32-1289

32-1289. Employment of dental hygienist by
public agency, institution or school; definitions

A. A public health agency or institution or a public or private school authority
may employ dental hygienists to perform necessary dental hygiene procedures under either
direct or general supervision pursuant to section 32-1281.

B. A dental hygienist employed by or working under contract or as a volunteer for a
public health agency or institution or a public or private school authority before an
examination by a dentist may screen patients and apply topical fluoride without entering
into an affiliated practice relationship pursuant to this section.

C. A public health agency or institution, a public or private school authority or A
government sponsored program that provides dental services may enter into a contract for
dental hygiene services with licensees who have entered into an affiliated practice
relationship pursuant to this section.

D. The dental hygienist and the affiliated dentist must notify the board of the
beginning of the affiliated practice relationship and provide the board with a copy of
the agreement and any amendments to the agreement within thirty days after the effective
date of the agreement or amendment. The dental hygienist and the affiliated dentist must
also notify the board within thirty days after the termination date of the affiliated
practice relationship if this date is different than the contract termination date.

E. A dental hygienist must satisfy all of the following to be eligible to enter
into an affiliated practice relationship with a dentist to perform dental hygiene
procedures in affiliated practice settings:

1. Hold an active license pursuant to this article.

2. Enter into an affiliated practice relationship with a specific dentist who is
licensed pursuant to this chapter.

3. Have held a license as a dental hygienist for at least five years and actively
engaged in dental hygiene practice for at least two thousand hours in the five years
immediately preceding the affiliated practice relationship.

F. An affiliated practice relationship between a dental hygienist and a dentist
must be in writing and must include at least the following:

1. An identification of the affiliated practice settings in which the dental
hygienist may engage in dental hygiene practice pursuant to an affiliated practice
relationship.

2. An identification of the procedures and standing orders the dental hygienist
must follow. The standing orders must include the circumstances in which a patient may be
seen by a dental hygienist.

3. A requirement that the patients who have been assessed by the dental hygienist
be directed to the affiliated dentist for treatment or planning that is outside of the
dental hygienist's scope of practice and that the affiliated dentist make any necessary
referrals to other dentists.

4. A requirement that a patient be seen by a licensed dentist within twelve months
of initial treatment by the dental hygienist. If the patient has not received an
examination and a treatment plan by a licensed dentist, the dental hygienist shall not
provide further treatment.

5. A requirement that a patient sixty-five years of age or older be seen by a
licensed dentist after treatment by the dental hygienist. If the patient has not received
an examination and a treatment plan by a licensed dentist, the dental hygienist shall not
provide further treatment.

6. A requirement that if a patient presents with a complex medical history or
medication regimen, the affiliated dental hygienist shall consult with the affiliated
dentist prior to any treatment by the affiliated dental hygienist. The patient shall be
directed to the affiliated dentist and the affiliated dentist shall make any necessary
referrals to other licensed dentists.

7. A requirement that the patient be informed that the dental hygienist providing
the care is a licensed dental hygienist and that the care does not take the place of a
diagnosis or treatment plan by a dentist.

8. Pursuant to paragraph 3, 4 or 5 of this subsection, a requirement that the
patient be informed that further dental hygiene services may not be provided unless the
patient has been seen by a licensed dentist.

G. The board shall adopt rules regarding participation in affiliated practice
relationships by dentists and dental hygienists that specify the following:

1. Additional continuing education requirements that must be satisfied by a dental
hygienist.

2. Additional standards and conditions that may apply to affiliated practice
relationships.

3. Compliance with the dental practice act and rules adopted by the board.

H. Each dentist in an affiliated practice relationship must:

1. Be available to provide an appropriate level of contact, communication and
consultation with the affiliated dental hygienist.

2. Adopt standing orders applicable to dental hygiene procedures that may be
performed and populations that may be treated by the dental hygienist under the terms of
the applicable affiliated practice agreement and to be followed by the dental hygienist
in each affiliated practice setting in which the dental hygienist performs dental hygiene
services under the affiliated practice relationship.

3. Adopt procedures to provide timely referral of patients referred by the
affiliated dental hygienist to a licensed dentist for examination and treatment planning.
If the examination and treatment planning is to be provided by the dentist, that
treatment shall be scheduled in an appropriate time frame. The dentist or the dentist to
whom the patient is referred must be geographically available to see the patient.

I. Each affiliated dental hygienist when practicing under an affiliated practice
relationship:

1. May perform only those duties within the terms of the affiliated practice
relationship.

2. Must maintain an appropriate level of contact, communication and consultation
with the affiliated dentist.

3. Is responsible and liable for all services rendered by the dental hygienist
under the affiliated practice relationship.

J. Subject to the terms of the written affiliated practice agreement entered into
between a dentist and a dental hygienist, a dental hygienist may perform all dental
hygiene procedures authorized by this chapter except for the procedures identified in
section 32-1281, subsection B, paragraphs 4, 5 and 6 or any diagnostic procedures that
are required to be performed by a dentist.

K. Subject to the terms of the written affiliated practice agreement entered into
between a dentist and a dental hygienist, a dental hygienist may perform dental hygiene
procedures in affiliated practice settings only on a person who is any of the following:

1. Enrolled in a federal, state, county or local health care program.

2. Participating in the national school meal program.

3. From a family with a household income that is less than two hundred per cent of
the federal poverty guidelines.

L. This section does not require any dentist or dental hygienist to enter into an
affiliated practice relationship.

M. For the purposes of this section:

1. "Affiliated practice setting" means the delivery of dental hygiene services by a
dental hygienist under an affiliated practice relationship through a public health agency
or institution, a public or private school authority or a government sponsored program
that provides dental services.

2. "Screen" means visually examining the teeth and hard or soft tissue of the mouth
for obvious oral health problems for the purpose of advising the patient of the need for
dental care, and shall not include an examination diagnosis or treatment planning.