201 KAR 8:562. Licensure of dental hygienists.

 

      RELATES TO: KRS 214.615, 304.40 - 075, 313.030, 313.040, 313.060, 313.080, 313.130, 313.254

      STATUTORY AUTHORITY: KRS 214.615(2), 313.021(1)(a) - (c), 313.040(1), (2), (7), 313.254

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 313.040 requires the board to promulgate administrative regulations relating to requirements and procedures for the licensure of dental hygienists. This administrative regulation establishes requirements and procedures for the licensure of dental hygienists.

 

      Section 1. General Licensure Requirements. An applicant desiring licensure in the Commonwealth shall at a minimum:

      (1) Understand, read, speak, and write the English language with a comprehension and performance level equal to at least the ninth grade of education, otherwise known as Level 4, verified by testing as necessary;

      (2) Submit a completed, signed, and notarized Application for Dental Hygiene Licensure with an email contact address and an attached applicant photo taken within the past six (6) months;

      (3) Pay the fee required by 201 KAR 8:520;

      (4) Not be currently subject to disciplinary action pursuant to KRS Chapter 313 that would prevent licensure;

      (5) Provide proof of completion of the requirements of KRS 214.615(1);

      (6) Complete and pass the board’s jurisprudence exam;

      (7) Provide proof of having current certification in cardiopulmonary resuscitation (CPR) that meets or exceeds the guidelines established by the American Heart Association, incorporated by reference in 201 KAR 8:532;

      (8) Submit to a criminal background check from the Administrative Office of the Courts in Kentucky, from the state or states of residence for the last five (5) years, or by fingerprint;

      (9) Provide verification within three (3) months of the date the application is received at the office of the board of any license to practice dental hygiene held previously or currently in any state or jurisdiction;

      (10) Provide proof that the applicant is a graduate of a Commission on Dental Accreditation (CODA) accredited dental hygiene school or college or dental hygiene department of a university;

      (11) Provide proof that the applicant has successfully completed the National Board Dental Hygiene Examination, which is written and theoretical, conducted by the Joint Commission on National Dental Examinations; and

      (12) Provide a written explanation for any positive returns on a query of the National Practitioner Data Bank.

 

      Section 2. Requirements for Licensure by Examination. (1) Each individual desiring initial licensure as a dental hygienist by examination shall complete all of the requirements established in Section 1 of this administrative regulation.

      (2) Each individual desiring initial licensure as a dental hygienist by examination shall successfully complete a clinical examination within the five (5) years preceding the filing of his Application for Dental Hygiene Licensure.

      (a) Prior to July 15, 2013, the board shall accept the following regional clinical examinations:

      1. The examination of the Council of Interstate Testing Agencies (CITA);

      2. The examination of the Central Regional Dental Testing Service (CRDTS);

      3. The examination of the North East Regional Board of Dental Examiners (NERB);

      4. The examination of the Southern Regional Testing Agency (SRTA); or

      5. The examination of the Western Regional Examining Board (WREB).

      (b) After July 15, 2013, the board shall only accept a nationalized clinical examination.

      (3) An individual desiring initial licensure as a dental hygienist by examination more than two (2) years after fulfilling all of the requirements of his CODA accredited dental hygiene education shall:

      (a) Hold a license to practice dental hygiene in good standing in another state or territory of the United States or the District of Columbia; or

      (b) If the applicant does not hold a license to practice dental hygiene in good standing, complete a board-approved refresher course prior to receiving a license to practice dental hygiene in the Commonwealth of Kentucky.

      (4) An applicant who has taken a clinical examination three (3) times and failed to achieve a passing score shall not be allowed to sit for the examination again until the applicant has completed and passed a remediation plan prescribed by the board based on the applicant's deficiencies.

 

      Section 3. Requirements for Licensure by Credentials. Each individual desiring initial licensure as a dental hygienist by credentials shall:

      (1) Complete all of the requirements established in Section 1 of this administrative regulation;

      (2) Provide proof of having passed a state, regional, or national clinical examination used to determine clinical competency in a state or territory of the United States or the District of Columbia; and

      (3) Provide proof that, for five (5) of the six (6) years immediately preceding the filing of the application, the applicant has been engaged in the active practice of dental hygiene while he or she was legally authorized to practice dental hygiene in a state or territory of the United States or the District of Columbia if the qualifications for the authorization were equal to or higher than those of the Commonwealth of Kentucky.

 

      Section 4. Requirements for Charitable Limited Licensure. (1) Each individual desiring a charitable limited license shall:

      (a) Understand, read, speak, and write the English language with a comprehension and performance level equal to at least the ninth grade of education, otherwise known as Level 4, verified by testing as necessary;

      (b) Submit a completed, signed, and notarized Application for Charitable Dental Hygiene Licensure with an attached applicant photo taken within the past six (6) month;

      (c) Not be subject to disciplinary action pursuant to KRS Chapter 313 that would prevent licensure;

      (d) Have a license to practice dental hygiene in good standing in another state; and

      (e) Provide a written explanation for any positive returns on a query of the National Practitioner Data Bank.

      (2) An individual licensed pursuant to this section shall:

      (a) Work only with charitable entities registered with the Cabinet for Health and Family Services that have met requirements of KRS 313.254 and 201 KAR 8:580;

      (b) Only perform procedures allowed by KRS 313.254, which shall be completed within the duration of the charitable event;

      (c) Be eligible for the provisions of medical malpractice insurance procured pursuant to KRS 304.40-075;

      (d) Perform these duties without expectation of compensation or charge to the individual and without payment or reimbursement by any governmental agency or insurer;

      (e) Have a charitable limited license that shall be good for two (2) years and expire during the regular dental hygiene renewal cycle; and

      (f) Comply with reciprocity requirements if applicable.

      1. A state that extends a reciprocal agreement shall comply with this section.

      2. An individual shall notify the sponsor of a charitable clinic and the board of the intent to conduct or participate in the clinic.

      3. An individual conducting or participate in a charitable clinic shall have a license to practice dental hygiene in the state in which the dental hygienist practices.

 

      Section 5. Minimum Continuing Education Requirements. (1) Each individual desiring renewal of an active dental hygiene license shall complete thirty (30) hours of continuing education that relates to or advances the practice of dental hygiene and would be useful to the licensee in his practice.

      (2) Acceptable continuing education hours shall include course content designed to increase:

      (a) Competency in treating patients who are medically compromised or who experience medical emergencies during the course of dental hygiene treatment;

      (b) Knowledge of pharmaceutical products and the protocol of the proper use of medications;

      (c) Awareness of currently accepted methods of infection control;

      (d) Knowledge of basic medical and scientific subjects including, biology, physiology, pathology, biochemistry, pharmacology, epidemiology, and public health;

      (e) Knowledge of clinical and technological subjects;

      (f) Knowledge of subjects pertinent to patient management, safety, and oral healthcare;

      (g) Competency in assisting in mass casualty or mass immunization situations;

      (h) Clinical skills through the volunteer of clinical charitable dental hygiene that meets the requirements of KRS 313.254;

      (i) Knowledge of office business operations and best practices; or

      (j) Participation in dental or dental hygiene association or society business meetings.

      (3) A minimum of ten (10) hours shall be taken in a live interactive presentation format.

      (4) A maximum of ten (10) hours total may be taken that meet the requirements of subsection (2)(h) - (j) of this section.

      (5) All continuing education hours shall be verified by the receipt of a certificate of completion or certificate of attendance bearing:

      (a) The signature of the provider;

      (b) The name of the licensee in attendance;

      (c) The title of the course or meeting attended or completed;

      (d) The date of attendance or completion;

      (e) The number of hours earned; and

      (f) Evidence of the method of delivery if the course was taken in a live interactive presentation format.

      (6) It shall be the sole responsibility of the individual dental hygienist to obtain documentation from the provider or sponsoring organization verifying participation as established in subsection (5) of this section and to retain the documentation for a minimum of five (5) years.

      (7) At license renewal, each licensee shall attest to the fact that he or she has complied with the requirements of this section.

      (8) Each licensee shall be subject to audit of proof of continuing education compliance by the board.

 

      Section 6. Requirements for Renewal of a Dental Hygiene License. (1) Each individual desiring renewal of an active dental hygiene license shall:

      (a) Submit a completed, signed, and notarized Application for Renewal of Dental Hygiene Licensure with an email contact address and an attached applicant photo taken within the past six (6) months;

      (b) Pay the fee required by 201 KAR 8:520;

      (c) Maintain with no more than a thirty (30) day lapse, CPR certification that meets or exceeds the guidelines established by the American Heart Association, incorporated by reference in 201 KAR 8:530, unless a hardship waiver is submitted to and subsequently approved by the board;

      (d) Meet the requirements of KRS 214.615(1); and

      (e) Meet the continuing education requirements as established in Section 5 of this administrative regulation except in the following cases:

      1. If a hardship waiver has been submitted to and is subsequently approved by the board;

      2. If the licensee graduated in the first year of the renewal biennium, in which case the licensee shall complete one-half (1/2) of the hours as established in Section 5 of this administrative regulation; and

      3. If the licensee graduated in the second year of the renewal biennium, in which case the licensee shall not be required to complete the continuing education requirements established in Section 5 of this administrative regulation.

      (2) If a licensee has not actively practiced dental hygiene in the two (2) consecutive years preceding the filing of the renewal application, he or she shall complete and pass a board-approved refresher course prior to resuming the active practice of dental hygiene.

 

      Section 7. Retirement of a License. (1) Each individual desiring retirement of a dental hygiene license shall submit a completed and signed Retirement of License Form.

      (2) Upon receipt of Retirement of License Form, the board shall send written confirmation of retirement to the last known address of the licensee.

      (3) A licensee shall not retire a license that has pending disciplinary action against it.

      (4) Each retirement shall be effective upon the processing of the completed and signed Retirement of License Form by the board.

 

      Section 8. Reinstatement of a License. (1) Each individual desiring reinstatement of a properly retired dental hygiene license shall:

      (a) Submit a completed, signed, and notarized Application for Dental Hygiene Licensure with an email contact address and an attached applicant photo taken within the past six (6) months;

      (b) Pay the fee required by 201 KAR 8:520;

      (c) Show proof of having current certification in CPR that meets or exceeds the guidelines established by the American Heart Association, incorporated by reference in 201 KAR 8:532;

      (d) Provide verification within three (3) months of the date the Application for Dental Hygiene Licensure is received at the office of the board of any license to practice dental hygiene held previously or currently in any state or jurisdiction;

      (e) Submit to a criminal background check from the Administrative Office of the Courts in Kentucky, from the state or states of residence for the last five (5) years, or by fingerprint; and

      (f) Provide a written explanation for any positive returns on a query of the National Practitioner Data Bank.

      (2) If an individual is reinstating a license that was retired within the two (2) consecutive years immediately preceding the filing of the reinstatement application, the individual shall provide proof of having met the continuing education requirements as established in Section 5 of this administrative regulation within those two (2) years.

      (3) If the applicant has not actively practiced dental hygiene in the two (2) consecutive years immediately preceding the filing of the Application to Reinstate a Dental Hygiene License, the applicant shall complete and pass a refresher course approved by the board.

      (4) If a license is reinstated in the first year of a renewal biennium, the licensee shall complete all of the continuing education requirements as established in Section 5 of this administrative regulation prior to the renewal of his license.

      (5) If a license is reinstated in the second year of a renewal biennium, the licensee shall complete one-half (1/2) of the hours as established in Section 5 of this administrative regulation prior to the renewal of his license.

 

      Section 9. Requirements for Verification of Licensure. Each individual desiring verification of a dental hygiene license shall:

      (1) Submit a signed and completed Verification of Licensure or Registration Form; and

      (2) Pay the fee required by 201 KAR 8:520.

 

      Section 10. Requesting a Duplicate License. Each individual desiring a duplicate dental hygiene license shall:

      (1) Submit a signed and completed Duplicate License or Registration Request Form; and

      (2) Pay the fee required by 201 KAR 8:520.

 

      Section 11. Requirements for Local Anesthesia Registration. (1) An individual who has completed a course of study in dental hygiene at a board-approved CODA accredited institution on or after July 15, 2010, which meets or exceeds the education requirements as established in KRS 313.060(10) shall be granted the authority to practice local anesthesia upon the issuance by the board of a dental hygiene license.

      (2) An individual licensed as a hygienist in Kentucky and not subject to disciplinary action who desires to administer local anesthesia and does not qualify to do so pursuant to Section 12(1) of this administrative regulation shall complete a training and education course as described in KRS 313.060(10).

      (3) The training and education course shall be offered by at least one (1) of the following institutions in Kentucky:

      (a) University of Louisville School of Dentistry;

      (b) University of Kentucky College of Dentistry;

      (c) Western Kentucky University Dental Hygiene Program; and

      (d) Kentucky Community Technical College System Dental Hygiene Programs.

      (4) Training received outside of Kentucky shall be from a CODA accredited dental or dental hygiene school and shall meet the requirements established in KRS 313.060(10).

      (5) Once the required training is complete the applicant shall:

      (a) Complete the Dental Hygiene Local Anesthesia Registration Application; and

      (b) Pay the fee required by 201 KAR 8:520.

      (6) Individuals authorized to practice pursuant to this provision shall receive a license from the board indicating registration to administer local anesthesia.

      (7) A licensed dental hygienist shall not administer local anesthesia if the licensee does not hold a local anesthesia registration issued by the board.

      (8) A licensed dental hygienist holding a local anesthesia registration from the board who has not administered block anesthesia, infiltration anesthesia, or nitrous oxide analgesia for one (1) year shall complete a board-approved refresher course prior to resuming practice of that specific technique.

 

      Section 12. Requirements for General Supervision Registration. (1) An individual licensed as a hygienist in Kentucky and not subject to disciplinary action who desires to practice under general supervision shall:

      (a) Complete the General Supervision Registration Application;

      (b) Meet the requirements of KRS 313.040(7)(a);

      (c) Document through payroll records, employment records, or other proof that is independently verifiable, the dates and hours of employment by a dentist in the practice of dental hygiene that demonstrate the required two (2) years and 3,000 hours of experience;

      (d) Successfully complete a live three (3) hour course approved by the board in the identification and prevention of potential medical emergencies that shall include, at a minimum, the following topics:

      1. Medical history, including American Society of Anesthesiologists (ASA) classifications of physical status;

      2. Recognition of common medical emergency situations, symptoms, and possible outcomes;

      3. Office emergency protocols; and

      4. Prevention of emergency situations during dental treatments.

      (2) An individual authorized to practice pursuant to these provisions shall receive a license from the board indicating registration to practice under general supervision.

      (3) A dentist who employs a dental hygienist who has met the standards of this administrative regulation and who allows the dental hygienist to provide dental hygiene services pursuant to KRS 313.040(7) shall complete a written order prescribing the dental service or procedure to be done to a specific patient by the dental hygienist and shall retain the original order in the patient's dental record.

      (4) The minimum requirements for the written order shall include:

      (a) Medical history update;

      (b) Radiographic records requested;

      (c) Dental hygiene procedures requested;

      (d) Name of the patient;

      (e) Date of last oral examination;

      (f) Date of the written order; and

      (g) Signature of the dentist.

      (5) The oral examination of the patient by the supervising dentist shall have been completed within the seven (7) months preceding treatment by the dental hygienist practicing under general supervision.

      (6) The supervising dentist shall evaluate and provide to the board written validation of an employed dental hygienist’s skills necessary to perform dental hygiene services established in KRS 313.040(7) as part of the General Supervision Registration Application.

      (7) The supervising dentist shall provide a written protocol addressing the medically compromised patients who may or may not be treated by the dental hygienist. The dental hygienist shall only treat patients who are in the ASA Patient Physical Status Classification of ASA I or ASA II as established in Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, 2007 Edition, American Dental Association.

      (8) A licensed dental hygienist shall not practice under general supervision if the licensee does not hold a general supervision registration issued by the board.

 

      Section 13. Requirements for Starting Intravenous Access Lines. (1) An individual licensed as a dental hygienist in Kentucky and not subject to disciplinary action pursuant to KRS Chapter 313 who desires to start an intravenous (IV) access line while under the direct supervision of a dentist who holds a sedation or anesthesia permit issued by the board shall:

      (a) Submit a signed and completed Application for Intravenous Access Line Registration;

      (b) Pay the fee required by 201 KAR 8:520; and

      (c) Submit documentation proving successful completion of a board-approved course in starting IV access lines.

      (2) An individual authorized to practice pursuant to this provision shall receive a license from the board indicating registration to start IV access lines.

      (3) A licensed dental hygienist shall not start an IV access line if the licensee does not hold a board-issued registration to start IV access lines.

 

      Section 14. Requirements for Performing Laser Debridement. (1) An individual licensed as a dental hygienist in Kentucky and not subject to disciplinary action pursuant to KRS Chapter 313 who desires to perform laser debridement while under the direct supervision of a dentist licensed by the board shall:

      (a) Submit a signed and completed Application for Laser Debridement Registration;

      (b) Pay the fee required by 201 KAR 8:520; and

      (c) Submit documentation proving successful completion of a board-approved course in performing laser debridement.

      (2) An individual authorized to practice pursuant to this provision shall receive a license from the board indicating registration to perform laser debridement.

      (3) A licensed dental hygienist shall not perform laser debridement if the licensee does not hold a registration to do so issued by the board.

 

      Section 15. Requirements for Public Health Registered Dental Hygienist Registration. (1) An individual licensed as a hygienist in Kentucky and not subject to disciplinary action who desires to practice as a public health registered dental hygienist shall:

      (a) Submit a completed Public Health Registered Dental Hygienist Application;

      (b) Meet the requirements established in KRS 313.040(8);

      (c) Document through payroll records, employment records, or other proof that is independently verifiable, the dates and hours of employment by a dentist in the practice of dental hygiene that demonstrate the required two (2) years and 3,000 hours of experience; and

      (d) During each renewal cycle, successfully complete a live three (3) hour course that has been approved by the board on the identification and prevention of potential medical emergencies that shall include, at a minimum, the following topics:

      1. Medical history, including American Society of Anesthesiologists (ASA) classifications of physical status;

      2. Recognition of common medical emergency situations, symptoms, and possible outcomes;

      3. Office emergency protocols; and

      4. Prevention of emergency situations during dental treatments.

      (2) An individual authorized to practice pursuant to subsection (1) of this section shall receive a certificate from the board indicating registration to practice as a public health registered dental hygienist.

      (3) A public health registered dental hygienist desiring to maintain certification as a public health registered dental hygienist shall be required to complete at least five (5) hours of continuing education in the area of public health or public dental health during each renewal cycle.

      (4) Pursuant to KRS 313.040(8)(c), a public health registered dental hygienist may practice in a government-created public health program at the following sites:

      (a) Local health departments;

      (b) Public or private educational institutions that provide Head Start, preschool, elementary and secondary instruction to school-aged children under the jurisdiction of the State Board of Education, and that have an affiliation agreement with the health department of jurisdiction;

      (c) Mobile and portable dental health programs under contract with a governing board of health; and

      (d) Public or private institutions under the jurisdiction of a federal, state, or local agency.

      (5) A public health registered dental hygienist shall perform dental hygiene services only under the supervision of the governing board of health, as required by KRS 313.040(3)(b), as established in KRS 313.040(8), and as identified by the Department for Public Health Practice Reference.

      (a) These services shall be limited to preventative services.

      (b) The public health registered dental hygienist shall only treat a patient who is in the ASA Patient Physical Status Classification of ASA I or ASA II as established in the current edition of Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, American Dental Association.

      (c) The informed consent shall be required prior to preventative services and shall include:

      1. The name of the public health entity, including the name of the dentist, that assumes responsibility and control;

      2. An inquiry as to the current dentist; and

      3. A statement that services are provided by a dental hygienist without the direct supervision of a dentist.

      (d) This administrative regulation shall not preclude a Kentucky-licensed dentist from directly participating in a public health program referenced in subsection 4(a), (b), (c), or (d) of this subsection.

 

      Section 16. Issuance of Initial Licensure. If an applicant has completed the requirements for licensure the board shall:

      (1) Issue a license in sequential numerical order; or

      (2) Deny licensure due to a violation of KRS Chapter 313 or 201 KAR Chapter 8.

 

      Section 17. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) "Application for Dental Hygiene Licensure", January 2011;

      (b) "Application for Charitable Dental Hygiene Licensure", July 2010;

      (c) "Application for Renewal of Dental Hygiene Licensure", January 2011;

      (d) "Retirement of License Form", July 2010;

      (e) "Application to Reinstate a Dental Hygiene License", July 2010;

      (f) "Verification of Licensure or Registration Form", July 2010;

      (g) "Duplicate License or Registration Request Form", July 2010;

      (h) "Dental Hygiene Local Anesthesia Registration Application", July 2010;

      (i) "General Supervision Registration Application", July 2010;

      (j) "Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students", 2007 Edition;

      (k) "Application for Intravenous Access Line Registration", July 2010;

      (l) "Application for Laser Debridement Registration", July 2010; and

      (m) "Application for Public Health Registered Dental Hygienist", May 2013.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Kentucky Board of Dentistry, 312 Whittington Parkway, Suite 101, Louisville, Kentucky 40222, Monday through Friday, 8 a.m. through 4:30 p.m. This material is also available on the board’s Web site at http://dentistry.ky.gov. (37 Ky.R. 3027; 504; eff. 9-13-2011; 38 Ky.R. 1870; 39 Ky.R. 199; eff. 8-15-2012; TAm. 5-22-2013.)