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OAC 4715-9-05 Practice when the dentist is not physically present.
(A) A dental hygienist may provide, for not more than fifteen consecutive business days, or no
more than three consecutive weeks, dental hygiene services to a patient when the supervising dentist is not physically
present at the location at which the services are provided if all of the following requirements are met:
(1) The dental hygienist has at least two years and a minimum of three thousand hours of experience
in the practice of dental hygiene. This experience shall be documented on a form supplied by the board, with any
necessary supporting information attached, and the form shall be maintained in the facility(s) where the dental
hygienist is working.
(2) The dental hygienist has successfully completed a course approved by the state dental board in the identification
and prevention of potential medical emergencies. This board approved course shall be taken through a permanent
sponsor, shall be at least four hours in duration, and shall include, at a minimum, the following topics:
(a) Medical history;
(b) Recognition of common medical emergency situations;
(c) Office emergency protocols;
(d) Basic airway management;
(e) Prevention of emergency situations during dental appointments; and
(f) Recognition of symptoms, first aid treatment and possible outcomes for patients who exhibit bleeding injuries,
cardiovascular disease, insulin reaction, diabetic coma, shock, syncope, epileptic seizures and allergic reactions.
Completion of this course shall be documented on a form supplied by the board, with all necessary
supporting information attached, and the form shall be maintained in the facility(s) where the dental hygienist
is working.
(3) The dental hygienist shall be currently certified in cardiopulmonary resuscitation (CPR)
at all times while treating patients when the dentist is not physically present. This must be verified on a form
supplied by the board, with all necessary supporting information attached, and the form shall be maintained in
the facility(s) where the dental hygienist is working.
(4) The dental hygienist complies with written protocols for emergencies the supervising dentist establishes.
(5) The supervising dentist has evaluated the dental hygienist's skills and has made a determination that the dental
hygienist is competent to treat patients without the dentist being physically present. This determination shall
be documented on a form supplied by the board, and the form shall be maintained at the facility(s) where the dental
hygienist is working.
(6) The supervising dentist examined the patient not more than seven months prior to the date the dental hygienist
provides the dental hygiene services to the patient.
(7) The dental hygienist complies with written protocols or written standing orders that the supervising dentist
establishes, including an updated medical history.
(8) The supervising dentist completed and evaluated a medical and dental history of the patient not more than one
year prior to the date the dental hygienist provides dental hygiene services to the patient, unless there has been
a medically significant change in the patient's medical history since the last appointment, And, except when the
dental hygiene services are provided in a health care facility, the supervising dentist determines that the patient
is in a medically stable condition.
(9) If the dental hygiene services are provided in a health care facility, a doctor of medicine and surgery or
osteopathic medicine and surgery who holds a current certificate issued under Chapter 4731. of the Revised Code
or a registered nurse licensed under Chapter 4723. of the Revised Code is present in the health care facility when
the services are provided.
(10) In advance of the appointment for dental hygiene services, the patient is notified that the supervising dentist
will be absent from the location and that the dental hygienist cannot diagnose the patient's dental health care
status. This notification must be documented in the patient record.
(B) A dental hygienist may provide dental hygiene services to a patient when the supervising dentist is not physically
present at the location at which the services are provided if the services are provided as part of a dental hygiene
program that is approved by the state dental board and all of the following requirements are met:
(1) The program is operated through a school district board of education or the governing board
of an educational service center; the board of health of a city or general health district or the authority having
the duties of a board of health under section 3709.05 of the Revised Code; a national, state, district, or local
dental association; or any other public or private entity recognized and approved by the state dental board.
(2) The supervising dentist is employed by or a volunteer for, and the patients are referred by, the entity through
which the program is operated.
(3) The services are performed after examination and diagnosis by the dentist and in accordance with the dentist's
written treatment plan for the procedures to be performed by the dental hygienist.
(C) The supervising dentist shall have no more than three dental hygienists treating patients
when the dentist is not physically present.
(D) No person shall do either of the following;
(1) Practice dental hygiene in a manner that is separate or otherwise independent from the dental
practice of a supervising dentist;
(2) Establish or maintain an office or practice that is primarily devoted to the provision of dental hygiene services.
(E) The following procedures may not be performed by a dental hygienist when the supervising
dentist is not physically present:
(1) Procedures while the patient is anesthetized,
(2) Definitive subgingival curettage
(3) Definitive root planing
(4) Sulcular placement of prescribed materials
(5) Selection of shade for fabrication of appliances or restorations.
(6) Pulp testing.
(7) Application of periodontal dressings (packs).
(8) Suture removal.
(9) Placement of a rubber dam over preplaced clamp, and removal of clamp and rubber dam.
(10) Application of cavity varnish.
(11) Placement of surgical dressings.
(12) The following orthodontic procedures:
(a) Preliminary selection and sizing of orthodontic bands and arch wires.
(b) Checking for and removal of loosened orthodontic bands and arch wires.
(c) Placement and removal of orthodontic arch wires, auxiliary arch wires, and ligation of same to orthodontic
bands and/or brackets.
(d) Placement and removal of orthodontic separators and ties (steel or elastomeric).
(13) The following endodontic procedures:
(a) Irrigation and drying of canals during endodontic procedures.
(b) Placement of medication in pulp chamber of teeth with non-vital pulp or instrumented root canals.
(14) The following restorative procedures:
(a) Construction of provisional (temporary) crowns (metal or plastic).
(b) Preliminary selection and sizing of stainless steel crowns.
(c) Polymerization of light-activated restorative or bonding materials.
(15) The preparation of materials, drugs and medications for use in dental procedures, including,
but not limited to:
(a) Palliative materials;
(b) Restorative materials.
(16) All non-invasive supportive services normally utilized in conjunction with the treatment
by the dentist of fascia pain or TMJ syndrome.
HISTORY: Eff. 6-17-99
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