Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule specifies the level of supervision
for and the procedures that a dentist may and may not delegate to a
hygienist.
(1) A hygienist
may be employed by any person or entity so long as the hygienist is working
under the supervision of a dentist as set forth in section
332.311,
RSMo, and does not engage in the practice of dentistry as set forth in section
332.071,
RSMo.
(2) The dentist is
responsible for patient care. Nothing contained in the authority given the
dentist by this rule to delegate the performance of certain procedures shall
relieve the dentist from responsibility to the patient.
(3) A hygienist may perform the following
procedures under general supervision:
(A)
Scaling and polishing teeth (prophylaxis);
(B) Applying dental sealants;
(C) Periodontal root planing, debridement,
and curettage;
(D) Nonsurgical
periodontal procedures;
(E) All
procedures delegable to a dental assistant or certified dental assistant,
except the expanded functions in section (5) of this rule.
(4) A hygienist may perform the following
procedures under indirect supervision:
(A)
Administering nitrous oxide analgesia, as outlined in section (8) of this
rule;
(B) Administering local
anesthesia, as outlined in sections (9) and (10) of this rule;
(C) Procedures deemed appropriate by a
dentist as outlined in section
332.091,
RSMo; and
(D) All procedures
allowed under general supervision as outlined in section (3) of this
rule.
(5) A hygienist
may perform the following procedures under direct supervision:
(A) All procedures allowed under general
supervision and indirect supervision as outlined in sections (3) and (4) of
this rule; and
(B) Expanded
functions in
20 CSR
2110-2.120 after receiving a permit to perform
expanded functions duties issued by the Missouri Dental Board. Neither a
Missouri basic skills test nor certification in dental assisting is required
for a dental hygienist to take expanded functions courses. The board shall
issue the appropriate expanded functions permit upon receipt of a completed
application form, payment of the appropriate fee specified in
20 CSR 2110-2.170, and proof
that the dental hygienist has completed a board-approved expanded functions
training course. The requirements of this section must be completed within one
(1) year of the date of submission of the application form. The board-issued
expanded functions permit must be displayed in plain view in any facility where
the dental hygienist will be providing expanded functions prior to delegation
of expanded functions to that dental hygienist. Dental hygienists shall renew
expanded functions permits in accordance with the requirements in
20 CSR
2110-2.120. A licensed dental hygienist may use
continuing education hours obtained for license renewal to renew an expanded
functions permit.
(6) A
hygienist may not perform procedures considered the practice of dentistry as
set forth in section
332.071,
RSMo, including, but not limited to, the following:
(A) Diagnosis, including the interpretation
of dental radiographs and treatment planning;
(B) Cutting of tooth structure;
(C) Surgical procedures on hard and soft
tissues including, but not limited to, the removal of teeth and the cutting and
suturing of soft tissues;
(D)
Prescription, injection, and parenteral administration of drugs, with the
exception of the administration of nitrous oxide analgesia or local anesthesia
as outlined in sections (8), (9), and (10) of this rule; and
(E) Final bending of an archwire prior to
ligation.
(7) A
hygienist may provide oral hygiene instructions, conduct oral screenings, and
apply fluoride without a dentist being present. The hygienist shall refer the
individual screened to a dentist for diagnosis.
(8) A hygienist may administer nitrous oxide
analgesia if s/he:
(A) Obtains proof of
competency in a nitrous oxide analgesia course; and
(B) Obtains a nitrous oxide analgesia permit,
issued by the board, upon submitting the following:
1. A completed application form provided by
the board; and
2. A nonrefundable
fee, payable to the Missouri Dental Board; and
3. A copy of proof of competency.
(9) A hygienist may
administer local anesthesia, which includes infiltration and block anesthesia,
if s/he:
(A) Obtains proof of competency in a
local anesthesia course or holds a Missouri Dental Board infiltration
anesthesia permit issued prior to the effective date of this rule and obtains
proof of competency in a local anesthesia course which includes block
anesthesia; and
(B) Receives a
local anesthesia permit, issued by the board, upon submitting the following:
1. A completed application form provided by
the board; and
2. A nonrefundable
fee, payable to the Missouri Dental Board; and
3. A copy of proof of competency.
(10) A hygienist may
administer only infiltration anesthesia if s/he currently holds a Missouri
Dental Board infiltration anesthesia permit issued prior to the effective date
of this rule.
(11) For purposes of
this rule, proof of competency means documentation verifying completion of
didactic and clinical training and passage of competency testing of that
training from a dental, dental hygiene, or dental assisting school accredited
by the Commission on Dental Accreditation of the Americandental Association or
other training courses approved by the Missouri Dental Board.
(12) The provisions of this rule are declared
severable. If a court of competent jurisdiction holds any provision of this
rule invalid, the remaining provisions of this rule shall remain in full force
and effect, unless otherwise determined by a court of competent
jurisdiction.
*Original authority: 332.031, RSMo 1969, amended 1981,
1993, 1995; 332.071, RSMo 1969, amended 1976, 1995, 2003, 2004, 2006; 332.091,
RSMo 1969, amended 1995; 332.098, RSMo 2010; and 332.311 , RSMo 1969, amended
1997, 2001, 2006.
