My dentist wants to know when I can start practicing without him/her in the office.

Unfortunately, many dentists and hygienists are misinformed about the nature of the new NC limited supervision law.  This legislation addresses dental hygiene practice in certain alternative sites only; such as nursing homes, assisted living centers, rural health clinics operated by Board approved non-profits, etc.   Patients must have had a medical history review and a dental examination within the previous 120 days.  The dentist must provide a diagnosis and written treatment plan, and retain treatment records for 10 years.

How do I become certified as for limited supervision?

The Board rules for limited supervision require that the hygienist show proof of at least 3 years or 2,000 hours of clinical hygiene practice within the previous five years, maintain CPR certification, and complete 6 hours of medical emergency CE.  There is no formal certification process.  Instead, the employing dentist must designate the hygienist as being capable of performing clinical hygiene procedures without the direct supervision of the dentist.

Are there any dental hygiene duties that I cannot perform in the alternative practice site?

The law states that the hygienist may perform “one or more dental hygiene functions as described in G.S 90-221(a)”.  Basically, you are allowed to perform any hygiene duty that would be legal in a dental office.

I work as a public health hygienist for the State of North Carolina.  I am willing to volunteer to clean teeth at a nursing home one day per month if a dentist could do the exams and treatment plans.  Who can designate me for limited supervision?

Unfortunately, public health hygienists, educators, newly retired hygienists, and unemployed hygienists are probably ineligible for volunteering under the limited supervision law.  Even though the intent of the law was to increase access to dental care for the underserved, the wording of the law disenfranchises many potential dental health care providers such as the ones mentioned previously.  To be in compliance with the law, the dental hygienist must have an employing dentist who certifies him/her as capable of performing dental hygiene duties without the direct supervision of a dentist.  If you work for the state or county instead of for a dentist, you would not have an “employing dentist”.

Why did NCDHA sponsor such a limited bill?

SB 1337 is the compromise that was negotiated by the North Carolina Dental Hygienists’ Association and the North Carolina Dental Society at the mandate of the Senate Health Committee of the NC General Assembly.  For example, the original bill submitted by Dr. William Purcell included limited supervision for dental offices as well as for alternative sites.  The original bill also provided for examinations and treatment prescriptions by any licensed dentist within the past year.  In order for the bill to have made it through the health committees, and through the entire Senate and House, MANY concessions were made by all interested parties.  Although the finished product is too restrictive to be as helpful to the citizens of NC as NCDHA had hoped for, it is a start.  If every dental hygienist who is eligible will fulfill the requirements for limited supervision and partner with his/her employing dentist to provide care to patients in alternative practice sites, we can show that dental hygienists are capable of using limited supervision privileges responsibly. 

I have heard that all but a few states allow dental hygienists to administer local anesthesia injections.  Why can’t we do this in NC?

Dental hygienists are permitted to administer infiltration and/or block anesthesia in 39 of the 50 states.  Anesthesia administration by injection is not listed as a clinical dental hygiene procedure in G.S 90-221(a), so it is not an approved dental hygiene function in NC.  Until the legislature is convinced that anesthesia administration by a dental hygienist would be safe and beneficial for patients in NC, they will not change the current law.  Until NC dentists, dental hygienists, and the public demand this privilege for registered dental hygienists, it will not happen. 

Is it true that a separate North Carolina Board Exam will no longer be administered?  Will NC accept another state or regional board for licensure instead?

It is true that a separate NC dental hygiene clinical board exam will no longer be administered.  North Carolina has joined the Council of Interstate Testing Agencies (CITA) for dental and dental hygiene exam administration.  The good news is that this is a regional board exam, and is currently recognized by Alabama,  Louisiana, Massachusetts, Maine, Mississippi, Missouri, Montana, New Hampshire, North Dakota, Oregon, Puerto Rico, Virginia, Washington, and West Virginia. 

If a dental hygienist has been in practice for the previous two years in another state, he/she may apply for a license by credential.  Call the North Carolina State Board of Dentistry for an application or more information.

Need More Information?

For the specific wording of  SB 1337 and associated NC Dental Board rules, see the governmental affairs section of this web page.  For more information on state dental practice acts, visit the governmental affairs section of the ADHA website at www.adha.org .  For  information on the CITA exam, please visit www.citaexam.com  .

Want to help?

Join your professional organization and get active in local and state issues.

Ask your employing dentist to tell the North Carolina Dental Society representatives that he/she is in favor of in-office limited supervision and local anesthesia administration by dental hygienists.

Donate toward a dental hygiene student’s CITA fees-call your local dental hygiene school for suggestions.