234 CMR 5.00:REQUIREMENTSFORTHEPRACTICEOFDENTISTRYANDDENTAL
HYGIENE
Section
5.01: Purpose
5.02: GeneralRequirements for the Conduct of aDental Practice5.03: Dental Specialties
5.04: Posting ofLicenses and Permits, and Identification of Personnel
5.05: InfectionControl,OccupationalSafetyandHealthStandards, andRadiationControlRequirements
5.06: Controlled Substances
5.07: Dental HygienePracticeand Public Health DentalHygienist Practice
5.08: Collaborative AgreementwithaPublicHealthDentalHygienist
(5.09: Dental Assistants: Reserved)
5.10: RequirementsforTrainingin Radiology5.11: Delegation of Duties
5.12: DelegableProcedures
5.13: Non-delegableDental Duties
5.14: PatientRecords:Content,Confidentiality,Retention,andAvailability
5.15: Content of Patient Records
5.16: EmergencyProtocol
5.17: Reporting ofPatient Deaths in DentalFacilities
5.18: Inspection of Facilities and Requirements for CorrectiveAction5.19: Advertising
5.20: PrinciplesofEthicsandCodeofProfessionalConduct5.21: Prohibited Practices
5.01: Purpose
The purposeof 234 CMR 5.00 is to set forth the standards and requirements that licenseesoftheBoardmustcomplywithinthepracticeofdentistryanddentalhygieneintheCommonwealth.
5.02: GeneralRequirements for the Conduct of aDental Practice
(1)Anypersonwhoowns,leases,maintains,oroperatesadentalpracticeinanyfacilityorroom(s)wheredentalservicesareprovided,ordirectlyorindirectlyisdirector,proprietororconductorofsame,isrequiredtoconductsuchdentalpracticeinaccordancewithM.G.L.c.112,
§§43through53and234CMR.
(2)AdentalpracticenotwhollyownedbyadentistordentistslicensedtopracticedentistryintheCommonwealthshallbelicensedasadentalclinicorhospitalpursuanttoM.G.L.c.111,
§ 51 unless it is exempt from such licensurepursuant to M.G.L. c. 111, § 52.
(3)Theowner(s)ofadentalpracticewhereanynon-ownerdentistpracticesdentistryshalldesignateadentistwhoholdsavalidlicenseissuedpursuanttoM.G.L.c.112,§45toactasDentalDirector.TheappointmentofaDentalDirectorshallnotabsolveany ownerorotherlicenseepracticingatthesitefromensuringthatthedentalpracticeisestablished,maintainedandoperatedinaccordancewithstatutesandregulationsgoverningthepracticeofdentistryordentalhygieneintheCommonwealth.Anon-ownerdentistincludes,butisnotlimitedto,adentistwho works full-time, part-time or on atemporarybasis or as anindependentcontractor.
(a)ThenameoftheDentalDirectorandatleastoneoftheownerswhoisadentistlicensedtopracticedentistryintheCommonwealth shallbepostedateachpracticesiteina publicplacewhere a patient can observesuch notice.
(b)TheDentalDirectorshall,ataminimum,beresponsibleforimplementingpoliciesandprocedurestoensurecompliancewithlocalordinancesandstateandfederalstatutesandregulationsgoverningthe practice ofdentistryin areasincluding, but not limited to:
1.Licensure andqualifications ofdentistsanddentalauxiliaries;
2.Delegationofdutiestodentalauxiliariespursuantto234CMR;
3.Anesthesia administration as permitted bythe Board
5.02: continued
4.Stateandfederalcontrolledsubstancesrulesandregulations;
5.CDCguidelines,includingweeklysporetesting;
6.OSHAstandards;
7.Radiationcontrolrequirements;
8.Postingdentallicensesinthepractice;
9.Advertisingdentalservicesorfees;
10.Scheduleofequipmentanddrugstoensuretimelyinspections,maintenanceand
currentdrugs; and
11.Compliancewithapplicablelocal,stateandfederalregulationsandstatutes,including,butnotlimitedto,occupancycodes,firesafetycodes,anddisposalofhazardous waste.
5.03: Dental Specialties
(1)Adentistmayholdhim/herselfoutasanADAspecialistinaparticularareaofpracticeonlyif he/she:
(a)HascompletedaspecialtyeducationprogramapprovedbytheAmericanDentalAssociation(ADA)andtheCommissiononDentalAccreditationortheCommissiononDental Accreditation of Canada; and
(b)Iseligible for examination bya national specialtyboard recognized bythe ADA; or
(c)Is a diplomate of anational specialtyboard recognized bythe ADA.
(2)Adentistisprohibitedfromholdinghim/herselfoutindirectories,listingsorotherwrittenorelectronicpublicationsasapractitionerinanyspecialtyrecognizedbytheADAunlesshis/herpracticeislimitedonlytothespecialtyarea(s)thatisbeingadvertised,listed,orotherwisenotedor published.
5.04: Posting ofLicenses and Permits and Identification of Personnel
(1)Alicenseeshallposthis/hernameandcurrentlicense,orcopyofsaidlicenseineachlocation of practice in aplacewhere it can beobserved bythe public.
(2)Alicenseeshallposthis/herindividualanesthesiaandFacilityPermit,ifapplicable,ineachpractice site in a placewheretheycan beobserved bythe public.
(3)Alllicenseesanddentalauxiliariesprovidingdentalservicestoapatient,orassistingadentistinthedirectcareortreatmentofapatient,shallwearanametagwiththeindividual'sname andprofessional title and function.
5.05: InfectionControl,OccupationalSafetyandHealthStandards,andRadiationControl Requirements
(1)InfectionControlPractices.AllpersonslicensedbytheBoardandallpracticesprovidingdentalservicesarerequiredtooperateincompliance withthecurrent RecommendedInfectionControlInDentalHealth-CareSettings-2003,CentersforDiseaseControlandPrevention(CDC), U.S. Department of Health and Human Services,Atlanta.
(2)OccupationalHealthandSafetyPractices.AllpersonslicensedbytheBoardandallpracticesprovidingdentalservicesarerequiredtooperateincompliancewiththeOccupationalSafetyandHealthAdministrationStandardsat29CFR: OSHA Standards.
(3)RadiationControl.Allpersonslicensedby theBoardandalldentalpracticesprovidingdentalservicesutilizingradiologicalequipmentarerequiredtooperateandmaintainsuchequipmentincompliancewithMassachusettsRadiationControlProgramstatutesandregulations.
5.06: Controlled Substances
(1)Dentistsregisteredtodispense,administerandprescribeanycontrolledsubstancesshalldosoinaccordancewithM.G.L.c.94Cand105CMR700.00andallapplicablestateandfederalstatutesandregulations pertainingtocontrolledsubstances.
(2)Dentistsarelimitedtowritingprescriptionsforcontrolledsubstancesforlegitimatedentalpurposes in the usual courseof practiceand areprohibited from prescribingcontrolledsubstances in SchedulesII-IV for personal use.
(3)Exceptinanemergency,adentistisprohibitedfromprescribingScheduleIIcontrolledsubstancestoamemberofhis/herimmediatefamilyincludingaspouse(orequivalent),parent,child,sibling,parent-in-law,son/daughter-in-law,brother/sister-in-law,step-parent,step-child,step-sibling, orother relativepermanentlyresidingin the same residenceas the licensee.
(4)Prior to prescribing a hydrocodone-only extended release medication that is not in an abuse deterrent form, a licensee must
(a)Thoroughly assess the patient, including an evaluation of the patient’s risk factors, substance abuse history, presenting condition(s), current medication(s) and a check of the online Prescription Monitoring Program;
(b)Discuss the risks and benefits of the medication with the patient;
(c)Enter into a Pain Management Treatment Agreement with the patient that shall appropriately address drug screening, pill counts, safe storage and disposal and other requirements based on the patient’s diagnoses, treatment plan, and risk assessment;
(d)Supply a Letter of Medical Necessity as required by the Board of Registration in Pharmacy that includes the patient’s diagnoses and treatment plan, verifies that other pain management treatments have failed, indicates that a risk assessment was performed and that the licensee and the patient have entered into a Pain Management Treatment Agreement; and
(e)Document 234 CMR 5.06(4)(a)-(d) in the patient’s medical record.
The purpose of 234 CMR 5.06(4) is to enhance the public health and welfare by promoting optimum therapeutic outcomes, avoiding patient injury and eliminating medication errors. Nothing in 234 CMR 5.06(4) shall alter the standard of care a licensee must use when prescribing any Schedule II, III or IV controlled substance.
5.07: Dental HygienePracticeand Public Health DentalHygienist Practice
(1)Adentalhygienistmayprovidedentalserviceswhichareeducational,therapeutic,prophylactic andpreventiveinnatureasmaybe authorizedbythe Board andmayperformalltasksperformedbyadentalassistantunderthespecifictypeofsupervisionsetforthin234CMR
5.07.Adentalhygienistorpublichealthdentalhygienistmaynotperformactsorserviceswhichrequirediagnosisandtreatmentplanningfornon-dentalhygieneservices,surgicalorcuttingproceduresonhardorsofttissue,and/ortheprescriptionofmedications,unlessspecificallyauthorized in 234 CMR 5.07 and 5.12.
(2)EducationalRequirements for Public Health Dental HygienePractice.
(a)Priortopracticingasapublichealthdentalhygienistpursuantto234CMR2.03and5.08,adentalhygienistshallsuccessfullycompleteaminimumoftenhoursofcontinuingeducationasfollows:
1.Aminimumofsixhoursofhands-onexperienceinapublichealthsetting.AdentalhygienistwhohasdocumentationdemonstratingaminimumofsixhoursofhandsonexperienceinapublichealthsettingbetweenJanuary1,2005andAugust20,2010shallbedeemedtohavefulfilledthisrequirement.
2.Successfulcompletion,within24monthspriortocommencementofpracticeasapublic healthdentalhygienist,ofcontinuingeducationineachofthefollowingareas:
a.CDC Guidelines (234 CMR 2.00);
b.Risk Management forpractice in a public health setting; and
c.Managementofmedicalemergencies.
(b)Thepublichealthdentalhygienistshallpermanentlyretaindocumentationdemonstratingcompliancewith 234 CMR5.07(2)(a)and 5.08.
5.07: continued
(3)ApublichealthdentalhygienistpracticinginapublichealthsettingmayperformthosedentalserviceswhichareauthorizedbytheBoardpursuanttoM.G.L.c.112,§51,tobeprovidedinapublichealthsetting,pursuanttoawrittencollaborativeagreementthatcomplieswithrequirementsdescribedin234CMR5.08includingasignedaffidavitthatconfirmssuccessful completion of the continuingeducation required in 234 CMR 5.07(2).
(4)Aregistereddentalhygienistpracticinginapublichealthsettingmayprovidedentalhygieneservices,includingplacementofsealants,withoutfirsthavingadentistexaminethepatient,eitherpursuanttoawrittencollaborativeagreementthatcomplieswithrequirementsdescribed in 234CMR 5.08,orpursuantto astandingorderunder thegeneral supervision of adentist licensed pursuant to M.G.L. c. 112, § 45.
5.08: Collaborative Agreement withaPublicHealthDentalHygienist
A public health dental hygienist who holds avalidlicenseto practicedental hygiene in theCommonwealthissuedpursuanttoM.G.L.c.112,§51,andwhohascompletedtheappropriatetrainingrequiredbytheBoardandhaseitherthreeyearsoffull-timeoranequivalent4,500hoursofclinicalexperienceshallpracticeinaccordancewithBoardstatutesandregulationsandshallenterintoawrittencollaborativeagreementwithadentistwhoholdsavalidlicenseissuedpursuanttoM.G.L.c.112,§45orwiththeappropriatelocalorstategovernmentagencyorinstitution pursuanttoM.G.L. c.112,§51,whereadentistlicensedpursuanttoM.G.L.c.112,§ 45,isavailable toprovide theappropriate level of communication and consultation with thedentalhygienist to ensure patienthealthandsafety.
(1)Apublic healthdentalhygienistshall:
(a)Enterintoawrittencollaborativepracticewhichcomplieswiththerequirementsat234CMR5.08beforerenderingtreatment,advertising,orsolicitingpatientstoprovideanydentalhygieneservicesina public healthsettingpursuanttoacollaborative agreement;
(b)Maintaincontactanddocumentcommunicationwiththedentistwithwhomthepublichealthdentalhygienisthasenteredintoacollaborative agreement;
(c)Practice inaccordance withBoardrulesandregulations;
(d)Practiceinaccordancewithsystems,policiesandproceduresestablishedpursuanttoBoardstatute andregulations;
(e)Obtainwritten,signedinformedconsentofthepatientorlegalrepresentativewhichcomplieswithBoardregulationscontainedin234CMR5.08,informsthepatientorlegalrepresentativethattheservicesprovidedbythepublichealthdentalhygienistarenotasubstituteforadentalexaminationbyadentistandinformsthepatientthatthepatientorlegalrepresentativethatthepatientshouldobtain,orshouldhavehadadentalexaminationbya dentistwithin90days;
(f)ProvideeachpatientwithawrittenInformationSheetattheconclusionofthepatient'svisit. SaidInformationSheetshall,ataminimum, includethefollowing:
1.Results of the dental hygieneevaluation;
2.Thename(s)ofthepublichealthdentalhygienistsandanylicenseddentistandotherdentalauxiliarieswhoprovidedservices;
3.A description of the treatmentrenderedincluding, but not limited to, billed servicecodes andfeesassociated with treatment, and tooth numbers when appropriate;
4.Informationonhowtocontactthepublichealthdentalhygienist,dentalhealthservicesprogramdirector,mobiledentalfacilityorportabledentaloperationpermitholder(See234 CMR 7.00);
5.Ifnecessary,provide a referralforemergencyassessmentbyadentist;
6.Whenareferralismade,thepatientorlegalrepresentativeshallbereferredtothepatient'sregulardentistifoneisidentified.Ifnoneisidentified,thenthepatientorlegalrepresentativemustbeprovidedwiththenamesofdentist(s),communityhealthcenter(s)ordentalschoolclinic(s)locatedwithinareasonablegeographicdistancefromthepatient'shomeandwithwhomthepublichealthdentalhygienistordentalhealthservicesprogramhadcommunicatedwithregardingtheacceptance ofreferrals;
7.The name and signatureof the public health dental hygienist; and
8.Ifthepatientorlegalrepresentativehasgivenconsentforaninstitutionalfacility(e.g.school,nursinghome)toaccessthepatient'sdentalhealthrecords,thenthedentalhygienistshallalsoprovidetheinstitutionwithacopyoftheinformationsheet.
5.07: continued
(2)Adentistenteringintoacollaborativeagreementwithapublichealthdentalhygienist,may,butisnotrequiredto,providesubsequentdentaltreatmenttopatientsservedundersaid agreement.
(3)WrittenCollaborativeAgreement.Acollaborativeagreementbetweenapublichealthdentalhygienistandamunicipalityorstateagencyorinstitution,orwithalicenseddentistwhoholdsavalidlicenseissuedpursuantto M.G.L.c.112,§45shall,ataminimum,addressallofthefollowing:
(a)Identifybyname(s)thedentist(s)whoshallbeavailabletoprovidetheappropriatelevelofcommunicationandconsultationwiththepublichealthdentalhygienisttoensurepatienthealthandsafety;
(b)Describe,withspecificity,howcommunicationandconsultationbetweenthedentistandpublichealthdentalhygienistwillbeaccomplished,includingthefrequencyandarrangementsforback-upcoveragewhenthedentistisnotaccessibletoprovidecommunication and consultation(e.g., duringvacation, illness);
(c)Providethenames,licensenumbers,addresses,telephoneandfacsimilenumbers,andemergencycontactinformationforthedentist(s)andpublic healthdentalhygienist;
(d)Includeanattestationfromthepublichealthdentalhygienistwhichissignedunderthepainsandpenaltiesofperjurythatdescribesthepublichealthdentalhygienist'squalificationstopracticeasapublic healthdentalhygienistand explicitlystatesthatthe dentalhygienisthasaminimumofthreeyearsoffull-timeoranequivalentof4,500hoursofclinicalexperienceasaregistereddentalhygienistandhascompletedalltrainingrequiredbytheBoard;
(e)Identifyentity(ies)andgeographicarea(s)wherepublichealthdentalhygienistserviceswillbe providedpursuanttothe collaborative agreement;
(f)Specifythedentalhygieneprocedurestobeprovidedandthepopulationstobeservedpursuanttothe collaborative agreement;
(g)Specifyanddescriberesponsibilitiesfor creating, maintaining,storing,retrievingandprovidingfortheconfidentialityofpatientrecords;
(h)Specifyanddescriberesponsibilitiesforestablishingsystems,policiesandprocedurestoensurecompliancewithBoardregulations,includingbutnotlimitedtorequirementsof234CMR5.00and7.00asmaybeapplicable;
(i)Specifyanddescriberesponsibilitiesfordeveloping,implementing,andmaintainingemergencymedicalprotocolsandfortheprovisionofperiodicreviewandtrainingonsame;
(j)Includeanyconsiderationsforage-orprocedure-specificprotocolsasmaybedeemednecessarybythedentistorpublichealthdentalhygienist;
(k)Includeanyconsiderationsformedically-compromisedpatientsasmaybedeemednecessarybythedentistorpublichealthdentalhygienist;
(l)Outlineresponsibilitiesforbillingandreimbursementforservicesrenderedbythedentalhygienist in the public health setting, ifindicated;
(m)Identify aprocessforthepublichealthdentalhygienisttolegally obtainprescriptionproducts(e.g.chemotherapeutics,fluoridevarnish)pertinenttotheprovisionofdentalhygieneservicesandwhicharetobeutilizedwhenrenderingservicesinapublichealthsetting; and
(n)Term of the collaborativeagreement, if applicable.
(4)Thedentistandpublichealthdentalhygienistshallreviewandupdatethewrittencollaborative agreementatleastannually.
(5)Thedentistandpublichealthdentalhygienistshallimmediately notifyeachotherand,ifapplicable,themunicipality,stateagencyorinstitutioninvolvedinthecollaborativeagreementofanydisciplinaryactionimposedbytheBoardoranyothergovernmentalagencyagainsthis/her licenseto practice dentistryor dentalhygiene in the Commonwealth.
(6)Acopyofthewrittencollaborativeagreementshallbemaintainedbythemunicipality,stateagencyorinstitution,licenseddentist,andthepublichealthdentalhygienist.Uponwrittenrequest,saidagreementshallbemadeavailabletotheBoard,ortoapatientwhoreceivedtreatment pursuant to the agreement or his/her legalrepresentative.
5.08: continued
(7)Eachpublichealthdentalhygienistshall maintain thefollowingdatatobereportedtotheMassachusettsDepartmentofPublicHealth'sOfficeofOralHealthonformsandinaccordancewith proceduresand timelines established bythat office:
(a)Thedatesofeachsessionwithnameandaddressofthesitewherepublichealthdentalhygieneservices wereprovided; and
(b)Thenumberofpatientsservedandthetype(s)andquantity(ies)ofeachserviceprovided.
(5.09: Dental Assistants: Reserved)
5.10: RequirementsforTrainingin Radiology
(1)ARegisteredDentalHygienist(RDH),PublicHealthDentalHygienist(PHDH),ExpandedFunctionDentalAssistant(EFDA),CertifiedDentalAssistant(CDA)orFormally-trainedDentalAssistant(FTDA)maytakedentalradiographsonlyunderthesupervisionofadentistprovidedthatthedentalauxiliaryhassuccessfully completedacoursewithacurriculumthatcomplieswith CODA-standards for radiologicaltechniques and safeguards in dentistry.
(2)AnOn-the-jobTrainedDentalAssistant(OJT)maytakeradiographsonlyunderthedirectsupervisionofadentistandmusthavecompletedacourseinradiologicaltechniquesandsafeguardsandsuccessfullypassedtheDANBRadiationHealthandSafetyExamination(RHS),or other examination as approved bythe Board,within one yearof the coursecompletion.
5.11: Delegation of Duties
(3)AdentistlicensedtopracticedentistryintheCommonwealthpursuanttoM.G.L.c.112,
§45maydelegatecertaindentaldutiessetforthinthissectiontoadentalauxiliarywhoisproperlyeducated,trained, and qualified as specified in Board statutes and regulations.
(4)Thesupervisingdentistshallberesponsibleforalldelegatedactsandproceduresperformedbythedentalauxiliary.Anydentistwhodelegatesaproceduretoanauxiliarywhodoesnotmeettherequirementsnecessarytoperformthatproceduremaybesubjecttodisciplinaryactionbythe Board.
5.12: DelegableProcedures
RegisteredDentalHygienists(RDH),PublicHealthDentalHygienist(PHDH),ExpandedFunctionDentalAssistant(EFDA),CertifiedDentalAssistant(CDA),Formally-TrainedDentalAssistant(FTDA),andOn-the-JobTrainedDentalAssistant(OJT)andmayperformthefollowingdentalprocedurespursuanttothedesignatedlevelofsupervisionordirection:GeneralSupervision(G),CollaborativeAgreement(CA),DirectSupervision(D),ImmediateSupervision
(I) or Delegation Not Allowed (N/A).
DELEGATEDDUTY / RDH / PHDH / EFDA / CDA / FTDA / OJT(1) / Reviewmedicalanddentalhistoryandconsultwhen
necessarywithmedicalpractitioner / G / CA / G / G / G / G
(2) / Performpreliminaryevaluationtodetermineneeded
dentalhygieneservices / G / CA / N/A / N/A / N/A / N/A
(3) / Makereferralstodentists,physicians,andother
practitionersinconsultationwithadentist / G / CA / N/A / N/A / N/A / N/A
(4) / Provideoralhealthinstruction / G / CA / G / G / G / G
(5) / Performdietaryscreeningfordentaldisease
preventionandcontrol / G / CA / G / G / G / G
(6) / Conductdentalscreenings / G / CA / N/A / N/A / N/A / N/A
(7) / Recorddentalscreenings / G / CA / D / D / D / D
(8) / Exposeradiographs / G / CA / G / G / D / D
(9) / Evaluateradiographsforprovisionofdentalhygiene
services / G / CA / N/A / N/A / N/A / N/A
(10) / Takeintra-oralphotographs / G / CA / G / G / G / G
(11) / Performandrecordchartingoftheoralcavityand surroundingstructures,includingbutnotlimitedto,
existingdentalrestorations,lesionsandperiodontalprobingdepths / G / CA / N/A / N/A / N/A / N/A
5.12: continued
DELEGATEDDUTY / RDH / PHDH / EFDA / CDA / FTDA / OJT(12) / Recordchartingoftheoralcavityandsurroundingstructures,includingbutnotlimitedto,dental
restorations,lesionsandperiodontalprobingdepths / G / CA / D / D / D / D
(13) / Takeandrecordvitalsigns / G / CA / G / G / G / G
(14) / Performminoremergencydentureadjustmentsto
eliminatepainanddiscomfortinnursinghomesandotherresidentialorlongtermcarefacilities / G / CA / N/A / N/A / N/A / N/A
(15) / Performpulptesting / D / N/A / N/A / N/A / N/A / N/A
(16) / Applyanti-cariogenicagents,includingfluoride
varnish / G / CA / G / G / G / D
(17) / Applytopicalanestheticagents / G / CA / I / I / I / I
(18) / Applyandadjustdentalsealants / G / CA / I / I / I / N/A
(19) / Takeimpressionsforstudycasts,biteregistrations,includingforidentificationpurposes,nightguards,
andcustomfluorideandbleachingtrayspursuanttoa
dentist’sprescriptionororder / G / CA / G / G / G / I
(20) / Takeimpressionsforathleticmouthguards / G / CA / G / G / G / I
(21) / Retractlips,cheek,tongueandotheroraltissueparts / G / CA / G / G / G / G
(22) / Irrigateandaspiratetheoralcavity / G / CA / D / D / D / D
(23) / Re-cementandadjustintacttemporaryrestorations
intra-orally / G / CA / G / D / D / N/A
(24) / Placetemporaryrestorations(notincluding
temporizationofinlays,on-lays,crowns,andbridges)toprovidepalliativetreatment / G / CA / G / D / D / I
(25) / Assistormonitornitrousoxideanalgesia / I / I / I / I / I / I
(26) / Placeandremovegingivalretractionmaterials / D / D / D / D / D / D
(27) / Applycavityvarnish,liner(s)andbondingagents / I / I / I / I / I / I
(28) / Applydesensitizingagents / G / CA / G / D / D / D
(29) / Placerestorativematerialsintoothforcondensation
andfinishingbythedentist / I / I / I / I / I / I
(30) / Removetemporaryrestorationswithhandinstruments / G / CA / G / I / I / N/A
(31) / Placeandremovewedges / G / CA / G / D / D / I
(32) / Placeandremovematrixbands / G / CA / G / D / D / I
(33) / Placeandremovedentaldams / G / CA / G / G / G / D
(34) / Placeandremoveperiodontaldressings / G / CA / G / G / G / N/A
(35) / Removesutures / G / CA / G / G / G / D
(36) / Removalofimplanthealingcaps/coverscrewsfor restorativeprocedures / I / I / I / I / I / I
(37) / Irrigateanddryrootcanalswithpaperpoints / I / I / I / I / I / I
(38) / Placecottonpelletsandtemporaryrestorative
materialsintoendodonticopenings / G / CA / G / D / D / D
(39) / Removeexcesscementandbondingagentsfrom
bridgesand applianceswithhandinstruments / G / CA / G / D / D / I
(40) / Cementandremovetemporarycrownsandbridges / G / CA / G / G / G / I
(41) / Insertand/orperformminoradjustmentofnightmouthguards,athleticmouthguards,andcustom
fluoridetrays / G / CA / G / G / G / I
(42) / Selectandadaptstainlesssteelcrownsorotherpre
formedcrownforinsertionbydentist / I / I / I / I / I / I
(43) / Performsub-gingivalandsupra-gingivalscaling / G / CA / N/A / N/A / N/A / N/A
(44) / Polishteeth,afterdentistordentalhygienisthas
determinedthatteetharefreeofcalculus,withslowspeedhandpiece / G / CA / G / G / G / N/A
(45) / Administerlocalanesthesiapursuantto234CMR
6.00 / D / D / N/A / N/A / N/A / N/A
5.12: continued
DELEGATEDDUTY / RDH / PHDH / EFDA / CDA / FTDA / OJT(46) / Performgrossdebridementand/orscalingandroot
planing / G / CA / N/A / N/A / N/A / N/A
(47) / Prepareandperformoralcytologicalsmearsorstudies / D / N/A / N/A / N/A / N/A / N/A
(48) / Usediagnosticandperiodonticnon-cuttinglasers / G / CA / N/A / N/A / N/A / N/A
(49) / PerformanyotherprocedureapprovedbytheBoard
OrthodonticProcedures:Performedonlypursuantto
anorthodontictreatmentplandevelopedbyadentist.
(50) / Takeimpressionsfororthodonticretainers / G / CA / G / G / G / D
(51) / Preliminaryintra-oralfitofbands / G / CA / G / G / G / D
(52) / Preliminaryoralfitofarchwire / G / CA / G / G / G / D
(53) / Selectsizeofheadgear / G / CA / G / G / G / D
(54) / Placeandremoveorthodonticseparators / G / CA / G / G / G / D
(55) / Placeandremoveorthodonticarchwires / G / CA / G / G / G / D
(56) / Etchappropriateenamelsurfacesbeforebondingof
orthodonticappliancesbyadentist / G / CA / G / G / G / D
(57) / Placeelasticsandligaturewires / G / CA / G / G / G / D
(58) / Removefixedorthodonticappliances / G / CA / G / G / G / D
(59) / Removeexcesscementandbondingagentsfrom
orthodonticapplianceswithhandinstruments / G / CA / G / G / G / D
(60) / Performminoremergencypalliativeorthodontic
adjustmentstoeliminatepainanddiscomfort / G / CA / G / G / G / D
5.13: Non-delegableDental Duties
Onlylicenseddentistsshall:
(1)Performfinaldiagnosesandtreatmentplanning;
(2)Performsurgicalorcuttingproceduresonhardorsofttissue;
(3)Prescribeorparenterallyadministerdrugsormedicaments;
(4)Prescribedentallabworkordersforanyapplianceorprostheticdeviceorrestorationtobeinsertedintoapatient'smouth;
(5)Operatehighspeedrotaryinstrumentsinthemouth;
(6)Performpulp-cappingprocedures;
(7)Takefinalimpressionsforfixedandremovableprostheticrestorationofteethororalstructures;
(8)Performfinal positioning andattachment of orthodontic bonds and bands;
(9)Performfinalcementationofcrownsandbridges
5.14: Patient Records:Content,Confidentiality,Retention,andAvailability
(1)ContentofPatientRecord.Patientrecordsinclude,butarenotlimitedto,dentalcharts,photographs,patienthistories,examinationandtestresults,diagnoses,treatmentplans,progressnotes,anesthesiacharts,orthodonticmodels,prescriptions,radiographs,patientconsents,andbilling records.
5.14: continued
(2)ConfidentialityofPatientRecords.Allpatientrecordsincluding,butnotlimitedto,dentalcharts,photographs,patienthistories,examinationandtestresults,diagnoses,treatmentplans,progressnotes,anesthesiacharts,orthodonticmodels,prescriptions,radiographs,patientconsents,andbillingrecordsofanypatienttreatedshallbemaintainedinamannerthatensuresconfidentialityandaccessforpatientsandauthorizedpractitionerswhomaywishtoobtainacopyofpatientrecords.
(3)RecordRetentionRequirement.Thelicenseeshallmaintainapatient'soriginaldentalrecordandoriginalradiographs(x rays)foraminimumofsevenyearsfromthedateofthelastpatient treatment.In addition, thepatientrecordofaminorshallberetainedfor aminimumofseven years fromthedateofthelastpatienttreatmentor three years fromwhen thepatienthasreached theage of majority,whichever is later.
(4)AvailabilityofDentalRecords.
(a)RequestforCopyofDentalRecord.Thelicenseeshallprovideuponrequestbyapatientoranotherspecificallyauthorizedperson,acompletecopyofthepatient'sdentalrecord in accordancewithM.G.L. c. 112, § 12CC. A copyof the patientrecord, includingradiographs,shallbeprovidedwithinareasonableamountoftimenottoexceed30calendardaysfromthedateoftherequest.Thelicenseemaychargeareasonablefeefortheexpenseofprovidingapatient'sdentalrecord,nottoexceedthecostofeitherlaborand/ormaterialsincurredinthecopyingofthepatientrecord,radiographsandmodels.Thelicenseeshallnotrequirepaymentfordentalservicesrenderedasaconditionofprovidingacopyofthedentalrecord.Adentistmayoffertoprovidethepatientwithasummaryofthepatient'srecord,butthe summaryshall not be in lieu of the complete patient record if requested.
(b)TreatmentinaSchoolSetting.Whereconsenthasbeengrantedbythepatientorlegalrepresentative,acopyofthepatient'sInformationSheetorotherwrittensummaryofthescreening,examination,ortreatmentshallbeprovidedtotheofficialdesignatedbytheschool.
(c)TreatmentinaNursingHomeorResidentialTreatmentFacility.Acopyofthepatient'sinformationsheetorotherwrittensummaryofthescreening,examination,ortreatmentshallbeprovidedtotheofficialdesignatedbythefacilityorinstitutionandshallbemadepartofthepatientrecordpursuanttothe applicablestateandfederalstatutesandregulations.
(d)Ifthelicenseediesandthepracticeisclosed,theestatemaynotifypatientstreatedwithinthetwoyearsprior to thedateofpassing.Said noticeshallinformpatients ofhowtheymayobtainacopy oftheirpatientrecord,includingradiographs.Noticemay beby awrittenlettertoeachpatient,byelectronicnotice,publicnoticeintheappropriatenewspaper,and/orbyothermeanswhichiswidelydisseminated.Acopyofsaidnoticemustbesubmitted to the Board upon issuance and/orpublication.
(e)Electronicpatientrecordsshallcomplywiththerequirementsof234CMR5.14and5.15andshallbe unalterableandproducible inpaperformuponrequest.
5.15: Content of Patient Records
(1)Thepatientrecordshallbeacompleterecordofallpatientcontact,including,butnotlimitedto,ageneraldescriptionofthepatient'smedicalanddentalhistoryandstatusattimeofexamination,diagnoses,patienteducation,treatmentplan,referralforspecialtytreatment,medicationsadministeredandprescribed,pre-andpost-treatmentinstructionsandinformationconveyed to the patient pursuant to M.G.L. c. 112, §§ 43 through 53 and 234 CMR 2.00.
(2)Patientrecordsshallbelegibleandclearinmeaningtoasubsequentexaminingortreatingdentist,thepatient,dentalauxiliariesorotherauthorizedpersons.
(3)At aminimum, a patient'srecord must include:
(a)Patient Information
1.Name,addressanddateofbirthofthepatient;
2.Ifthepatientisnotoftheageofmajority,thenameoftheparentorlegalrepresentative;
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3.Iftheparentsoftheminorchildareseparatedordivorced,thenameofthecustodialparent;
4.Ifthepatienthasalegalrepresentativepursuantto234CMR2.00,thenameandaddress of the legalrepresentative.
5.Whether the patient is an emancipated minor; and
6.Patient'stelephonenumbers(s)andelectronicmailaddresses,exceptifthepatientdeclines to providethis information.
(b)MedicalandDentalHistoryForm.Thepatient'smedicalhistoryanddentalhistoryshallinclude,butnotbe limitedto:
1.Areviewofpastandpresentillnesses, diseasesanddisabilities;
2.Systemicdisease(s)thatmayaffectthe oralcavity;
3.Currentprescriptionandnon-prescriptionmedicationsaswellasanyknowndrugallergies;
4.Documentationofconsultationwiththepatient'smedicalphysician(s)asappropriate;and
5.Dateofthepatient'slastdentalexamination,frequencyofdentalvisits,currenthomecare regime anddocumentation ofthe patient'sprimarydentalcomplaint, ifany.
6.Uponreviewofthepatient'smedicalanddentalhistory,anylicenseeordentalauxiliaryinthepracticetreatingthepatientshallsignanddatethemedicalanddentalhistory;
7.Ateachpatientvisit,thelicenseeshallinquireanddocumentandinitialinthepatientrecord,whetherthereareanychangesinthepatient'smedicalhistory,includingbutnotlimitedto,changesinprescriptionmedications.
(c)RecordofDentalExamination.Eachpatientrecordshallincludedocumentationoftheresultsofa comprehensiveclinicalexaminationofthefollowingareas:
1.Head and neck;
2.Radiographicimagesasnecessaryandappropriatetofacilitateacomprehensivediagnosis of the patient.Radiographsshall be clearlyidentified with the patient name,dateofexaminationandthenameofthedentist;
3.Intra-oralandextra-oralsofttissueexamination,includingchartingofexistingrestorations and current status of patient's hard and soft tissue;
4.Comprehensiveperiodontalscreening;
5.Oralcancerscreening;
6.Examination of the teeth;
7.Theresultsofanyotherexaminationperformedbythelicenseeand/ordentalauxiliaryasnecessaryandappropriatetofacilitatecomprehensivediagnosesofthepatient's dental status; and
8.Findings which are within or outside of normal limits.
(d)Diagnoses.Thepatientrecordshallincludewrittendiagnosesofthepatient'scurrentdentalstatusbasedontheevaluationofthepatient'smedicalanddentalhistory,dentalclinical examination and radiographicfindings.
(e)TreatmentPlan.Thepatientrecordshallincludeawrittentreatmentplandescribingindetailtheproposedtreatment.Theproposedtreatmentplanandinformationregardingestimatedfeesmustbereviewedwiththepatientpriortothecommencementoftreatment.Thetreatmentplanshallalsoincludereferralstospecialistsasnecessary.Ifthereisnotreatment plan this mustbe explained and documented in the patient record.
(f)GeneralandSpecificInformedConsent.Generaland/orspecificinformedconsentmustbeobtainedinwriting,signedanddatedfromthepatientorlegalrepresentativepriortotreatmentandshallnotbeobtainedfraudulentlyfromapatientunderduressorwhoisnotmentallycompetent, the age of majorityor an emancipated minor.
1.GeneralInformedConsent.Eachlicenseeshallobtainfromthepatientorlegalrepresentativegeneralinformedconsentallowingthelicenseetoexamine,diagnoseandtreatthepatient.Procedurescoveredbyageneralinformedconsentincludebasicrestorativeorpreventiveproceduresandpermissiontobillpatient'sinsurer,ifany. Thegeneralinformedconsentmayremainineffectuntiltreatmentisterminatedeitherbythelicenseeand/or the patient and the patient is no longerregarded as a patient of record.
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2.SpecificInformedConsent.Eachlicenseeshallobtainfromthepatientorthepatient'slegalrepresentativeaspecificinformedconsentallowingthelicenseetoperformspecializedtreatmentincluding,butnotlimitedto:administrationofanesthesiaotherthanlocalanesthesia,periodontal,endodontic,orthodontic,prostheticandoralandmaxillofacialprocedures,andspecializedtreatmentforpediatricpatients,includingbehaviormanagementtechniques.
3.AdditionalRequirementsforMobileDentalFacilities,PortableDentalOperations,andforLicenseesProvidingDentalServicesinaPublicHealthSetting.AnMDF,PDOasdefinedin234CMR7.03orlicenseeprovidingdentalservicesinapublichealthsettingshallobtainasignedwrittenconsentfromthepatientorlegalrepresentativewhichconforms to 234 CMR 5.15(3)(f)andalsoincludesthefollowing:
a.An explanation of the scope of services that maybe rendered;
b.Noticethatthepatientmaycontinuetoobtaindentalcarethroughanyotherprovider;
c.Notice thatthe treatmentofthepatientmayaffectthe future rightsandbenefitsduethepatientunderprivateinsurance,Medicaid,orthechildren'shealthinsuranceprogram;
d.Ifapplicable,arequestforpermissiontoallowthepatient'sdentalinsurancecarriertobe billedfortreatmentprovidedtothepatient;
e.Ifapplicableforservicesrenderedinapublichealthsetting,arequestforpermissiontoprovidetheofficialdesignatedbytheschool,nursinghome,residentialfacility, or institution with a written summaryof the examination; and
f.InformationonhowthepatientorlegalrepresentativecancontacttheMDForPDOpermit-holder,orpublic healthdentalservicesprogram.
(g)ProgressNotes.Thepatientrecordshallincludewrittendocumentationofthetreatmentprovidedbythedentistand/ordentalauxiliaryincludingbutnotlimitedto:
1.Administrationofmedicinesandmedicamentsincludingthetype,amount,androuteofadministration;
2.Astatementofservicesprovidedincludingpatientreaction,ifany,duringthetreatmentvisit,proceduresperformedanddiagnoses;
3.Adescriptionofthepre-andpost-treatmentinstructionsincluding,ifapplicable,plans forsubsequenttreatment;
4.Documentationofanyreferralforspecialtytreatment,includingthenameofthespecialist the patient is referred to; and
5.Adatedwrittenorelectronicsignaturebythedentistordentalauxiliarywhotreatedthepatient.
(h)ProstheticandOrthodonticPrescriptions.Allprostheticandorthodonticprescriptions,whetherfilledbythelicenseeorotherlaboratory,shallbewritteninaccordancewith
M.G.L.(copyto be retained bydentist) and include:
1.Name andaddress ofthe dentallaboratory;
2.Name,initialsoridentifyingnumberforthepatient;
3.Date;
4.Descriptionofthetreatmentandprocedures,includingplacementofthepatient'sname and/oridentifyingpatient number;
5.Specification of the type and qualityof materials to be used; and
6.Signature andlicense numberofthedentist.
(i)PatientFinancialRecord.Thepatient'sfinancialrecordshallinclude,butnotbelimitedto,thenameofthepatient'sdentalinsurer,documentationoffeesfortreatmentandpaymentschedule, and claims submitted to third parties.
5.16: EmergencyProtocol
Alldentalpracticesshall:
(1)Havea writtenprotocolformanagingmedicalordentalemergencies;
(2)Maintainacurrentemergencydrugkit;
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(3)Havecommunicationequipmentthatensuresrapidaccesstoemergency respondersandothers as necessary; and
(4)Ensurethat all staffaretrainedwhenhired,andatleastannuallythereafter,toimplementtheemergencyprotocols.
5.17: Reporting ofPatient Deaths in DentalFacilities
(1)Purpose.Alldentalpatientdeathsthatoccurinadentalfacilityorthatarepronounced inanotherfacility,e.g.hospitaltowhichthedentalpatienthasbeentransportedfromadentalfacility,mustbereportedtotheBoard.Thedentistwhowastreatingand/orresponsibleforsaidpatientmustsubmitawrittenreportdescribingtheeventtotheBoardbycertifiedmail,electronic mail, or facsimile within seven days.
(2)FailuretoComply.Thelicense,permit,orregistrationofthedentistresponsibleforsaidpatientmayberevoked,suspended,orplacedonprobationforfailuretocomplywiththisreportingrequirement.
5.18: Inspection of Facilities and Requirements for CorrectiveAction
(1)InspectionofDentalFacilities.TheBoardoritsdesignee(s)mayvisitadentalpracticeatanytimewithoutpriornoticeandconductaninspectiontodeterminecompliancewithstatelawM.G.L.c.112,§§43through53and§61and234CMR2.00orboth,oranystateorfederalstatutes or regulations relatingto the practice of dentistryand dentalhygiene.
(2)DeficiencyStatement. FollowingaBoardinspectionduringwhichanyviolationofM.G.L.c.112,§§43through53and234CMR2.00isfound,theBoardoritsdesignee(s)mayprepare adeficiencystatement citinganyand all violationsobserved, a copyof which shall besent to the licenseefor response.
(3)PlansofCorrection.ThelicenseeshallsubmittotheBoardawrittenplanofcorrectionforviolationscitedinadeficiencystatementwithinthetimespecifiedbytheBoard.Theplanofcorrectionshallsetforth,withrespecttoeachdeficiency,thespecificcorrectivestep(s)tobetaken,atimetableforsuchsteps,andthedatebywhichcompliancewillbeachieved.Thetimetableandthecompliancedatesshallbeconsistentwithachievementof compliance inthemostexpeditiousmannerpossible.Aplanofcorrectionwhichdoesnotmeetthe requirementsofthissectionshallbeconsideredunacceptablebytheBoardandmaybereturnedtothelicenseefor furthercorrection.
5.19: Advertising
(1)IllegalAdvertisingPractices.Adentistmayadvertisetruthfulandaccurateinformationpertainingtodentalservices.Unfair,misleading,deceptiveandfraudulentadvertisingisprohibited.
(2)AdvertisingDentalServicesandDentalFees.
(a)Adentalserviceisonethatadentistand/ordentalauxiliaryperformsforaspecificfee.
(b)Dentalservicesadvertisedasfreeornochargemustdescribethespecificservicesofferedand the comparativemonetaryvalue.
(c)Theperiodoftime duringwhichtheadvertisedfeeswill bein effect must be includedintheadvertisement.Advertisedfeesforalldentalservicesmustbeineffectforareasonableperiod of time from the initial date of the advertisement.
(3)ContentofAdvertisements.
(a)Anyadvertisementfordentalservices,regardlessofmedium,mustincludethefollowing:
1.Thenameofatleastoneownerofthepracticewhoiscurrentlylicensedtopracticedentistryin the Commonwealth; and
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2.If the dental practice is organized as a professional corporation pursuant to
M.G.L.c.156A,thenameofatleastoneoftheownerswhoislicensedtopracticedentistryin the Commonwealth.
(b)Theinformationdisclosedbytheadvertisingdentistinapublicationorabroadcastshallcomplywith M.G.L. c. 112, § 52A, and other provisions of 234 CMR 2.00.
5.20: Principles of Ethics and Code ofProfessional Conduct
Alldentists licensedbythe Board andallpractices providingdentalservicesshallcomplywiththePrinciplesofEthicsandCodeofProfessionalConduct,January2004oftheAmericanDentalAssociation,andallregistereddentalhygienistsshallcomplywiththeCodeofEthics,2006 of the American Dental Hygienists Association, Inc.
5.21: Prohibited Practices
Licenseesareprohibitedfromengaginginthefollowingpractices:
(1)Associatingorcooperatingwithanyperson,firmorcorporationinanymannerinaneffortto avoid or circumvent the intent or provisions of M.G.L. c. 112, §§ 43 through 53 and § 61;
(2)Payingoracceptingfeesinanyformormannerascompensationforreferringpatientstoanypersonforprofessionalservices,writtenworkorders,orotherservicesorarticlessuppliedtothepatient;
(3)Enteringintoanagreementorotherarrangementwitha personwhodoesnotholdavalidlicensetopracticedentistryintheCommonwealthwhichallowssaidpersonfinaldecision-makingauthorityoveranyofthefollowing:
(a)Selectionofacourse oftreatmentforapatient;
(b)Proceduresformaterialstobe usedaspartofsuchtreatment;
(c)Mannerinwhichtreatmentiscarriedoutbythelicensee;
(d)Professionalpractice decision-making;
(e)Patientrecords;
(f)Policiesanddecisionsrelatingto pricing,credit,refunds,warrantiesandadvertising;
(g)) Decisionsrelated to delegation of dental duties; and
(h)Controlandmaintenance ofdentalequipment,materialsandsupplies.
(4)Operatingorowningacommercialdentallaboratoryandcontinuingin the active practiceofdentistryexceptwhereadentistownsoroperatesaprivate,non-commercialdentallaboratoryforhis/herownuseandbenefit.Wherethelicenseeownsoroperatesaprivate,non-commercialdentallaboratoryandemploysadentaltechnician,thelicenseeshallprovidethedentaltechnicianawrittenworkorderwhichcontainsthedate,informationidentifyingthepatient(e.g.name,initials,or socialsecuritynumber), thedescriptionof theworktobedone,andaspecificationof the type and qualityof materials to be used. Thework ordershall be in duplicate, signed bythe dentist and a copybe retained in the patient record.
REGULATORYAUTHORITY:
234CMR5.00:M.G.L.c.112,§§12CC,43through53,61;c.94Candc.111,§§51and52.
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