R EGULATION OF D ENTISTS: Preparing for the Minnesota Board of Dentistry Jurisprudence Exam DENT 6422 Summer 2008 Patricia Glasrud

Topics to be covered today… 1.How is “practicing dentistry” defined in statute? 2.What functions may be legally delegated to whom? 3.What is “professional development?” 4.What is a dentist required to report? 5.How may a dentist advertise appropriately?

Minnesota Board of Dentistry Jurisprudence Exam Required for Minnesota licensure of dentists and dental hygienists and for registration of dental assistants All dental professionals take the same test Test items are changed every few years as new statutes and rules go into effect Score of 75% or more 100 multiple-choice test items Can be retaken, if necessary

What’s in “the book?” Legislature enacted (statutes): Dental Practice Act (Ch. 150A) Professional Firms (Ch. 319B) Dept. of Health (Ch.144) Examining and Licensing Boards (Ch.214) Board of Dentistry promulgated (rules): Board of Dentistry Rules (Ch.3100) Health Licensing Boards Infection Control (Ch. 6950)

How is “practicing dentistry” defined in statute? (150A.05) 1.Diagnose, treat, prescribe, operate on human teeth, alveolar process, gums, jaw, adjacent or assoc. structures 2.Manage place where dental operations are done 3.Perform dental operations for a fee or gratuitously 4.Use X-rays for dental diagnostic purposes 5.Perform extractions, corrects malpositioned teeth, jaws

Practicing dentistry definition, cont’d. 6. Diagnose, treat or remove stains, accretions from teeth, jaws 7. Replace teeth or part of tooth with filling, crown, bridge, denture, other appliance 8. Makes prosthetic dentures, bridges, etc. 9. Perform any clinical operation included in dental curricula

What (intra-oral) functions may be legally delegated to whom? WHO? –Dental hygienists, registered dental assistants, and “chairside” dental assistants WHAT? –Intra-oral procedures (reversible) WHERE? –Level of supervision by DDS –Collaborative Agreements define places, patients

Types of Delegation Rules Permissive: Dentist may delegate only those duties listed (MN has this type of rule) Non-permissive: Dentist may delegate what is NOT prohibited

Current Levels of Supervision GENERAL: Dentist is not in office or on premises, but procedures are performed with prior knowledge and consent of dentist

Current Levels of Supervision INDIRECT: Dentist is in the office, authorizes the procedures to be performed, and remains in the office while procedures are being performed.

Current Levels of Supervision DIRECT: Dentist is in the office, personally diagnoses and authorizes the procedures, and before dismissal of patient, evaluates the performance of the auxiliary.

Dental Hygiene Duties: Under General Supervision Preliminary charting of oral cavity and surrounding structures to include case histories; Perform initial and periodic examinations and assessments to determine periodontal status, and Formulate a dental hygiene treatment plan in coordination with a dentist’s treatment plan.

Dental Hygiene Duties: Under General Supervision Exposing radiographs Scaling and root planing Administering local anesthetic, nitrous oxide Other preventive and education functions (sealants, fluoride, etc.) Several specific orthodontic procedures Make referrals to dentists, physicians, and other practitioners

Dental Hygiene Duties: Under Indirect Supervision Perform restorative procedures limited to placing, contouring, and adjusting: - amalgam restorations, - glass ionomers, and - supragingival class I & V composites - adapting & cementing stainless steel crowns.

Dental Hygiene Duties: Under Direct Supervision Place & remove matrix bands; Attach prefit & readjusted ortho appliances; Etch before bonding of ortho appliances; Remove bond material from teeth with rotary instruments; Fabricate, cement and adjust temp restorations; Remove fixed ortho bands & brackets

Dental Assistant Credentials may include… Registered (RDA) Certified (CDA) RDA, CDA RDA, RF RDA, CDA, RF Unregistered

Registered Dental Assisting: Entering the Profession Must meet state requirements In Minnesota, this means- Graduation from accredited dental assisting program Minnesota Registration Examination (written) Current CPR certification Jurisprudence examination (Minnesota laws) Application form & pay fee

Certified Dental Assistant: “CDA” Granted by Dental Assisting National Board (“DANB”)—NOT the MN Board of Dentistry Therefore, has NO legal standing in Minnesota May NOT perform functions listed in Dental Practice Act Many MN dental assistants have earned both registration and certification and refer to themselves as “CDA, RDA”

Unregistered Dental Assisting May be trained on-the-job Assists dentist at chairside May help with patient reception, infection control Not regulated by the state

RDA Duties: Under General Supervision Take radiographs Take impressions for casts and bite registration (not for final construction of fixed and removable prostheses) Cut arch wires, remove loose bands and brackets on orthodontic appliances Re-cement intact temporary restorations Deliver vacuum-formed orthodontic retainers

RDA Duties: Under Indirect Supervision Apply topical medications (fluoride, bleaching agents, etc.) Apply sealants Remove cement with hand instruments only Mechanical polishing of teeth Remove sutures Pre-select orthodontic bands Place and remove periodontal dressings Monitor nitrous oxide Place and remove rubber dam Many more!

RDA Duties: Under Direct Supervision Remove excess bond material from orthodontic appliances Remove bond material from teeth with rotary instruments (special course is required) Place and remove matrix bands Administer nitrous oxide Attach pre-fit and pre-adjusted orthodontic appliances Remove fixed orthodontic bands and brackets

“Restorative Expanded Functions” Requirements May be performed by Minnesota RDA or Minnesota licensed hygienists who: –Have successfully completed the Board- approved course, AND –Minnesota licensed dentist has authorized procedure AND - Dentist is available in the clinic while the procedure is being performed (indirect supervision)

Restorative Expanded Functions PLACE, CONTOUR AND ADJUST— –Amalgam restorations; –Glass ionomer; –Class I and Class V supragingival composites where the margins are entirely within the enamel, and –Adapt and cement stainless steel crowns.

Collaborative Agreement Law Created in 2001 by Minnesota Legislature; amended in 2004 & 2005 (Mn.Stat.150A.10, Subd. 1a) Written agreement between DDS & qualified DH, must include all of the specifics set forth in statute Allows DH to provide dental hygiene services without DDS present in places other than the dental office, and without a dentist’s diagnosis and treatment plan

Collaborative Dental Hygiene Practice Allows qualified dental hygienists to provide care in schools, Head Start programs, nursing homes, community clinics, nonprofit organizations, hospitals, etc. Care may be given to patients, students, residents of the facility, program or organization. Intended to address dental access problem

Collaborative Practice Dental Hygienist’s Qualifications include… Active clinical dental hygiene practice for not less than 2400 hours in previous 18 months Career total of 3000 hours including at least 200 hrs. in clinical practice in 2 of past 3 years CDE in infection control, medical emergencies, and current in CPR

Dental Laboratory Technicians Fabricate full and partial dentures (No direct patient contact) Precision and accuracy working with small hand instruments Artistic abilities; attention to minute details Today’s large labs often provide their own training Not regulated by the state (but this could change)

What is “professional development?” Continuing dental education requirements for licensure/registration renewal DENTISTS – 50 credits every 2 years Fundamental Credits - at least 30 Elective Credits - no more than 20

Professional development, cont’d. Fundamental credits: Activities directly related to the provision of dental services Elective credits: Activities directly related to, or supportive of, the practice of dentistry, dental hygiene or dental assisting Professional Portfolio is required

Professional development, cont’d. Professional Portfolio must include: –Healthcare Provider CPR course –Board’s “self-assessments” (1 per cycle) –Documentation of required number of hours needed (DDS = 50; RDH = 25; RDA = 25)

Professional development, cont’d. Credits must have been earned in 2 of the Core Subject areas: 1.Record keeping 2.Infection Control 3.Ethics 4.Patient Communication 5.Management of Medical Emergencies 6.Treatment & Diagnosis

Professional development, cont’d. Professional development activities include: –Lectures/ Symposiums/ Seminars –Study Clubs –Advanced Education/ College Courses –Volunteerism/ Community Service –Distance Learning –Self-Study

Professional development, cont’d. Subjects NOT granted credit include: –Estate Planning –Marketing –Financial Planning –Investments –Personal Health, Growth

Professional development, cont’d. Acceptable documentation must include: –Name & Location of organization/presenter; –Contact info and credentials/training that qualified the person to teach the course; –Course Title, Date, Hours and Subject Matter –Individuals will be randomly audited!

Professional development, cont’d. Random audits –Must submit complete portfolio All self-assessment examinations provided by Board of Dentistry Copy of front & back of current CPR card / certificate Confirming documentation from the presenting organization Personal log of published articles read (title, author, name of journal/publication, date published)

Professional development, cont’d. Audits: - Random audit OR due to complaints - Advance notification to licensee by Board (60 days) - Failure to supply portfolio may result in disciplinary action by Board - Falsification of info submitted may result in disciplinary action by Board

Professional development, cont’d. Failure of an audit: - 6 months to comply----Could result in loss of license Deficiencies include: - Lack of proof of documentation or participation; - Credit hours earned outside of renewal period (no “carry-over”) - Insufficient hours in core competencies - Failure to submit portfolio - Unacceptable professional development sources

What is a dentist required to report and to whom? ADVERSE REACTIONS (MN Rule ) –Any incident arising from administration of nitrous oxide, or drug used for general anesthesia, conscious sedation, local anesthesia –Results in “serious or unusual outcome” –That produces a temporary or permanent physiological injury, harm. Report to Board of Dentistry

Required Reporting, cont’d. HIV, HBV, HCV (Minn. Stat ) Required to report yourself if you are diagnosed as infected with HIV, HBV, HCV Report to MN Department of Health

Required Reporting, cont’d. If you have knowledge of a licensee or registrant (including you) who is unable to practice with reasonable skill and safety … Because of illness, drug/alcohol use, or any mental, physical or psychological condition Report to the Board of Dentistry or to HPSP

Required Reporting, cont’d. CHILD ABUSE/ NEGLECT (Minn. Stat ) Dental professionals are often the first to see child abuse Licensed/ registered dental professionals are required to report - Mandated Reporter is“…a professional or professional’s delegate who is engaged in the practice of the healing arts…”

Required Reporting, cont’d. NEGLECT is defined as… “…failure by a person responsible for a child’s care to supply a child with necessary food, clothing, shelter, health, medical, or other care required for the child’s physical or mental health when reasonably able to do so.”

Required Reporting, cont’d. Report suspected child abuse / neglect to local welfare agency, police department or county sheriff, or “agency responsible for assessing or investigating the report.” Immunity from liability if mandated reporter is “acting in good faith.” Failure to report is considered a misdemeanor.

Reporting Requirements, cont’d. MALTREATMENT OF VULNERABLE ADULTS (Minn. Stat ) Protects adults who, because of physical or mental disability or dependency on institutional services, are particularly vulnerable to maltreatment

Advertising Rules ( – ) False, fraudulent, misleading or deceptive statement or claim –“...create false or unjustified expectations of favorable results;” –“…appeals to an individual’s anxiety in an excessive or unfair way;” –“contains material claims that cannot be substantiated;” –“misrepresents a dentist’s credentials, training, experience, or ability.”

Advertising If routine dental services are advertised, either the ad must include the components, or disclose what’s NOT included. (Example: Coupons advertising “free dental exam and x-rays”) MN Rules list definitions of exams, x-rays, dentures, prophies, extractions (what must be included or listed as not included)

Advertising Ads MUST include the corporation, partnership, or individual’s name and address; Payment to media for publicity MUST disclose the fact of payment in the ad; Ads MUST NOT reveal patient’s identity or personally identifiable facts without the patient’s written waiver of confidentiality.

Advertising MUST NOT offer, give, receive, or agree to receive payment for referring a patient After 1 year, it is prohibited to include the name of a dentist who formerly practiced at or associated with any advertised location. Dentists MUST respond to advertising complaint to the Board of Dentistry within 30 days.

MN Board of Dentistry Statement on Advertising “The Minnesota Dental Practice Act prohibits a dentist from using a public communication that contains a misleading or deceptive statement or claim. The Minnesota Board of Dentistry regards the designation and advertisement of a dentist as a ‘Top Dentist’ to be misleading or deceptive. Such designation is misleading or deceptive because it is not substantiated by empirical evidence of special training, experience, education or expertise.” (Adopted, 2005)

Thank you!