Commonwealth of Virginia



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Commonwealth of Virginia









Regulations

Governing Dental Practice
Virginia Board of Dentistry

Title of Regulations: 18 VAC 60-20-10 et seq.


Statutory Authority: § 54.1-2400 and Chapter 27

of Title 54.1 of the Code of Virginia


Revised Date: May 7, 2014

9960 Mayland Drive, Suite 300 (804) 367-4538 (TEL)

Henrico, Virginia 23233-1463 (804) 527-4428 (FAX)

www.dhp.virginia.gov email: denbd@dhp.virginia.gov


TABLE OF CONTENTS


Part I. General Provisions. 4

18VAC60-20-10. Definitions. 4

18VAC60-20-15. Recordkeeping. 6

18VAC60-20-16. Address of record; posting of licenses or registrations. 6

18VAC60-20-17. Criteria for delegation of informal fact-finding proceedings to an agency subordinate. 7

18VAC60-20-18. Recovery of disciplinary costs. 7

Part II. Renewal and Fees. 8

18VAC60-20-20. Renewal and reinstatement. 8

18VAC60-20-30. Other fees. 9

18VAC60-20-40. Refunds. 11

18VAC60-20-50. Requirements for continuing education. 11

Part III. Entry Requirements. 13

18VAC60-20-60. Educational requirements for dentists and dental hygienists. 13

18VAC60-20-61. Educational requirements for dental assistants II. 14

18VAC60-20-70. Licensure examinations; registration certification. 15

18VAC60-20-71. Licensure by credentials for dentists. 16

18VAC60-20-72. Registration by endorsement as a dental assistant II. 16

18VAC60-20-80. Licensure by endorsement for dental hygienists. 17

18VAC60-20-90. Temporary permit, teacher's license, and faculty license. 19

18VAC60-20-91. Temporary licenses to persons enrolled in advanced dental education programs. 20

18VAC60-20-100. Other application requirements. 21

18VAC60-20-105. Inactive license or registration. 21

18VAC60-20-106. Voluntary practice. 22

Part IV. Anesthesia, Sedation and Analgesia. 23

18VAC60-20-107. General provisions. 23

18VAC60-20-108. Administration of minimal sedation (anxiolysis or inhalation analgesia). 25

18VAC60-20-110. Requirements for the administration of deep sedation/general anesthesia. 26

18VAC60-20-120. Requirements for administration of conscious/moderate sedation. 29

18VAC60-20-130. (Repealed.) 34

18VAC60-20-135. Personnel assisting in sedation or anesthesia. 34

18VAC60-20-140. (Repealed.) 34

Part V. Unprofessional Conduct. 34

18VAC60-20-150 to 18VAC60-20-160. [Repealed] 34

18VAC60-20-170. Acts constituting unprofessional conduct. 34

18VAC60-20-180. Advertising. 35

Part VI. Direction and Delegation of Duties. 36

18VAC60-20-190. Nondelegable duties; dentists. 36

18VAC60-20-195. Radiation certification. 37

18VAC60-20-200. Utilization of dental hygienists and dental assistants II. 37

18VAC60-20-210. Requirements for direction and general supervision. 37

18VAC60-20-220. Dental hygienists. 38

18VAC60-20-230. Delegation to dental assistants. 39

18VAC60-20-240. What does not constitute practice. 39

Part VII. Oral and Maxillofacial Surgeons. 39

18VAC60-20-250. Registration of oral and maxillofacial surgeons. 39

18VAC60-20-260. Profile of information for oral and maxillofacial surgeons. 40

18VAC60-20-270. Reporting of malpractice paid claims and disciplinary notices and orders. 41

18VAC60-20-280. Noncompliance or falsification of profile. 41

18VAC60-20-290. Certification to perform cosmetic procedures; applicability. 41

18VAC60-20-300. Certification not required. 42

18VAC60-20-310. Credentials required for certification. 42

18VAC60-20-320. Renewal of certification. 43

18VAC60-20-330. Quality assurance review for procedures performed by certificate holders. 44

18VAC60-20-331. Complaints against certificate holders for cosmetic procedures. 44

Part VIII. Mobile Dental Clinics and Portable Dental Operations. 44

18VAC60-20-332. Registration of a mobile dental clinic or portable dental operation. 44

18VAC60-20-342. Requirements for a mobile dental clinic or portable dental operation. 45

18VAC60-20-352. Exemptions from requirement for registration. 46


Part I. General Provisions.




18VAC60-20-10. Definitions.


A. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"ADA" means the American Dental Association.
"Advertising" means a representation or other notice given to the public or members thereof, directly or indirectly, by a dentist on behalf of himself, his facility, his partner or associate, or any dentist affiliated with the dentist or his facility by any means or method for the purpose of inducing purchase, sale or use of dental methods, services, treatments, operations, procedures or products, or to promote continued or increased use of such dental methods, treatments, operations, procedures or products.
"CODA" means the Commission on Dental Accreditation of American Dental Association.
"Dental assistant I" means any unlicensed person under the direction of a dentist who renders assistance for services provided to the patient as authorized under this chapter but shall not include an individual serving in purely a secretarial or clerical capacity.
"Dental assistant II" means a person under the direction and direct supervision of a dentist who is registered to perform reversible, intraoral procedures as specified in this chapter.
"Mobile dental facility" means a self-contained unit in which dentistry is practiced that is not confined to a single building and can be transported from one location to another.
"Portable dental operation" means a nonfacility in which dental equipment used in the practice of dentistry is transported to and utilized on a temporary basis at an out-of-office location, including patients' homes, schools, nursing homes, or other institutions.
"Radiographs" means intraoral and extraoral x-rays of hard and soft tissues to be used for purposes of diagnosis.
B. The following words and terms relating to supervision as used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Direct supervision" means that the dentist examines the patient and records diagnostic findings prior to delegating restorative or prosthetic treatment and related services to a dental assistant II for completion the same day or at a later date. The dentist prepares the tooth or teeth to be restored and remains immediately available to the dental assistant II for guidance or assistance during the delivery of treatment and related services. The dentist examines the patient to evaluate the treatment and services before the patient is dismissed.
"Direction" means the level of supervision that a dentist is required to exercise with a dental hygienist, a dental assistant I, or a dental assistant II or that a dental hygienist is required to exercise with a dental assistant to direct and oversee the delivery of treatment and related services.
"General supervision" means that a dentist completes a periodic comprehensive examination of the patient and issues a written order for hygiene treatment that states the specific services to be provided by a dental hygienist during one or more subsequent appointments when the dentist may or may not be present. The order may authorize the dental hygienist to supervise a dental assistant performing duties delegable to dental assistants I.
"Immediate supervision" means the dentist is in the operatory to supervise the administration of sedation or provision of treatment.
"Indirect supervision" means the dentist examines the patient at some point during the appointment, and is continuously present in the office to advise and assist a dental hygienist or a dental assistant who is (i) delivering hygiene treatment, (ii) preparing the patient for examination or treatment by the dentist or dental hygienist, or (iii) preparing the patient for dismissal following treatment.
C. The following words and terms relating to sedation or anesthesia as used in the chapter shall have the following meanings unless the context clearly indicates otherwise:
"Conscious/moderate sedation" or "moderate sedation" means a drug-induced depression of consciousness, during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
"Deep sedation" means a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Reflex withdrawal from a painful stimulus is not considered a purposeful response. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
"Enteral" means any technique of administration in which the agent is absorbed through the gastrointestinal tract or oral mucosa (i.e., oral, rectal, sublingual).
"General anesthesia" means a drug induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilator function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
"Inhalation" means a technique of administration in which a gaseous or volatile agent, including nitrous oxide, is introduced into the pulmonary tree and whose primary effect is due to absorption through the pulmonary bed.
"Local anesthesia" means the loss of sensation or pain in the oral cavity or the maxillofacial or adjacent and associated structures generally produced by a topically applied or injected agent without depressing the level of consciousness.
"Minimal sedation" means a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilator and cardiovascular functions are unaffected. Minimal sedation includes "anxiolysis" (the diminution or elimination of anxiety through the use of pharmacological agents in a dosage that does not cause depression of consciousness) and includes "inhalation analgesia" (the inhalation of nitrous oxide and oxygen to produce a state of reduced sensibility to pain without the loss of consciousness).
"Moderate sedation" (see meaning of conscious/moderate sedation).
"Monitoring" means to observe, interpret, assess, and record appropriate physiologic functions of the body during sedative procedures and general anesthesia appropriate to the level of sedation as provided in Part IV (18VAC60-20-107 et seq.).
"Parenteral" means a technique of administration in which the drug bypasses the gastrointestinal tract (i.e., intramuscular, intravenous, intranasal, submucosal, subcutaneous, or intraocular).
"Titration" means the incremental increase in drug dosage to a level that provides the optimal therapeutic effect of sedation.

18VAC60-20-15. Recordkeeping.


A dentist shall maintain patient records for not less than three years from the most recent date of service for purposes of review by the board to include the following:

1. Patient's name and date of treatment;

2. Updated health history;

3. Diagnosis and treatment rendered;

4. List of drugs prescribed, administered, dispensed and the quantity;

5. Radiographs;

6. Patient financial records;

7. Name of the dentist and the dental hygienist or the dental assistant II providing service; and

8. Laboratory work orders which meet the requirements of §54.1-2719 of the Code of Virginia.

18VAC60-20-16. Address of record; posting of licenses or registrations.


A. Address of record. At all times, each licensed dentist, dental hygienist , and dental assistant II shall provide the board with a current address of record. All required notices mailed by the board to any licensee or registrant shall be validly given when mailed to the latest address of record given. All changes in the address of record or in the public address, if different from the address of record, shall be furnished to the board in writing within 30 days of such changes.

B. Posting of license or registration. A copy of the registration of a dental assistant II shall either be posted in an operatory in which the person is providing services to the public or in the patient reception area where it is clearly visible to patients and accessible for reading.


18VAC60-20-17. Criteria for delegation of informal fact-finding proceedings to an agency subordinate.


A. Decision to delegate.
In accordance with §54.1-2400 (10) of the Code of Virginia, the board may delegate an informal fact-finding proceeding to an agency subordinate at the time a determination is made that probable cause exists that a practitioner may be subject to a disciplinary action. If delegation to a subordinate is not recommended at the time of the probable cause determination, delegation may be approved by the president of the board or his designee.
B. Criteria for an agency subordinate.
1. An agency subordinate authorized by the board to conduct an informal fact-finding proceeding may include current or past board members and professional staff or other persons deemed knowledgeable by virtue of their training and experience in administrative proceedings involving the regulation and discipline of health professionals.
2. The executive director shall maintain a list of appropriately qualified persons to whom an informal fact-finding proceeding may be delegated.
3. The board may delegate to the executive director the selection of the agency subordinate who is deemed appropriately qualified to conduct a proceeding based on the qualifications of the subordinate and the type of case being heard.

18VAC60-20-18. Recovery of disciplinary costs.


A. Assessment of cost for investigation of a disciplinary case.

1. In any disciplinary case in which there is a finding of a violation against a licensee or registrant, the board may assess the hourly costs relating to investigation of the case by the Enforcement Division of the Department of Health Professions and, if applicable, the costs for hiring an expert witness and reports generated by such witness.

2. The imposition of recovery costs relating to an investigation shall be included in the order from an informal or formal proceeding or as part of a consent order agreed to by the parties. The schedule for payment of investigative costs imposed shall be set forth in the order.

3. At the end of each fiscal year, the board shall calculate the average hourly cost for enforcement that is chargeable to investigation of complaints filed against its regulants and shall state those costs in a guidance document to be used in imposition of recovery costs. The average hourly cost multiplied by the number of hours spent in investigating the specific case of a respondent shall be used in the imposition of recovery costs.

B. Assessment of cost for monitoring a licensee or registrant.

1. In any disciplinary case in which there is a finding of a violation against a licensee or registrant and in which terms and conditions have been imposed, the costs for monitoring of a licensee or registrant may be charged and shall be calculated based on the specific terms and conditions and the length of time the licensee or registrant is to be monitored.

2. The imposition of recovery costs relating to monitoring for compliance shall be included in the board order from an informal or formal proceeding or as part of a consent order agreed to by the parties. The schedule for payment of monitoring costs imposed shall be set forth in the order.

3. At the end of each fiscal year, the board shall calculate the average costs for monitoring of certain terms and conditions, such as acquisition of continuing education, and shall set forth those costs in a guidance document to be used in the imposition of recovery costs.

C. Total of assessment. In accordance with § 54.1-2708.2 of the Code of Virginia, the total of recovery costs for investigating and monitoring a licensee or registrant shall not exceed $5,000, but shall not include the fee for inspection of dental offices and returned checks as set forth in 18VAC60-20-30 or collection costs incurred for delinquent fines and fees.


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