federally qualified health centers; public health dental vans; free clinics; nonprofit community health centers; nursing facilities; and federal, state, or local public health programs.
	10.5(2) Public health supervision defined. “Public health supervision” means all of the following:
	a. 	The dentist authorizes and delegates the services provided by a dental hygienist to a patient in a public health setting, with the exception that hygiene services may be rendered without the patient’s first being examined by a licensed dentist;
	b. 	The dentist is not required to provide future dental treatment to patients served under public health supervision;
	c. 	The dentist and the dental hygienist have entered into a written supervision agreement that details the responsibilities of each licensee, as specified in subrule 10.5(3); and
	d. 	The dental hygienist has an active Iowa license with a minimum of three years of clinical practice experience.
	10.5(3) Licensee responsibilities. When working together in a public health supervision relationship, a dentist and dental hygienist shall enter into a written agreement that specifies the following responsibilities.
	a. 	The dentist providing public health supervision must:
	(1)	Be available to provide communication and consultation with the dental hygienist;
	(2)	Have age- and procedure-specific standing orders for the performance of dental hygiene services. Those standing orders must include consideration for medically compromised patients and medical conditions for which a dental evaluation must occur prior to the provision of dental hygiene services;
	(3)	Specify a period of time in which an examination by a dentist must occur prior to providing further hygiene services. However, this examination requirement does not apply to educational services, assessments, screenings, and fluoride if specified in the supervision agreement; and
	(4)	Specify the location or locations where the hygiene services will be provided under public health supervision.
	b. 	A dental hygienist providing services under public health supervision may provide assessments; screenings; data collection; and educational, therapeutic, preventive, and diagnostic services as defined in rule 10.3(153), except for the administration of local anesthesia or nitrous oxide inhalation analgesia, and must:
	(1)	Maintain contact and communication with the dentist providing public health supervision;
	(2)	Practice according to age- and procedure-specific standing orders as directed by the supervising dentist, unless otherwise directed by the dentist for a specific patient;
	(3)	Provide to the patient, parent, or guardian a written plan for referral to a dentist and assessment of further dental treatment needs;
	(4)	Have each patient sign a consent form that notifies the patient that the services that will be received do not take the place of regular dental checkups at a dental office and are meant for people who otherwise would not have access to services; and
	(5)	Specify a procedure for creating and maintaining dental records for the patients that are treated by the dental hygienist, including where these records are to be located.
	c. 	The written agreement for public health supervision must be maintained by the dentist and the dental hygienist and must be made available to the board upon request. The dentist and dental hygienist must review the agreement at least biennially.
	d. 	A copy of the agreement shall be filed with the Oral Health Bureau, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, Iowa 50319.
	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 the Iowa department of public health on forms provided and include information related to the number of patients seen and services provided to enable the department to assess the impact of the program. The department will provide summary reports to the board on an annual basis.
This rule is intended to implement Iowa Code section 153.15.
[ARC 7767B, IAB 5/20/09, effective 6/24/09; ARC 0629C, IAB 3/6/13, effective 4/10/13]
650—10.6(147,153,272C) Other requirements.
	10.6(1) Change of address or name. Each person licensed or registered by the board must notify the board, by written correspondence or through the board’s online system, of a change of legal name or address within 60 days of such change. Proof of a legal name change, such as a notarized copy of a marriage certificate, must accompany the request for a name change.
	10.6(2) Child and dependent adult abuse training. Licensees or registrants who regularly examine, attend, counsel or treat children or adults in Iowa must obtain mandatory training in child and dependent adult abuse identification and reporting within six months of initial employment and subsequently every five years in accordance with 650—subrule 25.2(9).
	10.6(3) Reporting requirements. Each licensee and registrant shall be responsible for reporting to the board, within 30 days, any of the following:
	a. 	Every adverse judgment in a professional malpractice action to which the licensee or registrant was a party.
	b. 	Every settlement of a claim against the licensee or registrant alleging malpractice.
	c. 	Any license or registration revocation, suspension or other disciplinary action taken by a licensing authority of another state, territory or country within 30 days of the final action by the licensing authority.
This rule is intended to implement Iowa Code sections 147.9, 232.69, 235B.16 and 272C.9.
[ARC 0265C, IAB 8/8/12, effective 9/12/12]
[Filed 8/23/78, Notice 6/28/78—published 9/20/78, effective 10/25/78]
[Filed emergency 12/16/83—published 1/4/84, effective 12/16/83]
[Filed emergency 2/24/84 after Notice 1/4/84—published 3/14/84, effective 2/24/84]
[Filed 12/14/84, Notice 10/10/84—published 1/2/85, effective 2/6/85]
[Filed 4/28/88, Notice 3/23/88—published 5/18/88, effective 6/22/88]
[Filed 7/28/95, Notice 5/10/95—published 8/16/95, effective 9/20/95]
[Filed 10/30/98, Notice 5/20/98—published 11/18/98, effective 12/23/98]
[Filed 1/22/99, Notice 11/18/98—published 2/10/99, effective 3/17/99]
[Filed 7/23/99, Notice 5/19/99—published 8/11/99, effective 9/15/991]
[Filed 1/21/00, Notice 12/15/99—published 2/9/00, effective 3/15/00]
[Filed 10/23/00, Notice 8/9/00—published 11/15/00, effective 1/1/01]
[Filed 1/19/01, Notice 11/15/00—published 2/7/01, effective 3/14/01]
[Filed 6/21/02, Notice 2/20/02—published 7/10/02, effective 8/14/02]
[Filed 12/4/03, Notice 9/17/03—published 12/24/03, effective 1/28/04]
[Filed 7/1/04, Notice 5/12/04—published 7/21/04, effective 8/25/04]
[Filed 4/22/05, Notice 2/2/05—published 5/11/05, effective 6/15/05]
[Filed 1/27/06, Notice 9/28/05—published 2/15/06, effective 3/22/06]
[Nullified language editorially removed 5/24/06]†
[Filed emergency 4/23/07 after Notice 2/28/07—published 5/23/07, effective 4/23/07]
[Filed ARC 7767B (Notice ARC 7555B, IAB 2/11/09), IAB 5/20/09, effective 6/24/09]
[Filed ARC 0265C (Notice ARC 0128C, IAB 5/16/12), IAB 8/8/12, effective 9/12/12]
[Filed ARC 0629C (Notice ARC 0471C, IAB 11/28/12), IAB 3/6/13, effective 4/10/13]
1	Effective date of 10.3(1) delayed until the end of the 2000 Session of the General Assembly by the Administrative Rules Review Committee at its meeting held September 15, 1999.