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BOD Bill SB754 by Paxton
Bill Number: OK59RSB 754 SENATE FLOOR VERSION SENATE FLOOR VERSION 1 February 23, 2023 2 COMMITTEE SUBSTITUTE 3 FOR 4 SENATE BILL NO. 754 By: Paxton 5 An Act relating to the practice of dentistry; 6 amending 59 O.S. 2021, Section 328.3, which relates 7 to definitions used in the State Dental Act; 8 modifying and adding definitions; amending 59 O.S. 9 2021, Section 328.21, as amended by Section 3, 10 Chapter 158, O.S.L. 2022 (59 O.S. Supp. 2022, Section 11 328.21), which relates to application for license; 12 modifying allowed time period, type, and criteria of 13 examinations; adding available advanced procedures 14 for dental hygienist; specifying qualifications and 15 procedures for obtainment of advanced procedure 16 permit by credentials; amending 59 O.S. 2021, Section 17 328.22, which relates to specialty license; modifying 18 certain terminology and qualifications related to 19 specialty license; amending 59 O.S. 2021, Section 20 328.24, which relates to dental assistant permits; 21 adding expanded duty permits available to dental 22 assistants; broadening permitting provisions to apply 23 to oral maxillofacial surgery assistants; providing 24 for addition of expanded duties to licenses; amending 1
1 59 O.S. 2021, Section 328.32, as amended by Section 2 6, Chapter 158, O.S.L. 2022 (59 O.S. Supp. 2022, 3 Section 328.32), which relates to grounds for 4 penalties; modifying grounds for penalties; amending 5 59 O.S. 2021, Section 328.34, which relates to 6 practice of dental hygiene under supervision of 7 dentist; requiring certain supervision for advanced 8 procedures; deleting certain definition; adding 9 references; modifying rulemaking authority of Board 10 of Dentistry for advanced procedures; authorizing 11 licensed dentist to allow teledentistry treatment by 12 certain dental hygienists for patients in certain 13 long-term care settings; providing for application 14 for elder care and public health advanced procedure 15 permit; allowing treatment of patients by dental 16 hygienist upon receipt of permit; requiring certain 17 documentation, recording, and maintenance of 18 recording by dental hygienist; requiring completion 19 of certain assessment; requiring supervising dentist 20 to maintain certain records; allowing certain dental 21 assistants to apply for public health and elder care 22 expanded duty permit; authorizing dental assistant 23 with permit to assist hygienist with treatment in 24 certain facilities; requiring patient records to list 25 dental assistant; updating statutory language; 26 providing for codification; providing an effective 27 date; and declaring an emergency. 2
1 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: 2 SECTION 1. AMENDATORY 59 O.S. 2021, Section 328.3, is 3 amended to read as follows: 4 Section 328.3. As used in the State Dental Act, the following 5 words, phrases, or terms, unless the context otherwise indicates, 6 shall have the following meanings: 7 1. Accredited dental college means an institution whose 8 dental educational program is accredited by the Commission on Dental 9 Accreditation of the American Dental Association; 10 2. Accredited dental hygiene program means a dental hygiene 11 educational program which is accredited by the Commission on Dental 12 Accreditation of the American Dental Association; 13 3. Accredited dental assisting program means a dental 14 assisting program which is accredited by the Commission on Dental 15 Accreditation of the American Dental Association; 16 4. Advanced procedure means a dental procedure for which a 17 dental hygienist has received special training in a course of study 18 approved by the Board; 19 5. Board means the Board of Dentistry; 20 [5.] 6. Certified dental assistant means a dental assistant who 21 has earned and maintains current certified dental assistant 22 certification from the Dental Assisting National Board (DANB); 23 [6.] 7. Coronal polishing means a procedure limited to the 24 removal of plaque and stain from exposed tooth surfaces, utilizing a 25 slow speed hand piece with a prophy/polishing cup or brush and 26 polishing agent and is not prophylaxis. To be considered 27 prophylaxis, examination for calculus and scaling must be done by a 3
1 hygienist or dentist; 2 [7.] 8. Deep sedation means a drug-induced depression of 3 consciousness during which patients cannot be easily aroused but 4 respond purposefully following repeated or painful stimulation. The 5 ability to independently maintain ventilator function may be 6 impaired. Patients may require assistance in maintaining a patent 7 airway, and spontaneous ventilation may be inadequate. 8 Cardiovascular function is usually maintained; 9 [8.] 9. Dentistry means the practice of dentistry in all of its 10 branches; 11 [9.] 10. Dentist means a graduate of an accredited dental 12 college who has been issued a license by the Board to practice 13 dentistry as defined in Section 328.19 of this title; 14 [10.] 11. Dental ambulatory surgical center (DASC) means a 15 facility that operates exclusively for the purpose of furnishing 16 outpatient surgical services to patients. A DASC shall have the 17 same privileges and requirements as a dental office and additionally 18 must be an accredited facility by the appropriate entity; 19 [11.] 12. Dental office means an establishment owned and 20 operated by a dentist for the practice of dentistry, which may be 21 composed of reception rooms, business offices, private offices, 22 laboratories, and dental operating rooms where dental operations are 23 performed; 24 [12.] 13. Dental hygiene means the science and practice of the 25 promotion of oral health and prevention and treatment of oral 26 disease through the provision of educational, therapeutic, clinical, 27 and preventive services; 4
1 14. Dental hygienist means an individual who has fulfilled 2 the educational requirements and is a graduate of an accredited 3 dental hygiene program and who has passed an examination and has 4 been issued a license by the Board and who is authorized to practice 5 dental hygiene as hereinafter defined; 6 [13.] 15. [Dental assistant or oral maxillofacial surgery] 7 [assistant] Dental assistant or oral maxillofacial surgery 8 assistant means an individual working for a dentist, under the 9 dentists direct supervision or direct visual supervision, and 10 performing duties in the dental office or a treatment facility 11 including the limited treatment of patients in accordance with the 12 provisions of the State Dental Act. A dental assistant or oral 13 maxillofacial surgery assistant may assist a dentist with the 14 patient; provided, this shall be done only under the direct 15 supervision or direct visual supervision and control of the dentist 16 and only in accordance with the educational requirements and rules 17 promulgated by the Board; 18 [14.] 16. Dental laboratory means a location, whether in a 19 dental office or not, where a dentist or a dental laboratory 20 technician performs dental laboratory technology; 21 [15.] 17. Dental laboratory technician means an individual 22 whose name is duly filed in the official records of the Board, which 23 authorizes the technician, upon the laboratory prescription of a 24 dentist, to perform dental laboratory technology, which services 25 must be rendered only to the prescribing dentist and not to the 26 public; 27 [16.] 18. Dental laboratory technology means using materials 5
1 and mechanical devices for the construction, reproduction or repair 2 of dental restorations, appliances or other devices to be worn in a 3 human mouth; 4 [17.] 19. Dental specialty means a specialized practice of a 5 branch of dentistry, recognized by the Board, where the dental 6 college and specialty program are accredited by the Commission on 7 Dental Accreditation (CODA), or a dental specialty recognized by the 8 Board, requiring a minimum number of hours of approved education and 9 training and/or recognition by a nationally recognized association 10 or accreditation board; 11 [18.] 20. Direct supervision means the supervisory dentist is 12 in the dental office or treatment facility and, during the 13 appointment, personally examines the patient, diagnoses any 14 conditions to be treated, and authorizes the procedures to be 15 performed by a dental hygienist, dental assistant, or oral 16 maxillofacial surgery assistant. The supervising dentist is 17 continuously on-site and physically present in the dental office or 18 treatment facility while the procedures are being performed and, 19 before dismissal of the patient, evaluates the results of the dental 20 treatment; 21 [19.] 21. Direct visual supervision means the supervisory 22 dentist has direct ongoing visual oversight which shall be 23 maintained at all times during any procedure authorized to be 24 performed by a dental assistant or an oral maxillofacial surgery 25 assistant; 26 [20.] 22. Expanded duty means a dental procedure for which a 27 dental assistant has received special training in a course of study 6
1 approved by the Board; 2 23. Fellowship means a program designed for post-residency 3 graduates to gain knowledge and experience in a specialized field; 4 [21.] 24. General anesthesia means a drug-induced loss of 5 consciousness during which patients are not arousable, even by 6 painful stimulation. The ability to independently maintain 7 ventilator function is often impaired. Patients often require 8 assistance in maintaining a patent airway, and positive pressure 9 ventilation may be required because of depressed spontaneous 10 ventilation or drug-induced depression of neuromuscular function. 11 Cardiovascular function may be impaired; 12 [22.] 25. General supervision means the supervisory dentist has 13 diagnosed any conditions to be treated within the past thirteen (13) 14 months, has personally authorized the procedures to be performed by 15 a dental hygienist, and will evaluate the results of the dental 16 treatment within a reasonable time as determined by the nature of 17 the procedures performed, the needs of the patient, and the 18 professional judgment of the supervisory dentist. General 19 supervision may only be used to supervise a hygienist and may not be 20 used to supervise an oral maxillofacial surgery assistant or dental 21 assistant except as provided by Section 7 of this act; 22 [23.] 26. Indirect supervision means the supervisory dentist is 23 in the dental office or treatment facility and has personally 24 diagnosed any conditions to be treated, authorizes the procedures to 25 be performed by a dental hygienist, remains in the dental office or 26 treatment facility while the procedures are being performed, and 27 will evaluate the results of the dental treatment within a 7
1 reasonable time as determined by the nature of the procedures 2 performed, the needs of the patient, and the professional judgment 3 of the supervisory dentist. Indirect supervision may not be used 4 for an oral maxillofacial surgery assistant or a dental assistant; 5 [24.] 27. Investigations means an investigation proceeding, 6 authorized under Sections 328.15A and 328.43a of this title, to 7 investigate alleged violations of the State Dental Act or the rules 8 of the Board; 9 [25.] 28. Laboratory prescription means a written description, 10 dated and signed by a dentist, of dental laboratory technology to be 11 performed by a dental laboratory technician; 12 [26.] 29. Minimal sedation means a minimally depressed level of 13 consciousness, produced by a pharmacological method, that retains 14 the patients ability to independently and continuously maintain an 15 airway and respond normally to tactile stimulation and verbal 16 command. Although cognitive function and coordination may be 17 modestly impaired, ventilator and cardiovascular functions are 18 unaffected; 19 [27.] 30. Mobile dental anesthesia provider means a licensed 20 and anesthesia-permitted dentist, physician or [certified registered] 21 [nurse anesthetist] Certified Registered Nurse Anesthetist (CRNA) that 22 has a mobile dental unit and provides anesthesia in dental offices 23 and facilities in the state; 24 [28.] 31. Mobile dental clinic means a permitted motor vehicle 25 or trailer utilized as a dental clinic, and/or that contains dental 26 equipment and is used to provide dental services to patients on-site 27 and shall not include a mobile dental anesthesia provider. A mobile 8
1 dental clinic shall also mean and include a volunteer mobile dental 2 facility that is directly affiliated with a church or religious 3 organization as defined by Section 501(c)(3) or 501(d) of the United 4 States Internal Revenue Code, the church or religious organization 5 with which it is affiliated is clearly indicated on the exterior of 6 the mobile dental facility, and such facility does not receive any 7 form of payment either directly or indirectly for work provided to 8 patients other than donations through the affiliated church or 9 religious organization; provided, that the volunteer mobile dental 10 facility shall be exempt from any registration fee required under 11 the State Dental Act; 12 [29.] 32. Moderate sedation means a drug-induced depression of 13 consciousness during which patients respond purposefully to verbal 14 commands, either alone or accompanied by light tactile stimulation. 15 No interventions are required to maintain a patent airway, and 16 spontaneous ventilation is adequate. Cardiovascular function is 17 usually maintained; 18 [30.] 33. Prophylaxis means the removal of any and all 19 calcareous deposits, stains, accretions or concretions from the 20 supragingival and subgingival surfaces of human teeth, utilizing 21 instrumentation by scaler or periodontal curette on the crown and 22 root surfaces of human teeth including rotary or power-driven 23 instruments. This procedure may only be performed by a dentist or 24 dental hygienist; 25 [31.] 34. Patient or patient of record means an individual 26 who has given a medical history and has been examined and accepted 27 by a dentist for dental care; 9
1 [32.] 35. Residencies are programs designed for advanced 2 clinical and didactic training in general dentistry or other 3 specialties or other specialists at the post-doctoral level 4 recognized by the Commission on Dental Accreditation (CODA) or the 5 Board; 6 [33.] 36. Supervision means direct supervision, direct visual 7 supervision, indirect supervision or general supervision; 8 [34.] 37. Teledentistry means the remote delivery of dental 9 patient care via telecommunications and other technology for the 10 exchange of clinical information and images for dental consultation, 11 preliminary treatment planning and patient monitoring; and 12 [35.] 38. Treatment facility means: 13 a. a federal, tribal, state or local public health 14 facility, 15 b. a Federally Qualified Health Center (FQHC), 16 c. a private health facility, 17 d. a group home or residential care facility serving the 18 elderly, handicapped or juveniles, 19 e. a hospital or dental ambulatory surgery center 20 (DASC), 21 f. a nursing home, 22 g. a penal institution operated by or under contract 23 with 24 the federal or state government, 25 h. a public or private school, 26 i. a patient of records private residence, 27 j. a mobile dental clinic, 10
1 k. a dental college, dental program, dental hygiene 2 program or dental assisting program accredited by the 3 Commission on Dental Accreditation, or 4 l. such other places as are authorized by the Board. 5 SECTION 2. AMENDATORY 59 O.S. 2021, Section 328.21, as 6 amended by Section 3, Chapter 158, O.S.L. 2022 (59 O.S. Supp. 2022, 7 Section 328.21), is amended to read as follows: 8 Section 328.21. A. No person shall practice dentistry or 9 dental hygiene without first applying for and obtaining a license 10 from the Board of Dentistry. 11 B. Application shall be made to the Board in writing and shall 12 be accompanied by the fee established by the rules of the Board, 13 together with satisfactory proof that the applicant: 14 1. Is of good moral character; 15 2. Is twenty-one (21) years of age, or over, at the time of 16 making application to practice dentistry or eighteen (18) years of 17 age, or over, if the applicant is to practice dental hygiene; 18 3. Has passed a written theoretical examination and a clinical 19 examination approved by the Board within the previous five (5) 20 years; and 21 4. Has passed a written jurisprudence examination over the 22 rules and laws affecting dentistry in this state. 23 C. An application from a candidate who desires to secure a 24 license from the Board to practice dentistry or dental hygiene in 25 this state shall be accompanied by satisfactory proof that the 26 applicant: 27 1. Is a graduate of an accredited dental college, if the 11
1 applicant is to practice dentistry; 2 2. Is a graduate of an accredited dental hygiene program, if 3 the applicant is to practice dental hygiene; and 4 3. Has passed all portions of the National Board Dental 5 Examination or the National Board Dental Hygiene Examination. 6 D. Pursuant to Section 328.15 of this title, the Board may 7 affiliate as a member state, and accept regional exams from the 8 Commission on Dental Competency Assessments [(CDCA) or the Western] 9 [Regional Examining Board (WREB)] (CDCA-WREB-CITA) if the following 10 requirements are included: 11 1. For dental licensing the following components on a live 12 patient or manikin: 13 a. a fixed prosthetic component of the preparation of an 14 anterior all porcelain crown and the preparation of a 15 three-unit posterior bridge, 16 b. a periodontal component [on a live patient or manikin], 17 c. an endodontic component, 18 d. an anterior class III and posterior class II 19 restorative component [on a live patient or manikin], 20 e. a diagnosis and treatment planning section as 21 approved 22 by the Board, as specified in Section 328.15 of this 23 title, and 24 f. the Board may determine equivalencies based on 25 components of other exams for the purpose of 26 credentialing; or 27 2. For dental hygienists licensing the following components on 12
1 a live patient or manikin: 2 a. clinical patient treatments with an evaluation of 3 specific clinical skills, and 4 b. evaluation of the candidates compliance with 5 professional standards during the treatment as 6 approved by the Board in Section 328.15 of this title 7 and shall include: 8 (1) extra/intra oral assessment, 9 (2) periodontal probing, and 10 (3) scaling/subgingival calculus removal and 11 supragingival deposit removal. 12 E. When the applicant and the accompanying proof are found 13 satisfactory, the Board shall notify the applicant to appear for the 14 jurisprudence examination at the time and place to be fixed by the 15 Board. A dental student or a dental hygiene student in the 16 students last semester of a dental or dental hygiene program, 17 having met all other requirements, may make application and take the 18 jurisprudence examination with a letter from the dean of the dental 19 school or director of the hygiene program stating that the applicant 20 is a candidate for graduation within the next six (6) months. 21 F. The Board shall require every applicant for a license to 22 practice dentistry or dental hygiene to submit, for the files of the 23 Board, a copy of a dental degree or dental hygiene degree, an 24 official transcript, a recent photograph duly identified and 25 attested, and any other information as required by the Board. 26 G. Any applicant who fails to pass the jurisprudence 27 examination may apply for a second examination, in which case the 13
1 applicant shall pay a reexamination fee as established by the 2 statutes or rules of the State Dental Act. 3 H. A dentist or dental hygienist currently licensed in another 4 state having met the qualifications in paragraphs 1 through 3 of 5 subsections B and C of this section may apply for a license by 6 credentials upon meeting the following: 7 1. A dentist holding a general dentist license in good standing 8 and having practiced for at least five hundred (500) hours within 9 the previous five (5) years immediately prior to application and 10 having passed a regional examination substantially equivalent to the 11 requirements for this state may apply for licensure by credentials; 12 2. A dental hygienist holding a dental hygiene license in good 13 standing and having practiced for at least four hundred twenty (420) 14 hours within the previous five (5) years immediately prior to 15 application and having passed a regional examination substantially 16 equivalent to the requirements for this state may apply for 17 licensure by credentials. Applicants for credentialing must 18 include: 19 a. a letter of good standing from all states in which 20 the 21 applicant has ever been licensed, and 22 b. any other requirements as set forth by the rules; and 23 3. An applicant applying for a dental or dental hygiene license 24 by credentials shall only be required to pass the jurisprudence 25 portion of the examination requirements as set forth in paragraph 4 26 of subsection B of this section[; or] 27 [4. A dental hygienist applying for credentialing for advanced] 14
1 [procedures by providing proof of passage of the advanced procedure] 2 [in a CDCA, WREB or CRDTS exam]. 3 I. 1. There shall be [two] six types of advanced [procedure] 4 procedures available for dental hygienists upon completion of a 5 Commission on Dental Accreditation (CODA) approved program [or], 6 course, or certification program that has been approved by the 7 Board: 8 [1. Administration] 9 a. administration of nitrous oxide[; and], 10 [2. Administration] 11 b. administration of local anesthesia, 12 c. neuromodulator administration, 13 d. therapeutic use of lasers, 14 e. phlebotomy and venipuncture, and 15 f. elder care and public health pursuant to Section 7 of 16 this act. 17 2. A dental hygienist holding an advanced procedure permit or 18 credential in any other state for two (2) years shall be eligible 19 for the advanced procedure permit by credentials; provided, that 20 application for the advanced procedure permit by credentials for 21 administration of local anesthesia shall additionally require proof 22 of passage of such advanced procedure in a CDCA-WREB-CITA exam. 23 3. For all advanced procedures other than administration of 24 local anesthesia, a dental hygienist may apply by filling out an 25 application with required documentation of training as required by 26 state law and rules of the Board. 27 4. All advanced procedures shall be added to the dental hygiene 15
1 license upon approval. 2 J. All licensees and permit holders shall display the current 3 permit or license in a visible place within the dental office or 4 treatment facility. 5 K. The Board shall have the authority to temporarily change 6 requirements of an examination due to availability or changes in the 7 examination format, not to exceed one (1) year. 8 L. During a year in which governmental officials have declared 9 a health pandemic, a state or federal disaster, or other natural or 10 man-made disaster, the Board shall have the authority through a 11 resolution to change or make allowances in requirements of all 12 candidates for licensure and issue temporary licenses for extended 13 periods of time or as needed until the event passes. The resolution 14 shall have a beginning and an end date and shall automatically 15 expire no less than thirty (30) days after the end of the disaster 16 is declared by governmental officials. 17 M. Every licensee or permit holder shall have an official 18 address and email address listed with the Board. Every licensee or 19 permit holder shall update the address within thirty (30) calendar 20 days of moving. Official notification of any action of the Board 21 adverse to a licensee or permit holder including but not limited to 22 notification of license or permit cancellation due to nonrenewal, 23 notice of a formal complaint, or a decision of the hearing panel or 24 board, shall be served to the licensee or permit holder by 25 registered mail at the official address, in person, to the 26 licensees or permit holders attorney, by agreement of the 27 individual, by a process server, or by an [Investigator] investigator 16
1 of the Board pursuant to Section 2004 of Title 12 of the Oklahoma 2 Statutes. 3 SECTION 3. AMENDATORY 59 O.S. 2021, Section 328.22, is 4 amended to read as follows: 5 Section 328.22. A. 1. The Board of Dentistry may issue a 6 dental specialty license authorizing a dentist to represent himself 7 or herself to the public as a specialist, and to practice as a 8 specialist, in a dental specialty. 9 2. No dentist shall represent himself or herself to the public 10 as a specialist or practice as a specialist as listed in this 11 paragraph, unless the individual: 12 a. has successfully completed an advanced dental 13 specialty educational program accredited by the 14 Commission on Dental Accreditation, or has met the 15 [Board Certification] board certification requirements 16 and is recognized as a current board certified member 17 of a dental specialty organization or association 18 recognized by the National Commission on Recognition 19 of Dental Specialties and Certifying Boards, 20 b. has passed the jurisprudence examination covering the 21 State Dental Act, rules and state laws, and 22 c. has completed any additional requirements set forth in 23 state law or rules and has been issued a dental 24 specialty license by the Board. 25 3. Specialty licenses recognized by the Board shall include: 26 a. dental public health, 27 b. endodontics, 17
1 c. oral and maxillofacial surgery, 2 d. oral and maxillofacial radiology, 3 e. orthodontics and dentofacial orthopedics, 4 f. pediatric dentistry, 5 g. periodontics, 6 h. prosthodontics, 7 i. oral and maxillofacial pathology, 8 j. dental anesthesiology, 9 k. oral medicine, and 10 l. orofacial pain. 11 B. 1. At the time of application, if the dentist has ever been 12 licensed in any other state, he or she shall provide a letter of 13 good standing from such state before the Board may issue a specialty 14 license. 15 2. In conducting an investigation of an applicant who has 16 applied for a dental specialty license pursuant to this subsection, 17 the Board shall require of the applicant disclosure of the same 18 background information as is required of an applicant for a license 19 to practice dentistry in this state. 20 C. Any person holding an Oklahoma specialty license that does 21 not have an Oklahoma general dentistry license shall be limited to 22 practicing that specialty for which they hold a license. 23 D. The Board may use the American Dental Association National 24 Commission on Recognition of Dental Specialties and Certifying 25 Boards guidelines or the guidelines of another nationally recognized 26 dental association or board for the purpose of defining a specialty 27 practice area not otherwise defined herein. 18
1 SECTION 4. AMENDATORY 59 O.S. 2021, Section 328.24, is 2 amended to read as follows: 3 Section 328.24. A. No person shall practice as a dental 4 assistant or oral maxillofacial surgery assistant for more than one 5 (1) day in a calendar year without having applied for a permit as a 6 dental assistant or oral maxillofacial surgery assistant from the 7 Board of Dentistry within thirty (30) days of beginning employment. 8 During this time period, the dental assistant shall work under the 9 direct visual supervision of a dentist at all times. 10 B. The application shall be made to the Board in writing and 11 shall be accompanied by the fee established by the Board, together 12 with satisfactory proof that the applicant passes a background check 13 with criteria established by the Board. 14 C. Beginning January 1, 2020, every dental assistant receiving 15 a permit shall complete a class on infection control as approved by 16 the Board within one (1) year from the date of receipt of the 17 permit. Any person holding a valid dental assistant permit prior to 18 January 1, 2020, shall complete an infection-control class as 19 approved by the Board before December 31, 2020. Failure to complete 20 the class shall be grounds for discipline pursuant to Section 21 328.29a of this title. 22 D. There shall be [five] seven types of expanded duty permits 23 available for dental assistants or oral maxillofacial surgery 24 assistants upon completion of a program approved by the Commission 25 on Dental Accreditation (CODA) or a course that has been approved by 26 the Board: 27 1. Radiation safety; 19
1 2. Coronal polishing and topical fluoride; 2 3. Sealants; 3 4. Assisting in the administration of nitrous oxide; [or] 4 5. Phlebotomy and venipuncture; 5 6. Elder care and public health; or 6 7. Assisting a dentist who holds a parenteral or pediatric 7 anesthesia permit; provided, only the dentist may administer 8 anesthesia and assess the patients level of sedation. 9 All expanded duties shall be added to the dental assistant 10 license or oral maxillofacial surgery assistant license upon 11 approval. 12 E. The training requirements for all [five] expanded duty permits 13 shall be set forth by the Board. A program that is not CODA- 14 certified must meet the standards set forth and be approved by the 15 Board. 16 F. An applicant for a dental assistant permit who has graduated 17 from a dental assisting program accredited by CODA and has passed 18 the jurisprudence test shall receive all [five] expanded duty permits 19 provided for in subsection D of this section if the course materials 20 approved by the Board are covered in the program. 21 G. A dental assistant who holds an out-of-state dental 22 assistant permit with expanded duties may apply for credentialing 23 and reciprocity for a dental assistant permit including any expanded 24 duty by demonstrating the following: 25 1. The dental assistant has had a valid dental assistant permit 26 in another state for a minimum of two (2) years and is in good 27 standing; 20
1 2. The dental assistant has had a valid expanded duty in 2 another state for a minimum of one (1) year; and 3 3. The dental assistant provides a certificate or proof of 4 completion of an educational class for the expanded duty and that 5 the dental assistant has been providing this treatment to dental 6 patients while working as a dental assistant in a dental office for 7 one (1) year. 8 H. Any person having served in the military as a dental 9 assistant shall receive credentialing and reciprocity for expanded 10 functions by demonstrating the following: 11 1. Proof of military service in excess of two (2) years with 12 any certifications or training in the expanded function areas; and 13 2. Verification from the commanding officer of the medical 14 program or the appropriate supervisor stating that the dental 15 assistant provided the expanded functions on patients in the 16 military dental facility for a minimum of one (1) year within the 17 past five (5) years. 18 SECTION 5. AMENDATORY 59 O.S. 2021, Section 328.32, as 19 amended by Section 6, Chapter 158, O.S.L. 2022 (59 O.S. Supp. 2022, 20 Section 328.32), is amended to read as follows: 21 Section 328.32. A. The following acts or occurrences by a 22 dentist shall constitute grounds for which the penalties specified 23 in Section 328.44a of this title may be imposed by order of the 24 Board of Dentistry or be the basis for denying a new applicant any 25 license or permit issued by the Board: 26 1. Pleading guilty or nolo contendere to, or being convicted 27 of, a felony, a misdemeanor involving moral turpitude, any crime in 21
1 which an individual would be required to be a registered sex 2 offender under state law, any violent crime, Medicaid fraud, 3 insurance fraud, identity theft, embezzlement or a violation of 4 federal or state controlled dangerous substances laws; 5 2. Presenting to the Board a false diploma, license, or 6 certificate, or one obtained by fraud or illegal means, or providing 7 other false information on an application or renewal; 8 3. Being, by reason of persistent inebriety or addiction to 9 drugs, incompetent to continue the practice of dentistry; 10 4. Publishing a false, fraudulent, or misleading advertisement 11 or statement; 12 5. Authorizing or aiding an unlicensed person to practice 13 dentistry, to practice dental hygiene or to perform a function for 14 which a permit from the Board is required; 15 6. Authorizing or aiding a dental hygienist to perform any 16 procedure prohibited by the State Dental Act or the rules of the 17 Board; 18 7. Authorizing or aiding a dental assistant or oral 19 maxillofacial surgery assistant to perform any procedure prohibited 20 by the State Dental Act or the rules of the Board; 21 8. Failing to pay fees as required by the State Dental Act or 22 the rules of the Board; 23 9. Failing to complete continuing education requirements; 24 10. Representing himself or herself to the public as a 25 specialist in a dental specialty without holding a dental specialty 26 license [therefor] as listed in Section 328.22 of this title; 27 11. [Representing himself or herself to the public as a] 22
1 [specialist whose practice is limited to a dental specialty, when] 2 [such representation is false, fraudulent, or misleading] Practicing 3 below the basic standard of care of a patient which an ordinary 4 prudent dentist with similar training and experience within the 5 local area would have provided including, but not limited to, 6 failing to complete proper training and demonstrate proficiency for 7 any procedure delegated to a dental hygienist or dental assistant; 8 12. Endangering the health of patients by reason of having a 9 highly communicable disease and continuing to practice dentistry 10 without taking appropriate safeguards; 11 13. Practicing dentistry in an unsafe or unsanitary manner or 12 place including but not limited to repeated failures to follow 13 Centers for Disease Control and Prevention (CDC) or Occupational 14 Safety and Health Administration (OSHA) guidelines; 15 14. Being shown to be mentally unsound; 16 15. Being shown to be grossly immoral and that such condition 17 represents a threat to patient care or treatment; 18 16. Being incompetent to practice dentistry while delivering 19 care to a patient; 20 17. Committing gross negligence in the practice of dentistry; 21 18. Committing repeated acts of negligence in the practice of 22 dentistry; 23 19. Offering to effect or effecting a division of fees, or 24 agreeing to split or divide a fee for dental services with any 25 person, in exchange for the person bringing or referring a patient; 26 20. Being involuntarily committed to an institution for 27 treatment for substance abuse, until recovery or remission; 23
1 21. Using or attempting to use the services of a dental 2 laboratory or dental laboratory technician without issuing a 3 laboratory prescription, except as provided in subsection C of 4 Section 328.36 of this title; 5 22. Aiding, abetting, or encouraging a dental hygienist 6 employed by the dentist to make use of an oral prophylaxis list, or 7 the calling by telephone or by use of letters transmitted through 8 the mail to solicit patronage from patients formerly served in the 9 office of any dentist formerly employing such hygienist; 10 23. Having more than the equivalent of three full-time dental 11 hygienists for each dentist actively practicing in the same dental 12 office; 13 24. Allowing a person not holding a permit or license issued by 14 the Board to assist in the treatment of a patient without having a 15 license or permit issued by the Board; 16 25. Knowingly patronizing or using the services of a dental 17 laboratory or dental laboratory technician who has not complied with 18 the provisions of the State Dental Act and the rules of the Board; 19 26. Authorizing or aiding a dental hygienist, dental assistant, 20 oral maxillofacial surgery assistant, dental laboratory technician, 21 or holder of a permit to operate a dental laboratory to violate any 22 provision of the State Dental Act or the rules of the Board; 23 27. Willfully disclosing information protected by the Health 24 Information Portability and Accountability Act, P.L. 104-191; 25 28. Writing a false, unnecessary, or excessive prescription for 26 any drug or narcotic which is a controlled dangerous substance under 27 either federal or state law, or prescribing, dispensing or 24
1 administering opioid drugs in excess of the maximum limits 2 authorized in Section 2-309I of Title 63 of the Oklahoma Statutes; 3 29. Prescribing or administering any drug or treatment without 4 having established a valid dentist-patient relationship; 5 30. Using or administering nitrous oxide gas in a dental office 6 in an inappropriate or unauthorized manner; 7 31. Engaging in nonconsensual physical contact with a patient 8 which is sexual in nature, or engaging in a verbal communication 9 which is intended to be sexually demeaning to a patient; 10 32. Practicing dentistry without displaying, at the dentists 11 primary place of practice, the license issued to the dentist by the 12 Board to practice dentistry and the current renewal certificate; 13 33. Being dishonest in a material way with a patient or during 14 the practice of dentistry; 15 34. Failing to retain all patient records for at least seven 16 (7) years from the date of the last treatment as provided by Section 17 328.31b of this title, except that the failure to retain records 18 shall not be a violation of the State Dental Act if the dentist 19 shows that the records were lost, destroyed, or removed by another, 20 without the consent of the dentist; 21 35. Failing to retain the dentists copy of any laboratory 22 prescription for at least seven (7) years, except that the failure 23 to retain records shall not be a violation of the State Dental Act 24 if the dentist shows that the records were lost, destroyed, or 25 removed by another, without the consent of the dentist; 26 36. Allowing any corporation, organization, group, person, or 27 other legal entity, except another dentist or a professional entity 25
1 that is in compliance with the registration requirements of 2 subsection B of Section 328.31 of this title, to direct, control, or 3 interfere with the dentists clinical judgment. Clinical judgment 4 shall include, but not be limited to, such matters as selection of a 5 course of treatment, control of patient records, policies and 6 decisions relating to pricing, credit, refunds, warranties and 7 advertising, and decisions relating to office personnel and hours of 8 practice. Nothing in this paragraph shall be construed to: 9 a. limit a patients right of informed consent, or 10 b. prohibit insurers, preferred provider organizations 11 and managed care plans from operating pursuant to the 12 applicable provisions of the Oklahoma Insurance Code 13 and the Oklahoma Public Health Code; 14 37. Violating the state dental act of another state resulting 15 in a plea of guilty or nolo contendere, conviction or suspension or 16 revocation or other sanction by another state board, of the license 17 of the dentist under the laws of that state; 18 38. Violating or attempting to violate the provisions of the 19 State Dental Act or the rules of the Board, a state or federal 20 statute or rule relating to scheduled drugs, fraud, a violent crime 21 or any crime for which the penalty includes the requirement of 22 registration as a sex offender in this state as a principal, 23 accessory or accomplice; 24 39. Failing to comply with the terms and conditions of an order 25 imposing suspension of a license or placement on probation issued 26 pursuant to Section 328.44a of this title; 27 40. Failing to cooperate during an investigation or providing 26
1 false information, verbally or in writing, to the Board, the Boards 2 investigator or an agent of the Board; 3 41. Having multiple administrative or civil actions reported to 4 the National Practitioner [Databank] Data Bank; 5 42. Failing to complete an approved two-hour course on opioid 6 and scheduled drug prescribing within one (1) year of obtaining a 7 license or a violation of a law related to controlled dangerous 8 substances including prescribing laws pursuant to Section 2-309D of 9 Title 63 of the Oklahoma Statutes; 10 43. Falling below the basic standard of care of a licensed 11 dentist or dentist practicing in his or her specialty, a hygienist, 12 dental assistant, or other licensee or permit holder pursuant to the 13 State Dental Act and Section 20.1 of Title 76 of the Oklahoma 14 Statutes; or 15 44. Failing to provide patient records as provided by Sections 16 19 and 20 of Title 76 of the Oklahoma Statutes. 17 B. The provisions of the State Dental Act shall not be 18 construed to prohibit any dentist from displaying or otherwise 19 advertising that the dentist is also currently licensed, registered, 20 certified or otherwise credentialed pursuant to the laws of this 21 state or a nationally recognized credentialing board, if authorized 22 by the laws of the state or credentialing board to display or 23 otherwise advertise as a licensed, registered, certified, or 24 credentialed dentist. 25 SECTION 6. AMENDATORY 59 O.S. 2021, Section 328.34, is 26 amended to read as follows: 27 Section 328.34. A. A dental hygienist may practice dental 27
1 hygiene under the supervision of a dentist in a dental office or 2 treatment facility. A dentist may employ not more than the 3 equivalent of three full-time dental hygienists for each dentist 4 actively practicing in the same dental office. Employing the 5 equivalent of three dental hygienists shall mean the employment or 6 any combination of full- or part-time dental hygienists not to 7 exceed one hundred twenty (120) hours per week per dentist. 8 B. 1. A dentist may delegate to a dental hygienist the 9 following procedures: 10 a. the duties and expanded duties authorized for dental 11 assistants by the State Dental Act or the rules of the 12 Board of Dentistry, 13 b. health history assessment pertaining to dental 14 hygiene, 15 c. dental hygiene examination and the charting of intra- 16 oral and extra-oral conditions, which include 17 periodontal charting, dental charting and classifying 18 occlusion, 19 d. dental hygiene assessment and treatment planning for 20 procedures authorized by the supervisory dentist, 21 e. prophylaxis, which means the removal of any and all 22 calcareous deposits, stains, accretions, or 23 concretions from the supragingival and subgingival 24 surfaces of human teeth, utilizing instrumentation by 25 scaler or periodontal curette on the crown and root 26 surfaces of human teeth, including rotary or power- 27 driven instruments. This paragraph shall not be 28
1 construed to prohibit the use of a prophy/polishing 2 cup or brush on the crowns of human teeth by a dental 3 assistant who holds a current expanded duty permit for 4 [Coronal Polishing/Topical Fluoride] coronal polishing 5 and topical fluoride issued by the Board, 6 f. periodontal scaling and root planing, 7 g. dental hygiene nutritional and dietary evaluation, 8 h. placement of subgingival prescription drugs for 9 prevention and treatment of periodontal disease, 10 i. soft tissue curettage, 11 j. placement of temporary fillings, 12 k. removal of overhanging margins, 13 l. dental implant maintenance, 14 m. removal of periodontal packs, 15 n. polishing of amalgam restorations, and 16 o. other procedures authorized by the Board. 17 2. The procedures specified in subparagraphs b through o of 18 paragraph 1 of this subsection may be performed only by a dentist or 19 a dental hygienist. 20 3. Except as provided in subsections C and D of this section, 21 the procedures specified in paragraph 1 of this subsection may be 22 performed by a dental hygienist only on a patient of record and only 23 under the supervision of a dentist. The advanced procedures of 24 administration of nitrous oxide, administration of local anesthesia, 25 neuromodulator administration, therapeutic use of lasers, and 26 phlebotomy and venipuncture shall be performed only under the direct 27 or indirect supervision of a dentist. The level of supervision, 29
1 whether direct, indirect, or general, for the advanced procedure of 2 elder care and public health pursuant to Section 7 of this act shall 3 be at the discretion of the supervisory dentist. Authorization for 4 general supervision shall be limited to a maximum of thirteen (13) 5 months following an examination by the supervisory dentist of a 6 patient of record[. For the purposes of this paragraph, patient of] 7 [record means an individual who has given a medical history and has] 8 [been examined and accepted by a dentist for dental care]. 9 C. 1. A dentist may authorize procedures to be performed by a 10 dental hygienist, without complying with the provisions of paragraph 11 3 of subsection B of this section, if: 12 a. the dental hygienist has at least two (2) [years] 13 years 14 experience in the practice of dental hygiene, 15 b. the authorization to perform the procedures is in 16 writing and signed by the dentist, and 17 c. the procedures are performed during an initial visit 18 to a person in a treatment facility, or pursuant to 19 Section 7 of this act. 20 2. The person upon whom the procedures are performed must be 21 referred to a dentist after completion of the procedures performed 22 pursuant to paragraph 1 of this subsection. 23 3. A dental hygienist shall not perform a second set of 24 procedures on a person pursuant to this subsection until the person 25 has been examined and accepted for dental care by a dentist. 26 4. The treatment facility in which any procedure is performed 27 by a dental hygienist pursuant to this subsection shall note each 30
1 such procedure in the medical records of the person upon whom the 2 procedure was performed and list the dentist that authorized the 3 hygienist to perform the procedures signed by the hygienist. 4 D. A treatment facility may employ dental hygienists whose 5 services shall be limited to the examination of teeth and the 6 teaching of dental hygiene or as otherwise authorized by the Board. 7 E. The Board is authorized to[:] 8 [1. Prescribe] prescribe, by rule, the educational requirements 9 for advanced procedures that may be performed by a dental hygienist 10 [who has satisfactorily completed a course of study regarding the] 11 [performance of such procedures] upon receipt of the advanced 12 procedures designated on his or her license. The [advance] advanced 13 procedures shall include the administration of local anesthesia [and], 14 the administration of nitrous oxide analgesia[;] 15 [2. Establish guidelines for courses of study necessary for a] 16 [dental hygienist to perform advanced procedures;] 17 [3. Issue authorization to perform advanced procedures to those] 18 [dental hygienists who meet the eligibility requirements; and] 19 [4. Establish the level of supervision, whether direct, indirect] 20 [or general, under which the advanced procedures may be performed], 21 neuromodulator administration, therapeutic use of lasers, phlebotomy 22 and venipuncture, and elder care and public health pursuant to 23 Section 7 of this act. 24 F. A dental hygienist shall not own or operate an independent 25 practice of dental hygiene. 26 G. Nothing in the State Dental Act shall be construed to 27 prohibit a dentist from performing any of the procedures that may be 31
1 performed by a dental hygienist. 2 H. Nothing in the State Dental Act shall be construed to allow 3 a dental assistant to work under the supervision of a dental 4 hygienist while acting under direct, indirect or general 5 supervision, except as provided by Section 7 of this act. 6 SECTION 7. NEW LAW A new section of law to be codified 7 in the Oklahoma Statutes as Section 328.58 of Title 59, unless there 8 is created a duplication in numbering, reads as follows: 9 A. A licensed dentist may allow a dental hygienist with an 10 elder care advanced procedure permit to treat patients under general 11 supervision by utilizing teledentistry on a patient in: 12 1. A nursing facility, specialized facility, or nursing care 13 component of a continuum of care facility licensed under or 14 otherwise subject to the Nursing Home Care Act, Section 1-1901 et 15 seq. of Title 63 of the Oklahoma Statutes; 16 2. An assisted living center or continuum of care facility 17 licensed under the Continuum of Care and Assisted Living Act, 18 Section 1-890.1 et seq. of Title 63 of the Oklahoma Statutes; 19 3. A residential care home licensed under the Residential Care 20 Act, Section 1-819 et seq. of Title 63 of the Oklahoma Statutes; 21 4. An adult day care center or adult day care component of a 22 continuum of care facility licensed under or otherwise subject to 23 the Adult Day Care Act, Section 1-870 et seq. of Title 63 of the 24 Oklahoma Statutes; or 25 5. Another healthcare facility or long-term care facility as 26 specifically approved by the Board of Dentistry. 27 B. A dental hygienist with a minimum of two (2) years of 32
1 licensed active hygiene practice may apply to the Board for an 2 advanced procedure permit for elder care and public health. 3 C. Upon receipt of the advanced procedure permit, the dental 4 hygienist may provide hygiene treatments to a new or existing 5 patient in a facility listed in subsection A of this section, 6 utilizing mobile or other applicable dental equipment. In addition 7 to a written record and patient file, the hygienist shall complete a 8 visual recording of the patients mouth through video or live 9 teledentistry to aid the dentist in completing an evaluation and 10 diagnosis of the patient. The video recording shall be maintained 11 as part of the patient record. 12 D. A dentist shall complete an in-person, live, or recorded 13 teledentistry assessment, diagnosis, and treatment plan for the 14 patient taking into consideration the needs, health, and physical 15 abilities of the patient a minimum of every thirteen (13) months. 16 E. The supervising dentist shall maintain all patient records 17 including teledentistry recordings for a period of seven (7) years. 18 F. A dental assistant having a minimum of two (2) years of 19 active dental assisting practice may apply to the Board for an 20 expanded duty permit for elder care and public health. Upon receipt 21 of the expanded duty permit, the dental assistant may assist a 22 hygienist while providing treatment in a facility listed in 23 subsection A of this section under the general supervision of the 24 supervising dentist. The patient records shall list the dental 25 assistant providing treatment while assisting the dental hygienist. 26 SECTION 8. This act shall become effective July 1, 2023. 27 SECTION 9. It being immediately necessary for the preservation 33
1 of the public peace, health or safety, an emergency is hereby 2 declared to exist, by reason whereof this act shall take effect and 3 be in full force from and after its passage and approval. 4 COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES 5 February 23, 2023 - DO PASS AS AMENDED BY CS 6 SENATE FLOOR VERSION - SB754 SFLRPage 2 7 (Bold face denotes Committee Amendments) 34