Title of Regulation: 18VAC60-20. Regulations Governing Dental Practice (amending 18VAC60-20-61).

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

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: November 7, 2012.

Effective Date: November 22, 2012.

Agency Contact: Sandra Reen, Executive Director, Board of Dentistry, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4538, FAX (804) 527-4428, or email sandra.reen@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides the Board of Dentistry the authority to promulgate regulations to administer the regulatory system.

Purpose: The purpose of the amended regulation is to ensure that dental assistants II, after completion of required education and training, will be able to perform procedures on patients that were previously nondelegable and only performed by a dentist. Pulp capping is a necessary part of amalgam or composite resin restoration, so if a dental assistant II is authorized to perform those tasks, it is essential for the health and safety of dental patients that he is properly trained in a laboratory and in clinical practice.

Rationale for Using Fast-Track Process: This regulatory action is necessary for the fast-track process to ensure clarity in the education and training of a dental assistant II. In the development of regulations, pulp capping was not initially listed in 18VAC60-20-230 as a duty delegable to a dental assistant II, so it was not considered in the formulation of regulations for the education and training of a dental assistant II. In the adoption of proposed regulations, it was stricken from the list of duties that a dentist cannot delegate and added to the list that could be delegated to a dental assistant II. Training in pulp capping procedures should have been added to 18VAC60-20-61 but was inadvertently omitted.

In September of 2010, the board recognized the omission and authorized the promulgation of a fast-track action as soon as the regulations for dental assistant IIs were effective. There are no additional hours of training required, and it is generally acknowledged that appropriate training in amalgam and composite resin restoration should be inclusive of pulp capping procedures. Therefore, the board has determined that the promulgation of this amendment is appropriate as a fast-track action.

Substance: The amendments to 18VAC60-20-61 will include pulp capping procedures in the 40 hours of training in placing, packing, carving, and polishing amalgam restorations and in the 60 hours of training in placing and shaping composite resin restorations.

Issues: The primary advantage to the public is assurance of some training and clinical experience in pulp capping by a dental assistant II, which if done improperly, could result in patient harm. There are no disadvantages to the public.

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. Rules on registration of dental assistants II (DAII) were added to these regulations and became effective on March 2, 2011. In these rules pulp capping procedures are among the duties that a dentist may delegate to a DAII. However, training in pulp capping as part of training in amalgam or composite resin restorations was inadvertently omitted in the educational requirements for DAII's set forth in the regulations. The Board of Dentistry (Board) therefore proposes to include the topic of pulp capping in 18VAC60-20-61 without adding to the number of hours of training required for each area of practice.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. In the initial development of regulations for DAII, pulp capping was not initially listed as a duty delegable to a DAII, so it was not considered in the formulation of regulations for education and training of DAIIs. In the adoption of proposed regulations, it was stricken from the list of duties that a dentist cannot delegate and added to the list that could be delegated to a DAII. According to the Department of Health Professions, training in pulp capping procedures should have been added to the list of educational requirements but was inadvertently omitted.

In September of 2010, the Board recognized the omission and authorized the promulgation of a fast-track action as soon as the regulations for DAIIs were effective. There are no additional hours of training required, and it is generally acknowledged that appropriate training in amalgam and composite resin restoration should be inclusive of pulp capping procedures. There should not be a significant increase in cost since under the proposed amendment the number of hours of required training does not change. The proposed amendment is beneficial in that it provides assurance that DAIIs are trained to perform a procedure which dentists may delegate to them under these regulations.

Businesses and Entities Affected. The proposed amendments potentially affect those seeking to meet educational and training requirements for registration as a DAII. Since the registration of DAIIs only became effective March 2, 2011, there is no one currently registered and the Board does not know how many students are working towards registration. There are currently three educational programs planned for DAII; those programs will need to ensure training in pulp capping as part of training in restorations. There are currently 6,392 licensed dentists in the Commonwealth. The proposed amendment potentially affects dentists who delegate tasks to DAIIs.

Localities Particularly Affected. The proposed amendments do not disproportionately affect particular localities.

Projected Impact on Employment. The proposal amendments are unlikely to significantly affect employment.

Effects on the Use and Value of Private Property. The proposed amendments are unlikely to significantly affect the value of private property, but may moderately increase the likelihood that dentists assign pulp capping tasks to DAIIs.

Small Businesses: Costs and Other Effects. The proposed amendments are unlikely to significantly affect costs for small businesses.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed amendments do not adversely affect small businesses.

Real Estate Development Costs. The proposed amendments are unlikely to significantly affect real estate development costs.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Dentistry concurs with the analysis of the Department of Planning and Budget for the proposed regulation, 18VAC60-20, Regulations Governing the Practice of Dentistry and Dental Hygiene, relating to inclusion of training in pulp capping for dental assistants II.

Summary:

According to regulations for registration of dental assistants II, which became effective March 2, 2011, pulp capping procedures are among the duties that a dentist may delegate to a dental assistant II. However, training in pulp capping as part of training in amalgam or composite resin restorations was inadvertently omitted in the educational requirements for dental assistants II set forth in 18VAC60-20-61 of the regulation. The amendments include the topic of pulp capping in 18VAC60-20-61 without adding to the number of hours of training required for each area of practice.

18VAC60-20-61. Educational requirements for dental assistants II.

A. A prerequisite for entry into an educational program preparing a person for registration as a dental assistant II shall be current certification as a Certified Dental Assistant (CDA) conferred by the Dental Assisting National Board.

B. To be registered as a dental assistant II, a person shall complete the following requirements from an educational program accredited by the Commission on Dental Accreditation of the American Dental Association:

1. At least 50 hours of didactic course work in dental anatomy and operative dentistry that may be completed on-line.

2. Laboratory training that may be completed in the following modules with no more than 20% of the specified instruction to be completed as homework in a dental office:

a. At least 40 hours of placing, packing, carving, and polishing of amalgam restorations and pulp capping procedures;

b. At least 60 hours of placing and shaping composite resin restorations and pulp capping procedures;

c. At least 20 hours of taking final impressions and use of a non-epinephrine retraction cord; and

d. At least 30 hours of final cementation of crowns and bridges after adjustment and fitting by the dentist.

3. Clinical experience applying the techniques learned in the preclinical coursework and laboratory training that may be completed in a dental office in the following modules:

a. At least 80 hours of placing, packing, carving, and polishing of amalgam restorations;

b. At least 120 hours of placing and shaping composite resin restorations;

c. At least 40 hours of taking final impressions and use of a non-epinephrine retraction cord; and

d. At least 60 hours of final cementation of crowns and bridges after adjustment and fitting by the dentist.

4. Successful completion of the following competency examinations given by the accredited educational programs:

a. A written examination at the conclusion of the 50 hours of didactic coursework;

b. A practical examination at the conclusion of each module of laboratory training; and

c. A comprehensive written examination at the conclusion of all required coursework, training, and experience for each of the corresponding modules.

C. All treatment of patients shall be under the direct and immediate supervision of a licensed dentist who is responsible for the performance of duties by the student. The dentist shall attest to successful completion of the clinical competencies and restorative experiences.