California Dental Hygiene Regulations and Procedures, Exams of Dentistry

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Definition of Committee - ANSWER-the Dental Hygiene Committee of California (DHCC) Definition of Dental Board - ANSWER-the Dental Board of California Direct supervision - ANSWER-A set of procedures where The dentist must physically be present in treatment facility General supervision - ANSWER-Procedures where the dentist does NOT need to be physically present in treatment facility Oral prophylaxis - ANSWER-Preventative and therapeutic dental procedures that include -- bacterial debridements with complete removal of supra and sub calculus, soft deposits, plaque and stains. And to smooth out tooth surfaces What is the purpose of the prophylaxis - ANSWER-To create an environment for a patient to maintain healthy hard and soft tissues Can an RDH perform the same functions of an rda? - ANSWER-Yes What does the practice of an rdh include - ANSWER-Dental hygiene assessment and development, planning and implementation of a dental hygiene plan. It also includes oral hygiene education, counseling and health screenings Dental hygiene does NOT include what - ANSWER----Diagnosing or comprehensive treatment plans ---Placing, moving, condensing, carving, removing of permanent restorations ---surgery, or cutting on hard and soft tissue , removing teeth and cutting and suturing --- prescribing meds ---administering local or general anesthesia or oral or parenteral conscious sedation other than nitrous oxide and oxygen and allowed local anesthetic. What can an rdh do under direct supervision? - ANSWER----Soft-tissue curettage ---Administration of local anesthesia ---Administration of nitrous oxide and oxygen, whether administered in tandem or alone. What can an rdh do under general supervision - ANSWER---- preventative and therapeutic interventions including : oral prophylaxis, scaling and root planing

---application of topical, therapeutic and subgingival agents used for the control of caries and periodontal disease. ---the taking of impressions for bleaching trays and activation of non laser, light curing devices ---the taking of impressions for bleaching trays and placements of in office tooth whitening devices What can an rdh do without any supervision - ANSWER--Educational services -Oral health training programs -Oral health screenings *rdh must refer any screened patients with abnormalities to a dentist to receive a comprehensive exam, diagnosis and a treatment plan In a government public health program an rdh may provide without supervision the following: - ANSWER--oral prophylaxis,srp. -Fluoride application -Pit and fissure sealants

• the rdh may submit insurance claims for the services provided under the public health programs. No person shall be allowed to practice as a dental hygenist except for what Exceptions - ANSWER----a student in a dental/dental hygiene school performing the curriculum. ---a dental assistant acting under the rules of the dental board may perform the following: *taking impressions *applying fluorides *applying non-areosol and non caustic topical agents --- an rda acting under the rules of the dental board my perform the following: *coronal polishing *applying bleaching agents *activating bleaching agents with a non laser light curing device *applying pit and fissure sealants ---an rdaef can apply a pit and fissure sealant ---a rdh,rdhap,rdhef that is licensed in a different juristriction that is performing a clinical demonstration for educational purposes What is the timeframe required to notify the board if there are any name changes or address/email changes (1934) - ANSWER-The board must be notified within 30 days for all living address and email address changes The board must be notified within 10 days of a name change When does a license expire (1935) - ANSWER-12 midnight On the last day of the birth month of the applicant on the second year of a 2 year term License is good for 2 years must renew prior to that day

Can you renew an expired license? (1936) - ANSWER-Yes, it must be renewed within 5 years of expiring by filing an application for renewal and paying accrued renewal and delinquency fees. For what reasons may a license be revoked, suspended, or put on probations (1949) - ANSWER-Gross negligence, Incompetence Unprofessional conduct Repeated acts of negligence Receiving a license by mistake Why may a licensee get their license revoked, suspended, reprimanded, or put on probation. (1950) - ANSWER---If they have committed a crime that is substantially related to the licensees qualifications, functions or duties When would the dhcc revoke, suspend, reprimand, or probate the license (1950) - ANSWER-*When the time to appeal has lapsed *When the judgment for conviction has been affirmed on appeal *When an order granting probation is made suspending the imposition of sentence, allowing a person to withdraw guilty plea and enter a plea of not guilty, or dismissing accusation, info, or indicictment When would the committee undertake proceedings under this section? (1950) - ANSWER-upon receipt of a certified copy of the record of conviction. A plea or verdict of guilty or a conviction following a plea of nolo contendere made to a charge of a felony or of any misdemeanor related to the licensee's qualifications, functions, or duties Define Unprofessional conduct - ANSWER-See law 1950. When a licensee is placed on probation what could be the terms of probation (1951) - ANSWER-Requirement to receive additional training -or- Requirement to pass an exam ( the exam can be written, oral, clinical , or practical. Or all) -or both- If the probation is because of physical or mental issues, there may be an examination required by physician --restriction or limiting of the scope of practice. ---Licensee may need to pay restitution to pts Community service may be option in lieu of part or all of a period of suspension in cases other than violations relating to quality of care It is unprofessional conduct in relation to controlled substances to do what (1952) - ANSWER----Obtain or possess a controlled substance

---Use of a controlled substance, dangerous drug or alcoholic beverage to an extent or manner dangerous to himself, any person, or public. ---be convicted of a charge that is federal or state regarding a controlled substance - or be convicted of more than one misdemeanor, or any felony, involving the use or consumption of alcohol or drugs If a rdh performs a service on a patient what must they do to identify themselves (1953)

• ANSWER-Name signature or identification number with initials must be written next to the services performed. All entries must be dated. (repeated violation is considered unprofessional conduct) Is it illegal to establish ones self as being able to perform services that is beyond their scope of practice. (1954) - ANSWER-No but is considered unprofessional. This includes using a device or instrument in a manner that is different from standard practices of dental hygiene. The exception is when conducting research. It is against the law to provide care that discourages health. (1956) - ANSWER-True It is unprofessional conduct to provide hygiene care that discourages necessary treatment, or permits clearly excessive, incompetent, unnecessary, or grossly negligent treatment What could the punishment be for a misdemeanor crime (1958) - ANSWER-Not less than 10 days in a county jail, and not more than 1 year Or by a fine that is not less than 100.00 or more than 1,500.00 or both fine and imprisonment What are the ways that an rdh can be convicted of a misdemeanor (1958) - ANSWER--- assumes the title of rdh without having the right to do so --engages in rdh practice without displaying their license --fails to furnish names and addresses of all employees in office within 10 days of demand -- is under the influence of alcohol or controlled substances while engaged in dental hygiene activities to extent that impairs ability to conduct hygiene safely to patients and public. If a person willfully, under circumstances that cause risk of bodily harm, serious physical or mental harm or death, practices, attempts to practice or advertises to practice may be convicted and sentenced to what? (1961) - ANSWER-Up to 1 year in jail Who is accepted in the diversion program? (1966.1) - ANSWER-A- a licensee not under investigation may self refer B- a licensee under investigation may request to participate in the diversion program by contacting the committee - may need to be evaluated for eligiblity and could still be disciplined.

*Unless ordered by the committee, only licensees who have voluntarily requested diversion treatment shall participate in a diversion program. Does participation in the diversion program mean that the committee cannot investigate or take disciplinary actions against the licensee? (1966.1) - ANSWER-No. They can still investigate or continue to investigate, or take disciplinary action or continuing to take disciplinary action against, any licensee for any unprofessional conduct committed before, during, or after participation in the program. What if the reason for investigation is self-administration of any controlled substance, drugs, or alcohol, or the illegal possession, prescription, or procurement of any controlled substance or drug for self-administration that doesn't involve actual, direct harm to the public? (1966.1) - ANSWER-The committee will close the investigation without further action if the licensee is accepted into a diversion program and successfully completes the program.

• The investigation shall be reopened and disciplinary action imposed, if warranted, by the committee if licensee withdraws or is terminated from program What happens if a participant withdraws or is terminated from the diversion program? (1966.1) - ANSWER-- If the licensee presents a threat to the public's health and safety, the committee will use the diversion treatment records in the criminal proceedings
  • They are subject to disciplinary action by the committee for acts committed before, during, and after participation in the diversion program. If a person is admitted into a diversion program what are their responsibilities and what could happen if they do not comply (1966.4) - ANSWER-They need to pay for all costs of the program ( unless the committee waives the fees) If they do not abide by the rules they may be terminated from the program In regards to the subversion of licensing examinations what could the crime be and what can you NOT do (123) - ANSWER-The crime is a misdemeanor. You can not --remove materials from exam --unauthorized reproduction of any exam materials -- paying or using any paid examination takers to recreate portions of the test --buying, selling, distributing any portion of a current, future or past exam -- communicating with any other exam taker -- copying another exam taker -- having books, notes Other than misdemeanor penalties, and other associated penalties, what would a person found guilty of section 123 be liable for? - ANSWER-the actual damages sustained by the agency administering the examination not to exceed $10,000 and the costs of litigation.

In regards to enjoining violations (123.5) - ANSWER-Whenever any person has engaged, or is about to engage, in any acts or practices with constitute, or will constitute, a violation of section 123, the superior court for that county may issue an injunction, or other appropriate order, restraining such conduct on application a board, the Attorney General or the district attorney of the county The remedy provided for by this section shall be in addition to, and not a limitation on, the authority provided for in any other provision of law. When can a board deny, revoke, suspend, or restrict a license? (496) - ANSWER-when an applicant has violated Section 123 pertaining to subversion of licensing examinations. A mandated reporter is defined as? (11165.7 a.) - ANSWER-a dental hygienist (21) Are employers required to provide training for mandated reporters? (11165.7 c.) - ANSWER-No. They are strongly encouraged to though. They are required to provide employees who are mandated reporters with the statement required pursuant to subdivision (a) of Section 11166. Do you still have to report abuse if you haven't received training? (11165.7 e.) - ANSWER-Yes. The absence of training shall not excuse a mandated reporter from the duties imposed by this article. What is the protocol for reporting abuse, reasonably suspected abuse or neglect of a child? (11166 a.) - ANSWER-They shall make an initial report by phone to the agency immediately or as soon as possible, and shall send, fax, or email a written followup report within 36 hours of incident. What is reasonable suspicion? (11166 a.1) - ANSWER-it is objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing on their training and experience, to suspect child abuse or neglect. ---It doesn't require certainty or a specific medical indication. *The pregnancy of a minor does not, in itself, constitute a basis for reasonable suspicion of sexual abuse. What if a mandated reporter fails to report abuse? (11166 c.) - ANSWER-They are guilty of a misdemeanor punishable by up to 6 months in county jail or by a fine of $1,000 or by both imprisonment and fine. What if two people, who are required to report, have knowledge of suspected abuse? (11166 h.) - ANSWER-They will mutually agree who will make a single report. If that person fails to make the report, the other person should then make the report.

Is reporting the information to an employer the same as a mandated report? (11166 i.3)

• ANSWER-No. You must report directly to the specified agency. Health practioner according to 15610.37 - ANSWER-is a dental hygienist Who is a mandated reporter for elder abuse? (15630) - ANSWER-Any person who has assumed full or intermittent responsibility for the care or custody of an elder or dependent adult including a health practitioner (dental hygienist) What is elder abuse? - ANSWER-physical abuse, abandonment, abduction, isolation, financial abuse, or neglect. When and how should a mandated report be made of suspected elder abuse? - ANSWER-It should be reported immediately or as soon as possible by phone or through a confidential Internet reporting tool. If reported by phone, a written report must be sent within two working days. See long-term care abuse for exceptions What if the abuse happened in a long-term care facility? - ANSWER-If the suspected abuse results in serious bodily injury a phone report must be made immediately, and no later than 2 hours after. If it doesn't result in serious injury, a phone report must be made within 24 hours and a written report must be made within 24 hours. If abuse is caused by another resident with dementia causing no serious injury, a report should be made by phone as soon as possible and a written report within 24 hours. What if you fail to report or inhibit a report of elder abuse? - ANSWER-It is a misdemeanor and is punishable by max of 6 months in jail and $1, If the patient dies from that abuse or incurs great bodily harm, it shall be punished by max of 1 year in jail and $5, Or both fine and imprisonment What are the requirements of continuing education (1017) - ANSWER-Dentists 50 hr Rdh- 25 hrs Rdh ap- 35 hours 2 units need to be infection control 2 units need to be for California Dental Practice Act 4 units max. of Basic Life Support

Can CEs be taken online or at home? (1017 h.&i.) - ANSWER-Yes but these materials (non-live instruction) cannot exceed 50% of the licensee's total required units. Live interactive courses can be taken online and can be counted to make up the other 50% How long do you have to keep CE certificates? (1017 n.) - ANSWER-3 renewal periods (6 years). You will need to forward these to the board upon an audit. 6 core principles of ethical dental care - ANSWER-1. Nonmaleficence

2. Veracity
3. Autonomy
4. Beneficence
5. Confidentiality
6. Justice Nonmaleficence - ANSWER-Do no harm Veracity - ANSWER-Our obligation to tell the truth Autonomy - ANSWER-Pt's right to informed consent prior to treatment with full disclosure of relevant information to make an informed decision about treatment. Beneficence - ANSWER-Do good - promote the well being of individuals and the public by engaging in health promotion/disease prevention activities Confidentiality - ANSWER-Respect the confidentiality of client information and relationships. Do not share without pt. consent or legal need. Justice - ANSWER-Fair and equal rights to quality and affordable oral healthcare Compassion - ANSWER-Caring and the ability to identify with the patient's overall well- being. Acts of kindness and sympathy. Competence - ANSWER-The competent dentist is able to diagnose and treat the patient's oral health needs and to refer when it is in the patient's best interest. It involves a commitment to continual learning and self-assessment. Professionalism - ANSWER-Self-governance is the hallmark of a profession. All members must support and promote the profession in its service to the public. (Oral health initiatives for society) Tolerance - ANSWER-Tolerance to diversity requires dentists to recognize cultural and ethnic differences and how they may affect patient choices and treatment

Informed Consent - ANSWER-A dentist has an obligation to obtain informed consent of the patient prior to treatment or the use of identifiable artifacts (photos, x-rays, study models). This includes: Explanation of proposed treatment, reasonable alternatives, and the risk of not performing treatment. It must be explained in a manner that is accurate, easily understood, and allows the patient to be involved in the decision of their oral health or for participation in research. You do not need consent to take photos, x-rays or impressions if suspecting abuse. Integrity - ANSWER-Requires the dentist to behave with honor and decency. He affirms core values and recognizes when words, actions or intentions are in conflict with one's values and conscience. Standard Precautions - ANSWER-a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. These include: hand hygiene, use of gloves, gown, mask, eye protection, or face shield, depending on the anticipated exposures, and safe handling of sharps. Critical items - ANSWER-confer a high risk for infection if they are contaminated with any microorganism. These include: all instruments, devices, and other items used to penetrate soft tissue or bone. Semi-critical items - ANSWER-are instruments, devices and other items that are not used to penetrate soft tissue or bone, but contact oral mucous membranes, non-intact skin or other potentially infectious materials (OPIM) Non-critical items - ANSWER-are instruments, devices, equipment, and surfaces that come in contact with soil, debris, saliva, blood, OPIM and intact skin, but not oral mucous membranes Low-level disinfection - ANSWER-is the least effective disinfection process. It kills some bacteria, some viruses and fungi, but doesn't kill bacterial spores or mycobacterium tuberculosis var bovis (TB), a lab test organism used to classify the strength of disinfection chemicals. Intermediate-level disinfection - ANSWER-kills TB indicating that many human pathogens are also killed. This process does not necessarily kill spores High-level disinfection - ANSWER-kills some, not not necessarily all bacterial spores. This process kills TB, bacteria, fungi, and viruses. Germicide - ANSWER-a chemical agent that can be used to disinfect items and surfaces based on the level of contamination

Sterilization - ANSWER-a validated process used to render a product free of all forms of viable microorganisms. Cleaning - ANSWER-is the removal of visible soil (e.g., organic and inorganic material) debris and OPIM from objects and surfaces and shall be accomplished manually or mechanically using water with detergents or enzymatic products Personal Protective Equipment (PPE) - ANSWER-specialized clothing or equipment worn or used for protection against a hazard. PPE items may include, but are not limited to, gloves, masks, respiratory devices, protective eyewear and protective attire which are intended to prevent exposure to blood, body fluids, OPIM, and chemicals used for infection control. General work attire such as uniforms, scrubs, pants and shirts, are not considered to be PPE. Other Potentially Infectious Materials (OPIM) - ANSWER-means any of the following: A. Human body fluids such as saliva in dental procedures and any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. B. Any unfixed tissue or organ (other than intact skin) from a human (living or dead) C. Any of the following, if known or reasonably likely to contain or be infected with HIV, Hep B, or Hep C:

1. Cell, tissue, or organ cultures from humans or experimental animals;
2. Blood, organs, or other tissues from experimental animals; or
3. Culture medium or other solutions. Dental Healthcare Personnel (DHCP) - ANSWER-are all paid and non-paid personnel in the dental healthcare setting who might be occupationally exposed to infections materials, including body substances and contaminated supplies, equipment, environmental surfaces, water, or air. All DHCP shall comply with infection control precautions and enforce the following minimum precautions to protect patients and DHCP and to minimize transmission of pathogens in health care settings as mandated by California division of OSHA - ANSWER-1. Standard precautions shall be practiced in the care of all patients
4. A written protocol shall be developed, maintained, and periodically updated for proper instrument procession, operatory cleanliness, and management of injuries. the protocol shall be made available to all DHCP at the dental office.
5. A copy of this regulation shall be conspicuously posted in each dental office. What PPE should be worn? - ANSWER-- Surgical masks in combination with either chin length plastic face shield or protective eyewear whenever there is potential for aerosol spray, splashing or spattering.

• Chemical-resistant utility gloves and appropriate PPE shall be worn when handling hazardous chemicals

• Protective attire shall be worn for disinfection, sterilization, and housekeeping procedures involving germicides or handling contaminated items. *attire must be changed daily or between patients if visibly soiled or moist and must be removed when leaving lab or area of patient care. What do you do with PPE after each patient? - ANSWER-Masks must be changed and disposed. Face shields and eyewear should be cleaned, disinfected, or disposed. Hand hygiene protocols - ANSWER-All DHCP must wash hands with soap and water at the start and end of each workday. They will wash contaminated or visibly soiled hands with soap and water and put on new gloves before treating patient. If hands aren't visibly soiled or contaminated an alcohol based rub may be used. Hands should be thoroughly dried before putting on gloves and washed immediately after removal of gloves. *all DHCP with exudative lesions or weeping dermatitis of the hand shall refrain from all direct patient care and from handling equipment until condition resolves. When should medical exam gloves be worn? - ANSWER-whenever there is contact with: mucous membranes blood OPIM during all: pre-clinical clinical post-clinical lab procedures When should gloves be discarded? - ANSWER-when torn or punctured upon completion of treatment before leaving operatories What type of glove should be worn to process contaminated instruments and sharps? - ANSWER-heavy-duty utility gloves What is the protocol for needle recapping and disposal? - ANSWER-Needles shall be recapped only by using the scoop technique or a protective device. Needles and other sharps should be placed into sharps disposal containers as close as possible to the point of use. *needles should never be bent or broken for disposal. Sterilization Protocols - ANSWER-Cleaning must precede any disinfection or sterilization process.

Critical and Semi-Critical instruments and items shall be discarded or pre-cleaned, packaged or wrapped and sterilized after each use. If item is heat sensitive, it shall, at minimum, be processed with high-level disinfection and packaged or wrapped upon completion of disinfection. Package should be labeled with the date and specific sterilizer. Non-critical surfaces and patient care items shall be cleaned and disinfected with Cal/EPA low-level hospital disinfectant labeled against HBV and HIV. If item is visibly contaminated with blood or OPIM an intermediate-level disinfectant with tuberculocidal claim shall be used. All rotary hand pieces and components shall be packaged, labeled and heat-sterilized same as a semi-critical item. How often should you test sterilization devices? - ANSWER-at least once weekly with a biological indicator. Results should be documented and maintained for 12 months. How should you clean non-critical items in operatory? - ANSWER-Items that are unable to be disinfected should be protected with an impervious barrier that would be changed after each patient and when visibly soiled. All other surfaces should be disinfected with a hospital grade low to intermediate germicide after each patient. What should be done daily with water/air lines? - ANSWER-They should be flushed for 2 minutes at beginning of the day before attaching handpieces or other devices. The lines and devices should be flushed between patients for at least 20 seconds.