GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	1 

SENATE BILL 845

Short Title:  Dental Hygienist Amendments.	(Public)
─────────────────────────────────────── 
Sponsors: Senator Lee.
─────────────────────────────────────── 
Referred to:  Judiciary I.
─────────────────────────────────────── 

April 14, 1993

A BILL TO BE ENTITLED
AN ACT TO AMEND THE STATUTES GOVERNING THE PRACTICE OF DENTISTRY WITH RESPECT TO DENTAL HYGIENISTS.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 90-22(b) reads as rewritten:
"(b)	The North Carolina State Board of Dental Examiners heretofore created by Chapter 139, Public Laws 1879 and by Chapter 178, Public Laws 1915, is hereby continued as the agency of the State for the regulation of the practice of dentistry in this State.  Said Board of Dental Examiners shall consist of six dentists who are licensed to practice dentistry in North Carolina, four dental hygienists who are licensed to practice dental hygiene in North Carolina and one person who shall be a citizen and resident of North Carolina and who shall be licensed to practice neither dentistry nor dental hygiene.  Members of the Board licensed to practice dentistry in North Carolina shall have been elected in an election held as hereinafter provided in which every person licensed to practice dentistry in North Carolina and residing or practicing in North Carolina shall be entitled to vote.  Each member of said Board shall be elected for a term of three years and until his successor shall be elected and shall qualify.  Each year there shall be elected two dentists for such terms of three years each.  Each year there shall be elected one dental hygienist for a term of three years, except that in 1993 and every third year thereafter, two dental hygienists shall be elected to the Board.  Dental hygienists shall be elected to the Board in an election held in accordance with the procedures hereinafter provided in which those persons licensed to practice dental hygiene in North Carolina and residing or practicing in North Carolina shall be entitled to vote.  Every year a person who is a citizen and resident of North Carolina and licensed to practice neither dentistry nor dental hygiene shall be appointed to the Board for a term of three years by the Governor of North Carolina.  Any vacancy occurring on said Board shall be filled by a majority vote of the remaining members of the Board to serve until the next regular election conducted by the Board, at which time the vacancy will be filled by the election process provided for in this Article, except that when the seat on the Board held by a person licensed to practice neither dentistry nor dental hygiene in North Carolina shall become vacant, the vacancy shall be filled by appointment by the Governor for the period of the unexpired term.  No dentist shall be nominated for or elected to membership on said Board, unless, at the time of such nomination and election such person is licensed to practice dentistry in North Carolina and actually engaged in the practice of dentistry.  No dental hygienist shall be nominated for or elected to membership on said Board unless, at the time of such nomination and election, such person is licensed to practice dental hygiene in North Carolina and is currently employed in dental hygiene in North Carolina.  No person shall be nominated, elected, or appointed to serve more than two consecutive terms on said Board."
Sec. 2.  G.S. 90-41(a) reads as rewritten:
"(a)	The North Carolina State Board of Dental Examiners shall have the power and authority to
(1)	Refuse to issue a license to practice dentistry;
(2)	Refuse to issue a certificate of renewal of a license to practice dentistry;
(3)	Revoke or suspend a license to practice dentistry; and
(4)	Invoke such other disciplinary measures, censure, or probative terms against a licensee as it deems fit and proper;
in any instance or instances in which the Board is satisfied that such applicant or licensee:
(1)	Has engaged in any act or acts of fraud, deceit or misrepresentation in obtaining or attempting to obtain a license or the renewal thereof;
(2)	Is a chronic or persistent user of intoxicants, drugs or narcotics to the extent that the same impairs his ability to practice dentistry;
(3)	Has been convicted of any of the criminal provisions of this Article or has entered a plea of guilty or nolo contendere to any charge or charges arising therefrom;
(4)	Has been convicted of or entered a plea of guilty or nolo contendere to any felony charge or to any misdemeanor charge involving moral turpitude;
(5)	Has been convicted of or entered a plea of guilty or nolo contendere to any charge of violation of any state or federal narcotic or barbiturate law;
(6)	Has engaged in any act or practice violative of any of the provisions of this Article or violative of any of the rules and regulations promulgated and adopted by the Board, or has aided, abetted or assisted any other person or entity in the violation of the same;
(7)	Is mentally, emotionally, or physically unfit to practice dentistry or is afflicted with such a physical or mental disability as to be deemed dangerous to the health and welfare of his patients. An adjudication of mental incompetency in a court of competent jurisdiction or a determination thereof by other lawful means shall be conclusive proof of unfitness to practice dentistry unless or until such person shall have been subsequently lawfully declared to be mentally competent;
(8)	Has conducted in-person solicitation of professional patronage or has employed or procured any person to conduct such solicitation by personal contact with potential patients, except to the extent that informal advice may be permitted by regulations issued by the Board of Dental Examiners;
(9)	Has permitted the use of his name, diploma or license by another person either in the illegal practice of dentistry or in attempting to fraudulently obtain a license to practice dentistry;
(10)	Has engaged in such immoral conduct as to discredit the dental profession;
(11)	Has obtained or collected or attempted to obtain or collect any fee through fraud, misrepresentation, or deceit;
(12)	Has been negligent in the practice of dentistry;
(13)	Has employed a person not licensed in this State to do or perform any act or service, or has aided, abetted or assisted any such unlicensed person to do or perform any act or service which under this Article or under Article 16 of this Chapter, can lawfully be done or performed only by a dentist or a dental hygienist licensed in this State;
(14)	Is incompetent in the practice of dentistry;
(15)	Has practiced any fraud, deceit or misrepresentation upon the public or upon any individual in an effort to acquire or retain any patient or patients;
(16)	Has made fraudulent or misleading statements pertaining to his skill, knowledge, or method of treatment or practice;
(17)	Has committed any fraudulent or misleading acts in the practice of dentistry;
(18)	Has, directly or indirectly, published or caused to be published or disseminated any advertisement for professional patronage or business which is untruthful, fraudulent, misleading, or in any way inconsistent with rules and regulations issued by the Board of Dental Examiners governing the time, place, or manner of such advertisements;
(19)	Has, in the practice of dentistry, committed an act or acts constituting malpractice;
(20)	Repealed by Session Laws 1981, c. 751, s. 7.
(21)	Has permitted a dental hygienist or a dental assistant in his employ or under his supervision to do or perform any act or acts violative of this Article, or of Article 16 of this Chapter, or of the rules and regulations promulgated by the Board;
(22)	Has wrongfully or fraudulently or falsely held himself out to be or represented himself to be qualified as a specialist in any branch of dentistry;
(23)	Has persistently maintained, in the practice of dentistry, unsanitary offices, practices, or techniques;
(24)	Is a menace to the public health by reason of having a serious communicable disease;
(25)	Has distributed or caused to be distributed any intoxicant, drug or narcotic for any other than a lawful purpose; 
(26)	Has engaged in any unprofessional conduct as the same may be, from time to time, defined by the rules and regulations of the Board; or
(27)	Has harassed, terminated the employment of, or caused the loss of employment of, or otherwise retaliated against a person who has in good faith reported to the Board a suspected violation of this Article or Article 16 or the rules or regulations of the Board."
Sec. 3.  G.S. 90-221 reads as rewritten:
"§ 90-221. Definitions.
(a)	'Dental hygiene' as used in this Article shall mean the provision of preventive, therapeutic, and educational oral health care and the performance of the following functions: Complete oral prophylaxis which is defined to include the removal of calculus, stains, and accretions from the surfaces of the teeth to the attachment of the sulcus and polishing the surfaces of the teeth; application of preventive agents to oral structures, exposure and processing of radiographs, administration of medicaments prescribed by a licensed dentist, preparation of diagnostic aids, and written records of oral conditions for interpretation by the dentist, together with such other and further functions as may be permitted by rules and regulations of the Board not inconsistent herewith.
(b)	'Dental hygienist' as used in this Article, shall mean any person who is a graduate of an accredited and Board-approved school of dental hygiene, who has been licensed by the Board, and who practices dental hygiene as prescribed by the Board.
(c)	'License' shall mean a certificate issued to any applicant upon completion of requirements for admission to practice dental hygiene.
(d)	'Renewal certificate' shall mean the annual certificate of renewal of license to continue practice of dental hygiene in the State of North Carolina.
(e)	'Board' shall mean 'The North Carolina State Board of Dental Examiners' created by Chapter 139, Public Laws of 1879, and Chapter 178, Public Laws of 1915 as continued in existence by G.S. 90-22.
(f)	'Supervision' as used in this Article shall mean that acts are deemed to be under the supervision of a licensed dentist when such acts are being performed pursuant to the dentist's order and approval.  The dentist does not need to be present in the facility while dental hygiene treatment is being performed.
A dental hygienist shall not practice independently from the supervision of a dentist nor shall a dental hygienist establish or maintain an office or other workplace separate from the office or other workplace in which the supervision by the dentist is provided."
Sec. 4.  G.S. 90-223(d) reads as rewritten:
"(d)	The Board shall, in addition to any other requirements for Board approval of a school or program of dental hygiene for purposes of this Article, require that any school or program in North Carolina develop and implement a procedure for advanced placement of potentially qualified persons. This procedure shall be designed to encourage and allow credit for any person who has attained special capabilities in dental work through military service, military on-the-job training or military working experience, not otherwise qualifying the person to be immediately eligible for licensure. The procedure shall include these elements: public announcement of the procedure, a method for persons who have special capabilities through military training or experience to make application to the school or program for advanced placement, personal counseling on obtaining advanced placement, administration of specially prepared written and clinical examinations for all parts of the curriculum otherwise required for graduation, exemption from course requirements when results of the examinations so indicate, and appropriate modification of curriculum requirements, when necessary, to facilitate individual advancement in education programs. The procedure for advanced placement shall not be approved by the Board unless it is fairly designed to facilitate the substitution of military training and experience for regular curricula, taking into account that the special nature of military training and experience may be equivalent without necessarily being identical to the courses of the school or program."
Sec. 5.  G.S. 90-224(a) reads as rewritten:
"(a)	The applicant for licensure must be of good moral character, have graduated from an accredited high school or hold a high school equivalency certificate duly issued by a governmental agency or unit authorized to issue the same, and be a graduate of a minimum two-year academic program of dental hygiene in a postsecondary school or college approved by the Board and that the program be accredited by a national accrediting agency recognized by the Council on Postsecondary Education or the United States Department of Education, and must have successfully passed the national written dental hygiene examination administered by the Joint Commission on National Dental Examinations."
Sec. 6.  G.S. 90-233 reads as rewritten:
"§ 90-233. Practice of dental hygiene.
(a)	A dental hygienist may practice only under the supervision of one or more licensed dentists. Provided, however, that this subsection (a) shall be deemed to be complied with in the case of dental hygienists employed by the Department of Environment, Health, and Natural Resources and especially trained by said Department as public health hygienists while performing their duties in the public schools and other public health settings under the direction of a duly licensed dentist.  Direction means supervision whereby the dentist may authorize the dental hygienist to perform in these settings the following services for a specified class of people without the dentist being present:  a preliminary examination of the oral structures and recording findings, the application of preventive agents to oral structures, and any other dental hygiene functions authorized by the Board.
(b)	A dentist in private practice may not employ more than two dental hygienists at one and the same time who are employed in clinical dental hygiene positions.
(c)	Dental hygiene may be practiced only by the holder of a license or provisional license currently in effect and duly issued by the Board. The following acts, practices, functions or operations, however, shall not constitute the practice of dental hygiene within the meaning of this Article:
(1)	The teaching of dental hygiene in a school or college approved by the Board in a board-approved program by an individual licensed as a dental hygienist in any state in the United States.
(2)	Activity which would otherwise be considered the practice of dental hygiene performed by students enrolled in a school or college approved by the Board in a board-approved dental hygiene program under the direct supervision of a dental hygienist or a dentist duly licensed in North Carolina or qualified for the teaching of dentistry pursuant to the provisions of G.S. 90-29(c)(3), acting as an instructor.
(3)	Any act or acts performed by an assistant to a dentist licensed to practice in this State when said act or acts are authorized and permitted by and performed in accordance with rules issued by the Board, except that only a dentist or dental hygienist may perform any element of the prophylaxis as defined in G.S. 90-211, or perform a preliminary oral examination to chart for periodontal disease.
(4)	Dental assisting and related functions as a part of their instructions by students enrolled in a course in dental assisting conducted in this State and approved by the Board, when such functions are performed under the supervision of a dentist acting as a teacher or instructor who is either duly licensed in North Carolina or qualified for the teaching of dentistry pursuant to the provisions of G.S. 90-29(c)(3)."
Sec. 7.  G.S. 90-233.1 reads as rewritten:
"§ 90-233.1. Violation a misdemeanor.
Any person who shall violate, or aid or abet another in violating, or harass, terminate the employment of or cause the loss of employment of, or otherwise retaliate against a person who has in good faith reported to the Board a suspected violation of any of the provisions of this Article shall be guilty of a misdemeanor and upon conviction shall be punished in the discretion of the court."
Sec. 8.  This act becomes effective October 1, 1993.