Nev. Admin. Code § 631.210 - Dental hygienists: Authorization to perform certain services; referral of patient to authorizing dentist for certain purposes
1. A dentist who is licensed in this State
may authorize a dental hygienist in his or her employ to perform the following
acts before a patient is examined by the dentist:
(a) Expose radiographs.
(b) Conduct an assessment of the oral health
of the patient through medical and dental histories, radiographs, indices, risk
assessments and intraoral and extraoral procedures that analyze and identify
the oral health needs and problems of the patient.
(c) After conducting an assessment pursuant
to paragraph (b), develop a dental hygiene care plan to address the oral health
needs and problems of the patient.
(d) Take impressions for the preparation of
diagnostic models.
The dental hygienist must obtain authorization from the licensed dentist of the patient on whom the services authorized pursuant to this subsection are to be performed.
2. A dentist who is licensed in this State
may authorize a dental hygienist in his or her employ to:
(a) Remove stains, deposits and accretions,
including dental calculus.
(b)
Smooth the natural and restored surface of a tooth by using the procedures and
instruments commonly used in oral prophylaxis, except that an abrasive stone,
disc or bur may be used only to polish a restoration. As used in this
paragraph, "oral prophylaxis" means the preventive dental procedure of scaling
and polishing which includes the removal of calculus, soft deposits, plaques
and stains and the smoothing of unattached tooth surfaces in order to create an
environment in which hard and soft tissues can be maintained in good health by
the patient.
(c) Provide dental
hygiene care that includes:
(1) Assessment of
the oral health of patients through medical and dental histories, radiographs,
indices, risk assessments and intraoral and extraoral procedures that analyze
and identify the oral health needs and problems of patients.
(2) Implementation of a dental hygiene care
plan to address the oral health needs and problems of patients described in
subparagraph (1).
(3) Evaluation of
oral and periodontal health after the implementation of the dental hygiene care
plan described in subparagraph (2) in order to identify the subsequent
treatment, continued care and referral needs of the
patient.
(d) Take the
following types of impressions:
(1) Those
used for the preparation of diagnostic models;
(2) Those used for the fabrication of
temporary crowns or bridges; and
(3)
Those used for the fabrication of temporary removable appliances, provided no
missing teeth are replaced by those appliances.
(e) Perform subgingival curettage.
(f) Remove sutures.
(g) Place and remove a periodontal
pack.
(h) Remove excess cement from
cemented restorations and orthodontic appliances. A dental hygienist may not
use a rotary cutting instrument to remove excess cement from restorations or
orthodontic appliances.
(i) Train
and instruct persons in the techniques of oral hygiene and preventive
procedures.
(j) Recement and repair
temporary crowns and bridges.
(k)
Recement permanent crowns and bridges with nonpermanent material as a
palliative treatment.
(l) Place a
temporary restoration with nonpermanent material as a palliative
treatment.
(m) Administer local
intraoral chemotherapeutic agents in any form except aerosol, including, but
not limited to:
(1) Antimicrobial
agents;
(2) Fluoride
preparations;
(3) Topical
antibiotics;
(4) Topical
anesthetics; and
(5) Topical
desensitizing agents.
(n)
Apply pit and fissure sealant to the dentition for the prevention of decay.
Before performing any of the services set forth in this subsection, the dental hygienist must obtain authorization from the licensed dentist of the patient on whom the services are to be performed and the patient must have been examined by that dentist not more than 18 months before the services are to be performed. After performing any of the services set forth in this subsection, the dental hygienist shall refer the patient to the authorizing dentist for follow-up care or any necessary additional procedures that the dental hygienist is not authorized to perform.
3. A
dentist who is licensed in this State may authorize a dental hygienist in his
or her employ and under his or her supervision to:
(a) Place and secure orthodontic
ligatures.
(b) Fabricate and place
temporary crowns and bridges.
(c)
Fit orthodontic bands and prepare teeth for orthodontic bands if the bands are
cemented or bonded, or both, into the patient's mouth by the dentist who
authorized the dental hygienist to perform this procedure.
(d) Perform nonsurgical cytologic
testing.
(e) Apply and activate
agents for bleaching teeth with a light source.
(f) Use a laser that has been cleared by the
Food and Drug Administration to perform intrasulcular periodontal procedures or
tooth whitening procedures if:
(1) The use of
such a laser for those purposes is within the scope of the education,
experience and training of the dental hygienist;
(2) Before operating the laser, the dental
hygienist has provided proof to the supervising dentist that the dental
hygienist has successfully completed a course in laser proficiency that:
(I) Is at least 6 hours in length;
and
(II) Is based on the
Curriculum Guidelines and Standards for Dental Laser
Education, adopted by reference pursuant to NAC 631.035;
and
(3) The supervising
dentist has successfully completed a course in laser proficiency that:
(I) Is at least 6 hours in length;
and
(II) Is based on the
Curriculum Guidelines and Standards for Dental Laser
Education, adopted by reference pursuant to NAC 631.035.
The dental hygienist must obtain authorization from the licensed dentist of the patient on whom the services authorized pursuant to this subsection are to be performed.
4. If a dentist who is licensed in this State
has in his or her employ and under his or her supervision a dental hygienist
who has:
(a) Successfully completed a course
of continuing education in the administering of local anesthetics or nitrous
oxide-oxygen analgesia, or both, which has been approved by the Board;
or
(b) Graduated from an accredited
program of dental hygiene which includes the administering of local anesthetics
or nitrous oxide-oxygen analgesia, or both, in its curriculum, the dentist may
authorize the dental hygienist to administer local anesthetics or nitrous
oxide-oxygen analgesia, or both, as appropriate, if the dental hygienist has
received from the Board a certificate or permit certifying the hygienist for
this level of administration. The dental hygienist must obtain the
authorization from the licensed dentist of the patient on whom the services are
to be performed.
5. A
dental hygienist in a health care facility may administer local intraoral
chemotherapeutic agents and, if he or she has complied with paragraph (a) or
(b) of subsection 4, may administer local anesthetics or nitrous oxide-oxygen
analgesia, or both, as appropriate, if he or she first:
(a) Obtains written authorization from the
licensed dentist of the patient to whom the local anesthetics, nitrous
oxide-oxygen analgesia or local intraoral chemotherapeutic agents are to be
administered; and
(b) Submits to the
Secretary-Treasurer a written confirmation from the director of the health care
facility that the facility has licensed medical personnel and necessary
emergency supplies and equipment that will be available when the local
anesthetics, nitrous oxide-oxygen analgesia or local intraoral chemotherapeutic
agents are administered.
6. The Board may authorize a dental hygienist
to perform the services set forth in subsection 1 and paragraphs (a) to (n),
inclusive, of subsection 2 without supervision by a dentist and without
authorization from the licensed dentist of the patient on whom the services are
to be performed, at a health facility, a school or a place in this State
approved by the Board after the Board:
(a)
Issues a special endorsement of the dental hygienist's license.
(b) Approves the treatment protocol submitted
by the dental hygienist which includes an explanation of the methods that the
dental hygienist will use to:
(1) Treat
patients; and
(2) Refer patients to
a dentist for:
(I) Follow-up care;
(II) Diagnostic services; and
(III) Any service that the dental hygienist
is not authorized to perform.
7. The Board may revoke the authorization
described in subsection 6 if the:
(a) Dental
hygienist fails to renew his or her license or it is cancelled, suspended or
revoked;
(b) Board receives a
complaint filed against the dental hygienist;
(c) Dental hygienist commits an act which
constitutes a cause for disciplinary action; or
(d) Dental hygienist violates any provision
of this chapter or chapter 631 of NRS.
Nothing in this subsection prohibits a dental hygienist from reapplying for authorization to perform the services described in subsection 6 if the Board revokes the authorization pursuant to this subsection.
8. As
used in this section:
(a) "Health care
facility" has the meaning ascribed to it in
NRS
162A.740.
(b) "Health facility" has the meaning
ascribed to it in subsection 6 of
NRS
449.260.
(c) "School" means an elementary, secondary
or postsecondary educational facility, public or private, in this
State.
Notes
NRS 631.190, 631.310, 631.313, 631.317
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