January 2011 Update

• DAII Regulations have been signed by Governor McDonnell and will go into effect on March 2, 2011 which will allow a dentist to utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction at one and the same time! Under the definition of “General Supervision”, the current regulations also read- “a dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment that states the specific services to be provided by a dental hygienist during one or more subsequent appointments when the dentist may or may not be present.” Under duties delegated to a dental hygienist under general supervision it still states that the services noted on the written order shall be rendered within a specific time period, not to exceed 10 months from the date the dentist last examined the patient.

Dental Assistants -  Guidance Document: 60-7  December 3, 2010
Virginia Board of Dentistry  
 www.dhp.virginia.gov/dentistry

 

DUTIES THAT MAY BE DELEGATED TO DENTAL ASSISTANTS I AND II UNDER INDIRECT SUPERVISION OF A DENTIST

GENERAL SERVICES

Prepare patients for treatment/seating/positioning chair/placing napkin

Perform health assessment

Preventive education and oral hygiene instruction

Perform mouth mirror inspection of the oral cavity

Chart existing restorations and conditions as instructed by the dentist

Take, record and monitor vital signs

Transfer dental instruments

Prepare procedural trays/armamentaria set-ups

Maintain emergency kit

Sterilization and disinfection procedures

Compliance with OSHA Regulations and Centers for Disease Control Guidelines

Prep lab forms for signature by the dentist

Maintenance of dental equipment

RADIOLOGY and IMAGING

Mount and label images

Place x-ray film and expose radiographs ONLY WITH REQUIRED TRAINING

Use intraoral camera or scanner to take images for tooth preparation and CAD CAM restorations

RESTORATIVE SERVICES

Provide pre- and post operative instructions

Place and remove dental dam

Maintain field of operation through use of retraction, suction, irrigation, drying

Acid Etch - Apply/wash/dry remove only when reversible

Amalgam:  Place only

Amalgam:  Polish only with slow-speed handpiece and prophy cup

Apply pit and fissure sealants

Apply and cure primer and bonding agents

Fabricate, cement, and remove temporary crowns/restorations

Make impressions and pour and trim study/diagnostic models and opposing models

Make impressions for athletic/night/occlusal/snore mouthguards and fluoride/bleaching trays

Matrices - place and remove

Measure instrument length

Remove excess cement from coronal surfaces of teeth

Remove sutures

Dry canals with paper points

Mix dental materials

Place and remove post-extraction dressings/monitor bleeding

Rubber Dams: Place and remove

Sterilization and disinfection procedures

HYGIENE

Apply dentin desensitizing solutions

Apply fluoride varnish, gels, foams and agents

Apply pit and fissure sealant

Address risks of tobacco use

Give oral hygiene instruction

Polish coronal portion of teeth with rotary hand piece and rubber prophy cup or brush

Place and remove periodontal dressings

Clean and polish removable appliances and prostheses

 

DUTIES THAT MAY BE DELEGATED TO DENTAL ASSISTANTS I AND II UNDER INDIRECT SUPERVISION OF A DENTIST CONTINUED

ORTHODONTICS

Place and remove elastic separators

Check for loose bands and brackets

Remove arch wires and ligature ties

Place ligatures to tie in archwire

Select and fit bands and brackets for cementation by dentist

Instruct patients in placement and removal of retainers and appliances after dentist has fitted and  made adjustments in the mouth

Take impressions and make study models for orthodontic treatment and retainers

BLEACHING

Take impressions and fabricate bleaching trays

Apply bleach/whitener

Bleach with light but not laser

Instruct pt on bleaching procedures

SEDATION AND ANESTHESIA SERVICES

Apply topical Schedule VI anesthetic

Monitor patient under nitrous oxide

Monitor patient under minimal sedation/anxiolysis

Monitor patient under moderate/conscious sedation ONLY WITH REQUIRED TRAINING

Monitor patient under deep sedation/general anesthesia ONLY WITH REQUIRED TRAINING

Take blood pressure, pulse and temperature

DUTIES THAT MAY BE DELEGATED TO DENTAL ASSISTANTS I AND II UNDER INDIRECT SUPERVISION OF A DENTAL HYGIENIST

Prepare patients for treatment/seating/positioning chair/placing napkin

Perform health assessment

Preventive education and oral hygiene instruction

Transfer dental instruments

Prepare procedural trays/armamentaria set-ups

Maintain emergency kit

Sterilization and disinfection procedures

Compliance with OSHA Regulations and Centers for Disease Control Guidelines

Maintenance of dental equipment

Polish coronal portion of teeth with rotary hand piece and rubber prophy cup or brush

Place and remove periodontal dressings

Clean and polish removable appliances and prostheses

Mount and label images

Place x-ray film and expose radiographs ONLY WITH REQUIRED TRAINING

DUTIES THAT MAY ONLY BE DELEGATED TO DENTAL ASSISTANTS II UNDER DIRECT SUPERVISION OF A DENTIST

Condense/pack and carve amalgam

Place, cure and finish composite resin restorations only with slow-speed handpiece

Apply base and cavity liners/perform pulp capping procedures

Final cementation of crowns and bridges after adjustment and fitting by the dentist

Select and manipulate gypsums and waxes

Make final impressions and fabricate master casts

Place and remove non-epinephrine retraction cord

 

October 10, 2010

NOIRA (Notice of Intended Regulatory Action)

The Virginia Board of Dentistry (BOD) has sent notice that they intend to update the regulations pertaining to the practice of dentists, dental hygienists and dental assistants.  The last complete update of these regulations was 13 years ago.  This is going to be a long involved process and there will be numerous chances for public comment.  The Virginia Dental Hygiene Association President, Dr. Rita Sheaves, did submit comment on concern over dental hygienists and dental assistants II being grouped together in a number of instances where we should be listed as completely separate entities based on our level of education and expertise.  Our Governmental and Professional Affairs Council is working closely with our legislative counsel, Hilton Graham, to monitor the actions of the BOD and to keep our members informed of any changes that may require more input such as comments from our membership at large.  All members are asked to share this information with potential members and let them know that this is a crucial time to bond together to protect the rights of our profession and to protect the treatment of our patients and the public.

Websites to help you stay informed are www.dhp.virginia.gov/dentistry, to register to receive the quarterly BOD Briefs report and TownHall@dpb.virginia.gov to get notices on when the BOD meetings are being held and to get copies of the minutes from previous meetings.

DENTAL ASSISTANT II

The Virginia Board of Dentistry (BOD) has instituted a new level of the dental assistant which will allow for more extended duties such as placing, packing, carving and polishing of amalgams; placing and shaping composite resin restorations; taking final impressions and use of a non-epinephrine retraction cord; final cementation of crowns and bridges after adjustment and fitting by the dentist and performing pulp capping procedures.  A prerequisite for entry into an educational program preparing a person for registration as a dental assistant II shall be current certification as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board (DANB).  How this affects our profession falls under the utilization of dental hygienists and dental assistants II which reads: A dentist may utilize up to a total of four dental hygienists or dental assistants II in any combination practicing under direction or general supervision at one and the same time, with the exception that a dentist may issue written orders for services to be provided by dental hygienists under general supervision in a free clinic, a public health program, or on a voluntary basis.  The DAII regulations are awaiting the Governor’s review for permission to publish them as final regulations.  The regulations will become effective following a 30 day comment  period which follows publication.

If you have any other questions or concerns please contact me at ftvlykit@shentel.net and I will do my best to find the answers you need.

Respectfully submitted,

Pam Kitner, RDH

Component 10 Regulation and Practice Committee Chair