A5277

An Act concerning the regulation of dental therapy, amending various parts of the statutory law, and supplementing chapter 6 of Title 45 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 7 of P.L.1951, c.199 (C.45:6-15.7) is amended to read as follows:

7. In every dental clinic operated, conducted or maintained in this State all dental operations shall be performed by a licensed dentist [or] , licensed hygienist, or licensed dental therapist in accordance with the provisions of Title 45, chapter six of the Revised Statutes.

(cf: P.L.1951, c.199, s.7)

2. Section 2 of P.L.1979, c.46 (C.45:6-49) is amended to read as follows:

2. For the purposes of this act:

a. "Board" means the New Jersey State Board of Dentistry.

b. "Registered dental assistant" means any person who has fulfilled the requirements for registration established by this act and who has been registered by the board. A registered dental assistant shall work under the direct supervision of a licensed dentist.

c. "Dental assistant" means any person who is trained by formal education or office internship to perform, under the direct supervision of a dentist, any routine office procedure, not including an intra-oral procedure, in the office of a dentist.

d. "Dental hygienist" means any person who performs in the office of any licensed dentist or in any appropriately equipped school, dental clinic, or institution under the supervision of a licensed dentist, those educational, preventive and therapeutic services and procedures which licensed dental hygienists are trained to perform, and which are specifically permitted by regulation of the board, and such intra-oral clinical services which are primarily concerned with preventive dental procedures, including, but not limited to, during the course of a complete prophylaxis, removing all hard and soft deposits and stains from the surfaces of the human teeth to the depth of the gingival sulcus, polishing natural and restored surfaces of teeth, applying indicated topical agents, surveying intra- and extra-oral structures, noting deformities, defects and abnormalities thereof, performing a complete oral prophylaxis and providing clinical instruction to promote the maintenance of dental health.

e. "Direct supervision" means acts performed in the office of a licensed dentist wherein he is physically present at all times during the performance of such acts and such acts are performed pursuant to his order, control and full professional responsibility.

f. "Supervision" means acts performed pursuant to a dentist's written order, control and full professional responsibility, whether or not he is physically present.

g. "Limited registered dental assistant" means any person who has fulfilled the requirements for registration established by this amendatory and supplementary act and who has been registered by the board. A limited registered dental assistant shall be limited to working under the direct supervision of a dentist who conducts a limited dental practice in the dental specialty for which the assistant has been trained and registered, and in performing those intra-oral procedures as defined by the board which are involved in that specialty.

h. "Dental clinic" means dental clinic as defined in section 1 of P.L.1951, c.199 (C.45:6-15.1).

i. "Institution" means any nursing home, veterans' home, hospital or prison, or any State or county facility providing inpatient care, supervision and treatment for persons with developmental disabilities.

j. “Practice of dental therapy” means the performance of educational, preventive and therapeutic services through one or more of the following practices and procedures: identification of oral and systemic conditions requiring evaluation or treatment by dentists, physicians or other health care providers, and management of referrals to dentists, physicians and other health care providers; diagnosis and treatment of oral diseases and conditions that are within the dental therapist scope of practice; comprehensive charting of the oral cavity; oral health instruction and disease prevention education, including nutritional counseling and dietary analysis; dispensing and administering of nonnarcotic analgesics and anti-inflammatory and antibiotic medications as prescribed by a licensed health care provider, except schedule II, III or IV controlled substances; applying topical preventive or prophylactic agents, including fluoride varnish, antimicrobial agents and pit and fissure sealants; pulp vitality testing; applying desensitizing medication or resin in the oral cavity; interim therapeutic restorations; fabricating athletic mouth guards; changing periodontal dressings; administering local anesthetics in the oral cavity under the general supervision of a dentist; simple extraction of erupted primary teeth; nonsurgical extraction of periodontally diseased permanent teeth with tooth mobility of three or greater, except a tooth that is unerupted, impacted, fractured or needs to be sectioned for removal; emergency palliative treatment of dental pain; preparation and placement of direct restoration in primary and permanent teeth that does not require the fabrication of crowns, bridges, veneers or dentures; fabrication and placement of single-tooth temporary crowns; preparation and placement of preformed crowns on primary teeth; indirect and direct pulp capping on permanent teeth; indirect pulp capping on primary teeth; dental suture removal; minor adjustments and repairs on removable prostheses; placement and removal of space maintainers; and recementing permanent crowns.

“Collaborative agreement” means a written agreement between a dental therapist and a dentist licensed pursuant to chapter 379 of the general statutes, that defines the working relationship between the dental therapist and the dentist and the parameters of the practice of dental therapy.

“Dental therapist” means a licensed dental hygienist authorized to engage in the practice of dental therapy under a collaborative agreement.

(cf: P.L.2012, c.29, s.1)

3. Section 9 of P.L.1979, c.46 (C.45:6-56) is amended to read as follows:

9. a. (1) Every two years, at the time of license renewal, each person licensed to practice dental hygiene and dental therapy in this State shall provide the board with a certified statement, upon a form issued and distributed by the board, that such licensed person has attended, or participated in not less than 20 hours of continuing education in dental hygiene or dental therapy as follows: lectures or study club sessions dealing with clinical subjects, college post-graduate courses, scientific sessions of conventions, research on clinical subjects, service as a clinician or any other such evidence of continuing education which the board may approve.

(2) Every two years, at the time of registration renewal, each person registered as a registered dental assistant or limited registered dental assistant in this State shall provide the board with a certified statement, upon a form issued and distributed by the board, that such registered person has attended, or participated in not less than 10 hours of continuing education in dental assisting or dental therapy as follows: lectures or study club sessions dealing with clinical subjects, college post-graduate courses, scientific sessions of conventions, research on clinical subjects, service as a clinician or any other such evidence of continuing education which the board may approve.

b. The board shall notify each licensed or registered person of any failure to comply with this requirement, and shall further notify said person that upon continued failure to comply for a period of three months from the date of notice, the board may, at its discretion take action pursuant to section 11 of this act.

c. The board, in its discretion, may waive any of the requirements of this section in cases of certified illness or undue hardship to be determined on an individual basis.

(cf: P.L.2005, c.5, s.1)

4. Section 10 of P.L.1979, c.46 (C.45:6-57) is amended to read as follows:

10. Every person licensed to practice dental hygiene or dental therapy shall biennially apply, on a form furnished by the board, for a certificate of registration, which shall be issued by the secretary of the board upon payment of a fee of $10.00. The certificate of registration shall be displayed in the office or place in which the holder thereof practices dental hygiene or dental therapy. Where a dental hygienist practices dental hygiene or a dental therapist practices dental therapy at more than one office or place, a duplicate registration certificate shall be issued upon the payment of an additional fee of $5.00 for each such certificate. The license of any person who fails to procure any biennial certificate of registration, at the time and in the manner required by the board, except a person on the inactive status list, may be suspended by the board in the manner provided by section 12 of P.L. 1979, c. 46 (C. 45:6-59). Any license so suspended shall be reinstated at any time within three years from the date of such suspension upon the payment of all past due biennial registration fees and an additional reinstatement fee of $25.00. Any person whose license shall have been suspended for such cause shall, during the period of such suspension, be regarded as an unlicensed person and, in case such person shall continue or engage in the practice of dental hygiene during such period, shall be liable to the penalties prescribed by section 11 of P.L. 1979, c. 46 (C. 45:6-58) for practicing dental hygiene or dental therapy without a license. Said fees shall be used by the board in the same manner as similar fees received by it under the provisions of chapter 6 of Title 45 of the Revised Statutes.

(cf: P.L.1988, c.31, s.1)

5. Section 3 of P.L.1988, c.31 (C.45:6-57.1) is amended to read as follows:

3. A licensed dental hygienist or licensed dental therapy may apply to the board for inactive license status on a form furnished by the board. Upon receipt of the completed inactive status application form the board shall place the licensee on an inactive status list. While on the list, the person shall pay an inactive license renewal fee in an amount prescribed by the board and shall not practice dental hygiene or dental therapy within the State.

A person on the inactive status list who wants to resume the practice of dental hygiene or dental therapy shall apply to the board for a current biennial certificate of registration and shall pay the prescribed registration fee. Any person who has been on the inactive status list for five or more years shall furnish the board with satisfactory evidence of current knowledge and skill in the practice of dental hygiene or dental therapy as required by regulation of the board.

(cf: P.L.1988, c.31, s.3)

6. Section 11 of P.L.1979, c.46 (C.45:6-58) is amended to read as follows:

11. Any person practicing dental hygiene or dental therapy in this State without first having obtained a license as provided by this act or P.L. , c. (C. ) (pending before the Legislature as this bill), or without the current biennial certificate of registration, or contrary to any of the provisions of this act, or any person who fails to comply with the provisions of section 9 of P.L.1979, c.46 (C.45:6-56), except a person on the inactive status list, or who practices dental hygiene or dental therapy, or works as a registered dental assistant or limited registered dental assistant under a false or assumed name, or buys, sells or fraudulently obtains a diploma or certificate showing or purporting to show graduation or completion of a course in dental hygiene [or], dental assisting, or dental therapy, or who violates any of the provisions of this act, shall be liable to a penalty of $300.00 for the first offense and of $500.00 for the second and each subsequent offense.

(cf: P.L.1995, c.367, s.5)

7. Section 13 of P.L.1979, c.46 (C.45:6-60) is amended to read as follows:

13. Any person, company or association who commits any of the following acts is a disorderly person, and upon every conviction thereof shall be subject to a fine of not less than $300.00 nor more than $500.00 or by imprisonment for not less than 30 days nor more than 90 days, or by both such fine and imprisonment:

a. Selling or bartering, or offering to sell or barter, any diploma or document showing or purporting to show graduation as a dental hygienist or dental assistant;

b. Purchasing or procuring by barter any such diploma, certificate or transcript with intent that it be used as evidence of the qualifications of the holder to practice dental hygiene [or], work as a registered dental assistant or limited registered dental assistant, or of the holder to practice dental therapy, or in fraud of the laws regulating such practice or work;

c. With fraudulent intent, altering in a material regard, such diploma, certificate or transcript;

d. Using or attempting to use such diploma, certificate or transcript which has been purchased, fraudulently issued, and counterfeited or materially altered, either as a license or registration or color of license or registration to practice dental hygiene or work as a registered dental assistant or limited registered dental assistant or to practice a dental therapist, or in order to procure registration as a dental hygienist; or

e. In any affidavit or examination required of an applicant for examination, license or registration under the laws regulating the practice of dental hygiene or dental assisting or dental therapy, willfully making a false statement in a material regard, or impersonating another applicant at an examination.

(cf: P.L.1995, c.367, s.7)

8. Section 14 of P.L.1979, c.46 (C.45:6-61) is amended to read as follows:

14. Any licensed dentist who shall permit any unlicensed or unregistered person to practice dental hygiene [or], work as a registered dental assistant or limited registered dental assistant, or practice dental therapy under his direction or control or shall permit or direct a licensed dental hygienist, registered dental assistant or limited registered dental assistant, or licensed dental therapist to perform any act not authorized in this act shall be guilty of a violation of this act and of conduct constituting willful and gross malpractice or willful and gross neglect in the practice of dentistry.

(cf: P.L.1995, c.367, s.8)

9. Section 17 of P.L.1979, c.46 (C.45:6-64) is amended to read as follows:

17. Nothing in this act shall be construed as permitting a licensed dental hygienist or licensed dental therapist to establish an independent office or engage in independent practice in connection with the performance of traditional hygienist services or traditional therapist services whether or not there is supervision or direct supervision of a licensed dentist.

(cf: P.L.2012, c.29, s.3)

10. Section 4 of P.L.2012, c.29 (C.45:6-69.1) is amended to read as follows:

4. The administration of local anesthesia, the monitoring of a patient administered nitrous oxide, and any other anesthetic procedures that may be designated by the New Jersey State Board of Dentistry, by regulation, shall be performed by a licensed dental hygienist or licensed dental therapist only under direct supervision.

(cf: P.L.2012, c.9, s.4)

11. Section 6 of P.L.2012, c.29 (C.45:6-73) is amended to read as follows:

6. Except as otherwise provided in P.L.1964, c.186 (C.45:6-16.1 et seq.), R.S.45:6-19 and R.S.45:6-20, no person other than a person duly licensed to practice dentistry in this State shall:

a. make any diagnosis or develop any treatment plan with respect to the dental condition or treatment of any living person in this State;

b. perform any surgical or irreversible procedure, including, but not limited to, the cutting of hard or soft tissue or the extraction of any tooth on any living person in this State;

c. either bill or submit a claim for any service rendered involving the practice of dentistry or dental hygiene in this State; or

d. receive payment for the performance of dental [or], dental hygienist services, or dental therapist services from any source other than an employer authorized by law to practice dentistry in this State or any dental clinic, institution, or employment agency, as defined pursuant to section 1 of P.L.1989, c.331 (C.34:8-43), that employs licensed dental hygienists or licensed dental therapists to provide temporary dental hygiene or dental therapy services.

(cf: P.L.2012, c.29, s.6)

12. (New section) No person shall engage in the practice of dental therapy unless that person:

a. is a dental hygienist licensed pursuant to section 3 of P.L.1979, c.46 (C.45:6-50);

b. has obtained a dental therapist certification that is:

(1) in writing, on a form issued by an institution of higher education accredited by the Commission on Dental Accreditation after successful completion of a dental therapy program that includes, in accordance with the Commission on Dental Accreditation's standards for dental therapy education programs, full-time instruction or its equivalent at the postsecondary college level and incorporates all dental therapy practice competencies; and

(2) signed by the dental therapist and the director of the dental therapy education program;

c. has successfully completed a comprehensive examination prescribed by the Commission on Dental Competency Assessments, or its equivalent, and administered independently of any institution of higher education that offers a program in dental therapy; and

d. has entered into a collaborative agreement. Prior to entering the first collaborative agreement, a person shall have received a certificate of completion, signed by a dentist licensed pursuant to chapter 6 of Title 45 of the Revised Statutes, that verifies completion of one thousand hours of clinical training under the direct supervision of that dentist.

13. (New section) A dental therapist shall practice in a dental clinic or institution under the supervision of a dentist licensed pursuant to chapter 6 of Title 45 of the Revised Statutes in accordance with a collaborative agreement.

14. (New section) No provision of this section shall be construed to prohibit a dental hygienist enrolled in a dental therapy program, as described in section 11 of P.L. , c. (C. ) (pending before the Legislature as this bill) from performing dental therapy work as a required component of his or her course of study in such program, provided such dental hygienist:

a. performs such work under supervision of a dentist licensed pursuant to chapter 6 of Title 45 of the Revised Statutes;

b. shall not hold them self out as a licensed dental therapist; and

c. shall not receive compensation for such work.

15. (New section) a. A collaborative agreement shall include:

(1) identification of public health facilities where services may be provided and the populations to be served;

(2) any limitations on the services that may be provided by the dental therapist;

(3) age and procedure-specific practice protocols, including case selection criteria, assessment guidelines and imaging frequency;

(4) a procedure for creating and maintaining dental records for the patients that are treated by the dental therapist;

(5) a plan to manage medical emergencies in each institution and dental clinic where the dental therapist provides care;

(6) a quality assurance plan for monitoring care provided by the dental therapist, including patient care review, referral follow-up and a quality assurance chart review;

(7) protocols for dispensing and administering medications, including the specific conditions and circumstances under which these medications may be dispensed and administered;

(8) criteria relating to the provision of care to patients with specific medical conditions or complex medication histories, including requirements for consultation prior to the initiation of care;

(9) criteria for the supervision of dental assistants, limited registered dental assistants, and dental hygienists; and

(10) a plan for the provision of referrals in situations that are beyond the capabilities or the scope of practice of the dental therapist.

b. A collaborative agreement shall be:

(1) signed and maintained by the supervising dentist and the dental therapist and kept on file at the locations where the dental therapist is employed;

(2) reviewed by the dentist and dental therapist on an annual basis and revised as needed; and

(3) available for inspection upon the request of the New Jersey Division of Consumer Affairs.

16. A dentist who enters into a collaborative agreement with a dental therapist:

a. shall be professionally responsible and legally liable for all services authorized and performed by the dental therapist pursuant to a collaborative agreement; and

b. shall not enter into a collaborative agreement with more than two dental therapists at any one time.

Nothing in this section shall be construed to require a dentist to enter into a collaborative agreement with a dental therapist.

17. A dental therapist may directly supervise not more than two dental assistants, limited registered dental assistants, or licensed dental hygienists to the extent permitted in the collaborative agreement.

18. Each dental therapist shall complete, in addition to the continuing education requirements of section 9 of P.L.1979, c.46 (C.45:6-56), six hours of continuing education in dental therapy within the 12-month period after the dental therapist enters into a collaborative agreement with a dentist and within each subsequent 24-month period thereafter.

19. Within one year after the effective date of this act, the board shall propose rules and regulations governing the practice of dental therapy. The rules and regulations shall take effect two years after the enactment of this act.

20. This act shall take effect on the first day of the seventh month next after enactment.

STATEMENT

This bill provides for the licensure and regulation of dental therapists by the New Jersey Board of Dentistry. A dental therapist is defined in the bill as a licensed dental hygienist authorized to engage in the practice of dental therapy under a collaborative agreement. Under the bill, the regulation of dental therapists is incorporated into various provisions of current law, including statutory requirements regarding the operations of dental clinics, licensure renewal, and continuing education.

Additionally, the bill adds language regarding numerous requirements to practice as a dental therapist, including the requirements for licensure, the components of a collaborative agreement as well as the role of a dentist in a collaborative agreement, and the level of supervision a dental therapist is required to have to perform services. The bill also requires the board to compose regulations for dental therapists, which are to be put together within the first year after the bill is enacted and be effective within two years of enactment of the bill.