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)