(A) A dental hygienist may provide, for not more than fifteen consecutive business days, dental hygiene services to a patient when the supervising dentist is not physically present at the location at which the services are provided if all of the following requirements are met:
(1) The dental hygienist has at least one year and a minimum of one thousand five hundred hours of experience in the practice of dental hygiene. This experience shall be documented on a form supplied by the board, with any necessary supporting information attached, and the form shall be maintained in the facility(s) where the dental hygienist is working.
(2) The dental hygienist has successfully completed a course approved by the state dental board in the identification and prevention of potential medical emergencies. This board approved course shall be taken through a permanent sponsor, shall be at least four hours in duration, and shall include, at a minimum, the following topics:
(a) Medical history;
(b) Recognition of common medical emergency situations;
(c) Office emergency protocols;
(d) Basic airway management;
(e) Prevention of emergency situations during dental appointments; and
(f) Recognition of symptoms, first aid treatment and possible outcomes for patients who exhibit bleeding injuries, cardiovascular disease, insulin reaction, diabetic coma, shock, syncope, epileptic seizures and allergic reactions.
Completion of this course shall be documented on a form supplied by the board, with all necessary supporting information attached, and the form shall be maintained in the facility(s) where the dental hygienist is working.
(3) The dental hygienist must have completed a basic life-support training course certified by the American heart association, American red cross, or the American safety and health institute, and remain current at all times while treating patients when the dentist is not physically present. This must be verified on a form supplied by the board, with all necessary supporting information attached, and the form shall be maintained in the facility(s) where the dental hygienist is working.
(4) The dental hygienist complies with written protocols for emergencies the supervising dentist establishes.
(5) The supervising dentist has evaluated the dental hygienist's skills and has made a determination that the dental hygienist is competent to treat patients without the dentist being physically present. This determination shall be documented on a form supplied by the board, and the form shall be maintained at the facility(s) where the dental hygienist is working.
(6) The supervising dentist examined the patient not more than one year prior to the date the dental hygienist provides the dental hygiene services to the patient.
(7) The dental hygienist complies with written protocols or written standing orders that the supervising dentist establishes, including an updated medical history.
(8) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one year prior to the date the dental hygienist provides dental hygiene services to the patient, unless there has been a medically significant change in the patient's medical history since the last appointment, and, except when the dental hygiene services are provided in a health care facility, the supervising dentist determines that the patient is in a medically stable condition.
(9) If the dental hygiene services are provided in a health care facility, a doctor of medicine and surgery or osteopathic medicine and surgery who holds a current certificate issued under Chapter 4731. of the Revised Code or a registered nurse licensed under Chapter 4723. of the Revised Code is present in the health care facility when the services are provided.
(10) In advance of the appointment for dental hygiene services, the patient is notified that the supervising dentist will be absent from the location and that the dental hygienist cannot diagnose the patient's dental health care status. This notification must be documented in the patient record.
(B) A dental hygienist may provide dental hygiene services to a patient when the supervising dentist is not physically present at the location at which the services are provided if the services are provided as part of a dental hygiene program that is approved by the state dental board and all of the following requirements are met:
(1) The program is operated through a school district board of education or the governing board of an educational service center; the board of health of a city or general health district or the authority having the duties of a board of health under section 3709.05 of the Revised Code; a national, state, district, or local dental association; or any other public or private entity recognized and approved by the state dental board.
(2) The supervising dentist is employed by or a volunteer for, and the patients are referred by, the entity through which the program is operated.
(a) Except as provided in paragraph (B)(3)(b) of this rule, the services are performed after examination and diagnosis by the dentist and in accordance with the dentist's written treatment plan.
(b) The requirement in paragraph (B)(3)(a) of this rule does not apply when the only service to be provided by the dental hygienist is the placement of pit and fissure sealants.
(C) A dental hygienist may apply fluoride varnish, apply desensitizing agents, and discuss general nonmedical nutrition information for the purpose of maintaining good oral health when the supervising dentist is not physically present at the location where the services are provided, regardless of whether the dentist has examined the patient, if the dental hygienist is employed by, or under contract with, the supervising dentist or another person or government entity specified in paragraph (B) of this rule.
(D) The supervising dentist shall have no more than three dental hygienists treating patients when the dentist is not physically present.
(E) No person shall do either of the following:
(1) Practice dental hygiene in a manner that is separate or otherwise independent from the dental practice of a supervising dentist.
(2) Establish or maintain an office or practice that is primarily devoted to the provision of dental hygiene services.
(F) The following procedures may not be performed by a dental hygienist when the supervising dentist is not physically present:
(1) Administration of intraoral block and infiltration local anesthesia
(2) Administration (initiate, adjust, monitor, and terminate) of nitrous oxide-oxygen
(N2O-O2 ) minimal sedation
(3) Monitoring of nitrous oxide-oxygen (N2 O-O2) minimal sedation
(4) Procedures while the patient is anesthetized.
(5) Definitive subgingival curettage.
(6) Definitive root planing.
(7) Sulcular placement of prescribed materials.
(8) Shade selection for fabrication of appliances or restorations.
(9) Pulp testing.
(10) Suture removal.
(11) Placement of a rubber dam over preplaced clamp, and removal of clamp and rubber dam.
(12) Application of cavity varnish.
(13) Placement and removal of surgical dressings.
(14) Bleaching of teeth.
(15) The following orthodontic procedures:
(a) Preliminary selection and sizing of orthodontic bands and arch wires.
(b) Checking for and removal of loose orthodontic bands and loose brackets.
(c) Placement and removal of orthodontic arch wires, auxiliary arch wires, and ligation of same to orthodontic bands and/or brackets.
(d) Placement and removal of orthodontic separators and ties.
(16) The following endodontic procedures:
(a) Irrigation and drying of canals during endodontic procedures.
(b) Placement of medication in the pulp chamber(s) of teeth with non-vital pulp or instrumented root canals.
(17) The following restorative procedures:
(a) Impression, fabrication, cementation and removal of any provisional restorations.
(b) Preliminary selection and sizing of stainless steel crowns.
(c) Polymerization of light-activated restorative or bonding materials.
(18) The preparation of materials, drugs and medications for use in dental procedures, including, but not limited to:
(a) Palliative materials.
(b) Restorative materials.
(19) All non-invasive supportive services normally utilized in conjunction with the treatment by the dentist of fascia pain or TMJ syndrome.
(20) Intra-oral bite registrations for restorations and appliances.
(21) Preparing the teeth for restorations or for the bonding of orthodontic brackets by treating the supragingival coronal surfaces of the teeth to be bonded with a conditioning or etching agent and by the placement of a bonding agent adhesive.
(22) Impressions for removable or fixed orthodontic appliances.
Five Year Review (FYR) Dates: 06/24/2016 and 08/01/2021
Promulgated Under: 119.03
Statutory Authority: 4715.03, 4715.22
Rule Amplifies: 4715.22
Prior Effective Dates: 06-17-99, 04-04-02, 05-15-03, 12/24/10