Florida Senate - 2010 SB 490
By Senator Smith
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.
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,
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,
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,
62 Be It Enacted by the Legislature of the State of Florida:
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
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.
(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
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
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
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.
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
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.
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
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
269 (a) Taking impressions for study casts but not for the
270 purpose of fabricating any intraoral restorations or orthodontic
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
283 (k) Obtaining bacteriological cytological specimens not
284 involving cutting of the tissue.
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
298 (c) Applying dental sealants.
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
321 (a) Any prescription of drugs or medications requiring the
322 written order or prescription of a licensed dentist or
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.