HB 1367

1	A bill to be entitled
2	An act relating to dentistry; providing a short title;
3	amending s. 466.003, F.S.; providing definitions; amending
4	s. 466.004, F.S.; requiring a specified number of members
5	of the Board of Dentistry to have work experience in a
6	public health setting or an advanced degree in public
7	health; creating s. 466.0067, F.S.; establishing licensure
8	by credentials for a dentist licensed in another state to
9	receive a public health dental license without meeting
10	certain criteria; providing criteria for licensure by
11	credentials; authorizing periodic verifications of
12	credentials by board; providing for revocation of a
13	license; providing for conversion of a public health
14	dental license to an unrestricted license to practice
15	dentistry in the state; providing criteria for an
16	unrestricted license; amending s. 466.011, F.S.; providing
17	that the board shall certify for dental licensure an
18	applicant who satisfies requirements for licensure by
19	credentials; amending s. 466.021, F.S.; revising
20	requirements relating to retention of dental laboratories
21	by dentists; changing terminology to reflect employment of
22	dental laboratories and to change references to work
23	orders to prescriptions; requiring a dental laboratory to
24	keep the original or electronic copy of prescriptions;
25	amending s. 466.023, F.S.; removing requirement for board
26	rule to determine level of supervision for specified scope
27	and area of practice for a dental hygienist in certain
28	areas; providing that the level of supervision for duties
29	in a dentist's private office shall be determined by rule;
30	providing that a dental hygienist in public health
31	settings under public health supervision may perform
32	duties as specified by law; amending s. 466.024, F.S.;
33	providing that certain procedures performed by a dental
34	hygienist under public health supervision are remediable
35	and delegable; amending s. 466.032, F.S.; requiring
36	specified continuing education for renewal of registration
37	of a dental laboratory by a time certain; providing a
38	listing of agencies or organizations authorized to develop
39	and offer continuing education; requiring a dental
40	laboratory owner to submit a sworn statement attesting to
41	compliance with continuing education requirements and
42	providing specified information; providing that the
43	Department of Health may request documentation of
44	continuing education with cause; providing that the
45	department may request such documentation at random
46	without cause; providing exemptions from continuing
47	education requirements; providing for voluntary compliance
48	by certain dental laboratories; providing for rulemaking;
49	providing effective dates.
50
51	WHEREAS, tooth decay is one of the most prevalent chronic
52	diseases of childhood, and
53	WHEREAS, oral diseases are associated with a variety of
54	systemic diseases, including cardiovascular disease, diabetes,
55	and cancer, and
56	WHEREAS, oral disease in pregnant women is associated with
57	preterm birth and low birth weight, and
58	WHEREAS, early dental care helps to prevent oral disease
59	and its associated pain, risks, and high costs to individuals,
60	and
61	WHEREAS, the application of dental sealants and fluorides
62	are a central and critical aspect of preventive oral healthcare,
63	especially for children, and
64	WHEREAS, dental care for low-income and other underserved
65	patients is provided primarily through publicly funded programs,
66	and
67	WHEREAS, the current public health infrastructure is
68	inadequate to provide access to preventive and interventional
69	oral healthcare services, and
70	WHEREAS, current dental licensure laws and rules in Florida
71	create barriers for dentists licensed in other states who are
72	willing to serve in public health settings in this state from
73	doing so, and
74	WHEREAS, Florida's current scope of practice rules restrict
75	the ability of dental hygienists to cost-effectively deliver
76	needed care to low-income and other underserved patients, and
77	WHEREAS, Florida is one of four states and the United
78	States Virgin Islands to not offer a process by which dentists
79	from other states may achieve licensure by credentials to
80	practice in public or private settings, and
81	WHEREAS, Florida is one of nine states to not permit dental
82	hygienists to apply dental sealants without the physical
83	presence of a dentist, and
84	WHEREAS, the membership of the Board of Dentistry has no
85	requirement that any of its members have a background or
86	experience in a public health setting, NOW, THEREFORE,
87
88	Be It Enacted by the Legislature of the State of Florida:
89
90	Section 1.  Short title.--This act may be cited as the
91	"Access to Oral Healthcare Act."
92	Section 2.  Subsections (11) through (13) of section
93	466.003, Florida Statutes, are renumbered as subsections (12)
94	through (14), respectively, and new subsections (11) and (15)
95	are added to that section to read:
96	466.003  Definitions.--As used in this chapter:
97	(11)  "Public health supervision" means administrative
98	supervision whereby a dental hygienist in a public health
99	setting shall, without supervision or the presence of a dentist
100	or the prior authorization of a dentist, provide remedial
101	services as established by statute. The board may add additional
102	services by rule.
103	(15)  "Public health settings" means public health programs
104	and institutions of the Department of Children and Family
105	Services, Department of Health, Department of Juvenile Justice,
106	nonprofit community health centers, Head Start Centers,
107	federally qualified health centers, federally qualified health
108	center look-alikes, and other public health dental safety net
109	providers as designated by the board.
110	Section 3.  Subsection (1) of section 466.004, Florida
111	Statutes, is amended to read:
112	466.004  Board of Dentistry.--
113	(1)  To carry out the provisions of this chapter, there is
114	created within the department the Board of Dentistry consisting
115	of 11 members who shall be appointed by the Governor and subject
116	to confirmation by the Senate. Seven members of the board must
117	be licensed dentists actively engaged in the clinical practice
118	of dentistry in this state, two of whom must have public health
119	experience that shall include having practiced dentistry in a
120	public health setting for 2 of the past 5 years or holding an
121	advanced degree in public health; two members must be licensed
122	dental hygienists actively engaged in the practice of dental
123	hygiene in this state; and the remaining two members must be
124	laypersons who are not, and have never been, dentists, dental
125	hygienists, or members of any closely related profession or
126	occupation. Each member of the board who is a licensed dentist
127	must have been actively engaged in the practice of dentistry
128	primarily as a clinical practitioner for at least 5 years
129	immediately preceding the date of her or his appointment to the
130	board and must remain primarily in clinical practice during all
131	subsequent periods of appointment to the board. Each member of
132	the board who is connected in any way with any dental college or
133	community college must be in compliance with s. 456.007. At
134	least one member of the board must be 60 years of age or older.
135	Members shall be appointed for 4-year terms, but may serve no
136	more than a total of 10 years.
137	Section 4.  Section 466.0067, Florida Statutes, is created
138	to read:
139	466.0067  Licensure by credentials.--
140	(1)  Notwithstanding the requirements of s. 466.006, the
141	board shall grant a public health dental license to practice
142	dentistry by credentials in this state to an applicant who:
143	(a)  Has filed an appropriate application as supplied by
144	the board.
145	(b)  Has provided proof of graduation from a dental school
146	accredited by the Commission on Dental Accreditation of the
147	American Dental Association or its successor agency, if any.
148	(c)  Has provided evidence of successful completion of the
149	National Board of Dental Examiners dental examination and a
150	state or regional clinical licensing examination.
151	(d)  Has provided proof that she or he currently holds a
152	valid, active license to practice dentistry from another state,
153	the District of Columbia, or a United States territory and that
154	such license is in good standing and has not been revoked,
155	suspended, or restricted.
156	(e)  Has provided proof that she or he has been engaged in
157	the active, clinical practice of dentistry providing direct
158	patient care in the United States or one of its territories, the
159	armed forces, or a state or federal program or clinical
160	residency program for 2 out of the 3 years preceding the date of
161	application. The board may consider waivers to this requirement
162	in cases of military service, illness, disability, or pregnancy.
163	The board shall evaluate years spent in postgraduate training,
164	research and teaching positions, and other nonclinical intern or
165	residency programs on a case-by-case basis as a substitute for
166	the required years of prior practice.
167	(f)  Has provided documentation of having completed
168	continuing education equivalent to the requirements for a
169	dentist licensed under s. 466.006 for the 2 years prior to
170	applying for licensure by credentials.
171	(g)  Has paid the appropriate licensure fees, as set by the
172	board in rules, that apply to other dentists licensed under this
173	chapter.
174	(h)  Has passed a written examination covering the laws and
175	rules regulating the practice of dentistry in this state as
176	described in s. 466.006(4)(a).
177	(2)  A public health dental license will allow qualifying
178	licensees to perform unsupervised dentistry in public health
179	settings in the state.
180	(3)  The board may periodically request verification of
181	compliance with these requirements and may revoke the dentist's
182	license upon a finding that the employment requirement, or any
183	other requirement for licensure under this section, has not been
184	met.
185	(4)(a)  A dentist licensed under this section may apply to
186	the board to convert the public health dental license to an
187	active, unrestricted dental license, without further examination
188	and without being subject to the requirements of s. 466.006, at
189	such time that she or he has engaged in the active, clinical
190	practice of dentistry in a public health setting in the state
191	for a minimum of 3,000 hours in the 3 years prior to application
192	under this section.
193	(b)  A dentist licensed under this section who provides 10
194	percent of her or his salaried time teaching health profession
195	students in any state public education setting, including, but
196	not limited to, a community college, college, or university, may
197	apply to convert the public health dental license to an active,
198	unrestricted dental license, without further examination and
199	without being subject to the requirements of s. 466.006, at such
200	time that she or he has engaged in the active, clinical practice
201	of dentistry in a public health setting in this state for a
202	minimum of 1,500 hours in the 2 years prior to application.
203	(c)  A dentist licensed under this section who is a retired
204	or veteran dentist of any branch of the United States Armed
205	Services who practiced dentistry while on active duty may apply
206	to convert the public health dental license to an active,
207	unrestricted dental license, without further examination and
208	without being subject to the requirements of s. 466.006, at such
209	time that she or he has engaged in the active, clinical practice
210	of dentistry in a public health setting in this state for a
211	minimum of 1,500 hours in the 2 years prior to application.
212	Section 5.  Section 466.011, Florida Statutes, is amended
213	to read:
214	466.011  Licensure.--The board shall certify for licensure
215	by the department any applicant who satisfies the requirements
216	of s. 466.006, s. 466.0067, or s. 466.007. The board may refuse
217	to certify an applicant who has violated any of the provisions
218	of s. 466.026 or s. 466.028.
219	Section 6.  Effective January 1, 2009, section 466.021,
220	Florida Statutes, is amended to read:
221	466.021  Retention Employment of dental laboratories
222	unlicensed persons by dentist; penalty.--Each Every duly
223	licensed dentist who uses the services of any dental laboratory
224	unlicensed person for the purpose of constructing, altering,
225	repairing, or duplicating any denture, implant, veneer, partial
226	denture, bridge splint, or orthodontic or other prosthetic
227	appliance, or other suitable form of artificial oral restorative
228	device shall be required to furnish the dental laboratory such
229	unlicensed person with a written prescription work order in a
230	such form as prescribed by rule of the board. This prescription
231	form shall be dated and signed by the such dentist and shall
232	include the license number of the dentist, the patient's name or
233	number with sufficient descriptive information to clearly
234	identify the case for each separate and individual piece of work
235	to be performed by the dental laboratory, and a specification of
236	materials to be contained in each work product. A copy of the
237	prescription such work order shall be retained in a file in the
238	prescribing dentist's office for a period of 4 years from the
239	date the prescription was issued, and the original prescription
240	work order shall be retained in a file by the dental laboratory
241	for a period of 4 years by such unlicensed person in her or his
242	place of business. A registered dental laboratory shall disclose
243	in writing at the time of delivery of the final restoration to
244	the prescribing dentist both the materials and all certificates
245	of authenticity that constitute each product manufactured and
246	the point of origin of manufacture of each restoration,
247	including the address and contact information of the dental
248	laboratory. The Such file of prescriptions work orders to be
249	kept by the such dentist and the dental laboratory or by such
250	unlicensed person shall be open to inspection at any reasonable
251	time by the department or its duly constituted agent. Failure of
252	the dentist to keep records of each prescription such work
253	orders shall subject the dentist to suspension or revocation of
254	her or his license to practice dentistry. Failure of a dental
255	laboratory that has accepted a prescription to have the original
256	or electronic copy of each prescription and to ensure the
257	accuracy of each product's material disclosure at the time it is
258	delivered to the prescribing dentist such unlicensed person to
259	have in her or his possession a work order as required by this
260	section is shall be admissible evidence of a violation of this
261	chapter and constitutes shall constitute a misdemeanor of the
262	second degree, punishable as provided in s. 775.082 or s.
263	775.083. This section does not preclude a registered dental
264	laboratory from working for another registered dental laboratory
265	if, provided that such work is performed pursuant to written
266	authorization, in a form to be prescribed by rule of the board,
267	that which evidences that the originating laboratory has
268	obtained a valid prescription work order and that which sets
269	forth the work to be performed and the resulting material
270	certifications to be provided. A dental laboratory accepting
271	prescriptions from dentists shall be liable for damages caused
272	by inaccuracies in the material disclosure, certificates of
273	authenticity, or point of origin provided by the dental
274	laboratory to the prescribing dentist. This section does not
275	preclude a registered laboratory from providing its services to
276	dentists licensed and practicing in another state if, provided
277	that such work is requested or otherwise authorized in written
278	form that which clearly identifies the name and address of the
279	requesting dentist and which sets forth the work to be performed
280	and otherwise complies with all applicable laws and treaties.
281	Section 7.  Subsections (1) and (2) of section 466.023,
282	Florida Statutes, are amended to read:
283	466.023  Dental hygienists; scope and area of practice.--
284	(1)  Except as otherwise provided in s. 466.024, only
285	dental hygienists may be delegated the task of removing calculus
286	deposits, accretions, and stains from exposed surfaces of the
287	teeth and from the gingival sulcus and the task of performing
288	root planing and curettage. In addition, dental hygienists may
289	expose dental X-ray films, apply topical preventive or
290	prophylactic agents, and perform all tasks delegable by the
291	dentist in accordance with s. 466.024. The board by rule shall
292	determine whether such functions shall be performed under the
293	direct, indirect, or general supervision of the dentist.
294	(2)  Dental hygienists may perform their duties:
295	(a)  In the private office of a licensed dentist, in which
296	case the board shall by rule determine whether such functions
297	shall be performed under the direct, indirect, or general
298	supervision of the dentist;
299	(b)  In public health settings programs and institutions of
300	the Department of Children and Family Services, Department of
301	Health, and Department of Juvenile Justice under public health
302	the general supervision. Dental hygienists in public health
303	settings under public health supervision may perform duties
304	provided in this section, s. 466.0235, or s. 466.024 or any
305	other duties for dental hygienists as prescribed by law of a
306	licensed dentist; or
307	(c)  Upon a patient of record of a dentist who has issued a
308	prescription for the services of a dental hygienist, which
309	prescription shall be valid for 2 years unless a shorter length
310	of time is designated by the dentist, in:
311	1.  Licensed public and private health facilities;
312	2.  Other public institutions of the state and federal
313	government;
314	3.  Public and private educational institutions;
315	4.  The home of a nonambulatory patient; and
316	5.  Other places in accordance with the rules of the board.
317
318	However, the dentist issuing such prescription shall remain
319	responsible for the care of such patient. As used in this
320	subsection, "patient of record" means a patient upon whom a
321	dentist has taken a complete medical history, completed a
322	clinical examination, recorded any pathological conditions, and
323	prepared a treatment plan.
324	Section 8.  Section 466.024, Florida Statutes, is amended
325	to read:
326	466.024  Delegation of duties; expanded functions.--
327	(1)  A dentist may not delegate irremediable tasks to a
328	dental hygienist or dental assistant, except as provided by law.
329	A dentist may delegate remediable tasks to a dental hygienist or
330	dental assistant when such tasks pose no risk to the patient. A
331	dentist may only delegate remediable tasks so defined by law or
332	rule of the board. The board by rule shall designate which tasks
333	are remediable and delegable, except that the following are by
334	law found to be remediable and delegable:
335	(a)  Taking impressions for study casts but not for the
336	purpose of fabricating any intraoral restorations or orthodontic
337	appliance.
338	(b)  Placing periodontal dressings.
339	(c)  Removing periodontal or surgical dressings.
340	(d)  Removing sutures.
341	(e)  Placing or removing rubber dams.
342	(f)  Placing or removing matrices.
343	(g)  Placing or removing temporary restorations.
344	(h)  Applying cavity liners, varnishes, or bases.
345	(i)  Polishing amalgam restorations.
346	(j)  Polishing clinical crowns of the teeth for the purpose
347	of removing stains but not changing the existing contour of the
348	tooth.
349	(k)  Obtaining bacteriological cytological specimens not
350	involving cutting of the tissue.
351
352	Nothing in this subsection shall be construed to limit delegable
353	tasks to those specified herein.
354	(2)  The following procedures performed by dental
355	hygienists are by law found to be remediable and delegable under
356	public health supervision:
357	(a)  Medical and dental history.
358	(b)  A dental screening to include preliminary dental
359	charting to record the patient's missing dentition, existing
360	restorations, caries, periodontal disease, and oral pathology.
361	(c)  Taking of dental radiographs.
362	(d)  Diagnostic impressions.
363	(e)  Oral hygiene instruction.
364	(f)  Cleaning and polishing of the clinical crowns of
365	teeth, including the removal of calculus deposits, accretions,
366	and stains from the exposed surfaces of the dentition and from
367	tooth surfaces within the gingival sulcus.
368	(g)  Fluoride treatments, including the application of
369	fluoride varnish.
370	(h)  Application of dental sealants.
371	(i)  Placing subgingival resorbable chlorhexidine,
372	doxycycline hyclate, or minocycline hydrochloride.
373	(j)  Referral to a dentist licensed under this chapter for
374	a comprehensive dental examination or treatment or both, when
375	indicated.
376
377	Nothing in this subsection shall be construed to limit delegable
378	tasks to those specified herein.
379	(3)(2)  Notwithstanding subsection (1) or subsection (2), a
380	dentist may delegate the tasks of gingival curettage and root
381	planing to a dental hygienist but not to a dental assistant.
382	(4)(3)  All other remediable tasks shall be performed under
383	the direct, indirect, or general supervision of a dentist, as
384	determined by rule of the board, or by dental hygienists under
385	public health supervision in public health settings, and after
386	such formal or on-the-job training by the dental hygienist or
387	dental assistant as the board by rule may require. The board by
388	rule may establish a certification process for expanded-duty
389	dental assistants, establishing such training or experience
390	criteria or examinations as it deems necessary and specifying
391	which tasks may be delegable only to such assistants. If the
392	board does establish such a certification process, the
393	department shall implement the application process for such
394	certification and administer any examinations required.
395	(5)(4)  Notwithstanding subsection (1) or subsection (2), a
396	dentist may not delegate to anyone other than another licensed
397	dentist:
398	(a)  Any prescription of drugs or medications requiring the
399	written order or prescription of a licensed dentist or
400	physician.
401	(b)  Any diagnosis for treatment or treatment planning.
402	(6)(5)  Notwithstanding any other provision of law, a
403	dentist is primarily responsible for all procedures delegated by
404	her or him.
405	(7)(6)  No dental assistant shall perform an intraoral
406	procedure except after such formal or on-the-job training as the
407	board by rule shall prescribe.
408	Section 9.  Effective January 1, 2009, subsection (5) is
409	added to section 466.032, Florida Statutes, to read:
410	466.032  Registration.--
411	(5)  Either the dental laboratory owner or at least one
412	employee of any dental laboratory renewing registration on or
413	after July 1, 2010, shall be required to have completed 18 hours
414	of continuing education biennially. Programs of continuing
415	education shall be programs of learning that contribute directly
416	to the education of the dental technician and may include, but
417	shall not be limited to, attendance at lectures, study clubs,
418	college courses, or scientific sessions of conventions; and
419	research.
420	(a)  The aim of continuing education for dental technicians
421	is to improve dental health care delivery to the public as such
422	is impacted through the design, manufacture, and use of
423	artificial human oral prosthetics and related restorative
424	appliances.
425	(b)  Continuing education courses shall address one or more
426	of the following areas of professional development, including,
427	but not limited to:
428	1.  Laboratory and technological subjects, including, but
429	not limited to, laboratory techniques and procedures, materials,
430	and equipment; and
431	2.  Subjects pertinent to oral health, infection control,
432	and safety.
433	(c)  Programs meeting the general requirements of
434	continuing education may be developed and offered to dental
435	technicians by the Florida Dental Laboratory Association and the
436	Florida Dental Association. Other organizations, schools, or
437	agencies may also be approved to develop and offer continuing
438	education in accordance with specific criteria established by
439	the department.
440	(d)  Any dental laboratory renewing a registration on or
441	after July 1, 2010, shall submit a sworn affidavit, on a form
442	acceptable to the department, attesting that either the dental
443	laboratory owner or one dental technician employed by the
444	registered dental laboratory has completed the continuing
445	education required in this subsection in accordance with the
446	guidelines and provisions of this subsection and listing the
447	date, location, sponsor, subject matter, and hours of completed
448	continuing education courses. The dental laboratory shall retain
449	in its records such receipts, vouchers, or certificates as may
450	be necessary to document completion of the continuing education
451	courses listed in accordance with this subsection. With cause,
452	the department may request that the documentation be provided by
453	the applicant. The department may also request the documentation
454	from applicants selected at random without cause.
455	(e)1.  This subsection does not apply to a dental
456	laboratory that is physically located within a dental practice
457	operated by a dentist licensed under this chapter.
458	2.  A dental laboratory in another state or country that
459	provides service to a dentist licensed under this chapter is not
460	required to register with the state and may continue to provide
461	services to such dentist with a proper prescription. A dental
462	laboratory in another state or country, however, may voluntarily
463	comply with this subsection.
464	Section 10.  The board shall adopt rules pursuant to ss.
465	120.536(1) and 120.54, Florida Statutes, to implement this act.
466	Section 11.  Except as otherwise expressly provided in this
467	act, this act shall take effect July 1, 2009.

CODING: Words stricken are deletions; words underlined are additions.