# COMAR Title 10 — Maryland Department of Health

## Subtitle 44 — Board of Dental Examiners

### Chapter 21 — Practice of Dental Hygiene Under General Supervision in a Facility or Long-Term Care Facility

#### Regulation .10 Long-Term Care Facilities.

*COMAR 10.44.21.10*

A. 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.

B. 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:

  (1) 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

  (2) Ensure that the supervising dentist is available for consultation with the dental hygienist:

    (a) In person;

    (b) By telephone; or

    (c) Electronically.

C. A dental hygienist working under general supervision in a long-term care facility shall:

  (1) 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;

  (2) Assess the appropriate recall interval based on the individual needs of the patient or as otherwise recommended by the supervising dentist;

  (3) Limit dental hygiene tasks and procedures to:

    (a) Toothbrush prophylaxis;

    (b) Application of fluoride;

    (c) Dental hygiene instruction; and

    (d) Other duties as may be delegated, verbally or in writing, by the supervising dentist.

D. A dental hygienist shall:

  (1) Assess the patient’s apparent need for further evaluation by a dentist in order to diagnose the presence of dental disease; and

  (2) Submit the findings of the initial assessment to the supervising dentist for a determination of future treatment.

E. A dental hygienist may perform subsequent authorized dental hygiene services without the supervising dentist on the premises only if:

  (1) 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

  (2) 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.

F. Upon expiration of a prescribed treatment, the supervising dentist is responsible for determining future protocols for the treatment of the patient.

G. 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:

  (1) Hold an active license to practice dental hygiene in the State;

  (2) Hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation;

  (3) Have at least 2 years of active clinical practice in direct patient care; and

  (4) Ensure that the long-term care facility where the dental hygienist will practice under general supervision has:

    (a) A written medical emergency plan in place;

    (b) Adequate equipment, including portable equipment and appropriate armamentarium, available for the appropriate delivery of dental hygiene services; and

    (c) Adequate safeguards to protect the patient’s health and safety.

H. 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:

  (1) Hold an active general license to practice dentistry in the State;

  (2) Hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation; and

  (3) Have at least 2 years of active clinical practice in direct patient care.

I. This regulation may not be construed to:

  (1) Authorize a dental hygienist to practice dental hygiene independent of a supervising dentist;

  (2) Prohibit a dentist from being available for personal consultation or on the premises where a dental hygienist is practicing; or

  (3) Prohibit a dental hygienist, without the supervision of a dentist, from performing a preliminary dental examination with a subsequent referral to a dentist.

J. 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.

K. Before a long-term care facility may allow a dental hygienist to practice dental hygiene, the facility shall report to the Board:

  (1) That the facility is operating under general supervision;

  (2) The identity of each dental hygienist providing dental hygiene services in the facility; and

  (3) The identity of each supervising dentist.