Part 4B: Michigan is on the forefront of licensing dental therapists. Other states that regulate dental therapy include
Alaska, Arizona, Connecticut, Maine, Nevada, New Mexico, and Vermont. Similar to the proposed rules, Minnesota
requires a dental therapist to practice under the supervision of a dentist who is licensed in that state, and supervision
does not require the supervising dentist to be on site.
Part 5: Illinois and Minnesota have systems for specialty licensure similar to Michigan. Each state either issues a
certification or license to applicants who have passed a specialty board examination. The specialties recognized
include those recognized by the American Dental Association (ADA). All of the states in the Great Lakes region,
except Pennsylvania, allow licensure for an applicant who is currently licensed in another state and has experience.
Part 6: Michigan requires a dentist to obtain training and use appropriate facilities but does not require the dentist to
apply for a permit. All of the states in the Great Lakes region regulate and require a permit to use general anesthesia.
Only Illinois, Minnesota, and Pennsylvania regulate the use of nitrous oxide inhalation analgesia. Only Minnesota,
Ohio, and Pennsylvania require an office inspection to use general anesthesia and conscious sedation. The proposed
rules regulate a hygienist’s administration of anesthesia through training, examination, and certification. In Michigan
the monitoring and assisting in the administration of nitrous oxide by a registered dental assistant is regulated through
education. In Pennsylvania a hygienist is not permitted to administer nitrous oxide. In Illinois, Minnesota, and Ohio,
although the use is regulated, the hygienist does not need a permit.
Part 7: The amount of CE hours required for dentists per year varies from 10 to 25. The amount of CE hours required
for hygienists per year varies from 6 to13.
Part 8: In other states that have amalgam regulations, the regulations are not handled through dentistry regulations.
A. If the rules exceed standards in those states, please explain why and specify the costs and benefits arising out of
Overall, the standards in the proposed rules do not exceed those of the other states in the Great Lakes region.
Although other states do not have a requirement that a dental professional identify themselves and provide a written
consent for treatment to the patient, the proposed rules include this requirement because of the potential expected
confusion in dental offices when dental therapists are licensed in this state. Very few states license dental therapists.
Michigan is one of the few states that licenses dental therapists. The proposed dental therapy rules are required by the
Code to implement licensure of dental therapists.
3. Identify any laws, rules, and other legal requirements that may duplicate, overlap, or conflict with the proposed
The Amalgam Separator Act, 2008 PA 503, (2008), requires dental offices that discharge dental amalgam into a
wastewater system, to install a dental amalgam system to remove the dental amalgam and mercury before the waste is
discharged. Section 16631 of the Code, MCL 333.16631, requires the Department, in consultation with the DEQ,
renamed the EGLE, to promulgate rules regarding best management practices for dental amalgam collection, disposal,
and recycling, and the retention and inspection of dental office records. The rules were effective in 2012, and require
dentists, who discharge dental amalgam in a dental office, to remove the amalgam with an amalgam separator. The
rules also require all dentists, who use, remove, or discharge dental amalgam, except those exempted from the rule, to
comply with R 338.11815, which regulates the collection, disposal and recycling of dental amalgam. The EPA enacted
requirements on the handling of mercury in 40 CFR Part 441 (2016), for a dental discharger, which is defined as “a
facility where the practice of dentistry is performed, including, but not limited to, institutions, permanent or temporary
offices, clinics, home offices, and facilities owned and operated by federal, state or local governments, that discharges
wastewater to a publicly owned treatment works.” The date for compliance with the EPA’s amalgam requirements for
existing dental offices is July 14, 2020, and for new dental offices, within 90 days of taking ownership. The federal
rules and the proposed rules are consistent with each other except the federal rules exempt dentists that are
prosthodontists, while 2008 PA 503 does not include this exemption.
There are no other laws, rules, or other legal requirements that may duplicate, overlap, or conflict with these proposed