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What Is Legislative Advocacy?
Advocacy is the deliberate process of influencing legislators who make decisions on issues that affect you, your family and your profession. If NCDHA members spend time introducing themselves to their local Representative and Senator, the strength of the profession would grow significantly!
Now is the time to speak up about the benefits and needs of our profession!
Rule Changes Regarding Public Health Dental Hygienists
The North Carolina State Board of Dental Examiners and the Rules Review Commission (RCC) of the NC General Assembly recently APPROVED all proposed changes related to the direction of public health dental hygienists especially in underserved areas: Rules 21 NCAC 16W, .0101 and 21 NCAC 16W .0104! These changes will allow public health dental hygienists to provide specific preventive care services to individuals without receiving a prior examination by a dentist and without a dentist being present. These changes will be effective February 1, 2020! To comply with the new rule, a dental hygienist would have to complete the Public Health Dental Hygiene training offered through DHHS [NCGS 20-233(a)] and work with a dentist who has signed an agreement, contract, memo of understanding, or a similar legal document with a public health entity, a county health department for example, and provide the services as provided for in 21 NCAC 16W .0104(a). This rule DOES NOT apply to dentists who provide these services while exclusively in private practice.
This is one positive step forward in addressing the access to oral health care issue in NC!
Any dental hygienist wishing to practice under this rule must complete the Public Health Dental Hygiene training offered through DHHS [NCGS 20-233(a)] and work with a dentist who has signed an agreement, contract, memo of understanding, or a similar legal document with a public health entity [a county health dept. for example] and provide the services as provided for in Rule 21 NCAC 16W .0104(a) as well as changes made to Rule 21 NCAC 16W .0101
Revisions to Rule the Public Hygiene Rule 21 NCAC 16W .0101 and .0104
What has changed?
Newly adopted changes to 21 NCAC 16W .0101 and the addition of 21 NCAC 16W .0104 allow public health hygienists to work pursuant to a standing order in certain facilities in designated dental access shortage areas.
How do the new rules work?
First: No rules have changed for dentists and dental hygienists in private practice. Supervision of auxiliaries and delegable duties remain unchanged. “A dentist in private practice may not employ more than two dental hygienists at one and the same time who are employed in clinical dental hygiene positions.” [NCGS 90-233(b)] The new rules apply ONLY to dentists employed by a federal, state, county, or local government and are, therefore, not considered to be in private practice.
Second: The key condition is employment. Unless already employed by a local health department, state government dental public health program, or the Dental Health Section of the Department of Health and Human Services, a dentist in private practice must enter into a contract of employment with one of the aforementioned agencies in order to utilize these rules.
The contract must create an employment relationship: full-time, part-time, or temporary. It is also expected that the parties will address other terms to ensure that treatment does not fall below the standard of care and that a “dental home” is created and available for all patients seen pursuant to the standing order. The list of potential contract terms below is not exhaustive and is intended only to provide guidance in addressing potential issues:
- Designate the approved facility in a DHHS defined dental access shortage area where the services are to be performed.
- Delineate what procedures will be allowed to be performed under the standing order.
- Indicate how many hygienists will be performing assessments so that follow-up treatment does not exceed capacity.
- Clearly indicate that the patients seen by the public health hygienist are patients of record for the supervising dentist.
- Ensure that patients of record will be seen and treated by the employed dentist for those procedures not covered by the standing order.
- Indicate the dates, times, and places of all regularly scheduled return visits throughout the year.
- Ensure that the employed dentist will adhere to all sterilization, infection control, radiation protection, and patient safety requirements.
- Provide clear direction as to how billing, collections, and other administrative functions will be handled and by whom.
- Include other terms and conditions that the parties deem necessary to meet local or individual needs.
Third: Dentists employed by a local health department, state government dental public health program, or the Dental Health Section of the Department of Health and Human Services (DHHS) may allow a public health hygienist “especially trained by the Dental Health Section of the Department of Health and Human Services” to perform procedures described in NCGS 90- 221(a) based on a standing order rather than an in-person examination by the dentist. The public health hygienist in these situations may also supervise a Dental Assistant.
Fourth: Restrictions apply! The public health hygienist may not work independently. He or she may only assess patients pursuant to a standing order from a supervising dentist employed by an approved government agency and the assessments can only occur in public schools, nursing homes, rest homes, long-term care facilities, and rural and community clinics operated by federal, State, county or local governments in areas identified by DHHS as dental access shortage areas.
Fifth: The standing order must describe what procedures the public health hygienist can perform. No standing order may allow the public health hygienist to perform irreversible procedures or exceed delegable functions as defined in NCGS 90-221(a), 21 NCAC 16G .0101 and 21 NCAC 16H .0203.
Stay tuned for more information as it becomes available. Please reach out to us with any questions, etc.
The North Carolina Oral Health Collaborative (NCOHC) convenes diverse stakeholders to identify and resolve consumer-level and systemic barriers to good oral health and to accelerate implementation of policies and practices that reduce oral health disparities and promote improved oral health for all North Carolinians.
North Carolina Licensure Information
FAQ Regarding Dental Hygiene Licensure
The following provides reference information about requirements and procedures related to obtaining a dental hygiene license in North Carolina.
Application Forms and Information: Application Forms and Information
Fees for License: Fees for License
Under North Carolina Law, § 90-233, A dental hygienist may practice only under the supervision of one or more licensed dentists.
Eligibility to Practice Dental Hygiene Outside Direct Supervision: Eligibility to Practice Dental Hygiene Outside Direct Supervision
Dental hygienists are required to complete 6 hours of continuing education every year. In addition, dental hygienists area required to maintain current CPR certification received from a “hands on” course.
Dental hygienists may obtain any or all of their required hours through correspondence or online courses which have post-tests and issue certificates of completion.
Dental hygienists with a limited supervision license must complete 6 hours of continuing education every year in dental office medical emergencies, in addition to the minimum 6 hours of continuing education as required for license renewal.
Appropriate course subjects: Courses must be related to patient care. Courses stressing practice management or self-improvement, for example, could not count, while courses in sterilization and infection control, pharmacology, dental materials and dental procedures are acceptable. The Board will accept some risk management courses.
Approved Sponsors for CE Hours: providers who are recognized by the American Dental Association’s Continuing Education Recognition Program, courses sponsored the Academy of General Dentistry, the American Dental or American Dental Hygienists’ Association, or components of such organizations, the North Carolina Area Health Education Centers, educational institutions with dental or dental hygiene schools or departments, and national, state, or local societies or associations. (Study clubs are considered “associations”.)
Reporting CE Hours: The number of hours completed each year is reported on the license renewal form and no documentation of course work should be sent to the Board’s office. Each person is responsible for maintaining his/her own documentation for at least two years of CE courses completed and must show evidence of completing CE when requested by the Board.
The online renewal system is open from November 1 to March 31 each year. A $50 late penalty will be assessed to those renewing after January 31. Licensees may use the online system to update their address and phone information throughout the year.
All licenses that are not renewed by March 31 become void and continuing to practice without a valid renewal certificate is a Class I misdemeanor. Each day’s violation is a separate offense.
Licenses not renewed by March 31 must be reinstated by the Board. Reinstatement involves submitting an application and paying a reinstatement fee ($225 for dentists; $60 for dental hygienists) along with the current year’s renewal fee.
North Carolina State Board of Dental Examiners
The North Carolina State Board of Dental Examiners is responsible for the professions of dental hygienists, dentists and dental assistants. The purpose of the North Carolina State Board of Dental Examiners is to ensure that the dental profession merit and receive the confidence of the public and that only qualified persons be permitted to practice dentistry and dental hygiene in the state of North Carolina. The board members include 6 dentists, 1 dental hygienist and 1 consumer member.