REGULATION OF DENTISTS:
Preparing for the
Minnesota Board of Dentistry
Jurisprudence Exam
DENT 6422
Summer 2008
Patricia Glasrud
Topics to be covered today…
1. How is “practicing dentistry” defined in
statute?
2. What functions may be legally delegated
to whom?
3. What is “professional development?”
4. What is a dentist required to report?
5. How may a dentist advertise
appropriately?
Minnesota Board of Dentistry
Jurisprudence Exam
• Required for Minnesota licensure of dentists and
dental hygienists and for registration of dental
assistants
• All dental professionals take the same test
• Test items are changed every few years as new
statutes and rules go into effect
• Score of 75% or more
• 100 multiple-choice test items
• Can be retaken, if necessary
• www.dentalboard.state.mn.us
What’s in “the book?”
Legislature enacted (statutes):
• Dental Practice Act (Ch. 150A)
• Professional Firms (Ch. 319B)
• Dept. of Health (Ch.144)
• Examining and Licensing Boards (Ch.214)
Board of Dentistry promulgated (rules):
• Board of Dentistry Rules (Ch.3100)
• Health Licensing Boards Infection Control
(Ch. 6950)
How is “practicing dentistry”
defined in statute? (150A.05)
1. Diagnose, treat, prescribe, operate on human teeth,
alveolar process, gums, jaw, adjacent or assoc.
structures
2. Manage place where dental operations are done
3. Perform dental operations for a fee or gratuitously
4. Use X-rays for dental diagnostic purposes
5. Perform extractions, corrects malpositioned teeth,
jaws
Practicing dentistry definition, cont’d.
6. Diagnose, treat or remove stains, accretions
from teeth, jaws
7. Replace teeth or part of tooth with filling, crown,
bridge, denture, other appliance
8. Makes prosthetic dentures, bridges, etc.
9. Perform any clinical operation included in dental
curricula
What (intra-oral) functions may be
legally delegated to whom?
•
WHO?
–
•
WHAT?
–
•
Dental hygienists, registered dental assistants, and
“chairside” dental assistants
Intra-oral procedures (reversible)
WHERE?
–
–
Level of supervision by DDS
Collaborative Agreements define places, patients
Types of Delegation Rules
• Permissive:
Dentist may delegate only those duties listed
(MN has this type of rule)
• Non-permissive:
Dentist may delegate what is
NOT prohibited
Current Levels of Supervision
GENERAL:
Dentist is not in office or on
premises, but procedures are
performed with prior knowledge and
consent of dentist
Current Levels of Supervision
INDIRECT:
• Dentist is in the office, authorizes the
procedures to be performed, and
remains in the office while
procedures are being performed.
Current Levels of Supervision
DIRECT:
Dentist is in the office, personally
diagnoses and authorizes the
procedures, and before dismissal of
patient, evaluates the performance
of the auxiliary.
Dental Hygiene Duties:
Under General Supervision
• Preliminary charting of oral cavity and
surrounding structures to include case
histories;
• Perform initial and periodic examinations and
assessments to determine periodontal status,
and
• Formulate a dental hygiene treatment plan in
coordination with a dentist’s treatment plan.
Dental Hygiene Duties:
Under General Supervision
•
•
•
•
Exposing radiographs
Scaling and root planing
Administering local anesthetic, nitrous oxide
Other preventive and education functions
(sealants, fluoride, etc.)
• Several specific orthodontic procedures
• Make referrals to dentists, physicians, and
other practitioners
Dental Hygiene Duties:
Under Indirect Supervision
• Perform restorative procedures limited to
placing, contouring, and adjusting:
- amalgam restorations,
- glass ionomers, and
- supragingival class I & V composites
- adapting & cementing stainless steel
crowns.
Dental Hygiene Duties:
Under Direct Supervision
•
•
•
•
Place & remove matrix bands;
Attach prefit & readjusted ortho appliances;
Etch before bonding of ortho appliances;
Remove bond material from teeth with rotary
instruments;
• Fabricate, cement and adjust temp restorations;
• Remove fixed ortho bands & brackets
Dental Assistant
Credentials may include…
• Registered (RDA)
• Certified (CDA)
• RDA, CDA
• RDA, RF
• RDA, CDA, RF
• Unregistered
Registered Dental Assisting:
Entering the Profession
Must meet state requirements
In Minnesota, this means• Graduation from accredited dental assisting
program
• Minnesota Registration Examination (written)
• Current CPR certification
• Jurisprudence examination (Minnesota laws)
• Application form & pay fee
Certified Dental Assistant:
“CDA”
• Granted by Dental Assisting National Board
(“DANB”)—NOT the MN Board of Dentistry
• Therefore, has NO legal standing in Minnesota
• May NOT perform functions listed in Dental
Practice Act
• Many MN dental assistants have earned both
registration and certification and refer to
themselves as “CDA, RDA”
Unregistered Dental Assisting
• May be trained on-the-job
• Assists dentist at chairside
• May help with patient reception, infection
control
• Not regulated by the state
RDA Duties:
Under General Supervision
• Take radiographs
• Take impressions for casts and bite registration
(not for final construction of fixed and removable
prostheses)
• Cut arch wires, remove loose bands and
brackets on orthodontic appliances
• Re-cement intact temporary restorations
• Deliver vacuum-formed orthodontic retainers
RDA Duties:
Under Indirect Supervision
• Apply topical medications (fluoride, bleaching
agents, etc.)
• Apply sealants
• Remove cement with hand instruments only
• Mechanical polishing of teeth
• Remove sutures
• Pre-select orthodontic bands
• Place and remove periodontal dressings
• Monitor nitrous oxide
• Place and remove rubber dam
• Many more!
RDA Duties:
Under Direct Supervision
• Remove excess bond material from orthodontic
appliances
• Remove bond material from teeth with rotary
instruments (special course is required)
• Place and remove matrix bands
• Administer nitrous oxide
• Attach pre-fit and pre-adjusted orthodontic
appliances
• Remove fixed orthodontic bands and brackets
“Restorative Expanded
Functions” Requirements
• May be performed by Minnesota RDA or
Minnesota licensed hygienists who:
– Have successfully completed the Boardapproved course, AND
– Minnesota licensed dentist has authorized
procedure AND
- Dentist is available in the clinic while the
procedure is being performed (indirect
supervision)
Restorative Expanded
Functions
PLACE, CONTOUR AND ADJUST—
– Amalgam restorations;
– Glass ionomer;
– Class I and Class V supragingival composites
where the margins are entirely within the
enamel, and
– Adapt and cement stainless steel crowns.
Collaborative Agreement Law
• Created in 2001 by Minnesota Legislature;
amended in 2004 & 2005 (Mn.Stat.150A.10,
Subd. 1a)
• Written agreement between DDS & qualified DH,
must include all of the specifics set forth in
statute
• Allows DH to provide dental hygiene services
without DDS present in places other than the
dental office, and without a dentist’s diagnosis
and treatment plan
Collaborative Dental Hygiene
Practice
• Allows qualified dental hygienists to provide care
in schools, Head Start programs, nursing
homes, community clinics, nonprofit
organizations, hospitals, etc.
• Care may be given to patients, students,
residents of the facility, program or organization.
• Intended to address dental access problem
Collaborative Practice Dental
Hygienist’s Qualifications include…
• Active clinical dental hygiene practice for
not less than 2400 hours in previous 18
months
• Career total of 3000 hours including at
least 200 hrs. in clinical practice in 2 of
past 3 years
• CDE in infection control, medical
emergencies, and current in CPR
Dental Laboratory Technicians
• Fabricate full and partial dentures (No direct
patient contact)
• Precision and accuracy working with small hand
instruments
• Artistic abilities; attention to minute details
• Today’s large labs often provide their own
training
• Not regulated by the state (but this could
change)
What is “professional development?”
• Continuing dental education requirements
for licensure/registration renewal
• DENTISTS – 50 credits every 2 years
Fundamental Credits - at least 30
Elective Credits - no more than 20
Professional development, cont’d.
• Fundamental credits: Activities directly
related to the provision of dental services
• Elective credits: Activities directly related
to, or supportive of, the practice of
dentistry, dental hygiene or dental
assisting
• Professional Portfolio is required
Professional development, cont’d.
• Professional Portfolio must include:
– Healthcare Provider CPR course
– Board’s “self-assessments” (1 per cycle)
– Documentation of required number of hours
needed (DDS = 50; RDH = 25; RDA = 25)
Professional development,
cont’d.
Credits must have been earned in 2 of the Core
Subject areas:
1. Record keeping
2. Infection Control
3. Ethics
4. Patient Communication
5. Management of Medical Emergencies
6. Treatment & Diagnosis
Professional development,
cont’d.
• Professional development activities
include:
–
–
–
–
–
–
Lectures/ Symposiums/ Seminars
Study Clubs
Advanced Education/ College Courses
Volunteerism/ Community Service
Distance Learning
Self-Study
Professional development, cont’d.
• Subjects NOT granted credit include:
– Estate Planning
– Marketing
– Financial Planning
– Investments
– Personal Health, Growth
Professional development,
cont’d.
• Acceptable documentation must include:
– Name & Location of organization/presenter;
– Contact info and credentials/training that
qualified the person to teach the course;
– Course Title, Date, Hours and Subject Matter
– Individuals will be randomly audited!
Professional development,
cont’d.
• Random audits
– Must submit complete portfolio
• All self-assessment examinations provided by
Board of Dentistry
• Copy of front & back of current CPR card /
certificate
• Confirming documentation from the presenting
organization
• Personal log of published articles read (title,
author, name of journal/publication, date
published)
Professional development, cont’d.
• Audits:
- Random audit OR due to complaints
- Advance notification to licensee by Board
(60 days)
- Failure to supply portfolio may result in
disciplinary action by Board
- Falsification of info submitted may result
in disciplinary action by Board
Professional development, cont’d.
• Failure of an audit:
- 6 months to comply----Could result in loss of
license
• Deficiencies include:
- Lack of proof of documentation or
participation;
- Credit hours earned outside of renewal period
(no “carry-over”)
- Insufficient hours in core competencies
- Failure to submit portfolio
- Unacceptable professional development
sources
What is a dentist required to report
and to whom?
• ADVERSE REACTIONS (MN Rule 3100.3600)
– Any incident arising from administration of nitrous oxide, or
drug used for general anesthesia, conscious sedation, local
anesthesia
– Results in “serious or unusual outcome”
– That produces a temporary or permanent physiological
injury, harm.
Report to Board of Dentistry
Required Reporting, cont’d.
HIV, HBV, HCV (Minn. Stat. 214.19)
• Required to report yourself if you are
diagnosed as infected with HIV, HBV, HCV
Report to MN Department of Health
Required Reporting, cont’d.
• If you have knowledge of a licensee or
registrant (including you) who is unable to
practice with reasonable skill and safety …
• Because of illness, drug/alcohol use, or
any mental, physical or psychological
condition
Report to the Board of Dentistry
or to HPSP
Required Reporting, cont’d.
CHILD ABUSE/ NEGLECT (Minn. Stat. 626.556)
• Dental professionals are often the first to see
child abuse
• Licensed/ registered dental professionals are
required to report Mandated Reporter is“…a professional or
professional’s delegate who is engaged in
the practice of the healing arts…”
Required Reporting, cont’d.
NEGLECT is defined as…
“…failure by a person responsible for a child’s care
to supply a child with necessary food, clothing,
shelter, health, medical, or other care required
for the child’s physical or mental health when
reasonably able to do so.”
Required Reporting, cont’d.
• Report suspected child abuse / neglect to
local welfare agency, police department or
county sheriff, or “agency responsible for
assessing or investigating the report.”
• Immunity from liability if mandated reporter
is “acting in good faith.”
• Failure to report is considered a
misdemeanor.
Reporting Requirements, cont’d.
MALTREATMENT OF VULNERABLE ADULTS
(Minn. Stat. 626.557)
Protects adults who, because of physical
or mental disability or dependency on
institutional services, are particularly
vulnerable to maltreatment
Advertising Rules
(3100.6500 – 3100.7200)
• False, fraudulent, misleading or deceptive
statement or claim
– “...create false or unjustified expectations of
favorable results;”
– “…appeals to an individual’s anxiety in an
excessive or unfair way;”
– “contains material claims that cannot be
substantiated;”
– “misrepresents a dentist’s credentials,
training, experience, or ability.”
Advertising
• If routine dental services are advertised,
either the ad must include the
components, or disclose what’s NOT
included. (Example: Coupons advertising
“free dental exam and x-rays”)
• MN Rules list definitions of exams, x-rays,
dentures, prophies, extractions (what must
be included or listed as not included)
Advertising
• Ads MUST include the corporation, partnership,
or individual’s name and address;
• Payment to media for publicity MUST disclose
the fact of payment in the ad;
• Ads MUST NOT reveal patient’s identity or
personally identifiable facts without the patient’s
written waiver of confidentiality.
Advertising
• MUST NOT offer, give, receive, or agree to
receive payment for referring a patient
• After 1 year, it is prohibited to include the name
of a dentist who formerly practiced at or
associated with any advertised location.
• Dentists MUST respond to advertising complaint
to the Board of Dentistry within 30 days.
MN Board of Dentistry Statement
on Advertising
“The Minnesota Dental Practice Act prohibits a
dentist from using a public communication that
contains a misleading or deceptive statement or
claim. The Minnesota Board of Dentistry regards
the designation and advertisement of a dentist
as a ‘Top Dentist’ to be misleading or deceptive.
Such designation is misleading or deceptive
because it is not substantiated by empirical
evidence of special training, experience,
education or expertise.” (Adopted, 2005)
Thank you!