D.C. Mun. Regs. tit. 17, r. 17-4215

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 17-4215 - DELEGATION OF DUTIES

4215.1

The following duties shall only be performed by a dentist licensed under the Act and shall not be delegated to a dental hygienist or auxiliary:

(a) Performing final diagnosis and treatment planning;

(b) Performing surgical or cutting procedures on hard or soft tissue;

(c) Prescribing or parenterally administering drugs or medications;

(d) Administering or monitoring general anesthetics and conscious sedation;

(e) Administering inhalants or inhalation conscious sedation agents;

(f) Administering or monitoring nitrous oxide or local anesthesia except as permitted in Chapter 43 § 4310.2 of this Title;

(g) Authorizing work orders for any appliance or prosthetic device or restoration to be inserted into a patient's mouth;

(h) Operating high speed rotary instruments in the mouth;

(i) Performing pulp capping procedures;

(j) Condensing, contouring or adjusting any final, fixed or removable prosthodontic appliance or restoration in the mouth;

(k) Final positioning of orthodontic bonds and bands;

(l) Orthodontic arch wire activation with the exception of minor adjustments to eliminate pain or discomfort;

(m) Taking impressions for master casts to be used for prosthetic restoration of teeth or oral structures;

(n) Final cementation of crowns, bridges, inlays, onlays, posts and cores, and insertion of final prosthesis;

(o) Placing sutures;

(p) Flushing root canals;

(q) Temporary wire ligation;

(r) Application of cavity liners and bases;

(s) Placing, carving, or finishing of amalgam restorations; and

(t) Placing and finishing of composite resin/silicate restorations.

4215.2

Except as provided in § 4215.3 of this chapter, no person unless otherwise licensed by the Board shall place or expose dental x-ray film unless he or she has:

(a) Satisfactorily completed a radiation course or examination recognized by the American Dental Association Continuing Education Recognition Program (CERP);

(b) Been certified by the American Registry of Radiologic Technologists; or

(c) Satisfactorily completed a radiation course and passed an examination given by the Dental Assisting National Board.

4215.3

For the time period beginning from the effective date of these regulations and ending December 31, 2011, a dentist may permit an auxiliary who does not meet the requirements under § 4215.2 to place or expose dental x-ray film if the auxiliary has completed in-office training and demonstrated competency to perform the task to the supervising dentist's satisfaction.

4215.4

Except as provided in § 4215.1 of this chapter, a dentist may delegate to a dental hygienist licensed under the Act those procedures which are appropriate to the training and experience of the dental hygienist, the type of practice of the supervising dentist, and to be performed under the direct or general supervision of the dentist.

4215.5

Except as provided in § 4215.6 a dentist may delegate to an auxiliary those procedures which are:

(a) Appropriate to the training and experience of the auxiliary, and the practice of the supervising dentist;

(b) Reversible; and

(c) To be performed under the direct or general supervision of the dentist.

4215.6

Except as provided in § 4215.7 of this chapter, the following dental procedures shall only be delegated to an auxiliary who has:

(a) Satisfactorily completed training in a CERP approved program, a training program or course recognized by the American Dental Association Commission on Dental Accreditation (CODA), or by the Dental Assisting National Board; and

(b) Who performs the tasks under direct supervision with the supervising dentist checking and approving the completed task prior to dismissal of the patient from the office:

(1) Placement of retraction cord;

(2) Placement or removal of matrices;

(3) The application of a medicinal agent to a tooth for a prophylactic purpose;

(4) Placement of periodontal dressings;

(5) Removal of temporary restorations without the use of a rotary instrument;

(6) Removal of sutures; and

(7) Bleaching.

4215.7

A dentist may delegate performance of the tasks set forth in § 4215.6 of this chapter to an auxiliary who does not meet the training requirements in § 4215.6(a), if the auxiliary had been performing the tasks for at least three (3) months prior to the effective date of these regulations and has demonstrated competency to perform the tasks to the supervising dentist's satisfaction.

4215.8

A dentist shall not delegate to an auxiliary any of the following procedures:

(a) Those procedures excluded by § 4215.1 of this chapter;

(b) A preliminary dental examination; a complete prophylaxis, including the removal of any deposits, diseased crevicular tissue, accretion, or stain from the surface of a tooth or a restoration; the intraoral polishing of a tooth or a restoration;

(c) The charting of cavities during preliminary examination, prophylaxis, or polishing, however a dentist may permit an auxiliary to record the charting of cavities as dictated by the dentist or dental hygienist during the course of an examination or dental procedure;

(d) The instruction of individuals or groups of individuals in oral health care, unless it is in the dental office and done as instructed by the dentist;

(e) The application of pit and fissure sealants;

(f) The performing of a diagnostic screening to identify indications of oral abnormalities;

(g) Administration of local anesthesia with board identified criteria and certification;

(h) Administration of nitrous oxide with board identified criteria and certification; or

(i) Placement of temporary restorations.

4215.9

In all instances, the licensed dentist assumes ultimate responsibility for determining, on the basis of his or her diagnosis, the specific treatment the patient will receive and which aspects of treatment will be delegated to qualified personnel in accordance with this chapter and the Act.

D.C. Mun. Regs. tit. 17, r. 17-4215

Final Rulemaking published at 56 DCR 295 (January 9, 2009)