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)