Dental Hygienists

Establishes the educational requirements for the administration
of local anesthesia by dental hygienists; establishes
documentation required for dental board certification of a
hygienist to administer anesthesia; allows Board of Dental
Examiners to adopt rules for educational requirements for
anesthesia. (SD1)

THE SENATE                              S.B. NO.           779
TWENTIETH LEGISLATURE, 1999                                S.D. 1
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Chapter 447, Hawaii Revised Statutes, is amended
 2 by adding a new section to be appropriately designated and to
 3 read as follows:
 4      "447-     Educational requirements for anesthesia.  (a)
 5 The applicant for certification to administer intra-oral
 6 infiltration local anesthesia and intra-oral block anesthesia
 7 shall show proof that the applicant successfully completed a
 8 course of study which may include the following categories of
 9 intra-oral infiltration local anesthesia and intra-oral block
10 anesthesia:
11      (1)  Maxillary mandibular infiltration anesthesia;
12      (2)  Long buccal nerve block anesthesia;
13      (3)  Mental nerve block;
14      (4)  Inferior alveolar/lingual nerve block;
15      (5)  Incisive nerve block;
16      (6)  Posterior superior alveolar nerve block;
17      (7)  Middle superior alveolar nerve block;
18      (8)  Anterior superior alveolar nerve block;
19      (9)  Nasopalatine (incisive canal) nerve block; and

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 1     (10)  Greater (anterior) palatine nerve block.
 2      (b)  A course of study shall also include didactic
 3 experience, including successful passage of an examination,
 4 demonstration of clinical proficiency, and clinical experiencefor
 5 intra-oral block anesthesia categories in subsection (a)(1) to
 6 (10), for at least thirty-nine hours, and a minimum of fifty
 7 successful injections of which ten shall be in intra-oral block
 8 in subsection (a)(4) and five in intra-oral block in subsection
 9 (a)(6).
10      (c)  The curriculum of the course of study shall include as
11 follows:
12      (1)  Cardio-pulmonary certification;
13      (2)  Medical history evaluation procedures;
14      (3)  Physical evaluation procedures;
15      (4)  Anatomy of head, neck, and oral cavity as it relates to
16           administering local anesthetic agents;
17      (5)  Pharmacology of local anesthetics and vasoconstrictors;
18      (6)  Indications and contraindications for administration of
19           local anesthetics;
20      (7)  Prevention, diagnosis, and management of medical
21           emergency;
22      (8)  Recognition and management of post-injection

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 1           complications and management of reactions to
 2           injections;
 3      (9)  Medical and legal management complications;
 4     (10)  Selection and preparation of the armamenteria and
 5           record keeping for administering various local
 6           anesthetics;
 7     (11)  Methods of administering local anesthetics with
 8           emphasis on technique, which includes aspiration and
 9           slow injection, in addition to minimum effective
10           dosage; and
11     (12)  Proper infection control techniques with regard to
12           local anesthesia and the proper disposal of sharps.
13      (d)  For purposes of this section, the board of dental
14 examiners may adopt rules pursuant to chapter 91."
15      SECTION 2.  Section 447-1, Hawaii Revised Statutes, is
16 amended to read as follows:
17      "447-1 Who may become dental hygienists; fees.  (a)  Any
18 person:
19      (1)  Eighteen years of age or over;
20      (2)  Holding and having a diploma or proper certificate of
21           graduation from a dental hygiene school accredited by
22           the American Dental Association (A.D.A.) Commission on
23           Dental Accreditation requiring at least a two year

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 1           course, recognized by the board of dental examiners;
 2           and
 3      (3)  Having been officially certified in the administration
 4           of intra-oral infiltration local anesthesia and block
 5           anesthesia by an accredited dental hygiene school or by
 6           a certification program previously approved by the
 7           board;
 8 upon written application made to and filed with the board at
 9 least sixty days prior to the date selected by the board for the
10 examination, may be examined by the board for qualification as a
11 dental hygienist.
12      The application for examination shall be accompanied by the
13 applicant's certificate of graduation from an accredited dental
14 hygiene school together with documentary proof of the applicant's
15 certification in the administration of intra-oral infiltration
16 local anesthesia and block anesthesia[.] which complies with the
17 standards provided in this chapter.  At the time of filing the
18 application, the applicant shall pay to the board application and
19 examination fees, which fees, together with all other fees or
20 charges in this chapter, shall be as provided in rules adopted by
21 the director of commerce and consumer affairs pursuant to chapter
22 91, and shall be deposited to the credit of the compliance
23 resolution fund established pursuant to section 26-9(o).

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 1      (b)  Two examinations shall be held in each year at the time
 2 the board designates.  The examinations shall cover subjects
 3 considered essential by the board for a dental hygienist and
 4 shall likewise include a practical examination on the removal of
 5 deposits or stains from the surfaces of the teeth.  The board
 6 shall furnish a chair and engine, but the applicant shall supply
 7 all necessary instruments, materials, and patients for the
 8 examination.
 9      (c)  If the applicant successfully passes the examination,
10 the applicant shall be [registered and receive a certificate of
11 ability] licensed to practice as a dental hygienist in the State.
12 Every [registered] licensed dental hygienist, before entering
13 practice, shall pay the board a [registration] license fee.  On
14 or before December 31 of each odd-numbered year, every
15 [registered] licensed dental hygienist desiring to begin or
16 continue to practice in the State shall pay to the board a fee
17 for the biennial [registration] licensure thereof.  The failure,
18 neglect, or refusal of any duly licensed dental hygienist to pay
19 the biennial [registration] licensure fee shall constitute a
20 forfeiture of the license, but the license may be restored upon
21 written application therefor and payment to the board of a
22 restoration fee.
23      (d)  A dental hygienist's competence to administer intra-

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 1 oral infiltration local anesthesia shall be demonstrated by
 2 having been certified in the administration of intra-oral
 3 infiltration local anesthesia by an accredited dental hygiene
 4 school or by a certification program previously approved by the
 5 board.  In addition, a dental hygienist's competence to
 6 administer intra-oral block anesthesia shall be demonstrated by
 7 proof of successful completion of a course of study in accordance
 8 with standards provided for in this chapter, and the issuance of
 9 a certificate or other program documentation listing the intra-
10 oral block anesthesia categories in which the dental hygienist
11 has acquired knowledge and proficiency.  The applicant shall also
12 submit documentation of the course content when submitting the
13 certificate.  The board shall certify that the applicant or
14 licensed dental hygienist has met the requirements of this
15 chapter; provided that the dental hygienist's administration of
16 intra-oral block anesthesia shall be under the direct supervision
17 of a licensed dentist and shall be for those categories of intra-
18 oral block anesthesia listed on the course of study certificate
19 submitted to the board.
20      [(d)] (e)  No person shall practice dental hygiene, either
21 gratuitously or for pay, or shall offer or attempt so to
22 practice, or shall advertise or announce publicly or privately as
23 being prepared or qualified so to practice, without having a

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 1 license as in this section provided, nor shall any licensed
 2 dental hygienist practice except under the supervision of a
 3 licensed dentist as in this chapter provided." 
 4      SECTION 3.  Section 447-3, Hawaii Revised Statutes, is
 5 amended by amending subsection (b) to read as follows:
 6      "(b)  Clinical dental hygiene may be practiced by a licensed
 7 dental hygienist.  The practice of clinical dental hygiene is
 8 defined as the removal of hard and soft deposits and stains from
 9 the portion of the crown and root surfaces to the depth of the
10 gingival sulcus, polishing natural and restored surfaces of
11 teeth, the application of preventive chemical agents to the
12 coronal surfaces of teeth, which chemical agents have been
13 approved by the board of dental examiners, and the use of mouth
14 washes as are approved by the board, but shall not include the
15 performing of any repair work or the preparation thereof, or any
16 other operation on the teeth or tissues of the mouth; provided
17 that nothing herein shall prohibit a dental hygienist from using
18 or applying topically any chemical agent which has been approved
19 in writing by the department of health for any of the purposes
20 set forth in part V of chapter 321, and other procedures
21 delegated by [the] a dentist in accordance with the rules of the
22 board of dental examiners.
23      In addition, a licensed dental hygienist may administer

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 1 intra-oral infiltration local anesthesia and intra-oral block
 2 anesthesia under the direct supervision of a dentist [upon
 3 providing documentary proof satisfactory to the board of
 4 certification in the administration of these procedures.] after
 5 being certified by the board, and for those categories of intra-
 6 oral infiltration local anesthesia and intra-oral block
 7 anesthesia for which the licensed dental hygienist has been
 8 certified through a course of study meeting the requirements of
 9 this chapter."
10      SECTION 4.  Statutory material to be repealed is bracketed.
11 New statutory material is underscored.
12      SECTION 5.  This Act shall take effect upon its approval.