An Act To Implement the Recommendations of the Board of Dental Practice Related to the Definitions of "Supervision" and "Teledentistry"
Sec. 1. 32 MRSA §18302, sub-§18, as enacted by PL 2015, c. 429, §21, is amended to read:
Sec. 2. 32 MRSA §18302, sub-§22, as enacted by PL 2015, c. 429, §21, is amended to read:
Sec. 3. 32 MRSA §18302, sub-§35 is enacted to read:
Sec. 4. 32 MRSA §18302, sub-§36 is enacted to read:
Sec. 5. 32 MRSA §18302, sub-§37 is enacted to read:
Sec. 6. 32 MRSA §18342, sub-§6, ¶D, as enacted by PL 2015, c. 429, §21, is amended to read:
Sec. 7. 32 MRSA §18371, sub-§2, ¶E, as enacted by PL 2015, c. 429, §21, is amended to read:
Sec. 8. 32 MRSA §18371, sub-§3, as amended by PL 2017, c. 388, §15, is further amended to read:
(1) Changing or replacing dry socket packets after diagnosis and treatment planned by a dentist;
(2) For instruction purposes, demonstrating to a patient how the patient should place and remove removable prostheses, appliances or retainers;
(3) For the purpose of eliminating pain or discomfort, removing loose, broken or irritating orthodontic appliances;
(4) Giving oral health instructions;
(5) Irrigating and aspirating the oral cavity;
(6) Performing dietary analyses for dental disease control;
(7) Placing and recementing with temporary cement an existing crown that has fallen out as long as the dentist is promptly notified that this procedure was performed so that appropriate follow-up can occur;
(8) Placing and removing periodontal dressing;
(9) Pouring and trimming dental models;
(10) Removing sutures and scheduling a follow-up appointment with the dentist within 7 to 10 days of suture removal;
(11) Retracting lips, cheek, tongue and other tissue parts;
(12) Obtaining impressions for study casts;
(13) Taking and recording the vital signs of blood pressure, pulse and temperature;
(14) Taking dental plaque smears for microscopic inspection and patient education; and
(15) Taking intraoral photographs.
(1) Placing temporary fillings on an emergency basis as long as the patient is informed of the temporary nature of the fillings; and
(2) Removing excess cement from the supragingival surfaces of teeth.
(1) Applying cavity varnish;
(2) Applying liquids, pastes and gel topical anesthetics;
(3) Assisting a dentist who provides orthodontic services in preparation of teeth for attaching, bonding and cementing fixed appliances in a manner appropriate and according to manufacturer's directions;
(4) Delivering, but not condensing or packing, amalgam or composite restoration material;
(5) Fabricating temporary crowns and bridges, limiting handpiece rotary instrumentation used in the fabrication to extraoral use only, as long as the dentist checks the occlusion and fit prior to releasing the patient;
(6) Irrigating and drying root canals;
(7) Isolating the operative field;
(8) Performing pulp vitality testing with confirmation by the dentist;
(9) Performing electronic vitality scanning with confirmation by the dentist;
(10) Performing preliminary selection and fitting of orthodontic bands, with final placement and cementing in the patient's mouth by the dentist;
(11) Placing and cementing temporary crowns with temporary cement;
(12) Placing and removing matrix bands, rubber dams and wedges;
(13) Placing elastics and instructing in their use;
(14) Placing, holding or removing celluloid and other plastic strips prior to or subsequent to the placement of a filling by the dentist;
(15) Placing or removing temporary separating devices;
(16) Placing wires, pins and elastic ligatures to tie in orthodontic arch wires that have been fitted and approved by the dentist at the time of insertion;
(17) Preparing tooth sites and surfaces with a rubber cup and pumice for banding or bonding of orthodontic brackets. This procedure may not be intended or interpreted as an oral prophylaxis, which is a procedure specifically reserved to be performed by dental hygienists or dentists. This procedure also may not be intended or interpreted as a preparation for restorative material. A dentist or dental hygienist shall check and approve the procedure;
(18) Reapplying, on an emergency basis only, orthodontic brackets;
(19) Recording readings with a digital caries detector and reporting them to the dentist for interpretation and evaluation;
(20) Removing composite material using slow-speed instrumentation for debonding brackets, as long as the dentist conducts a final check prior to release of the patient;
(21) Removing excess cement from the supragingival surfaces of teeth;
(22) Removing gingival retraction cord;
(23) Removing orthodontic arch wires and tension devices and any loose bands or bonds, but only as directed by the dentist;
(24) Selecting and trying in stainless steel or other preformed crowns for insertion by the dentist;
(25) Obtaining impressions for opposing models and retainers;
(26) Obtaining impressions for single-arch athletic mouth guards, bleaching trays, custom trays and fluoride trays; and
(27) Taking intraoral measurements and making preliminary selection of arch wires and intraoral and extraoral appliances, including head gear.
Sec. 9. 32 MRSA §18371, sub-§4, as amended by PL 2017, c. 288, Pt. A, §35, is further amended to read:
Sec. 10. 32 MRSA §18373, sub-§1, as amended by PL 2017, c. 388, §17, is further amended to read:
(1) Has ordered the cavity liner or base; and
(2) Has checked the cavity liner or base prior to the placement of the restoration; and
(3) Has checked the final restoration prior to patient dismissal;
Sec. 11. 32 MRSA §18373, sub-§2, as amended by PL 2017, c. 388, §17, is repealed.
Sec. 12. 32 MRSA §18374, as amended by PL 2017, c. 388, §§18 and 19, is further amended to read:
§ 18374. Dental hygienist
Sec. 13. 32 MRSA §18377, sub-§1, as amended by PL 2019, c. 388, §10, is further amended to read:
(1) Perform oral health assessments, pulpal disease assessments for primary and young teeth, simple cavity preparations and restorations and simple extractions;
(2) Prepare and place stainless steel crowns and aesthetic anterior crowns for primary incisors and prepare, place and remove space maintainers;
(3) Provide referrals;
(4) Administer local anesthesia and nitrous oxide analgesia;
(5) Perform preventive services;
(6) Conduct urgent management of dental trauma, perform suturing, extract primary teeth and perform nonsurgical extractions of periodontally diseased permanent teeth if authorized in advance by the supervising dentist; and
(7) Provide, dispense and administer anti-inflammatories, nonprescription analgesics, antimicrobials, antibiotics and anticaries materials ; .
(8) Administer radiographs; and
(9) Perform other related services and functions authorized by the supervising dentist and for which the dental therapist is trained.
Sec. 14. 32 MRSA §18394 is enacted to read:
§ 18394. Teledentistry
An individual licensed under this chapter may provide oral health care services and procedures authorized under this chapter or by rule using teledentistry. The board shall adopt by rule guidelines and practice standards for the use of teledentistry, including, but not limited to, practice requirements for protecting patient rights and protocols for referrals, quality and safety, informed consent, patient evaluation, treatment parameters, patient records, prescribing, supervision and compliance with data exchange standards for the security and confidentiality of patient information. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 15. Board of Dental Practice to review dental practice laws and recommend changes. The Board of Dental Practice, in consultation with interested parties, shall review the Maine Revised Statutes, Title 32, chapter 143, any rules adopted by the board and the laws and rules in other states related to the scope of practice for licensed dental hygienists and dental therapists. The board shall recommend changes to the scope of practice for licensed dental hygienists and dental therapists for the purpose of aligning current practice settings and reflecting advancements in the profession and technology. The board shall submit its report and recommendations to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters no later than February 1, 2021. The joint standing committee may report out a bill to the First Regular Session of the 130th Legislature based on the board's recommendations.
summary
This bill implements the recommendations of the Board of Dental Practice that were included in the report required by Public Law 2019, chapter 388. The bill makes the following changes.
1. It makes changes to the definitions of "direct supervision" and "general supervision" and makes corresponding changes to the activities that may be performed under direct or general supervision by a person licensed by the Board of Dental Practice.
2. It makes changes to provisions governing the delegation authority of dentists to unlicensed persons and to persons licensed by the Board of Dental Practice.
3. It adds a definition of "teledentistry" and authorizes oral health care services and procedures to be provided through teledentistry in accordance with rules adopted by the Board of Dental Practice.
4. It directs the Board of Dental Practice to recommend changes to the scope of practice for dental hygienists and dental therapists for the purpose of aligning current practice settings and reflecting advancements in the profession and technology. The Board of Dental Practice is required to submit its recommendations to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters no later than February 1, 2021. The joint standing committee may report out a bill to the First Regular Session of the 130th Legislature based on the board's recommendations.