Dental Hygienists

Establishes the educational requirements for the administration
of intra-oral block anesthesia by dental hygienists.  Establishes
documentation required for dental board certification of a
hygienist to administer anesthesia.  Rules adopted by the Board
of Dental Examiners on the education and certification of dental
hygienists to administer intra-oral block anesthesia will
supersede this measure.  (HB324 HD2)

HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Chapter 447, Hawaii Revised Statutes, is amended
 2 by adding a new section to be appropriately designated and to
 3 read as follows:
 4      "447-     Educational requirements for intra-oral block
 5 anesthesia.  (a)  The applicant for certification to administer
 6 intra-oral block anesthesia shall show proof that the applicant
 7 successfully completed a course of study that shall include the
 8 following categories of intra-oral infiltration local anesthesia
 9 and intra-oral block anesthesia:
10      (1)  Maxillary mandibular infiltration anesthesia;
11      (2)  Long buccal nerve block anesthesia;
12      (3)  Mental nerve block;
13      (4)  Inferior alveolar/lingual nerve block;
14      (5)  Incisive nerve block;
15      (6)  Posterior superior alveolar nerve block;
16      (7)  Middle superior alveolar nerve block;
17      (8)  Anterior superior alveolar nerve block;
18      (9)  Nasopalatine (incisive canal) nerve block; and
19     (10)  Greater (anterior) palatine nerve block;

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                                     H.B. NO.           H.D. 2

 1      (b)  A course of study shall also include didactic studies
 2 and clinical experience, and for intra-oral block anesthesia
 3 categories in subsection (a)(1) to (10), at least thirty-nine
 4 hours, and a minimum of fifty successful injections of which ten
 5 shall be in intra-oral block in subsection (a)(4) and five in
 6 intra-oral block in subsection (a)(6).
 7      (c)  The curriculum of the course of study shall include as
 8 follows:
 9      (1)  CPR certification;
10      (2)  Medical history evaluation procedures;
11      (3)  Physical evaluation procedures;
12      (4)  Anatomy of head, neck, and oral cavity as it relates to
13           administering local anesthetic agents;
14      (5)  Pharmacology of local anesthetics and vasoconstrictors;
15      (6)  Indications and contraindications for administration of
16           local anesthetics;
17      (7)  Prevention, diagnosis, and management of medical
18           emergency;
19      (8)  Recognition and management of post-injection
20           complications and management of reactions to
21           injections;
22      (9)  Medical and legal management complications;

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                                     H.B. NO.           H.D. 2

 1     (10)  Selection and preparation of the armamenteria and
 2           recordkeeping for administering various local
 3           anesthetics;
 4     (11)  Methods of administering local anesthetics with
 5           emphasis on technique, which includes aspiration and
 6           slow injection, in addition to minimum effective
 7           dosage; and
 8     (12)  Proper infection control techniques with regard to
 9           local anesthesia and the proper disposal of sharps.
10      (d)  The applicant or licensed dental hygienist shall pass
11 an examination to determine if the applicant or licensed dental
12 hygienist has acquired the necessary knowledge and clinical
13 proficiency to administer intra-oral block anesthesia.
14      (e)  Notwithstanding this section to the contrary, the board
15 of dental examiners may adopt rules pursuant to chapter 91,
16 relating to the education and certification of dental hygienists
17 to administer intra-oral block anesthesia; provided that upon the
18 adoption of such rules, this section shall be superseded."
19      SECTION 2.  Section 447-1, Hawaii Revised Statutes, is
20 amended to read as follows:
21      "447-1 Who may become dental hygienists; fees.  (a)  Any
22 person:

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                                     H.B. NO.           H.D. 2

 1      (1)  Eighteen years of age or over;
 2      (2)  Holding and having a diploma or proper certificate of
 3           graduation from a dental hygiene school accredited by
 4           the American Dental Association (A.D.A.) Commission on
 5           Dental Accreditation requiring at least a two year
 6           course, recognized by the board of dental examiners;
 7           and
 8      (3)  Having been officially certified in the administration
 9           of intra-oral infiltration local anesthesia and intra-
10           oral block anesthesia by an accredited dental hygiene
11           school or by a certification program previously
12           approved by the board;
13 upon written application made to and filed with the board at
14 least sixty days prior to the date selected by the board for the
15 examination, may be examined by the board for qualification as a
16 dental hygienist.
17      The application for examination shall be accompanied by the
18 applicant's certificate of graduation from an accredited dental
19 hygiene school together with documentary proof of the applicant's
20 certification in the administration of intra-oral infiltration
21 local anesthesia and intra-oral block anesthesia.  At the time of
22 filing the application, the applicant shall pay to the board
23 application and examination fees, which fees, together with all

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                                     H.B. NO.           H.D. 2

 1 other fees or charges in this chapter, shall be as provided in
 2 rules adopted by the director of commerce and consumer affairs
 3 pursuant to chapter 91, and shall be deposited to the credit of
 4 the compliance resolution fund established pursuant to section
 5 26-9(o).
 6      (b)  Two examinations shall be held in each year at the time
 7 the board designates.  The examinations shall cover subjects
 8 considered essential by the board for a dental hygienist and
 9 shall likewise include a practical examination on the removal of
10 deposits or stains from the surfaces of the teeth.  The board
11 shall furnish a chair and engine, but the applicant shall supply
12 all necessary instruments, materials, and patients for the
13 examination.
14      (c)  If the applicant successfully passes the examination,
15 the applicant shall be [registered and receive a certificate of
16 ability] licensed to practice as a dental hygienist in the State.
17 Every [registered] licensed dental hygienist, before entering
18 practice, shall pay the board a [registration] license fee.  On
19 or before December 31 of each odd-numbered year, every
20 [registered] licensed dental hygienist desiring to begin or
21 continue to practice in the State shall pay to the board a fee
22 for the biennial [registration] licensure thereof.  The failure,
23 neglect, or refusal of any duly licensed dental hygienist to pay

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                                     H.B. NO.           H.D. 2

 1 the biennial [registration] licensure fee shall constitute a
 2 forfeiture of the license, but the license may be restored upon
 3 written application therefor and payment to the board of a
 4 restoration fee.
 5      (d)  An applicant's or licensed dental hygienist's
 6 competence to administer intra-oral infiltration local anesthesia
 7 shall be demonstrated by certification in the administration of
 8 intra-oral infiltration local anesthesia by an accredited dental
 9 hygiene school or by a certification program previously approved
10 by the board.  In addition, an applicant's or licensed dental
11 hygienist's competence to administer intra-oral block anesthesia
12 shall be demonstrated by proof of successful completion of a
13 course of study in accordance with standards provided for in this
14 chapter, and the issuance of a certificate or other program
15 documentation listing the intra-oral block anesthesia categories
16 in which the applicant or licensed dental hygienist has acquired
17 knowledge and proficiency.
18      The applicant or licensed dental hygienist shall also submit
19 documentation of the course content when submitting the
20 certificate.  The board shall certify that the applicant or
21 licensed dental hygienist has met the requirements of this
22 chapter; provided that the licensed dental hygienist's
23 administration of intra-oral block anesthesia shall be under the

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                                     H.B. NO.           H.D. 2

 1 direct supervision of a licensed dentist and shall be for those
 2 categories of intra-oral block anesthesia listed on the course of
 3 study certificate submitted to the board.
 4      [(d)] (e)  No person shall practice dental hygiene, either
 5 gratuitously or for pay, or shall offer or attempt so to
 6 practice, or shall advertise or announce publicly or privately as
 7 being prepared or qualified so to practice, without having a
 8 license as in this section provided, nor shall any licensed
 9 dental hygienist practice except under the supervision of a
10 licensed dentist as in this chapter provided." 
11      SECTION 3.  Section 447-3, Hawaii Revised Statutes, is
12 amended by amending subsection (b) to read as follows:
13      "(b)  Clinical dental hygiene may be practiced by a licensed
14 dental hygienist.  The practice of clinical dental hygiene is
15 defined as the removal of hard and soft deposits and stains from
16 the portion of the crown and root surfaces to the depth of the
17 gingival sulcus, polishing natural and restored surfaces of
18 teeth, the application of preventive chemical agents to the
19 coronal surfaces of teeth, which chemical agents have been
20 approved by the board of dental examiners, and the use of mouth
21 washes as are approved by the board, but shall not include the
22 performing of any repair work or the preparation thereof, or any
23 other operation on the teeth or tissues of the mouth; provided

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                                     H.B. NO.           H.D. 2

 1 that nothing herein shall prohibit a dental hygienist from using
 2 or applying topically any chemical agent which has been approved
 3 in writing by the department of health for any of the purposes
 4 set forth in part V of chapter 321, and other procedures
 5 delegated by [the] a dentist in accordance with the rules of the
 6 board of dental examiners.
 7      In addition, a licensed dental hygienist may administer
 8 intra-oral infiltration local anesthesia and intra-oral block
 9 anesthesia under the direct supervision of a dentist [upon
10 providing documentary proof satisfactory to the board of
11 certification in the administration of these procedures.] after
12 being certified by the board, and for those categories of intra-
13 oral infiltration local anesthesia and intra-oral block
14 anesthesia for which the licensed dental hygienist has been
15 certified through a course of study meeting the requirements of
16 this chapter."
17      SECTION 4.  Statutory material to be repealed is bracketed.
18 New statutory material is underscored.
19      SECTION 5.  This Act shall take effect upon its approval;
20 provided that:
21      (1)  This Act shall be repealed upon the effective date of
22           rules adopted by the board of dental examiners pursuant
23           to chapter 91, Hawaii Revised Statutes, relating to

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                                     H.B. NO.           H.D. 2

 1           education and certification of dental hygienists to
 2           administer intra-oral infiltration local anesthesia and
 3           intra-oral block anesthesia; and
 4      (2)  Upon the repeal of this Act, sections 447-1 and 447-3,
 5           Hawaii Revised Statutes, shall be reenacted in the form
 6           in which they read on the day before the approval of
 7           this Act.