HB-4675, As Passed House, July 1, 2003

SUBSTITUTE FOR

HOUSE BILL NO. 4675

                                                                             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 or nitrous oxide                   

16  analgesia, or both, if the following criteria are met:                      

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

18  in the administration of local anesthesia or nitrous oxide                  

19  analgesia, or both as applicable, offered by a dental or dental             

20  hygiene program accredited by the commission on dental                      

21  accreditation of the American dental association and approved by            

22  the department.  A course described in this subdivision involving           

23  local anesthesia administration must contain a minimum of 15                

24  hours didactic instruction and 14 hours of clinical experience.             

25  A course described in this subdivision involving nitrous oxide              

26  analgesia administration must contain a minimum of 4 hours of               

27  didactic instruction and 4 hours of clinical experience. The                

1   courses of instruction shall include content in all of the                  

2   following:                                                                  

3   (i) In the case of local anesthesia, the following:

4   (A)  (i)  Theory of pain control.                                           

5   (B)  (ii)  Selection of pain control modalities.                             

6   (C)  (iii)  Anatomy.                                                         

7   (D)  (iv)  Neurophysiology.                                                  

8   (E)  (v)  Pharmacology of local anesthetics.                                

9   (F)  (vi)  Pharmacology of vasoconstrictors.                                 

10  (G)  (vii)  Psychological aspects of pain control.                           

11  (H)  (viii)  Systemic complications.                                          

12  (I)  (ix)  Techniques of maxillary anesthesia.                               

13  (J)  (x)  Techniques of mandibular anesthesia.                              

14  (K)  (xi)  Infection control.                                                

15  (L)  (xii)  Local anesthesia medical emergencies.                            

16  (ii) In the case of nitrous oxide analgesia, the following:                  

17      (A) Nitrous oxide analgesia medical emergency techniques.                   

18      (B) Pharmacology of nitrous oxide.                                          

19      (C) Nitrous oxide techniques.                                               

20      (D) If such a course is available, selection of pain control                

21  modalities.

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

23  or regional board-administered written examination on  local                

24  anesthesia either or both of the following within 18 months of             

25  completion of the course work required under subdivision (a):  .

26  (i) Local anesthesia.                                                               

27      (ii) Nitrous oxide analgesia, if such an examination is                      

1   available and approved by the department.

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

3   current certification in basic or advanced cardiac life support             

4   in compliance with R 338.11701 of the Michigan administrative               

5   code.                                                                       

6       (5) Application for certification in the administration of                  

7   local anesthesia and nitrous oxide under subsection (4) is at the           

8   discretion of each individual dental hygienist and the                      

9   certification shall be issued or documented by the department or            

10  its designee.                                                               

11  (6) Monitoring and assisting the administration of nitrous                  

12  oxide analgesia is at the discretion of each individual                     

13  registered dental assistant who fulfills the applicable                     

14  conditions imposed in subsection (7).

15  (7) Upon delegation by a dentist under section 16215 and                    

16  under the direct supervision of a dentist, a registered dental              

17  assistant may assist and monitor the administration of nitrous              

18  oxide analgesia by the dentist or dental hygienist if the                   

19  registered dental assistant has successfully completed a course             

20  in the assisting and monitoring of the administration of nitrous            

21  oxide analgesia offered by a dental or dental assisting program             

22  accredited by the commission on dental accreditation of the                 

23  American dental association and approved by the department.  The            

24  course must contain a minimum of 5 hours of didactic instruction            

25  and include content in all of the following:                                

26      (a) Nitrous oxide analgesia medical emergencies techniques.                 

27      (b) Pharmacology of nitrous oxide.                                          

1       (c) Nitrous oxide techniques.                                               

2       (8) The ability of a dental hygienist to administer nitrous                 

3   oxide analgesia under this section is limited to circumstances in           

4   which the dental hygienist may inspire to not more than 50%                 

5   nitrous oxide.                                                              

6       (9) In the assisting by a registered dental assistant                       

7   otherwise qualified under this section in the administration of             

8   nitrous oxide analgesia, the nitrous oxide levels must be preset            

9   by the dentist or dental hygienist and shall not be adjusted by             

10  the registered dental assistant except in the case of an                    

11  emergency, in which circumstances the registered dental assistant           

12  may turn off the nitrous oxide and administer 100% oxygen.                  

13      (10) Notwithstanding anything to the contrary in this                       

14  section, in the case of a patient under 18 years of age who is              

15  currently taking another sedative, the dentist shall always                 

16  personally administer the nitrous oxide analgesia.                          

17      (11)  (6)  As used in this section:  , "direct

18  (a) "Assisting" means setting up equipment and placing the                  

19  face mask.  Assisting does not include titrating and turning on             

20  or off equipment.                                                           

21      (b) "Direct supervision" means that a dentist complies with                 

22  all of the following:                                                       

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

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

25  performed.                                                                  

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

27  procedures to be performed and upon completion of the                       

1   procedures.                                                                 

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

3   the procedures are being performed.                                         

4   (c) "Monitoring" means observing levels, admonishing, and                   

5   reporting to the dentist or dental hygienist.