1. A. A dental hygienist may practice dental hygiene under the general supervision of a dentist in a long-term care facility in accordance with this regulation.

2. B. Initial Appointment. A dental hygienist practicing under the general supervision of a licensed dentist in a long-term care facility and performing an authorized dental hygiene service for a patient’s initial appointment shall:

   1. (1) Have a written agreement between the supervising dentist and the dental hygienist that clearly sets forth the terms and conditions under which the dental hygienist may practice, including a statement that the dental hygienist may provide dental hygiene services without the dentist on the premises; and

   2. (2) Ensure that the supervising dentist is available for consultation with the dental hygienist:

      1. (a) In person;
      2. (b) By telephone; or
      3. (c) Electronically.

3. C. A dental hygienist working under general supervision in a long-term care facility shall:

   1. (1) Consult with the supervising dentist or a treating physician before proceeding with initial treatment if there has been a change in a recall patient’s medical history;
   2. (2) Assess the appropriate recall interval based on the individual needs of the patient or as otherwise recommended by the supervising dentist;

   3. (3) Limit dental hygiene tasks and procedures to:

      1. (a) Toothbrush prophylaxis;
      2. (b) Application of fluoride;
      3. (c) Dental hygiene instruction; and
      4. (d) Other duties as may be delegated, verbally or in writing, by the supervising dentist.

4. D. A dental hygienist shall:

   1. (1) Assess the patient’s apparent need for further evaluation by a dentist in order to diagnose the presence of dental disease; and
   2. (2) Submit the findings of the initial assessment to the supervising dentist for a determination of future treatment.

5. E. A dental hygienist may perform subsequent authorized dental hygiene services without the supervising dentist on the premises only if:

   1. (1) The supervising dentist examines the patient and authorizes in the patient’s record a prescription of specific treatment to be provided by the dental hygienist; and
   2. (2) An authorized treatment is provided by the dental hygienist as soon as possible, but no later than 7 months from the date the patient was examined by the supervising dentist.
6. F. Upon expiration of a prescribed treatment, the supervising dentist is responsible for determining future protocols for the treatment of the patient.

7. G. Qualifications of a Dental Hygienist. Before a dental hygienist is authorized to practice dental hygiene under general supervision in a long-term care facility, the dental hygienist shall:

   1. (1) Hold an active license to practice dental hygiene in the State;
   2. (2) Hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation;
   3. (3) Have at least 2 years of active clinical practice in direct patient care; and

   4. (4) Ensure that the long-term care facility where the dental hygienist will practice under general supervision has:

      1. (a) A written medical emergency plan in place;
      2. (b) Adequate equipment, including portable equipment and appropriate armamentarium, available for the appropriate delivery of dental hygiene services; and
      3. (c) Adequate safeguards to protect the patient’s health and safety.

8. H. Qualifications of a Dentist. Before a dental hygienist is authorized to practice dental hygiene under general supervision in a long-term care facility, the supervising dentist shall:

   1. (1) Hold an active general license to practice dentistry in the State;
   2. (2) Hold a current certificate evidencing Health Care Provider Level C Proficiency, or its equivalent, in cardiopulmonary resuscitation; and
   3. (3) Have at least 2 years of active clinical practice in direct patient care.

9. I. This regulation may not be construed to:

   1. (1) Authorize a dental hygienist to practice dental hygiene independent of a supervising dentist;
   2. (2) Prohibit a dentist from being available for personal consultation or on the premises where a dental hygienist is practicing; or
   3. (3) Prohibit a dental hygienist, without the supervision of a dentist, from performing a preliminary dental examination with a subsequent referral to a dentist.
10. J. Long-term care facilities are not required to obtain a waiver from the Board pursuant to Health Occupations Article, §4-308(e), Annotated Code of Maryland.

11. K. Before a long-term care facility may allow a dental hygienist to practice dental hygiene, the facility shall report to the Board:

    1. (1) That the facility is operating under general supervision;
    2. (2) The identity of each dental hygienist providing dental hygiene services in the facility; and
    3. (3) The identity of each supervising dentist.

Authority: Health Occupations Article, §4-308, Annotated Code of Maryland;
Ch. 221, Acts of 2003; Ch. 164 and 165, Acts of 2007; Ch. 733, Acts of 2010

Effective date:

Regulations .01 — .09 adopted as an emergency provision effective April 11, 1994 (21:9 Md. R. 747); emergency status expired October 7, 1994

Regulations .01 — .09 adopted effective October 10, 1994 (21:20 Md. R. 1733)

Chapter, Waiver of Supervision Requirements for Dental Hygienists, repealed and new chapter, Practice of Dental Hygiene Under General Supervision, adopted effective October 4, 1999 (26:20 Md. R. 1546)

Chapter revised effective December 11, 2003 (30:24 Md. R. 1743)

Regulation .02B amended effective January 26, 2009 (36:2 Md. R. 101)

Regulation .04A amended effective January 26, 2009 (36:2 Md. R. 101)

Regulation .05A amended effective January 26, 2009 (36:2 Md. R. 101)

Regulation .05B amended effective March 14, 2005 (32:5 Md. R. 580)

Regulation .07 amended effective January 26, 2009 (36:2 Md. R. 101)

Regulation .08 amended effective October 22, 2007 (34:21 Md. R. 1916); January 26, 2009 (36:2 Md. R. 101)

Regulation .09 recodified to be Regulation .10 and new Regulation .09 adopted effective October 22, 2007 (34:21 Md. R. 1916)

Regulation .09 repealed and new Regulation .09 adopted effective January 26, 2009 (36:2 Md. R. 101)

Chapter revised effective December 12, 2011 (38:25 Md. R. 1581)