HB-4356,As Passed Senate, June 12, 2003                                     

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                          SENATE SUBSTITUTE FOR                                 

                                                                                

                           HOUSE BILL NO. 4356                                  

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                

                                                                                 A bill to amend 1978 PA 368, entitled                                             

                                                                                

    "Public health code,"                                                       

                                                                                

    by amending section 16611 (MCL 333.16611), as amended by 2002               

                                                                                

    PA 423.                                                                     

                                                                                

                THE PEOPLE OF THE STATE OF MICHIGAN ENACT:                      

                                                                                

1       Sec. 16611.  (1) An individual shall not engage in the                      

                                                                                

2   practice of dentistry, the practice as a dental hygienist, or the           

                                                                                

3   practice as a dental assistant unless he or she is licensed or              

                                                                                

4   otherwise authorized by this article.                                       

                                                                                

5       (2) Deep scaling, root planing, and the removal of calcareous               

                                                                                

6   deposits may only be performed by an individual licensed or                 

                                                                                

7   otherwise authorized by this article as a dental hygienist or a             

                                                                                

8   dentist.                                                                    

                                                                                

9       (3) The department shall not issue a dental hygienist's                     

                                                                                

10  license to an individual unless the individual has graduated from           

                                                                                


                                                                                

1   a school or college for dental hygienists whose dental hygiene              

                                                                                

2   program is accredited by the commission on dental accreditation             

                                                                                

3   of the American dental association and approved by the                      

                                                                                

4   department.  The school or college must be accredited by a                  

                                                                                

5   regional accrediting agency for colleges, universities, or                  

                                                                                

6   institutions of higher education that is recognized by the United           

                                                                                

7   States department of education and approved by the department and           

                                                                                

8   must conduct a curriculum consisting of not less than 2 academic            

                                                                                

9   years for dental hygiene graduation with courses at the                     

                                                                                

10  appropriate level to enable matriculation into a more advanced              

                                                                                

11  academic degree program.                                                    

                                                                                

12      (4) Upon delegation by a dentist under section 16215 and                    

                                                                                

13  under the direct supervision of a dentist, a dental hygienist may           

                                                                                

14  administer intraoral block and infiltration anesthesia to a                 

                                                                                

15  patient who is 18 years of age or older if the following criteria           

                                                                                

16  are met:                                                                    

                                                                                

17      (a) The dental hygienist has successfully completed a course                

                                                                                

18  in the administration of local anesthesia offered by a dental or            

                                                                                

19  dental hygiene program accredited by the commission on dental               

                                                                                

20  accreditation of the American dental association and approved by            

                                                                                

21  the department.  A course described in this subdivision must                

                                                                                

22  contain a minimum of 15 hours didactic instruction and 14 hours             

                                                                                

23  of clinical experience.  The courses of instruction shall include           

                                                                                

24  content in all of the following:                                            

                                                                                

25                                                                               (i) Theory of pain control.                                                         

                                                                                

26      (ii) Selection of pain control modalities.                                   

                                                                                

27      (iii) Anatomy.                                                               


                                                                                

1       (iv) Neurophysiology.                                                        

                                                                                

2       (v) Pharmacology of local anesthetics.                                      

                                                                                

3       (vi) Pharmacology of vasoconstrictors.                                       

                                                                                

4       (vii) Psychological aspects of pain control.                                 

                                                                                

5       (viii) Systemic complications.                                                

                                                                                

6       (ix) Techniques of maxillary anesthesia.                                     

                                                                                

7       (x) Techniques of mandibular anesthesia.                                    

                                                                                

8       (xi) Infection control.                                                      

                                                                                

9       (xii) Local anesthesia medical emergencies.                                  

                                                                                

10      (b) The dental hygienist has successfully completed a state                 

                                                                                

11  or regional board-administered written examination on local                 

                                                                                

12  anesthesia within 18 months of completion of the course work                

                                                                                

13  required under subdivision (a).                                             

                                                                                

14      (c) The dental hygienist maintains and can show evidence of                 

                                                                                

15  current certification in basic or advanced cardiac life support             

                                                                                

16  in compliance with R 338.11701 of the Michigan administrative               

                                                                                

17  code.                                                                       

                                                                                

18      (5) Application for certification in the administration of                  

                                                                                

19  local anesthesia under subsection (4) is at the discretion of               

                                                                                

20  each individual dental hygienist.                                           

                                                                                

21      (6) Upon assignment by a dentist, a dental hygienist may take               

                                                                                

22  an impression for orthodontic appliances, mouth guards, bite                

                                                                                

23  splints, and bleaching trays.                                               

                                                                                

24      (7) In addition to the rules promulgated by the department                  

                                                                                

25  under this part, upon delegation by a dentist under section 16215           

                                                                                

26  and under the direct supervision of a dentist, a registered                 

                                                                                

27  dental assistant may perform the following procedures:                      


                                                                                

1       (a) Placing, condensing, and carving amalgam restorations.                  

                                                                                

2       (b) Taking final impressions for indirect restorations.                     

                                                                                

3       (8) In addition to the rules promulgated by the department                  

                                                                                

4   under this part, upon delegation by a dentist under section 16215           

                                                                                

5   and under the general supervision of a dentist, a registered                

                                                                                

6   dental assistant may perform the following intra-oral dental                

                                                                                

7   procedures:                                                                 

                                                                                

8       (a) Performing pulp vitality testing.                                       

                                                                                

9       (b) Placing and removing matrices and wedges.                               

                                                                                

10      (c) Applying cavity liners and bases.                                       

                                                                                

11      (d) Placing and packing nonepinephrine retraction cords.                    

                                                                                

12      (e) Applying desensitizing agents.                                          

                                                                                

13      (f) Taking an impression for orthodontic appliances, mouth                  

                                                                                

14  guards, bite splints, and bleaching trays.                                  

                                                                                

15      (g) Drying endodontic canals with absorbent points.                         

                                                                                

16      (h) Etching and placing adhesives prior to placement of                     

                                                                                

17  orthodontic brackets.                                                       

                                                                                

18      (9) This section does not require new or additional third                   

                                                                                

19  party reimbursement or mandated worker's compensation benefits              

                                                                                

20  for services rendered by an individual licensed as a dental                 

                                                                                

21  assistant or as a dental hygienist under this article.                      

                                                                                

22      (10)  (6)  As used in this section:  , "direct                              

                                                                                

23      (a) "Direct supervision" means that a dentist complies with                 

                                                                                

24  all of the following:                                                       

                                                                                

25                                                                               (i)  (a)  Designates a patient of record upon whom the                               

                                                                                

26  procedures are to be performed and describes the procedures to be           

                                                                                

27  performed.                                                                  


                                                                                

1       (ii)  (b)  Examines the patient before prescribing the                       

                                                                                

2   procedures to be performed and upon completion of the                       

                                                                                

3   procedures.                                                                 

                                                                                

4       (iii)  (c)  Is physically present in the office at the time                  

                                                                                

5   the procedures are being performed.                                         

                                                                                

6       (b) "General supervision" means that a dentist complies with                

                                                                                

7   all of the following:                                                       

                                                                                

8                                                                                (i) Designates a patient of record upon whom services are to                        

                                                                                

9   be performed.                                                               

                                                                                

10      (ii) Is physically present in the office at the time the                     

                                                                                

11  procedures are being performed.