An applicant for a certificate to administer local anesthesia
shall file a completed application on a form provided by the board. The
application shall include all of the following:
(1) The dental hygienist license number in
this state and the signature of the applicant.
(2) Evidence of current qualification in
cardiopulmonary resuscitation from either the American heart association or the
American red cross.
successful completion of a didactic and clinical program sponsored by an
accredited dental or dental hygiene program, resulting in the dental hygienist
becoming competent to administer local anesthesia under the delegation and
supervision of a dentist, the curriculum of which meets or exceeds the basic
course requirements set forth in s.
For those dental hygienists who are employed and taking a local anesthesia
program as continuing education outside of the initial accredited dental
hygiene program, the administration of local anesthesia on a non-classmate may
be performed at the place where the dental hygienist is employed. In those
instances the application:
(a) Shall contain
a statement from the employing dentist that he or she supervised and verifies
the successful completion of an inferior alveolar injection on a patient who
was informed of the situation and granted his or her consent to the dentist,
and that the dentist assumed liability for the injection performed on the
(b) Shall indicate that
the inferior alveolar injection was completed within 6 weeks from the time that
the licensed dental hygienist completed the coursework; or, if licensed by
endorsement of a dental hygienist license from another state, within 6 weeks of
becoming licensed as a dental hygienist in this state.
Wis. Admin. Code Dentistry Examining Board § DE 7.04
Cr. Register, October,
1999, No. 526, eff. 11-1-99.
Applications are available upon request to the board office
at 1400 East Washington Avenue, P.O. Box 8935, Madison, Wisconsin 53708.