PROPOSED RULEMAKING
[49 PA. CODE CH. 33]
Expanded Function Dental Assistants
[28 Pa.B. 3296] The State Board of Dentistry (Board) proposes to amend §§ 33.101--33.104, 33.107--33.109, 33.201, 33.209 and 33.211--33.212 and by adding §§ 33.120 and 33.205a, to read as set forth in Annex A relating to expanded function dental assistants.
A. Effective Date
The proposed amendments will be effective upon publication of final-form regulations in the Pennsylvania Bulletin.
B. Statutory Authority
The proposed amendments are governed by sections 2--5.1 , 10, 10.1, 11, 11.5 and 11.7 of the Dental Law (act) (63 P. S. §§ 121--124.1, 129--129.1, 130, 130e and 130h).
C. Background and Purpose
On December 27, 1994, the act was amended throughout to provide for Board certification and regulation of expanded function dental assistants. The proposal will incorporate the certification process into the Board's regulations and conform existing regulations to the act by including the new certification class of expanded function dental assistants.
D. Description of Amendments
Substantive Amendments
New § 33.102(c) (relating to professional education) would implement section 3(d.1)(1) of the act. Expanded function dental assistants would be required to satisfy one of three educational pathways:
1. Graduate from an expanded function dental assisting program at an accredited 2-year college or institution which offers an associate degree.
2. Graduate from an accredited dental hygiene school requiring the successful completion of at least 75 hours of clinical and didactic instruction in restorative functions.
3. Complete a certification program in expanded function dental assisting of at least 200 hours of clinical and didactic instruction from an accredited dental assisting program.
In developing these proposed amendments, the Board considered requiring accreditation by the Commission on Dental Accreditation of the American Dental Association (CODA) for each educational pathway, to parallel the requirements for dentists and dental hygienists. However, section 3(d.1)(1) of the act, recognizes varying accrediting bodies. Therefore, under the Board's proposal, 2-year colleges, under subsection (c)(1)(i), would be accredited by an accrediting agency approved by the United States Department of Education Council on Postsecondary Accreditation. Dental hygiene schools, under subsection (c)(1)(ii), would receive CODA accreditation. Dental assisting programs, under subsection (c)(1)(iii), would be accredited by either CODA or an accredited agency approved by the United States Department of Education Council on Postsecondary Accreditation whose expanded function educational standards are approved by the Board.
Proposed § 33.114 (relating to first certification examination), which implements section 11.7(b) of the act would establish the procedure for temporary permit holders to take the certification examination. All temporary permit holders would be first required to take that examination. Those who fail would be required to cease practicing and return their permits to the Board. Those who register for the examination and fail to appear would be deemed to have failed the examination, unless they have received a waiver from the Board due to illness or bereavement. Those who pass will be permitted to continue practicing pending receipt of their certificate.
New § 33.205a (relating to practice as an expanded function dental assistant) which implements section 2 of the act, would delineate the scope of practice. Proposed subsection (a) lists the procedures which expanded function dental assistants are statutorily authorized to perform. Each of these procedures may only be performed under the direct supervision of a dentist. Proposed subsection (b) would list the procedures which expanded function dental assistants are statutorily prohibited from performing.
Technical Amendments
Sections 33.101--33.104, 33.107--33.109, 33.201, 33.209 and 33.211--33.212 would be amended to add provisions for expanded function dental assistants similar to those currently in existence for dentists and dental hygienists.
E. Compliance with Executive Order 1996-1
In accordance with the requirements of Executive Order 1996-1 (February 6, 1996), in drafting and promulgating the regulation the Board solicited input and suggestions from the regulated community by providing drafts to organizations and entities which represent the professions, educational institutions and interested individuals.
F. Fiscal Impact and Paperwork Requirements
1. Commonwealth--There will be no adverse fiscal impact in creating this certification class because expanded function dental assistant applicants will be charged initial certification and biennial renewal fees. Additional paperwork will be incurred by the Board to generate and file application forms.
2. Political subdivisions--There will be no adverse fiscal impact or paperwork requirements imposed.
3. Private sector--The amendments should impose no additional fiscal requirements. Additional paperwork will be required of expanded function dental assistants in filing initial and renewal applications.
G. Sunset Date
The Board continuously monitors its regulations. Therefore, no sunset date has been assigned.
H. Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), on July 1, 1998, the Board submitted a copy of these proposed amendments to the Independent Regulatory Review Commission (IRRC) and the Chairpersons of the House Professional Licensure Committee and the Senate Consumer Protection and Professional Licensure Committee (Committees). In addition to submitting the proposed amendments, the Board has provided IRRC and the Committees with a copy of a detailed Regulatory Analysis Form prepared by the Board in compliance with Executive Order 1996-1, ''Regulatory Review and Promulgation.'' A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, if IRRC has objections to any portion of the proposed amendments, it will notify the Board within 10 days of the close of the Committees' review period. The notification shall specify the regulatory review criteria which have not been met by that portion. The Regulatory Review Act specifies detailed procedures for review of objections raised prior to final publication of the amendments by the Board, the General Assembly and the Governor.
I. Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding the proposed amendments to Judith Pachter Schulder, Counsel, State Board of Dentistry, 116 Pine Street, Post Office Box 2649, Harrisburg, PA 17105-2649, within 30 days of publication of this proposed rulemaking. Please reference No. 16A-465 (Expanded function dental assistant), when submitting comments.
EDWIN F. WEAVER, III, D.D.S.,
ChairpersonFiscal Note: 16A-465. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 33. STATE BOARD OF DENTISTRY
Subchapter B. LICENSURE OF DENTISTS AND DENTAL HYGIENISTS
AND CERTIFICATION OF EXPANDED FUNCTION DENTAL ASSISTANTS§ 33.101. General information.
* * * * * (b) Only persons holding a certificate issued by the Board may practice as an expanded function dental assistant in this Commonwealth.
(c) To secure a license [to practice dentistry or to practice as a dental hygienist] or certificate, an applicant shall satisfy the requirements of the act and of this subchapter.
[(c)] (d) Applications for licensure or certification shall be made on forms supplied by the Board and shall be accompanied by the application fee in § 33.3 (relating to fees).
§ 33.102. Professional education.
* * * * * (c) Expanded function dental assistants.
(1) Candidates for certification as expanded function dental assistants shall show compliance with 3(d.1) of the act (63 P. S. § 120(d.1)) by submitting verification of one of the following:
(i) Graduation from an expanded function dental assisting program at a 2-year college or other institution accredited or provisionally accredited by an accrediting agency approved by the United States Department of Education Council on Postsecondary Accreditation which offers an associate degree.
(ii) Graduation from a dental hygiene school which required the successful completion of at least 75 hours of clinical and didactic instruction in restorative functions accredited or provisionally accredited by the Commission on Accreditation of the American Dental Association.
(iii) Completion of a certification program in expanded function dental assisting of at least 200 hours of clinical and didactic instruction from a dental assisting program accredited by the Commission on Dental Accreditation of the American Dental Association or an accrediting agency approved by the United States Department of Education Council on Postsecondary Accreditation whose expanded function educational standards are approved by the Board.
(2) Candidates for certification who receive their professional education outside the United States may satisfy the education requirement by submitting their credentials to a program listed in paragraph (1) and obtaining additional training that will lead to the awarding of a degree by that school.
§ 33.103. Examinations.
* * * * * (c) Expanded function dental assistants. Candidates for certification shall pass an examination comprised of both a written and a clinical component acceptable to the Board.
(d) [NERB] Recognition of examinations. The Board will recognize successful completion of the NERB Dental or Dental Hygiene Examination or the expanded function dental assistant clinical examination for up to 5 years from the date scores are reported to the Board. After 5 years, the Board will accept [NERB] passing scores on the examinations only if the candidate for licensure has been engaged in [post-graduate] post graduate training or in the practice of dentistry [or], as a dental hygienist or as an expanded function dental assistant in another jurisdiction.
[(d) Effective date. Subsection (c) is effective June 24, 1996.]
§ 33.104. Initial licensure/certification; licensure/certification documents.
* * * * * (b) Each new certificate holder is issued a wall certificate indicating initial certification and a registration packet including a biennial renewal certificate and a wallet-size certification card that show the expiration date of the certificate. Certificates expire on March 31 of each odd-numbered year, regardless of the date of issuance.
(c) Fees as prescribed by the Bureau of Professional and Occupational Affairs Fee Act (63 P. S. §§ 1401-101--1401-501), shall be charged for duplicate wall certificates and biennial renewal documents. A duplicate will be issued only upon submission by the licensee or certificate holder of a notarized statement specifying why the original is unavailable and stating that the duplicate will be returned if the original is recovered.
§ 33.107. Licensure and certification by criteria approval.
Dentists [and], dental hygienists and expanded function dental assistants who are currently licensed or certified in another state or territory or in Canada may be granted licensure or certification in this Commonwealth if the credentials submitted meet the requirements of the act and of this subchapter. Licensure and certification by criteria approval will be granted only to applicants whose licensing boards confirm that they reciprocate with [Pennsylvania] the Commonwealth. An applicant shall cause the licensing authority of each state where the applicant has practiced to submit to the Board a letter of good standing. The Board may grant a personal interview to resolve questions concerning an applicant's qualifications.
§ 33.108. Transfers out-of-State.
Dentists [and], dental hygienists and expanded function dental assistants who wish their licensure, certification or grades certified to another state shall pay the [certification of licensure] fee [set out] in § 33.3 (relating to fees).
§ 33.109. Licensee's and certificate holder's change of name or address; service of process and legal papers.
(a) A licensee's or certificate holder's name on file with the Board shall be the name that appears on the license or certificate unless that name is legally changed, in which case the licensee or certificate holder shall report the change to the Board in writing within 10 days.
(b) A licensee or certificate holder who changes an address on file with the Board shall notify the Board in writing within 10 days. Licensees or certificate holders who do not comply with this subsection shall bear full responsibility for failure to receive correspondence, including biennial renewal notifications, from the Board or the Department.
(c) A licensee's or certificate holder's most recent name and address on file with the Board will be deemed the licensee's or certificate holder's official name and address for purposes of service of process and other legal papers.
§ 33.114. First certification examination.
(a) Temporary permit holders shall register and take the first expanded function dental assistant examination.
(b) Temporary permit holders who fail to register for the first examination shall immediately cease practicing as an expanded function dental assistant in this Commonwealth and return their temporary permits to the Board.
(c) Temporary permit holders who fail the first examination shall, upon notice, immediately cease practicing as an expanded function dental assistant in this Commonwealth and return their temporary permits to the Board.
(d) Temporary permit holders who register but fail to sit for the examination, shall be deemed to have failed the examination and shall forfeit their temporary permits unless granted a waiver under subsection (d).
(e) Temporary permit holders who fail to appear for the examination by reason of illness or bereavement shall apply to the Board for a waiver within 10 days of the examination. Documentation, including a letter from a physician supporting the applicant's claim of illness or bereavement, shall accompany the request for a waiver. A waiver which is granted will extend the temporary permit until the results of the next scheduled examination.
Subchapter C. MINIMUM STANDARDS OF CONDUCT AND PRACTICE § 33.201. Use of titles and other designations.
(a) Dentists [and], dental hygienists and expanded function dental assistants may use only the following titles when formally holding themselves out to the public as members of their respective professions:
* * * * * (3) Expanded function dental assistants. ''Expanded function dental assistant'' or ''EFDA'' when preceded by the certificate holder's name.
* * * * * (c) References in this section to the licensee's or certificate holder's name shall be interpreted to mean the name appearing on the licensee's or certificate holder's current [biennial renewal registration] license or certificate but to allow for the use of initials preceding the licensee's or certificate holder's surname.
§ 33.205a. Practice as an expanded function dental assistant.
(a) Scope of professional practice.
(1) An expanded function dental assistant may offer to perform or perform the following services:
(i) Placing and removing rubber dams.
(ii) Placing and removing matrices.
(iii) Placing and removing wedges.
(iv) Applying cavity liners and bases.
(v) Placing and condensing amalgam restorations.
(vi) Carving and contouring amalgam restorations.
(vii) Placing and finishing composite resin restorations.
(2) Each of the professional services identified in paragraph (1) shall be performed under the direct supervision of a dentist.
(b) Prohibitions. An expanded function dental assistant may not:
(1) Examine, diagnose or plan treatment.
(2) Cut hard or soft tissue.
(3) Prescribe drugs, medicaments or lab authorizations.
(4) Evaluate or adjust final occlusion.
(5) Perform pulp capping, pulpotomy and other endodontic procedures.
(6) Place or adjust fixed and removable prosthetic appliances.
(7) Administer local anesthesia, parenteral or inhalational sedation, nitrous oxide analgesia or general anesthesia.
§ 33.209. Preparing, maintaining and retaining patient records.
(a) A dentist shall maintain a dental record for each patient which accurately, legibly and completely reflects the evaluation and treatment of the patient. A patient dental record shall be prepared and maintained regardless of whether treatment is actually rendered or whether a fee is charged. The record shall include, at a minimum, the following:
* * * * * (4) A description of the treatment or service rendered at each visit and the identity of the [dentist or dental auxiliary] person rendering it.
* * * * * (8) The date of each entry into the record and the identity of the person providing the service if not the dentist of record--for example, dental hygienist, expanded function dental assistant, dental assistant, and the like.
* * * * * § 33.211. Unprofessional conduct.
* * * * * (c) Expanded function dental assistants. Unprofessional conduct, as defined in section 4.1(a)(8) of the act (63 P. S. § 123.1(a)(8)), includes the following conduct by an expanded function dental assistant:
(1) Practicing as an expanded function dental assistant without the direct supervision of a dentist.
(2) Performing a service that the expanded function dental assistant is not competent or not authorized to perform.
(3) Physically, sexually or verbally abusing a patient.
(4) Failing to follow current infection-control recommendations issued by the Federal Centers for Disease Control.
(5) Providing ionizing radiation in violation of § 33.302 (relating to auxiliary personnel performing radiologic procedures).
§ 33.212. Misleading, deceptive, untrue or fraudulent representations.
As used in section 4.1(a)(2) of the act (63 P. S. § 123.1(a)(2)), the phrase ''misleading, deceptive, untrue or fraudulent representations'' includes the following conduct by dentists [and], dental hygienists and expanded function dental assistants.
(1) Misrepresenting or concealing a material fact in obtaining [or], renewing [a license to practice dentistry or as a dental hygienist] or [in] seeking reinstatement of [the] a license or certificate.
* * * * *
[Pa.B. Doc. No. 98-1099. Filed for public inspection July 10, 1998, 9:00 a.m.]
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