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A bill to be entitled

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An act relating to dentistry; providing a short title;

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amending s. 466.003, F.S.; defining the terms "public

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health supervision" and "public health setting"; amending

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s. 466.004, F.S.; revising the requirements for membership

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on the Board of Dentistry within the Department of Health;

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authorizing the board to adopt rules; creating s.

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466.0067, F.S.; requiring the board to grant a public

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health dental license to an applicant who meets certain

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requirements; providing requirements for licensure;

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authorizing the holder of a public health dental license

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to practice dentistry in a public health setting;

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authorizing the board to request verification or to revoke

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a public health dental license; authorizing a holder of a

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public health dental license to convert it to a dental

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license under certain conditions; authorizing the board to

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adopt rules; amending s. 466.011, F.S.; conforming a

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provision to changes made by the act; authorizing the

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board to adopt rules governing the licensure of

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applicants; amending s. 466.021, F.S.; revising

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requirements relating to retention of dental laboratories

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by dentists; changing terminology to reflect employment of

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dental laboratories and to change references to work

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orders for prescriptions; requiring a dental laboratory to

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keep the original or electronic copy of prescriptions;

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amending s. 466.023, F.S.; authorizing dental hygienists

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to perform dental hygiene services under public health

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supervision; authorizing the board to adopt rules;

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amending s. 466.024, F.S.; providing that certain tasks

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are remediable and delegable to dental hygienists in

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certain settings; prohibiting a dentist from delegating

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irremediable tasks to a dental hygienist; authorizing a

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dentist to delegate remediable tasks to a dental hygienist

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under certain conditions; providing a list of remediable

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and delegable tasks; authorizing the board to adopt rules;

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amending s. 466.032, F.S.; requiring specified continuing

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education for renewal of registration of a dental

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laboratory by a time certain; providing a listing of

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agencies or organizations that are authorized to develop

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and offer continuing education; requiring a dental

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laboratory owner to submit a sworn statement attesting to

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compliance with continuing education requirements and

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providing specified information; authorizing the

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Department of Health to request documentation of

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continuing education; authorizing the department to

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request such documentation at random without cause;

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providing exemptions from continuing education

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requirements; providing for voluntary compliance by

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certain dental laboratories; providing an effective date.

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     WHEREAS, tooth decay is one of the most prevalent chronic

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diseases of childhood, and

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     WHEREAS, oral diseases are associated with a variety of

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systemic diseases, including cardiovascular disease, diabetes,

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and cancer, and

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     WHEREAS, oral disease in pregnant women is associated with

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preterm birth and low birth weight, and

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     WHEREAS, early dental care helps to prevent oral disease and

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its associated pain, risks, and high costs to individuals, and

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     WHEREAS, the placement of dental sealants and fluorides are

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a central and critical aspect of preventive oral health care,

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especially for children, and

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     WHEREAS, dental care for low-income and other underserved

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patients is provided primarily through publicly funded programs,

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and

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     WHEREAS, the current public health infrastructure is

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inadequate to provide access to preventive and interventional

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oral health care services, and

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     WHEREAS, current dental licensure statutes and rules in

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Florida create barriers for dentists licensed in other states who

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are willing to serve in public health settings from doing so, and

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     WHEREAS, Florida's current scope of practice rules restrict

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the ability of dental hygienists to deliver needed care to low-

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income and other underserved patients cost-effectively, and

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     WHEREAS, Florida is one of four states and the U.S. Virgin

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Islands that does not offer a process by which dentists from

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other states may achieve licensure by credentials to practice in

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public or private settings, and

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     WHEREAS, Florida is one of nine states to prohibit dental

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hygienists from placing dental sealants without the physical

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presence of a dentist, and

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     WHEREAS, the membership of the Florida Board of Dentistry

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does not require any of its members to have a background in or

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experience in a public health setting, NOW, THEREFORE,

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1. This act may be cited as the "Access to Oral

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Health Act."

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     Section 2.  Subsections (14) and (15) are added to section

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466.003, Florida Statutes, to read:

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     466.003  Definitions.--As used in this chapter:

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     (14) "Public health setting" means a public health program

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or an institution of the Department of Children and Family

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Services, the Department of Health, the Department of Juvenile

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Justice, a nonprofit community health center, a Head Start

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center, a federally qualified health center or other similar

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entity, and any other public health dental safety net provider

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designated by the board.

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     (15) "Public health supervision" means administrative

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supervision whereby a dental hygienist in a public health

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setting, without supervision or the presence of a dentist or the

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prior authorization of a dentist, provides remedial services as

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established by law. The board may authorize additional services

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by rule.

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     Section 3.  Subsection (1) of section 466.004, Florida

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Statutes, is amended to read:

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     466.004  Board of Dentistry.--

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     (1)  To carry out the provisions of this chapter, there is

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created within the department the Board of Dentistry consisting

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of 11 members who shall be appointed by the Governor and subject

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to confirmation by the Senate. Seven members of the board must be

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licensed dentists actively engaged in the clinical practice of

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dentistry in this state; two members must be licensed dental

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hygienists actively engaged in the practice of dental hygiene in

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this state; and the remaining two members must be laypersons who

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are not, and have never been, dentists, dental hygienists, or

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members of any closely related profession or occupation. Each

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member of the board who is a licensed dentist must have been

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actively engaged in the practice of dentistry primarily as a

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clinical practitioner for at least 5 years immediately preceding

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the date of her or his appointment to the board and must remain

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primarily in clinical practice during all subsequent periods of

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appointment to the board. Two of the seven members of the board

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who are licensed dentists must have public health experience that

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includes having practiced dentistry in a public health setting

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for 2 of the past 5 years or must hold an advanced degree in

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public health. Each member of the board who is connected in any

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way with any dental college or community college must be in

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compliance with s. 456.007. At least one member of the board must

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be 60 years of age or older. Members shall be appointed for 4-

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year terms, but may serve no more than a total of 10 years. The

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board may adopt rules pursuant to ss. 120.536(1) and 120.54 to

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administer this subsection.

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     Section 4.  Section 466.0067, Florida Statutes, is created

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to read:

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     466.0067 Licensure by credentials.--

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     (1) Notwithstanding the requirements of s. 466.006, the

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board shall grant a public health dental license to practice

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dentistry by credentials in this state to an applicant who meets

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the following requirements:

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     (a) Files an appropriate application as supplied by the

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board;

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     (b) Provides proof of graduation from a dental school

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accredited by the Commission on Dental Accreditation of the

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American Dental Association or its successor agency;

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     (c) Submits evidence of successful completion of the

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National Board examinations and a state or regional clinical

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licensing examination;

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     (d) Currently holds a valid, active license in good

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standing which has not been revoked, suspended, or restricted

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from another state, the District of Columbia, or a United States

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territory;

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     (e) Submits proof that he or she has been engaged in the

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active, clinical practice of dentistry by providing direct

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patient care in the United States or one of its territories, the

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Armed Forces, a state or federal program, or a clinical residency

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program for 2 out of the 3 years preceding the date of

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application. The board may consider a waiver to this requirement

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in cases of military service, illness, disability, or pregnancy.

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The board shall evaluate the number of years an applicant has

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been active in postgraduate training, in research and in teaching

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positions, in nonclinical internships, or in residency programs

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on a case-by-case basis as a substitute for the required years of

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prior practice;

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     (f) Submits documentation of having completed continuing

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education that is at least equivalent to the state's requirements

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for dentists licensed under s. 466.006 for the 2 years before

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applying for licensure by credentials;

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     (g) Has paid the appropriate licensure fees as defined by

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board rules which apply to dentists licensed under this chapter;

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and

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     (h) Has passed an examination covering the laws and rules

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of the practice of dentistry in this state as described in s.

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466.006(4)(a).

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     (2) A public health dental license allows qualifying

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licensees to perform unsupervised dentistry in this state's

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public health settings as defined in s. 466.003(14).

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     (3) The board may periodically request verification of

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compliance with these requirements and may revoke the license

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upon a finding that the employment requirement or any other

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requirement of this section has not been met.

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     (4) If the holder of a public health dental license has

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engaged in the active, clinical practice of dentistry in a public

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health setting in this state for a minimum of 3,000 hours in the

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3 years prior to application, he or she may apply to the board to

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convert the public health dental license to an active,

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unrestricted dental license, without further examination and

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without being subject to the requirements of s. 466.006.

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     (5) The board may adopt rules pursuant to ss. 120.536(1)

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and 120.54 to administer this section.

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     Section 5.  Section 466.011, Florida Statutes, is amended to

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read:

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     466.011  Licensure.--The board shall certify for licensure

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by the department any applicant who satisfies the requirements of

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s. 466.006, s. 466.0067, or s. 466.007. The board may refuse to

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certify an applicant who has violated any of the provisions of s.

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466.026 or s. 466.028. The board may adopt rules pursuant to ss.

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120.536(1) and 120.54 to administer this section.

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     Section 6.  Section 466.021, Florida Statutes, is amended to

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read:

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     466.021 Retention Employment of dental laboratories

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unlicensed persons by dentist; penalty.--Each Every duly licensed

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dentist who uses the services of any dental laboratory unlicensed

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person for the purpose of constructing, altering, repairing, or

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duplicating any denture, implant, veneer, partial denture, bridge

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splint, or orthodontic or other prosthetic appliance, or other

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suitable form of artificial oral restorative device shall be

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required to furnish the dental laboratory such unlicensed person

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with a written prescription work order in a such form as

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prescribed by rule of the board. This prescription form shall be

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dated and signed by the such dentist and shall include the

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license number of the dentist, the patient's name or number with

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sufficient descriptive information to clearly identify the case

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for each separate and individual piece of work to be performed by

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the dental laboratory, and a specification of materials to be

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contained in each work product. A copy of the prescription such

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work order shall be retained in a file in the prescribing

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dentist's office for a period of 4 years following the date the

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prescription was issued, and the original prescription work order

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shall be retained in a file by the dental laboratory for a period

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of 4 years by such unlicensed person in her or his place of

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business. A registered dental laboratory shall disclose in

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writing at the time of delivery of the final restoration to the

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prescribing dentist the materials and all certificates of

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authenticity that constitute each product manufactured and the

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point of origin of manufacture of each restoration, including the

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address and contact information of the dental laboratory. The

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Such file of prescriptions work orders to be kept by the such

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dentist and the dental laboratory or by such unlicensed person

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shall be open to inspection at any reasonable time by the

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department or its duly constituted agent. Failure of the dentist

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to keep records of each prescription such work orders shall

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subject the dentist to suspension or revocation of her or his

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license to practice dentistry in this state. Failure of a dental

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laboratory that has accepted a prescription to have the original

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or electronic copy of each prescription and to ensure the

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accuracy of each product's material disclosure at the time it is

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delivered to the prescribing dentist such unlicensed person to

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have in her or his possession a work order as required by this

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section is shall be admissible evidence of a violation of this

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chapter and constitutes shall constitute a misdemeanor of the

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second degree, punishable as provided in s. 775.082 or s.

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775.083. This section does not preclude a registered dental

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laboratory from working for another registered dental laboratory

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if, provided that such work is performed pursuant to written

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authorization, in a form to be prescribed by rule of the board,

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which evidences that the originating laboratory has obtained a

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valid prescription work order and which sets forth the work to be

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performed and the resulting material certifications to be

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provided. A dental laboratory accepting prescriptions from

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dentists is liable for damages caused by inaccuracies in the

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material disclosure, certificates of authenticity, or point of

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origin provided by the dental laboratory to the prescribing

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dentist. This section does not preclude a registered laboratory

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from providing its services to dentists licensed and practicing

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in another state if, provided that such work is requested or

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otherwise authorized in written form that which clearly

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identifies the name and address of the requesting dentist and

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which sets forth the work to be performed and otherwise complies

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with all applicable laws and treaties.

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     Section 7.  Subsections (1) and (2) of section 466.023,

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Florida Statutes, are amended, and subsection (7) is added to

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that section, to read:

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     466.023  Dental hygienists; scope and area of practice.--

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     (1)  Except as otherwise provided in s. 466.024, only dental

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hygienists may be delegated the task of removing calculus

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deposits, accretions, and stains from exposed surfaces of the

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teeth and from the gingival sulcus and the task of performing

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root planing and curettage. In addition, dental hygienists may

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expose dental X-ray films, apply topical preventive or

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prophylactic agents, and perform all tasks delegable by the

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dentist in accordance with s. 466.024. The board by rule shall

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determine whether such functions shall be performed under the

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direct, indirect, or general supervision of the dentist.

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     (2)  Dental hygienists may perform their duties:

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     (a) In the private offices the office of a licensed

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dentists where the board by rule shall determine whether such

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functions shall be performed under the direct, indirect, or

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general supervision of the dentist;

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     (b) In public health settings, as defined in s. 466.003,

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programs and institutions of the Department of Children and

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Family Services, Department of Health, and Department of Juvenile

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Justice under public health supervision as defined in s. 466.003.

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Dental hygienists in public health settings under public health

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supervision may perform duties delineated in s. 466.023, s.

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466.0235, or s. 466.024, or may perform any other duties

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prescribed by state law the general supervision of a licensed

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dentist; or

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     (c)  Upon a patient of record of a dentist who has issued a

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prescription for the services of a dental hygienist, which

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prescription shall be valid for 2 years unless a shorter length

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of time is designated by the dentist, in:

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     1.  Licensed public and private health facilities;

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     2.  Other public institutions of the state and federal

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government;

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     3.  Public and private educational institutions;

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     4.  The home of a nonambulatory patient; and

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     5.  Other places in accordance with the rules of the board.

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However, the dentist issuing such prescription shall remain

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responsible for the care of such patient. As used in this

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subsection, "patient of record" means a patient upon whom a

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dentist has taken a complete medical history, completed a

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clinical examination, recorded any pathological conditions, and

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prepared a treatment plan.

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     (7) The board may adopt rules pursuant to ss. 120.536(1)

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and 120.54 to administer this section.

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     Section 8.  Section 466.024, Florida Statutes, is amended to

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read:

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     466.024  Delegation of duties; expanded functions.--

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     (1)  A dentist may not delegate irremediable tasks to a

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dental hygienist or dental assistant, except as provided by law.

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A dentist may delegate remediable tasks to a dental hygienist or

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dental assistant when such tasks pose no risk to the patient. A

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dentist may only delegate remediable tasks so defined by law or

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rule of the board. The board by rule shall designate which tasks

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are remediable and delegable, except that the following are by

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law found to be remediable and delegable to dental hygienists in

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settings under s. 466.023(2)(a) and (c):

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     (a)  Taking impressions for study casts but not for the

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purpose of fabricating any intraoral restorations or orthodontic

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appliance.

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     (b)  Placing periodontal dressings.

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     (c)  Removing periodontal or surgical dressings.

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     (d)  Removing sutures.

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     (e)  Placing or removing rubber dams.

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     (f)  Placing or removing matrices.

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     (g)  Placing or removing temporary restorations.

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     (h)  Applying cavity liners, varnishes, or bases.

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     (i)  Polishing amalgam restorations.

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     (j)  Polishing clinical crowns of the teeth for the purpose

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of removing stains but not changing the existing contour of the

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tooth.

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     (k)  Obtaining bacteriological cytological specimens not

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involving cutting of the tissue.

337

338

Nothing in this subsection shall be construed to limit delegable

339

tasks to those specified herein.

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     (2) A dentist may not delegate irremediable tasks to a

341

dental hygienist except as provided by law or rule of the board.

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A dentist may delegate remediable tasks to a dental hygienist

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when such tasks do not pose a risk to the patient. A dentist may

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delegate only remediable tasks defined by law or rule of the

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board. The following tasks are remediable and delegable in

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settings under s. 466.023:

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     (a) All duties listed in subsection (1).

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     (b) Applying topical fluorides, including applying fluoride

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varnish.

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     (c) Applying dental sealants.

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     (3)(2) Notwithstanding subsection (1) or subsection (2), a

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dentist may delegate the tasks of gingival curettage and root

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planing to a dental hygienist but not to a dental assistant.

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     (4)(3) All other remediable tasks shall be performed under

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the direct, indirect, or general supervision of a dentist or by

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dental hygienists under public health supervision in a public

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health setting, as determined by rule of the board, and after

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such formal or on-the-job training by the dental hygienist or

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dental assistant as the board by rule may require. The board by

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rule may establish a certification process for expanded-duty

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dental assistants, establishing such training or experience

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criteria or examinations as it deems necessary and specifying

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which tasks may be delegable only to such assistants. If the

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board does establish such a certification process, the department

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shall implement the application process for such certification

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and administer any examinations required.

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     (5)(4) Notwithstanding subsection (1) or subsection (2), a

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dentist may not delegate to anyone other than another licensed

369

dentist:

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     (a)  Any prescription of drugs or medications requiring the

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written order or prescription of a licensed dentist or physician.

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     (b)  Any diagnosis for treatment or treatment planning.

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     (6)(5) Notwithstanding any other provision of law, a

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dentist is primarily responsible for all procedures delegated by

375

her or him.

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     (7)(6) A No dental assistant may not shall perform an

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intraoral procedure except after such formal or on-the-job

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training as the board by rule shall prescribe.

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     (8) The board may adopt rules pursuant to ss. 120.536(1)

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and 120.54 to administer this section.

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     Section 9.  Subsection (5) is added to section 466.032,

382

Florida Statutes, to read:

383

     466.032  Registration.--

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     (5) Either the dental laboratory owner or at least one

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employee of any dental laboratory renewing registration on or

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after July 1, 2010, shall be required to have completed 18 hours

387

of continuing education biennially. Programs of continuing

388

education shall be programs of learning that contribute directly

389

to the education of the dental technician and may include, but

390

are not limited to, attendance at lectures, study clubs, college

391

courses, or scientific sessions of conventions; and research.

392

     (a) The aim of continuing education for dental technicians

393

is to improve dental health care delivery to the public as such

394

is impacted through the design, manufacture, and use of

395

artificial human oral prosthetics and related restorative

396

appliances.

397

     (b) Continuing education courses shall address one or more

398

of the following areas of professional development, including,

399

but not limited to:

400

     1. Laboratory and technological subjects, including, but

401

not limited to, laboratory techniques and procedures, materials,

402

and equipment; and

403

     2. Subjects pertinent to oral health, infection control,

404

and safety.

405

     (c) Programs meeting the general requirements of continuing

406

education may be developed and offered to dental technicians by

407

the Florida Dental Laboratory Association and the Florida Dental

408

Association. Other organizations, schools, or agencies may also

409

be approved to develop and offer continuing education in

410

accordance with specific criteria established by the department.

411

     (d) Any dental laboratory renewing a registration on or

412

after July 1, 2010, shall submit a sworn affidavit, on a form

413

approved by the department, attesting that either the dental

414

laboratory owner or one dental technician employed by the

415

registered dental laboratory has completed the continuing

416

education required in this subsection in accordance with the

417

guidelines and provisions of this subsection and listing the

418

date, location, sponsor, subject matter, and hours of completed

419

continuing education courses. The dental laboratory shall retain

420

in its records such receipts, vouchers, or certificates as may be

421

necessary to document completion of the continuing education

422

courses listed in accordance with this subsection. With cause,

423

the department may request that the documentation be provided by

424

the applicant. The department may also request the documentation

425

from applicants selected at random without cause.

426

     (e)1. This subsection does not apply to a dental laboratory

427

that is physically located within a dental practice operated by a

428

dentist licensed under this chapter.

429

     2. A dental laboratory in another state or country which

430

provides service to a dentist licensed under this chapter is not

431

required to register with the state and may continue to provide

432

services to such dentist with a proper prescription. A dental

433

laboratory in another state or country, however, may voluntarily

434

comply with this subsection.

435

     Section 10.  This act shall take effect January 1, 2009.