SD Collaborative Agreement - South Dakota Dental Hygienists

Zona Hornstra, RDH, BS
SDDHA Legislative Chair
May 18, 2013
This is a Working Document and will be updated periodically
with new information as it becomes available
Describe Collaborative Supervision Practice
Awareness of Level of Supervision
Discuss Opportunities for Direct Access
Review Specifics of SD Collaborative Agreement
Laws and Regulations that regulate CS
Identify Treatment Settings and Roles of Providers
Documentation and Reporting Structures
Determine an Awareness of SD Provider Shortage Areas
Considerations for Business Planning and Tax Implications
Reimbursement of Services/ CDT Codes
Information of NPI numbers
Location and Contact Info of State Public Access Opportunities
Questions and Answers
Collaborative practice means that the dental
hygienist has established a written agreement with
a dentist who has agreed to monitor treatment of
patients and consult as needed.
The dental hygienist and dentist jointly establish a
protocol that describes the services the hygienist
may provide without the dentist’s supervision.
The science of the prevention and treatment
of oral disease through the provision of
education, assessment, preventive, clinical,
and other therapeutic services in a
cooperative working relationship with a
consulting dentist, but without general
Christine Nathe RDH MS, University of New Mexico
"Direct supervision," the supervision of a dental hygienist or dental assistant
requiring that a dentist diagnose the condition to be treated, a dentist authorize
the procedure to be performed, a dentist remain in the dental office while the
procedures are performed, and before dismissal of the patient a dentist has
approved the work performed by the dental hygienist or dental assistant;
"General supervision," the supervision of a dental hygienist requiring that
a dentist authorize the procedures to be carried out, and that the patient
to be treated is a patient of record of the supervising dentist and has had a
complete evaluation within the previous thirteen months of the
delegation of procedures;
"Indirect supervision," the supervision of a dental hygienist or dental
assistant requiring that a dentist authorize the procedure and a dentist be
in the dental office while the procedures are performed by the dental
assistant or dental hygienist
Source: SD Dental Practice Act p. pg. 12-13
Direct access dental hygiene practice options are
available that would offer you:
a professional challenge
open doors to new opportunities
provide unique satisfaction
Being able to provide services to people unable to obtain
Collaborative practice can be a new career option:
 as a part-time vocation
 on an occasional volunteer basis
Private dental office remains the primary place of employment.
Career opportunities from alternative clinical setting to school
sealant program.
Career pathways in public health and career opportunities outside
of private practice.
ADHA give career opportunities in public health and `other
Information about specific job opportunities can be found in ADHA’s Career Center
within the ADHA. org website
Dental hygiene was created as a distinct profession positioned in dental public health
model in schools.
Wide access to preventive care is provided by educated dental hygiene professionals in
public settings in Early 1900’s.
Emphasis was placed on the dental hygienist as an outreach worker to bring patients in
need of restorative dental care.
The effectiveness of the care provided in communities and schools spread to the private
dental practice.
Nation's health care leaders are quickly realizing the important connection between oral
health and total health.
Emphasis by both dental hygienists and dentists is now wisely being placed on
interdisciplinary health care delivery options.
One of the top ten fastest growing health professions in the country, ***
*** American Dental Hygienists' Association. July 10, 2010. ADHA Offers Testimony at CMS National Dental Medicaid
Dental Town Hall Forum. Accessed July 16, 2010 from
2002 Oral Health Coalition recommended Limited Access Permit RDH.
2005 was brought in as a Bill and was not approved in Committee.
2009 Oral Health Coalition recommended investigation of a model of
Public Health Supervision.
Surgeon General mandates each state to have options for improved
dental access.
SDDHA brought forth House Bill 1045 which was Established by Statute
in 2011 to allow dental hygienists to provide preventative services.
Rules and statute put into SD Dental Practice Act July 2012.
The intent of collaborative dental hygiene
practice is to:
 Extend dental hygiene services to those unable
to access services
 Offering services in locations where there are
transportation barriers
There are many possibilities for a variety of
locations and populations
The process of Collaborative Supervision practice agreement is
defined by South Dakota law.
Dental hygienists and dentists must enter into a written
collaborative agreement.
Collaboration will negotiate all details and protocols (e.g.,
billing practices and where and when dental exams occur)
Purpose of the written agreement is to clarify and document
mutual decisions regarding specific dental hygiene services.
Details discussed and direction given within the SD Dental
Practice Act.
Knowing the laws governing dental hygiene and more specifically dental hygiene services in
community settings is essential for all involved in Collaborative Supervision hygiene services.
The SD Dental Practice Act gives a complete picture of regulations addressing all aspects of
dental care in South Dakota for regulations of dentists and dental hygienist, including
Collaborative Supervision:
Under Statutes and Rules Review:
Title 36 : 36-6A-26, 36-6A-31; 36-6A-40; 36-6A-40.1
Title 20 Article 43/ 20:43:04:04; 20:43:10
36-6A-40. Employment of hygienist--Scope of permitted practice--Preventive and therapeutic
services. Any licensed dentist, public institution, or school authority may use the services of a
licensed dental hygienist. Such licensed dental hygienist may perform those services which are
educational, diagnostic, therapeutic, or preventive in nature and are authorized by the Board of
Dentistry, including those additional procedures authorized by subdivision 36-6A-14(10).
As an employee of a public institution or school authority, functioning without the supervision of a
licensed dentist, a licensed dental hygienist may only provide educational services.
May not include the establishment of a final diagnosis or treatment plan for a dental patient. Services
performed under supervision of a licensed dentist. and all care rendered by the hygienist is
completed under the definition of patient of record. A dental hygienist may perform
preventive and therapeutic services under collaborative supervision if the requirements
of § 36-6A-40.1 are met. However, no dental hygienist may perform preventive and
therapeutic services under collaborative supervision for more than thirteen months for
any person who has not had a complete evaluation by the supervising dentist.
Source: SD Dental Practice Act
36-6A-40.1 Hygienist requirements for preventative and therapeutic
services under collaborative supervision. A dental hygienist may provide
preventive and therapeutic services under collaborative supervision of a
dentist if the dental hygienist has met the following requirements:
(1) Possesses a license to practice in the state and has been actively
engaged in the practice of clinical dental hygiene in two of the previous
three years;
(2) Has a written collaborative agreement with a licensed dentist; and
(3) Has satisfactorily demonstrated knowledge of medical and dental
emergencies and their management; infection control; pharmacology;
disease transmission; management of early childhood caries; and
management of special needs populations.
Source: SD Dental Practice Act pg. 19
The Collaborative Agreement is designed as a
guide for dental hygienists, dentists and
facilities that are establishing dental hygiene
services in community settings.
Laws pertaining specifically to Collaborative
Supervision for dental hygienists are found in
Chapter 10 of the South Dakota Dental Practice
20:43:10:01. Practice settings. A dentist may provide collaborative supervision to a dental hygienist
pursuant to a collaborative agreement if the dentist holds a license in good standing in the state of
South Dakota and the following services are provided:
(1) In a school as defined in § 24:43:01:01(38);
(2) In a nursing facility as defined in SDCL 34-12-1.1;
(3) Under the auspices of a Head Start program or Early Head Start program being operated by an
agency designated pursuant to section 641 or 645A of the Head Start Act;
(4) Under the auspices of a mobile or portable dental unit operated by any nonprofit organization
affiliated with a nonprofit dental service corporation organized under SDCL chapter 58-39;
(5) Under the auspices of a community based primary health care delivery organization, which is
operating as a community health center or migrant health center, receiving funding assistance
pursuant to section 329 or 330 of the United States Public health Service Act;
(6) Through a program administered by the South Dakota Department of Health;
(7) Through a program administered by the South Dakota Department of Social Services;
(8) Through a program administered by the South Dakota Department of Human Services; or
(9) Through a program administered by the South Dakota Department of Corrections.
Source: SD Dental Practice Act pg. 65
Nursing home, home health agency
Nursing facility as defined in SDCL 34-12-1.1
Group home serving the elderly, disabled, or juveniles
State-operated facility licensed by the commissioner of human services or commissioner of
Federal, state, or local public health facility
Community clinic
United States Public Health Service Act
section 329 or 330
Tribal clinics- have their own requirements and contractual agreements that need to be met
School authority
In a school as defined in § 24:43:01:01(38)
Head Start programs
Mobile Units
(Delta Dental Ronald McDonald bus, van)
24:43:10:02. Qualifications
A dental hygienist providing services under collaborative supervision must hold a license in good standing
in the state of South Dakota and meet the following requirements:
(1) Completion of three years of clinical practice in dental hygiene; and
(2) Completion of a minimum of 4,000 practice hours. A minimum of 2,000 of those hours must have been
completed within two of the three years preceding application.
20:43:10:03. Application for registration.
A dental hygienist registering to provide services under collaborative supervision must submit the
(1) A completed application form;
(2) A completed board approved collaborative agreement;
(3) A fee of $20;
(4) Verification of completion of three years of clinical practice in dental hygiene;
(5) Verification of completion of a minimum of 4,000 practice hours; and
(6) Verification of completion of a minimum of 2,000 practice hours within two of the three years preceding
Source: SD Dental Practice Act pg. 67
(2) A dental hygienist providing services under collaborative supervision may provide all
preventative and therapeutic services that a hygienist is allowed to provide pursuant to SDCL
chapter 36-6A and this chapter, except for the administration of local anesthesia and nitrous oxide
inhalation analgesia, and must:
(a) Maintain appropriate contact and communication with the dentist providing collaborative
(b) Practice according to age and procedure specific standing orders as directed by the supervising
dentist, unless otherwise directed by the dentist for a specific patient;
(c) Provide to the patient, parent, or guardian a written plan for referral to a dentist land assessment
of further dental treatment needs;
(d) Have each patient sign a consent form that notifies the patient that the services that will be
provided do not take the place of regular dental checkups at a dental office and are meant for people
who otherwise would not have access to services; and
(e) Specify a procedure for creating and maintaining dental records for patients that are treated by the
dental hygienist, including where these records are to be located;
Source: SD Dental Practice Act pg. 68
(3) A copy of the collaborative agreement shall be filed with the board. If
any changes are made to the collaborative agreement, an updated copy of
the agreement shall be filed with the board and must be approved;
(4) If the agreement is terminated by the dentist or dental hygienist, the
board shall be notified in writing within 30 days. A termination of the
collaborative agreement constitutes a suspension of the registration
(5) The collaborative agreement must be maintained by the dentist and the
dental hygienist in each location where collaborative supervision is
provided and must be made available to the board upon request. The
dentist and dental hygienist must review the agreement annual
20:43:10:06. Termination of agreement. If any provision of the
collaborative agreement is violated, the registration may be suspended or
revoked by the Board.
Source: SD Dental Practice Act pg. 68
Child’s Name:
Date of Birth
Phone #:
Parent name or
Child Physician:
Child’s Dentist:
Medicaid #:
Physician phone #:
Dentist phone #:
Other Insurance:
Parent or Guardian
phone #:
Please answer the following questions:
Is your child currently under a physician’s care?
___Yes ___ No
Is your child currently taking any medications?
___Yes ___ No
a. If Yes What Medications:___________________________________________________
b. What are they for: ________________________________________________________
Does your child have any allergies?
___Yes ___No
a. List Allergies:_____________________________________________________________
______Yes, I give permission for my child to receive a dental screening ad fluoride varnish application _______.
_____No, I do not give permission to receive a dental screening and fluoride varnish application ____________.
Does your child have a regular dentist:
If yes, does your child see that dentist at least once a year?
My child’ most recent dentist visit was within the past:
_____6 months
____3 year
_____5 years
_____Has never seen a dentist
How will you pay for your child’s dental care?
_____ Self
_____1 year
___Yes ___No
___Yes ___No
_____ Private dental insurance
I understand that this consent is valid for one (1) years.
I understand that these services are provided under a Collaborative Supervision agreement and that I am
being referred for further follow up with a dentist for an exam and other operative treatments.
Referring Dentist_______________________
I understand records created and maintained are maintained by the dentist that I am being referred to for
Parent/Guardian Signature
Patient Name:______________________
Parent/ Guardian:_____________________
Medicaid ID:________________
Patient/ Guardian Interview:
Chief Complaint:
Home Care:
Oral Intake/ Eating Habits:
Last Dental Visit:
Oral Screening: Considerations
Number of teeth:
Suspected Decay:
Restored teeth:
Soft tissue/ hard tissue Conditions:
Sealed teeth:
Dentures /Partials:
Treatment Completed this Visit dated: _________
Fluoride Application: Varnish____
Sealant Application:____ tooth numbers_____
Oral Health Instructions Given to:
Tooth eruption:___
Dietary Counseling:___ Sealant:___
Sippy Cup/ thumb sucking/ bottle use:___
Coordination of Care/ Referral to:
DDS Name: ______________________ DDS Address:_____________________________ Phone:______
Appointment should be made:
Within 3months
Within 6months
Potential Problems or possible treatment needed on: ____________________
Provider Name:____________
Provider Signature:_______________
20:43:10:04. Collaborative agreement.
A dentist and dental hygienist shall enter into a written board approved
collaborative agreement that specifies the following responsibilities:
Provide appropriate communication and consultation with the dental
Have age and procedure specific standing orders for the performance of dental
hygiene services.
Must include consideration for medically compromised patients and medical
conditions for which a dental evaluation must occur prior to the provision of
dental hygiene services;
Specify no more than 13 months, examination must occur prior to providing
further hygiene services.
Limit the number of dental hygienists that he or she has a collaborative
agreement with to four or less;
Source: SD Dental Practice Act: pg. 67
The law does not require the dentist to examine or treat people
The document formalizes the working relationship
Hygienists may have more than one sponsoring dentist if they are
providing services in different community sites .
If hygienists change sponsoring dentists, they must complete a different
form, and resubmit to the SD Board of Dentistry.
20:43:10:05. Reporting requirements.
Each dental hygienist must complete a
summary report and submit the information to
the board at the completion of a program or, in
the case of an ongoing program, annually.
Form given to Collaborating Team after application is approved by State Board of
SD Collaborative Supervision Reporting Form :
Is an Annual requirement
Requires begin and end dates of the Services provided.
Requires a one specific location where treatment was given
Requires tabulation of preventative treatment given per age group
Requires tabulation of Regular or Urgent referral given per age group
Form will specify and document one location per form.
Form copy is to be maintained by Collaborating by Hygienist and Dentist and also sent to
the SD State Board of Dentistry.
State Board of Dentistry site:
Licensure tab
Application/ Documentation
General tab
 Bottom of page
 Collaborative Supervision Agreement
Consideration to make this info more visible to Dentists
Utilize a public health programming model:
Define the Target Population
Formulate the Problem Statement
Perform a “Needs Assessment”
 % of people who need care, have teeth, neglected
Access To oral health care
Create a Logic Model
 Collaborative Supervision Model
Secure your collaboration with a dentist, discussing an
effective referral and/ or follow through mechanism, i. e.
dental home
Design plans in collaboration with the intended agency/
facility/ population
Interview dental hygienists and dentists currently involved with
collaborative practice
Formulate a business plan with Collaborating DDS
Utilize the Dental Safety Net Clinic Manual http://
Safety Net Dental Clinic Manual
Welcome to Safety Net Dental Clinic Manual, which is designed to
help safety net dental clinic staff with all aspects of clinic development
and ongoing operations.
Partnerships & Planning
Facility Design & Staffing
Clinic Operations
Quality Improvement
Program Sustainability
Collaborating Dentist
Facility Based
Opportunity for Grants
Q: How is a dental hygienist paid; how is a program financed?
A. Various options, to include :
As an employee of a dentist, submit claims through the
dental office
Fee-for for-service; Sliding fee scale
Grant funding
Philanthropic donations; funding from Foundations
Medicaid direct billing utilizing the RDH’s NPI numbers
Health plan billing utilizing the RDH’s NPI numbers
Private insurance companies may reimburse dental
hygienists in some states.
Need to consider coordinating billing through the
Collaborating dentist.
Some might limit the codes they will reimburse to
dental hygienists.
To order the CDT manual of dental codes see:
ADA determines CDT codes (Current Dental
Terminology) Responsibility of a Code
Maintenance Committee (CMC).
Mission is to incorporate best practices from
HIPAA, CDT, ICD-9 codes. Provisioned for
Affordable Health Care Act
Pre-diagnostic Services
 D0190 Screening of a Patient to determine need to be seen by a
 D0191 Assessment of Patient – a limited inspection to determine
need for referral for diagnosis and treatment
D0380-0386 Capturing radiographic image without interpretation
 D0391 Image captured by practitioner not associated with
interpretation or report.
D1206 topical application of fluoride varnish
 D1208 topical application of fluoride
Source: Department of Human Services April 2013
Caries management by risk
A methodology of identifying the cause of disease through the assessment of risk factors
This approach has been qualified through various experts, researchers and advocated by numerous
professional organizations
Become a new standard of care which should be incorporated into the dental hygiene process of care
ADA has approved 3 New CAMBRA CDT codes for 2014 book
Along with assessment forms, suggested management
protocols and clinical guidelines:
0-5 years of age:
• Frequency of periodic examination
• Frequency of radiographs
• Saliva testing
• Fluoride Utilization (in-office, daily use and care giver)
• Xylitol products
• Sealants
• Antibacterials
• Anticipatory guidance/counseling
• Self management goals
• White spot precavitated lesion management
• Restoration/Existing lesions
5 through Adult(5):
• Frequency of radiographs
• Frequency of caries recall exams
• Saliva test (saliva flow & bacterial culture)
• Antibacterials, chlorhexidine & xylitol
• Fluoride (in-office & daily use)
• pH control
• Calcium phosphate topical supplements
• Sealants
Governor Daugaard decided not to fund Medicaid
Expansion this last legislative session
A task force developed to gather information determine the
best decision for SD . Meetings to be held Spring/ Summer
2013 with a report to the Governor September 2013.
Can Find more info at:
Total individuals eligible in Fiscal Year 2010 = 96,781
38.6% of children enrolled in Medicaid accessed preventive dental services
(37,353 eligible)
17.6% of children enrolled in Medicaid received dental treatment services
(17,032 eligible)
5.1% of children enrolled in Medicaid received a sealant on a permanent molar
tooth (4,951 eligible)
Total eligible receiving any dental services= 41,271 (42.6%)
Total eligible receiving dental diagnostic services= 34,815 (35.97%)
Total eligible receiving oral health services provided by a non-dentist provider
= 287 (0.3%)
Total eligible receiving any dental or oral health services= 41,460 (42.8%)
Based on four indicators as a key part of any state’s
prevention strategy:
 having sealant programs in high-need schools,
 allowing hygienists to place sealants in school-based
programs without requiring a dentist’s exam,
 collecting data regularly about the dental health of
school-children and submitting it to a national oral
health database, and
 meeting a national health objective on sealants.
Each state Medicaid program is Federally mandated and identifies the types of
procedures and providers it reimburses for services.
Federal / State Medicaid Assistance Percentage is decided on matching funds based on
3yr income average of each state.
SD Privatized Medicaid by contracting with Delta Dental to administrate the program.
Medicaid in other states will reimburse dental hygienists who provide care if alternative
settings for: prophylaxis, sealants, and fluoride with improvement on reimbursement
due to new CDT codes.
SD currently does not allow Medicaid reimbursement to dental hygienists but does
reimburse medical providers and others for fluoride application.
Many rules and stipulations dependent on age and inability to pay programs determine
reimbursement under Medicaid program.
Utilize Call center to determine eligibility: Call Center 877-841-1478
Fax Back 877-789-5241 or
Health Insurance Portability and Accountability Act (HIPAA)- every health care provider, regardless
of size, who electronically transmits health information in connection with certain transactions, is a
covered entity.
These transactions include claims, benefit eligibility inquiries, and referral authorization
The Office of Civil Rights and US Department of Health and Human Services offers a full
range of easily understood explanations of HIPAA regulations.
You may need to have patients sign a Notice of Privacy Practices.
Decision Matrix for HIPAA: Online “test” to determine if a specific Collaborative
Supervision services qualifies for coverage.
In order to file an electronic claim to a third party payer, whether
private insurance or Medicaid, you need your own National
Provider Identifier (NPI).
An NPI is a 10 digit number, assigned for free by the federal
government, that serves as a permanent identifier of you as a
healthcare provider, even if you move or are relicensed in a
different profession.
Good idea to apply for the free NPI even if you do not bill third
parties directly you can apply anyway because it may facilitate
billing actually submitted by a health department or other entity
for services that you provided.
For more information about the NPI and how to obtain one, please visit the NPPES website or
=static.npistart or contact NPPES directly by phone at (800) 4653203.
Possibilities to Discuss within the Agreement:
Obtain Wage from Collaborating Dentist
Self- Employed and Contract Basis
Receive Percentage of Services Provided
If Medicaid, DDS is willing to submit CMS 416
(Medicaid form for reimbursement)
Volunteer Basis
Tax Implications of employment status under: Self-employment
IRS self-employment tax- (quoted from IRS)
If the hygienist is reimbursed for her services as an independent
contractor, rather than an employee with taxes takes out, the IRS will
expect regular “self-employment” taxes and hygienist may be
responsible for paying your own social security and federal and state
income taxes directly to the government.
Check with IRS website and an accountant to determine if expenses
incurred in a Collaborative Agreement volunteering in community
settings are tax deductible.
Why you need professional liability insurance!
Insurance coverage held by the employer is written to protect the employer
and patients served by the employer. Individual employees have limited
protection and limited access to the legal defense services provided to the
policy holder.
If you are self-employed you need individual protection for yourself and your
business even more so.
Insurance protects hygienists and Collaborative Supervision sites against
claims made in conjunction. Please discuss CS intent with Insurance agent!
Professional liability insurance coverage is generally restricted to matters
relating to patient care - it will not cover loss or damage to equipment,
general negligence issues or other matters.
ADHA offers great information on professional liability and other types of insurance for self-employed dental hygienists, as
well as equipment replacement insurance at:
Two sources to explore:
Marsh Affinity Group Services
Health Providers Services Organization (HPSO)
It is in addition to whatever coverage hygienists
may have with employers.
Hygienists in a self-employed environment,
should carry professional liability coverage selfemployed and employed situations.
The insurance application has a section for
checking off both types of employment.
Coverage for damage, loss and theft of equipment, tools and
Laws governing Collaborative Supervision do not require
the hygienist to have insurance covering damage and loss
of instruments and equipment.
It is wise to make sure that loss or theft of supplies,
instruments and equipment are insured. Most insurance
companies offering homeowners and renters insurance
can advise on the type of coverage and cost to cover
business equipment.
OPTION: Lockton Insurance:
Manual Overview
Chapter 1 - Introduction/Planning
Chapter 2 - Mobile Dental Systems
Chapter 3 - Portable Equipment
Chapter 4 - Mobile-Portable Hybrid
Chapter 5 - Measuring Effectiveness and Outcomes
Various methods of service delivery Portable
dental equipment (e. g. Aseptico Dentlworks)
Mobile vans, trucks
Stationary equipment in schools
Stationary equipment in long term care or
other facilities
The Association of State and Territorial Dental Directors
(ASTDD) is a national non-profit organization representing
the directors and staff of state public health agency programs
for oral health.
ASTDD formulates and promotes the establishment of
national dental public health policy, assists state dental
programs in the development and implementation of
programs and policies for the prevention of oral diseases;
builds awareness and strengthens dental public health
professionals' knowledge and skills by developing position
papers and policy statements; provides information on oral
health to health officials and policy makers, and conducts
conferences for the dental public health community.
MMWR Report
[email protected]
Also available is a Training Power point for Employees
Occupational Safety and Health Administration (OSHA)
Web site:
Regulatory agency within the federal government.
"Safety and Health Issues" are listed the "Blood Borne
Pathogen Standard," the "Needlestick Injury Rule," and
the "Ergonomics Standard. “
Organization for Safety and Asepsis Procedures (OSAP)
Web site:
OSAP is a non-profit organization whose mission is
dedicated to promoting infection control and related
science based health and safety policies and procedures
and training information.
ADHA’s Standards for Clinical Dental Hygiene
Community Health & WIC
Office of Family and Community Health Services
(Public Health Alliance Sites Included)
WIC services available at all offices.
Offices are listed by county offices/CHS
South Dakota Head Start Program Availability by Area. Detailed program descriptions below.
Head Start
Early Head Start
Cheyenne River Sioux
Crow Creek RAI Dakota
Inter-Lakes Community
Lower Brule Sioux Tribe
Northeast South Dakota
Oahe Child Development
Oglala Lakota College
Rosebud Sioux Tribe
South Dakota Head Start Program Availability by Area. Detailed
program descriptions below.
Head Start
Early Head Start
Cheyenne River Sioux Tribe
Crow Creek RAI Dakota Site
Inter-Lakes Community Action
Lower Brule Sioux Tribe
Northeast South Dakota
Oahe Child Development
Oglala Lakota College
Rosebud Sioux Tribe
Rural America
Initiatives Lakota Site
Sioux Falls
Sioux Tribe
South Central Child
Standing Rock Sioux
University of South
Yankton Sioux Tribe
Youth & Family
SD Federally Qualified Health Centers
Bennett County Family Health Center
PO Box 70 D Martin, SD 57551
Phone: (605) 685-6622
Fax: (605) 685-1166
DeSmet Dental Services
PO Box 49, 801 Third St. SW
DeSmet, SD 57231
Phone: (605) 854-3444
Howard Community Health Center
PO Box 99, 208 South Main Street
Howard, SD 57349-0099
Phone: (605) 772-4574
Fax: (605) 772-4128
Rapid City Community Health Center
504 East Monroe Street
Rapid City, SD 57701-1400
Phone: (605) 394-6665
Fax: (605) 394-4116
Falls Community Health
132 North Dakota Sioux Falls, SD 57104-6419
Phone: (605) 367-8760
Fax: (605) 367-7806
Jerauld County Dental Clinic
602 1st Street NE Suite 2
Wessington Springs, SD 57382
Who is “liable” for acts of commission or omission by
the dental hygienist even if the RDH has liability
Does the dentist “have to” incorporate the patients
seen by the dental hygienist as patients of record?
How are dental hygienists reimbursed and is it
financially feasible for the collaborating dentist?
Q. How do I find a dentist to sponsor me for an
Collaborative Supervision?
A successful professional relationship has respect and trust at its
These are the ingredients for all partnerships, teams, and
professional/client relationships. You can begin by asking a
dentist you have worked with. As an alternative, consider
seeking out a dentist who demonstrates a commitment to
public health dentistry: someone working at a public health
clinic, volunteering in community projects, or serving patients
covered by Medicaid.
Q. What do I say to a dentist who might collaborate?
If you are just starting to explore the benefits of having an
agreement, you could simply ask dentists if they have
considered sponsoring hygienists. You can prepare for the
conversation by listing the basic requirements of the agreement.
Here’s one way of introducing the topic:
I have begun looking into a Collaborative Agreement, but I am just
at the stage of exploring how it might fit into professional practice. I
have a lot of research to do but one stipulation is having a dentist to
sponsor me. Would you be willing to talk with me about your
interest in and questions about being a sponsoring dentist?
Since you are clear that you are just exploring it yourself, you
provide the dentist with a graceful exit.
Q. What do I say after the dentist says, “Sure
lets talk. What is the role of a sponsoring
You can begin with the statute of South Dakota
Legislature and referring to the SD Dental Practice Act
(Ch 10).
This includes a signed agreement stating the dentist shall
monitor the dental hygienist's activities. Read the entire
statute before your discussion and have a copy of the
statute with you for reference.
The Working column in Access magazine
highlights on dental hygienists who have pursued
a variety of career paths:
Infection Control/Medical Info Ready Reference
Web Site Resources Fact Sheet
Listed here are sites to locate guidelines and information on clinical topics and issues of interest to the dental
hygienist and the oral health care profession.
American Dental Hygienists' Association (ADHA)
Web site:
The national association Web site offers definitive information about the profession of dental hygiene including
a list of all dental hygiene education program; a career resource center; association position papers; and timely,
relevant articles. Join on line if you are not already a member!
American Heart Association (AHA)
Web site:
This site contains the 1997 guidelines for prevention of bacterial endocarditis. Located under the "Diseases and
Conditions" section, select
"Other" to locate the comprehensive guidelines and other heart-related information.
Centers for Disease Control and Prevention
Web site:
This site contains a wide range of health-related information. Examples include "Infection Control Guidelines
released in1998 and found under "Issues in Health Care Settings" and the "Guideline for Hand Hygiene in
Health Care Settings" released in 2002. Other valuable sections are the "Fluoride Recommendations" and the
Office of Smoking and Health.
Web site:
For information on latex allergies, use the National Institute of Occupational Safety and Health through the CDC
Journal of Cancer
Web site:
A free online resource journal about cancer treatment and prevention for clinicians.
National Institutes of Health
Web site:
This site provides the gateway to all of the individual groups that comprise the National Institutes of Health. While all are of interest,
there are several that may be very useful. From the homepage, scroll down to "Institutes, centers and offices." Here is a selection of
listings based on areas of current interest and which are particularly useful for dental hygienists.
National Institute for Dental and Craniofacial Research
The National Oral Health Information Clearinghouse, a service of the NIDCR, contains, is a resource for data on special care patients.
National Heart. Lung and Blood Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institute of Diabetes, Digestive, and Kidney Diseases
National Center for Complimentary and Alternative Medicine
National Library of Medicine
Web site:
A division of the National Institute of Health, the National Library of Medicine allows access to the MEDLINE/PubMed, one of the
best sources for health care literature. Once in the site, choose "Health Information " and then, MEDLINE/PubMed. This will provide
references and abstracts from more than 4000 journals.
Clare Larkin, RDH MEd RF CDHC Normandale Community College
SD State Board of Dentistry
IA State Board of Dentistry
ADHA Career Options Toolkit
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