Scope of practice for certified dental assistants and dental hygienists and the education requirements for certification as a dental assistant.
Purpose:
To implement the requirements of section 6608 of the Education Law, as added by L. 2006, ch. 300 by expanding the scope of practice for certified dental assistants and dental hygienists and amending the curriculum requirements for registration as a program leading to licensure in certified dental assisting.
Text of proposed rule:
1. Paragraph (3) of subdivision (a) of section 52.26 of the Regulations of the Commissioner of Education is amended, effective June 14, 2007, as follows:
(3) Clinical content area shall mean course work in clinical procedures which includes, but is not limited to, the following curricular areas:
(i) chairside dental assisting and dental laboratory procedures appropriate to the practice of certified dental assisting[;] which shall include, but not be limited to, specific course work in the following clinical procedures subject to the restrictions set forth in subdivision (c) of section 61.13 of this title:
(a) placing and removing temporary restorations;
(b) placing, condensing, and carving amalgam restorations; and
(c) placing, condensing, and finishing non-metallic restorations.
(ii) …
(iii) …
(iv) …
(v) …
2. Subparagraph (ii) of paragraph (1) of subdivision (b) of section 52.26 of the Regulations of the Commissioner of Education is amended, effective June 14, 2007, as follows:
(ii) an alternate course of study in certified dental assisting, which requires the student to complete equivalent study as that required in a program prescribed in subparagraph (i) of this paragraph and in an educational setting prescribed in section 6608-b(4)(B)(ii) of the Education Law, such course of study to include:
(a) …
(b) …
3. Subdivision (c) of section 61.9 of the Regulations of the Commissioner of Education is amended, effective June 14, 2007, as follows:
(c) The following services may be performed only under the personal supervision of a licensed dentist:
(1) …
(2) …
(3) …
(4) …
(5) …
[(6) placing and removing temporary restorations. Temporary restorations shall include only nonmetallic substances generally used for temporary intracoronal filling materials. Placing and removing temporary restorations shall not include cutting or excising hard or soft tissue or the use of mechanical instrumentation;]
[(7)] (6) …
[(8)] (7) …
[(9)] (8) …
[(10)] (9) …
[(11)] (10)…
[(12)] (11) …
[(13)] (12) …
4. Subdivision (d) of section 61.9 of the Regulations of the Commissioner of Education is added, effective June 14, 2007, as follows:
(d) The dental supportive services that a licensed dentist authorizes a certified dental assistant to perform under paragraph (18) of subdivision (b) of section 61.13 of this Part, designated in such paragraph as other dental supportive services, may be performed by a licensed dental hygienist under the personal supervision of a licensed dentist who has delegated such function to the licensed dental hygienist, unless general supervision for such service is otherwise expressly prescribed in this section.
5. Subdivision (e) of section 61.9 of the Regulations of the Commissioner of Education is added, effective June 14, 2007, as follows:
(e) In accordance with section 29.1(b)(9) and (10) of this Title, a licensed dental hygienist is not permitted to provide dental services or dental supportive services that the licensed dental hygienist knows or has reason to know that he or she is not competent to perform, and a licensed dentist is not permitted to delegate to a licensed dental hygienist dental services or dental supportive services that the licensed dentist knows or has reason to know that the licensed dental hygienist is not qualified by training, experience or by licensure to perform.
6. Section 61.13 of the Regulations of the Commissioner of Education is repealed and a new section 61.13 is added, effective June 14, 2007, as follows:
61.13 Practice of certified dental assisting.
(a) The practice of certified dental assisting shall be that practice defined in section 6608 of the Education Law. In accordance with section 6608 of the Education Law, the practice of certified dental assisting must be supportive services to a licensed dentist in the dentist's performance of dental services and must be performed under the direct personal supervision of a licensed dentist. For purposes of this section, under the direct personal supervision of a licensed dentist shall mean supervision of dental procedures based on instructions given by a licensed dentist in the course of a procedure who remains in the dental office where the supportive services are being performed, personally diagnoses the condition to be treated, personally authorizes the procedures, and before dismissal of the patient, who remains the responsibility of the licensed dentist, evaluates the services performed by the dental assistant. Such practice shall include the dental supportive service prescribed in subdivision (b) of this section and shall exclude the dental supportive services prescribed in subdivision (c) of this section.
(b) The practice of certified dental assisting shall include the following supportive services to a licensed dentist while under the direct personal supervision of the licensed dentist:
(1) providing patient education;
(2) taking preliminary medical histories and vital signs to be reviewed by the dentist;
(3) placing and removing rubber dams;
(4) selecting and prefitting provisional crowns;
(5) selecting and prefitting orthodontic bands;
(6) removing orthodondic arch wires and ligature ties;
(7) placing and removing matrix bands;
(8) taking impressions for study casts or diagnostic casts;
(9) removing periodontal dressings;
(10) removal of sutures placed by a licensed dentist;
(11) taking impressions for space maintainers, orthodontic appliances, and occlusal guards;
(12) removing temporary cement;
(13) applying topical anticariogenic agents to the teeth;
(14) applying desensitizing agents to the teeth;
(15) placing and removing temporary separating devices;
(16) placing orthodontic ligatures;
(17) taking x-rays in accordance with the requirements of section 3515(4)(c) of the Public Health Law; and
(18) other dental supportive services authorized by the licensed dentist while the certified dental assistant is under the direct personal supervision of the licensed dentist, provided that such other dental supportive services are not excluded in subdivision (c) of this section.
(c) Excluded dental supportive services. The practice of certified dental assisting shall not include the following dental supportive services:
(1) diagnosing;
(2) performing surgical procedures;
(3) performing irreversible procedures;
(4) performing procedures that would alter the hard or soft tissue of the oral and maxillofacial area;
(5) dental supportive services prescribed in section 61.9 of this Part which are services that a dental hygienist may perform, unless such services are expressly permitted as dental supportive services in paragraphs (1) through (17) of subdivision (b) of this section; and
(6) such dental supportive services that a certified dental assistant would not reasonably be qualified to perform based upon meeting the requirements for certification as a certified dental assistant in section 6608-b of the Education Law, and/or obtaining additional legally authorized experience in the practice of certified dental assisting.
(d) In accordance with section 29.1(b)(9) and (10) of this Title, a certified dental assistant is not permitted to provide dental supportive services that the certified dental assistant knows or has reason to know that he or she is not competent to perform, and a licensed dentist is not permitted to delegate to a certified dental assistant dental supportive services the licensed dentist knows or has reason to know that the certified dental assistant is not qualified by training, experience or by licensure to perform.
Text of proposed rule and any required statements and analyses may be obtained from:
Anne Marie Koschnick, Legal Assistant, Office of Counsel, Education Department, State Education Bldg., Rm. 148, Albany, NY 12234, (518) 473-8296, e-mail: legal@mail.nysed.gov
Data, views or arguments may be submitted to:
Johanna Duncan-Poitier, Deputy Commissioner, Office of the Professions, Education Department, 89 Washington Ave., 2M West Wing Education Bldg., Albany, NY 12234, (518) 474-3862, e-mail: opdepcom@mail.nysed.gov
Public comment will be received until:
45 days after publication of this notice.
This action was not under consideration at the time this agency's regulatory agenda was submitted.
Regulatory Impact Statement
1. STATUTORY AUTHORITY:
Section 207 of the Education Law grants general rule-making authority to the Board of Regents to carry into effect the laws and policies of the State relating to education.
Subdivision (1) of section 6506 of the Education Law authorizes the Board of Regents to supervise the practice of the professions and to promulgate rules to carry out such supervision.
Paragraph (a) of subdivision (2) of section 6507 of the Education Law authorizes the Commissioner of Education to promulgate regulations in administering the practice of the professions.
Subdivision (2) of section 6606 of the Education Law authorizes the commissioner to promulgate regulations defining the functions a dental hygienist may perform, consistent with the training and qualifications for a license as a dental hygienist.
Section 6608 of the Education Law defines the scope of practice for certified dental assistants and authorizes the Commissioner of Education to promulgate regulations authorizing the dental assistant to perform certain dental supportive services. This section also permits the Commissioner of Education to promulgate regulations defining what dental supportive services a dental hygienist may perform under a dentist's supervision.
Section 6608-b authorizes the Commissioner of Education to promulgate regulations relating to the education and experience requirements for certification as a certified dental assistant.
2. LEGISLATIVE OBJECTIVES:
The proposed amendment to the Regulations of the Commissioner of Education carries out the intent of the aforementioned statutes by expanding the scope of practice for dental assistants and dental hygienists and clarifying the curriculum requirements for registration as a program leading to licensure in certified dental assisting.
3. NEEDS AND BENEFITS:
Chapter 300 of the Laws of 2006 amends Sections 6608 and 6608-b of the Education Law by expanding the scope of practice for certified dental assistants and dental hygienists and amending the curriculum requirements for registration as a program leading to licensure in certified dental assisting. The purpose of the proposed amendment is to implement these requirements.
Currently, certified dental assistants are only allowed to perform certain dental supportive services, as delineated in a list set forth in Section 6608 of the Education Law. Chapter 300 of the Laws of 2006 expands this list by permitting licensed certified dental assistants to perform any other dental supportive services authorized by the supervising dentist, provided that such services do not include diagnosing and/or performing surgical procedures, irreversible procedures or procedures that would alter the hard or soft tissue of the oral and maxillofacial area or any other procedures determined by the Education Department. The proposed amendment amends the current regulations to expand the scope of practice for dental assistants to conform to these requirements, and establishes a definition of unprofessional conduct relating to such practice.
In order to conform with the new requirements set forth in 6608-b of the Education Law, as amended by chapter 300 of the Laws of 2006, the proposed amendment also amends the current curriculum requirements for programs leading to licensure in certified dental assisting. Specifically, the amendment provides that an equivalent approved one year course of study by a non-degree granting institution for certified dental assistants shall not be provided by a professional association or organization, and specifies that an alternate course of dental assisting shall be provided by a degree-granting institution or a board of cooperative educational services. The proposed amendment also amends the definition of clinical content area for registration as a program leading to licensure in certified dental assisting to include course work in other clinical procedures, including placing and removing temporary restorations; placing, condensing, and carving amalgam restorations; and placing, condensing and finishing non-metallic restorations due to the expansion of the certified dental assistant's scope of practice.
The proposed amendment also impacts the scope of practice of dental hygienists in New York State. Section 6608 of the Education Law provides that all dental supportive services performed by certified dental assistants may also be performed by currently registered dental hygienists. With the expansion of the scope of practice of dental assistants, this amendment also amends the scope of practice for dental hygienists to include any dental supportive services that a licensed dentist authorizes a certified dental assistant to perform, and establishes a definition of unprofessional conduct relating to such practice.
4. COSTS:
(a) Costs to State Government: The proposed amendment implements statutory requirements and establishes standards as directed by statute. It will not impose will not impose any additional cost on State government.
(b) Costs to local government: None.
(c) Costs to private regulated parties: None. The proposed amendment will not impose any cost on private regulated parties, beyond those imposed by the statute.
(d) Cost to the regulatory agency: As stated above in “Costs to State Government”, the proposed amendment does not impose costs on the State Government, including the State Education Department.
5. LOCAL GOVERNMENT MANDATES:
The proposed amendment implements the requirements of sections 6608 and 6608-b of the Education Law, as amended by Chapter 300 of the Laws of 2006, relating to the scope of practice for certified dental assistants and dental hygienists and the curriculum requirements for registration as a program leading to licensure as a dental assistant. It does not impose any program, service, duty or responsibility upon local governments.
6. PAPERWORK:
The proposed amendment will not require any additional paperwork for the licensee.
7. DUPLICATION:
The proposed amendment does not duplicate other existing State or Federal requirements.
8. ALTERNATIVES:
There are no viable alternatives to the proposed amendment, and none were considered. The amendment implements statutory requirements.
9. FEDERAL STANDARDS:
There are no federal standards that define the scope of certified dental assistants or dental hygienists.
10. COMPLIANCE SCHEDULE:
The proposed amendment must be complied with on its effective date. No additional period of time is necessary to enable regulated parties to comply.
Regulatory Flexibility Analysis
(a) Small Businesses:
1. EFFECT OF RULE:
The proposed amendment to the Regulations of the Commissioner of Education applies to licensed and registered certified dental assistants and dental hygienists in New York State. All 683 certified dental assistants and 9,439 dental hygienists registered to practice in New York would be subject to the requirements of the proposed amendment.
2. COMPLIANCE REQUIREMENTS:
Chapter 300 of the Laws of 2006 amends Sections 6608 and 6608-b of the Education Law by expanding the scope of practice for certified dental assistants and dental hygienists and amending the curriculum requirements for registration as a program leading to licensure in certified dental assisting. The purpose of the proposed amendment is to implement these requirements.
Currently, certified dental assistants are only allowed to perform certain dental supportive services, as delineated in a list set forth in Section 6608 of the Education Law. Chapter 300 of the Laws of 2006 expands this list by permitting licensed certified dental assistants to perform any other dental supportive services authorized by the supervising dentist, provided that such services do not include diagnosing and/or performing surgical procedures, irreversible procedures or procedures that would alter the hard or soft tissue of the oral and maxillofacial area or any other procedures determined by the Education Department. The proposed amendment amends the current regulations to expand the scope of practice for dental assistants to conform to these requirements, and establishes a definition of unprofessional conduct relating to such practice.
In order to conform with the new requirements set forth in 6608-b of the Education Law, as amended by chapter 300 of the Laws of 2006, the proposed amendment also amends the current curriculum requirements for programs leading to licensure in certified dental assisting. Specifically, the amendment provides that an equivalent approved one year course of study by a non-degree granting institution for certified dental assistants shall not be provided by a professional association or organization, and specifies that an alternate course of dental assisting shall be provided by a degree-granting institution or a board of cooperative educational services. The proposed amendment also amends the definition of clinical content area for registration as a program leading to licensure in certified dental assisting to include course work in other clinical procedures, including placing and removing temporary restorations; placing, condensing, and carving amalgam restorations; and placing, condensing and finishing non-metallic restorations due to the expansion of the certified dental assistant's scope of practice.
The proposed amendment also impacts the scope of practice of dental hygienists in New York State. Section 6608 of the Education Law provides that all dental supportive services performed by certified dental assistants may also be performed by currently registered dental hygienists. With the expansion of the scope of practice of dental assistants, this amendment also amends the scope of practice for dental hygienists to include any dental supportive services that a licensed dentist authorizes a certified dental assistant to perform, and establishes a definition of unprofessional conduct relating to such practice.
3. PROFESSIONAL SERVICES:
No professional services are expected to be required by small businesses to comply with the proposed amendment.
4. COMPLIANCE COSTS:
The proposed amendment will not impose any costs beyond those required to comply with the statutory requirements.
5. ECONOMIC AND TECHNOLOGICAL FEASIBILITY:
The proposed amendment will not impose any special technological requirements on regulated parties. As stated above in “Compliance Costs,” the amendment will not result in additional costs to regulated parties.
6. MINIMIZING ADVERSE IMPACT:
The amendment expands the scope of practice for certified dental assistants and dental hygienists and amends the curriculum requirements for registration as a program leading to licensure in certified dental assisting. Because of the nature of the proposed amendment, there will be no adverse impact on small businesses. Therefore, establishing different standards for certified dental assistants and dental hygienists based upon the size of the business where they are employed is unnecessary.
7. SMALL BUSINESS PARTICIPATION:
Members of the State Board for Dentistry, many of whom have experience in a small business environment, provided input during the development of the proposed amendment. In addition, comments on the proposed amendment were solicited from statewide organizations representing all parties having an interest in the practice of dentistry. Included in the group were New York Dental Assistants Association, Dental Hygienists' Association of the State of New York and the New York State Dental Association. These organizations include membership who own and operate small businesses or are employed by small businesses.
(b) Local Governments:
The proposed amendment concerns the scope of practice for individuals licensed as certified dental assistants and dental hygienists in New York State and the curriculum requirements for registration as a program leading to licensure in certified dental assisting. The amendment will not affect local governments in New York State. The measure will not impose any adverse economic, reporting, recordkeeping, or any other compliance requirements on local governments. Because it is evident from the nature of the rule that it does not affect local governments, no further steps were needed to ascertain that fact and none were taken. Accordingly, a regulatory flexibility analysis for local governments is not required and one has not been prepared.
Rural Area Flexibility Analysis
1. TYPES AND ESTIMATED NUMBERS OF RURAL AREAS:
The proposed amendment to the Regulations of the Commissioner of Education applies to certified dental assistants and dental hygienists, including those that are located in the 44 rural counties with less than 200,000 inhabitants and the 71 towns in urban counties with a population density of 150 per square mile or less. At the present time, of the 683 certified dental assistants and the 9,439 dental hygienists licensed and registered to practice in New York State, 245 certified dental assistants and 1,959 dental hygienists reported that their permanent address of record is in a rural county.
2. REPORTING, RECORDKEEPING AND OTHER COMPLIANCE REQUIREMENTS; AND PROFESSIONAL SERVICES:
Chapter 300 of the Laws of 2006 amends Sections 6608 and 6608-b of the Education Law by expanding the scope of practice for certified dental assistants and dental hygienists and amending the curriculum requirements for registration as a program leading to licensure in certified dental assisting. The purpose of the proposed amendment is to implement these requirements.
Currently, certified dental assistants are only allowed to perform certain dental supportive services, as delineated in a list set forth in Section 6608 of the Education Law. Chapter 300 of the Laws of 2006 expands this list by permitting licensed certified dental assistants to perform any other dental supportive services authorized by the supervising dentist, provided that such services do not include diagnosing and/or performing surgical procedures, irreversible procedures or procedures that would alter the hard or soft tissue of the oral and maxillofacial area or any other procedures determined by the Education Department. The proposed amendment amends the current regulations to expand the scope of practice for dental assistants to conform to these requirements, and establishes a definition of unprofessional conduct relating to such practice.
In order to conform with the new requirements set forth in 6608-b of the Education Law, as amended by chapter 300 of the Laws of 2006, the proposed amendment also amends the current curriculum requirements for programs leading to licensure in certified dental assisting. Specifically, the amendment provides that an equivalent approved one year course of study by a non-degree granting institution for certified dental assistants shall not be provided by a professional association or organization, and specifies that an alternate course of dental assisting shall be provided by a degree-granting institution or a board of cooperative educational services. The proposed amendment also amends the definition of clinical content area for registration as a program leading to licensure in certified dental assisting to include course work in other clinical procedures, including placing and removing temporary restorations; placing, condensing, and carving amalgam restorations; and placing, condensing and finishing non-metallic restorations due to the expansion of the certified dental assistant's scope of practice.
The proposed amendment also impacts the scope of practice of dental hygienists in New York State. Section 6608 of the Education Law provides that all dental supportive services performed by certified dental assistants may also be performed by currently registered dental hygienists. With the expansion of the scope of practice of dental assistants, this amendment also amends the scope of practice for dental hygienists to include any dental supportive services that a licensed dentist authorizes a certified dental assistant to perform, and establishes a definition of unprofessional conduct relating to such practice.
3. COSTS:
The proposed amendment does not impose additional costs on certified dental assistants or dental hygienists, including those that are located in rural areas, beyond those imposed by statute.
4. MINIMIZING ADVERSE IMPACT:
The proposed amendment implements statutory requirements and makes no exception for certified dental assistants or dental hygienists located in rural areas. In any event, consistent practice requirements should apply no matter the geographic origin of the licensee to ensure a uniform high standard of competency across the State. Because of the nature of the proposed amendment, establishing different standards for certified dental assistants and dental hygienists located in rural areas of New York State is inappropriate.
5. RURAL AREA PARTICIPATION:
Comments on the proposed amendment were solicited from statewide organizations representing all parties having an interest in the practice of dentistry. Included in the group were the State Board for Dentistry, New York Dental Assistants Association, Dental Hygienists' Association of the State of New York and the New York State Dental Association, which represent among others individuals, certified dental assistants and dental hygienists who live or work in rural areas.
Job Impact Statement
The purpose of the proposed amendment is to implement the requirements of Sections 6608 and 6608-b of the Education Law, as added by Chapter 300 of the Laws of 2006, by expanding the scope of practice for certified dental assistants and dental hygienists and amending the curriculum requirements for registration as a program leading to licensure in certified dental assisting. The amendment implements statutory requirements and will have no impact on jobs or employment opportunities in the fields of dental assisting or dental hygiene or any other field. Because it is evident from the nature of this proposed amendment that it will have no impact on jobs or employment opportunities, no further steps were needed to ascertain that fact and none were taken. Accordingly, a job impact statement is not required and one was not prepared.
