Current through Register Vol. 50, No. 9, September 20, 2024
A. Dental
hygienists are expressly authorized to perform the procedure referred to as an
oral prophylaxis, which is defined as the removal of plaque,
calculus and stains from the exposed and unexposed surfaces of the teeth by
scaling and polishing as a preventive measure for the control of local
irritational factors.
B. A person
licensed to practice dentistry in the state of Louisiana may delegate to any
dental hygienist any chairside dental act which said dentist deems reasonable,
using sound professional judgment. Such act must be performed properly and
safely on the patient. Furthermore, the act must be under the direct
on-premises supervision of the treating dentist. A dentist may not delegate to
a dental hygienist:
1. comprehensive
examination or diagnosis and treatment planning;
2. a surgical or cutting procedure on hard or
soft tissue including laser and micro abrasion reduction of tooth
material;
3. the prescription of a
drug, medication, or work authorization;
4. the taking of an impression for a final
fixed or removable restoration or prosthesis;
5. the final placement and intraoral
adjustment of a fixed appliance;
6.
the final placement and intraoral or extraoral adjustment of a removable
appliance;
7. the making of any
intraoral occlusal adjustment;
8.
the performance of direct pulp capping or pulpotomy;
9. the placement or finishing of any final
restoration except for the polishing of an amalgam restoration;
10. the final placement of orthodontic bands
or brackets except in indirect bonding procedures in which the dentist has
either performed the final placement of the brackets on the model or when the
dentist has written a detailed prescription to the laboratory for placement of
the bracket; and
11. the
administration of parenteral, intravenous (IV), or any general anesthetic
agent.
C. The delegating
dentist shall remain responsible for any dental act performed by a dental
hygienist.
D. Registered dental
hygienists may not hold themselves out to the public as authorized to practice
dentistry.
E. In accordance with
Act 744 of the regular session of the Louisiana Legislature, effective June 29,
2006, dental hygienists may work under the general supervision of dentists
licensed to practice in the state of Louisiana.
F. Under general supervision, a dental
hygienist may provide to patients of record, for not more than five consecutive
business days, all dental hygiene services (exc ept the administration of
nitrous oxide inhalation or local anesthesia, and root planing which must be
under direct supervision) if all of the following conditions are satisfied:
1. the dental hygienist has at least one year
of full time practice of dental hygiene;
2. the dental hygienist has current CPR
certification and complies with the established protocols for emergencies which
the supervising dentist has established;
3. the supervising dentist has examined the
patient of record not more than nine months prior to the date that the dental
hygienist provides the dental hygiene services;
4. the dental hygienist provides dental
hygiene services to the patient of record in accordance with a written
treatment protocol prescribed by the supervising dentist for the
patient;
5. the patient of record
is notified in advance of the appointment that the supervising dentist will be
absent from the location;
6. no
licensed dental hygienist, under general supervision, may delegate or supervise
any dental hygiene duties for an expanded duty dental assistant; and
7. the dentist is responsible for all actions
of the dental hygienist during treatment of patients under general
supervision;
8. dental hygienists
may perform light enhanced teeth whitening procedures such as Zoom under
general supervision.
G .
The following limitations also apply to the practice of dental hygiene under
general supervision.
1. No entity may employ
dental hygienists to provide treatment for patients of record under general
supervision other than:
a. a public
institution that has supervision by a Louisiana licensed dentist;
b. a nonprofit entity that meets the
statutory, regulatory and program requirements for grantees supported under
Section 330 of the Public Health Service Act (42 U.S.C. §
254b or its successor) and that has
supervision by a Louisiana licensed dentist;
c. a school that has supervision by a
Louisiana licensed dentist, or
d.
an office owned by a dentist or group of dentists licensed in
Louisiana.
2. No duly
licensed and registered dentist shall supervise more than two dental hygienists
under general supervision at any one time.
3. No duly licensed and registered dentist
shall supervise a dental hygienist for more than five consecutive business days
or for more than 20 total days in any calendar year. These limits do not apply
to a hygienist working at a school or public institution.
4. No patient can be seen twice consecutively
under general supervision.
5. An
examination fee must not be charged if a patient is seen under general
supervision.
H.
Notwithstanding the above sections, a dental hygienist licensed in Louisiana
may perform radiographs, oral prophylaxis, place sealants and place fluoride
varnish without a Louisiana licensed dentist being physically present in the
clinic if all of the following conditions are met:
1. The dental hygienist is employed by one of
the following entities and is performing the radiographs, oral prophylaxis,
sealants and/or the fluoride varnish as part of his employment with that
entity:
a. A government agency.
b. A nonprofit entity that meets the
statutory, regulatory and program requirements for grantees supported under
Section 330 of the Public Health Service Act (42 U.S.C. §
254b or its successor).
c. A nonprofit entity providing the
radiographs, oral prophylaxis, sealants and/or the fluoride varnish which
receives no compensation for the provided service.
2. The radiographs, oral prophylaxis,
sealants and/or the fluoride varnish are done in one of the following settings:
a. A public elementary or middle school in
which 50 percent or more of students are economically disadvantaged or meeting
with Community Eligibility Provision (CEP) requirements under the Louisiana
Department of Education and is in a parish with a parish-wide geographic Dental
Health Professional Shortage Area (HPSA) scores above 15.
b. A fixed clinic of a nonprofit entity that
meets the statutory, regulatory, and program requirements for grantees
supported under Section 330 of the Public Health Service Act (42 U.S.C. §
254b or its successor) that does not have a
dentist employed by it and is in a parish with a parish-wide geographic Dental
Health Professional Shortage Area (HPSA) scores above 15.
3. A Louisiana licensed dentist is providing
direct supervision via teledentistry and reviews exams being done by the
hygienist and images of the patients oral cavity via the teledentistry
connection. Unless restricted by bandwidth considerations, the teledentistry
must be contemporaneous (synchronist). If bandwidth prohibits contemporaneous
viewing by the dentist, non-contemporaneous (asynchronist) viewing of the
patient may be employed, but the dentist must review the exam before the
patient is dismissed from the clinic on the day of treatment.
4. Oral health education involving the
benefits of sealants, fluoride varnish, and fluoridated water is provided to
the patient or patients representative.
5. All patients who are deemed to need
additional treatment are referred to a dentist and follow up is done to confirm
that the patient has obtained treatment and, if treatment has not been
obtained, to re-urge the patient or his representatives to obtain
treatment.
6. The patient or his
representatives must give informed consent to the use of teledentistry in the
supervision of the dental hygienist.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
37:760(8).
