TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF DENTISTRY

Proposed Regulation

Titles of Regulations: 18VAC60-21. Regulations Governing the Practice of Dentistry (adding 18VAC60-21-175).

18VAC60-30. Regulations Governing the Practice of Dental Assistants (adding 18VAC60-30-85).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

February 18, 2022 - 9 a.m. - Department of Health Professions, Perimeter Building, 9960 Mayland Drive, 2nd Floor, Board Room 4, Henrico, VA 23233

Public Comment Deadline: March 4, 2022.

Agency Contact: Sandra Reen, Executive Director, Board of Dentistry, 9960 Mayland Drive Suite 300, Richmond, VA 23233, telephone (804) 367-4437, FAX (804) 527-4428, or email sandra.reen@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Dentistry the authority to promulgate regulations to administer the regulatory system. Specific authority for regulation of the profession of dental assisting is found in § 54.1-2729.01 of the Code of Virginia.

Purpose: The purpose of the action is to address concerns about breaches in infection control techniques that endanger the health and safety of the public. In several other states, there have been egregious cases of infection with long-term consequences for patients who were exposed to pathogens during the course of dental treatment. While the board is not aware of such reports in Virginia, it did review several disciplinary cases within the past few years in which dentists were disciplined for a lack of infection control in sterilization of instruments and other risky practices. Since dental assistants I are not regulated by the board, the dentist is accountable for infection control practice, but often the dental assistant is responsible for infection control processes and procedures. The purpose of a regulatory action is to ensure some consistency in training and a level of competency that protects dental patients. The goal of the proposed action is to ensure dental assistants are properly trained in practices that mitigate the chances of infections in dental practices.

Substance: 18VAC60-30-85 requires that a dental assistant complete annual training in infection control standards as recommended by the Centers for Disease Control and Prevention (CDC) through the Occupational Safety and Health Administration (OSHA). A newly employed assistant must receive training within 60 days of hire.18VAC60-21-175 requires a dentist to be responsible for assuring that dental assistants complete annual training in infection control and that newly employed assistants receive training within 60 days of hire. Dentists are required to maintain documentation of training for three years.

Issues: The primary advantage to the public is a standardized expectation of training in infection control for patient safety throughout the Commonwealth, at all dental offices. There are no disadvantages for the public. Dentists are already expected to adhere to OSHA and CDC guidelines for infection control. There are no advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. As the result of a 2019 petition for rulemaking,¹ the Board of Dentistry (Board) is proposing to add an infection control training requirement for Dental Assistant Is and Dental Assistant IIs to the regulation.

Background. According to the Department of Health Professions (DHP), it is expected that dental assistants follow common sense infection control practices. Currently, a guidance document² lists "Follow the applicable CDC infection control guidelines and recommendations" under Practitioner Responsibility, but the regulation is silent about any required training that dental assistants must complete in infection control. The Board proposes to require dental assistants to complete annual training in infection control standards and also require dentists to assure that that the training is completed.

Estimated Benefits and Costs. DHP believes that training of dental assistants in infection control is already occurring in most dental offices. However, DHP is aware of four or five cases where infection control standards were not followed. The details of the proposed annual training are not specified in the proposed text, only that it be "required by the Occupational Safety and Health Administration and as recommended by the Centers for Disease Control" (CDC). DHP states that free online training videos are available from CDC on infection control which would satisfy the proposed training requirement.

Since most dental offices likely train dental assistants on common sense infection control measures already, the main benefit of the proposed action is to emphasize and clarify that dental assistants complete annual training. As a result, the proposed changes would also be beneficial to the extent they reduce infections in dental practices.

Businesses and Other Entities Affected. The proposed regulation applies to 7,516 dentists, hundreds of dental assistant Is,³ and 40 dental assistant IIs. No adverse economic impact⁴ on dentists or dental assistants is expected, as they are already supposed to follow common sense infection control measures.

Small Businesses⁵ Affected. The proposed amendments do not appear to adversely affect small businesses.

Localities⁶ Affected.⁷ The proposed amendments do not introduce costs for local governments or particularly affect any locality.

Projected Impact on Employment. The proposed amendments do not affect total employment.

Effects on the Use and Value of Private Property. No impact of the use and value of private property or real estate development costs is expected.

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¹ https://townhall.virginia.gov/L/viewpetition.cfm?petitionid=313

²https://townhall.virginia.gov/L/GetFile.cfm?File=C:\TownHall\docroot\GuidanceDocs\223\GDoc_DHP_4171_v9.pdf

³Dental Assistant Is are not directly regulated by the Board. Therefore, DHP lacks an exact count.

⁴Adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined.

⁵Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁶"Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁷§ 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The Board of Dentistry concurs with the economic impact analysis of the Department of Planning and Budget.

Summary:

In response to a petition for rulemaking, the proposed amendments require (i) a dental assistant to complete annual training in infection control standards as recommended by the Centers for Disease Control and Prevention through the Occupational Safety and Health Administration; (ii) newly employed assistants receive training within 60 days of hire; and (iii) dentists ensure that such training take place and maintain documentation of training for three years.

18VAC60-21-175. Training in infection control.

A. A dentist shall be responsible for assuring that dental assistants complete annual training in infection control standards required by the Occupational Safety and Health Administration and as recommended by the Centers for Disease Control and Prevention. Newly employed dental assistants shall receive training as soon as possible but no later than 60 days from employment.

B. Documentation records shall show the dates of completion of initial and annual training, including the date of employment for new dental assistants. All documentation of training in infection control shall be maintained by the dentist for three years.

Part II

Practice of Dental Assistants II

18VAC60-30-85. Training in infection control.

Dental assistants shall complete annual training in infection control standards required by the Occupational Safety and Health Administration and as recommended by the Centers for Disease Control and Prevention. Newly employed dental assistants shall complete training as soon as possible but no later than 60 days from employment.