Allows licensed dental hygienist to practice under the direct or general supervision of a licensed dentist. (HB1603 HD1)

A BILL FOR AN ACT

SECTION 1. The legislature finds that access to dental services is an essential element in improving Hawaii's poor oral health. Hawaii's children have the worst tooth decay rate in

the nation. Across all islands, oral health for children can be up to four times worse than the United States average.

The legislature finds that licensed dental hygienists can play a major role in improving Hawaii's oral health. These trained and certified professionals specialize in the education of dental hygiene and prevention of dental caries, and are currently regulated by the department of commerce and consumer affairs. However, because the existing law requires direct supervision of a licensed dental hygienist in a private practice, dental hygienists are precluded from performing essential dental services outside the dental office, without the physical presence of a licensed dentist.

While the existing law does provide for general supervision of licensed dental hygienists in limited circumstances where they are employed by a legally incorporated eleemosynary dental dispensary or infirmary, private school, or welfare center, or in any building owned or occupied by the State or any county, the availability of such licensed dental hygienists is too few to impact the necessary level of dental care in Hawaii. For example, there are only twelve dental hygienists employed by the department of health whose services reach only one-third of Hawaii's public schools every three years. By comparison, there are about six hundred sixty-seven licensed dental hygienists in Hawaii as of July 2000, the majority of whom are employed by dentists in private practice.

The legislature finds that there needs to be greater access to dental care not only for Hawaii's children, but to Hawaii's elderly and rural population who may not have the ability to visit a dental office. Licensed dental hygienists are trained and can help meet such dental needs. By enabling licensed dental hygienists employed in private practice to perform services under the general or direct supervision of a licensed dentist, the number of dental hygienists available to service Hawaii's public schools, nursing homes, and rural areas will dramatically increase. This will enable dental hygienists to:

without having the dentist physically present to oversee such basic dental services.

The legislature also finds that Hawaii is one of the last states in the country that has maintained its direct supervision provision. Forty-five states have some form of general supervision provision that enables the licensed dental hygienists to provide certain dental services without the physical presence of a licensed dentist.

The purpose of this Act is to increase the availability of licensed dental hygienists to provide oral services by enabling them to perform under the general or direct supervision of a licensed dentist.

SECTION 2. Section 447-3, Hawaii Revised Statutes, is amended to read as follows:

"§447-3 Employment of and practice by dental hygienists. (a) Any licensed dentist, legally incorporated eleemosynary dental dispensary or infirmary, private school, or welfare center, the State or any county, may employ licensed dental hygienists.

(b) Clinical dental hygiene may be practiced by a licensed dental hygienist. The practice of clinical dental hygiene is defined as the removal of hard and soft deposits and stains from the portion of the crown and root surfaces to the depth of the gingival sulcus, polishing natural and restored surfaces of teeth, the application of preventive chemical agents to the coronal surfaces of teeth, which chemical agents have been approved by the board of dental examiners, and the use of mouth washes as are approved by the board, but shall not include the performing of any repair work or the preparation thereof, or any other operation on the teeth or tissues of the mouth; provided that nothing herein shall prohibit a dental hygienist from using or applying topically any chemical agent which has been approved in writing by the department of health for any of the purposes set forth in part V of chapter 321, and other procedures delegated by a dentist in accordance with the rules of the board of dental examiners.

In addition, a licensed dental hygienist may administer intra-oral infiltration local anesthesia and intra-oral block anesthesia under the direct supervision of a dentist after being certified by the board, and for those categories of intra-oral infiltration local anesthesia and intra-oral block anesthesia for which the licensed dental hygienist has been certified through a course of study meeting the requirements of this chapter.

(c) The licensed dental hygienist may operate in the office of any licensed dentist, or legally incorporated eleemosynary dental dispensary or infirmary, private school, or welfare center, or in any building owned or occupied by the State or any county, but only under the aforesaid employment and under the direct or general supervision of a licensed dentist; provided that in the private practice of dentistry, the hygienist shall be under the direct supervision of a licensed dentist. No dental hygienist may establish or operate any separate care facility which exclusively renders dental hygiene services.

(d) Notwithstanding subsection (c) to the contrary, the licensed dental hygienist may perform prophylaxis, scalings, preliminary screenings, dental surveys, fluoride application, sealants, and conduct dental education under the general supervision of a licensed dentist; provided that the licensed dentist is in the private practice of dentistry. No direct reimbursements will be provided to dental hygienists."

SECTION 3. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 4. This Act shall take effect upon its approval.