A dental hygienist may prescribe, administer and dispense a fluoride supplement, topically applied fluoride, and topically applied antimicrobials from the following formulary under the following stipulations.

1. A. A New Mexico licensed dentist shall supervise, at least by general supervision the prescribing, administration or dispensing by the hygienist. In a collaborative hygiene practice the formulary used by the dental hygienist and situations for each therapeutic agent must be set forth in the collaborative practice agreement. Dental hygienists shall keep as part of the patient record a clear documentation of the therapeutic agent prescribed, administered or dispensed, the date and reason.

2. B. Under no circumstances shall a dental hygienist be allowed to prescribe, dispense or administer:

   1. (1) drugs whose primary effect is systemic; and
   2. (2) dangerous drugs or controlled substances as defined in the pharmacy act (NMSA 1978, Section 61-11-1 et deq.) controlled substances act (NMSA 1978, Sections 31-30-1 et seq.) or Drug Device and Cosmetic Act (NMSA 1978, Sections 26-1-1 et seq.).

3. C. Dental hygienists may prescribe from the following list:

   1. (1) fluoride supplements (all using sodium fluoride);

      1. (a) tablets - 0.5 mg, 1.1 mg, 2.2 mg;
      2. (b) lozenges - 2.21 mg;
      3. (c) drops - 1.1 mg/mL;

   2. (2) topical anti-caries treatments (all using sodium fluoride unless otherwise stated);

      1. (a) toothpastes - 1.1% or less (or stannous fluoride 0.4%);
      2. (b) topical gels - 1.1% or less (or stannous fluoride 0.4%);
      3. (c) oral rinses - 0.05%, 0.2%, 0.44%, 0.5%;
      4. (d) oral rinse concentrate (used in periodontal disease) - 0.63% stannous fluoride;
      5. (e) fluoride varnish - 5 %;
      6. (f) prophy pastes (containing approximately 1.23% sodium fluoride and used for cleaning and polishing procedures as part of professional dental prophylaxis treatment);

   3. (3) topical anti-infectives:

      1. (a) chlorhexidine gluconate ;

         1. (i) rinses - 0.12%;
         2. (ii) periodontal chips (for insertion into the periodontal pocket);
      2. (b) tetracycline impregnated fibers (inserted subgingivally into the periodontal sulcus);
      3. (c) doxycycline hyclate periodontal gel (inserted subgingivally into the periodontal sulcus); and
      4. (d) minocycline hydrochloride periodontal paste (inserted subgingivally into the periodontal sulcus).

[16.5.29.11 NMAC - N, 01/09/12; A, 01/04/14]