Table C-1 LEGAL SCOPE OF PRACTICE INDEX FOR DENTAL HYGIENISTS IN THE UNITED STATES, 2001 Detailed Criteria, Scoring, and Data Sources for AL, AK, AZ, AR, CA, and CO
SCORING CATEGORY Points Max Score fn AL   AK   AZ   AR   CA   CO  
Regulated by:
Board of Dental Hygiene/Independent Dental Hygiene Committee
4
4
a
Board of Dentistry/Dental Examiners with Dental Hygiene Advisory Committee
4
4
a
4
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member (2+)
3
3
a
3
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member
2
2
a
2
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Non-Voting Member
1
Other State Boards or Departments
3
Other Regulatory:
Licensure by Credential/Endorsement with no new clinical exam required
2
2
b
0
b
2
b
0
b
2
b
0
b
2
b
Scope of Practice Defined in Law or Regulations
2
2
c
2
c
2
c
2
c
2
c
2
c
2
c
Hygienist not restricted to patient of record of primary employing dentist
2
2
d
0
2
0
d
0
2
2
Total Regulation Score
10
6
9
6
6
8
9
Supervision:
                       
Dental Hygiene Practice: Highest level of supervision in state laws and regs:
Unsupervised
4
4
e
4
e
4
e
Collaborative Practice Arrangements
3
General
2
2
e
2
e
2
e
Direct
1
1
e
Supervision Requirements In:
Dentists Office
Unsupervised
4
4
f
4
f
Collaborative Practice Arrangements
3
General
2
2
f
2
f
2
f
Direct
1
1
f
1
f
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Long Term Care Facilities - Skilled Nursing Facilities
Unsupervised
4
4
g
4
g
4
g
Collaborative Arrangements
3
General
2
2
g
Direct
1
1
g
0
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Schools-Private or Public
Unsupervised
4
4
h
4
h
4
h
Collaborative Practice Arrangements
3
General
2
2
h
2
h
Direct
1
1
h
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Public Health Agencies- Federally Qualified Health Centers
Unsupervised
4
4
i
4
i
4
i
Collaborative Practice Arrangements
3
General
2
2
i
2
i
Direct
1
1
i
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Correctional Facilities
Unsupervised
4
4
j
4
j
4
j
Collaborative Practice Arrangements
3
General
2
2
j
2
j
2
j
Direct
1
1
j
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Public Institutions- Mental Health Facilities
Unsupervised
4
4
k
4
k
4
k
Collaborative Practice Arrangements
3
General
2
2
k
2
k
Direct
1
1
k
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Hospitals/Rehabilitation Hospitals or Convalescent settings
Unsupervised
4
4
l
4
l
4
l
Collaborative Practice Arrangements
3
General
2
2
l
Direct
1
1
l
0
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
Home Settings- Personal Residences
Unsupervised
4
4
m
4
m
4
m
Collaborative Practice Arrangements
3
General
2
2
m
Direct
1
1
m
0
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
1
No Limits on Settings Allowed for Practice by Dental Hygienists
3
3
n
3
0
3
n
0
3
n
3
n
Total Supervision Score
47
12
12
21
5
37
47
 
Dental Hygienist Tasks Allowed in Legislation:
                     
Prophylaxis - Physical Presence of Dentist Not Required
2
2
o
0
o
2
o
2
o
2
o
2
o
2
o
Fluoride Treatment - Physical Presence of Dentist Not Required
2
2
p
0
p
2
p
2
p
2
p
2
p
2
p
Sealant Application - Physical Presence of Dentist Not Required
2
2
q
0
q
2
q
2
q
2
q
2
q
2
q
X-Rays - Physical Presence of Dentist Not Required
2
2
r
0
r
2
r
2
r
0
r
2
r
2
r
Place Amalgam Restorations
2
2
s
0
0
s
0
s
0
0
s
2
s
Administer Local Anesthesia
2
2
t
0
2
t
2
t
2
t
2
t
2
t
Administer Nitrous Oxide
2
2
u
0
2
u
2
u
2
u
2
u
2
u
Hygienist allowed to perform initial screening or assessment
2
2
v
2
v
2
2
v
2
v
2
v
2
v
Hygienist allowed to refer patient
2
2
w
0
0
0
0
2
w
2
w
Hygienist may be self employed other than as an independent contractor
2
2
x
0
x
0
x
0
0
x
2
x
2
x
Hygienist may supervise a dental assistant
2
2
y
0
0
0
0
2
y
2
Hygienist may be supervised by a medical provider
2
2
z
0
z
0
z
0
z
0
z
2
z
0
Expanded functions and/or extended practice available in the state
4
4
aa
0
0
4
aa
4
aa
4
aa
4
aa
Total Tasks Score
28
0
14
18
16
26
26
Reimbursement:
                     
Medicaid Reimbursement Directly to Hygienists
10
10
bb
0
0
0
0
10
bb
10
bb
Dental Hygienist may be paid directly for services provided
5
5
cc
0
0
0
0
5
cc
5
cc
Total Reimbursement Score
15
0
0
0
0
15
15
TOTAL SCORE
100
18
35
45
27
86
97

FOOTNOTES

ALABAMA
a) 6 member Board of Dental Examiners with 1 dental hygienist member. The dental hygienist member is only permitted to vote on matters pertaining to dental hygiene. (Statutes, Alabama Code, Title 34, Chapter 9, Article 1, 34-9-40).
b) In 2001, not available. Licensure by credential for dental hygienists is available in the state effective in 2002. (Statute, Alabama Code, Title 34, Chapter 9, Article 1, 34-9-10). Another avenue to licensure is the Alabama Dental Hygiene Program. A dental assistant with one year work experience (two years effective in 2004) may train as a dental hygiene trainee under a qualified dentist while attending academic instruction under the auspices of the Dental Board and then be licensed as a dental hygienist. (Statutes, Alabama Code, Title 34, Chapter 9, Article 1, 34-9-26 and Rules, Administrative Code, 270-X-3-.04(4 ) and (9).
c) Scope of practice is defined in regulation. (Rules, Administrative Code, Chapter 270-X-3-.10(2) and (3).
e) All services must be performed under direct supervision. (Rules, Administrative Code, 270-X-3-.06) The dentist must examine and diagnose the patient before any hygiene treatment can be provided. (Rules, Administrative Code, 270-X-3-.10).
f,g,h,i,j,k,l,m) There are no limits enumerated in statute or regulation on practice locations. However, all practice must be under direct supervision of a dentist.
o,p,q,r) Direct supervision is required for fluoride treatments, x-rays, prophylaxis and sealants. ( Statutes, Alabama Code, Title 34, Chapter 9, Article 1, 34-9-27 and Rules, Administrative Code, 270-X-3-.10(2) and (3)). A dentist must examine the patient's teeth both immediately before and after application of pit and fissure sealants. (Rules, Administrative Code, 270-X-3-.10
v) Hygienists are permitted to perform preliminary charting and inspection of the oral cavity. (Rules, Administrative Code, 270-X-3-.10(2)(a).
x) Only a licensed dentist can employ a hygienist. (Statutes, Alabama Code, Title 34, Chapter 9, Article 1, 34-9-9).
z) A hygienist may provide services only under the direct supervision of a licensed dentist in the state. (Statutes, Alabama Code, Title 34, Chapter 9, Article 1, 34-9-27).

ALASKA
a) The Alaska Dental Board is under the auspices of the Division of Occupational Licensing in the Department of Community and Economic Development. 9 Member Board. 2 voting dental hygienists. (Statutes, Alaska Statutes, Title 8, Chapter 36, Article 1, 08.36.010).
b) Licensure by credentials is available in the state. (Statutes, Alaska Statutes, Title 8, Chapter 32, Article 1, AS 08.32.030).
c) Scope of practice is defined as educational, preventive and therapeutic services. (Statutes, Alaska Statutes, Title 8, Chapter 32,Article 3, 08.32.190(2). A list of permissible tasks is also provided in statute. (Statutes, Alaska Statute, Title 8, Chapter 32, Article 2, 08.32.110).
e,z) A hygienist practices under the general supervision of a licensed dentist. Direct or indirect supervision applies for administration of local anesthetics. (Statutes, Alaska Statutes, Title 8, Chapter 32, Article 2, 08.32.140 and 08.32.110(6). Services provided to patients must be in accordance with the diagnosis and treatment plan of a dentist. (Statutes, Alaska Statutes, Title 8, Chapter 32, Article 3, 08.32.190(4)).
f,h,i,j,k) Hygienists may practice in offices, charitable dental clinics, schools, welfare centers, state or federal institutions, village health facilities and in other places approved by the board. (Statutes, Alaska Statutes, Title 8, Chapter 32, Article 2, 08.32.120).
t) Certification to administer local anesthesia is available from the Board. (Statutes, Alaska Code, Title 8, Chapter 32, Article 2, 08.32.110(6) and Rules, Article 3, 12 AAC 28.320).
u) A dental hygienist may qualify to administer nitrous oxide under direct or indirect supervision through a course of instruction. (Rules, Article 7, 12 AAC 28.720).
x) A hygienist may only be employed by a dentist or others designated in statute and work in the office of a dentist or in the organizations of the specific employers. (Statutes, Alaska Statutes, Title 8, Chapter 32, Article 2, 08.32.100 and 08.32.120).

ARIZONA
a) The Board of Dental Examiners is composed of 11 members, 2 of whom are hygienists. (Statutes, Title 32, Chapter 11, Article 1, 32-1203). There is also a Dental Hygiene Committee which makes recommendations to the Board regarding hygiene issues. The committee consists of 7 members, 5 of whom are hygienists. (Rules, R4-11-605).
b) Licensure by credential was not effective in 2001. However, in 2002, the Arizona legislature passed a statutory revision to permit licensure by credential for dentists and dental hygienists. (Statutes, Title 32, Chapter 11, Article 4, 32-1292.01).
c) Scope of practice is defined in statute in a list of enumerated tasks. (Statutes, Title 32, Article 4, 32-1281 and in Rules, R4-11-601).
d,e) When providing services in a dental office, the hygienist is limited to a patient of record. In other settings, the patient must have been examined by a dentist within the previous twelve months. (Statutes, Title 32, Article 4, 32-1281(G)). Services must have been authorized by a dentist under all applicable levels of supervision. (Statutes, Title 32, Article 4, 32-1281(E)and (H)). All procedures must be performed under the supervision of a dentist. (Rules, R4-11-601). Statutes 32-1281 G
f,g,h,i,j,k,l,m) A hygienist may provide services in a dental office, in a health care facility, nursing home, public health agency or institution and for patients who are homebound. (Statutes, Title 32, Chapter 11, Article 1, 32-1203(A) and (B). Article 4, 32-1281(G). Special provisions for treating homebound patients appear in regulation. (Rules, R4-11-602). A hygienist may provide services in a public or private school. (Statutes, Title 32, Chapter 11, Article 4, 32-1289.)
t,u,aa) A hygienist may administer local anesthesia or nitrous oxide after completion of a course and under the direct supervision of a dentist. (Statutes, Title 32, Article 4, 32-1281(F)).
v) A hygienist may examine the oral cavity and perform a periodontal exam. (Statutes, Title 32, Article 4, 32-1281). A hygienist employed in public agencies, institutions or schools may screen patients before a dental exam. (Statutes, Title 32, Article 4, 32-1289).

ARKANSAS
a) The Arkansas State Board of Dental Examiners is under the auspices of the Governor's Office of Boards and Commissions. It is a 9 member Board with 1 voting dental hygienist. (Statutes, Arkansas Code Annotated, 17-82-201(a)).
b) Licensure by credential is available to hygienists. ( Statutes, Arkansas Code Annotated, 17-82-308 and Rules, Article IX, (B)).
c) Scope of practice is defined in statute as "assessment, prevention and treatment of oral diseases". Services which may be provided include removal of deposits above and below the gum line and any services permitted in regulation by the Board. (Statutes, Arkansas Code Annotated, 17-82-102(2)).
e,f,j) Services in a dental office must be provided under direct, personal or operative supervision. (Rules, Article XI) However, a hygienist working in a correctional facility may provide services under general supervision. (Statutes, Arkansas Code Annotated, 17-82-104(d)(1)).
o) Prophylaxis may only be provided under direct supervision in a dental office (Rules, Article XI (A)(1)) but may be provided under general supervision in correctional facilities. (Statutes, Arkansas Code Annotated, 17-82-104(d)(2)(C)).
p) Application of fluoride treatments may be performed by dental assistants under personal supervision. (Rules, Article XVII(A)(2)(p)). Dental hygienists are permitted to provided the same services as dental assistants under direct supervision. (Rules, Article XI(A)(1)(a)). These services may be provided under general supervision in correctional facilities. (Statutes, Arkansas Code Annotated, 17-82-104(d)(2)(C).
q) Sealants may only be applied under personal supervision in a dental office (Rules, Article XI (2)(a)) but under general supervision in a correctional facility. (Statutes, Arkansas Code Annotated, 17-82-104(d)(2)(C).
r) Statute requires that x-rays taken by a hygienist be provided in the dental office under the direct supervision of the dentist. (Statutes, Arkansas Code Annotated, 17-82-102(2)(B). X-rays may by provided under direct supervision. (Rules, Article XI(A)(1).
t,aa) A hygienist with certification may administer local anesthetic under supervision of a dentist. (Statutes, Arkansas Code Annotated, 17-82-103(c) and Rules, Article XVI(A)).
u,aa) A hygienist may induce and monitor nitrous oxide upon certification and under the direct supervision of a licensed dentist. (Rules, Article XI(A)(1)(e).
x) Only licensed dentists may employ hygienists. (Statutes, Arkansas Code Annotated, 17-82-103(a).
z) All procedures must be performed under the supervision of a licensed dentist (Statutes, Arkansas Code Annotated, 17-82-103(b)(2)).

CALIFORNIA
a) The California Dental Board is under the auspices of the Department of Consumer Affairs. The Dental Board has 14 members with 1 voting hygienist. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 1, 1601.1) There is a Committee on Dental Auxiliaries. Auxiliaries include all classes of dental assistants and dental hygienists in the state. The committee reviews education programs for auxiliaries, reviews and issue licenses, composes examinations, and makes recommendations regarding practice for dental auxiliaries. ( Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1742). The committee includes 3 hygienists and 3 assistants. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1743).
b) Licensure by credential was not available in 2001 but is effective in 2003.
c) In statutes in 2001, scope of practice is defined in terms of the tasks which can be performed. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1760). In statutes revised in 2002, scope of practice includes dental hygiene assessment, development, planning and implementation of a dental hygiene care plan. It also includes oral health education counseling and screenings. (Statutes, Business and Professions Code 2003, Division 2, Chapter 4, Article 7, 1760.5).
e) Dental hygienists provide most services under general supervsion.(Rules, Title 16, Chapter 3, Article 5, 1088(c)). Expansion of settings and permission for some unsupervised services (i.e. screenings) by dental hygienists in certain public settings was effective in 2003. In 2001, a registered dental hygienist in alternative practice (RDHAP) may perform functions "independently" and without supervision of a dentist including oral prophylaxis but agreements with dentists for referral and consultation are required. A RDHAP must provide to the board documentation of an existing relationship with dentist. (Rules, Title 16, Chapter 3, Article 5, 1090(8)(c). Practice for RDHAPs is defined in law. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1768 and Statutes, Business and Professions Code 2003, Division 2, Chapter 4, Article 7, 1775). ).
f,g,h,i,j,k,l,m) RDHAP may practice in an office, in residences of the homebound, in schools, in residential facilities and other institutions, and in HPSAs. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1770(b) and Statutes, Business and Professions Code 2002, Division 2, Chapter 4, Article 7, 1775(b). Settings listed in regulations include licensed clinics, community care facilities, public institutions and mobile units. (Rules, Title 16, Chapter 3, Article 5. 1088(e)). In 2002, hygienists may practice in any setting within their scope of practice under the required supervision. (Statutes, Business and Professions Code 2002, Division 2, Chapter 4, Article 7, 1764(b)).
o,p,q,r) A RDHAP may provide services to a patient upon written prescription of a dentist or physician who has examined and diagnosed the patient prior to the services being provided. The prescription is valid for services up to 15 months from date of issuance.(Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1770(h) and Statutes, Business and Professions Code 2002, Division 2, Chapter 4, Article 7, 1775(h)
s) Placing of restorations is prohibited. (Rules, Title 16, Chapter 3, Article 5, 1090(a)(5)).
t,u,aa) Dental hygienists may complete courses for Board approval to administer local anesthesia and nitrous oxide. (Rules, Title 16, Chapter 3, Article 5, 1088(3) and (4).
v) Dental hygienists are permitted to perform preliminary examinations detailed in regulations. (Rules, Title 16, Chapter 3, Article 5, 1088(c)(5)).
w) A RDHAP must have a documented relationship with a dentist to permit referral for patients. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, 1770(g) and Statutes, Business and Professions Code 2003, Division 2, Chapter 4, 1775(g)).
x) A RDHAP may be a proprietor of a dental hygiene practice. (Statutes, Business and Professions Code (2001), Division 2, Chapter 4, Article 7, 1770(a), Statutes, Business and Professions Code (2002), Division 2, Chapter 4, Article 7, 1775(a).
y) A RDHAP may hire and supervise dental assistants. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, 1770(f)). Statutes, Business and Professions Code 2003, Division 2, Chapter 4, Article 7, 1775(f)).
z) An RDHAP may provide services to a patient who presents with a prescription form a dentist or physician. (Statutes, Business and Professions Code, Division 2, Chapter 4, Article 7, 1770(h) and Statutes, Business and Professions Code 2003, Division 2, Chapter 4, Article 7, 1775(h)).
bb,cc) Statutes permits an RDHAP to submit insurance or third party claims for services performed for patients. (Statutes, Business and Professions Code 2001, Division 2, Chapter 4, Article 7, 1770(d) and Statutes, Business and Professions Code 2002, Division 2, Chapter 4, Article 7, 1775(d)).

COLORADO
a) The Colorado Board of Dental Examiners is under the auspices of the Department of Regulatory Agencies-Division of Registrations. 10 member Board, two voting dental hygienists. (Statutes, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35-104).
b) Licensure by credential is available. (Statues, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35-124(4)(a)).
c) Scope of practice is defined in law. (Statutes, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35-122.5 and 12-35-122.6)
e) Statutes contain a description of both supervised and unsupervised practice for dental hygienists. Supervised hygiene practice requires general supervision. (Statues, Colorado Revised Statutes, Title 12 Article 35, Part 1, 12-35-122.5 and 122.6).
f,g,h,i,j,k,l,m) There is no limitation on settings in which services may be provided.
o,p,q,r) Prophylaxis, application of sealants and fluoride treatments and taking x-rays are all services which may be provided by an unsupervised dental hygienist. (Statutes, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35-122.5(1).
s) "A dental hygienist may perform any dental task or procedure assigned the hygienist by a licensed dentist that does not required the professional skill of a dentist under general supervision." (Statutes, Colorado Revised Statutes, Title 12,Article 35, Part 1, 12-35-125(2)(a)).
t,u, aa) Dental hygienists may administer local anesthesia and nitrous oxide. They must qualify to provide the services through completion of appropriate coursework. (rules, Rule XVII (G)(1)(4)(a) and Rule XVIII (D)(2)).
v) Hygienist gathers and assembles information, performs an oral inspection and dental and periodontal charting. (Statutes, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35-122.5(d)).
w) Hygienists are required by law to refer a patient. (Statutes, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35.118(w)). A dental hygienist providing services for Medicaid eligible children must attempt to identify a dentist participating in Medicaid to whom to refer the child as needed. (Statutes, Colorado Revised Statutes, Title 26, Article 4,Part 4, 26-4-414.3(2)).
x) The group practice of dental hygiene is permitted. (Statutes, Colorado Revised Statutes, Title 12, Article 35, Part 1, 12-35-112(2)). "A dental hygienist may be the proprietor of a place where supervised or unsupervised dental hygiene is performed." (Statutes, Colorada Revised Statues, Title 12, Article 35, Part 1, 12-35-122.5(3)).
bb, cc) When an unsupervised hygienist provides services in public settings, direct reimbursement is permitted in law. (Statutes, Colorado Revised Statutes, Title 26, Article 4, Part 4, 26-4-414.3(1)).

SOURCES

ALABAMA
http://www.legislature.state.al.us/CodeofAlabama/1975/coatoc.htm
http://alabamaadministrativecode.state.al.us/

ALASKA
http://www.dced.state.ak.us/occ/pub/DentalStatutes.pdf

ARIZONA
http://www.azleg.state.az.us/ars/32/title32.htm
http://www.sosaz.com/public_services/Title_04/4-11.pdf

ARKANSAS
http://www.asbde.org/

CALIFORNIA
http://www.comda.ca.gov/laws-regs.pdf

COLORADO
http://www.dora.state.co.us/dental/dstatu.htm#statute
http://www.dora.state.co.us/dental/rules.htm

Table C-1, continued LEGAL SCOPE OF PRACTICE INDEX FOR DENTAL HYGIENISTS IN THE UNITED STATES, 2001 Detailed Criteria, Scoring, and Data Sources for CT, DE, DC, FL, GA, and HI
SCORING CATEGORY
Points
Max Score
fn
CT
 
DE
 
DC
 
FL
 
GA
 
HI
 
Regulated by:
Board of Dental Hygiene/Independent Dental Hygiene Committee
4
4
a
Board of Dentistry/Dental Examiners with Dental Hygiene Advisory Committee
4
4
a
4
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member (2+)
3
3
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member
2
2
a
2
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Non-Voting Member
1
Other State Boards or Departments
3
3
a
Other Regulatory:
Licensure by Credential/Endorsement with no new clinical exam required
2
2
b
2
b
2
b
2
b
0
b
2
b
0
Scope of Practice Defined in Law or Regulations
2
2
c
2
c
2
c
2
c
2
c
2
c
2
c
Hygienist not restricted to patient of record of primary employing dentist
2
2
d
2
0
0
0
d
2
0
Total Regulation Score
10
9
8
6
6
8
5
Supervision:
Dental Hygiene Practice: Highest level of supervision in state laws and regs:
Unsupervised
4
4
e
4
e
Collaborative Practice Arrangements
3
General
2
2
e
2
e
2
e
2
e
2
e
Direct
1
Supervision Requirements In:
Dentists Office
Unsupervised
4
4
f
Collaborative Practice Arrangements
3
2
f
General
2
2
f
2
f
2
f
Direct
1
1
f
1
f
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Long Term Care Facilities - Skilled Nursing Facilities
Unsupervised
4
4
g
4
g
Collaborative Practice Arrangements
3
General
2
2
g
2
g
2
g
Direct
1
0
0
No requirement for prior examination by a dentist
1
1
1
0
0
0
0
0
Schools-Private or Public
Unsupervised
4
4
h
4
h
Collaborative Practice Arrangements
3
General
2
2
h
2
h
2
h
2
h
Direct
1
0
h
No requirement for prior examination by a dentist
1
1
1
0
0
0
0
0
Public Health Agencies- Federally Qualified Health Centers
Unsupervised
4
4
i
4
i
Collaborative Practice Arrangements
3
General
2
2
i
2
i
2
i
2
i
2
i
Direct
1
No requirement for prior examination by a dentist
1
1
1
0
0
0
0
0
Correctional Facilities
Unsupervised
4
4
j
Collaborative Practice Arrangements
3
General
2
2
j
2
j
2
j
2
j
2
j
2
j
Direct
1
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Public Institutions- Mental Health Facilities
Unsupervised
4
4
k
4
k
Collaborative Practice Arrangements
3
General
2
2
k
2
k
2
k
2
k
2
k
Direct
1
No requirement for prior examination by a dentist
1
1
1
0
0
0
0
0
Hospitals/Rehabilitation Hospitals or Convalescent settings
Unsupervised
4
4
l
4
l
Collaborative Practice Arrangements
3
General
2
2
l
2
l
2
l
Direct
1
0
l
0
No requirement for prior examination by a dentist
1
1
1
0
0
0
0
0
Home Settings- Personal Residences
Unsupervised
4
4
m
Collaborative Practice Arrangements
3
General
2
2
m
Direct
1
0
0
0
0
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
No Limits on Settings Allowed for Practice by Dental Hygienists
3
3
n
0
0
0
3
0
0
Total Supervision Score
47
33
16
16
21
9
11
Dental Hygienist Tasks Allowed in Legislation:
Prophylaxis - Physical Presence of Dentist Not Required
2
2
o
2
2
2
2
2
o
2
o
Fluoride Treatment - Physical Presence of Dentist Not Required
2
2
p
2
2
2
2
0
p
2
p
Sealant Application - Physical Presence of Dentist Not Required
2
2
q
2
2
2
0
q
0
q
2
q
X-Rays - Physical Presence of Dentist Not Required
2
2
r
2
2
2
2
0
r
2
r
Place Amalgam Restorations
2
2
s
0
s
0
0
s
0
0
0
Administer Local Anesthesia
2
2
t
0
t
0
0
t
0
0
2
t
Administer Nitrous Oxide
2
2
u
0
u
0
0
u
0
u
0
u
0
Hygienist allowed to perform initial screening or assessment
2
2
v
2
v
0
v
2
v
0
2
v
2
v
Hygienist allowed to refer patient
2
2
w
2
w
0
0
0
2
w
0
Hygienist may be self employed other than as an independent contractor
2
2
x
0
x
0
x
0
0
0
0
x
Hygienist may supervise a dental assistant
2
2
y
2
0
0
0
y
0
y
0
Hygienist may be supervised by a medical provider
2
2
z
0
0
z
0
z
0
0
0
Expanded functions and/or extended practice available in the state
4
4
aa
4
aa
0
0
0
0
4
aa
Total Tasks Score
28
18
8
10
6
6
16
Reimbursement:
Medicaid Reimbursement Directly to Hygienists
10
10
bb
10
bb
0
0
0
0
0
Dental Hygienist may be paid directly for services provided
5
5
cc
5
cc
0
0
0
0
0
Total Reimbursement Score
15
15
0
0
0
0
0
TOTAL SCORE
100
75
32
32
33
23
32

FOOTNOTES

CONNECTICUT
a) The Commissioner of Public Health in Connecticut issues the regulations governing practice of dentists and hygienists in the state with the advice of a State Dental Commission. There are 9 members on the dental commission, none of whom are hygienists. (Statutes, Chapter 379, Sec 20-103a).
b) Licensure without examination available. (Statutes, Chapter 379a, Sec. 20-126k).
c) Scope of practice is defined in statute as educational, preventive and therapeutic services with certain tasks specifically enumerated. (Statutes, Chapter 379a, Sec. 20-1261(a)(3)).
e,f,j) General supervision of a dentist is required unless the hygienists has met the requirements to practice in a public health setting without supervision. (Chapter 379a, Sec. 20-1261(b)). General supervision requires that the dentist authorize the procedures to be performed by the hygienist. (Statutes, Chapter 3791, Section 126l(a)(1)).
f,g,h,i,j,k,l) Hygienists may practice in the office of a dentist, in a public or private institution or in a convalescent home. (Statutes, Chapter 379a, Sec. 20-126l(c). Hygienists may also practice in a public health facility which is an institution, a community health center, a group home or a school. (Statutes, Chapter 379a, Sec. 20-126l(2)).
g,h,i,k,l,aa) Hygienists may practice unsupervised if qualified to practice in a public health facility as a public health dental hygienist. (Statutes, Chapter 379a, Sec.126l(b)(B) and (e)).
s,t,u) Placing of restorations and the administration of anesthetics is specifically prohibited to hygienists in legislation. (Statutes,Chapter 379a, Sec 20-126l(d)(4) and (6)).
v) Dental hygiene examination, assessment, treatment planning and evaluation is included in the definition of scope of practice. (Statutes, Chapter 379a, Sec. 20-126l(a)(3)).
w) "Each dental hygienist practicing in public health facility shall refer for treatment any patient with needs outside the hygienists scope of practice." (Statutes, Chapter 379a, Sec 20-126l(e)).
x) Only a licensed dentist or a professional service corporation (with certain exceptions) is permitted to own a dental services corporation. (Statutes, Chapter 379,Sec. 20-122).
bb,cc) Payment for care provided to patients by hygienists in chronic or convalescent hospitals or homes may be made directly to the hygienist, (Statutes, Chapter 379a, Sec. 20-126s). Public health dental hygienists are permitted to participate in Medicaid and to provide necessary and appropriate services to patients in nursing facilities, intermediate care facilities for the mentally retarded, a group home, a school, clinic, community health center or hospital outpatient department without on-site dental clinic. (Regulations, Department of Social Services, Section 17b-262-697(5)).

DELAWARE
a) The Board of Dental Examiners is regulated by the Division of Professional Regulation in the Department of Administrative Services. 9 members on Board with 1 voting hygienist member.(Statutes, Delaware Code Annotated, Title 24, Chapter 11, Subchapter 1, 1101(b)). There is an Advisory Commitee for Dental Hygiene which consists of 3 hygienists who advise the board on matters pertaining to hygiene and participate in board votes on matters pertaining to licensure and examination of hygienists. (Statutes, Delaware Code Annotated, Title 24, Chapter 11, Subchapter 1, 1104).
b) Licensure by reciprocity is available under certain conditions. (Statute, Delaware Code Annotated, Title 24, Chapter 11, Subchapter III, 1153).
c) Scope of practice is defined in statute by the tasks which can be performed and as proplylactic and preventive measures authorized by the Board. (Statutes, Delaware Code Annotated, Title 24, Chapter 11, Subchapter III, 1157(b)).
e,z) Statute requires that hygienists work under the "general direction or supervision" of a licensed dentist. (Statutes, Delaware Code Annotated, Title 24, Chapter 11, Subchapter III, (c)). Rules provide for three levels of supervision - direct, indirect, and general. (Rules, 1100 Board of Dental Examiner 1.0). The conditions that are applicable to general supervision are defined in regulation including the proviso that a dentist must review the treatment records of each patient prior to and following the hygiene treatment. (Rules, 1100 Board of Dental Examiners 5.0).
f,g,h,i,j,k,l) Hygienists may provide services in dental offices, in public schools or institutions. (Statutes, Delaware Code Annotated, Title 24, Chapter 11, Subchapter III, 1157(c). A hygienist may also provide services in state institutions, federally qualified health centers, and other locations as designated by public authority. (Statutes, Delaware Code Annotated, Title d24, Chapter 11, Subchapter III, 1157(d)).
v) Hygienists may make instrumental examaination fo the teeth for cavities and assemble information for use by the dentist in making a diagnosis. (Statute, Delaware Code Annotated, Title 24, Chapter 11, Subchapter III, 1157(b)).
x) Dental hygienists may be employed by a dentist, a public institution or a school. (Statutes, Delaware Code Annotated, Title 24, Chapter 11, Subchapter III, 1157(a)).

DISTRICT OF COLUMBIA
a) A Board of Dentistry regulated by Department of Health governs practice. 7 Board members, 1 voting dental hygienist. (Statutes, DC Official Code, Division 1, Title 3, Subtitle I, Chapter 12, Unit A, Subchapter II, 3-1202.01)
b) Licensure by reciprocity and endorsement is available. (Statutes, Division I, Title 3, Subtitle I, Chapter 12, Subchapter V, 3-1203.07 and Rules, Title 17, Chapter 43, 4309.1).
c) Scope of Practice is defined in statute in terms of the tasks which are permitted. (Statutes, DC Official Code, Division 1, Title 3, Subtitle I, Chapter 12, Subchapter I, 3-1201.02(4)).
e,z) Services may be provided by a dental hygienist only under the supervision of a licensed dentist. (Statutes, Division 1, Title 3, Subtitle I, Chapter 12, Subchapter 1, 3-1201.02(4)(B).
f,g,h,i,j,k,l) Hygienists may provide services in an office, a public school or and institution.
s)The restoration of all or a part of a tooth with an artificial substance or material is considered the practice of dentistry. (Statutes, Division 1, Title 3, Subtitle I, Chapter 12, Subchapter I, 3-1201.02(5)(C)). Placement of amalgam restorations is prohibited in regulation. (Rules, Title 17, Chapter 43, 4310.3).
t,u) The administration of an anesthetic agent is considered the practice of dentistry.(Statutes, Division I, Title 3, Subtitle I, Chapter 12, Subchapter I, 3-1201.02(5)E)). Hygienists may assist in the administration of nitrous oxide and monitor the procedure, but may not administer local anesthetics. (Rules, Title 17, Chapter 43, 4310.2, and 4310.3).
v) Hygienists may provide a preliminary dental examination (Statutes, Division I, title 3, Subtitle I, Chapter 12, Subchapter I, 3-1201.02(4)(A)(i) and including charting of cavities. (Rules, Title 17, Chapter 43, 4310.1(a) and (b)).

FLORIDA
a) Florida Dental Board is within the Florida Department of Health. 11 member Board with two hygienists. (Statutes, Title XXXII, Chapter 466, 466.004(1)). Florida also has both a Council on Dental Hygiene and a separate Council on Dental Assisting. Recommendations made to the Board by these Councils are advisory and not mandatory. (Statutes, Title XXXII, Chapter 466, 466.004(2)(a).
b) There is no licensure by endorsement available to hygienists in this state. Licensure requires passage of the national board within the previous ten years and a clinical and written exam for each applicant . (Statutes, Title XXXII, Chapter 46, 466.007).
c) Scope of Practice is defined in law by the tasks which are permitted. (Statutes, Title XXXII, Chapter 466, 466.023(1)). Dental hygiene is defined as a provision of educational, preventive, and therapeutic dental services. (Statutes, Title XXXII, Chapter 466, 466.003(4)).
d) Each patient must have a dentist of record who is responsible for all treatment on the patient. This section assigns responsibility for treatments by hygienists on patients of record to the supervising dentist. (Statutes, Title XXXII, Chapter 466, 466.018(1)).
e) Dental hygiene services may be provided under direct, indirect, or general supervision of a dentist. (Statutes, Title XXXII, Chapter 466, 466.023(1)). DH may "without supervision provide educational programs and fluoride rinse programs" as approved by the Board but may not provide treatment services for dental conditions without supervision of a dentist. (Statutes, Title XXXII, Chapter 466, 466.023 (3). In order to provide services under general supervision, a dentist must authorize the services no more than 13 months prior to the hygienist's treatment. (Rules, FAC 64B516.001). Levels of supervision required are defined in regulation. (rules, FAC 64B5-16.007).
f,g,h,i,j,k,l,m) Hygienists may work in offices, in public health programs and institutions of Dept. of Juvenile Justice, Children and Family Services and Health, in licensed public and private health facilities, other state and federal public institutions, educational institutions and homes of patients as well as in other places approved by the Board. (Statutes, Title XXXII, Chapter 466, 466.023.
q) Application of sealants is a remediable delegable task which must be performed under direct supervision. (Rules, FAC 64B5-16.006).
u) Hygienists may only monitor the administration of nitrous oxide. (Rules, FAC 64B5-16.006).

GEORGIA
a) Georgia Board of Dentistry is under the auspices of the Professional Licensing Boards Division of the Secretary of State. 1 dental hygienist member on 11 member Board. (Statutes, Georgia Code, 43-11-2(a)(2)). The hygienist member is only permitted to vote on matters related to dental hygiene. (Statutes, Georgia Code, 43-11-2 (d)(1)).
b) Licensure without examination is only available to hygienists from another state seeking a teacher's or instructor's license to teach in a college or clinic in Georgia. (Statutes, Georgia Code, 43-11-42(a)).
c) Scope of Practice is defined in regulations. (Rules, 150-5-.01).
f) Dental hygienists may only perform services under direct supervision of a dentist. (Statutes, Georgia Code, 43-11-74(a)) Direct supervision in the state requires that the dentist order the procedures to be performed by the hygienist and examine the patient before the patient is dismissed. (Rules, 150-5-.03).
h,l) Hygienists may only perform dental screenings in schools and hospitals.
e,i,j,k) General supervision is permitted in approved dental facilities of the Dept. of Human Resources or Dept. of Corrections, or in county boards of health. (Rules, 150-5-.03).
o) A hygienist may only provide services under general supervision in certain public facilities. Otherwise, all services are provided under direct supervision. (Rules, 150-5-.03(2)(b) and (1).
p,q,r) These services may only be provided under the direct supervision of a dentist. (Rules, 150-5-.03(4)).
u) In statute, the Board is specifically prohibited from permitting hygienists to administer anesthesia. (Statutes, Georgia Code, 43-11-74(a).
v) Dental screenings by hygienists without direct supervision are permitted in certain public settings. (Statutes, Georgia Code, 43-11-74(2)). Dental screenings are defined as a visual assessment of the oral cavity. (Statutes, Georgia Code, 43-11-74(e)(1)).
w) Hygienists providing screening services must advise patients to seek an examination by a dentist for a thorough diagnosis. (Statutes, Georgia Code, 43-11-74(3).)
y) Dental assistants may only perform duties assigned to them under the direct personal supervision of a dentist. (Statutes, Georgia Code, 43-11-81).

HAWAII
a) Board of Dental Examiners is under the auspices of the Governor's Office of Commerce and Consumer Affairs, Professional and Vocational Licensing Division. 12 member Board with 2 voting dental hygienists. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447, 447-2).
c) Scope of practice is defined in statute by the tasks which are permitted. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447, 447-3(b)).
e) Hygienists may only provide services under the direct or general supervision of a licensed dentist. In private dental practices, the hygienist must practice under direct supervision. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447, 447-3(c)).
f,g,h,i,j,k,l) Hygienists may provide services in an office , charitable dental clinic or infirmary, school, welfare center, and state or county building. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447, 447-3). This statute was amended to clarify settings permitted and now includes nursing homes, adult day care centers, hospitals, assisted living facilities, mental institutions, and nonprofit health clinics effective in 06/02.
f,g,h,i,j,k,l) The conditions of direct and general supervision in the state require that the dentist examine and diagnose the patient prior to treatment by a hygienist. (Rules, Title 16, Chapter 79, 16-19-2(1) and (2)).
o,p,r) Effective in 2002, the hygienist may provide only education, screening and fluoride treatments in public settings. All other services require that a dentist prescreen and authorize the procedures for the patient. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447, 447-3(d)).
q) Application of sealants under general supervision is only permitted in enumerated public settings. Otherwise, application requires direct supervision. (Rules, Title 16, Chapter 79, 16-79-69.10(4)).
t,aa) A hygienist may administer local anesthesia with certification under the direct supervision of a dentist. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447-3(b) and Rules, Title 16, Chapter 79, 16-79-6).
v) Hygienists are permitted to provide a preliminary oral screening. (Rules, Title 16, Chapter 79, 16-79-67). Statutes permit hygienists to provide dental screenings in public health settings. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447, 447-3(d)).
x) A dental hygienist may not establish or operate any separate facility to provide hygiene services exclusively. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447-3(c)).
z) A hygienist may only provide services under the supervision of a licensed dentist. (Statutes, Division 2, Title 25, Chapter 447-3(c)).
bb and cc) Revised provisions of the dental hygiene statute passed in 2002 specifically state that no direct reimbursement should be provided to dental hygienists. (Statutes, Hawaii Revised Statutes, Division 2, Title 25, Chapter 447-3(d)).

SOURCES:

Connecticut
http://www.cga.state.ct.us/2001/pub/Chap379.htm
http://www.cga.state.ct.us/2001/pub/Chap379a.htm
http://www.dph.state.ct.us/Licensure/apps/dent_hyg_ceu_regs.pdf
http://www.ctmedicalprogram.com/bulletin/pb01_36.pdf

Delaware
http://198.187.128.12/delaware/lpext.dll?f=templates&fn=fs-main.htm&2.0
http://www.state.de.us/research/profreg/Frame.htm

District of Columbia
http://dccode.westgroup.com/Find/Default.wl?DocName=DCCODES3-1202%2E01&FindType=W&DB=DC-TOC-WEB%3BSTADCTOC&RS=WLW2%2E07&VR=2%2E0
http://dchealth.dc.gov/prof_license/services/boards_regulations_action.asp?strAppId=5

Florida
http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0466/titl0466.htm&StatuteYear=2002&Title=%2D%3E2002%2D%3EChapter http://fac.dos.state.fl.us/faconline/chapter64.pdf

Georgia
http://www.legis.state.ga.us/legis/2003_04/gacode/43-11-1.html
http://www.state.ga.us/rules/index.cgi?base=150

Hawaii
http://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0471/HRS0447/HRS_0447-0001.htm
http://www.hsba.org/Hawaii/Admin/DCCA/79-C.pdf

Table C-1, continued LEGAL SCOPE OF PRACTICE INDEX FOR DENTAL HYGIENISTS IN THE UNITED STATES, 2001 Detailed Criteria, Scoring, and Data Sources for ID, IL, IN, IA, KS, and KY
SCORING CATEGORY
Points
Max Score
fn
ID
IL
IN
IA
KS
KY
  
Regulated by:
Board of Dental Hygiene/Independent Dental Hygiene Committee
4
4
a
Board of Dentistry/Dental Examiners with Dental Hygiene Advisory Committee
4
4
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member (2+)
3
3
a
3
a
3
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member
2
2
a
2
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Non-Voting Member
1
Other State Boards or Departments
3
Other Regulatory:
Licensure by Credential/Endorsement with no new clinical exam required
2
2
b
2
b
2
b
2
b
2
b
2
b
2
b
Scope of Practice Defined in Law or Regulations
2
2
c
2
c
2
c
2
c
2
c
2
c
2
c
Hygienist not restricted to patient of record of primary employing dentist
2
2
d
0
0
2
0
0
0
 
Total Regulation Score   10   7   7   8   8   7   6  
 
Supervision:                              
Dental Hygiene Practice: Highest level of supervision in state laws and regs:
Unsupervised
4
4
e
4
e
Collaborative Practice Arrangements
3
General
2
2
e
2
e
2
e
2
e
Direct
1
1
e
Supervision Requirements In:
Dentists Office
Unsupervised
4
4
f
Collaborative Practice Arrangements
3
General
2
2
f
2
f
2
f
Direct
1
1
f
1
f
1
f
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Long Term Care Facilities - Skilled Nursing Facilities
Unsupervised
4
4
g
Collaborative Practice Arrangements
3
General
2
2
g
2
g
1
g
2
g
Direct
1
0
1
g
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Schools-Private or Public
Unsupervised
4
4
h
4
h
Collaborative Practice Arrangements
3
General
2
2
h
2
h
2
h
Direct
1
1
h
1
h
No requirement for prior examination by a dentist
1
1
0
0
1
0
0
0
Public Health Agencies- Federally Qualified Health Centers
Unsupervised
4
4
i
Collaborative Practice Arrangements
3
General
2
2
i
2
i
2
i
Direct
1
1
i
1
i
1
i
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Correctional Facilities
Unsupervised
4
4
j
Collaborative Practice Arrangements
3
General
2
2
j
1
j
Direct
1
1
j
0
0
1
j
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Public Institutions- Mental Health Facilities
Unsupervised
4
4
k
Collaborative Practice Arrangements
3
General
2
2
k
2
k
1
k
2
k
Direct
1
0
1
k
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Hospitals/Rehabilitation Hospitals or Convalescent settings
Unsupervised
4
4
l
Collaborative Practice Arrangements
3
General
2
2
l
1
l
2
l
2
l
Direct
1
1
l
1
l
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
Home Settings- Personal Residences
Unsupervised
4
4
m
Collaborative Practice Arrangements
3
General
2
2
Direct
1
0
1
m
0
0
0
No requirement for prior examination by a dentist
1
1
0
0
0
0
0
0
No Limits on Settings Allowed for Practice by Dental Hygienists
3
3
n
0
0
3
0
0
0
Total Supervision Score
47
18
11
19
10
14
8
 
Dental Hygienist Tasks Allowed in Legislation:
Prophylaxis - Physical Presence of Dentist Not Required
2
2
o
2
2
2
o
2
o
2
0
Fluoride Treatment - Physical Presence of Dentist Not Required
2
2
p
2
2
0
p
2
p
2
0
Sealant Application - Physical Presence of Dentist Not Required
2
2
q
2
2
0
q
2
q
2
0
X-Rays - Physical Presence of Dentist Not Required
2
2
r
2
2
0
r
2
r
2
0
r
Place Amalgam Restorations
2
2
s
0
0
s
2
0
0
2
Administer Local Anesthesia
2
2
t
2
t
2
t
0
2
t
2
t
0
t
Administer Nitrous Oxide
2
2
u
2
u
2
u
0
2
u
2
u
0
u
Hygienist allowed to perform initial screening or assessment
2
2
v
2
v
2
v
2
v
2
v
2
v
2
v
Hygienist allowed to refer patient
2
2
w
0
0
0
0
0
0
Hygienist may be self employed other than as an independent contractor
2
2
x
0
0
x
0
0
x
0
0
x
Hygienist may supervise a dental assistant
2
2
y
0
0
y
0
0
0
0
Hygienist may be supervised by a medical provider
2
2
z
2
z
0
0
0
z
0
0
z
Expanded functions and/or extended practice available in the state
4
4
aa
4
aa
4
aa
4
aa
4
aa
4
aa
0
Total Tasks Score
28
20
18
10
18
18
4
 
Reimbursement:                              
Medicaid Reimbursement Directly to Hygienists
10
10
bb
0
0
0
0
0
0
Dental Hygienist may be paid directly for services provided
5
5
cc
0
0
0
0
cc
0
0
Total Reimbursement Score
15
0
0
0
0
0
0
 
TOTAL SCORE
100
45
36
37
36
39
18

FOOTNOTES

IDAHO
a) Board of Dentistry is under the auspices of the Bureau of Occupational Licenses in the Department of Self-Governing Agencies. 2 voting dental hygienists on 8 member Board. (Statutes, Title 54 Chapter 9, 54-907).
b) Licensure by credential available. (Statutes, Title 54, Chapter 9, 54-916a and Rules, IDAPA 19.01.01.020).
c) Scope of Practice defined in law. (Statutes, Title 54, Chapter 9, 54-902).
e,f,g,h,i,j,k,l) A hygienist may only work under general supervision if the dentist has provided written orders for the patient which have been signed within the twelve months prior to the hygienist providing services. (Rules, IDAPA 19.01.01.30.04).
f,g,h,i,j,k,l) A hygienist may work in a private office or in public settings. (Statutes, Title 54, Chapter 9, 54-904).
t,u) Hygienists "may administer prescribed anesthetics." (Statutes, Title 54, Chapter 9, 54-902). Hygienists are prohibited from administering local anesthetic or nitrous oxide except under the indirect supervision of a dentist or physician in a hospital setting. (Rules, IDAPA 19.01.030.01).
v) A hygienist is permitted to prepare preliminary records of oral conditions. (Statutes, Title 54, Chapter 9, 54-902).
z) A hygienist who provides services without the supervision of a dentist commits a misdemeanor in the state. (Statutes, Title 54, Chapter 9, 54-906). However, they may administer local anesthesia or nitrous oxide under the supervision of an attending physician in a hospital. (Rules, IDAPA 19.01.030.01`
aa) Hygienists are permitted to administer local anesthesia and nitrous oxide.

ILLINOIS
a) Illinois Board of Dentistry is situated in the Illinois Department of Professional Regulation. 2 voting dental hygienists on 11 member Board. (Statutes, 225 ILCS 25/6).
b) Licensure by credential is available. (Statutes, 225 ILCS 25/19).
c) Scope of Practice is defined in law. (Statutes, 225 ILCS 25/18).
e) Supervision is defined in Illinois statute as requiring the physical presence of the dentist when hygiene services are performed. (Statutes, 225 ILCS 25/4(h)). Acts permitted to hygienists must be "under the supervision of a dentist." (Statutes, 225 ILCS 25/18(a)). There is an exception for services provided in long-term care, mental health or development disability facilities which permits general supervision if the dentist has examined, diagnosed and provided the patient with a treatment order within 90 days of provision of hygiene services. (Statutes, 225 ILCS 25 (b)).
e,f,g,h,i,j,k,l) Hygienists in Illinois may work in the office a dentist, in a federal, state, county or municipal agency or institution, in a public or private school, or in a federal state, county, municipal or other public clinic. (Statutes, 225 ILCS 25/18).
s) Placing restorations is expressly prohibited in regulation. (Rules, Title 68, Chapter VII, Subchapter b, Part 1220. 240(3)).
t,u,aa) Upon completion of a training program, a hygienist may be certified to administer and monitor nitrous oxide and local anesthetics. (Statutes, 225 ILCS 25 (v) and (vi) and Rules, Title 68, Chapter Vii, Subchapter b, 1220.240(e)).
v) Hygienist "may record case histories and oral conditions observed." (Statutes, 225 ILCS 25/18 (c) and Rules, Title 68, Chapter VII, Subchapter b, Part 1220.240(b)).
x) A hygienist is prohibited from providing services if employed by any one other than a dentist. (Statutes, 225 ILCS 25/38.1).
y) Dental assistant must be supervised by a dentist. (Statutes, 225 ILCS 25/4 (f).

INDIANA
a) Indiana Dental Board is under the auspices of the Indiana Health Professions Bureau. 1 voting dental hygienist on 11 member State Board of Dentistry. (Statutes, Indiana Code Annotated, IC 25-14-12 (a)(2)).
b) Licensure by endorsement is available under specific conditions. (Statutes, Indiana Code Annotated, IC 25-13-1-17 and Rules, 828 IAC 1-3-1-1(a)).
c) Scope of practice is defined in law. (Statutes, Indiana Code Annotated IC-25-13-1-11).
f,g,h,i,j,k,l,m) Hygienists may work in hospitals, public health clinics, rural, charitable or federally qualified health centers, for government entities or in any location (including mobile vans) approved by the board. (Statutes, Indiana Code Annotated, IC 25-14-1-1 (b)) Hygienists may also work in dental offices, schools, and industrial clinics. (Statutes, Indiana Code Annotated, IC 25-13-1-10). Homes of patients are included in the definition of a mobile dental facility or portable dental operation. (Rules, 828 IAC 4-2-2 (2). Hygienists are permitted to provide hygiene services in mobile facilities or portable dental operations. (Rules, 828 IAC 4-1-2(d)).
e,h) Hygiene services must be supervised by a licensed dentist in all settings except schools or institutional practice where prophylaxis and hygiene instruction to children up to grade 12 is provided or when providing screening and referrals for patients in public health settings. These services may be provided without the supervision of a dentist. (Statutes, Indiana Code Annotated, IC 25-13-1-10).
f,g,i,j,k,l,m) The level of supervision in offices and other settings is direct or indirect. Improper conduct of a dentist is partly defined as "failing to inspect dental services during the course of their performance" (direct supervision) or "failing to be present in the dental facility to properly supervise the treatment of patients" (indirect supervision). (Rules, 828 IAC 1-1-15(10) and (11)).
h) Hygienists may provide prophylaxis without supervision of a dentist to children up to grade 12. (Statutes, Indiana Code Annotated, IC 25-13-1-10(5)(b)(2)).
o,p,q,r) All services must be provided under direct or indirect supervision of a dentist with the exception of prophylaxis which can be provided to children in public settings without supervision by a dentist.
v,w) Screening and referral of patients in public health settings may be provided by hygienists without supervision by a dentist. (Statutes, Indiana Code Annotated, IC 25-13-1-10(5)(b)(3)). Screening is defined as assessment of the health of the hard or soft tissues of the oral cavity. (Statutes, Indiana Code Annotated, IC 25-13-1-2(g)). Referral is defined as a recommendation to seek further care from a dentist but not a specific dentist. (Statutes, Indiana Annotated Code, IC 25-13-1-2(f)).

IOWA
a) The Iowa Board of Dental Examiners is under the auspices of the Bureau of Professional Licensure in the Division of Administrative and Regulatory Affairs in the Department of Public Health. 2 dental hygienists on 9 member Dental Board. (Statutes, Iowa Code, 147.14(4) and Rules, Iowa Administrative Code, IAC 650-5.1(133)). A Dental Hygiene Committee of the Board was created In 1999. (Statutes, Iowa Code, 153.33A and Rules, Iowa Administrative Code, IAC 650-5.1(153)(5.1(3) and 5.6(153)).
b) A reciprocity license was available under law (Statues, Iowa Code, 147.80(11)) in 2001. Regulations also permitted licensure by credential (Rules, Iowa Administrative Code, IAC 650-11.6(153). Iowa Code addressing reciprocity for dentists was changed in 2002 to licensure by credential for both dentists and dental hygienists. (Statutes, Iowa Code 153.21).
c) Scope of practice is defined in law as educational, therapeutic, and preventive services. Some of the permitted services are enumerated. (Statutes, Iowa Code, 153.15).
f,h,i,l) Hygiene services may be provided in dental offices, schools, public health agencies, hospitals, and for the armed forces. (Statutes, Iowa Code, 153.15).
e,f,h,i,l o,p,q,r) Hygienists may provide services in any allowable setting under general supervision but the patient must have been examined and the services authorized by the supervising dentist. Certain other requirements apply to general supervision. (Rules, Iowa Administrative Code, IAC650-10.3(153(10.3(2)).
t,u,aa) Administration of local anesthesia or nitrous oxide is permitted under direct supervision of dentist. A permit issued by the Board is required to administer local anesthesia. (Rules, Iowa Administrative Code, IAC 650-10.3(153)(10.3(1) and IAC 650-11.10(153)). The hygienist must meet the training requirements established by the Board for administration of nitrous oxide. (Rules, Iowa Administrative Code, IAC 650-29.6(153).
v) Rules explicitly state that nothing in them shall prevent a dental hygienist from providing certain services including assessment and screening. (Rules, Iowa Administrative Code, IAC 650-10.3(153)).
x,z) Rules specifically state that a hygienist is not allowed to practice independent of the supervision of a dentist and is also prohibited from establishing a separate office. (Rules, Iowa Administrative Code, IAC 650-10.3(153)910.3(3)).

KANSAS
a) 2 voting dental hygienists on 9 member Board, members of Board appointed by governor. (Statutes, Chapter 74, Article 14, 74-1404(a) and (b)).
b) A hygienist may be licensed without examination by endorsement after meeting certain qualifications. (Statutes, Chapter 65, Article 14, 65-1434).
c) Scope of Practice is defined in law as educational, preventive and therapeutic procedures including the delineation of some specific tasks permitted to dental hygienists. (Statutes, Chapter 65, Article 14, 65-1456(b)).
e) Kansas statutes provide for hygienists to work "under direct or general" supervision. General supervision applies only if the dentist has immediately or within the previous 12 months examined the patient and authorized hygiene services. (Statutes, Chapter 65, Article 14, 65-1465(d)(2)).
f,g,h,i,j,k,l) In 2001, hygienists were permitted to practice in these settings only under the direct supervision of a dentist. Effective in 2002 with the revised statutes, hygienists may practice in dental offices, schools, health care facilities, or government institutions under general supervision. (Statutes, Title XXVI, Chapter 313, KRS 313.310).
t,u,aa) Hygienists are permitted to administer local anesthesia and nitrous oxice under direct supervision after completion of required courses of inistruction. (Statutes, Chapter 65, Article 14, 65-1456(g)(3)).
v,aa) The dental hygienist must have a permit issued by the Board to provide screening services in public institutions or facilities. (Statutes, Chapter 65,Article 14, 65-1435(f)).
x,z) A hygienist may be employed by a dentist or by certain public institutions but must always be under the supervision of a licensed dentist. (Statutes, Chapter 65, Article 14, 65-1456(e)(2)).

KENTUCKY
a) Board of Dentistry is supported by the Division of Occupations which is regulated by the Department of Finance and Administration. 1 voting hygienist on a 9 member Board. (Statutes, Title XXVI, Chapter 313, KRS 313.200(1)
b) Reciprocal licensing is available to hygienists holding a valid license from another state. (Statutes, Title XXVI, Chapter 313, KRS 313.303).
c) Scope is defined in statute in terms of prophylaxis but may also include other dental activities. (Statute, Title XXVI, Chapter 313, KRS 313.010(3)).
e) In 2001, hygienists practiced under direct supervision of a dentist. (Rules, 201 KAR 8:135, Section 1). Effective in 2002, a hygienist is permitted to practice under general supervision for not more than 15 consectuive days and provided that the patient has been examined by the supervising dentist within the previous 7 months. (Statutes, Title XXVI, Chapter 313, KRS 313.310(3)). New regulations were written to address the change in supervision. (Rules, 201 KAR 8:450).
f,g,,h,i,j,k,l) In 2001, hygienists were permitted to practice in these settins only under the direct supervision of a dentist. Effective in 2002 with the revised statutes, hygienists may practice in dental offices, schools, health care facilities, or government institutions under general supervision. (Statutes, Title XXVI, Chapter j313, KRS 313.310).
r) Continuous supervision of dentist is required when taking X-rays. (Rules, 201 KAR 8:130, Section 2).
t,u) Effective in 2002, a hygienist with appropriate education can admininister nitrous oxide or local anasthesia under direct supervision. (Statutes, Title XXVI, Chapter 313, KRS 313.343(1)) with new administrative regulations (Rules, 201 KAR 8:460, Section 3).
v) Screening is permitted as delegated by dentist. (Rules, 201 KAR 8:135 Section 1
x) It is unlawful to practice dental hygiene in a manner that is separate from the dental practice of a supervising dentist. (Statutes, Title XXVI, Chapter 313, KRS 313.310(7)).
z) Hygienists may practice in the state only as an employee of a practicing, licensed dentist and the continuous supervision of that dentist. (Statutes, Title X
XVI, Chapter 313, KRS 313.310)

SOURCES

Idaho
http://www3.state.id.us/idstat/TOC/54009KTOC.html
http://www2.state.id.us/adm/adminrules/rules/idapa19/0101.pdfIllinois
http://www.legis.state.il.us/legislation/ilcs/ch225/ch225act25.htm
http://www1.ildpr.com/WHO/ARpropsd/WEBdentrules.pdf

Indiana
http://www.in.gov/legislative/ic/code/title25/ar13/
http://www.in.gov/legislative/iac/title828.html

Iowa
http://www.legis.state.ia.us/IACODE/2003/153/
http://www.state.ia.us/dentalboard/boardrules.html

Kansas
www.accesskansas.org/kdb/statutes.html
www.accesskansas.org/kdb/regulations.html

Kentucky
http://www.lrc.state.ky.us/KRS/313-00/CHAPTER.HTM
http://www.lrc.state.ky.us/kar/TITLE201.HTM

Table C-1, continued LEGAL SCOPE OF PRACTICE INDEX FOR DENTAL HYGIENISTS IN THE UNITED STATES, 2001 Detailed Criteria, Scoring, and Data Sources for LA, ME, MD, MA, MI, and MN
SCORING CATEGORY
Points
Max Score
fn
LA
ME
MD
MA
MI
MN
Regulated by:
Board of Dental Hygiene/Independent Dental Hygiene Committee
4
4
a
Board of Dentistry/Dental Examiners with Dental Hygiene Advisory Committee
4
4
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member (2+)
3
3
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Voting Member
2
2
a
2
a
2
a
2
a
Board of Dentistry/Dental Examiners with Dental Hygienist as a Non-Voting Member
1
Other State Boards or Departments
3
Other Regulatory:
Licensure by Credential/Endorsement with no new clinical exam required
2
2
b
2
b
2
b
2
b
2
b
2
b
2
b
Scope of Practice Defined in Law or Regulations
2
2
c
2
c
2
c
2
c
2
c
2
c
2
c
Hygienist not restricted to patient of record of primary employing dentist
2
2
d
2
d
2
d
2
d
0
0
d
2
Total Regulation Score
10
8
8
10
6
7
8
Supervision:
Dental Hygiene Practice: Highest level of supervision in state laws and regs:
Unsupervised
4
4
e
Collaborative Practice Arrangements
3
3
e
3
e
General
2
2
e
2
e
2
2
e
Direct
1
Supervision Requirements In:
Dentists Office
Unsupervised
4
4
f
Collaborative Practice Arrangements
3
General
2
2
f
2
f
2
f
Direct
1
1
f
1
f
1
f
No requirement for prior examination by a dentist
1
1
0
1
1
0
0
f
0
Long Term Care Facilities - Skilled Nursing Facilities
Unsupervised
4
4
g
Collaborative Practice Arrangements
3
3
g
3
g
General
2
2
g
2
g
2
g
2
g
Direct
1
No requirement for prior examination by a dentist
1
1
0
1
0
0
1
1
Schools-Private or Public
Unsupervised
4
4
h
Collaborative Practice Arrangements
3
3
h
3
h
General
2
2
h
2
h
2
h
2
h
Direct
1
No requirement for prior examination by a dentist
1
1
0
1
0
0
1
1
Public Health Agencies- Federally Qualified Health Centers
Unsupervised
4
4
i
Collaborative Practice Arrangements
3
3
i
3
i
General
2
2
i
2
i
2
i
2
i
Direct
1
No requirement for prior examination by a dentist
1
1
0
1
0
0
1
1
Correctional Facilities
Unsupervised
4
4
j
Collaborative Practice Arrangements
3
3
j
3
j
General
2
2
j
2
j
2
j
2
j
Direct
1
No requirement for prior examination by a dentist
1
1
0
1
0
0
1
1
Public Institutions- Mental Health Facilities
Unsupervised
4
4
k
Collaborative Practice Arrangements
3
3
k
3
k
General
2
2
k
2
k
2
k
2
k
Direct
1
No requirement for prior examination by a dentist
1
1
0
1
0
0
1
1
Hospitals/Rehabilitation Hospitals or Convalescent settings
Unsupervised
4
4
l
Collaborative Practice Arrangements
3
3
l
3
l
General
2
2
l
2
l
2
l
Direct
1
0
No requirement for prior examination by a dentist
1
1
0
1
0
0
0