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.