Michigan Office of Administrative Hearings and Rules  
611 W. Ottawa Street  
Lansing, MI 48909  
Phone: 517-335-8658 Fax: 517-335-9512  
AGENCY REPORT TO THE  
JOINT COMMITEE ON ADMNINISTRATIVE RULES (JCAR)  
1. Agency Information  
Agency name:  
Licensing and Regulatory Affairs  
Division/Bureau/Office:  
Bureau of Professional Licensing  
Name of person completing this form:  
Andria Ditschman  
Phone number of person completing this form:  
517-290-3361  
E-mail of person completing this form:  
DitschmanA@michigan.gov  
Name of Department Regulatory Affairs Officer reviewing this form:  
Elizabeth Arasim  
2. Rule Set Information  
MOAHR assigned rule set number:  
2020-27 LR  
Title of proposed rule set:  
Dentistry - General Rules  
3. Purpose for the proposed rules and background:  
The purpose of the Dentistry – General Rules is to regulate the prelicensure education, licensure,  
licensure renewal, relicensure, and continuing education, for dentists, dental therapists, registered  
dental assistants, and registered dental hygienists; delegation and assignment of dental procedures;  
dental specialties; anesthesia; intravenous conscious sedation, and enteral sedation training  
requirements; and, requirements for disposal of dental amalgam. The proposed rules will add rules  
pursuant to Public Act 463 of 2018, which requires the Department in consultation with the Board to  
promulgate any rules the Department considers necessary to implement sections 16651 to 16658 of  
the Public Health Code, MCL 333.16651 to 333.16658.  
4. Summary of proposed rules:  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 2  
The proposed rules will update definitions; require dental professionals to identify themselves to the  
patient at the inception of care and provide a written consent for treatment; delete violations; clarify  
licensing requirements; add licensing, practice requirements, and educational standards for dental  
therapists; allow an application to the Board for dental assistant examinations that meet certain  
requirements; modify the relicensure requirements and place them in tables; update educational  
standards; modify delegation, supervision , and assignment of dental assistants, registered dental  
assistants, and registered dental hygienists and place in a table; clarify specialty licenses; modify  
advertising of specialty licenses; update the anesthesia and sedation requirements; add 1 hour of  
continuing education in ethics and jurisprudence for all dental professions; add 1 hour of continuing  
education in infection control for dental assistants and hygienists; modify continuing education  
requirements and place them in tables; and update dental amalgam requirements.  
5. List names of newspapers in which the notice of public hearing was published and  
publication dates:  
Marquette Mining Journal – September 4, 2020; Flint Journal – September 6, 2020; Grand Rapids  
Press – September 6, 2020  
6. Date of publication of rules and notice of public hearing in Michigan Register:  
9/15/2020  
7. Date, time, and location of public hearing:  
9/18/2020 01:00 PM at This meeting will be held virtually via Zoom pursuant to Executive Order  
2020-132. , Web Link: https://zoom.us/j/91037626554?  
pwd=U2hCenFlWnhJZEV1dmV4bmZlSVUzUT09; Password: 658403; Phone number: 877-336-  
1831; Conference Code for audio connection: 486917  
8. Provide the link the agency used to post the regulatory impact statement and cost-benefit  
analysis on its website:  
https://ARS.apps.lara.state.mi.us/Transaction/RFRTransaction?TransactionID=155  
9. List of the name and title of agency representative(s) attending public hearing:  
Kerry Przybylo, Manager; Andria Ditschman, Senior Policy Analyst; Kimberly Catlin, Board  
Support; and LeAnn Payne, Board Support.  
10. Persons submitting comments of support:  
Amy Zaagman, Executive Director, Maternal & Child Health submitted comments in support.  
11. Persons submitting comments of opposition:  
Ona Erdt, Michigan Dental Assistants Association (MDAA), Chris Farrell, Michigan Department of  
Health and Human Services (MDHHS), Winie Furnari, American Academy of Dental Hygiene  
(AADH), Rob Kent, American Association of Orthodontists (AAO), Stephen Meraw, Michigan  
Dental Association (MDA), and Sandy Sutton, Greater Detroit Dental Hygienists submitted  
comments and suggested changes to the proposed rule set.  
12. Identify any changes made to the proposed rules based on comments received during the  
public comment period:  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 3  
Name &  
Comments made at Written  
Agency Rationale Rule number  
Organization public hearing  
Comments  
for change  
& citation  
changed  
1
Sandy Sutton  
(Sutton)  
Remove the word  
“the” and, and replace  
with “a”, to read:  
“Allied dental  
The provision as R 338.11101  
written shows  
unnecessary  
(1)(a)  
possessive  
personnel” means the  
supporting team who  
receives appropriate  
delegation from a  
dentist or dental  
therapist to participate  
in dental treatment.”  
The provision as  
ownership over  
the allied dental  
personnel and  
many practices  
have more than  
one dentist.  
written shows  
unnecessary  
possessive ownership  
over the allied dental  
personnel and many  
practices have more  
than one dentist.  
2
Farrell/MDHH  
S
Add at least 1  
hour of infection with the comment (iii)  
The Board agrees 338.11263(e)  
control to the  
continuing  
education (CE)  
to add infection  
control to the CE  
requirements for  
requirements for relicensure for  
relicensure for  
dentists.  
dentists similar to  
the infection  
control CE  
requirements for  
other dental  
professionals.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 4  
3
Erdt/MDAA  
Change to “ethics and  
The Board agrees 338.11263(e)  
to require dental (ii)  
professionals to  
have CE in the  
“delegation of  
duties to allied  
dental personnel”  
in addition to  
ethics and  
jurisprudence with  
inclusion of delegation  
of duties to dental  
auxiliaries.” MDAA  
has a concern over the  
amount of duties  
assigned by dentists to  
dental auxiliaries that  
are not within their  
scope of practice. All  
dentists should  
jurisprudence.  
understand the scope  
of practice for dental  
assistants, RDAs, and  
RDHs, and dental  
therapists.  
4
Erdt/MDAA  
Change to “ethics and  
jurisprudence with  
inclusion of delegation  
of duties to dental  
auxiliaries.” MDAA  
has a concern as dental  
hygienists and dental  
assistants perform  
duties illegally.  
The Board to add 338.11267(e)  
“delegation of  
(ii)  
duties to allied  
dental personnel.”  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 5  
5
Meraw/MDA  
The MDA  
recommends  
The Board agrees 338.11401(e)  
with the comment  
replacing “RDA to replace “RDA  
or RDH” with  
“allied dental  
personnel.”  
or RDH” with  
“allied dental  
personnel.”  
However, to  
differentiate which  
allied dental  
personnel are  
included in the  
second sentence of  
the definition the  
following  
language is  
recommended: “A  
patient of record  
includes a patient  
getting  
radiographic  
images by allied  
dental personnel  
with training  
pursuant to R  
338.11411(a) after  
receiving approval  
from the assigning  
dentist or dental  
therapist.”  
6
Erdt/MDAA  
Remove. This is a duty  
for dental assistants,  
RDAs, RDSs and it  
would be compared to  
a second pair of hands  
as opposed to a duty.  
It is not in the Public  
Health Code, so it can  
be removed.  
(b) Agrees with  
the comment to  
delete (b) as is a  
“second pair of  
hands duty” that is  
not a delegation of  
an activity.  
338.11411(b)  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 6  
7
Erdt/MDAA  
Remove D for DA.  
This should be under  
assignment to the  
DAs. This is not an  
appropriate duty to  
assign to a non-  
licensed dental  
assistant. No further  
duties should be  
assigned to a non-  
licensed assistants  
until they have been  
named in the Public  
Health Code and are  
required to have CPR  
inclusive education  
like all other dental  
providers. It is not in  
the best interest of the  
public to allow more  
duties. A dental  
Agrees with the  
comment to delete  
the D for DA’s in  
this category. This  
is not an  
appropriate duty to  
assign to a non-  
licensed dental  
assistant. Dental  
assistants that are  
not licensed do not  
have that training  
for these  
338.11411(i)  
procedures.  
assistant is defined as  
a non-licensed person  
who may perform  
basics before each  
procedure. Removing  
brackets and cement  
are pretty involved and  
non-basic and require  
formal education.  
Orthodontic brackets,  
bands, and adhesive  
materials often are  
located sub gingivally  
and the RDA and  
RDH have training in  
that anatomy and soft  
tissue intraoral  
attachments. Dental  
assistants that are not  
licensed do not have  
that training.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 7  
8
Meraw/MDA  
RDHs should be Agrees with  
338.11411(k)  
required to  
comment that  
complete the  
RDHs should have  
training similar to training so an  
RDAs for this  
procedure.  
asterisk will be  
added to the RDHs  
for training and  
“RDH” will be  
added to the  
explanation of * at  
the bottom of the  
table.  
9
Erdt/MDAA  
Add DAs to (o) under  
assignment so can  
apply commonly  
accepted  
medical emergency  
procedures, including  
CPR. Medical  
Agrees with the  
comment to allow  
dental assistants  
(DA) to apply  
commonly  
338.11411(o)  
accepted medical  
emergency  
emergencies are  
procedures for the  
best interest of the  
public.  
unpredictable, and  
they can happen at any  
time, and many offices  
at times merely have  
office personnel who  
are non-licensed on  
the premises. All team  
members should be  
knowledgeable and  
ready to provide  
medical care if  
needed. The ADA  
states that through  
academic and  
continuing education  
should be familiar  
with the prevention,  
diagnosis, and  
management of  
common emergency.  
They should provide  
appropriate training to  
their staff so each  
person knows what to  
do and can act  
promptly.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 8  
10  
Erdt/MDAA  
Remove for registered  
Agrees with the  
comment to delete  
this activity for the  
RDHs as they are  
not trained in this  
activity. Also, the  
term “replacing” is  
not the correct  
338.11411(u)  
dental hygienists.  
RDAs and RDHs can  
cement and glue  
temporaries and RDAs  
can place them. The  
RDA is formally  
trained to make  
temporaries, and it is  
in their clinical exam  
as well. The duty of  
replacing should not  
be provided to the  
RDH as their  
term, it should be  
“fabricate” and the  
word “existing”  
should be deleted  
in order to make  
this provision  
education does not  
provide the training  
nor does their exam  
have a temporary  
clinical component  
like the RDA.  
reflect the actual  
activity in the  
profession.  
11  
12  
Erdt/MDAA  
Meraw/MDA  
Modify “registrations”  
to “restorations.”  
Agrees as this is a 338.11411(aa)  
clerical error.  
Add “direct.”  
Agrees to add  
338.11411(ll)  
“direct” as RDAs  
do have training in  
this activity.  
13  
14  
Meraw/MDA  
Erdt/MDAA  
Modify  
“planning” to  
“planing.”  
Agrees to fix typo 338.11411  
in “planning.” (oo)  
(qq) seems to be a  
Agrees that (qq) is 338.11411  
combination of (s) and  
(z) and is repetitive.  
repetitive and  
should be deleted.  
(qq)  
15  
Erdt/MDAA  
This category is  
Agrees to delete  
(ss) as it is  
repetitive and add  
“preliminary  
examination  
including” to both  
(q) and (y).  
338.11411(ss)  
repetitive. What is the  
different between (ss)  
and (q) and (y). What  
is the implication of  
“preliminary  
examining” that has  
been added to the  
beginning of (ss).  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 9  
16  
Erdt/MDAA  
(uu) and (v) – sedative  
restoration and  
Replace” intra-  
coronal” with  
338.11411  
(uu)  
sedative dressing  
make this confusing.  
“surgical” in (uu)  
to reduce the  
confusion between  
(uu) and (v) and  
no changes to (v).  
17  
18  
Meraw/MDA  
Meraw/MDA  
Allow RDAs by Allow RDAs to do 338.11411  
assignment.  
activity by  
(uu)  
assignment.  
Add DAs by  
Agrees to add DAs 338.11411(zz)  
direct and modify by direct and  
RDAs and RDHs modify RDAs and  
to general. Also RDHs to general.  
modify  
Also modify  
“impressions” to “impressions” to  
scans” and add  
“or intraoral  
appliances.”  
scans” and add “or  
intraoral  
appliances.”  
19  
Meraw/MDA  
Add (7): “If the The Board agrees 338.11417(7)  
patient requires with the comment  
treatment that  
exceeds the  
to require a  
referral to be to a  
dental therapist’s health professional  
capabilities or the within a  
scope of practice reasonable  
as a dental  
therapist, a  
referral to an  
appropriate  
distance subject to  
the Code  
provisions and the  
written practice  
provider within a agreement.  
reasonable  
distance must be  
given to the  
patient.”  
Patient safety is  
also a top priority  
for the MDA.  
Once dental  
therapists begin  
to treat Michigan  
patients, it will be  
imperative for  
dental therapists  
and the patients  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 10  
they treat to have  
reasonable access  
to a dentist. As  
currently written,  
the rules allow a  
dental therapist to  
treat a patient  
without the  
patient being first  
seen by a dentist.  
If the patient  
requires treatment  
that goes beyond  
the capabilities of  
the dental  
therapist or if  
there is a dental  
emergency, for  
the patient’s  
safety, the patient  
should have  
assurance that an  
appropriate  
provider is  
available within a  
reasonable  
distance. This is  
why dental  
therapists practice  
agreements,  
outlined in Rule  
338.11417,  
should include a  
referral to an  
appropriate  
provider within a  
reasonable  
distance, similar  
to requirements  
in the mobile  
dentistry law.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 11  
20  
Meraw/MDA  
Add (8): “Dental The Board agrees 338.11417(8)  
therapists have with the comment  
the same level of that a dental  
supervision therapist’s  
requirements over authority to  
allied dental  
personnel as  
delegate to allied  
dental personnel  
dentists have as should not exceed  
stated in  
a dentist’s  
338.11411.”  
authority to  
Along the lines of delegate to allied  
patient safety, it is dental personnel  
important to  
define the  
subject to the  
Code and the  
procedures dental dental therapist’s  
therapists can written practice  
delegate to dental agreement.  
assistants,  
registered dental  
assistants, and  
registered dental  
hygienists.  
Current law  
allows dental  
therapists to treat  
patients without a  
dentist present,  
but the rules do  
not limit  
supervision levels  
and what a dental  
therapist can  
delegate to allied  
dental personnel.  
Therefore, the  
MDA  
recommends that  
dental therapists  
have the same  
limitations as  
dentists in regard  
to delegating  
duties and  
supervising allied  
dental personnel.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 12  
As proposed, The Board agrees 338.11601(2)  
21  
Meraw/MDA  
Rule 338.11601 with the comment (a)(i)  
(2)(a)(i), strikes to change JCNDE  
“Joint back to the “Joint  
Commission” and Commission.”  
replaces it with  
“JCNDE,” which  
is incorrect.  
JCNDE does not  
accredit hospitals,  
the Joint  
Commission  
should remain the  
reference under  
this subpart.  
22  
Erdt/MDAA  
Change to “ethics and  
jurisprudence with  
inclusion of delegation  
of duties to dental  
auxiliaries.” MDAA  
has a concern over the  
amount of duties  
assigned by dentists to  
dental auxiliaries that  
are not within their  
scope of practice. All  
dentists should  
The Board agrees 338.11701  
to require dental (12)(b)  
professionals to  
have CE in the  
“delegation of  
duties to allied  
dental personnel”  
in addition to  
ethics and  
jurisprudence.  
understand the scope  
of practice for dental  
assistants, RDAs, and  
RDHs, and dental  
therapists.  
23  
Farrell/MDHH  
S
Add at least 1  
hour of infection with the comment (12)(d)  
The Board agrees 338.11701  
control to the  
continuing  
education (CE)  
to add infection  
control to the CE  
requirements for  
requirements for dentists similar to  
dentists.  
the infection  
control CE  
requirements for  
other dental  
professionals.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 13  
24  
Sutton  
All of the forms of  
meeting the CE  
requirements, such as  
online, electronic  
The Board agrees 338.11701  
that clarification is (12)(e)  
needed to  
differentiate  
media, video, internet,  
web-based seminar …  
are not defined.  
According to the AGD  
the only official  
between the online  
and live  
acceptable CE  
requirements of  
“online” versus  
“live” wherever  
these terms are  
used in the rules.  
However, as the  
Board desires to  
be consistent in  
the rules,  
delivery method is  
lecture, self-  
instruction, and hands  
on class participation.  
The location can be  
online, a live webinar,  
or a live online lecture.  
clarifying  
language is  
necessary to  
sections that limit  
and require online  
or live CE.  
Therefore, in  
section 12(e) and  
similar rules  
“synchronous,  
live” is  
recommended and  
in section 12(f)  
and similar rules,  
“asynchronously,  
noninteractive” is  
recommended.  
The Board agrees 338.11704(7)  
to add “delegation (e)  
of duties to allied  
dental personnel.”  
As the CE  
requirements are  
repeated in the  
relicensure rules  
the change must  
also be added to R  
338.11267(e)(ii)  
above.  
25  
Erdt/MDAA  
Change to “ethics and  
jurisprudence with  
inclusion of delegation  
of duties to dental  
auxiliaries.” MDAA  
has a concern as dental  
hygienists and dental  
assistants perform  
duties that have not  
been legally delegated  
to them.  
MCL 24.242 and 24.245  
Agency Report to JCAR-Page 14  
26  
Furnari/AADH  
Add the  
The Board agrees 338.11704a  
American  
Academy of  
to make both  
suggested changes  
(1)(a)  
Dental Hygiene to section 1(a).  
(AAADH) as it is  
an organization  
that approves  
continuing  
education courses  
for dental  
hygienists. We  
are not a sponsor  
nor offer courses,  
we approve  
course content  
using standards  
of quality  
education.  
Modify the  
spelling of  
Hygienist to  
Hygienists’ in  
American Dental  
Hygienists’  
Association.  
27  
Meraw/MDA  
References to the All references to 338.11704a  
ADA “CERP”  
should be  
the CERP  
organization shall  
(1)(a)  
replaced with the be “Commission  
“Commission on on Continuing  
Continuing  
Education  
Provider  
Education  
Provider  
Recognition  
American Dental  
Recognition.”  
The Commission Association  
on Continuing  
Education  
Continuing  
Education  
Provider  
Recognition is  
Recognition  
Program (ADA  
now responsible CERP).”  
for approving CE  
providers.  
13.Date report completed:  
12/3/2020  
MCL 24.242 and 24.245  
;