October 22, 2020
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       Florida Senate - 2010                                     SB 490
       
       
       
       By Senator Smith
       
       
       
       
       29-00507-10                                            2010490__
    1                        A bill to be entitled                      
    2         An act relating to the practice of dentistry; amending
    3         s. 466.003, F.S.; defining the term “public health
    4         supervision” and redefining the term “health access
    5         settings” to include school-based prevention programs;
    6         amending ss. 466.006 and 466.0067, F.S.; conforming
    7         cross-references; amending s. 466.00775, F.S.;
    8         conforming a cross-reference; requiring the Board of
    9         Dentistry to adopt additional rules; amending s.
   10         466.023, F.S.; authorizing dental hygienists to
   11         perform certain additional dental hygiene services
   12         under public health supervision; authorizing dental
   13         hygienists to perform fluoride treatments without
   14         supervision; authorizing the board to adopt rules;
   15         amending s. 466.024, F.S.; providing that certain
   16         tasks are remediable and delegable to dental
   17         hygienists in certain settings; prohibiting a dentist
   18         from delegating irremediable tasks to a dental
   19         hygienist; authorizing a dentist to delegate
   20         remediable tasks to a dental hygienist under certain
   21         conditions; providing a list of remediable and
   22         delegable tasks; authorizing the board to adopt rules;
   23         providing an effective date.
   24  
   25         WHEREAS, tooth decay is one of the most prevalent chronic
   26  diseases of childhood, and
   27         WHEREAS, oral diseases are associated with a variety of
   28  systemic diseases, including cardiovascular disease, diabetes,
   29  and cancer, and
   30         WHEREAS, oral disease in pregnant women is associated with
   31  preterm birth and low birth weight, and
   32         WHEREAS, early dental care helps to prevent oral disease
   33  and its associated pain, risks, and high costs to individuals,
   34  and
   35         WHEREAS, the placement of dental sealants and fluorides are
   36  a central and critical aspect of preventive oral health care,
   37  especially for children, and
   38         WHEREAS, dental care for low-income and other underserved
   39  patients is provided primarily through publicly funded programs,
   40  and
   41         WHEREAS, the current public health infrastructure is
   42  inadequate to provide access to preventive and interventional
   43  oral health care services, and
   44         WHEREAS, current dental licensure statutes and rules in
   45  Florida create barriers for dentists licensed in other states
   46  who are willing to serve in public health settings from doing
   47  so, and
   48         WHEREAS, Florida’s current statutes and rules restrict the
   49  ability of dental hygienists to deliver needed care to low
   50  income and other underserved patients cost-effectively, and
   51         WHEREAS, Florida is one of four states and the U.S. Virgin
   52  Islands that does not offer a process by which dentists from
   53  other states may achieve licensure by credentials to practice in
   54  public or private settings, and
   55         WHEREAS, Florida is one of nine states to prohibit dental
   56  hygienists from placing dental sealants without the physical
   57  presence of a dentist, and
   58         WHEREAS, the membership of the Florida Board of Dentistry
   59  does not require any of its members to have a background in or
   60  experience in a public health setting, NOW, THEREFORE,
   61  
   62  Be It Enacted by the Legislature of the State of Florida:
   63  
   64         Section 1. Present subsections (11), (12), (13), and (14)
   65  of section 466.003, Florida Statutes, are redesignated as
   66  subsections (12), (13), (14), and (15), respectively, and
   67  amended, and a new subsection (11) is added to that section, to
   68  read:
   69         466.003 Definitions.—As used in this chapter:
   70         (11) Public health supervision” means administrative
   71  supervision whereby a dental hygienist in a health access
   72  setting, without supervision or the presence of a dentist,
   73  provides remedial services as established under s. 466.024. The
   74  board may authorize additional services by rule.
   75         (12)(11) “Irremediable tasks” are those intraoral treatment
   76  tasks that which, when performed, are irreversible and create
   77  unalterable changes within the oral cavity or the contiguous
   78  structures or that which cause an increased risk to the patient.
   79  The administration of anesthetics other than topical anesthesia
   80  is considered to be an irremediable task for purposes of this
   81  chapter.
   82         (13)(12) “Remediable tasks” are those intraoral treatment
   83  tasks that which are reversible and do not create unalterable
   84  changes within the oral cavity or the contiguous structures and
   85  that which do not cause an increased risk to the patient.
   86         (14)(13) “Oral and maxillofacial surgery” means the
   87  specialty of dentistry involving diagnosis, surgery, and
   88  adjunctive treatment of diseases, injuries, and defects
   89  involving the functional and esthetic aspects of the hard and
   90  soft tissues of the oral and maxillofacial regions. This term
   91  does may not be construed to apply with respect to any
   92  individual exempt under s. 466.002(1).
   93         (15)(14) “Health access settings” means programs and
   94  institutions of the Department of Children and Family Services,
   95  the Department of Health, the Department of Juvenile Justice,
   96  nonprofit community health centers, Head Start centers,
   97  federally qualified health centers (FQHCs), FQHC look-alikes as
   98  defined by federal law, school-based prevention programs, and
   99  clinics operated by accredited colleges of dentistry in this
  100  state if such community service programs and institutions
  101  immediately report to the Board of Dentistry all violations of
  102  s. 466.027, s. 466.028, or other practice act or standard of
  103  care violations related to the actions or inactions of a
  104  dentist, dental hygienist, or dental assistant engaged in the
  105  delivery of dental care in such settings.
  106         Section 2. Paragraph (c) of subsection (2) of section
  107  466.006, Florida Statutes, is amended to read:
  108         466.006 Examination of dentists.—
  109         (2) An applicant shall be entitled to take the examinations
  110  required in this section to practice dentistry in this state if
  111  the applicant:
  112         (c)1. Has successfully completed the National Board of
  113  Dental Examiners dental examination within 10 years of the date
  114  of application; or
  115         2. Has an active health access dental license in this
  116  state; and
  117         a. The applicant has at least 5,000 hours within 4
  118  consecutive years of clinical practice experience providing
  119  direct patient care in a health access setting as defined in s.
  120  466.003(14); the applicant is a retired veteran dentist of any
  121  branch of the United States Armed Services who has practiced
  122  dentistry while on active duty and has at least 3,000 hours
  123  within 3 consecutive years of clinical practice experience
  124  providing direct patient care in a health access setting as
  125  defined in s. 466.003(14); or the applicant has provided a
  126  portion of his or her salaried time teaching health profession
  127  students in any public education setting, including, but not
  128  limited to, a community college, college, or university, and has
  129  at least 3,000 hours within 3 consecutive years of clinical
  130  practice experience providing direct patient care in a health
  131  access setting as defined in s. 466.003(14);
  132         b. The applicant has not been disciplined by the board,
  133  except for citation offenses or minor violations;
  134         c. The applicant has not filed a report pursuant to s.
  135  456.049; and
  136         d. The applicant has not been convicted of or pled nolo
  137  contendere to, regardless of adjudication, any felony or
  138  misdemeanor related to the practice of a health care profession.
  139         Section 3. Section 466.0067, Florida Statutes, is amended
  140  to read:
  141         466.0067 Application for health access dental license.—The
  142  Legislature finds that there is an important state interest in
  143  attracting dentists to practice in underserved health access
  144  settings in this state and further, that allowing out-of-state
  145  dentists who meet certain criteria to practice in health access
  146  settings without the supervision of a dentist licensed in this
  147  state is substantially related to achieving this important state
  148  interest. Therefore, notwithstanding the requirements of s.
  149  466.006, the board shall grant a health access dental license to
  150  practice dentistry in this state in health access settings as
  151  defined in s. 466.003(14) to an applicant that:
  152         (1) Files an appropriate application approved by the board;
  153         (2) Pays an application license fee for a health access
  154  dental license, laws-and-rule exam fee, and an initial licensure
  155  fee. The fees specified in this subsection may not differ from
  156  an applicant seeking licensure pursuant to s. 466.006;
  157         (3) Has not been convicted of or pled nolo contendere to,
  158  regardless of adjudication, any felony or misdemeanor related to
  159  the practice of a health care profession;
  160         (4) Submits proof of graduation from a dental school
  161  accredited by the Commission on Dental Accreditation of the
  162  American Dental Association or its successor agency;
  163         (5) Submits documentation that she or he has completed, or
  164  will obtain prior to licensure, continuing education equivalent
  165  to this state’s requirement for dentists licensed under s.
  166  466.006 for the last full reporting biennium before applying for
  167  a health access dental license;
  168         (6) Submits proof of her or his successful completion of
  169  parts I and II of the dental examination by the National Board
  170  of Dental Examiners and a state or regional clinical dental
  171  licensing examination that the board has determined effectively
  172  measures the applicant’s ability to practice safely;
  173         (7) Currently holds a valid, active, dental license in good
  174  standing which has not been revoked, suspended, restricted, or
  175  otherwise disciplined from another of these United States, the
  176  District of Columbia, or a United States territory;
  177         (8) Has never had a license revoked from another of these
  178  United States, the District of Columbia, or a United States
  179  territory;
  180         (9) Has never failed the examination specified in s.
  181  466.006, unless the applicant was reexamined pursuant to s.
  182  466.006 and received a license to practice dentistry in this
  183  state;
  184         (10) Has not been reported to the National Practitioner
  185  Data Bank, unless the applicant successfully appealed to have
  186  his or her name removed from the data bank;
  187         (11) Submits proof that he or she has been engaged in the
  188  active, clinical practice of dentistry providing direct patient
  189  care for 5 years immediately preceding the date of application,
  190  or in instances when the applicant has graduated from an
  191  accredited dental school within the preceding 5 years, submits
  192  proof of continuous clinical practice providing direct patient
  193  care since graduation; and
  194         (12) Has passed an examination covering the laws and rules
  195  of the practice of dentistry in this state as described in s.
  196  466.006(4)(a).
  197         Section 4. Section 466.00775, Florida Statutes, is amended
  198  to read:
  199         466.00775 Rulemaking.—The board shall adopt rules pursuant
  200  to ss. 120.536(1) and 120.54 to administer ss. 466.003(15)
  201  466.003(14), 466.004(1), 466.0067, 466.00671, 466.00672,
  202  466.00673, 466.011, 466.021, and 466.032.
  203         Section 5. Subsections (1), (2), and (3) of section
  204  466.023, Florida Statutes, are amended, and subsection (7) is
  205  added to that section, to read:
  206         466.023 Dental hygienists; scope and area of practice.—
  207         (1) Except as otherwise provided in s. 466.024, only dental
  208  hygienists may be delegated the task of removing calculus
  209  deposits, accretions, and stains from exposed surfaces of the
  210  teeth and from the gingival sulcus and the task of performing
  211  root planing and curettage. In addition, dental hygienists may
  212  expose dental X-ray films, apply topical preventive or
  213  prophylactic agents, and perform all tasks delegable by the
  214  dentist in accordance with s. 466.024. The board by rule shall
  215  determine whether such functions shall be performed under the
  216  direct, indirect, or general supervision of the dentist.
  217         (2) Dental hygienists may perform their duties:
  218         (a) In the private office of a licensed dentist wherein the
  219  board shall determine by rule whether the functions in
  220  subsection (1) must be performed under the direct, indirect, or
  221  general supervision of the dentist;
  222         (b) In public health access settings, programs and
  223  institutions of the Department of Children and Family Services,
  224  Department of Health, and Department of Juvenile Justice under
  225  public health supervision, as defined in s. 466.003. Dental
  226  hygienists in health access settings under public health
  227  supervision may perform the duties delineated in this section,
  228  ss. 466.0235 and 466.024, and any other duties as prescribed by
  229  this chapter the general supervision of a licensed dentist; or
  230         (c) Upon a patient of record of a dentist who has issued a
  231  prescription for the services of a dental hygienist, which
  232  prescription is shall be valid for 2 years unless a shorter
  233  length of time is designated by the dentist, in:
  234         1. Licensed public and private health facilities;
  235         2. Other public institutions of the state and federal
  236  government;
  237         3. Public and private educational institutions;
  238         4. The home of a nonambulatory patient; and
  239         5. Other places in accordance with the rules of the board.
  240  
  241  However, the dentist issuing such prescription remains shall
  242  remain responsible for the care of such patient. As used in this
  243  subsection, “patient of record” means a patient upon whom a
  244  dentist has taken a complete medical history, completed a
  245  clinical examination, recorded any pathological conditions, and
  246  prepared a treatment plan.
  247         (3) Dental hygienists may, without supervision, provide
  248  educational programs, faculty or staff training programs,
  249  authorized fluoride rinse programs, and fluoride treatments,
  250  including fluoride varnish applications. Dental hygienists may
  251  also, without supervision, instruct patients in oral hygiene
  252  care and provide other services that which do not involve
  253  diagnosis or treatment of dental conditions and which services
  254  are approved by rule of the board.
  255         (7) The board may adopt rules to administer this section.
  256         Section 6. Section 466.024, Florida Statutes, is amended to
  257  read:
  258         466.024 Delegation of duties; expanded functions.—
  259         (1) A dentist may not delegate irremediable tasks to a
  260  dental hygienist or dental assistant, except as provided by law.
  261  A dentist may delegate remediable tasks to a dental hygienist or
  262  dental assistant when such tasks pose no risk to the patient. A
  263  dentist may only delegate only those remediable tasks that are
  264  so defined by law or rule of the board. The board by rule shall
  265  designate which tasks are remediable and delegable, except that
  266  the following are by law found to be remediable and delegable to
  267  dental hygienists in settings defined in s. 466.023(2)(a) and
  268  (c):
  269         (a) Taking impressions for study casts but not for the
  270  purpose of fabricating any intraoral restorations or orthodontic
  271  appliance.
  272         (b) Placing periodontal dressings.
  273         (c) Removing periodontal or surgical dressings.
  274         (d) Removing sutures.
  275         (e) Placing or removing rubber dams.
  276         (f) Placing or removing matrices.
  277         (g) Placing or removing temporary restorations.
  278         (h) Applying cavity liners, varnishes, or bases.
  279         (i) Polishing amalgam restorations.
  280         (j) Polishing clinical crowns of the teeth for the purpose
  281  of removing stains but not changing the existing contour of the
  282  tooth.
  283         (k) Obtaining bacteriological cytological specimens not
  284  involving cutting of the tissue.
  285  
  286  Nothing in This subsection does not shall be construed to limit
  287  delegable tasks to those specified herein.
  288         (2) A dentist may not delegate irremediable tasks to a
  289  dental hygienist except as provided by law. A dentist may
  290  delegate remediable tasks to a dental hygienist when such tasks
  291  pose no risk to the patient. A dentist may delegate only those
  292  remediable tasks that are defined by law or rule of the board.
  293  The following tasks are remediable and delegable in settings
  294  defined in s. 466.023(2)(a) and (c):
  295         (a) All duties listed in s. 466.023(1).
  296         (b) Applying topical fluorides, which includes fluoride
  297  varnish.
  298         (c) Applying dental sealants.
  299  
  300  This subsection does not limit delegable tasks to those
  301  specified herein.
  302         (3)(2) Notwithstanding subsection (1) or subsection (2), a
  303  dentist may delegate the tasks of gingival curettage and root
  304  planing to a dental hygienist but not to a dental assistant.
  305         (4)(3) All other remediable tasks shall be performed under
  306  the direct, indirect, or general supervision of a dentist, as
  307  determined by rule of the board, or by dental hygienists under
  308  public health supervision in a health access setting, and after
  309  such formal or on-the-job training by the dental hygienist or
  310  dental assistant as the board by rule may require. The board by
  311  rule may establish a certification process for expanded-duty
  312  dental assistants, establishing such training or experience
  313  criteria or examinations as it deems necessary and specifying
  314  which tasks may be delegable only to such assistants. If the
  315  board does establish such a certification process, the
  316  department shall implement the application process for such
  317  certification and administer any examinations required.
  318         (5)(4) Notwithstanding subsection (1) or subsection (2), a
  319  dentist may not delegate to anyone other than another licensed
  320  dentist:
  321         (a) Any prescription of drugs or medications requiring the
  322  written order or prescription of a licensed dentist or
  323  physician.
  324         (b) Any diagnosis for treatment or treatment planning.
  325         (6)(5) Notwithstanding any other provision of law, a
  326  dentist is primarily responsible for all procedures delegated by
  327  her or him.
  328         (7)(6)A No dental assistant may not shall perform an
  329  intraoral procedure except after such formal or on-the-job
  330  training as the board prescribes by rule shall prescribe.
  331         (8) The board may adopt rules to administer this section.
  332         Section 7. This act shall take effect July 1, 2010.

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