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Dental Hygiene- FL Laws & Rules
466.001 Purpose of the Law - Ensure that every DDS or RDH practicing in this state meets minimum requirements for safe practice without undue clinical interference by persons not licensed Dentistry - the healing art which is concerned with the exam, diagnosis, treatment planning, and care of conditions within the human oral cavity and adjacent tissues and structures Dental Hygiene - the rendering of educational, preventive, and therapeutic dental services and any related extra- oral procedure required in the performance of service Board of Dentistry Members - Total: 11 Dentists (actively practicing): 7 DH (actively practicing): 2 Lay Persons (are not and have never been dentists, hygienists, or related to dental profession): 2 How many years experience does the dentist/hygienist have if on the board? - At least 5 years. Must remain primarily in clinical practice during all periods of appointment to the board How many term years do dental hygiene board members serve? - 4 years Maximum number of years a board member may serve? - 10 years Who appoints the Board of Dentistry? - Governor of Florida At least one member of BOD must be how old? - 60 years old Delegation of Duties: Irremediable - Dentists may not delegate irremediable tasks except as provided by law Delegation of Duties: Remediable - Remediable tasks may be delegated if they pose no risk Remediable tasks must be defined by laws Intraoral treatment tasks which are reversible and do not create unalterable changes within the oral cavity or structures and do not cause an increased risk to the patient? - Remediable Tasks
Intraoral treatment tasks which are irreversible and create unalterable changes within the oral cavity or structures? - Irremediable Applying topical with jet spray is what type of task? (Irremediable or remediable) - Irremediable A dental hygienist who applies bleaching solution, activates light source, monitors and removes in- office bleaching materials is performing what type of task? (Irremediable or remediable) - Remediable The practicing dentist is out of the country and a patient comes into the office with an emergency. Which remediable task is the hygienist/assistant able to perform? (Regarding cementing crowns) - Recementing temporary crowns with temporary cement The use of a laser or laser type device is considered to be what type of task? (Irremediable or remediable) - Irremediable Who may perform remediable emergency tasks under conditions specified by the law? - Dental hygienist and dental assistant CE Requirements: CPR - Basic support level every biennium CE Requirements: Medical Errors Prevention - 2 hours CE Requirements: Domestic Violence - 2 hours every 3rd biennium CE Requirements: HIV/AIDS - By first renewal How many CE hours are credited for being an EXPERT WITNESS in the review of a disciplinary case
- 11 hours How many CE hours are credited for each semester of teaching a course at an ADA accredited school?
- 3 hours How many CE hours are credited for attending a Board meeting where disciplinary cases are heard? - 4 hours How many CE hours are credited for 1 hour of pro bono work? - 1 hour What is the maximum HOURS of CE credits a hygienist can receive for doing pro bono work? -
T/F: Hygienist must submit proof of CE credits biennially - False *Hygienist shall not submit proof of CE credits unless audited Who is required to take CE courses? - Dentists and dental hygienists T/F: A dentist or dental hygienist takes a 10 hour course on HIV/AIDS. Considering s/he is only required 1 hour in HIV/AIDS, the remaining 9 hours can count towards his/her total required hours for licensure renewal. - True T/F: If 40 hours of CE are taken in one biennium, the remaining hours of taken can out towards the renewal requirement for the next biennium. - False *Credits may not be transferred from one biennium to the next T/F: Dentists can prescribe drugs and administer anesthesia & sedation as long as it is within the scope of training (dentistry) - True T/F: A dental hygienist can prescribe fluoride or chlorhexidine to a patient of record - False *Hygienists may recommend but shall not prescribe What must be included on a prescription? -
- Patient name and address
- Dentist name, address, and license number
- Dental hygienist name, business address, license number
- SPECIFIC services authorized
- Statement of frequency Who keeps original Rx vs. copy of Rx? -
- Patient keeps original Rx
- Office keeps a copy of Rx in patient chart T/F: A dentist can write a prescription for a patient with a sinus infection. - False *A dentist can only write prescriptions within scope of dentistry How long is a dental hygienist prescription valid for? - 24 months What must be included in a prescription for a prescription strength fluoride gel?
A) Dentist License Number B) Dental Hygienist License Number C) Expiration date written on the script D) Instructions for patient use - A) Dentist License Number Remember: Hygienist cannot prescribe fluoride nor chlorhexidine Analgesia - Absence of pain without loss of consciousness Anesthesia - Loss of feeling or sensation, especially loss of sensation of pain Local Anesthesia - Loss of sensation or pain in a SPECIFIC AREA of the body, generally produced by a topically applied agent or injected agent WITHOUT causing the loss of consciousness. General Anesthesia - A CONTROLLED state of unconsciousness produced by a pharmacologic agent. Accompanied by a partial or complete loss of protective refluxes such as the inability to independently maintain open airway and respond purposefully to physical stimulation or verbal command. This modality includes administration of medication via parenteral routes such as: orally, rectally, or transmucosally Deep Sedation - a controlled state of depressed consciousness accompanied by partial loss of protective reflexes, including either or both the inability to continually maintain airway or respond to physical stimulation or verbal command. Produced by pharmacologic or non-pharmacologic method or combination. Administration of medications via: Parenteral routes such as intravenous, intra muscular, subcutaneous, submucosal, inhalation Enteral routes such as oral, rectal, or trans mucosal. Conscious Sedation - A depressed level of consciousness produced by the administration of pharmacologic substances, that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation. Pediatric Conscious Sedation - A depressed level of conciousness produced by the administration of pharmacologic substances, that retains a child patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command. A child is defined as an individual under 18 years of age, or any person who has special needs, which means having a physical or mental impairment that substantially limits one or more major life activities.
True How many didactic hours are required for a dentist to obtain conscious sedation permit? - 60 didactic hours How many people must be present for a dentist to perform CONSCIOUS sedation on a patient? - Two people How many people must be present for a dentist to perform GENERAL sedation on a patient? - Three people Pediatric Conscious Sedation: Operation Room -
- Be of ADEQUATE SIZE and design to permit physical access of emergency equipment and personnel and to permit effective emergency management
- Be equipped with a CHAIR or TABLE adequate for EMERGENCY TREATMENT, including a CPR board or chair suitable for CPR
- Be equipped with SUCTION and BACKUP SUCTION equipment, also including tonsil suction and suction catheters Pediatric Conscious Sedation: Recover Room -
- Shall be equipped with SUCTION and BACKUP SUCTION equipment, POSITIVE PRESSURE OXYGEN and sufficient LIGHT to provide emergency treatment
- Recovery room shall also be of ADEQUATE SIZE and design to allow emergency access and management
- Recovery room shall be situated so that the patient can be OBSERVED BY DENTIST or an office team member at all times The following equipment must be readily available to the operatory and recovery room and maintained in good working order -
- POSITIVE PRESSURE oxygen delivery system and BACKUP system including FULL FACE MASK for pediatric patients
- AIRWAYS of appropriate size for pediatric patient
- BLOOD PRESSURE CUFF and STETHOSCOPE
- SUCTION and BACKUP SUCTION equipment, also including TONSIL SUCTION and SUCTION CATHETERS
- A PULSE OXIMETER which provides continuous monitoring of pulse and rate of oxygen saturation of the blood be used during each procedure
- SCALE for weighing pediatric patient
- THERMOMETER Emergency equipment that must be present during pediatric conscious sedation -
- Appropriate INTRAVENOUS SET-UP, including appropriate hardware and fluids
- Appropriate SYRINGES
- TOURNIQUET and TAPE
- DEFIBRILLATOR equipment appropriate for the patient population being treated Drugs or types of drugs maintained and easily accessible from operatory and recovery room -
- Epinephrine
- Atropine
- Lidocaine
- Narcotic
- Benzodiazepine
- Antihistamine
- Corticosteroid
- Nitroglycerine
- Bronchodilator
- Anti-hypoglycemic
- Vasopressor
- Anticonvulsant
- Antihypertensive
- Nitroglycerin
- Anticholinergic
- Antiemetic
- Amiodarone Records required when pediatric conscious sedation is administered -
- Patient's current written MEDICAL HISTORY, including known allergies, history of previous surgery and anesthesia, patient's age, weight, calculation of MAX. allowable local anesthesia
- Physical and RISK assessment
- Base line VITAL SIGNS, including pulse, percent hemoglobin oxygen saturation, and when possible, blood pressure
- Sedation record shall include:
- Periodic vital signs recorded at appropriate intervals during procedure
- Drugs, including local anesthetics, administers during procedure. Including route of administration, dosage, time, and sequence of administration
- Duration of procedure
- Documentation of complications or morbidity
- Status of patient upon discharge and to whom discharged
- Names of participating personnel Who grants sedation permits? - Board of Dentistry Any dentist practicing in FL must notify the Board in writing of any mortality or other incident occurring in the outpatient facilities within how many hours? - 48 hours A COMPLETE WRITTEN REPORT shall be filed with the Board of a mortality or other incident within how many days? - 30 days What type of supervision is necessary for a dental hygienist to administer local anesthesia, including intraoral block anesthesia, soft tissue infiltration anesthesia, or both, to a non-sedated patient who is 15 YEARS OF AGE or older, if they meet criteria outlined in the laws manual? - No supervision as it is prohibited *Patient must be 18 years of age or older for a hygienist to administer local anesthesia
- Two witnesses that list the date of transfer and persons to whom records were transferred to Dentist of record may be relieved of responsibility to maintain records if: -
- S/he leaves practice where treatment was rendered and transfers custody of records to owner of practice (must retain written statement) What is the minimum a patients record must contain? -
- Appropriate medical history
- Written dental records should include:
- Patient history
- Exam results
- Test results which justify course of treatment (treatment plan) Within how many days of a dentists death does the dentists estate or agent must transfer all patient records to another Florida licensed dentist? In this scenario, patient records must be accessible by each patient for how many years? - 90 Days; 4 years If a dentist relocates, he must place patient records in the care of another Florida licensed dentist for how many years? When does that 4 years begin? - 4 years; Begins from the date of the patients last examination T/F: Patient records must stay in same county if they are transferred due to dentists' death or relocation.
- True How long do dental laboratories keep patient records following the date the prescription was issued? - 4 years How long must patient records remain in the office? - 4 years from the date of patient's last appointment If a new patient comes in to see a hygienist but it NOT a patient of record, and the dentist has to leave due to an emergency, how does hygienist proceed? - Reschedule the patient with the dentist first before treatment is provided by hygienist If there are multiple dentists seeing a patient and there is no dentist of record on file who is the dentist of record? - The dentist who OWNS the practice Who owns the patients record or chart? - The dentist In the event that a dentist dies, how long are the records to be kept? A) Must surrender to individual patient within 30 days B) Transfer to another dentist within 60 days C) Keep records for 4 years
D) Turn over to department of health - C) Keep records for 4 years In the event that a dentist dies, where do all the patient of record files go? - To another Florida licensed dentist Advertising - Shall mean any statements ORAL or WRITTEN disseminated to the public for the purpose of seeking professional services or inducing the public to enter into any obligation relating to such professional services Advertisement must identify: - Florida licensed dentist who assumes TOTAL responsibility for advertisement including license number, commonly used name, current address, phone number If the dentist advertises something but forgets to put an expiration date on it, how long is the ad good for? - 90 days T/F: Purpose of advertising is to allow public access to information which provides a sufficient basis to make an informed selection - True T/F: In person and telephone solicitation is permitted - False *In person and telephone solicitation is PROHIBITED If dentist advertises through a referral service, who is responsible for advertisement content? - The dentist No dentist shall disseminate advertising that is: -
- False, deceptive, misleading
- Contains laudatory statements
- Intended to create false expectations
- Related to the quality of dental services as compared to others
- Contains representations that would deceive an ordinarily prudent person
- Intended to appeal to layperson's fears T/F: Dental health care licensee may represent that he or she is HIV negative or free from AIDS - False *NO dental health care licensee may represent that he or she is HIV negative or free from AIDS UNLESS advertisement clearly states: "this negative HIV test cannot guarantee that I am currently free of HIV" When advertising HIV status, one must: - Inform the patient that current status guarantees nothing
T/F: Extracted teeth may be rendered non-biohazardous by disinfection so that they may be returned to the patient or the patient's legal guardian. - True T/F: Extracted teeth must be scrubbed and sterilized if using for scientific, educational, or testing purposes. - True T/F: Extracted teeth should first be cleaned of adherent patient material by scrubbing with detergent or water or by using an ultrasonic cleaner - True What should extracted teeth be stored or immersed in? - Fresh solution of sodium hypochlorite or any liquid chemical germicide suitable for clinical specimen fixation How should extracted teeth or tissue fragments that are not required for microscopic exam be discarded? - As biohazardous waste or as a sharp What is not a sterilization process? A) Dry heat B) Autoclave C) Radiation D) Chemical vapor - C) Radiation When handling soiled instruments which is NOT appropriate? A) Carry instruments in a closed container B) Use of regular examination gloves C) Wear mask and eye wear D) Use ultrasonic cleaner (if available) - B) Use of regular examination gloves Who would be the enforcement of making guidelines and rules for contaminants pertaining to blood, saliva, and other bodily fluids? - CDC What PPE is not required? - Eye protection *Eye protection is recommended but not mandatory Which of the following is not consistent with the CDC recommendations of use? A) Soaking heat sensitive instruments in a chemical solution for 10 hours
B) Scrubbing instruments with soap and water before sterilization C) Washing prosthodontics appliances with soap and water before allowing patient to place in mouth - C) Washing prosthodontics appliances with soap and water before allowing patient tot place in mouth Grounds for Disciplinary Action -
- Failure to report other healthcare specialists known to have violated the law
- Failing to report in writing within 30 days any actions against ones license elsewhere
- Minor violation: failure to notify within 10 days of change of address Can a dentist/hygienist accept fees during a suspension period? - No
- When a license is suspended you may not accept fees from anyone including employer, third party, or insurance
- Fines may range from $500-10, Change of address must be submitted to the Board within how many days? - 10 days How much is the penalty for failure to change address with the Board? - $ A dental lab should notify the Board with any changes in address within how many days? - 30 days A dental assistant must complete _____ months of on-the-job training to receive a radiographer permit. They have _____ months to complete an accredited course to the be certified by the ADA. There is a $_____ fee for a radiographer permit. - 3, 12, 35 Is using the name RDH or "Dental Hygienist" if not licensed a misdemeanor or a felony? - Misdemeanor How recent must an applicant for licensure have taken the Dental Hygiene National Board? - At any date. Previously, one had to have taken the Boards within 10 years of an application. However, it has been changed to allow applicants who have taken the exam at any point. If primary dentist is out of town, who can diagnose and create a treatment plan for the patient? - Another dentist *Hint: Hygienists cannot diagnose Can a dental hygienist repair an x-ray machine? - No
- An x-ray machine has to be repaired by a licensed technician who has radiology credentials Permits may be issued to non-profit corporations for the following purposes: -
Penalty: Operate as a lab - Misdemeanor in 2nd degree Fines: DDS practicing 2-6 months without license - $1,000 fine; 4 hours risk management Fines: Hygienist practicing 2-6 months without license - $250 fine Fines: DDS fee per CE hour not completed - $100 fine Fines: DDS fee for not doing CPR - $150 fee Fines: Hygienist fee per CE hour not completed - $25 fine Fines: Hygienist fee for not doing CPR - $50 fine Fines: Pre-sign lab forms - $500 fine Fines: Failure to give patient documents - $1,000 fine Fines: Fraud - $10,000 fine per offense Fines: Malpractice or practicing beyond the scope of dentistry - $500-10,000 fine and probation for the 1st offense If a dentist is terminated, how long does s/he have to notify their patient? - 30 days If a dentist is suspended, how long does s/he have to notify their patients? - 30 days A person holding a dental hygiene license in the State of Florida has been ruled by a court of law that they are delinquent on their child support. The Board has the right to? - Hold or deny their license A patient is referred to a specialist, and at that location the patient also received treatment from the dental hygienist. Who is ultimately responsible? - The referring dentist When is it acceptable for a dentist to refer a patient to another dentist due to a financial interest?
A) It is prohibited B) Can happen only if patient has paid bill in full C) Can only happen if the patients interest is in best interest - C) Can only happen if the patients interest is in best interest If a dental hygienist injures a patient, who is ultimately responsible? - The dentist When can a licensee choose to become inactive? - Anytime Inactive licenses must be renewed biennially and the licensee is responsible for paying applicable fees - Inactive Status Fee How often can a person renew their inactive status? - Biennually If a license becomes suspended for a year or more, a dental professional must inform their patient within: - One month Any licensee whose license to practice dentistry or dental hygiene in Florida has been revoked or suspended for a period of one year or more in length shall: -
- Notify his patients of within one month
- Remove any telephone listings identifying him/her as licensed
- Remove his/her name from any sign or advertising materials
- Refrain from addressing the public in a manner that suggests they are a licensed provider Who is in charge of protecting the public from dentists or dental hygienists who present danger to the public? - Board of Dentistry T/F: The Board finds that licensees who are infected with Hep B present a grave danger to the public by virtue of the communicability of this infectious disease in a clinical setting. - True Who is ultimately responsible for the safety of patients when the licensee or personnel employed by the licensee represents a health risk through direct or indirect contact with patients? - The licensee themselves T/F: There are rules set in place to assure to ability of infected licensees to practice so long as adequate safeguards are maintained. - True Any Florida licensed dentist or dental hygienist practicing in the State of Florida who is infected with Hep B is required to notify the Board of such in writing no later than how many days after learning of his/her infection? - 14 days
- Personal interviews with each member of the office staff regarding procedures which are followed in the clinical settings
- Review of the dentist's appointment book to document the number of days the dentist has practiced since notification of being infected or the last evaluation, and the number of patients seen since that date
- The number of boxes of examination and surgical protective gloves on hand and the number of purchased since notification of infection or the last evaluation
- The number and type of masks on hand and the number and type purchased since notification of infection or the last evaluation
- A determination of whether all personnel since notification of infection or any new personnel since the last evaluation have been checked for surface antigens and surface antibodies and whether all personnel have been specifically educated regarding appropriate sterilization, disinfection, and barrier technique necessary to prevent communication of the Hep B virus
- Identification and description of training provided and procedures and protocols utilized
- A determination of whether all office personnel are familiar with procedures and reporting requirements which are necessary if a break in barrier techniques occurs
- A determination of whether heat sterilization is routinely used and whether the heat sterilization is monitored monthly
- A determination of the type of cold disinfectant used, its spectrum, brand name, and chemical composition
- A list of instruments and materials which are routinely cold sterilized and a determination of the efficacy of the procedures
- Identification and documentation of any incidents of a break in barrier technique or potential breaks which were averted
- Documentation of the monitor's conclusions regarding compliance which addresses the results of each of the procedures ou Should a monitor determine that unreported breaks in barrier techniques have occurred, or should the monitor determine that appropriate sterilization, disinfection and barrier techniques have not been followed adequately to protect the public, the monitor shall so notify the Board's Executive Director by telephone within how many hours of the on-site inspection? And provide a written confirmation within how many hours? - 24 hours; 72 hours T/F: The Board MAY NOT limit the number of dental hygienists or dental assistants to be supervised by a dentist if they perform expanded duties requiring direct or indirect supervision. - False The Board MAY limit the number of dental auxillaries What is the purpose of the Board limiting dental auxillaries per dentist whom performs expanded duties? - To protect the health and safety of patients and ensure procedures which require more than general supervision be adequately supervised Direct Supervision for RDH -
- Fabricate temp crowns/bridges intra-orally
- Selecting ortho bands and wires/ extra-oral appliances
- Packing/removing retraction cord (without vasoconstrictor)
- Placement and removal of dry socket dressing
- Remove and re-cement loose bands
- In-office bleaching placement
- Changing bleach pellets
- Condition tooth for ortho
- Monitor NO2 (with analgesia)
- Gingival curettage
- Administer local anesthesia when appropriately certified by Board Direct Supervision for CDA -
- Fabricate temp crowns/bridges intra-orally
- Selecting ortho bands and wires/ extra-oral appliances
- Packing/removing retraction cord (without vasoconstrictor)
- Placement and removal of dry socket dressing
- Impression for/delivery bleach tray/ sports guard
- Polishing restorations and clinical crowns
- Remove excess cement-restorations
- Condition tooth for ortho
- Monitor Nitrous/ turn off at completion
- Cement temporary crown with temporary cement
- Place/remove temporary restoration
- Charting restorations, missing teeth, existing oral conditions
- Applying topical anesthetics Indirect Supervision for RDH -
- Placing/removing dental dam
- Placing/removing matrix band
- Applying cavity liners/varnish/base
- Impressions- study casts/bleach trays/ opposing casts/ sports guards
- Marginate restorations
- Removal of in-office bleaching
- Local delivery placement: Adjunct perio therapy placement (Atridox, Arestin, Perio chip, etc.)
- Cementing temporary crowns with temporary cement
- Root planning
- Marginate amalgams
- Monitor nitrous oxicde/ turn off (oxygen)
- Secure/unsecure archwires
- Remove excess cement- Ortho Indirect Supervision for CDA -
- Placing/removing dental dam
- Placing/removing matrix band
- Applying cavity liners/varnish/base
- Impressions- study casts/bleach trays/ opposing casts/ sports guards
- Applying topical fluoride
- Sealants
- Suture removal
- Take radiographs (w formal training)
- Place/remove perio/surgical dressing
