This interactive California Dentist Ebook contains 25 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.
CALIFORNIA Dentist Continuing Education
Elite Learning
Inside: California Dental Practice Act, 6th Edition Infection Control Standards for California Dental Health Care Workers, 6th Edition
25-hour Continuing Education Package $150.00
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WHAT’S INSIDE
Course 1: California Dental Practice Act, 6th Edition (Mandatory)
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[2 CE Hours] The California Dental Practice Act is the set of regulations that governs dentists, dental hygienists, and dental assistants. This course provides an overview of these governmental entities and outlines the content of the Dental Practice Act, its attending regulations, and other statutes relating to dental practice. The content of this basic-level course was derived primarily from the State of California Department of Consumer Affairs Dental Practice Act, California Code of Regulations, and California Dental Association Code of Ethics. With a more complete understanding of this Dental Practice Act, all dental team members will be better able to practice within its guidelines. THIS COURSE FULFILLS THE REQUIREMENT FOR THE CA DENTAL PRACTICE ACT AND IT’S REGULATIONS Course 2: Infection Control Standards for California Dental Health Care Workers, 6th Edition (Mandatory)
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[2 CE Hours] This course is designed to familiarize dental healthcare personnel with the requirements for infection control in dental offices in the State of California related to the Dental Board of California’s Minimum Standards for Infection Control (Cal. Code Regs., Title 16, Section 1005) as revised effective August 20, 2011. This basic-level course addresses terminology, reasons for infection control, minimum required standards, and procedures for preventing disease transmission in dental healthcare settings. Additional regulations and recommendations pertaining to worker safety, transmission-based precautions, and emerging infectious diseases should be considered in a dental practice comprehensive infection control program. State regulations are reviewed regularly to ensure that they reflect the current state of knowledge and to assure optimum levels of safety for both healthcare personnel and patients. California dental healthcare personnel (DHCP) should check the Dental Board of California website regularly for any changes or updates to these regulations. A thorough working knowledge of these regulations provides patient and DHCP safety, and assurance that the dental office is in compliance with the most current state dental board mandates. It should be noted that, with the arrival of the SARS-CoV-2 (COVID-19) pandemic, infection control has expanded to the outer office, with the advent of initial patient screening and patient masking. In the operatory, use of N95 masks and face shields became more of a standard practice (Kane, 2021). As has always been the case, it is important to follow guidelines, prescribed practices, and legal requirements. THIS COURSE FULFILLS THE REQUIREMENT FOR INFECTION CONTROL SPECIFIC TO CA REGULATIONS Course 3: Chronic Pain Management for the Dental Practitioner: A Psychosocial Perspective 33 [5 CE Hours] This intermediate-level course is intended to address this training deficit by providing dental healthcare professionals with an overview of the nature and scope of chronic pain, as well as basic skills for effective assessment and adjunctive treatments of chronic orofacial pain conditions and related problems. To accomplish these goals, the course first examines the basic physiological principles that underlie pain, describes the distinction between acute and chronic pain, and explains the factors that contribute to acute pain becoming chronic. The prevalence and impact of chronic pain on physical functioning, health, and quality of life are examined. An introduction to the practical assessment of chronic pain provides readers with a description of selected assessment tools and interview procedures. Dental practitioners may be familiar with the diagnosis and treatment of pain in a specific context, for example, temporomandibular disorders. However, the emphasis of this course lies in assessing other causes of chronic orofacial pain and in discussing their corresponding pharmacological and biobehavioral treatment modalities. The course provides an overview of common medications used to treat chronic orofacial pain and discusses issues surrounding addiction and adherence to a prescribed medication regimen. The course also provides basic information on empirically supported psychosocial treatment strategies that can be useful when working with patients who are experiencing chronic pain. This course is designed for dental health professionals who wish to further their knowledge in orofacial pain conditions. After taking the course, the participant will be able to assess the patient with chronic orofacial pain, identify comorbid disorders, and recommend appropriate treatment or referral options. Course 4: Dental Ethics and the Digital Age, 2nd Edition 61 [3 CE Hours] This course will help dental professionals gain a better understanding of dental ethics, professionalism, and current ethical challenges, with a particular emphasis on the impact of the digital age. A section of this course will address the ways that the law and ethics intersect. Through a systematic, case-based approach, this course will provide dentists, dental hygienists, and dental assistants with the tools to recognize and navigate the complex ethical issues that may arise in practice.
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DENTAL CONTINUING EDUCATION
Course 5: Herbal-Drug Interactions Important in Dentistry, 3rd Edition
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[2 CE Hours] After completing this basic-level course, the learner will be able to discuss the most commonly used herbal medicines in the United States. A stoplight approach to risk assessment is discussed and a general strategy to avoid the most common herbal-drug interactions is suggested. Critical patient populations are emphasized and specific herbal-drug interactions that can lead to increased bleeding, decreased blood glucose levels, and sedation changes are discussed. This course is specifically designed for all members of the dental healthcare team: dentists, dental hygienists, and dental assistants. Course 6: Maintaining Dental Implants, 2nd Edition 104 [1 CE Hour] The use of dental implants has been an important treatment in restorative dentistry since the establishment of outcome predictability and recognition of long-term dental implant and restoration success. Additionally, the evolution of this treatment modality has resulted in widespread interest in restorative implant options among both patients and practitioners (Rosen, 2020). The increasing number of patients selecting dental implants as a treatment option presents the dental team with the challenge of maintaining these implant-supported restorations. This basic-level course, appropriate for dentists, dental hygienists, and dental assistants, provides a general overview of the basic types of dental implants and the oral hygiene for dental implants, including the identification of similarities and differences in the periodontal structure surrounding a natural tooth versus that surrounding a dental implant. The course discusses the clinical procedures used to evaluate the status of dental implants as healthy, ailing, or failing and the methods employed in professionally cleaning implants and improving home care techniques. Course 7: Medicinal Marijuana, 2nd Edition 110 [5 CE Hours] Designed for dentists, dental hygienists, and dental assistants, this intermediate-level course will review the pharmacology and current state of medicinal marijuana as it relates to oral health care. The information presented in this course should be considered essential knowledge for all OHCPs, both seasoned and newly credentialed. Course 8: Oral Health Issues for the Female Patient, 3rd Edition 133 [2 CE Hours] This course explores the variables affecting women’s oral health and discusses the issues and concerns that dental professionals face in providing care to females across their life span. Course 9: Radiation: A Review of Radiographic and Processing Techniques for Dental X-Rays, 3rd Edition 145 [1 CE Hour] This course reviews intraoral and extraoral film, projections, digital receptor types, and the use of intensifying screens. In addition, the course describes multiple radiographic techniques and challenges, including common radiographic mistakes, working with patients with a severe gag reflex, dimple-down techniques, and focal lengths, and reviews processing techniques, safelights, white-light leakage, film baths, and temperature. The course also addresses the importance of standardized, consistent film mounting for accurate interpretation of patient x-rays. The dental office may find this information helpful in training new staff members as well as training or retraining seasoned personnel; dental professionals can also review the material to enhance diagnostic accuracy and reduce patient exposure to radiation. Course 10: Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod III: Anesthetics, 3rd Edition 152 [2 CE Hours] Upon completing this intermediate-level course, the learner will be able to discuss the differences among local anesthetics typically administered by oral healthcare professionals. The course will also fill gaps in knowledge concerning the selection, timing, and dosage of appropriate anesthetics for certain special populations requiring advanced consideration. The principles learned will be directly applicable to the appropriate selection of local anesthetics for the cardiac, pregnant, and breast-feeding patient, as well as to the recognition and best and safest treatment of patients with a significant allergic history. Final Examination Answer Sheet 170
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. ii DENTAL CONTINUING EDUCATION
FREQUENTLY ASKED QUESTIONS
What are the requirements for license renewal? License Expires CE Hours Required
Mandatory Subjects
2 hours of California Infection Control 2 hours of California Dental Practice Act 2 hours - Responsibilities and Requirements of Prescribing Schedule II Opioids 4 hours of Basic Life Support (must be live; online courses do not satisfy this requirement)
50 No more than 25 hours are allowed through home-study. You cannot receive credit for more than 8 hours per day.
Licenses expire every two years on the last day of licensee’s birth month
How much will it cost?
COURSE TITLE
HOURS PRICE COURSE CODE
Course 1:
California Dental Practice Act, 6th Edition (Mandatory)
2
$19.95 DCA02DP
Infection Control Standards for California Dental Health Care Workers, 6th Edition (Mandatory) Chronic Pain Management for the Dental Practitioner: A Psychosocial Perspective
Course 2:
2
$19.95 DCA02IC23
Course 3:
5
$49.95 DCA05CP
Course 4:
Dental Ethics and the Digital Age, 2nd Edition
3
$29.95 DCA03DE
Course 5:
Herbal-Drug Interactions Important in Dentistry, 3rd Edition
2
$19.95 DCA02HD
Course 6:
Maintaining Dental Implants, 2nd Edition
1
$8.95 DCA01MD
Course 7:
Medicinal Marijuana, 2nd Edition
5
$48.95 DCA05MM
Course 8:
Oral Health Issues for the Female Patient, 3rd Edition
2
$19.95 DCA02OH
Radiation: A Review of Radiographic and Processing Techniques for Dental X-Rays, 3rd Edition Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod III: Anesthetics, 3rd Edition
Course 9:
1
$9.95 DCA01RA
Course 10:
2
$19.95 DCA02DR
Best Value - Save $97.50 - All 25 Hours
25 $150.00
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you an California board-approved provider?
Colibri Healthcare, LLC is designated as a Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. Current approval period is 1/1/2022 to 12/31/2025; Provider ID# 217536. Colibri Healthcare, LLC is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. California Dental Board Provider #RP6030. In accordance with California Code of Regulations (Title 16, Section 1016), a maximum of 8 credit hours may be awarded to you in one day. When completing multiple courses, please submit completed exams for grading as you complete each course, not to exceed more than 8 CE hours in any given day. Are my credit hours reported to the California board? No, the Dental Board of California requires licensees to certify at the time of renewal that he/she has complied with the continuing education requirement. The board performs audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Dental you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 866-344-0972, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Licensing board contact information:
The Dental Board of California I Department of Consumer Affairs I 2005 Evergreen Street, Suite 1550 Sacramento, CA 95815 I Phone (916)-263-2300 I Fax (916) 263-2140 I Website: https://www.dbc.ca.gov/
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DENTAL CONTINUING EDUCATION
Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must provide your customer information and complete the evaluation. We offer three ways for you to complete. Choose an option below to receive credit and your certificates of completion. How to complete continuing education
Fastest way to receive your certificate of completion
Online • Go to EliteLearning.com/Book . Locate the course code found at the bottom of each course final exam page or in the table below and enter it in the example box then click GO . You will need to submit each course individually. Remember you can only complete 8-hours per day . • If you already have an account created, sign in to your account with your username and password. If you do not have an account already created, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey.
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Enter book code
Example: ANCCFL2422
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If you need help finding your code, Browse Book Code FAQs
Your profession
Course Name
Course Code
California Dental Practice Act, 6th Edition (Mandatory)
DCA02DP
Infection Control Standards for California Dental Health Care Workers, 6th Edition (Mandatory)
DCA02IC23
Chronic Pain Management for the Dental Practitioner: A Psychosocial Perspective
DCA05CP
Dental Ethics and the Digital Age, 2nd Edition
DCA03DE
Herbal-Drug Interactions Important in Dentistry, 3rd Edition
DCA02HD
Maintaining Dental Implants, 2nd Edition
DCA01MD
Medicinal Marijuana, 2nd Edition
DCA05MM
Oral Health Issues for the Female Patient, 3rd Edition
DCA02OH
Radiation: A Review of Radiographic and Processing Techniques for Dental X-Rays, 3rd Edition
DCA01RA
Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod III: Anesthetics, 3rd Edition
DCA02DR
By mail • Fill out the answer sheet and evaluation found in the back of this booklet. Please include a check or credit card information and e-mail address. Mail to Elite, PO Box 37, Ormond Beach, FL 32175 . • Completions will be processed within 2 business days from the date it is received and certificates will be e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
By fax • Fill out the answer sheet and evaluation found in the back of this booklet. Please include credit card information and e-mail address. Fax to (386) 673-3563 . • All completions will be processed within 2 business days of receipt and certificates e-mailed to the address provided. • Submissions without a valid e-mail will be mailed to the address provided.
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DENTAL CONTINUING EDUCATION
Course 1: California Dental Practice Act, 6th Edition (Mandatory) 2 CE Hours
Release Date: September 1, 2021
Expiration Date: September 1, 2024
Faculty Author:
annual conventions of the American Dental Association, California Dental Association, and American Association of Oral and Maxillofacial Surgeons for more than 15 years. He is an associate of the American Board of Trial Advocates. Mr. Curley has published several articles on risk management and authored chapters in five dental textbooks. Arthur W. Curley has disclosed that he has no significant financial or other conflicts of interest pertaining to this course book Dental planner : Karen D. Hallisey, DMD The planner has disclosed that she has no significant financial or other conflicts of interest pertaining to this course book.
Arthur W. Curley, JD , is the president and a managing partner in the San Francisco-based healthcare defense firm of Bradley, Curley, Asiano, Barrabee, Abel, & Kowalski, P.C. After graduating with honors from the University of California, Berkeley, in 1970, he obtained his JD in 1974 from the University of California, Hastings School of Law, in San Francisco. He is currently an assistant professor of dental jurisprudence at the Arthur A. Dugoni School of Dentistry in San Francisco and an adjunct professor at the University of California, San Francisco. As a trial attorney, Arthur Curley has been defending medical professionals for more than four decades and has presented risk management courses throughout the United States and Canada. He has presented the dental practice course at the Course offering requirements This course meets the Dental Board of California’s requirements for 2 units of continuing education. How to receive credit ● Read the entire course online or in print. ● Depending on your state requirements you will be asked to complete: ○ A mandatory test (a passing score of 75 percent is required). Test questions link content to learning Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative Disclosures Resolution of conflict of interest
AGD Subject Code - 563
objectives as a method to enhance individualized learning and material retention. ● Provide required personal information and payment information. ● Complete the mandatory Course Evaluation. ● Print your Certificate of Completion. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
to diagnostic and treatment options of a specific patient’s medical condition.
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. INTRODUCTION Learning objectives
After completing this course, the learner will be able to: List the agencies regulating dental practice in California. Describe the scope of practice and initial licensing requirements of dentists and dental auxiliaries in California. Describe the requirements for licensing renewal of dental professionals in California. Outline the prescription privileges of dental professionals in California. Course overview The profession of dentistry in California is regulated by the California Department of Consumer Affairs, the Dental Board of California, and the Dental Hygiene Board of California. The Dental Practice Act (part of the California Business and
Describe the citations, fines, revocations, and suspensions that may be imposed on dental professionals. Describe malpractice claims arising from violations of laws and codes of ethics. Identify the regulations on dental advertising. Describe dental professionals’ mandatory reporter obligations and their role in identifying abuse. Explain the poster requirements for California dental practices. Professions Code) is the set of regulations that governs dentists, dental hygienists, and dental assistants. The Dental Board of California, the Dental Hygiene Board of California, and the California Department of Consumer Affairs have the power to
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amend or revoke these laws as needed, subject to approval by the California Legislature. This course provides an overview of these governmental entities and outlines the content of the Dental Practice Act, its attending regulations, and other statutes relating to dental practice. The content of this basic-level course was derived primarily from the State of California Department of Consumer Affairs Dental California Dental Practice Act The California Dental Practice Act consists of the basic body of laws governing dentistry found in the California Business and Professions Code (B&P): Division 2, Chapter 4 (beginning with Section 1600), and the California Code of Regulations (CCR): Title 16, Division 10 (beginning with Section 1000). California law requires every dental professional to have a grasp of this basic body of law and related portions of other selected California statutes. California Department of Consumer Affairs The California Department of Consumer Affairs includes 39 regulatory entities that protect public health and safety through licensing and oversight of various professions. These boards and bureaus establish minimum qualifications and levels of competency for licensure in more than 280 business and professional categories, including all health professions (Department of Consumer Affairs, S. of C., 2021). The Dental Board of California is one such board falling within the purview of the California Department of Consumer Affairs, which provides a variety of key administrative services to these semi- autonomous boards. Dental Board of California The Dental Board of California (the Board) is part of the California Department of Consumer Affairs. The stated mission of the Board is to “protect and promote the health and safety of consumers in the State of California” (Dental Board of California, 2021g). The Board licenses qualified dental healthcare professionals, takes actions to enforce compliance with the Dental Practice Act and other laws of the State of California, and strives to enhance the education of consumers and licensees. The Board regulates licensed dentists, registered dental assistants (RDAs), and registered dental assistants in extended functions (RDAEFs). It also delineates each group’s scope of practice, including any required levels of supervision or any restrictions on the settings in which they may work. Other areas of the Board’s concern include licensing, examinations, and continuing education (CE) requirements. The Board also sets fees for dentists and for all dental auxiliaries, including fees in connection with initial licensure and license renewal, permits and permit renewals, and examinations. These regulations are set forth for dentists and dental auxiliaries in the CCR (Sections 1021 and 1022, respectively). Section 1601.2 of the California Dental Practice Act states that “protection of the public shall be the highest priority for the Dental Board of California in exercising its licensing, regulatory, and disciplinary functions. Whenever the protection of the public is inconsistent with other interests sought to be promoted, the protection of the public shall be paramount” (California Dental Practice Act, 2003). According to its vision statement, the Board strives to “be the leader in public protection, promotion of oral health, and access to care” (Dental Board of California, 2021g). The Board consists of 15 members: ● Eight practicing dentists. ● One registered dental hygienist (RDH). ● One RDA. ● Five members of the public. (California Dental Practice Act, 2020a)
Practice Act, California Code of Regulations, California Dental Association Code of Ethics, and American Dental Association Principles of Ethics and Code of Professional Conduct. With a more complete understanding of the California Dental Practice Act, dentists, dental hygienists, and dental assistants will be better able to practice within its guidelines.
CALIFORNIA LAWS AND AGENCIES
Throughout this course, regulations of the California Dental Practice Act will be identified or cited by their section number in either the B&P or the CCR, but will be referred to collectively as the Dental Practice Act . Appendix A outlines the pertinent contents of each of these laws by section. Relevant sections of the B&P can be read in their entirety at https://www.dbc.ca.gov/ lawsregs/laws.shtml; relevant sections of the CCR can be read in their entirety at https://www.dir.ca.gov/dlse/CCR.htm. Board members collectively are the leaders of these licensing agencies, and make important decisions on agency policies and disciplinary actions against professionals who violate state consumer protection laws. Board members approve regulations and help guide licensing, enforcement, public education, and consumer protection activities. Some board members are licensed professionals, whereas others are public members. The governor appoints many board members, but the legislature makes appointments as well. State law requires board members within the California Department of Consumer Affairs to complete orientation and training in several important areas, including ethics, conflict of interest laws, and sexual harassment prevention. To ensure that all Board functions are conducted with optimum efficiency, selecting qualified Board members is essential. The governor, Senate Committee on Rules, and speaker of the assembly appoint public members. Because experience is a critical component in the decision-making process, all members of the Board, except public members, must have at least five years of clinical practice in the State of California, preceding the date of their appointments. No more than one member may be on the faculty of any dental college or department, and no members may have financial interests in any dental academic institution. Members are appointed for a four-year term, and no member can remain on the Board for more than 2 terms (California Dental Practice Act, 2020b). Of the eight practicing dentists on the Board, one must be a member of a California dental college, and one must be practicing in a nonprofit community clinic (California Dental Practice Act, 2020a). The Board may inspect the books, records, and premises of any licensed dentist, as well as the licensing documents, records, and premises of any dental assistant in response to a complaint that either entity has violated a law or regulation constituting grounds for disciplinary action. The Board may employ inspectors for this purpose (California Dental Practice Act, 2019a). To assist California licensed dentists, RDAs, and RDAEFs whose ability to practice dentistry has been impaired by alcohol or drug abuse, the Board has established a diversion program that provides access to appropriate intervention and treatment programs. The diversion program offers these practitioners a means to recover from substance abuse without the added hardship of losing their professional license. The dual purpose of the program is to protect the public and rehabilitate the licensee. The program also provides a voluntary alternative approach to traditional disciplinary actions. Participants must meet the diversion program’s eligibility requirements and agree to comply with the terms of the program. Involvement in the program is kept confidential. Upon successfully completing treatment, the licensee may return to practice, and all records
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pertaining to the licensee’s participation in the diversion program are purged and destroyed (California Dental Practice Act, 2016b). All licensees must register with the Board. According to the California Dental Practice Act, Section 1650.1, all applicants Dental Hygiene Board of California Whereas the Board regulates licensed dentists, RDAs, and RDAEFs, the Dental Hygiene Board of California (formerly the Dental Hygiene Committee of California) now oversees all functions and requirements of all categories of RDHs (California Dental Practice Act, 2019c). The Dental Hygiene Board of California consists of nine members, seven of whom are appointed by the governor: two public members, one licensed practicing general or public health dentist, and four RDHs. Of the four RDHs, one must be licensed either in alternative practice or in extended functions and one must be a dental hygiene educator. The Senate Committee on Rules appoints one public member, and the Speaker of the Assembly appoints another public member. Members serve for no more than two consecutive four-year terms, and the governor has the power to remove any member for neglect of The Dental Practice Act defines the practice of dentistry and permits dentists licensed in California to engage in the diagnosis or treatment, by surgery or other method, of diseases and lesions and the correction of malpositions of the human teeth, alveolar process, gums, jaws, or associated structures; and such diagnosis or treatment may include all necessary related procedures as well as the use of drugs, anesthetic agents, and physical evaluation (California Dental Practice Act, 2020c). Concerning oral and maxillofacial surgery, please see Section 1638 of the Dental Practice Act, which discusses the treatment of the “functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.” Initial licensure In California there are three basic pathways to licensure for dentists, including licensure by examination, licensure by credential, and licensure by residency (Dental Board of California, 2021d). One pathway is to apply following successful completion of the Western Regional Examining Board (WREB) examination, and another is to successfully complete the American Board of Dental Examiners (ADEX) examination. Applicants must provide satisfactory evidence of having passed the California Restorative Technique (RT) examination. If licensed in another state or country, the applicant must submit a completed Out of State/Country Licensure Certification form. Applicants must also provide fingerprints, submit to a criminal background check, and successfully complete the Law and Ethics examination (Dental Board of California, 2021d). Applicants enrolled in a Board-approved dental school may apply for licensure by portfolio. (See https://dbc.ca.gov/ applicants/licensure_by_portfolio.shtml (Dental Board of California, 2021d. Applicants must have (a) graduated from a Board-approved dental school in good academic standing and with no pending ethical issues, (b) have passed Parts I and II of the National Board Written Examinations, (c) submit a completed portfolio to the Board within 90 days of graduation, and (d) successfully complete the Law and Ethics examination. Dentists with a current valid license in another state may pursue licensure by credential. (See https://dbc.ca.gov/applicants/ licensure_by_credential.shtml.) Section 1635.5 of the Dental Practice Act requires the applicant to show that he or she has either been in active clinical practice or has been a full-time faculty member in an accredited dental education program, and Dentists Scope of practice
and licensees who have electronic mail addresses must report the address to the Board, which will send a notice annually to confirm that the address is still current (California Dental Practice Act, 2016a).
duty, incompetence, or unprofessional or dishonorable conduct (California Dental Practice Act, 2020h). The responsibilities of the Dental Hygiene Board include determining the scope of practice for all dental hygienists; issuing, reviewing, and revoking licenses; and developing and administering examinations. Additional functions include adopting regulations and determining fees and CE requirements for all hygiene licensure categories. Section 1966 mandates that the Dental Hygiene Board establish a diversion program for licensees whose competency may be impaired due to drug or alcohol abuse, as well as one or more diversion evaluation committees to further the goals of the diversion program (California Dental Practice Act, 2020L).
SCOPE OF PRACTICE AND INITIAL LICENSURE
in active clinical practice for a total of at least 5,000 hours in five of the seven consecutive years immediately preceding the date of his or her application. With two years of clinical practice or completion of an accredited residency training program, the remainder of the five-year requirement may be fulfilled with a contract to teach or to practice in certain specified settings. The applicant must submit a letter from WREB to the effect that he or she has not failed the WREB examination within the past five years. The applicant also must not have failed the ADEX examination after November 15, 2019. The applicant must have completed 50 units of continuing education in the past two years, including current mandatory courses (Dental Board of California, 2021d). In 2008, in response to a shortage of dentists (Pourat & Nicholson, 2009), the Board implemented a program allowing licensure by residency . Under this program, individuals are allowed to qualify for dental licensure based on proof of (a) graduation from a CODA-approved or Board- approved dental school, (b) the completion of a minimum of 12 months of a general practice residency or advanced education in a CODA-approved general dentistry program, (c) not having failed the WREB examination within the past five years, (d) not having failed the ADEX examination after November 15, 2019, (e) successful completion of the California Law and Ethics examination, and (f) fulfilling the requisite fingerprinting requirements. (See https://dbc.ca.gov/applicants/licensure_by_ residency.shtml) (Dental Board of California, 2021d). In 2008, California had 233 dental professional shortage areas (Pourat & Nicholson, 2009). Today, geographic areas throughout California continue to experience shortages of dental health providers (State of California, 2021). This situation is likely to persist because the percentage of dentists who may be nearing retirement age is greater than the percentage of dentists who are newly licensed. According to a report from the UCLA Center for Health Policy Research, the dentist shortage in California is further exacerbated by the growing percentage of newly licensed dentists who are opting to reside or work out of state (Pourat & Choi, 2014). The Board regulates more than 100,000 licensees, including dentists, RDAs, and RDAEFs (Dental Board of California, 2021c). The U.S. Census Bureau has estimated that, as of July 1, 2019, 39,512,223 individuals resided in the State of California (U.S. Census Bureau, n.d.). The California Dental Association and the Board continue to seek cooperative dialogue with the dental schools and with one another to implement changes that will advance the oral health
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of all Californians, help eliminate barriers to care, and enable dentists to better serve their patients and the public (California Dental Association, 2021). Special permits Special permits are required for dentists who want to administer general anesthesia or conscious sedation (to be called “moderate sedation” as of January 1, 2022) in the dental office. Offices providing these services are required to maintain specialized equipment, and to have such equipment inspected. Dentists must meet certain initial requirements to obtain these permits and other ongoing requirements to renew these permits every two years (Dental Board of California, 2021h). General anesthesia permit A dentist may not administer general anesthesia on an outpatient basis for dental patients, unless he or she possesses a current license in good standing and holds a Board-issued valid general anesthesia permit, or possesses a current permit under Section 1638 (a physician or surgeon with a license to practice dentistry in another state) or 1640 (having a pending contract as a professor in a California dental college; having graduated from a Board-approved dental college, or having completed an advanced education program accredited by either the Commission on Dental Accreditation of the ADA or a Board- approved national accrediting body; and being a diplomate of a specialty board, or being qualified to take a specialty board examination, or having completed an advanced educational program from a Board-approved dental college) and holds a Board-issued valid general anesthesia permit (California Dental Practice Act, 2019b). To obtain such a permit, the dentist must supply documentation of the successful completion of a residency program in anesthesia – approved by the Board of Directors of the American Dental Society of Anesthesiology for eligibility for fellowship in general anesthesia – of not less than one calendar year, documentation of the successful completion of a graduate program in oral and maxillofacial surgery that has been approved by the Commission on Accreditation of the ADA, and have a fellowship in anesthesia approved by the Board of Directors of the American Dental Society of Anesthesiology. In order to renew a general anesthesia permit, the dentist must complete, at least once every two years, 24 hours of approved courses of study related to general anesthesia, and successful completion of an advanced cardiac life support (ACLS) course. Units earned in the ACLS course may be used toward fulfillment of the general anesthesia course requirement (Dental Board of California, 2021f). Conscious sedation permit A dentist who wants to administer or order the administration of conscious (moderate) sedation must hold a conscious sedation permit. To obtain this permit, the dentist must show proof of successful completion of a course of study in conscious sedation consisting of at least 60 hours of instruction and satisfactory completion of at least 20 cases of the administration of conscious sedation for a variety of dental procedures. The course must comply with the requirements of the ADA’s Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry. To renew this permit, the dentist must complete at least once every two years a minimum of 15 hours of coursework related to the administration of conscious sedation and to medical emergencies (Dental Board of California, 2021a). Oral conscious sedation for minors Similarly, permits must be obtained in order for a dentist to administer oral conscious sedation for minors younger than the age of 13. Renewal of this permit requires a minimum of seven hours of approved courses of study related to oral conscious sedation of minors (Dental Board of California, 2021i). Along with an application fee and the form, the dentist needs to submit evidence that he or she has (a) satisfactorily completed a postgraduate program in oral and maxillofacial surgery or pediatric dentistry approved by the Commission on Dental
Accreditation or a comparable Board-approved organization, (b) satisfactorily completed a periodontics or general practice residency or other advanced education in a Board-approved general dentistry program, and (c) satisfactorily completed a Board-approved program on oral medications and sedation. A dentist who has already been using oral sedation for adult patients should submit documentation of 10 such cases in any three-year period (California Dental Practice Act, 2006). Informed consent, complications, and future legislation When the treatment involves general anesthesia or intravenous conscious sedation, the dentist must obtain written informed consent from the patient or from the parent or guardian (California Dental Practice Act, 2020f). In the case of a minor, the written consent must include the wording: The administration and monitoring of deep sedation or general anesthesia may vary depending on the type of procedure, the type of practitioner, the age and health of the patient, and the setting in which anesthesia is provided. Risks may vary with each specific situation. You are encouraged to explore all the options available for your child’s anesthesia for their dental treatment and consult with your dentist, family physician, or pediatrician as needed (California Dental Practice Act, 2020f). In 2015, the death of a six-year-old child named Caleb Sears inspired legislation concerning the administration and monitoring of dental anesthesia and sedation. The first law, AB 2235, requiring the Board to review laws and regulations, was known as Caleb’s Law Part I . The next legislation, Caleb’s Law Part II, was introduced to codify the recommendations in Part I. Yet another piece of legislation, SB 501, on the same subject was introduced at the same time. Governor Brown signed SB 501 into law in 2018 (Senate Bill No. 501, 2018). According to the California Society of Pediatric Dentistry, this law: Scheduled to become effective January 1, 2022, requires significant change to permitting of General Anesthesia, Conscious Sedation, and Oral Conscious Sedation for Minors in the dental setting. These changes include the introduction of a pediatric endorsement and additional patient monitoring requirements when administering general anesthesia or sedation to a minor dental patient, and the creation a new Pediatric Minimal Sedation (PMS) permit. The PMS permit will be required to administer or order the administration of minimal sedation to a patient under 13 years of age (Niethamer, 2021). However, it is unlikely that the Dental Board of California will be able to complete its rule making by the date the law is to go into effect, and the enactment date may be extended (Niethamer, 2021). The dentist must report within seven days in writing the death of a patient that takes place during any dental or dental hygiene procedure. The dentist must also report any death discovered to be the result of such treatment. Also, unless previously planned, the removal of a patient to a hospital or emergency center for treatment for problems resulting from a dental or dental hygiene procedure must be reported. A report is also necessary in the case of such a removal when the patient has received conscious sedation, oral conscious sedation, or general anesthesia. With the exception of patients to whom oral conscious sedation, conscious sedation, or general anesthesia was administered, removal to a hospital or emergency center that is the normal or expected treatment for the underlying dental condition is not required to be reported. Reports must be submitted to the Board on forms approved by the Board, with copies sent to the Dental Hygiene Board of California if an RDH was involved in the treatment (California Dental Practice Act, 2020e). The report, in cases in which the patient received anesthesia, must contain at least the following information: ● Procedure date. ● Patient’s age in years and months, as well as weight and sex.
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● Patient’s American Society of Anesthesiologists (ASA) physical status. ● Patient’s primary diagnosis. ● Any other diagnoses. ● Procedures performed. ● Setting in which sedation was performed. ● Medications employed. ● Monitoring equipment employed. ● Category of provider responsible for supervising sedation. ● Category of provider delivering sedation. ● Category of provider monitoring patient during sedation. ● Whether the person supervising sedation performed any of the procedures. ● What airway management was planned. ● What depth of sedation was planned. ● Complications. ● Description of unexpected occurrences in airway management. ● Whether the patient was sedated at any time during transportation. ● Category of provider performing resuscitation. Dental auxiliaries There are different categories of dental assistants and dental hygienists, each with specific requirements regarding training and skills. Laws specifically define the duties that each category of auxiliary is allowed to perform, the level of dentist supervision required, and the settings in which the duties may be performed (Cal. Code Regs., 2002). It is a criminal offense to perform illegal functions, as well as grounds for license discipline of both the person performing the illegal function and any person who aids or abets such illegal activity. A dental assistant is an individual who, without a license, may perform basic supportive dental procedures, as authorized by law and by regulations adopted by the Board, under the supervision of a licensed dentist. “Basic supportive dental procedures” are defined in Section 1750 of the Dental Practice Act as procedures that have technically elementary characteristics, are completely reversible, and are unlikely to precipitate potentially hazardous conditions for the patient being treated. Since January 1, 2010, the scope of practice for dental assistants has included new and expanded duties and two new “add- on” specialty permits in orthodontics and dental sedation. All categories of dental assistants are eligible to obtain these specialty permits after completing the required instruction. In addition, licensure and license renewal requirements have changed for RDAs and RDAEFs. The Dental Board of California publishes a duty table available at https://www.dbc.ca.gov/ formspubs/pub_permitted_duties.pdf, and it is shown in Appendix B. Levels of supervision For all categories of dental assistants, dentists retain the Dental assistants Scope of practice authority to determine which new duties their staff members can perform and on which patients these procedures are performed. The level of required supervision is determined by statute for the dental assistant and the RDAEF. For RDAs, the supervising dentist determines on an individual basis which allowable procedures may be completed under general supervision, and which must be completed under direct supervision. In addition to documenting the permitted and prohibited duties of all licensed dental auxiliaries and dental assistants, the table shown in Appendix B designates four basic levels of supervision, using the letters D , C , G , and DD : ● Direct supervision, designated in Appendix B by the letter D , refers to supervision of dental procedures based on instructions given by a licensed dentist who must be
● Resuscitation equipment employed. (California Dental Practice Act, 2020e) Disclosure of individually identifiable patient information must be consistent with applicable law, and the required report cannot be admissible in any action brought by a patient against the licensee. The form must state that the information is not an admission of guilt, but is to be used for educational, data, or investigative purposes (California Dental Practice Act, 2020e). It should be noted that the death of a patient must be reported even in cases in which the dentist comes to believe well after the event that it was related to treatment by the dentist or the RDH. Other permits Special permits also are required to be a full-time professor, an associate professor, or an assistant professor for a California dental college (Dental Board of California, 2021j). Sections 1640 and 1640.3 of the Dental Practice Act set forth the requirements to qualify for, apply for, and renew such a permit, as well as the causes for revocation of this specialty permit. Other special permits include operating a mobile dental clinic, using a fictitious business name, or having an additional dental office. According to the Dental Practice Act, Section 1684.5(d): “A dentist shall not concurrently supervise more than a total of five registered dental assistants in extended functions, registered dental hygienists, or registered dental hygienists in alternative practice providing services pursuant to Sections 1753.55, 1910.5, and 1926.05.” (California Dental Practice Act, 2015) physically present in the treatment facility during the performance of those procedures. ● Another type of supervision (C) allows the assistant to perform in a designated setting under the supervision of a dentist, RDH, or registered dental hygienist in alternate practice (RDHAP). ● General supervision, designated by the letter G , means that a duty is permitted based on instructions given by a licensed dentist, but does not require the physical presence of the supervising dentist during its performance. ● Finally, in the category designated DD , the dentist determines whether each procedure can be performed under general supervision, or whether direct supervision of the RDA is required. Exceptions to this category are found in Section 1777 of the Dental Practice Act, which states that direct supervision by the dentist or an RDH or RDHAP is necessary for an RDA or RDAEF engaging in (a) coronal polishing, (b) the application of topical fluoride, or (c) the application of sealants (after having completed a Board-approved course on the procedure) (California Dental Practice Act, 2009c). There is another level of supervision that is not defined but is specified in the description of the actual duty by statute. In those cases, the patient must be seen by the supervising dentist after the duty is performed and before the patient is dismissed. Proof of that compliance requires that the supervising dentist sign off the chart note made by the dental auxiliary. It is a requirement that all supervising dentists be familiar with the permitted and prohibited duties of dental auxiliaries. Therefore, it is essential that supervising dentists review the dental duty tables. Section 1753.7 of the Dental Practice Act also stipulates that a dentist may not simultaneously supervise more than three extended function dental assistants or extended function dental hygienists. Unlicensed dental assistants Although the dental assistant is an unlicensed dental professional, the employer of a dental assistant is responsible for ensuring that any dental assistant hired and in continuous
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