Dental Services That Can be Provided by a Dental Hygienist or EFDA Through Teledentistry

The attorneys at Nardone Limited strive to keep dental professionals aware of new guidelines and rules that impact dental practices and dental operations.  Our recent article on Ohio Senate Bill 259 (the “Dental Act”) explained the new legislation authorizing licensed dentists in Ohio to perform dental services through teledentistry.  The Dental Act’s teledentistry provisions will become effective September 20, 2019.   

Teledentistry is the delivery of dental services by a dentist, or by a dental hygienist or EFDA pursuant to the dentist’s authorization, through the use of synchronous, real-time communication.  Synchronous, real-time communication is a live, two-way interaction between a patient and dentist conducted through audiovisual technology.  The Dental Act allows a dentist, who holds a current, valid teledentistry permit, to do either of the following without examining a patient in person:

  1.  Authorize a dental hygienist or EFDA to perform certain services at a location where a dentist is not physically present; and
  2. Prescribe a drug that is not a controlled substance for a patient who is at a location where a dentist is not physically present.

If authorized, a dental hygienist or EFDA may perform certain services at a location where a dentist is not physically present through the use of teledentistry. Under the Dental Act, a dental hygienist can be generally authorized to perform “dental hygiene services.” Dental hygiene services are defined as prophylactic, preventive, and other procedures that dentists are authorized under the Ohio Revised Code and Ohio State Dental Board (“Dental Board”) rules to assign to dental hygienists.  The services an EFDA may perform under the Dental Act through the use of teledentistry are: (1) application of pit and fissure sealants; (2) recementation of temporary crowns or recementation of crowns with temporary cement; (3) application of topical fluoride; (4) application of fluoride varnish; (5) application of disclosing solutions; (6) application of desensitizing agents; (7) caries susceptibility testing; (8) instruction on oral hygiene home care, including the use of toothbrushes and dental floss; and (9) additional procedures as authorized by the Dental Board.

Additionally, if authorized to do so by an authorizing dentist through teledentistry, both dental hygienists and EFDAs may place interim therapeutic restorations and apply silver diamine fluoride. Both dental hygienists and EFDAs must complete a Dental Board-approved course covering the placement of interim therapeutic restorations and the application of silver diamine fluoride before they may be authorized to complete either service. An “interim therapeutic restoration” is a direct provisional restoration placed to stabilize a tooth until a licensed dentist can assess the need for further treatment. It includes the removal of debris, other than carious or noncarious tooth structure, from the carious lesion using air or water irrigation. The Dental Act also permits an EFDA with a valid dental x-ray machine operator certificate to be authorized via teledentistry to perform standard, diagnostic radiologic procedures.

Before they may be authorized to perform the services discussed above via teledentistry, a dental hygienist or EFDA must meet the following requirements: (1) at least one year and a minimum of 1,500 hours of practice experience as a dental hygienist or EFDA; (2) completion of a course on the identification and prevention of potential medical emergencies; (3) a skills evaluation by the authorizing dentist; and (4) compliance with written protocols or written standing orders established by the authorizing dentist, including those established for emergencies.

Nardone Limited Comment: The implementation of the rules included in the Dental Act will need to be addressed by the Dental Board. Prior to the Dental Board providing rules specifically related to the implementation of teledentistry in Ohio, dentists should tread carefully and ensure they are obtaining the necessary guidance and direction from both a clinical, legal, and overall business perspective. According to a recent update from the Dental Board, the Dental Board has completed its draft of specific teledentistry rules, and this draft was likely discussed at the Dental Board meeting on July 24, 2019.

Contact Nardone Limited

The dental attorneys at Nardone Limited have vast experience interpreting existing laws and Ohio State Dental Board rules governing the practice of dentistry and can properly advise you regarding your compliance.   If you need guidance regarding your dental practice services or operations, contact Nardone Limited.