§447-3  Employment of and practice by dental hygienists.  (a)  Any licensed dentist, legally incorporated eleemosynary dental dispensary or infirmary, private school, welfare center, hospital, nursing home, adult day care center or assisted living facility, mental institution, nonprofit health clinic, or the State or any county, may employ licensed dental hygienists.

     (b)  Clinical dental hygiene may be practiced by a licensed dental hygienist.  The practice of clinical dental hygiene is defined as the removal of hard and soft deposits and stains from the portion of the crown and root surfaces to the depth of the gingival sulcus, polishing natural and restored surfaces of teeth, the application of preventive chemical agents to the coronal surfaces of teeth, which chemical agents have been approved by the board of dentistry, and the use of mouth washes approved by the board, but shall not include the performing of any repair work or the preparation thereof, or any other operation on the teeth or tissues of the mouth; provided that nothing in this subsection shall prohibit a dental hygienist from using or applying topically any chemical agent which has been approved in writing by the department of health for any of the purposes set forth in part V of chapter 321, and other procedures delegated by a dentist in accordance with the rules of the board of dentistry.

     In addition, a licensed dental hygienist may administer intra-oral infiltration local anesthesia and intra-oral block anesthesia under the supervision of a dentist as provided in section 447-1(f) after being certified by the board, and for those categories of intra-oral infiltration local anesthesia and intra-oral block anesthesia for which the licensed dental hygienist has been certified through a course of study meeting the requirements of this chapter.

     (c)  A licensed dental hygienist may operate in the office of any licensed dentist, or legally incorporated eleemosynary dental dispensary or infirmary, private school, welfare center, hospital, nursing home, adult day care center or assisted living facility, mental institution, nonprofit health clinic, or in any building owned or occupied by the State or any county, but only under the aforesaid employment and under the direct or general supervision of a licensed dentist as provided in section 447‑1(f).  No dental hygienist may establish or operate any separate care facility which exclusively renders dental hygiene services.

     (d)  Notwithstanding section 447-1(f), a licensed dental hygienist may operate under the supervision of any licensed dentist providing dental services in a public health setting.  General supervision is permitted in a public health setting; provided that the supervising licensed dentist is available for consultation; provided further that a licensed dental hygienist shall not perform any irreversible procedure or administer any intra-oral block anesthesia under general supervision.  In a public health setting, the supervising licensed dentist shall be responsible for all delegated acts and procedures performed by a licensed dental hygienist.  Notwithstanding section 447-1(f), a licensed dental hygienist under the general supervision of a licensed dentist employed in a public health setting may perform dental education, dental screenings, teeth cleanings, intra-oral or extra-oral photographs, x-rays if indicated, and fluoride applications on individuals who are not yet patients of record, have not yet been examined by a licensed dentist, or do not have a treatment plan.  Other permissible duties shall be pre-screened and authorized by a supervising licensed dentist, subject to the dentist's determination that the equipment and facilities are appropriate and satisfactory to carry out the recommended treatment plan.  A licensed dental hygienist shall refer individuals not currently under the care of a dentist and who are seen in a public health setting to a dental facility for further dental care.  No direct reimbursements shall be provided to licensed dental hygienists.

     As used in this subsection, "public health setting" includes but is not limited to dental services in a legally incorporated eleemosynary dental dispensary or infirmary, private or public school, welfare center, community center, public housing, hospital, nursing home, adult day care center or assisted living facility, mental institution, nonprofit health clinic or facility, or the State or any county. [L 1920, c 7, §3; RL 1925, §1085; am L 1925, c 33, pt of §1; RL 1935, §1002; RL 1945, §2183; am L 1945, c 118, §3; RL 1955, §62-3; am L 1965, c 242, §1; HRS §447-3; am L 1970, c 30, §1; am L 1971, c 53, §1; am L 1985, c 285, §1; am L 1987, c 73, §2; am L 1989, c 232, §2; am L 1994, c 183, §3; am L 1997, c 9, §3; am L 1999, c 97, §4; am L 2002, c 231, §2; am L 2017, c 83, §3; am L 2018, c 139, §1 and c 203, §4]