08/27/10

This page will inform registered dental hygienists of current
                                   legislative issues of concern to the profession.                                         

AS of April 2008, dental hygienists can now administer local anesthesia and nitrous oxide/oxygen sedation! The following are the regulations that can also be found on the Board website.   http://www.dhp.virginia.gov/dentistry

18VAC60-20-81. Administration of local anesthesia and/or nitrous oxide by dental hygienists.

A. A dental hygienist who meets the qualifications set forth in this section and who is under the direction of a dentist may administer nitrous oxide/inhalation analgesia or, to patients 18 years of age or older, local anesthesia. Local anesthesia shall not include topical Schedule VI medicinal agents that may be administered under general supervision pursuant to 18VAC60-20-220 B.

B. To be eligible to administer only nitrous oxide/inhalation analgesia, a dental hygienist shall:

1. Successfully complete a didactic and clinical course leading to certification in administration of nitrous oxide offered by a dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association, which includes a minimum of eight hours in didactic and clinical in the following topics:

a. Patient physical and psychological assessment;
b. Medical history evaluation;
c. Equipment and techniques used for administration of nitrous oxide;
d. Neurophysiology of nitrous oxide administration;
e. Pharmacology of nitrous oxide;
f. Recordkeeping, medical and legal aspects of nitrous oxide;
g. Adjunctive uses of nitrous oxide for dental patients; and
h. Clinical experiences in administering nitrous oxide, including training with live patients.

2. Successfully complete an examination with a minimum score of 75% in the administration of nitrous oxide/inhalation analgesia given by the accredited program.

C. To be eligible to administer both local anesthesia and nitrous oxide/inhalation analgesia, a dental hygienist shall:

1. Successfully complete a didactic and clinical course leading to certification in administration of local anesthesia and nitrous oxide/inhalation analgesia that is offered by a dental or dental hygiene program accredited by the Commission on Dental Accreditation of the American Dental Association, which includes a minimum of 36 didactic and clinical hours in the following topics:

a. Patient physical and psychological assessment;
b. Medical history evaluation and recordkeeping;
c. Neurophysiology of local anesthesia;
d. Pharmacology of local anesthetics and vasoconstrictors;
e. Anatomical considerations for local anesthesia;
f. Techniques for maxillary infiltration and block anesthesia;
g. Techniques for mandibular infiltration and block anesthesia;
h. Local and systemic anesthetic complications;
i. Management of medical emergencies;
j. Clinical experiences in maxillary and mandibular infiltration and block injections;
k. Pharmacology of nitrous oxide;
l. Adjunctive uses of nitrous oxide for dental patients; and
m. Clinical experiences in administering nitrous oxide and local anesthesia injections on patients.

2. Successfully complete an examination with a minimum score of 75% in the administration of nitrous oxide/inhalation analgesia and local anesthesia given by the accredited program.

D. A dental hygienist who holds a certificate or credential issued by the licensing board of another U.S. jurisdiction that authorizes the administration of nitrous oxide/inhalation analgesia or local anesthesia may be authorized for such administration in Virginia if:

1. The qualifications on which the credential or certificate was issued were substantially equivalent in hours of instruction and course content to those set forth in subsections B and C of this section; or

2. If the certificate or credential issued by another jurisdiction was not substantially equivalent, the hygienist can document experience in such administration for at least 24 of the past 48 months preceding application for licensure in Virginia.

E. A dentist who provides direction for the administration of nitrous oxide/inhalation analgesia or local anesthesia shall ensure that the dental hygienist has met the qualifications for such administration as set forth in this section.

General Supervision Timeframe Increased

    Effective August 25, 2007, the period of time in which treatment by a dental hygienist under general supervision might occur before the dentist examines the patient again is increased from a maximum of seven (7) months to ten (10) months from the date the dentist last examined the patient.  This change to the general supervision regulations at 18 VAC 60-20-210.D(1) was adopted by the Board to respond to concerns raised by dentists and dental hygienists about patients who need multiple hygiene visits and those who are unable to schedule appointments for complete examinations every 6 to 7 months due to either time conflicts or costs.  

   The order for treatment under general supervision must specify the time period in which the prescribed treatment must be rendered.  Orders written prior to August 25, 2007 may be amended to reflect this regulatory change.

Changes Made to the Dentistry Chapter of the Code of Virginia and Related Statutes

·         The Drug Control Act was amended effective July 1, 2007, to permit doctors of medicine or osteopathic medicine to issue oral or written orders or a standing protocol for nurses and dental hygienists to possess and to administer topical fluoride varnish to the teeth of children aged six months to three years.  The doctor’s order or protocol must conform to standards adopted by the Department of Health.  Such administration by dental hygienists is limited to children who receive home visits from the Health Department or who are enrolled in Head Start programs or who are clients of safety-net healthcare facilities (e.g. rural health, community health centers, mobile dental clinics, and Health Department programs).

• In the same legislation, the provisions for dental hygienists in the Dentistry Chapter were amended effective July 1, 2007 to reflect that dental hygienists might practice under orders or protocols issued by doctors of medicine or osteopathic medicine only under the narrow provisions of the Drug Control Act at §54.1-3408.U

Monitoring of Nitrous Oxide

     The requirement for a second person to be in the operatory with the dentist to monitor the patient during the administration of inhalation analgesia (nitrous oxide) was deleted from the regulations on anxiolysis and inhalation analgesia at 18 VAC 60-20-108 effective November 18, 2006.  During the administration of inhalation analgesia one person must be with the patient at all times.  The one person with the patient could be the dentist, a dental hygienist or a dental assistant.  Only a dentist might start and stop the administration of nitrous oxide and a dentist may direct a dental hygienist or a dental assistant to adjust the flow nitrous oxide.

    A two person treatment team, the dentist and a second person to assist, monitor and observe the patient, is still required for the administration of anxiolysis.  Continuous monitoring of the patient is also required for anxiolysis.

 
Revised Regulations Governing the Practice of Dentistry and Dental Hygiene

Effective June 29, 2006, a dentist or a dental hygienist shall be required to maintain evidence of successful completion of training in basic cardiopulmonary resuscitation.

Effective June 29, 2006, a dentist who administers or a dental hygienist who monitors patients under general anesthesia, deep sedation or conscious sedation shall complete four hours every two years of approved continuing education directly related to administration or monitoring of such anesthesia or sedation as part of the hours required for licensure renewal.

Effective June 29, 2006  Continuing education hours in excess of the number required for renewal may be transferred or credited to the next renewal year for a total of not more than 15 hours. 

Practice Act changes  ( Code of VA):

Dental assistants may aid dental hygienists under general supervision.

For more information, visit the Virginia Board of Dentistry website.