5 ADMINISTRATIVE RULES

 

SOAHR 2005-028 DEPARTMENT OF COMMUNITY HEALTH

DIRECTOR’S OFFICE DENTISTRY RULES - GENERAL RULES

Filed with the Secretary of State on June 9, 2006

 

These rules become effective immediately upon filing with the Secretary of State unless adopted under sections 33, 44, or 45a(6) of 1969 PA 306. Rules adopted under these sections become effective 7 days after filing with the Secretary of State.

 

(By authority conferred on the director of the department of community health by sections 16145(3) and 16601 of 1978 PA 368, MCL 333.16145(3) and 333.16601 et seq.  and Executive Reorganization Order

Nos. 1996-1, 1996-2 and 2003-1, MCL 330.3101, 445.2001 and 445.2011)

 

R 338.11101, R 338.11201, R 338.11202, R 338.11203, R 338.11221,  R 338.11222, R 338.11223, R

338.11247, R 338.11255, R 338.11259,   R 338.11261, R 338.11301, R 338.11303, R 338.11307, R

338.11403,  R 338.11405, R 338.11406, R 338.11408, R 338.11603, R 338.11605,  R 338.11704a, and

R 338.11705 are amended and R 338.11404, R 338.11405a, R 338.11409, and R 338.11605 are added to the Michigan Administrative Code as follows:

 

PART 1. GENERAL PROVISIONS

 

R 338.11101 Definitions.

Rule 1101. As used in these rules:

(a) “Act” means 1978 PA 368, MCL 333.1101.

(b) “Analgesia” means the diminution or elimination of pain in the conscious patient.

(c)“Approved course” means a course offered by either a dental, dental hygiene, or dental assisting program accredited by the

commission on dental accreditation of the American dental association and approved by the department, or as defined in section 16611 of the act.

(d)   “Assignment” means that a dentist has designated a patient of record upon whom services are to be performed by an assistant, registered dental assistant, or registered dental hygienist and has

described the procedure to be performed. The dentist need not be physically present in the office or in the treatment room at the time the procedures are being performed.

(e)    “Assistant” means a nonlicensed person who may perform basic supportive procedures under the supervision of a dentist as provided in these rules.

(f)  “Board” means the Michigan board of dentistry.

(g)    “Conscious sedation” means a minimally depressed level of consciousness that retains a patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command and that is produced by a pharmacological or a non-pharmacological method or a combination of both.

 

 

(h)   “Combination inhalation-enteral conscious sedation” means conscious sedation using inhalation and enteral agents. Nitrous oxide/oxygen when used in combination with sedative agents may produce conscious or deep sedation or general anesthesia.

(i)   “Dental school” means an institution that offers a curriculum that provides a core of required dental education, training, and experience, and includes at least 4 years of academic instruction or its equivalent leading to the degree of doctor of dental surgery or doctor of dental medicine. The dental school is a component of an institution of higher education that is accredited by an agency recognized by the United States department of education and that the American dental association’s commission on dental accreditation has accredited as a dental education program.

(j)   “Dentist” means a person licensed by the board under the act and these rules.

(k)   “Direct supervision” means that a dentist has designated a patient of record upon whom services are to be performed by an assistant, registered dental assistant, or registered dental hygienist and has described the procedures to be performed. The dentist shall examine the patient before prescribing the procedure to be performed and again upon completion of the procedure. The dentist shall be physically present in the office at the time the procedures are being performed.

(l)     “Enteral” means any technique of administration in which the agent is absorbed through the gastrointestinal or oral mucosa.

(m)      “General anesthesia” means the elimination of all sensations accompanied by a state of unconsciousness and loss of reflexes necessary to maintain a patient airway.

(n)   “General supervision” means that a dentist has designated a patient of record upon whom services are to be performed. The dentist shall be physically present in the office at the time the procedures are being performed.

(o)   “Licensed” means the possession of a full license to practice, unless otherwise stated.

(p)   “Local anesthesia” means the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.

(q)   “Office” means the building or suite in which dental treatment is performed.

(r)   “Parenteral” means a technique of administration in which the drug bypasses the gastrointestinal (gi) tract, such as intramuscular (im), intravenous (iv), intranasal (in), submucosal (sm), subcutaneous (sc), and intraocular (io).

(s)   “Patient of record” means a patient who has been examined and diagnosed by a licensed dentist and whose treatment has been planned by a licensed dentist.

(t)    “Public health service” means the United States public health service. A person applying for an exemption under this classification shall submit a certified copy of his or her official papers verifying active duty status.

(u)   “Registered dental assistant” means a person licensed as such by the board under the act and these rules. A dental hygienist may perform the functions of a registered dental assistant if he or she is licensed by the board as a registered dental assistant.

(v)   “Registered dental hygienist” means a person licensed as such by the board under the act and these rules.

(w)    “Second pair of hands,” as used in R 338.11109, means acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist at the direction of a dentist who is in the process of rendering dental services and treatment to a patient. The acts, tasks, functions, and procedures performed by a dental assistant, registered dental assistant, or registered dental hygienist are ancillary to the procedures performed by the dentist and intended to provide help and assistance at the time the procedures are performed. This definition shall not be deemed to expand the duties of the dental assistant, registered dental assistant, or registered dental hygienist as provided by the act and rules promulgated by the board.

 

 

(x)    “Sedation” means the calming of a nervous, apprehensive individual, without inducing loss of consciousness, through the use of systemic drugs. Agents may be given orally, parenterally, or by inhalation.

(y)    “Titration” means the administration of small incremental doses of a drug until a desired clinical effect is observed. In accordance with this definition, titration of oral medication for the purposes of sedation is unpredictable. Repeated dosing of orally administered sedative agents may result in an alteration of the state of consciousness beyond the intent of the practitioner. The maximum recommended dose (mrd) of an oral medication shall not be exceeded. Facilities, personnel and standards for enteral sedation are the same as those for parenteral sedation.

(z)    “Treatment room” means the particular room or specific area in which the dental treatment is performed upon a patient.

 

PART 2. LICENSURE

 

R 338.11201 Licensure by examination to practice dentistry; graduates of schools in compliance with board standards.

Rule 1201. An applicant for dentist licensure by examination shall submit a completed application on a form provided by the department, together with the requisite fee. In addition to meeting the requirements of the code and administrative rules promulgated under the code, an applicant for dentist licensure by examination shall meet all of the following requirements:

(a)    Graduate from a dental school that is in compliance with the standards in R 338.11301.

(b)    Pass all parts of the national board examination that is conducted and scored by the joint commission on national dental examinations in order to qualify for the licensing examination provided in subdivision

(c)    of this rule. The requirement does not apply to applicants who have graduated before 1950.

(c) Pass a dental simulated clinical written examination that is conducted and scored by the northeast regional board of dental examiners, incorporated, or a successor organization, and 1 of the following:

(i)    Pass all parts of a clinical examination that is conducted and scored by the north east regional board of dental examiners, incorporated, or a successor organization, or pass all parts of a clinical examination that is conducted by a regional testing agency that is approved by the board.

(ii)     Pass all parts of a clinical examination developed and scored by a state or other entity and that is substantially equivalent, as provided in R 338.11203(5), to the clinical examination of the north east regional board of dental examiners, incorporated, or a successor organization.

 

R 338.11202 Licensure to practice dentistry; graduates of school not meeting board standards; requirements.

Rule 1202. An individual who graduated from a school of dentistry that does not comply with the standards provided in R 338.11301 may be licensed by the board if the individual meets all of the following requirements:

(a)    Complies with section 16174 of the act.

(b)    Presents to the board a final, official transcript establishing graduation from a school in which he or she has obtained a dental degree. If the transcript is issued in a language other than English, an original, official translation shall also be submitted.

(c)    Meets one of the following requirements:

(i)    Successfully completes a minimum 2-year program in dentistry in a dental school that complies with the standards in R 338.11301 and that leads to the awarding of a doctor of dental surgery (dds) or doctor of dental medicine (dmd) degree. The completion of the program shall be confirmed by the dean of the school attended or official transcripts from the dental school.

 

 

(ii)    Successfully completes a minimum 2-year master’s degree or certificate program in a dental school that complies with the standards in R 338.11301 and that leads to the awarding of a degree or certificate from a dental specialty program that complies with the standards in R 338.11501 and R 338.11503(b) and (c).

(d)      Passes all parts of the national board examination that  is  conducted  and scored by the  joint commission on national dental examinations.

(e)     Passes the dental simulated clinical written examination and a clinical examination, as described in R 338.11201(c).

 

R 338.11203 Dental examinations; required passing scores.

Rule 1203. (1) The board approves and adopts the examination developed and scored by the joint commission on national dental examinations. An applicant shall present evidence of passing each component of the examination with a converted score of not less than 75.

(3)    The board approves and adopts the clinical examination developed and scored by the north east regional board of dental examiners, incorporated. A passing score on the clinical examination shall be the score recommended by the north east regional board of dental examiners, incorporated, or its successor organization. In no case shall the applicant present evidence of less than a converted score of 75 on each component of the examination.

(4)   The board approves and adopts the clinical examinations of other regional testing agencies or state boards if the examinations are considered to be substantially equivalent to the clinical examination of the north east regional board of dental examiners, incorporated. A passing score on the clinical examination shall be the score recommended by the sponsoring organization. In no case shall the applicant present evidence of less than a converted score of 75 on each component of the examination.

(5)   To determine substantial equivalency as specified in subrule (4) of this rule, the board shall consider factors such as the following:

(a)    Subject areas included.

(b)    Detail of material.

(c)    Comprehensiveness.

(d)    Length of an examination.

(e)    Degree of difficulty.

(6)   To demonstrate substantial equivalency as specified in subrule (4) of this rule, an applicant may be required to submit, or cause to be submitted, materials such as the following:

(a)    A copy of the examination booklet or description of the examination content and examination scores issued by the testing agency.

(b)    An affidavit from the appropriate state licensing agency that describes the examination and sets forth the legal standards which were in effect at the time of the examination.

(c)    An affidavit from a state licensing board or examination agency that describes the examination.

 

R 338.11221 Licensure by examination to practice dental hygiene; requirements; graduates of schools in compliance with board standards.

Rule 1221. An applicant for dental hygienist licensure by examination shall submit a completed application on a form provided by the department, together with the requisite fee. In addition to meeting the requirements of the code and administrative rules promulgated under the code, an applicant for dental hygienist licensure by examination shall meet all of the following requirements:

 

 

(a)    Graduate from a dental hygiene program in compliance with the standards in R 338.11303.

(b)     Pass all parts of the dental hygiene national board examination that is conducted and scored by the joint commission on national dental examinations in order to qualify for the licensing examination provided for in subdivision (c) of this rule. The requirement does not apply to applicants who have graduated before 1962.

(c)    Pass a dental hygiene simulated clinical written examination conducted and scored by the north east regional board of dental examiners, incorporated, or a successor organization, and 1 of the following:

(i)    Pass all parts of a clinical examination that is conducted and scored by the north east regional board of dental examiners, incorporated, or a successor organization or pass all parts of a clinical examination that is conducted by a regional testing agency approved by the board.

(ii)      Pass all parts of a clinical examination developed and scored by a state or other entity that is substantially equivalent to the clinical examination of the north east regional board of dental examiners, incorporated, or a successor organization.

 

R 338.11222 Licensure to practice dental hygiene; graduates of schools not in compliance with board standards; requirements.

Rule 1222. An individual who graduated from a school of dental hygiene that is not in compliance with the standards provided in R 338.11303 may be licensed by the board if the individual meets all of the following requirements:

(a)    Complies with section 16174 of the act.

(b)    Presents to the board a final, official transcript establishing graduation from a school in which he or she has obtained a dental hygiene degree.

(c)       Successfully completes a program in a dental hygiene school that is in compliance with R 338.11303. The completion of the program shall be confirmed by the administrator of the school attended.

(d)    Passes all parts of the dental hygiene national board examination that is conducted and scored by the joint commission on national dental examinations.

(e)     Passes a dental hygiene simulated clinical written examination conducted and scored by the north east regional board of dental examiners, incorporated, or a successor organization, and 1 of the following:

(i)     Passes all parts of a clinical examination that is conducted and scored by the north east regional board of dental examiners, incorporated, or a successor organization or pass all parts of a clinical examination that is conducted by a regional testing agency approved by the board.

(ii)     Passes all parts of a clinical examination developed and scored by a state or other entity that is substantially equivalent to the clinical examination of the north east regional board of dental examiners, incorporated, or a successor organization.

 

R 338.11223 Registered dental hygienist examinations; passing scores.

Rule 1223. (1) The board approves and adopts the dental hygiene examination developed and scored by the joint commission on national dental examinations. An applicant shall present evidence of passing each component of the examination with a converted score of not less than 75.

(2)   The board approves and adopts the dental hygiene simulated clinical written examination developed and scored by the northeast regional board of dental examiners, incorporated, or a successor organization. An applicant shall present evidence of passing each component of the examination with a converted score of not less than 75.

(3)    The board approves and adopts the clinical examination developed and scored by the north east regional board of dental examiners, incorporated. A passing score on the clinical examination shall be the score recommended by the north east regional board of dental examiners, incorporated, or its

 

 

successor organization. In no case shall the applicant present evidence of less than a converted score of 75 on each component of the examination.

(4)   The board approves and adopts the clinical examinations of other regional testing agencies or state boards, if they are considered to be substantially equivalent. A passing score on the clinical examination shall be the score recommended by the sponsoring organization. In no case shall the applicant present evidence of less than a converted score of 75 on each component of the examination.

(5)   To determine substantial equivalency, as specified in subrule (4) of this rule, the board shall consider factors such as the following:

(a)    Subject areas included.

(b)    Detail of material.

(c)    Comprehensiveness.

(d)    Length of an examination.

(e)    Degree of difficulty.

(6)   To demonstrate substantial equivalency as specified in subrule (4) of this rule, an applicant may be required to submit, or cause to be submitted, materials such as the following:

(a)    A copy of the examination booklet or description of the examination content and examination scores issued by the testing agency.

(b)    An affidavit from the appropriate state licensing agency that describes the examination and sets forth the legal standards which were in effect at the time of the examination.

(c)    An affidavit from a state licensing board or examination agency that describes the examination.

 

R 338.11247 Limited licenses; issuance; requirements.

Rule 1247. (1) The board may issue a limited license, under section 16182(2)(a) of the act, to an individual who is a graduate of a dental, dental hygiene, or dental assisting program approved by the board and who is enrolled or involved in a postgraduate course of study.

(2)   The board may issue a limited license, under section 16182(2)(b) of the act, to an individual who is a graduate dentist, dental hygienist, or dental assistant who is employed by a dental program or a dental auxiliary program as a faculty member, and who functions only in a nonclinical academic research setting or in an administrative setting.

(3)   The board may issue a limited license, under section 16182(2)(c) of the act, to an individual who is a graduate dentist, dental hygienist, or dental assistant and who is employed by a dental program or a dental auxiliary program as a faculty member. A limited licensed dentist may perform dental procedures upon patients while employed as a faculty member by the dental or dental auxiliary program. A limited licensed dental hygienist or a limited licensed dental assistant may perform dental procedures upon patients while employed as a faculty member of a dental or dental auxiliary program, if such procedures are performed under the general supervision of a faculty member who is fully licensed as a dentist. An individual licensed under this subrule shall not do either of the following:

(a)    Hold himself or herself out to the public as being engaged in the practice of dentistry other than as a faculty member.

(b)    Provide dental services outside his or her employment as a faculty member.

(4)   An individual applying for a limited license under section 16182(2) of the act shall meet both of the following requirements:

(a)    Comply with section 16174 of the act.

(b)    Submit proof of graduation from an approved school of dentistry, dental hygiene, or dental assisting or a certified copy of the diploma and transcript from an unapproved school of dentistry, dental hygiene, or dental assisting.

(c)    Submit proof of appointment to a faculty position.

(5)   Limited licenses shall be renewed annually at the discretion of the board.

 

 

 

R 338.11255 Licensure by endorsement of dentist; requirements.

Rule 1255. (1) A dentist applying for licensure by endorsement shall be currently licensed in another state or territory of the United States and shall comply with section 16186 of the act and all of the following requirements:

(a)      Have graduated from a school which meets the standards provided in R 338.11301 and submit original, official transcripts of professional education and documentation of graduation for board evaluation.

(b)    Have passed all phases of the national board examination for dentists, in sequence. This requirement is waived for persons who graduated from an accredited school before 1950.

(c)    Be endorsed, on a form supplied by the board, by the licensing agency of any state or territory of the United States in which the applicant holds a current license or ever held a license as a dentist.

(d)    Show proof, on a form supplied by the board, of having no record of final or pending disciplinary action in any state or territory of the United States in which the applicant is or has been licensed.

(e)    Show proof of successful completion of 1 of the regional examinations as described in R 338.11203 (2), (3), and (4). This requirement is waived for individuals who were licensed initially in another state or territory of the United States before 2002 and who were not required to complete any regional examination as part of the initial licensing process as confirmed by the state or territory of the United States in which the initial license was awarded.

(2)    The board may deny an application for licensure by endorsement upon finding the existence of a board action in any other state or territory of the United States for a violation related to applicable provisions of section 16221 of the act or upon determining that the applicant does not fulfill the requirements of section 16186 of the act.

 

R 338.11259 Licensure by endorsement of dental hygienists; requirements.

Rule 1259. (1) A dental hygienist applying for licensure by endorsement shall be currently licensed in another state or territory of the United States and shall comply with section 16186 of the act and all of the following requirements:

(a)      Have graduated from a school which meets the standards provided in R 338.11303 and submit original, official transcripts of professional education and documentation of graduation for board evaluation.

(b)     Have passed all phases of the national board examination for dental hygienists. This requirement is waived for persons who graduated from an accredited school before 1962.

(c)    Be endorsed, on a form supplied by the board, by the licensing agency of any state or territory of the United States in which the applicant holds a current license or ever held a dental hygienist license.

(d)    Show proof, on a form supplied by the board, of having no record of final or pending disciplinary action in any state or territory of the United States in which the applicant is or has been licensed.

(e)     Show proof of successful completion of a substantially equivalent written and clinical examination under R 338.1223 (2), (3), and (4). This requirement is waived for individuals who were licensed initially in another state or territory of the United States before 2002 and who were not required to complete any regional examination as part of the initial licensing process as confirmed by the state or territory of the United States in which the initial license was awarded.

(2)    The board may deny an application for licensure by endorsement upon finding the existence of a board action in any other state or territory of the United States for a violation related to applicable provisions of section 16221 of the act or upon determining that the applicant does not fulfill the requirements of section 16186 of the act.

 

R 338.11261 Licensure by endorsement of registered dental assistants; requirements.

 

 

Rule 1261. (1) A dental assistant applying for licensure by endorsement as a registered dental assistant shall be currently licensed or registered in another state or territory of the United States for performance of expanded functions as described in R 338.11405 and shall comply with section 16186 of the act and all of the following requirements:

(a)      Have graduated from a school which meets the standards provided in R 338.11307 and submit original, official transcripts of professional education and documentation of graduation for board evaluation.

(b)    Be endorsed, on a form supplied by the board, by the licensing agency of any state or territory of the United States in which the applicant holds a current license for performance of expanded functions.

(c)     Show proof, on a form supplied by the board, of having no record of final or pending disciplinary action in any state or territory of the United States in which the applicant is or has been licensed.

(d)    Show proof of successful completion of a substantially equivalent written and clinical examination under R 338.11239.

(2)    To determine substantial equivalency as specified in subrule (1)(d) of this rule, the board will consider factors such as the following:

(a)    Subject areas included.

(b)    Detail of material.

(c)    Comprehensiveness.

(d)    Length of the examination.

(e)    Degree of difficulty.

(a)    A certified copy of the examination.

(b)    An affidavit from the responsible official of the appropriate state agency describing the examination and setting forth the legal standards which were in effect at the time of the examination.

(c)     An affidavit from the responsible official within a state society or another organization describing the examination.

(d)    Other credible evidence.

(4)    A dental assistant who does not fulfill the requirements of subrule (1) shall not be eligible for licensure by endorsement in this state and shall be required to comply with the provisions of R 338.11235.

(5)    The board may deny an application for licensure by endorsement upon finding the existence of a board action in any other state or territory of the United States for a violation related to applicable provisions of section 16221 of the act or upon determining that the applicant does not fulfill the requirements of section 16186 of the act.

 

PART 3. EDUCATION

 

R 338.11301 Approval of dental schools; standards; adoption by reference.

Rule 1301. (1) The board adopts by reference in these rules the standards of the commission on dental accreditation of the American dental association, as set forth in the publication entitled “Accreditation Standards for Dental Education Programs,” copyright 1998 and revised 2005, as the standards by which the board shall determine whether to approve a school that complies with these standards. Certification by the commission on dental accreditation that a school complies with these standards constitutes a prima facie showing that the school complies with these standards. The board shall actively participate in the evaluation process.

 

 

(2) These standards may be obtained at no cost from the Commission on Dental Accreditation of the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611-2678 or at no cost from the association’s website at http://www.ada.org. Copies of these standards are available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P. O. Box 30670, Lansing, MI 48909.

 

R 338.11303 Approval of dental hygiene schools; standards; adoption by reference.

Rule 1303. (1) The board adopts by reference in these rules the standards of the commission on dental accreditation of the American dental association, as set forth in the publication entitled “Accreditation Standards for Dental Hygiene Education Programs,” copyright 1998 and revised 2005, as the standards by which the board shall determine whether to approve a school that prepares persons for licensure as dental hygienists. Certification by the commission on dental accreditation that a school complies with these standards constitutes a prima facie showing that the school complies with these standards. The board shall actively participate in the evaluation process.

(2) These standards may be obtained at no cost from the Commission on Dental Accreditation of the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611-2678 or at no cost from the association’s website at http://www.ada.org. Copies of these standards are available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

 

R 338.11307 Approval of dental assisting schools; standards; adoption by reference.

Rule 1307. (1) The board adopts by reference the standards of the commission on dental accreditation of the American dental association, as set forth in the publication entitled “Accreditation Standards for Dental Assisting Education Programs,” copyright 1998 and revised 2005, as the standards by which the board shall determine whether to approve a school that complies with these standards. Certification by the commission on dental accreditation that a school complies with these standards constitutes a prima facie showing that the school complies with the standards. The board shall actively participate in the evaluation process.

(2)    These standards may be obtained at no cost from the Commission on Dental Accreditation of the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611-2678 or at no cost from the association’s website at http://www.ada.org. Copies of these standards are available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

 

PART 4. DELEGATION, SUPERVISION, ASSIGNMENT

 

R 338.11403 Assistant; delegation of intra-oral procedures under general supervision.

Rule 1403. (1) The following intra-oral procedures shall not be delegated to an assistant unless the procedures are performed under general supervision:

(a)    Trial sizing of orthodontic bands.

(b)    Holding the matrix for anterior resin restorations.

(c)    Making impressions for study and opposing models.

(d)    Applying of topical anesthetic solutions (nonaerosol).

(e)    Instructing in the use and care of dental appliances.

(f)     Operating dental radiographic equipment if the assistant has successfully completed a course in dental radiography which is substantially equivalent to a course taught in a program approved by the board pursuant to R 338.11303 or R 338.11307. This subdivision takes effect July 26, 1992.

 

 

 

R 338.11404 Assistant; delegation of intra-oral procedures under direct supervision.

Rule 11404. (1) The following intra-oral procedures shall not be delegated to an assistant unless the procedures are performed under direct supervision:

Placement and removal of orthodontic separators.

(b) Placement and removal of orthodontic elastics, ligatures, and arch wires.

(2) Except for those procedures described in R 338.11403 and this rule, intra-oral procedures shall not be delegated to an assistant.

 

R  338.11405     Registered  dental  assistant;  performance  of  intra-oral  procedures  under  general supervision.

Rule 1405. (1) A dentist shall not assign the intra-oral dental procedures detailed in R 338.11403(1) and the following additional intra-oral procedures to a registered dental assistant unless the procedures are performed under the general supervision of a dentist:

(a)    Placing and removing a rubber dam.

(b)    Placing and removing a nonmetallic temporary restoration with nonrotary instruments.

(c)    Removing excess cement from supragingival surfaces of a tooth with nonrotary instruments.

(d)    Applying anticariogenics after oral prophylaxis, when ordered by a licensed dentist.

(e)     Inspecting an oral cavity with a mouth mirror, including chartings of lesions, existing restorations, missing teeth, and classification of occlusion.

(f)    Sizing of temporary crowns and bands.

(2) A dentist shall not assign the following additional intra-oral procedures to a registered dental assistant unless the registered dental assistant has successfully completed an approved course, as defined in section 16611(12) and (13) of the act. These procedures shall be performed under the general supervision of a dentist:

Performing pulp vitality testing.

Placing and removing matrices and wedges. Applying cavity liners and bases.

Placing and removing nonepinephrine retraction cords. Applying desensitizing agents.

(f) Making an impression for orthodontic appliances, mouth guards, bite splints, and bleaching trays. Drying endodontic canals with absorbent points.

(h) Etching and placing adhesives before placement of orthodontic brackets.

 

R 338.11405a Registered dental assistant; assignment of intra-oral procedures under direct supervision. Rule  11405a.  (1)  A  dentist  shall  not  assign  to  a  registered  dental  assistant  the  intra-oral  dental procedures specified in R 338.11404(1) and the following intra-oral procedures unless the procedures are performed under the direct supervision of a dentist:

(a)    Placing and removing periodontal dressings.

(b)    Temporarily cementing and removing temporary crowns and bands.

(c)    Removing sutures.

(d)     Polishing specific teeth with a slow-speed rotary hand piece immediately before procedures that require acid etching, for any of the following:

(i)    Placing sealants.

(ii)    Placing resin-bonded orthodontic appliances.

(iii)    Placing direct restorations by the dentist.

(2)   Except for the procedures described in this rule, a dentist shall not assign intra-oral procedures to a registered dental assistant.

 

 

(3)   A dentist shall not assign the following intra-oral procedures to a registered dental assistant unless the registered dental assistant has successfully completed an approved course, as defined in section 16611(11) of the act, followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a criterion-based assessment instrument. These procedures shall be performed under the direct supervision of a dentist:

(a)    Placing, condensing, and carving amalgam restorations.

(b)    Making final impressions for indirect restorations.

(4)    A dentist shall not assign the assisting and monitoring of the administration of nitrous oxide analgesia by the dentist or registered dental hygienist to a registered dental assistant unless the registered dental assistant has successfully completed an approved course, as defined in section 16611(7) of the act, in the assisting and monitoring of the administration of nitrous oxide analgesia. This procedure shall be performed under the direct supervision of a dentist.

(5)   Except for the procedures described in R 338.11405 and this rule, a dentist shall not assign intra-oral procedures to a registered dental assistant.

 

R 338.11406 Assignment of intra-oral procedures to registered dental hygienist.

Rule 1406. The intra-oral procedures listed in R 338.11405(1)(b) and (f) and shall not be assigned to a registered dental hygienist unless the registered dental hygienist is also licensed as a registered dental assistant under R 338.11235.

 

R 338.11408   Registered dental hygienist; performance of intra-oral procedures under assignment of dentist.

Rule 1408. (1) A registered dental hygienist shall not perform the following intra-oral  dental procedures unless the procedures are performed under the assignment of a dentist as defined in section 16601 of the code:

(a)    Removing accretions and stains from the surfaces of the teeth and applying topical agents essential to complete prophylaxis.

(b)    Root planing or debridement.

(c)    Polishing and contouring restorations.

(d)    Applying anticariogenic agents.

(e)    Charting of the oral cavity,including all of the following:

(i)    Periodontal charting.

(ii)    Intra- and extra-oral examining of soft tissue.

(iii)    Charting of radiolucencies or radiopacities, existing restorations, and missing teeth.

(f)    Preliminary examining that includes both of the following:

(i)    Classifying occlusion.

(ii)    Testing pulp vitality using an electric pulp tester.

(g)    Applying nonaerosol and noncaustic topical anesthetic agents by prescription of the dentist.

(h)    Placing and removing intra-coronal temporary sedative dressings.

(i)    Taking intra-oral measurements for orthodontic procedures.

(j)    Placing and removing postextraction and periodontal dressings.

(k)    Removing excess cement from tooth surfaces.

(l)    Providing nutritional counseling for oral health and maintenance.

(m)    Applying commonly accepted emergency procedures.

(n)    Removing sutures.

(o)    Placing and removing a rubber dam.

(p)      Making impressions for study or opposing models, orthodontic appliances, mouth guards, bite splints, and bleaching trays.

 

 

(q)    Operating dental radiographic equipment.

(r)    Placing subgingival medicaments.

(s)    Temporary cementing and removing of temporary crowns and bands.

 

R 338.11409 Registered dental hygienist; assignment of intra-oral procedures under direct supervision. Rule  11409.  (1)  A  registered  dental  hygienist  shall  not  perform  the  following  intra-oral  dental procedures unless the procedures are performed under the direct supervision of a dentist as defined in section 16601 of the code:

Performing soft tissue curettage.

(b) Administering intra-oral block or infiltration anesthesia or nitrous

oxide analgesia or both to a patient 18 years of age or older and only if the registered dental hygienist has met the following requirements:

(i)      Successfully completed an approved course, as defined in section 16611(4) of the act, in the administration of local anesthesia and/or nitrous oxide analgesia.

(ii)       Successfully  completed  a  state  or  regional  board  administered  written  examination  in  local anesthesia within 18 months of completion of the approved course.

(iii)    Successfully completed a state or regional board administered written examination on nitrous oxide analgesia, within 18 months of completion of the approved course, if such an examination exists.

(iv)    Maintains and provides evidence of current certification in basic or advanced cardiac life support.

(2) A dental hygienist who meets the requirements of this rule may not administer more than 50% nitrous oxide.

 

PART 6. GENERAL ANESTHESIA AND INTRAVENOUS CONSCIOUS SEDATION AND ENTERAL SEDATION

 

R 338.11603 Adoption of standards; effect of certification of programs.

Rule 3. (1) The board adopts the standards for advanced training in anesthesia and pain control set forth by the commission on dental education of the American dental association in part 2 of the publication entitled "Guidelines  for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry," October 2003 edition. Part 2 of the guidelines may be obtained at no cost from the Commission on Dental Education, American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611, or on the association’s website at http://www.ada.org/prof/resources. A copy of the standards is available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. Certification of programs by the council on dental education as meeting the standards adopted constitutes a prima facie showing that the program is in compliance with the standards.

(2)  The board adopts the standards for training in intravenous conscious sedation and related subjects set forth by the council on dental education of the American dental association in part 1 of the publication entitled "Guidelines for Teaching the Comprehensive  Control  of  Anxiety and  Pain in Dentistry," October 2003 edition. Part 1 of the guidelines may be obtained at no cost from the Commission on Dental Education, American Dental Association, 211 E. Chicago Avenue, Chicago, IL  60611, or on the association’s website at http://www.ada.org/prof/resources. A copy of the standards is available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. Certification of programs by the council on dental education as meeting the standards adopted constitutes a prima facie showing that the program is in compliance with the standards.

(3)   The board adopts the standards for credentialing in basic and advanced life support set forth by the American heart association in the guidelines for cardiopulmonary resuscitation and emergency cardiac

 

 

care for professional providers and published in “Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (70-2041). A copy of the guidelines for cardiopulmonary resuscitation and emergency cardiac care may be obtained from the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 or at http://www.americanheart.org, at a cost of $20.00 as of the adoption of these rules. A copy of this document is available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

(4)   The board adopts the standards regarding the equipment within a facility set forth by the American association of oral and maxillofacial surgeons in the publication entitled "Office Anesthesia Evaluation Manual," sixth edition. A copy of this manual may be obtained from the American Association of Oral and Maxillofacial Surgeons, 9700 West Bryn Mawr Avenue, Rosemont, IL 60018, or at the association’s website at http://www.aaoms.org at a cost of $95 for members and professional/allied staff,

$285 for nonmembers, and $190 for institutions as of the adoption of these rules. A copy of this document is available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

 

R 338.11605 Enteral sedation; requirements for approval of course and instructor.

Rule 11605. (1) A course in enteral sedation shall be approved by the board of dentistry and shall, at a minimum, be consistent with the enteral sedation course as outlined in the American dental association’s educational guidelines “Part Three: Teaching the Comprehensive Control of Pain and Anxiety in a Continuing Education Program,” October 2003, whose guidelines are adopted by the board.  Such a course must provide training in patient assessment, recognition of emergencies and airway management, including the ability to manage an unconscious airway. Part 3 of the guidelines may be obtained at no cost from the American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611, or on the association’s website at http://www.ada.org. A copy of the guidelines is available for inspection and distribution at cost from the Michigan Board of Dentistry, Department of Community Health, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

(2)   An instructor of a course in enteral sedation shall be approved by the board of dentistry and shall have at least 3 years experience which includes his or her formal postdoctoral training in anxiety and pain control.

(3)    An instructor of an approved enteral sedation course shall certify the competency of a participant upon a participant’s satisfactorily completing training in each conscious sedation technique, including instruction, clinical experience, and airway management.

 

PART 7. CONTINUING EDUCATION

 

R 338.11704a Acceptable continuing education for dental hygienists and dental assistants; limitations. Rule 4a. The board shall consider any of the following as acceptable continuing education:

(a)     Successful completion of a course or courses offered for credit in a dental school or hospital-based dental specialty program approved by the board under R 338.11301, a dental hygiene school approved by the board under R 338.11303, or a dental assisting school approved by the board under R 338.11307. Ten hours of continuing education shall be credited for each quarter credit earned and 15 hours shall be credited for each semester credit earned, without limitation.

(b)     Attendance at a continuing education program offered by a dental school or hospital-based dental specialty program approved by the board under R 338.11301, a dental hygiene school approved by the board under R 338.11303, or a dental assisting school approved by the board under R 338.11307. One hour of continuing education shall be credited for each hour of program attendance, without limitation.

 

 

(c)    Attendance at a continuing education program approved by the board under R 338.11705 of this part. One hour of continuing education shall be credited for each hour of program attendance, without limitation.

(d)     Development and presentation of a table clinic demonstration or a continuing education lecture offered in conjunction with the presentation of continuing education programs approved by the board. One hour of continuing education shall be credited for each hour devoted to the development and initial presentation of a table clinic demonstration or a continuing education lecture, with a maximum of 10 hours of continuing education credited for the development and presentation of the same table clinic demonstration or continuing education lecture.

(e)     Twelve hours of continuing education shall be credited for the initial publication of an article or articles related to the practice of dentistry, dental hygiene, or dental assisting in the journal of an accredited school of dentistry, dental hygiene or dental assistant, or in a state or state component association of dentists, dental specialists, dental hygienists, or dental assistants.

(f)    Twenty-five hours of continuing education shall be credited for the initial publication of an article or articles related to the practice of dentistry, dental hygiene, or dental assisting in a textbook or in the journal of a national association of dentists, dental specialists, dental hygienists, or dental assistants.

(g)       Twelve hours of continuing education may be earned in board-approved, online continuing education activities.

(h)     One hour of continuing education shall be credited for each hour of reading articles and viewing or listening to media, other than online programs, devoted to dental, dental hygiene, or dental assisting education with a maximum of 10 hours credited under this category.

(i)    Renewal of a license held in another state that requires continuing education for license renewal that is substantially equivalent to that required in these rules if the applicant resides and practices in another state. For a registered dental hygienist or registered dental assistant, 36 hours of continuing education shall be credited for evidence of current licensure in such other state.

(j)     For a registered dental assistant, meeting the requirements for recertification in R 338.11705(3). Thirty-six hours of continuing education shall be credited for evidence of current certification, other than life certification, by the dental assisting national board.

(k)     One continuing education contact hour may be granted for each hour of program attendance at a continuing education program which has been granted approval by another state board of dentistry.

(l)    Six hours of continuing education shall be credited to dental hygienists or registered dental assistants for attendance at dental related programs which are documented by the licensee as relevant to health care and advancement of the licensee’s dental education. The board shall deny a request for approval if the continuing education request does not meet the criteria used by the board for approval of continuing education sponsors.

(m)     A maximum of 18 credit hours per renewal period may be earned for programs related to specific dental specialty topics approved for category 1 continuing education by the boards of medicine or osteopathic medicine.

 

R 338.11705 Standards and requirements; adoption by reference.

Rule 5. (1) The board approves and adopts by reference the standards and criteria of the national sponsor approval program of the academy of general dentistry for approval of continuing education sponsoring organizations, institutions, and individuals, which are set forth in the publication entitled “Program Approval for Continuing Education (PACE), a Guidebook, Revised July 2002”. Information on the pace standards and criteria is available at no cost from the Academy of General Dentistry, 211 East Chicago Avenue, Suite 900, Chicago, IL 60611 or from the academy’s internet website at http://www.agd.org. A copy of the guidebook is available for inspection and distribution at no cost from the Michigan Department of Community Health, Bureau of Health Professions, 611 West Ottawa,

 

 

P.O. Box 30670, Lansing, MI 48909. Approval of a sponsor by the academy of general dentistry committee on national sponsor approvals or by any academy of general dentistry constituent academy shall constitute prima facie evidence that the sponsor meets the standards and criteria adopted by the board.

(2)    The board approves and adopts by reference the standards and criteria of the National Sponsor Approval Program of the American Dental Association Continuing Education Recognition Program (ADA CERP) for approval of continuing education sponsoring organizations, which are set forth in the publication entitled “ADA CERP Recognition Standards and Procedures, Revised April 2002.” A copy of this publication may be obtained at no cost from the association at ADA CERP 211 E. Chicago Avenue, Chicago, IL 60611-2678 or from the association’s internet website at http://www.ada.org/prof/ed/ce/cerp. A copy of the publication is available for inspection and distribution at cost from the Department of Community Health, Bureau of Health Professions, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909. Approval of a sponsor by the ADA CERP or by any constituent group of ADA CERP shall constitute prima facie evidence that the sponsor meets the standards and criteria adopted by the board.

(3)   The board approves and adopts by reference the requirements for recertification established by the dental assisting national board and set forth in the publication entitled “2002 Recertification Guidelines

& Requirements.” A copy of the publication may be obtained at no cost from the Dental Assisting National Board, 676 N. St. Clair Street, Suite 1880, Chicago, IL 60611 or from the national board’s internet website at http://www.danb.org. A copy of the guidelines and requirements are available for inspection and distribution at cost from the Department of Community Health, Bureau of Health Professions, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

(4)   The board shall consider any continuing education program that is offered by a sponsor that applies to the board and demonstrates it substantially meets the standards and criteria adopted by the board as a continuing education program approved by the board.

(5)    The board adopts by reference the standards for certification in basic and advanced cardiac life support set forth by the American heart association in the standards and guidelines for cardiopulmonary resuscitation and emergency cardiac care for professional providers and published in “Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (70-2041). A copy of the guidelines for cardiopulmonary resuscitation and emergency cardiac care may be obtained from the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 or at http://www.ahajournals.org at a cost of $20.00 as of the adoption of these rules. A copy of this document is available for inspection and distribution at cost from the Department of Community Health, Bureau of Health Professions, 611 West Ottawa, P.O. Box 30670, Lansing, MI 48909.

(6)   The board may approve a state, regional, or national dental organization as an acceptable provider of continuing education courses if the organization presents standards, criteria, and course monitoring procedures for its courses that are acceptable to the board. This approval may be withdrawn if the board determines the organization is not complying with the standards and criteria presented. The standards, criteria, and monitoring procedures will be retained in the department’s board files. An organization shall update its file with the department every 5 years.