(a) If the collaborative agreement is approved by the board under (d) of this section, a licensed dental hygienist with a minimum of 4,000 documented hours of clinical experience within the five years preceding application for the board's approval may enter into a collaborative agreement with a licensed dentist in which the licensed dentist authorizes the licensed dental hygienist to perform one or more of the following:

1. (1) oral health promotion and disease prevention education;
2. (2) removal of calcareous deposits, accretions, and stains from the surfaces of teeth;
3. (3) application of topical preventive or prophylactic agents, including fluoride varnishes and pit and fissure sealants;
4. (4) polishing and smoothing restorations;
5. (5) removal of marginal overhangs;
6. (6) preliminary charting and triage to formulate a dental hygiene assessment and dental hygiene treatment plan;
7. (7) the exposure and development of radiographs;
8. (8) use of local periodontal therapeutic agents; and
9. (9) performance of nonsurgical periodontal therapy, with or without the administration of local anesthesia, subsequent to a licensed dentist's authorization or diagnosis as specified in the licensed hygienist's collaborative agreement.

(b) The services described in (a) of this section may be performed under a collaborative agreement approved by the board

1. (1) without the presence of the licensed dentist;
2. (2) in a setting other than the usual place of practice of the licensed dentist; and
3. (3) without the dentist's diagnosis and treatment plan unless otherwise specified in the collaborative agreement or in (a) of this section.