REPORT TITLE:
Dental Hygienists


DESCRIPTION:
Establishes the educational requirements for the administration
of intra-oral block anesthesia by dental hygienists.  Establishes
documentation required for dental board certification of a
hygienist to administer anesthesia.  Establishes continuing
education program for dentists and dental hygienists.  (SB779
HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        779
THE SENATE                              S.B. NO.           S.D. 2
TWENTIETH LEGISLATURE, 1999                                H.D. 2
STATE OF HAWAII                                            
                                                             
________________________________________________________________
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                   A  BILL  FOR  AN  ACT

RELATING TO DENTAL HYGIENISTS.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Chapter 447, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to be appropriately designated and to
 
 3 read as follows:
 
 4      "§447-     Educational requirements for intra-oral block
 
 5 anesthesia.  (a)  The applicant for certification to administer
 
 6 intra-oral block anesthesia shall show proof that the applicant
 
 7 successfully completed a course of study that shall include the
 
 8 following categories of intra-oral infiltration local anesthesia
 
 9 and intra-oral block anesthesia:
 
10      (1)  Maxillary mandibular infiltration anesthesia;
 
11      (2)  Long buccal nerve block anesthesia;
 
12      (3)  Mental nerve block;
 
13      (4)  Inferior alveolar/lingual nerve block;
 
14      (5)  Incisive nerve block;
 
15      (6)  Posterior superior alveolar nerve block;
 
16      (7)  Middle superior alveolar nerve block;
 
17      (8)  Anterior superior alveolar nerve block;
 
18      (9)  Nasopalatine (incisive canal) nerve block; and
 
19     (10)  Greater (anterior) palatine nerve block.
 

 
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 1      (b)  A course of study shall also include didactic studies
 
 2 and clinical experience, and for intra-oral block anesthesia
 
 3 categories in subsection (a)(1) to (10), at least thirty-nine
 
 4 hours, and a minimum of fifty successful injections of which ten
 
 5 shall be in intra-oral block in subsection (a)(4) and five in
 
 6 intra-oral block in subsection (a)(6).
 
 7      (c)  The curriculum of the course of study shall include as
 
 8 follows:
 
 9      (1)  Cardiopulmonary resuscitation certification;
 
10      (2)  Medical history evaluation procedures;
 
11      (3)  Physical evaluation procedures;
 
12      (4)  Anatomy of head, neck, and oral cavity as it relates to
 
13           administering local anesthetic agents;
 
14      (5)  Pharmacology of local anesthetics and vasoconstrictors;
 
15      (6)  Indications and contraindications for administration of
 
16           local anesthetics;
 
17      (7)  Prevention, diagnosis, and management of medical
 
18           emergency;
 
19      (8)  Recognition and management of post-injection
 
20           complications and management of reactions to
 
21           injections;
 
22      (9)  Medical and legal management complications;
 

 
 
 
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 1     (10)  Selection and preparation of the armamenteria and
 
 2           recordkeeping for administering various local
 
 3           anesthetics;
 
 4     (11)  Methods of administering local anesthetics with
 
 5           emphasis on technique, which includes aspiration and
 
 6           slow injection, in addition to minimum effective
 
 7           dosage; and
 
 8     (12)  Proper infection control techniques with regard to
 
 9           local anesthesia and the proper disposal of sharps.
 
10      (d)  As part of the course of study, the applicant or
 
11 licensed dental hygienist shall be required to pass an
 
12 examination to determine if the applicant or licensed dental
 
13 hygienist has acquired the necessary knowledge and clinical
 
14 proficiency to administer intra-oral block anesthesia.
 
15      (e)  The board of dental examiners may adopt rules pursuant
 
16 to chapter 91, relating to the education and certification of
 
17 dental hygienists to administer intra-oral block anesthesia."
 
18      SECTION 2.  Chapter 448, Hawaii Revised Statutes, is amended
 
19 by adding a new section to be appropriately designated and to
 
20 read as follows:
 
21      "§448-    Continuing education requirements.  The board
 
22 shall adopt a program of continuing education for dentists and a
 
23 program of continuing education for dental hygienists.  After
 

 
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 1 January 1, 2002, at the time of reregistration of license as a
 
 2 dentist or dental hygienist, each licensee shall present to the
 
 3 board evidence of compliance with the program of continuing
 
 4 education applicable to their profession.  Failure to reregister
 
 5 and present evidence of compliance shall constitute a forfeiture
 
 6 of license, which may be restored only upon written application
 
 7 therefor and payment to the board of a restoration fee."
 
 8      SECTION 3.  Section 447-1, Hawaii Revised Statutes, is
 
 9 amended to read as follows:
 
10      "§447-1 Who may become dental hygienists; fees.  (a)  Any
 
11 person:
 
12      (1)  Eighteen years of age or over;
 
13      (2)  Holding and having a diploma or proper certificate of
 
14           graduation from a dental hygiene school accredited by
 
15           the American Dental Association (A.D.A.) Commission on
 
16           Dental Accreditation requiring at least a two year
 
17           course, recognized by the board of dental examiners;
 
18           and
 
19      (3)  Having been officially certified in the administration
 
20           of intra-oral infiltration local anesthesia and intra-
 
21           oral block anesthesia by an accredited dental hygiene
 
22           school or by a certification program previously
 
23           approved by the board;
 

 
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 1 upon written application made to and filed with the board at
 
 2 least sixty days prior to the date selected by the board for the
 
 3 examination, may be examined by the board for qualification as a
 
 4 dental hygienist.
 
 5      The application for examination shall be accompanied by the
 
 6 applicant's certificate of graduation from an accredited dental
 
 7 hygiene school together with documentary proof of the applicant's
 
 8 certification in the administration of intra-oral infiltration
 
 9 local anesthesia and intra-oral block anesthesia.  At the time of
 
10 filing the application, the applicant shall pay to the board
 
11 application and examination fees, which fees, together with all
 
12 other fees or charges in this chapter, shall be as provided in
 
13 rules adopted by the director of commerce and consumer affairs
 
14 pursuant to chapter 91, and shall be deposited to the credit of
 
15 the compliance resolution fund established pursuant to section
 
16 26-9(o).
 
17      (b)  Two examinations shall be held in each year at the time
 
18 the board designates.  The examinations shall cover subjects
 
19 considered essential by the board for a dental hygienist and
 
20 shall likewise include a practical examination on the removal of
 
21 deposits or stains from the surfaces of the teeth.  The board
 
22 shall furnish a chair and engine, but the applicant shall supply
 
23 all necessary instruments, materials, and patients for the
 
24 examination.
 

 
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 1      (c)  If the applicant successfully passes the examination,
 
 2 the applicant shall be [registered and receive a certificate of
 
 3 ability] licensed to practice as a dental hygienist in the State.
 
 4 Every [registered] licensed dental hygienist, before entering
 
 5 practice, shall pay the board a [registration] license fee.  On
 
 6 or before December 31 of each odd-numbered year, every
 
 7 [registered] licensed dental hygienist desiring to begin or
 
 8 continue to practice in the State shall pay to the board a fee
 
 9 for the biennial [registration] licensure thereof.  The failure,
 
10 neglect, or refusal of any duly licensed dental hygienist to pay
 
11 the biennial [registration] licensure fee shall constitute a
 
12 forfeiture of the license, but the license may be restored upon
 
13 written application therefor and payment to the board of a
 
14 restoration fee.
 
15      (d)  An applicant's or licensed dental hygienist's
 
16 competence to administer intra-oral infiltration local anesthesia
 
17 shall be demonstrated by certification in the administration of
 
18 intra-oral infiltration local anesthesia by an accredited dental
 
19 hygiene school or by a certification program previously approved
 
20 by the board.  In addition, an applicant's or licensed dental
 
21 hygienist's competence to administer intra-oral block anesthesia
 
22 shall be demonstrated by proof of successful completion of a
 
23 course of study in accordance with standards provided for in this
 

 
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 1 chapter, and the issuance of a certificate or other program
 
 2 documentation listing the intra-oral block anesthesia categories
 
 3 in which the applicant or licensed dental hygienist has acquired
 
 4 knowledge and proficiency.
 
 5      The applicant or licensed dental hygienist shall also submit
 
 6 documentation of the course content when submitting the
 
 7 certificate.  The board shall certify that the applicant or
 
 8 licensed dental hygienist has met the requirements of this
 
 9 chapter; provided that the licensed dental hygienist's
 
10 administration of intra-oral block anesthesia shall be under the
 
11 direct supervision of a licensed dentist and shall be for those
 
12 categories of intra-oral block anesthesia listed on the course of
 
13 study certificate submitted to the board.
 
14      [(d)] (e)  No person shall practice dental hygiene, either
 
15 gratuitously or for pay, or shall offer or attempt so to
 
16 practice, or shall advertise or announce publicly or privately as
 
17 being prepared or qualified so to practice, without having a
 
18 license as in this section provided, nor shall any licensed
 
19 dental hygienist practice except under the supervision of a
 
20 licensed dentist as in this chapter provided." 
 
21      SECTION 4.  Section 447-3, Hawaii Revised Statutes, is
 
22 amended by amending subsection (b) to read as follows:
 

 
 
 
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 1      "(b)  Clinical dental hygiene may be practiced by a licensed
 
 2 dental hygienist.  The practice of clinical dental hygiene is
 
 3 defined as the removal of hard and soft deposits and stains from
 
 4 the portion of the crown and root surfaces to the depth of the
 
 5 gingival sulcus, polishing natural and restored surfaces of
 
 6 teeth, the application of preventive chemical agents to the
 
 7 coronal surfaces of teeth, which chemical agents have been
 
 8 approved by the board of dental examiners, and the use of mouth
 
 9 washes as are approved by the board, but shall not include the
 
10 performing of any repair work or the preparation thereof, or any
 
11 other operation on the teeth or tissues of the mouth; provided
 
12 that nothing herein shall prohibit a dental hygienist from using
 
13 or applying topically any chemical agent which has been approved
 
14 in writing by the department of health for any of the purposes
 
15 set forth in part V of chapter 321, and other procedures
 
16 delegated by [the] a dentist in accordance with the rules of the
 
17 board of dental examiners.
 
18      In addition, a licensed dental hygienist may administer
 
19 intra-oral infiltration local anesthesia and intra-oral block
 
20 anesthesia under the direct supervision of a dentist [upon
 
21 providing documentary proof satisfactory to the board of
 
22 certification in the administration of these procedures.] after
 
23 being certified by the board, and for those categories of intra-
 

 
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 1 oral infiltration local anesthesia and intra-oral block
 
 2 anesthesia for which the licensed dental hygienist has been
 
 3 certified through a course of study meeting the requirements of
 
 4 this chapter."
 
 5      SECTION 5.  If any provision of this Act, or its application
 
 6 to any person or circumstance is held invalid, the invalidity
 
 7 does not affect other provisions or applications of this Act
 
 8 which can be given effect without the invalid provision or
 
 9 application, and to this end the provisions of this Act are
 
10 severable.
 
11      SECTION 6.  Statutory material to be repealed is bracketed.
 
12 New statutory material is underscored.
 
13      SECTION 7.  This Act shall take effect upon its approval.