Certification of Expanded Function Dental Auxiliaries* (EFDA)

(1) In this section, “auxiliary” means an expanded function dental auxiliary*.

(2) A certification to practice as an EFDA granted under this chapter shall permit the holder to perform all of the following as delegated and supervised by a dentist:

(a) Placement and finishing of restoration material after the dentist prepares a tooth for restoration

(b) Application of sealants and silver diamine fluoride

(c) Coronal polishing

(d) Impressions and digital scans

(e) Temporizations

(f) Placement of retraction cord and paste

(g) Removal of cement from crowns

(h) Adjustment of dentures and other removable oral appliances

(i) Removal of sutures and dressings

(k) Application of topical fluoride or other topical remineralizing agents

(l) The fitting and contouring of stainless-steel crowns

(3)

(a) The examining board shall promulgate rules for the certification and practice of an EFDA.

(b) The rules promulgated shall do all of the following:

(1) Require an applicant to the instructional program described in subd. 2. to demonstrate in his or her application that the individual satisfies one of the following criteria in order to be permitted to enroll in the instructional program:

(A) Has completed at least 1,000 hours practicing as a dental assistant and holds the certified dental assistant credential issued by the Dental Assisting National Board, Inc., or its successor.

(B) Has completed at least 2,000 hours practicing as a dental assistant, as verified by the supervising licensed dentist.

(2) Require an applicant for certification under this chapter to demonstrate to the satisfaction of the examining board that the applicant has successfully completed an instructional program that provides training in practice as an EFDA and requires at least 70 hours of classroom instruction.

(3) Require a dentist who delegates a procedure to an EFDA certified under this chapter to remain on the premises where the EFDA is performing the procedure until the procedure is complete and the dentist has verified that the procedure has been performed successfully.

(4) Require EFDAs to maintain current proficiency in cardiopulmonary resuscitation, including the use of an automated external defibrillator achieved through instruction provided by an individual, organization, or institution of higher education approved to provide such instruction.

(c) The rules promulgated under (3)(a) may not permit an EFDA to perform any of the following:

(1) Diagnosis.

(2) Treatment planning.

(3) Irreversible procedures such as cutting of hard or soft tissue.

Certification of Oral Preventive Assistants (OPA)

(1) The scope of practice for an oral preventive assistant shall be limited to taking and recording periodontal probe readings, documenting areas of periodontal concern, and supragingival scaling and polishing. Oral preventive assistants shall be further limited to practicing on periodontally healthy patients or patients with reversible gingivitis. For the first five (5) years after certification of the OPA position in the state, oral preventive assistants shall be limited to practicing in federally designated Health Provider Shortage Areas (HPSAs) or in counties with a population of less than 100,000.

(2) Oral preventive assistants shall complete a dental board-approved oral preventive assistant expanded function training course, and apply for an expanded function permit issued by the board. Before taking an oral preventive assistant expanded functions training course, a dental assistant shall successfully complete a dental board-approved course containing the appropriate level of didactic and hand skills assessment or possess current certification as a Certified Dental Assistant from the Dental Assisting National Board.

Authorization of Teledentistry Services

Teledentistry. This rule establishes the standards of practice for teledentistry.

Definition. “Teledentistry” means a dentist is providing asynchronous or synchronous dental services or supervising dental services and education using technology when the patient is in another location. Teledentistry is not solely a response to a patient online inquiry consisting of a set of questions.

License or registration required. A dentist, dental hygienist, or expanded function dental auxiliary who uses teledentistry for a patient located in this state shall hold an active license in this state or registration issued by the board.

General requirements. The standard of dental care is the same whether a patient is seen in person or through a teledentistry encounter. The use of teledentistry is not an expansion of the scope of practice for dental hygienists or dental assistants. A dentist who uses teledentistry shall utilize evidence-based standards of practice, appropriate delegation and supervision of appropriately trained dental hygienists or expanded function dental assistants, and practice guidelines to ensure patient safety, quality of care, and positive outcomes.

Informed consent. Informed consent must be obtained before the placement of interim therapeutic restorations or the application of silver diamine fluoride, when services are provided under a teledentistry permit and the patient is not examined in person by the authorizing dentist.

When teledentistry will be utilized, a dentist shall ensure informed consent covers the following additional information:

(a) A description of the types of dental care services provided via teledentistry, including limitations on services;

(b) The identity, contact information, practice location, licensure, credentials, and qualifications of all dentists, dental hygienists, and dental assistants involved in the patient’s dental care, which must be publicly displayed on a website or provided in writing to the patient; and

(c) Precautions for technological failures or emergency situations.

Examination. A dentist may use teledentistry to conduct an examination for a new patient or for a new diagnosis if the examination is conducted in accordance with evidence-based standards of practice to sufficiently establish an informed diagnosis. A dentist shall not conduct a dental examination using teledentistry if the standard of care necessitates an in-person dental examination. Once an examination has been conducted, a dentist may determine a treatment plan and provide a referral. Delegation and supervision is determined with state statute.

Follow-up and emergency care. A dentist who uses teledentistry shall have adequate knowledge of the nature and availability of local dental resources to provide appropriate follow-up care to a patient following a teledentistry encounter. A dentist shall refer a patient to an acute care facility or an emergency department when referral is necessary for the safety of the patient or in the case of emergency.

Supervision. With the exception of administering local anesthesia or nitrous oxide inhalation analgesia, or performing expanded functions, a dentist may delegate to and supervise services to be performed by a dental hygienist or expanded function dental assistant. Delegation should conform to the applicable dental practice act in the state, territory or jurisdiction of the United States where the patient receives services and where the dentist is licensed. The dentist should be knowledgeable regarding the competence and qualifications of the allied personnel utilized, and should have the capability of immediately contacting both the allied dental personnel providing service and the patient receiving services.

(a) When general supervision of a dental hygienist or expanded function dental auxiliary is required, a dentist may utilize teledentistry.

(b) When public health supervision is utilized, a supervising dentist may authorize use of teledentistry.

Patient records. A teledentistry encounter shall be clearly characterized as such in a patient record.

Privacy and security. All dentists, dental hygienists, and expanded function dental auxiliary shall ensure that the use of teledentistry complies with the privacy and security requirements of the Health Insurance Portability and Accountability Act.