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An Act To Implement the Recommendations of the Board of Dental Practice Related to the Definitions of "Supervision" and "Teledentistry"
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 32 MRSA §18302, sub-§18, as enacted by PL 2015, c. 429, §21, is amended to read:
 
18. Direct supervision.   "Direct supervision" means the supervision required by the board by rule of those tasks and procedures requiring the physical presence of the supervisor in the practice setting at the time such tasks or procedures are being performed. In order to provide direct supervision of patient treatment, the supervisor must at least identify or diagnose the condition to be treated,and authorize the treatment procedure prior to implementation and examine the condition after treatment and prior to the patient's discharge.
Sec. 2. 32 MRSA §18302, sub-§22, as enacted by PL 2015, c. 429, §21, is amended to read:
 
22. General supervision.   "General supervision" means the supervision required by the board by rule of those tasks and procedures whenthat do not require the physical presence of the supervisor is not required in the practice setting while procedures are being performed but do require the tasks and procedures to be performed with the prior knowledge and consent of the supervisor.
Sec. 3.  32 MRSA §18302, sub-§35  is enacted to read:
 
35.  Supervision.     "Supervision" means either direct supervision or general supervision as determined by the tasks and procedures that are being performed in accordance with this chapter.
Sec. 4.  32 MRSA §18302, sub-§36  is enacted to read:
 
36.  Supervisor.     "Supervisor" means an individual licensed by the board and authorized to provide supervision under this chapter.
Sec. 5.  32 MRSA §18302, sub-§37  is enacted to read:
 
37.  Teledentistry.     "Teledentistry," as it pertains to the delivery of oral health care services, means the use of interactive real-time visual and audio or other electronic media for the purposes of education, assessment, examination, diagnosis, treatment planning, consultation and directing the delivery of treatment by individuals licensed under this chapter and includes synchronous encounters, asynchronous encounters, remote patient monitoring and mobile oral health care in accordance with practice guidelines specified in rules adopted by the board.
Sec. 6. 32 MRSA §18342, sub-§6, ¶D, as enacted by PL 2015, c. 429, §21, is amended to read:
 
D. A statement from the sponsoringsupervising dentist that demonstrates that the level of supervision and control of the services to be performed by the applicant are adequate and that the performance of these services are within the applicant's dental knowledge and skill.
Sec. 7. 32 MRSA §18371, sub-§2, ¶E, as enacted by PL 2015, c. 429, §21, is amended to read:
 
E.  An individual with a resident dentist license may provide dental services only under the supervision of the sponsoringa dentist and in accordance with the level of supervision and control for which the license was issued by the board.
Sec. 8. 32 MRSA §18371, sub-§3, as amended by PL 2017, c. 388, §15, is further amended to read:
 
3. Delegation authorized.   A dentist may delegate to an unlicensed person the activities listed in this subsectionor a licensed person activities related to dental care and treatment that are delegated by custom and usage as long as those activities are under the supervision or control of the dentist. A dentist who delegates activities as described is legally liable for the activities of that unlicensed person and the unlicensed person in this relationship is considered the dentist's agent.
 
A.  A dentist may delegate the following activities to an unlicensed person as long as these activities are conducted under the general supervision of the delegating dentist:
 
(1) Changing or replacing dry socket packets after diagnosis and treatment planned by a dentist;
 
(2) For instruction purposes, demonstrating to a patient how the patient should place and remove removable prostheses, appliances or retainers;
 
(3) For the purpose of eliminating pain or discomfort, removing loose, broken or irritating orthodontic appliances;
 
(4) Giving oral health instructions;
 
(5) Irrigating and aspirating the oral cavity;
 
(6) Performing dietary analyses for dental disease control;
 
(7) Placing and recementing with temporary cement an existing crown that has fallen out as long as the dentist is promptly notified that this procedure was performed so that appropriate follow-up can occur;
 
(8) Placing and removing periodontal dressing;
 
(9) Pouring and trimming dental models;
 
(10) Removing sutures and scheduling a follow-up appointment with the dentist within 7 to 10 days of suture removal;
 
(11) Retracting lips, cheek, tongue and other tissue parts;
 
(12) Obtaining impressions for study casts;
 
(13) Taking and recording the vital signs of blood pressure, pulse and temperature;
 
(14) Taking dental plaque smears for microscopic inspection and patient education; and
 
(15) Taking intraoral photographs.
 
B.  If the unlicensed person has successfully passed a certification examination administered by a national dental assisting board, the dentist may delegate to that unlicensed person the following additional activities, as long as these activities are conducted under the general supervision of the dentist:
 
(1) Placing temporary fillings on an emergency basis as long as the patient is informed of the temporary nature of the fillings; and
 
(2) Removing excess cement from the supragingival surfaces of teeth.
 
C.  A dentist may delegate to an unlicensed person the following intraoral activities, which must be conducted under the direct supervision of the delegating dentist:
 
(1) Applying cavity varnish;
 
(2) Applying liquids, pastes and gel topical anesthetics;
 
(3) Assisting a dentist who provides orthodontic services in preparation of teeth for attaching, bonding and cementing fixed appliances in a manner appropriate and according to manufacturer's directions;
 
(4) Delivering, but not condensing or packing, amalgam or composite restoration material;
 
(5) Fabricating temporary crowns and bridges, limiting handpiece rotary instrumentation used in the fabrication to extraoral use only, as long as the dentist checks the occlusion and fit prior to releasing the patient;
 
(6) Irrigating and drying root canals;
 
(7) Isolating the operative field;
 
(8) Performing pulp vitality testing with confirmation by the dentist;
 
(9) Performing electronic vitality scanning with confirmation by the dentist;
 
(10) Performing preliminary selection and fitting of orthodontic bands, with final placement and cementing in the patient's mouth by the dentist;
 
(11) Placing and cementing temporary crowns with temporary cement;
 
(12) Placing and removing matrix bands, rubber dams and wedges;
 
(13) Placing elastics and instructing in their use;
 
(14) Placing, holding or removing celluloid and other plastic strips prior to or subsequent to the placement of a filling by the dentist;
 
(15) Placing or removing temporary separating devices;
 
(16) Placing wires, pins and elastic ligatures to tie in orthodontic arch wires that have been fitted and approved by the dentist at the time of insertion;
 
(17) Preparing tooth sites and surfaces with a rubber cup and pumice for banding or bonding of orthodontic brackets. This procedure may not be intended or interpreted as an oral prophylaxis, which is a procedure specifically reserved to be performed by dental hygienists or dentists. This procedure also may not be intended or interpreted as a preparation for restorative material. A dentist or dental hygienist shall check and approve the procedure;
 
(18) Reapplying, on an emergency basis only, orthodontic brackets;
 
(19) Recording readings with a digital caries detector and reporting them to the dentist for interpretation and evaluation;
 
(20) Removing composite material using slow-speed instrumentation for debonding brackets, as long as the dentist conducts a final check prior to release of the patient;
 
(21) Removing excess cement from the supragingival surfaces of teeth;
 
(22) Removing gingival retraction cord;
 
(23) Removing orthodontic arch wires and tension devices and any loose bands or bonds, but only as directed by the dentist;
 
(24) Selecting and trying in stainless steel or other preformed crowns for insertion by the dentist;
 
(25) Obtaining impressions for opposing models and retainers;
 
(26) Obtaining impressions for single-arch athletic mouth guards, bleaching trays, custom trays and fluoride trays; and
 
(27) Taking intraoral measurements and making preliminary selection of arch wires and intraoral and extraoral appliances, including head gear.
Sec. 9. 32 MRSA §18371, sub-§4, as amended by PL 2017, c. 288, Pt. A, §35, is further amended to read:
 
4. Delegation not authorized.   A dentist may not delegate any dental activity not listed in subsection 3 or 6 to an unlicensed person activities related to dental care or treatment that require a license under this chapter. A dentist may not delegate to a licensed person activities related to dental care or treatment that are outside the scope of practice of that licensed person.
Sec. 10. 32 MRSA §18373, sub-§1, as amended by PL 2017, c. 388, §17, is further amended to read:
 
1. Scope of practice; direct supervision.   An expanded function dental assistant may perform under the directgeneral supervision of a dentist all of the activities that may be delegated by a dentist to an unlicensed person pursuant to section 18371, subsection 3, paragraph C. An expanded function dental assistant may also perform the following activities authorized under the directgeneral supervision of a dentist:
 
A. Apply cavity liners and bases as long as the dentist:
 
(1) Has ordered the cavity liner or base; and
 
(2) Has checked the cavity liner or base prior to the placement of the restoration; and
 
(3) Has checked the final restoration prior to patient dismissal;
 
B. Apply pit and fissure sealants after an evaluation of the teeth by the dentist at the time of sealant placement;
 
C. Apply supragingival desensitizing agents to an exposed root surface or dentinal surface of teeth;
 
D. Apply topical fluorides recognized for the prevention of dental caries;
 
E.  Cement provisional or temporary crowns and bridges and remove excess cement;
 
F.  Perform pulp vitality tests;
 
G. Place and contour amalgam, composite and other restorative materials prior to the final setting or curing of the material;
 
I. Place and remove gingival retraction cord;
 
K. Size, place and cement or bond orthodontic bands and brackets with final inspection by the dentist;
 
L. Supragingival polishing. A dentist or a dental hygienist must first determine that the teeth to be polished are free of calculus or other extraneous material prior to polishing. Dentists may permit an expanded function dental assistant to use onlyusing a slow-speed rotary instrument and rubber cup. Dentists may allow an expanded function dental assistant to use high-speed, power-driven handpieces or instruments to contour or finish newly placed composite materials; and
 
M.  Obtain impressions for athletic mouth guards, provisional or temporary crowns and bridges.
 
HH.  Contour or finish restorative materials using a high-speed, power-driven handpiece or instrument.
Sec. 11. 32 MRSA §18373, sub-§2, as amended by PL 2017, c. 388, §17, is repealed.
Sec. 12. 32 MRSA §18374, as amended by PL 2017, c. 388, §§18 and 19, is further amended to read:
§ 18374.Dental hygienist
 
1. Scope of practice; direct supervision.   A dental hygienist and faculty dental hygienist may perform the following proceduresprocedure under the direct supervision of a dentist:
 
A. Administer local anesthesia or nitrous oxide analgesia, as long as the dental hygienist or faculty dental hygienist has authority to administer the relevant medication pursuant to section 18345, subsection 2, paragraph D or E;.
 
B.  Irrigate and dry root canals;
 
C.  Record readings with a digital caries detector and report them to the dentist for interpretation and evaluation;
 
D.  Remove socket dressings;
 
E.  Take cytological smears as requested by the dentist; and
 
F.  Obtain impressions for nightguards and occlusal splints.
 
2. Scope of practice; general supervision.   A dental hygienist and faculty dental hygienist may perform under the general supervision of a dentist all of the activities that may be delegated to an unlicensed person pursuant to section 18371, subsection 3, except the activities in section 18371, subsection 3, paragraph C, subparagraphs (6), (17) and (19). A dental hygienist and faculty dental hygienist may also perform the following procedures under the general supervision of a dentist:
 
A. Prescribe, dispense or administer anticavity toothpastes or topical gels with 1.1% or less sodium fluoride and oral rinses with 0.05%, 0.2%, 0.44% or 0.5% sodium fluoride, as well as chlorhexidine gluconate oral rinse;
 
C.  Apply desensitizing agents to teeth;
 
D.  Apply fluoride to control caries;
 
F. Apply sealants;
 
J. Expose and process radiographs;
 
O.  Interview patients and record complete medical and dental histories;
 
R.  Obtain bacterial sampling when treatment is planned by the dentist;
 
S. Perform all procedures necessary for a complete prophylaxis, including root planing;
 
U. Perform complete periodontal and dental restorative charting;
 
X. Perform oral inspections, recording all conditions that should be called to the attention of the dentist;
 
Y.  Perform postoperative irrigation of surgical sites;
 
CC.  Place and remove gingival retraction cord without vasoconstrictor;
 
GG. Place localized delivery of chemotherapeutic agents when treatment is planned by the dentist;
 
JJ. Place temporary restorations as an emergency procedure, as long as the patient is informed of the temporary nature of the restoration; and
 
LL.  Prepare tooth sites and surfaces with a rubber cup and pumice for banding or bonding of orthodontic brackets. This procedure may not be interpreted as a preparation for restorative material;
 
TT. Smooth and polish amalgam restorations; and.
 
VV.  Obtain impressions for study casts, athletic mouth guards, custom trays, bleaching trays, fluoride trays, opposing models, retainers and stents.
 
3. Limitation.   An individual with a faculty dental hygienist license may provide the services described in this section only as part of the education program for which the license was issued by the board.
Sec. 13. 32 MRSA §18377, sub-§1, as amended by PL 2019, c. 388, §10, is further amended to read:
 
1. Scope of practice.   A dental therapist may perform the following procedures in limited practice settings, if authorized by a written practice agreement with a dentist licensed in this State pursuant to subsection 3.
 
A. To the extent permitted in a written practice agreement, a dental therapist may provide the care and services listed in this paragraph only under the direct supervision of the supervising dentist:
 
(1) Perform oral health assessments, pulpal disease assessments for primary and young teeth, simple cavity preparations and restorations and simple extractions;
 
(2) Prepare and place stainless steel crowns and aesthetic anterior crowns for primary incisors and prepare, place and remove space maintainers;
 
(3) Provide referrals;
 
(4) Administer local anesthesia and nitrous oxide analgesia;
 
(5) Perform preventive services;
 
(6) Conduct urgent management of dental trauma, perform suturing, extract primary teeth and perform nonsurgical extractions of periodontally diseased permanent teeth if authorized in advance by the supervising dentist; and
 
(7) Provide, dispense and administer anti-inflammatories, nonprescription analgesics, antimicrobials, antibiotics and anticaries materials;.
 
(8) Administer radiographs; and
 
(9) Perform other related services and functions authorized by the supervising dentist and for which the dental therapist is trained.
 
B. To the extent permitted in a written practice agreement, a dental therapist may provide the care and services listed inidentified in section 18371, subsection 3 and section 18374, subsections 1 and 2 under the general supervision of the supervising dentist.
Sec. 14.  32 MRSA §18394  is enacted to read:
§ 18394. Teledentistry
An individual licensed under this chapter may provide oral health care services and procedures authorized under this chapter or by rule using teledentistry. The board shall adopt by rule guidelines and practice standards for the use of teledentistry, including, but not limited to, practice requirements for protecting patient rights and protocols for referrals, quality and safety, informed consent, patient evaluation, treatment parameters, patient records, prescribing, supervision and compliance with data exchange standards for the security and confidentiality of patient information. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.
Sec. 15. Board of Dental Practice to review dental practice laws and recommend changes. The Board of Dental Practice, in consultation with interested parties, shall review the Maine Revised Statutes, Title 32, chapter 143, any rules adopted by the board and the laws and rules in other states related to the scope of practice for licensed dental hygienists and dental therapists. The board shall recommend changes to the scope of practice for licensed dental hygienists and dental therapists for the purpose of aligning current practice settings and reflecting advancements in the profession and technology. The board shall submit its report and recommendations to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters no later than February 1, 2021. The joint standing committee may report out a bill to the First Regular Session of the 130th Legislature based on the board's recommendations.
 
SUMMARY
This bill implements the recommendations of the Board of Dental Practice that were included in the report required by Public Law 2019, chapter 388. The bill makes the following changes.
1. It makes changes to the definitions of "direct supervision" and "general supervision" and makes corresponding changes to the activities that may be performed under direct or general supervision by a person licensed by the Board of Dental Practice.
2. It makes changes to provisions governing the delegation authority of dentists to unlicensed persons and to persons licensed by the Board of Dental Practice.
3. It adds a definition of "teledentistry" and authorizes oral health care services and procedures to be provided through teledentistry in accordance with rules adopted by the Board of Dental Practice.
4. It directs the Board of Dental Practice to recommend changes to the scope of practice for dental hygienists and dental therapists for the purpose of aligning current practice settings and reflecting advancements in the profession and technology. The Board of Dental Practice is required to submit its recommendations to the joint standing committee of the Legislature having jurisdiction over health coverage, insurance and financial services matters no later than February 1, 2021. The joint standing committee may report out a bill to the First Regular Session of the 130th Legislature based on the board's recommendations.