In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means State Board of Dental Examiners. “Dental assistant” means a person, other than an individual licensed in the state as a dentist or dental hygienist, employed for the purpose of assisting a dentist in the performance of intraoral duties related to dental care. “Direct supervision” means that the supervising dentist is in the dental office, personally diagnoses the condition to be treated, personally authorizes the procedure, and, before dismissal of the patient, personally evaluates the performance of the dental assistant. “General supervision” means the supervision of a dental assistant by a dentist where the dentist may or may not be present when the dental assistant performs the dental assisting procedures. Notwithstanding any other provisions of this chapter, a dental assistant may provide the following dental assisting duties under the general supervision of a dentist for a dental sealant program: Instructing on oral hygiene; Cleaning and disinfecting environmental surfaces and equipment; Preparing materials for the application of sealants; Retracting lips, cheek, and tongue; Placing and removing materials for the isolation of the dentition, if the material is not retained by the dentition; Transferring instruments and sealants to a dentist or dental hygienist; Rinsing and aspirating of the oral cavity; and Sterilizing instruments. Under general supervision of a dentist, a dental assistant may only perform the duties enumerated in §A of this regulation: For a facility that has been granted a waiver of on-site supervision for a dental hygienist under COMAR 10.44.21; and While assisting a dental hygienist who has received a waiver of on-site supervision under COMAR 10.44.21. A dental assistant who provides dental assistant duties under this regulation shall maintain cardiopulmonary resuscitation certification from one of the following programs: The American Heart Association's Basic Life Support for Healthcare Providers; The American Red Cross's Cardiopulmonary Resuscitation for Professional Rescuers; or An equivalent program approved by the Board. A dental assistant who provides dental assistant duties under this regulation shall have at least 400 hours of dental assisting clinical practice in direct patient care. A dental assistant who provides dental assistant duties under this regulation shall successfully complete a Board-approved course of at least 2 hours in infection control with OSHA protocol if the dental assistant is not: Certified by the Dental Assisting National Board as qualified in general duties and recognized by the Dental Board as qualified in general duties; Certified by the Dental Assisting National Board as qualified in orthodontics and recognized by the Dental Board as qualified in orthodontics; or Certified by the Dental Assisting National Board as a certified dental assistant or certified orthodontic assistant. A facility that uses a dental assistant to provide dental assistant duties under this regulation shall ensure that there is a written agreement between the supervising dentist and the dental assistant practicing under general supervision that clearly sets forth the terms and conditions under which the dental assistant may practice, including a statement that the dental assistant may provide dental assistant duties without the supervising dentist on the premises. Each facility that uses the services of a dental assistant to provide dental assistant duties under this regulation shall maintain for 5 years for inspection by the Board: The name of the dentist providing general supervision to the dental assistant; The name and current address of the dental assistant; The name and address of each institution where the dental assistant provided dental assistant duties; and The date the dental assistant provided dental assistant duties. This regulation does not affect the duties a dental assistant may lawfully perform under the direct supervision of a dentist under this chapter. A violation of this regulation may result in: Revocation of the facility's right to operate under a waiver of on-site supervision for dental hygienists; or Revocation of the facility's right to utilize the services of a dental assistant under this regulation. Penalties. For violations of this regulation, a dentist or dental assistant is subject to the penalties contained in Regulation .08 of this chapter. A dental hygienist who uses the services of a dental assistant who is not qualified or for purposes other than what are permitted under this regulation may be found guilty of: Unprofessional conduct under Health Occupations Article, §4-315(b)(3), Annotated Code of Maryland; or Violating any rule or regulation adopted by the Board under Health Occupations Article, §4-315(b)(9), Annotated Code of Maryland. A dentist may use the services of a dental assistant to perform the following intraoral duties under the direct supervision of a dentist: Rinsing and aspiration of the oral cavity; Retraction of the lips, cheek, tongue, and flaps; Placement and removal of materials for the isolation of the dentition, provided that the material is not retained by the dentition; Instructing on oral hygiene; Performing intraoral photography; Taking impressions for study models or diagnostic casts; Constructing athletic mouth guards on models; Applying topical anesthesia; Curing by the use of halogen light; Checking for loose bands; and Any other duty approved by the Board. A dentist may use the services of a dental assistant to perform certain duties if the dental assistant: Has successfully completed a Board-approved course of at least 35 hours related to Maryland orthodontic dental assisting; and Is certified by the Dental Assisting National Board in orthodontics or was recognized by the Board of Dental Examiners, on or before June 19, 1974, as a dental assistant qualified in orthodontics. If a dental assistant meets the qualifications of §A of this regulation, a dentist may permit the dental assistant qualified in orthodontics to perform the following intraoral tasks, provided that the tasks are performed only in response to a specific instruction from and under direct supervision of a licensed dentist: Taking impressions for study models or diagnostic casts; Applying topical fluoride; Preparing and fitting orthodontic bands; Etching; Removing excess cement from around orthodontic bands; Placing and removing arch wires; Cementing of orthodontic bands, placement of bonded attachments, or the removal of cemented or bonded orthodontic bands and attachments: Placing elastics and ligatures; Selecting headgear; Applying desensitizing agents; Applying topical anesthesia; Constructing athletic mouth guards on models; Taking alginate impressions for intraoral appliances; Curing by the use of halogen light; and Any other duty approved by the Board. A dentist may not use the services of a dental assistant qualified in orthodontics to perform any of the following services on the basis that the dental assistant meets the qualifications of §A of this regulation: Examination, diagnosis, and treatment planning; Surgery on hard or soft tissues; Oral prophylactic procedures, including scaling, root planing, and polishing of teeth with rotary instruments; Condensing, carving, or finishing any restoration; Administering injectable local anesthesia; Applying pit and fissure sealants; Initiation of treatment at any time for the correction of malocclusions and malformations of the teeth or jaws; Adjusting occlusion of natural teeth, restorations, or appliances; Placing an initial surgical dressing; Performing vitality tests; Preparing temporary crowns; Cementing temporary or permanent crowns or restorations; Removing temporary crowns; Placing or removing retraction cord; Placing or removing a rubber dam; Placing or removing a matrix band; Preparing and fitting stainless steel crowns; Drying a root canal; Removing or placing a periodontal dressing; and Adjusting prosthetic appliances. A dentist may use the services of a dental assistant to perform certain duties if the dental assistant: Has successfully completed a Board-approved course of at least 35 hours related to Maryland general duties dental assisting; and Is certified by the Dental Assisting National Board as qualified in general duties or was recognized by the Board of Dental Examiners, on or before June 19, 1974, as a dental assistant qualified in general duties. If a dental assistant meets the qualifications of §A of this regulation, a dentist may use the services of the dental assistant qualified in general duties to perform the following intraoral tasks, provided that the tasks are performed only in response to a specific instruction from and under the direct supervision of a licensed dentist: Performing vitality tests; Taking impressions for study models or diagnostic casts; Taking alginate impressions for intraoral appliances; Applying topical fluoride; Applying desensitizing agents; Applying topical anesthesia; Placing or removing a rubber dam; Etching; Curing by the use of a halogen light; Fabricating indirect restorations in a dental office; Placing or removing a matrix band; Drying a root canal; Preparing and fitting stainless steel crowns; Placing or removing retraction cord; Preparing temporary crowns; Cementing temporary crowns or restorations; Removing temporary crowns; Removing excess cement; Removing or placing a periodontal dressing (except placing the original periodontal dressing); Removing sutures; Constructing athletic mouth guards on models; and Any other duty approved by the Board. A dentist may not use the services of a dental assistant qualified in general duties to perform any of the following services on the basis that the dental assistant meets the qualifications of §A of this regulation: Examination, diagnosis, and treatment planning; Surgery on hard or soft tissues; Oral prophylactic procedures, including scaling, root planing, and polishing teeth; Condensing, carving, or finishing any restoration; Administering injectable local anesthesia; Applying pit and fissure sealants; Initiation of treatment at any time for the correction of malocclusions and malformations of the teeth or jaws; Cementing of orthodontic bands, placement of bonded attachments or the removal of cemented or bonded orthodontic bands and attachments; Cementing permanent crowns or restorations; Adjusting occlusion of natural teeth, restorations, or appliances; Registration of jaw relations; Placing an initial surgical dressing; Preparing or fitting orthodontic bands; Placing or removing an arch wire; Selecting headgear; Placing elastics or ligatures; and Adjusting prosthetic appliances. A dentist may not permit a dental assistant to place and expose radiographs unless the dental assistant is a dental assistant certified to practice dental radiation technology. The dentist in charge of a dental office shall post a copy of these regulations and the list of Board-approved dental assistant duties in a conspicuous place in the office for the information of office personnel. A dentist who uses the services of a dental assistant who is not qualified or for purposes other than what is permitted may be found guilty of unprofessional conduct under Health Occupations Article, §4-315(a)(16), Annotated Code of Maryland, or violating any rule or regulation adopted by the Board under Health Occupations Article, §4-315(a)(18), Annotated Code of Maryland. The performance of intraoral duties not authorized by these regulations by a dental assistant may constitute the illegal practice of dentistry, a misdemeanor which on conviction is subject to: For a first offense, a fine not exceeding $2,000 or imprisonment in jail not exceeding 6 months; or For a subsequent offense, a fine not exceeding $6,000 or imprisonment in the State penitentiary not exceeding 1 year. Health Occupations Article, §4-205, Annotated Code of Maryland Effective date: June 19, 1974 Chapter revised effective July 20, 1981 (8:14 Md. R. 1228) Chapter revised effective December 31, 1984 (11:26 Md. R. 2278) Chapter revised effective February 19, 1990 (17:3 Md. R. 300) Regulation .01B amended effective October 23, 2006 (33:21 Md. R. 1677) Regulation .02 amended effective June 15, 1998 (25:12 Md. R. 947) Regulation .02 repealed effective June 25, 2001 (28:12 Md. R. 1110) Regulation .02 adopted effective October 23, 2006 (33:21 Md. R. 1677) Regulation .02E amended effective January 7, 2016 (42:26 Md. R. 1595) Regulation .03 amended effective January 7, 2002 (28:26 Md. R. 2274) Regulation .04 amended effective January 7, 2002 (28:26 Md. R. 2274) Regulation .04A amended effective June 6, 2016 (43:11 Md. R. 634) Regulation .05 amended effective January 7, 2002 (28:26 Md. R. 2274) Regulation .05A amended effective June 6, 2016 (43:11 Md. R. 634) Regulation .07 amended effective August 24, 1998 (25:17 Md. R. 1360) In this chapter, the following terms have the meanings indicated. Terms Defined. “Applicant” means any person applying for a license to practice dentistry pursuant to the provisions of these regulations and of Health Occupations Article, §§4-303 and 4-303.1, Annotated Code of Maryland. “Board” means the Maryland State Board of Dental Examiners. “Graduate of a foreign dental school” means any person who has graduated from a dental school located in any country outside the United States, its territories, districts, or possessions and the Dominion of Canada, and recognized by the country in which it is located. This regulation does not apply to a pediatric dental fellow or an individual who has successfully completed a pediatric dental fellowship. The requirements for these individuals are contained in Regulation .03 of this chapter. In addition to meeting the requirements set forth in Health Occupations Article, §4-302, Annotated Code of Maryland, with respect to moral character, and in addition to passing any required examination, to qualify for a limited license to practice dentistry, a graduate of a foreign dental school shall be 21 years old or older and shall submit the following credentials to the Board: A completed application on a form the Board prescribes and furnishes to the applicant, accompanied by a 3 inch by 3 inch notarized photograph of the applicant; Evidence satisfactory to the Board that the applicant has completed at least 24 months of formal general clinical training in a United States or Canadian accredited institution; A copy of the degree or diploma issued to the applicant by the foreign dental school conferring it, properly authenticated by an official of that foreign dental school authorized to make the authentication; A copy of the subjects taken and the credits earned by the applicant at the foreign dental school, duly authenticated by an official authorized to make the authentication; A license to practice dentistry issued by the foreign country, or the proper subdivision of the country, in which the applicant has graduated, duly authenticated by the issuing authority; A translation into English of a degree, diploma, or license required to be furnished to the Board, certified by an individual acceptable to the Board, if issued in a language other than English; Two letters of recommendation written by persons acceptable to the Board, which shall certify to the Board the good moral character of the applicant and the applicant's age, qualifications, background, and experience, if any; and A letter indicating that the applicant possesses sufficient comprehension and communication skills in written and spoken English to enable the applicant to adequately treat dental patients. The letter required in §B(8) of this regulation shall be received from: The administrator of the hospital at which the license is limited; The administrator of the sanitarium at which the license is limited; The dean of the dental school at which the license is limited; or The administrator of the public health program at which the license is limited. In addition to the requirements of Health Occupations Article, §4-304, Annotated Code of Maryland, a graduate of a foreign dental school applying for a limited license to practice dentistry under these regulations shall submit to the Board with the application the credentials processing fee as specified in COMAR 10.44.20. This fee is not refundable in whole or in part. A limited license to practice dentistry in this State is valid for 1 year from the date of issuance and is not renewable. An individual who has been in possession of a limited license may reapply for a limited license by submitting a new application to the Board. In addition to meeting the requirements set forth in Health Occupations Article, §4-303.1, Annotated Code of Maryland, with respect to moral character, and in addition to passing any required examination, to qualify for a limited license to practice pediatric dentistry in a public health dental clinic, federally qualified health center, or Maryland qualified health center under Health Occupations Article, §4-303.1, Annotated Code of Maryland, a graduate of a foreign dental school shall submit the following credentials to the Board: A completed application on a form provided by the Board; A photograph of the applicant 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; A copy of the degree or diploma issued to the applicant by the foreign dental school conferring it, properly authenticated by an official of that foreign dental school authorized to make the authentication; A copy of the subjects taken and the credits earned by the applicant at the foreign dental school, duly authenticated by an official authorized to make the authentication; A translation into English of a degree, diploma, or subjects taken which are required to be submitted to the Board, certified by an individual acceptable to the Board, if issued in a language other than English; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant holds an active dental license or ever held an active dental license indicating that the license is or was in good standing and whether the applicant: Is being investigated; Has charges pending against the applicant's license; Has been disciplined; or Has been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A copy of the applicant's National Practitioners Data Bank file; Proof satisfactory to the Board that the applicant has passed parts one and two of the National Board Examinations conducted by the Council of National Boards of the American Dental Association; Proof satisfactory to the Board that the applicant has successfully completed at least a 2-year pediatric dentistry residency program at a dental school or a hospital authorized by any state and which is recognized by the Board; Proof satisfactory to the Board that the applicant is either a pediatric dental fellow, or has successfully completed a pediatric dental fellowship at the University of Maryland Dental School; Proof satisfactory to the Board that the applicant is contractually obligated to provide pediatric dental services for at least 2 years in a: Public health dental clinic operated by the State or a county or municipality of the State; Federally qualified health center; or Maryland qualified health center; A letter from the health officer of the public health program for which the applicant has contractually agreed to provide at least 2 years of pediatric dental services: Requesting that the Board waive the education requirements of Health Occupations Article, §4-302, Annotated Code of Maryland, for the applicant; Stating that circumstances exist to justify granting the waiver; and Requesting that a limited license be issued to the applicant; A letter from the Dean of the University of Maryland Dental School: Requesting that the Board waive the education requirements of Health Occupations Article, §4-302, Annotated Code of Maryland for the applicant; and Stating that circumstances exist to justify granting the waiver; Two letters of recommendation written by persons acceptable to the Board, which certify to the Board the applicant's: Good moral character; Age; Qualifications; Background; and Experience, if any; A letter from the dean of the dental school at which the license is limited indicating that the applicant possesses sufficient comprehension and communication skills in written and spoken English to enable the applicant to adequately treat dental patients; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. A limited license to practice dentistry in this State is valid for 1 year from the date of issuance and is not renewable. An individual who has been in possession of a limited license may reapply for a limited license by submitting a new application to the Board. Fees as specified in COMAR 10.44.20 shall accompany the application. The credentials processing fee for limited licenses is not refundable in whole or in part. A limited licensee granted a waiver under Health Occupations Article, §4-303.1, Annotated Code of Maryland, may be granted a general license if the limited licensee fulfills the requirements of Health Occupations Article, §4-303.1, Annotated Code of Maryland, and submits the following credentials to the Board: A completed application on a form provided by the Board; A photograph of the applicant 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; A copy of the degree or diploma issued to the applicant by the foreign dental school conferring it, properly authenticated by an official of that foreign dental school authorized to make the authentication; A copy of the subjects taken and the credits earned by the applicant at the foreign dental school, properly authenticated by an official authorized to make the authentication; If issued in a language other than English, a translation into English of a degree, diploma, or subjects taken which are required to be submitted to the Board, certified by an individual acceptable to the Board; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant holds an active dental license or ever held an active dental license, indicating that the license is or was in good standing and whether the applicant: Is being investigated; Has charges pending against the applicant's license; Has been disciplined; Has been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A copy of the applicant's National Practitioners Data Bank file; Proof satisfactory to the Board that the applicant has passed the written and clinical examinations of the North East Regional Board; Proof satisfactory to the Board that the applicant has passed parts one and two of the National Board Examinations conducted by the Council of National Boards of the American Dental Association; Proof satisfactory to the Board that the applicant has successfully completed at least a 2-year pediatric dentistry residency program at a dental school or a hospital authorized by any state and which is recognized by the Board; Proof satisfactory to the Board that the applicant has successfully completed a pediatric dental fellowship at the University of Maryland Dental School; Proof satisfactory to the Board that the applicant has successfully completed the applicant's contractual obligation to provide pediatric dental services for at least 2 years in a: Public health dental clinic operated by the State or a county or municipality of the State; Federally qualified health center; or Maryland qualified health center; Two letters of recommendation written by persons acceptable to the Board, which certify to the Board the applicant's: Good moral character; Age; Qualifications; Background; and Experience, if any; Proof of passing the Maryland Dental Jurisprudence Examination on the Maryland State Dental Law; Documentation of changes of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The applicant shall be 18 years old or older. In addition to meeting the requirements set forth in Health Occupations Article, §4-302, Annotated Code of Maryland, with respect to moral character, to qualify for a teacher's license to practice dentistry, a graduate of a foreign dental school shall: Be 21 years old or older; Hold a degree of Doctor of Dental Surgery, Doctor of Dental Medicine, or an equivalent degree from a school, college, or faculty of dentistry; and Submit the following credentials to the Board: A completed application, on a form the Board prescribes and furnishes to the applicant, accompanied by a 3 inch by 3 inch notarized photograph of the applicant; A copy of the degree or diploma issued to the applicant by the foreign dental school conferring it, properly authenticated by an official of that foreign dental school authorized to make the authentication; A copy of the subjects taken and the credits earned by the applicant at the foreign dental school, duly authenticated by an official of that foreign dental school authorized to make the authentication; A translation into English of a degree or diploma required to be furnished to the Board, certified by an individual acceptable to the Board, if issued in a language other than English; Two letters of recommendation, written by persons acceptable to the Board, which shall certify to the Board the good moral character of the applicant and the applicant's age, qualifications, background, and experience, if any; A letter from the dean of the dental school at which the license is limited indicating that the applicant possesses sufficient comprehension and communication skills in written and spoken English to enable the applicant to adequately treat dental patients; Proof satisfactory to the Board that the applicant has at least 5 years of clinical dental experience; and Proof satisfactory to the Board that the applicant is professionally competent. If the applicant has been tested, licensed, or qualified in some other state of the United States, or its districts, territories, or possessions, the Board may accept the credentials submitted to the other state, district, territory, or possession, provided that the credentials meet the minimum standards of the Board as set forth in these regulations. In addition to the requirements of Health Occupations Article, §4-304, Annotated Code of Maryland, a graduate of a foreign dental school applying for a teacher's license to practice dentistry under this chapter shall submit to the Board with the application the credentials processing fee as specified in COMAR 10.44.20. This fee is not refundable in whole or in part. The requirements of §A(3)(e) of this regulation shall be waived if the applicant: Is approved by the Dean of the University of Maryland Dental School; Fulfills §A(1), (2), and (3)(a) — (d) and (g) — (h) of this regulation; and Is appointed to a full-time faculty position at the University of Maryland Dental School. A teacher's license to practice dentistry in the State is immediately void upon leaving the faculty position at the University of Maryland Dental School. Health Occupations Article, §§4-303 and 4-303.1, Annotated Code of Maryland; Ch. 131, Acts of 2003 Effective date: June 7, 1973 Regulation .04A amended effective November 17, 1978 (5:23 Md. R. 1740); October 3, 1980 (7:20 Md. R. 1880) Regulations .01 — .05 amended effective July 29, 1985 (12:15 Md. R. 1520) Chapter revised effective April 5, 1999 (26:7 Md. R. 544) Regulation .02 amended effective February 19, 2001 (28:3 Md. R. 206) Regulation .03 amended effective February 19, 2001 (28:3 Md. R. 206) Chapter revised effective December 11, 2003 (30:24 Md. R. 1743) Regulation .02 amended effective January 2, 2006 (32:26 Md. R. 1997) Regulation .03A amended effective January 2, 2006 (32:26 Md. R. 1997) Regulation .06A, D amended effective January 2, 2006 (32:26 Md. R. 1997) Any experimental program shall be under the direct supervision of a full time faculty member of the dental school or college. All dental assistants utilized by or employed in connection with any program shall be “qualified dental assistants” as that term is defined in the regulations of the Board. All dental hygienists utilized by or employed in connection with any program shall be duly licensed to practice dental hygiene in the State of Maryland. If the conduct of an experimental program requires the delegation to a dental assistant or the hygienist would not otherwise be permitted to perform by law or regulation of the Board, the faculty supervisor of the experimental program shall notify in writing the assistant or hygienists, as well as students participating in the program, of the fact that this delegation of duty is for the purpose of the experimental program only and that the performance of the delegated duties by an assistant or hygienist, outside the experimental program, may be in violation of law or the regulations of the Board. On and after June 1, 1973, all experimental programs proposed to be conducted in dental school or college, and not theretofore implemented which may involve dental procedures not otherwise approved by law or regulation of the Board, shall be submitted to the Board of Dental Examiners and the Maryland State Dental Association for review and comment at least 180 days in advance of the beginning of the experimental program. Health Occupations Article, §§4-308 and 4-309, Annotated Code of Maryland Effective date: June 19, 1974 This chapter governs the practice of dental hygiene by all licensed dental hygienists in the State. In this chapter, the following terms have the meaning indicated. Terms Defined. “Administer medication” means the direct introduction of a single dosage of a medication by a dental hygienist while the patient is physically on the premises where the treatment is rendered. “Administer nitrous oxide” means the initiation, adjustment, monitoring, and termination of the flow of nitrous oxide. “Board” means the Maryland State Board of Dental Examiners. “CDCA” means the Commission on Dental Competency Assessments or its successor organization. “Dental hygienist” means a registered dental hygienist who holds an active license to practice dental hygiene in Maryland. “Dentist" means a dentist who holds an active license to practice dentistry in Maryland. “Dispense medication” means a dental hygienist disbursing a single dosage or multiple dosages of a medication to a patient or an agent of the patient for introduction at a time subsequent to the rendered treatment. “Monitor” means the observation of the patient: During the flow of nitrous oxide; During the reduction of the flow of nitrous oxide; During the shutting off of the equipment controlling the flow of nitrous oxide; and At all times in between the start of the flow of nitrous oxide until after nitrous oxide has been terminated and the patient has fully awoken and is coherent. “Nitrous oxide” means a chemical compound with the formula N2O. The following intraoral functions may be performed in the practice of dental hygiene: Preliminary dental examination; Dental prophylaxis, which includes: Scaling and root planing; or Polishing a tooth or a restoration; Placing and removing perio dressings, including an initial dressing; Placing sealants; Taking impressions for study models, custom fluoride trays, or athletic mouth guards; Exposing a dental x-ray; Performing a brush biopsy; Placing subgingival medicaments; Cementing temporary crowns or restorations; and Performing any duty that a dental assistant, or a dental assistant who is listed on the roster of dental assistants recognized as qualified in orthodontics or general duties, may perform. A dental hygienist may administer local anesthesia by infiltration and local anesthesia by inferior alveolar nerve block only after Board recognition as provided in this chapter. A dental hygienist may perform manual curettage in conjunction with scaling and root planning only after meeting the requirements of Regulation .12 of this chapter. A dental hygienist may administer nitrous oxide only after Board recognition as provided in this chapter. The following intraoral functions may not be performed in the practice of dental hygiene: Diagnosis; Extraction; Cavity repair; Tooth placement correction; Surgical procedures; Anesthesia procedures other than: Administering topical anesthesia; or Administering local anesthesia by infiltration or local anesthesia by inferior alveolar nerve block in accordance with: Health Occupations Article, §§4-206.1 and 4.206.3, Annotated Code of Maryland; and The requirements of Regulation .06 of this chapter; and Administering nitrous oxide in accordance with: Health Occupations Article, §4-206.2, Annotated Code of Maryland; and The requirements of Regulation .17 of this chapter; Prescribing or administering medication other than: Prescribing and administering medication in accordance with Health Occupations Article, §§4-205 and 4-206.4, Annotated Code of Maryland; and The requirements of Regulation .27 of this chapter; Condensing, carving, or finishing any restoration; and Cementing permanent crowns or restorations. In addition to those functions described in Regulation .03A of this chapter, a dental hygienist who is recognized by the Board as qualified may: Administer local anesthesia by infiltration; Administer local anesthesia by inferior alveolar nerve block; Administer nitrous oxide; and Prescribe and administer medication. A dental hygienist who is recognized by the Board to administer local anesthesia may do so provided that the administration of local anesthesia is: By infiltration or by inferior alveolar nerve block to facilitate the practice of dental hygiene by a dental hygienist or the practice of dentistry by a dentist; Not performed as a medical specialty; and Under the supervision of a dentist who: Is physically on the premises; and Prescribes the administration of local anesthesia by the dental hygienist. A dental hygienist may administer local anesthesia only as provided in this regulation. A dental hygienist may not administer local anesthesia unless recognized by the Board as being qualified to do so as provided in this chapter. Classification of Board Recognition. The Board shall recognize the classification of recognized to administer local anesthesia. A dental hygienist who successfully completes a Board-approved course in manual curettage in conjunction with scaling and root planing as outlined in Regulation .11 of this chapter may perform manual curettage in conjunction with scaling and root planing without applying for or receiving recognition from the Board. A dental hygienist who successfully completes the Board-approved course in manual curettage in conjunction with scaling and root planing as outlined in Regulation .12 of this chapter shall: Maintain proof of successful completion of the course; and Provide documentation of successful completion of the course to the Board upon the Board's request. A dental hygienist who wishes to receive recognition by the Board as being qualified to administer local anesthesia by infiltration and local anesthesia by inferior alveolar nerve block shall: Hold an active license to practice dental hygiene in this State; and Successfully complete a Board-approved course of instruction as outlined in Regulation .09 of this chapter that documents training of at least 28 hours consisting of at least: 20 hours of didactic training in administering local anesthesia; and 8 hours of clinical training in administering local anesthesia. A dental hygienist shall pass a written and clinical examination administered by the Board-approved course with an overall passing grade of at least 75 percent in both the written examination portion and the clinical examination portion. The Board-approved course of instruction in administering local anesthesia may be obtained by: A dental hygienist while an undergraduate student in a Board-approved school for dental hygiene that is accredited by the American Dental Association Committee on Dental Accreditation or its successor organization; or A dental hygienist who completes the course offered by an accredited dental hygiene program. In addition to the requirements of this regulation, a dental hygienist who wishes to receive recognition by the Board as being qualified to administer local anesthesia shall pass the CDCA Local Anesthesia Examination for Dental Hygienists. The 28-hour Board-approved local anesthesia course of instruction outlined in Regulation .08A and B of this chapter shall include but not be limited to the following: 20 hours of didactic training, including at least the following: The psychology of pain management; A review of anatomy, physiology, and pharmacology of anesthetic agents; Emergency precautions and management; Patient management; and Instruction on the safe and effective administration of local anesthesia; and 8 hours of clinical training, including the direct observation of the performance of procedures. Before administering local anesthesia by inferior alveolar nerve block, a dental hygienist who successfully completed the education requirements and examination for the 28-hour local anesthesia Board-approved course as outlined in Regulation .08 of this chapter before October 1, 2011 shall: Successfully complete a Board-approved refresher course of at least 2 hours on local anesthesia by inferior alveolar nerve block offered by an accredited dental hygiene program; Pass a clinical examination administered by the Board-approved course with an overall passing grade of at least 75 percent; and Submit a letter from an accredited dental hygiene program indicating that the applicant has: Successfully completed the Board-approved course; and Received an overall passing grade of at least 75 percent in the course’s clinical examination. The letter from the accredited dental hygiene program referred to in §A of this regulation shall: Be on the letterhead of the accredited dental hygiene program; Contain a raised embossed school seal; and Contain the original signature of either: The Dean of the accredited dental hygiene program; or The head of the dental hygiene department. A dental hygienist who is subject to this regulation shall receive written permission from the Board before administering local anesthesia by inferior alveolar nerve block. A dental hygienist who is subject to §A of this regulation and who has not received written permission from the Board to administer local anesthesia by inferior alveolar nerve block as described in §C of this regulation may administer local anesthesia by infiltration only. Local Anesthesia. A dental hygienist holding an active certification to administer local anesthesia in another state or who is otherwise recognized to administer local anesthesia in another state may be granted recognition to administer local anesthesia in Maryland without taking and passing the Board-approved course outlined in Regulation .08A and B of this chapter if the dental hygienist: Has passed the CDCA Local Anesthesia Examination for Dental Hygienists; and Applies for and receives recognition by the Board as qualified to administer local anesthesia. Manual Curettage in Conjunction with Scaling and Root Planing. A dental hygienist holding an active certification to perform manual curettage in conjunction with scaling and root planing in another state, or who is otherwise recognized to perform manual curettage in conjunction with scaling and root planing in another state, may, while so certified or recognized in another state, perform manual curettage in conjunction with scaling and root planing without taking and passing the Board-approved course in manual curettage in conjunction with scaling and root planing outlined in Regulation .12 of this chapter. A dental hygienist who wishes to perform manual curettage in conjunction with scaling and root planing shall successfully complete a 2-hour Board-approved course of instruction in manual curettage in conjunction with scaling and root planing. The 2-hour Board-approved course of instruction in manual curettage in conjunction with scaling and root planing shall contain a total of 2 hours of didactic instruction. A dental hygienist who takes the Board-approved course of instruction in manual curettage in conjunction with scaling and root planing outlined in §A of this regulation shall pass a written examination administered by the Board-approved course with a grade of at least 75 percent. The Board-approved course of instruction in manual curettage in conjunction with scaling and root planing may be obtained by a dental hygienist while an undergraduate student in a Board-approved school for dental hygiene that is accredited by the American Association Committee on Dental Accreditation or its successor organization. The 2-hour Board-approved course of instruction in manual curettage in conjunction with scaling and root planing: May but need not be taken from an accredited dental hygiene program; and May be taken online. A dental hygienist is not required to renew the Board recognition to: Administer local anesthesia; or Perform manual curettage in conjunction with scaling and root planing. A dental hygienist who has successfully completed the following since graduating from an approved school of dental hygiene may receive continuing education credit toward renewal of their dental hygiene license: The 28-hour Board-approved course of instruction for local anesthesia; The 2-hour Board-approved course of instruction in manual curettage in conjunction with scaling and root planing; and The CDCA Local Anesthesia Examination for Dental Hygienists. If the Board-approved course of instruction in local anesthesia is taught by a dental hygienist, a dentist shall: Be present in the classroom during clinical instruction, which includes but is not limited to the administration of local anesthesia; and Be affiliated with the same dental hygiene program as the dental hygienist teaching the course. A dental hygienist shall submit a completed Board-approved application with the Board to be recognized as qualified to administer local anesthesia. Recognized as Qualified to Administer Local Anesthesia. Not Certified or Otherwise Recognized in Another State. A dental hygienist who applies to be recognized as qualified to administer local anesthesia and who is not certified or otherwise recognized to administer local anesthesia in another state shall submit to the Board: A completed Board-approved application; Proof of completion of a 28-hour Board-approved course of instruction in the administration of local anesthesia in the form of a letter from an accredited dental hygiene program indicating that the applicant has: Successfully completed the course; and Received an overall passing grade of at least 75 percent in both the course's written examination and the course's clinical examination; A certified examination score from the CDCA indicating that the applicant has passed the CDCA Local Anesthesia Examination for Dental Hygienists; A fee as specified in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. Recognized as Qualified to Administer Local Anesthesia by Virtue of Being Recognized in Another State. A dental hygienist who applies to be recognized as qualified to administer local anesthesia by virtue of being certified or otherwise recognized to administer local anesthesia in another state shall submit the following to the Board: A Board-approved application; A certified copy of the dental hygienist's most recent license or certification from the state of licensure or certification, indicating that the dental hygienist holds a current license or certification to administer local anesthesia; A certified examination score from the CDCA indicating that the applicant has passed the CDCA Local Anesthesia Examination for Dental Hygienists; An affidavit indicating that the hygienist has successfully administered local anesthesia at least 25 times in the 2-year period immediately preceding the date of application; A fee as specified in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. The letter from the accredited dental hygiene program referenced in §B(1)(b) of this regulation shall: Be on the letterhead of the accredited dental hygiene program; Contain a raised embossed school seal; and Contain the original signature of either: The Dean of the accredited dental hygiene program; or The head of the dental hygiene department. The experience requirements of §B2(d) of this regulation may not be obtained as an undergraduate dental hygiene student. A dental hygienist recognized by the Board as qualified to administer local anesthesia shall display the recognition conspicuously in the office where the holder is engaged in practice. Classification of Board Recognition. The Board shall recognize the classification of recognized to monitor nitrous oxide. A dental hygienist may not administer nitrous oxide unless recognized by the Board as being qualified to do so as provided in this chapter. A dental hygienist who is recognized by the Board to administer nitrous oxide may do so provided that the administration of nitrous oxide is under the supervision of a dentist who: Is physically on the premises; and Prescribes the administration of nitrous oxide by the dental hygienist. The supervising dentist and the dental hygienist who administers nitrous oxide shall insure that the patient retains the ability to independently and continuously maintain an airway and respond purposely to physical stimulation and verbal commands. A dental hygienist who administers or monitors a patient to whom nitrous oxide has been administered shall enter the details of the procedure during and after the procedure into the patient’s record. A dental hygienist may not monitor or administer nitrous oxide to more than one patient at a time. A dental hygienist who administers nitrous oxide to a patient or who monitors a patient to whom nitrous oxide has been administered may not: Treat any other patient during the course of the administration or monitoring; or Leave the operatory during the administration or monitoring except in emergency circumstances. A dental hygienist who is recognized to either monitor or administer nitrous oxide may remove the patient from nitrous oxide when the procedures have been completed. If a dental hygienist either monitors or administers nitrous oxide, the supervising dentist shall remain in the dental office and in close proximity to be summoned in the event of an emergency. A dental hygienist who wishes to receive recognition by the Board as being qualified to administer nitrous oxide shall: Hold an active license to practice dental hygiene in this State; and Successfully complete a Board-approved course of instruction as outlined in Regulation .20 of this chapter that documents training of at least 6 hours consisting of at least: 4 hours of didactic classroom training; and 2 hours of clinical training. A dental hygienist shall pass a written and clinical examination administered by the Board-approved course with an overall passing grade of at least 75 percent in both the written examination portion and the clinical examination portion. The Board-approved course of instruction in administering nitrous oxide may be obtained by: A dental hygienist while an undergraduate student in a Board-approved school for dental hygiene that is accredited by the American Dental Association Committee on Dental Accreditation or its successor organization; or A dental hygienist who completes the course offered by an accredited dental hygiene program. In addition to the Requirements outlined in §§A—C of this regulation, an applicant for recognition to administer nitrous oxide shall take and pass the CDCA Nitrous Oxide Examination for Dental Hygienists. A dental hygienist who holds a Board recognition to monitor a patient to whom nitrous oxide has been administered may, on and after October 1, 2016, continue to monitor a dentist’s administration of nitrous oxide to a patient, but may not administer nitrous oxide to a patient unless the dental hygienist holds a recognition to administer nitrous oxide. A dental hygienist who is recognized to monitor a patient to whom nitrous oxide has been administered may not increase the nitrous levels. The supervising dentist shall discharge the patient upon completion of the procedures. Beginning on October 1, 2016, the Board may not issue a recognition to monitor nitrous oxide. A dental hygienist may not administer nitrous oxide to a patient unless recognized by the Board as being qualified to do so as provided in this chapter. The 6-hour Board-approved course of instruction shall include but not be limited to the following: 4 hours of didactic classroom training, including at least the following: The history, philosophy, and psychology of nitrous oxide minimal sedation; The definition and descriptions of the physiological and psychological aspects of pain and anxiety; Concepts and management of pain and anxiety; Indications and contraindications for nitrous oxide sedation; Anatomy and physiology of pediatric and adult respiration; Medical assessment of a patient before administration of nitrous oxide; Moderate sedation, deep sedation, and general anesthesia versus nitrous oxide; Pharmacological and physiological effects of nitrous oxide including drug interactions; A description of the stages of drug induced central nervous system depression through all levels of consciousness and unconsciousness with emphasis on the distinction between the conscious and unconscious state; Administering and monitoring the flow of nitrous oxide, including the monitoring of a patient’s vital functions; Recognition and management of complications and medical emergencies; Occupational exposure; and Preventing, recognizing, and managing possible complications of inhalation sedation; and 2 hours of clinical training, including the direct observation of the performance of procedures. A dental hygienist holding an active certification or who is otherwise recognized in another state to administer nitrous oxide may be granted recognition to administer nitrous oxide without taking and passing the Board-approved course if the dental hygienist: Has successfully administered nitrous oxide to at least 10 dental patients within the 2-year period immediately preceding the date of application without complications; Has passed the CDCA Nitrous Oxide Examination for Dental Hygienists; and Applies for and receives recognition by the Board as qualified to administer nitrous oxide. The experience requirements of §A(1) of this regulation may not be obtained as an undergraduate dental hygiene student. A dental hygienist who administers nitrous oxide shall enter clinic details of the procedure during and after the procedure into the patient’s dental record. A dental hygienist may not administer nitrous oxide to more than one patient at a time. A dental hygienist who administers nitrous oxide to a patient may not: Treat any other patient during the course of the initiation, adjustment, monitoring, or termination of the flow of nitrous oxide; or Leave the operatory during the initiation, adjustment, monitoring, or termination of the flow of nitrous oxide except in emergency circumstances. The dental hygienist may remove the patient from nitrous oxide when the procedures have been completed. The supervising dentist shall remain in the dental office and in appropriate proximity to be summoned in the event of an emergency. A dentist that utilizes a dental hygienist to administer nitrous oxide shall have a medical emergency plan for the dental hygienist to follow in the event of an emergency. In the event of an emergency, the dental hygienist may turn off the nitrous oxide and administer 100 percent oxygen. In the event of an emergency the dental hygienist shall immediately summon the supervising dentist. A dental hygienist who has successfully completed the following since graduating from an approved school of dental hygiene may receive continuing education credit toward renewal of their dental hygiene license: The 6-hour Board-approved course of instruction for administering nitrous oxide; and The CDCA Nitrous Oxide Examination for Dental Hygienists. A dental hygienist shall submit a completed Board-approved application with the Board to be recognized as qualified to administer nitrous oxide. Recognized as Qualified to Administer Nitrous Oxide. Not Certified or Otherwise Recognized in Another State. A dental hygienist who applies to be recognized as qualified to administer nitrous oxide and who is not certified or otherwise recognized in another state to administer nitrous oxide shall submit to the Board: A completed Board-approved application; Proof of completion of a 6-hour Board-approved course of instruction in administering nitrous oxide in the form of a letter from an accredited dental hygiene program indicating that the applicant has: Successfully completed the course; and Received an overall passing grade of at least 75 percent in both the course's written examination and the course's clinical examination; A certified examination score from the CDCA indicating that the applicant has passed the CDCA Nitrous Oxide Examination for Dental Hygienists. A fee as specified in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. Recognized as Qualified to Administer Nitrous Oxide by Virtue of Being Recognized in Another State. A dental hygienist who applies to be recognized as qualified to administer nitrous oxide by virtue of being certified or otherwise recognized in another state to administer nitrous oxide shall submit the following to the Board: A Board-approved application; A certified copy of the dental hygienist's most recent license or certification from the state of licensure or certification, indicating that the dental hygienist holds a current license or certification to administer nitrous oxide; A certified examination score from the CDCA indicating that the applicant has passed the CDCA Nitrous Oxide Examination for Dental Hygienists; An affidavit indicating that the dental hygienist has within the 2-year period immediately preceding the date of the application successfully administered nitrous oxide to at least 10 dental patients without complications; A fee as specified in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. The affidavit referenced in §B(2)(d) of this regulation shall contain the name, business address, and business telephone number of each dentist who supervised the applicant’s administration of nitrous oxide, as well as a statement indicating whether the dentist is currently practicing dentistry, is retired, or is deceased; The letter from the accredited dental hygiene program referenced in §B(1)(b) of this regulation shall: Be on the letterhead of the accredited dental hygiene program; Contain a raised embossed school seal; and Contain the original signature of either: The Dean of the accredited dental hygiene program; or The head of the dental hygiene department. The fee required under §B(1)(d) of this regulation shall be waived for a dental hygienist who applies for recognition to administer nitrous oxide if the dental hygienist: Holds a recognition issued by the Board to monitor a patient to whom nitrous oxide has been administered; Has taken and passed the CDCA Nitrous Oxide Examination for Dental Hygienists; and Otherwise meets the requirements to administer nitrous oxide established under this chapter. A dental hygienist recognized by the Board as qualified to either monitor or administer nitrous oxide shall display the recognition conspicuously in the office where the holder is engaged in practice. The Board shall recognize the joint classification of recognized to prescribe and administer medication. A dental hygienist may not prescribe or administer medication unless recognized by the Board as being qualified to do so as provided in this chapter. A dental hygienist may not dispense medication. A dental hygienist who is recognized by the Board to prescribe medication may, under the general supervision of a dentist, prescribe: Topical and systemic types of prescription or over-the-counter fluoride preparations; Topical antimicrobial rinses; and Ibuprofen not exceeding 600 mg every 6 hours for up to 3 days after nonsurgical periodontal therapy. A dental hygienist may not prescribe a drug: That is classified as a controlled dangerous substance under Criminal Law Article, Title 5, Annotated Code of Maryland; That is a controlled dangerous substance as defined by 21 U.S.C. §812; or The prescription of which requires a federal Drug Enforcement Agency registration. A dental hygienist may prescribe a medication under §A of this regulation under a standing order in the patient’s record that is authorized by the supervising dentist, if the dental hygienist includes the following information in the patient’s record: The name of the medication; The dosage of the medication; The date and time the medication was administered; The route by which the medication was administered; and Any allergies that the patient has. The standing order entered into the patient’s record by the supervising dentist shall include at least: The name of the medication; The dosage of the medication; and The particular circumstances under which the medication should be administered. In addition to the requirements of §D of this regulation, the standing order entered into the patient’s record by the supervising dentist shall identify any allergies that the patient has. A dental hygienist who is recognized by the Board to administer medication may, under the general supervision of a dentist, administer medication including: Topical and systemic types of prescription or over-the-counter fluoride preparations; Topical antimicrobial rinses; Ibuprofen not exceeding 600 mg every 6 hours for up to 3 days after nonsurgical periodontal therapy; Premedication antibiotics by mouth as required for dental treatment; Subgingival antibiotics and antimicrobials; and Nonopioid pain medication. A dental hygienist may not administer a medication: That is classified as a controlled dangerous substance under Criminal Law Article, Title 5, Subtitle 4, Annotated Code of Maryland, or a controlled substance as defined by 21 U.S.C. §812; The prescription of which requires a federal Drug Enforcement Agency Registration; or Except for local anesthesia that is administered by intramuscular, subcutaneous, intravenous, or intradermal injection and administered in accordance with Health Occupations Article, §4-206.1 or 4-206.3, Annotated Code of Maryland, and this chapter. A dental hygienist may administer a medication under §A of this regulation under a standing order in the patient’s record that is authorized by the supervising dentist, if the dental hygienist includes the following information in the patient’s record: The name of the medication; The dosage of the medication; The date and time the medication was administered; and The route by which the medication was administered. The standing order entered into the patient’s record by the supervising dentist shall include at least the: Name of the medication; Dosage of the medication; Particular circumstances under which the medication should: Be administered; or Not be administered. A dental hygienist who wishes to receive recognition by the Board as being qualified to prescribe and administer medication shall: Hold an active license to practice dental hygiene in this State; and Successfully complete a Board-approved course of at least 4 hours consisting of at least 4 hours of didactic training. A dental hygienist shall pass a written examination administered by the Board-approved course with an overall passing grade of at least 75 percent. The examination shall consist of at least 25 questions with a time limit of no more than 60 minutes to complete the examination. The Board-approved course of instruction in prescribing and administering medication may be obtained by: A dental hygienist while an undergraduate student in a Board-approved school for dental hygiene that is accredited by the American Dental Association Committee on Dental Accreditation or its successor organization; or A dental hygienist who completes the course offered by an accredited dental hygiene program. The course offered by the accredited dental hygiene program may be completed in-person or online. The 4-hour Board-approved course of instruction shall include but not be limited to the following: Responsible medication prescribing; Accuracy in prescription writing; Electronic prescribing; Telephonic prescribing; Professional accountability; Risk management; Safeguarding prescription pads; Application for a National Provider Identifier number; Principles of and prohibitions against drug dispensing by dental hygienists; Chairside medication administration; Proper storage and disposal of medications; Labeling requirements; Drug classifications and scheduling; Controlled substances: The role of the federal Drug Enforcement Agency; and The Maryland Prescription Drug Monitoring Program; Recognizing and addressing drug abuse; Review of medical history; Questioning patients for safe prescribing; Drug Interactions; Premedication — antibiotic prophylaxis; American Dental Hygienists’ Association guidelines for prescribing and administering medication; Drug recommendations and dosing; Adverse reactions and hypersensitivities; Medical emergencies and emergency drugs; Adjuvant therapy for nonsurgical periodontal treatment: Evidence-based decision making for drug therapy; Conditions and recommended therapies; Pharmacokinetics — the effect of drugs on the body; Pharmacodynamics — drug processing; Specific medications: Local anesthetics: Antimicrobials — subgingival and systemic; Nonsteroidal anti-inflammatory drugs; Fluoride preparations; Over-the-counter medications; Nutraceuticals and herbal supplements; and Vitamin and mineral supplements; Record-keeping requirements for medications prescribed and administered; and Patient follow-up care. A dental hygienist holding an active certification or who is otherwise recognized in another state to prescribe and administer medication may be granted recognition to prescribe and administer medication without taking and passing the Board-approved course if the dental hygienist: Has prescribed medication to at least 100 dental patients within the 2-year period immediately preceding the date of application without complications; Has administered medication to at least 100 dental patients within the 2-year period immediately preceding the date of application without complications; and Applies for and receives recognition by the Board as qualified to prescribe and administer medication. The application referred to in §A(3) of this regulation shall include a signed Board-approved affidavit affirming the experience requirements. The experience requirements of §A(1) and (2) of this regulation may not be obtained as an undergraduate dental hygiene student. A dentist who supervises a dental hygienist who is recognized by the Board to prescribe and administer medication shall have a medical emergency plan for the dental hygienist to follow in the event of an emergency. In the event of an emergency, the dental hygienist shall immediately summon the supervising dentist. A dental hygienist who successfully completes the 4-hour Board-approved course of instruction for prescribing and administering medication since graduating from an approved school of dental hygiene may receive 4 hours of continuing education credit toward renewal of their dental hygiene license. A dental hygienist shall submit a completed Board-approved application with the Board to be recognized as qualified to prescribe and administer medication. Recognized as Qualified to Prescribe and Administer Medication. Not Certified or Otherwise Recognized in Another State. A dental hygienist who applies to be recognized as qualified to prescribe and administer medication and who is not certified or otherwise recognized in another state to prescribe and administer medication shall submit to the Board: A completed Board-approved application; Proof of completion of a 4-hour Board-approved course of instruction in prescribing and administering medication in the form of a letter from an accredited dental hygiene program indicating that the applicant has: Successfully completed the course; and Received an overall passing grade of at least 75 percent in the course’s written examination; A fee as specified in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. Recognized as Qualified to Prescribe and Administer Medication by Virtue of Being Recognized in Another State. A dental hygienist who applies to be recognized as qualified to prescribe and administer medication by virtue of being certified or otherwise recognized as qualified in another state to prescribe and administer medication shall submit to the Board: A Board-approved application; A certified copy of the dental hygienist’s most recent license or certification from the state of licensure or certification, indicating that the dental hygienist holds a current license or certification to prescribe and administer medication; An affidavit indicating that the dental hygienist has within the 2-year period immediately preceding the date of the application successfully: Prescribed medication to at least 100 patients without complications; and Administered medication to at least 100 patients without complications; A fee as specified in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. The affidavit referenced in §B(2)(c) of this regulation shall contain the name, business address, and business telephone number of each dentist who supervised the applicant’s prescribing and administering medication as well as a statement indicating whether the dentist is currently practicing dentistry, is retired, or is deceased. The letter from the accredited dental hygiene program referenced in §B(1)(b) of this regulation shall: Be on the letterhead of the accredited dental hygiene program; Contain a raised embossed school seal; and Contain the original signature of either: The dean of the accredited dental hygiene program; or The head of the dental hygiene department. The Board may issue a recognition as qualified to prescribe and administer medication to a dental hygienist who is not certified or otherwise recognized in another state after the Board’s review of: The applicant’s application; The applicant’s qualifications; and Any other pertinent documents or information requested by the Board. The Board may issue a recognition as qualified to prescribe and administer medication to a dental hygienist who is certified or otherwise recognized in another state after the Board’s review of: The applicant’s application and accompanying affidavit; The applicant’s qualifications; and Any other pertinent documents or information requested by the Board. A dental hygienist is not required to renew the Board recognition to prescribe and administer medication. A dental hygienist who has successfully completed the 4-hour Board-approved course of instruction for recognition to prescribe and administer medication since graduating from an approved school of dental hygiene may receive 4-hours of continuing education credit toward renewal of their dental hygiene license. A dental hygienist recognized by the Board to prescribe and administer medication shall display the recognition conspicuously in the office where the holder is engaged in practice. Subject to the hearing provisions of Health Occupations Article, §4-318, Annotated Code of Maryland, the Board may take the following action against a dental hygienist who violates any provision of this chapter or who violates any provision of Health Occupations Article, §4-315(b), Annotated Code of Maryland: Deny, suspend, or revoke the recognition to administer local anesthesia; Deny the privilege to perform manual curettage in conjunction with scaling and root planning; Deny, suspend, or revoke the recognition to administer nitrous oxide; Suspend or revoke the recognition to monitor nitrous oxide; Deny, suspend, or revoke the recognition to prescribe and administer medication; Issue a reprimand; and Take disciplinary action under Health Occupations Article, §4-315(b), Annotated Code of Maryland. In addition to the action authorized under §A of this regulation, the Board may take formal or informal disciplinary action as specified in COMAR 10.44.07. Failure to comply with this chapter constitutes unprofessional conduct and may constitute other violations of law. The Board may order the summary suspension of the recognition qualified to administer local anesthesia, the privilege to perform manual curettage in conjunction with scaling and root planning, the recognition qualified to monitor nitrous oxide, the recognition to administer nitrous oxide, or the recognition to prescribe and administer medication if the Board: Finds that the public health, safety, or welfare imperatively requires emergency action; and Promptly gives the licensee: Written notice of the suspension, the finding, and the reasons that support the finding; and An opportunity to be heard. Service of the notice of the suspension, the finding, the reasons that support the finding, and the notice of the opportunity to be heard may be effected upon the holder of the recognition by: Personal service; or Written notice sent by certified mail and regular mail to the recognition holder's address on file with the Board. Service made pursuant to §B(2) of this regulation shall be effective upon mailing. The methods of service provided in this regulation are in addition to and not exclusive of any other means of service that are reasonably calculated to provide notice. Health Occupations Article, §§4-205, 4-206.1, 4-206.2 4-206.3, 4-206.4, and 12-101, Annotated Code of Maryland Effective date: November 18, 1977 (4:24 Md. R. 1806) Chapter revised effective April 22, 1985 (12:8 Md. R. 803) Regulation .01-1 adopted effective May 31, 2010 (37:11 Md. R. 765) Regulation .02 amended effective January 21, 2002 (29:1 Md. R. 23); May 31, 2010 (37:11 Md. R. 765) Regulation .03 amended effective January 21, 2002 (29:1 Md. R. 23); May 31, 2010 (37:11 Md. R. 765) Regulations .04—.16 adopted effective May 31, 2010 (37:11 Md. R. 765) Regulations .01—.16 repealed and new Regulations .01—.28 adopted effective April 29, 2013 (40:8 Md. R. 724) Chapter revised effective November 24, 2016 (43:23 Md. R. 1279) Chapter revised effective September 5, 2022 (49:18 Md. R. 819) In this chapter, the following terms have the meaning indicated. Terms Defined. “ADEX” means the American Board of Dental Examiners, Inc., or its successor organization. “ADLEX” means the American Dental Licensing Examination, which includes both a written component and a clinic component, designed and developed by ADEX, or its successor examination. “Board” means the Maryland State Board of Dental Examiners. A dentist holding an active license in any other state may be granted a license in Maryland if the applicant: Meets the requirements of Health Occupations Article, §4-306, Annotated Code of Maryland; Is of good moral character; Holds a Degree of Doctor of Dental Surgery, Doctor of Dental Medicine, or the equivalent from a college or university that is: Authorized by any state or province of Canada to grant the degree; and Recognized by the Board as: Requiring adequate preprofessional collegiate training; and Maintaining an acceptable course of dental instruction; and Meets the qualifications otherwise required by Health Occupations Article, Title 4, Annotated Code of Maryland, for an active general license to practice dentistry. In addition to meeting the requirements of Regulation .02 of this chapter, a dentist holding an active license in any other state shall be issued a license if the applicant: Has passed the ADLEX with a score of 75 or greater in each required section; and Has passed the Maryland Dental Jurisprudence Examination given by the Board or its designee with a score of 75 or greater on each section of the examination. In addition to the requirements of §A of this regulation, a candidate holding an active license in another state, or who has ever held an active license in another state, shall provide adequate evidence satisfactory to the Board that the candidate: Is not being investigated by a disciplinary authority of another state: Does not have charges pending against the applicant’s license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland. In addition to meeting the requirements of Regulation .02 of this chapter, a dentist holding an active license in another state who has not passed the ADLEX examination with a score of 75 or greater in each required section of the ADLEX shall be issued a license if the applicant: For the 5 preceding years has been actively engaged in practicing dentistry for at least 850 hours on average per year; Has passed an examination with a clinical component as a requirement for licensure in another state; Has passed a comprehensive written examination on applied clinical diagnosis and treatment planning administered by ADEX with a score of 75 or greater in each required section; and Has passed the Maryland Dental Jurisprudence Examination given by the Board or its designee with a score of 75 or greater percent on each section of the examination. The practice of dentistry in the armed forces, the practice of dentistry in state and federal programs, participation in post-graduate intern programs, or participation in residency programs within the 5 years preceding application counts toward the required hours of active practice. An applicant who has passed the ADLEX with a score of 75 or greater in each required section shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead, bearing an original signature, do not require a raised embossed seal; A certified examination score of the ADLEX and, if requested by the Board, a specific point breakdown by procedure including penalty deductions if available; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant holds an active dental license or ever held an active dental license indicating that the license is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. An applicant who has not passed the ADLEX with a score of 75 or greater in each required section of the ADLEX shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead, bearing an original signature, do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant holds an active dental license or ever held an active dental license indicating that the license is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A notarized affidavit or other evidence satisfactory to the Board indicating that for the 5 preceding years the applicant has been actively engaged in practicing dentistry for at least 850 hours on average per year; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The application fee shall accompany the application and is specified in COMAR 10.44.20. The application fee is nonrefundable. Health Occupations Article, §§4-303.1(d) and 4-306, Annotated Code of Maryland Effective date: May 25, 1977 (4:11 Md. R. 868) Regulation .01 recodified to Regulation .01-1 and the Preface recodified to Regulation .01 in November 1990 Regulation .01 amended effective April 19, 1999 (26:8 Md. R. 615) Regulation .01-1 amended effective April 19, 1999 (26:8 Md. R. 615) Regulation .02A amended effective April 19, 1999 (26:8 Md. R. 615) Regulation .02B amended effective September 3, 1990 (17:17 Md. R. 2081); April 19, 1999 (26:8 Md. R. 615); September 17, 2001 (28:18 Md. R. 1621) Regulation .03 amended effective April 12, 1982 (9:7 Md. R. 711); April 19, 1999 (26:8 Md. R. 615) Regulation .04D adopted effective April 12, 1982 (9:7 Md. R. 711) Regulation .04D amended effective September 3, 1990 (17:17 Md. R. 2081) Regulation .05A amended effective April 19, 1999 (26:8 Md. R. 615) Regulations .01—.05 repealed and new Regulations .01 — .05 adopted effective December 22, 2003 (30:25 Md. R. 1848) Regulation .04 amended effective August 16, 2004 (31:16 Md. R. 1255) Regulations .01—.05 repealed and new Regulations .01 — .06 adopted as an emergency provision effective October 1, 2012 (39:22 Md. R. 1426); adopted permanently effective December 24, 2012 (39:25 Md. R. 1613) In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Dental Examiners. “Dentist” means an individual who holds a current license to practice dentistry in Maryland. “General dentist” means a dentist not recognized by the Board as a specialist in an area of dental specialty. A dentist may not, on behalf of himself, his partner, or his associate, or for any other dentist affiliated with him, use or participate in the use of any form of public communication which contains a deceptive or misleading statement or claim. Deceptive or misleading statements or claims are those that: Contain a material misrepresentation of fact; Fail to state any fact necessary to make the statement not misleading; Are intended or are likely to create unjustified expectations; State or imply that a dentist is a certified or recognized specialist other than as recognized by the Board; State or imply superior service; Contain a representation or implication that is likely to cause an ordinary prudent person to misunderstand or to be deceived; Contain statistical data or other information based on past performance coupled with an explicit representation that the data or information indicates a likelihood of future success; Contain or imply any guarantee of satisfaction, except the guarantee to return a fee if the patient is not satisfied with the treatment rendered; Use electronic media, including television, radio, and motion pictures, in a manner inconsistent with these regulations and the following criteria: Broadcast advertising shall be communicated to the public only over radio or television stations that are approved by the Federal Communications Commission or over cable television, Broadcast advertisements shall be prerecorded, and approved for broadcast by the advertising dentist, and A recording of the actual transmission shall be retained by the advertising dentist for a period of 3 years; Fail to include the name of a responsible licensed dentist who provides dental services at the location advertised; or State or imply that a dentist practices in an area of dental specialty unless the dentist: Is recognized by the Board as a specialist in the area advertised, Includes in the advertisement a disclaimer that the dentist is not recognized by the Board as a specialist in the area of practice advertised, or Includes in the advertisement a statement that the dentist is a general dentist. A statement regarding fees shall be considered deceptive or misleading if the dentist: Renders the service at more than the fees advertised; Fails to offer the service at the fee advertised for a reasonable period of time following the advertisement unless a specific time limit is included in the original advertisement. A dentist shall be responsible for an advertisement of service regardless of whether the advertising has been generated by him personally, by his employees, or by a proprietorship, partnership, corporation, union, public school clinic, state institution, or eleemosynary institution which uses his services. Violations of these regulations pertaining to the use of advertising shall constitute unprofessional conduct and may result in disciplinary action against the dentist as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. A dentist shall: Retain a copy of all advertising, in the form in which it was published, for a period of 3 years from the date of publication; and Make the copy available for inspection and copying when requested by the Board. Health Occupations Article, §§4-205, 4-315, and 4-503, Annotated Code of Maryland Effective date: January 23, 1981 (8:2 Md. R. 112) Regulation .02 amended effective November 2, 1998 (25:22 Md. R. 1652) Regulation .03B amended effective February 19, 1990 (17:3 Md. R. 300); November 2, 1998 (25:22 Md. R. 1652) Regulation .07 adopted effective July 12, 1998 (25:14 Md. R. 1132) Chapter revised effective December 10, 2001 (28:24 Md. R. 2129) Regulation .02B amended effective August 16, 2004 (31:16 Md. R. 1255); April 30, 2012 (39:8 Md. R. 536) This chapter governs procedures for disciplinary matters and hearings before the State Board of Dental Examiners. In this chapter, the following terms have the meanings indicated. Terms Defined. “Administrative law judge” means the hearing officer assigned to preside over a hearing in a case the Board has delegated to the Office of Administrative Hearings. “Administrative Procedure Act” means State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland, which governs contested cases arising from charges brought by the Board. “Administrative prosecutor” means the attorney assigned by the Office of the Attorney General to prosecute disciplinary charges for the Board. “Advisory letter” means an informal action consisting of a nonpublic letter issued by the Board where the Board has a basis to charge the licensee with disciplinary violations but closes the case by advising the licensee of the basis to charge and admonishes the licensee not to repeat the conduct. “Board” means the State Board of Dental Examiners. “Case resolution conference” means an informal, confidential meeting between the parties to a contested case and the Board's case resolution conference committee to discuss possible settlement of a disciplinary matter pending before the Board. “Case resolution conference committee” means a committee composed of members of the Board that makes recommendations to the Board regarding settlement of disciplinary matters. “Cease and desist letter” means an informal action consisting of a nonpublic letter issued by the Board ordering: A licensee to cease doing a specified activity; or An unlicensed individual to cease the unauthorized practice of dentistry or dental hygiene. “Charging document” means a nonpublic document issued by the Board which: Alleges conduct by a licensee which the Board believes constitutes a violation under the Maryland Dentistry Act; Sets forth provisions of the Maryland Dentistry Act that the Board believes were violated; and Provides notice to the licensee of disciplinary proceedings before the Board. “Complaint” means information received by the Board which sets out conduct by a licensee which may: Violate the Maryland Dentistry Act; and Be grounds for an investigation or disciplinary action by the Board. “Consent agreement” means informal action taken by the Board consisting of a nonpublic document which has been negotiated and agreed to by both the licensee and the Board to resolve an administrative, nondisciplinary matter. “Consent order” means a public document issued by the Board which is a final order of the Board that has been negotiated and agreed to by both the licensee and the Board to resolve a disciplinary matter. “Contested case” means a proceeding conducted pursuant to the Administrative Procedure Act. “Disciplinary review committee” means a committee composed of members of the Board that makes recommendations to the Board regarding any disciplinary matter. “Disposition agreement” means a formal nonpublic agreement entered into with an impaired licensee instead of formal disciplinary action, in which the licensee agrees to comply with certain conditions. “Final order” means a public document issued by the Board resolving a contested case either by consent or after an adjudication, which includes findings of fact, conclusions of law, and a disposition which: Denies a license; Sanctions by reprimand, probation, civil penalty, or suspension or revocation of a license; Summarily suspends a license; Dismisses charges; Provides for surrender of a license; or Takes any other action that the Board may take. “Imperatively requires emergency action” means a finding by the Board that emergency action be taken against a licensee under State Government Article, §10-226(c)(2), Annotated Code of Maryland, based on investigative facts that raise a substantial likelihood of risk of harm to the public health, safety, or welfare before a full evidentiary hearing can be held. “Informal action” means that the Board closes a case without taking any formal disciplinary action and without issuing a final order. “Investigation” means the gathering of information after the Board receives a complaint against a licensee, which is necessary for the Board to determine if there is reasonable cause to charge a licensee with a violation of the Maryland Dentistry Act. “Letter of education” means informal action consisting of a nonpublic letter to a licensee: Issued by the Board if the Board does not believe that the licensee's conduct rose to the level of a violation of the Maryland Dental Act; and In which the Board educates the licensee concerning the laws and standards of the practice of dentistry or dental hygiene. Letter of Surrender. “Letter of surrender” means a public letter accepted by the Board in which the licensee agrees to surrender the licensee's license to practice dentistry or dental hygiene. “Letter of Surrender” may include conditions for the Board's acceptance of the surrender. “Licensure” means the permission granted to an individual by the Board pursuant to the Board's authority under the Maryland Dentistry Act to practice dentistry or dental hygiene in this State which is evidenced by a license issued by the Board. “Maryland Dentistry Act” means Health Occupations Article, Title 4, Annotated Code of Maryland. “Notice of initial denial” means a nonpublic document issued by the Board by which an applicant or licensee is notified: That the Board intends to deny: A license; A change in licensure status; or Another benefit sought by the licensee; Of the statutory grounds or other reasons for the denial; and Of any proceedings scheduled before the Board. “Peer review” means an evaluation by appropriate members of a professional association or one of its components of a: Licensee's clinical care; or Dispute between a dentist and a consumer of dental services. “Postdeprivation evidentiary hearing” means a contested case hearing held before the Board after the Board has issued an order for summary suspension under State Government Article, §10-226(c)(2), Annotated Code of Maryland, in which the licensee may challenge the Board's basis for issuing the order for summary suspension. “Postdeprivation show cause hearing” means a nonevidentiary hearing held before the Board at which the licensee has an opportunity to demonstrate to the Board why the order for summary suspension issued under State Government Article, §10-226(c)(2), Annotated Code of Maryland, should not remain in effect. “Predeprivation hearing” means a nonevidentiary, show cause hearing held before the Board at which the licensee has an opportunity to demonstrate to the Board why it should not: Issue an order for summary suspension under State Government Article, §10-226 (c)(2), Annotated Code of Maryland; or Take another action that the Board may take. “Preliminary investigation” means the gathering of information necessary for the Board to determine if the Board should dismiss a complaint or conduct further investigation to determine if there is reasonable cause to charge a licensee with a violation of the Maryland Dentistry Act. “Probation” means a sanction imposed by the Board in a final order, in which the licensee is: Monitored by the Board for a period of time; and Subject to certain requirements to avoid further disciplinary action. “Public document” means a document that the Board is permitted or required to disclose to the public under State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland. “Recommended decision” means a nonpublic document issued by an administrative law judge that sets out proposed findings of fact, proposed conclusions of law, a proposed sanction, or any combination of them, under a delegation by the Board. “Recusal” means the disqualification of a member of the Board from participation in a proceeding because of interest, bias, or other reason. “Respondent” means a licensee, subject to the jurisdiction of the Board, that has been: Charged with violations of Health Occupations Article, §4-315, Annotated Code of Maryland; Notified that the Board intends to initially deny a license, change a licensee's status, or deny another benefit sought by the licensee; Notified of a potential emergency suspension of licensure; or Notified of the opportunity to appear before the Board to respond to allegations by the Board in a contested case. “Reprimand” means a sanction imposed by the Board in a final order in which the Board publicly admonishes the licensee for violating the Maryland Dentistry Act. “Revocation” means a sanction imposed by the Board in a final order in which the licensee's permission to practice dentistry or dental hygiene in Maryland is terminated. “Sanction” means an action taken against a licensee by the Board in a final order, which includes one or a combination of the following: A reprimand; Probation; Suspension or revocation of the license; or A civil penalty. “Show cause hearing” means a nonevidentiary hearing before the Board in which the licensee may demonstrate to the Board why the Board should not: Issue a proposed order; Continue an order currently in effect; or Take an action that the Board may take. “Stay” means the withholding of an action ordered by the Board which may be subject to certain conditions. “Summary suspension” means the indefinite suspension of a license under State Government Article, §10-226(c)(2), Annotated Code of Maryland, issued if the Board believes that the action is necessary to protect the public health, safety, or welfare. “Surrender” means the voluntary relinquishment of a license to practice dentistry or dental hygiene that may be subject to certain conditions set by the Board. “Suspension” means a sanction imposed by the Board in a final order in which the licensee's ability to practice dentistry or dental hygiene is temporarily denied for a specific period of time or until certain conditions are met. “Triage Committee” means a committee composed of members of the Board to which newly filed complaints are referred for initial recommendation before review by the Discipline Review Committee. Except as otherwise provided by law, the proceedings of the Board are confidential and that confidentiality may not be waived by the parties. Office of Administrative Hearings proceedings involving the adjudication of a contested case and the administrative law judge's recommended decision are confidential. The respondent may not waive the confidentiality of the proceedings or of the patients whose medical or dental records or care are reflected in the record of the proceedings. To the extent possible, even after a final order is issued by the Board, the parties shall refrain from revealing legal documents, oral statements, or information that would reveal the identity of any patients referred to in the Board's order. Every party who appears at a formal hearing has the right to appear in proper person or by or with counsel. If the matter goes to a hearing, the respondent shall be represented only by an attorney who has been admitted to the Maryland Bar or specially admitted to practice law under Maryland Rules, Rules Governing Admission to the Bar of Maryland, Rule 14. The administrative prosecutor assigned to a disciplinary matter by the Office of the Attorney General shall prosecute the disciplinary matter in Board proceedings. In all proceedings, the Board shall be represented by and obtain advice from counsel assigned to it by the Office of the Attorney General. The Board may commence proceedings or open an investigation under Health Occupations Article, §4-315, Annotated Code of Maryland, after the filing of a complaint: Received from an individual who is not a member of the Board; or Completed by the Board on its own initiative and signed by a member of the Board. If a person who is not a member of the Board files a complaint, the complaint shall: Be completed on a Board-approved form; Be in writing; Allege facts such that the Board may determine whether the facts may constitute violations of the Maryland Dentistry Act or the regulations adopted by the Board; Contain a Release of Medical Records and a Release of Additional Information; Contain an affidavit indicating that the matters set forth in the complaint are true to the best of the knowledge, information, and belief of the complainant; and Be signed by the complainant. The Board may accept a complaint for filing that substantially fulfills the requirements of this regulation. Absent extenuating circumstances, the Board shall send a letter to the complainant or the complainant’s representative acknowledging receipt of the complaint within 45 days of its filing. The letter referred to in §D of this regulation shall: Contain a brief explanation of the Board’s complaint process; and Advise the complainant that the complaint may ultimately: Be dismissed; Be referred to a Peer Review Committee; Result in an informal action; or Result in a final order. The Board may not bring disciplinary charges against a respondent based solely on events contained in a complaint the Board receives more than 6 years after: The day the complainant actually discovered the facts that form the basis of the complaint; or The day when a reasonable person exercising due diligence should have discovered the facts that form the basis of the complaint. The provisions of §F of this regulation may not apply to a complaint based on: Criminal convictions or sexual misconduct or other similar boundary violations; Reciprocal disciplinary matters; Ongoing substance abuse; Fraudulent concealment of material information; or Acts that occur while a patient is a minor. The Board shall log in and assign a case number to complaints that meet the requirements of this chapter. Complaints that do not meet the requirements of this chapter shall be returned to the complainant with a brief explanation of why the complaint was returned. Complaints shall be referred to the Board’s Triage Committee. To the extent practicable, filed complaints shall be presented to the Board’s Triage Committee within 60 days of their receipt. To the extent practicable, the Board’s staff shall remove the respondent’s name and address from complaint before the documents are reviewed by the Triage Committee. The name and address of the respondent shall appear on documents that are referred from the: Triage Committee to the Discipline Review Committee; or Discipline Review Committee to the Board. After review of the complaint, the Triage Committee shall make recommendations to the Board’s Discipline Review Committee (DRC). The Triage Committee may make the following recommendations to the DRC: Dismiss the complaint; Close the case with informal action; Issue an advisory letter or letter of education; Issue a cease and desist order; Mail or deliver to the respondent a request for: A response to the complaint and a request for patient records; A response to the complaint only; or Patient records only; Refer the case to peer review for mediation; Refer the matter to the: Dental Well-Being Committee; or Dental Hygiene Well-Being Committee; Refer the matter to another governmental agency or other regulatory agency; Refer the matter for further investigation; Refer the matter to an administrative prosecutor; Request any other information or documentation from any person that the committee deems relevant to the disposition of the complaint; or Any other recommendation that the Triage Committee may make to the Board. Participation in the Triage Committee is not a basis for recusal of a Board member, Board counsel, or the administrative prosecutor from further proceedings in a case. The DRC shall: Consider and vote on the recommendations of the Triage Committee; Review documents received by the Board during the course of the Board’s investigations; and Make recommendations to the Board for the disposition of the complaint for the Board’s vote. When considering the recommendations of the Triage Committee, the DRC may vote to: Accept all of the recommendations of the Triage Committee; Accept some of the recommendations of the Triage Committee; Accept none of the recommendations of the Triage Committee; or Make any other recommendations. After receiving recommendations from the Triage Committee, the DRC, without Board approval, may vote to: Mail or deliver to the respondent a request for: A response to the complaint and a request for patient records; A response to the complaint only; or Patient records only; Mail or deliver to any person a request for information; or Refer the matter for further investigation. Complaints may be referred directly to the DRC without prior review by the Triage Committee. The DRC may make the following recommendations to the Board: Dismiss the complaint; Place the case on administrative hold; Close the case; Issue an advisory letter or letter of education; Issue a cease and desist order; Refer the case to peer review for mediation; Mail or deliver to the respondent a request for: A response to the complaint and a request for patient records; A response to the complaint only; or Patient records only; Mail or deliver to any person a request for information; Refer the matter to the: Dental Well-Being Committee; or Dental Hygiene Well-Being Committee; Refer the matter for further investigation; Refer the matter to an administrative prosecutor; Request other information or documentation from any person that the committee deems relevant to the disposition of the complaint; or Any other recommendation that the DRC may make to the Board. For each complaint, after reviewing any completed investigative information or reports and considering the recommendation of the Triage Committee or Discipline Review Committee, if applicable, the Board shall: Dismiss the complaint; Place the case on administrative hold; Close the case; Refer the case to peer review for mediation; Refer the matter to the: Dental Well-Being Committee; Dental Hygiene Well-Being Committee; Close the case with informal action; Issue a cease and desist order; Refer the matter for further investigation; Refer the matter to an administrative prosecutor; or Vote to: Charge a licensee with a violation of Health Occupations Article, §4-315, Annotated Code of Maryland, or the regulations adopted by the Board; Consider the matter as a basis for summary suspension under State Government Article, §10-226(c)(2), Annotated Code of Maryland; Initially deny: Licensure or reinstatement of a license; or Certification or reinstatement of a certificate; Accept the surrender of a license subject to conditions acceptable to the Board; or Take any other action the Board is authorized to take. The Board may refer a complaint or other disciplinary matter to the administrative prosecutor at any time, regardless of whether it has voted to charge a licensee with violations of the Maryland Dentistry Act or the regulations adopted by the Board. If the Board investigates a complaint, the Board shall mail a copy of the complaint to the respondent unless: The complaint alleges facts which may constitute fraud or dishonesty; or Disclosing the complaint may prejudice the investigation. Absent exigent circumstances, the Board shall grant a person at least 10 calendar days to: Provide the Board with requested documents; or File a written response to a request for information. Board investigations are warranted when there is evidence that the respondent or other person may have violated the Maryland Dentistry Act or the regulations adopted by the Board. A matter that may serve as a basis for summary suspension under State Government Article, §10-226(c)(2), Annotated Code of Maryland, may be referred directly to: The DRC; The Board; or The Administrative Prosecutor. The Board's DRC shall: Review complaints; and Make a recommendation to the Board as to the disposition of the complaint. Participation in the Disciplinary Review Committee is not a basis for recusal of a Board member, Board counsel, or the administrative prosecutor from further proceedings in a complaint. If the Board votes to refer a matter to an investigator, to the extent practicable, the complaint shall be assigned to an investigator within 3 business days of the Board’s vote. An investigator shall provide periodic reports to the complainant or the complainant’s representative within the bounds of the Maryland Public Information Act or other applicable laws. To the extent practicable, an investigator shall strive to complete an initial investigative report within 180 days after a complaint is assigned. Factors that affect the length of time to complete an initial investigative report include but are not limited to: The number of alleged violations included in the complaint; The severity of the allegations in the complaint; The number of additional violations that arise as a result of the investigation of the complaint; The complexity of the legal issues encountered during the investigation; The cooperation or lack thereof of the respondent, counsel, and witnesses; The availability of the investigator; Other investigative priorities; The necessity and availability of additional required documents or findings from other agencies or authorities including but not limited to: Other governmental agencies or other regulatory agencies; Hospitals; The courts; and Law enforcement agencies. An initial investigative report shall be presented to the Board within 90 days of its completion. The failure to meet the goal of completing an initial investigative report within 180 days or the presentation to the Board of an initial investigative report within 90 days of its completion may not: Be raised as a defense by a respondent; and Be admissible by the respondent in any civil or administrative proceeding. An initial investigative report may also be a final investigative report. The Board shall advise the complainant or the complainant’s representative of the final disposition of a complaint within the bounds of the Maryland Public Information Act or other applicable laws. To the extent practicable, the Board shall mail copies of final orders to the respondent or to the respondent’s counsel within 15 days. If a complaint results in a final order against a respondent that is a public document under State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland, the Board shall mail a copy of the final order to the complainant or the complainant’s representative within 15 days. At the conclusion of a case the Board shall make reasonable efforts to return original medical records in its possession to the appropriate health care provider within 45 days. If the Board issues charges or a notice of initial denial, the Executive Director or an officer of the Board shall hand deliver or send the charges or notice of initial denial to the respondent's last known business and home addresses by certified mail. Charges or a notice of initial denial shall: Inform the respondent of the statutory basis for the charges or denial of licensure; Allege sufficient facts which the Board believes constitute either a basis for: Violation of the Maryland Dentistry Act; or Denial of licensure; Notify the respondent of: Any proceedings scheduled before the Board or of an opportunity to request a hearing within a certain period of time; and The consequences of failing to appear for those proceedings or of failing to request a hearing; and Be accompanied by a letter of procedure notifying respondent of the applicability of the Administrative Procedure Act to the Board's proceedings. If the Board is unable to serve the charges or notice of initial denial upon the respondent as described in §A of this regulation, the Board nevertheless may proceed in prosecuting the case. If the Board issues a notice of initial denial to an applicant for a license, the applicant may not withdraw the application without approval of the Board. Discovery on Request. By written request served on the other party and filed with the Board or the Office of Administrative Hearings, as appropriate, a party may request another party to produce, within 15 calendar days, the following: A list of the witnesses to be called; Copies of all documents intended to be produced at the hearing; or Both §A(1) and (2) of this regulation. Mandatory Discovery. Each party shall provide to the other party not later than 15 days before the prehearing conference, if scheduled, or 45 days before the scheduled hearing date, whichever is earlier: The name and curriculum vitae of any expert witness that will testify at the hearing; and A detailed written report summarizing the expert's testimony, which includes the opinion offered and the factual basis and reasons underlying the opinion. If the Board or the Office of Administrative Hearings, as appropriate, finds that the report is not sufficiently specific, or otherwise fails to comply with the requirements of this section, the testimony of the expert, and any report of the expert, shall be excluded from the hearing. The Board or the Office of Administrative Hearings, as appropriate, shall consider and decide arguments regarding the sufficiency of the report: At the prehearing conference, if scheduled; or Immediately before the scheduled hearing. If an expert adopts a sufficiently specific charging document as the expert's report, that adoption satisfies the requirements set forth in this section. Parties are not entitled to discovery of items other than those listed in §§A and B of this regulation. Both parties have a continuing duty to supplement their disclosures of witnesses and documents. Absent unforeseen circumstances which would impose an extraordinary hardship on a party, witnesses or documents may not be added to the list after: The prehearing conference, if scheduled; or If no prehearing conference is scheduled, 15 days before the hearing. The prohibition against adding witnesses or documents does not apply to witnesses or documents to be used for impeachment or rebuttal purposes. Construction. In hearings conducted by an administrative law judge of the Office of Administrative Hearings, this regulation shall be construed, whenever possible, as supplementing and in harmony with COMAR 28.02.01. In a conflict between this regulation and COMAR 28.02.01, this regulation applies. After service of charges or notice of initial denial, the Board shall offer a respondent the opportunity for a case resolution conference. At any other time during disciplinary proceedings, the Board may offer or the respondent may request a case resolution conference to discuss a disciplinary matter. The Board may grant or deny the respondent's request. Matters admitted, revealed, negotiated, or otherwise discussed at a case resolution conference are without prejudice and may not be used by the respondent, administrative prosecutor, or the Board in any subsequent proceedings, unless the information is otherwise discovered or available through another source. The recommendations of the case resolution conference committee are not binding on the Board, which may: Accept a proposed settlement; Modify a proposed settlement; or Reject the proposed settlement and require the respondent to proceed to a hearing. If the respondent and the administrative prosecutor are unable to reach an agreement for settlement, the case resolution conference committee may offer a proposed settlement agreement to the parties. If either the respondent or administrative prosecutor disagrees with the recommendation of the case resolution conference committee, either party may elect to proceed to a hearing in the matter regardless of whether the Board has ratified the recommendation of the case resolution conference committee. Participation in a case resolution conference is not ordinarily a basis for recusal of a Board member, Board counsel, or Board prosecutor from further proceedings in a case. Prehearing Conference. The Board may set a prehearing conference upon motion of either party, or on the Board's own motion. The prehearing conference may be used to: Attempt to settle the case; or Prepare for hearing by: Delineating the issues; Stipulating to the facts, laws, and other matters; Arranging a schedule; and Arranging for the submission of names of witnesses to be called and the subject matter of testimony to be presented in the hearing; and Accomplish any other purpose the Board considers necessary. A motion shall be accompanied by a memorandum of points and authorities and shall be filed with the Board at least 15 days before the hearing. A copy shall be served on the opposing party. A response shall be filed with the Board at least 7 days before the hearing and a copy served on the opposing party. The Board may consider a motion on the day of the hearing. Hearings shall be conducted under the contested case provision of State Government Article, Title 10, Subtitle 2 and Health Occupations Article, Title 4, Annotated Code of Maryland. The Board may delegate its authority to hear contested cases to the Office of Administrative Hearings. Proceedings are closed to the public and all records, including the recommended decision, are confidential and shall be sealed except as otherwise provided in a final Board order or as provided by law. If a matter has been delegated to the Office of Administrative Hearings, the administrative law judge presiding over the proceedings shall issue to the Board a recommended decision containing proposed findings of fact, proposed conclusions of law, a proposed sanction, or any combination of them under the Board's delegation. A licensee against whom the Board has issued a notice of initial denial has the burden to demonstrate by a preponderance of the evidence that the licensee is entitled to licensure or to receive the benefit sought which the Board has denied. The State has the burden to demonstrate by a preponderance of the evidence that the licensee has committed a violation or violations of the Maryland Dentistry Act or of the rules and regulations promulgated under the Act. If a matter has been delegated by the Board to the Office of Administrative Hearings, each party may file exceptions to the administrative law judge's proposed findings of fact, proposed conclusions of law, and proposed sanction, as set out in the recommended decision, before the Board makes a final decision. Unless otherwise permitted by the Board, or as otherwise specified by the administrative law judge in the recommended decision, either party shall file written exceptions with the Board within 15 days after the issuance of the recommended decision. Unless otherwise permitted by the Board, a party's written exceptions may not be longer than 25 double-spaced pages and shall state with particularity: The finding of fact, conclusion of law, or other matter excepted to; and The relevant portions of the record supporting the party's exception. Unless otherwise permitted by the Board, within 15 days after a party's exceptions are filed with the Board, the opposing party may file a response to the exceptions. Unless otherwise permitted by the Board, a party's response to the exceptions may not be longer than 25 double-spaced pages, and shall state with particularity a response to an exception and the relevant portions of the record supporting that response. Unless otherwise permitted, the Board may not consider a party's reply to a response to exceptions. Unless otherwise agreed to by the parties and permitted by the Board, an exceptions hearing shall be scheduled within 30 days after receipt of the parties' exceptions and any response to exceptions, and on a day on which the Board regularly meets. An exceptions hearing shall be held before the Board. The hearing shall be a nonevidentiary hearing to provide the parties with an opportunity for oral argument on the exceptions and response to exceptions. The Board member presiding over the hearing shall determine all procedural issues and shall make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing. The respondent and the administrative prosecutor ordinarily shall be limited to 30 minutes each in which to present oral argument. Unless otherwise agreed by the parties and permitted by the Board, the parties may not, in any response to exceptions, or in the hearing on exceptions, reference any document or other evidence or offer any exhibit that is outside the record of the evidentiary hearing before the administrative law judge. If neither party files exceptions within the time specified in Regulation .14 of this chapter, the Board shall consider only the recommended decision of the administrative law judge and the record of the evidentiary hearing in making its final decision. The Board shall consider the sanctioning guidelines contained in COMAR 10.44.31 before issuing a final order and before taking informal disciplinary action. After review of the record and deliberation, the Board shall issue a final order of either: Dismissal; Revocation; Suspension; Denial of licensure; Reprimand; Probation; Civil penalty; or Other disposition as appropriate. Within 15 days after the Board issues a final order, either party may file a motion for reconsideration with the Board, which the Board may grant. There is no right to a hearing on a party's motion for reconsideration, and the Board may request a response to the motion from the opposing party. The Board may require conditions for surrender of a license, including, but not limited to: The admission of a violation of the Maryland Dentistry Act; The admission of facts; A statement of the circumstances under which the surrender was offered or accepted; Restrictions on future licensure; Conditions for reinstatement of the license; or An agreement that the respondent may not apply for reinstatement of the license. A letter of surrender is a final order of the Board and is a public document under State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland. Under State Government Article, §10-226(c)(2), Annotated Code of Maryland, the Board shall order the summary suspension of a license if the Board determines that there is a substantial likelihood that a licensee poses a risk of harm to the public health, safety, or welfare. Notice of Intent to Summarily Suspend. Based on information gathered in an investigation or otherwise provided to the Board, the Board shall vote to issue a notice of intent to summarily suspend a license. If the Board votes to issue a notice of intent to summarily suspend a license, the Board shall refer the matter to the administrative prosecutor for prosecution. A notice of intent to summarily suspend a license shall include, but is not limited to: A proposed order of summary suspension which is unexecuted by the Board and which includes: The statutory authority on which the action has been taken; Allegations of fact which the Board believes demonstrate a substantial likelihood that the licensee poses a risk of harm to the public health, safety, or welfare; and Notice to the respondent of the right to request a full hearing on the merits of the summary suspension if the Board executes the proposed order of summary suspension; and An order or summons to appear before the Board to show cause why the Board should not execute the order of summary suspension and which notifies the respondent of the consequences of failing to appear. Service. The Board shall serve a respondent with a notice of intent to summarily suspend a license: At least 5 calendar days before a predeprivation show cause hearing is scheduled before the Board; and By hand delivery by the Executive Director or an officer of the Board to the address the respondent is required to maintain with the Board, or by any other reasonable means to effect service. If the Board is unable to serve the notice of intent to summarily suspend a license upon the respondent as described in §B(4)(a) of this regulation, the Board may nevertheless proceed in prosecuting the case. If the Board issues a notice of intent to summarily suspend a license, the Board shall offer the respondent the opportunity to appear before the Board to show cause why the respondent's license should not be suspended before the Board executes the order of summary suspension. A Predeprivation Show Cause Hearing before the Board. The hearing shall be a nonevidentiary hearing to provide the parties with an opportunity for oral argument on the proposed summary suspension. The Board member presiding over the hearing shall determine all procedural issues and shall make any rulings reasonably necessary to facilitate the effective and efficient operation of the hearing. The respondent and the administrative prosecutor ordinarily shall be limited to 30 minutes each in which to present oral argument. The respondent shall proceed first and may reserve part of the allotted time for rebuttal. The Board member who presides over the hearing: May allow either the respondent or the administrative prosecutor to present documents or exhibits which are relevant and material to the proceedings and which are not unduly repetitious if the presiding Board member believes that the documents or exhibits are necessary in order for a fair hearing; and May not allow testimony by any witness unless agreed to by the parties and approved by the Board. The members of the Board may be recognized by the presiding member to ask questions of either party appearing before the Board. In extraordinary circumstances, the Board may, after consultation with Board counsel, order the summary suspension of a license without first issuing a notice of intent to summarily suspend license or providing a respondent with an opportunity for a predeprivation hearing if: The Board determines that the public health, safety, and welfare require the immediate suspension of the license without prior notice and an opportunity to be heard; and The respondent is provided with an opportunity for a hearing before the Board at the Board's next regularly scheduled meeting but not to exceed 30 days from the date of respondent's request. If the Board votes to issue an order of summary suspension, the Board shall refer the matter to the administrative prosecutor for prosecution. An order of summary suspension of a license shall include, but is not limited to: The statutory authority on which the action has been taken; Allegations of fact which the Board believes demonstrate a substantial likelihood that the licensee poses a risk of harm to the public health, safety, or welfare; Notice to the respondent of the right to request a postdeprivation show cause hearing to provide the respondent with the opportunity to show cause why the order of summary suspension should not continue and which notifies the respondent of the consequences of failing to appear; and Notice to the respondent of the right to request a full hearing on the merits of the summary suspension Service. The Board shall serve a respondent with the order of summary suspension by having the Executive Director or an officer of the Board hand deliver the order to the address the respondent is required to maintain with the Board within 24 hours after its execution; or By any other reasonable means to effect service. If the respondent requests a hearing under §C(3) of this regulation, the Board shall conduct the hearing as provided in Regulation .19B of this chapter. In a show cause proceeding under Regulation .19B of this chapter, the respondent may present argument in opposition to the allegations presented in the order for summary suspension or which otherwise demonstrate that the public health, safety, or welfare is not at risk. The administrative prosecutor bears the burden of demonstrating by a preponderance of the evidence that the health, safety, or welfare of the public imperatively requires the Board to summarily suspend the respondent's license. If the Board issues a notice of intent to summarily suspend a license before summarily suspending a license, after the show cause hearing, it may vote to: Order a summary suspension; Deny the summary suspension; Enter into an order agreed upon by the parties; or Enter into any interim order warranted by the circumstances of the case, including one providing for stay of the summary suspension subject to certain conditions. If the Board orders a summary suspension before a show cause hearing, at the conclusion of the hearing, the Board may vote to: Affirm its order of summary suspension; Rescind the order for summary suspension; Enter into an order agreed upon by the parties; or Enter into any interim order warranted by the circumstances of the case, including one providing for a stay of the summary suspension subject to certain conditions. An order for summary suspension or any other order of the Board issued after the initiation of summary suspension proceedings are final orders of the Board and public documents under State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland. If the Board orders the summary suspension of a license under Regulation .19 of this chapter, the respondent shall be provided with the opportunity for an appeal. The appeal from a summary suspension shall be an evidentiary hearing under the Administrative Procedure Act. The respondent may request an evidentiary hearing within 10 days after the Board issues the order of summary suspension. Unless otherwise agreed by the parties, the Board shall provide a hearing within 45 days after the respondent's request. An evidentiary hearing may be consolidated with a hearing on charges issued by the Board which include the facts which form the basis for the summary suspension. The Board shall conduct an evidentiary hearing under the contested case provisions of State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. If the Board has delegated the matter to the Office of Administrative Hearings, the administrative law judge shall issue to the Board a recommended decision with proposed findings of fact, proposed conclusions of law, and a proposed disposition, or any combination of these under the Board's delegation of the matter to the Office of Administrative Hearings. If the hearing is one combined with charges, the administrative law judge's determination as to the merits of the summary suspension shall be based only on those parts of the record that were available to the Board at the time it voted for the summary suspension. The parties may file exceptions to the recommended decision as provided in the State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland. An order issued by the Board after a postdeprivation evidentiary hearing is a final order of the Board and is a public document under State Government Article, Title 10, Subtitle 6, Annotated Code of Maryland. If the Board imposes a period of probation as a sanction, the Board may impose conditions of probation which it considers appropriate, including: Re-education or completion of approved courses; Payment of a civil penalty or donation to an approved institution providing dental services for the poor, indigent, or handicapped; Provision of free dental services in a Board-approved program; Entrance into and compliance with a contract with the Dental Well-Being Committee or Dental Hygiene Well-Being Committee; Practice supervision; Monitoring by the Board or by an individual or entity approved by the Board with periodic reporting to the Board; Periodic review of a licensee's clinical practice; Periodic review of a licensee's billing practices; Periodic audits of a licensee's billing practices; An examination by a physician or appropriate health care provider; Limitation of the licensee's practice; A passing score on an appropriate examination; or Any other condition the Board considers appropriate for the rehabilitation or re-training of a licensee. A term of probation may be defined by a specific period of time or the successful completion of certain conditions or acts by the licensee. A licensee seeking termination of probation shall do so only by petitioning the Board for termination of probation when the specific period of time has passed or when the licensee has successfully completed the conditions or acts required for termination, as provided in the Board's order. If at any time the Board determines that the licensee is not in compliance with the conditions of probation, the Board shall: Charge the licensee with a violation of probation; Take any action provided for in the final order or consent order if there is a violation of probation, including suspension of the license; Consider a summary suspension of the license; or Take any other action the Board considers appropriate and which the Board may take. If the Board issues charges for a violation of probation, the service shall be as provided in Regulation .07A of this chapter. The charging document for a violation of probation shall: Inform the respondent of the statutory provision, condition of probation, or provision of the Board's order that the Board believes has been violated; Allege facts that the Board believes constitute either a basis for a violation of probation; and Notify the respondent of any proceedings scheduled before the Board or of an opportunity to request a hearing within a certain period of time and the consequences of failing to appear for those proceedings or failing to request a hearing. If the respondent requests a hearing on the charge of a violation of probation, the Board, before the hearing, shall provide the respondent with a case resolution conference to discuss settlement of the matter. The case resolution conference shall be conducted as provided in Regulation .09 of this chapter. The hearing shall be an evidentiary hearing held in the manner set forth in Regulation .12 of this chapter. The burden of proof shall be as set forth in Regulation .13 of this chapter. After a hearing, the Board shall issue a final order consisting of findings of fact, conclusions of law, and an order. The order shall be a final order of the Board. If the Board determines that a respondent has violated probation, the Board may: Take any action provided for in the consent order or final order in the event of a violation of probation; Impose additional conditions of probation; or Impose any sanction or take any other action that the Board considers appropriate and may take. Petition for Reinstatement. A licensee shall petition the Board for reinstatement after suspension, revocation, or surrender of a license. Subject to contrary provisions in a final order of revocation or a surrender, the Board may not consider a petition for reinstatement after the revocation of a license or a surrender until 3 years after the effective date of the revocation or surrender. A licensee who petitions the Board for reinstatement under terms and conditions for reinstatement set out in a final order, letter of surrender, or other order of the Board, shall apply for reinstatement only under those terms and conditions. A licensee whose license has been revoked or surrendered for 3 or more years before filing a petition for reinstatement is not eligible for reinstatement but instead shall apply for initial licensure. In addition to complying with any conditions for reinstatement ordered by the Board, an applicant for reinstatement shall: File an application for reinstatement with the Board; Meet the requirements for reinstatement set out in COMAR 10.44.10; and Achieve a passing score on the Board's law examination. Notice of Intent to Deny Reinstatement and Opportunity for a Hearing. If the Board issues a notice of intent to deny reinstatement, the Board shall serve the notice as provided in Regulation .07A of this chapter. A notice of intent to deny reinstatement shall: Inform the applicant of the Board's legal basis for its belief that the applicant is not qualified for reinstatement, including any applicable statutory provision; Allege any facts which the Board believes supports the Board's reasons for denying reinstatement; and Notify the respondent of any proceedings scheduled before the Board or of an opportunity to request a hearing within a certain period of time and the consequences of failing to appear for those proceedings or to request a hearing. If the applicant requests a hearing on the notice of intent to deny reinstatement, the Board, before the hearing, shall provide the applicant with a case resolution conference to discuss settlement of the matter. The case resolution conference shall be conducted as provided in Regulation .09 of this chapter. A hearing on the notice of denial of reinstatement shall be held before the Board or delegated to the Office of Administrative Hearings. If the Board grants reinstatement of a license, the Board may impose any restrictions or conditions on the license or the licensee's practice that the Board considers appropriate. A final order of the Board is subject to judicial review as provided in Health Occupations Article, §4-319, and State Government Article, §10-222, Annotated Code of Maryland. The Board may impose a civil monetary penalty instead of or in addition to a disciplinary sanction authorized by Health Occupations Article, §4-315, Annotated Code of Maryland, and as provided in COMAR 10.44.08. A Board member or the Dental Compliance Officer may not participate in an investigation or a proceeding in which the impartiality of the Board member or Dental Compliance Officer might reasonably be questioned, including, but not limited to those investigations or proceedings in which the Board member or Dental Compliance Officer has or appears to have: A personal bias or prejudice concerning a party; or Personal knowledge of disputed evidentiary facts obtained outside the administrative or disciplinary process. Participation by a Board member or Dental Compliance Officer in an investigation, disciplinary review committee, case resolution conference, or other administrative proceeding involving a respondent or applicant is not a basis for recusal in a contested case unless the Board member or Dental Compliance Officer has: A personal bias or prejudice concerning a party; or Personal knowledge of disputed evidentiary facts obtained outside the administrative or disciplinary process. A Board member or the Dental Compliance Officer may make a voluntary determination to recuse oneself from further proceedings in a case. A respondent who seeks recusal of one or more Board members shall name the Board member or members the respondent seeks to have recused and state with specificity on the record the reasons why the Board member or members should be recused. The Board may deliberate on the issue of recusal of the Board member or Board members and shall state its finding on the record. In any matter governed by this chapter, the Board may take official notice of any information contained in the Board's files. Health Occupations Article, §§1-603, 4-205, 4-316, and 4-318, Annotated Code of Maryland Effective date: Regulations .01 — .09 adopted as an emergency provision effective September 29, 1980 (7:21 Md. R. 1989); emergency status expired February 14, 1981; adopted permanently effective March 6, 1981 (8:5 Md. R. 475) Regulation .05A amended effective November 20, 1994 (21:23 Md. R. 1933) Regulations .01—.09 repealed and new Regulations .01 — .31 adopted effective March 1, 2004 (31:4 Md. R. 317) chapter revised effective March 5, 2012 (39:4 Md. R. 337) Regulation .05A amended effective December 8, 2016 (43:24 Md. R. 1350) These regulations establish the standards by which the Board may impose a civil penalty of not more than $5,000 against any dentist licensed in the State who is found to be in violation of Health Occupations Article, Title 4, Annotated Code of Maryland. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Board of Dental Examiners. “Civil penalty” means a monetary penalty. “Universal precautions” means blood and body fluid precautions as defined in “Control of Communicable Diseases in Man”, which is incorporated by reference in COMAR 10.06.01.01. After a hearing as provided in COMAR 10.44.07, the Board may impose a civil penalty against a dentist for violation of Health Occupations Article, §4-315, and pertinent regulations: In place of, or in addition to, suspension of a dentist's license; or In addition to the revocation of a dentist's license. Civil penalties may be imposed if a dentist is found to have violated any section of Health Occupations Article, §4-315(a), Annotated Code of Maryland. The Board may impose a penalty for violations of Regulation .04 of this chapter considering the nature and severity of the violation consistent with the following guidelines: For the first violation, a civil penalty of not more than 25 percent of the maximum civil penalty; For the second violation, a civil penalty of not more than 50 percent of the maximum civil penalty; For the third and any subsequent violation, a civil penalty of not more than the maximum civil penalty. The power and authority of the Board to impose these civil penalties may not be affected or diminished by any other proceeding, civil or criminal, concerning the same violation or violations except as provided in these regulations. A licensee against whom a civil penalty has been imposed may have judicial review of the Board's decision as provided by law. A civil penalty imposed under these regulations shall be paid to the Board by the licensee upon the expiration of the period allowed for appeal. Noting of an appeal does not stay the Board's order. Money collected by the Board under these regulations shall be paid over to the State Treasurer and shall become part of the General Fund of the State. When payment of a civil penalty imposed by the Board against a license in accordance with these regulations is not paid by the licensee when due under these regulations, the Board shall refer the case to the Central Collection Unit of the Department of Budget and Management to institute and maintain proceedings for enforcement of payment. Health Occupations Article, §§4-205(b)(3) and 4-317, Annotated Code of Maryland Effective date: November 23, 1981 (8:23 Md. R. 1857) (Originally promulgated as COMAR 10.44.09. Recodified to 10.44.08) Regulation .02 amended effective June 15, 1998 (25:12 Md. R. 947) Regulation .04 amended effective February 19, 1990 (17:3 Md. R. 300); June 15, 1998 (25:12 Md. R. 947) Regulation .04 repealed and new Regulation .04 adopted effective June 25, 2001 (28:12 Md. R. 1110) Regulation .05 amended effective February 19, 1990 (17:3 Md. R. 300); June 15, 1998 (25:12 Md. R. 947) In this chapter, the following terms have the meaning indicated. Terms Defined. “ADEX” means the American Board of Dental Examiners, Inc., or its successor organization. “ADHLEX” means the American Dental Hygiene Licensing Examination, which includes both a written component and a clinic component, designed and developed by ADEX, or its successor examination. “Board” means the Maryland State Board of Dental Examiners. A dental hygienist holding an active license in any other state may be granted a license in Maryland if the applicant: Meets the requirements of Health Occupations Article, §4-306, Annotated Code of Maryland; Is of good moral character; Is a graduate of a school for dental hygienists that: Requires at least 2 years of education in an institution of higher education; Is accredited by the American Dental Association Commission on Dental Accreditation; and Is approved by the Board; and Meets the qualifications otherwise required by Health Occupations Article, Title 4, Annotated Code of Maryland, for an active general license to practice dental hygiene. In addition to meeting the requirements of Regulation .02 of this chapter, a dental hygienist holding an active license in any other state shall be issued a license if the applicant: Has passed the ADHLEX with a score of 75 or greater in each required section; and Has passed the Maryland Dental Hygiene Jurisprudence Examination given by the Board or its designee with a minimum score of 75 or greater on each section of the examination. In addition to the requirements of §A of this regulation, a candidate holding an active license in another state, or who has ever held an active license in another state, shall provide adequate evidence satisfactory to the Board that the candidate: Is not being investigated by a disciplinary authority of another state: Does not have charges pending against the applicant’s license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland. In addition to meeting the requirements of Regulation .02 of this chapter, a dental hygienist holding an active license in another state who has not passed the ADHLEX examination with a score of 75 or greater in each required section of the ADHLEX shall be issued a license if the applicant: For the 3 preceding years has been actively engaged in practicing dental hygiene for at least 150 hours on average per year; Has passed an examination with a clinical component as a requirement for licensure in another state; Has passed a comprehensive written examination on applied clinical diagnosis and treatment planning administered by ADEX with a score of 75 or greater in each required section; and Has passed the Maryland Dental Hygiene Jurisprudence Examination given by the Board or its designee with a score of 75 or greater on each section of the examination. The practice of dental hygiene in the armed forces, the practice of dental hygiene in state and federal programs, participation in post-graduate intern programs, or participation in residency programs within the 5 years preceding application counts toward the required hours of active practice. An applicant who has passed the ADHLEX with a score of 75 or greater in each required section shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental hygiene education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead, bearing an original signature, do not require a raised embossed seal; A certified examination score of the ADHLEX and, if requested by the Board, a specific point breakdown by procedure including penalty deductions if available; A certified letter with a raised embossed seal from the dental hygiene licensing authority of each state in which the applicant holds an active dental hygiene license or ever held an active dental hygiene license indicating that the license is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. An applicant who has not passed the ADHLEX shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental hygiene education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead, bearing an original signature, do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental hygiene licensing authority of each state in which the applicant holds an active dental hygiene license or ever held an active dental hygiene license indicating that the license is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A notarized affidavit or other evidence satisfactory to the Board indicating that for the 3 preceding years the applicant has been actively engaged in practicing dental hygiene for at least 150 hours on average per year; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The application fee shall accompany the application and is specified in COMAR 10.44.20. The application fee is nonrefundable. Health Occupations Article, §§4-303.1(d) and 4-306, Annotated Code of Maryland Effective date: August 1, 1983 (10:15 Md. R. 1351) Recodified from COMAR 10.44.12 to 10.44.09 Regulation .01 recodified to Regulation .01-1 and the Preface recodified to Regulation .01 in November 1990 Regulation .01 amended effective April 19, 1999 (26:8 Md. R. 615) Regulation .01-1 amended effective April 19, 1999 (26:8 Md. R. 615) Regulation .02A amended effective September 3, 1990 (17:17 Md. R. 2081); April 19, 1999 (26:8 Md. R. 615) Regulation .02B amended effective April 19, 1999 (26:8 Md. R. 615); December 23, 2002 (29:25 Md. R. 1984) Regulation .02C adopted effective September 3, 1990 (17:17 Md. R. 2081) Regulation .02C amended effective September 17, 2001 (28:18 Md. R. 1621) Regulation .02C repealed effective December 23, 2002 (29:25 Md. R. 1984) Regulation .03 amended effective September 3, 1990 (17:17 Md. R. 2081); April 19, 1999 (26:8 Md. R. 615) Regulation .04C adopted effective September 3, 1990 (17:17 Md. R. 2081) Regulation .05A amended effective April 19, 1999 (26:8 Md. R. 615) Regulations .01—.05 repealed and new Regulations .01 — .05 adopted effective December 22, 2003 (30:25 Md. R. 1848) Regulation .02 amended effective October 24, 2005 (32:21 Md. R. 1708) Regulation .03A amended effective October 24, 2005 (32:21 Md. R. 1708) Regulations .01—.05 repealed and new Regulations .01 — .06 adopted as an emergency provision effective October 1, 2012 (39:22 Md. R. 1426); adopted permanently effective December 24, 2012 (39:25 Md. R. 1613) A general license to practice dentistry and a general license to practice dental hygiene shall expire on June 30 of the second year following the effective date of the license. A limited license to practice dentistry shall expire 1 year from its effective date and must be reapplied for. A teacher's license to practice dentistry and a teacher's license to practice dental hygiene shall expire in the same manner as the general license, or when the licensee ceases teaching at the institution named on the license. Before a general license to practice dentistry expires, the licensee may renew it for an additional term, if the licensee: Otherwise is entitled to be licensed; Pays the renewal fee specified in COMAR 10.44.20; Submits to the Board a renewal application on the form that the Board provides; and Has fulfilled the continuing education requirements of the Board. Before a teacher's license to practice dentistry expires, the licensee may renew it for an additional term, if the licensee: Otherwise is entitled to be licensed; Pays the renewal fee specified in COMAR 10.44.20; and Submits to the Board a renewal application on the form that the Board provides. Before a general license to practice dental hygiene or a teacher's license to practice dental hygiene expires, the licensee may renew it for an additional term, if the licensee: Otherwise is entitled to be licensed; Pays the renewal fee specified in COMAR 10.44.20; Submits to the Board a renewal application on the form the Board provides; and Has fulfilled the continuing education requirements of the Board. A limited license to practice dentistry is not renewable. Following the expiration date of a license to practice dentistry or dental hygiene in the State, the licensee may renew the license within 30 days of its expiration if the licensee: Is otherwise entitled to be licensed; Submits to the Board a completed renewal application on the form provided by the Board; and Pays to the Board the renewal fee and the late renewal fee as specified in COMAR 10.44.20. Dental License. A licensee who has failed to renew a license to practice dentistry in this State by July 31 of the year in which the license is due for renewal is prohibited from practicing dentistry in this State after the expiration date of the license. The Board shall reinstate the license if the licensee: Is otherwise entitled to be licensed; Meets the requirements for renewal and reinstatement of a license as provided in this chapter; Submits to the Board a completed renewal application on the form provided by the Board; and Pays to the Board the reinstatement fee as specified in COMAR 10.44.20. If the Board determines that a dentist has practiced dentistry in this State after the license has expired, the Board may order the dentist to immediately cease and desist the practice of dentistry in this State until the dentist's license has been reinstated by the Board. The Board may take action against a dentist for unprofessional conduct if it determines that the dentist has practiced dentistry in this State after the dentist's license has expired. The Board may: Impose an administrative penalty through a nonpublic consent agreement which the dentist agrees to make an anonymous donation of $400 to a charitable institution and to perform 40 hours of Board-approved pro bono dental services; Provide the dentist with a settlement conference; or Charge the dentist with unprofessional conduct as provided in Health Occupations Article, §4-315(a)(16), Annotated Code of Maryland, for practicing dentistry without a license. Dental Hygienist License. A licensee who has failed to renew a license to practice dental hygiene in this State by July 31 of the year in which the license is due for renewal is prohibited from practicing dental hygiene in this State after the expiration date of the license. The Board shall reinstate the license if the licensee: Is otherwise entitled to be licensed; Meets the requirements for renewal and reinstatement of a license as provided in this chapter; Submits to the Board a completed renewal application on the form provided by the Board; and Pays to the Board the reinstatement fee as specified in COMAR 10.44.20. If the Board determines that a dental hygienist has practiced dental hygiene in this State after the license has expired, the Board may order the dental hygienist to immediately cease and desist the practice of dental hygiene in this State until the dental hygienist's license has been reinstated by the Board. The Board may take action against a dental hygienist for unprofessional conduct if it determines that the dental hygienist has practiced dental hygiene in this State after the dental hygienist's license has expired. The Board may: Impose an administrative penalty through a nonpublic consent agreement which the dental hygienist agrees to make an anonymous donation of $200 to a charitable institution and to perform 20 hours of Board-approved pro bono dental services; Provide the dental hygienist with a settlement conference; or Charge the dental hygienist with unprofessional conduct as provided in Health Occupations Article, §4-315(b)(3), Annotated Code of Maryland, for practicing dental hygiene without a license. An individual holding an expired general license to practice dentistry may apply for reinstatement if the individual: Submits to the Board notarized affidavits, or other evidence satisfactory to the Board, that the applicant has actively practiced dentistry within the 3 years immediately preceding the date of application for reinstatement; Submits to the Board satisfactory proof of licensure and good standing from all states in which the applicant is currently licensed; Submits to the Board an application for reinstatement on a form provided by the Board; Is otherwise entitled to be licensed; Pays the reinstatement fee specified in COMAR 10.44.20; Has fulfilled the continuing education requirements of the Board; and Passes a written Maryland Law Examination given by the Board with at least a score of 75. An individual holding an expired dental or dental hygiene teacher's license may apply for reinstatement if the individual: Submits to the Board satisfactory proof of licensure and good standing from all states in which the applicant is currently licensed; Submits to the Board an application for reinstatement on a form provided by the Board; Is otherwise entitled to be licensed; Pays the reinstatement fee specified in COMAR 10.44.20; Has fulfilled the continuing education requirements of the Board; and Passes a written Maryland Law Examination given by the Board with at least a score of 75. An individual holding an expired general license to practice dental hygiene may apply for reinstatement if the individual: Submits to the Board notarized affidavits, or other evidence satisfactory to the Board, that the applicant has actively practiced dental hygiene within the 3 years immediately preceding the date of application for reinstatement; Submits to the Board satisfactory proof of licensure and good standing from all states in which the applicant is currently licensed; Submits to the Board an application for reinstatement on a form provided by the Board; Is otherwise entitled to be licensed; Pays the reinstatement fee specified in COMAR 10.44.20; Has fulfilled the continuing education requirements of the Board; and Passes a written Maryland Law Examination given by the Board with at least a score of 75. An individual holding a license to practice dentistry or dental hygiene which has been expired for more than 3 years may not apply for reinstatement under this regulation. Health Occupations Article, §§4-309 and 4-311, Annotated Code of Maryland Effective date: June 4, 1984 (11:11 Md. R. 962) Regulation .01 amended effective August 24, 1998 (25:17 Md. R. 1360) Regulation .02A amended effective August 24, 1998 (25:17 Md. R. 1360) Regulation .03 amended effective August 24, 1998 (25:17 Md. R. 1360) Regulation .03E adopted effective March 8, 1999 (26:5 Md. R. 391) Regulation .03F, G adopted effective September 20, 1999 (26:19 Md. R. 1448) Regulation .04 amended effective August 6, 1990 (17:15 Md. R. 1860); August 24, 1998 (25:17 Md. R. 1360) Regulation .04A—C amended effective September 20, 1999 (26:19 Md. R. 1448) Chapter revised effective September 4, 2000 (27:17 Md. R. 1620) Regulation .02 amended effective March 29, 2004 (31:6 Md. R. 509) Regulation .02E amended effective February 17, 2003 (30:3 Md. R. 181) Regulation .03 amended effective March 29, 2004 (31:6 Md. R. 509); June 21, 2004 (31:12 Md. R. 913) In this chapter, the following terms have the meanings indicated. Terms Defined. Active Practice. “Active practice” with respect to dentistry means the practice of dentistry for at least 500 hours within the 36-month period preceding expiration of a license. “Active practice” with respect to dental hygiene means the practice of dental hygiene for at least 150 hours within the 36-month period preceding expiration of a license. “Approved school” means a school determined by the Commission on Dental Accreditation to have met minimum standards. “Board” means the Board of Dental Examiners. After receipt of a renewal application from the Board and before expiration of the current license, a dentist or dental hygienist who holds a general license may inform the Board on the renewal application of the licensee's intent to change the status of the license from active to inactive. A licensee assigned inactive status shall submit to the Board the inactive status: Application form provided by the Board; and Fee as specified in COMAR 10.44.20. The Board shall issue an inactive status certificate to a licensee whose license is placed on inactive status. An inactive status certificate expires on June 30 of the second year following the effective date of the certificate. Before an inactive status certificate expires, the licensee may renew the certificate if the licensee: Submits to the Board a renewal application on the form provided by the Board; and Pays to the Board the inactive status application fee as specified in COMAR 10.44.20. A licensee whose license is on inactive status may not practice in Maryland unless otherwise authorized by law. The practice of dentistry or dental hygiene in Maryland by a licensee whose license is on inactive status constitutes the unauthorized practice of dentistry or dental hygiene unless the practice is otherwise authorized by law. A licensee whose license to practice dentistry or dental hygiene is on inactive status may apply for reactivation of that license. A licensee who applies for reactivation of a dental or dental hygienist license shall submit to the Board: A completed application form provided by the Board; Notarized affidavits or other evidence satisfactory to the Board that the applicant has actively practiced within the 36 months immediately preceding the application date; Satisfactory proof of good standing from all states in which the applicant is currently licensed; Satisfactory evidence of completion, during the 2 years preceding application, of continuing education courses or programs equivalent in hours and type to those required of licensees by the Board; and Satisfactory evidence of passage, within 3 months of the application date, of the Board's jurisprudence examination. In addition to submitting an application as required under §B of this regulation, an applicant for reactivation of a license shall: Be of good moral character; Arrange for the National Practitioner's Data Bank to forward a report of the applicant's disciplinary activity to the Board; and Pay to the Board the difference between the license renewal fee and the inactive status application fee as specified in COMAR 10.44.20. If the applicant is unable to demonstrate active practice within the 36 months immediately preceding application for reactivation of a license, the applicant shall: Pass the North East Regional Board examination; or Have passed the North East Regional Board examination. Health Occupations Article, §4-310, Annotated Code of Maryland Effective date: August 1, 1983 (10:15 Md. R. 1351) Regulation .01 amended effective November 20, 1994 (21:23 Md. R. 1933) Regulation .02 amended effective November 20, 1994 (21:23 Md. R. 1933) Chapter, Fee for Inactive Status, repealed and new chapter, Inactive Licenses, adopted effective March 8, 1999 (26:5 Md. R. 392) Chapter revised effective September 4, 2000 (27:17 Md. R. 1620) Chapter revised effective June 21, 2004 (31:12 Md. R. 913) This chapter covers the use of anesthesia and sedation by dentists in Maryland for the practice of dentistry. The use of local anesthesia by a dentist is not governed by this chapter. The administration of anesthesia and sedation by dentists in hospitals licensed in Maryland is not governed by this chapter. Dentists are increasingly administering anesthesia and sedation on an outpatient basis. It is in the best interests of the public and the dentists of Maryland to require dentists who administer anesthesia and sedation to meet certain minimal training and competency standards. Requiring a dentist to obtain a permit before the dentist may administer anesthesia, sedation, or both is the best method to ensure that such administration is performed by competent dentists trained in the use of such techniques. In this chapter, the following terms have the meanings indicated. Terms Defined. “Accredited facility” means a facility holding current certification from: The Accreditation Association for Ambulatory Health Care (AAAHC); The Joint Commission on Accreditation of Healthcare Organizations (JCAHO); The Joint Commission Ambulatory Health Care Accreditation (JCAHCA); The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF); or Their successor organizations. “Administration evaluation” means an evaluation by the Board or its designee to determine if an applicant for a permit demonstrates knowledge of management of emergencies and anesthesia techniques to a level that meets the requirements of this chapter. “Advanced Cardiac Life Support (ACLS)” means a certification that an individual has successfully completed an advanced cardiac life support course offered by the American Heart Association or other entity approved by the Board. “Anesthesia” means an artificially induced insensibility to pain usually achieved by the administration of gases or the use of drugs. “Anesthesia and sedation” means: Moderate sedation; Deep sedation; and General anesthesia. Anxiolysis. “Anxiolysis” means a drug-induced state, with or without nitrous oxide/oxygen to decrease anxiety, in which patients respond normally to tactile stimulation and verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are maintained and require no assistance. “Anxiolysis” includes a single dose of one sedative, narcotic, class of drugs, or medication prescribed by the treating dentist and taken the evening before a procedure or the morning of a procedure, or both, provided that the dosage complies with the definition of anxiolysis under §B(6)(a) of this regulation. “Anxiolysis” does not include the administering, prescribing, or dispensing of any other sedative, narcotic, class of drugs, or medication for the purpose of anesthesia by a dentist to a patient to be used for anesthesia or sedation, to be taken the evening before a procedure or the morning of a procedure. “Board” means the State Board of Dental Examiners. “Certified registered nurse anesthetist” means a registered nurse who is currently certified to practice nurse anesthesia in Maryland. “Deep sedation” means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Cardiovascular function is usually maintained. “Dentist” means an individual who holds a current license to practice dentistry in Maryland. “Facility” means any location in which anesthesia or sedation is administered for the practice of dentistry. “Facility evaluation” means an on-site inspection by the Board or its designee to determine if a facility where the applicant proposes to provide anesthesia and sedation is adequately supplied, equipped, staffed, and maintained in a condition to support the provision of anesthesia and sedation services in a manner that meets the requirements of this chapter. “General anesthesia” means a drug-induced loss of consciousness during which patients are not arousable even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation, drug-induced depression, or changes in neuromuscular function. Cardiovascular function may be impaired. “General anesthesia administration permit” means a permit that was issued by the Board before January 4, 2010, that authorized the dentist to whom the permit was issued to administer general anesthesia for the practice of dentistry. “General anesthesia facility permit” means a permit that was issued by the Board before January 4, 2010, that authorized the administration of general anesthesia for the practice of dentistry in the facility named in the permit. “Incident” means dental treatment performed on a patient under moderate sedation, deep sedation, or general anesthesia with unforeseen complications. “Moderate enteral sedation” means a drug-induced depression of consciousness through the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. “Moderate parenteral sedation” means a drug-induced depression of consciousness that bypasses the gastrointestinal tract or oral mucosa during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. “Moderate sedation” means a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is maintained. “Parenteral” means a technique of administration in which the drug bypasses the gastrointestinal tract, that is, through an intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraosseous technique. “Parenteral sedation administration permit” means a permit that was issued by the Board before January 4, 2010, that authorized the dentist to whom the permit was issued to administer parenteral sedation for the practice of dentistry. “Parenteral sedation facility permit” means a permit that was issued by the Board before January 4, 2010, that authorized the administration of parenteral sedation for the practice of dentistry in the facility named in the permit. “Pediatric Advanced Life Support (PALS)” means a certification that an individual has successfully completed a pediatric advanced life support course offered by the American Heart Association or other entity approved by the Board. “Physician” means a physician, including a doctor of osteopathy, who holds a current license to practice medicine in Maryland. “Renewal evaluation” means an on-site inspection by the Board or its designee before the renewal of a permit to determine if a facility where the applicant proposes to provide anesthesia and sedation is adequately supplied, equipped, staffed, and maintained in a condition to support the provision of anesthesia and sedation services in a manner that meets the requirements of this chapter. “Sedation” means the reduction of stress or excitement by the administration of a drug that has a soothing, calming, or tranquilizing effect. A permit is not required for a dentist to administer anxiolysis. The administering, prescribing, or dispensing of more than one type of sedative, narcotic, class of drug, or medication for the purpose of anesthesia to be taken the evening before a procedure, or the morning of a procedure, is not anxiolysis and shall require the appropriate anesthesia or sedation permit. A dentist who intends to administer anxiolysis shall indicate the intent to administer anxiolysis in the patient's records. A dentist who administers anxiolysis may not administer a dose that is inappropriate for a patient's: Age; Weight; Medical condition; Infirmities; or Other propensities. Medications used to produce anxiolysis may not exceed current limits set by the manufacturer for unmonitored use by the individual. A dentist who administers anxiolysis shall maintain a margin of safety and a level of consciousness that does not approach moderate sedation and other deeper states of sedation and general anesthesia. The following permits shall be issued by the Board: Class I permit that authorizes a dentist to use a nonparenteral anesthetic technique to attain the level of moderate sedation; Class II permit that authorizes a dentist to use: A parenteral anesthetic technique to attain the level of moderate sedation; and Any procedure allowed with a Class I permit; Class III permit that authorizes a dentist to use: An anesthetic technique to attain the level of deep sedation or general anesthesia; and Any procedure allowed under either a Class I permit or a Class II permit; and Class III dental school facility permit issued to a dental school that allows a dentist who holds the appropriate Class I, Class II, or Class III permit to administer anesthesia or sedation in a dental school recognized by the Commission on Dental Accreditation or its successor organization. The following certificates shall be issued to qualified dentists by the Board: Certificate to allow a physician or another dentist to administer anesthesia and sedation, which allows a physician or another dentist to administer anesthesia and sedation to a patient at a specific practice location; Certificate to allow a dentist to treat a patient at a practice location other than their own at which anesthesia and sedation is administered, which allows a dentist to treat a patient at a practice location other than their own in which anesthesia and sedation is administered; and Certificate to allow a certified registered nurse anesthetist to administer anesthesia and sedation, which allows a certified registered nurse anesthetist to administer anesthesia and sedation to a patient at a specific practice location. After January 4, 2010, a dentist may not administer an anesthetic technique in order to attain a level beyond anxiolysis for the practice of dentistry unless the dentist holds an appropriate Class I, II, or III permit issued by the Board. On a form provided by the Board, a dentist shall advise the Board of the name and address of each location where the dentist wishes to administer anesthesia and sedation. A dentist may not administer anesthesia and sedation unless the dentist has obtained the appropriate permit for each location. On a form provided by the Board, a dentist shall advise the Board of each location at which the dentist has ceased to administer anesthesia and sedation. The Board shall keep a record of: Each location for which a dentist has been granted a permit to administer anesthesia and sedation; and Each location at which a dentist has ceased to administer anesthesia and sedation. Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Therefore, practitioners intending to produce a given level of sedation shall be able to recover patients whose level of sedation becomes deeper than initially intended. Individuals administering moderate enteral sedation or moderate parenteral sedation shall be able to recover patients who enter a state of deep sedation or general anesthesia, while those administering deep sedation shall be able to recover patients who enter a state of general anesthesia. Training and evaluation guidelines shall reflect this concern. In addition to the requirements outlined in this regulation, in order to obtain a permit, a dentist shall also meet the requirements outlined in Regulations .09—.11 of this chapter. A permit may be issued to a dentist authorizing the use of moderate sedation, deep sedation, or general anesthesia at a specific practice location. Class I: Moderate Enteral Sedation Permit. To qualify for a Class I permit, an applicant shall successfully complete: A Board-approved course of instruction that documents training of at least 24 hours of didactic education plus 20 clinically oriented experiences that provide competency in oral and combination inhalation-oral moderate sedation; or A postdoctoral training program accredited by the Commission on Dental Accreditation or its successor organization that affords comprehensive and appropriate training necessary to administer and manage moderate enteral sedation. Clinically oriented experiences referred to in §D(1) of this regulation may include: Supervised administration; Observations of videotaped patients undergoing oral or combination inhalation-oral moderate sedation; or Human simulation. In addition to the requirements outlined in §D of this regulation, an applicant for a Class I permit shall: Hold current certification in either ACLS or PALS, which the permit holder may not allow to expire, or successfully complete a course approved by the Board that provides instruction on medical emergencies and airway management; Receive a successful evaluation by the Board or the Board's designee; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; and Submit any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §F(3) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include at least the following: The date of the incident; The name, age, and address of the patient; The patient's original complete dental records; The name and license number of the licensee and the name and address of all other persons present during the incident; The address where the incident took place; The preoperative physical condition of the patient; The type of anesthesia and dosages of drugs administered to the patient; The techniques used in administering the drugs; Any adverse occurrence including: The patient's signs and symptoms; The treatments instituted in response to adverse occurrences; The patient's response to the treatment; and The patient's condition on termination of any procedures undertaken; and A narrative description of the incident including approximate times and evolution of symptoms. Class II: Moderate Parenteral Sedation Permit. To qualify for a Class II permit, an applicant shall successfully complete: A Board-approved course of instruction that documents training of at least 60 hours of didactic instruction plus management of at least 20 dental patients, who may be simulated, per participant in moderate parenteral sedation techniques; or A postdoctoral training program accredited by the Commission on Dental Accreditation or its successor organization that affords comprehensive and appropriate training necessary to administer and manage moderate parenteral sedation. In addition to the requirements outlined in §§H and I of this regulation, an applicant for a Class II permit shall: Hold current certification in either ACLS or PALS, which the permit holder may not allow to expire; Receive a successful evaluation by the Board or the Board's designee; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; and Submit any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §I(3) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in §G of this regulation. Class III: Deep Sedation and General Anesthesia Permit. To qualify for a Class III permit, an applicant shall have successfully completed: An advanced training program in anesthesia and related subjects beyond the undergraduate dental curriculum that is approved by the Board; or A postdoctoral training program accredited by the Commission on Dental Accreditation or its successor organization that affords comprehensive and appropriate training necessary to administer and manage deep sedation and general anesthesia. In addition to the requirements outlined in §I of this regulation, an applicant for a Class III permit shall: Hold current certification in either ACLS or PALS, which the permit holder may not allow to expire; Receive a successful evaluation by the Board or its designee; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; and Submit any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §L(3) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in §G of this regulation. Class I Permit. To qualify for a Class I permit, the dentist who will perform the administration shall pass: An office inspection evaluation; A clinical evaluation consistent with the age level of the patients treated by the dentist; An evaluation of the dentist to safely administer sedation techniques; and An evaluation of the ability of the dentist to effectively respond to sedation related emergencies. The clinical evaluation required in §A of this regulation shall require the participation of the office staff. The clinical evaluation required by §A(2) of this regulation shall include evaluating treatment of at least the following: Laryngospasm; Foreign body airway obstruction; Emergency airway management; Emesis and aspiration; Acute allergic reaction; Bronchospasm; Angina; Conditions requiring advanced cardiac life support, including: Bradycardia; Tachycardia; Ventricular fibrillation; and Cardiac arrest; Hypotension; Hypoglycemia; Hypertension; Seizure; and Syncope. Class II or Class III Permit. To qualify for a Class II or Class III permit, the dentist who will perform the administration shall pass an administration evaluation that consists of an office inspection and clinical evaluation. The clinical evaluation required by §D(1) of this regulation shall: Require the participation of the clinical office staff; and Evaluate the technical competency of the dentist to: Safely administer moderate parenteral sedation, deep sedation, or general anesthesia; and Effectively respond to anesthesia related emergencies. The clinical evaluation required by §D(1) of this regulation shall include evaluating the treatment of at least the following: Laryngospasm; Foreign body airway obstruction; Emergency airway management; Emesis and aspiration; Acute allergic reaction; Bronchospasm; Angina; Conditions requiring advanced cardiac life support, including: Bradycardia; Tachycardia; Ventricular fibrillation; and Cardiac arrest; Hypotension; Hypoglycemia; Hypertension; Seizure; Syncope; and Venipuncture complications. In addition to the requirements outlined in Regulation .09 of this chapter, for a dentist to obtain a Class I, Class II, or Class III permit, each facility in which the dentist wishes to administer an anesthesia technique shall pass a facility evaluation in order to attain: A level beyond anxiolysis; Moderate enteral sedation; Moderate parenteral sedation; or Deep sedation and general anesthesia. Except as otherwise provided in this regulation, to qualify for a permit, the facility and the applicant shall pass an evaluation of facility equipment, medications, and clinical records to include at least the following: Oxygen and gas delivery system, backup system fail-safe; Gas storage facility; Safety indexed gas system; Suction and backup system; Auxiliary lighting system; Suitability of operating room: Size; Lighting; Communications; and EMT accessibility; Recovery area, including oxygen, suction, and visual and electronic monitoring, which may include the operating room; Appropriate emergency drugs; Nonexpired drugs; Appropriate devices to maintain an airway with positive pressure ventilation; Preoperative medical history and physical evaluation form; Anesthesia records, including monitoring and discharge records; Monitoring equipment, including pulse oximeter and blood pressure monitoring; Anesthesia and monitoring equipment to ensure they are in proper working order; Defibrillator or automated external defibrillator (AED); For deep sedation or general anesthesia in pediatric patients: A precordial stethoscope; A pretracheal stethoscope; or A capnograph; and For Class II and Class III permits: An electrocardiogram (EKG); A capnograph measuring device; and Pulse oximeter. In addition to the requirements outlined in §A of this regulation, to qualify for a permit, the dentist who will perform the administration and the dentist's staff shall be present in the operatory during the evaluation. An applicant for a permit may not transport anesthesia or sedation equipment from one dental office to another for facility examination purposes. A Board evaluator shall hold a permit at the same or higher level as the permit sought by the applicant being evaluated. To the extent practicable, a Board evaluator shall provide the results of the evaluation to the Board in writing within 7 days of an applicant’s evaluation. Either the Board or the Board’s Anesthesia Committee shall: Review the results of the evaluation; and Notify the applicant of the results in a timely manner. If requested, an applicant shall be provided with a copy of the evaluation provided to the Board. An applicant who fails either an administration evaluation or a facility evaluation twice shall be required to pay a fee equal to the renewal fee for the permit sought by the applicant before either the third evaluation or any subsequent evaluations. A dentist who has passed an administration and facility evaluation for a Class I, Class II, or Class III permit may receive a like permit for another facility or facilities if: The dentist holds an active Class I, Class II, or Class III permit for which the dentist has passed an administration and facility evaluation; and Each facility for which the dentist seeks another permit has at least one dentist who has passed an administration and facility evaluation for a like permit at that location within 2 years of the date of application for the additional permit. Alternatively, a dentist who has passed an administration and facility evaluation for a Class I, Class II, or Class III permit may receive a like permit for another facility or facilities if: The dentist holds an active Class I, Class II, or Class III permit for which the dentist has passed an administration and facility evaluation; and The dentist seeking the additional permit: Is present during a facility evaluation at which the dentist and the dentist's staff pass a facility evaluation; and Passes an evaluation, appropriate for the permit level, that includes simulated management of emergencies with the participation of the clinical office staff trained to handle emergencies. In addition to the requirements of §§A and B of this regulation, the dentist seeking the additional permit or permits shall: Submit to the Board an application on a form provided by the Board; and Pay the appropriate fee. Administration of moderate enteral sedation, moderate parenteral sedation, deep sedation, or general anesthesia to a patient requires at least the following appropriately trained individuals: The treating dentist; An individual trained and competent in basic life support or its equivalent to assist the treating dentist; and Another individual trained and competent in basic life support or its equivalent in close proximity to assist if needed. A dentist administering moderate enteral sedation, moderate parenteral sedation, deep sedation, or general anesthesia to a patient: May not leave the site until the patient: Is conscious; Is spontaneously breathing; Has stable vital signs; Is ambulatory with assistance; and Is under the care of a responsible adult; and May not induce a second patient until the first patient: Is conscious; Is spontaneously breathing; Has stable vital signs; Is ambulatory with assistance; and Is under the care of a responsible adult. A treating dentist who allows a physician, another dentist, or certified registered nurse anesthetist to administer moderate enteral sedation, moderate parenteral sedation, deep sedation, or general anesthesia under Regulation .31, .32, or .33 of this chapter shall ensure that the physician, dentist, or certified registered nurse anesthetist does not leave the site until the patient: Is conscious; Is spontaneously breathing; Has stable vital signs; Is ambulatory with assistance; and Is under the care of a responsible adult. A treating dentist who allows a physician, another dentist, or certified registered nurse anesthetist to administer moderate sedation, deep sedation, or general anesthesia shall ensure that the physician, dentist, or certified registered nurse anesthetist does not induce a second patient until the first patient: Is conscious; Is spontaneously breathing; Has stable vital signs; Is ambulatory with assistance; and Is under the care of a responsible adult. A dentist who held a current general anesthesia administration permit on January 4, 2010, may continue to administer anesthesia and sedation under the general anesthesia administration permit until the expiration of the permit only as provided in this regulation. A dentist who held a current parenteral sedation administration permit on January 4, 2010, may continue to administer moderate parenteral sedation under the parenteral sedation administration permit until the expiration of the permit only as provided in this regulation. A dentist who held a current general anesthesia administration permit on January 4, 2010, may administer anesthesia and sedation under the general anesthesia administration permit, consistent with a Class III permit, only in a facility for which the dentist holds a current general anesthesia facility permit. A dentist who held a current general anesthesia administration permit on January 4, 2010, and who wishes to administer general anesthesia in a facility for which the dentist does not hold a general anesthesia facility permit shall apply for and be issued a Class III permit for that site in accordance with Regulations .07—.11 of this chapter. A dentist who held a current parenteral sedation administration permit on January 4, 2010, may administer parenteral sedation under the parenteral sedation administration permit consistent with a Class II permit, only in a facility for which the dentist holds a current parenteral sedation facility permit. A dentist who held a current parenteral sedation administration permit on January 4, 2010, and who wishes to administer parenteral sedation at a facility for which the dentist does not hold a parenteral sedation facility permit, shall apply for and be issued a Class II permit for that site in accordance with Regulations .07—.11 of this chapter. A dentist whose general anesthesia administration permit has expired may not administer general anesthesia unless the dentist holds a Class III permit issued by the Board. A dentist whose parenteral sedation administration permit has expired may not administer parenteral sedation unless the dentist holds a Class II permit issued by the Board. General anesthesia facility permits and parenteral sedation facility permits in existence on January 4, 2010, shall expire as provided in this regulation. A general anesthesia facility permit issued to a dentist who does not hold a general anesthesia administration permit shall expire on January 4, 2010. A parenteral sedation facility permit issued to a dentist who does not hold a parenteral sedation administration permit shall expire on January 4, 2010. At least 120 days before the expiration of a general anesthesia administration permit the Board shall mail an application to each individual who holds a general anesthesia administration permit to convert the general anesthesia administration permit to a Class III permit. At least 120 days before the expiration of a parenteral sedation administration permit the Board shall mail an application to each individual who holds a parenteral sedation administration permit to convert the parenteral sedation administration permit to a Class II permit. A dentist who held a current general anesthesia administration permit and a general anesthesia facility permit on January 4, 2010, and who wishes to receive a Class III permit for a location for which the dentist holds a current general anesthesia facility permit, may receive a Class III permit for the location for which the dentist held a general anesthesia facility permit if the applicant: Submits to the Board at least 90 days before the expiration of the permit an application on a form provided by the Board; Passes a renewal evaluation in each facility for which the applicant wishes to receive a Class III permit; Pays the renewal fee set by the Board in COMAR 10.44.20; Provides an affidavit to the Board indicating whether the applicant, since the issuance of the original general anesthesia administration permit, has treated a patient under deep sedation or general anesthesia with an incident; Provides evidence satisfactory to the Board that the applicant meets the continuing education requirements outlined in Regulation .29 of this chapter; and Submits any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §C(4) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The evaluation outlined in §C(2) of this regulation shall consist of an evaluation of: Anesthesia and monitoring equipment to ensure they are in proper working order; Simulated management of emergencies with the participation of the clinical office staff trained to handle emergencies; and Drugs in the office to ensure that the applicant: Maintains the appropriate drugs on the premises; and Only utilizes drugs on the premises the dates of which have not expired. If an applicant returns an application to the Board at least 90 days before the expiration of the permit, and the Board is unable to approve or deny the application before the expiration of the permit through no fault of the applicant, the permit shall remain in effect until the Board: Issues the permit; or Denies issuance of the permit. Failure to receive the Board's application does not relieve a permit holder from the requirement to submit an application to the Board at least 90 days before the expiration of a permit. The Board may issue a Class III permit to an applicant for a specific practice location after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; The evaluation; and Any other pertinent documents or information, including, but not limited to, patient complaints that may affect the applicant's ability to safely and effectively administer anesthesia and sedation. This regulation does not preclude the Board from taking disciplinary action against a dentist who holds a: General anesthesia administration permit; or Class III permit. A dentist who held a current parenteral sedation administration permit and a parenteral sedation facility permit on January 4, 2010, and who wishes to receive a Class II permit for the location for which the dentist holds a current parenteral sedation facility permit, may receive a Class II permit for the location for which the dentist held a parenteral sedation facility permit or permits if the applicant: Submits to the Board at least 90 days before the expiration of the permit: An application on a form provided by the Board; Written verification of inspection of the applicant's anesthesia and monitoring equipment from a recognized service company; and Written verification from the applicant that: Since the issuance of the parenteral sedation administration permit, the applicant and the appropriate individuals in the applicant's staff have completed training in basic life support and the handling of medical emergencies; The applicant maintains the appropriate drugs on the premises; and The applicant only utilizes drugs on the premises the dates of which have not expired; Pays the renewal fee set by the Board in COMAR 10.44.20; Provides an affidavit to the Board indicating whether the applicant, since the issuance of the original parenteral sedation administration permit, has treated a patient under deep sedation or general anesthesia with an incident; Provides evidence satisfactory to the Board that the applicant meets the continuing education requirements outlined in Regulation .29 of this chapter; and Submits any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §J(3) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The training in basic life support and the handling of emergencies outlined in §J(1)(c)(i) of this regulation shall be completed before the submission of each application. If an applicant returns an application to the Board at least 90 days before the expiration of a permit, and the Board is unable to approve or deny the application before the expiration of the permit through no fault of the applicant, the permit shall remain in effect until the Board: Issues the permit; or Denies issuance of the permit. Failure to receive the Board's application does not relieve a permit holder from the requirement to submit an application to the Board at least 90 days before the expiration of a permit. The Board may issue a Class II permit to an applicant for a specific practice location after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; and Any other pertinent documents or information, including, but not limited to, patient complaints that may affect the applicant's ability to safely and effectively administer sedation. This regulation does not preclude the Board from taking disciplinary action against a dentist who holds a: Parenteral sedation administration permit; or Class II permit. A dentist with a general anesthesia administration permit or a parenteral sedation administration permit in existence on January 4, 2010, shall comply with Regulations .14, .26, .27, .30, .31, .32, and .34 of this chapter. To apply to obtain a permit, an applicant shall: Submit to the Board an application on a form provided by the Board; Pay the fee set by the Board in COMAR 10.44.20; and Provide evidence satisfactory to the Board that the applicant meets the qualifications for a Class I, Class II, or Class III permit. The Board may issue a Class I, Class II, or Class III permit to an applicant for a specific practice location after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; The applicant's administration evaluation; The applicant's facility evaluation; and Any other pertinent documents or information including, but not limited to, patient complaints that may affect the applicant's ability to safely and effectively administer anesthesia and sedation. A permit expires on April 1 of the 5th year following the effective date of the permit. The Board shall mail a renewal application to each individual holding a Class I or Class II permit at least 180 days before the expiration of the permit. Before a Class I or Class II permit expires, an applicant may apply to renew the permit for an additional 5-year term if the applicant: Submits to the Board at least 90 days before the expiration of the permit: A renewal application on a form provided by the Board; Written verification of inspection of the applicant's anesthesia and monitoring equipment from a recognized service company; and Written verification from the applicant that: Since the issuance of the permit or the previous renewal of the permit, the applicant and the appropriate individuals on the applicant's office staff have completed training in basic life support and the handling of medical emergencies; The applicant maintains the appropriate drugs on the premises; and The applicant only utilizes drugs on the premises the dates of which have not expired; Pays the renewal fee set by the Board in COMAR 10.44.20; Provides an affidavit to the Board indicating whether the applicant, since the issuance of the original permit or renewal, whichever is later, has treated a patient under deep sedation or general anesthesia with an incident requiring admission to a hospital either for a period greater than 24 hours, or for purposes other than observation. Provides evidence satisfactory to the Board that the applicant meets the continuing education requirements outlined in Regulation .29 of this chapter; and Submits any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §B(3) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The training in basic life support and the handling of medical emergencies outlined in §B(1)(c)(i) of this regulation shall be completed before the submission of each application for renewal. If an applicant for the renewal of a Class I or Class II permit returns a renewal application to the Board at least 90 days before the expiration of the permit, and the Board is unable to approve or deny the application before the expiration of the permit through no fault of the applicant, the permit shall remain in effect until the Board: Renews the permit; or Denies renewal of the permit. Failure to receive the Board's renewal application does not relieve the permit holder from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the permit. The Board may issue a renewal of a Class I or Class II permit to an applicant for a specific practice location after the Board's review of: The applicant's renewal application and accompanying affidavit; The applicant's qualifications; and Any other pertinent documents or information, including, but not limited to, patient complaints that may affect the applicant's ability to safely and effectively administer anesthesia and sedation. The Board shall mail a renewal application to each individual holding a Class III permit at least 180 days before the expiration of the permit. Before a permit expires, an applicant may apply to renew the permit for an additional 5-year term if the applicant: Submits to the Board, at least 90 days before the expiration of the permit, a renewal application on a form provided by the Board; Passes a renewal evaluation in each facility for which the applicant wishes to renew a permit; Pays the renewal fee set by the Board in COMAR 10.44.20; Provides an affidavit to the Board indicating whether the applicant, since the issuance of the original permit or renewal, whichever is later, has treated a patient under deep sedation or general anesthesia with an incident requiring admission to a hospital either for a period greater than 24 hours, or for purposes other than observation; Provides evidence satisfactory to the Board that the applicant meets the continuing education requirements outlined in Regulation .29 of this chapter; and Submits any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §B(4) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The renewal evaluation outlined in §B(2) of this regulation shall consist of an evaluation of an administration evaluation that consists of an office inspection and clinical evaluation. The clinical evaluation required by §D of this regulation shall: Require the participation of the clinical office staff; and Evaluate the technical competency of the dentist to: Safely administer general anesthesia, deep sedation, and moderate parenteral sedation; and Effectively respond to simulated anesthesia related emergencies with the participation of the clinical office staff trained to handle emergencies. The clinical evaluation outlined in §E of this regulation shall include evaluating the treatment of at least the following: Laryngospasm; Foreign body airway obstruction; Emergency airway management; Emesis and aspiration; Acute allergic reaction; Asthmatic attack; Bronchospasm; Angina; Conditions requiring advanced cardiac life support, including: Bradycardia; Tachycardia; Ventricular fibrillation; and Cardiac arrest; Hypotension; Hypoglycemia; Hypertension; Seizure; and Syncope. In addition to the requirements of §D of this regulation, a dentist who wishes to renew a Class III permit shall pass a facility evaluation of facility equipment, medications, and clinical records to include at least the following: Oxygen and gas delivery system, backup system, back-up system fail-safe; Gas storage facility; Safety indexed gas system; Suction and backup system; Auxiliary lighting system; Suitability of operating room: Size; Lighting; Communications; and EMT accessibility; Recovery area, including oxygen, suction, and visual and electronic monitoring, which may include the operating room; Appropriate emergency drugs; Nonexpired drugs; Appropriate devices to maintain an airway with positive pressure ventilation; Preoperative medical history and physical evaluation form; Anesthesia records, including monitoring and discharge records; Monitoring equipment, including pulse oximeter and blood pressure monitoring; Electrocardiogram (EKG); Anesthesia and monitoring equipment to ensure that they are in proper working order; Defibrillator or automated external defibrillator (AED); Capnograph measuring device; and In addition to the requirements of this section, for deep sedation or general anesthesia in pediatric patients a dentist shall have a pulse oximeter and either a: Precordial stethoscope; or Pretracheal stethoscope. The applicant and the applicant’s staff shall be present in the operatory during the evaluation. If an applicant for the renewal of a Class III permit returns a renewal application to the Board at least 90 days before the expiration of the permit, and the Board is unable to approve or deny the application before the expiration of the permit through no fault of the applicant, the permit shall remain in effect until the Board: Renews the permit; or Denies renewal of the permit. Failure to receive the Board's renewal application does not relieve the permit holder from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the permit. The Board may issue a renewal of a Class III permit to an applicant for a specific practice location after the Board's review of: The applicant's renewal application and accompanying affidavit; The applicant's qualifications; The renewal evaluation; and Any other pertinent documents or information, including, but not limited to, patient complaints that may affect the applicant's ability to safely and effectively administer anesthesia and sedation. After January 4, 2010, a dentist may not administer anesthesia or sedation for the practice of dentistry in a dental school recognized by the Commission on Dental Accreditation or its successor organization unless the dental school holds a Class III dental school facility permit. A dental school that applies for a Class III dental school facility permit shall pass an on-site facility evaluation by the Board or its designee as specified in Regulation .11 of this chapter. To obtain a dental school Class III facility permit a dental school recognized by the Commission on Dental Accreditation or its successor organization shall: Submit to the Board an application on a form provided by the Board; Pay the fee set by the Board in COMAR 10.44.20; and Provide evidence satisfactory to the Board that the dental school meets the qualifications for a Class III dental school facility permit. A Class III dental school facility permit shall expire on April 1 of the 5th year following the effective date of the permit. The Board shall mail a renewal application to each dental school holding a Class III dental school facility permit at least 180 days before the expiration of the permit. Before a Class III dental school facility permit expires, the dental school may renew the permit for an additional 5-year term if the dental school: Submits to the Board, at least 90 days before the expiration of the permit, a renewal application on a form provided by the Board; Passes a renewal facility evaluation in each facility for which the dental school wishes to renew a permit; and Pays the renewal fee set by the Board in COMAR 10.44.20. The renewal evaluation outlined in §B(2) of this regulation shall consist of an evaluation of: Anesthesia and monitoring equipment to ensure they are in proper working order; and Drugs in the facility to ensure that the dental school: Maintains the appropriate drugs on the premises; and Only utilizes drugs on the premises the dates of which have not expired. If a dental school returns a renewal application for a Class III dental school facility permit to the Board at least 90 days before the expiration of the permit, and the Board is unable to approve or deny the application before the expiration of the permit through no fault of the dental school, the permit shall remain in effect until the Board: Renews the permit; or Denies renewal of the permit. Failure to receive the Board's renewal application does not relieve the dental school from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the permit. A dental school that holds a Class III Dental School Facility Permit shall advise the Board of any additional locations it has opened since the issuance or the renewal of its original permit. The notice required under §A of this regulation shall be provided to the Board in writing not later than 30 days before the opening of the additional location. A dentist may not administer anesthesia or sedation for the practice of dentistry in an additional location unless the school holds a Class III dental school facility permit for the additional location. A dental school that applies for a Class III dental school facility permit for an additional location shall pass an on-site facility evaluation by the Board or its designee as contained in Regulation .11 of this chapter. All facilities including a dental school that holds a Class III dental school facility permit shall maintain for 5 years for inspection by the Board: The name of each dentist who has administered anesthesia or sedation; and The license number of each dentist who has administered anesthesia or sedation. During reasonable business hours, the Board or its designee may conduct unannounced inspection visits of any dental office or facility if the Board has: Received a complaint or has initiated a complaint; and Reason to believe that anesthesia or sedation has been administered: Without an appropriate permit; or In violation of this chapter. Dentists and all associated personnel shall cooperate with the inspectors. Within 30 days of the conclusion of the inspection, the inspectors shall make reasonable efforts to submit a written report of the inspection to: The Board; and Each dentist and individual who was the subject of the inspection. The owner or operator of a facility may not permit an individual to administer anesthesia or sedation unless the individual is qualified to do so under this chapter. The owner or operator of a facility shall ensure that the facility: Remains properly equipped in accordance with Regulation .11A of this chapter; and Remains properly staffed in accordance with Regulation .14 of this chapter. In addition to the requirements contained in §B of this regulation, the owner or operator of a facility shall ensure that the facility has: Appropriate nonexpired emergency drugs; and Appropriate nonexpired drugs. After an opportunity for a hearing, the Board may take disciplinary action against a dentist under Health Occupations Article, §4-315(a) or (b), Annotated Code of Maryland, if the Board finds that: The dentist violates any provisions of this chapter; or The facility is inadequate under the provisions of this chapter. Failure to comply with this chapter constitutes unprofessional conduct and may constitute other violations of law. Renewal of a Class I, Class II, or Class III Permit. Beginning in 2016 and thereafter, an applicant who seeks renewal of a Class I, Class II, or Class III permit shall: Complete not less than 24 hours of clinical continuing education related to sedation or anesthesia in a classroom setting during the 5-year term of the permit; and Maintain cardiopulmonary resuscitation certification from one of the following programs: The American Heart Association's Basic Life Support for Healthcare Providers; The American Red Cross's Cardiopulmonary Resuscitation for Professional Rescuers; The American Safety & Health Institute; or An equivalent program approved by the Board. Additional Requirements for Renewal of a Class I Permit. In addition to the requirements outlined in §A of this regulation, an applicant for the renewal of a Class I permit shall: Complete a Board-approved course of at least 4 hours that provides instruction on medical emergencies and airway management; Maintain Advanced Cardiac Life Support (ACLS) certification; or Maintain Pediatric Advanced Life support certification (PALS). The following courses may count toward the required hours of continuing education: Advanced Cardiac Life Support (ACLS) course; Pediatric Advanced Life Support (PALS) course; or A Board-approved course in medical emergency and airway management. Additional Requirements for Renewal of a Class II or Class III Permit. In addition to the requirements outlined in §A of this regulation, an applicant for the renewal of a Class II or Class III permit shall: Complete a Board-approved course of at least 4 hours that provides instruction on medical emergencies and airway management; Maintain Advanced Cardiac Life Support (ACLS) certification; or Maintain Pediatric Advanced Life Support (PALS) certification. The following courses may count toward the required hours of continuing education: Advanced Cardiac Life Support (ACLS) course; Pediatric Advanced Life Support (PALS) course; or A Board-approved course in medical emergency and airway management. A Class I, Class II, or Class III permit may not be transferred to another person or location. A treating dentist who wishes to allow a physician or another dentist to administer anesthesia and sedation to a patient at a specific practice location shall receive a certificate from the Board before allowing a physician or another dentist to administer anesthesia and sedation at that location. To apply for a certificate to allow a physician or another dentist to administer anesthesia and sedation: A treating dentist shall: Apply to the Board on a form approved by the Board; Possess either a Class I, Class II, or Class III permit; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; Submit any other pertinent documents or information requested by the Board; and Pay a nonrefundable fee to the Board as set forth in COMAR 10.44.20; or A treating dentist shall: Apply to the Board on a form approved by the Board; Provide documentation to the Board that the treating dentist has completed a Board-approved training program where the treating dentist received competent training in treating patients under: Moderate enteral sedation and airway management; Moderate parenteral sedation and airway management; Deep sedation and airway management; or General anesthesia and airway management; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; Submit any other pertinent documents or information requested by the Board; and Pay a nonrefundable fee to the Board as set forth in COMAR 10.44.20. An affidavit provided to the Board under §B(1)(c) or (2)(c) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. In addition to the requirements contained in §§A—C of this regulation, a treating dentist who applies for a certificate to allow a physician or another dentist to administer anesthesia and sedation to a patient shall: Maintain either a Class I, Class II, or Class III permit for the administration site; and Maintain facility equipment in the facility consistent with a Class III permit as outlined in Regulation .11A of this chapter. The Board may issue a certificate to a dentist to allow a physician or another dentist to administer anesthesia and sedation after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; The applicant's patient records; and Any other pertinent documents or information including, but not limited to, patient complaints which may affect the applicant's ability to safely and effectively treat patients under anesthesia and sedation. A certificate issued to a treating dentist to allow a physician or another dentist to administer anesthesia and sedation at a specific location shall expire on April 1 of the 5th year following the effective date of the certificate. A dentist who administers anesthesia or sedation pursuant to §A of this regulation shall maintain the appropriate permit for the administration site. A dentist who holds a certificate to allow a physician or another dentist to administer anesthesia or sedation shall be present in the operatory during the administration of the anesthesia or sedation. Renewal. The Board shall mail a renewal application to each treating dentist who has received a certificate from the Board to allow a physician or another dentist to administer anesthesia and sedation at least 180 days before the expiration of the certificate. Before the certificate expires, an applicant may apply to renew the certificate for an additional 5-year term if the applicant submits to the Board at least 90 days before the expiration of the certificate: A renewal application on a form provided by the Board; An affidavit indicating whether the applicant, since the issuance of the original certificate or renewal, whichever is later, has treated a patient under deep sedation or general anesthesia with an incident; A nonrefundable fee as set forth in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §J(2) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The Board may issue a renewal certificate to a dentist to allow a physician or another dentist to administer anesthesia and sedation after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; and Any other pertinent documents or information including but not limited to patient complaints which may affect the applicant's ability to safely and effectively treat patients under anesthesia and sedation. If an applicant for the renewal of a certificate to allow a physician or another dentist to administer anesthesia and sedation returns a renewal application to the Board at least 90 days before the expiration of the certificate, and the Board is unable to approve or deny the application before the expiration of the certificate through no fault of the applicant, the certificate shall remain in effect until the Board: Renews the certificate; or Denies renewal of the certificate. Failure to receive the Board's renewal application does not relieve the certificate holder from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the certificate. A treating dentist who treats a patient at a practice location other than the dentist's own location, at which anesthesia and sedation are administered to the patient, shall receive a certificate from the Board before treating the patient. To apply for a certificate to treat a patient at a practice location other than the dentist's own location, at which anesthesia and sedation are administered to the patient: A treating dentist shall: Apply to the Board on a form approved by the Board; Possess a Class I, Class II, or Class III permit; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; Submit any other pertinent documents or information requested by the Board; and Pay a nonrefundable fee to the Board as set forth in COMAR 10.44.20; or A treating dentist shall: Apply to the Board on a form approved by the Board; Provide documentation to the Board that the treating dentist has completed a Board-approved training program where the treating dentist received competent training in treating patients under: Moderate enteral sedation and airway management; Moderate parenteral sedation and airway management; Deep sedation and airway management; or General anesthesia and airway management; Provide an affidavit to the Board indicating whether the applicant has ever treated a patient under deep sedation or general anesthesia with an incident; Submit any other pertinent documents or information requested by the Board; and Pay a nonrefundable fee to the Board as set forth in COMAR 10.44.20. An affidavit provided to the Board under §B(1)(c) or (2)(c) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. In addition to the requirements contained in §§A—C of this regulation, a treating dentist who applies for a certificate shall maintain a Class I, Class II, or Class III permit for an administration site in the State. The Board may issue a certificate after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; The applicant's patient records; and Any other pertinent documents or information, including, but not limited to, patient complaints which may affect the applicant's ability to safely and effectively treat patients under anesthesia and sedation. A certificate issued under this regulation is not specific to a particular practice location. A certificate expires on April 1 of the 5th year following the effective date of the certificate. A dentist who administers anesthesia or sedation pursuant to this regulation shall maintain the appropriate permit for the administration site. A treating dentist who holds a certificate to treat a patient at a practice location other than the dentist’s own location, at which anesthesia or sedation are administered to the patient, shall be present in the operatory during the administration of the anesthesia or sedation. Renewal. The Board shall mail a renewal application to each treating dentist who has received a certificate from the Board at least 180 days before the expiration of the certificate. Before the certificate expires, an applicant may apply to renew the certificate for an additional 5-year term if the applicant submits to the Board at least 90 days before the expiration of the certificate: A renewal application on a form provided by the Board; An affidavit indicating whether the applicant, since the issuance of the original certificate or renewal, whichever is later, has treated a patient under deep sedation or general anesthesia with an incident; A nonrefundable fee as set forth in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §K(2) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The Board may issue a renewal certificate to a dentist after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; and Any other pertinent documents or information, including, but not limited to, patient complaints which may affect the applicant's ability to safely and effectively treat patients under anesthesia and sedation. If an applicant for the renewal of a certificate returns a renewal application to the Board at least 90 days before the expiration of the certificate, and the Board is unable to approve or deny the application before the expiration of the certificate through no fault of the applicant, the certificate shall remain in effect until the Board: Renews the certificate; or Denies renewal of the certificate. Failure to receive the Board's renewal application does not relieve the certificate holder from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the certificate. A treating dentist who wishes to allow a certified registered nurse anesthetist to administer anesthesia and sedation to a patient at a specific practice location shall receive a certificate from the Board before allowing a certified registered nurse anesthetist to administer anesthesia and sedation at that location. To apply for a certificate to allow a certified registered nurse anesthetist to administer anesthesia and sedation, a treating dentist shall: Apply to the Board on a form approved by the Board; Provide an affidavit to the Board indicating whether the treating dentist has ever treated a patient under deep sedation or general anesthesia with an incident; Submit any other pertinent documents or information requested by the Board; and Pay a nonrefundable fee to the Board as set forth in COMAR 10.44.20. An affidavit provided to the Board under §B(2) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. In addition to the requirements in §§A—C of this regulation, a treating dentist who applies for a certificate to allow a certified registered nurse anesthetist to administer anesthesia and sedation to a patient shall maintain permits as follows: A treating dentist who allows a certified registered nurse anesthetist to administer moderate enteral sedation to a patient shall maintain a Class I permit for the administration site; A treating dentist who allows a certified registered nurse anesthetist to administer moderate parenteral sedation to a patient shall maintain a Class II permit for the administration site; and A treating dentist who allows a certified registered nurse anesthetist to administer deep sedation or general anesthesia to a patient shall maintain a Class III permit for the administration site. In addition to the requirements of this regulation, a dentist who allows a certified registered nurse anesthetist to administer anesthesia and sedation shall maintain facility equipment in the facility consistent with a Class III permit as outlined in Regulation .11A of this chapter. A treating dentist who holds a certificate to allow a certified registered nurse anesthetist to administer anesthesia or sedation shall be present in the operatory during the administration of the anesthesia or sedation. The Board may issue a certificate to a dentist to allow a certified registered nurse anesthetist to administer anesthesia and sedation after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; The applicant's patient records; and Any other pertinent documents or information, including, but not limited to, patient complaints which may affect the applicant's ability to safely and effectively treat patients under anesthesia and sedation. A certificate issued to a treating dentist to allow a certified registered nurse anesthetist to administer anesthesia and sedation at a specific location expires on April 1 of the 5th year following the effective date of the certificate. Renewal. The Board shall mail a renewal application to each treating dentist who has received a certificate from the Board to allow a certified registered nurse anesthetist to administer anesthesia and sedation at least 180 days before the expiration of the certificate. Before the certificate expires, an applicant may apply to renew the certificate for an additional 5-year term if the applicant submits to the Board at least 90 days before the expiration of the certificate: A renewal application on a form provided by the Board; An affidavit indicating whether the applicant, since the issuance of the original certificate or renewal, whichever is later, has treated a patient under deep sedation or general anesthesia with an incident; A nonrefundable fee as set forth in COMAR 10.44.20; and Any other pertinent documents or information requested by the Board. An affidavit provided to the Board under §J(2) of this regulation, which indicates that the applicant has treated a patient under deep sedation or general anesthesia with an incident, shall include the information contained in Regulation .08G of this chapter. The Board may issue a renewal certificate to a dentist to allow a certified registered nurse anesthetist to administer anesthesia and sedation after the Board's review of: The applicant's application and accompanying affidavit; The applicant's qualifications; and Any other pertinent documents or information, including, but not limited to, patient complaints which may affect the applicant's ability to safely and effectively treat patients under anesthesia and sedation. If an applicant for the renewal of a certificate to allow a certified registered nurse anesthetist to administer anesthesia and sedation returns a renewal application to the Board at least 90 days before the expiration of the certificate, and the Board is unable to approve or deny the application before the expiration of the certificate through no fault of the applicant, the certificate shall remain in effect until the Board: Renews the certificate; or Denies renewal of the certificate. Failure to receive the Board's renewal application does not relieve the certificate holder from the requirement to submit a renewal application to the Board at least 90 days before the expiration of the certificate. A dentist who holds a Class I, Class II, or Class III permit shall maintain their wallet certificate in their possession for inspection at the administration site. A dentist who holds a general anesthesia facility permit or a parenteral sedation facility permit shall display the permit and any current renewal certificates in the facility. A dentist who treats a patient at an accredited facility as defined in Regulation .03 of this chapter where anesthesia or sedation is being administered to the patient by either another dentist, physician, or certified registered nurse anesthetist is not required to hold: A Class I, Class II, or Class III permit; or A certification to allow another dentist, physician, or certified registered nurse anesthetist to administer anesthesia or sedation. A dentist shall report to the Board, in writing, any death caused by or resulting from the dentist's administration of anxiolysis, moderate sedation, deep sedation, or general anesthesia within 7 days after its occurrence. A dentist shall report to the Board, in writing, any complication or disabling incident requiring admission to a hospital either for a period greater than 24 hours, or for purposes other than observation, as a result of the dentist’s administration of anxiolysis, moderate sedation, deep sedation, or general anesthesia within 15 days after its occurrence. The written report to the Board required in §§A and B of this regulation shall include: The date of the incident; The name, age, and address of the patient; The patient's original complete dental records; The name and license number of the licensee and the name and address of all other persons present during the incident; The address where the incident took place; The preoperative physical condition of the patient; The type of anesthesia and dosages of drugs administered to the patient; The techniques used in administering the drugs; Any adverse occurrence including: The patient's signs and symptoms; The treatment instituted in response to adverse occurrences; The patient's response to the treatment; and The patient's condition on termination of any procedures undertaken; and A narrative description of the incident including approximate times and evolution of symptoms. The duties outlined in §§A—C of this regulation apply to every dentist whether or not the dentist holds a permit. The Board may initiate a complaint based upon the contents of a morbidity or mortality report. A Board initiated complaint under §E of this regulation shall be independent of and may not prejudice the filing of a complaint by a third party. After an opportunity for a hearing, the Board may revoke or suspend a Class I, Class II, or Class III permit or take disciplinary action under Health Occupations Article, §4-315(a) or (b), Annotated Code of Maryland, if the Board finds that: The holder of the permit violates any provision of this chapter; or The facility is inadequate under the provisions of this chapter. Failure to comply with this chapter constitutes unprofessional conduct and may constitute other violations of law. After an opportunity for a hearing, the Board may revoke or suspend a general anesthesia administration permit or a parenteral sedation administration permit or take disciplinary action under Health Occupations Article, §4-315(a) or (b), Annotated Code of Maryland, if the Board finds that: The holder of the permit violates Regulation .13, .14, .26, .31, .32, .33, or .36 of this chapter; or The facility is inadequate under the provisions of this chapter. Failure to comply with the applicable provisions of this chapter constitutes unprofessional conduct and may constitute other violations of law. The Board may order the summary suspension of a permit if the Board: Finds that the public health, safety, or welfare imperatively requires emergency action; and Promptly gives the licensee: Written notice of the suspension, the finding, and the reasons that support the finding; and An opportunity to be heard. Service of the notice of the suspension, the finding, the reasons that support the finding, and the notice of the opportunity to be heard may be effected upon the holder of a permit by: Personal service; or Written notice sent by certified mail and regular mail to the permit holder's address on file with the Board. Service made pursuant to §B(2) of this regulation shall be effective upon mailing. The methods of service provided in this regulation are in addition to and not exclusive of any other means of service that are reasonably calculated to provide notice. Health Occupations Article, §4-205, Annotated Code of Maryland Effective date: February 11, 1985 (12:3 Md. 245) Regulation .04 amended effective March 8, 1999 (26:5 Md. R. 392) Regulation .07B, C amended effective September 23, 1996 (23:19 Md. R. 1376) Regulation .09 amended effective February 19, 1990 (17:3 Md. R. 300); March 8, 1999 (26:5 Md. R. 392) Regulation .10C amended effective September 23, 1996 (23:19 Md. R. 1376); March 8, 1999 (26:5 Md. R. 392) Regulations .01—.13 under General Anesthesia, repealed, and new Regulations .01—.37 under Anesthesia and Sedation, adopted effective January 4, 2010 (36:18 Md. R. 1380) Chapter revised effective May 11, 2015 (42:9 Md. R. 648) Regulation .11A amended effective December 30, 2019 (46:26 Md. R. 1165) Regulation .21G amended effective December 30, 2019 (46:26 Md. R. 1165) These regulations govern all licensed dentists, licensed dental hygienists, dental assistants, dental students, dental hygiene students, and dental assistant students. For purposes of these regulations, “protection” means the lead shielding of 0.25 millimeter lead equivalence or greater. Dental X-Ray Protection, NCRP Report No. 35 (National Council on Radiation Protection and Measurements, Issued March 9, 1970), is incorporated by reference. Protection shall be placed over the patient in accordance with Dental X-Ray Protection, NCRP Report No. 35. Protection is not required if its use would interfere with the diagnostic quality of the resultant radiographs. A violation of these regulations during the exposure of dental radiographs constitutes unprofessional conduct. Health Occupations Article, §4-506, Annotated Code of Maryland Effective date: January 14, 1985 (12:1 Md. R. 16) Regulation .02-1 adopted effective October 16, 2000 (27:20 Md. R. 1839) Regulation .03 repealed and new Regulation .03 adopted effective October 16, 2000 (27:20 Md. R. 1839) These regulations govern the qualifications for identification of a licensed dentist as a specialist by the Maryland State Board of Dental Examiners, and the application procedures and fees for the identification. For purposes of this chapter, “Board” means the Maryland State Board of Dental Examiners. The Board recognizes the following areas of dentistry as specialties: Endodontics; Oral surgery, also known as oral and maxillofacial surgery; Oral pathology; Orthodontics; Pediatric dentistry; Periodontics; Prosthodontics; Public health; and Any area of specialty approved by the Commission on Dental Accreditation or its successor organization. A licensed dentist qualifies for identification as specialist by the Board if the dentist: Has successfully completed a Board-approved specialty training program in that specialty; or Before July 1, 1979, reasonably represented to the public that the dentist was a specialist in that specialty while limiting the dentist's practice to the specialty. To apply for identification as a specialist, a licensed dentist shall submit to the Board: An application on a form that the Board provides; A fee as set forth in COMAR 10.44.20; and Either evidence of having successfully completed a Board-approved specialty training program or a written statement, under oath, that sets forth the basis for the dentist's claim that, before July 1, 1979, the dentist reasonably represented to the public that the dentist was a specialist in that specialty, including in that written statement the: Dates during which the dentist's practice was limited to that specialty; and Education and experience on which the claim to be a specialist was based. The Board shall maintain a roster of all licensed dentists identified as specialists in each of the specialties recognized by the Board. The Board shall maintain a list of all specialty training programs it approves. The list shall be open to the public during the normal business hours of the Board. On or after July 1, 1985, a person may not represent to the public that the person is a dentist specializing in any specialty of dentistry or limiting the dentist's practice of dentistry to any specialty of dentistry unless the person is recognized by the Board as a specialist in that specialty. A person may not represent to the public that the person is a specialist in any area not approved by the Board. Violation of these regulations constitutes unprofessional conduct and may result in disciplinary action as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. Health Occupations Article, §4-504, Annotated Code of Maryland Effective date: January 28, 1985 (12:2 Md. R. 141) Regulation .03 amended effective June 26, 2000 (27:12 Md. R. 1141) Regulation .03E amended effective August 20, 1990 (17:16 Md. R. 1991) Regulation .05B amended effective November 20, 1994 (21:23 Md. R. 1954) Regulation .08 amended effective August 20, 1990 (17:16 Md. R. 1991) This chapter governs dentists and dental hygienists who seek a general license to practice dentistry or dental hygiene and who do not hold a license to practice dentistry or dental hygiene in another state. Licensure for dentists licensed in another state is governed by COMAR 10.44.05. Licensure for dental hygienists licensed in another state is governed by COMAR 10.44.09. General licensure for pediatric dental residents with a limited license at the University of Maryland Dental School who have successfully met all requirements for general licensure is governed by COMAR 10.44.02. In this chapter, the following terms have the meanings indicated. Terms Defined. “ADEX” means the American Board of Dental Examiners, Inc., or its successor organization. “ADHLEX” means the American Dental Hygiene Licensing Examination, which includes both a written component and a clinical component, designed and developed by ADEX, or its successor examination. “ADLEX” means the American Dental Licensing Examination, which includes both a written component and a clinical component, designed and developed by ADEX, or its successor examination. “Board” means the Maryland State Board of Dental Examiners. To qualify for a general license to practice dentistry an applicant shall: Be of good moral character; Be at least 18 years old; and Hold a degree of Doctor of Dental Surgery, Doctor of Dental Medicine, or the equivalent from a college or university that is: Authorized by any state or any province of Canada to grant the degree; and Recognized by the Board as: Requiring adequate preprofessional collegiate training; and Maintaining an acceptable course of dental instruction. In addition to the requirements contained in §A of this regulation, an applicant for a dental license shall meet all the requirements for licensure contained in Health Occupations Article, Title 4, Annotated Code of Maryland. To qualify for a general license to practice dental hygiene an applicant shall: Be of good moral character; and Be a graduate of a school for dental hygienists that: Requires at least 2 years of education in an institution of higher education; Is accredited by the American Dental Association Commission on Dental Accreditation; and Is approved by the Board. In addition to the requirements contained in §C of this regulation, an applicant for a dental hygiene license shall meet all of the requirements for licensure contained in Health Occupations Article, Title 4, Annotated Code of Maryland. An applicant who otherwise qualifies for an initial dental license shall pass the written and clinical ADLEX examination with a score of 75 or greater in each required section. An applicant who otherwise qualifies for an initial dental hygiene license shall pass the written and clinical ADHLEX examination with a score of 75 or greater in each required section. An applicant for an initial dental or dental hygiene license shall pass the national boards examinations, also known as the National Boards, administered by the Council of National Boards of the American Dental Association. An applicant who fails the ADLEX or ADHLEX examinations four times may not be licensed. The ADEX has the authority to determine: Examination sites; Frequency of examinations; Examination content; and Grading method, provided that the grading method is not arbitrary and capricious. Applicants may not be licensed until they have successfully passed: All required sections of the ADLEX or ADHLEX examination; and The national board examinations. In addition to passing the ADLEX or ADHLEX examination and national board examinations, an applicant shall pass a written examination on laws, regulations, and ethics given by the Board or its designee. The examination shall consist of the following two parts: General questions on: Laws; Regulations; and Ethics; and Questions on Maryland jurisprudence. An applicant shall attain a score of 75 or greater on each section of the examination described in §B of this regulation. The Board may require that an applicant for licensure successfully pass each required section of the ADLEX or ADHLEX clinical examination if the Board determines that the applicant may have lost clinical skills because of an extended absence from clinical practice. A candidate for licensure shall: Fully complete the appropriate Board application; and Pay the required fee in accordance with COMAR 10.44.20. An application shall be returned to the applicant and the applicant may not be licensed if the application: Is incomplete; Does not contain all of the requested information or documentation; or Is not accompanied by the required fee. The Board shall refund the application fee, less a $50 processing fee, to a dentist or a dental hygienist who does not qualify for licensure. An applicant for a dental or a dental hygiene license shall submit the following to the Board: A completed application on a form provided by the Board; A recent photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental or dental hygiene education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead, bearing an original signature, do not require a raised embossed seal; A certified ADLEX or ADHLEX score; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. Health Occupations Article, §§4-302, 4-303.1(d), 4-305, and 4-306, Annotated Code of Maryland Effective date: February 19, 1990 (17:3 Md. R. 300) Chapter revised effective July 5, 2004 (31:13 Md. R. 995) Regulation .05 amended effective August 13, 2007 (34:16 Md. R. 1432) Regulations .01—.08 repealed and new Regulations .01—.09 adopted as an emergency provision effective October 1, 2012 (39:22 Md. R. 1427); adopted permanently effective December 24, 2012 (39:25 Md. R. 1614) These regulations govern the State Board of Dental Examiners and a petitioner for a declaratory ruling. The following terms have the meanings indicated. Terms Defined. “Board” means the State Board of Dental Examiners. “Person” means an individual, an agency, an association, a corporation, or any other entity. An interested person may file with the Board a petition for a declaratory ruling with respect to the manner in which the Board would apply a statute, a regulation, or an order that the Board enforces to a particular case based on the facts presented in the petition. The petition for a declaratory ruling shall be filed in writing on a form provided by the Board. The petition shall contain a statement describing in detail the: Interest of the petitioner in making a request; Issue involved; Facts to be considered; and Documents or statements, or both, to be considered. The petition shall contain a sworn statement by the petitioner that the facts contained in the petition are true to the best of the person's knowledge and belief. Within 60 days after receipt of the petition, the Board shall inform the petitioner whether the petition will be granted. If the petition is denied, the Board shall inform the petitioner in writing of the reasons for denial. If the petition is granted, the Board or its designee shall inform the petitioner of the date on which the Board will issue the declaratory ruling. A petition will be granted unless the Board or its designee considers a declaratory ruling inadvisable due to considerations listed in §H of this regulation. In rendering its ruling, the Board or its designee: Shall consider all materials submitted with the petition; May consider any document, data, or other relevant material; May consult individuals; May consider comments from the staff; or May require argument of the question or permit the introduction of evidence. A declaratory ruling issued shall be in writing, stating the: Issue; Conclusion; Facts upon which the conclusion was based; and Sources relied upon. A declaratory ruling issued by the Board shall plainly state that it is a declaratory ruling made pursuant to these regulations. A written answer from the Board or any employee of the Board to an inquiry may not be construed as a declaratory ruling unless made in conformity with these regulations. The Board shall keep a record of each declaratory ruling issued and index all declaratory rulings issued by reference to statute or regulation involved. The Board may publish declaratory rulings of general interest subject to the mandates of the Public Information Act, State Government Article, §10-601 et seq., Annotated Code of Maryland, and allow inspection of the declaratory rulings subject to the Public Information Act. A petition may be denied if the: Request contains incomplete information upon which to base an informed declaratory ruling; Board or its designee concludes that a declaratory ruling cannot reasonably be given on the matter; Matter is adequately covered by a: Prior regulation, Declaratory ruling, Decision, or Legal opinion; or Board or its designee concludes that a ruling would not be in the public interest. A declaratory ruling shall be binding upon the Board and the petitioner on the statement of facts covered in the declaratory ruling and set forth in the petition. A petitioner may apply for revision of a declaratory ruling. The petitioner's application for revision of the declaratory ruling shall: Be filed within 10 days after the issuance of the declaratory ruling; State the grounds for the revision; and Stay enforcement of the declaratory ruling until disposition. Upon receipt of the application, the Board may: Reopen the declaratory ruling to receive additional information; Amend its ruling or its statement of reasons for the ruling; Set forth additional findings or reasons; and Enter new findings, new reasons, or a new ruling. The Board shall grant or deny the application for revision within 45 days of its receipt. The Board may exercise revisory power and control over the declaratory ruling in the case of fraud, mistake, or irregularity. A declaratory ruling is subject to review as provided in State Government Article, §10-305, Annotated Code of Maryland. State Government Article, §§10-304 and 10-305, Annotated Code of Maryland Effective date: February 19, 1990 (17:3 Md. R. 300) These regulations establish qualifications and requirements for applicants for a temporary license to practice dental hygiene in Maryland. An individual is eligible for a temporary license to practice dental hygiene if the individual: Is a graduate of a school for dental hygienists that requires at least 2 years of education in an institution of higher learning that is accredited by the American Dental Association Commission on Dental Accreditation and is approved by the Board; Is currently licensed to practice dental hygiene in any other state or any province of Canada; and Has practiced dental hygiene at least 800 hours per year for 2 years and has practiced dental hygiene during the past 2 years. An applicant shall submit to the Board: An application on the form that the Board requires for a temporary license; Proof of current licensure in another state or province of Canada; A statement from previous employers verifying the required practice experience; An application fee as specified in COMAR 10.44.20. Before a temporary license to practice dental hygiene is issued, the applicant shall pass a written examination administered by the Board, on the Maryland Dentistry Act, Health Occupations Article, Title 4, Annotated Code of Maryland, and regulations adopted under that Act. A temporary license expires on the date when licenses are issued to those who pass the first examination for a general license to practice dental hygiene given over 30 days after the effective date of the temporary license. Notification that the temporary licensee has failed the first examination for a general license to practice dental hygiene given over 30 days after the effective date of the temporary license shall serve as notice of the expiration of that temporary license. A temporary license to practice dental hygiene is not renewable. Health Occupations Article, §4-312, Annotated Code of Maryland Effective date: February 19, 1990 (17:3 Md. R. 301) Regulation .02A amended effective July 27, 1998 (25:15 Md. R. 1191) Regulation .03D amended effective July 27, 1998 (25:15 Md. R. 1191) Effective date: September 3, 1990 (17:17 Md. R. 2081) Regulation .10A amended effective August 24, 1998 (25:17 Md. R. 1361) Regulation .11C adopted effective August 24, 1998 (25:17 Md. R. 1361) Regulations 01—.15 repealed effective January 4, 2010 (36:18 Md. R. 1380) In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Dental Examiners. “Dental radiation technologist” means an individual other than a licensed dentist or a licensed dental hygienist who practices dental radiation technology. “Direct supervision” means that the supervising dentist is in the dental office and personally: Diagnoses the condition to be treated: Authorizes the placement or exposure of dental radiographs; and Before dismissal of the patient, evaluates the performance of the dental radiation technologists. “Licensed dental hygienist” means an individual licensed by the Board to practice dental hygiene. “Licensed dentist” means an individual licensed by the Board to practice dentistry. “Practice of dental radiation technology” means the placement or exposure of dental radiographs by an individual other than a licensed dentist, a licensed dental hygienist, an individual permitted to practice dentistry without a license under Health Occupations Article, §4-301(b)(1), (2), or (3), Annotated Code of Maryland, or an individual enrolled in an educational program recognized by the Board for dental hygiene or dental assisting, who places or exposes dental radiographs pursuant to the educational program. An individual shall be currently certified by the Board as a dental radiation technologist before the individual may practice dental radiation technology on a human being in this State. Except as otherwise provided in these regulations, to qualify to be certified as a dental radiation technologist, an applicant shall be an individual who: Is 18 years old or older; Is of good moral character; Holds a high school degree or the equivalent; Satisfactorily completes the Board-approved educational requirements established by the Maryland State Dental Association or the Maryland Dental Society; Successfully completes a Board-approved course of at least 24 hours related to Maryland dental radiology; and Passes an examination administered or approved by the Board for qualifying to place and expose radiographs; and Meets any requirements established by the American Dental Association or any applicable federal standards for training and certification as a dental radiation technologist. An individual holding an active license or certification to practice dental radiation technology in another state may be granted certification in Maryland if the individual: Has engaged in practicing dental radiation technology for at least 150 hours in the 3 years preceding application for certification in Maryland; and Meets any requirements established by the American Dental Association or any applicable federal standards for training and certification as a dental radiation technologist. Except as otherwise provided in these regulations, the Board shall certify as a dental radiation technologist an individual who: Meets the qualifications for certification; Applies for certification on a form provided by the Board; and Pays a fee to the Board as set forth in COMAR 10.44.20. A certification as a dental radiation technologist expires on the second anniversary of the issuance of the certification unless it is renewed for an additional 2-year term as provided in this regulation. At least 2 months before a certification as a dental radiation technologist expires, the Board shall send, by first-class mail to the last known address of the individual so certified, a renewal notice that states the: Date on which the current certification expires; Date by which the renewal application has to be received by the Board for the renewal to be issued and mailed before the certification expires; and Amount of the renewal fee. Before a certification as a dental radiation technologist expires, the individual so certified periodically may renew the certification for an additional 2 years if the individual: Applies for renewal of the certification on a form provided by the Board; Pays to the Board a fee as set forth in COMAR 10.44.20; and Meets one of the following requirements: Has actively practiced dental radiation technology for at least 600 hours within the 6 years before the expiration of the certification; or If the applicant has not actively practiced dental radiation technology in accordance with §C(3)(a) of this regulation, provides to the Board evidence satisfactory to the Board that the individual has completed 8 classroom hours of dental continuing education, 4 hours of which shall be on the subject of radiation safety within the 1-year period preceding renewal. In addition to the requirements of §C of this regulation, a dental radiation technologist seeking renewal of a certificate shall complete a 2-hour Board-approved course on infection control. In addition to the requirements of §C of this regulation, a dental radiation technologist seeking renewal of a certificate in 2025 and thereafter shall complete a 3-hour Board-approved course on infection control. The infection control course identified in §E of this regulation shall be a single 3-hour course, which teaches the practices contained in the document Centers for Disease Control and Prevention, Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; October 2016, or its successor document. After the expiration date of a certificate to practice dental radiation technology in the State, the certificate holder may renew the certificate within 30 days of its expiration if the certificate holder: Is otherwise entitled to be issued a certificate; Complies with the requirements of §§C(3) and D of this regulation; Submits to the Board a completed renewal application on the form provided by the Board; and Pays to the Board the renewal fee and the late renewal fee as specified in COMAR 10.44.20. Certification After April 1. A certificate holder who has failed to renew a certificate to practice dental radiation technology in this State by April 1 of the year in which the certificate is due for renewal is prohibited from practicing dental radiation technology in this State after the expiration date of the certificate. If the Board determines that a dental radiation technologist has practiced dental radiation technology in this State after the certificate has expired, the Board may order the dental radiation technologist to immediately cease and desist the practice of dental radiation technology in this State until the dental radiation technologist's certificate has been reinstated by the Board. The Board may take action against a dental radiation technologist for unprofessional conduct if the Board determines that the dental radiation technologist has practiced dental radiation technology in this State after the dental radiation technologist's certificate has expired. The Board may impose an administrative penalty through a nonpublic consent agreement in which the dental radiation technologist agrees to: Make an anonymous donation of $100 to a charitable institution; and Perform: 10 hours of Board-approved pro bono community service; or 10 hours of Board-approved pro bono dental services which the applicant may lawfully perform. Notwithstanding the provisions of §E of this regulation, the Board may charge the dental radiation technologist with unprofessional conduct as provided in Regulation .11 of this chapter. An individual holding an expired certification to practice dental radiation technology may apply for reinstatement if the individual: Completes a dental radiation technology reinstatement application; Provides proof of 10 hours of dental continuing education from Board-approved courses of which: 4 hours shall be in radiology; and 2 hours shall be in infection control; and Pays to the Board a certification reinstatement fee as set forth in COMAR 10.44.20. Commencing on January 1, 2025, and thereafter, a dental radiation technologist who applies for reinstatement of an expired certification shall complete the 3-hour Board-approved infection control course identified in Regulation .05E and F of this chapter. An individual may not practice dental radiation technology on a human being in this State unless the individual is certified by the Board as a dental radiation technologist. An individual shall be certified by the Board as a dental radiation technologist before a licensed dentist may employ the individual to practice dental radiation technology. A certified dental radiation technologist may be referred to as a dental assistant certified to practice dental radiation technology. A certified dental radiation technologist shall perform the duties of a dental radiation technologist under the direct supervision of a licensed dentist. Each holder of a certificate to practice dental radiation technology shall display the certificate conspicuously in the office where the holder is engaged in practice. Subject to the hearing provisions of this chapter, the Board may deny a certificate to practice dental radiation technology, reprimand any certified dental radiation technologist, place any certified dental radiation technologist on probation, or suspend or revoke the certificate of any certified dental radiation technologist, if the holder of the certificate: Practices dental radiation technology in an incompetent manner; Fails to conform to generally accepted standards in the practice of radiation technology; Fraudulently or deceptively obtains or attempts to obtain a certificate for the applicant or for another; Fraudulently or deceptively uses a certificate; Is disciplined by a disciplinary authority of any other state or jurisdiction or is convicted or disciplined by a court in any other state or jurisdiction for an act that would be grounds for disciplinary action under this regulation; Violates any rule or regulation adopted by the Board; Is convicted of or pleads guilty or nolo contendere to a felony or a crime involving moral turpitude, whether or not any appeal or other proceeding is pending to have the conviction or plea set aside; Provides professional services while under the influence of alcohol or any controlled dangerous substance or drug in excess of therapeutic amounts; Willfully makes or files a false report or record or fails to file a report or record in the practice of dental radiation technology or willfully induces another to file a false report; Refuses, withholds from, denies, or discriminates against an individual with regard to the provision of professional services for which the certified individual is qualified to render because the individual is HIV positive; Except in an emergency life-threatening situation where it is not feasible or practicable, fails to comply with the Center for Disease Control's guidelines on universal precautions; Fails to comply with a Board order; Is mentally or physically incompetent to practice dental radiation technology; Engages in sexual misconduct as set forth in COMAR 10.44.23; or Behaves dishonorably or unprofessionally. An individual who practices dental radiation technology without being certified under these regulations is guilty of practicing dentistry without a license, a misdemeanor which, upon conviction, may result in: For a first offense, a fine not exceeding $2,000 or imprisonment in jail not exceeding 6 months; or For a subsequent offense, a fine not exceeding $6,000 or imprisonment in the State penitentiary not exceeding 1 year. A licensed dentist who employs an individual to practice dental radiation technology who is not certified under these regulations is guilty of unprofessional conduct and may be subject to disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland. A licensed dentist who supervises an individual practicing dental radiation technology who is not certified under these regulations is guilty of permitting an unauthorized individual to practice dentistry under the supervision of that licensed dentist, and may be subject to disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland. Health Occupations Article, §§1-212 and 4-505, Annotated Code of Maryland Effective date: February 18, 1991 (18:3 Md. R. 306) Regulation .03 amended effective March 8, 1999 (26:5 Md. R. 392); April 12, 2004 (31:7 Md. R. 585) Regulation .04 amended effective November 20, 1994 (21:23 Md. R. 1934) Regulation .05C amended effective November 20, 1994 (21:23 Md. R. 1934); April 1, 2002 (29:6 Md. R. 568); April 12, 2004 (31:7 Md. R. 585) Regulation .05D adopted effective February 23, 1998 (25:4 Md. R. 244) Regulation .05D amended effective March 8, 1999 (26:5 Md. R. 392); April 1, 2002 (29:6 Md. R. 568); April 12, 2004 (31:7 Md. R. 585); September 13, 2004 (31:18 Md. R. 1350) Regulation .08 amended effective February 19, 2001 (28:3 Md. R. 206) Chapter revised effective January 2, 2006 (32:26 Md. R. 1997) Regulation .03A amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .05 amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .06B amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .11A amended effective January 26, 2009 (36:2 Md. R. 101) Chapter revised effective December 21, 2015 (42:25 Md. R. 1544) Regulation .03A amended effective June 6, 2016 (43:11 Md. R. 634) Chapter revised effective January 1, 2025 (51:22 Md. R. 963) A person shall pay a fee as set forth in Regulation .02 of this chapter by check or money order. The Board shall provide a copy of this chapter: Along with any application form or renewal form; and To any other person on request. The Board shall refund the initial licensure or renewal fee, less a $50 processing fee, to a dentist or a dental hygienist who does not qualify for initial licensure or renewal. The following fees are established by the Board: Initial application fee: Dentist . . . $450; Dental hygienist . . . $275; Limited license fee: Dentist . . . $225; Credentials processing (foreign dental school graduate surcharge) . . . $75; Teacher's license fee: Dentist . . . $225; Dental hygienist . . . $225; Credentials processing (foreign school graduate surcharge) . . . $75; Temporary license application fee — dental hygienist . . . $75; Application fee for dentists licensed in another state . . . $450; Application fee for dental hygienists licensed in another state . . . $275; License renewal fee: Dentist . . . $560; Dental hygienist . . . $182; Teacher's license . . . $225; Dentist late renewal fee (July 1 through July 31 of the year in which the renewal is due) . . . $300; Dental hygienist late renewal fee (July 1 through July 31 of the year in which the renewal is due) . . . $150; Dental radiation technologist certification fee: Certification renewal . . . $68; For the renewal period ending March 1, 2017, a one-time 1-year certificate for dental radiation technologists whose certificates end in an even number . . . $34; Certification reinstatement . . . $118; For the period March 2, 2017 through April 1, 2017, for the 2017 renewal period, a late renewal fee for dental radiation technologists whose certificates end in an even number . . . $25; On and after April 2, 2017, for the 2017 renewal period, a certification reinstatement fee for dental radiation technologists whose certificates end in an even number . . . $59; For the period March 2, 2018 through April 1, 2018, for the 2018 renewal period, a late renewal fee for dental radiation technologists whose certificates end in an even number . . . $25; On and after April 2, 2018, for the 2018 renewal period, a certification reinstatement fee for dental radiation technologists whose certificates end in an even number . . . $59; Late renewal fee (March 2 through April 1 of the year in which the renewal is due) . . . $50; Initial application fee for applicants holding an active license or certification to practice dental radiation technology in another state . . . $20; Reinstatement of lapsed license fee: Dentist . . . $860; Dentist—teacher's license . . . $225; Dental hygienist . . . $332; Dental hygienist—teacher's license . . . $225; Lost, destroyed, or duplicate license fee . . . $15; Verification of licensure fee . . . $20; Specialty identification fee (one-time only) . . . $150; Advanced clinical training continuing education program application fee for a dentist who does not hold a Maryland license . . . $25; Dental assistant examination fee . . . $20; Class I and Class II permit fees: Initial application . . . $1000; Renewal . . . $300; Additional location for a like permit — further evaluation not necessary . . . $500; Additional location for a like permit — further evaluation necessary . . . $700; Renewal of additional location for a like permit . . . $300; Class III permit fees: Initial application . . . $1000; Renewal . . . $600; Additional location for a like permit — further evaluation not necessary . . . $600; Additional location for a like permit — further evaluation necessary . . . $700; Renewal of additional location for a like permit . . . $600; Conversion of parenteral sedation administration permit to a Class II permit . . . $300; Conversion of a general anesthesia administration permit to a Class III permit . . . $600; Class III dental school facility permit fee: Initial application . . . $1000; Renewal . . . $600; Additional location permit . . . $600; Renewal of additional location permit . . . $600; Certificate fee for a treating dentist to allow another dentist or physician to administer anesthesia and sedation at the site of the treating dentist: Initial application . . . $1000; Renewal . . . $300; Additional location certificate . . . $300; Renewal of additional location certificate . . . $300; Certificate fee for a treating dentist to treat a patient at a practice location other than their own, at which anesthesia and sedation is administered to the patient: Initial application . . . $1000; Renewal . . . $300; Additional location certificate . . . $300; Renewal of additional location certificate . . . $300; Single fee for dental hygienist recognition as qualified to administer local anesthesia, or qualified to administer nitrous oxide, or qualified to prescribe and administer medication, or any combination thereof . . . $50; Certificate fee for a treating dentist to allow a certified registered nurse anesthetist to administer anesthesia and sedation at a specific practice location: Initial application . . . $1000; Renewal . . . $300; Additional location certificate . . . $300; Renewal of additional location certificate . . . $300; Inactive status application fee (per renewal): Dentist . . . $150; Dental hygienist . . . $75; Board fee for full permit to dispense prescription drugs . . . $75; Required Division of Drug Control inspection fee for full permit to dispense prescription drugs . . . $1,000; Limited permit for dispensing prescription drugs: Initial application . . . $75; Renewal . . . $75; Application reprocessing fee . . . $50; Corporate name application fee . . . $150; Returned check fee . . . $25; Late fee for failure to notify the Board within 60 days of change of address . . . $10; Dentists — diskettes, labels, rosters, or tapes . . . $190; Dental hygienists — diskettes, labels, rosters, or tapes . . . $130; Dental assistants — diskettes, labels, rosters, or tapes . . . $145; Jurisprudence Examination . . . $50; and Copy of Maryland Laws and Regulations on computer disc or booklet . . . $25. Health Occupations Article, §§4-205, 4-207, 4-304, 4-505, and 12-102.1, Annotated Code of Maryland; Ch.469, Acts of 2006 Effective date: Regulation .01 adopted as an emergency provision effective August 1, 1992 (19:16 Md. R. 1469); adopted permanently effective February 15, 1993 (20:3 Md. R. 259) Regulation .01C amended effective September 17, 2001 (28:18 Md. R. 1621) Regulation .02 adopted as an emergency provision effective August 1, 1992 (19:16 Md. R. 1469); adopted permanently effective February 15, 1993 (20:3 Md. R. 259) Regulation .02 amended effective February 13, 1995 (22:3 Md. R. 154); November 4, 1996 (23:22 Md. R. 1497); April 19, 1999 (26:8 Md. R. 616); August 7, 2000 (27:15 Md. R. 1400) Regulation .02 amended as an emergency provision effective November 12, 2002 (29:24 Md. R. 1915); amended permanently effective February 17, 2003 (30:3 Md. R. 181) Regulation .02 amended effective March 29, 2004 (31:6 Md. R. 509); July 17, 2006 (33:14 Md. R. 1164); September 10, 2007 (34:18 Md. R. 1580); October 20, 2008 (35:21 Md. R. 1825); May 31, 2010 (37:11 Md. R. 765); March 7, 2011 (38:5 Md. R. 318); April 29, 2013 (40:8 Md. R. 724); July 20, 2015 (42:14 Md. R. 880); September 5, 2022 (49:18 Md. R. 819) Regulation .02G amended effective January 2, 2006 (32:26 Md. R. 1997) Regulation .02H amended effective August 16, 2004 (31:16 Md. R. 1256); June 6, 2016 (43:11 Md. R. 634); January 2, 2017 (43:26 Md. R. 1447) Regulation .02I amended effective October 23, 2006 (33:21 Md. R. 1677) Regulation .02V amended effective November 24, 2016 (43:23 Md. R. 1279) This chapter governs the practice of dental hygiene in a facility and in a long-term care facility. The practice of dental hygiene in long-term care facilities is specifically governed in Regulation .10 of this chapter. The practice of dental hygiene in a private dental office is governed by COMAR 10.44.27. In this chapter, the following terms have the meanings indicated. Terms Defined. “Assisted living program” has the meaning stated in Health Occupations Article, §19-1801, Annotated Code of Maryland. “Contractual employee” means a dental hygienist who has an annual contract to practice dental hygiene an average of at least 8 hours per week in a facility identified in Regulation .09A of this chapter. “Facility” as used in Regulation .09 of this chapter includes a program operated within a facility that is specified under Regulation .09 of this chapter, but excludes “long-term care facilities” which are regulated in Regulation .10 of this chapter. “Federally qualified health center” has the meaning stated in 42 U.S.C. §254b(a). “Federally qualified health center look-alike” has the meaning stated in 42 U.S.C. §1396d(l)(2)(B). “General supervision” means the supervision of a dental hygienist by a dentist where the dentist may or may not be present when the dental hygienist performs the dental hygiene procedures. “Long-term care facility” means: A nursing home; or An assisted living program. “Nursing home” has the meaning stated in Health Occupations Article, §19-1401, Annotated Code of Maryland. “On-site supervision” means the supervision of a dental hygienist by a dentist who is physically present on the premises and may or may not be present in the operatory when the dental hygiene services are provided. “Waiver of on-site supervision” means that a facility has been approved by the Board to enable a licensed dental hygienist to provide dental hygiene services under general supervision. Unless a facility is operating pursuant to this chapter, a general license to practice dental hygiene in a facility authorizes the licensee to practice dental hygiene only under the on-site supervision of a licensed dentist. With the exception of those facilities identified in Regulations .09A and .10 of this chapter, a facility is qualified to permit a dental hygienist to practice under general supervision if the facility has filed a report with the Board and the facility is owned or operated by: The federal government; The State government; A county or local government; or A public health department of the federal, State, or local government. A facility shall include in the report to the Board: The name of the federal, State, or local government agency which owns or operates the facility; The location of the facility and all other sites where dental hygiene services will be provided; The name of the supervising dentist affiliated with the facility who will be responsible for carrying out the requirements necessary for the facility to operate under general supervision; and The names of the dental hygienists who will provide dental hygiene services under general supervision. A facility which is qualified for practice under general supervision by report to the Board may do so on receipt of the report by the Board. With the exception of those facilities identified in Regulations .09A and .10 of this chapter, the Board may grant on a case-by-case basis a waiver of on-site supervision qualifying a facility to permit the practice of dental hygiene under general supervision, after the facility has made application to the Board, if the facility is a health facility that is licensed by the Maryland Department of Health and: Provides medical care to the poor, elderly, or handicapped; Is owned or operated by a charitable institution; Is a federal-qualified or State-qualified community health care program; or Is a setting otherwise authorized by the Board to provide dental hygiene services. The facility shall include in the application for a waiver of on-site supervision the following: The name of the facility; The location of the facility; The name and signature of each supervising dentist responsible for carrying out the requirements necessary for the facility to operate under a waiver of on-site supervision affirming that the dentist understands and accepts those responsibilities; The name and signature of each dental hygienist who will provide dental hygiene services at the facility under a waiver of on-site supervision affirming that the dental hygienist understands and accepts the terms of the waiver of on-site supervision; The supervisory responsibilities of the supervising dentist or dentists; A description of the program and how the program will operate and be administered; A description of a medical emergency plan of action; and A description of the facility that demonstrates that it has adequate equipment for the delivery of dental hygiene services, unless the dental hygiene services that are provided are limited to fluoride rinse programs. The Board shall grant or deny an application for waiver of on-site supervision: Within 60 calendar days after receipt of the application by the Board; or Within 90 calendar days after receipt of the application by the Board, if the Board notifies the applicant that extraordinary circumstances exist. If the Board fails to grant or deny an application within the appropriate time, the Board shall consider the application granted. The Board may, on written request or its own motion, conduct a public informational hearing on the granting or denial of a waiver of on-site supervision. A report or waiver issued by the Board under this chapter is effective for a 5-year term. At least 90 days before the expiration of the 5-year term, the Board shall notify the facility of the expiration of the report or waiver and send to the facility an application for renewal of the waiver. A facility seeking to renew a report to qualify for practice under general supervision shall file a new report with the Board not later than 60 days before the expiration of the existing 5-year term. A facility seeking to renew a waiver of on-site supervision shall file the application with the Board not later than 60 days before the expiration of the existing waiver. Each supervising dentist responsible for carrying out the requirements necessary for the facility to operate under general supervision shall: Hold an active license to practice dentistry in this State; Hold a current certificate of Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; and Have at least 2 years experience in providing direct patient care in the active clinical practice of dentistry. Each dental hygienist providing dental hygiene services under general supervision shall: Hold an active license to practice dental hygiene in this State; Hold a current certificate of Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; and Have at least 2 years experience in direct patient care in the active clinical practice of dental hygiene. Within 30 days after there has been a change in either the supervising dentist or the dental hygienist, a facility shall notify the Board in writing of the following: The name of the new supervising dentist or the new dental hygienist; The date of the change in personnel; and A statement affirming that all personnel meet the criteria established in this regulation for practice under general supervision. A facility shall provide adequate facilities and equipment for the delivery of dental hygiene services; Each time a patient receives dental hygiene services under general supervision, the dental hygienist shall determine, before initiation of treatment, that there has been no change in the patient's medical history; If there is a change in the medical history of the patient, the dental hygienist shall consult with the supervising dentist, the patient's own dentist, the facility's dental consultant, or the patient's treating physician before providing dental hygiene services; and All recall patients seen by a dental hygienist working under general supervision shall be scheduled for an oral examination with a dentist every 6 months or as otherwise recommended by the supervising dentist. This regulation applies to the following facilities: A dental facility owned and operated by: The federal government; The State government; or A county or local government; A public health department of: The State; or A county or local government; A public school of: The State; or A county or local government; A facility in which a program licensed by the Maryland Department of Health is operating; A facility owned and operated by the Department of Juvenile Services; A facility owned and operated by the State, county, or local government that provides medical care to the poor, elderly, or handicapped; A facility in which a federally qualified health center or a federally qualified health center look-alike is located; or A facility in which a State-licensed Head Start Program or Early Head Start Program operates. A general license to practice dental hygiene authorizes the licensee to practice dental hygiene under general supervision in a facility identified in §A of this regulation and apply: Sealants; Fluoride agents, such as professional topical fluoride agents; Mouth wash; or Varnish. The Board may not require a facility identified in §A of this regulation to obtain a waiver in order to practice in accordance with §B of this regulation. Before a facility may allow a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation, the facility shall report to the Board: That the facility is operating under general supervision; The identity of each hygienist employed by the facility; and The identity of each supervising dentist. A facility that authorizes a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation shall insure that the supervising dentist for the facility: Holds an active general license to practice dentistry in the State; Holds a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; and Has at least 2 years of active clinical practice in direct patient care. A facility that authorizes a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation shall insure that the dental hygienist: Holds an active general license to practice dental hygiene in the State; Holds a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in Cardiopulmonary Resuscitation; Has at least 2 years of active clinical practice in direct patient care; and Is a permanent or contractual employee of: The federal government; A state government; A county or local government; or A federally qualified health center. A facility that authorizes a dental hygienist to practice dental hygiene in a facility identified in §A of this regulation shall insure that: The facility has a medical emergency plan; Adequate equipment, including portable equipment where appropriate and appropriate armamentarium, is available for the appropriate delivery of dental hygiene services; and Adequate safeguards are present to protect the patient's health and safety. A dental hygienist may practice dental hygiene under the general supervision of a dentist in a long-term care facility in accordance with this regulation. Initial Appointment. A dental hygienist practicing under the general supervision of a licensed dentist in a long-term care facility and performing an authorized dental hygiene service for a patient’s initial appointment shall: Have a written agreement between the supervising dentist and the dental hygienist that clearly sets forth the terms and conditions under which the dental hygienist may practice, including a statement that the dental hygienist may provide dental hygiene services without the dentist on the premises; and Ensure that the supervising dentist is available for consultation with the dental hygienist: In person; By telephone; or Electronically. A dental hygienist working under general supervision in a long-term care facility shall: Consult with the supervising dentist or a treating physician before proceeding with initial treatment if there has been a change in a recall patient’s medical history; Assess the appropriate recall interval based on the individual needs of the patient or as otherwise recommended by the supervising dentist; Limit dental hygiene tasks and procedures to: Toothbrush prophylaxis; Application of fluoride; Dental hygiene instruction; and Other duties as may be delegated, verbally or in writing, by the supervising dentist. A dental hygienist shall: Assess the patient’s apparent need for further evaluation by a dentist in order to diagnose the presence of dental disease; and Submit the findings of the initial assessment to the supervising dentist for a determination of future treatment. A dental hygienist may perform subsequent authorized dental hygiene services without the supervising dentist on the premises only if: The supervising dentist examines the patient and authorizes in the patient’s record a prescription of specific treatment to be provided by the dental hygienist; and An authorized treatment is provided by the dental hygienist as soon as possible, but no later than 7 months from the date the patient was examined by the supervising dentist. Upon expiration of a prescribed treatment, the supervising dentist is responsible for determining future protocols for the treatment of the patient. Qualifications of a Dental Hygienist. Before a dental hygienist is authorized to practice dental hygiene under general supervision in a long-term care facility, the dental hygienist shall: Hold an active license to practice dental hygiene in the State; Hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation; Have at least 2 years of active clinical practice in direct patient care; and Ensure that the long-term care facility where the dental hygienist will practice under general supervision has: A written medical emergency plan in place; Adequate equipment, including portable equipment and appropriate armamentarium, available for the appropriate delivery of dental hygiene services; and Adequate safeguards to protect the patient’s health and safety. Qualifications of a Dentist. Before a dental hygienist is authorized to practice dental hygiene under general supervision in a long-term care facility, the supervising dentist shall: Hold an active general license to practice dentistry in the State; Hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation; and Have at least 2 years of active clinical practice in direct patient care. This regulation may not be construed to: Authorize a dental hygienist to practice dental hygiene independent of a supervising dentist; Prohibit a dentist from being available for personal consultation or on the premises where a dental hygienist is practicing; or Prohibit a dental hygienist, without the supervision of a dentist, from performing a preliminary dental examination with a subsequent referral to a dentist. Long-term care facilities are not required to obtain a waiver from the Board pursuant to Health Occupations Article, §4-308(e), Annotated Code of Maryland. Before a long-term care facility may allow a dental hygienist to practice dental hygiene, the facility shall report to the Board: That the facility is operating under general supervision; The identity of each dental hygienist providing dental hygiene services in the facility; and The identity of each supervising dentist. A violation of this chapter by a dentist or dental hygienist shall constitute unprofessional conduct. A violation of this chapter may result in revocation of the facility's right to operate under a waiver of on-site supervision. Health Occupations Article, §4-308, Annotated Code of Maryland;Ch. 221, Acts of 2003; Ch. 164 and 165, Acts of 2007; Ch. 733, Acts of 2010 Effective date: Regulations .01 — .09 adopted as an emergency provision effective April 11, 1994 (21:9 Md. R. 747); emergency status expired October 7, 1994 Regulations .01 — .09 adopted effective October 10, 1994 (21:20 Md. R. 1733) Chapter, Waiver of Supervision Requirements for Dental Hygienists, repealed and new chapter, Practice of Dental Hygiene Under General Supervision, adopted effective October 4, 1999 (26:20 Md. R. 1546) Chapter revised effective December 11, 2003 (30:24 Md. R. 1743) Regulation .02B amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .04A amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .05A amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .05B amended effective March 14, 2005 (32:5 Md. R. 580) Regulation .07 amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .08 amended effective October 22, 2007 (34:21 Md. R. 1916); January 26, 2009 (36:2 Md. R. 101) Regulation .09 recodified to be Regulation .10 and new Regulation .09 adopted effective October 22, 2007 (34:21 Md. R. 1916) Regulation .09 repealed and new Regulation .09 adopted effective January 26, 2009 (36:2 Md. R. 101) Chapter revised effective December 12, 2011 (38:25 Md. R. 1581) These regulations govern the continuing education requirements for dentists and dental hygienists seeking renewal of their licenses. In this chapter, the following terms have the meanings indicated. Terms Defined. Advanced Clinical Training Program. “Advanced clinical training program” means: A program of postgraduate training developed, offered, and sponsored by the University of Maryland Dental School as part of its curriculum for dental students or dental school graduates; A program of postgraduate training offered by the University of Maryland Dental School as continuing education for licensed dentists; or A program of postgraduate training offered by an approved continuing education sponsor or its equivalent as provided in Regulation .08 of this chapter. “Advanced clinical training program” includes clinical treatment provided to a patient by a student of dentistry while under the supervision of the training faculty. “Board” means the State Board of Dental Examiners. “Continuing education” means any eligible course or program approved by the Board. “Cultural competency” means courses or programs that teach a defined set of values, principles, demonstrated behaviors, attitudes, policies, and structures that will increase a licensee’s ability to work effectively in a cross-cultural manner. “Direct supervision” means that the supervising dentist personally: Diagnoses the condition to be treated; Authorizes the procedure; and Examines the patient before dismissal. “Licensee” means a licensed dentist or a licensed dental hygienist. “Significant change” means a change in a Board-approved continuing education program that in the sole discretion of the Board produces a measurable change in the course material or course objectives. “Student of dentistry” means: A student enrolled in a doctoral program in an accredited dental school with a curriculum leading to either a Doctor of Dental Surgery or Doctor of Dental Medicine degree; A graduate of a dental doctoral program enrolled in an advanced dental education program offered as a course of one semester or longer by the University of Maryland Dental School; A dentist licensed in Maryland who enrolls in an advanced clinical training program offered as a continuing education program for licensed dentists; A dentist licensed in another state, who does not hold a Maryland dental license and who: Enrolls in an advanced clinical training program offered as a continuing education program for licensed dentists; and Receives written approval from the Board to participate in the advanced clinical training program; A dentist licensed in Maryland who enrolls in an advanced clinical training program offered as continuing education by an approved sponsor or its equivalent as provided in Regulation .08 of this chapter; or A dentist licensed in another state, who does not hold a Maryland dental license and who: Enrolls in an advanced clinical training program offered as continuing education by an approved sponsor or its equivalent as provided in Regulation .08 of this chapter; and Receives written approval from the Board to participate in the advanced clinical training program. “Webinar” means a live seminar or other presentation for continuing education credit that takes place on the Internet, allowing participants in different locations to see and hear the presenter and ask questions and receive responses in real time. The licensee shall: Maintain for 5 years accurate records of continuing education courses or programs in which the licensee has participated under these regulations; and Make continuing education records available to the Board or the Board's representative or representatives on request. On a renewal form provided by the Board, a licensee shall verify compliance with this regulation. All continuing education credits shall be pre-approved by the Board. A licensee seeking renewal shall complete at least 30 full hours of Board-approved continuing education. Of the 30 hours of Board-approved continuing education, a minimum of 13 hours shall be completed with attendance at: In-person Board-approved courses or programs; or Webinars. To be considered for Board approval, a webinar shall: Be designed to enhance the licensee’s clinical knowledge and ability to treat dental patients; Be presented in real time; Allow all participants an opportunity to interact with the instructor; and Allow the participants an ample opportunity to ask questions and receive responses in real time. A pre-recorded webinar viewed by a licensee that otherwise meets the requirements of this chapter may be considered by the Board for continuing education credit toward the 17 hours that do not require in-person attendance. A maximum of 17 hours of Board-approved continuing education may be earned for self-study activities, including: Preparing and presenting table clinics; Preparing lectures; and Preparing articles for publication in dental journals. Continuing education courses and programs shall meet the criteria established in Regulation .06 of this chapter. A licensee shall maintain written documentation of successful completion of continuing education programs for 5 years. A licensee may not receive continuing education credit for a course or program that was: Not Board-approved; or Completed before the course or program gained Board approval. Unless otherwise provided in this chapter, the Board may not accept a submission for continuing education credit of less A licensee shall maintain cardiopulmonary resuscitation certification from one of the following programs: The American Heart Association's Basic Life Support for Healthcare Providers; The American Red Cross's Cardiopulmonary Resuscitation for Professional Rescuers; or An equivalent program approved by the Board. A licensee seeking renewal shall complete a Board- approved course of 2 hours in infection control. A licensee seeking renewal in 2025 and thereafter shall complete a Board-approved course of 3 hours in infection control every renewal cycle. A licensee seeking renewal shall complete a Board-approved course of 2 hours in abuse and neglect. The 2-hour, Board-approved course in abuse and neglect required by §N of this regulation shall: Be completed by each licensee every other renewal cycle; Relate to Maryland law on the subject of abuse and neglect; and Count toward the 30 full hours of required continuing education. A dentist seeking renewal shall complete a 2-hour Board- approved course on proper prescribing and disposal of prescription drugs, which shall count toward the 30 full hours of required continuing education. A dentist seeking renewal shall complete a 2-hour Board- approved course on proper prescribing and disposal of prescription drugs, which shall count toward the 30 full hours of required continuing education. Optional Pro Bono Program. A licensee seeking renewal may receive up to 8 continuing education hours for providing volunteer pro bono dental or dental hygiene services in accordance with Regulation .07 of this chapter. Cultural Competency, Military Culture, and Implicit Bias Training. A licensee may receive up to a combined total of 4 continuing education hours for Board-approved courses on: Cultural competency; Military culture; or Implicit bias training. A licensee may receive up to 2 continuing education hours for Board-approved courses on abuse and neglect. A study club course shall first receive Board approval before attendees may receive continuing education credit for attendance at the study club meeting. Dentists and dental hygienists may receive one continuing education credit for attending a regularly scheduled open session Board meeting in its entirety. The Board shall issue a certificate of completion to dentists and dental hygienists who attend a regularly scheduled open session Board meeting in its entirety. A dentist or a dental hygienist may earn up to two continuing education credits per renewal period for attendance at regularly scheduled open session Board meetings. A licensee who has received a license within 6 months of graduation from an approved dental or dental hygiene school is not required to fulfill the continuing education requirements of the Board for the first renewal following initial licensure. A licensee who is on inactive status shall provide evidence of compliance with the continuing education requirements of the Board for the 2-year period preceding application for reactivation of the licensee's license. A licensee who fails to obtain the required continuing education due to disability or retirement shall comply with this regulation within 6 months of the licensee's return to practice. The infection control course identified in §M of this regulation shall be a single 3-hour course which teaches the practices contained in the document Centers for Disease Control and Prevention, Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care, Atlanta, GA: Centers for Disease Control and Prevention, US Dept. of Health and Human Services; October 2016, or its successor document. A. The period for completing continuing education requirements extends for a 2-year period from July 1 through June 30 of the second year following the effective date of the license. The 2-year period in which the continuing education shall be completed ends on June 30 of the year in which the license is due for renewal. For the renewal period beginning on June 1, 2025, only, the period for completing continuing education requirements extends for the period January 1, 2023, through June 30, 2025. Eligibility Guidelines. General. With the exceptions listed in §A(2) of this regulation, only those courses or programs that satisfy the following eligibility guidelines qualify for continuing education credit for license renewal: The course or program is designed to enhance the licensee's clinical knowledge and ability to treat dental patients; and The course or program is offered by a Board-approved sponsor. Abuse and Neglect Courses, Cultural Competency Courses, Military Culture Courses, Implicit Bias Training Courses, and Pro Bono Programs. To qualify for continuing education credit for license renewal: The mandatory course in abuse and neglect identified in Regulation .04N and O of this chapter: Does not need to be designed to enhance the licensee’s clinical knowledge and ability to treat dental patients; and Shall be offered by a Board-approved sponsor; Cultural competency courses: Do not need to enhance the licensee’s clinical knowledge; and Shall be offered by a Board-approved sponsor; Military culture courses: Do not need to enhance the licensee’s clinical knowledge; and Shall be offered by a Board-approved sponsor; Implicit bias training courses: Do not need to be designed to enhance the licensee’s clinical knowledge and ability to treat dental patients; and Shall be approved by the Maryland Office of Minority Health and Health Disparities. Pro bono programs: Do not need to enhance the licensee’s clinical knowledge and ability to treat dental patients; and Shall be offered by a Board-approved sponsor. Excluded Courses and Programs. Courses and programs that are not approved for continuing education credit for license renewal include, but are not limited to, the subjects of: Money management; Personal finance; Personal business matters; With the exception of those courses or programs on cultural competency, military culture, and implicit bias training courses, cultural subjects; Personal health and recreation; Politics; Memory training; and Speed reading. Beginning on the effective date of this regulation dentists or dental hygienists may receive continuing education credit for providing volunteer pro bono dental and dental hygiene services within the State as provided in this regulation. A dentist or dental hygienist may provide volunteer pro bono care at a Board-approved program that: Is a non-profit entity or event; and Provides substantial pro bono dental services to the indigent or dentally underserved populations. With the exception of food, lodging, and parking fees, a dentist or dental hygienist may not receive direct or indirect remuneration of any kind, including but not limited to remuneration for materials purchased or used. With the exception of those pro bono services provided at a dentist’s or dental hygienist’s office as outlined in §E of this regulation, the program shall require a dentist or dental hygienist to sign in and sign out daily upon commencement and termination of the provision of services. A dentist or dental hygienist may provide pro bono services for continuing education credit at the dentist’s or dental hygienist’s office: If the patient is referred to the dentist or dental hygienist by a Board-approved nonprofit entity that provides substantial pro bono dental services to the indigent or dentally underserved populations; and If the Board provides prior approval of the provision of the dental or dental hygiene services. Continuing education credit shall be calculated based on the time a dentist or dental hygienist has actually dedicated to the performance of dental or dental hygiene services. Continuing education credit shall be calculated at the ratio of 1 continuing education credit for each 60 minutes of patient services. Credit may not be provided for missed appointments. Board-approved nonprofit entities that provide substantial dental services for continuing education credit shall: Retain patient records; Retain documentation of all pro bono assignments and the hours of service provided; and Provide the records and a copy of the assignments and the hours of service provided to the Board upon request. The Board may revoke the approval status of any nonprofit entity that fails to cooperate with the Board. A dental hygienist who provides pro bono dental services shall work under the direct supervision of a dentist. A dentist or dental hygienist that is employed by a nonprofit entity that provides substantial pro bono dental services to the indigent or dentally underserved populations may not obtain credit for pro bono services at the entity at which the dentist or dental hygienist is employed, but may receive credit for qualified pro bono services at other nonprofit entities. A dentist who is a Board-recognized specialist and who has announced a specialization shall limit the pro bono services exclusively to the announced special areas. In accordance with COMAR 10.44.12, a dentist may administer general anesthesia or sedation only with the appropriate Board permit issued for the specific practice location at which the dentist wishes to administer general anesthesia or sedation. A dental hygienist may administer local anesthesia by infiltration only with the appropriate Board recognition. A dentist and dental hygienist who provide pro bono dental services shall: Maintain proof of such services for at least 5 years on a Board-approved form; and Provide documentation of the services to the Board on request. A dentist or dental hygienist who fails to maintain accurate and complete records of services rendered may not receive continuing education credit for those services. A dentist shall use a Board-approved form for patients with clear instructions for any follow-up care. A dentist or a dental hygienist under a formal or informal Board order or agreement that provides for the provision of pro bono services may not receive continuing education credit for the provision of the pro bono services. Failure to comply with the provisions of this regulation constitutes unprofessional conduct. The Board approves for credit any course or program that: Satisfies all eligibility criteria in Regulations .06 and .07 of this chapter; and Is sponsored by any one of the following entities: An accredited dental school; An accredited dental hygiene school; The American Dental Association; The National Dental Association; The American Dental Hygienists' Association; The National Dental Hygiene Association; The American Medical Association; The American Hospital Association; The American Heart Association; The American Red Cross; The American Society of Dentistry for Children; Any American Dental Association recognized specialty society; The Academy of General Dentistry; The Veterans Administration; The United States uniformed services; The U.S. Department of Health and Human Services; The Maryland Department of Health; Any American Medical Association recognized specialty society; The Mid-Atlantic PANDA Coalition; and Any constituent or component organization of the groups in §A(2)(a)—(s) of this regulation. The Board approves for credit any course or program that is designed to enhance the licensee’s clinical knowledge and ability to treat dental patients and is approved by any one of the following credentialing agencies: The American Dental Association Commission for Continuing Education Recognition Program (CERP); The Academy of General Dentistry Program Approval for Continuing Education (PACE); The American Association of Dental Boards Accredited Continuing Education Program (ACE); and The American Academy of Dental Hygiene (AADH). The Board may approve individual programs of sponsors who are not automatically approved sponsors of continuing education credits under Regulation .08 of this chapter. Applicants meeting the requirements of this chapter, who are not automatically approved to sponsor continuing education programs may apply to the Board at least 90 days before the scheduled program for authorization to sponsor a program. The Board shall provide the applicant with an application form. An applicant shall provide the following information on the application which shall be submitted to the Board along with a processing fee as set forth in COMAR 10.44.20: Full name, business address, and contact information of the sponsor; Full name of the program for which approval is sought; A program description; Program objectives; A detailed syllabus of the course; Continuing education hours requested; An overview of any examinations that shall be passed as a condition of program completion; and A sample of the certificate of completion that will be provided to program participants. In addition to the requirements of §D of this regulation, the applicant shall provide the following to the Board regarding the program presenter or speaker: Full name, business address, and contact information; Current curriculum vitae; Educational background and all professional degrees earned; A list of all professional licenses or certifications held; A brief description of any other professional programs taught; and A copy of any public disciplinary orders issued by any health occupational board, including the Maryland Dental Board. The Board shall give notice to the applicant that the applicant has been approved or disapproved, including a statement whether the number of approved continuing education hours is different from the number requested. If a program is disapproved, the Board shall advise the applicant of the reasons for disapproval. An approval of a particular program is an approval of the program and the presenter or speaker of that program. A sponsor shall resubmit an application and pay a processing fee for approval of the program if: The presenter or speaker changes; or There is a significant change in the course material or course objectives. Fees for approval of a continuing education program are nonrefundable. A licensee or certificate holder under a Board order may not present a continuing education course or program during the pendency of their Board order. A sponsor of a Board-approved continuing education program shall: Maintain records of all attendees for at least 5 years; Provide copies of program attendance to the Board upon request; Provide attendees with an opportunity to complete a program evaluation at the conclusion of the program, which shall be provided to the Board upon request; and Allow the Board to audit the program upon payment of any applicable program fees. The Board may rescind approval of a continuing education course or program if it determines that: The course or program: Does not meet the requirements of Regulations .06 and .07 of this chapter; or In the Board’s sole discretion, does not meet its stated objectives; or The sponsor has committed fraud or made other misrepresentations to the Board. Legible certificates of program completion shall be provided to those who complete the program and shall contain at least: The full name of the sponsor; The full name of the program; The dates of program presentation; The location of the program, including whether the program was presented electronically; The number of continuing education hours awarded, which may not exceed those approved by the Board; The printed name and signature of the presenter or speaker; A statement that the program is approved by the Board; The Board’s program approval number; and A statement that the sponsor maintains responsibility for the program. A dentist licensed in another state who does not hold a Maryland dental license and who wishes to participate in an advanced clinical training program of postgraduate training offered as continuing education for licensed dentists shall receive written approval from the Board before participation in the advanced clinical training program as provided in Regulation .10B of this chapter. At least 45 days before the commencement of an advanced clinical training program of postgraduate training offered as continuing education for licensed dentists, a dentist who is licensed in another state and who is not licensed in Maryland shall apply to the Board for written approval to participate in the advanced clinical training program as provided in Regulation .10A of this chapter. To qualify to participate in an advanced clinical training program, a dentist who is licensed in another state and who does not hold a Maryland dental license shall hold a degree of Doctor of Dental Surgery or Doctor of Dental Medicine, or the equivalent, from a college or university that is authorized by any state or province of Canada to grant the degree. To apply for written approval to participate in an advanced clinical training program offered as continuing education for licensed dentists, a dentist licensed in another state who does not hold a Maryland dental license shall: Apply to the Board on a form approved by the Board; Pay a nonrefundable fee to the Board as set forth in COMAR 10.44.20; Submit to the Board a copy of the applicant's National Practitioner Data Bank file; Submit documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Submit any other pertinent documents or information requested by the Board. After review of the documentation and other pertinent information provided to the Board, the Board shall provide the applicant with a written notice stating that the application to participate in the advanced clinical training program has been approved or denied. The Board's approval or denial of an application to participate in an advanced clinical training program shall apply only to the advanced clinical training program for which the applicant has made application. A dentist whose application to participate in an advanced clinical training program for continuing education has been approved shall be covered by a policy of malpractice insurance during the period in which the dentist participates in the advanced clinical training program. An individual who is a student of dentistry under Regulation .02B(6)(d) and (f) of this chapter may only practice dentistry in Maryland in accordance with the advanced clinical training program. Successful completion of a Board-approved examination within the preceding 2-year period may be substituted for continuing education credits. The Board recognizes successful completion of the following written examinations as equivalent to 30 full hours of continuing education: For dental hygienists only, the North East Regional Board's (NERB) Dental Hygiene Comprehensive Examination; NERB's Simulated Clinical Examinations; Academy of General Dentistry's Fellowship Examination; Examinations leading to recognized specialty boards' Diplomate status; National Board's Part II examination; Central Regional Dental Testing Agency's written examinations; South East Regional Testing Agency's written examinations; or Western Regional Examining Board's written examination. A dentist or dental hygienist who has completed the continuing education requirements shall attest to the completion on a form supplied by the Board as part of the application for license renewal, reinstatement, or reactivation. The Board may request verification of compliance with this chapter through inspection of continuing education records maintained by licensees in accordance with Regulation .03A of this chapter. Except as provided in this regulation, the Board shall audit a percentage of dentists and dental hygienists, selected by the Board for each renewal cycle. A licensee who receives notice of a continuing education audit shall verify compliance with this chapter by the date specified in the notice and submit to the Board a report of the continuing education hours required for renewal on a form approved by the Board along with the appropriate documentation. Documentation. A dentist or dental hygienist shall provide to the Board: A certificate of completion for approved courses or programs; Current CPR certification as specified under Regulation .04 of this chapter; If applicable, proof of Board-approved pro bono dental or dental hygiene services provided; and If a certificate of completion is not available, satisfactory proof of time spent preparing and presenting table clinics, lectures, articles for publications in dental or medical journals, or attending study clubs, or other meetings involved with performing clinical dentistry. A dentist or a dental hygienist may request an extension of time to comply with the requirements of this chapter. A request for an extension of time under §F of this regulation shall: Be made in writing; Detail and document the reasons the licensee was not able to complete the continuing education requirements within the allotted time; and Provide a period of time requested by the licensee to complete the required continuing education. The grant of an extension and the period of the extension is within the sole discretion of the Board. A dentist or dental hygienist who requests and is granted an extension of time by the Board shall be audited at the next renewal cycle. A dentist or dental hygienist granted an extension of time shall attest to completion of continuing education requirements by the end of the extension period. Failure to submit the required attestation or failure to meet continuing education requirements by the end of the extension period may subject the licensee to disciplinary action. The Board’s staff shall conduct a preliminary review and evaluation of the documentation submitted to the Board and report their findings to the Board. After the Board’s review of the submitted documentation, the Board may find one or both of the following: That the dentist or dental hygienist has not met the Board’s continuing education requirements; or That the dentist or dental hygienist has submitted courses or programs that have not been Board-approved. The Board may require a dentist or a dental hygienist who has not met the Board’s continuing education requirements or who has submitted courses or programs that have not been Board-approved to take additional continuing education courses or programs in order to meet the Board’s continuing education requirements. Penalties for Violation. A false, misleading, or deceptive statement on a renewal, reinstatement, or reactivation form may constitute unprofessional conduct and may result in disciplinary action against the licensee as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. Failure to complete continuing education requirements within the time period specified under Regulation .05 of this chapter or any applicable extension constitutes unprofessional conduct and may result in disciplinary action against the licensee as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. The Board may waive any or all of the requirements of this chapter for a licensee who is unable to complete the requirements due to the licensee's active military service. Health Occupations Article, §4-205, Annotated Code of Maryland Effective date: Regulations .01—.09 adopted as an emergency provision effective November 25, 1992 (19:25 Md. R. 2199); adopted permanently effective May 26, 1993 (20:6 Md. R. 581) Regulation .04 amended effective July 12, 1998 (25:14 Md. R. 1132) Regulation .09B amended effective June 25, 2001 (28:12 Md. R. 1110) Chapter revised effective January 5, 2004 (30:26 Md. R. 1915) Regulation .10 recodified to be Regulation .11 and new Regulation .10 adopted effective June 21, 2004 (31:12 Md. R. 913) Chapter revised effective July 17, 2006 (33:14 Md. R. 1164) Regulation .04 amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .06A amended effective January 26, 2009 (36:2 Md. R. 101) Regulation .07 amended effective January 26, 2009 (36:2 Md. R. 101) Chapter revised effective April 18, 2011 (38:8 Md. R. 506) Regulation .02B amended effective March 18, 2013 (40:5 Md. R. 411); March 3, 2025 (52:4 Md. R. 218) Regulation .04 amended effective October 13, 2014 (41:20 Md. R. 1112); March 3, 2025 (52:4 Md. R. 218) Regulation .04D-1 adopted effective March 18, 2013 (40:5 Md. R. 411) Regulation .05 amended effective March 3, 2025 (52:4 Md. R. 218 Regulation .06 amended effective March 3, 2025 (52:4 Md. R. 218) Regulation .06A amended effective October 13, 2014 (41:20 Md. R. 1112) Regulation .08 amended March 3, 2025 (52:4 Md. R. 218) Regulation .08C amended effective October 13, 2014 (41:20 Md. R. 1112) Regulation .09 adopted effective March 3, 2025 (52:4 Md. R. 218) Regulations .09—.11 recodified to Regulations .11—.13 and Regulation .13 to be Regulation .15 effective March 3, 2025 (52:4 Md. R. 218) Regulation .10 adopted effective March 3, 2025 (52:4 Md. R. 218) Regulation .12 repealed effective March 3, 2025 (52:4 Md. R. 218) Regulation .14 repealed and new Regulation .14 adopted effective March 3, 2025 (52:4 Md. R. 218) In this chapter, the following term has the meaning indicated. Term Defined. “Legitimate patient” means a patient who has an existing written dental record or who has one created within 72 hours of the patient's first communication with the dentist. In this chapter, the following documents are incorporated by reference. Principles of Ethics and Code of Professional Conduct (American Dental Association, With official advisory opinions revised to September 2016). Bylaws — Code of Ethics (for Dental Hygienists), (American Dental Hygienists’ Association, June 23, 2014). A dentist, dental hygienist, or dental radiation technologist may not engage in unprofessional or dishonorable conduct. The following shall constitute unprofessional or dishonorable conduct in the practice of dentistry, dental hygiene, or dental radiation technology: Misrepresenting the following to a patient or the public: The description, chemical composition, or quality of the materials the licensee uses or intends to use; or Methods and techniques the licensee uses or intends to use; Engaging in conduct which is unbecoming a member of the dental profession; Representing that a dental procedure has been completed when in fact the procedure has not been completed; Permitting or failing to prevent the placement or exposure of dental radiographs by an individual not certified or otherwise qualified to do so; Committing an act of sexual misconduct as described in §C of this regulation; Performing a dental procedure without first obtaining informed consent from the patient or the patient’s legal representative; Willfully and without legal justification, failing to cooperate with a lawful investigation conducted by the Board, which includes, but is not limited to: Furnishing information requested; Complying with a subpoena; Responding to a complaint at the request of the Board; and Providing meaningful and timely access to relevant patient records; or Committing any other unprofessional or dishonorable act or omission in the practice of dentistry, dental hygiene, or dental radiation technology. Sexual misconduct of either a verbal or a physical nature shall include, but is not limited to: Sexual behavior with a patient in the context of a professional evaluation, treatment, procedure, or other service to the client or patient, regardless of the setting in which professional service is provided; Sexual behavior with a patient under the pretext of diagnostic or therapeutic intent or benefit; Requesting sexual favors of a patient; Touching a patient in a sexual manner; Therapeutically unnecessary discussion of sexual matters or other verbal conduct of a sexual nature while treating a patient; Taking photographs or videotapes of a patient for sexual purposes; Sexual behavior that would be considered unethical or unprofessional; or The use of a drug on a patient for the purpose of sexual behavior. Dentists. In addition to the requirements stated in §§A—C of this regulation, a dentist shall comply with the Principles of Ethics and Code of Professional Conduct. It shall constitute unprofessional and dishonorable conduct for a dentist to: Self-prescribe prescription medications except that a dentist may self-prescribe when necessary to order prescription medications for dental office inventory for patient use only; Prescribe prescription medications for individuals who are not legitimate patients; Prescribe prescription medications to legitimate patients other than for therapeutic purposes; Sell, prescribe, trade, give away, or administer a prescription drug for any illegal or illegitimate purpose; Treat family members or staff differently than any other patient by: Not maintaining accurate records of all treatment provided in accordance with COMAR 10.44.30, including financial records and records of all medication prescribed; and Not adhering to all record retention requirements in accordance with Health General Article, §4-403, Annotated Code of Maryland; and Fail to comply with the requirements of the Prescription Drug Monitoring Program as established in Health-General Article, Title 21, Subtitle 2A, Annotated Code of Maryland, and COMAR 10.47.07. Dental Hygienists. In addition to the requirements stated in §§A — C of this regulation, a dental hygienist shall comply with the Bylaws — Code of Ethics (for Dental Hygienists). A dentist who violates this chapter is subject to the sanctions enumerated in Health Occupations Article, §4-315(a), Annotated Code of Maryland. A dental hygienist who violates this chapter is subject to the sanctions enumerated in Health Occupations Article, §4-315(b), Annotated Code of Maryland. A dental radiation technologist who violates this chapter is subject to the sanctions enumerated in COMAR 10.44.19.11A. Health Occupations Article, §§1-212, 4-205(c)(3), 4-315(a)(16) and (b)(3), and 4-505(a)(2) and (c)(3), Annotated Code of Maryland Effective date: March 5, 2001 (28:4 Md. R. 419) Regulation .01B amended effective January 19, 2004 (31:1 Md. R. 31) Regulation .02 amended and recodified to be Regulation .03, new Regulation .02 adopted effective September 3, 2001 (28:17 Md. R. 1557) Chapter revised effective August 6, 2012 (39:15 Md. R. 964) Regulation .01 amended effective April 14, 2014 (41:7 Md. R. 422) Chapter revised effective July 17, 2017 (44:14 Md. R.655) The license of a retired volunteer dentist or a retired volunteer dental hygienist shall be used only for volunteer services and not for compensation. To qualify for a retired volunteer dentist's or dental hygienist's license, a dentist or dental hygienist shall: Be of good moral character; Have had an active general license to practice dentistry or dental hygiene in Maryland within the past 2 years; Meet the qualifications otherwise required by Health Occupations Article, Title 4, Annotated Code of Maryland, for an active general license to practice dentistry or dental hygiene in the State, except that the North East Regional Board examination requirements are waived by the Board; Complete the continuing education requirements for an active general license to practice dentistry or dental hygiene in the State; and Provide dental or dental hygiene services as set forth in Regulation .06 of this chapter. To apply for a retired volunteer license to practice dentistry or dental hygiene, a dentist or dental hygienist shall submit: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that the “photograph is a true photograph of me”; A certified letter with a raised embossed seal from the licensing authority of each state in which the applicant holds an active dental or dental hygiene license, or ever held an active dental or dental hygiene license, indicating that the license is or was in good standing and whether the applicant: Is being investigated; Has charges pending against the applicant's license; Has been disciplined; or Has been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A copy of the applicant's National Practitioner Data Bank file; A notarized affidavit stating that the dentist or dental hygienist will donate at least 100 hours of dental or dental hygiene services without compensation; Evidence that the dentist or dental hygienist is covered by malpractice insurance as set forth in Regulation .04 of this chapter; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. An applicant for a retired volunteer dentist's or dental hygienist's license and an applicant for the renewal of a retired volunteer dentist's or dental hygienist's license shall be covered by malpractice insurance. If the malpractice insurance consists of a personal policy of malpractice insurance, the dentist or dental hygienist shall provide the Board with evidence of the insurance which shall consist of: The name of the insurance provider; The name, address, and telephone number of the insured's agent, or if the insured has no agent, the address and telephone number of the insurance provider; The policy number; The amounts of coverage; and The expiration date of the policy. If the malpractice insurance is provided from or through the institution at which the applicant is to provide volunteer services, the dentist or dental hygienist shall provide the Board with evidence of the insurance which shall consist of: The name of the insurance provider; The amounts of coverage; The expiration date of the policy or coverage; and A letter from the institution verifying the intent of the institution to provide malpractice insurance. A dentist or dental hygienist shall be granted a retired volunteer dentist's or dental hygienist's license if the dentist or dental hygienist: Meets the qualifications for licensure as a retired volunteer dentist or dental hygienist; and Is covered by a personal policy of malpractice insurance. A dentist or dental hygienist shall be granted a retired volunteer dentist's or dental hygienist's license that is site-specific to the institution at which the dentist or dental hygienist is to provide the volunteer services if the dentist or dental hygienist: Meets the qualifications for licensure as a retired volunteer dentist or dental hygienist; and Is covered with malpractice insurance from or through the institution at which the dentist or dental hygienist is to provide volunteer services. A dentist or dental hygienist who has been granted a site-specific retired volunteer dentist's or dental hygienist's license shall practice dentistry or dental hygiene only at the institution named on the license. A dentist or dental hygienist with a retired volunteer license to practice dentistry or dental hygiene in the State shall practice only: In a dental office; In a dental clinic; In an ambulatory care facility; In a hospital; or For an entity providing medical care to the poor, the elderly, or handicapped that is operated: By the State; By a local government; By a bona fide charitable organization; or In any other setting approved by the Board. A dentist or dental hygienist with a retired volunteer license may not receive compensation for practicing dentistry or dental hygiene in the State. A retired volunteer license to practice dentistry and a retired volunteer license to practice dental hygiene expire on June 30 of the second year following the effective date of the license. Before a retired volunteer license to practice dentistry or dental hygiene expires, the licensee may renew it for an additional term if the licensee: Submits a completed renewal application on a form provided by the Board; Completes the continuing education requirements for an active general license to practice dentistry or dental hygiene in the State; Submits proof satisfactory to the Board that the dentist has donated at least 100 hours of dental services, or that the dental hygienist has donated at least 100 hours of dental hygiene services, without compensation; Provides evidence that the dentist or dental hygienist is covered by malpractice insurance as set forth in Regulation .04 of this chapter; Submits a copy of the licensee's National Practitioner Data Bank file; Submits documentation of change of name if the name on any of the documents submitted to the Board differs from the licensee's name; and Submits any other documents or information pertinent to licensure required by the Board. A dentist or a dental hygienist who has been granted a site-specific retired volunteer dentist's or dental hygienist's license shall immediately surrender the license to the Board when the dentist or dental hygienist ceases to: Provide volunteer dental or dental hygiene services at the institution named on the license; or Be covered by malpractice insurance from or through the institution named on the license. A dentist or a dental hygienist who has been granted a retired volunteer dentist's or dental hygienist's license that is not site-specific shall immediately surrender the license to the Board when the dentist or dental hygienist ceases to be covered by malpractice insurance. There is no fee for an initial retired volunteer license to practice dentistry or dental hygiene, and there is no fee for the renewal of a retired volunteer license to practice dentistry or dental hygiene. Violations of this chapter pertaining to the use of a retired volunteer license constitute unprofessional conduct and may result in disciplinary action against the licensee as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. Health Occupations Article,§§4-101, 4-302, 4-304, and 4-308, Annotated Code of Maryland; Ch. 237, Acts of 2003 Effective date: June 25, 2001 (28:12 Md. R. 1110) Regulations .01—.07 repealed and new Regulations .01—.08 adopted effective December 11, 2003 (30:24 Md. R. 1743) Chapter revised effective July 18, 2005 (32:14 Md. R. 1276) The Board may find that a compelling public purpose warrants disclosure of information in a certification, licensing, or investigative file, regardless of whether there has been a request for the information, if the information concerns: Possible criminal activity, and is disclosed to a federal, state, or local law enforcement or prosecutorial official or authority; A possible violation of law, and is disclosed to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation, and the information disclosed is limited to information relevant to the possible violation by that individual; or Conduct by an individual which the Board reasonably believes may pose a risk to the public health, safety, or welfare, and is disclosed to a law enforcement authority, administrative official or agency that regulates the individual, or to a hospital or other health care facility where the individual has privileges. This chapter does not prevent or limit the ability of the Board to disclose general licensing information as provided in State Government Article, §10-617(h), Annotated Code of Maryland, or any information which the Board may otherwise disclose by law. Health Occupations Article, §4-205; State Government Article, §10-617(h)(3); Annotated Code of Maryland Effective date: December 24, 2001 (28:25 Md. R. 2192) The license of a volunteer dentist or a volunteer dental hygienist shall be used for volunteer services and not for compensation. To qualify for a volunteer dentist's license, a dentist who has passed a regional board as defined in Health Occupations Article, §4-306(a)(3), Annotated Code of Maryland, shall: Be of good moral character; Be 18 years old or older; Hold a Degree of Doctor of Dental Surgery, Doctor of Dental Medicine, or the equivalent from a college or university that is: Authorized by any state or province of Canada to grant the degree; and Recognized by the Board as: Requiring adequate preprofessional collegiate training; and Maintaining an acceptable course of dental instruction; Pass the NERB dental written examinations; Pass the Maryland Jurisprudence Examination on the Maryland State Dental Law; Hold an active license to practice dentistry in another state or in the District of Columbia; Meet the qualifications otherwise required for a general license to practice dentistry by Health Occupations Article, Title 4, Annotated Code of Maryland; Complete the continuing education requirements for an active general license to practice dentistry; and Provide dental services as set forth in Regulation .11 of this chapter. To qualify for a volunteer dentist's license, a dentist who has not passed a regional board shall: Be of good moral character; Be 18 years old or older; Hold a Degree of Doctor of Dental Surgery, Doctor of Dental Medicine, or the equivalent from a college or university that is: Authorized by any state or province of Canada to grant the degree; and Recognized by the Board as: Requiring adequate preprofessional collegiate training; and Maintaining an acceptable course of dental instruction; Submit a notarized affidavit or other evidence satisfactory to the Board indicating that during the 5 years preceding application the applicant has actively engaged in practicing dentistry for at least 850 hours; Pass the NERB dental written examinations; Pass the Maryland Jurisprudence Examination on the Maryland State Dental Law; Hold an active license to practice dentistry in another state or in the District of Columbia; Meet the qualifications otherwise required for a general license to practice dentistry by Health Occupations Article, Title 4, Annotated Code of Maryland; Complete the continuing education requirements for an active general license to practice dentistry; and Provide dental services as set forth in Regulation .11 of this chapter. If occurring during the 5 years preceding an application, the practice of dentistry in the armed forces, state and federal programs, and intern and residency programs counts toward the required hours of active practice. To qualify for a volunteer dental hygienist's license, a dental hygienist who has passed a regional board as defined in Health Occupations Article, §4-306(a)(3), Annotated Code of Maryland, shall: Be of good moral character; Be a graduate of a school for dental hygienists that: Requires at least 2 years of education in an institution of higher education; Is accredited by the American Dental Association Commission on Dental Accreditation; and Is approved by the Board; Pass the Maryland Jurisprudence Examination on the Maryland State Dental Law; Hold an active license to practice dental hygiene in another state or in the District of Columbia; Meet the qualifications otherwise required for a general license to practice dental hygiene by Health Occupations Article, Title 4, Annotated Code of Maryland; Complete the continuing education requirements for an active general license to practice dental hygiene; and Provide dental hygiene services as set forth in Regulation .11 of this chapter. To qualify for a volunteer dental hygienist's license, a dental hygienist who has not passed a regional board shall: Be of good moral character; Be a graduate of a school for dental hygienists that: Requires at least 2 years of education in an institution of higher education; Is accredited by the American Dental Association Commission on Dental Accreditation; and Is approved by the Board; Submit a notarized affidavit or other evidence satisfactory to the Board indicating that during the 3 years preceding application the applicant has actively engaged in practicing dental hygiene for at least 150 hours; Pass the Maryland Jurisprudence Examination on the Maryland State Dental Law; Hold an active license to practice dental hygiene in another state or in the District of Columbia; Meet the qualifications otherwise required for a general license to practice dental hygiene by Health Occupations Article, Title 4, Annotated Code of Maryland; Complete the continuing education requirements for an active general license to practice dental hygiene; and Provide dental hygiene services as set forth in Regulation .11 of this chapter. The practice of dental hygiene in the armed forces, state, or federal programs within the 3 years preceding application counts toward the required hours of active practice. To apply for a volunteer license to practice dentistry or dental hygiene, a dentist or a dental hygienist who has passed a regional board in accordance with Health Occupations Article, §4-306, Annotated Code of Maryland, shall submit: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental or dental hygiene education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead bearing an original signature do not require a raised embossed seal; A certified examination score of a regional board; A certified letter with a raised embossed seal from the dental or dental hygiene licensing authority of each state in which the applicant holds an active dental or dental hygiene license or ever held an active dental or dental hygiene license indicating that the licensee is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A copy of the applicant's National Practitioner Data Bank file; A notarized affidavit stating that the dentist or dental hygienist will donate at least 100 hours of dental or dental hygiene services without compensation; Evidence that the dentist or dental hygienist is covered by malpractice insurance as set forth in Regulation .09 of this chapter; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. In addition to the requirement of §A(5) of this regulation that a dentist submit a certified examination score of a regional board, a dentist, if requested by the State Dental Board, shall submit a specific point breakdown by procedure including penalty deductions. To apply for a volunteer license to practice dentistry or dental hygiene, a dentist or a dental hygienist who has not passed a regional board in accordance with Health Occupations Article, §4-306, Annotated Code of Maryland, shall submit: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement stating that “the photograph is a true photograph of me”; An original National Board Score Card; Certified proof of dental or dental hygiene education which contains the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead, bearing an original signature do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental or dental hygiene licensing authority of each state in which the applicant holds an active dental or dental hygiene license or ever held an active dental or dental hygiene license indicating that the licensee is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; A copy of the applicant's National Practitioner Data Bank file; A notarized affidavit stating that the dentist or dental hygienist will donate at least 100 hours of dental or dental hygiene services without compensation; Evidence that the dentist or dental hygienist is covered by malpractice insurance as set forth in Regulation .09 of this chapter; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. In addition to the requirements of Regulation .07 of this chapter, a dentist who has not passed a regional board in accordance with Health Occupations Article, §4-306, Annotated Code of Maryland, shall submit a notarized affidavit or other evidence satisfactory to the Board indicating that during the 5 years preceding application, the dentist has actively engaged in practicing dentistry for at least 850 hours. In addition to the requirements of Regulation .05 of this chapter, a dental hygienist who has not passed a regional board in accordance with Health Occupations Article, §4-306, Annotated Code of Maryland, shall submit a notarized affidavit or other evidence satisfactory to the Board indicating that during the 3 years preceding application, the dental hygienist has actively engaged in practicing dental hygiene for at least 150 hours. An applicant for a volunteer dentist's or dental hygienist's license, and an applicant for the renewal of a volunteer dentist's or dental hygienist's license, shall be covered by malpractice insurance. If the malpractice insurance consists of a personal policy of malpractice insurance, the dentist or dental hygienist shall provide the Board with evidence of the insurance which shall consist of: The name of the insurance provider; The name, address, and telephone number of the insured's agent, or if the insured has no agent, the address and telephone number of the insurance provider; The policy number; The amounts of coverage; and The expiration date of the policy. If the malpractice insurance is provided from or through the institution at which the applicant is to provide volunteer services, the dentist or dental hygienist shall provide the Board with evidence of the insurance which shall consist of: The name of the insurance provider; The amounts of coverage; The expiration date of the policy or coverage; and A letter from the institution verifying the intent of the institution to provide malpractice insurance. A dentist or dental hygienist shall be granted a volunteer dentist's or dental hygienist's license if the dentist or dental hygienist: Meets the qualifications for licensure as a volunteer dentist or dental hygienist; and Is covered by a personal policy of malpractice insurance. A dentist or dental hygienist shall be granted a volunteer dentist's or dental hygienist's license that is site-specific to the institution at which the dentist or dental hygienist is to provide the volunteer services if the dentist or dental hygienist: Meets the qualifications for licensure as a volunteer dentist or dental hygienist; and Is covered with malpractice insurance from or through the institution at which the dentist or dental hygienist is to provide volunteer services. A dentist or dental hygienist who has been granted a site-specific volunteer dentist's or dental hygienist's license shall practice dentistry or dental hygiene only at the institution named on the license. A dentist or dental hygienist with a volunteer license to practice dentistry or dental hygiene in the State shall practice only: In a dental office; In a dental clinic; In an ambulatory care facility; In a hospital; or For an entity providing medical care to the poor, the elderly, or handicapped that is operated: By the State; By a local government; By a bona fide charitable organization; or In any other setting approved by the Board. A volunteer license to practice dentistry and a volunteer license to practice dental hygiene expire on June 30 of the second year following the effective date of the license. Before a volunteer license to practice dentistry or dental hygiene expires, the licensee may renew it for an additional term if the licensee: Submits a completed renewal application on a form provided by the Board; Completes the continuing education requirements for an active general license to practice dentistry or dental hygiene in the State; Submits proof satisfactory to the Board that the dentist or dental hygienist has donated at least 100 hours of dental or dental hygiene services without compensation; Submits evidence that the dentist or dental hygienist is covered by malpractice insurance as set forth in Regulation .09 of this chapter; Submits documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Submits any other documents or information pertinent to licensure required by the Board. A dentist or a dental hygienist who has been granted a site-specific volunteer dentist or dental hygienist's license shall immediately surrender the license to the Board if the dentist or dental hygienist ceases to: Provide volunteer dental or dental hygiene services at the institution named on the license; or Be covered by malpractice insurance from or through the institution named on the license. A dentist or a dental hygienist who has been granted a volunteer dentist's or dental hygienist's license that is not site-specific shall immediately surrender the license to the Board if the dentist or dental hygienist ceases to be covered by malpractice insurance. There is no fee for an initial volunteer license to practice dentistry or dental hygiene, and there is no fee for the renewal of a volunteer license to practice dentistry or dental hygiene. Violations of this chapter pertaining to the use of a volunteer license constitute unprofessional conduct and may result in disciplinary action against the licensee as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. Health Occupations Article, §§4-101, 4-302, 4-304, and 4-308, Annotated Code of Maryland;Ch. 237, Acts of 2003 Effective date: December 11, 2003 (30:24 Md. R. 1743) Regulation .07 amended effective August 16, 2004 (31:16 Md. R. 1256) Chapter revised effective July 18, 2005 (32:14 Md. R. 1276) This chapter governs the practice of dental hygiene in a private dental office. The practice of dental hygiene in a facility is governed by COMAR 10.44.21. In this chapter, the following term has the meaning indicated. Term Defined. “General supervision” means the supervision of a dental hygienist by a dentist in a private dental office where the dentist may or may not be present when the dental hygienist performs the dental hygiene procedures. While it is effective, a general license to practice dental hygiene issued under Health Occupations Article, Title 4, Annotated Code of Maryland, authorizes the licensee to practice dental hygiene under the general supervision of a licensed dentist in a private dental office pursuant to the provisions of Health Occupations Article, §4-308(i), Annotated Code of Maryland. In addition to the requirements contained in Health Occupations Article, §4-308(l), Annotated Code of Maryland, if a dental hygienist works under general supervision in a private dental office where a dentist is not on the premises while authorized dental hygiene services are provided, the requirements in §§B—F of this regulation shall be met. Both the private dental office and the dental hygienist shall maintain written documentation of at least 1,500 hours of dental hygiene clinical practice in direct patient care before commencing practice. Before an appointment, the patient or the custodial parent or legal guardian of a minor or incompetent adult shall: Be informed that a dental hygienist will be providing services previously prescribed by a dentist who will not be on the premises during the appointment; and Consent in writing to receiving the dental hygiene services. A copy of the signed consent shall be maintained in the patient's record. The number of unsupervised clinical hours worked by a dental hygienist in any given 3-month period shall be less than 60 percent of the dental hygienist’s total hours worked during that 3-month period. To insure compliance with this provision, the supervising dentist and the dental hygienist shall maintain a written record of the dental hygienist’s total monthly hours worked and the total number of monthly hours worked by the dental hygienist when a dentist was not on the premises. A supervising dentist may not have more than two dental hygienists working under the dentist's general supervision at any given time, regardless of the number of offices in which the supervising dentist practices dentistry. A violation of this chapter by a dentist or dental hygienist is unprofessional conduct. Health Occupations Article, §4-308, Annotated Code of Maryland; Ch. 221, Acts of 2003 Effective date: December 11, 2003 (30:24 Md. R. 1743) Regulation .04E amended effective March 3, 2014 (41:4 Md. R. 301) This chapter establishes the requirements for: A teacher's license to practice dentistry for a graduate of a United States or Canadian dental school; and A teacher's license to practice dental hygiene for a graduate of a United States or Canadian school for dental hygienists. The requirements for a teacher's license to practice dentistry for a graduate of a foreign dental school are set forth in COMAR 10.44.02. To qualify for a teacher's license to practice dentistry, an applicant shall meet the requirements set forth in Health Occupations Article, §4-302, Annotated Code of Maryland. An applicant for a teacher's license to practice dentistry shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement that “the photograph is a true photograph of me” ; Certified proof of dental education with the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead and bearing an original signature do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant holds an active dental license or ever held an active dental license, indicating that the license is or was in good standing, and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; Proof satisfactory to the Board that the applicant has at least 5 years of active dental experience; A copy of the applicant's National Practitioner Data Bank file; A letter from the Dean of the college or university in which the applicant is to teach a subject required by the dental school of that college or university: Requesting that the license be issued; and Indicating that the applicant is to be a full-time faculty member; Documentation of a change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The practice of dentistry in the armed forces, state and federal programs, and intern and residency programs within the 5 years preceding application shall count toward the required active dental experience. To qualify for a teacher's license to practice dental hygiene, an applicant shall meet the requirements set forth in Health Occupations Article, §4-302, Annotated Code of Maryland. An applicant for a teacher's license to practice dental hygiene shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement that “the photograph is a true photograph of me” ; Certified proof of dental hygiene education with the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead and bearing an original signature do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental hygiene licensing authority of each state in which the applicant holds an active dental hygiene license or ever held an active dental hygiene license, indicating that the license is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; Proof satisfactory to the Board that the applicant has at least 5 years of active dental hygiene experience; A copy of the applicant's National Practitioner Data Bank file; A letter from the Dean of the college or university in which the applicant is to teach a subject required by the dental hygiene school or dental school of that college or university: Requesting that the license be issued; and Indicating that the applicant is to be a full-time faculty member; Documentation of change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The practice of dental hygiene in the armed forces, state and federal programs, and intern and residency programs within the 5 years preceding application shall count toward the required active dental hygiene experience. A graduate of a United States or Canadian dental school who is not licensed to practice dentistry in another state and who wishes to obtain a teacher's license to teach dentistry at the University of Maryland Dental School, shall meet the requirements set forth in Health Occupations Article, §4-303(c), Annotated Code of Maryland. A graduate of a United States or Canadian dental school who is not licensed to practice dentistry in another state and who wishes to apply for a teacher's license to teach dentistry at the University of Maryland Dental School shall submit the following to the Board: A completed application on a form provided by the Board; A photograph of the applicant not to exceed 3 inches by 3 inches accompanied by a notarized statement that “the photograph is a true photograph of me” ; Certified proof of dental education with the raised embossed school seal certifying its authenticity, except that letters from educational institutions on original letterhead and bearing an original signature do not require a raised embossed seal; A certified letter with a raised embossed seal from the dental licensing authority of each state in which the applicant ever held an active dental license indicating that the license is or was in good standing and that the applicant: Is not being investigated; Does not have charges pending against the applicant's license; Has not been disciplined; and Has not been convicted or disciplined by a court of any state or country for an act that would be grounds for disciplinary action under Health Occupations Article, §4-315, Annotated Code of Maryland; Proof satisfactory to the Board that the applicant has at least 5 years of clinical dental experience; A copy of the applicant's National Practitioner Data Bank file; A letter from the Dean of the University of Maryland Dental School: Providing the reasons why the Board should waive the requirement that the applicant be licensed in another state; and Indicating that the applicant is to be a full-time faculty member; Documentation of a change of name if the name on any of the documents submitted to the Board differs from the applicant's name; and Any other documents or information pertinent to licensure required by the Board. The applicant shall submit the fee specified in COMAR 10.44.20 with the application for a teacher's license to practice: Dentistry; or Dental hygiene. The application fee is nonrefundable. A teacher's license to practice dentistry and a teacher's license to practice dental hygiene in the State are immediately void upon leaving the faculty position. Health Occupations Article, §§4-302 and 4-303, Annotated Code of Maryland Effective date: January 6, 2005 (31:26 Md. R. 1863) In accordance with Health Occupations Article, §4-202, Annotated Code of Maryland, the Governor appoints the dentist and dental hygienist Board members, with the advice of the Secretary of Health, from a list of names submitted to the Governor by the Board. This chapter covers the nomination and balloting process that will result in that list of names. The process of choosing consumer Board members is not covered by this chapter. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland State Board of Dental Examiners. Dental Hygienist. “Dental hygienist” means an individual who, on the date of the mailing of the Board's notice referred to in Regulation .04B(1) of this chapter, holds a current Maryland: General license to practice dental hygiene; Teacher's license to practice dental hygiene; Retired volunteer license to practice dental hygiene; Volunteer license to practice dental hygiene; or Temporary license to practice dental hygiene. “Dental hygienist” does not include an individual who holds a dental hygienist inactive status registration certificate. Dentist. “Dentist” means an individual who, on the date of the mailing of the Board's notice referred to in Regulation .03B(1) of this chapter, holds a current Maryland: General license to practice dentistry; Limited license to practice dentistry; Teacher's license to practice dentistry; Retired volunteer license to practice dentistry; or Volunteer license to practice dentistry. “Dentist” does not include an individual who holds a dentist inactive status registration certificate. “Electronic mail (e-mail)” means a message sent or received electronically over a computer network. “State dental hygienist organization affiliated with a national organization” means: An affiliation of dental hygienists who have current membership in a common and distinct Maryland dental hygienist organization or association that is committed to serving generally accepted interests in dental hygiene; An affiliation that is formed pursuant to the laws of Maryland; and A constituent organization of a national dental hygienist organization that is: Committed to serving generally accepted interests in dental hygiene; and Formed pursuant to the laws of the state in which it was formed. “State dental organization affiliated with a national organization” means: An affiliation of dentists who have current membership in a common and distinct Maryland dental organization or association that is committed to serving generally accepted interests in dentistry; An affiliation that is formed pursuant to the laws of Maryland; and A constituent organization of a national dental organization which is: Committed to serving generally accepted interests in dentistry; and Formed pursuant to the laws of the state in which it was formed. General. If there are one or more dentist vacancies on the Board, the Board shall hold an annual election to elect nominees to fill the dentist vacancies. Notice. The Board shall send notice of the election referred to in §A of this regulation by regular mail to: Each dentist to the last known address on file with the Board; and Each properly registered State dental organization affiliated with a national organization, to the address known to the Board. The notice referred to in §B(1) of this regulation shall: Advise the recipient of the: Number of vacancies that exist on the Board; and Terms of office for each vacancy; Solicit nominations for each vacancy; State that a nomination petition form may be requested from the Board; State the date by which the completed nomination petition form shall be returned to the Board; State that a dentist may vote for a single candidate in the election; State the dates at which time voting by e-mail shall be permitted; State that in lieu of an e-mail ballot a dentist may request a paper ballot from the Board which shall be completed and submitted by a certain date; and Advise the recipient that the results of the balloting will be posted on the Board's website. In addition to the notice mailed by regular mail described in §B of this regulation, the Board or its designee may send an e-mail notice of the election to each dentist to the last known e-mail address on file with the Board. The e-mail notice described in §C of this regulation shall contain the information described in §B(2) of this regulation. Nominations — Criteria. Candidates. A candidate's name may appear on the ballot only once. A State dental organization affiliated with a national organization shall only nominate a candidate who is a member of the organization. Dentist. A dentist may not nominate more than one candidate. A dentist may be both a petitioner and a candidate. A dentist who is a petitioner but not a candidate is counted as one of the ten dentists who support the nomination. A dentist who is a petitioner and a candidate is not counted as one of the ten dentists who support the nomination. Dentist and a State Dental Organization Affiliated with a National Organization. A dentist and a State dental organization affiliated with a national organization may nominate a candidate to fill a dentist vacancy on the Board. A dentist or a State dental organization affiliated with a national organization may not nominate more than one candidate. If a dentist or a State dental organization affiliated with a national organization nominates more than one candidate, each Board-approved nomination petition form submitted by the dentist or State dental organization affiliated with a national organization is invalid. Nomination Petition Form. The Board-approved nomination petition form referred to in §B(2)(c) of this regulation shall: Include: The candidate's name; The candidate's address on file with the Board; The candidate's license number on file with the Board; The names of the petitioners; and The license numbers of the petitioners on file with the Board; Be signed: By the candidate; By the petitioner; If the petitioner is a State dental organization affiliated with a national organization, by its: President; Executive director; or Administrator; and By ten dentists who support the nomination; and Include on separate pages, not greater than 8-1/2 inches wide by 11 inches in length, and not exceeding two pages of 12-point type: The candidate's biographical information; The candidate's resume; or The candidate's curriculum vitae. Board-approved nomination petition forms for dentists and for State dental organizations affiliated with a national organization shall be available from the Board upon request. Filing of Nomination Petition Form. The petitioner shall deliver the original nomination petition form and supporting documents to the offices of the Board: On or before the date specified in the Board's notice; and During normal business hours. The Board may not accept the filing of any document by: Electronic facsimile transmittal; or E-mail. A nomination petition form is invalid if: It is received by the Board after the date specified in the Board's notice, regardless of the date of postmark; or It does not otherwise meet the requirements of this chapter. A State dental organization affiliated with a national organization shall be properly registered with the Board to nominate a candidate. Posting of Candidates. The Board shall post the names and the biographical information, resumes, or curriculum vitae of the candidates on its website. Biographical information, resumes, or curriculum vitae that do not meet the requirements of §F(3) of this regulation may not be posted on the Board's website. General. If there are one or more dental hygienist vacancies on the Board, the Board shall hold an annual election to elect nominees to fill the dental hygienist vacancies. Notice. The Board shall send notice of the election referred to in §A of this regulation by regular mail to: Each dental hygienist to the last known address on file with the Board; and Each properly registered State dental hygienist organization affiliated with a national organization, to the address known to the Board. The notice referred to in §B(1) of this regulation shall: Advise the recipient of the: Number of vacancies that exist on the Board; and Terms of office for each vacancy; Solicit nominations for each vacancy; State that a nomination petition form may be requested from the Board; State the date by which the completed nomination petition form shall be returned to the Board; State that a dental hygienist may vote for a single candidate in the election; State the dates at which time voting by e-mail shall be permitted; State that in lieu of an e-mail ballot a dental hygienist may request a paper ballot from the Board which shall be completed and submitted by a certain date; and Advise the recipient that the results of the balloting will be posted on the Board's website. In addition to the notice mailed by regular mail described in §B of this regulation, the Board or its designee may send an e-mail notice of the election to each dental hygienist to the last known e-mail address on file with the Board. The e-mail notice described in §C of this regulation shall contain the information described in §B(2) of this regulation. Nominations-Criteria. Candidates. A candidate's name may appear on the ballot only once. A State dental hygienist organization affiliated with a national organization shall only nominate a candidate who is a member of the organization. Dental Hygienist. A dental hygienist may not nominate more than one candidate. A dental hygienist may be both a petitioner and a candidate. A dental hygienist who is a petitioner but not a candidate is counted as one of the ten dental hygienists who support the nomination. A dental hygienist who is a petitioner and a candidate is not counted as one of the ten dental hygienists who support the nomination. Dental Hygienists and a State Dental Hygienist Organization Affiliated with a National Organization. A dental hygienist and a State dental hygienist organization affiliated with a national organization may nominate a candidate to fill a dental hygienist vacancy on the Board. A dental hygienist or a State dental hygienist organization affiliated with a national organization may not nominate more than one candidate. If a dental hygienist or State dental hygienist organization affiliated with a national organization nominates more than one candidate, each Board-approved nomination petition form submitted by the dental hygienist or State dental hygienist organization affiliated with a national organization is invalid. Nomination Petition Form. The Board-approved nomination petition form referred to in §B(2)(d) of this regulation shall: Include: The candidate's name; The candidate's address on file with the Board; The candidate's license number on file with the Board; The names of the petitioners; and The license numbers of the petitioners on file with the Board; Be signed: By the candidate; By the petitioner; If the petitioner is a State dental hygienist organization affiliated with a national organization, by its: President; Executive director; or Administrator; and By ten dental hygienists who support the nomination; and Include on separate pages, not greater than 8-1/2 inches wide by 11 inches in length, and not exceeding two pages of 12-point type: The candidate's biographical information; The candidate's resume; or The candidate's curriculum vitae. Board-approved nomination petition forms for dental hygienists and dental hygienist organizations affiliated with a national organization shall be available from the Board upon request. Filing of Nomination Petition Form. The petitioner shall deliver the original nomination petition form and supporting documents to the offices of the Board: On or before the date specified in the notice; and During normal business hours. The Board may not accept the filing of any document by: Electronic facsimile transmittal; or E-mail. A nomination petition form is invalid if: It is received by the Board after the date specified in the Board's notice, regardless of the date of postmark; or It does not otherwise meet the requirements of this chapter. A State dental hygienist organization affiliated with a national organization shall be properly registered with the Board to nominate a candidate. Posting of Candidates. The Board shall post the names and the biographical information, resumes, or curriculum vitae of the candidates on its website. Biographical information, resumes, or curriculum vitae that do not meet the requirements of §F(3) of this regulation may not be posted on the Board's website. A State dental organization affiliated with a national organization or a State dental hygienist organization affiliated with a national organization that wishes to nominate candidates for membership on the Board shall register with the Board on a form approved by the Board. Registration Form. A registration form shall include: A current Certificate of Status issued by the State Department of Assessments and Taxation; A certified copy of the State dental organization's or the State dental hygienist organization's bylaws; A certified copy of the national organization's bylaws; and Proof that the State dental organization or the State dental hygienist organization is a constituent organization of the national organization. A completed registration form shall be delivered to the offices of the Board: On or before the date specified in the Board's notice; and During normal business hours. A completed registration form is invalid if: It is received by the Board after the date specified in the Board's notice, regardless of the date of postmark; It is incomplete; or It does not meet the requirements of this regulation. Registration forms from a State dental organization affiliated with a national organization or a State dental hygienist organization affiliated with a national organization shall: Be signed by its: President; Executive director; or Administrator; and Contain an affidavit from its president, executive director, or administrator that states: “I solemnly affirm under penalties of perjury and upon personal knowledge that the contents of the foregoing paper and all attachments are true.” If a registration form does not meet the requirements of this chapter, the Board shall: Return the form to the organization by regular mail; and State the reason for the return. There is no registration fee for submitting a registration form. A registrant is not required to reregister for subsequent elections. A registration form may be obtained: By contacting the Board; or From the Board's website. A State dental organization affiliated with a national organization and a State dental hygienist organization affiliated with a national organization shall notify the Board in writing of any change of address or telephone number. A special election may not be held for a dentist or a dental hygienist who: Resigns from the Board; or Dies while a Board member. Dentist. Each dentist Board member shall: Be an individual of recognized ability and honor; Be a practicing holder of a general license to practice dentistry who has practiced dentistry actively in this State for at least 5 years immediately before appointment; and Be a resident of this State. In the case of a Board member belonging to an association whose members are regulated by the Board, the dentist may not be: An officer of the association; A member of the association's governing board or committee; A member of the association's house of delegates; or A voting member of a committee of the association that contributes to the establishment of governmental, regulatory, or legislative policy objectives of the association. Dental Hygienist. Each dental hygienist Board member shall: Be a practicing holder of a general license to practice dental hygiene who has practiced dental hygiene actively in this State for at least 3 years immediately before appointment; and Be a resident of this State. In the case of a Board member belonging to an association whose members are regulated by the Board, the dental hygienist may not be: An officer of the association; A member of the association's governing board or committee; A member of the association's house of delegates; or A voting member of a committee of the association that contributes to the establishment of governmental, regulatory, or legislative policy objectives of the association. The Board shall disqualify any candidate that does not meet the qualifications of this regulation. One of the following individuals shall be the Election Judge in the order indicated: The Board's President unless the President is: Absent; or Eligible for and seeks reappointment; The Board's President-Elect unless the President-Elect is: Absent; or Eligible for and seeks reappointment; The Board's Secretary-Treasurer unless the Secretary-Treasurer is: Absent; or Eligible for and seeks reappointment; The member of the Board who has received either a dental license or a dental hygiene license in this State before any other Board member; The member of the Board who has been appointed to the Board longer than any other Board member; or The oldest member of the Board. A consumer member of the Board is not eligible to be the presiding chair under §A(5) and (6) of this regulation. Balloting shall be by either: Electronic mail (e-mail); or Paper ballot. A dentist may cast a single vote for a qualified candidate. A dental hygienist may cast a single vote for a qualified candidate. A dentist or a dental hygienist who was not mailed a written solicitation for nominations and notice of the election, or who was not mailed an e-mail solicitation to vote but is otherwise qualified to vote at the time of the election shall be permitted to vote during the election. Voting Procedures. Voting shall be performed by e-mail ballot or paper ballot during a time specified by the Board. Eligible voters with e-mail addresses on file with the Board shall be provided with an e-mail ballot. The Board shall make a paper ballot available to eligible voters upon request. Notwithstanding its postmark the paper ballot must be completed, signed, and received by the Board during a time specified by the Board. There shall be no absentee ballots. An election may be held for one or more vacancies after the vacancy or vacancies have occurred. Ballots shall be tallied by either: The Board; or A designee of the Board. Ballots may be tallied electronically, manually, or a combination thereof. In the event that the Board tallies the ballots for the dentist's election, the Executive Director shall tally the ballots in the presence of: The President of the Board; A dental hygienist member of the Board; A consumer member of the Board; and Representatives from State dental organizations affiliated with a national organization that are properly registered with the Board. In the event that the Board tallies the ballots for the dental hygienist's election, the Executive Director shall tally the ballots in the presence of: The President of the Board; A dentist member of the Board; A consumer member of the Board; and Representatives from State dental hygienist organizations affiliated with a national organization that are properly registered with the Board. Disqualified Ballots. The Board shall disqualify: The ballot of any dentist or dental hygienist who was not qualified to vote; The ballot for any dentist or dental hygienist who was not a qualified candidate; A ballot received after its due date; All ballots of a dentist or dental hygienist who attempts to vote more than once; or Any ballot that does not otherwise meet the requirements of this chapter. The Board shall disqualify the nomination of any candidate who was not a qualified candidate. The Board shall retain possession of the results of the balloting and any paper ballots for at least 3 years. The Board shall post the results of the balloting on its website. Grievance. A dentist nominee or a dental hygienist nominee aggrieved by the election process shall submit a grievance in writing by hand delivery to the offices of the Board within 5 days of the alleged occurrence. The grievance shall contain all relevant facts of alleged impropriety and have attached all relevant documents. The grievance shall be signed by the grievant, dated, and contain an affidavit from the grievant that states: “I solemnly affirm under penalties of perjury and upon personal knowledge that the contents of the foregoing paper and all attachments, if any, are true.” The Board shall provide the presiding officer and members of the Board with a copy of the grievance within 3 business days of its receipt. The election judge or the election judge's designee shall investigate the allegations. Decision. The election judge shall make a decision regarding the grievance. The decision of the election judge shall be: In writing; Mailed to the grievant by first class mail postage prepaid; and Delivered to the members of the Board for the Board's review. The election judge shall have the responsibility and authority to resolve any matters in dispute regarding the election process. Except for §C of this regulation, the determination of the election judge shall be final. The decision of the election judge may be reversed or modified by a 75 percent or more vote of a quorum of the Board. The Board shall submit the result of the balloting to the Governor in a list of names in descending order indicating the number of votes received by each candidate. For dentists, the number of names on the list for each vacancy shall be as follows: One vacancy-at least four names; Two vacancies-at least three names for each vacancy; and Three or more vacancies-at least two names for each vacancy. For dental hygienists, the number of names on the list shall be 4 times the number of vacancies. A tie vote shall be reported as a tie vote. The inability to provide the number of names requested in §B of this regulation does not invalidate: The election; or The Governor's appointments. The names of the individuals who are nominees may not be disclosed to the public until the names are posted on the Board's website. Substantial Violations. The election judge may determine that a substantial violation or violations of this chapter have occurred. In the event of a substantial violation of this chapter, the election judge may, in the judge's discretion and subject to Regulation .12C of this chapter, declare the election invalid. Nonsubstantial Violations. A violation of this chapter that is determined by the election judge not to be substantial shall not invalidate the election process. Dentist. If an election for a dentist board member is declared invalid by the election judge, the Board shall notify by regular mail or by e-mail: Each dentist; and Each State dental organization affiliated with a national organization. The notice referred to in §A(1) of this regulation shall state: The reason that the election has been declared invalid; The date, time, and location of the new election; Whether it is necessary to solicit nominations for the new election; and Any other information the Board finds necessary to ensure that the subsequent election is properly conducted. Dental Hygienist. If an election for a dental hygienist board member is declared invalid by the election judge, the Board shall notify by regular mail or by e-mail: Each dental hygienist; and Each State dental hygienist organization affiliated with a national organization. The notice referred to in §B(1) of this regulation shall state: The reason that the election has been declared invalid; The date, time, and location of the new election; Whether it is necessary to solicit nominations for the new election; and Any other information the Board finds necessary to ensure that the subsequent election is properly conducted. Health Occupations Article, §4-202, Annotated Code of Maryland Effective date: Regulations .01 — .19 adopted as an emergency provision effective January 23, 2009 (36:4 Md. R. 345); emergency status extended to July 1, 2009 (36:10 Md. R. 715); emergency status expired Regulations .01 — .16 adopted as an emergency provision effective April 6, 2010 (37:10 Md. R. 718); adopted permanently effective June 28, 2010 (37:13 Md. R. 852) This chapter covers the production and maintenance of patient records by dentists in any form or medium. The following is not governed by this chapter: Retention schedules of dental records; Confidentiality of dental records; Disclosure of dental records; Requests for copies of dental records; Concealment of dental records; Destruction and disposal of dental records; and Requirements imposed by: 45 CFR Part 160, as amended; and 45 CFR Part 164, as amended. In this chapter the following terms have the meanings indicated. Terms Defined. “Best practices” means a method or technique that through experience and research has shown to reliably lead to results superior to those achieved by other means. “Electronic health records” means health records created and maintained on computer or other electronic device. A dentist shall create and maintain a separate dental record for each patient. Dental records shall include: A patient’s clinical chart as described in Regulation .03 of this chapter; and Financial records as described in Regulation .04 of this chapter. Dental records may be: Handwritten in ink; Typed; or Generated on a computer or other electronic device. Dental records may not be created or maintained in pencil. If treatment is rendered, dental records shall be made contemporaneously with the treatment rendered. Dental records shall be created and maintained for each individual seeking or receiving dental services, regardless of whether: Any treatment is actually rendered; or Any fee is charged. All entries shall be dated. Electronic Health Records. A dentist who creates and maintains electronic health records shall utilize best practices related to: Hazard and risk analysis and mitigation; Software development; Validation; Maintenance; Security measures; and System integration and operation. A dentist who creates and maintains electronic health records shall maintain a back-up copy of the records and, if feasible, a back-up copy off site. The initials and signatures in electronic health records required by this chapter may be produced electronically. Electronic health record systems shall include an audit-trail function that details all interactions between systems and their users and all interactions among systems. The audit-trail identified in §H(4) of this regulation shall include: Attempted or successful unauthorized access to the electronic health records where the determination is feasible; Attempted or successful unauthorized modification or destruction of any records where the determination is feasible; Interference with application operations of the electronic records; Any setting of or change to logical access controls related to the dispensing of controlled substance prescriptions; and Attempted or successful interference with audit trail functions. Electronic health record systems shall provide the capability to produce a hard copy business version of each treatment or progress note and shall indicate: The date and time of each entry; The identity of each individual who made the entry; The method used in the creation of each entry, which shall include but not be limited to: Direct entry via keyboard or mouse; Speech recognition; Automation; Machine-entered default information; Pre-created documentation via form or template; Copy or import of an object including the date and time of the entry and the identity of the original author; Copy forward previous note contents including the date and time of the entry and the identity of the original author; and Dictation and transcription from an external system. A dental record shall contain: The patient’s name or other patient identifier; If the patient is a minor, the name and address of the patient’s parents or guardian; The patient’s address and telephone number; The patient’s date of birth; The patient’s place of employment if the patient wishes to provide the information; Emergency contact information; Medical and dental histories which shall be updated at each visit; and Insurance information. To the extent practicable, each document in the dental records shall contain one or more patient identifiers. Dental records shall: Be accurate; Be detailed; Be legible; Be well organized; and Document all data in the dentist’s possession pertaining to the patient's dental health status; Entries shall be signed or initialed by the individual who provided the treatment. With the exception of dental hygienists, entries made by auxiliary personnel shall be: Reviewed by the treating dentist; and Signed or initialed by the treating dentist. Entries made by individuals other than the individual who provided the treatment shall: Identify the individual who made the entry; Identify the individual who provided the treatment; Be signed or initialed by the individual who provided the treatment; and Be signed or initialed by the treating dentist. Exception. Entries made by an individual other than the individual who provided the treatment may not require the signature or initials of the treating dentist if the treatment was provided by a dental hygienist. A dentist and auxiliary personnel may not erase, alter, obliterate, or “white out” dental records. Blank spaces may not be left between entries. Changes to handwritten and typed dental records shall: Be made by a single line strike-through of the incorrect entry so that the incorrect entry may be read; Contain changes in the corresponding margin or in close proximity to the incorrect entry; Be dated; Be signed or initialed by the treating dentist; and If the change was made by auxiliary personnel: Be reviewed; Be approved; and Be signed or initialed by the treating dentist. The dental records shall contain only those abbreviations that are commonly acceptable within the profession and comprehensible to other dentists. Except for notations of payment or failure to make payment, financial records may not be maintained in the clinical chart. Dentists are responsible for the content of the dental records. A dentist who has been issued a dispensing permit by the Board shall maintain dispensing records in accordance with Regulation .03J of this chapter. Each patient’s clinical chart shall include at a minimum the following: Patient's name and date of treatment; Reasons for the patient’s visit; Treatment plans that are signed and dated by both the treating dentist and the patient; Patient’s complaints; Diagnosis and treatment notes; Progress notes; Post operative instructions; Study models; In-person conversations, telephone conversations, and other correspondence with the patient or their representative; Identification of medications prescribed, administered, dispensed, quantity, and directions for use; Clinical details with regard to the administration of: Nitrous oxide; Anxiolytics; Sedation; and General anesthesia. Radiographs of diagnostic quality; Periodontal charting; Laboratory work authorization forms and correspondence to and from laboratories; Informed consent; Copies of correspondence and reports provided to other health care providers, diagnostic facilities, and legal representatives; Records and reports provided by other health care providers and diagnostic facilities; Details regarding referrals and consultations; Patient complaints pertaining to the dentist and staff, and their manner of resolution; Noncompliance and missed appointment notes; and Dismissal letter. A dentist who performs diabetes or blood pressure screening shall include the results of the screenings in the patient’s clinical chart. Financial records shall be considered part of the dental records but shall be maintained separately from the patient’s clinical chart. Financial records shall include at a minimum the following: Complete financial data concerning the patient’s account, including: Each amount billed to or received from the patient or third-party payor; and The date of each bill and each payment; Copies of all claim forms submitted to third-party payors by the dentist or by the dentist’s agent or employee; and Payment vouchers received from third-party payors. Failure to comply with this chapter constitutes unprofessional conduct and may constitute other violations of law. Health Occupations Article, §4-205(c)(3), Annotated Code of Maryland Effective date: June 11, 2012 (39:11 Md. R. 687) Regulation .01-1 adopted effective April 29, 2013 (40:8 Md. R. 724) Regulation .02 amended effective April 29, 2013 (40:8 Md. R. 724) Regulation .03 amended effective April 29, 2013 (40:8 Md. R. 724) This chapter shall be used by the Board and the Maryland Office of Administrative Hearings as a framework for imposing discipline. The Board and the Maryland Office of Administrative Hearings shall take into consideration a range of activity within certain types of conduct rather than assigning particular sanctions to each specific violation. The Board shall complete a worksheet for each complaint considered by the Board that is not initially closed. The Board is aware that there may be conduct by a licensee or certificate holder that does not fall squarely within a particular grid contained in Regulation .06 of this chapter. In that event the Board will so indicate on the worksheet and use its best judgment to determine the appropriate sanction. The Board and the Maryland Office of Administrative Hearings shall make determinations that maximize the protection of the public’s health while maintaining the rights of licensees and certificate holders. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland State Board of Dental Examiners. “Conditions” means requirements in a public or nonpublic order that a licensee or certificate holder must satisfy which include but are not limited to: Treatment and counseling for an emotional or physical illness; Submission to drug and alcohol testing; Abstinence from specified drugs; Abstinence from alcohol; Remedial training; Inspection; Monitoring; Evaluation; Supervision; Testing of clinical skills; Submission of written reports; A demonstration of knowledge or competency; Limitation of practice; Limitation on the administration or prescription of specified drugs to patients; The provision of pro bono dental care to the poor, elderly, or disabled; Obeyance of dental laws, including federal, State, and local laws; An anonymous monetary donation; and The payment of a civil penalty. “Conduct” means behavior or action, or a failure to behave or act, that results in a violation of the Maryland Dentistry Act or the regulations adopted by the Board. This chapter shall be used by the Board as a guide for sanctioning licensees and certificate holders in formal and informal actions and proceedings. Except as provided in Regulation .05 of this chapter, the Board shall impose a sanction not less severe than the minimum listed in Regulation .06 of this chapter, nor more severe than the maximum listed in Regulation .06 of this chapter. When conduct results in multiple violations of the Maryland Dentistry Act and the regulations adopted by the Board, the Board shall consider sanctions that are greater than those imposed for a single violation. This chapter does not apply to disciplinary matters reviewed by the Board that are initially closed. Unless otherwise indicated, the period of a suspension may be stayed in whole or in part. A respondent placed on suspension or probation shall have conditions attached to the suspension or probation which focus on the conduct and steps needed to assure public protection. Consent orders shall: Include an acknowledgement of the violation or violations; and Indicate that the respondent accepts personal responsibility for the respondent's behavior. If the conduct is not described in Regulation .06 of this chapter, the Board shall use its judgment to determine appropriate sanctions and shall so state in the sanctions worksheet. A departure from the sanctioning guidelines alone may not be grounds for any hearing or appeal of any Board action before the Board or the Maryland Office of Administrative Hearings. The sanctioning guidelines are not applicable to: Individuals seeking an initial license or certificate; or The summary suspension of a license or certificate under State Government Article, §10-226, Annotated Code of Maryland. Notwithstanding the sanctioning guidelines, a respondent may surrender a license or certificate. The Board shall complete a sanctions worksheet after considering each disciplinary matter. The sanctions worksheet shall, at a minimum: Briefly summarize the conduct that constituted the violation or violations meriting action; Identify the severity of the conduct; Describe other factors that the Board considered in determining the recommended sanctions imposed, including but not limited to: Aggravating factors as outlined in Regulation .05 of this chapter; Mitigating factors as outlined in Regulation .05 of this chapter; and Prior disciplinary history; and Identify the recommended sanctions. The Board’s summary of the conduct that constituted the violation or violations need not: Be exhaustive; or Include every violation meriting action by the Board. The existence of one or more aggravating or mitigating factors contained in Regulation .05 of this chapter does not impose on the Board any requirement to make findings of fact or to articulate its reasoning for not exercising its discretion to impose a sanction outside the range of sanctions. A copy of the sanctions worksheet may be obtained by the respondent or the respondent's legal representative. Sanctions in a particular case may fall outside the range of the sanctioning guidelines established by the Board. If the sanctions imposed by the Board fall outside the range of the sanctioning guidelines, the Board shall state its reasons on its worksheet. Depending on the facts and circumstances of each case, and to the extent that the facts and circumstances apply, the Board may consider the following aggravating and mitigating factors in determining whether the sanction in a particular case should fall outside the range of the sanctioning guidelines: Aggravating Factors: Previous criminal or administrative discipline history; Whether the offense was committed deliberately or with gross negligence or recklessness; Whether the offense has the potential for, or caused, serious patient harm; Whether the offense was part of a pattern of detrimental conduct; Whether the respondent pursued the respondent's financial gain over the patient’s welfare; Whether the patient was especially vulnerable; Whether the respondent attempted to hide error or misconduct from patients or others; Whether the respondent: Concealed, falsified, or destroyed evidence; or Presented false testimony or evidence; Whether the respondent willfully and without legal justification failed to cooperate with a lawful investigation conducted by the Board; and Whether previous attempts to rehabilitate the respondent were unsuccessful; and Mitigating Factors: Absence of a prior disciplinary record; The passage of time since any prior offenses; Whether the respondent self-reported to the Board; Cooperation with the Board’s investigation; Full disclosure to the Board; Implementation of remedial measures to correct or mitigate harm arising from the misconduct; Timely good-faith efforts to make restitution or to rectify consequences of misconduct; Evidence of rehabilitation or rehabilitative potential; Absence of premeditation to commit the offense; Absence of potential harm to the public; Absence of adverse impact; Whether the offense was an isolated incident and not likely to recur; How and when the respondent has been involved in community service and the value of the community service to the community; and Voluntary admissions of misconduct. The following guidelines shall be used by the Board when sanctioning licensees and certificate holders in formal and informal actions and proceedings: Abuse — Physical and Emotional. Advertising. Criminal Convictions or Plea of Nolo Contendere. Disciplined by Another Licensing or Disciplinary Authority. Diversion of Controlled Substances or Prescription Drugs. Infection Control Guidelines — Centers for Disease Control and Prevention (CDC). Late License and Certificate Renewal When the Licensee or Certificate Holder Has Continued to Practice. Noncompliance with Board Orders. Practice Below Acceptable Standards of Care. Sexual Misconduct. Substance Abuse. Unauthorized Practice. Unprofessional Conduct. Health Occupations Article, §1-606, Annotated Code of Maryland Effective date: January 23, 2012 (39:1 Md. R. 18) In this chapter, the following term has the meaning indicated. Term Defined. “Practice dentistry” means to: Be a manager, a proprietor, or a conductor of or an operator in any place in which a dental service or dental operation is performed intraorally; Perform or attempt to perform any intraoral dental service or intraoral dental operation; Diagnose, treat, or attempt to diagnose or treat any disease, injury, malocclusion, or malposition of a tooth, gum, or jaw, or structures associated with a tooth, gum, or jaw if the service, operation, or procedure is included in: The curricula of an accredited dental school; or An approved dental residency program of an accredited hospital or teaching institution; Perform or offer to perform dental laboratory work; Place or adjust a dental appliance in a human mouth; or Administer anesthesia for the purposes of dentistry and not as a medical specialty. A dentist shall practice dentistry as defined in Regulation .01 of this chapter. A dentist shall: Limit their practice to the areas of competence by which proficiency has been gained through education, training, and experience; Acquire the special education and training needed to address the cultural differences of diverse populations; Avoid unfair discrimination based on age, gender, race, ethnicity, culture, national origin, disability, socioeconomic status, or other basis proscribed by law; Use treatment only when the dentist knows that the circumstances are appropriate; Maintain competence by meeting the requirements of continuing education in accordance with COMAR 10.44.22; Engage in ongoing consultation with other dentists or relevant professionals; Seek appropriate education, training, and experience when developing competence in a new service or technique; and Document and maintain appropriate records of all relevant course work and training used to gain competence. Health-General Article, §§4-205(a)(5), 4-205(c)(3), and 4-315(a), Annotated Code of Maryland Effective date: July 9, 2012 (39:13 Md. R. 786) This chapter establishes the requirements for the issuance of: A temporary volunteer dentist’s license to practice dentistry; A temporary volunteer dental hygienist’s license to practice dental hygiene; and A temporary dental clinic permit. In this chapter, the following terms have the meaning indicated. Terms Defined. “Board” means the Maryland State Board of Dental Examiners. “Temporary dental clinic” means a dental clinic of a specific limited duration at which a bona fide charitable organization provides dental services to the poor, elderly, or disabled. “Temporary dental clinic permit” means a temporary permit issued by the Board to a bona fide charitable organization to provide dental services to the poor, elderly, or disabled at a temporary dental clinic. “Temporary volunteer dental hygienist’s license” means a temporary license issued by the Board to a dental hygienist who: Holds an active general license to practice clinical dental hygiene in another state; and Otherwise meets the requirements of this chapter to obtain a temporary volunteer dental hygienist’s license. “Temporary volunteer dentist’s license” means a temporary license issued by the Board to a dentist who: Holds an active general license to practice clinical dentistry in another state; and Otherwise meets the requirements of this chapter to obtain a temporary volunteer dentist’s license. License Required. A dentist who holds a general license to practice dentistry in another state may practice dentistry at a temporary dental clinic or for a government entity only after receiving a temporary volunteer dentist’s license to practice dentistry as provided in this chapter. Qualifications for Out-of-State Dentists. The Board shall issue a temporary volunteer dentist’s license to a dentist who satisfies the requirements of this chapter. To qualify for a temporary volunteer dentist’s license, an applicant shall: Comply with the following: Submit a completed Board-approved application with the Board at least 60 days before the date the temporary dental clinic is scheduled to open; Hold an active general license to practice clinical dentistry in another state that is not subject to clinical restrictions; and Have passed the North East Regional Board Clinical Examination or submit to the Board a notarized affidavit or other evidence satisfactory to the Board that for the 5 years preceding application the applicant has actively engaged in the practice of dentistry for at least 850 hours on average per year; Provide a notarized affidavit to the Board: Agreeing to donate dental services without compensation for a temporary dental clinic operated by a bona fide charitable organization or government entity; and Indicating that the applicant does not practice dentistry for profit in the State; Provide documentation to the Board that evidences that the dentist is covered by malpractice insurance; and Provide current verification of cardiopulmonary resuscitation certification. The Board may require a dentist seeking a temporary volunteer dentist’s license to: Pass the Maryland Jurisprudence Examination; or Fulfill any other requirements relating to knowledge of the laws and regulations concerning the practice of dentistry in the State. An applicant for a temporary volunteer dentist’s license may not be required to pay an application fee. The Board may deny a temporary volunteer dentist’s license on the grounds provided under Health Occupations Article, §4-315, Annotated Code of Maryland. Practice Locations. A temporary volunteer dentist’s license authorizes the licensee to practice dentistry only in a temporary dental clinic providing medical care to the poor, elderly, or disabled that is operated by: A bona fide charitable organization; The State or a local government; or A local health department. Practice Restrictions. A dentist who holds a temporary volunteer dentist’s license may not administer, monitor, or maintain general anesthesia or sedation. A dentist who holds a temporary volunteer dentist’s license may administer, monitor, and maintain nitrous oxide oxygen. A dentist who holds a temporary volunteer dentist’s license may only provide services authorized under the: Maryland Dentistry Act; and Regulations adopted by the Board. Dentists Licensed in Maryland. A dentist who holds an active general license to practice dentistry in Maryland may: Practice at a temporary dental clinic without obtaining a temporary volunteer dentist’s license; and Only provide services authorized under the: Maryland Dentistry Act; and Regulations adopted by the Board. Follow-Up Care. The treating dentist shall ensure that each patient receives a form at the conclusion of treatment that contains: A summary of the services that were provided to the patient by the dentist and, if applicable, the dental hygienist; and Instructions for any recommended follow-up care. Expiration and Renewal. A temporary volunteer dentist's license issued under this chapter shall be issued for the duration of the temporary dental clinic only and may not be renewed. The Board may issue a temporary volunteer dentist's license to a dentist who previously held a temporary volunteer dentist's license if the dentist: Applies for a new license; and Satisfies the requirements of this chapter. Continuing Education. The Board may not require continuing education as a condition for the issuance of a temporary volunteer dentist’s license. Display of License. The holder of a temporary volunteer dentist’s license shall maintain the holder’s wallet license on the premises of the temporary dental clinic while practicing dentistry at the temporary dental clinic. License Required. A dental hygienist who holds a general license to practice dental hygiene in another state may practice dental hygiene at a temporary dental clinic or for a government entity only after receiving a temporary volunteer dental hygienist’s license to practice dental hygiene as provided in this chapter. Qualifications for Out-of-State Dental Hygienists. The Board shall issue a temporary volunteer dental hygienist’s license to a dental hygienist who satisfies the requirements of this chapter. To qualify for a temporary volunteer dental hygienist’s license, an applicant shall: Comply with the following: Submit a completed Board-approved application with the Board at least 60 days before the date the temporary dental clinic is scheduled to open; Hold an active general license to practice clinical dental hygiene in another state that is not subject to clinical restrictions; and Have passed the North East Regional Board Clinical Examination or submit to the Board a notarized affidavit or other evidence satisfactory to the Board that for the 3 years preceding application the applicant has actively engaged in the practice of dental hygiene for at least 150 hours on average per year; Provide a notarized affidavit to the Board: Agreeing to donate dental hygiene services without compensation for a temporary dental clinic operated by a bona fide charitable organization or government entity; and Indicating that the applicant does not practice dental hygiene for profit in the State; Provide documentation to the Board that evidences that the dental hygienist is covered by malpractice insurance; and Provide current verification of cardiopulmonary resuscitation certification. The Board may require a dental hygienist seeking a temporary volunteer dental hygienist’s license to: Pass the Maryland Jurisprudence Examination; or Fulfill any other requirements relating to knowledge of the laws and regulations concerning the practice of dental hygiene in the State. An applicant for a temporary volunteer dental hygienist’s license may not be required to pay an application fee. The Board may deny a temporary volunteer dental hygienist’s license on the grounds provided under Health Occupations Article, §4-315, Annotated Code of Maryland. Practice Locations. A temporary volunteer dental hygienist's license authorizes the licensee to practice dental hygiene only in a temporary dental clinic providing medical care to the poor, elderly, or disabled that is operated by: A bona fide charitable organization; The State or a local government; or A local health department. Practice Restrictions. A dental hygienist who holds a temporary volunteer dental hygienist’s license may not: Administer, monitor, or maintain general anesthesia or sedation; Administer local anesthesia by infiltration; Administer block anesthesia; or Administer, monitor, or maintain nitrous oxide oxygen. A dental hygienist who holds a temporary volunteer dental hygienist’s license may only provide services authorized under the: Maryland Dentistry Act; and Regulations adopted by the Board. Dental Hygienists Licensed in Maryland. A dental hygienist who holds an active general license to practice dental hygiene in Maryland may: Practice at a temporary dental clinic without obtaining a temporary volunteer dental hygienist's license; and Only provide services authorized under the: Maryland Dentistry Act; and Regulations adopted by the Board. General Supervision. A temporary volunteer dental hygienist’s license authorizes the dental hygienist to practice dental hygiene at a temporary dental clinic under the general supervision of a dentist who: Is on the premises; Examines the patient at any time during the treatment; and Is available for personal consultation while the services are being performed. A dental hygienist may: Perform an assessment of dental needs; and Provide dental hygiene services before an examination by a supervising dentist. This section may not be construed to: Require a preliminary dental examination or treatment by a dental hygienist; or Prohibit a supervising dentist from either examining a patient or providing treatment to a patient before treatment by a dental hygienist. Expiration and Renewal. A temporary volunteer dental hygienist's license issued under this chapter shall be issued for the duration of the temporary dental clinic only and may not be renewed. The Board may issue a temporary volunteer dental hygienist license to a dental hygienist who previously held a temporary volunteer dental hygienist license if the dental hygienist: Applies for a new license; and Satisfies the requirements of this chapter. Continuing Education. The Board may not require continuing education as a condition for the issuance of a temporary volunteer dental hygienist’s license. Display of License. The holder of a temporary volunteer dental hygienist's license shall maintain the holder’s wallet license on the premises of the temporary dental clinic while practicing dental hygiene at the temporary dental clinic. Bona Fide Charitable Organization. A bona fide charitable organization may utilize holders of a temporary volunteer dentist’s license or a temporary volunteer dental hygienist’s license to provide dental services to the poor, elderly, or disabled at a temporary dental clinic only after receiving a temporary dental clinic permit issued by the Board. The Board shall issue a temporary dental clinic permit to a bona fide charitable organization that meets the requirements of this chapter. To apply for a temporary dental clinic permit, a bona fide charitable organization: Shall submit an application on a form that the Board requires; and May not be required to pay an application fee. Expiration and Renewal of Permit. A temporary dental clinic permit issued under this chapter: Shall be issued for the duration of the temporary dental clinic only; and May not be renewed. The Board may issue a temporary dental clinic permit to a bona fide charitable organization that previously held a temporary dental clinic permit if the bona fide charitable organization: Applies for a new permit; and Satisfies the requirements of this chapter. A bona fide charitable organization that conducts a temporary dental clinic under this chapter may not be construed to be practicing dentistry. Government Entities. The State, a local government, or a local health department that provides dental services to the poor, elderly, or disabled and that wishes to utilize the services of dentists or dental hygienists that hold an active general license in another state at a temporary dental clinic shall at least 60 days before the services are to be provided: Provide written notice to the Board of: Its intention to provide the services; The dates and location of the temporary dental clinic; The name, address, and telephone number of the temporary dental clinic’s coordinator; and Indicate whether it has provided malpractice insurance to those who are applying for either a: Temporary volunteer dentist’s license; or Temporary volunteer dental hygienist’s license. The State, a local government, or a local health department may not be required by the Board to seek authorization to provide services at a temporary dental clinic. A holder of an active general license to practice dentistry or dental hygiene in another state who wishes to provide dental services sponsored by the State, a local government, or a local health department shall obtain a temporary volunteer dentist’s license or a temporary volunteer dental hygienist’s license as provided in this chapter before providing the dental services. Permit Holders. The holder of a temporary dental clinic permit shall have: A medical emergency plan; Adequate equipment, including: Portable equipment where appropriate; and Appropriate armamentarium available for the delivery of dental services; and Adequate safeguards to protect the health and safety of patients. Display of Permit. The holder of a temporary dental clinic permit shall display the permit conspicuously in the clinic. The Board may: Enter and inspect a temporary dental clinic in order to carry out a duty under Health Occupations Article, Title 4, Annotated Code of Maryland, or this chapter; and Conduct an investigation of: A temporary dental clinic; A holder of a temporary volunteer dentist’s license providing services at a temporary dental clinic; A holder of a temporary volunteer dental hygienist’s license providing services at a temporary dental clinic; A holder of a general license to practice dentistry providing services at a temporary dental clinic; or A holder of a general license to practice dental hygiene providing services at a temporary dental clinic. This regulation may not be construed to limit the authority of the Board to conduct investigations under Health Occupations Article, Title 4, Annotated Code of Maryland. Health Occupations Article, §§4-101, 4-304, 4-306, and 4-308, Annotated Code of Maryland Effective date: December 12, 2011 (38:25 Md. R. 1582) The purpose of this chapter is to prescribe procedures for unannounced inspections of a dental office to determine compliance at that office with the Centers for Disease Control and Prevention's guidelines on universal precautions in accordance with the Health Occupations Article, §4-205(a)(6), Annotated Code of Maryland. On receipt of a written and signed complaint, including a referral from the Commissioner of Labor and Industry, alleging potential non-compliance with the Centers for Disease Control and Prevention's guidelines on universal precautions, the Board may conduct an unannounced inspection of the dental office. A Board inspector or designee shall inspect the dental office in accordance with the Centers for Disease Control and Prevention's guidelines on universal precautions and shall produce an inspection report. The Board shall review the inspection report and make a determination as to whether any violations exist. Within 2 weeks of the inspection, the Board shall notify the appropriate licensee or licensees of the results of the inspection in writing. If the inspection found violations, the notification shall include a notice of those violations and the specified time to correct those violations. Except as provided in §§C and D of this regulation, if the Board’s inspection indicated violations, the appropriate licensee or licensees within the dental office shall correct violations within 30 days after receipt of the Board’s written notification. The Board may require less than 30 days to correct a violation if the Board considers the correction necessary to the interest of public health. A licensee may request an extension of time for correction of violations. The Board may approve or deny an extension of time for correction of violations. Upon completion of correction of all violations, the licensee shall notify the Board in writing within 1 week of the corrections with adequate documentation of all corrections. Upon notification of the corrections, the Board or its designee shall re-inspect the dental office. The Board shall notify the appropriate licensee or licensees in writing of the results of the re-inspection within 1 week of the re-inspection. If re-inspection reveals additional violations not cited in the first inspection report, the appropriate licensee or licensees shall correct those violations in the time period specified unless an extension of time is requested by a licensee and approved by the Board in accordance with §§C and D of this regulation. Failure to allow an inspection of a dental office may result in disciplinary action against a licensee in accordance with COMAR 10.44.07, subject to the hearing requirements set forth in Health Occupations Article, §4-318, Annotated Code of Maryland. Failure to comply with a notice to correct violations within a 30-day period, or any extension granted by the Board under Regulation .03 of this chapter, may result in disciplinary action against a licensee in accordance with COMAR 10.44.07, subject to the hearing requirements set forth in Health Occupations Article, §4-318, Annotated Code of Maryland. Nothing in this chapter precludes the Board from taking concurrent or subsequent disciplinary action, including summary action, against a licensee found to have violated applicable Centers for Disease Control and Prevention guidelines, subject to the Administrative Procedure Act, the notice and hearing requirements set forth in Health Occupations Article, §4-318, Annotated Code of Maryland, and Board regulations. Health Occupations Article, §§4-205(c)(1) and 4-205(a)(6), Annotated Code of Maryland Effective date: August 18, 2025 (52:16 Md. R. 847) This chapter covers the issuance by the State Board of Dental Examiners of a limited dental drug dispensing permit for dentists who wish to dispense only prescription strength: Home fluoride products; Dentin/enamel remineralizing products; or Antimicrobial rinses. This chapter does not apply to a dentist who dispenses prescription drugs in the course of treating a patient at a: Medical facility or clinic that is operated on a nonprofit basis; Health center that operates on a campus of an institution of higher learning; Public health facility; Medical facility under contract with the State or local health department: or Facility funded with public funds. A dentist who dispenses a full course of antibiotics to a patient for infection control is not required to obtain a drug dispensing permit if the dispensing meets the requirements of Regulation .05A of this chapter. A dentist who wishes to dispense prescription drugs other than those covered in this chapter is required to obtain a drug dispensing permit as required by COMAR 10.13.01. In this chapter the following terms have the meanings indicated. Terms Defined. “Administer” means the direct introduction of a single dosage of a drug at a given time, whether by injection or other means, and whether in liquid, tablet, capsule, or other form. “Board” means the Maryland State Board of Dental Examiners. “Dentist” means an individual who holds a current license to practice dentistry in Maryland. “Limited dental drug dispensing permit” means a drug dispensing permit for dentists who wish to dispense only prescription strength: Home fluoride products; Dentin/enamel remineralizing products; or Antimicrobial rinses. “Starter dosage” means an amount of a drug sufficient to begin therapy: Of short duration of 72 hours or less; or Before obtaining a large quantity of the drug to complete the therapy. Subject to the exception contained in Regulation .05 of this chapter, a dentist may not dispense home fluoride products, dentin/remineralizing products or antimicrobial rinses unless the dentist holds a limited drug dispensing permit issued by the Board. A permit expires on October 1 of the 5th year following the effective date of the permit. To obtain a permit, a dentist shall: Submit to the Board an application on a form provided by the Board; and Pay the fee set by the Board in COMAR 10.44.20. The Board shall mail a renewal application to each dentist holding a limited dental drug dispensing permit at least 90 days before the expiration of the permit. Before the permit expires, an applicant may apply to renew the permit for an additional 5-year term if the applicant: Submits to the Board a renewal application on a form provided by the Board; and Pays the renewal fee set by the Board in COMAR 10.44.20. Drug Samples. A dentist is not required to have a limited dental drug dispensing permit to dispense drug samples if: The sample complies with the labeling requirements contained in Health Occupations Article, §12-505, Annotated Code of Maryland, except that the labeling requirements may not apply if the dentist dispenses the drug: In an emergency situation; or As a sample dispensed in the regular course of the dentist’s practice; No charge is made for the sample; and The dentist enters an appropriate record in the patient’s chart. Starter Dosages. A dentist is not required to have a limited dental drug dispensing permit to dispense starter dosages if: The starter dosage complies with the labeling requirements contained in Health Occupations Article, §12-505, Annotated Code of Maryland, except that the labeling requirements may not apply if the dentist dispenses the drug: In an emergency situation; or As a starter dosage dispensed in the regular course of the dentist’s practice; No charge is made for the starter dosage; and The dentist enters an appropriate record in the patient’s chart. Course of Treating a Patient. A dentist is not required to have a limited drug dispensing permit to administer a prescription drug in the course of treating a patient. After an opportunity for a hearing, the Board may revoke or suspend a limited permit or take disciplinary action under Health Occupations Article, §4-315(a) or (b), Annotated Code of Maryland, if the Board finds that the holder of the permit violates any provision of this chapter. Failure to comply with the provisions of this chapter constitutes unprofessional conduct and may constitute other violations of law. The Board may order the summary suspension of a permit if the Board: Finds that the public health, safety, or welfare imperatively requires emergency action; and Promptly gives the licensee: Written notice of the suspension, the finding, and the reasons that support the finding; and An opportunity to be heard. Service of the notice of the suspension, the finding, the reasons that support the finding, and the notice of the opportunity to be heard may be effected upon the holder of a permit by: Personal service; or Written notice sent by certified mail and regular mail to the permit holder’s address on file with the Board. Service made pursuant to §B(2) of this regulation shall be effective upon mailing. The methods of service provided in this regulation are in addition to and not exclusive of any other means of service that are reasonably calculated to provide notice. Health Occupations Article, §4-207(b), Annotated Code of Maryland Effective date: July 20, 2015 (42:14 Md. R. 880) In this chapter, the following terms have the meanings indicated. Terms Defined. “CDC Guidelines” means the Centers for Disease Control and Prevention Guidelines for Infection Control in Dental Health-Care Settings—2003. “Practice dentistry” has the meaning stated in Health Occupations Article, §4-101, Annotated Code of Maryland. “Private dental office” has the meaning stated in Health Occupations Article, §4-308, Annotated Code of Maryland. “Standard and transmission based precautions” means the minimum infection control prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. “Supervising dentist” means a dentist licensed in the State, including a solo practitioner, who is responsible for all infection control activities within a private dental office as set forth in this chapter. Guidelines for Infection Control in Dental Health-Care Settings—2003 (Morbidity and Mortality Weekly Report (MMWR): Recommendations and Reports, 2003; v. 52; no. 17, Centers for Disease Control and Prevention (CDC, Atlanta, GA)) is incorporated by reference. Each owner of a private dental office shall designate a licensed dentist to be the supervising dentist for the private dental office. A supervising dentist designated under §A of this regulation shall: Complete the registration required by the Board on a form provided by the Board; and Be responsible for all infection control activities within the private dental office. If a supervising dentist for a private dental office relinquishes the supervising dentist’s responsibilities under §B(2) of this regulation, for any reason, the owner of the private dental office shall immediately designate an interim supervising dentist who shall be responsible for all infection control within the private dental office until a new supervising dentist for the private dental office registers with the Board. An interim supervising dentist may remain an interim supervising dentist for no more than 45 calendar days prior to the registration of a subsequent supervising dentist. The responsibilities of a supervising dentist set forth in this regulation is not considered the practice of dentistry. This regulation may not be construed to prevent an unlicensed individual from assisting with regulatory compliance consistent with Health Occupations Article, §4-103(e)(12), Annotated Code of Maryland. The Board may charge a fee not to exceed the fee set forth in COMAR 10.44.20 for the registration and any subsequent registrations of supervising dentists. The owner of a private dental office shall display the name of the supervising dentist and the name of the interim supervising dentist, if applicable, conspicuously in the office on the form provided by the Board. The supervising dentist in a private dental office shall be responsible for the following infection control activities: Adherence to the CDC Guidelines in their individual capacity as described in Regulation .06 of this chapter; The provision and accessibility of sufficient and appropriate: Personal protective equipment including but not limited to: Gloves; Masks; Eyewear; and Gowns; Hand soaps and hand scrubs; Puncture-resistant sharps containers located in close proximity to where they are to be used; Products for cleaning and disinfecting environmental surfaces that are approved by the Environmental Protection Agency or its successor; Periodic water quality testing to ensure that water meets Environmental Protection Agency regulatory standards for drinking water; Sterilization monitoring of reusable dental equipment and instruments in accordance with the manufacturer’s instructions for use, including: Biological spore testing; Chemical monitoring; and Mechanical monitoring; Maintenance of a biohazard waste removal contract for the office; and Signage for patient waiting areas for those exhibiting symptoms of respiratory infection. In addition to the activities set forth in §A of this regulation, a supervising dentist shall be responsible for the training of clinical staff upon hire and before engaging in clinical duties, and at minimum, annually. The training of clinical staff shall include training regarding: Standard and transmission based precautions; Hand hygiene; Personal protective equipment; Respiratory hygiene/cough etiquette; Sharps safety; Safe injection practices; Sterilizing and disinfecting clinical contact and housekeeping surfaces; Spore testing; Water quality testing; and The Occupational Safety and Health Administration Bloodborne Pathogens Standard as set forth in 29 C.F.R. §1910.1030. A supervising dentist shall ensure that evidence-based written policies and procedures, based upon current CDC Guidelines, regulatory requirements, and other relevant guidance documents, are developed, maintained, and readily available for review by the office’s clinical staff. The policies and procedures referred to in §D of this regulation shall be updated either annually or more often if appropriate, to reflect new evidence, guidelines, or regulatory requirements. A supervising dentist shall maintain adequate written records of the activities set forth in §§A—E of this regulation in each office for which the records apply. A supervising dentist who practices clinical dentistry shall, for their own practice of dentistry, be responsible for all infection control activities in the dental office including those activities that are not considered structural infection control or those that do not impact the entirety of the private dental office. Notwithstanding the responsibilities of a supervising dentist set forth in Regulation .05 of this chapter, an individual dentist who is not a supervising dentist shall be responsible for infection control activities in the control of the individual dentist including: Use of adequate personal protective equipment; and Sterilization of instruments. Violations of this chapter constitutes unprofessional conduct and may result in disciplinary action against a dentist as set forth in Health Occupations Article, §4-315, Annotated Code of Maryland. Health Occupations Article, §§4-104 and 4-205(c)(1)(v), Annotated Code of Maryland Effective date: January 19, 2026 (53:1 Md. R. 23))