September 17, 2020

Attention: Policy Analyst

SUSTAINING MEMBERS

Department of Licensing and Regulatory Affairs

Bureau of Professional Licensing

Boards and Committees Section

P.O. Box 30670

Beaumont Children’s Hospital

Children’s Hospital of

Michigan/Detroit Medical Center

Henry Ford Health System

Hurley Medical Center

Lansing, MI 48909-8170

Email: BPL_BoardSupport@michigan.gov

University of Michigan C.S. Mott

Children’s Hospital and Von

Voigtlander Women’s Hospital

RE:

Rule set 2020-27 LR

CONTRIBUTING MEMBERS

Administrative Rules for Dentistry – General Rules

Michigan Section, American

Congress of Obstetricians and

Gynecologists

Thank you for the opportunity to present comments to Rule set 2020-27 LR. The

Michigan Council for Maternal and Child Health represents a collective advocacy

voice working on public policy to improve maternal and child health outcomes.

Mott Children’s Health Center

School-Community Health

Alliance of Michigan

We partnered with other organizations concerned about access to oral health care

for underserved populations to form the MI Dental Access coalition and advocated

for Public Act 463 of 2018 to license dental therapists.

PARTNERING MEMBERS

Calhoun County Public Health

Department

Health Department of Northwest

Michigan

MCMCH is in support of the rules as presented, specifically the provisions that apply

to the licensing of dental therapists. We believe they are substantially in keeping

with the legislative intent of the statute and, if promulgated, will create a regulatory

structure that helps ensure only qualified individuals educated at institutions that

meet the Commission on Dental Accreditation standards can be licensed as dental

therapists in this state. The rules in their current form also do not create any

unnecessary burdens for dental therapists to enter the profession or practice within

their scope of practice as defined in statute.

Inter-Tribal Council of Michigan

Michigan Association for Infant

Mental Health

Michigan Breastfeeding Network

Michigan School Health

Coordinators’ Association

Michigan State Medical Society

Washtenaw County Public

Health

We would like to thank the department and staff for the opportunity to engage in

a rules workgroup along with other stakeholders. The process allowed for

collaborative input and was an important opportunity to share knowledge about

how dental therapists can be integrated into oral health care delivery with other

professionals licensed under the Board of Dentistry in Michigan.

GENERAL MEMBERS

Maternal-Newborn Nurse

Professionals of Southeastern

Michigan

Michigan Association of School

Nurses

Sincerely,

Michigan Chapter, National

Association of Pediatric

Nurse Practitioners

Nurse Administrators Forum

Amy U. Zaagman

Executive Director

EXECUTIVE DIRECTOR

Amy Zaagman

azaagman@mcmch.org

110 W. Lenawee Street / Lansing / MI 48933 517.482.5807 mcmch.org

S

TATE OF MICHIGAN

DEPARTMENT OF HEALTH AND HUMAN SERVICES

L

GRETCHEN WHITMER

GOVERNOR

ROBERT GORDON

DIRECTOR

ANSING

September 18, 2020

LARA Bureau of Professional Licensing and Board of Dentistry members:

The Michigan Department of Health and Human Services, Oral Health Program is

pleased to take the opportunity to comment on the proposed dentistry general

rules.

Oral Health Program (OHP) staff provide the following comments on the proposed

rules:

Rule 1101, (1) page 2, defines Allied dental personnel. The new definition states

that “allied dental personnel means the dentist’s supporting team who receives

appropriate delegation from the dentist or dental therapist to participate in

dental treatment.” The OHP would like to know the reference and the source for

this definition since this appears to be new terminology? We would like to

propose the following revision: “allied dental personnel means the support staff

in a dental office or clinic who receive appropriate delegation from a dentist or

dental therapist to participate in dental treatment.” Currently, dental offices

have multiple dentists and personnel that work together. Personnel may not be

assigned to specific team members.

Rule 1101, (1)(h), page 2, defines the term dental therapist based on the PA 463

of 2018 that became law in 2019. Language from the law is incorporated

throughout the proposed rules. The rules include language on licensure,

education, testing and accreditation. The OHP supports the language as

recommended for dental therapists throughout the proposed rules.

Under R338.11263, Rule 1263 Relicensure requirements; dentists, page 23-25.

Under 1263, (e), there is no mention of infection control continuing education

requirements. COVID-19 has brought many changes to dental practices in

infection control practices, this should also be a requirement for dentists to know

the current guidelines. The OHP recommends to include the same language for

dentists as already identified for continuing education with dental therapists,

333 SOUTH GRAND AVENUE

• PO BOX 30195 • LANSING, MICHIGAN 48909

www.michigan.gov/mdhhs • 517-373-3740

dental hygienists and dental assistants in the proposed rules: Complete at least

one hour in infection control training, which must include sterilization of hand

pieces, personal protective equipment, and education on the Centers of Disease

Control and Prevention’s infection control guidelines.

Under Part 7, Continuing Education, R338.11701, Rule 1701,(12) there is no

mention of infection control continuing education requirements. COVID-19 has

brought many changes to dental practices in infection control practices, this

should also be a requirement for dentists to know the current guidelines and have

be part of their continuing education requirements. This provision should be for

both active license dentists and retired-volunteer dentists. The OHP recommends

to include the same language for dentists as already identified for continuing

education with dental therapists, dental hygienists and dental assistants in the

proposed rules: Complete at least one hour in infection control, which must

include sterilization of hand pieces, personal protective equipment, and the

Centers of Disease Control and Prevention’s infection control guidelines.

Also, the OHP recommends including the Organization for Safety, Asepsis and

Prevention (OSAP) as an additional organization for infection control guidance

could be included in the rules for all dentists, dental hygienists, dental assistants,

and dental therapists.

Under the licensure and education requirements for dentists and dental

therapists, there is mention of opioid training. In addition, the OHP recommends

additional requirements for licensure and education requirements for dentists

and dental therapists on antibiotic stewardship. There are many antibiotic

prescriptions written by dental providers that may be unnecessary. Including

requirements for antibiotic stewardship can promote better understanding and

decrease unnecessary prescriptions for antibiotics.

Under Rule 1704a(1) Acceptable Continuing Education activities table, page 73

(m), it mentions providing volunteer patient or supportive dental services in this

state at a board-approved program. The first bullet states: The program is a

public or nonprofit entity, program, or event, or a school or a nursing home.

The OHP would like further clarification on this designation.

1) Does school mean K-12 only.

2) Does this include public, private and charter schools.

3) Can Head Start programs, preschools or daycare programs qualify as a

school.

4) If they are a non-profit, do they qualify.

5) If a daycare or preschool is not a non-profit, can they qualify as a school.

6) What is the definition of nursing home.

7) Does it have to be a skilled facility.

8) Can it be a senior housing complex.

9) Assisted living facility. There is now a continuum of care for seniors based

on health care needs.

10) What about agencies that serve older adults like Area Agencies on Aging.

They can provide events and other activities that require oral health

professionals.

The OHP recommends further definition and explanation of the programs that

can be state board approved.

The OHP would like to thank the LARA and the Board of Dentistry for granting the

opportunity to comment on the proposed rules. If there are any questions and

concerns, please contact Christine Farrell, Oral Health Program director at

farrellc@michigan.gov . Thank you.

Michigan Department of Licensing and Regulatory Affairs:

Policy Analyst

Department of Licensing and Regulatory Affairs

Bureau of Professional Licensing

Boards and Committee Section

VIA E-MAIL: ditschmana@michigan.gov

Dear Michigan Department of Licensing and Regulatory Affairs:

This letter is sent on behalf of the American Association of Orthodontists

("AAO") to provide comments on the proposed rule changes to Rule Set

2020-27 LR, Administrative Rules for Dentistry- General Rules, as

published in the September 15^th, 2020 issue of the Michigan Register.

We appreciate the opportunity to provide further feedback.

The AAO supports regulations that require those who are advertising as

"specialists" to have successfully completed a post-doctoral program in a

program is accredited by an accreditation agency that is recognized by the

U.S. Department of Education ( i.e. CODA). CODA is the only nationally

recognized accrediting body for dentistry and the related dental fields,

receiving its accreditation authority from the acceptance of all stakeholders

within the dental community and recognition by the United States Department

of Education. The AAO is opposed to dentists with less education and training

being able to advertise on the same level or in the same manner or with

similar words used to describe those who have graduated from accredited

programs that receive accreditation from an agency recognized by the U.S

Department of Education (U.S. DOE), as the AAO believes it is not in the best

interest of patients' health and safety.

An accreditation standard backed by the U.S. DOE best assures Michigan

citizens that an individual who truthfully holds himself or herself out as a

specialist has met high standards for education and training. Allowing a

dentist to advertise as a "specialist" without completing a multi-year

accredited program backed by the U.S. DOE, risks diluting Michigan's

"specialty" laws and allowing certain providers, who do not have years of

supervised clinical and didactic training and/or who have not satisfied

extensive criterion, to advertise on par with those providers who have long

term, comprehensive education and training through U.S. DOE accredited programs. Such dilution

threatens the health and safety of Michigan patients by obscuring important distinctions between dental

professionals as well as their respective educational and training backgrounds. As such, the AAO

supports the proposed rule R 338.11501 Specialties (2) that requires that, “Each branch of a dental

specialist that is licensed by the board is defined in the rules, and by the standards set forth by CODA

under R 338.11301.”

Additionally, the AAO proposes adding language to Part 4, Delegation and Supervision, R 338.11401

Definitions, (e) “Patient of Record.” The AAO supports language to clarify that performing an in-person

examination prior to dental, and especially orthodontic, treatment because it would allow the treating

dentist to more fully understand what is going on beneath the gums (impacted teeth, bone loss, etc.),

seek to avoid complications, and in the case of orthodontists, determine if patients are suitable

candidates for orthodontic treatment. The AAO believes there are certain diagnoses and evaluations that

can only be performed in-person or are best performed in-person (x-rays, etc.) during an examination,

and the AAO believes that dental treatment, especially the movement of teeth via orthodontic treatment,

should not be undertaken without sufficient diagnostic information obtained during such an

examination. The AAO’s proposed revisions are in red.

(e) “Patient of record” means a patient who has been examined and diagnosed by a dentist in-

person and whose treatment has been planned by a dentist or a patient who has been examined,

evaluated, assessed, and treatment planned by a dental therapist to the extent authorized by the

supervising dentist. A patient of record includes a patient getting radiographic images by an RDA

or RDH after receiving approval from the assigning dentist.

Thank you again for the opportunity to provide feedback. If you or your staff have any questions, please

contact the AAO’s Government Affairs Specialist, Gianna Hartwig, at ghartwig@aaortho.org or 314-292-6527.

Sincerely,

Rob Kent

Vice President of Advocacy and General Counsel

American Association of Orthodontists

September 18, 2020

Andria Ditschman

Bureau of Professional Licensing

Dept. of Licensing and Regulatory Affairs

611 W Ottawa St,

Lansing, MI 48933

Dear Ms. Ditschman and members of the Board of Dentistry,

On behalf of the Michigan Dental Association’s (MDA) members, I am respectfully recommending the revisions

outlined below to the pending rule set 2019-27 LR, the Dentistry General Rules. The recommendations outlined

below are based on the MDAs commitment to patient safety and increasing access to dental care.

One way to increase access to care is to expand the scope of practice of registered dental assistants (RDA) to better

align with their training. For years, Michigan has faced a shortage of RDAs. This shortage has limited the efficiency of

treating patients for both private practice dentists and public health clinics. Instead of focusing their time on

comprehensive care, dentists are being forced to spend time on procedures he or she could be delegating to an RDA.

By updating the scope of practice of RDAs, the RDA profession will become more intriguing and lucrative for

prospective students, in addition to becoming an even more valuable member to the dental team. Therefore, the

MDA recommends the revisions in “Table 1 – Delegated and Assigned Dental Procedures for Allied Dental Personnel”

under Rule 338.11411. Attached is a copy of this table containing the MDA’s recommended revisions.

In addition to expanding the scope of practice of RDAs, it is important to avoid creating barriers for RDAs to obtain a

license. Currently, the board of dentistry conducts an examination at a modest cost for individuals seeking licensure

as an RDA. The MDA requests maintaining this method of examination, as opposed to the proposed rules which allow

for the board to contract the exam to a third party. Based on evidence from other states, third party administered

exams may cost more than twice the current cost. This will create a financial barrier for people who are interested in

becoming an RDA in Michigan. The MDA recommends the following language for Rule 338.11239(1):

Rule 1239. (1) The board shall conduct a written and clinical examination for individuals seeking licensure

as a registered dental assistant.

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 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.

The MDA requests adding the following subsection to Rule 338.11417:

(7) If the patient requires treatment that exceeds the dental therapist’s capabilities or the scope of practice

as a dental therapist, a referral to an appropriate provider within a reasonable distance must be given to

the patient.

3657 OKEMOS ROAD • SUITE 200 • OKEMOS MI 48864-3927 • 517.372.9070 • FAX: 517.372.0008 • MICHIGANDENTAL.ORG

Andria Ditschman

September 18, 2020

Page 2

Along the lines of patient safety, it is important to define the procedures dental therapists can delegate to dental

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 an allied dental personnel. Therefore, the MDA recommends that dental therapists have the same limitations as

dentists in regards to delegating duties and supervising allied dental personnel. This can be achieved by adding the

following subsection under Rule 338.11417:

(8) Dental therapists have the same level of supervision requirements over allied dental personnel as dentists

have as stated in 338.11411.

Regarding supervision requirements and the delegation of duties rules, as you know, the proposed rules contain

numerous changes. The MDA carefully reviewed the changes in the proposed chart, “Table 1 - Delegated and Assigned

Dental Procedures for Allied Dental Personnel” and is recommending a number of revisions. These recommendations

are also outlined in the attached chart. I would like to elaborate on one of the recommendations in the attached chart,

line “zz” - digital impressions. The MDA strongly believes it is critical for patient safety that this procedure be referred to

as “digital scan” and apply to intraoral appliances. In addition, the MDA is recommending revising the supervision levels

as outlined in the attached chart. This recommendation is based on the proliferation of do-it-yourself diagnostic tools

such as digital scanning done via retail stores. These types of retail stores are the practice of dentistry and should be

considered as such by being included in the “Delegated and Assigned Dental Procedures for Allied Dental Personnel” and

designated supervision requirements.

Another change in the proposed rules is the definition of “patient of record.” Under Rule 338.11401(e) in the proposed

rules, the definition of “patient of record” includes an additional sentence stating, “A patient of record includes a patient

getting radiographic images by an RDA or RDH after receiving approval from the assigning dentist.” The MDA

recommends replacing “RDA or RDH” with “allied dental personnel”:

(e) “Patient of record” means a patient who has been examined and diagnosed by a dentist and whose

treatment has been planned by a dentist or a patient who has been examined, evaluated, assessed, and

treatment planned by a dental therapist to the extent authorized by the supervising dentist. A patient of

record includes a patient getting radiographic images by an RDA or RDH allied dental personnel after receiving

approval from the assigning dentist.

The MDA also recommends including the Joint Commission on National Dental Examination’s (JCNDE's) Dental Licensure

Objective Structured Clinical Examination (DLOSCE) under Rule 338.11201 as an acceptable dental simulated clinical

written examination. Attached to this letter are two documents, “DLOSCE FAQ” and “DLOSCE Quick Facts,” containing

detailed information about the DLOSCE.

Finally, the MDA recommends two technical changes to the rules:



As proposed, Rule 338.11601(2)(a)(i), strikes “Joint Commission” and replaces it with “JCNDE,” which is

incorrect. JCNDE does not accredit hospitals, the Joint Commission should remain the reference under this

subpart.



References to the ADA “CERP” should be replaced with the “Commission on Continuing Education Provider

Recognition.” The Commission on Continuing Education Provider Recognition is now responsible for approving

CE providers.

Thank you for taking the time to review these requests. Your service to the state of Michigan and the profession of

dentistry is much appreciated. If you have any questions about these requests, please contact Bill Sullivan, MDA vice

president of advocacy and professional relations, at 517-346-9405.

Andria Ditschman

September 18, 2020

Page 3

Sincerely,

Dr. Stephen Meraw

MDA President

43

MDA Recommendations: Table 1 - Delegated and Assigned Dental Procedures for

Allied Dental Personnel

DA RDA RDH

Procedure

Operating of dental radiographic equipment. A DA must have successfully completed a

course in dental radiography which is substantially equivalent to a course taught in a

program approved by the board pursuant to R 338.11302, R 338.11303, or R 338.11307. A

dentist may delegate necessary radiographs for a new patient to an RDA or RDH.

Holding the matrix for anterior resin restorations.

Instructing in the use and care of dental appliances.

Taking impressions for study and opposing models.

Applying nonprescription topical anesthetic solution.

Trial sizing of orthodontic bands.

Placing, removing and replacing orthodontic elastic or wire separators, arch wires, elastics,

and ligatures.

Placing and removing orthodontic separators.

Placing and removing orthodontic elastics, ligatures and arch wires.

Dispensing orthodontic aligners.

Removing orthodontic bands, brackets and adhesives with non-tissue cutting instruments.

Polishing specific teeth with a slow-speed rotary hand piece immediately before a procedure

that would require acid etching before placement of sealants, resin-bonded orthodontic

appliances, and direct restorations.

a.

G

A

b.

c.

d.

e.

f.

G

D

AG

A

AG

A

AG

A

AG

A

Commented [JK1]: This procedure cannot be done

without a dentist present in the office performing the

procedure.

Commented [JK2]: "Nonprescription" is rare and should

be stricken. This duty should be combined with “tt.”

Commented [JK3]: Supervision for this procedure is

currently General for RDAs and RDHs and should remain

General for both in case problems arise.

g.

g(a).

g(b).

h.

i.

j.

D

A

D

A

D

A

Commented [JK4]: This procedure is currently broken

down into two procedures: 1. orthodontic separators and 2.

orthodontic elastics, ligatures and arch wires. The current

supervision for these procedures is Direct for all personnel.

The procedure should remain broken down into two

procedures and supervision should be as presented in “g(a)”

and “g(b)”.

k.

l.

G*

D

G*

D

Etching and placing adhesives before placement of orthodontic brackets and attachment for

aligners.

Cementing orthodontic bands or initial placement of orthodontic brackets and attachments

for aligners.

Commented [JK5]: If RDHs are allowed to perform this

procedure, RDHs should also be required to successfully

complete the training under *. Currently, RDHs are not

allowed to perform this procedure.

m.

A

Removing excess cement from supragingival surfaces of a tooth with a non-tissue cutting

instrument.

n.

o.

p.

q.

r.

s.

A

Providing nutritional counseling for oral health and maintenance.

Applying commonly accepted medical emergency procedures.

Inspecting and charting the oral cavity using a mouth mirror and radiographs.

Classifying occlusion.

Placing and removing dental dam.

Applying anticariogenic agents including, but not limited to, sealants, fluoride varnish, and

D

Formatted: Font: 12 pt, Bold

Formatted: Font: Bold

Formatted: Font: 12 pt, Bold

44

fluoride applications.

t.

A

Polishing & contouring of sealants with a slow-speed rotary hand piece immediately

following a procedure for occlusal adjustment.

Replacing existing temporary restorations and existing temporary crowns and temporary

bridges.

Placing and removing a nonmetallic temporary or sedative restoration with non-tissue

cutting instruments.

u.

v.

w.

x.

y.

z.

aa.

A

G*

A

Sizing of temporary crowns and bands.

Temporarily cementing and removing temporary crowns and bands.

Performing pulp vitality testing.

Applying desensitizing agents.

Taking impressions for intraoral appliances including bite restorations registration.

Commented [JK6]: This procedure should be combined

with the current procedure that includes, “Taking

impressions for study models, orthodontic appliances, mouth

guards, bite splints, and whitening trays.”

bb.

cc.

dd.

ee.

ff.

gg.

hh.

ii.

G*

DG*

G*

A

D

G

Placing and removing matrices and wedges.

Applying cavity liners and bases.

Drying endodontic canals with absorbent points.

Placing and removing nonepinephrine retraction cords or materials.

Placing and removing post extraction and periodontal dressings.

Removing sutures.

A

G

Applying and dispensing in-office bleaching whitening products.

Prior to cementation by the dentist, adjust and polish contacts and occlusion of indirect

restorations. After cementation remove excess cement from around restorations.

Placing, condensing, and carving amalgam, composite, and glass ionomer restorations.

Placing Class I resin bonded restorations, occlusal adjustment, finishing and polishing with

non-tissue cutting slow-speed rotary hand pieces.

jj.

kk.

D**

ll.

D

Taking final impressions for direct and indirect restorations and prosthesis including bite

registration.

mm.

D

Assisting and monitoring the administration of nitrous oxide analgesia by a dentist or the

RDH. A dentist shall assign these procedures only if the RDA or RDH has successfully

completed an approved course that meets the requirements of section 16611(7) of the code,

MCL 333.16611, with a minimum of 5 hours of didactic instruction. The levels must be

preset by the dentist or RDH and shall not be adjusted by the RDA except in case of an

emergency, in which case the RDA may turn off the nitrous oxide and administer 100%

45

oxygen. Assisting means setting up equipment and placing the face mask. Assisting does not

include titrating and turning the equipment on or off, except in the case of an emergency in

which circumstances the RDA may turn off the nitrous oxide and administer 100% oxygen.

Removing accretions and stains from the surfaces of the teeth and applying topical agents

essential to complete prophylaxis.

nn.

A

oo.

pp.

qq.

A

Root planning, debridement, deep scaling, and removal of calcareous deposits.

Polishing and contouring restorations.

Applying anticariogenic and desensitizing agents including, but not limited to, sealants,

fluoride varnish, and fluoride applications.

Commented [JK7]: Please clarify why s., qq., and z. are

listed as different procedures.

rr.

A

Charting of the oral cavity, including all the following: periodontal charting, intra oral and

extra oral examining of the soft tissue, charting of radiolucencies or radiopacities, existing

restorations, and missing teeth.

ss.

A

Preliminary examining that includes both of the following: classifying occlusion and testing

pulp vitality using an electric pulp tester.

Commented [JK8]: Please clarify why ss., y., and q. are

listed as different procedures.

tt.

A

D

DG

Applying topical anesthetic agents by prescription of the dentist.

Placing and removing intra-coronal temporary sedative dressings.

Removing excess cement from tooth surfaces.

A

uu.

vv.

ww.

xx.

yy.

zz.

Commented [JK9]: Combine with e.

Formatted: Font: Bold

Placing subgingival medicaments.

Micro abrasion of tooth surfaces to remove defects, pitting, or deep staining.

Performing soft tissue curettage with or without a dental laser.

Taking digital impressions scans for final restorations or intraoral appliances.

DG

D

Formatted: Font: 12 pt, Bold

Formatted: Font: Bold

aaa.

D*** Administer intra oral block and infiltration anesthesia, or no more than 50% nitrous oxide

analgesia, or both, to a patient who is 18 years of age or older if the RDH has met all of the

following requirements:

(i) Successfully completed an approved course that meets the requirements in section

16611(4) of the code, MCL 333.16611, in the administration of local anesthesia, with a

minimum of 15 hours didactic instruction and 14 hours clinical experience.

(ii) Successfully completed a state or regional board administered written examination in

local anesthesia within 18 months of completion of the approved course in (i).

(iii) Successfully completed an approved course that meets the requirements in section

16611(4) of the code, MCL 333.16611, in the administration of nitrous oxide analgesia, with

a minimum of 4 hours didactic instruction and 4 hours clinical experience.

46

(iv) Successfully completed a state or regional board administered written examination in

nitrous oxide analgesia, within 18 months of completion of the approved course in(iii).

(v) Maintains and provides evidence of current certification in basic or advanced cardiac life

support that meets the standards contained in R 338.11705.

A = Assignment as defined in R 338.11401.

G = General supervision as defined in R 338.11401.

D = Direct supervision as defined in R 338.11401.

DA = Dental assistant as defined in R 338.11101.

RDA = Registered dental assistant as defined in R 338.11101.

* A dentist shall assign these procedures to an RDA only if the RDA has successfully completed an approved course that meets

the requirements in section 16611(12) and 16611(13) of the code, MCL 333.16611, and contains a minimum of 10 hours of

didactic and clinical instruction.

** A dentist shall assign these procedures to an RDA only if the RDA has successfully completed an approved course that

meets the requirements in section 16611(11) of the code, MCL 333.16611, and contains a minimum of 20 hours of didactic

instruction followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a

criterion based assessment instrument.

RDH = Registered dental hygienist as defined in R 338.11101.

*** The department fee for certification of completion of the requirements is $10.

Dental Licensure Objective Structured Clinical Examination

(DLOSCE)

FAQ

updated September 2020

Answers to frequently asked questions about the Dental Licensure Objective Structured Clinical

Examination (DLOSCE) are provided below. To view the answer, click the question and the answer will

appear. For additional information, read the April 6, 2020 , April 24, 2017 and March 10, 2017 articles in

ADA News.

What is the purpose of the DLOSCE?

The Joint Commission on National Dental Examination’s (JCNDE's) Dental Licensure OSCE (DLOSCE)

is a high-stakes examination consisting of multiple questions which will require candidates to use their

clinical skills to successfully complete one or more dental problem solving tasks. The DLOSCE is

designed to provide information to US dental boards, concerning whether a candidate for dental licensure

possesses the necessary level of clinical skills to safely practice entry-level dentistry. This will be

accomplished through the use of a valid and reliable examination that has been professionally developed.

What is an objective structured clinical examination (OSCE)? Why were OSCEs developed?

The OSCE format often includes stimulus materials, such as radiographs, photographs, models, and

prescription writing. Standardized patients (actors) have been used in medical OSCEs. The National

Dental Examining Board (NDEB) of Canada’s OSCE is presented as a written, multiple-choice

examination that presents stimulus materials in multiple stations. Advances in simulated patient and

haptic technologies suggest that simulations may be incorporated in a dental OSCE sooner rather than

later.

OSCEs were developed to help accurately assess the complex notion of clinical competence in the

medical field. More specifically, Harden, Stevenson, Wilson Downie, and Wilson (1975) indicated that

they introduced the OSCE format to avoid many of the weaknesses and disadvantages of traditional

clinical examinations.

OSCEs are widely used in the health sciences, including: optometry, medicine, physical therapy,

radiography, rehabilitation medicine, nursing, pharmacy, podiatry, and veterinary medicine. Since their

inception in the 1970s, OSCEs are now part of the US Medical Licensing Examination for all US medical

graduates.

The NDEB Canada OSCE is used for dental licensure in Canada.

How do candidates apply to take the DLOSCE?

Candidates may register for this examination on the DLOSCE website .

The examination is offered during testing windows; the next testing window is November 9 – 27, 2020.

Applications are now open for candidates to register for an appointment during this testing window.

Which states currently accept the DLOSCE?

The following states have adopted regulations which permit the acceptance of the DLOSCE:

•

•

Please refer to each state board's website for specific details, clarifications, and updated policies. Other

states are currently considering the DLOSCE for initial licensure and information will be provided as

dental boards approve the examination for use in each state.

Why did the JCNDE develop a DLOSCE?

There are many reasons why the JCNDE developed a DLOSCE and why the JCNDE feels it is uniquely

positioned to build a high quality clinical licensure examination:

•

The JCNDE has a long and successful track record of delivering high quality, high stakes

examinations for licensure purposes that help protect the public.

As the governing body that oversees both the NBDE and DLOSCE Programs, the JCNDE is

positioned to provide a comprehensive evaluation of the skills necessary to safely practice

dentistry.

•

The JCNDE is a Commission with mechanisms in place to reduce conflicts of interest and help

ensure that no single community of interest has an undue influence on governance decisions

related to the DLOSCE.

The JCNDE possesses the in-house expertise to develop an OSCE through the Department of

Testing Services (DTS), which is staffed by testing professionals with advanced degrees in

psychological measurement and related fields.

Lastly and most importantly, the JCNDE feels that a DLOSCE can protect the public health more

effectively than existing clinical licensure solutions.

Will the DLOSCE be a regional clinical examination?

The DLOSCE is available nationally, to all state dental boards. Examination content will remain the same

regardless of the region of the country where it is administered, and regardless of the curriculum

implemented at different dental schools.

How is the DLOSCE content determined?

Consistent with the Standards for Educational and Psychological Testing established by the American

Educational Research Association, American Psychological Association, and the National Council on

Measurement in Education (2014), the content of the DLOSCE is based on a practice analysis involving

entry level general dentists. The DLOSCE practice analysis involves collecting information on the tasks

performed by entry-level practicing dentists, with regard to their frequency and criticality for patient

care. This information will be used to identify the clinical areas to be tested, and the numbers of items

and OSCE stations devoted to these areas.

How was the decision made to pursue DLOSCE development and who supported this decision?

The ADA’s Council on Dental Education and Licensure (CDEL) requested that the ADA Department of

Testing Services (DTS) create a business plan to develop an OSCE. CDEL believed that developing an

OSCE for dental licensure would help achieve goals stated within several long-standing ADA policies on

licensure, including the elimination of patients from the clinical examination process, and dental license

portability. Subsequent to business plan development, both CDEL and the Joint Licensure Task Force

(co-sponsored by the ADA and the American Dental Education Association) reviewed and strongly

endorsed the business plan. In February 2017, the ADA Board of Trustees’ Finance Committee

recommended approval of the requested funds so exam development could begin in 2017. After a

thorough review and discussion, the Board of Trustees voted to fund the startup costs for exam

development.

Dental Licensure Objective Structured Clinical Examination (DLOSCE) Quick Facts

Dental Licensure Objective Structured Clinical Examination (DLOSCE)

Name of

Examination

The DLOSCE assesses clinical judgment, and is intended for use in fulfilling dental board’s

clinical examination requirement. The DLOSCE provides dental boards with information

concerning whether a candidate for licensure possesses the level of clinical skills that is

necessary to safely practice.

Purpose

The DLOSCE is comprehensive in its evaluation of clinical judgment, measuring content in

the following areas:

Content Domain

and Test

Specifications

•

Restorative 24%

Prosthodontics 19%

Oral Pathology, Pain Management, and Temporomandibular Dysfunction 13%

Periodontics 10%

Oral Surgery 9%

Endodontics 8%

Orthodontics 6%

Medical Emergencies and Prescriptions 11%

Additionally, the following applies:

•

Diagnosis and Treatment Planning—as well as Occlusion—are covered across the

topics listed above.

The DLOSCE includes questions involving patients of various types and

backgrounds, including pediatric, geriatric, special needs, and medically complex.

Question

Format

DLOSCE questions can be accompanied by 3-D models, clinical photographs, and

radiographs. While all DLOSCE questions involve a patient, it is not a “patient-based”

examination (administration occurs without the need for live patients).

DLOSCE practice questions can be obtained via the following link:

https://www.ada.org/~/media/JCNDE/pdfs/practice_questions.pdf?la=en

Practice

Questions

First Date of

Availability

On April 2, 2020, the JCNDE announced that the DLOSCE will be released on June 15,

2020. The DLOSCE will be administered in testing windows, with availability for 2020

currently as follows:

•

June 15 – July 17, 2020

November 9 - 27, 2020

DLOSCE eligibility rules for students of US dental programs accredited by the Commission

on Dental Accreditation (CODA) are determined by each program. Each program at its

discretion may institute its own specific requirements pertaining to the examination.

Eligibility

The DLOSCE will contain 150 questions and require 1 day to administer. Administrations will

occur at select Prometric testing centers located throughout the US. The DLOSCE Candidate

Guide can be downloaded via the following link:

Administration

https://www.ada.org/~/media/JCNDE/pdfs/dlosce_guide.pdf?la=en

Cost of

Administration

The fee for 2020 administrations of the DLOSCE will be $800. A lower fee is being charged in

2020, due to COVID-19 and the unique challenges faced by students. Beginning in 2021, the fee

charged for DLOSCE administrations will be $1,650.

Unless stated otherwise, DLOSCE policies and procedures are anticipated to be fully

consistent with the policies and procedures of the JCNDE. This includes, for example, policies

concerning examination rules of conduct and appeals.

General

Policies and

Procedures

Candidate Results. The DLOSCE is a criterion-referenced examination, with the minimum

passing score (i.e., 75) determined by subject matter experts through rigorous standard-setting

activities. DLOSCE results will be reported as Pass/Fail. Candidates who Pass will simply

receive notification of their status as having passed the examination. Candidates who Fail

will be provided general information that permits them to understand areas where

remediation would be beneficial.

DLOSCE results will typically be made available approximately four to five weeks after the

close of each administration window. Results can be viewed online by logging into the My

Account Summary

Results

Reporting

School Results. Candidates’ Pass/Fail status will be reported through the DTS Hub. Schools

will receive periodic reports that describe how their students perform on the examination,

relative to students from other schools.

Dental Board Results. Candidates’ Pass/Fail status will be reported through the DTS Hub.

The DLOSCE Retest Policy is as follows:

•

Candidates who have not passed may apply for re-examination.

Candidates will be permitted to test once per testing window.

Candidates who have not passed the examination within five attempts or five

years from their first attempt are limited to one examination attempt per 12-

month period.

Retesting

Policy

•

Candidates who have passed may not retake the examination unless required

by a state board or relevant regulatory agency.

Candidates should contact the dental boards of each state to understand state

requirements and the acceptability of the DLOSCE. With respect to administration timing,

the JCNDE has received informal feedback suggesting a general preference for

candidates to complete the examination in close proximity to when they are applying for

licensure.

Dental Boards

Governance

The governing body of the DLOSCE Program is the Joint Commission on National Dental

Examinations (JCNDE).

In 2017, the ADA Board of Trustees authorized the formation of a DLOSCE Steering

Committee charged with developing and validating the DLOSCE. Consistent with its

charge, the DLOSCE Steering Committee identified the JCNDE as the ideal governing

body, due to the JCNDE’s long and distinguished track record of providing valid and

reliable high-stakes examinations for licensure purposes, to protect the public health. In

January 2020, the Board of Trustees approved the transfer of final development and future

administration oversight of the DLOSCE to the Joint Commission on National Dental

Examinations (JCNDE). The DLOSCE Steering Committee now serves as an ad hoc committee

of the JCNDE.

A specific timeline of activity can be found at https://www.ada.org/en/jcnde/dental-

licensure-objective-structured-clinical-examination/dlosce-historical-timeline .

Validity and

Technical

Information

The DLOSCE is supported by content validity arguments, the same type of validity evidence

that is used to support the JCNDE’s other examination programs–the National Board Dental

Examinations Parts I and II, the National Board Dental Hygiene Examination, and the

Integrated National Board Dental Examination. DLOSCE content has been developed by

teams of highly qualified subject matter experts, working together to build examination

questions that are capable of accurately and reliably identifying those who possess the

clinical skills necessary to safely practice dentistry. A summary of DLOSCE validity evidence

is provided at the following link:

https://www.ada.org/en/jcnde/dental-licensure-objective-structured-clinical-examination/news-

and-resources

The DLOSCE Technical Report will be made available subsequent to results reporting for the

first test administration window.

Please see the DLOSCE website: www.ada.org/jcnde/dlosce . The JCNDE can also be

reached via dlosce@ada.org.

Additional

Information

Dentistry General Rules - ORR 2020-027 LR

Public Comment Summary

Rules Committee’s Recommendations and Board’s Response to September 18, 2020 Public Comments

Testimony/Comments Received:

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)

Sandy Sutton, Greater Detroit Dental Hygienists

Amy Zaagman, Michigan Council for Maternal and Child Health (MCMCH) - Comments in Support

Rule 338.11101

Rule Numbers

Section (1)(a)

Definitions.

Commenter

Sutton

Comment

Remove the words “dentists” and “the” prior to dentists, and replace with “a”, to read: “Allied

dental personnel” means the supporting team who receives appropriate delegation from a dentist or

dental therapist to participate in dental treatment.” The provision as written shows unnecessary

possessive ownership over the allied dental personnel and many practices have more than one

dentist.

Section (1)(a)

Section (1)(h)

Farrell/DHHS

Modify to: “Allied dental personnel means the support staff in a dental office or clinic who receive

appropriate delegation from a dentist or dental therapist to participate in dental treatment.” Offices

have multiple dentists and personal that work together.

Supports the definition of dental therapist throughout the rules.

Rules Committee (1)(a): The Rules Committee agrees with the following suggested language, “Allied dental personnel” means the

Response supporting team who receives appropriate delegation from a dentist or dental therapist to participate in dental treatment.”

November 24, 2020

Rule 1101. (1) As used in these rules:

(a) “Allied dental personnel” means the supporting team who receives appropriate delegation from a dentist or dental

therapist to participate in dental treatment.

(h) “Dental therapist” means a person licensed under part 166 of the code, MCL 333.16601 to 333.16659, to provide the care

and services and perform any of the duties described in section 16656 of the code, MCL 333.16656.

(s) “Second pair of hands, ” as used in R 338.11109, means acts, tasks, functions, and procedures performed by a dental assistant,

registered dental assistant, or registered dental hygienist at the direction of a dentist, dental therapist, or registered dental hygienist

who is in the process of rendering dental services and treatment to a patient. The acts, tasks, functions, and procedures performed by a

dental assistant, registered dental assistant, or registered dental hygienist are ancillary to the procedures performed by the dentist,

dental therapist, or registered dental hygienist and intended to provide help and assistance at the time the procedures are

performed. This definition shall does not be deemed to expand the duties of the dental assistant, registered dental assistant, or

registered dental hygienist as provided by the code and rules promulgated by the board.

Board Response

(1)(a): The Board agrees with the following suggested language, “Allied dental personnel” means the supporting

team who receives appropriate delegation from a dentist or dental therapist to participate in dental treatment.”

(1)(s): The definition of “second pair of hands” is not consistent with the Public Health Code and needs to be

modified to include the registered dental hygienist as shown above in (1)(s).

Rule 338.11201

Licensure by examination to practice dentistry; graduated of programs in compliance with board

standards.

Rule Numbers

Section (c)

Commenter

Meraw/MDA

Comment

The MDA also recommends including the Joint Commission on National Dental Examination’s

(JCNDE's) Dental Licensure Objective Structured Clinical Examination (DLOSCE) under Rule

338.11201 as an acceptable dental simulated clinical written examination. Attached to this letter are

two documents, “DLOSCE FAQ” and “DLOSCE Quick Facts,” containing detailed information

about the DLOSCE.

Rules Committee (c): The commenter did not realize that (c) is being replaced with (d) and therefore, pursuant to the commenter, the Rules

Response Committee does not need to address the comment.

2

Rule 1201. In addition to meeting the requirements of section 16174 of the code, MCL 333.16174, An an applicant for dentist

licensure by examination shall submit a completed application, on a form provided by the department, together with the requisite fee.

In addition to meeting the requirements of the code and administrative rules promulgated under the code, an applicant for dentist

licensure by examination and shall meet all of the following requirements:

(a) Graduate from a dental school educational program that is in compliance complies with the standards in R 338.11301, in which

he or she has obtained a doctor of dental surgery (DDS) degree or doctor of dental medicine (DMD) degree.

(b) Pass all parts of the national board examination that is conducted and scored by the joint commission on national dental

examinations Joint Commission on National Dental Examinations (JCNDE), in order to qualify for the licensing examination

provided in subdivision (c) or (d) of this rule. The requirement does not apply to applicants who have graduated before 1950.

(c) Subject to subdivision (d) of this rule, Pass pass a dental simulated clinical written examination that is conducted by and scored

by the northeast regional board of dental examiners, the Commission on Dental Competency Assessments (CDCA), previously

known as North East Regional Board (NERB), or a successor organization, and 1 of the following:

(i) Pass all parts of a clinical examination that is conducted and scored by the CDCA, north east regional board of dental examiners,

incorporated, or a successor organization, or pass all parts of a clinical examination that is conducted by a regional testing agency if

the examination is substantially equivalent, as provided in R 338.11255(5) and (6), to the dental simulated clinical written

examination conducted by the CDCA, or a successor organization that is approved by the board.

(ii) Pass all parts of a clinical examination developed and scored by a state or other entity and that is substantially equivalent, as

provided in R 338.11203(5) 338.11255(5) and (6), to the clinical examination of the north east regional board of dental examiners,

incorporated, CDCA, or a successor organization.

(d) Pass all parts, written and clinical, of the American Board of Dental Examiners, Inc (ADEX) clinical examination that is

conducted by the CDCA, a successor organization, or by another regional testing agency. Beginning 1 year after the effective

date of this subdivision, an applicant shall meet the requirements of this subdivision instead of the requirements under

subdivision (c) of this rule.

(e) Beginning January 6, 2022, complete a 1-time training identifying victims of human trafficking as required in R

338.11271 and section 16148 of the code, MCL 333.16148.

(f) Complete a 1-time training in opioids and other controlled substances awareness as required in R 338.3135.

Board Response

(c): The commenter withdrew the comment, so the Board did not address the comment.

Rule 338.11239

Registered dental assistant examination; content; time; place; passing score.

Rule Numbers

Commenter

Comment

3

Section (1)

Meraw/MDA

In addition to expanding the scope of practice of Registered Dental Assistants (RDA), it is

important to avoid creating barriers for RDAs to obtain a license. Currently, the board of dentistry

conducts an examination at a modest cost for individuals seeking licensure as an RDA. The MDA

requests maintaining this method of examination, as opposed to the proposed rules which allow for

the board to contract the exam to a third party. Based on evidence from other states, third party

administered exams may cost more than twice the current cost. This will create a financial barrier

for people who are interested in becoming an RDA in Michigan. The MDA recommends the

following language for Rule 338.11239(1):

Rule 1239. (1) The board shall conduct a written and clinical examination for individuals

seeking licensure as a registered dental assistant.

Rules Committee (1): The Rules Committee does not agree with the comment to maintain the state RDA examination as the RDA

Response

examination should be written by examination writers and should be a national examination, similar to the other dental

professionals.

R 338.11239 Registered dental assistant examination; content; time; place; passing score.

Rule 1239. (1) Upon a written request, The the board shall conduct shall review a written and clinical examination for individuals

seeking licensure as a registered dental assistant examination for compliance with the criteria in subrule (2) of this rule.

(2) An Examination examination for licensure as a registered dental assistant shall must be both written and clinical and shall

include, but not be limited to, all of the following:

(a) Oral anatomy.

(b) Law and rules governing allied dental personnel auxiliaries.

(c) Instrumentation and use of dental materials.

(d) Mouth mirror inspection.

(e) Rubber/Dental dam application.

(f) Application of anticariogenics, which includes sealants, fluoride varnish, and fluoride applications.

(g) Placement and removal of temporary crowns and bands.

(h) Radiography.

(i) Periodontal dressings,; application, and removal. Application and removal of post extraction and periodontal dressings.

(j) Removal of sutures.

(k) Construction Fabrication of temporary crowns.

(l) Placing, condensing, and carving amalgam restorations.

4

(m) Making Taking final impressions for indirect restorations.

(n) Assisting and monitoring in the administration of nitrous oxide analgesia.

(o) Placing, condensing, and carving intracoronal temporaries.

(p) Infection control, safety, and occupational safety and health administration.

(q) Orthodontic procedures.

(r) Placing resin bonded restorations, occlusal adjustment, and finishing and polishing with a non-tissue cutting slow-speed

handpiece.

(s) Selective coronal polishing before orthodontic or restorative procedures only.

(t) Charting the oral cavity.

(u) Classifying occlusion.

(v) Nutritional counseling.

(w) Medical emergency procedures.

(x) Pulp vitality testing.

(y) Placement and removal of gingival retraction materials or agents.

(z) Drying endodontic canals.

(aa) Taking impressions for study and opposing models.

(bb) Instructing in the use and care of dental appliances.

(cc) Applying topical anesthetic solution.

(dd) Etching, placing, contouring, and polishing of sealants with a slow-speed rotary handpiece for occlusal adjustment.

(ee) Placing and removing matrices and wedges.

(ff) Applying cavity liners and bases.

(gg) Applying and dispensing in-office bleaching products.

(hh) Adjusting and polishing contacts and occlusion of indirect restorations.

(3) The examination shall be given at least once a year. The passing score for the an examination shall is be a converted score of 75

on each section.

(4) A candidate who fails to achieve a passing score on all parts within an 18-month period shall reapply to take the entire clinical

and written examination.

Board Response

(1): The Board does not agree with the comment to maintain the state RDA examination as the RDA

examination should be written by examination writers and should be a national examination, similar to the other

dental professionals.

5

Rule 338.11263

Relicensure requirements; dentists.

Rule Numbers

Commenter

Comment

Section (e)

Farrell/MDHHS

Add infection control CE for dentists. Should require at least one hour, “which must include

sterilization of hand pieces, personal protective equipment, and education on the Centers of Disease

Control and Prevention’s infection control guidelines.”

Rules Committee (e): The Rules Committee agrees with the comment to add infection control to the CE requirements for dentists similar to

Response

the infection control CE requirements for other dental professionals. As CE requirements are also listed in the renewal

rules infection control for dentists will also be added to the CE renewal rule.

As the “inclusion of delegation of duties to allied dental personnel” is being added to the dentists’ renewal requirements,

and the same requirements are listed in the relicensure rule, it should also be added to the relicensure requirements for

dentists (see page 21-26).

Rule 1263. An applicant whose dentist license in this state has lapsed, under the provisions of section 16201(3) or (4) of the

code, MCL 333.16201, as applicable, may be relicensed by complying with the following requirements:

For a dentist who has let his or her license in this Lapsed

Lapsed

state lapse:

0-3

more than 3 5 or more

years

years, but

less than 5

years

(a) Submits a completed application, on a form

provided by the department, together with the

requisite fee.

(b) Establishes that he or she is of good moral

character as defined under sections 1 to 7 of 1974 √

PA 381, MCL 338.41 to 338.47.

√

(c) Submits fingerprints as required under

section 16174(3) of the code, MCL 333.16174.

6

(d) Submits proof of current certification in basic

or advanced cardiac life support for health care

providers with a hands-on component from an

agency or organization that grants certification

pursuant to standards equivalent to those

established by the American Heart Association

(AHA), earned within the 2-year period before

receiving the license.

(e) Submits proof of having completed 60 hours

of continuing education in courses and

programs approved by the board as required

under R 338.11701, all of which were earned

within the 3-year period immediately preceding

the application for licensure. If the continuing

education hours submitted with the application

are deficient, the applicant has 2 years from the

date of the application to complete the deficient

hours. The department shall hold the

√

application and shall not issue the license until

the applicant has completed the continuing

education requirements. The 60 hours of

continuing education must include all of the

following:

(i) At least 3 hours in pain and symptom

management.

(ii) One hour in dental ethics and

jurisprudence with inclusion of delegation of

duties to allied dental personnel.

(iii) One hour in infection control, which must

7

include sterilization of hand pieces, personal

protective equipment, and the Centers for

Disease Control and Prevention’s infection

control guidelines.

(f) Completed a 1-time training in identifying

victims of human trafficking that meets the

standards in R 338.11271.

(g) Completed a 1-time training in opioids and

other controlled substances awareness as

required in R 338.3135.

(h) A dentist who is subject to part 8 of these

rules, R 338.11801 to R 338.11821, shall verify

with his or her application for relicensure, that

he or she complies with part 8 of these rules, R

338.11801 to R 338.11821, and specify the make

of the amalgam separator in his or her office and

the year that each separator was installed.

(i) An applicant’s license must be verified by the

licensing agency of all other states of the United

States in which he or she ever held a license as a

dentist. Verification must include the record of

any disciplinary action taken or pending against

the applicant.

√

(j) If an applicant’s license is lapsed for more

than 3 years but less than 5 years, he or she shall

meet either of the following:

√

(i) Within the 2-year period immediately

preceding the application for relicensure,

retakes and passes the ADEX simulated clinical

written examination for dentists developed and

scored by the CDCA or another testing agency

8

with a passing score of not less than 75.

(ii) Provides the department documentation

that he or she holds or held a valid and

unrestricted dentist’s license in another state in

the United States within 3 years immediately

preceding the application for relicensure.

(k) If an applicant’s license is lapsed 5 or more

years, he or she shall provide the department

with documentation that proves he or she holds

or held a valid and unrestricted dentist license in

another state in the United States within 3 years

immediately preceding the application for

relicensure and meets all of the requirements in

subrules (a) to (i) of this rule or complies with all

of the following:

√

(i) Meets the requirements of section 16174 of

the code, MCL 333.16174, and the

administrative rules.

(ii) Provides proof of graduation from a dental

educational program that meets the standards

in R 338.11301 in which he or she obtained a

DDS or DMD degree.

(iii) Provides proof of having passed all parts of

the national board examination conducted and

scored by the JCNDE to qualify for the dental

simulated clinical written examination.

(iv) Provides proof of having passed the ADEX

dental simulated clinical written examination

conducted and scored by the CDCA or another

regional agency within the 2-year period

immediately preceding the application for

9

relicensure.

(v) Provides proof of having passed the ADEX

dental clinical examination conducted and

scored by the CDCA or another regional

testing agency.

Board Response

(e): The Board agrees with the comment to add infection control to the CE requirements for dentists similar to

the infection control CE requirements for other dental professionals.

As the CE requirements are also listed in the renewal rules, infection control for dentists will be added to the CE

renewal rule, R 338.11701 below.

As the “inclusion of delegation of duties to allied dental personnel” is being added to the dentist’s renewal CE

requirements pursuant to a comment to R 338.11701, it should also be added to this rule which repeats the

renewal requirements for dentists.

Rule 338.11401 Definitions.

Rule Numbers

Section (e)

Commenter

Kent/AAO

Comment

The AAO proposes adding language to “Patient of Record.” The AAO supports language to clarify

that performing an in-person examination prior to dental, and especially orthodontic, treatment

because it would allow the treating dentist to more fully understand what is going on beneath the

gums (impacted teeth, bone loss, etc.), seek to avoid complications, and in the case of orthodontists,

determine if patients are suitable candidates for orthodontic treatment. The AAO believes there are

certain diagnoses and evaluations that can only be performed in-person or are best performed in-

person (x-rays, etc.) during an examination, and the AAO believes that dental treatment, especially

the movement of teeth via orthodontic treatment, should not be undertaken without sufficient

diagnostic information obtained during such an examination.

(e) “Patient of record” means a patient who has been examined and diagnosed by a dentist in-

person and whose treatment has been planned by a dentist or a patient who has been

examined, evaluated, assessed, and treatment planned by a dental therapist to the extent

authorized by the supervising dentist. A patient of record includes a patient getting

10

radiographic images by an RDA or Registered Dental Hygienist (RDH) after receiving

approval from the assigning dentist.

Section (e)

Meraw/MDA

Under Rule 338.11401(e) in the proposed rules, the definition of “patient of record” includes an

additional sentence stating, “A patient of record includes a patient getting radiographic images by an

RDA or RDH after receiving approval from the assigning dentist.” The MDA recommends

replacing “RDA or RDH” with “allied dental personnel”:

(e) “Patient of record” means a patient who has been examined and diagnosed by a dentist

and whose treatment has been planned by a dentist or a patient who has been examined,

evaluated, assessed, and treatment planned by a dental therapist to the extent authorized by

the supervising dentist. A patient of record includes a patient getting radiographic images by

an RDA or RDH allied dental personnel after receiving approval from the assigning dentist.

Rules Committee (e): The Rules Committee does not agree with the comment to add “in person” to the definition of “patient of record” as

Response

this requirement is inconsistent with the concept of telemedicine and the dentist or dental therapist should be the

professional to make the determination of whether they must examine and diagnose the patient “in person.”

The Rules Committee agrees with the comment to replace “RDA 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.”

Rule 1401. As used in this part:

(a) “Assignment” means that a dentist designates a patient of record upon whom services are to be performed and describes the

procedures to be performed. Unless assignment is designated in these rules under general or direct supervision, the dentist need not be

physically present in the office at the time the procedures are being performed.

(b) “Delegation” means an authorization granted by a licensee to a licensed or unlicensed individual to perform selected acts, tasks,

or functions that fall within the scope of practice of the delegator and that are not within the scope of practice of the delegatee and that,

in the absence of the authorization, would constitute illegal practice of a licensed profession.

(c) “Direct supervision” means that a dentist complies with all of the following:

(i) Designates a patient of record upon whom the procedures are to be performed and describes the procedures to be performed.

(ii) Examines the patient before prescribing the procedures to be performed and upon completion of the procedures.

(iii) Is physically present in the office at the time the procedures are being performed.

11

(d) “General supervision” means that a dentist complies with both of the following:

(i) Designates a patient of record upon whom services are to be performed.

(ii) Is physically present in the office at the time the procedures are being performed.

(e) “Patient of record” means a patient who has been examined and diagnosed by a dentist and whose treatment has been

planned by a dentist or a patient who has been examined, evaluated, assessed, and treatment planned by a dental therapist to

the extent authorized by the supervising dentist. A patient of record includes a patient getting radiographic images by allied

dental personnel with training pursuant to R 338.114119(a), after receiving approval from the assigning dentist or dental

therapist.

Board Response

(e): The Board does not agree with the comment to add “in person” to the definition of “patient of record” as this

requirement is inconsistent with the concept of telemedicine and the dentist or dental therapist should be the

professional to make the determination of whether they must examine and diagnose the patient “in person.”

The Board agrees with the comment to replace “RDA 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.”

Rule 338.11411

Rule Numbers

Table

Delegated and assigned dental procedures for allied dental personnel.

Commenter

Comment

Meraw/MDA

Various modifications to the Table. See comments attached to this document.

I would like to elaborate on one of the recommendations in the attached chart, line “zz” - digital

impressions. The MDA strongly believes it is critical for patient safety that this procedure be

referred to as “digital scan” and apply to intraoral appliances.

In addition, the MDA is recommending revising the supervision levels as outlined in the attached

chart. This recommendation is based on the proliferation of do-it-yourself diagnostic tools such as

digital scanning done via retail stores. These types of retail stores are the practice of dentistry and

should be considered as such by being included in the “Delegated and Assigned Dental Procedures

12

for Allied Dental Personnel” and designated supervision requirements.

Section (b)

Section (e)

Section (f)

Section (g)

Erdt/MDAA

Meraw/MDA

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.

This procedure cannot be done without a dentist present in the office performing the procedure. All

personnel should be modified to G in the chart

Nonprescription topical anesthetic solution is rare, so combine (e) with (tt) applying topical

anesthetic agents by prescription.

Supervision for trial sizing of orthodontic bands should be general for all personnel in case

problems arise.

Make two categories, placing and removing orthodontic separators and placing and removing

orthodontic elastics, ligatures, and arch wires, and place the RDHs under direct for the second

category as the current supervision for these procedures id direct or all personnel.

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 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.

Section (i)

Erdt/MDAA

Section (k)

Section (o)

Meraw/MDA

Erdt/MDAA

RDHs should required to complete the training similar to RDAs.

Add assignment as an option to the dental assistants of applying commonly accepted medical

emergency procedures, including CPR. Medical emergencies are 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.

13

Section (p) and (q) Meraw/MDA

Add - allow DA under direct.

Section (u)

Erdt/MDAA

Remove for registered 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 education does not

provide the training nor does their exam have a temporary clinical component like the RDA.

Modify to taking impressions for intraoral appliances including bite registrations as opposed to

restorations.

Modify RDAs from general with training to direct.

Modify “bleaching” to whitening” products.

Add “composite, and glass ionomer.”

Delete “class I resin bonded restorations.”

Section (aa)

Erdt/MDAA

Meraw/MDA

Mewaw/MDA

Meraw/MDA

Erdt/MDAA

Meraw/MDA

Erdt/MDAA

Meraw/MDA

Erdt/MDAA

Meraw/MDA

Section (cc)

Section (hh)

Section (jj)

Section (kk)

Section (ll)

Section (oo)

Section (qq)

Add “direct.”

Modify planning and delete “deep scaling, and removal of calcareous deposits.”

This category combines (s) and (z). Subsection (qq) is repetitive.

Section (ss)

This category is 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).

Section (tt)

Section (uu)

(uu) and (v) – sedative restoration and sedative dressing make this confusing.

Allow RDAs by assignment.

Add DAs by direct and modify RDAs and RDHs to general. Also modify “impressions” to scans”

and add “or intraoral appliances.”

Section (zz)

Rules Committee The Rules Committee:

Response (b) Agrees with the comment to delete (b) as is a “second pair of hands duty”.

(e) Does not agree with combining (e) with (tt) as both situations may arise.

(f) Does not agree as this action was not previously addressed for all personnel and it is a common practice for the RDA

and RDH to be under assignment for this activity.

(g) Does not agree with modifying RDHs to direct as both RDAs and RDHs can be taught to handle this activity without

direct supervision.

(i) Does not come to a consensus on this comment so it requires more discussion.

14

(k) Agrees with comment that RDHs should have training.

(o) Agrees with the comment to allow dental assistants (DA) to apply commonly accepted medical emergency

procedures.

(p) and (q) Does not agree with allowing DAs to handle these activities as they are not trained.

(u) Does not agree with the comment to delete (u) as this is a long-standing function of RDAs and RDHs and there is no

harm to leave as written.

(aa) Agrees as this is a clerical error.

(cc) Does not agree as this is per the Code and is not subject to change.

(hh) Agrees to use the term “whitening” as this is the accepted term used in the profession.

(jj) Does not agree with adding “composite, and glass ionomer” as is not comfortable with extending to this activity.

(kk) Does not agree with deleting “class I resin bonded restorations.”

(ll) Agrees to add “direct” as RDAs do have training in this activity.

(oo) Agrees to fix typo in planing but does not agree with deleting the rest of the provision as it is in the Code.

(qq) Agrees that (qq) is repetitive and should be deleted.

(ss) Delete (ss) as it is repetitive and add “preliminary examination including” to both (q) and (y).

(uu) Agrees with the comment that the provision is confusing, therefore, clarify by replacing ” intra-coronal” with

“surgical” in (uu) to reduce the confusion between (uu) and (v) and do not change (v). The Board also agrees to allow

RDAs to do the activity by assignment.

(zz) Agrees with the comment to add DAs by direct and modify RDAs and RDHs to general. Also modify “impressions”

to scans” and add “or intraoral appliances.”

R 338.11411 Delegated and assigned dental procedures for allied dental personnel.

Rule. 1411. A dentist may assign or delegate procedures to an unlicensed dental assistant, registered dental assistant, or

registered dental hygienist under the provisions of section 16611 of the code, MCL 333.16611, as provided in Table 1:

Table 1 - Delegated and Assigned Dental Procedures for Allied Dental Personnel

DA RDA RDH

Procedure

Operating of dental radiographic equipment. A DA shall have successfully completed a

15

(a)

G

A

course in dental radiography that is substantially equivalent to a course taught in a program

approved by the board pursuant to R 338.11302, R 338.11303, or R 338.11307. A dentist

may delegate necessary radiographs for a new patient to an RDA or RDH.

Instructing in the use and care of dental appliances.

Taking impressions for study and opposing models.

Applying nonprescription topical anesthetic solution.

Trial sizing of orthodontic bands.

Placing, removing, and replacing orthodontic elastic or wire separators, arch wires, elastics,

and ligatures.

(c)

(d)

(e)

(f)

G

D

A

(g)

(h)

(i)

(j)

D

A

D

A

Dispensing orthodontic aligners.

Removing orthodontic bands, brackets, and adhesives with non-tissue cutting instruments.

Polishing specific teeth with a slow-speed rotary hand piece immediately before a procedure

that requires acid etching before placement of sealants, resin-bonded orthodontic

appliances, and direct restorations.

(k)

(l)

G*

D

G*

D

Etching and placing adhesives before placement of orthodontic brackets and attachment for

aligners.

Cementing orthodontic bands or initial placement of orthodontic brackets and attachments

for aligners.

(m)

A

Removing excess cement from supragingival surfaces of a tooth with a non-tissue cutting

instrument.

(n)

(o)

(p)

(q)

(r)

(s)

A

Providing nutritional counseling for oral health and maintenance.

Applying commonly accepted medical emergency procedures.

Inspecting and charting the oral cavity using a mouth mirror and radiographs.

Preliminary examination including classifying occlusion.

Placing and removing dental dam.

A

Applying anticariogenic agents including, but not limited to, sealants, fluoride varnish, and

fluoride applications.

(t)

A

Polishing and contouring of sealants with a slow-speed rotary hand piece immediately

following a procedure for occlusal adjustment.

Fabricating temporary restorations and temporary crowns and temporary bridges.

(u)

16

(v)

A

Placing and removing a nonmetallic temporary or sedative restoration with non-tissue

cutting instruments.

(w)

(x)

(y)

(z)

(aa)

A

G*

A

Sizing of temporary crowns and bands.

Temporarily cementing and removing temporary crowns and bands.

Preliminary examination including performing pulp vitality testing.

Applying desensitizing agents.

Taking impressions for intraoral appliances including bite registrations.

(bb)

(cc)

(dd)

(ee)

(ff)

(gg)

(hh)

(ii)

G*

A

D

G

Placing and removing matrices and wedges.

Applying cavity liners and bases.

Drying endodontic canals with absorbent points.

Placing and removing nonepinephrine retraction cords or materials.

Placing and removing post extraction and periodontal dressings.

Removing sutures.

A

G

Applying and dispensing in-office bleaching products.

Prior to cementation by the dentist, adjusting and polishing contacts and occlusion of

indirect restorations. After cementation, removing excess cement from around restorations.

Placing, condensing, and carving amalgam restorations.

Placing Class I resin bonded restorations, occlusal adjustment, finishing and polishing with

non-tissue cutting slow-speed rotary hand pieces.

(jj)

(kk)

D**

(ll)

D**

D

Taking final impressions for direct and indirect restorations and prosthesis including bite

registration.

(mm)

D

Assisting and monitoring the administration of nitrous oxide analgesia by a dentist or the

RDH. A dentist shall assign these procedures only if the RDA or RDH has successfully

completed an approved course that meets the requirements of section 16611(7) of the code,

MCL 333.16611, with a minimum of 5 hours of didactic instruction. The levels must be

preset by the dentist or RDH and must not be adjusted by the RDA except in case of an

emergency, in which case the RDA may turn off the nitrous oxide and administer 100%

oxygen. As used in this subdivision, “assisting” means setting up equipment and placing the

face mask. Assisting does not include titrating and turning the equipment on or off, except in

the case of an emergency in which circumstances the RDA may turn off the nitrous oxide

17

and administer 100% oxygen.

(nn)

A

Removing accretions and stains from the surfaces of the teeth and applying topical agents

essential to complete prophylaxis.

(oo)

(pp)

(rr)

A

Root planing, debridement, deep scaling, and removal of calcareous deposits.

Polishing and contouring restorations.

Charting of the oral cavity, including all the following: periodontal charting, intra oral and

extra oral examining of the soft tissue, charting of radiolucencies or radiopacities, existing

restorations, and missing teeth.

(tt)

(uu)

A

Applying topical anesthetic agents by prescription of the dentist.

Agrees with the comment that the provision is confusing, therefore, clarify by replacing ”

intra-coronal” with “surgical” in (uu) to reduce the confusion between (uu) and (v) and do

not change (v). The Board also agrees to allow RDAs to do the activity by assignment.

Removing excess cement from tooth surfaces.

A

(vv)

(ww)

(xx)

(yy)

(zz)

A

D

G

Placing subgingival medicaments.

Micro abrasion of tooth surfaces to remove defects, pitting, or deep staining.

Performing soft tissue curettage with or without a dental laser.

Taking digital scans for final restorations or intra-oral appliances.

D

G

(aaa)

D*** Administering intra oral block and infiltration anesthesia, or no more than 50% nitrous

oxide analgesia, or both, to a patient who is 18 years of age or older if the RDH has met all of

the following requirements:

(i) Successfully completed an approved course that meets the requirements in section

16611(4) of the code, MCL 333.16611, in the administration of local anesthesia, with a

minimum of 15 hours didactic instruction and 14 hours clinical experience.

(ii) Successfully completed a state or regional board administered written examination in

local anesthesia within 18 months of completion of the approved course in paragraph (i) of

this subdivision.

(iii) Successfully completed an approved course that meets the requirements in section

16611(4) of the code, MCL 333.16611, in the administration of nitrous oxide analgesia, with

a minimum of 4 hours didactic instruction and 4 hours clinical experience.

(iv) Successfully completed a state or regional board administered written examination in

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nitrous oxide analgesia, within 18 months of completion of the approved course in

paragraph (iii) of this subdivision.

(v) Maintains and provides evidence of current certification in basic or advanced cardiac life

support that meets the standards contained in R 338.11705.

A = Assignment as defined in R 338.11401.

G = General supervision as defined in R 338.11401.

D = Direct supervision as defined in R 338.11401.

DA = Dental assistant.

RDA = Registered dental assistant as defined in R 338.11101.

* A dentist shall assign these procedures to an RDA and RDH only if the RDA has successfully completed an approved course

that meets the requirements in section 16611(12) and (13) of the code, MCL 333.16611, and contains a minimum of 10 hours of

didactic and clinical instruction.

** A dentist shall assign these procedures to an RDA only if the RDA has successfully completed an approved course that

meets the requirements in section 16611(11) of the code, MCL 333.16611, and contains a minimum of 20 hours of didactic

instruction followed by a comprehensive clinical experience of sufficient duration that validates clinical competence through a

criterion based assessment instrument.

RDH = Registered dental hygienist as defined in R 338.11101.

*** The department fee for certification of completion of the requirements is $10.

Board Response

The Board:

(b) Agrees with the comment to delete (b) as is a “second pair of hands duty”.

(e) Does not agree with combining (e) with (tt) as both situations may arise.

(f) Does not agree as this action was not previously addressed for all personnel and it is a common practice for

the RDA and RDH to be under assignment for this activity.

(g) Does not agree with modifying RDHs to direct as both RDAs and RDHs can be taught to handle this activity

without direct supervision.

(i) Agrees with the comment to delete the D for DA’s in this category.

(k) Agrees with comment that RDHs should have training so an asterisk will be added to the RDHs for training

and “RDH” will be added to the explanation of * at the bottom of the table.

(o) Agrees with the comment to allow dental assistants (DA) to apply commonly accepted medical emergency

19

procedures.

(p) and (q) Does not agree with allowing DAs to handle these activities as they are not trained.

(u) 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 term, it should be “fabricate” and the word “existing” should be deleted in

order to make this provision reflect the actual activity in the profession.

(aa) Agrees as this is a clerical error.

(cc) Does not agree as this is per the Code and is not subject to change.

(hh) Does not agree to use the term “whitening” as “bleaching” is used in the Code.

(jj) Does not agree with adding “composite, and glass ionomer” as is not comfortable with extending to this

activity.

(kk) Does not agree with deleting “class I resin bonded restorations.”

(ll) Agrees to add “direct” as RDAs do have training in this activity.

(oo) Agrees to fix typo in planing but does not agree with deleting the rest of the provision as it is in the Code.

(qq) Agrees that (qq) is repetitive and should be deleted.

(ss) Agrees to delete (ss) as it is repetitive and add “preliminary examination including” to both (q) and (y).

(uu) Agrees to replace” intra-coronal” with “surgical” in (uu) to reduce the confusion between (uu) and (v) and

no changes to (v). Also allow RDAs to do activity by assignment.

(zz) Agrees to add DAs by direct and modify RDAs and RDHs to general. Also modify “impressions” to scans”

and add “or intraoral appliances.”

Rule 338.11417

Rule Numbers

Add Section (7)

Practice agreement; care or services.

Commenter

Comment

Meraw/MDA

The MDA requests adding the following subsection to Rule 338.11417:

(7) If the patient requires treatment that exceeds the dental therapist’s capabilities or the

scope of practice as a dental therapist, a referral to an appropriate provider within a

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 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

20

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.

Add Section (8)

Meraw/MDA

Along the lines of patient safety, it is important to define the procedures dental therapists can

delegate to dental 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. This can be achieved by adding the

following subsection under Rule 338.11417:

(8) Dental therapists have the same level of supervision requirements over allied dental

personnel as dentists have as stated in 338.11411.

Rules Committee (7): The Rules Committee agrees with the comment to require a refer to be to a health professional within a reasonable

Response

distance subject to the Code provisions and the written practice agreement.

(8): The Rules Committee agrees with the comment that a dental therapist’s supervision over allied dental personnel

should be the same or less than a dentist’s supervision over allied dental personnel subject to the Code and the dental

therapist’s written practice agreement.

Rule 1417. (1) A dental therapist may practice only under the supervision of a dentist licensed and practicing in this state

through a written practice agreement that is signed by the dental therapist and dentist licensed and practicing in this state and

that meets all the requirements in section 16655 of the code, MCL 333.16655.

(2) A dentist may supervise no more than 4 dental therapists pursuant to section 16655(5) of the code, MCL 333.16655.

(3) A dental therapist may supervise no more than 3 dental assistants or registered dental assistants and 2 registered dental

hygienists in any 1 health setting as allowed in a written practice agreement. The practice agreement must define the type of

supervision required by the dental therapist.

(4) A dentist may not authorize a dental therapist to do either of the following:

(a) Prescribe controlled substances.

(b) Administer phentolamine mesylate.

21

(5) A dentist may authorize a dental therapist to provide care or services described in sections 16656(1)(a) to (w) of the code,

MCL 333.16656.

(6) A dental therapist may perform other services and functions agreed to by the supervising dentist for which the dental

therapist is trained that are ancillary to those care and services described in sections 16656(1)(a) to (w) of the code, MCL

333.16656.

(7) Subject to section 16657 of the code, MCL 333.16657, and the dental therapist’s written practice agreement, if the patient

requires treatment that exceeds the dental therapist’s capabilities or the scope of practice as a dental therapist, the dentist or

dental therapist shall refer the patient to an appropriate provider within a reasonable distance.

(8) Subject to section 16655 and 16656(2) of the code, MCL 333.16655 and 333.16656, and the dental therapists’s written

practice agreement, a dental therapist’s authority to delegate to allied dental personnel may not exceed a dentist’s authority to

delegate to allied dental personnel under R 338.11411.

Board Response

(7): The Board agrees with the comment to require a referral to be to a health professional within a reasonable

distance subject to the Code provisions and the written practice agreement.

(8): The Board agrees with the comment that a dental therapist’s authority to delegate to allied dental personnel

should not exceed a dentist’s authority to delegate to allied dental personnel subject to the Code and the dental

therapist’s written practice agreement.

Rule 338.11601

Rule Numbers

Section (2)(a)(i)

General anesthesia; conditions; violation.

Commenter

Comment

Meraw/MDA

As proposed, Rule 338.11601(2)(a)(i), strikes “Joint Commission” and replaces it with “JCNDE,”

which is incorrect. JCNDE does not accredit hospitals, the Joint Commission should remain the

reference under this subpart.

Rules Committee (2)(a)(i): The Rules Committee agrees with the comment to change JCNDE to the Joint Commission.

Response

R 338.11601 General anesthesia; conditions; violation.

Rule 1601. (1) A dentist shall not administer general anesthesia to a dental patient or delegate and supervise the performance of any

act, task, or function involved in the administration of general anesthesia to a dental patient, unless all of the following conditions are

satisfied:

22

(a) The dentist has completed a minimum of 1 year of advanced training in general anesthesia and pain control in a program which

that meets the standards adopted in R 338.11603(l). A program that is accredited by CODA as meeting the accreditation

standards for advanced dental education programs in anesthesiology meets the requirements of this subdivision. This

subdivision takes effect 1 year after the effective date of this amendatory rule.

(b) The dentist and the delegatee, if any, maintain current certification in basic and advanced cardiac life support for health care

providers with a hands-on component from an agency or organization that grants such certification pursuant to standards

substantially equivalent to the standards adopted in R 338.11603(2). A certification in basic and advanced cardiac life for health

care providers with a hands-on component from AHA meets the requirements of this subdivision.

(c) The facility in which the anesthesia is administered meets the equipment standards adopted in R 338.11603(3).

(d) The dentist shall be physically present with the patient who is given any general anesthesia until he or she regains consciousness

and the dentist shall remain on the premises until such the patient is capable of being discharged.

(2) A dentist who does not meet the requirements of subrule (1) of this rule shall not offer general anesthesia services for dental

patients unless all of the following conditions are met:

(a) General anesthesia services are directly provided through association with, and by, either of the following individuals:

(i) A physician who is licensed under the provisions of part 170 or 175 of the act code, MCL 333.17001 to 333.17097, and

333.17501 to 333.17556, and who is a member in good standing on the anesthesiology staff of a hospital accredited by the Joint

Commission.

(ii) A dentist who meets the requirements of subrule (1)(a) and (b) of this rule.

(b) A person who administers anesthesia, as authorized by under the provisions of subdivision (a) of this subrule, shall be

physically present with the patient who is given any general anesthesia until he or she regains consciousness and the dentist shall

remain on the actual premises where the general anesthesia is administered until the patient anesthetized is capable of being

discharged.

(c) The provisions of subrule (1)(b) and (c) of this rule shall must be complied with.

(3) A dentist is in violation of section 16221(l)(h) of the code, MCL 333.16221(1)(h) 333.16221, if he or she fails to comply with

subrules (1) and (2) of this rule. administers general anesthesia to a dental patient or delegates and supervises the performance of any

act, task, or function involved in the administration of general anesthesia to a dental patient or offers general anesthesia services for

dental patients without being in compliance with subrules (1) and (2) of this rule.

Board Response

(2)(a)(i): The Board agrees with the comment to change JCNDE to the Joint Commission.

23

Rule 338.11701

License renewal for a dentist, dental specialist, and special-retired volunteer dentist; requirements;

applicability.

Rule Numbers

Section (12)(b)

Commenter

Erdt/MDAA

Comment

Change to “ethics and jurisprudence with inclusion of delegation of duties to dental auxiliaries.”

Leave the hours earned through volunteer patient supportive dental services. 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 understand the scope of practice for dental assistants, RDAs, and

RDHs, and dental therapists.

Section (12)

Erdt/MDAA

Sutton

Add 3 hours in infection control in the dental setting. Training in infection control is imperative for

the dentist as well as the rest of the team. The dentist is ultimately in charge of making sure the

office complies. It is difficult to secure formally trained assistants, so with less than 2,000 in the

state with formal training, it is the responsibility of the dentist to ensure that the unlicensed

assistants have the proper training in infection control.

Farrell/MDHHS

Sutton

Add requirements for both active and retired dentists with retired-volunteer license. Also, include

Organization for Safety, Asepsis and Prevention (OSAP) as an additional organization for infection

control guidance for all dental professionals. Also, recommending training on antibiotic

stewardship. Many antibiotic prescriptions are written that may be unnecessary.

All of the forms of meeting the CE requirements, such as online, electronic media, video, internet,

web-based seminar … are not defined. According to the AGD the only official delivery method is

lecture, self-instruction, and hands on class participation. The location can be online, a live

webinar, or a live online lecture.

Section (12)(e)

Rules Committee (12)(b): The Rules Committee agrees to require dental professionals to have CE in the “delegation of duties to allied

Response

dental personnel” in addition to ethics and jurisprudence. This change will also be added to the dental therapist renewal

rule R 338.11703 as a dental professional. As the relicensure rule requires the same CE the new language will also be

added to the relicensure rules, R 338.11263 (dentists) and R 338.11265 (dental therapists).

(12)(b): The Rules Committee does not agree with the comment to allow volunteer hours to be used for the CE in ethics

and jurisprudence and delegation of duties to allied dental personnel.

(12)(d): The Rules Committee agrees with the comment to add 1 hour, not 3, of infection control to the CE requirements

24

for dentists similar to the infection control CE requirements for other dental professionals. The Rules Committee did not

agree with including Organization for Safety, Asepsis and Prevention (OSAP) as an additional organization for infection

control guidance or including training on antibiotic stewardship.

(12)(e): The Rules Committee agrees that clarification is needed to differentiate between the online and live acceptable

CE wherever these terms are used in the rules. However, as the Rules Committee desires to be consistent in the rules,

clarifying language is necessary to sections that limit or require online and 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.

Rule 1701. (1) This rule applies to an application applications for the renewal of a dentist license, dental specialist license, and

special retired volunteer dentist license under sections 16201 (1) and (2) and 16184(2) and (3) of the code, MCL 333.16201 and

333.16184.

(2) Subject to subrule (8) of this rule, An an applicant for a dentist license renewal who has been licensed for the 3-year period

immediately preceding the expiration date of the license shall comply with both of the following during the 3-year period before the

end of the license cycle:

(a) Possess current certification in basic or advanced cardiac life support from an agency or organization that grants certification

pursuant to standards substantially equivalent to the standards adopted in R 338.11705(3) 338.11705(4).

(b) Complete at least 3 continuing education credits in pain and symptom management in each renewal period. Continuing

education credits in pain and symptom management may include, but are not limited to, courses in behavior management, psychology

of pain, pharmacology, behavior modification, stress management, clinical applications, and drug interactions.

(3) Subject to subrule (8) of this rule, In in addition to the requirements of subrule (2) of this rule, an applicant for a dentist

license renewal, who has been licensed for the 3-year period immediately preceding the expiration date of the license, shall

comply with all of the following during the 3-year period before the end of the license cycle:

(a) Complete not less than 60 hours of continuing education approved by the board under R 338.11704a. during the 3-year period

immediately preceding the application for renewal.

(b) Complete a minimum of 20 hours of the required 60 hours required of approved continuing education hours in programs

directly related to clinical issues such as including delivery of care, materials used in delivery of care, and pharmacology.

(c) Complete a minimum of 20 hours of the required 60 hours of approved continuing education hours by attending synchronous,

live courses or programs that provide for direct interaction between faculty and participants, including, but not limited to, lectures,

symposia, live teleconferences, workshops, and participation in volunteer clinical patient or supportive dental services provided for

25

in R 338.11703(o) R 338.11704a(1)(m). These courses, with the exception of the volunteer clinical services, may be counted toward

the required courses in clinical issues such as delivery of care, materials used in delivery of care, and pharmacology.

(4) Subject to subrule (8) of this rule, In in addition to the requirements of subrules (2) and (3) of this rule, a dental specialist shall

complete 20 hours of the 60 required board-approved continuing education hours in the dental specialty field in which he or she is

certified within during the 3-year period immediately preceding the renewal application before the end of the license cycle.

(5) Subject to subrule (8) of this rule, In in addition to the requirements of subrule (2) of this rule, an applicant for a special retired

dentist license shall comply with the following during the 3-year period before the end of the license cycle:

(a) Complete not less than 40 hours of continuing education acceptable to the board in R 338.11704a. during the 3-year period

immediately preceding the date of the application.

(b) Complete a minimum of 14 hours of the required 40 hours of approved continuing education in programs directly related to

clinical issues such as delivery of care, materials used in delivery of care, and pharmacology.

(c) Complete a minimum of 14 hours of the required 40 hours of approved continuing education by attending synchronous, live

courses or programs that provide for direct interaction between faculty and participants, including but not limited to, lectures,

symposia, live teleconferences, workshops, and providing volunteer clinical services provided for in R 338.11703(o) R

338.11704a(1)(m) . These courses, with the exception of the volunteer clinical services, may be counted toward the required courses

in clinical issues such as delivery of care, materials used in delivery of care, and pharmacology.

(d) Comply with the conditions for renewal in section 16184(2) of the code, MCL 333.16184(2).

(6) The submission of the application for online renewal shall constitute constitutes the applicant's certification of compliance with

the requirements of this rule. The board may require an applicant or a licensee to submit evidence to demonstrate compliance with

this rule. The applicant or licensee shall maintain evidence of complying with the requirements of this rule for a period of 4 5 years

from the date of the submission for renewal. Failure to comply with this rule is a violation of section 16221(h) of the code, MCL

333.16221.

(7) A request for a waiver under section 16205 of the code, MCL 333.16205, must be received by the department before the

expiration date of the license.

(8) Effective for an application for renewal that is filed for the renewal cycle that begins 1 year or more after the effective

date of this subrule, an applicant shall meet the requirements of this subrule and subrules (1), (7), and (9) to (14) of this rule.

An applicant for a dentist license renewal who has been licensed for the 3-year period immediately preceding the expiration

date of the license shall complete not less than 60 hours of continuing education approved by the board under R 338.11704a

during the 3-year period before the end of the license cycle.

(9) An applicant for a dental specialist license renewal who has been licensed for the 3-year period immediately preceding the

expiration date of the license shall complete 60 hours of continuing education approved by the board under R 338.11704a with

26

not less than 20 hours of the required 60 hours in board-approved continuing education in the dental specialty field in which

he or she is licensed within the 3-year period before the end of the license cycle.

(10) In addition to meeting the requirements of section 16184 of the code, MCL 333.16184, an applicant for a special retired

volunteer dentist license renewal who has been licensed for the 3-year period immediately preceding the expiration date of the

license shall complete not less than 60 hours of continuing education approved by the board under R 338.11704a during the 3-

year period before the end of the license cycle.

(11) An applicant shall possess current certification in basic or advanced cardiac life support for health care providers with a

hands-on component from an agency or organization that grants certification pursuant to standards substantially equivalent

to the standards adopted in R 338.11705(4).

(12) In complying with the requirements of subrules (8) to (10) of this rule, an applicant for a dentist license, dental specialist

license, and special retired volunteer dentist license renewal who has been licensed for the 3-year period immediately

preceding the expiration date of the license shall comply with all of the following before the end of the license cycle:

(a) Complete at least 3 hours of the required continuing education hours in pain and symptom management. Continuing

education hours in pain and symptom management may include, but are not limited to, courses in behavior management,

psychology of pain, pharmacology, behavior modification, stress management, clinical applications, and drug interactions.

Hours earned through volunteer patient or supportive dental services provided for in R 338.11704a(1)(m) do not count toward

the required hours for pain and symptom management.

(b) Complete at least 1 hour of the required continuing education hours in dental ethics and jurisprudence with inclusion of

delegation of duties to allied dental personnel. Hours earned through volunteer patient or supportive dental services provided

for in R 338.11704a(1)(m) do not count toward the required hours for dental ethics and jurisprudence with inclusion of

delegation of duties to allied dental personnel.

(c) Complete a minimum of 20 hours of the required continuing education hours in programs directly related to clinical

issues including delivery of care, materials used in delivery of care, and pharmacology. Hours earned through volunteer

patient or supportive dental services provided for in R 338.11704a(1)(m) do not count toward the required hours for clinical

issues.

(d) Complete at least 1 hour of the required continuing education hours in infection control, which must include sterilization

of hand pieces, personal protective equipment, and the Centers for Disease Control and Prevention’s infection control

guidelines. Hours earned through volunteer patient or supportive dental services provided for in R 338.11704a(1)(m) do not

count toward the required hours for infection control.

(e) Complete a minimum of 20 hours of the required continuing education hours by attending synchronous, live courses or

programs that provide for direct interaction between faculty and participants including, but not limited to, lectures, symposia,

27

live teleconferences, workshops, and participation in volunteer patient or supportive dental services provided for in R

338.11704a(1)(m). These courses, with the exception of the volunteer services in R 338.11704a(1)(m), may be counted toward

the required courses in clinical issues such as delivery of care, materials used in delivery of care, and pharmacology.

(f) Complete no more than 30 hours of the required continuing education hours asynchronously, noninteractive.

(13) Except for the 1-time training in human trafficking and 1-time training in opioid and controlled substances awareness,

which may be used to comply with the requirement for the 1-time training and a continuing education requirement, an

applicant may not earn credit for a continuing education program or activity that is identical to a program or activity an

applicant has already earned credit for during that renewal period.

(14) The submission of the application for renewal constitutes the applicant's certification of compliance with the

requirements of this rule. The board may require an applicant or a licensee to submit evidence to demonstrate compliance

with this rule. An applicant or licensee shall maintain evidence of complying with the requirements of this rule for a period of

5 years from the date of the submission for renewal. Failure to comply with this rule is a violation of section 16221(h) of the

code, MCL 333.16221.

Board Response

(12)(b): The Board agrees to require dental professionals to have CE in the “delegation of duties to allied dental

personnel” in addition to ethics and jurisprudence. As the relicensure rule requires the same CE the new

language will also be added to the relicensure rules, R 338.11263 (dentists).

(12)(b): The Board does not agree with the comment to allow volunteer hours to be used for the CE in ethics and

jurisprudence and delegation of duties to allied dental personnel.

(12)(d): The Board agrees with the comment to add 1 hour, but not 3, of infection control to the CE requirements

for dentists similar to the infection control CE requirements for other dental professionals. The Rules

Committee did not agree with including Organization for Safety, Asepsis and Prevention (OSAP) as an

additional organization for infection control guidance or including training on antibiotic stewardship.

(12)(e): The Board agrees that clarification is needed to differentiate between the online and live acceptable CE

wherever these terms are used in the rules. However, as the Board desires to be consistent in the rules, clarifying

language is necessary to sections that limit or require online and 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.

28

Rule 338.11704 License renewal for a registered dental hygienist, registered dental hygienist special volunteer, registered

dental assistant, and registered dental assistant special volunteer; requirements; applicability.

Rule Numbers

Section (7)(e)

Commenter

Erdt/MDAA

Comment

Add 1 hour in the inclusion of delegation of duties to dental auxiliary. Duties are performed illegally

in the state, and knowledge may help with this issue.

Rules Committee (7)(e): The Rules Committee agrees to add language that includes the delegation of duties to allied dental personnel.

Response

As the CE is referenced in the relicensure rule, R 338.11267, the language “with inclusion of delegation of duties to

allied dental personnel” should be added to the relicensure rules for RDHs and RDAs.

Rule 1704. (1) This rule applies to applications an application for the renewal of a registered dental hygienist license, or and a

registered dental assistant license under section 16201(1) and (2) of the code, MCL 333.16201(1) and (2), and a registered dental

hygienist special-retired volunteer license and a registered dental assistant special-retired volunteer license under section

16184 of the code, MCL 333.16184.

(2) An applicant for a registered dental hygienist license renewal or a registered dental assistant license renewal who has been

licensed for the 3-year period immediately preceding the expiration date of the license, shall possess current certification in basic or

advanced cardiac life support for an agency or organization that grants certification pursuant to standards substantially equivalent to

the standards adopted in R 338.11705(3) and shall comply with the following requirements, as applicable: complete not less than 36

hours of continuing education approved by the board under R 338.11704a during the 3 years before the end of the license

cycle.

(a) For a registered dental hygienist license or a registered dental assistant license, the applicant shall have completed not less than 36

hours of continuing education acceptable to the board during the 3-year period immediately preceding the date of the application.

Each licensee shall complete a minimum of 12 hours of the required 36 hours of approved continuing education in programs directly

related to clinical issues such as delivery of care, materials used in the delivery of care, and pharmacology.

(b) For a registered dental hygienist license or a registered dental assistant license, the applicant shall complete a minimum of 12

hours of the required 36 hours of approved continuing education by attending live courses or programs that provide for direct

interaction between faculty and participants, including, but not limited to, lectures, symposia, live teleconferences, workshops and

provision of volunteer clinical services provided for in R 338.11704a. These courses, with the exception of the volunteer clinical

29

services, may be counted toward the required courses in clinical issues such as delivery of care, materials used in delivery of care, and

pharmacology.

(c) (3) Applicants An applicant holding both a registered dental hygienist license and a registered dental assistants license shall have

completed complete not less than a total of 36 hours of continuing education acceptable to the board under R 338.11704a during the

3-year period immediately 3 years preceding the date of application before the end of the license cycle. The 36 hours shall must

include not less than 12 hours devoted to registered dental hygienist functions, and not less than 12 hours devoted to registered dental

assistant functions.

(d) If an organized continuation course or program is offered in segments of 50 to 60 minutes each, 1 hour of credit shall be given for

each segment.

(e) Each licensee shall complete at least 2 continuing education credits in pain and symptom management in each renewal period.

Continuing education credits in pain and symptom management may include, but are not limited to, courses in behavior management,

psychology of pain, pharmacology, behavior modification, stress management, clinical applications, and drug interactions.

(4) In addition to meeting the requirements of section 16184 of the code, MCL 333.16184, an applicant for a special-retired

volunteer registered dental assistant license renewal or a special-retired volunteer registered dental hygienist license renewal

who has been licensed for the 3-year period immediately preceding the expiration date of the license shall complete not less

than 36 hours of continuing education approved by the board under R 338.11704a during the 3-year period before the end of

the license cycle.

(5) An applicant shall possess current certification in basic or advanced cardiac life support for health care providers with a

hands-on component from an agency or organization that grants certification pursuant to standards substantially equivalent

to the standards adopted in R 338.11705(4).

(6) A request for a waiver under section 16205 of the code, MCL 333.16205, must be received by the department before the

expiration date of the license.

(7) In complying with the requirements of subrules (2) to (4) of this rule, an applicant for a registered dental assistant license,

registered dental hygienist license, special-retired volunteer registered dental assistant license, or special-retired volunteer

registered dental hygienist license renewal who has been licensed for the 3-year period immediately preceding the expiration

date of the license shall also comply with all of the following before the end of the license cycle:

(a) Complete a minimum of 12 hours of the required continuing education hours in programs directly related to clinical

issues including delivery of care, materials used in the delivery of care, and pharmacology. Hours earned through volunteer

patient or supportive dental services provided for in R 338.11704a(1)(m) do not count toward the required hours for clinical

issues.

30

(b) Complete a minimum of 12 hours of the required continuing education hours by attending live courses or programs that

provide for direct interaction between faculty and participants including, but not limited to, lectures, symposia, live

teleconferences, workshops, and provision of volunteer patient or supportive dental services provided for in R

338.11704a(1)(m). These courses, with the exception of the volunteer services in R 338.11704a(1)(m), may be counted toward

the required courses in clinical issues including delivery of care, materials used in delivery of care, and pharmacology.

(c) Complete at least 2 hours of the required continuing education hours in pain and symptom management. Continuing

education credits in pain and symptom management may include, but are not limited to, courses in behavior management,

psychology of pain, pharmacology, behavior modification, stress management, clinical applications, and drug interactions.

Hours earned through volunteer patient or supportive dental services provided for in R 338.11704a(1)(m) do not count toward

the require d hours for pain and symptom management.

(d) Earn no more than 18 of the 36 hours of the required continuing education hours online or through electronic media,

including videos, internet web-based seminars, video conferences, online continuing education programs, and online journal

articles.

(e) Effective for an application for renewal that is filed for the renewal cycle that begins 1 year or more after the effective

date of this subrule, complete at least 1 hour of the required continuing education hours in dental ethics and jurisprudence

with inclusion of delegation of duties to allied dental personnel. Hours earned through volunteer patient or supportive dental

services provided for in R 338.11704a(1)(m) do not count toward the required hours for ethics and jurisprudence with

inclusion of delegation of duties to allied dental personnel.

(f) Effective for applications for renewal that are filed for the renewal cycle that begins 1 year or more after the effective

date of this subrule, complete at least 1 hour of the required continuing education hours in infection control, which must

include sterilization of hand pieces, personal protective equipment, and the Centers for Disease Control and Prevention’s

infection control guidelines. Hours earned through volunteer patient or supportive dental services provided for in R

338.11704a(1)(m) do not count toward the required hours for infection control.

(8) Effective for an application for renewal that is filed for the renewal cycle that begins 1 year or more after the effective

date of this subrule, an applicant may not earn credit for a continuing education program or activity that is identical to a

program or activity the applicant has already earned credit for during that renewal period, except for the 1-time training in

human trafficking and 1-time training in opioid and controlled substances awareness, which may be used to comply with the

requirement for the 1-time training and a continuing education requirement.

(3) (9) The submission of the online application for renewal shall constitute constitutes the applicant's certification of compliance

required by this rule. The board may require an applicant or licensee to submit evidence to demonstrate compliance with this rule. The

31

applicant or licensee shall maintain evidence of complying with the requirements of this rule for a period of 4 5 years from the date

of the submission for renewal. Failure to comply with this rule is a violation of section 16221(h) of the code, MCL 333.16221.

Board Response

(7)(e): The Board agrees to add language that includes the delegation of duties to allied dental personnel.

As the CE is referenced in the relicensure rule, R 338.11267, the language “with inclusion of delegation of duties

to allied dental personnel” should be added to the relicensure rules for RDHs and RDAs.

R 338.11704a

Rule Numbers

Section (1)(a)

Acceptable continuing education for licensees, limitations.

Commenter

Comment

Furnari/AADH

Our request is that you include the AADH is this list. Many other states have included our name

specifically in their statute or rules. Many have given us written confirmation that they will accept

our course approvals to satisfy the mandated continuing education. They acknowledge dental

hygienists appreciate taking courses approved by a body solely dedicated to their needs and

requirements. Your rules state you would accept courses approved by other state boards and we

believe that this would in fact include the AADH, yet we are not named.

For dentists, you state the Academy of General Dentistry and it may be fitting to include the

American Academy of Dental Hygiene.

Much information about us may be found on our web site at aadh.org or I may be contacted for any

further information.

The American Academy of Dental Hygiene 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. (Attached to the comments).

You specifically state the American Dental Hygienists’ Association there. We are the approval body

for that organization. We approve their courses. We also approve courses for international groups.

Modify spelling of Hygienist to Hygienists’ in American Dental Hygienists’ Association.

References to the ADA “CERP” should be replaced with the “Commission on Continuing

Education Provider Recognition.” The Commission on Continuing Education Provider Recognition

is now responsible for approving CE providers.

Section (1)(a)

Meraw/MDA

32

Section (1)(m)

Farrell/MDHHS

Further clarification is needed on what qualifies as a “public or nonprofit entity, program, or event,

or a school, or nursing home.

1) Does school mean K-12 only.

2) Does this include public, private and charter schools.

3) Can Head Start programs, preschools or daycare programs qualify as a school.

4) If they are a non-profit, do they qualify.

5) If a daycare or preschool is not a non-profit, can they qualify as a school.

6) What is the definition of nursing home.

7) Does it have to be a skilled facility.

8) Can it be a senior housing complex.

9) Assisted living facility. There is now a continuum of care for seniors based on health care needs.

10) What about agencies that serve older adults like Area Agencies on Aging. They can provide

events and other activities that require oral health professionals.

Rules Committee (1)(a): The Rules Committee agrees to make the suggested changes to section 1(a).

Response

(1)(m): The Rules Committee declines to make the suggested changes to section (1)(m) as it is happy with the current

Board approval process that is in place for vetting volunteer hours spent providing volunteer patient or supportive dental

services. The Committee suggested that the Board approve these applications for volunteer hours on an individual basis

and desires to keep the broader language so as not to limit volunteer opportunities.

ACCEPTABLE CONTINUING EDUCATION ACTIVITIES

(a) Completion of an approved continuing

education program or activity related to the

The number of hours earned are

the number of hours approved

practice of dentistry. A continuing education by the sponsor or the approving

program or activity is approved, regardless

of the format in which it is offered, if it is

organization.

approved or offered for continuing education If the activity was not approved

credit by any of the following:

for a set number of hours, then 1

credit hour for each 50 minutes

• A dental, dental therapy, dental

33

hygiene, dental assistant, or a

hospital-based dental specialty

educational program approved by

CODA.

of participation may be earned.

No limitation on the number of

hours earned.

• A continuing education sponsoring

organization, institution, or individual

approved by the Academy of General

Dentistry (AGD).

• A continuing education national

sponsoring organization, institution,

or individual approved by the

American Academy of Dental Hygiene

(AADH), American Dental

Hygienists’ Association (ADHA), the

American Dental Assistants

Association (ADAA), and the

Commission on Continuing Education

Provider Recognition American

Dental Association Continuing

Education Recognition Program

(ADA CERP).

• A continuing education sponsoring

organization, institution, or individual

approved by the Michigan Dental

Association (MDA), Michigan Dental

Hygienists Association (MDHA), and

Michigan Dental Assistants

Association (MDAA).

• Another state board of dentistry.

34

If audited, an applicant shall submit a copy

of a letter or certificate of completion

showing the applicant’s name, number of

hours earned, sponsor name or the name of

the organization that approved the program

or activity for continuing education credit,

and the date on which the program was held

or activity completed.

(m) Providing volunteer patient or supportive

dental services in this state at a board-

One hour for each 120 minutes

of providing patient or

approved program pursuant to subrule (4) of supportive dental services.

this rule that is not a part of the licensee’s

regular job description nor required under a

board order or agreement and that complies A dentist or special-retired

with the following:

volunteer dentist may earn a

maximum of 20 hours per

renewal period.

• The program is a public or nonprofit

entity, program, or event, or a school

or nursing home.

A dental therapist, registered

dental hygienist, registered

dental assistant, special-retired

volunteer dental therapist,

special-retired volunteer

registered dental hygienist, and

special-retired volunteer

registered dental assistant may

earn a maximum of 12 hours

per renewal period.

• The program provides patient or

supportive dental services to the

indigent or dentally underserved

populations.

• The licensee does not receive direct or

indirect remuneration of any kind

including, but not limited to,

remuneration for materials

purchased or used.

• The licensee shall sign in and sign out

daily upon commencement and

35

termination of the provision of

services.

• A dentist with a specialty license

issued from this state shall limit

volunteer clinical dental services to

the specialty area in which the dentist

is licensed.

If audited, an applicant shall submit proof

from the sponsor of the assignments and the

hours of service provided.

Board Response

(1)(a): The Board agrees to make all the suggested changes to section 1(a), however, the reference to the CERP

organization shall be Commission on Continuing Education Provider Recognition American Dental Association

Continuing Education Recognition Program (ADA CERP).

(1)(m): The Board declines to make the suggested changes to section (1)(m) as the current Board approval

process is working to vet volunteer hours spent providing volunteer patient or supportive dental services. The

Rules Committee suggested, and the Board agrees that the Board should approve these applications for volunteer

hours on an individual basis and keep the broader language so as not to limit volunteer opportunities.

36