REPORT TITLE:
Dental Hygienists


DESCRIPTION:
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. (HB324 HD1)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        324
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO DENTAL HYGIENISTS.



BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 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;
 
20     (10)  Greater (anterior) palatine nerve block;
 

 
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                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1     (11)  Infraorbital nerve block;
 
 2     (12)  Mandibular nerve block;
 
 3           (A)  Gow gates technique; and
 
 4           (B)  Vazirani-akinosi technique;
 
 5           and
 
 6     (13)  Maxillary (second division) nerve block.
 
 7      (b)  A course of study shall also include didactic
 
 8 experience, including successful passage of an examination,
 
 9 demonstration of clinical proficiency, and clinical experience as
 
10 follows:
 
11      (1)  For intra-oral block anesthesia categories in
 
12           subsection (a)(1) to (10), at least thirty-nine hours,
 
13           and a minimum of fifty successful injections of which
 
14           ten shall be in intra-oral block in subsection (a)(4)
 
15           and five in intra-oral block in subsection (a)(6); and
 
16      (2)  If the course of study includes intra-oral block
 
17           anesthesia in subsection (a)(11), (12)(A), (12)(B), or
 
18           (13), a minimum of five additional successful
 
19           injections per category.
 
20      (c)  The curriculum of the course of study shall include as
 
21 follows:
 
22      (1)  CPR certification;
 
23      (2)  Medical history evaluation procedures;
 
24      (3)  Physical evaluation procedures;
 

 
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                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1      (4)  Anatomy of head, neck, and oral cavity as it relates to
 
 2           administering local anesthetic agents;
 
 3      (5)  Pharmacology of local anesthetics and vasoconstrictors;
 
 4      (6)  Indications and contraindications for administration of
 
 5           local anesthetics;
 
 6      (7)  Prevention, diagnosis, and management of medical
 
 7           emergency;
 
 8      (8)  Recognition and management of post-injection
 
 9           complications and management of reactions to
 
10           injections;
 
11      (9)  Medical and legal management complications;
 
12     (10)  Selection and preparation of the armamenteria and
 
13           record keeping for administering various local
 
14           anesthetics;
 
15     (11)  Methods of administering local anesthetics with
 
16           emphasis on technique, which includes aspiration and
 
17           slow injection, in addition to minimum effective
 
18           dosage; and
 
19     (12)  Proper infection control techniques with regard to
 
20           local anesthesia and the proper disposal of sharps."
 
21      SECTION 2.  Section 447-1, Hawaii Revised Statutes, is
 
22 amended to read as follows:
 

 
 
 
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                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1      "§447-1 Who may become dental hygienists; fees.  (a)  Any
 
 2 person:
 
 3      (1)  Eighteen years of age or over;
 
 4      (2)  Holding and having a diploma or proper certificate of
 
 5           graduation from a dental hygiene school accredited by
 
 6           the American Dental Association (A.D.A.) Commission on
 
 7           Dental Accreditation requiring at least a two year
 
 8           course, recognized by the board of dental examiners;
 
 9           and
 
10      (3)  Having been officially certified in the administration
 
11           of intra-oral infiltration local anesthesia and block
 
12           anesthesia by an accredited dental hygiene school or by
 
13           a certification program previously approved by the
 
14           board;
 
15 upon written application made to and filed with the board at
 
16 least sixty days prior to the date selected by the board for the
 
17 examination, may be examined by the board for qualification as a
 
18 dental hygienist.
 
19      The application for examination shall be accompanied by the
 
20 applicant's certificate of graduation from an accredited dental
 
21 hygiene school together with documentary proof of the applicant's
 
22 certification in the administration of intra-oral infiltration
 
23 local anesthesia and block anesthesia[.] which complies with the
 

 
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                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1 standards provided in this chapter.  At the time of filing the
 
 2 application, the applicant shall pay to the board application and
 
 3 examination fees, which fees, together with all other fees or
 
 4 charges in this chapter, shall be as provided in rules adopted by
 
 5 the director of commerce and consumer affairs pursuant to chapter
 
 6 91, and shall be deposited to the credit of the compliance
 
 7 resolution fund established pursuant to section 26-9(o).
 
 8      (b)  Two examinations shall be held in each year at the time
 
 9 the board designates.  The examinations shall cover subjects
 
10 considered essential by the board for a dental hygienist and
 
11 shall likewise include a practical examination on the removal of
 
12 deposits or stains from the surfaces of the teeth.  The board
 
13 shall furnish a chair and engine, but the applicant shall supply
 
14 all necessary instruments, materials, and patients for the
 
15 examination.
 
16      (c)  If the applicant successfully passes the examination,
 
17 the applicant shall be [registered and receive a certificate of
 
18 ability] licensed to practice as a dental hygienist in the State.
 
19 Every [registered] licensed dental hygienist, before entering
 
20 practice, shall pay the board a [registration] license fee.  On
 
21 or before December 31 of each odd-numbered year, every
 
22 [registered] licensed dental hygienist desiring to begin or
 
23 continue to practice in the State shall pay to the board a fee
 

 
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                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1 for the biennial [registration] licensure thereof.  The failure,
 
 2 neglect, or refusal of any duly licensed dental hygienist to pay
 
 3 the biennial [registration] licensure fee shall constitute a
 
 4 forfeiture of the license, but the license may be restored upon
 
 5 written application therefor and payment to the board of a
 
 6 restoration fee.
 
 7      (d)  A dental hygienist's competence to administer intra-
 
 8 oral infiltration local anesthesia shall be demonstrated by
 
 9 having been certified in the administration of intra-oral
 
10 infiltration local anesthesia by an accredited dental hygiene
 
11 school or by a certification program previously approved by the
 
12 board.  In addition, a dental hygienist's competence to
 
13 administer intra-oral block anesthesia shall be demonstrated by
 
14 proof of successful completion of a course of study in accordance
 
15 with standards provided for in this chapter, and the issuance of
 
16 a certificate or other program documentation listing the intra-
 
17 oral block anesthesia categories in which the dental hygienist
 
18 has acquired knowledge and proficiency.  The applicant shall also
 
19 submit documentation of the course content when submitting the
 
20 certificate.  The board shall certify that the applicant or
 
21 licensed dental hygienist has met the requirements of this
 
22 chapter; provided that the dental hygienist's administration of
 
23 intra-oral block anesthesia shall be under the direct supervision
 

 
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                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1 of a licensed dentist and shall be for those categories of intra-
 
 2 oral block anesthesia listed on the course of study certificate
 
 3 submitted to the board.
 
 4      [(d)] (e)  No person shall practice dental hygiene, either
 
 5 gratuitously or for pay, or shall offer or attempt so to
 
 6 practice, or shall advertise or announce publicly or privately as
 
 7 being prepared or qualified so to practice, without having a
 
 8 license as in this section provided, nor shall any licensed
 
 9 dental hygienist practice except under the supervision of a
 
10 licensed dentist as in this chapter provided." 
 
11      SECTION 3.  Section 447-3, Hawaii Revised Statutes, is
 
12 amended by amending subsection (b) to read as follows:
 
13      "(b)  Clinical dental hygiene may be practiced by a licensed
 
14 dental hygienist.  The practice of clinical dental hygiene is
 
15 defined as the removal of hard and soft deposits and stains from
 
16 the portion of the crown and root surfaces to the depth of the
 
17 gingival sulcus, polishing natural and restored surfaces of
 
18 teeth, the application of preventive chemical agents to the
 
19 coronal surfaces of teeth, which chemical agents have been
 
20 approved by the board of dental examiners, and the use of mouth
 
21 washes as are approved by the board, but shall not include the
 
22 performing of any repair work or the preparation thereof, or any
 
23 other operation on the teeth or tissues of the mouth; provided
 

 
Page 8                                                     324
                                     H.B. NO.           H.D. 1
                                                        
                                                        

 
 1 that nothing herein shall prohibit a dental hygienist from using
 
 2 or applying topically any chemical agent which has been approved
 
 3 in writing by the department of health for any of the purposes
 
 4 set forth in part V of chapter 321, and other procedures
 
 5 delegated by [the] a dentist in accordance with the rules of the
 
 6 board of dental examiners.
 
 7      In addition, a licensed dental hygienist may administer
 
 8 intra-oral infiltration local anesthesia and intra-oral block
 
 9 anesthesia under the direct supervision of a dentist [upon
 
10 providing documentary proof satisfactory to the board of
 
11 certification in the administration of these procedures.] after
 
12 being certified by the board, and for those categories of intra-
 
13 oral infiltration local anesthesia and intra-oral block
 
14 anesthesia for which the licensed dental hygienist has been
 
15 certified through a course of study meeting the requirements of
 
16 this chapter."
 
17      SECTION 4.  Statutory material to be repealed is bracketed.
 
18 New statutory material is underscored.
 
19      SECTION 5.  This Act shall take effect upon its approval and
 
20 shall be repealed on June 30, 2000.