Chapter 150-5 DENTAL HYGIENE

Rule 150-5-.01 Dental Hygiene

(1)	Persons of good moral character, at least eighteen (18) years of age, who have been examined, found qualified and issued licenses by the Georgia Board of Dentistry, may practice as dental hygienists in this State under the terms and limitations set forth in this Chapter.

Rule 150-5-.02 Qualifications for Dental Hygienists

(1)

No persons shall be issued a license to practice as a dental hygienist unless such person is a graduate of a school or college for dental hygienists recognized by the board and accredited by the Commission on Dental Accreditation of the American Dental Association or its successor agency. Such school or college must conduct a course consisting of not less than two (2) academic years for dental hygiene graduation.

(2)

All applicants must show passage of all sections with a score of 75 or higher on a clinical examination administered by the board or a testing agency designated and approved by the board. The board will only consider examination results from the Southern Regional Testing Agency (SRTA) that were attained between February 22, 1993 and December 31, 2005. SRTA retake examination results will be accepted until December 31, 2006. After December 31, 2005, the board will only consider the dental hygiene examination as uniformly administered by the Central Regional Dental Testing Service, Inc. (CRDTS) or any other testing agency designated and approved by the board. Applicants must also pass a jurisprudence examination on the laws and rules governing the practice of dental hygiene in the State of Georgia. Such examinations shall be administered in the English language. The Board may hold other examinations as may be required and necessary.

(3)

Any candidate who fails any clinical examination three times must take a remedial course of study designated and pre-approved by the board.

(a)	Once the candidate shows written proof of successful completion of the approved course of study, the Board will grant the candidate one additional attempt at successful passage of a clinical licensing examination approved by the board.

(b)	After a fourth failure of any clinical examination, no further attempts will be authorized or scores recognized by the board for licensure in Georgia.

(4)	The applicant must provide the board with a copy of his or her score showing passage of all sections with a score of 75 or higher on the National Board Examination.

(5)

An applicant for dental hygiene licensure must provide the board with the following items:

(a)	An official transcript under seal showing the date of graduation and degree awarded from an accredited dental hygiene school certified by the appropriate officials;

(b)	A certified copy of the results of the clinical examination given by the board or a testing agency designated and approved by the board;

(c)	Copies of score of the National Board Examination;

(d)	Proof of current CPR certification;

(e)	Copies of any and all National Practitioner's Data Bank reports pertaining to the applicant;

(f)	Furnish a criminal background check. The applicant shall be responsible for all fees associated with the performance of a background check; and

(g)	Verification of licensure from all states where the applicant has ever held or currently holds a license to practice dental hygiene. All such licenses shall be unencumbered by any past or present disciplinary action.

(h)	In accordance with O.C.G.A. § 50-36-1, all applicants applying for licensure must submit an Affidavit Regarding Citizenship and submit a copy of secure and verifiable documentation supporting the Affidavit with his or her application.

Rule 150-5-.03 Supervision of Dental Hygienists

(1)

Definitions.

(a)	"Authorizing dentist" shall mean a dentist licensed to practice in Georgia who permits a dental hygienist to practice under general supervision.

(b)	"Dental hygiene duties" and "dental hygiene services" shall mean those tasks which a dental hygienist may lawfully perform under O.C.G.A. § 43-11-74 and this Rule

(c)	"Dental hygienist" shall mean an individual licensed to practice dental hygiene in Georgia.

(d)	"Dental screening" shall mean a visual assessment of the oral cavity without the use of x-rays, laboratory tests, or diagnostic models to determine if it appears that a more thorough clinical examination and diagnosis should be conducted by a licensed dentist.

(e)	"Dentist" shall mean an individual licensed to practice dentistry in Georgia.

(f)

"Direct supervision" shall mean that a licensed dentist is in the dental office or treatment facility, personally diagnoses the condition to be treated, personally authorizes the procedure and remains in the dental office or treatment facility while the procedure is being performed by the dental hygienist, and before dismissal of the patient, examines the patient.

(g)	"General supervision" shall mean that a licensed dentist has authorized the delegable duties of a dental hygienist but does not require that a licensed dentist be present when such duties are performed.

(2)	No dentist shall be required to authorize a dental hygienist to perform dental hygiene duties under general supervision, and no part of this Rule shall be construed as to establish independent dental hygiene practice.

(3)	A dental hygienist shall perform duties only under the direct supervision of a duly licensed dentist who is licensed to practice in the State of Georgia, except where otherwise provided in O.C.G.A. § 43-11-74 and this rule.

(4)

The requirement of direct supervision shall not apply to:

(a)	The educational training of dental hygiene students at an institution approved by the Board and the Commission on Dental Accreditation of the American Dental Association, or its successor agency.

(b)

The performance of dental hygiene duties at approved dental facilities of the Department of Public Health, county boards of health, or the Department of Corrections, or the performance of dental hygiene duties by personnel of the Department of Public Health or county boards of health at approved off-site locations.

(c)

The performance of dental hygienists providing dental screenings in settings which include: schools; hospitals; clinics; state, county, local, and federal public health programs; federally qualified health centers; volunteer community health settings; senior centers; family violence shelters, as defined in O.C.G.A. § 19-13-20; and free health clinics, as defined in O.C.G.A. § 51-1-29.4. Other health fair settings must be pre-approved by the board.

1.

School settings.

(i)

School settings shall include only schools that are Title I schools under the federal Elementary and Secondary Education Act, schools in which at least 65% of the student population is eligible for free or reduced price lunch under federal guidelines, Head Start programs, and Georgia's Pre-K Program.

(ii)

Dental hygienists may apply topical fluoride and perform the application of sealants and oral prophylaxis under general supervision, with written permission of the student's parent or guardian. A dental hygienist may also, without prior written permission of the student's parent or guardian, provide oral hygiene instruction and counseling.

(iii)

A dental hygienist and the authorizing dentist shall maintain the confidentiality of any records related to services provided to a student under subparagraph (4)(c) in compliance with laws including without limitation the federal Family Education Rights and Privacy Act of 1974, 20 U.S.C. Section 1232g.

2.

Hospitals; nursing homes; long-term care facilities; rural health clinics; federally qualified health centers, health facilities operated by federal, state, county or local governments; hospices; family violence shelters, as defined in O.C.G.A. § 19-13-20; and free health clinics, as defined in O.C.G.A. § 51-1-29.4.

(i)	Dental hygienists may apply topical fluoride and perform the application of sealants and oral prophylaxis under general supervision.

3.

A dental hygienist performing duties under subparagraphs (4)(c)(1.) or (4)(c)(2.) shall:

(i)

Not perform any dental hygiene services on a patient that has dental pain or clearly visible evidence of widespread dental disease. The dental hygienist shall immediately refer such patient to the authorizing dentist for clinical examination and treatment. The dental hygienist shall notate such patient's file, and the patient shall not be eligible to receive dental hygiene services under subparagraphs (4)(c)(1.) or (4)(c)(2.) until a dentist provides written authorization that such services may be performed on the patient.

(ii)

Prior to providing any dental hygiene services, obtain, study, and comprehend the school's or facility's protocols and procedures regarding medical emergencies and implement and comply with such protocols and procedures if a medical emergency arises during the provision of dental hygiene services; and

(iii)

Provide to each patient receiving such services written notice containing:

(I)	The name and license number of the dental hygienist and the authorizing dentist;

(II)

Any dental hygiene issues that the dental hygienist identified during the performance of dental hygiene duties. If dental hygiene services are not performed on a patient under subparagraph (4)(c)(3.)(i), the written notice shall include a statement that the patient is not eligible to receive dental hygiene services until a clinical examination is performed by a dentist, and a dentist provides written authorization that services may be performed;

(III)

A statement advising each patient who receives dental hygiene services to seek a more thorough clinical examination by a dentist within 90 days, unless the authorizing dentist performed a clinical examination of the patient.

(iv)

Make all reasonable efforts to provide such written notice as required in subparagraph (4)(c)(3.)(iii) to parents or legal guardians of minors or incapacitated adults who receive dental hygiene services and to the long-term care facility or nursing home for residents of such facilities who receive dental hygiene services, as applicable.

(v)

Not charge a fee for a dental screening provided under subparagraph (4)(c), except where provided by an employee of the Department of Public Health or county boards of health. However, these fees must be paid directly to the Department of Public Health or that county board of health and not to the dental hygienist who performed the screening.

(vi)	Not require a school or facility receiving dental hygiene services under subparagraphs (4)(c)(1.) and (4)(c)(2.) to purchase any equipment.

(5)

General Supervision in a Private Office Setting.

(a)

A dental hygienist may perform only the following functions under general supervision:

1.	Application of sealants and oral prophylaxis and assessment;

2.	Fluoride treatment;

3.	Oral hygiene instruction and education; and

4.	Exposure and processing of radiographs if provided for by specific, individualized standing orders of the authorizing dentist, including any protocols regarding urgent dental issues that arise.

(b)

A dentist in a private dental office setting may authorize general supervision of a dental hygienist only upon meeting the following criteria:

1.	A new patient of record must be clinically examined by the authorizing dentist during the initial visit;

2.	A patient must be examined by the authorizing dentist at a minimum of twelve-month intervals; and

3.	A patient must be notified in advance of the appointment that the patient will be treated by the dental hygienist under general supervision without the authorizing dentist being present or being examined by the authorizing dentist.

(6)

A dental hygienist performing dental hygiene services under general supervision shall have at least two (2) years of experience in the practice of dental hygiene, shall be in compliance with the continuing education requirements under O.C.G.A. § 43-11-73.1 and the cardiopulmonary resuscitation certification requirements under O.C.G.A. § 43-11-73, shall be licensed in good standing, and shall maintain coverage under a professional liability occurrence or claims insurance policy with a policy limit minimum of $1,000,000.

(7)

In schools; hospitals; clinics; state, county, local, and federal public health programs; federally qualified health centers; volunteer community health settings; senior centers; family violence shelters, as defined in O.C.G.A. § 19-13-20; and free health clinics, as defined in O.C.G.A. § 51-1-29.4, it shall be in the sole discretion of the authorizing dentist as to whether to require an initial examination of the patient prior to the performance by a dental hygienist of dental hygiene services under general supervision.

(8)

A dentist may only authorize up to four dental hygienists total to provide dental hygiene services in any setting or number of settings at any one time. A dentist authorizing one or more dental hygienists to provide dental hygiene services under (4)(c)(1.) and (4)(c)(2.) shall practice dentistry and treat patients in a physical and operational dental office located in this State within 50 miles of the setting in which the dental hygiene services are to be provided under general supervision.

(9)	Dental hygiene services provided by dental hygienists in mobile dental vans shall always be provided under direct supervision.

(10)

In addition to routine duties and the procedures of any of the operations or procedures authorized in O.C.G.A. § 43-11-74, the following activities may be performed by a dental hygienist working under the direct supervision of a dentist:

(a)

All the duties that are usually performed by a dental assistant pursuant to Title 43, Chapter 11, Article 4 of the Official Code of Georgia Annotated and Chapter 150-9 of the Rules of the Georgia Board of Dentistry, under the limitations and stipulations set forth in Title 43, Chapter 11, Article 3 of the Official Code of Georgia Annotated and Chapter 150-5 of the Rules of the Georgia Board of Dentistry.

(b)	Take and mount oral x-rays;

(c)	Apply medications and/or solutions approved by the Board and prescribed by the dentist that can be applied by methods approved by the Board, be that by irrigation, tray, or insertion of bioresorbable materials;

(d)	Remove calcareous deposits, secretions, and stains from the surfaces of teeth. Ultrasonic technologies are authorized for use by dental hygienists;

(e)	Utilize techniques and materials necessary for the application of sealant(s) to pits of and fissures of teeth;

(f)	Perform root planning and curettage with hand instruments; and

(g)	Perform periodontal probing.

(11)

Nothing in these rules shall be construed as authorizing dental hygienists to utilize other techniques in the course of the performance of their duties, otherwise authorized by these rules. Only dentists licensed by the Georgia Board of Dentistry shall be authorized to perform procedures involving laser technology which alters tissue, creates thermal effect, or is intended to cut, coagulate, photocoagulate, vaporize, or ablate essentially any soft or hard tissues of the body. Additionally, only dentists licensed by the Board shall be authorized to perform procedures utilizing air abrasive technology, which is normally intended for cavity preparation or enamel removal. This is to be distinguished from "micro etching" and "air polishing" technologies which are intended for stain removal and roughening the surfaces of enamel to enhance bonding, similar to acid etching, (i.e., Micro etching and air polishing are technologies authorized for use by dental hygienists).

Rule 150-5-.04 CPR Requirements for Dental Hygienists

Dental hygienists shall maintain at all times during licensure and furnish to the Board, upon request, current certification in one and two rescuer CPR and management of obstructed airway for adults, children and infants as taught by the American Heart Association, the American Red Cross, the American Safety and Health Institute, the National Safety Council, EMS Safety Services, or other such agencies approved by the Board. Current certification is a condition for license renewal. Failure to maintain current CPR certification may serve as grounds to deny the renewal of a license and may also result in disciplinary action against the licensee. In response to an audit request, a dental hygienist shall be required to produce proof of CPR certification during the biennium for which the audit is being conducted.

Rule 150-5-.05 Requirements for Continuing Education for Dental Hygienists

(1)

Dental hygienists licensed to practice in the state of Georgia shall maintain and furnish to the Board, upon request, official documentation of having completed a minimum of twenty-two (22) hours of continuing education during each biennium. Official documentation shall be defined as documentation from an approved provider that verifies a licensee's attendance at a particular continuing education course. Official documentation of course attendance must be maintained by a dental hygienist for at least three (3) years following the end of the biennium during which the course was taken.

(a)	Compliance with all continuing education requirements is a condition for license renewal. Failure to complete all hours of mandatory continuing education shall serve as grounds to deny the renewal of a license and may also result in disciplinary action being taken against a licensee.

(b)

Upon its own motion, the Board may at any time randomly select a percentage of actively licensed dental hygienists for the purpose of auditing their compliance with the continuing education requirements of the Board. Those licensees selected for an audit shall submit official documentation of their compliance within thirty (30) days of receipt of the audit letter. Failure to respond to an audit request in a timely manner shall be grounds for disciplinary action against a licensee.

(c)

The continuing education requirements shall apply within the first biennium that a dental hygienist is licensed in Georgia. However, in order to meet the continuing education requirements during the first biennium, a newly licensed dental hygienist may submit as their continuing education hours proof of dental hygiene coursework taken within the previous two (2) years of the date of the renewal application from a university or other institution accredited by the Commission on Dental Accreditation of the American Dental Association. Following the first biennium that a dental hygienist is licensed in Georgia such licensees shall comply with the continuing education requirements set forth in Rule 150-5-.05(2) and (3).

(d)	The continuing education requirements shall not apply to dental hygienists who are on inactive status.

(e)	The continuing education requirements for dental hygienists holding volunteer licenses may be satisfied by compliance with this rule, or they may alternatively be satisfied by compliance with Rule 150-3-.10.

(2)	Coursework, including home study courses, sponsored or approved by any organization recognized under Rule 150-3-.09(2) will be accepted.

(3)

Course content:

(a)	All courses must reflect the professional needs of the hygienist providing quality dental health care to the public;

(b)	At least fifteen (15) hours of the minimum requirement must be scientific courses in the actual delivery of dental services to the patient or to the community;

(c)

Four (4) credit hours for successful completion of the CPR course required by Georgia law offered by the American Heart Association, the American Red Cross, the American Safety and Health Institute, the National Safety Council, EMS Safety Services, or other such agencies approved by the Board may be used to satisfy continuing education requirements per renewal period.

(d)

Up to eight (8) hours of continuing education per year may be obtained by assisting the Board with administering the clinical licensing examination or by assisting the Board with investigations of licensees. These hours shall be approved by the Continuing Education Committee of the Georgia Board of Dentistry and need not be sponsored by any agency or organization listed in 150-3-.09(2).

(e)

Up to five (5) hours of continuing education per biennium may be obtained by teaching dental hygiene at any ADA-approved educational facility. These hours shall be awarded, in writing, by the course director at the facility and approved by the Continuing Education Committee of the Georgia Board of Dentistry.

(f)

Up to five (5) hours of continuing education per biennium may be obtained by providing, uncompensated dental hygiene care at a public agency or institution, not for profit agency, not for profit institution, nonprofit corporation or not for profit association which provides dental hygiene services to indigent patients.

(g)	Up to ten (10) hours of continuing education per biennium may be obtained by members of the Georgia Board of Dentistry for member service, where one continuing education hour is credited for each five hours of Board service provided.

(4)

Criteria for receiving credit for attending an approved continuing education course:

(a)	Credit hours are not retroactive or cumulative. All credit hours must be received during the two (2) year period to which they are applied; and

(b)	One credit hour for each hour of course attendance will be allowed;

(c)	Only twelve hours of credit will be accepted per calendar day;

(d)	Effective January 1, 2008, at least eleven (11) of the required twenty-two (22) hours of credit must be acquired in person at an on-site course or seminar; you are not allowed to acquire all CE hours through on-line courses, electronic means, journal studies, etc.

(5)

Criteria for receiving credit for teaching an approved continuing education course:

(a)	Credit hours for teaching an approved course must be obtained and used during the biennium that the approved course is taught;

(b)

A dental hygienist that teaches an approved continuing education course is eligible to receive two (2) credit hours for each hour of coursework that he or she presents at a particular course.

Credit will be given for teaching a particular course on one occasion only. A maximum of five (5) credit hours per biennium may be obtained by a dental hygienist by whom an approved continuing education course is taught;

(c)

Only continuing education course designated in Rule 150-5.05(2) as being sponsored or approved by recognized organizations will be considered for credit pursuant to this subsection of the rule. Courses taught by a dental hygienist prior to or a part of the process of obtaining his or her R.D.H. shall not be eligible for consideration pursuant to this provision of the rule;

(d)

In the event that an audit is conducted of the continuing education hours of a dental hygienist who has taught a course approved by a recognized organization, the following shall be required to document the dental hygienists role in presenting a continuing education course:

1.	Documentation from an approved provider verifying that the dental hygienist presented an approved continuing education course;

2.	Documentation from an approved provider reflecting the content of the course;

3.	Documentation from an approved provider specifying the list of materials used as part of the course; and

4.	Documentation from an approved provider verifying the hours earned and the dates and times that the course in question was given.

(e)

In the event that an approved continuing education course is taught by more than one dental hygienist, continuing education credit will be given for those portions of course work in which the dental hygienist is directly involved and primarily responsible for the preparation and presentation thereof. Continuing education credit will not be available to a dental hygienist whose participation in preparing and presenting an approved course is not readily identifiable.

(6)

Criteria for receiving credit for providing uncompensated indigent dental hygiene care.

(a)

Up to five (5) hours of continuing education per biennium may be obtained by providing uncompensated dental hygiene care at a public agency or institution, not for profit agency, not for profit institution, nonprofit corporation or not for profit association which provides dental hygiene services to indigent patients.

(b)	Dental hygienists may receive one hour of continuing education for every four hours of indigent dental hygiene care the dental hygienist provides, up to five (5) hours. Such continuing education credits will be applied toward the dental hygienist's clinical courses.

(c)	All credit hours must be received during the two (2) year renewal period;

(d)	Dental hygienists shall at all times be required to meet the minimal standards of acceptable and prevailing practice in Georgia;

(e)

The Board shall have the right to request the following:

1.	Documentation from the organization indicating that the dental hygienist provided the services;

2.	Documentation from the organization that it provided medical and/or dental hygiene services to the indigent and/or those making up the underserved populations;

3.	Notarized verifications from the organization documenting the dental hygienist agreement not to receive compensation for the services provided;

4.	Documentation from the organization detailing the actual number of hours spent providing said services; and

5.	Documentation from the dental hygienist and/or organization verifying the services provided.

Rule 150-5-.06 Temporary Permits for Dental Hygienists

(1)	An applicant applying for a temporary permit must be currently licensed to practice as a dental hygienist in another state and meet the conditions as specified in O.C.G.A. §§ 43-11-70 and 43-11-71.

(2)	An application to take the required examination must have been completed and on file before the Board will consider an application for a temporary permit.

(3)	A person requesting a temporary permit must submit proof of current CPR certification in one and two rescuer and the management of obstructed airway for infant, child and adult.

(4)	It shall be the responsibility of the dental hygienist to inform the Board of the name of the dentist/employer where he/she will be practicing.

(5)	A temporary permit shall be valid from the date of issuance until the results of the first examination scheduled for the applicant are released.

(6)	If applicant fails the examination or fails to appear at the examination, the temporary permit shall automatically stand revoked, without a requirement of prior notice of such revocation.

(7)	No temporary permit will be issued to an applicant who has previously failed the examination.

(8)	No temporary permit shall be issued more than one time.

(9)	A temporary permit shall be posted and displayed in the place in which the dental hygienist is employed.

(10)	All fees are due at the time of making application. Fees are as shown in the schedule of fees adopted by the Board of Dentistry. Fees are not refundable.

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