Chapter 04. Practice of Dental Hygiene

In this chapter, the following terms have the meaning indicated.

Terms Defined.

The following intraoral functions may be performed in the practice of dental hygiene:

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.

Diagnosis;

Extraction;

Cavity repair;

Tooth placement correction;

Surgical procedures;

Anesthesia procedures other than:

Prescribing or administering medication other than:

Condensing, carving, or finishing any restoration; and

Cementing permanent crowns or restorations.

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:

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:

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:

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:

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.

20 hours of didactic training, including at least the following:

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:

The letter from the accredited dental hygiene program referred to in §A of this regulation shall:

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:

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:

A dental hygienist is not required to renew the Board recognition to:

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:

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.

The letter from the accredited dental hygiene program referenced in §B(1)(b) of this regulation shall:

The experience requirements of §B2(d) of this regulation may not be obtained as an undergraduate dental hygiene student.

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:

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:

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:

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:

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.

4 hours of didactic classroom training, including at least the following:

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:

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:

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.

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.

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:

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:

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:

A dental hygienist may not prescribe a drug:

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 standing order entered into the patient’s record by the supervising dentist shall include at least:

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:

A dental hygienist may not administer a medication:

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 standing order entered into the patient’s record by the supervising dentist shall include at least the:

A dental hygienist who wishes to receive recognition by the Board as being qualified to prescribe and administer medication shall:

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:

The course offered by the accredited dental hygiene program may be completed in-person or online.

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:

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:

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:

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 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.

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:

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 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:

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.

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:

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:

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:

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.