Current through Rules and Regulations filed through March 20, 2024
(1)
Definitions.
(a) "Authorizing dentist" shall mean a
dentist licensed to practice in Georgia who permits a dental hygienist to
practice under general supervision.
(b) "Dental hygiene duties" and "dental
hygiene services" shall mean those tasks which a dental hygienist may lawfully
perform under O.C.G.A. §
43-11-74 and this Rule
(c) "Dental hygienist" shall mean an
individual licensed to practice dental hygiene in Georgia.
(d) "Dental screening" shall mean a visual
assessment of the oral cavity without the use of x-rays, laboratory tests, or
diagnostic models to determine if it appears that a more thorough clinical
examination and diagnosis should be conducted by a licensed dentist.
(e) "Dentist" shall mean an individual
licensed to practice dentistry in Georgia.
(f) "Direct supervision" shall mean that a
licensed dentist is in the dental office or treatment facility, personally
diagnoses the condition to be treated, personally authorizes the procedure and
remains in the dental office or treatment facility while the procedure is being
performed by the dental hygienist, and before dismissal of the patient,
examines the patient.
(g) "General
supervision" shall mean that a licensed dentist has authorized the delegable
duties of a dental hygienist but does not require that a licensed dentist be
present when such duties are performed.
(2) No dentist shall be required to authorize
a dental hygienist to perform dental hygiene duties under general supervision,
and no part of this Rule shall be construed as to establish independent dental
hygiene practice.
(3) A dental
hygienist shall perform duties only under the direct supervision of a duly
licensed dentist who is licensed to practice in the State of Georgia, except
where otherwise provided in O.C.G.A. §
43-11-74 and this rule.
(4) The requirement of direct supervision
shall not apply to:
(a) The educational
training of dental hygiene students at an institution approved by the Board and
the Commission on Dental Accreditation of the American Dental Association, or
its successor agency.
(b) The
performance of dental hygiene duties at approved dental facilities of the
Department of Public Health, county boards of health, or the Department of
Corrections, or the performance of dental hygiene duties by personnel of the
Department of Public Health or county boards of health at approved off-site
locations.
(c) The performance of
dental hygienists providing dental screenings in settings which include:
schools; hospitals; clinics; state, county, local, and federal public health
programs; federally qualified health centers; volunteer community health
settings; senior centers; family violence shelters, as defined in O.C.G.A. §
19-13-20; and free health clinics,
as defined in O.C.G.A. §
51-1-29.4. Other health fair
settings must be pre-approved by the board.
1. School settings.
(i) School settings shall include only
schools that are Title I schools under the federal Elementary and Secondary
Education Act, schools in which at least 65% of the student population is
eligible for free or reduced price lunch under federal guidelines, Head Start
programs, and Georgia's Pre-K Program.
(ii) Dental hygienists may apply topical
fluoride and perform the application of sealants and oral prophylaxis under
general supervision, with written permission of the student's parent or
guardian. A dental hygienist may also, without prior written permission of the
student's parent or guardian, provide oral hygiene instruction and
counseling.
(iii) A dental
hygienist and the authorizing dentist shall maintain the confidentiality of any
records related to services provided to a student under subparagraph (4)(c) in
compliance with laws including without limitation the federal Family Education
Rights and Privacy Act of 1974,
20 U.S.C. Section
1232g.
2. Hospitals; nursing homes; long-term care
facilities; rural health clinics; federally qualified health centers, health
facilities operated by federal, state, county or local governments; hospices;
family violence shelters, as defined in O.C.G.A. §
19-13-20; and free health clinics,
as defined in O.C.G.A. §
51-1-29.4.
(i) Dental hygienists may apply topical
fluoride and perform the application of sealants and oral prophylaxis under
general supervision.
3.
A dental hygienist performing duties under subparagraphs (4)(c)(1.) or
(4)(c)(2.) shall:
(i) Not perform any dental
hygiene services on a patient that has dental pain or clearly visible evidence
of widespread dental disease. The dental hygienist shall immediately refer such
patient to the authorizing dentist for clinical examination and treatment. The
dental hygienist shall notate such patient's file, and the patient shall not be
eligible to receive dental hygiene services under subparagraphs (4)(c)(1.) or
(4)(c)(2.) until a dentist provides written authorization that such services
may be performed on the patient.
(ii) Prior to providing any dental hygiene
services, obtain, study, and comprehend the school's or facility's protocols
and procedures regarding medical emergencies and implement and comply with such
protocols and procedures if a medical emergency arises during the provision of
dental hygiene services; and
(iii)
Provide to each patient receiving such services written notice containing:
(I) The name and license number of the dental
hygienist and the authorizing dentist;
(II) Any dental hygiene issues that the
dental hygienist identified during the performance of dental hygiene duties. If
dental hygiene services are not performed on a patient under subparagraph
(4)(c)(3.)(i), the written notice shall include a statement that the patient is
not eligible to receive dental hygiene services until a clinical examination is
performed by a dentist, and a dentist provides written authorization that
services may be performed;
(III) A
statement advising each patient who receives dental hygiene services to seek a
more thorough clinical examination by a dentist within 90 days, unless the
authorizing dentist performed a clinical examination of the patient.
(iv) Make all reasonable efforts
to provide such written notice as required in subparagraph (4)(c)(3.)(iii) to
parents or legal guardians of minors or incapacitated adults who receive dental
hygiene services and to the long-term care facility or nursing home for
residents of such facilities who receive dental hygiene services, as
applicable.
(v) Not charge a fee
for a dental screening provided under subparagraph (4)(c), except where
provided by an employee of the Department of Public Health or county boards of
health. However, these fees must be paid directly to the Department of Public
Health or that county board of health and not to the dental hygienist who
performed the screening.
(vi) Not
require a school or facility receiving dental hygiene services under
subparagraphs (4)(c)(1.) and (4)(c)(2.) to purchase any equipment.
(5) General
Supervision in a Private Office Setting.
(a) A
dental hygienist may perform only the following functions under general
supervision:
1. Application of sealants and
oral prophylaxis and assessment;
2.
Fluoride treatment;
3. Oral hygiene
instruction and education; and
4.
Exposure and processing of radiographs if provided for by specific,
individualized standing orders of the authorizing dentist, including any
protocols regarding urgent dental issues that arise.
(b) A dentist in a private dental office
setting may authorize general supervision of a dental hygienist only upon
meeting the following criteria:
1. A new
patient of record must be clinically examined by the authorizing dentist during
the initial visit;
2. A patient
must be examined by the authorizing dentist at a minimum of twelve-month
intervals; and
3. A patient must be
notified in advance of the appointment that the patient will be treated by the
dental hygienist under general supervision without the authorizing dentist
being present or being examined by the authorizing dentist.
(6) A dental hygienist
performing dental hygiene services under general supervision shall have at
least two (2) years of experience in the practice of dental hygiene, shall be
in compliance with the continuing education requirements under O.C.G.A. §
43-11-73.1 and the cardiopulmonary
resuscitation certification requirements under O.C.G.A. §
43-11-73, shall be licensed in
good standing, and shall maintain coverage under a professional liability
occurrence or claims insurance policy with a policy limit minimum of
$1,000,000.
(a) "Experience" means a minimum
of 1000 hours of hands-on treatment of patients within the twenty-four (24)
month period immediately post-graduation from an accredited dental hygiene
program.
(7) In schools;
hospitals; clinics; state, county, local, and federal public health programs;
federally qualified health centers; volunteer community health settings; senior
centers; family violence shelters, as defined in O.C.G.A. §
19-13-20; and free health clinics,
as defined in O.C.G.A. §
51-1-29.4, it shall be in the sole
discretion of the authorizing dentist as to whether to require an initial
examination of the patient prior to the performance by a dental hygienist of
dental hygiene services under general supervision.
(8) A dentist may only authorize up to four
dental hygienists total to provide dental hygiene services in any setting or
number of settings at any one time. A dentist authorizing one or more dental
hygienists to provide dental hygiene services under (4)(c)(1.) and (4)(c)(2.)
shall practice dentistry and treat patients in a physical and operational
dental office located in this State within 50 miles of the setting in which the
dental hygiene services are to be provided under general supervision.
(9) Dental hygiene services provided by
dental hygienists in mobile dental vans shall always be provided under direct
supervision.
(10) In addition to
routine duties and the procedures of any of the operations or procedures
authorized in O.C.G.A. §
43-11-74, the following activities
may be performed by a dental hygienist working under the direct supervision of
a dentist:
(a) All the duties that are
usually performed by a dental assistant pursuant to Title 43, Chapter 11,
Article 4 of the Official Code of Georgia Annotated and Chapter 150-9 of the
Rules of the Georgia Board of Dentistry, under the limitations and stipulations
set forth in Title 43, Chapter 11, Article 3 of the Official Code of Georgia
Annotated and Chapter 150-5 of the Rules of the Georgia Board of
Dentistry.
(b) Take and mount oral
x-rays;
(c) Apply medications
and/or solutions approved by the Board and prescribed by the dentist that can
be applied by methods approved by the Board, be that by irrigation, tray, or
insertion of bioresorbable materials;
(d) Remove calcareous deposits, secretions,
and stains from the surfaces of teeth. Ultrasonic technologies are authorized
for use by dental hygienists;
(e)
Utilize techniques and materials necessary for the application of sealant(s) to
pits of and fissures of teeth;
(f)
Perform root planning and curettage with hand instruments; and
(g) Perform periodontal probing.
(11) Nothing in these rules shall
be construed as authorizing dental hygienists to utilize other techniques in
the course of the performance of their duties, otherwise authorized by these
rules. Only dentists licensed by the Georgia Board of Dentistry shall be
authorized to perform procedures involving laser technology which alters
tissue, creates thermal effect, or is intended to cut, coagulate,
photocoagulate, vaporize, or ablate essentially any soft or hard tissues of the
body. Additionally, only dentists licensed by the Board shall be authorized to
perform procedures utilizing air abrasive technology, which is normally
intended for cavity preparation or enamel removal. This is to be distinguished
from "micro etching" and "air polishing" technologies which are intended for
stain removal and roughening the surfaces of enamel to enhance bonding, similar
to acid etching, (i.e., Micro etching and air polishing are technologies
authorized for use by dental hygienists).
O.C.G.A.
§§
43-11-1,
43-11-7,
43-11-9,
43-11-17,
43-11-74.
