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    Maryland Department of Health
    Regulations

    ​
    PROPOSAL
    Maryland Register
    Issue Date:  September 2, 2016
    Volume 43 • Issue 18 • Pages 1028—1032
     
    Title 10
    DEPARTMENT OF HEALTH AND MENTAL HYGIENE
    Subtitle 44 BOARD OF DENTAL EXAMINERS
    Notice of Proposed Action
    [16-229-P]
    The Secretary of Health and Mental Hygiene proposes to:
    (1) Amend Regulations .02—.06, and Regulations .08, .11, .13, .15, .18, and .25—.28, repeal existing Regulations .17 and .24, adopt new Regulations .17 and .19, and amend and recodify existing Regulations .19—.23 to be Regulations .20—.24 under COMAR 10.44.04 Practice of Dental Hygiene; and
    (2) Amend Regulation .02 under COMAR 10.44.20 Fees.
    This action was considered by the Board of Dental Examiners at a public meeting held on July 6, 2016 notice of which was given under the Notice of Public Meetings link on the Board’s website pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.
    Statement of Purpose
    The purpose of this action is to permit:
    (1) Maryland licensed dental hygienists to administer nitrous oxide to dental patients under certain prescribed circumstances, in accordance with H.B. 470, Ch. 106, Acts of 2016; and
    (2) Dental hygienists to administer local anesthesia by infiltration and local anesthesia by inferior alveolar nerve block to facilitate the performance of either dental or dental hygiene procedures, in accordance with H.B. 680, Ch. 111, Acts of 2016.
    Comparison to Federal Standards
    There is no corresponding federal standard to this proposed action.
    Estimate of Economic Impact
    The proposed action has no economic impact.
    Economic Impact on Small Businesses
    The proposed action has minimal or no economic impact on small businesses.
    Impact on Individuals with Disabilities
    The proposed action has no impact on individuals with disabilities.
    Opportunity for Public Comment
    Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through October 3, 2016. A public hearing has not been scheduled.
     
    10.44.04 Practice of Dental Hygiene
    Authority: Health Occupations Article, §§4-206.1, and 4-206.3, Annotated Code of Maryland
    .02 Definitions.
    A. (text unchanged)
    B. Terms Defined.
    [(1) “ADEX” means the American Board of Dental Examiners, Inc., or its successor organization.]
    (1) “Administer nitrous oxide” means the initiation, adjustment, monitoring, and termination of the flow of nitrous oxide.
    (2) (text unchanged)
    (3) “CDCA” means the Commission on Dental Competency Assessments or its successor organization.
    [(3)] (4)—[(4)] (5) (text unchanged)
    [(5)] (6) “Monitor” means the observation of the patient:
    (a) During the flow of [sedation agents] nitrous oxide;
    (b) During the reduction of the flow of [sedation] nitrous oxide;
    (c) During the shutting off of the equipment controlling the flow of [sedation] nitrous oxide; and
    (d) At all times in between the start of the flow of [sedation] nitrous oxide until after [sedation] nitrous oxide has been terminated and the patient has fully awoken and is coherent.
    [(6)] (7) “Nitrous oxide” means [an induced, controlled state of minimal sedation, provided solely by the inhalation of a combination of nitrous oxide and oxygen in which the patient retains the ability to independently and continuously maintain an airway and respond purposefully to physical stimulation and to oral commands.] a chemical compound with the formula N2O.
    .03 Intraoral Functions.
    A.—C. (text unchanged)
    D. A dental hygienist may [monitor a patient to whom nitrous oxide has been administered] administer nitrous oxide only after Board recognition as provided in this chapter.
    .04 Exceptions.
    The following intraoral functions may not be performed in the practice of dental hygiene:
    A.—E. (text unchanged)
    F. Anesthesia procedures other than:
    (1)—(2) (text unchanged)
    (3) [Monitoring a patient to whom nitrous oxide has been administered] Administering nitrous oxide in accordance with:
    (a)—(b) (text unchanged)
    G.—H. (text unchanged)
    .05 Additional Functions for Dental Hygienists Who Obtain Board Recognition.
    In addition to those functions described in Regulation .03A of this chapter, a dental hygienist who is recognized by the Board as qualified may:
    A.—B. (text unchanged)
    C. [Monitor a patient to whom nitrous oxide has been administered.] Administer nitrous oxide.
    .06 Local Anesthesia.
    A. A dental hygienist who is recognized by the Board to administer local anesthesia may do so provided that the administration of local anesthesia is:
    (1) By infiltration or by inferior alveolar nerve block [for the purpose of anesthetizing soft tissue] to facilitate the [performance of dental hygiene procedures] practice of dental hygiene by a dental hygienist or the practice of dentistry by a dentist;
    (2)—(3) (text unchanged)
    B.—D. (text unchanged)
    .08 Qualifications for Board Recognition to Administer Local Anesthesia.
    A.—C. (text unchanged)
    D. In addition to the requirements of this regulation, a dental hygienist who wishes to receive recognition by the Board as being qualified to administer local anesthesia shall pass the [ADEX] CDCA Local Anesthesia Examination for Dental Hygienists.
    .11 Out-of-State Certification to Administer Local Anesthesia or Manual Curettage.
    A. Local Anesthesia. A dental hygienist holding an active certification to administer local anesthesia in another state or who is otherwise recognized to administer local anesthesia in another state may be granted recognition to administer local anesthesia in Maryland without taking and passing the Board-approved course outlined in Regulation .08A and B of this chapter if the dental hygienist:
    (1) Has passed the [ADEX] CDCA Local Anesthesia Examination for Dental Hygienists; and
    (2) (text unchanged)
    B. (text unchanged)
    .13 Continuing Education and Renewal for Local Anesthesia and Manual Curettage.
    A. (text unchanged)
    B. A dental hygienist who has successfully completed the following since graduating from an approved school of dental hygiene may receive continuing education credit toward renewal of their dental hygiene license:
    (1)—(2) (text unchanged)
    (3) The [ADEX] CDCA Local Anesthesia Examination for Dental Hygienists.
    .15 Application for Board Recognition to Administer Local Anesthesia.
    A. (text unchanged)
    B. Recognized as Qualified to Administer Local Anesthesia.
    (1) Not Certified or Otherwise Recognized in Another State. A dental hygienist who applies to be recognized as qualified to administer local anesthesia and who is not certified or otherwise recognized to administer local anesthesia in another state shall submit to the Board:
    (a)—(b) (text unchanged)
    (c) A certified examination score from the [ADEX] CDCA indicating that the applicant has passed the [ADEX] CDCA Local Anesthesia Examination for Dental Hygienists;
    (d)—(e) (text unchanged)
    (2) Recognized as Qualified to Administer Local Anesthesia by Virtue of Being Recognized in Another State. A dental hygienist who applies to be recognized as qualified to administer local anesthesia by virtue of being certified or otherwise recognized to administer local anesthesia in another state shall submit the following to the Board:
    (a)—(b) (text unchanged)
    (c) A certified examination score from the [ADEX] CDCA indicating that the applicant has passed the [ADEX] CDCA Local Anesthesia Examination for Dental Hygienists;
    (d)—(f) (text unchanged)
    C.—D. (text unchanged)
    .17 Nitrous Oxide.
    A. Classification of Board Recognition. The Board shall recognize the classification of recognized to monitor nitrous oxide.
    B. A dental hygienist may not administer nitrous oxide unless recognized by the Board as being qualified to do so as provided in this chapter.
    C. A dental hygienist who is recognized by the Board to administer nitrous oxide may do so provided that the administration of nitrous oxide is under the supervision of a dentist who:
    (1) Is physically on the premises; and
    (2) Prescribes the administration of nitrous oxide by the dental hygienist.
    D. The supervising dentist and the dental hygienist who administers nitrous oxide shall insure that the patient retains the ability to independently and continuously maintain an airway and respond purposely to physical stimulation and verbal commands.
    E. A dental hygienist who administers or monitors a patient to whom nitrous oxide has been administered shall enter the details of the procedure during and after the procedure into the patient’s record.
    F. A dental hygienist may not monitor or administer nitrous oxide to more than one patient at a time.
    G. A dental hygienist who administers nitrous oxide to a patient or who monitors a patient to whom nitrous oxide has been administered may not:
    (1) Treat any other patient during the course of the administration or monitoring; or
    (2) Leave the operatory during the administration or monitoring except in emergency circumstances.
    H. A dental hygienist who is recognized to either monitor or administer nitrous oxide may remove the patient from nitrous oxide when the procedures have been completed.
    I. If a dental hygienist either monitors or administers nitrous oxide, the supervising dentist shall remain in the dental office and in close proximity to be summoned in the event of an emergency.
    .18 Qualifications for Board Recognition to [Monitor] Administer Nitrous Oxide.
    A. A dental hygienist who wishes to receive recognition by the Board as being qualified to [monitor a patient to whom nitrous oxide has been administered] administer nitrous oxide shall:
    (1) (text unchanged)
    (2) Successfully complete a Board-approved course of instruction as outlined in Regulation [.19] .20 of this chapter that documents training of at least 6 hours consisting of at least:
    (a) 4 hours of didactic classroom training; and
    (b) (text unchanged)
    B. (text unchanged)
    C. The Board-approved course of instruction in [monitoring a patient to whom nitrous oxide has been administered] administering nitrous oxide may be obtained by:
    (1)—(2) (text unchanged)
    D. In addition to the Requirements outlined in §§A—C of this regulation, an applicant for recognition to administer nitrous oxide shall take and pass the CDCA Nitrous Oxide Examination for Dental Hygienists.
    .19 Recognition to Monitor a Patient to Whom Nitrous Oxide Has Been Administered.
    A. A dental hygienist who holds a Board recognition to monitor a patient to whom nitrous oxide has been administered may, on and after October 1, 2016, continue to monitor a dentist’s administration of nitrous oxide to a patient, but may not administer nitrous oxide to a patient unless the dental hygienist holds a recognition to administer nitrous oxide.
    B. A dental hygienist who is recognized to monitor a patient to whom nitrous oxide has been administered may not increase the nitrous levels.
    C. The supervising dentist shall discharge the patient upon completion of the procedures.
    D. Beginning on October 1, 2016, the Board may not issue a recognition to monitor nitrous oxide.
    E. A dental hygienist may not administer nitrous oxide to a patient unless recognized by the Board as being qualified to do so as provided in this chapter.
    [.19] .20 Board-Approved Course of Instruction for [Monitoring a Patient to Whom Nitrous Oxide Has Been Administered.] Administering Nitrous Oxide.
    The 6-hour Board-approved course of instruction shall include but not be limited to the following:
    A. 4 hours of didactic classroom training, including at least the following:
    (1)—(9) (text unchanged)
    (10) [Monitoring of a patient to whom nitrous oxide has been administered] Administering and monitoring the flow of nitrous oxide, including the monitoring of a patient’s vital functions;
    (11)—(13) (text unchanged)
    B. (text unchanged)
    [.20] .21 Out-of-State Certification to [Monitor a Patient to Whom Nitrous Oxide Has Been Administered] Administer Nitrous Oxide.
    A. A dental hygienist holding an active certification or who is otherwise recognized in another state to [monitor a patient to whom nitrous oxide has been administered, assist in the administration of nitrous oxide, or] administer nitrous oxide may be granted recognition to [monitor a patient to whom nitrous oxide has been administered] administer nitrous oxide without taking and passing the Board-approved course if the dental hygienist:
    (1) Has successfully administered nitrous oxide to at least 10 dental patients within the 2-year period immediately preceding the date of application [successfully:]without complications;
    [(a) Monitored at least 10 dental patients to whom nitrous oxide has been administered;
    (b) Assisted in the administration of nitrous oxide to at least 10 dental patients; or
    (c) Administered nitrous oxide to at least 10 dental patients;]
    (2) Has passed the [ADEX] CDCA Nitrous Oxide Examination for Dental Hygienists; and
    (3) Applies for and receives recognition by the Board as qualified to [monitor] administer nitrous oxide.
    B. (text unchanged)
    [.21] .22 [Monitoring a Patient to Whom Nitrous Oxide Has Been Administered.] Administering Nitrous Oxide to a Patient.
    A. A dental hygienist who [monitors a patient to whom nitrous oxide has been administered] administers nitrous oxide shall enter clinic details of the procedure during and after the procedure into the patient’s dental record.
    B. A dental hygienist may not [monitor] administer nitrous oxide to more than one patient at a time.
    C. A dental hygienist who [is monitoring a patient to whom nitrous oxide has been administered] administers nitrous oxide to a patient may not:
    (1) Treat any other patient during the course of the [monitoring;] initiation, adjustment, monitoring, or termination of the flow of nitrous oxide; or
    (2) Leave the operatory during the [monitoring] initiation, adjustment, monitoring, or termination of the flow of nitrous oxide except in emergency circumstances.
    D.—E. (text unchanged)
    [F. The supervising dentist shall discharge the patient upon completion of the procedures.]
    [.22] .23 Emergency Response Plan for [Monitoring] Administering Nitrous Oxide.
    A. A dentist that utilizes a dental hygienist to [monitor a patient to whom nitrous oxide has been administered] administer nitrous oxide shall have a medical emergency plan for the dental hygienist to follow in the event of an emergency.
    B.—C. (text unchanged)
    [.23] .24 Continuing Education Credit for Nitrous Oxide Course.
    A dental hygienist who has successfully completed the following since graduating from an approved school of dental hygiene may receive continuing education credit toward renewal of their dental hygiene license:
    A. The 6-hour Board-approved course of instruction for [monitoring a patient to whom nitrous oxide has been administered;] administering nitrous oxide; and
    B. The [ADEX] CDCA Nitrous Oxide Examination for Dental Hygienists.
    .25 Application for Board Recognition as Qualified to [Monitor] Administer Nitrous Oxide.
    A. A dental hygienist shall submit a completed Board-approved application with the Board to be recognized as qualified to [monitor] administer nitrous oxide.
    B. Recognized as Qualified to [Monitor] Administer Nitrous Oxide.
    (1) Not Certified or Otherwise Recognized in Another State. A dental hygienist who applies to be recognized as qualified to [monitor] administer nitrous oxide and who is not certified or otherwise recognized in another state to [monitor a patient to whom nitrous oxide has been administered, assist in the administration of nitrous oxide, or] administer nitrous oxide shall submit to the Board:
    (a) (text unchanged)
    (b) Proof of completion of a 6-hour Board-approved course of instruction in [monitoring] administering nitrous oxide in the form of a letter from an accredited dental hygiene program indicating that the applicant has:
    (i)—(ii) (text unchanged)
    (c) A certified examination score from the CDCA indicating that the applicant has passed the CDCA Nitrous Oxide Examination for Dental Hygienists.
    [(c)] (d)—[(d)] (e) (text unchanged)
    (2) Recognized as Qualified to [Monitor] Administer Nitrous Oxide by Virtue of Being Recognized in Another State. A dental hygienist who applies to be recognized as qualified to [monitor] administer nitrous oxide by virtue of being certified or otherwise recognized in another state to [monitor a patient to whom nitrous oxide has been administered, assist in the administration of nitrous oxide, or] administer nitrous oxide shall submit the following to the Board:
    (a) (text unchanged)
    (b) A certified copy of the dental hygienist’s most recent license or certification from the state of licensure or certification, indicating that the dental hygienist holds a current license or certification to [monitor a patient to whom nitrous oxide has been administered, assist in the administration of nitrous oxide, or] administer nitrous oxide;
    (c) A certified examination score from the [ADEX] CDCA indicating that the applicant has passed the [ADEX] CDCA Nitrous Oxide Examination for Dental Hygienists;
    (d) An affidavit indicating that the dental hygienist has within the 2-year period immediately preceding the date of the application successfully [:] administered nitrous oxide to at least 10 dental patients without complications;
    [(i) Monitored at least 10 dental patients to whom nitrous oxide has been administered;
    (ii) Assisted in the administration of nitrous oxide to at least 10 dental patients; or
    (iii) Administered nitrous oxide to at least 10 dental patients;]
    (e)—(f) (text unchanged)
    C. The affidavit referenced in §B(2)(d) of this regulation shall contain the name, business address, and business telephone number of each dentist who supervised the applicant’s administration of nitrous oxide, as well as a statement indicating whether the dentist is currently practicing dentistry, is retired, or is deceased;
    [C.] D. (text unchanged)
    E. The fee required under §B(1)(d) of this regulation shall be waived for a dental hygienist who applies for recognition to administer nitrous oxide if the dental hygienist:
    (1) Holds a recognition issued by the Board to monitor a patient to whom nitrous oxide has been administered;
    (2) Has taken and passed the CDCA Nitrous Oxide Examination for Dental Hygienists; and
    (3) Otherwise meets the requirements to administer nitrous oxide established under this chapter.
    .26 Display and Location of Recognition as Qualified to Monitor or Administer Nitrous Oxide.
    A dental hygienist recognized by the Board as qualified to either monitor or administer nitrous oxide shall display the recognition conspicuously in the office where the holder is engaged in practice.
    .27 Violations.
    A. Subject to the hearing provisions of Health Occupations Article, §4-318, Annotated Code of Maryland, the Board may take the following action against a dental hygienist who violates any provision of this chapter or who violates any provision of Health Occupations Article, §4-315(b), Annotated Code of Maryland:
    (1) Deny, suspend, or revoke the recognition to administer local anesthesia;
    [(2) Revoke or suspend the recognition to administer local anesthesia;]
    [(3)] (2) (text unchanged)
    [(4)] (3) Deny, suspend, or revoke the recognition to [monitor] administer nitrous oxide;
    [(5)] (4) [Revoke or suspend] Suspend or revoke the recognition to monitor nitrous oxide;
    [(6)] (5)—[(7)] (6) (text unchanged)
    B. In addition to the action authorized under §A of this chapter, the Board may take formal or informal disciplinary action as specified in COMAR 10.44.07.
    [B.] C. (text unchanged)
    .28 Summary Suspension.
    A. The Board may order the summary suspension of the recognition qualified to administer local anesthesia, the privilege to perform manual curettage in conjunction with scaling and root planing, [or] the recognition qualified to monitor nitrous oxide, or the recognition to administer nitrous oxide if the Board:
    (1)—(2) (text unchanged)
    B.—D. (text unchanged)
     
    10.44.20 Fees
    Authority: Health Occupations Article, §4-207(b), Annotated Code of Maryland
    .02 Fee Schedule.
    The following fees are established by the Board:
    A.—U. (text unchanged)
    V. Dental hygienist recognition as qualified to [monitor a patient to whom nitrous oxide has been administered] administer nitrous oxide . . . $50;
    W.—II. (text unchanged)
    VAN T. MITCHELL
    Secretary of Health and Mental Hygiene